Abstract WMP11: Safety and Efficacy of Mechanical Thrombectomy in Patients With Minor Stroke Due to Large Vessel Occlusion- Insights From the STAR Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sami Al Kasab ◽  
Eyad Almallouhi ◽  
Ali Alawieh ◽  
Reda M Chalhoub ◽  
Marios Psychogios ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Severe Symptom ◽  
Large Vessel ◽  
Minor Stroke ◽  
Complication Rates ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Safety And Efficacy ◽  
Excellent Outcome ◽  
Symptom Group

Introduction: Mechanical thrombectomy (MT) is the current standard of care treatment for patients presenting with severe symptoms due to large vessel occlusion (LVO); approximately 30% of patients with LVO however present with mild symptoms (NIHSS < 6). The safety and efficacy of MT in this group has not yet been established. The purpose of this study is to evaluate the safety of MT in patients presenting with mild symptoms due to LVO in a large multicenter registry. Methods: STAR registry combined the prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe and Asia. Patients who underwent MT were included in these analyses. Baseline features, risk factors, location of occlusion, time from symptom onset, tPA receipt, procedural complication rates, symptomatic hemorrhage, and long-term functional outcome were compared between patients with mild symptoms (NIHSS < 6) to those with severe symptoms (NIHSS ≥ 6). Results: Total of 2,114 patients were included in this analysis. Of those, 162 patients presented with NIHSS ≥ 6. Baseline features and outcomes are summarized in table 1. There was no difference in age, or sex, tPA receipt, number of attempts, rate of successful revascularization, symptomatic hemorrhage, or length of hospital stay. Median ASPECTS score was 9 in the mild Vs 8 in the severe symptom group (p=< 0.001), there was a higher percentage of patients in the mild symptom group with hypertension, hyperlipidemia, and LVO in the posterior circulation. Conversely there were more patients with atrial fibrillation in the severe symptom group. Excellent outcome (mRS 0-2 at 90 days) was achieved in 69.8% patients in the mild group compared to 38.3% in the severe group, p=<0.001) Conclusion: In patients with minor symptoms due to large vessel occlusion, mechanical thrombectomy appears to be safe with low complication rates. Approximately seventy percent of patients achieved excellent functional recovery. Table 1:

scholarly journals Mechanical Thrombectomy for Minor Stroke Patients (NIHSS <6) With Large Vessel Occlusion

2018 ◽  
Vol 24 (2) ◽  
pp. 67-70
Author(s):  
Çetin Kürşad Akpınar ◽  
Erdem Gürkaş ◽  
Emrah Aytaç ◽  
Murat Çalık
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Abstract 1122‐000220: Analysis of Protein Network to Predict Cognition Among Emergent Large Vessel Occlusion Undergoing Mechanical Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Chintan Rupareliya ◽  
Jacqueline A Frank ◽  
Benton Maglinger ◽  
Madison Sands ◽  
Christopher J McLouth ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Minor Stroke ◽  
Biological Processes ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Severe Stroke ◽  
Arterial Blood

Introduction : Emergent Large Vessel Occlusion (ELVO) strokes are devastating ischemic vascular events that can cause severe and permanent impairment. The purpose of the current study is to investigate interactions among different proteins at the time of mechanical thrombectomy (MT) which correlates to Montreal Cognitive Assessment (MOCA) scores at discharge and at 90‐day follow‐up. Methods : The Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC) study is a continually enrolling tissue bank (clinicaltrials.gov NCT03153683) and registry from stroke patients undergoing mechanical thrombectomy. Blood samples from systemic arterial blood (internal carotid artery) of twenty‐three patients were collected and sent to Olink Proteomics (Olink Proteomics, Boston, Massachusetts, USA) for analysis of protein expression of 92 cardiometabolic proteins and 92 inflammatory proteins. To determine which proteins had the most significant changes based on MOCA scoring, a series of 184 paired t‐tests were performed. Within each panel, proteins were then ranked based on the associated p values. Benjamini and Hochberg’s linear step‐up procedure was used to control the false discovery rate at 0.05. Pearson Correlation revealed proteins that were significantly related to the patients’ s discharge MOCA score as well as 90‐day follow‐up MOCA. Data and network analyses were performed using IBM SPSS Statistics, SAS v 9.4, and STRING V11. Common proteins between the discharge day miniMoCA and 90 days MOCA were identified. Network of these protein associations was created and biological processes correlating with these networks were identified. Results : Twenty‐two patients (15 with discharge day MiniMOCA and 7 with 90 days MOCA) were included in the analysis. Of these patients, 14 were females, and 9 were obese (BMI>30). 2 had minor stroke (NIHSS: 1–4), 13 had moderate stroke at admission (NIHSS: 5–15), 4 had moderate to severe stroke (NIHSS: 16–20), and 2 patients had severe stroke (NIHSS > 21). 19 patients had associated comorbidities (hypertension, diabetes, and hyperlipidemia). Mean last known normal to thrombectomy completion time was 621 + 333 minutes and mean infarct volume was 18,271 + 16,534 mm3. The 9 overlapping proteins from discharge to 90‐day follow up were later analyzed using interconnected STRING to determine association network and proteomic biological functions. Nine proteins include: DPP4, NCAM1, TGFBI, PRCP, APOM, TIE1, QPCT, MEGF9, and IGFBP3. Biological processes relating to the network of 9 proteins are depicted in table 1. Conclusions : This study uncovers network proteins that play a significant role in cognitive outcomes following ischemic stroke. This will allow future studies to develop predictive biomarkers for treatment and proteomic targets for adjunctive therapies to thrombectomy to improve our ability to treat cognitive dysfunction in ELVO stroke patients.

scholarly journals Safety and Efficacy of Intra-arterial Urokinase After Failed, Unsuccessful, or Incomplete Mechanical Thrombectomy in Anterior Circulation Large-Vessel Occlusion Stroke

2020 ◽  
Vol 77 (3) ◽  
pp. 318 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Sebastian Bellwald ◽  
Tomas Dobrocky ◽  
Thomas R. Meinel ◽  
Eike I. Piechowiak ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Safety And Efficacy

Abstract 172: Bridging Therapy versus Intravenous Thrombolysis in Minor Stroke With Large Vessel Occlusion. A French Multicentric Observational Study (MINOR-STROKE)

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pierre Seners ◽  
Claire Perrin ◽  
Guillaume Turc ◽  
. on behalf of the Minor-Stroke Collaborators
Keyword(s):  
Propensity Score ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Bridging Therapy ◽  
Vessel Occlusion ◽  
Potential Harm ◽  
Stroke Units ◽  
Excellent Outcome

Introduction: Whether bridging therapy (endovascular therapy [EVT] plus intravenous thrombolysis [IVT]) is superior to IVT alone in minor strokes with large vessel occlusion (LVO) is unknown. Methods: MINOR-STROKE was a multicentric retrospective cohort collecting data of IVT-treated minor strokes (NIHSS≤5) with LVO (ICA, M1 or M2; with central reading) treated with or without additional EVT in 45 French stroke units. Patients immediately intended for additional EVT -including those who eventually did not receive EVT- were analyzed in the bridging group, whereas patients initially intended for IVT alone -including those who eventually received rescue EVT- were analyzed in the IVT group. Propensity-score (inverse probability of treatment weighting) was used to reduce baseline between-groups differences. The primary outcome was excellent outcome defined as mRS 0-1 at 3 month. Results: Overall, 965 patients were included (237 and 728 in the bridging therapy and IVT groups, respectively). The distribution of all baseline clinical and radiological variables across the 2 groups were similar following propensity-score weighting. Compared with IVT alone, bridging therapy was not associated with better excellent outcome (OR=0.99; 95%CI 0.79-1.24; P =0.95), but was associated with higher risks of symptomatic intracranial haemorrhage (OR=2.39; 95%CI 1.51-3.80; P <0.001). However, occlusion site was a strong modifier of the effect of bridging therapy on excellent outcome (P interaction <0.0001), bridging therapy seeming beneficial in isolated ICA (OR=2.75; 95%CI 1.23 6.13; P =0.01) and proximal M1±ICA (OR=3.63; 95%CI 1.94-6.79; P <0.0001), neutral for distal M1±ICA (OR=0.96; 95%CI 0.63-1.48; P =0.87) but deleterious for M2±ICA (OR=0.54; 95%CI 0.38-0.75; P <0.001) occlusions. Bridging therapy was only associated with sICH in patients with M2 occlusions (OR=4.73; 95%CI 2.35-9.49; P <0.0001). Conclusion: Overall, we observed similar outcomes with bridging therapy or IVT alone in minor strokes with LVO. However, our data suggest benefit of bridging therapy in patients with ICA or proximal M1 occlusion and potential harm through sICH in patients with M2 occlusion. Randomized trials are strongly commended to confirm these results.

scholarly journals Comparison of Risk Factors, Safety, and Efficacy Outcomes of Mechanical Thrombectomy in Posterior vs. Anterior Circulation Large Vessel Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Joshua Mbroh ◽  
Khouloud Poli ◽  
Johannes Tünnerhoff ◽  
Alexandra Gomez-Exposito ◽  
Yi Wang ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Posterior Circulation ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Safety And Efficacy ◽  
Favorable Functional Outcome

Background and Purpose: It is believed that stroke occurring due to posterior circulation large vessel occlusion (PCLVO) and that occurring due to anterior circulation large vessel occlusion (ACLVO) differ in terms of their pathophysiology and the outcome of their acute management in relation to endovascular mechanical thrombectomy (MT). Limited sample size and few randomized controlled trials (RCTs) with respect to PCLVO make the safety and efficacy of MT, which has been confirmed in ACLVO, difficult to assess in the posterior circulation. We therefore conducted a meta-analysis to study to which extent MT in PCLVO differs from ACLVO.Materials and Methods: We searched the databases PubMed, Cochrane, and EMBASE for studies published between 2010 and January 2021, with information on risk factors, safety, and efficacy outcomes of MT in PCLVO vs. ACLVO and conducted a systematic review and meta-analysis; we compared baseline characteristics, reperfusion treatment profiles [including rates of intravenous thrombolysis (IVT) and onset-to-IVT and onset-to-groin puncture times], recanalization success [Thrombolysis In Cerebral Infarction scale (TICI) 2b/3], symptomatic intracranial hemorrhage (sICH), and favorable functional outcome [modified Rankin Score (mRS) 0–2] and mortality at 90 days.Results: Sixteen studies with MT PCLVO (1,172 patients) and ACLVO (7,726 patients) were obtained from the search. The pooled estimates showed higher baseline National Institutes of Health Stroke Scale (NIHSS) score (SMD 0.32, 95% CI 0.15–0.48) in the PCLVO group. PCLVO patients received less often IVT (OR 0.65, 95% CI 0.53–0.79). Onset-to-IVT time (SMD 0.86, 95% CI 0.45–1.26) and onset-to-groin puncture time (SMD 0.59, 95% CI 0.33–0.85) were longer in the PCLVO group. The likelihood of obtaining successful recanalization and favorable functional outcome at 90 days was comparable between the two groups. PCLVO was, however, associated with less sICH (OR 0.56, 95% CI 0.37–0.85) but higher mortality (OR 1.92, 95% CI 1.46–2.53).Conclusions: This meta-analysis indicates that MT in PCLVO may be comparably efficient in obtaining successful recanalization and 90 day favorable functional outcome just as in ACLVO. Less sICH in MT-treated PCLVO patients might be the result of the lower IVT rate in this group. Higher baseline NIHSS and longer onset-to-IVT and onset-to-groin puncture times may have contributed to a higher 90 day mortality in PCLVO patients.

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