Absent hyperdense middle cerebral artery sign is associated with poor functional outcome after mechanical thrombectomy

2021 ◽  
pp. 174749302199197
Author(s):  
Kiddy L Ume ◽  
Sudeepta Dandapat ◽  
Matthew W Weber ◽  
Cynthia B Zevallos ◽  
Amber Fifer ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Functional Disability ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Serum Glucose ◽  
Significant Difference ◽  
Hyperdense Middle Cerebral Artery

Background The hyperdense middle cerebral artery sign on computed tomography indicates proximal middle cerebral artery occlusion. Recent reports suggest an association between the hyperdense sign and successful reperfusion. The prognostic value of the hyperdense middle cerebral artery sign in patients receiving mechanical thrombectomy has not been extensively studied. Aims Our study aims to evaluate the association between the hyperdense middle cerebral artery sign and functional outcome in patients with M1 occlusions that had undergone mechanical thrombectomy. Methods We conducted a single-center retrospective observational cohort study of 102 consecutive patients presenting with acute M1 occlusions that had undergone mechanical thrombectomy. Patients were stratified into cohorts based on the presence of hyperdense middle cerebral artery sign visually assessed on computed tomography by two readers. The outcomes of interests were functional disability measured by the ordinal Modified Rankin Scale (mRS) at 90 days, mortality, reperfusion status and hemorrhagic conversion. Results Out of the 102 patients with M1 occlusions, 71 had hyperdense middle cerebral artery sign. There was no significant difference between the cohorts in age, baseline mRS, NIHSS, ASPECTS, and time to reperfusion. The absence of hyperdense middle cerebral artery sign was associated with increased odds of being dependent or dying (higher mRS) (OR: 3.24, 95% CI: 1.30–8.06, p = 0.011) after adjusting for other significant predictors, including age, female sex, hypertension, presenting serum glucose, ASPECTS, CTA collateral score, and successful reperfusion. Conclusion The absence of hyperdense middle cerebral artery sign is associated with worse functional outcome in patients presenting with M1 occlusions undergoing thrombectomy.

Abstract P361: Visualization of the Anterior Temporal Artery as a Predictor of Outcome in Middle Cerebral Artery Occlusion Patients Achieving Successful Recanalization After Interfacility Transfer

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jonathan M Parish ◽  
William R Stetler ◽  
Dale Strong ◽  
Tanushree Prasad ◽  
Jeremy B Rhoten ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Computerized Tomography ◽  
Patient Outcomes ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Mca Occlusion ◽  
Proximal Site

Introduction: Many non-thrombectomy centers lack Computerized Tomography Perfusion (CTP) capability. Anterior temporal artery (ATA) visualization on Computerized Tomography Angiography (CTA) has been previously associated with good outcomes in middle cerebral artery (MCA) occlusions, but not in the context of recanalization after interfacility transfer for thrombectomy. We hypothesized that independent functional outcome at 90 days would be greater for MCA occlusion patients initially presenting to non-thrombectomy centers with a visualized ATA on CTA who achieved TICI 2b or greater recanalization after transfer. Methods: We conducted a retrospective cohort study of patients transferred for mechanical thrombectomy. A neuroradiologist blinded to patient outcomes confirmed the MCA as the most proximal site of occlusion on CTA, and assessed for visualization of the ATA. TICI 2b or greater revascularization scores were confirmed by neurointerventionalists blinded to patient outcomes. Ninety-day mRS scores were obtained via telephone utilizing a structured questionnaire. Results: We identified a total of 107 MCA occlusion patients over a 3 ½ year period meeting our inclusion criteria. There were no significant differences in age, gender, race, comorbidities, median NIHSS, or time-to-revascularization variables between the ATA visualized (n=50) versus non-visualized (n=57) group, with the exception of significantly more wake-up strokes in the ATA visualized group (34.7% vs 16.1%, p=0.03). There was a non-significant trend for independent outcome (mRS ≤2) at 90 days for patients with ATA visualization compared to those for whom the ATA was not visualized on the CTA (63.8% vs 45.5%, p=0.06). Conclusion: For MCA occlusion patients initially presenting to non-thrombectomy centers achieving successful recanalization via mechanical thrombectomy, there is a strong trend for visualization of the anterior temporal artery on the CTA performed at the non-thrombectomy center as being a predictor of independent functional outcome. Especially for institutions without CTP capability, this association with ATA visualization should be further investigated as a predictor for good outcome after transfer for successful mechanical thrombectomy.

Mechanical thrombectomy versus intravenous alteplase alone in acute isolated posterior cerebral artery occlusion: a systematic review

2021 ◽  
pp. neurintsurg-2021-018017
Author(s):  
Andre Monteiro ◽  
Slah Khan ◽  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Nicco Ruggiero ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Symptomatic Intracranial Hemorrhage ◽  
Cerebral Artery Occlusion ◽  
Iv Tpa

BackgroundAcute isolated posterior cerebral artery occlusions (aPCAOs) were excluded or under-represented in major randomized trials of mechanical thrombectomy (MT). The benefit of MT in comparison to intravenous tissue plasminogen activator (alteplase; IV-tPA) alone in these patients remains controversial and uncertain.MethodsWe performed a systematic search of PubMed, MEDLINE, and EMBASE databases for articles comparing MT with or without bridging IV-tPA and IV-tPA alone for aPCAO using keywords (‘posterior cerebral artery’, ‘thrombolysis’ and ‘thrombectomy’) with Boolean operators. Extracted data from patients reported in the studies were pooled into groups (MT vs IV-tPA alone) for comparison. Estimated rates for favorable outcome (modified Rankin scale score 0–2), symptomatic intracranial hemorrhage (sICH), and mortality were extracted.ResultsSeven articles (201 MT patients, 64 IV-tPA) were included, all retrospective. There was no statistically significant difference between pooled groups in median age, median presentation National Institutes of Health Stroke Scale (NIHSS) score, PCAO segment, and median time from symptom onset to puncture or needle. The recanalization rate was significantly higher in the MT group than the IV-tPA group (85.6% vs 53.1%, p<0.00001). Odds ratios for favorable outcome (OR 1.5, 95% CI 0.8 to 2.5), sICH (OR 1.1, 95% CI 0.2 to 5.5), and mortality (OR 1.4, 95% CI 0.5 to 3.6) did not significantly favor any modality.ConclusionsWe found no significant differences in odds of favorable outcome, sICH, and mortality in MT and IV-tPA in comparable aPCAO patients, despite superior MT recanalization rates. Equipoise remains regarding the optimal treatment modality for these patients.

Impact of thrombus length on recanalization and clinical outcome following mechanical thrombectomy in acute ischemic stroke

2016 ◽  
Vol 9 (10) ◽  
pp. 937-939 ◽  
Author(s):  
Fatih Seker ◽  
Johannes Pfaff ◽  
Marcel Wolf ◽  
Silvia Schönenberger ◽  
Simon Nagel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Outcome ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Artery Occlusion ◽  
Good Clinical Outcome ◽  
Stent Retrievers ◽  
The Impact

PurposeThe impact of thrombus length on recanalization in IV thrombolysis for acute intracranial artery occlusion has been well studied. Here we analyzed the influence of thrombus length on the number of thrombectomy maneuvers needed for recanalization, intraprocedural complications, recanalization success, and clinical outcome after mechanical thrombectomy.MethodsWe retrospectively analyzed angiographic and clinical data from 72 consecutive patients with acute occlusion of the M1 segment of the middle cerebral artery who were treated with mechanical thrombectomy using stent retrievers. Successful recanalization was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. Good neurological outcome was defined as a modified Rankin Scale score of ≤2 at 90 days after stroke onset.ResultsMean thrombus length was 13.4±5.2 mm. Univariate binary logistic regression did not show an association of thrombus length with the probability of a good clinical outcome (OR 0.95, 95% CI 0.84 to 1.03, p=0.176) or successful recanalization (OR 0.92, 95% CI 0.81 to 1.05, p=0.225). There was no significant correlation between thrombus length and the number of thrombectomy maneuvers needed for recanalization (p=0.112). Furthermore, thrombus length was not correlated with the probability of intraprocedural complications (p=0.813), including embolization in a new territory (n=3).ConclusionsIn this study, thrombus length had no relevant impact on recanalization, neurological outcome, or intraprocedural complications following mechanical thrombectomy of middle cerebral artery occlusions. Therefore, mechanical thrombectomy with stent retrievers can be attempted with large clots.

scholarly journals Early Thrombectomy Protects the Internal Capsule in Patients With Proximal Middle Cerebral Artery Occlusion

Stroke ◽  
2021 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Mirjam Kaesmacher ◽  
Maria Berndt ◽  
Christian Maegerlein ◽  
Sebastian Mönch ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Internal Capsule ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Proximal Middle Cerebral Artery ◽  
Lenticulostriate Artery

Background and Purpose: Proximal middle cerebral artery (MCA) occlusions impede blood flow to the noncollateralized lenticulostriate artery territory. Previous work has shown that this almost inevitably leads to infarction of the dependent gray matter territories in the striate even if perfusion is restored by mechanical thrombectomy. Purpose of this analysis was to evaluate potential sparing of neighboring fiber tracts, ie, the internal capsule. Methods: An observational single-center study of patients with proximal MCA occlusions treated with mechanical thrombectomy and receiving postinterventional high-resolution diffusion-weighted imaging was conducted. Patients were classified according to internal capsule ischemia (IC+ versus IC−) at the postero-superior level of the MCA lenticulostriate artery territory (corticospinal tract correlate). Associations of IC+ versus IC− with baseline variables as well as its clinical impact were evaluated using multivariable logistic or linear regression analyses adjusting for potential confounders. Results: Of 92 included patients with proximal MCA territory infarctions, 45 (48.9%) had an IC+ pattern. Longer time from symptom-onset to groin-puncture (adjusted odds ratio, 2.12 [95% CI, 1.19–3.76] per hour), female sex and more severe strokes were associated with IC+. Patients with IC+ had lower rates of substantial neurological improvement and functional independence (adjusted odds ratio, 0.26 [95% CI, 0.09–0.81] and adjusted odds ratio, 0.25 [95% CI, 0.07–0.86]) after adjustment for confounders. These associations remained unchanged when confining analyses to patients without ischemia in the corona radiata or the motor cortex and here, IC+ was associated with higher National Institutes of Health Stroke Scale motor item scores (β, +2.8 [95% CI, 1.5 to 4.1]) without a significant increase in nonmotor items (β, +0.8 [95% CI, −0.2 to 1.9). Conclusions: Rapid mechanical thrombectomy with successful reperfusion of the lenticulostriate arteries often protects the internal capsule from subsequent ischemia despite early basal ganglia damage. Salvage of this eloquent white matter tract within the MCA lenticulostriate artery territory seems strongly time-dependent, which has clinical and pathophysiological implications.

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