Abstract WP2: Intracranial Stenting with the use of the Wingspan Intracranial Stent for Patients Presenting with Acute Stroke Symptoms and Critical Intracranial Arterial Stenosis.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Arash Padidar ◽  
Pejman Taghavi ◽  
Reza Malek ◽  
Ursula Tolley ◽  
Linda Catalli ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Intravenous Thrombolysis ◽  
Intracranial Stenosis ◽  
Arterial Stenosis ◽  
Treatment Modalities ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stenting ◽  
Intracranial Stent ◽  
Increased Risk

Introduction: Patients with pre-existing severe intracranial arterial stenosis are at increased risk of re-current stroke. The treatment modalities for patients presenting with acute stroke symptoms are limited due to risk of re-occlusion after thrombolysis. Following re-canalization of an occluded stenotic vessel, stenting can prevent re-occlusion. Currently the only FDA approved stent specifically indicated for intracranial stenosis is the wingspan stent which is listed as a Humanitarian Use Device (HUD). With the efficacy and safety of intracranial stenting still in question we present a 3 year retrospective review of a community based hospitals outcomes with stenting in an acute stroke setting. Methods: Between 2009-2012 our group treated 47 patients with intracranial stenosis presenting with acute ischemic stroke. These patients had failure of intravenous thrombolysis or had contraindications for its use, had symptomatic intracranial stenosis or tandem lesions, had evidence of salvageable tissue determined by CT perfusion scanning and had an acute infarct not exceeding 1/3 of the affected vascular territory. All patients were treated within 12 hours of the acute event and received the Wingspan intracranial stent after successful thrombolysis. Fifteen patients had posterior circulation stenosis and 32 patients had anterior circulation stenosis. Results: The 30 day post-procedural stroke rate was 12.8%, with a total early mortality rate of 8.4% (Table). The 35 patients with no complications had an average of 4 points improvement in NIHSS post procedure (Figure). Of these patients 15 were discharged home, 10 discharged to acute rehabilitation facilities, and 10 were transferred to nursing homes. Conclusion: Intracranial stenting using the Wingspan device results in significant clinical improvement in patients with acutely symptomatic intracranial stenosis, with acceptable mortality and low rate of symptomatic intracranial hemorrhage.

Abstract 3268: Ct Perfusion As A Tool To Predict The Risk Of Hemorrhagic Transformation In Ischemic Stroke Treated With Tissue Plasminogen Activator: A Single Center Experience.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tareq Kass-Hout ◽  
Maxim Mokin ◽  
Omar Kass-Hout ◽  
Emad Nourollahzadeh ◽  
David Wack ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Brain Tissue ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Stroke Therapy ◽  
Two Phase ◽  
The Mean

Objective: To use the Computed Tomography Perfusion (CTP) parameters at the time of hospital admission, including Cerebral Blood Volume (CBV) and Permeability Surface area product (PS), to identify patients with higher risk to develop hemorrhagic transformation in the setting of acute stroke therapy with intravenous thrombolysis. Methods: Retrospective study that compared admission CTP variables between patients with Hemorrhagic Transformation (HT) acute stroke and those with no hemorrhagic transformation. Both groups received standard of care intravenous thrombolysis with tPA. Twenty patients presented to our stroke center between the years 2007 - 2011 within 3 hours after stroke symptoms onset. All patients underwent two-phase 320 slice CTP which creates CBV and PS measurements. Patients were divided into two groups according to whether or not they had HT on a follow up CT head without contrast, done within 36 hours of the thrombolysis therapy. Clinical, demographic and CTP variables were compared between the HT and non-HT groups using logistic regression analyses. Results: HT developed in 8 (40%) patients. Patients with HT had lower ASPECT score ( P =.03), higher NIHSS on admission ( P= .01) and worse outcome ( P= .04) compared to patients who did not develop HT. Baseline blood flow defects were comparable between the two groups. The mean PS for the HT group was 0.53 mL/min/100g brain tissue, which was significantly higher than that for the non-HT group of 0.04 mL/min/100g brain tissue ( P <.0001). The mean area under the curve was 0.92 (95% CI). The PS threshold of 0.26 mL/min/100g brain tissue had a sensitivity of 80% and a specificity of 92% for detecting patients with high risk of hemorrhagic transformation after intravenous thrombolysis. Conclusions: Admission CTP measurements might be useful to predict patients who are at higher risk to develop hemorrhagic transformation after acute ischemic stroke therapy.

scholarly journals Risk Factors of Subacute Thrombosis After Intracranial Stenting for Symptomatic Intracranial Arterial Stenosis

Stroke ◽  
2017 ◽  
Vol 48 (3) ◽  
pp. 784-786 ◽  
Author(s):  
Xuan Sun ◽  
Xu Tong ◽  
Wai Ting Lo ◽  
Dapeng Mo ◽  
Feng Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stenting ◽  
Subacute Thrombosis

scholarly journals A Case That Showed Exacerbation of Intracranial Arterial Stenosis in the Chronic Phase after Percutaneous Intracranial Stent Retriever Thrombectomy

2017 ◽  
Vol 11 (8) ◽  
pp. 398-402
Author(s):  
Yoshinori Kurauchi ◽  
Tomoyuki Tsumoto ◽  
So Tokunaga ◽  
Yuichirou Tsurusaki ◽  
Masaki Saito ◽  
...  
Keyword(s):  
Chronic Phase ◽  
Stent Retriever ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stent

Abstract TP422: Comparison of Natural History and Effect of Intracranial Stent Placement Between Patients With Intra-Dural and Those With Sub-Arachnoid Intracranial Arterial Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sargun S Walia ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
Brandi R French ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Stent Placement ◽  
Cerebral Hemorrhage ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stent ◽  
Subarachnoid Spaces

Background: Intracranial stenosis can be located in intradural or subarachnoid space. It is unclear whether there are any differences in ipsilateral ischemic stroke risk, cerebral hemorrhage and death in response to stent placement in these two locations. Methods: We analyzed Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) data. We divided the patients based on location of arterial stenosis: intradural [petrous internal carotid artery (ICA), pre-cavernous ICA, cavernous ICA or pre-posterior inferior cerebellar artery (PICA) vertebral artery] and subarachnoid [post-cavernous ICA, middle cerebral artery, vertebral artery at the level of or distal to origin of PICA, or basilar artery]. Cox proportional hazards analyses were used to determine the effect of intradural versus subarachnoid location on risk of ipsilateral ischemic stroke, cerebral hemorrhage or death during the follow-up period. Results: A total of 451 patients with stenosis located in intradural (n=74, 16.4%) or subarachnoid (n=377, 83.5 %) spaces were followed for a mean (SD) period of 29.06 (15.22) months after randomization. The rate of ischemic stroke seen in intradural and subarachnoid spaces was 11.86% and 14.58%, respectively. The rate of cerebral hemorrhage in the intradural and subarachnoid spaces was 1.35% and 2.92 %, respectively. The rate of death in the intradural and subarachnoid spaces was 10.81% and 1.59%, respectively. In Cox proportional hazards analyses, the risk of ipsilateral ischemic stroke (HR 1.08, P = 0.46), cerebral hemorrhage (HR 1.05, P = 0.59) and death (HR 0.9, P = 0.9) was not significantly different between patients with intradural arterial stenosis and those with subarachnoid arterial stenosis. The interaction between location of stenosis and treatment (intracranial stent versus best medical treatment) was not significant for the either ipsilateral ischemic stroke (p= 0.21), cerebral hemorrhage (p= 0.18) or death (p=0.15). Conclusion: We did not find any evidence to suggest that there was any difference in natural history or response to intracranial stent placement in patients with intradural location of stenosis compared with those with subarachnoid location.

Diminished Signal Intensities Distal to Intracranial Arterial Stenosis on Time-of-Flight MR Angiography Might Indicate Delayed Cerebral Perfusion

2016 ◽  
Vol 42 (3-4) ◽  
pp. 232-239 ◽  
Author(s):  
Linfang Lan ◽  
Xinyi Leng ◽  
Jill Abrigo ◽  
Hui Fang ◽  
Vincent H.L. Ip ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Perfusion ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Time Of Flight ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Tof Mra ◽  
Signal Intensities

Background: Intracranial arterial stenosis (ICAS) is a predominant cause of ischemic stroke in Asia. Changes in the signal intensities (SIs) across ICAS lesions on time-of-flight magnetic resonance angiography (TOF-MRA) have been indicated to partially reflect the hemodynamic significance of the lesions, which we aimed to verify by correlating it with cerebral perfusion features provided by CT perfusion (CTP) imaging. Methods: Ischemic stroke or transient ischemic attack patients with unilateral symptomatic stenosis (≥50%) of intracranial internal carotid artery or middle cerebral artery (MCA) were included in this study. Change of SIs across an ICAS lesion on TOF-MRA was calculated by the distal and proximal SI ratio (SIR). Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) within the MCA territory of ipsilateral and contralateral hemispheres were evaluated on the CTP images at the basal ganglia level. Relative CBV, CBF and MTT were defined as ratios of the values obtained from ipsilateral and contralateral hemispheres. The relationships between SIR and CTP parameters were analyzed. Results: Fifty subjects (74% male, mean age 62) were recruited. Overall, the mean SIR was 0.77 ± 0.17. SIR of ICAS was significantly, linearly and negatively correlated with ipsilateral CBV (r = -0.335, p = 0.017), ipsilateral MTT (r = -0.301, p = 0.034), and ipsilateral/contralateral MTT ratio (r = -0.443, p = 0.001). Conclusions: Diminished SIs distal to ICAS on TOF-MRA might be associated with delayed ipsilateral cerebral perfusion. Changes of the SIs across ICAS lesions on TOF-MRA may be a simple marker to reflect cerebral perfusion changes in patients with symptomatic ICAS.

scholarly journals Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds

2015 ◽  
Vol 8 (6) ◽  
pp. 563-567 ◽  
Author(s):  
Zhong-Song Shi ◽  
Gary R Duckwiler ◽  
Reza Jahan ◽  
Satoshi Tateshima ◽  
Nestor R Gonzalez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Cerebral Microbleeds ◽  
Vessel Occlusion ◽  
Gradient Recall Echo ◽  
Increased Risk

BackgroundThe influence of cerebral microbleeds (CMBs) on post-thrombolytic hemorrhagic transformation (HT) in patients with acute ischemic stroke remains controversial.ObjectiveTo investigate the association of CMBs with HT and clinical outcomes among patients with large-vessel occlusion strokes treated with mechanical thrombectomy.MethodsWe analyzed patients with acute stroke treated with Merci Retriever, Penumbra system or stent-retriever devices. CMBs were identified on pretreatment T2-weighted, gradient-recall echo MRI. We analyzed the association of the presence, burden, and distribution of CMBs with HT, procedural complications, in-hospital mortality, and clinical outcome.ResultsCMBs were detected in 37 (18.0%) of 206 patients. Seventy-three foci of microbleeds were identified. Fourteen patients (6.8%) had ≥2 CMBs, only 1 patient had ≥5 CMBs. Strictly lobar CMBs were found in 12 patients, strictly deep CMBs in 12 patients, strictly infratentorial CMBs in 2 patients, and mixed CMBs in 11 patients. There were no significant differences between patients with CMBs and those without CMBs in the rates of overall HT (37.8% vs 45.6%), parenchymal hematoma (16.2% vs 19.5%), procedure-related vessel perforation (5.4% vs 7.1%), in-hospital mortality (16.2% vs 18.3%), and modified Rankin Scale score 0–3 at discharge. CMBs were not independently associated with HT or in-hospital mortality in patients treated with either thrombectomy or intravenous thrombolysis followed by thrombectomy.ConclusionsPatients with CMBs are not at increased risk for HT and mortality following mechanical thrombectomy for acute stroke. Excluding such patients from mechanical thrombectomy is unwarranted. The risk of HT in patients with ≥5 CMBs requires further study.

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