Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review

2020 ◽  
pp. neurintsurg-2020-016725
Author(s):  
Julien Allard ◽  
Sam Ghazanfari ◽  
Mehdi Mahmoudi ◽  
Julien Labreuche ◽  
Simon Escalard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Older Patients ◽  
Intravenous Thrombolysis ◽  
Review Of The Literature ◽  
Femoral Access ◽  
Life Threatening

BackgroundEndovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT.MethodsPatients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates (≥TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP.Results25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73–92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2–6) vs 6 (4–6), p=0.011).ConclusionRCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.

scholarly journals Intravenous Thrombolysis After Dabigatran Reversal by Idarucizumab: A Systematic Review of the Literature

2021 ◽  
Vol 12 ◽  
Author(s):  
Senta Frol ◽  
Dimitrios Sagris ◽  
Janja Pretnar Oblak ◽  
Mišo Šabovič ◽  
George Ntaios
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Therapeutic Strategy ◽  
Rare Event ◽  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Review Of The Literature ◽  
Safety And Efficacy ◽  
Symptomatic Intracranial Hemorrhage ◽  
Anticoagulated Patients

Background and Purpose: Idarucizumab achieves instant reversal of anticoagulation and enables intravenous thrombolysis (IVT) in dabigatran-treated acute ischemic stroke (AIS) patients. AIS in dabigatran-treated patients is a rare event, therefore the experience is limited. A review of all published cases was performed to evaluate the safety and effectiveness of this therapeutic strategy.Methods: We searched PubMed and Scopus for all published cases of IVT after reversal with idarucizumab in dabigatran-treated AIS patients. The outcomes were safety assessed by hemorhagic transformation (HT), symptomatic intracranial hemorrhage (SICH) and death, and efficacy assessed by National Institutes of Health Stroke Scale (NIHSS) reduction.Results: We identified 251 AIS patients (39,9% females) with an average age of 74 years. HT, SICH, and death were reported in 19 (7.6%), 9 (3.6%), and 21 (8.4%) patients, respectively. Patients experiencing HT presented with more severe strokes (median NIHSS on admission: 21 vs. 8, p < 0.001; OR: 1.12, 95% CI: 1.05–1.20). After IVT there was a significant NIHSS reduction of 6 points (IQR:3–10, p < 0.001) post-stroke and linear regression revealed a correlation of admission NIHSS to NIHSS reduction (p < 0.001).Conclusions: In this systematic review of all published cases of IVT in dabigatran-treated AIS patients after reversal with idarucizumab the rates of HT, SICH and mortality, as well as NIHSS reduction, were comparable with previous studies in non-anticoagulated patients. This provides reassuring evidence about the safety and efficacy of this therapeutic strategy.

Abstract WP41: Endovascular Therapy versus Intravenous Thrombolysis in Cervical Artery Dissection Ischemic Stroke - A Systematic Review and Meta-analysis and Results From the Swiss Registry

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Christopher Traenka ◽  
Simon Jung ◽  
Jan Gralla ◽  
Rebekka Kurmann ◽  
Christoph Stippich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Endovascular Therapy ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery

Abstract WMP5: Endovascular Therapy Stroke Outcome in Very Elderly: Meta-analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michelle P Lin ◽  
David S Liebeskind ◽  
Steven Cen ◽  
William J Mack ◽  
Arun P Amar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Age Groups ◽  
Large Vessel ◽  
Very Elderly

Introduction: Very elderly (age ≥80yo) individuals account for about one-third of all stroke admissions with mixed literature demonstrating relative poor stroke outcomes. With overwhelming recent evidence supporting the use of intra-arterial thrombectomy in addition to IV thrombolysis for large-vessel occlusive stroke, we conducted a metaanalysis to assess long-term functional outcome following mechanical thrombectomy in very elderly. Hypothesis: Very elderly patients with acute ischemic stroke treated with thrombectomy have equally favorable long-term functional outcomes to their younger counterparts Methods: Stroke endovascular trials published in New England Journal of Medicine 2014-2015 were included if they reported odds ratio of good functional outcome (improvement in modified Rankin score, mRS) comparing thrombectomy vs IV-tPA dichotomized by age groups (age ≤ 80yo vs >80yo, 2 studies dichotomized age at 70yo). Multivariate adjusted odds ratios and the corresponding standard errors were used for the metaanalysis. Pooled odds ratio estimates across trials were synthesized by using a random-effects model based on Mantel-Haenszel methods. The pooled estimates with 95% confidence interval were compared between elderly and younger age groups. Forest plots constructed. Results: Of the 5 recent intraartrial thrombectomy trials, 4 studies reported subgroup analysis by age with 1,206 participants, 28% (N=334) were above the age of 80yo, 72% (N=872) were ≤80yo. Among very elderly patients undergoing thrombectomy, the pooled odds ratio of good functional outcome at 3 months was 1.91 (1.13-3.24), in the younger group the pooled odds ratio was 1.95 (1.50-2.53). Conclusions: Endovascular therapy was an effective therapy for very elderly individuals presenting with acute ischemic stroke caused by large vessel occlusive disease. Future studies are needed to further assess the safety and effectiveness of thrombectomy in this growing population.

scholarly journals Clinical Significance of Hyperdense Area after Endovascular Therapy in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-10
Author(s):  
Qianmei Jiang ◽  
Jie Hou ◽  
Jian Ge ◽  
Zhichao Huang ◽  
Huaishun Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Significance ◽  
Endovascular Therapy ◽  
Meta Analysis ◽  
Poor Functional Outcome ◽  
Symptomatic Intracerebral Hemorrhage

<b><i>Objective:</i></b> We performed a systematic review and meta-analysis to investigate the clinical significance of hyperdense area after thrombectomy in patients with acute ischemic stroke (AIS). <b><i>Methods:</i></b> We searched Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and other Non-Indexed, Cochrane Library Clinical Controlled Trials and Embase from inception to September 2020 and collected the cohort and case-control studies about the clinical significance of hyperdense area on different types of computed tomography (CT) after thrombectomy in patients with AIS. Outcomes were poor functional outcome (modified Rankin Scale [mRS] Score 3–6 at discharge or 90-day), mortality and subtypes of hemorrhage according to the European Cooperative Acute Stroke Study (ECASS). <b><i>Results:</i></b> 1,999 patients from 16 studies were included in this meta-analysis. Pooled results indicated higher risk of symptomatic intracerebral hemorrhage (odds ratio [OR] = 3.02; 95% confidence interval [CI] 1.84–4.95; <i>p</i> &#x3c; 0.0001, <i>I</i><sup>2</sup> = 0%) in patients with hyperdense area, and the subtype of parenchymal hematoma as well. There was also higher odds of poor functional outcome based on the mRS 3–6 at discharge or 90-day (OR = 1.92; 95% CI 1.35–2.73; <i>p</i> = 0.0003, <i>I</i><sup>2</sup> = 31%) and mortality (OR = 2.06; 95% CI 1.41–3.02; <i>p</i> = 0.0002, <i>I</i><sup>2</sup> = 0%) in patients with hyperdense area after thrombectomy compared with those without hyperdense area. <b><i>Conclusions:</i></b> Our results indicated that the presence of hyperdense area on CT after thrombectomy was associated with high risk of symptomatic intracerebral hemorrhage, poor functional outcome, as well as mortality in patients with AIS. However, further studies were needed to confirm these results. The meta-analysis was conducted in adherence with the PRISMA Statement and was registered at the International Prospective Register of Systematic Reviews (CRD42020164165). To the best of our knowledge, this study is the first meta-analysis investigating the effect of hyperdense area after endovascular therapy in patients with AIS.

ROLE OF HBA1C ON SEVERITY AND FUNCTIONAL OUTCOME OF ISCHEMIC STROKE IN ELDERLY PATIENTS WITH DIABETES MELLITUS

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
beker nagueib ◽  
reda kamel ◽  
adham mohammed ◽  
hamed mohamed
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Functional Outcome ◽  
Patients With Diabetes
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