Abstract 194: Preliminary Results from the FIRST Trial: Natural History of Acute Stroke from Large Vessel Occlusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Vallabh Janardhan ◽  
Ryan M Gianatasio ◽  
Sherman H Chen ◽  
Parita Bhuva ◽  
Mark M Murray ◽  
...  
Keyword(s):  
Placebo Group ◽  
Natural History ◽  
Interim Analysis ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Adverse Event Rate ◽  
Delayed Presentation ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
History Of

Purpose: Current literature has limited information on the natural history of the stroke cohort eligible for mechanical thrombectomy. The placebo group from the PROACT II study is often used as a historical control, despite differences in entry criteria. Reported herein are data in a stroke cohort eligible for mechanical thrombectomy but untreated due to unavailability or inability to initiate endovascular treatment within the 8-hr window due to delayed presentation. The goal is to compare the functional independence rate with the PROACT placebo group. Methods: The FIRST Trial is a prospective, multicenter, natural history study of a stroke cohort eligible for but untreated by mechanical thrombectomy presenting within 8 hrs of symptom onset from a large vessel occlusion and a NIHSS of at least 10. The primary endpoint is functional outcome at 90 days as defined by a mRS 0-2. Results are reported from an interim analysis. Results: Fifty-nine (59) patients were enrolled and met study criteria for this interim analysis. The mean age was 68.2 ± 17 years; median NIHSS was 18 (5-34). Target vessel occlusions were in the ICA (35.7%), MCA (60.7%), and other (3.6%). At admission, the TIMI 0-1 rate was 89% (49/55), and the TICI 0-1 rate was 89% (48/54). Of these, only 10% (3/30) showed spontaneous recanalization (TIMI 2-3 or TICI 2a-3). Eleven of 55 (20%) patients achieved a good 90-day outcome, and 24 of 59 (40.7%) died. The serious adverse event rate was 52.6% (30/57), including respiratory failure (8 cases) and pneumonia (4 cases). A total of 6 (10%) patients suffered intracerebral hemorrhage (ICH). Below is a comparison of the MCA cohort vs. PROACT II placebo patients. Conclusion: Compared with PROACT II placebo patients, the stroke cohort eligible for mechanical thrombectomy who were untreated have a lower rate of recanalization and worse outcome. These results indicate it may not be appropriate to use the PROACT placebo patients as historical controls for mechanical thrombectomy trials.

Abstract P580: Prevalence and Natural History of Large Vessel Occlusion in Childhood Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Wilmot Bonnet ◽  
Michael M Dowling ◽  
Patricia Plumb
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Acute Ischemic Stroke ◽  
Chart Review ◽  
Pediatric Population ◽  
Adult Population ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
History Of

Introduction: Many studies have reported endovascular revascularization therapy (ERT) in children with Childhood Acute Ischemic Stroke (CAIS). With the recent expansion of thrombectomy windows via DAWN/DEFUSE3, more pediatric stroke patients are likely to be potential candidates for intervention. The prevalence of Large Vessel Occlusion (LVO) in the adult population is 25-33% however the prevalence and natural history of LVO in the pediatric population have not yet been described. Methods: This is an IRB approved single center observational study by retrospective chart review of all CAIS who presented acutely to our center from 2004 to 2019. Components of Chart review: Vessel involvement, Mortality/dependency, PSOM and MRS, Etiology, Intervention/Time window of presentation/eligibility for DAWN/DEFUSE, treatment (thrombolysis, ERT), and outcome. Results: 48/218 (22%) of patients with CAIS had an acute presentation consistent with LVO (95% CI 16.7-28.1%). Of the patients with LVO, 23 (46%) were due to large vessel arteriopathy, 15(30%) were cardioembolic, 4 had a hypercoagulable state and 7 were cryptogenic. Ages ranged from day of life 1 to 18 years. 6 (12%) patients died within 2 years of LVO (3 of stroke, 3 from other causes). 5 of the 218 patients reviewed received thrombolysis, with 4/48 LVO patients received thrombolytics. 5/49 LVO patients underwent ERT (4 with at least TICI 2A reperfusion). Average age of LVO patients 14.2 years. PSOM/ comparative outcome data collection is ongoing. Conclusion: Prevalence of LVO has not yet been described in the pediatric population. At our center, 22.4% of CAIS patients had imaging consistent with large vessel occlusion at presentation. This rate is close to that of the adult population (25-33%). Many children have tolerated ERT with good outcomes. Time windows may be less applicable in children given presence of better collaterals and good cardiovascular function. More data is needed regarding the use of advanced imaging modalities for patient stratification in acute neurovascular intervention. Different inclusion criteria may be necessary given improved outcomes among children without intervention.

Mechanical Thrombectomy Improves Outcome for Large Vessel Occlusion Stroke after Cardiac Surgery

2021 ◽  
Vol 30 (8) ◽  
pp. 105851
Author(s):  
D. Andrew Wilkinson ◽  
Sravanthi Koduri ◽  
Sharath Kumar Anand ◽  
Badih J. Daou ◽  
Vikram Sood ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

scholarly journals Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

2021 ◽  
Author(s):  
Simon Fandler-Höfler ◽  
Balazs Odler ◽  
Markus Kneihsl ◽  
Gerit Wünsch ◽  
Melanie Haidegger ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Unfavorable Outcome ◽  
Large Vessel ◽  
Study Cohort ◽  
Large Vessel Occlusion ◽  
Kidney Dysfunction ◽  
Vessel Occlusion ◽  
The Impact

AbstractData on the impact of kidney dysfunction on outcome in patients with stroke due to large vessel occlusion are scarce. The few available studies are limited by only considering single kidney parameters measured at one time point. We thus investigated the influence of both chronic kidney disease (CKD) and acute kidney injury (AKI) on outcome after mechanical thrombectomy. We included consecutive patients with anterior circulation large vessel occlusion stroke receiving mechanical thrombectomy at our center over an 8-year period. We extracted clinical data from a prospective registry and investigated kidney serum parameters at admission, the following day and throughout hospital stay. CKD and AKI were defined according to established nephrological criteria. Unfavorable outcome was defined as scores of 3–6 on the modified Rankin Scale 3 months post-stroke. Among 465 patients, 31.8% had an impaired estimated glomerular filtration rate (eGFR) at admission (< 60 ml/min/1.73 m2). Impaired admission eGFR was related to unfavorable outcome in univariable analysis (p = 0.003), but not after multivariable adjustment (p = 0.96). Patients frequently met AKI criteria at admission (24.5%), which was associated with unfavorable outcome in a multivariable model (OR 3.03, 95% CI 1.73–5.30, p < 0.001). Moreover, patients who developed AKI during hospital stay also had a worse outcome (p = 0.002 in multivariable analysis). While CKD was not associated with 3-month outcome, we identified AKI either at admission or throughout the hospital stay as an independent predictor of unfavorable prognosis in this study cohort. This finding warrants further investigation of kidney–brain crosstalk in the setting of acute stroke.

Acute occlusion of the fetal posterior cerebral artery: diagnosis and management paradigms

2021 ◽  
pp. 197140092110193
Author(s):  
Mohamad Abdalkader ◽  
Anurag Sahoo ◽  
Julie G Shulman ◽  
Elie Sader ◽  
Courtney Takahashi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery ◽  
Management Strategies ◽  
Artery Occlusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Cerebral Artery Occlusion

Background and purpose The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. Methods We performed a retrospective review of consecutive patients presenting with acute large vessel occlusion who underwent cerebral angiogram and/or mechanical thrombectomy between January 2015 and January 2021. Patients diagnosed with fetal posterior cerebral artery occlusion were included. Demographic data, clinical presentation, imaging findings and management strategies were reviewed. Results Between January 2015 and January 2021, three patients with fetal posterior cerebral artery occlusion were identified from 400 patients who underwent angiogram and/or mechanical thrombectomy for acute stroke (0.75%). The first patient presented with concomitant fetal posterior cerebral artery and middle cerebral artery occlusions. Thrombectomy was performed with recanalisation of the fetal posterior cerebral artery but the patient died from malignant oedema. The second patient presented with isolated fetal posterior cerebral artery occlusion. No endovascular intervention was performed and the patient was disabled from malignant posterior cerebral artery infarct. The third patient presented with carotid occlusion and was found to have fetal posterior cerebral artery occlusion after internal carotid artery recanalisation. No further intervention was performed. The patient was left with residual contralateral homonymous hemianopia and mild left sided weakness. Conclusion Fetal posterior cerebral artery occlusion is a rare, but potentially disabling, cause of ischaemic stroke. Endovascular treatment is feasible. Further investigation is needed to compare the efficacy of medical versus endovascular management strategies.

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