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 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

The Safety and Feasibility of Mechanical Thrombectomy for Mild Acute Ischemic Stroke With Large Vessel Occlusion

Neurosurgery ◽  
2019 ◽  
Vol 86 (6) ◽  
pp. 802-807 ◽  
Author(s):  
Gabor Toth ◽  
Santiago Ortega-Gutierrez ◽  
Jenny P Tsai ◽  
Russell Cerejo ◽  
Sami Al Kasab ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Invasive Procedure ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Abstract BACKGROUND Prospective evidence to support mechanical thrombectomy (MT) for mild ischemic stroke with large vessel occlusion (LVO) is lacking. There is uncertainty about using an invasive procedure in patients with mild symptoms. OBJECTIVE To evaluate the safety and feasibility of MT in patients with mild symptoms and LVO. METHODS Our single-arm prospective pilot study recruited patients with LVO and initial National Institute of Health Stroke Scale (NIHSS) &lt;6, who underwent standard MT. Primary safety endpoints were symptomatic intracerebral hemorrhage (sICH), and/or worsening NIHSS by ≥4 points. Secondary endpoints included angiographic recanalization, NIHSS change, final infarct volume, and modified Rankin score (mRS). RESULTS We enrolled 20 patients (mean age 65.6 ± 12.3 yr; 45% females). Thrombolysis in Cerebral Ischemia 2B/3 thrombectomy was achieved in 95%. No patients suffered sICH. One patient (5%) had neurologic worsening within 24 h because of underlying intracranial stenosis. No other complications or safety concerns were identified. Median NIHSS was significantly better at discharge (0.5, P = .007) and at last follow-up (0, P &lt; .001) than before treatment (3). Mean post vs preintervention infarct volumes were small without significant difference (1.2 ml, P = .434). Most patients (85%) were discharged directly home. Excellent clinical outcome (mRS 0-1) at last follow-up was seen in 95% of patients. CONCLUSION This is one of the first specifically designed prospective studies showing that MT is safe and feasible in patients with low NIHSS and LVO. Chronic underlying vasculopathy may be a challenging dilemma. We observed excellent clinical and radiographic outcomes, but randomized controlled trials are needed to demonstrate the efficacy of MT in this unique cohort.

Abstract 1122‐000189: Is Neutrophilia a Risk Factor for Fast Stroke Progression in Large Vessel Occlusion?

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Jawad Kirmani ◽  
Farah Fourcand ◽  
Nancy Gadallah ◽  
Arifa Ghori ◽  
Danisette Torres ◽  
...  
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Mechanical Thrombectomy ◽  
Statistical Significance ◽  
Large Vessel ◽  
Neurological Deficits ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Ct Head

Introduction : Rapid stroke progressors with large vessel occlusion (LVO) have a worse prognosis than their time‐matched cohorts receiving IV thrombolytics and/or mechanical thrombectomy. Our objective was to evaluate the association of neutrophilia with rapid stroke progression. Methods : Initial white blood cell (WBC) and absolute neutrophil counts (ANC) were collected for subjects presenting with acute ischemic stroke secondary to LVO who received IV thrombolytics and/or mechanical thrombectomy within 4.5 and 6 hours, respectively. Rapid stroke progression was determined by Alberta Stroke Program Early CT Score (ASPECTS) on initial CT head. Baseline and discharge NIHSS, age, and follow up mRS were also compared to presenting WBC and ANC. Spearman’s rho was used for correlation. Social Science Statistics was used for data analysis. Results : From October 2020 to April 2021, the association between neurophilia and stroke progression was evaluated in 19 subjects receiving tenecteplase (n = 16; 6 females; age, 63.25 95% CI [54.9207, 71.5793]) and alteplase (n = 4; 2 females; mean age 59, 95% CI [38.13, 79.87]) for LVO causing disabling neurological deficits. Mechanical thrombectomy was attempted in all subjects. The association between higher ANC and lower ASPECTS score reached statistical significance (rs = ‐0.49255, p = 0.04457). There was no significant association of white blood cell (WBC) and ASPECTS score. WBC and ANC were not associated with baseline or discharge NIHSS, age, or follow up mRS. Conclusions : Rapid stroke progression as measured by presenting ASPECTS score may be associated with neutrophilia. Larger prospective clinical trials are needed to validate our results.

Abstract 1122‐000201: Is Neutrophilia a Risk Factor for Fast Stroke Progression in Large Vessel Occlusion?

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Jawad Kirmani ◽  
Farrah Fourcand ◽  
Nancy Gadallah ◽  
Arifa Ghori ◽  
Danisette Torres ◽  
...  
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Mechanical Thrombectomy ◽  
Statistical Significance ◽  
Large Vessel ◽  
Neurological Deficits ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Ct Head

Introduction : Rapid stroke progressors with large vessel occlusion (LVO) have a worse prognosis than their time‐matched cohorts receiving IV thrombolytics and/or mechanical thrombectomy. Our objective was to evaluate the association of neutrophilia with rapid stroke progression. Methods : Initial white blood cell (WBC) and absolute neutrophil counts (ANC) were collected for subjects presenting with acute ischemic stroke secondary to LVO who received IV thrombolytics and/or mechanical thrombectomy within 4.5 and 6 hours, respectively. Rapid stroke progression was determined by Alberta Stroke Program Early CT Score (ASPECTS) on initial CT head. Baseline and discharge NIHSS, age, and follow up mRS were also compared to presenting WBC and ANC. Spearman’s rho was used for correlation. Social Science Statistics was used for data analysis. Results : From October 2020 to April 2021, the association between neurophilia and stroke progression was evaluated in 19 subjects receiving tenecteplase (n = 16; 6 females; age, 63.25 95% CI [54.9207, 71.5793]) and alteplase (n = 4; 2 females; mean age 59, 95% CI [38.13, 79.87]) for LVO causing disabling neurological deficits. Mechanical thrombectomy was attempted in all subjects. The association between higher ANC and lower ASPECTS score reached statistical significance (rs = ‐0.49255, p = 0.04457). There was no significant association of white blood cell (WBC) and ASPECTS score. WBC and ANC were not associated with baseline or discharge NIHSS, age, or follow up mRS. Conclusions : Rapid stroke progression as measured by presenting ASPECTS score may be associated with neutrophilia. Larger prospective clinical trials are needed to validate our results.

scholarly journals Mechanical Thrombectomy for Minor and Mild Stroke Patients Harboring Large Vessel Occlusion in the Anterior Circulation

Stroke ◽  
2017 ◽  
Vol 48 (12) ◽  
pp. 3274-3281 ◽  
Author(s):  
Cyril Dargazanli ◽  
Caroline Arquizan ◽  
Benjamin Gory ◽  
Arturo Consoli ◽  
Julien Labreuche ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Mild Stroke

scholarly journals Non-invasive markers of liver fibrosis and outcome in large vessel occlusion stroke

2021 ◽  
Vol 14 ◽  
pp. 175628642110372
Author(s):  
Simon Fandler-Höfler ◽  
Rudolf E. Stauber ◽  
Markus Kneihsl ◽  
Gerit Wünsch ◽  
Melanie Haidegger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Liver Fibrosis ◽  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Post Stroke ◽  
Non Invasive

Background: Liver fibrosis has been identified as an outcome predictor in cardiovascular disease and has been associated with hematoma expansion and mortality in patients with primary intracerebral hemorrhage. We aimed to explore whether clinically inapparent liver fibrosis is related to neurological outcome, mortality, and intracranial hemorrhage risk in ischemic stroke patients after mechanical thrombectomy. Methods: We included consecutive patients with anterior circulation large vessel occlusion stroke treated at our center with mechanical thrombectomy between January 2011 and April 2019. Clinical data had been collected prospectively; laboratory data were extracted from our electronic hospital information system. We calculated the Fibrosis-4 index (FIB-4), an established non-invasive liver fibrosis test. The main outcomes were postinterventional intracranial hemorrhage, unfavorable functional status (modified Rankin scale scores of 3–6), and mortality three months post-stroke. Results: In the 460 patients (mean age 69 years, 49.3% female) analyzed, FIB-4 indicated advanced liver fibrosis in 22.6%. Positive FIB-4 was associated with unfavorable neurological outcomes and mortality three months post-stroke, even after correction for co-factors [Odds Ratio (OR) 2.15 for unfavorable outcome in patients with positive FIB-4, 95% confidence interval (CI) 1.21–3.83, p = 0.009, and 2.16 for mortality, 95% CI 1.16–4.03, p = 0.01]. However, FIB-4 was neither related to hemorrhagic transformation nor symptomatic intracranial hemorrhage. Moreover, atrial fibrillation was more frequent in patients with liver fibrosis ( p < 0.001). Two further commonly-used liver fibrosis indices (Forns index and the Easy Liver Fibrosis Test) yielded comparable results regarding outcome and atrial fibrillation. Conclusions: Clinically inapparent liver fibrosis (based on simple clinical and laboratory parameters) represents an independent risk factor for unfavorable outcomes, including mortality, at three months after stroke thrombectomy. Elevated liver fibrosis indices warrant further hepatological work-up and thorough screening for atrial fibrillation in stroke patients.

scholarly journals Mechanical thrombectomy techniques for acute ischemic stroke

2020 ◽  
pp. 46-51
Author(s):  
A. Chiriac ◽  
Georgiana Ion ◽  
N. Dobrin ◽  
Dana Turliuc ◽  
I. Poeata
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Current Trends

Mechanical thrombectomy technique was introduced as an effective and secure method in acute ischemic stroke patients suffering from intracranial large vessel occlusion (LVO). In this article, we will review the main mechanical thrombectomy techniques and current trends in this type of treatment for acute ischemic stroke.

scholarly journals Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy

2019 ◽  
Vol 8 (21) ◽  
Author(s):  
Aristeidis H. Katsanos ◽  
Konark Malhotra ◽  
Nitin Goyal ◽  
Lina Palaiodimou ◽  
Peter D. Schellinger ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mortality Risk ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

scholarly journals Repeated Mechanical Thrombectomy of Recurrent Large Vessel Occlusion: Case Report and Brief Review of the Literature

2019 ◽  
Author(s):  
Yun-Long Ding ◽  
Ting-Ting Zhai ◽  
Li Ma ◽  
Zhi-Qun Gu ◽  
Jia-Li Niu ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vascular Events ◽  
Vessel Occlusion ◽  
Case Presentation ◽  
Short Period ◽  
Recurrent Strokes

Abstract Background Endovascular mechanical thrombectomy (MT) can significantly improve the prognosis of patients with Large Vessel Occlusion (LVO) stroke. It is still unclear whether it is safe and effective to perform MT again in patients with renal failure and atrial fibrillation (AF) in a short period of time. Case presentation We present the case of a LVO petients with concomitant AF and uremia who was successfully treated by MT for M1 segment occlusion of right middle cerebral artery (MCA) with good outcome. 15 days after the first MT, the patient's stroke recurred, angiography again revealed M1 segment and branch occlusion of right MCA, and repeated MT were performed. The recurrent strokes might attributed to no anticoagulant therapy. In an 4-months follow-up, no further vascular events occurred. Conclusions Repeated MT for recurrent LVO appears safe and effective. In patients with uremia and AF, it might be beneficial to give anticoagulant therapy after careful assessment of the patient's condition, which needs further evidence.

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