Rescue, Combined, and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study

Introduction : In‐hospital stroke (IHS) is defined as stroke that occurs during hospitalization for non‐stroke conditions. We aimed to understand the timing of symptom recognition for patients who experienced IHS and its impact on the care they receive. Methods : A prospective, single center registry of adult patients (9/20/19‐2/28/21) was queried for acute anterior circulation IHS. Indications for hospitalization, delays from last known well (LKW) to symptom recognition, imaging, and treatment were explored. Results : Of 928 consecutively evaluated adults with acute stroke, 85 (9%) developed an anterior circulation IHS, 39 (46%) of whom were female, with a median age of 67 years (IQR 60–76) and median NIHSS of 15 (IQR 4–22). Sixty‐eight (80%) had a >1 hour delay from last known well to symptom recognition. Two patients (2%) received IV thrombolysis, although another 38 (45%) would have been eligible if not for a delay in symptom recognition. An ICA, M1, or M2 occlusion was observed in 18 patients (21%), 7 of whom were treated at a median of 174 minutes after LKW (IQR 65–219). Compared to the 11 patients who did not undergo thrombectomy with large vessel occlusion, those who underwent thrombectomy had non‐significantly shorter delays from LKW until neuroimaging (median 85 [IQR 65‐162] vs. 216 [IQR 133‐507], p = 0.12). Conclusions : While uncommon, patients with IHS experience delays in symptom recognition and treatment, which lead to exclusion from acute care treatment such as thrombolysis and thrombectomy. Earlier detection with more frequent nursing assessments or advanced neuromonitoring devices in at‐risk patients may reduce delays in care.

Download Full-text

Abstract WP268: Evaluation and Validation of Prehospital Acute Stroke Severity Scale to Predict Large Vessel Occlusion in Patients with Proven Large Vessel Occlusion; Single Center Study in US

Stroke ◽

10.1161/str.48.suppl_1.wp268 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Muhammad H Niazi ◽

Mohammad El-Ghanem ◽

Alicia Richardson ◽

Kathy Morrison ◽

Reichwein Raymond ◽

...

Keyword(s):

Hospital Setting ◽

High Sensitivity ◽

Final Analysis ◽

Large Vessel ◽

P Value ◽

Stroke Severity ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Single Center Study

Background: In 2015 guidelines regarding endovascular treatment (ET) of Large Vessel Occlusion (LVO) in acute ischemic stroke (AIS) were changed, leading to more patients being transferred to comprehensive stroke centers (CSC) for ET in selected patients, sometimes bypassing primary stroke centers. In the era of ET, there is a need for a simple yet sensitive pre-hospital tool to triage appropriate patients to CSCs. Many prehospital stroke scales predicting LVO are not in widespread clinical use because they are complex and not reliable. A recently published Denmark study demonstrated the PASS tool (Score range 0-3) for detecting LVO where a score of ≥2 was considered to be optimal in predicting LVO with sensitivity of 0.66. Methods: A retrospective analysis of AIS patients with confirmed anterior circulation LVO by catheter-based cerebral angiography between January 2015 and June 2016 was conducted. PASS scores were calculated and correlated with NIHSS to assess for severity of the stroke. Results: Fifty-four patients received ET during the study period. Those who had posterior circulation LVO were excluded, leaving 44 patients for final analysis. Only 5 (11.4%) patients had PASS score of <2 while 39 patients (88.6 %) had a score of ≥2 showing sensitivity of 0.89 for those patients with LVO. Average NIHSS scores were 11 (95% CI 6.6-15) for PASS <2 and 20 (95% CI 18.5-22.5) for PASS ≥2 (p value 0.005). Conclusion: The PASS tool is simple, quick, and easy to perform and has high sensitivity in AIS patients with LVO. To assess its value and efficacy in real time it should be implemented into EMS systems and be performed in the pre-hospital setting.

Download Full-text

Role of Favorable Perfusion Imaging in Predicting the Outcome of Patients with Acute Ischemic Stroke due to Large Vessel Occlusion Undergoing Effective Thrombectomy: A Single-Center Study

Cerebrovascular Diseases Extra ◽

10.1159/000513025 ◽

2021 ◽

pp. 1-8

Author(s):

Riccardo Di Iorio ◽

Fabio Pilato ◽

Iacopo Valente ◽

Andrea Laurienzo ◽

Simona Gaudino ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Controlled Study ◽

Ischemic Penumbra ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Single Center Study

Introduction: We sought to verify the predicting role of a favorable profile on computed tomography perfusion (CTP) in the outcome of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing effective mechanical thrombectomy (MT). Methods: We retrospectively enrolled 25 patients with AIS due to LVO and with a CTP study showing the presence of ischemic penumbra who underwent effective MT, regardless of the time of onset. The controls were 25 AIS patients with overlapping demographics and clinical and computed tomography angiography features at admission who had undergone successful MT within 6 h from onset and without a previous CTP study. The outcome measure was the modified Rankin Scale (mRS) score at 90 days. Results: Sixty-four percent of the study patients had an mRS score of 0–1 at 90 days versus 12% of the control patients (p < 0.001). Patients of the study group had a more favorable distribution of disability scores (median mRS [IQR] score of 0 [0–2] vs. 2 [2–3]). Multivariate analysis showed that the selection of patients based on a favorable CTP study was strongly associated (p < 0.001) with a better neurological outcome. Conclusions: In our small-sized and retrospective study, the presence of ischemic penumbra was associated with a better clinical outcome in patients with AIS due to LVO after MT. In the future, a larger and controlled study with similar criteria of enrollment is needed to further validate the role of CTP in patient selection for MT, regardless of the time from the onset of symptoms.

Download Full-text

Corrigendum: Learning Curve for Endovascular Treatment of Anterior Circulation Large Vessel Occlusion at a Single Center

Frontiers in Neurology ◽

10.3389/fneur.2021.703055 ◽

2021 ◽

Vol 12 ◽

Author(s):

Qiankun Cai ◽

Yuyou Zhu ◽

Xianjun Huang ◽

Lulu Xiao ◽

Mengmeng Gu ◽

...

Keyword(s):

Learning Curve ◽

Endovascular Treatment ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Single Center ◽

Anterior Circulation ◽

Vessel Occlusion

Download Full-text

Open Embolectomy of Large Vessel Occlusion in the Endovascular Era: Results of a 12-Year Single-Center Experience

World Neurosurgery ◽

10.1016/j.wneu.2017.02.108 ◽

2017 ◽

Vol 102 ◽

pp. 65-71 ◽

Cited By ~ 3

Author(s):

Tetsuyoshi Horiuchi ◽

Junpei Nitta ◽

Yoshinari Miyaoka ◽

Alhusain Nagm ◽

Keiji Tsutsumi ◽

...

Keyword(s):

Large Vessel ◽

Large Vessel Occlusion ◽

Single Center ◽

Vessel Occlusion ◽

Single Center Experience

Download Full-text

Abstract 46: Six of One, Half a Dozen of the Other: Single-Center Retrospective Comparison of Prehospital Large Vessel Occlusion Tools

Stroke ◽

10.1161/str.49.suppl_1.46 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

David Ermak ◽

Alicia Richardson ◽

Chelsea Hogan ◽

Amy Brinkley ◽

Muhammad Niazi ◽

...

Keyword(s):

The Other ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Single Center ◽

Vessel Occlusion ◽

Retrospective Comparison

Download Full-text

Clinical Impact of Large Vessel Occlusion Achieved First Pass Effect with Stent Retriever Alone: A Single-Center Retrospective Analysis

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.oa.2021-0063 ◽

2021 ◽

Author(s):

Marie Tsunogae ◽

Satoru Fujiwara ◽

Nobuyuki Ohara ◽

Yasutaka Murakami ◽

Kota Maekawa ◽

...

Keyword(s):

Retrospective Analysis ◽

Clinical Impact ◽

Stent Retriever ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Single Center ◽

Vessel Occlusion ◽

First Pass Effect ◽

First Pass

Download Full-text

Learning Curve for Endovascular Treatment of Anterior Circulation Large Vessel Occlusion at a Single Center

Frontiers in Neurology ◽

10.3389/fneur.2020.587409 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qiankun Cai ◽

Yuyou Zhu ◽

Xianjun Huang ◽

Lulu Xiao ◽

Mengmeng Gu ◽

...

Keyword(s):

Learning Curve ◽

Endovascular Treatment ◽

Functional Independence ◽

Large Vessel ◽

Cusum Chart ◽

Large Vessel Occlusion ◽

Single Center ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Curve Effect

Background and purpose: Data concerning the learning curve for endovascular treatment (EVT) of anterior circulation large vessel occlusion are scarce. This study aimed to investigate the relationship between operator experience and the outcome of EVT and to further identify the number of cases needed to acquire the ability to perform successful reperfusion.Materials and methods: Four hundred and thirty-four patients who underwent EVT by seven operators at a single center from January 2016 to September 2019 were enrolled. Procedural experience was defined by the number of cases performed by each operator. Multivariable backward regression analyses were used to investigate the association between procedural experience and functional independence (defined as a modified Rankin Scale score of 0–2), 90-days mortality, successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3), and puncture-to-reperfusion time after adjusting for covariates. A risk-adjusted cumulative sum (RA-CUSUM) chart was utilized to identify the number of caseloads needed to overcome the learning curve effect.Results: Procedural experience was independently associated with functional independence, 90-days mortality, successful reperfusion, and puncture-to-reperfusion time reduction (per 10-case increment: OR 1.219, 95% CI: 1.079–1.383, P < 0.001; OR 0.847, 95% CI: 0.738–0.968, P = 0.016; OR 1.553, 95% CI: 1.332–1.830, P < 0.001 and β 8.087 min, 95% CI: 6.184–9.991, P < 0.001, respectively). The RA-CUSUM chart indicated that at least 29 cases were required to overcome the learning curve effect.Conclusions: There was a dose-response relationship between operator case volume and clinical outcome, procedure time, and successful reperfusion. The experience needed for successful EVT was at least 29 cases.

Download Full-text