Abstract WP66: Impaired Collaterals Are Associated With Intracranial Thrombus Extension: Evidence From MRI, Catheter Angiography, and Retrieved Thrombus Composition

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Neal M Rao ◽  
Kunakorn Atchaneeyasakul ◽  
Jiang Hongquan ◽  
Laura Solano ◽  
William H Yong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Academic Medical Centers ◽  
Spearman Correlation ◽  
Catheter Angiography ◽  
Endovascular Thrombectomy ◽  
Medical Centers ◽  
Academic Medical ◽  
Percent Composition ◽  
Hematoxylin And Eosin ◽  
Number Of Passes

Background: Clot propagation after initial occlusion may increase target thrombus burden and its pathophysiologic basis has not been extensively studied in acute human ischemic stroke. We investigated whether clot characteristics on MRI, catheter angiography, and thrombus histopathology indicated that impaired collaterals may be associated with extension of acute intracranial occlusions via stasis clotting in slow flow arterial segments. Methods: Analysis of consecutive AIS-LVO endovascular thrombectomy patients at 2 academic medical centers with: 1) pretreatment MRI, and 2) retrieved thrombi. GRE MR susceptibility vessel sign presence and extent of ASITN collateral scores were rated by blinded assessors. Extracted clots were fixed in formalin, stained by hematoxylin and eosin, and RBC, WBC and fibrin percent composition quantified by a neuropathologist blinded to clinical details. We evaluated the correlation of collateral grade with clot size by susceptibility vessel sign (SVS) and clot composition by RBC%. Non-parametric values were computed via Spearman correlation. Results: Among the 48 patients, mean age was 71.4 (SD 17.7), 56.3% female, and mean presenting NIHSS was 15.5 (SD 7.41). A susceptibility vessel sign was present in 65%, with mean SVS length 15.6 mm (SD 8.3). Collateral scores were mean 2.3 (SD 1.2). The number of passes per procedure was mean 1.98 (SD 1.30) The presence of a susceptibility vessel sign correlated with higher RBC% in retrieved thrombi (r s =0.36 p=0.011). Worse collateral grades correlated with longer SVS length (r s =-0.50 p=0.004) and greater SVS width (r s =-0.54 p=0.002). Worse collateral grade also trended toward correlation with higher RBC% in retrieved clots (r s =-0.19 p=0.18). Conclusion: Impaired angiographic collaterals are associated with longer RBC-rich thrombi on susceptibility imaging and trend toward association with higher RBC% in retrieved thrombi. These findings support that, in LVO acute ischemic stroke, clot propagation after initial occlusion occurs by stasis clotting accelerated by impaired collaterals.

Abstract TP7: Association of Retrieved Thrombus Composition With Measures of Thrombectomy Success

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Neal M Rao ◽  
Laura Solano ◽  
Kunakorn Atchaneeyasakul ◽  
Jiang Hongquan ◽  
Gornbein Jeffrey ◽  
...  
Keyword(s):  
Clinical Features ◽  
Academic Medical Centers ◽  
Endovascular Thrombectomy ◽  
Medical Centers ◽  
Academic Medical ◽  
First Pass ◽  
Thrombectomy Device ◽  
Stent Retrievers ◽  
Hematoxylin And Eosin ◽  
Number Of Passes

Introduction: Emboli retrieved from stroke patients undergoing mechanical thrombectomy vastly differ in histopathologic appearance, likely reflecting varying etiologies of stroke. We investigated whether clot components correlated with clinical features and thrombectomy outcomes. Methods: Retrieved thrombi from endovascular thrombectomy in consecutive AIS-LVO patients at 2 academic medical centers were fixed in formalin and sections stained by hematoxylin and eosin. The RBC, WBC and fibrin percentages of the clot were quantified by a neuropathologist blinded to the clinical details. We evaluated the association of these clot components, patient demographic and clinical features, with TICI score (both ordinal and dichotomized at 2c), AOL score, number of thrombectomy passes, and first-pass substantial recanalization (≥TICI 2b result on the first thrombectomy device pass). Non-parametric values were computed via Spearman correlation and pairwise interaction of clinical features was analyzed by ordinal logistic regression. Results: Among the 75 analyzed patients, mean age was 71.4 (SD 17.7), 50.7% were female and presenting NIHSS mean was 16.1 (SD 7.6). Devices employed were stent retrievers in 71% of patients, aspiration in 10%, and both stent retrievers and aspiration in 19%. Number of passes per procedure was mean 2.16 (SD 1.21). Substantial reperfusion (TICI 2B-3) was achieved in 88% and excellent reperfusion (TICI 2C-3) in 44%. In retrieved thrombi, mean RBC% was 44.8% (SD 31.9) and mean fibrin% was 49.8% (SD 31.4). Rates of first-pass substantial reperfusion, final substantial reperfusion, and final excellent reperfusion were homogenous across wide ranges of retrieved thrombus RBC% and fibrin% in correlation analysis. Conclusion: RBC and fibrin composition range widely among retrieved thrombi causing acute ischemic stroke. Current generation thrombectomy devices perform well across a broad range of clot compositions.

scholarly journals Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Stroke ◽  
2001 ◽  
Vol 32 (9) ◽  
pp. 2137-2142 ◽  
Author(s):  
Leslie Allison Gillum ◽  
S. Claiborne Johnston
Keyword(s):  
Ischemic Stroke ◽  
Academic Medical Centers ◽  
Stroke Outcomes ◽  
Medical Centers ◽  
Academic Medical

scholarly journals Utilization of Intravenous Tissue-Type Plasminogen Activator for Ischemic Stroke at Academic Medical Centers

Stroke ◽  
2001 ◽  
Vol 32 (5) ◽  
pp. 1061-1068 ◽  
Author(s):  
S. Claiborne Johnston ◽  
Lawrence H. Fung ◽  
Leslie A. Gillum ◽  
Wade S. Smith ◽  
Lawrence M. Brass ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Academic Medical Centers ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Medical Centers ◽  
Academic Medical ◽  
Type Plasminogen Activator

scholarly journals Characteristics of Academic Medical Centers Associated with Ischemic Stroke Outcome

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 382-382
Author(s):  
S. Claiborne Johnston ◽  
Leslie A Gillum
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Academic Medical Centers ◽  
Administrative Database ◽  
Hospital Death ◽  
Improvement Project ◽  
Medical Centers ◽  
Academic Medical ◽  
Hospital Deaths

P235 Background: Data supporting the efficacy of stroke center characteristics are limited. Methods: A questionnaire detailing stroke treatment practices was sent to 42 academic medical centers in the University Health Systems Consortium participating in a quality improvement project. In-hospital mortality of all emergency-department admissions for ischemic stroke at these institutions was evaluated in a large administrative database from 1997 through 1999. We used a multivariable method called generalized estimating equations, which broadens confidence intervals to adjust for clustering of variables at institutions. Using this technique, institutional characteristics were evaluated as predictors of in-hospital mortality after adjusting for age, gender, race, hospital treatment volume of ischemic stroke, and admission status (emergent, urgent, elective). Results: Thirty-two institutions completed the questionnaire and 29 of these were included in the administrative database. In-hospital deaths occurred in 758 (7.0%) of the 10,880 ischemic strokes admitted through the emergency department. In-hospital deaths were less frequent at hospitals with a vascular neurologist (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.36–0.74, p<0.001), and at those with guidelines stating that only neurologists could administer tPA (OR 0.65, 95% CI 0.49–0.88, p=0.004). There was a trend toward fewer deaths at hospitals with a dedicated stroke team available by pager (OR 0.76, 95% CI 0.56–1.04, p=0.09). The presence of a dedicated neurological intensive care unit, stroke unit, and written clinical pathway for stroke were not significantly associated with in-hospital death. Conclusions: Academic medical centers with a vascular neurologist and those with written guidelines limiting tPA administration to neurologists had lower rates of in-hospital mortality for ischemic stroke patients.

Abstract WMP9: National Trends in the Use of Endovascular Stroke Treatment at Academic Medical Centers (2009-15)

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Elan Guterman ◽  
Zachary D Threlkeld ◽  
Wade S Smith ◽  
Jay Chol Choi ◽  
Anthony S Kim
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Academic Medical Centers ◽  
Stroke Treatment ◽  
Negative Results ◽  
Medical Centers ◽  
Academic Medical ◽  
The Impact

Objective: To characterize temporal trends in the use of endovascular treatment (EVT) for acute ischemic stroke at academic medical centers in response to recent clinical trials. Background: Although endovascular devices for stroke were first cleared for marketing in 2004, initial clinical trials in 2013 failed to demonstrate efficacy and subsequent clinical trials beginning in 2014 were strongly positive. The impact of these data on practice patterns at academic medical centers, which perform most EVTs, is unknown. Methods: We identified all acute ischemic stroke hospitalizations at academic medical centers that were members in the University HealthSystem Consortium from October 2009 to July 2015 using International Classification of Disease, 9th revision codes 433.x1, 434.x1, and 436 for stroke and procedure code 39.74 for EVT. We compiled quarterly data on the number and proportion of stroke hospitalizations using EVT and we used segmented log-linear regression to identify temporal trends and to evaluate changes in trends at prespecified time points corresponding to the quarter in which pivotal trials were first reported. Results: From 2009-15, we identified 357,973 acute ischemic stroke hospitalizations at 161 medical centers. The proportion of stroke hospitalizations using EVT was 1.5% in 2009 and grew by 25% a year (95% CI 21% to 29%) to reach 3.1% in 2013. After negative results from the initial trials were reported in 2013, EVT use hovered between 2.5% and 2.7% (1% relative change per year; 95% CI -9% to +8%; p=0.004 for change in trend) until 2014 when the first positive trials were reported and EVT use jumped at a growth rate of 151% per year (95% CI 101% to 212%; p<0.001 for change in trend) to reach fully 4.7% of all stroke hospitalizations by 2015. Conclusion: The previously steady growth in EVT flattened in 2013, coincident with the initially negative results from clinical trials, but has dramatically increased since positive trials were first reported in 2014.

Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty

Hand ◽  
2020 ◽  
pp. 155894471989881 ◽  
Author(s):  
Taylor M. Pong ◽  
Wouter F. van Leeuwen ◽  
Kamil Oflazoglu ◽  
Philip E. Blazar ◽  
Neal Chen
Keyword(s):  
Risk Factors ◽  
Implant Removal ◽  
Academic Medical Centers ◽  
Implant Design ◽  
Factors Associated ◽  
Medical Centers ◽  
Total Wrist Arthroplasty ◽  
Academic Medical ◽  
Related Risk ◽  
Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed ( P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.

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