Abstract WP57: Acute Carotid Stenting Following Intracranial Thrombectomy Has Comparable Safety and Efficacy in Early versus Late Time Window Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amer Mitchelle ◽  
Fiona S Lau ◽  
Andrew Cheung ◽  
Jason Wenderoth ◽  
Alexander McQuinn ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Time Window ◽  
Time Windows ◽  
Early Time ◽  
Carotid Stenting ◽  
Late Time ◽  
Extracranial Internal Carotid Artery ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy

Introduction: Endovascular thrombectomy (EVT) is beneficial in late time window stroke. However, patients with tandem extracranial carotid and intracranial occlusions are under-represented in previous trials. We analysed our acute anterior circulation strokes with tandem occlusions treated with EVT and extracranial internal carotid artery stenting. Methods: A prospectively maintained database of EVT patients treated in two Australian comprehensive stroke centres between January 2016 and May 2019 was screened for acute anterior circulation ischaemic stroke patients treated with EVT and extracranial internal carotid artery stenting. The cohort was divided into patients treated in early ( < 6 hours from symptom onset) and late (>6 hours from symptom onset) time windows. Results: Endovascular thrombectomy with acute carotid stenting was performed in 96 patients (mean age 71years, 78.3% male, mean time to reperfusion 13.5 +/- 10.1 hours, median NIHSS 15). Treatment >6hours after symptom onset occurred in 61 (63.5%) patients. No significant difference was seen between the two groups with respect to age, sex, presenting NIHSS, or mTICI score. At 90-day follow-up, good functional outcome (mRS 0-2) was similar for patients treated in the late versus early time windows, 19 (54.3%) vs 34 (55.7%), p=0.89 respectively. No difference was seen for symptomatic intracranial haemorrhage, 5 (7.2%) vs 3 (8.1%) p=0.87, or mortality at 90-day follow-up, 15 (24.6%) vs 6 (17.1%) p=0.40. Conclusion: Carotid stenting in late time window has comparable safety and efficacy to early time window stroke.

scholarly journals MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome

2021 ◽  
Author(s):  
Silvia Pistocchi ◽  
Davide Strambo ◽  
Bruno Bartolini ◽  
Philippe Maeder ◽  
Reto Meuli ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Time Window ◽  
Early Time ◽  
Functional Independence ◽  
Late Time ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Automated Method ◽  
Key Points

Abstract Objective Impact of different MR perfusion software on selection and outcome of patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO) treated by endovascular thrombectomy (EVT) is unclear. We aimed at comparing two commercial MRI software, semi-automated with unadjusted (method A) and adjusted mask (method B), and fully automated (method C) in this setting. Methods MRI from 144 consecutive AIS patients with anterior circulation LVO was retrospectively analysed. All diffusion- and perfusion-weighted images (DWI-PWI) were post-processed with the three methods using standard thresholds. Concordance for core and hypoperfusion volumes was assessed with Lin’s test. Clinical outcome was compared between groups in patients who underwent successful EVT in the early and late time window. Results Mean core volume was higher and mean hypoperfusion volume was lower in method C than in methods A and B. In the early time window, methods A and B found fewer patients with a mismatch ratio ≤ 1.2 than method C (1/67 [1.5%] vs. 12/67 [17.9%], p = 0.0013). In the late time window, methods A and B found fewer patients with a mismatch ratio < 1.8 than method C (3/46 [6.5%] and 2/46 [4.3%] vs. 18/46 [39.1%], p ≤ 0.0002). More patients with functional independence at 3 months would not have been treated using method C versus methods A and B in the early (p = 0.0063) and late (p ≤ 0.011) time window. Conclusions MRI software for DWI-PWI analysis may influence patients’ selection before EVT and clinical outcome. Key Points • Method C detects fewer patients with favourable mismatch profile. • Method C might underselect more patients with functional independence at 3 months. • Software used before thrombectomy may influence patients’ outcome.

scholarly journals Evolution of Hypodensity on Non-Contrast CT in Correlation with Collaterals in Anterior Circulation Stroke with Successful Endovascular Reperfusion

2022 ◽  
Vol 11 (2) ◽  
pp. 446
Author(s):  
Michał Gębka ◽  
Anna Bajer-Czajkowska ◽  
Sandra Pyza ◽  
Krzysztof Safranow ◽  
Wojciech Poncyljusz ◽  
...  
Keyword(s):  
Time Window ◽  
Time Windows ◽  
Volume Ratio ◽  
Significant Negative Correlation ◽  
Artery Occlusion ◽  
Late Time ◽  
Anterior Circulation ◽  
Contrast Ct ◽  
The Impact

Introduction: The aim of the study was to assess the impact of collaterals on the evolution of hypodensity on non-contrast CT (NCCT) in anterior circulation stroke with reperfusion by mechanical thrombectomy (MT). Methods: We retrospectively included stroke patients with middle cerebral artery occlusion who were reperfused by MT in early and late time window. Artificial intelligence (AI)-based software was used to calculate of hypodensity volumes at baseline NCCT (V1) and at follow-up NCCT 24 h after MT (V2), along with the difference between the two volumes (V2-V1) and the follow-up (V2)/baseline (V1) volume ratio (V2/V1). The same software was used to classify collateral status by using a 4-point scale where the score of zero indicated no collaterals and the score of three represented contrast filling of all collaterals. The volumetric values were correlated with the collateral scores. Results: Collateral scores had significant negative correlation with V1 (p = 0.035), V2, V2− V1 and V2/V1 (p < 0.001). In cases with collateral score = 3, V2 was significantly smaller or absent compared to V1; in those with collateral score 2, V2 was slightly larger than V1, and in those with scores 1 and 0 V2 was significantly larger than V1. These relationships were observed in both early and late time windows. Conclusions: The collateral status determined the evolution of the baseline hypodensity on NCCT in patients with anterior circulation stroke who had MT reperfusion. Damage can be stable or reversible in patients with good collaterals while in those with poor collaterals tissues that initially appear normal will frequently appear as necrotic after 24 h. With good collaterals, it is stable or can be reversible while with poor collaterals, normal looking tissue frequently appears as necrotic in follow-up exam. Hence, acute hypodensity represents different states of the ischemic brain parenchyma.

scholarly journals Mobile Interventional Stroke Teams Improve Outcomes in the Early Time Window for Large Vessel Occlusion Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Jacob R. Morey ◽  
Xiangnan Zhang ◽  
Naoum Fares Marayati ◽  
Stavros Matsoukas ◽  
Emily Fiano ◽  
...  
Keyword(s):  
Scale Score ◽  
Time Window ◽  
Early Time ◽  
National Institutes Of Health ◽  
Large Vessel ◽  
Late Time ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Background and Purpose: Endovascular thrombectomy for large vessel occlusion stroke is a time-sensitive intervention. The use of a Mobile Interventional Stroke Team (MIST) traveling to Thrombectomy Capable Stroke Centers to perform endovascular thrombectomy has been shown to be significantly faster with improved discharge outcomes, as compared with the drip-and-ship (DS) model. The effect of the MIST model stratified by time of presentation has yet to be studied. We hypothesize that patients who present in the early window (last known well of ≤6 hours) will have better clinical outcomes in the MIST model. Methods: The NYC MIST Trial and a prospectively collected stroke database were assessed for patients undergoing endovascular thrombectomy from January 2017 to February 2020. Patients presenting in early and late time windows were analyzed separately. The primary end point was the proportion with a good outcome (modified Rankin Scale score of 0–2) at 90 days. Secondary end points included discharge National Institutes of Health Stroke Scale and modified Rankin Scale. Results: Among 561 cases, 226 patients fit inclusion criteria and were categorized into MIST and DS cohorts. Exclusion criteria included a baseline modified Rankin Scale score of >2, inpatient status, or fluctuating exams. In the early window, 54% (40/74) had a good 90-day outcome in the MIST model, as compared with 28% (24/86) in the DS model ( P <0.01). In the late window, outcomes were similar (35% versus 41%; P =0.77). The median National Institutes of Health Stroke Scale at discharge was 5.0 and 12.0 in the early window ( P <0.01) and 5.0 and 11.0 in the late window ( P =0.11) in the MIST and DS models, respectively. The early window discharge modified Rankin Scale was significantly better in the MIST model ( P <0.01) and similar in the late window ( P =0.41). Conclusions: The MIST model in the early time window results in better 90-day outcomes compared with the DS model. This may be due to the MIST capturing high-risk fast progressors at an earlier time point. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03048292.

Abstract P537: Patients With Similar Core Infarcts Presenting in Delayed Windows Have Worse Long-Term Outcomes Compared With Early Time Windows

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mahan Shahrivari ◽  
Sergio Salazar ◽  
Rania Abdelkhaleq ◽  
Victor Lopez-Rivera ◽  
Jerome Jeevarajan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Symptom Onset ◽  
Time Window ◽  
Propensity Score Analysis ◽  
Time Windows ◽  
Late Time ◽  
Infarct Core ◽  
Vessel Occlusion ◽  
Ischemic Time ◽  
Score Analysis

Introduction: Endovascular therapy (ET) in acute ischemic stroke (AIS) care has established clear improvements in clinical outcome. However, a large percentage of treated patients still do poorly, and the rate of good outcome remains relatively low, even in patients who achieve substantial reperfusion. While the importance of time and rapid reperfusion have been well described in AIS, the recent prominence of imaging-alone based selection criteria has brought the relevance of time into question. We hypothesize that ischemic time even in patients with comparable infarct cores at presentation still plays an important role in modifying outcome in patients with AIS and large vessel occlusion (LVO) treated with ET. Method: From our prospectively collected institutional registry across 4 comprehensive stroke centers, we identified consecutive patients with LVO AIS treated with ET from 1/2017 to 1/2020. Patients were included if they had anterior circulation LVO, successful reperfusion TICI 2b/3, and witnessed time of symptom onset. Propensity score analysis used among patients matched by age, NIHSS, occlusion location, ASPECTS, TICI score and infarct core to evaluate if time from onset to arrival affect the likelihood of mRS 0-2 at 90 days. Data are presented as median [IQR] or mean±SD. Results: Among 242 patients that met inclusion criteria, mean age was 67±13.8, 50% were female, median NIHSS was 16 [10], and mean time from symptom onset to arrival (SOA) was 4.17±0.19 (hrs.min). The most common locations of the occlusion included M1 47.1%, ICA 20.2 %, M2 13.2% and A1 1.2%. In univariable analysis, fewer patients in the late time window (SOA > 6 hrs) achieved 90d mRS 0-2 compared to patients in the early window, but this difference was not statistically significant (66%% vs 34%%, early vs. late, P=0.1, Fisher’s exact). Propensity score analysis showed that among matched patients, later SOA was associated with decreased likelihood of mRS 0-2 at 90 days (coef: -0.22 [0.37-0.60], P=0.007). Conclusion: In patients with successful endovascular reperfusion, those presenting in later time windows had worse outcomes compared to those presenting earlier, even after accounting for differences in presentation infarct core.

Abstract TP68: Predictive Value of CT Perfusion in Hyper Acute Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Varun Kumar Pala ◽  
Rahul Chandra ◽  
Aaron Ravelo ◽  
Christopher Hackett ◽  
Russell Cerejo
Keyword(s):  
Perfusion Imaging ◽  
Symptom Onset ◽  
Time Window ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Early Time ◽  
Imaging Data ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Core Volume

Introduction: Perfusion imaging has been an integral part in patient selection for Endovascular Thrombectomy (EVT) in the extended window. In studies evaluating perfusion imaging in the early window, the mean time from symptom onset to perfusion imaging was greater than 90 minutes. Objective: To determine the accuracy of perfusion imaging core volume compared to final infarct volume in patients presenting in the hyper acute period. Methods: We performed a retrospective analysis on a prospectively collected stroke data base from January 2018 to July 2019. We included patients with intracranial large vessel occlusion (anterior circulation) who presented within 90 minutes of symptom onset and underwent perfusion imaging with CT-perfusion (CT-P) with subsequent EVT. We collected demographics, clinical and imaging data as well as procedural variables. Final infarct volume on CTH or MRI brain (done> 24hr post EVT) was calculated manually using PACS volume analysis software. RAPID CT-P Software was used for core measurement and CBF<30% was used to predict core. Results: Out of 242 patients who underwent EVT, 22 (9%) patients met inclusion criteria. Of these, 32% (7/22) were males and 68 %( 15/22) were females. Median age was 79 yrs (interquartile range (IQR) 66.7 - 85.2) and median NIHSS was 16 (IQR 14 - 21). M1 occlusion was seen in 59% while, 27% had ICA terminus occlusion and 14% had proximal M2 occlusion. Median core volume pre EVT was 14.5ml (IQR 6.7 - 36.7) and final median infarct volume was 9.6ml (IQR 1.2 - 24.3). Most patients, had final infarct volume calculated on MRI 73 %( 16/22) while 27% (6/22) had follow up CTH. CT- P overestimated the final stroke volume in 55% (12/22 patients) of patients. In a subgroup of 5 patients who presented within 60 minutes of symptoms onset, 80% (4/5 patients) had an over estimated core on CT-P with a median predicted core of 29 ml (IQR 13 - 35) and median final infarct volume of 0.2ml (IQR 0.1 - 3.7). Conclusion: CT-P using CBF < 30% may overestimate the core infarct volume in patients presented in the hyper acute window (<90min). Caution is advised when utilizing CTP in the early time window.

Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept

2016 ◽  
Vol 9 (1) ◽  
pp. 66-69 ◽  
Author(s):  
Sandra Boned ◽  
Marina Padroni ◽  
Marta Rubiera ◽  
Alejandro Tomasello ◽  
Pilar Coscojuela ◽  
...  
Keyword(s):  
Cerebral Blood Volume ◽  
Time Window ◽  
Ct Perfusion ◽  
Early Time ◽  
Infarct Core ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Adjusted Logistic Regression ◽  
Contrast Ct

BackgroundIdentifying infarct core on admission is essential to establish the amount of salvageable tissue and indicate reperfusion therapies. Infarct core is established on CT perfusion (CTP) as the severely hypoperfused area, however the correlation between hypoperfusion and infarct core may be time-dependent as it is not a direct indicator of tissue damage. This study aims to characterize those cases in which the admission core lesion on CTP does not reflect an infarct on follow-up imaging.MethodsWe studied patients with cerebral large vessel occlusion who underwent CTP on admission but received endovascular thrombectomy based on a non-contrast CT Alberta Stroke Program Early CT Score (ASPECTS) >6. Admission infarct core was measured on initial cerebral blood volume (CBV) CTP and final infarct on follow-up CT. We defined ghost infarct core (GIC) as initial core minus final infarct >10 mL.Results79 patients were studied. Median National Institutes of Health Stroke Scale (NIHSS) score was 17 (11–20), median time from symptoms to CTP was 215 (87–327) min, and recanalization rate (TICI 2b–3) was 77%. Thirty patients (38%) presented with a GIC >10 mL. GIC >10 mL was associated with recanalization (TICI 2b–3: 90% vs 68%; p=0.026), admission glycemia (<185 mg/dL: 42% vs 0%; p=0.028), and time to CTP (<185 min: 51% vs >185 min: 26%; p=0.033). An adjusted logistic regression model identified time from symptom to CTP imaging <185 min as the only predictor of GIC >10 mL (OR 2.89, 95% CI 1.04 to 8.09). At 24 hours, clinical improvement was more frequent in patients with GIC >10 mL (66.6% vs 39%; p=0.017).ConclusionsCT perfusion may overestimate final infarct core, especially in the early time window. Selecting patients for reperfusion therapies based on the CTP mismatch concept may deny treatment to patients who might still benefit from reperfusion.

scholarly journals Unattended Emotional Prosody Affects Visual Processing of Facial Expressions in Mandarin-Speaking Chinese: A Comparison With English-Speaking Canadians

2021 ◽  
pp. 002202212199089
Author(s):  
Pan Liu ◽  
Simon Rigoulot ◽  
Xiaoming Jiang ◽  
Shuyi Zhang ◽  
Marc D. Pell
Keyword(s):  
Visual Processing ◽  
Time Window ◽  
Early Time ◽  
Cross Cultural ◽  
Late Time ◽  
Cultural Comparison ◽  
Emotional Prosody ◽  
Eastern Culture ◽  
Cross Cultural Comparison ◽  
English Speaking

Emotional cues from different modalities have to be integrated during communication, a process that can be shaped by an individual’s cultural background. We explored this issue in 25 Chinese participants by examining how listening to emotional prosody in Mandarin influenced participants’ gazes at emotional faces in a modified visual search task. We also conducted a cross-cultural comparison between data of this study and that of our previous work in English-speaking Canadians using analogous methodology. In both studies, eye movements were recorded as participants scanned an array of four faces portraying fear, anger, happy, and neutral expressions, while passively listening to a pseudo-utterance expressing one of the four emotions (Mandarin utterance in this study; English utterance in our previous study). The frequency and duration of fixations to each face were analyzed during 5 seconds after the onset of faces, both during the presence of the speech (early time window) and after the utterance ended (late time window). During the late window, Chinese participants looked more frequently and longer at faces conveying congruent emotions as the speech, consistent with findings from English-speaking Canadians. Cross-cultural comparison further showed that Chinese, but not Canadians, looked more frequently and longer at angry faces, which may signal potential conflicts and social threats. We hypothesize that the socio-cultural norms related to harmony maintenance in the Eastern culture promoted Chinese participants’ heightened sensitivity to, and deeper processing of, angry cues, highlighting culture-specific patterns in how individuals scan their social environment during emotion processing.

scholarly journals Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3465-3470 ◽  
Author(s):  
Byungjun Kim ◽  
Cheolkyu Jung ◽  
Hyo Suk Nam ◽  
Byung Moon Kim ◽  
Young Dae Kim ◽  
...  
Keyword(s):  
Time Window ◽  
Late Time ◽  
Endovascular Thrombectomy

scholarly journals Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results.

2019 ◽  
Author(s):  
Massimo Gamba ◽  
Nicola Gilberti ◽  
Enrico Premi ◽  
Angelo Costa ◽  
Michele Frigerio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Safety Profile ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage

Abstract Background and Purpose endovascular therapy (ET) is the standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). The role of adjunctive intravenous thrombolysis (IVT) in these patients is still unclear. The present study aims to test whether IVT plus ET (CoT, combined therapy) provides additional benefits over direct ET for anterior circulation AIS by LVO. Methods we performed a single center retrospective observational study of patients with AIS caused by anterior circulation LVO, referred to our center between January 2014 and January 2017 and treated with ET. The patients were divided in 2 groups based on the treatment they received: CoT and, if IVT contraindicated, direct ET. We compared functional recovery (modified Rankin at 3-months follow-up), recanalization rate (thrombolysis in cerebral infarction [TICI] score) and time, early follow-up infarct volume (EFIV) (for recanalized patients only) as well as safety profile, defined as symptomatic intracerebral hemorrhage (sICH) and 3-month mortality, between groups. Results 145 subjects were included in the study, 70 in direct ET group and 75 in CoT group. Patients who received CoT presented more frequently a functional independence at 3-months follow-up compared to patients who received direct ET (mRS score 0-1: 48.5% vs 18.6%; P<0.001. mRS score 0-2: 67.1% vs 37.3%; P<0.001), higher first-pass success rate (62.7% vs 38.6%, P<0.05), higher recanalization rate (84.3% vs 65.3%; P=0.009) and, in recanalized subjects, smaller EFIV (16.4ml vs 62.3ml; P=0.003). The safety profile was similar for the 2 groups. In multivariable regression analysis, low baseline NIHSS score (P<0.05), vessel recanalization (P=0.05) and CoT (P=0.03) were indipendent predictors of 3-month favorable outcome. Conclusions CoT appears more effective than ET alone for anterior circulation AIS with LVO, with similar safety profile.

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