E-035 Ct perfusion outcomes may lead to better clinical outcomes following endovascular therapy in large vessel occlusion stroke

2017 ◽  
Author(s):  
J Grossberg ◽  
M Bouslama ◽  
D Haussen ◽  
L Rebello ◽  
M Frankel ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Ct Perfusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Abstract 39: CT Perfusion Selection May Lead to Better Clinical Outcomes Following Endovascular Therapy in Large Vessel Occlusion Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mehdi Bouslama ◽  
Diogo C Haussen ◽  
Jonathan A Grossberg ◽  
Seena Dehkharghani ◽  
Meredith Bowen ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Functional Outcomes ◽  
Ct Perfusion ◽  
Univariate Analysis ◽  
Information Criterion ◽  
Stent Retriever ◽  
Large Vessel ◽  
Control Analysis ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Background and Purpose: Different imaging paradigms have been used to select patients for endovascular therapy (ET) in large vessel occlusion stroke (LVOS). We sought to determine whether CT perfusion (CTP) selection improves ET outcomes as compared to non-contrast CT (NCCT) alone. Methods: Review of a prospective single-center interventional database of consecutive patients between September 2010 and March 2016. Patients with anterior circulation strokes undergoing stent-retriever thrombectomy were categorized according to imaging selection: (1) CTP and (2) NCCT alone. Two separate analyses were performed: (1) Uni- and Multivariate analyses of the overall cohort and (2) Matched analysis based on age, baseline NIHSS, and glucose levels. Results: A total of 602 patients were included. CTP-selected patients (n=365; 61%) were younger (p=0.02) and had less comorbidities. On univariate analysis, CTP-selection was associated with higher rates of full reperfusion (mTICI-3, p<0.001), good outcomes (90-day mRS 0-2, p=0.005), lower mortality rates (p=0.005), and a favorable shift in the overall distribution of 90-day mRS (p<0.001) as compared with NCCT alone. The rates of any parenchymal hematoma were comparable between groups (p=0.671). Multivariate logistic regression showed that CTP was independently associated with mTICI-3 (OR=1.79 95%CI [1.27-2.53], p=0.001) and good outcomes (aOR=1.72 95%CI [1.10-2.67], p=0.017). In the matched case-control analysis (n=424 patients), CTP-selection was associated with a favorable shift in the distribution of 90-day mRS (p=0.016), lower 90-day mortality (p=0.02), higher rates of mTICI-3 reperfusion (p<0.001), and a trend towards higher rates of 90-day independence (p=0.06). There was an advantage in the ability of CTP to determine functional outcomes in patients presenting later than 6h (Akaike information criterion (AIC) 199.35 vs. 287.49 and Bayesian information criterion (BIC) 196.71 vs 283.27) and with an ASPECTS ≤7 (AIC 216.69 vs 334.96 and BIC 213.6 vs 329.94). Conclusion: CTP-based selection is associated with a favorable shift in functional outcomes in patients undergoing stent-retriever thrombectomy. Future prospective studies are warranted.

Abstract WP43: Body Mass Index and Clinical Outcomes in Large Vessel Occlusion Acute Ischemic Stroke After Endovascular Therapy: The Obesity Paradox

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Mehdi Bouslama ◽  
Hilarie Perez ◽  
Letícia C Rebello ◽  
Diogo C Haussen ◽  
Jonathan A Grossberg ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Endovascular Therapy ◽  
Obesity Paradox ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

scholarly journals Body Mass Index and Clinical Outcomes in Large Vessel Occlusion Acute Ischemic Stroke after Endovascular Therapy

2019 ◽  
Vol 8 (2-6) ◽  
pp. 144-151 ◽  
Author(s):  
Mehdi Bouslama ◽  
Hilarie J. Perez ◽  
Clara M. Barreira ◽  
Diogo C. Haussen ◽  
Jonathan A. Grossberg ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Endovascular Therapy ◽  
Normal Weight ◽  
Large Vessel ◽  
Obese Patients ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Glucose Levels

Background and Purpose: Several reports have described lower mortality rates in overweight or obese patients as compared to normal weight ones. In the past decade, several studies have investigated the phenomenon, commonly known as the obesity paradox, with mixed results thus far. We sought to determine whether outcomes differ between patients with large vessel occlusion strokes (LVOS) after endovascular therapy (ET) according to their body mass index (BMI). Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution. All patients that underwent ET for acute LVOS were categorized according to their BMI into 4 groups: (1) underweight (BMI < 18.5), (2) normal weight (BMI = 18.5–25), (3) overweight (BMI = 25–30), and (4) obese (BMI > 30). Baseline characteristics, procedural radiological as well as outcome parameters where compared. Results: A total of 926 patients qualified for the study, of which 20 (2.2%) were underweight, 253 (27.3%) had a normal weight, 315 (34%) were overweight, and 338 (36.5%) were obese. When compared with normal weight (reference), overweight patients were younger, had higher rates of dyslipidemia and diabetes and higher glucose levels, while obese patients were younger, less often smokers, and had higher rates of hypertension and diabetes and higher glucose levels. Other baseline and procedural characteristics were comparable. The rates of successful reperfusion (modified treatment in cerebral ischemia, 2b–3), parenchymal hematomas, 90-day good clinical outcomes (modified Rankin scale, 0–2), and 90-day mortality were comparable between groups. On multivariate analysis, BMI was not associated with good outcomes nor mortality. Conclusion: In patients treated with mechanical thrombectomy, BMI is not associated with outcomes. However, patients who are overweight or obese have more comorbidities and a higher stroke risk and, thus, should strive for a normal weight.

scholarly journals Clinical and Imaging Outcomes of Endovascular Therapy in Patients with Acute Large Vessel Occlusion Stroke and Mild Clinical Symptoms

2017 ◽  
Vol 7 (1-2) ◽  
pp. 91-98 ◽  
Author(s):  
Meredith T. Bowen ◽  
Leticia C. Rebello ◽  
Mehdi Bouslama ◽  
Diogo C. Haussen ◽  
Jonathan A. Grossberg ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Significant Proportion ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Tandem Occlusion

Background: The minimal stroke severity justifying endovascular intervention remains elusive. However, a significant proportion of patients presenting with large vessel occlusion stroke (LVOS) and mild symptoms go untreated and face poor outcomes. We aimed to evaluate the clinical outcomes of patients presenting with LVOS and low symptom scores (National Institutes of Health Stroke Scale [NIHSS] score ≤8) undergoing endovascular therapy (ET). Methods: We performed a retrospective analysis of a prospectively collected ET database between September 2010 and March 2016. Endovascularly treated patients with LVOS and a baseline NIHSS score ≤8 were included. Baseline patient characteristics, procedural details, and outcome parameters were collected. Efficacy outcomes were the rate of good outcome (90-day modified Rankin Scale score 0-2) and of successful reperfusion (modified Treatment in Cerebral Infarction [mTICI] score 2b-3). Safety was assessed by the rate of parenchymal hematoma (parenchymal hematoma type 1 [PH-1] and parenchymal hematoma type 2 [PH-2]) and 90-day mortality. Logistic regression was used to identify predictors of good clinical outcomes. Results: A total of 935 patients were considered; 72 patients with an NIHSS score ≤8 were included. Median [IQR] age was 61.5 years [56.2-73.0]; 39 patients (54%) were men. Mean (SD) baseline NIHSS score, computed tomography perfusion core volume, and ASPECTS were 6.3 (1.5), 7.5 mL (16.1), and 8.5 (1.3), respectively. Twenty-eight patients (39%) received intravenous tissue plasminogen activator. Occlusions locations were as follows: 29 (40%) proximal MCA-M1, 20 (28%) MCA-M2, 6 (8%) ICA terminus, and 9 (13%) vertebrobasilar. Tandem occlusion was documented in 7 patients (10%). Sixty-seven patients (93%) achieved successful reperfusion (mTICI score 2b-3); 52 (72%) had good 90-day outcomes. Mean final infarct volume was 32.2 ± 59.9 mL. Parenchymal hematoma occurred in 4 patients (6%). Ninety-day mortality was 10% (n = 7). Logistic regression showed that only successful reperfusion (OR 27.7, 95% CI 1.1-655.5, p = 0.04) was an independent predictor of good outcomes. Conclusion: Our findings demonstrate that ET is safe and feasible for LVOS patients presenting with mild clinical syndromes. Future controlled studies are warranted.

scholarly journals Computed Tomographic Perfusion Selection and Clinical Outcomes After Endovascular Therapy in Large Vessel Occlusion Stroke

Stroke ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 1271-1277 ◽  
Author(s):  
Mehdi Bouslama ◽  
Diogo C. Haussen ◽  
Jonathan A. Grossberg ◽  
Seena Dehkharghani ◽  
Meredith T. Bowen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Computed Tomographic

scholarly journals Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vessel Occlusion Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3495-3503 ◽  
Author(s):  
Jacob R. Morey ◽  
Thomas J. Oxley ◽  
Daniel Wei ◽  
Christopher P. Kellner ◽  
Neha S. Dangayach ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Patient Presentation

Background and Purpose: Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models. Methods: This is a prospective observational cohort study with 3-month follow-up between June 2016 and December 2018 at a multicenter health system, consisting of one comprehensive stroke center, 4 TSCs, and several primary stroke centers. A total of 228 of 373 patients received endovascular therapy via 1 of 4 models: mothership with patient presentation to a comprehensive stroke center, DS with patient transfer from primary stroke center or TSC to comprehensive stroke center, MIST with patient presentation to TSC and MIST transfer, or a combination of DS with patient transfer from primary stroke center to TSC and MIST. The prespecified primary end point was initial door-to-recanalization time and secondary end points measured additional time intervals and clinical outcomes at discharge and 3 months. Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes ( P <0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively ( P =0.83). A greater proportion had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge in MIST compared with DS (37.9% versus 16.7%; P <0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS ( P =0.10). Conclusions: MIST led to significantly faster initial door-to-recanalization times compared with DS, which was comparable to mothership. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03048292.

Real-World Experience with Artificial Intelligence-Based Triage in Transferred Large Vessel Occlusion Stroke Patients

2021 ◽  
pp. 1-6
Author(s):  
Jacob R. Morey ◽  
Xiangnan Zhang ◽  
Kurt A. Yaeger ◽  
Emily Fiano ◽  
Naoum Fares Marayati ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Clinical Outcomes ◽  
Warning System ◽  
Large Vessel ◽  
Time Interval ◽  
Large Vessel Occlusion ◽  
Time Intervals ◽  
Vessel Occlusion ◽  
Left Behind ◽  
Stroke Center

<b><i>Background and Purpose:</i></b> Randomized controlled trials have demonstrated the importance of time to endovascular therapy (EVT) in clinical outcomes in large vessel occlusion (LVO) acute ischemic stroke. Delays to treatment are particularly prevalent when patients require a transfer from hospitals without EVT capability onsite. A computer-aided triage system, Viz LVO, has the potential to streamline workflows. This platform includes an image viewer, a communication system, and an artificial intelligence (AI) algorithm that automatically identifies suspected LVO strokes on CTA imaging and rapidly triggers alerts. We hypothesize that the Viz application will decrease time-to-treatment, leading to improved clinical outcomes. <b><i>Methods:</i></b> A retrospective analysis of a prospectively maintained database was assessed for patients who presented to a stroke center currently utilizing Viz LVO and underwent EVT following transfer for LVO stroke between July 2018 and March 2020. Time intervals and clinical outcomes were compared for 55 patients divided into pre- and post-Viz cohorts. <b><i>Results:</i></b> The median initial door-to-neuroendovascular team (NT) notification time interval was significantly faster (25.0 min [IQR = 12.0] vs. 40.0 min [IQR = 61.0]; <i>p</i> = 0.01) with less variation (<i>p</i> &#x3c; 0.05) following Viz LVO implementation. The median initial door-to-skin puncture time interval was 25 min shorter in the post-Viz cohort, although this was not statistically significant (<i>p</i> = 0.15). <b><i>Conclusions:</i></b> Preliminary results have shown that Viz LVO implementation is associated with earlier, more consistent NT notification times. This application can serve as an early warning system and a failsafe to ensure that no LVO is left behind.

Sign in / Sign up

Export Citation Format

Share Document