Abstract TP26: The Outcome of Patients With Tandem Occlusion Remains Poor Despite Mechanical Thrombectomy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Robert Fahed ◽  
Hocine Redjem ◽  
Raphaël Blanc ◽  
Julien Labreuche ◽  
Stanislas Smajda ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Intravenous Thrombolysis ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tandem Occlusion ◽  
Treatment Data ◽  
Research Gap

Introduction: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Besides, the indications and effects of ICA stenting remain unclear. Hypothesis: To determine the factors associated with favorable outcome at 3-month in this subtype of AIS. Methods: From a prospectively gathered registry, we analyzed the data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, NIHSS, and stroke etiology), imaging (including DWI-ASPECTS), and endovascular treatment data were assessed and reviewed in consensus by two observers. Good clinical outcome was defined as a modified Rankin Scale (mRS) of ≤2 at 3-month follow-up. The mRS at 3 months follow-up was available in 67 patients. Results: At 3-month follow-up, 33 of 67 (49.3%) patients had a good clinical outcome and 34 (50.8%) had a poor clinical outcome, including 9 deaths (13.4%). Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (TICI 2b-3) were associated with a good clinical outcome (P<0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique, including the ICA stenting. Conclusions: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to intravenous thrombolysis, is also difficult to treat by endovascular means.

Endovascular Management of Acute Ischemic Strokes with Tandem Occlusions

2016 ◽  
Vol 41 (5-6) ◽  
pp. 298-305 ◽  
Author(s):  
Robert Fahed ◽  
Hocine Redjem ◽  
Raphaël Blanc ◽  
Julien Labreuche ◽  
Thomas Robert ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Carotid Stenting ◽  
National Institutes Of Health ◽  
Endovascular Management ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Treatment Data ◽  
Research Gap

Background: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Also, the indications and effects of carotid stenting remain unclear. Methods: From a prospectively gathered registry, we analyzed data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, National Institutes of Health Stroke Scale (NIHSS), and stroke etiology), imaging (including diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score), and endovascular treatment data were assessed and reviewed in consensus by 2 observers. Good clinical outcome was defined as a modified Rankin Scale of ≤2 at 3-month follow-up. Results: At 3-month follow-up, 50.8% had a poor clinical outcome, including death in 13.4%. Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (thrombolysis in cerebral infarction 2b-3) were associated with a good clinical outcome (p < 0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous (IV) tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique including the carotid stenting. Conclusions: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to IV thrombolysis, is also difficult to treat by endovascular means. Guidelines for the endovascular management of tandem occlusions are needed.

Flow diversion treatment for acutely ruptured aneurysms

2019 ◽  
Vol 12 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Michelle F M ten Brinck ◽  
Maike Jäger ◽  
Joost de Vries ◽  
J André Grotenhuis ◽  
René Aquarius ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Flow Diverter ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Ruptured Aneurysms ◽  
Secondary Endpoints ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Ruptured Intracranial Aneurysms

Background and purposeFlow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.MethodsWe conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0–2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.ResultsAt follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3–6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size ≥20 mm and <20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).ConclusionFlow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.

Abstract TP9: Safety of Endovascular Treatment in Acute Stroke Patients Taking Oral Anticoagulants

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Timo Uphaus ◽  
Oliver C Singer ◽  
Joachim Berkefeld ◽  
Christian H Nolte ◽  
Georg Bohner ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Positive Impact ◽  
Therapeutic Option ◽  
Oral Anticoagulants ◽  
Intravenous Thrombolysis ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Male Patients

Introduction: The endovascular treatment (EVT) of cerebral ischemia in the case of large vessel occlusion has been established over recent years. Randomized trials showed a positive impact on the clinical outcome of endovascular treatment in addition to thrombolysis with respect to clinical outcome and safety, so that this therapeutic option will be implemented in future guidelines. The role of EVT in patients treated with oral anticoagulants remains uncertain. Hypothesis: We assessed the hypothesis that application of EVT is safe with regard to the occurrence of intracranial bleeding and clinical outcome in patients taking anticoagulants. Methods: The ENDOSTROKE-Registry is a commercially independent, prospective observational study in 12 stroke centers in Germany and Austria launched in January 2011. An online tool served for data acquisition of pre-specified variables concerning endovascular stroke therapy. Results: Data from 815 patients (median age 70, 57% male) undergoing EVT and known anticoagulation status were analyzed. A total of 85 (median age 76, 52% male) patients (10.4%) took oral anticoagulants prior to EVT. Anticoagulation status as measured with INR was 2.0-3.0 in 24 patients (29%), <2.0 in 52 patients (63%) and above 3.0 in 7 patients (8%) of 83 patients with valid INR data prior to EVT. Patients taking anticoagulants were significantly older (median age 76 vs. 69, p < 0.001). Comparing those patients taking anticoagulants and those not, there were no differences concerning NIHSS at admission (with anticoagulants Median-NIHSS 17 vs. without Median-NIHSS 15, p = 0.492, Mann Whitney Test) and the rate of intracranial hemorrhage after intervention (with anticoagulants 11.8% vs. without 12.2%, p = 0.538). After adjustment for age and NIHSS at admission there were no significant differences between the two groups with regard to good clinical outcome, as measured with the modified ranking scale (mRS, 90d-mRS 0-2, 39.2% of patients not receiving anticoagulants; 25.9% of those receiving anticoagulants). Conclusion: The application of endovascular treatment in patients taking oral anticoagulants is safe and should be considered in acute stroke treatment as an important alternative to contraindicated intravenous thrombolysis.

Abstract P338: Incidence, Predictors and Impact of Infarct in New Territory in Escape Na1 Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nishita Singh ◽  
Martha Marko ◽  
Petra Cimflova ◽  
Johanna Ospel ◽  
Nima Kashani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Randomized Study ◽  
Maximum Diameter ◽  
Vascular Territory ◽  
Poor Clinical Outcome ◽  
Guide Catheter ◽  
Ct And Mri

Introduction: Infarct in new territory (INT) is a known complication of endovascular therapy. We assessed the prevalence, predictors and clinical relevance of INT Methods: We included patients from the ESCAPE-NA1: a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in patients with acute ischemic stroke who underwent EVT within 12 hours from onset. All imaging was re-evaluated, and INT was defined by presence of infarct in new vascular territory, outside the baseline target occlusion(s) on follow up CT and MRI. INT’s were classified by maximum diameter (<2mm, 2-20mm and >20mm) and location. Results: Of 1099 analyzed patients in ESCAPE NA1, 107 had INT (9.7%, mean age 67 years, 51.4% females). There were no differences at baseline in those with vs without INT. Most INTs (75.7%) were angiographically occult and 41(38.3%) were > 20mm. The most common INT territory was the ACA alone or in combination with MCA/PCA (30.3%). The presence of emboli in new territory angiographically was significantly associated with INT (OR 16.39, 95%CI 8.14-33.09). Alteplase use, balloon guide catheter use, nerinetide and initial occlusion site did not predict INT. INT patients had higher final median infarct volumes compared to non-INT (44.5cc vs 23.3cc, P<0.001). Large INT (diameter of >20mm) were associated with poor clinical outcome compared to INT (<2mm) OR (mRS 0-2) 0.17, 95%CI 0.05-0.55). Conclusion: Infarcts in new territory are common and are associated with poor outcome.

Abstract TP66: Single Slice Maximal Lesion Diameter Predicts Malignant Pattern of Diffusion Lesions in Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Anke Wouters ◽  
Patrick Dupont ◽  
Anna Kufner ◽  
Robin Lemmens ◽  
Vincent Thijs
Keyword(s):  
Clinical Outcome ◽  
Intravenous Thrombolysis ◽  
Volumetric Analysis ◽  
Maximum Diameter ◽  
Lesion Volume ◽  
Imaging Data ◽  
Poor Clinical Outcome ◽  
Lesion Diameter ◽  
Single Slice ◽  
Lesion Extension

Introduction: Recent endovascular trials excluded patients with large ischemic cores on diffusion-weighted imaging (DWI) or perfusion CT using automated volumetric analysis. Hypothesis: We investigated whether the largest diameter of the DWI lesion measured on a single slice could accurately predict large ischemic cores, as defined by automated volumetric analysis; such findings could result in a simple tool for predicting clinical outcome. Methods: Magnetic resonance imaging data from the multicenter AXIS 2-trial were used. Patients were included within 9h of symptom onset and received intravenous thrombolysis if eligible. The maximum diameter of the diffusion lesion was measured on the slice with the largest lesion extension. Maximum diameters on a single slice were compared with the volumes of > 50 ml, >70ml and >100ml determined by standard volumetric analysis. We also assessed whether and for which threshold, largest lesion diameter was a predictor of poor clinical outcome defined as modified ranking scale (mRS) 5 or 6. Results: A total of 304 patients were included of which 50 (16%) presented with a carotid occlusion. 96 (32%) patients had a DWI-volume of more than 50 ml, 63 (21%) more than 70ml and 46 (15%) more than 100ml. A diameter of respectively 5.5, 6.5 and 7 cm on a single slice with the largest lesion extension was the best predictor of a DWI lesion volume of more than 50 (sensitivity (sens) 97%, specificity (spec) 80%), 70 (sens 95%, spec 83%) and 100ml (sens 100%, spec 85%). The maximum diameter was a reasonable predictor of poor clinical outcome with an AUC of 0.76 (95%CI: 0.68-0.83). The optimal cut off point was found to be 5.5 cm (sens 71%, spec 67%). Conclusion: Measuring the maximum lesion diameter on a single slice on DWI identifies patients with large ischemic cores with a high sensitivity and specificity. This finding can be useful in clinical practice and for future clinical trials where rapid and uniform decision making to exclude patients with a malignant profile from endovascular therapy is essential.

scholarly journals Pseudoarthrosis of second metatarsal fracture

2018 ◽  
Vol 40 (2) ◽  
Author(s):  
Jessica Zanovello ◽  
Barbara Bertani ◽  
Redento Mora ◽  
Gabriella Tuvo ◽  
Mario Mosconi ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Good Clinical Outcome ◽  
Non Union ◽  
Fractures In Children ◽  
Second Metatarsal ◽  
Traumatic Fracture ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
Foot Fractures

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.

scholarly journals Acute Ischemic Stroke in Late Pregnancy Treated with Intravenous Thrombolysis and Endovascular Therapy

2019 ◽  
Vol 11 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Eva Szuchy Kristiansen ◽  
Hannah Holm Vestergaard ◽  
Boris Modrau ◽  
Lorenz Martin Oppel
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Intravenous Thrombolysis ◽  
Late Pregnancy ◽  
Exclusion Criterion ◽  
Good Clinical Outcome ◽  
Systemic Thrombolysis ◽  
In Pregnancy

Pregnancy has usually been an exclusion criterion in clinical trials with thrombolysis and endovascular therapy in acute ischemic stroke. For that reason, these therapies are not recommended causing lack of evidence and vice versa. In this case report, we describe a pregnant woman in week 33 + 3 presenting with acute ischemic stroke, which was successfully treated with systemic thrombolysis and endovascular therapy, resulting in a good clinical outcome for both mother and child. The altered fibrinolytic system and the risk factors related to pregnancy constitute a challenge for clinicians when choosing the most suitable treatment modality for treating acute ischemic stroke in pregnancy. It is still uncertain whether thrombolysis in combination with endovascular therapy or endovascular therapy alone is the most appropriate treatment option. However, there is slowly growing evidence that thrombolysis and thrombectomy in pregnancy are feasible and safe with a good clinical outcome for both the mother and the child.

scholarly journals Intracranial Hemorrhage Secondary to a Delayed Cerebral Pseudoaneurysm Rupture 18 Years after Cranial Trauma

2019 ◽  
Vol 11 (3) ◽  
pp. 325-329
Author(s):  
Mikel Terceño ◽  
Sebastià Remollo ◽  
Yolanda Silva ◽  
Saima Bashir ◽  
Carlos Castaño ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Previous History ◽  
Complete Recovery ◽  
Good Clinical Outcome ◽  
Intracranial Hematoma ◽  
Cranial Trauma ◽  
History Of ◽  
Etiological Study

We report the case of a 38-year-old male with a previous history of severe cranial trauma and subsequent large subdural and subarachnoid hemorrhage on whom an emergent hematoma evacuation was performed with a good outcome and follow-up. Despite a good clinical evolution, the patient experienced a further intracranial hematoma 18 years after the trauma, with severe aphasia and mild right hemiparesis. After complete etiological study, two cranial pseudoaneurysms were observed in the cerebral angiography. Endovascular treatment was successfully completed, achieving full embolization without complications. No rebleeding was detected during follow-up. The patient had a good clinical outcome at 3 months and achieved complete recovery. Cranial pseudoaneurysm rupture is a rare cause of intracerebral hemorrhage, especially if the trauma occurs years before the bleeding.

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