Abstract WP57: Perfusion Angiography Improves Clinical Outcomes Prediction in Endovascular Stroke Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sunil A Sheth ◽  
Julius Weng ◽  
Priscilla McElhinney ◽  
Benjamin Quachtran ◽  
David S Liebeskind ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Predictive Power ◽  
Important Determinant ◽  
Treatment Success ◽  
Regions Of Interest ◽  
Modified Rankin Scale ◽  
Stroke Therapy ◽  
Post Intervention ◽  
Quantitative Changes ◽  
Endovascular Stroke Therapy

Background: Successful reperfusion is a key determinant of outcome in endovascular stroke therapy (ET). However, present methods of grading treatment success using the Thrombolysis in Cerebral Infarction (TICI) scale fail to measure quantitative changes in cerebral blood flow and volume (CBF and CBV) and as such, may not fully represent treatment effect. Methods: From our prospectively maintained institutional registry, we identified patients treated with ET between February 2014 and May 2016. CBF and CBV maps were calculated automatically for both AP and Lateral projections and regions of interest (ROIs) were drawn by two experienced neuroimagers over the middle cerebral artery territories. Delta CBF and CBV scores were determined by subtracting pre- from post-intervention maps and averaging over the ROIs. Non-linear regression was used to calculate correlations against clinical outcome (modified Rankin scale at discharge). Results: Among 104 patients treated with ET, average age was 70, 50% were female, and median presentation NIHSS was 16 (IQR 10-19). Target occlusion location was ICA in 14%, M1 in 67%, and M2 in 18%. TICI scores ranged from 0 (4%), 1 (13%), 2a (2%), 2b (22%), 3 (58%). Relative increases in CBF and CBV ranged from 0.4-17% (CBF) and 0.3-14% (CBV). Delta CBF and CBV maps correlated well with angiographic TICI (CBF p<0.05, CBV p<0.05). TICI alone did not correlate significantly with outcome (r=0.24, p=0.14). However, including delta CBF and CBV with TICI resulted in a stronger correlation (r=0.37, p<0.05) against outcome. Conclusions: TICI is an important determinant of outcome in EST. The incorporation of perfusion angiography measurements (CBF and CBV) improves the predictive power of angiography for clinical outcome.

Abstract WP23: Comparison of Suction Thrombectomy, Stentriever, and Combined Approach: Thrombus Size, Fragmentation, and Outcome - A Single Center Analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Wolfgang Leesch ◽  
Pankajavalli Ramakrishnan ◽  
Dean Kostov ◽  
O’Brien Gossage ◽  
Frank Sanderson
Keyword(s):  
Clinical Outcome ◽  
Combined Approach ◽  
Stroke Therapy ◽  
Distal Embolization ◽  
Radiographic Images ◽  
Single Pass ◽  
Size Number ◽  
Data Points ◽  
Combined Technique ◽  
Endovascular Stroke Therapy

Introduction: Few reports have compared the commonly used technical approaches of stentriever, suction thrombectomy, and combined technique, particularly with emphasis on thrombus volume, fragmentation, distal embolization, and clinical outcome. Methods: Medical records and radiographic images of patients undergoing endovascular stroke therapy at our institution between 2014 and 2015 were reviewed for the following data points: Patient age, sex, NIH stroke scale (NIHSS) at presentation, number of passes, presence of distal embolization on angiography, TICI score, and Modified Rankin Scale (MRS) at discharge. When available, photographic images of the retrieved thrombus were analyzed for number of fragments and size of the largest fragment. Parameters were compared for the three thrombectomy techniques of suction (ADAPT technique), stentriever, and the combined approach. Results: Of 63 patients receiving endovascular stroke therapy, 47 (75%) underwent mechanical thrombectomy: Stentriever 17 (36%), Suction 18 (38%), and combined 12 (26%). Average age and presenting NIH stroke scales were similar in the groups. A single pass thrombectomy was more common in the suction group (72%) than in the stentriever (29%) and combined groups (8%). There were more thrombus fragments in the stentriever (2.3) and combined groups (3.4) than in the suction group (1.4), correlating to more frequent distal embolization (suction 22%, stentriever 70%, combined 50%). The retrieved thrombus was largest in the suction group (12.9 mm; stentriever 6.6 mm; combined 10.4 mm). Overall outcome at discharge was better in the suction group (61% MRS 0-2) than in the stentriever (35%) and combined groups (17%). Conclusions: In our patient sample suction thrombectomy outperformed the stentriever and combined techniques in the categories of achieved reperfusion grade, single pass, retrieved thrombus size, number of fragments, distal embolization and clinical outcome. While stent retriever and suction thrombetomy were used as primary approaches, the combined technique was commonly utilized as a rescue attempt once the primary approach had failed, constituting a potential limitation of the analysis in this category.

scholarly journals Angiographic Outcome of Endovascular Stroke Therapy Correlated with MR Findings, Infarct Growth, and Clinical Outcome in the DEFUSE 2 Trial

2014 ◽  
Vol 9 (7) ◽  
pp. 860-865 ◽  
Author(s):  
Michael P. Marks ◽  
Maarten G. Lansberg ◽  
Michael Mlynash ◽  
Stephanie Kemp ◽  
Ryan A. McTaggart ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Stroke Therapy ◽  
Endovascular Stroke Therapy

Endovascular stroke therapy: a single-center retrospective review

2011 ◽  
Vol 30 (6) ◽  
pp. E10 ◽  
Author(s):  
Jason S. Day ◽  
Michael C. Hurley ◽  
Mohamad Chmayssani ◽  
Rudy J. Rahme ◽  
Mark J. Alberts ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Retrospective Review ◽  
Recombinant Tissue Plasminogen Activator ◽  
Modified Rankin Scale ◽  
Stroke Therapy ◽  
Tissue Plasminogen ◽  
Endovascular Stroke Therapy

Object Endovascular treatment of acute ischemic stroke delivers direct therapy at the site of an occluded cerebral artery and can be employed beyond the 3–4.5-hour window limit set for intravenous recombinant tissue plasminogen activator. In this paper, the authors report their experience with various endovascular therapies in acute ischemic stroke. Methods The authors conducted a retrospective review of their clinical database for acute ischemic stroke in large-vessel cerebral territories that underwent endovascular treatment between May 2005 and February 2009. Endovascular treatment was defined as pharmacological and/or mechanical intervention, angioplasty, stenting, or a combination of these methods. Admission National Institutes of Health Stroke Scale and the modified Rankin Scale scores were recorded. Thrombolysis in Myocardial Infarction (TIMI) scores of 0, 1, 2A, 2B, and 3 were used to define recanalization. Results Forty procedures were performed in 39 patients, with 1 patient having sequential bilateral strokes. Nine patients were lost to follow-up after discharge. Strokes in the carotid artery circulation occurred in 82.5% of cases, and those in the vertebral-basilar territory occurred in 17.5%. The Merci device was used in 22 (55%) of 40 procedures, and the Penumbra device in 9 (22.5%) of 40. Angioplasty was performed in 15 (37.5%) of 40 procedures, and intraarterial recombinant tissue plasminogen activator was administered in 23 (57.5%) of 40 procedures. In 23 (57.5%) of 40 cases, multiple recanalization methods were used. The recanalization rate for all methods was 60%. The recanalization rate from TIMI Score 0/1 occlusions was 71.4% (20 of 28). An estimated modified Rankin Scale score of ≤ 2 was obtained in 11 (36.7%) of 30 cases. The overall mortality rate was 26.7% (8 of 30). Intracerebral hemorrhage at 24 hours postprocedure was noted in 17 (42.5%) of 40 cases, 3 (7.5%) of which were symptomatic. Conclusions The authors' institution performs endovascular stroke treatment with a safety and efficacy profile comparable to those of other major endovascular stroke therapy studies. Recanalization was associated with an improved clinical outcome. Protocols to maximize efficient triage of patients and better documentation of stroke treatments can assist in further studies.

Abstract TMP7: Endovascular Stroke Therapy Abrogates Sex-Related Differences in Recanalization in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sunil A Sheth ◽  
Steven Warach ◽  
Jan Gralla ◽  
Reza Jahan ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Functional Independence ◽  
Stent Retriever ◽  
Stroke Therapy ◽  
Procedural Time ◽  
History Of ◽  
Sex Disparities ◽  
The Impact ◽  
Endovascular Stroke Therapy

Background: Ischemic stroke affects women differently than men. Prior studies evaluating recanalization treatment with IV tpA showed that while women are more likely to achieve recanalization, there are strong sex disparities with respect to clinical outcome. We evaluated the effect of endovascular stroke therapy (ET) on recanalization and outcomes in women versus men. Methods: In the combined databases of the SWIFT, STAR, and SWIFT-PRIME trials, we identified patients treated with the Solitaire stent retriever to determine the effects of sex on recanalization and clinical outcome. Results: Among 389 patients treated with ET, mean age was 67±13, 55% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 [8-28]. There were no differences between females vs. males in presentation NIHSS (17 vs. 17, p=0.21), occlusion location (69% vs. 64% M1, p=0.62), or ASPECTS score (9 vs. 8, p=0.24). Rates of successful TICI 2b/3 recanalization were nearly identical (87% vs. 83%, p=0.374). There were no differences in onset to recanalization time (OTR) (277 vs. 306, p=0.46), procedural time (44 vs. 48 minutes, p=0.23), number of stent-retriever passes (1.7 vs. 1.8, p=0.17), rate of PH2 hemorrhage (1.9% vs. 1.1%, p=0.70), or functional independence at 90 days (53% vs. 56%, p=0.54). In ordinal multivariate analysis, collateral grade (OR 1.4, p=0.007) but not sex, age, or history of atrial fibrillation predicted improved TICI recanalization. In logistic (Figure) and ordinal regression analysis, the impact of delayed OTR was no different between men and women (1% versus 1.2% likelihood of worsened mRS outcome per 5 minute delay, p=0.27). Conclusions: In our prospective multicenter randomized cohort of nearly 400 patients undergoing ET, presentation and treatment characteristics of women were similar to men. Women were equally likely to achieve successful recanalization and good clinical outcomes.

scholarly journals Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 491-497
Author(s):  
Raul G. Nogueira ◽  
Diogo C. Haussen ◽  
David Liebeskind ◽  
Tudor G. Jovin ◽  
Rishi Gupta ◽  
...  
Keyword(s):  
Scale Score ◽  
Functional Disability ◽  
Time Window ◽  
Imaging Modality ◽  
Time Windows ◽  
Modified Rankin Scale ◽  
Extended Time ◽  
Stroke Therapy ◽  
Advanced Imaging ◽  
Endovascular Stroke Therapy

Background and Purpose: Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients. Methods: Patients from a prospective multicentric registry (n=2008) with occlusions involving the intracranial internal carotid or the M1- or M2-segments of the middle cerebral arteries, premorbid modified Rankin Scale score 0 to 2 and time to treatment 0 to 24 hours were categorized according to treatment times within the early (0–6 hour) or extended (6–24 hour) window as well as imaging modality with noncontrast computed tomography (NCCT)±CT angiography (CTA) or NCCT±CTA and CT perfusion (CTP). The association between imaging modality and 90-day modified Rankin Scale, analyzed in ordinal (modified Rankin Scale shift) and dichotomized (functional independence, modified Rankin Scale score 0–2) manner, was evaluated and compared within and across the extended and early windows. Results: In the early window, 332 patients were selected with NCCT±CTA alone while 373 also underwent CTP. After adjusting for identifiable confounders, there were no significant differences in terms of 90-day functional disability (ordinal shift: adjusted odd ratio [aOR], 0.936 [95% CI, 0.709–1.238], P =0.644) or independence (aOR, 1.178 [95% CI, 0.833–1.666], P =0.355) across the CTP and NCCT±CTA groups. In the extended window, 67 patients were selected with NCCT±CTA alone while 180 also underwent CTP. No significant differences in 90-day functional disability (aOR, 0.983 [95% CI, 0.81–1.662], P =0.949) or independence (aOR, 0.640 [95% CI, 0.318–1.289], P =0.212) were seen across the CTP and NCCT±CTA groups. There was no interaction between the treatment time window (0–6 versus 6–24 hours) and CT selection modality (CTP versus NCCT±CTA) in terms of functional disability at 90 days ( P =0.45). Conclusions: CTP acquisition was not associated with better outcomes in patients treated in the early or extended time windows. While confirmatory data is needed, our data suggests that extended window endovascular stroke therapy may remain beneficial even in the absence of advanced imaging.

scholarly journals Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis

2021 ◽  
pp. 197140092110091
Author(s):  
Hanna Styczen ◽  
Matthias Gawlitza ◽  
Nuran Abdullayev ◽  
Alex Brehm ◽  
Carmen Serna-Candel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Background Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

scholarly journals Recanalization and Angiographic Reperfusion Are Both Associated with a Favorable Clinical Outcome in the IMS III Trial

2016 ◽  
Vol 5 (3-4) ◽  
pp. 118-122 ◽  
Author(s):  
Marie L. Schmitz ◽  
Sharon D. Yeatts ◽  
Thomas A. Tomsick ◽  
David S. Liebeskind ◽  
Achala Vagal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Scale Score ◽  
Predictive Accuracy ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Arterial Tree ◽  
Stroke Treatment ◽  
Optimal Thresholds ◽  
Favorable Clinical Outcome

Background: Prompt revascularization is the main goal of acute ischemic stroke treatment. We examined which revascularization scale - reperfusion (modified Treatment in Cerebral Infarctions, mTICI) or recanalization (Arterial Occlusive Lesion, AOL) - better predicted the clinical outcome in ischemic stroke participants treated with endovascular therapy (EVT). Additionally, we determined the optimal thresholds for the predictive accuracy of each scale. Methods: We included participants from the Interventional Management of Stroke (IMS) III trial with complete occlusion in the internal carotid artery terminus or proximal middle cerebral artery (M1 or M2) who completed EVT within 7 h of symptom onset. The abilities of the AOL and mTICI scales to predict a favorable outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) were compared by receiver operating characteristic analyses. The maximal sensitivity and specificity for each revascularization scale were established. Results: Among 240 participants who met the study inclusion criteria, 79 (33%) achieved a favorable outcome. Higher scores of mTICI and AOL increased the likelihood of a favorable outcome (2.7% with mTICI 0 vs. 83.3% with mTICI 3, and 3.0% with AOL 0 vs. 43% with AOL 3). The accuracy of mTICI reperfusion and AOL recanalization for a favorable outcome prediction was similar, with optimal thresholds of mTICI 2b/3 and AOL 3, respectively. Conclusion: Reperfusion (mTICI) and recanalization (AOL) predicted a favorable clinical outcome with comparable accuracy in ischemic stroke participants treated with EVT. Optimal revascularization goals to maximize clinical outcome (modified Rankin Scale score of 0-2) consisted of complete recanalization (AOL 3) and reperfusion of at least 50% of the arterial tree of the symptomatic artery (mTICI 2b/3) in the IMS III trial setting.

scholarly journals Transcranial Color Coded Duplex Sonography Findings in Stroke Patients Undergoing Rehabilitation: An Observational Study

2022 ◽  
Author(s):  
Srikant Venkatakrishnan ◽  
Meeka Khanna ◽  
Anupam Gupta
Keyword(s):  
Clinical Outcome ◽  
Duplex Sonography ◽  
Modified Rankin Scale ◽  
Mean Flow ◽  
Stroke Patients ◽  
Symmetric Flow ◽  
Rehabilitation Outcomes ◽  
Outcome Scores ◽  
Color Coded Duplex Sonography ◽  
Flow Velocities

Abstract Background Transcranial color-coded duplex sonography (TCCD) provides information on intracranial blood flow status in stroke patients and can predict rehabilitation outcomes. Objective This study aimed to assess middle cerebral artery (MCA) parameters using TCCD in MCA territory stroke patients admitted for rehabilitation and correlate with clinical outcome measures. Material and Methods Patients aged 18 to 65 years with a first MCA territory stroke, within 6 months of onset were recruited. The clinical outcome scales and TCCD parameters were assessed at both admission and discharge. The scales used were the Scandinavian stroke scale (SSS), Barthel Index (BI), modified Rankin Scale (mRS), Fugl–Meyer upper extremity scale (FMA-UE), modified motor assessment scale (mMAS) scores. TCCD parameters measured were MCA peak systolic, end diastolic, mean flow velocities (MFV), and index of symmetry (SI) and were correlated with clinical scores. Results Fourteen patients were recruited with median age of 56.5 years, median duration of stroke was 42.5 days. Mean flow velocities of affected and unaffected MCA were 46.2 and 50.7 cm/s, respectively. Flow velocities and SI did not change between the two assessments. There was significant improvement in clinical outcome scores at discharge. Significant correlation was observed for patient group with SI > 0.9 at admission with FMA-UE, SSS, and BI scores at discharge (p < 0.05). Conclusion Flow velocity parameters did not change during in-patient rehabilitation. Patients with symmetric flow at admission had improved clinical outcomes measure scores at discharge. Thus SI can predict rehabilitation outcomes in stroke survivors.

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