Abstract W MP22: Hyperdense MCA Sign as a Recanalization and Outcomes Predictor of IA Thrombectomy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Anat Horev ◽  
David G Romero ◽  
Brian T Jankowitz ◽  
Amin Aghaebrahim ◽  
Cynthia L Kenmuir ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Treatment Options ◽  
Group Versus ◽  
Hounsfield Unit ◽  
Contralateral Side ◽  
Special Treatment ◽  
Procedure Duration ◽  
Procedural Outcomes ◽  
Iv Tpa

Background: The hyperdense MCA sign (HMCAS) is related to poor clinical outcomes and low recanalization rates after IV TPA. We explored the association between presence of HMCAS and clinical /procedural outcomes in patients with M1 MCA occlusion treated at our institution with endovascular therapy within the last five years. Methods: We retrospectively collected from our mechanical thrombectomy database a total of 193 patients with M1 occlusion, of which 107 patients were found to have HMCAS (55%). Eligible patients were treated with IV TPA prior to the intra-arterial thrombectomy. A blinded stroke neurologist evaluated baseline head CT done for possible HMCAS and measured the MCA Hounsfield Units (HU). Procedure times and other clinical and radiographic parameters were calculated. Results: A positive correlation between presence of HMCAS and procedure duration (mean time with HMCAS 112.3 min versus 89.89 min in the non HMCAS group P<0.05) was found. Intraprocedural perforation was 8% (n=9) in the HMCAS group versus 1% (n=1) in the non HMCAS group (P<0.05).Hounsfield Unit analysis (ratio of ipsilateral side/contralateral side), showed a linear correlation (p<0.05) between this ratio and procedure duration (Graph 1). Conclusions: HMCAS is associated with slower recanalization, higher rate of complications and lack of differences in clinical outcomes possibly explained by low power after endovascular therapy. This association may reflect differences in thrombus composition or thrombus burden which should be taken into account when choosing recanalization strategies.Further studies focused on clot analysis and better understanding of clot's structure, may serve a future role in selecting special treatment options for acute stroke patients.

Abstract W P3: Clinical Outcomes and Safety of Endovascular Therapy for IV tpa Ineligible Patients Who Present Within the IV tpa Time Window

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Amin Aghaebrahim ◽  
Srikant Rangaraju ◽  
Christopher Streib ◽  
Ramesh Grandhi ◽  
Michael Reznik ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Randomized Trials ◽  
Time Window ◽  
Hemorrhagic Transformation ◽  
Size Estimation ◽  
Good Outcome ◽  
Significant Difference ◽  
Iv Tpa

Background and Purpose: Outcomes in patients treated with endovascular therapy who present within the time window for IV tPA, but do not receive IV tPA, are poorly characterized. This information may be necessary in the planning of randomized trials. Methods: A retrospective analysis of a prospectively collected endovascular stroke database was performed to identify all patients who arrived within the time window for IV tPA (≤4.5 hours) who had significant neurologic deficits, but were not treated with IV tPA due to contraindications. Procedural, safety and clinical outcomes were assessed by determining rates of recanalization, hemorrhagic transformation and 90-day independent outcome (mRS 0-2). Results: Out of 961 patients entered in our endovascular stroke database, we identified 163 {mean age 69±1 years; median baseline NIH Stroke Scale 17 IQR 14-21; occlusion site: MCA-M1 82 (50%); MCA-M2 18 (11 %), ICA-T 33 (20 %), Basilar artery 15 (9 %), ACA-A1 2 (1%), ICA-intracranial 8 (5%)}. The main contraindications to IV tPA were elevated INR or PTT (25%), recent surgeries (34%), previous intracerebral hemorrhage (4%), recent stroke (7%), recent bleeding (5%) and others (25%). Following endovascular treatment, the symptomatic hemorrhage (sICH) rate was 11% and recanalization rates (TICI 2b or 3) was 74.7% (56/75). The rate of good functional outcomes at 90 days (mRS 0-2) was 40% (59/149). The 90-day mortality rate was 34.2% (51/149). There was no significant difference for 90-day good outcome, mortality or sICH with respect to the specific contraindication for IV tPA, but there was trend toward worse outcome and higher mortality rate for patients with elevated INR or PTT compared to other groups (good outcome: 29% vs. 38%, p=0.32, mortality rate: 44% vs. 33%, p=0.24) . Conclusion: This dataset provides an estimate of outcomes obtained with intra-arterial therapy in IV tPA ineligible patients over a 12 year period and may serve as preliminary data that can be used for sample size estimation in planned randomized trials. Our outcomes are comparable to patients treated with IV tPA in the IMS III trial and are superior to the natural history of this disease.

scholarly journals Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carlijn G. N. Voorend ◽  
Noeleen C. Berkhout-Byrne ◽  
Yvette Meuleman ◽  
Simon P. Mooijaart ◽  
Willem Jan W. Bos ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Qualitative Study ◽  
Clinical Outcomes ◽  
Geriatric Assessment ◽  
Clinical Care ◽  
Treatment Options ◽  
Routine Care ◽  
Treatment Team ◽  
Dutch Hospital ◽  
Additional Support

Abstract Background Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. Despite guideline recommendations, geriatric assessment is not part of standard clinical care, resulting in a missed opportunity to enhance (clinical) outcomes including quality of life in these patients. To develop routine geriatric assessment programs for patients approaching ESKD, it is crucial to understand patients’ and professionals’ experiences with and perspectives about the benefits, facilitators and barriers for geriatric assessment. Methods In this qualitative study, semi-structured focus group discussions were conducted with ESKD patients, caregivers and professionals. Participants were purposively sampled from three Dutch hospital-based study- and routine care initiatives involving geriatric assessment for (pre-)ESKD care. Transcripts were analysed inductively using thematic analysis. Results In six focus-groups, participants (n = 47) demonstrated four major themes: (1) Perceived characteristics of the older (pre)ESKD patient group. Patients and professionals recognized increased vulnerability and (cognitive) comorbidity, which is often unrelated to calendar age. Both believed that often patients are in need of additional support in various geriatric domains. (2) Experiences with geriatric assessment. Patients regarded the content and the time spent on the geriatric assessment predominantly positive. Professionals emphasized that assessment creates awareness among the whole treatment team for cognitive and social problems, shifting the focus from mainly somatic to multidimensional problems. Outcomes of geriatric assessment were observed to enhance a dialogue on suitability of treatment options, (re)adjust treatment and provide/seek additional (social) support. (3) Barriers and facilitators for implementation of geriatric assessment in routine care. Discussed barriers included lack of communication about goals and interpretation of geriatric assessment, burden for patients, illiteracy, and organizational aspects. Major facilitators are good multidisciplinary cooperation, involvement of geriatrics and multidisciplinary team meetings. (4) Desired characteristics of a suitable geriatric assessment concerned the scope and use of tests and timing of assessment. Conclusions Patients and professionals were positive about using geriatric assessment in routine nephrology care. Implementation seems achievable, once barriers are overcome and facilitators are endorsed. Geriatric assessment in routine care appears promising to improve (clinical) outcomes in patients approaching ESKD.

Clear cell carcinoma of the ovary: Epidemiology, pathological and biological features, treatment options and clinical outcomes

2021 ◽  
Author(s):  
Angiolo Gadducci ◽  
Francesco Multinu ◽  
Stefania Cosio ◽  
Silvestro Carinelli ◽  
Mariacristina Ghioni ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Clinical Outcomes ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Treatment Options ◽  
Biological Features ◽  
Carcinoma Of The Ovary

IV tPA given in the golden hour for emergent large vessel occlusion stroke improves recanalization rates and clinical outcomes

2021 ◽  
pp. 117580
Author(s):  
Rodica Di Lorenzo ◽  
Maher Saqqur ◽  
Andrew Blake Buletko ◽  
Lacy Sam Handshoe ◽  
Bhageeradh Mulpur ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Golden Hour ◽  
Iv Tpa

scholarly journals Erratum to: Locked posterior shoulder dislocation: treatment options and clinical outcomes

2011 ◽  
Vol 131 (12) ◽  
pp. 1745-1745
Author(s):  
Benedikt Schliemann ◽  
Daniel Muder ◽  
Jan Geßmann ◽  
Thomas A. Schildhauer ◽  
Dominik Seybold
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Dislocation ◽  
Treatment Options ◽  
Posterior Shoulder Dislocation ◽  
Locked Posterior Shoulder Dislocation ◽  
Posterior Shoulder

Abstract 202: Endovascular Therapy for Acute Ischemic Stroke With Distal Large Vessel Occlusion in the Anterior Circulation

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Amrou Sarraj ◽  
Navdeep Sangha ◽  
Muhammad Shazam Hussain ◽  
Dolora Wisco ◽  
Nirav Vora ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Primary Outcome ◽  
Large Vessel ◽  
Secondary Outcome ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
Baseline Characteristics ◽  
Iv Tpa

Introduction: Five RCTs demonstrated the superiority of endovascular therapy (EVT) over best medical management (MM) for acute ischemic strokes (AIS) with large vessel occlusion (LVO) in the anterior circulation. Patients with M2 occlusions, however, were underrepresented (95 randomized; 51 EVT treated). Evidence from RCTs of the benefit of EVT for M2 occlusions is lacking, as reflected in the recent AHA guidelines. Methods: A retrospective cohort was pooled from 10 academic centers from 1/12 to 4/15 of AIS patients with LVO isolated to M2 presenting within 8 hours from last known normal (LKN). Patients were divided into EVT and MM groups. Primary outcome was 90 day mRS (good outcome 0-2); secondary outcome was sICH. Logistic regression compared the 2 groups. Univariate and multivariate analyses evaluated predictors of good outcome in the EVT group. Results: Figure 1 shows participating centers, 522 patients (288 EVT and 234 MM) were identified. Table (1) shows baseline characteristics. MM treated patients were older and had higher IV tPA treatment rates, otherwise the 2 groups were balanced. 62.7 % EVT patients had mRS 0-2 at 90 days compared to 35.4 % MM (figure 2). EVT patients had 3 times the odds of good outcome as compared to MM patients (OR: 3.1, 95% CI:2.1-4.4, P <0.001) even after adjustment for age, NIHSS, ASPECTS, IV tPA and LKN to door time (OR: 3.2, 95%CI: 2-5.2, P<0.001). sICH rate was 5.6 %, which was not statistically different than the MM group (table 1, P=0.1). Age, NIHSS, good ASPECTS, LKN to reperfusion time and successful reperfusion mTICI ≥ 2b were independent predictors of good outcome in EVT patients. There was a linear relationship between good outcome and time LKN to reperfusion (Figure 3). Conclusion: Despite inherent limitations of its retrospective design, our study suggests that EVT may be effective and safe for distal LVO (M2) relative to best MM. A trial randomizing M2 occlusions to EVT vs. MM is warranted to confirm these findings.

Abstract 180: The Growth Rate of Early DWI Lesions is Highly Variable and Associated with Penumbral Salvage and Clinical Outcomes Following Endovascular Reperfusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hayley M Wheeler ◽  
Michael Mlynash ◽  
Manabu Inoue ◽  
Aaryani Tipirneni ◽  
John Liggins ◽  
...  
Keyword(s):  
Growth Rate ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Symptom Onset ◽  
Growth Rates ◽  
Initial Growth ◽  
Stroke Patients ◽  
Final Volume ◽  
Favorable Clinical Response

Background: The degree of variability in the rate of early DWI expansion has not been well characterized. We hypothesized that Target Mismatch patients with slowly expanding DWI lesions have more penumbral salvage and better clinical outcomes following endovascular reperfusion than Target Mismatch patients with rapidly expanding DWI lesions. Methods: This substudy of DEFUSE 2 included all patients with a clearly established time of symptom onset. The initial DWI growth rate was determined from the baseline scan by assuming a volume 0 ml just prior to symptom onset. Target Mismatch patients who achieved reperfusion (>50% reduction in PWI after endovascular therapy), were categorized into tertiles according to their initial DWI growth rates. For each tertile, penumbral salvage (comparison of final volume to the volume of PWI (Tmax > 6 sec)/ DWI mismatch prior to endovascular therapy), favorable clinical response, and good functional outcome (see figure for definitions) were calculated. We also compared the growth rate in patients with the Target mismatch vs. Malignant Profile. Results: 64 patients were eligible for this study. Target mismatch patients (n=44) had initial growth rates (range 0 to 43 ml/hr, median of 3 ml/hr) that were significantly less than the growth rates in Malignant profile (n=7) patients (12 to 92 ml/hr, median 39 ml/hr; p < 0.001). In Target mismatch patients who achieved reperfusion (n=30), slower early DWI growth rates were associated with better clinical outcomes (p<0.05) and a trend toward more penumbral salvage (n=27, p=0.137). Conclusions: The growth rate of early DWI lesions in acute stroke patients is highly variable; Malignant profile patients have higher growth rates than other MRI profiles. Among Target Mismatch patients, a slower rate of DWI growth is associated with a greater degree of penumbral salvage and improved clinical outcomes following endovascular reperfusion.

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

2021 ◽  
pp. neurintsurg-2021-017940
Author(s):  
Zeguang Ren ◽  
Gaoting Ma ◽  
Maxim Mokin ◽  
Ashutosh P Jadhav ◽  
Baixue Jia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Ct Perfusion ◽  
Non Invasive ◽  
Vessel Imaging ◽  
Baseline Characteristics ◽  
Procedural Outcomes ◽  
Head Computed Tomography

BackgroudThe goal of this study was to determine if the choice of imaging paradigm performed in the emergency department influences the procedural or clinical outcomes after mechanical thrombectomy (MT).MethodsThis is a retrospective comparative outcome study which was conducted from the ANGEL-ACT registry. Comparisons were made between baseline characteristics and clinical outcomes of patients with acute ischemic stroke undergoing MT with non-contrast head computed tomography (NCHCT) alone versus patients undergoing NCHCT plus non-invasive vessel imaging (NVI) (including CT angiography (with or without CT perfusion) and magnetic resonance angiography). The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included change in mRS score from baseline to 90 days, the proportions of mRS 0–1, 0–2, and 0–3, and dramatic clinical improvement at 24 hours. The safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, and mortality within 90 days.ResultsA total of 894 patients met the inclusion criteria; 476 (53%) underwent NCHCT alone and 418 (47%) underwent NCHCT + NVI. In the NCHCT alone group, the door-to-reperfusion time was shorter by 47 min compared with the NCHCT + NVI group (219 vs 266 min, P<0.001). Patients in the NCHCT alone group showed a smaller increase in baseline mRS score at 90 days (median 3 vs 2 points; P=0.004) after adjustment. There were no significant differences between groups in the remaining clinical outcomes.ConclusionsIn patients selected for MT using NCHCT alone versus NCHCT + NVI, there were improved procedural outcomes and smaller increases in baseline mRS scores at 90 days.

Bilateral Nervus Intermedius Sectioning for Geniculate Neuralgia: Case Report and Operative Video

2021 ◽  
Author(s):  
Keaton Piper ◽  
Qizhi Victoria Zheng ◽  
Robert S Heller ◽  
Siviero Agazzi
Keyword(s):  
Side Effects ◽  
Microvascular Decompression ◽  
Treatment Options ◽  
Rare Condition ◽  
Contralateral Side ◽  
Wide Range ◽  
Successful Resolution ◽  
Surgical Options ◽  
Vascular Loop ◽  
Nervus Intermedius

Abstract BACKGROUND AND IMPORTANCE Geniculate neuralgia is a rare condition characterized by excruciating ear pain. Surgical options for geniculate neuralgia include microvascular decompression and sectioning of the nervus intermedius. We report herein a case of bilateral geniculate neuralgia treated by nervus intermedius sectioning without prior microvascular decompression. To our knowledge, this is the first report of this treatment strategy with a subsequent description of the side effects of bilateral nervus intermedius disruption. CLINICAL PRESENTATION A 54-yr-old woman presented with bilateral geniculate neuralgia, worse on the left, refractory to medical therapy. Surgical treatment options were reviewed, including microvascular decompression and sectioning of the nervus intermedius. She opted for left nervus intermedius sectioning. The procedure was uncomplicated and no compressive vascular loop was identified during surgery. Postoperatively, she had complete symptom resolution with no discernable side effects. Three years later, the patient developed worsening geniculate neuralgia on the contralateral side. After the discussion of treatment options, she opted again for sectioning of the contralateral nervus intermedius with successful resolution of all symptoms after surgery. Following surgery, the patient identified partial impairment of lacrimation and gustation. She continued to have functional taste of the anterior two-thirds of the tongue, lacrimation, and hearing bilaterally. CONCLUSION Bilateral sectioning of nervus intermedius may provide benefit in patients with bilateral geniculate neuralgia without egregious side effects. However, lacrimatory and gustatory alterations are a potentially significant side effect with a wide range of symptomatology.

Usefulness of Lipoprotein(a) for Predicting Clinical Outcomes After Endovascular Therapy for Aortoiliac Atherosclerotic Lesions

2017 ◽  
Vol 24 (6) ◽  
pp. 793-799 ◽  
Author(s):  
Keiichi Hishikari ◽  
Hiroyuki Hikita ◽  
Shun Nakamura ◽  
Shun Nakagama ◽  
Masafumi Mizusawa ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Lipoprotein A ◽  
Atherosclerotic Lesions
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