Abstract W P24: Choice of Thrombectomy Device and Degree of Collateral Flow Predict Reperfusion in DEFUSE 2

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
John T Liggins ◽  
Michael Mlynash ◽  
Matus Straka ◽  
Stephanie Kemp ◽  
Roland Bammer ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Artery Occlusion ◽  
Collateral Flow ◽  
Stroke Patients ◽  
Ischemic Brain ◽  
Factors Associated ◽  
Thrombectomy Device ◽  
Stent Retrievers ◽  
The Relationship ◽  
Univariate Analyses

Background: Endovascular therapy for acute ischemic stroke is an effective tool for recanalizing occluded vessels. We sought to determine the factors associated with successful reperfusion and whether any differences in reperfusion rates existed between hospital sites. Methods: Stroke patients underwent endovascular treatment as part of the DEFUSE 2 study at nine hospital sites between 2008 and 2011. Patients were included for analysis if they had a baseline TICI score of 0 or 1. Successful reperfusion was defined as a TICI reperfusion score of 2b or 3 at the completion of the procedure. Collaterals were assessed using the Collateral Flow Grading System and were dichotomized as poor (0-2) or good (3-4). The relationship between clinical, neuroimaging and treatment variables and TICI reperfusion was assessed using logistic regression. Results: Eighty-nine patients had a baseline TICI score of 0 or 1; thirty-six patients achieved successful TICI reperfusion. Patients were treated with the Merci clot retriever (n=25), the Penumbra device (n=19), both Merci and Penumbra (n=17), or other endovascular therapies (n=28). Other interventions included manual aspiration (n=20), stent retrievers (n=7) and angioplasty (n=7). Variables associated with successful reperfusion in univariate analyses were: good collaterals (p<0.01), location of artery occlusion (p<0.05), use of the Merci retriever (p<0.01), and hospital site (p<0.01). In multivariate analysis, good collaterals (p<0.01) and use of the Merci retriever (p<0.05) remained as independent predictors of successful reperfusion. Conclusion: In acute stroke patients who undergo endovascular therapy, good collateral flow to the ischemic brain region and use of the Merci retriever are associated with successful reperfusion. The rates of successful reperfusion differed between hospital sites. This may have been driven by variation in the rates of use of the Merci retriever.

scholarly journals Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hai-fei Jiang ◽  
Yi-qun Zhang ◽  
Jiang-xia Pang ◽  
Pei-ning Shao ◽  
Han-cheng Qiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Large Vessel ◽  
Susceptibility Weighted Imaging ◽  
Regression Analyses ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Factors Associated ◽  
Univariate Analyses

AbstractThe prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.

scholarly journals Differences in characteristics and outcomes after endovascular therapy: A single-center analysis of patients with vertebrobasilar occlusion due to underlying intracranial atherosclerosis disease and embolism

2018 ◽  
Vol 25 (3) ◽  
pp. 254-260 ◽  
Author(s):  
Xuelei Zhang ◽  
Gang Luo ◽  
Baixue Jia ◽  
Dapeng Mo ◽  
Ning Ma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Endovascular Therapy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Factors Associated ◽  
Intracranial Atherosclerotic Disease ◽  
History Of ◽  
Group A ◽  
Baseline Characteristics ◽  
Focal Stenosis

Background Therapeutic strategies and outcomes vary with stroke subtypes for patients with acute vertebrobasilar occlusion (VBAO). This study aimed to compare characteristics and outcomes of VBAO due to intracranial atherosclerotic disease (ICAD) and embolisms and identify baseline predictors of ICAD. Methods Patients with VBAO who received endovascular therapy (EVT) were retrospectively analyzed. Participants fulfilling the criteria were classified as the ICAD group (focal stenosis of >70%, or fixed stenosis >50% in addition to either flow and perfusion impairment on angiography or an evident reocclusion tendency) and the embolism group (defined as no evidence of focal significant stenosis after thrombolysis or thrombectomy). Baseline characteristics and outcomes after EVT were compared between the two groups, and logistic regression was performed to explore the factors associated with ICAD. Results Among the 133 patients enrolled, 95 (71.4%) patients were categorized in the ICAD group, and 38 (28.6%) in the embolism group. A history of atrial fibrillation (odds ratio (OR) 0.142; 95% confidence interval (CI) (0.028–0.707), p = 0.017), distal basilar artery occlusion (OR 0.107; 95% CI (0.040–0.289), p < 0.001) and V4 segment occlusion (OR 3.423; 95% CI (1.172–9.999), p = 0.024) were independently associated with ICAD. Patients with VBAO due to ICAD had a lower rate of recanalization (81.1% vs 100%, p = 0.004), but the 90-day good clinical outcome was comparable (41.1% vs 50.0%, p = 0.347). Conclusions The occlusion sites and a history of atrial fibrillation might be helpful in predicting ICAD in patients with VBAO. Patients with ICAD who were treated by EVT had a lower rate of recanalization but comparable 90-day good outcomes.

Abstract W P11: A Clinical Scale to Predict Futile Arterial Recanalization in Acute Stroke Patients with Anterior Circulation Arterial Occlusion Treated with Endovascular Therapies.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Natalia Perez de la Ossa ◽  
Maria Hernández-Pérez ◽  
Monica Millán ◽  
Meritxell Gomis ◽  
Elena López-Cancio ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Univariate Analysis ◽  
Arterial Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
History Of ◽  
Stent Retrievers ◽  
Arterial Recanalization

Introduction: Futile arterial recanalization (FAR), considered as a lack of functional recovery despite complete recanalization, is observed in up to 30-50% of acute stroke patients treated with endovascular therapy. We aimed to develop a prognostic scale based on baseline clinical and radiological factors to predict FAR. Methods: Prospective analysis of consecutive stroke patients with anterior circulation occlusion treated with endovascular therapy (97% mechanical thrombectomy with stent-retrievers). Complete recanalization was considered as a TICI 2b-3. FAR was defined as a modified Rankin scale >2 at 90 days in patients with complete recanalization. Baseline factors associated with FAR were detected on univariate analysis and were used to compose the predictive scale. Results: From a total of 229 patients with anterior arterial occlusion, 166 (72.5%) achieved complete recanalization. FAR was observed in 80/166 (48.2%). Factors significantly associated with FAR were included to compose the predictive scale as follow: Age (scoring 0 if ≤70 and 1 if >70 years old), history of diabetes mellitus (0 if absent, 1 if present), history of hypertension (0 if absent, 1 if present), NIHSS (1 if NIHSS ≤10, 2 if NIHSS 10-19, 3 if NIHSS>19), ASPECTS (1 if ASPECTS 9-10, 2 if ASPECTS 7-8, 3 if ASPECTS<7) and i.v tPA use (0 if yes, 1 if not). The higher the scale score, the higher the risk of FAR (Figure). The scale showed a good predictive value of FAR (c-statistics 0.71). A scale score <5 was associated with a low rate of FAR (25%) whereas a score >7 increased FAR up to 86%. Conclusion: We developed a simple scale that can easily predict futile arterial recanalization (FAR) in stroke patients with large arterial occlusion treated with endovascular therapies. A larger validation study is necessary to confirm the utility of this predictive scale.

Abstract 188: Correlation of Angiographic Capillary Index Score (CIS) with Diffusion and Perfusion MR Imaging in the DEFUSE 2 Trial

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Michael P Marks ◽  
Firas Al-Ali ◽  
Maarten G Lansberg ◽  
Michael Mlynash ◽  
Stephanie M Kemp ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Lesion Volume ◽  
Collateral Flow ◽  
Point Scale ◽  
Median Volume ◽  
Perfusion Mr ◽  
Lesion Growth ◽  
Perfusion Mr Imaging ◽  
The Relationship

Objective: The CIS has been shown to be a predictor of good clinical outcome following endovascular therapy for acute ischemic stroke. We undertook this study to determine the relationship between CIS and baseline diffusion-perfusion imaging as well as angiographic collaterals in DEFUSE 2 study patients. Methods: Patients undergoing endovascular therapy within 12 hours of stroke onset were prospectively enrolled. Only patients with an ICA/M1 occlusion and adequate demonstration of the anterior and posterior circulations at baseline angiography were included in this analysis. Blinded reading of the CIS was made using a 4 point scale from 0 (no capillary blush in ischemic territory) to 3 (blush throughout). Analysis was dichotomized to poor CIS (0-1) versus good (2-3). CIS was correlated with baseline DWI volume, PWI volume (Tmax > 6, Tmax>10), an angiographic collateral score (using a previously described 5 point scale) and subsequent infarct growth. Results: Forty-eight patients had ICA/M1 occlusions and adequate angiographic images to evaluate CIS. Baseline DWI lesion volume correlated with CIS (p=0.001). Median DWI volume for patients with poor CIS (0-1) was 28 (IQR, 11-54) versus 13 (3-27) for those with good CIS (2-3), p=0.011. Baseline T max > 6 volume correlated with CIS (p=0.004). Median volume of tissue at risk (T max > 6 sec) in those with poor CIS was 108 ml (IQR, 74-138) versus 69(43-108) with good CIS, p=0.009. Severe T max delay (> 10 sec) also correlated with CIS (p=0.001). CIS was also found to correlate with angiographic collaterals (p=0.006). On follow-up MRI CIS correlated with subsequent lesion growth (p=0.043). Conclusions: CIS provides a rapid angiographic assessment of capillary blush from collateral flow into the ischemic territory and correlates with angiographic collateral scores. In DEFUSE 2 the CIS score was strongly associated with baseline DWI and PWI lesion volumes and subsequent lesion growth.

Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion

Neurology ◽  
2003 ◽  
Vol 60 (9) ◽  
pp. 1435-1441 ◽  
Author(s):  
R. H.C. Bisschops ◽  
C. J.M. Klijn ◽  
L. J. Kappelle ◽  
A. C. van Huffelen ◽  
J. van der Grond
Keyword(s):  
Carotid Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Brain Lesions ◽  
Collateral Flow ◽  
Ischemic Brain

scholarly journals Distance to Thrombus in Endovascular Treatment of Middle Cerebral Artery M1 Occlusion Predicts Recanalization Success and Clinical Outcome

2021 ◽  
Vol 24 (2) ◽  
pp. 113-117
Author(s):  
Nihat Sengeze ◽  
Semih Giray
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Internal Carotid ◽  
Measurement Techniques ◽  
Digital Subtraction ◽  
Stroke Patients ◽  
The Relationship ◽  
Distance To Thrombus

Background: The occlusion site of the cerebral artery can help to determine recanalization success, treatment and prognosis in acute stroke patients. In current studies, different measurement techniques and different length values have been considered. We aimed to determine the relationship between the location of occlusion and recanalization success following endovascular therapy of acute middle cerebral artery (MCA) M1 occlusion. Methods: This study was conducted from January 2015 to March 2019. The "M1 distance-to-thrombus length" was determined on curve-linear reformat reconstruction of the MCA, and measured from the center of internal carotid artery (ICA) bifurcation to the beginning of the thrombus on digital subtraction angiography (DSA). A successful recanalization was defined as ≥ modified thrombolysis in cerebral infarction (mTICI) 2b and full recanalization as mTICI 3. Evaluation of patients at the end of the third month was carried out with modified Rankin Scale (mRS) and mortality. Results: We eventually included 95 patients treated with endovascular therapy. The patients with distance to thrombus (DT) ≤13.2 mm showed significantly higher rates of full recanalization (AUC = 0.639 ± 0.06; P=0.014, 95% confidence interval [CI]). Additionally, DT could predict successful recanalization with an AUC of 0.639. The possibility to distinguish unsuccessful recanalization cases after the endovascular treatment by considering DT had 85.7% sensitivity (95% CI). Of the 82 (86.3%) patients who were treated with successful recanalization (≥mTICI 2b), 46 (48.4%) achieved mRS (0–3) and 38 (40%) expired at the end of the 3 months. Conclusion: Shorter DT was associated with higher rate of full recanalization (mTICI 3) after endovascular therapy. Having a longer DT reduces the chance of successful recanalization without distal embolism. However, there was no statistically significant effect for DT on a favorable outcome at third months or mortality with endovascular treatment of MCA M1 occlusions.

Distal versus Proximal Middle Cerebral Artery Occlusion: Different Mechanisms

2019 ◽  
Vol 47 (5-6) ◽  
pp. 238-244
Author(s):  
Young Seo Kim ◽  
Bum Joon Kim ◽  
Kyung Chul Noh ◽  
Kyung Mi Lee ◽  
Sung Hyuk Heo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
High Rate ◽  
Collateral Flow ◽  
Large Artery ◽  
Factors Associated ◽  
Imaging Characteristics ◽  
Distal Migration

Background: Clinical and radiological characteristics of middle cerebral artery (MCA) infarction may differ according to the location of occlusion. Objectives: We investigated the difference between proximal and distal symptomatic MCA occlusion (MCAO) in patients with ischemic stroke. The factors associated with the imaging characteristics were also analyzed. Methods: Patients with ischemic stroke due to MCAO were consecutively enrolled. The location of MCAO was determined by the ratio of the length of the ipsilesional MCA to that of the contralateral MCA and dichotomized to proximal and distal MCAO. Clinical and radiological characteristics were compared between patients with proximal and distal MCAO. Factors associated with the basal ganglia (BG) involvement, hemorrhagic transformation (HT), and neurological change during admission were investigated. Results: Among 181 included patients, MCAO location showed a bimodal peak (at the proximal [n = 99] and distal MCA [n = 82]). Proximal MCAO was more frequently associated with hyperlipidemia and large artery atherosclerosis, whereas distal MCAO was more frequently associated with hypertension, atrial fibrillation, and cardioembolic stroke. BG involvement was similar between the 2 groups (48 vs. 39%; p = 0.21), whereas HT was more frequent in distal MCAO (10 vs. 23%; p = 0.02). Among patients with proximal MCAO, hyperintense vessel sign was less frequently observed in those with a BG involvement than those without (38 vs. 60%; p = 0.03). Among those without BG involvement, the presence of HT was very low and similar between patients with proximal and distal MCAOs (1.9 vs. 2.0%). However, in patients with BG involvement, HT was more frequently observed in those with distal MCAO than in those with proximal MCAO (54.8 vs. 15.7%; p < 0.001). The presence of hyperintense vessel sign (OR 0.172, 95% CI 0.051–0.586; p = 0.005) and distal MCAO (OR 0.200, 95% CI 0.059–0.683; p = 0.011) was independently associated with improvement during admission. Conclusion: Proximal MCAO is more frequently associated with atherosclerosis, whereas distal MCAO is more frequently associated with cardioembolism. In proximal MCAO, the status of collateral flow presented by hyperintense vessel sign may affect the involvement of BG. In distal MCAO, distal migration of the embolus, which first impacted at the proximal MCA causing BG ischemia, may explain the high rate of HT by reperfusion injury. Hyperintense vessel sign and distal MCAO were independently associated with neurological improvement during admission.

THE RELATIONSHIP BETWEEN TIMING OF RECANALIZATION AND CLINICAL OUTCOME OF ISCHEMIC STROKE DUE TO ACUTE MIDDLE CEREBRAL ARTERY OCCLUSION AFTER ULTRASOUND-ENHANCED THROMBOLYSIS

2017 ◽  
pp. 38-43
Author(s):  
Quang Thang Tran ◽  
Dat Anh Nguyen ◽  
Van Chi Nguyen ◽  
Duy Ton Mai ◽  
Van Thinh Le
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Stroke Patients ◽  
Tissue Plasminogen ◽  
Cerebral Artery Occlusion ◽  
The Relationship

Purpose: The relationship between arterial recanalization after use of intravenous recombinant tissue plasminogen activator (rtPA) and outcome is still uncertain. The aim of our study was to evaluate the association between the timing and impact of recanalization on functional outcomes in ischemic stroke patients due to acute middle cerebral artery occlusion. Subjects and methods: Nonrandomized 40 stroke patients with proximal middle arterial occlusion on a prebolus TCD receiving intravenously 0.6 mg/kg rtPA within 4.5 hours after stroke onset were monitored with portable diagnostic TCD equipment and a standard headframe. Complete recanalization was defined as thrombolysis in brain ischemia (TIBI) flow grades 4-5. Results: 40 patients (mean age 67±14 years, NIH Stroke Scale [NIHSS] 16.15±8.6 points) were treated at 180±80 minutes from symptom onset. TCD was monitored continously for 120 minutes. Complete recanalization on TCD within 2 hours after bolus was found in 13 patients (32.5%). In this group, NIHSS decreased quickly at 2 hours and 24 hours. Modified Rankins 0-1point was seen in 92.3% of patients with complete recanalization compared to 37.0% of patients with uncomplete recanalization at 90 days. Non-symptomatic intracranial hemorrhage was seen in 1 patient in the group of complete recanalization. Conclusions: Complete recanalization of middle cerebral arteries within 2 hours after IV rtPA treatment plays a role in predicting the good functional and clinical outcomes after ultrasound-enhanced thrombolysis in acute ischemic stroke patients due to acute middle cerebral artery occlusion. Key words: stroke, recombinant tissue plasminogen activator, transcranial Doppler sonography

scholarly journals Hyperglycemia primes NETosis, which exacerbates ischemic brain damage

2019 ◽  
Author(s):  
Jiangshan Deng ◽  
Fei Zhao ◽  
Yunlong Zhang ◽  
Yajun Zhou ◽  
Xiaofeng Xu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Brain Damage ◽  
Artery Occlusion ◽  
Wild Type ◽  
Stroke Patients ◽  
Acute Hyperglycemia ◽  
Ischemic Brain ◽  
Infarction Volume ◽  
Cerebral Artery Occlusion

Abstract Background：Hyperglycemia is common and associated with poor outcomes in acute ischemic stroke patients. It is not well understood how hyperglycemia exacerbates brain damage in ischemic stroke. Neutrophil extracellular traps (NETs) have shown an emerging role in noninfectious diseases. We aimed to determine the role of NETs in acute ischemic stroke with hyperglycemia. Methods: NETs were immunostained using NET markers (citrullinated histone H3 (H3Cit)) and quantified in thrombi retrieved from ischemic stroke patients undergoing endovascular treatment. BKS-db/db and wild-type mice were used to establish the permanent middle cerebral artery occlusion (pMCAO) model. Wild-type mice were injected with glucose to simulate acute hyperglycemia after middle cerebral artery occlusion. NETs were detected in the peri-ischemic brain tissue. After inhibition of NET formation, infarction volume, neurological function and inflammatory factors in pMCAO mice were evaluated. Results: H3Cit, a marker of NETs, was observed in almost all thrombi. H3Cit was much more abundant in thrombi from diagnosed diabetic patients and acute hyperglycemic patients compared with those in normglycemic patients. In pMCAO mice, NETs were induced by chronic diabetes and acute hyperglycemia. Inhibition of NET formation with the peptidylarginine deiminase 4 (PAD4) inhibitor Cl-amidine decreased the infarction volume both in db/db and wild-type mice with hyperglycemia. Neurological function deficits were alleviated by blocking NET formation, as shown in the grip strength and rotarod tests. The levels of TNF-α and IL-1β but not IL-6 coincided with NET formation. Conclusions: Hyperglycemia may exacerbate brain damage in ischemic stroke through NETs. The underlying mechanisms deserve to be further studied.

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