O-001 Pre-treatment CTA ASPECTS as a predictor of clinical outcome in endovascular stroke therapy (EVT): results from the penumbra START trial

Introduction: Few reports have compared the commonly used technical approaches of stentriever, suction thrombectomy, and combined technique, particularly with emphasis on thrombus volume, fragmentation, distal embolization, and clinical outcome. Methods: Medical records and radiographic images of patients undergoing endovascular stroke therapy at our institution between 2014 and 2015 were reviewed for the following data points: Patient age, sex, NIH stroke scale (NIHSS) at presentation, number of passes, presence of distal embolization on angiography, TICI score, and Modified Rankin Scale (MRS) at discharge. When available, photographic images of the retrieved thrombus were analyzed for number of fragments and size of the largest fragment. Parameters were compared for the three thrombectomy techniques of suction (ADAPT technique), stentriever, and the combined approach. Results: Of 63 patients receiving endovascular stroke therapy, 47 (75%) underwent mechanical thrombectomy: Stentriever 17 (36%), Suction 18 (38%), and combined 12 (26%). Average age and presenting NIH stroke scales were similar in the groups. A single pass thrombectomy was more common in the suction group (72%) than in the stentriever (29%) and combined groups (8%). There were more thrombus fragments in the stentriever (2.3) and combined groups (3.4) than in the suction group (1.4), correlating to more frequent distal embolization (suction 22%, stentriever 70%, combined 50%). The retrieved thrombus was largest in the suction group (12.9 mm; stentriever 6.6 mm; combined 10.4 mm). Overall outcome at discharge was better in the suction group (61% MRS 0-2) than in the stentriever (35%) and combined groups (17%). Conclusions: In our patient sample suction thrombectomy outperformed the stentriever and combined techniques in the categories of achieved reperfusion grade, single pass, retrieved thrombus size, number of fragments, distal embolization and clinical outcome. While stent retriever and suction thrombetomy were used as primary approaches, the combined technique was commonly utilized as a rescue attempt once the primary approach had failed, constituting a potential limitation of the analysis in this category.

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Angiographic Outcome of Endovascular Stroke Therapy Correlated with MR Findings, Infarct Growth, and Clinical Outcome in the DEFUSE 2 Trial

International Journal of Stroke ◽

10.1111/ijs.12271 ◽

2014 ◽

Vol 9 (7) ◽

pp. 860-865 ◽

Cited By ~ 16

Author(s):

Michael P. Marks ◽

Maarten G. Lansberg ◽

Michael Mlynash ◽

Stephanie Kemp ◽

Ryan A. McTaggart ◽

...

Keyword(s):

Clinical Outcome ◽

Stroke Therapy ◽

Endovascular Stroke Therapy

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Abstract TMP7: Endovascular Stroke Therapy Abrogates Sex-Related Differences in Recanalization in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp7 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sunil A Sheth ◽

Steven Warach ◽

Jan Gralla ◽

Reza Jahan ◽

Mayank Goyal ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Functional Independence ◽

Stent Retriever ◽

Stroke Therapy ◽

Procedural Time ◽

History Of ◽

Sex Disparities ◽

The Impact ◽

Endovascular Stroke Therapy

Background: Ischemic stroke affects women differently than men. Prior studies evaluating recanalization treatment with IV tpA showed that while women are more likely to achieve recanalization, there are strong sex disparities with respect to clinical outcome. We evaluated the effect of endovascular stroke therapy (ET) on recanalization and outcomes in women versus men. Methods: In the combined databases of the SWIFT, STAR, and SWIFT-PRIME trials, we identified patients treated with the Solitaire stent retriever to determine the effects of sex on recanalization and clinical outcome. Results: Among 389 patients treated with ET, mean age was 67±13, 55% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 [8-28]. There were no differences between females vs. males in presentation NIHSS (17 vs. 17, p=0.21), occlusion location (69% vs. 64% M1, p=0.62), or ASPECTS score (9 vs. 8, p=0.24). Rates of successful TICI 2b/3 recanalization were nearly identical (87% vs. 83%, p=0.374). There were no differences in onset to recanalization time (OTR) (277 vs. 306, p=0.46), procedural time (44 vs. 48 minutes, p=0.23), number of stent-retriever passes (1.7 vs. 1.8, p=0.17), rate of PH2 hemorrhage (1.9% vs. 1.1%, p=0.70), or functional independence at 90 days (53% vs. 56%, p=0.54). In ordinal multivariate analysis, collateral grade (OR 1.4, p=0.007) but not sex, age, or history of atrial fibrillation predicted improved TICI recanalization. In logistic (Figure) and ordinal regression analysis, the impact of delayed OTR was no different between men and women (1% versus 1.2% likelihood of worsened mRS outcome per 5 minute delay, p=0.27). Conclusions: In our prospective multicenter randomized cohort of nearly 400 patients undergoing ET, presentation and treatment characteristics of women were similar to men. Women were equally likely to achieve successful recanalization and good clinical outcomes.

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Abstract WP57: Perfusion Angiography Improves Clinical Outcomes Prediction in Endovascular Stroke Therapy

Stroke ◽

10.1161/str.48.suppl_1.wp57 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sunil A Sheth ◽

Julius Weng ◽

Priscilla McElhinney ◽

Benjamin Quachtran ◽

David S Liebeskind ◽

...

Keyword(s):

Clinical Outcome ◽

Predictive Power ◽

Important Determinant ◽

Treatment Success ◽

Regions Of Interest ◽

Modified Rankin Scale ◽

Stroke Therapy ◽

Post Intervention ◽

Quantitative Changes ◽

Endovascular Stroke Therapy

Background: Successful reperfusion is a key determinant of outcome in endovascular stroke therapy (ET). However, present methods of grading treatment success using the Thrombolysis in Cerebral Infarction (TICI) scale fail to measure quantitative changes in cerebral blood flow and volume (CBF and CBV) and as such, may not fully represent treatment effect. Methods: From our prospectively maintained institutional registry, we identified patients treated with ET between February 2014 and May 2016. CBF and CBV maps were calculated automatically for both AP and Lateral projections and regions of interest (ROIs) were drawn by two experienced neuroimagers over the middle cerebral artery territories. Delta CBF and CBV scores were determined by subtracting pre- from post-intervention maps and averaging over the ROIs. Non-linear regression was used to calculate correlations against clinical outcome (modified Rankin scale at discharge). Results: Among 104 patients treated with ET, average age was 70, 50% were female, and median presentation NIHSS was 16 (IQR 10-19). Target occlusion location was ICA in 14%, M1 in 67%, and M2 in 18%. TICI scores ranged from 0 (4%), 1 (13%), 2a (2%), 2b (22%), 3 (58%). Relative increases in CBF and CBV ranged from 0.4-17% (CBF) and 0.3-14% (CBV). Delta CBF and CBV maps correlated well with angiographic TICI (CBF p<0.05, CBV p<0.05). TICI alone did not correlate significantly with outcome (r=0.24, p=0.14). However, including delta CBF and CBV with TICI resulted in a stronger correlation (r=0.37, p<0.05) against outcome. Conclusions: TICI is an important determinant of outcome in EST. The incorporation of perfusion angiography measurements (CBF and CBV) improves the predictive power of angiography for clinical outcome.

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Blood Pressure After Endovascular Stroke Therapy-II

Case Medical Research ◽

10.31525/ct1-nct04116112 ◽

2019 ◽

Author(s):

Keyword(s):

Blood Pressure ◽

Stroke Therapy ◽

Endovascular Stroke Therapy

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Checkpoint-blocker induced autoimmunity is associated with pretreatment T cell expression profiles and favourable outcome in melanoma

10.1101/2020.06.23.20138594 ◽

2020 ◽

Author(s):

W. Ye ◽

A Olsson-Brown ◽

R. A. Watson ◽

V. T. F. Cheung ◽

R. D. Morgan ◽

...

Keyword(s):

T Cells ◽

T Cell ◽

Clinical Outcome ◽

Adverse Events ◽

Metastatic Melanoma ◽

T Cell Receptor ◽

Immune Checkpoint ◽

Single Agent ◽

Cell Receptor ◽

Pre Treatment

1Abstract1.1BackgroundImmune checkpoint blockers (ICBs) activate CD8+ T cells to elicit anti-cancer activity but frequently lead to immune-related adverse events (irAEs). The relationship of irAE with baseline parameters and clinical outcome is unclear. We investigated associations between irAE development, CD8+ T cell receptor diversity and expression and clinical outcome in a non-trial setting.1.2MethodsPatients ≥18 years old with metastatic melanoma (MM) receiving combination ICB (ipilimumab plus nivolumab – cICB, n=60) or single-agent ICB (nivolumab/pembrolizumab – sICB, n=78) were prospectively recruited. We retrospectively evaluated the impact of irAEs on survival. This analysis was repeated in an independent cohort of MM patients treated at a separate institution (n=210, cICB:74, sICB:136). We performed RNA sequencing of CD8+ T cells isolated from patients prior to treatment, analysing T cell receptor clonality differential transcript expression according to irAE development.1.3Results48.6% of patients experienced treatment-related irAEs within the first 5 cycles of treatment. Development of irAE prior to the 5th cycle of ICB was associated with longer progression-free and overall survival (PFS, OS) in the primary cohort (log-rank test, PFS: P=0.00034; OS: P<0.0001), replicated in the secondary cohort (OS: P=0.00064). Across cohorts median survival for those patients not experiencing irAE was 14.4 (95% CI:9.6-19.5) months vs not-reached (95% CI:28.9 - Inf), P=3.0×10−7. Pre-treatment performance status and neutrophil count, but not BMI, were additional predictors of clinical outcome. Analysis of CD8+ T cells from 128 patients demonstrated irAE development was associated with increased T cell receptor diversity post-treatment (P=4.3×10−5). Development of irAE in sICB recipients was additionally associated with baseline differential expression of 224 transcripts (FDR<0.1), enriched in pro-inflammatory pathway genes including CYP4F3 and PTGS2.1.4ConclusionsEarly irAE development post-ICB is strongly associated with favourable survival in MM and increased diversity of peripheral CD8+ T cell receptors after treatment. irAE post-sICB is associated with pre-treatment upregulation of inflammatory pathways, indicating irAE development may reflect baseline immune activation states.Key messageImmune-related adverse events (irAEs) commonly occur in patients with metastatic melanoma treated with immune checkpoint blockade (ICB) therapy. In real world setting we find development of early irAEs post-ICB treatment is associated with survival benefit, indicative of a shared mechanism with anti-tumour efficacy. CD8+ T cells from patients who develop irAE show increased receptor diversity, and pre-treatment samples from patients who develop irAE post single-agent anti-PD1 show over-expression of inflammatory pathways, indicating baseline immune state can determine irAE development.

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