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.

Microbleeds, Cerebral Hemorrhage, and Functional Outcome after Endovascular Thrombectomy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011566
Author(s):  
Imad DERRAZ ◽  
Federico CAGNAZZO ◽  
Nicolas GAILLARD ◽  
Riccardo MORGANTI ◽  
Cyril DARGAZANLI ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Functional Outcome ◽  
Intravenous Thrombolysis ◽  
Stroke Severity ◽  
Confounding Factors ◽  
Poor Functional Outcome ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Poor Outcome ◽  
Increased Risk

Objective—To determine whether pre-treatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).Methods—Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin score >2).Results—Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH, in which 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03–1.36 per 1-CMB increase; P=0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, intravenous thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92–1.20 per 1-CMB increase; P=0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, nor presumed pathogenesis was independently correlated with ICH.Conclusions—Poor functional outcome or ICH were not correlated with CMB presence or burden on pre–EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted.Classification of Evidence—This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.

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.

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

2017 ◽  
Vol 44 (5-6) ◽  
pp. 351-358 ◽  
Author(s):  
Mona Laible ◽  
Markus Alfred Möhlenbruch ◽  
Johannes Pfaff ◽  
Ekkehart Jenetzky ◽  
Peter Arthur Ringleb ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Multivariate Regression ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Poor Outcome ◽  
Increased Risk

Background: Renal dysfunction (RD) may be associated with poor outcome in ischemic stroke patients treated with mechanical thrombectomy (MT), but data concerning this important and emerging comorbidity do not exist so far. Here, we investigated the influence of RD on postprocedural intracerebral hemorrhage (ICH), clinical outcome, and mortality in a large prospectively collected cohort of acute ischemic stroke patients treated with MT. Methods: Consecutive patients with anterior-circulation stroke treated with MT between October 2010 and January 2016 were included. RD was defined as glomerular filtration rate (GFR) <60 mL/min/1.73 m2. In a prospective database, clinical characteristics were recorded and brain images were analyzed for the presence of ICH after treatment in all patients. Clinical outcome was assessed by the modified Rankin Scale (mRS) after 3 months. To evaluate associations between clinical factors and outcomes uni- and multivariate regression analyses were conducted. Results: In total, 505 patients fulfilled all inclusion criteria (female: 49.7%, mean age: 71.0 years). RD at admission was present in 20.2%. RD patients were older and had cardiovascular risk factors more often. Multivariate regression analysis after adjustment for age, stroke severity, diabetes, hypertension, GFR, previous stroke, MT alone, or additional thrombolysis and recanalization results revealed that lower GFR was not independently associated with poor outcome (mRS 3-6; OR 1.13, 95% CI 0.99-1.28; p = 0.072) or ICH. However, lower GFR at admission was associated with a higher risk of mortality (OR 1.15, 95% CI 1.01-1.31; p = 0.038). Compared to admission, GFR values were higher at discharge (mean: 77.9 vs. 80.8 mL/min/1.73 m2; p = 0.046). Conclusions: We did not find evidence for an association of lower GFR with an increased risk of poor outcome and ICH, but lower GFR was a determinant of 90-day mortality after endovascular stroke treatment. Our findings encourage also performing MT in this relevant subgroup of acute ischemic stroke patients.

Increased Risk for Unfavorable Outcome in Patients with Pre-Existing Disability Undergoing Endovascular Therapy

2018 ◽  
Vol 27 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Ronen R. Leker ◽  
Pavel Gavriliuc ◽  
Nour Eddine Yaghmour ◽  
John M. Gomori ◽  
Jose E. Cohen
Keyword(s):  
Endovascular Therapy ◽  
Unfavorable Outcome ◽  
Increased Risk

Pittsburgh response to endovascular therapy score as a pre-treatment prognostic tool: External validation in Trevo2

2016 ◽  
Vol 12 (5) ◽  
pp. 494-501 ◽  
Author(s):  
Syed Ali Raza ◽  
Bin Xiang ◽  
Tudor G Jovin ◽  
David S Liebeskind ◽  
Ryan Shields ◽  
...  
Keyword(s):  
Patient Selection ◽  
Endovascular Therapy ◽  
Predictive Power ◽  
Large Vessel ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
Pre Treatment

Background Optimal patient selection is needed to maximize the therapeutic benefit of endovascular therapy for large vessel occlusion stroke. Aims To validate the Pittsburgh response to endovascular therapy (PRE) score in a randomized controlled trial (Trevo2) comparing stent retriever (Trevo) to the Merci device. Methods Trevo2 participants with internal carotid, M1 and M2 middle cerebral artery occlusions with prospectively collected baseline stroke severity (NIHSS), degree of hypodensity (CT ASPECTS), and three-month modified Rankin Scale (mRS) were included. Multivariable regression was used to confirm association between PRE score variables (age, NIHSS, and ASPECTS), medical comorbidities, randomization arm, and reperfusion status (mTICI2B/3) with good outcome (three-month modified Rankin Scale 0–2). Predictive power (area under the receiver operating characteristic curve) for good outcome of pre-treatment prognostic scores (PRE, THRIVE, HIAT2) was compared. Rates of good outcome were compared between successfully reperfused (mTICI2B/3) and non-reperfused (mTICI0-2A) patients across previously identified PRE score risk groups. Results Age, NIHSS, ASPECTS, reperfusion status, and randomization arm were independent predictors of good outcome. PRE score had moderate predictive power (AUC = 0.75) for good outcome and was comparable to other pre-treatment scores. Reperfusion resulted in maximal treatment benefit in patients with PRE score 0–24 (60% vs. 12.5%, p = 0.002) but not in those with PRE ≥50 (11.8% vs. 0.0%, p = 0.49). Conclusion The PRE score is a validated predictor of functional outcome and a tool for patient selection for endovascular therapy in anterior large vessel occlusion stroke. Our finding of limited benefit of reperfusion in patients with PRE score ≥50 needs to be prospectively validated.

Endovascular stroke therapy may be safe in patients with elevated international normalized ratio

2016 ◽  
Vol 9 (12) ◽  
pp. 1187-1190 ◽  
Author(s):  
Sibu Mundiyanapurath ◽  
Anne Tillmann ◽  
Markus Alfred Möhlenbruch ◽  
Martin Bendszus ◽  
Peter Arthur Ringleb
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
International Normalized Ratio ◽  
Unfavorable Outcome ◽  
Favorable Outcome ◽  
University Hospital ◽  
Increased Risk

IntroductionEndovascular therapy in acute ischemic stroke is safe and efficient. However, patients receiving oral anticoagulation were excluded in the larger trials.ObjectiveTo analyze the safety of endovascular therapy in patients with acute ischemic stroke and elevated international normalized ratio (INR) values.MethodsRetrospective database review of a tertiary care university hospital for patients with anterior circulation stroke treated with endovascular therapy. Patients with anticoagulation other than vitamin K antagonists were excluded. The primary safety endpoint was defined as symptomatic intracranial hemorrhage (sICH; ECASS II definition). The efficacy endpoint was the modified Rankin scale (mRS) score after 3 months, dichotomized into favorable outcome (mRS 0–2) and unfavorable outcome (mRS 3–6).Results435 patients were included. 90% were treated with stent retriever. 27 (6.2%) patients with an INR of 1.2–1.7 and 21 (4.8%) with an INR >1.7. 33 (7.6%) had sICH and 149 patients (34.3%) had a favorable outcome. Patients with an elevated INR did not have an increased risk for sICH or unfavorable outcome in multivariable analysis. The additional use of IV thrombolysis in patients with an INR of 1.2–1.7 did not increase the risk of sICH or unfavorable outcome. These results were replicated in a sensitivity analysis introducing an error of the INR of ±5%. They were also confirmed using other sICH definitions (Safe Implementation of Thrombolysis in Stroke (SITS), National Institute of neurological Disorders and Stroke (NINDS), Heidelberg bleeding classification).ConclusionsEndovascular therapy in patients with an elevated INR is safe and efficient. Patients with an INR of 1.2–1.7 may be treated with combined IV thrombolysis and endovascular therapy.

scholarly journals Serum CRP Concentrations and Severity of Ischemic Stroke Subtypes

2012 ◽  
Vol 39 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Yun Luo ◽  
Zhongyuan Wang ◽  
Jingwei Li ◽  
Yun Xu
Keyword(s):  
Ischemic Stroke ◽  
Severe Illness ◽  
Control Group ◽  
P Value ◽  
Stroke Severity ◽  
Stroke Subtype ◽  
Anterior Circulation ◽  
Stroke Subtypes ◽  
Increased Risk ◽  
Toast Classification

Objective:The aim of this retrospective study was to investigate if elevated C reactive protein (CRP) was related to the stroke severity, and to analyze its different distribution in stroke subtypes.Methods:316 patients with acute ischemic stroke (AIS) were enrolled and had CRP determinations; they were dichotomized as<7 or ≥7mg/L according to the previous report. 128 patients with transient ischemic attack who also had CRP measurements were selected as controls. A possible level-risk relationship between elevated CRP and NIHSS, which considered relatively severe illness as a value≥8, was studied within the AIS group.Results:CRP was elevated in 21% of the AIS compared to 4% in the control group (p = 0.000). Within the AIS group, patients with CRP levels ≥7mg/L had a significantly increased risk of severe stroke (OR 3.33, 95% CI 1.84-6.00, p =0.00). In subtype stroke, the highest rate of elevated CRP and NIHSS were in those with cardioembolic stroke (CE) using TOAST classification, total anterior circulation infarction (TACI) of OCSP classification and large volume infarction (LVI) of Adams classification; the odds ratio(OR) between elevated CRP and NIHSS was 6.14 (95% CI 1.43-26.44) in CE, 1.714 (95% CI 1.30-2.26) in TACI, 2.32 (95% CI 1.08-4.99) in LVI, and the p value were all below 0.05.Conclusion:Elevated CRP level can reflect the severity of AIS, which was association with stroke subtype.

Abstract T P24: Neurointervention for Acute Ischemic Stroke Caused by Carotid Dissection

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Diogo C Haussen ◽  
Andrey Lima ◽  
Mikayel Gregoryan ◽  
Jonathan Grossberg ◽  
Leah Craft ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Hemorrhagic Transformation ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Stroke Severity ◽  
Carotid Dissection ◽  
Increased Risk

Introduction: Data related to the treatment of patients with acute ischemic stroke caused by carotid artery dissection is scarce. Methods: We retrospectively reviewed our interventional stroke database Sep 2010 - Jan 2014 to investigate the clinical and radiological characteristics of patients presenting with tandem cervical and intracranial occlusions due to cervical carotid dissection. Results: Out of 504 consecutive patients treated with endovascular therapy for acute ischemic stroke during the study period, 12 (2.5%) patients were observed to have cervical carotid artery dissection as the underlying etiology. Mean age was 56±13 years, 75% were male, 50% received IV t-PA, mean NIHSS was 20±5, 75% had CT ASPECTS≥7, and mean time from last known normal to groin puncture was 6±3 hours. There were 4 MCA M1, 1 MCA M2 and 7 ICA-T occlusions. Extracranial carotid stent was used in 58% and angioplasty in 8% of cases. In 33% of the cases, the carotid dissection was not stented due to the fear of hemorrhagic transformation in cases of IV thrombolysis (presumably increased risk if dual antithrombotics used). IA tPA was used in 41% of cases, while Merci in 16%, Penumbra in 58%, and stentretrivers in 50%. Intracranial TICI 2b-3 reperfusion was achieved in 91% of patients, with PH2 hemorrhage in 8% and mRS at 90 days in 45% of cases. Conclusions: Carotid dissections with associated intracranial occlusions are often refractory to IV tPA and present with a high stroke severity. These lesions are amenable to endovascular therapy resulting in high rates of reperfusion with an acceptable safety profile.

Elevated mean platelet volume is associated with poor outcome after mechanical thrombectomy

2017 ◽  
Vol 10 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Feng Peng ◽  
Weihong Zheng ◽  
Fengli Li ◽  
Jinjing Wang ◽  
Zhaoji Liu ◽  
...  
Keyword(s):  
Mean Platelet Volume ◽  
Mechanical Thrombectomy ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Functional Independence ◽  
Unfavorable Outcome ◽  
Platelet Activity ◽  
Platelet Volume ◽  
Anterior Circulation ◽  
Poor Outcome

BackgroundElevated mean platelet volume (MPV), indicating higher platelet activity, could be a predictor of prognosis in patients with acute ischemic stroke receiving medical therapy.ObjectiveTo investigate the relationship between MPV and functional outcome in patients with acute anterior circulation stroke 3 months after undergoing mechanical thrombectomy (MT).MethodsA total of 153 consecutive patients with acute stroke following MT, in two separate stroke centers, were enrolled between May 2013 and March 2016. MPV was measured on admission. Subjects were divided into two groups according to average MPV level. Univariate and multivariate analyses were performed. MPV was also incorporated into the Houston IA Therapy (HIAT) score, which was developed as a scoring system to predict poor prognosis, and the prediction capability was compared with the HIAT score alone.ResultsThe average MPV was 10.4 fL. Patients with high MPV had a significantly lower rate of functional independence (28.9% vs 57.1%, p=0.000). After multivariable analysis, elevated MPV remained an independent predictor of unfavorable outcome (OR=3.93, 95% CI 1.73 to 8.94, p=0.001). When the MPV cut-off value was set at 10.4 fL using the receiver operating characteristic (ROC) analysis, MPV ≥10.4 fL predicted unfavorable outcome with 62.1% sensitivity and 66.7% specificity, respectively. Addition of MPV to the HIAT score did not improve predictive power compared with the HIAT score system alone by a comparison of the areas under the two ROC curves (0.70 vs 0.62, p=0.174).ConclusionsElevated MPV is an independent predictor of poor outcome in patients with acute anterior circulation stroke undergoing MT at 3 months.

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