scholarly journals E-085 Good Baseline Angiographic Collateral Flow Correlates with Successful Recanalization and Clinical Outcome after Endovascular Treatment for Acute Ischemic Stroke Within 24 Hours from Onset

2016 ◽  
Vol 8 (Suppl 1) ◽  
pp. A87.1-A87
Author(s):  
J Seo ◽  
E Kim ◽  
H Jeong
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Collateral Flow

scholarly journals Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

2021 ◽  
Vol 23 (6) ◽  
Author(s):  
A. Maud ◽  
G. J. Rodriguez ◽  
A. Vellipuram ◽  
F. Sheriff ◽  
M. Ghatali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Negative Impact ◽  
Systemic Blood Pressure ◽  
Hemodynamic Response ◽  
Collateral Flow ◽  
Early Management ◽  
Ischemic Tissue

Abstract Purpose of Review In this review article we will discuss the acute hypertensive response in the context of acute ischemic stroke and present the latest evidence-based concepts of the significance and management of the hemodynamic response in acute ischemic stroke. Recent Findings Acute hypertensive response is considered a common hemodynamic physiologic response in the early setting of an acute ischemic stroke. The significance of the acute hypertensive response is not entirely well understood. However, in certain types of acute ischemic strokes, the systemic elevation of the blood pressure helps to maintain the collateral blood flow in the penumbral ischemic tissue. The magnitude of the elevation of the systemic blood pressure that contributes to the maintenance of the collateral flow is not well established. The overcorrection of this physiologic hemodynamic response before an effective vessel recanalization takes place can carry a negative impact in the final clinical outcome. The significance of the persistence of the acute hypertensive response after an effective vessel recanalization is poorly understood, and it may negatively affect the final outcome due to reperfusion injury. Summary Acute hypertensive response is considered a common hemodynamic reaction of the cardiovascular system in the context of an acute ischemic stroke. The reaction is particularly common in acute brain embolic occlusion of large intracranial vessels. Its early management before, during, and immediately after arterial reperfusion has a repercussion in the final fate of the ischemic tissue and the clinical outcome.

scholarly journals Improved clinical outcome 3 months after endovascular treatment, including thrombectomy, in patients with acute ischemic stroke: a meta-analysis

2015 ◽  
Vol 8 (7) ◽  
pp. 665-670 ◽  
Author(s):  
Anna Falk-Delgado ◽  
Åsa Kuntze Söderqvist ◽  
Jian Fransén ◽  
Alberto Falk-Delgado
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Neurological Outcome ◽  
Meta Analysis ◽  
Intervention Group ◽  
Intravenous Thrombolysis ◽  
Controlled Trials ◽  
Randomized Controlled

Background and purposeIntravenous thrombolysis with tissue plasminogen activator is standard treatment in acute stroke today. The benefit of endovascular treatment has been questioned. Recently, studies evaluating endovascular treatment and intravenous thrombolysis compared with intravenous thrombolysis alone, have reported improved outcome for the intervention group. The aim of this study was to perform a meta-analysis of randomized controlled trials comparing endovascular treatment in addition to intravenous thrombolysis with intravenous thrombolysis alone.MethodsDatabases were searched for eligible randomized controlled trials. The primary outcome was a functional neurological outcome after 90 days. A secondary outcome was severe disability and death. Data were pooled in the control and intervention groups, and OR was calculated on an intention to treat basis with 95% CIs. Outcome heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I2 (significance cut-off value >50%) with the Mantel–Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant.ResultsSix studies met the eligibility criteria, and data from 1569 patients were analyzed. A higher probability of a functional neurological outcome after 90 days was found for the intervention group (OR 2, 95% CI 2 to 3). There was a significantly higher probability of death and severe disability in the control group compared with the intervention group.ConclusionsEndovascular treatment in addition to intravenous thrombolysis for acute ischemic stroke leads to an improved clinical outcome after 3 months, compared with patients receiving intravenous thrombolysis alone.

scholarly journals Endovascular Reperfusion for Acute Isolated Cervical Carotid Occlusions: The Concept of “Hemodynamic Thrombectomy”

2018 ◽  
Vol 8 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Luís Henrique de Castro-Afonso ◽  
Guilherme Seizem Nakiri ◽  
Lucas Moretti Monsignore ◽  
Francisco Antunes Dias ◽  
Frederico Fernandes Aléssio-Alves ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Consecutive Series ◽  
Collateral Flow ◽  
Endovascular Recanalization ◽  
Radiological Data

Background/Aims: Endovascular treatment improves the outcomes of patients presenting with acute large vessel occlusions. Isolated proximal carotid occlusions presenting with hemodynamic ischemic stroke may probably also benefit from endovascular treatment. We aimed to assess the clinical and radiological data findings on patients who underwent endovascular treatment for acute ischemic stroke related to an isolated cervical carotid artery occlusion. Methods: Of a consecutive series of 223 patients who were admitted with acute ische­mic stroke and were treated by thrombectomy, we included 9 patients with isolated cervical internal carotid occlusions. Results: The mean baseline National Institutes of Health Stroke Scale (NIHSS) score was 11.8. Complete carotid recanalization was achieved in 5 of the 9 patients (55.5%). In 2 patients, vertebral angioplasty was performed to improve the collateral flow. All patients had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3 at the end of the procedures. A good neurological outcome, defined as a modified Rankin Scale score ≤2 at the 3-month follow-up, was observed in 6 patients (66.7%). No symptomatic intracranial hemorrhages or deaths occurred during the 3 months of follow-up. Conclusions: The endovascular recanalization of isolated cervical carotid occlusions presenting with acute ischemic stroke symptoms is feasible. Because isolated cervical carotid occlusions are associated with hemodynamic ischemic symptoms, if carotid recanalization cannot be achieved, stenting other cervical arteries’ stenoses, with a focus on intracranial flow improvement, appears to be a reasonable strategy. Large controlled studies are necessary to assess the safety and efficacy of recanalization of acute isolated cervical carotid occlusions.

Abstract TP23: The Impact of Procedure Time on Clinical Outcome in Endovascular Treatment for Acute Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Yukiko Enomoto ◽  
Shinichi Yoshimura ◽  
Nobuyuki Sakai ◽  
Hiroshi Yamagami ◽  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Procedure Time ◽  
The Impact

Abstract TP19: Role of Pial Collateral Flow in Acute Ischemic Stroke Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sumul Modi ◽  
Horia Marin ◽  
Panayiotis Varelas ◽  
Panayiotis Mitsias
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Collateral Flow ◽  
Stroke Registry ◽  
Point Reduction ◽  
Mca Occlusion ◽  
Point Increase ◽  
Additional Imaging ◽  
Iv Tpa

Background and Purpose: Collateral flow can influence the pace and extent of evolution to irreversible tissue damage and thus have a significant impact on the clinical outcome of patients with acute ischemic stroke (AIS), including those treated with endovascular treatment (ET). Using prospectively collected data of a Stroke Registry, we explored the relationship between digital subtraction angiography (DSA) collateral status and clinical outcome of AIS patients with middle cerebral artery (MCA) occlusion treated with ET. Methods: We reviewed the data of all patients with acute MCA occlusion treated with ET within the past 5 years. Baseline DSA collaterals were classified as - no (0), poor (1), intermediate (2) and good (3). Clinical outcomes were assessed using the National Institute of Health Stroke Scale (NIHSS) at 24-48 hours and at the time of discharge. Multivariable regression analysis was done to evaluate association of DSA collateral score with the outcome. The regression model was adjusted for the age, baseline NIHSS, infusion of intravenous (IV) thrombolytic (tPA) and symptom-onset to angiographic recanalization time. Results: 50 patients with the MCA occlusion were treated with ET and 25 (50%) patients received IV tPA prior to ET. Median baseline NIHSS score was 19.5. Median time from the onset to IV tPA was 122 minutes and onset to angiographic recanalization was 277 minutes, respectively. Patients with DSA collateral score of 0, 1, 2 and 3 were 7 (15%), 21 (44%), 15 (31%) and 5 (10%), respectively. Every 1-point increase in the DSA collateral score was associated with 4.5-point reduction in NIHSS at 24-48 hours and 4.9-point reduction in NIHSS at discharge (Standard Error 1.4, p<0.01 for both). Conclusions: In the patients with AIS due to MCA occlusion, better collaterals on the DSA are independently associated with improved NIHSS at 24-48 hours after ET and at the time of discharge. This concept needs to be explored further in a larger dataset that will also include additional imaging parameters.

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