Low relative diffusion weighted image signal intensity can predict good prognosis after endovascular thrombectomy in patients with acute ischemic stroke

2021 ◽  
pp. neurintsurg-2021-017583
Author(s):  
Fumihisa Kishi ◽  
Ichiro Nakagawa ◽  
HunSoo Park ◽  
Masashi Kotsugi ◽  
Kaoru Myouchin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Signal Intensity ◽  
Good Prognosis ◽  
Good Clinical Outcome ◽  
Clinical Prognosis ◽  
Endovascular Thrombectomy ◽  
Relative Diffusion ◽  
Diffusion Weighted

BackgroundIt is vital to identify a surrogate last-known-well time to perform proper endovascular thrombectomy in acute ischemic stroke; however, no established imaging biomarker can easily and quickly identify eligibility for endovascular thrombectomy and predict good clinical prognosis.ObjectiveTo investigate whether low relative diffusion-weighted imaging (DWI) signal intensity can be used as a predictor of good clinical outcome after endovascular thrombectomy in patients with acute ischemic stroke.MethodsWe retrospectively identified consecutive patients with acute ischemic stroke who were treated with endovascular thrombectomy within 24 hours of the last-known-well time and achieved successful recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b). Relative DWI signal intensity was calculated as DWI signal intensity in the infarcted area divided by DWI signal intensity in the contralateral hemisphere. Good prognosis was defined as a modified Rankin Scale score of 0–2 at 90 days after stroke onset (good prognosis group).Results49 patients were included in the analysis. Relative DWI signal intensity was significantly lower in the group with good prognosis than in the those with poor prognosis (median (IQR) 1.32 (1.27–1.44) vs 1.56 (1.43–1.66); p<0.01), and the critical cut-off value for predicting good prognosis was 1.449 (area under the curve 0.78). Multiple logistic regression analysis revealed association of good prognosis after endovascular thrombectomy with low relative DWI signal intensity (OR=6.84; 95% CI 1.13 to 41.3; p=0.04).ConclusionsLow relative DWI signal intensity was associated with good prognosis after endovascular thrombectomy. Its ability to predict good clinical outcome shows potential for determining patient suitability for endovascular thrombectomy.

scholarly journals Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 11 (4) ◽  
pp. 504
Author(s):  
Dalibor Sila ◽  
Markus Lenski ◽  
Maria Vojtková ◽  
Mustafa Elgharbawy ◽  
František Charvát ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Good Clinical Outcome ◽  
Significant Difference ◽  
Aspiration Technique

Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

scholarly journals Acute Ischemic Stroke in Late Pregnancy Treated with Intravenous Thrombolysis and Endovascular Therapy

2019 ◽  
Vol 11 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Eva Szuchy Kristiansen ◽  
Hannah Holm Vestergaard ◽  
Boris Modrau ◽  
Lorenz Martin Oppel
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Intravenous Thrombolysis ◽  
Late Pregnancy ◽  
Exclusion Criterion ◽  
Good Clinical Outcome ◽  
Systemic Thrombolysis ◽  
In Pregnancy

Pregnancy has usually been an exclusion criterion in clinical trials with thrombolysis and endovascular therapy in acute ischemic stroke. For that reason, these therapies are not recommended causing lack of evidence and vice versa. In this case report, we describe a pregnant woman in week 33 + 3 presenting with acute ischemic stroke, which was successfully treated with systemic thrombolysis and endovascular therapy, resulting in a good clinical outcome for both mother and child. The altered fibrinolytic system and the risk factors related to pregnancy constitute a challenge for clinicians when choosing the most suitable treatment modality for treating acute ischemic stroke in pregnancy. It is still uncertain whether thrombolysis in combination with endovascular therapy or endovascular therapy alone is the most appropriate treatment option. However, there is slowly growing evidence that thrombolysis and thrombectomy in pregnancy are feasible and safe with a good clinical outcome for both the mother and the child.

Effect of routing paradigm on patient centered outcomes in acute ischemic stroke

2019 ◽  
Vol 11 (8) ◽  
pp. 762-767 ◽  
Author(s):  
Minerva H Zhou ◽  
Akash P Kansagra
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Rhode Island ◽  
Clinical Trial Data ◽  
Urban Setting ◽  
Rural Setting ◽  
Good Clinical Outcome ◽  
Minimal Impact ◽  
Stroke Center

BackgroundTo compare performance of routing paradigms for patients with acute ischemic stroke using clinical outcomes.MethodsWe simulated different routing paradigms in a system comprising one primary stroke center (PSC) and one comprehensive stroke center (CSC), separated by distances representative of urban, suburban, and rural environments. In the nearest center paradigm, patients are initially sent to the nearest center, while in CSC first, patients are sent to the CSC. In the Rhode Island and distributive paradigms, patients with a FAST-ED (Facial palsy, Arm weakness, Speech changes, Time, Eye deviation, and Denial/neglect) score ≥4 are sent to the CSC, while others are sent to the nearest center or PSC, respectively. Performance and efficiency were compared using rates of good clinical outcome, determined by type and timing of treatment using clinical trial data, and number needed to bypass (NNB).ResultsGood clinical outcome was achieved in 43.76% of patients in nearest center, 44.48% in CSC first, and 44.44% in Rhode Island and distributive in an urban setting; 43.38% in nearest center, 44.19% in CSC first, and 44.17% in Rhode Island in a suburban setting; and 41.10% in nearest center, 43.20% in CSC first, and 42.73% in Rhode Island in a rural setting. In all settings, NNB was generally higher for CSC first compared with Rhode Island or distributive.ConclusionRouting paradigms that allow bypass of nearer hospitals for thrombectomy capable centers improve population level patient outcomes. Differences are more pronounced with increasing distance between hospitals; therefore, paradigm choice may be most impactful in rural settings. Selective bypass, as implemented in the Rhode Island and distributive paradigms, improves system efficiency with minimal impact on outcomes.

JET 7 XTRA Flex reperfusion catheter related complications during endovascular thrombectomy

2020 ◽  
pp. neurintsurg-2020-016826
Author(s):  
Shahram Majidi ◽  
Devin V Bageac ◽  
Islam Fayed ◽  
Benjamin Yim ◽  
Reade De Leacy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Technological Advancement ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Device Malfunction ◽  
Inner Diameter

Endovascular thrombectomy has revolutionized the management of acute ischemic stroke from emergent large vessel occlusion. Continued technological advancement in the field, as evidenced by successive introduction of large bore aspiration catheters with enhanced trackability and large inner diameter, has played a major role in achieving fast and robust recanalization and improved clinical outcome. Here, we present three patients with intraprocedural device malfunction related to the JET 7 XTRA Flex reperfusion catheter.

CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review

2015 ◽  
Vol 8 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Lucas Elijovich ◽  
Nitin Goyal ◽  
Shraddha Mainali ◽  
Dan Hoit ◽  
Adam S Arthur ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Chart Review ◽  
Infarct Volume ◽  
Retrospective Chart Review ◽  
Favorable Outcome ◽  
Good Clinical Outcome

BackgroundAcute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.ObjectiveTo examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).MethodsA retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.ResultsFifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2–27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.ConclusionsGood CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.

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