Abstract WP25: Gender Disparity in Mechanical Thrombectomy Outcomes: The Role of Arterial Caliber

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mark A Davison ◽  
Kavantissa M Keppetipola ◽  
Bichun Ouyang ◽  
Michael Chen
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Vascular Anatomy ◽  
Gender Disparity ◽  
Circle Of Willis ◽  
Large Vessel ◽  
Consecutive Series ◽  
Anterior Circulation ◽  
Men And Women

Introduction: Despite level 1a evidence demonstrating the clinical benefit of mechanical thrombectomy in selected large vessel ischemic stroke patients, a gender disparity exists. Women not only have less favorable clinical outcomes after all stroke types, but the causes of this disparity remain elusive. Gender differences in cerebral vascular anatomy have been previously published. We hypothesize that differences in circle of Willis diameters may contribute to the gender disparity seen in clinical outcomes after mechanical thrombectomy for acute ischemic stroke. Methods: Clinical and radiographic data from a consecutive series undergoing mechanical thrombectomy for anterior circulation large vessel ischemic strokes were reviewed. Measurements of the proximal middle cerebral artery (M1) segment and supraclinoid internal carotid artery (ICA) diameters were obtained in a standardized fashion from the thrombectomy procedure angiogram. All M1 measurements were recorded at 3 mm of the vessel origin while ICA measurements were taken 3 mm proximal to the ICA terminus. Covariates included age, occlusion location, vascular risk factors, admission NIHSS score and final TICI grade. Modified Rankin score (mRS) at 90 days was the dependent variable. Variable significance between male and female cohorts was determined using student T-Tests. Multivariate regression analysis was also performed. Results: Ninety-four patients (41 female) between 6/2013 and 6/2016 fit the inclusion criteria. ICA terminus measurements for men and women were 3.07 mm (SD=0.46) and 2.88 mm (SD=0.47), respectively. M1 origin measurements for men and women were 2.46 mm (SD=0.31) and 2.21 mm (SD=0.37), respectively. Male ICA terminus and M1 origin measurements were larger than female (p = 0.05 and p < 0.001, respectively). 61% of men vs. 25% of women had 90-day mRS ≤ 2. Multivariate analysis indicated that only age was significantly associated with 90-day mRS ≤ 2. Conclusions: Our single center series suggests that differences in intracranial vessel diameter may contribute to the gender disparity in outcomes after mechanical thrombectomy. Smaller circle of Willis arterial diameters may compromise collateral blood flow and increase the difficulty in achieving sufficient reperfusion.

Abstract WP372: Hydration Status and Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mona N Bahouth ◽  
Rebecca Gottesman
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Blood Urea Nitrogen ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Hydration Status ◽  
Creatinine Ratio ◽  
Stroke Patients ◽  
Anterior Circulation

Introduction: Impaired hydration measured by elevated blood urea nitrogen (BUN) to creatinine ratio has been associated with worsened outcome after acute ischemic stroke. Whether hydration status is relevant for patients with acute ischemic stroke treated with mechanical thrombectomy remains unknown. Materials and Methods: We conducted a retrospective review of consecutive acute ischemic stroke patients who underwent endovascular procedures for anterior circulation large artery occlusion at Johns Hopkins Comprehensive Stroke Centers between 2012 and 2017. A volume contracted state (VCS), was determined based on surrogate lab markers and defined as blood urea nitrogen (BUN) to creatinine ratio greater than 15. Endpoints were achievement of successful revascularization (TICI 2b or 3), early re-occlusion, and short term clinical outcomes including development of early neurological worsening and functional outcome at 3 months. Results: Of the 158 patients who underwent an endovascular procedure, 102 patients had a final diagnosis of anterior circulation large vessel occlusion and met the inclusion criteria for analysis. Volume contracted state was present in 62/102 (61%) of patients. Successful revascularization was achieved in 75/102 (74%) of the cohort. There was no relationship between VCS and successful revascularization, but there was a 1.13 increased adjusted odds (95% CI 1.01, 1.27) of re-occlusion within 24 hours for every point higher BUN/creatinine ratio in the subset of patients who underwent radiological testing for pre-procedure planning (n=57). There was no relationship between VCS and clinical outcomes including early neurological worsening and 3 month outcome. Conclusions: Patients with VCS and large vessel anterior circulation stroke may have a higher odds of early re-occlusion after mechanical thrombectomy than their non-VCS counterparts, but no differences in successful revascularization nor clinical outcomes were present in this cohort. These results may suggest an opportunity for the exploration of pre-procedure hydration to improve outcomes.

Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes

2019 ◽  
Vol 11 (9) ◽  
pp. 874-878 ◽  
Author(s):  
Stephanie H Chen ◽  
Brian M Snelling ◽  
Samir Sur ◽  
Sumedh Subodh Shah ◽  
David J McCarthy ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Mechanical Thrombectomy ◽  
Vascular Anatomy ◽  
Patient Characteristics ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Cohort Differences ◽  
Number Of Passes

BackgroundA transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. Nonetheless, TRA may confer added benefits in MT since navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory.ObjectiveTo compare outcomes in patients who underwent MT via TRA versus TFA.MethodsWe performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2018. Patient characteristics, procedural techniques, and outcomes were recorded. TFA and TRA cohorts were compared.ResultsOf the 51 patients, 18 (35%) underwent MT via TRA. There were no significant cohort differences in patient characteristics, clot location, or aortic arch type and presence of carotid tortuosity. There were no significant differences in outcomes between the two cohorts, including single-pass recanalization rate (54.5% vs 55.6%, p=0.949) and average number of passes (1.9 vs 1.7, p=0.453). Mean access-to-reperfusion time (61.9 vs 61.1 min, p=0.920), successful revascularization rates (Thrombolysis in Cerebral Infarction score ≥2b 87.9% vs 88.9%, p=1.0) and functional outcomes (modified Rankin Scale score≤2, 39.4% vs 33.3%, p=0.669) were similar between TFA and TRA cohorts, respectively.ConclusionsOur results demonstrate equivalence in efficacy and efficiency between TRA and TFA for MT of anterior circulation large vessel occlusion in patients with challenging vascular anatomy. TRA may be better than TFA in well-selected patients undergoing MT.

scholarly journals “Y-stent retriever”: a new rescue technique for refractory large-vessel occlusions?

2018 ◽  
Vol 128 (5) ◽  
pp. 1349-1353 ◽  
Author(s):  
Roberto Crosa ◽  
Alejandro M. Spiotta ◽  
Matías Negrotto ◽  
Alejandra Jaume ◽  
Walter Casagrande
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Large Vessel ◽  
Positive Trial ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Flow Restoration ◽  
Stent Retrievers

Long-awaited positive trial data have shown the efficacy of endovascular treatment in patients with ischemic stroke who arrive at the hospital within the first 6 hours with large-vessel occlusion of the anterior circulation. With the introduction of stent retrievers (SRs) for mechanical thrombectomy, efficient and safe large-artery recanalization treatment can be achieved. However, sometimes there are patients who do not attain complete flow restoration following attempts with traditional maneuvers. The authors present the case of a 57-year-old man with acute ischemic stroke due to an M1 embolus that extended into both M2 trunks. This patient was successfully treated with an innovative technique in which a Solitaire SR (Covidien) and a Catch SR (Balt) were used in a “Y” configuration, for which the authors coined the term “Y-stent retriever.”

A novel nomogram for predicting prognosis after mechanical thrombectomy in patients with acute ischemic stroke

2021 ◽  
Vol 18 ◽  
Author(s):  
Huiling Sun ◽  
Feng Zhou ◽  
Guoxing Zhang ◽  
Jiankang Hou ◽  
Yukai Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Bridging Therapy ◽  
Anterior Circulation ◽  
Interval Time ◽  
Good Outcome

Background: Mounting evidence has shown that mechanical thrombectomy [MT] improves clinical outcomes for large vessel occlusions [LVOs] in patients with acute ischemic stroke [AIS] of the anterior circulation. The present study aimed to provide a comprehensive analysis of risk factors associated with clinical outcomes in AIS patients receiving MT. Methods: A total of 212 consecutive patients who underwent MT for AIS were enrolled in the present study. Clinical characteristics were recorded at admission. Two endpoints were defined according to the 3-month modified Rankin scale [mRS] score after AIS [good outcome, mRS 0-2; and death, mRS 6]. Additionally, we compared the clinical outcomes and safety of MT alone and bridging therapy in AIS patients. Results: Of the 212 patients treated with MT, 114 [53.77%] patients had a good outcome and 31 [14.62%] died. The incidence of a worse outcome after MT was significantly elevated in males and patients with high WBC counts, high admission blood glucose levels, high baseline NIHSS scores and a long interval time from groin puncture to reperfusion in AIS patients treated with MT after adjustment for covariates [P<0.05]; these risk factors were further confirmed by our constructed nomograms. In addition, we observed no significant benefit of bridging therapy compared to MT alone in AIS patients. Conclusion: Our constructed nomogram based on male sex, admission WBC, admission blood glucose, NIHSS, and the interval time from groin puncture to reperfusion predicts prognosis after mechanical thrombectomy in patients with acute ischemic stroke.

Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke

2020 ◽  
pp. neurintsurg-2020-016720
Author(s):  
Feras Akbik ◽  
Ali Alawieh ◽  
C Michael Cawley ◽  
Brian M Howard ◽  
Frank C Tong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Intracranial Hemorrhage ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Anterior Circulation ◽  
Increased Risk ◽  
First Pass

BackgroundAtrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT).ObjectiveTo determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT.MethodsWe performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.ResultsAF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001).ConclusionsIn patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.

scholarly journals Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

2020 ◽  
Author(s):  
Anas S. Al-Smadi ◽  
Srishti Abrol ◽  
Ali Luqman ◽  
Parthasarathi Chamiraju ◽  
Hani Abujudeh
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Ischemic Disease ◽  
Patient Demographics

Abstract Background and PurposeStroke is a drastic complication and a poor prognostic marker of COVID-19 disease which emphasizes the importance of early identification and management of this complication. In this case series, we describe our experience of mechanical thrombectomy of large vessel occlusions (LVO) in patients with COVID-19.MethodsWe performed a retrospective study of a series of confirmed COVID-19 patients who underwent endovascular thrombectomy for acute cerebrovascular ischemic disease with large vessel occlusion. Patient demographics, presentations, lab values, angiographic and clinical outcomes were also reviewed.ResultsThree COVID-19 patients with large vessel occlusion who underwent endovascular thrombectomy were identified in our multi-center institution. Two patients had respiratory symptoms prior presentation and one patient presented initially with clinical deficits. Two patients had anterior circulation occlusion in the middle cerebral artery territory vs one had posterior circulation occlusion in the basilar artery. There was good angiographic outcome post thrombectomy in all patients, however poor clinical outcomes noted with no significant improvement in neurological manifestations in comparison with baseline at presentation. All patients developed critically severe symptoms during hospitalization requiring intubation and one patient died of COVID-19 related respiratory failure.ConclusionIn this small case series, we noted worse clinical outcomes in COVID-19 related LVO stroke despite effective thrombectomy, which may be related to the underlying COVID-19 disease and/or the nature of clot in these patients.

scholarly journals TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry

2017 ◽  
Vol 10 (6) ◽  
pp. 516-524 ◽  
Author(s):  
Osama O Zaidat ◽  
Alicia C Castonguay ◽  
Raul G Nogueira ◽  
Diogo C Haussen ◽  
Joey D English ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Large Vessel ◽  
Complete Revascularization ◽  
Anterior Circulation

BackgroundRecent randomized clinical trials (RCTs) demonstrated the efficacy of mechanical thrombectomy using stent-retrievers in patients with acute ischemic stroke (AIS) with large vessel occlusions; however, it remains unclear if these results translate to a real-world setting. The TREVO Stent-Retriever Acute Stroke (TRACK) multicenter Registry aimed to evaluate the use of the Trevo device in everyday clinical practice.MethodsTwenty-three centers enrolled consecutive AIS patients treated from March 2013 through August 2015 with the Trevo device. The primary outcome was defined as achieving a Thrombolysis in Cerebral Infarction (TICI) score of ≥2b. Secondary outcomes included 90-day modified Rankin Scale (mRS), mortality, and symptomatic intracranial hemorrhage (sICH).ResultsA total of 634patients were included. Mean age was 66.1±14.8 years and mean baseline NIH Stroke Scale (NIHSS) score was 17.4±6.7; 86.7% had an anterior circulation occlusion. Mean time from symptom onset to puncture and time to revascularization were 363.1±264.5 min and 78.8±49.6 min, respectively. 80.3% achieved TICI ≥2b. 90-day mRS ≤2 was achieved in 47.9%, compared with 51.4% when restricting the analysis to the anterior circulation and within 6 hours (similar to recent AHA/ASA guidelines), and 54.3% for those who achieved complete revascularization. The 90-day mortality rate was 19.8%. Independent predictors of clinical outcome included age, baseline NIHSS, use of balloon guide catheter, revascularization, and sICH.ConclusionThe TRACK Registry results demonstrate the generalizability of the recent thrombectomy RCTs in real-world clinical practice. No differences in clinical and angiographic outcomes were shown between patients treated within the AHA/ASA guidelines and those treated outside the recommendations.

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