Abstract T P5: Sequential and Post-procedure ASPECTS Predict Clinical Outcome in Mechanical Thrombectomy of Acute Anterior Circulation Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Albert J Yoo ◽  
Osama O Zaidat ◽  
Zeshan A Chaudhry ◽  
Olvert A Berkhemer ◽  
R. G González ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Post Treatment ◽  
Imaging Data ◽  
Anterior Circulation ◽  
Post Procedure ◽  
Pre Treatment

Purpose: Final ASPECTS has been shown to predict patient outcomes after endovascular therapy in stroke. The goal of this study was to compare sequential ASPECTS imaging pre-treatment and post-treatment in predicting outcome. Methods: The PICS Study is a prospective registry of clinical and imaging data in proximal artery occlusion patients treated with the Penumbra System. In multivariate analysis, variables assessed for relationship to 90 day mRS included age, gender, time to reperfusion, occlusion location, ASPECTS, and NIHSS. ASPECTS scores were assessed by a central core laboratory, blinded except for stroke side. Results: In this study, 141 patients with mean age 67.9 ± 15.6 and median admission NIHSS score 16.0 (IQR 12.0-21.0) met study criteria. Univariate predictors of 90 day mRS included age, baseline NIHSS, 7 day/discharge NIHSS as well as post-treatment ASPECTS. After adjusting for age and baseline NIHSS, post procedure ASPECTS showed a stronger relationship with good outcome (p<0.0001) than pre-treatment ASPECTS (p=0.0520). Change in ASPECTS was also a significant predictor of 90 day mRS (p=0.0046) in the multivariate analysis. Conclusion: Sequential and post procedure ASPECTS are better predictors of clinical outcome following endovascular therapy than pre-ASPECTS. Final infarct volume quantified using ASPECTS serves as a surrogate biomarker for long-term functional outcome.

Abstract TP25: Increased Risk for Unfavorable Outcome in Patients with Pre-existing Disability Undergoing Endovascular Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ronen R Leker ◽  
Pavel Gavriliuc ◽  
Nour Eddine Yagmur ◽  
John M Gomori ◽  
Jose E Cohen
Keyword(s):  
Endovascular Therapy ◽  
Real Life ◽  
Unfavorable Outcome ◽  
Stroke Severity ◽  
Imaging Data ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Increased Risk ◽  
Degree Of Disability ◽  
Pre Treatment

Background and Objectives: Most studies evaluating endovascular therapy (EVT) for stroke only included patients without pre-existing disability. However, in real life many patients have pre-existing disability and whether they can benefit from EVT remains unknown. Methods: Patients with large vessel anterior circulation stroke were prospectively enrolled. Patients with no or mild disability (modified Rankin Scale [mRS] 0-2) were compared with patients presenting with pre-existing moderate disability (mRS≥3). Baseline demographics and risk factors, stroke severity (studied with the National Institutes of Health Stroke Scale [NIHSS]), imaging data including pre-treatment ASPECTS and ASPECTS collateral scores, as well as procedure related variables were accrued. Unfavorable outcome was defined as mRS≥4 at day 90. Results: Out of 100 enrolled patients, 85 had baseline mRS≤2 and 15 had pre-stroke mRS≥3. Patients with pre-existing mRS≥3 were significantly older (79.0±6 vs. 66.6±14, p=0.001) and more often had previous strokes (47% vs. 19%, p=0.04) and ASPECTS≤7 (33% vs. 12%, p=0.03). Patients with mRS≥3 at presentation were more likely to have poor outcome or death (OR 4.4 95%CI 1.3-15.0). Four of the patients with pre-existing moderate disability (27%) maintained their previous degree of disability. On multivariate analysis age (OR 1.1 95%CI 1.1-1.2), admission NIHSS (OR 1.2 95%CI 1-1.3) and complete recanalization (OR 0.2 95%CI 0.04-0.68) remained significant modifiers of poor outcome. Conclusions: Patients with pre-existing moderate disability have higher chances for sustaining unfavorable outcomes despite EVT. Nevertheless, some patients maintain the same level of moderate disability and therefore patients with pre-existing moderate disability should not be excluded from EVT.

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.

Abstract WMP1: DWI ASPECT Scores And Infarct Volume As Predictors Of Outcome After Recanalization In Middle Cerebral Artery Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Sunanda Nanduri ◽  
Ashutosh P Jadhav ◽  
Syed Zaidi ◽  
Amin Aghaebrahim ◽  
Mohammad Jumaa ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Infarct Volume ◽  
Serum Glucose ◽  
Quantitative Aspect ◽  
Anterior Circulation ◽  
Major Predictor ◽  
Automated Software

Background and Purpose: Final infarct volume has previously been shown to be a major predictor of outcome after endovascular therapy for middle cerebral artery (MCA) occlusion. However, the importance of specific location of infarct within the MCA territory has not been described. We sought to assess the predictive value of specific topographic regions as predictors of outcomes in a homogeneous cohort of patients treated with endovascular therapy of M1 occlusive disease who underwent post procedure MRI. Methods: A retrospective review of our prospectively maintained single center endovascular database was performed. Automated software was used to measure infarct volume and the DWI ASPECT score was assessed by visual inspection using standard templates. Univariate and multivariate analysis was performed to determine predictors of favorable outcomes using each of the 10 regions as part of the ASPECT score as well as total ASPECT score. Results: 100 patients were identified. 56% were female. Median age was 70. Successful recanalization was achieved with TIMI 2/3 flow in 87% of patients and TICI 2B/3 in 61% of patients. Good outcomes (mRS 0-2 at 3 months) in 46% of patients. There was no difference between outcomes based on the hemisphere involved. Median final infarct on DWI MRI at 24 hours was 39 cc. Median ASPECT score was 6. In multivariate analysis, strong predictors of good outcomes included: age (OR 0.88, 95% CI 0.8-0.96, p=0.006), serum glucose on admission (OR 0.98, 95% CI 0.97-1, p=0.046) and ASPECT score on MRI (OR 0.7, 95% CI 0.03-1.05, p=0.03). There was a high correlation between the volume of infarct and ASPECT score on the post recanalization MRI (Spearman’s rho of -0.76). Conclusions: Quantitative (automated software) and semi-quantitative (ASPECT score values) measurements of infarct size are highly predictive of outcomes after recanalization therapy in middle cerebral artery infarcts. No single topographic region or combination of regions is predictive of outcome, whereas total ASPECT scores are highly predictive. These data support the role of post procedural MRI in guiding prognosis after anterior circulation infarct.

Abstract WP87: Endovascular Treatment of Very Small Ruptured Intracranial Aneurysms: Complications, Occlusion Rates and Prediction of Outcome

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Robert M Starke ◽  
Nohra Chalouhi ◽  
Muhammad S Ali ◽  
David L Penn ◽  
Stavropoula I Tjoumakaris ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Post Treatment ◽  
Favorable Outcome ◽  
Predictors Of Outcome ◽  
Aneurysm Size ◽  
Ruptured Intracranial Aneurysms

Purpose: In this study we assess predictors of outcome following endovascular treatment of small ruptured intracranial aneurysms (SRA). Methods: Between 2004 and 2011, 91 patients with SRA (≤ 3 mm) were treated at our institution. Multivariate analysis was carried out to assess predictors of endovascular related complications, aneurysm obliteration (>95%), recanalization, and favorable outcome (Glasgow Outcome Scale 3-5). Results: Endovascular treatment was aborted in 9 of 91 patients (9.9%). Procedure-related complications occurred in 8 of 82 patients (9.8%) of which 5 were transient and 3 were permanent. Three patients (3.7%) undergoing endovascular therapy experienced an intra-procedural aneurysm rupture. Three of 9 patients (33.3%) treated with stent or balloon assisted coiling experienced peri-procedural complications compared to 5 of 73 patients (6.8%) receiving only coils or Onyx (p=0.039). There were no procedural deaths or rehemorrhages. Rates of recanalization and retreatment were 18.2% and 12.7%, respectively. No factors predicted initial occlusion or recanalization. In multivariate analysis pre-treatment factors predictive of favorable outcome included younger age (OR=0.94; 95% CI 0.91-0.99, p=0.017), larger aneurysm size (OR=3.4; 95% CI 1.02-11.11, p=0.045), Hunt and Hess grade (OR=0.38; 95% CI 0.19-0.75, p=0.005), and location (OR=5.12; 95% CI 1.29-20.25, p=0.02). When assessing treatment and post-treatment variables, vasospasm was the only additional covariate predictive of poor outcome (OR=5.90; 95% CI 1.34=25.93, p=0.019). Conclusions: The majority of SRA can be treated with endovascular therapy and limited complications. Overall predictors of outcome for patients undergoing endovascular treatment of SRA include age, aneurysm size, Hunt and Hess grade, location, and post-treatment vasospasm.

Safety of Endovascular Therapy in Progressive Ischemic Stroke and Anterior Circulation Large Artery Occlusion

2019 ◽  
Vol 122 ◽  
pp. e383-e389 ◽  
Author(s):  
Wen-Huo Chen ◽  
Ting-yu Yi ◽  
Yan-Min Wu ◽  
Mei-Fang Zhang ◽  
Ding-lai Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Therapy ◽  
Artery Occlusion ◽  
Large Artery ◽  
Anterior Circulation

scholarly journals Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

2017 ◽  
Vol 01 (03) ◽  
pp. 139-143 ◽  
Author(s):  
Yosuke Tajima ◽  
Michihiro Hayasaka ◽  
Koichi Ebihara ◽  
Masaaki Kubota ◽  
Sumio Suda
Keyword(s):  
Clinical Outcome ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Complete Revascularization ◽  
Anterior Circulation ◽  
Clinical Imaging ◽  
Good Outcome ◽  
Poor Outcome ◽  
Favorable Clinical Outcome

AbstractSuccessful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

Abstract WMP17: Early DWI Reversal Following Endovascular Reperfusion Is Typically Transient

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Manabu Inoue ◽  
Hayley M Wheeler ◽  
Michael Mlynash ◽  
Aaryani Tipirneni ◽  
Matus Straka ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Independent Predictor ◽  
Infarct Volume ◽  
Prognostic Significance ◽  
Reperfusion Therapy ◽  
Ischemic Lesion ◽  
Stroke Treatment ◽  
Median Volume

Background and Purpose: There are conflicting reports regarding the incidence and prognostic significance of DWI reversal following reperfusion therapy. The aim of this study was to assess the frequency and extent of early DWI reversal following endovascular therapy and to determine if early reversal is sustained or transient. Methods: This is a substudy of the DEFUSE 2. MRI with DWI and PWI was performed before (DWI 1) and within 12 hours after (DWI 2) endovascular stroke treatment and again at 5 days. Acute DWI lesions were outlined and quantified using mipav software (http://mipav.cit.nih.gov/). Ischemic lesion volumes were outlined on the Day 5 FLAIR then corrected for edema using a validated technique to determine the final infarct volume. Early DWI reversal was defined as (DWI 1 - DWI 2) >3 ml and permanent DWI reversal was defined (DWI 1 - final infarct volume) > 1 ml. Reperfusion was defined as a >50% reduction in PWI volume (Tmax >6 sec) on the MRI performed after endovascular therapy. The prognostic significance of early reversal was assessed in a regression model. Results: 104 patients had a technically adequate DWI and PWI prior to endovascular therapy (performed 4.4 [3.0-6.0] hours after symptom onset). Of these, 77 had an acute DWI lesion >3 ml and a follow-up MRI (156 min [72-342] after completion of endovascular therapy) and a 5 day MRI. Seventeen percent (13/77) of the patients had early DWI reversal representing a median (IQR) of 42.4% (25.0-57.6) of the initial DWI lesion (median volume 10.9 ml [IQR 7.3-18.2]). The incidence of early DWI reversal was 21% (11/52) following reperfusion vs. 8% (2/25) in patients who did not reperfuse (p=0.20). Of the 13 patients with early DWI reversal, permanent DWI reversal occurred in only 2 (volume of permanent DWI reversal 6.9 ml and 4.7 ml). Early DWI reversal was not an independent predictor of clinical outcome. Conclusion: Early DWI reversal occurs in about 15-20% of patients following endovascular therapy and can involve a substantial percentage of the initial DWI volume. However, early DWI reversal is usually transient and does not appear to signify tissue salvage.

Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre

2021 ◽  
Keyword(s):  
General Anaesthesia ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Significant Difference ◽  
Epidemiological Characteristics

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.

scholarly journals Novel Estimation of Penumbra Zone Based on Infarct Growth Using Machine Learning Techniques in Acute Ischemic Stroke

2020 ◽  
Vol 9 (6) ◽  
pp. 1977
Author(s):  
Yoon-Chul Kim ◽  
Hyung Jun Kim ◽  
Jong-Won Chung ◽  
In Gyeong Kim ◽  
Min Jung Seong ◽  
...  
Keyword(s):  
Machine Learning ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Intraclass Correlation ◽  
Artery Occlusion ◽  
Machine Learning Techniques ◽  
Learning Techniques ◽  
Pre Treatment ◽  
Cerebral Artery Occlusion ◽  
Growth Distribution

While the penumbra zone is traditionally assessed based on perfusion–diffusion mismatch, it can be assessed based on machine learning (ML) prediction of infarct growth. The purpose of this work was to develop and validate an ML method for the prediction of infarct growth distribution and volume, in cases of successful (SR) and unsuccessful recanalization (UR). Pre-treatment perfusion-weighted, diffusion-weighted imaging (DWI) data, and final infarct lesions annotated from day-7 DWI from patients with middle cerebral artery occlusion were utilized to develop and validate two ML models for prediction of tissue fate. SR and UR models were developed from data in patients with modified treatment in cerebral infarction (mTICI) scores of 2b–3 and 0–2a, respectively. When compared to manual infarct annotation, ML-based infarct volume predictions resulted in an intraclass correlation coefficient (ICC) of 0.73 (95% CI = 0.31–0.91, p < 0.01) for UR, and an ICC of 0.87 (95% CI = 0.73–0.94, p < 0.001) for SR. Favorable outcomes for mismatch presence and absence in SR were 50% and 36%, respectively, while they were 61%, 56%, and 25%, respectively, for the low, intermediate, and high infarct growth groups. The presented method can offer novel and alternative insights into selecting patients for recanalization therapy and predicting functional outcome.

IL10, An Independent Predictor of Outcome in HNSCC Patients

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P90-P90
Author(s):  
Osama Alhamarneh ◽  
Nicholas D. Stafford ◽  
John Greenman
Keyword(s):  
Treatment Group ◽  
Clinical Outcome ◽  
Oral Cavity ◽  
Potential Role ◽  
Tumor Stage ◽  
Post Treatment ◽  
Kaplan Meier ◽  
Tumor Load ◽  
Pre Treatment

Problem To determine the correlation between IL10, a Th2-type inhibitory cytokine, clinical outcome and survival in HNSCC patients. Methods IL10 levels in the serum of newly-presenting, untreated, patients with HNSCC were measured pre-treatment (n=107) and 4–6 weeks after treatment (n=43), and were compared with a cohort of healthy controls (n=40) of similar age and sex. A commercial IL10 ELISA (Biosource) with a minimum detectable level of 0.2 pg/ml was used. Statistical analysis of associations between the levels and detectability of IL10 and clinical outcome and survival were done. Results Both IL10 detectability and levels were significantly higher in patients than in controls (p=0.001). Post treatment, IL10 levels dropped significantly (p=0.02). Pretreatment, IL10 levels were significantly elevated in the advanced stage of the disease (III/IV vs. I/II), in node positive patients and in patients with bulkier tumor load (T3/T4 vs. T1/T2); p=0.005, 0.037 and 0.001 respectively. The larynx (n=36), oropharynx (n=25) and pharynx (n=16) showed significantly higher levels and increased detectability of IL10 in the pre-treatment group when compared to the post treatment group, however, oral cavity tumors (n=21) showed the opposite. Finally, the detectability of IL10 significantly correlated with poorer survival (Kaplan-Meier, p=0.026) after a mean follow up of 15 (range 1–36) months. Conclusion IL10 levels drop significantly once the tumor mass is removed suggesting that this is the most important source of the circulating cytokine. IL10, as well as the tumor bulk, the nodal status and the overall tumor stage, were shown to be independent factors in predicting a poorer clinical outcome and worse survival in tumors originating in the larynx, pharynx and oropharynx, but not oral cavity, suggesting distinct inter-tumour differences. Significance IL10 could play a potential role as a prognostic marker in HNSCC, in addition to the possible manipulation of IL10 in future immunotherapeutic agents.

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