Initial Stress Hyperglycemia Is Associated With Malignant Cerebral Edema, Hemorrhage, and Poor Functional Outcome After Mechanical Thrombectomy

Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy. Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was <2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days. Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p <0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3). Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.

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E-053 Peri-procedure anemia is associated with poor functional outcome after mechanical thrombectomy for acute ischemic stroke: single center experience

10.1136/neurintsurg-2020-snis.89 ◽

2020 ◽

Author(s):

H Carvalho ◽

A Wessell ◽

G Cannarsa ◽

T Miller ◽

D Gandhi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Single Center ◽

Poor Functional Outcome ◽

Single Center Experience

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Abstract WP60: Absence of Hyperdense Middle Cerebral Artery Sign, as Measured on the Hounsfield Scale, Predicts Poor Functional Outcome and May Indicate Atherosclerotic Disease in Patients Undergoing Mechanical Thrombectomy for M1 Occlusion

Stroke ◽

10.1161/str.51.suppl_1.wp60 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kiddy L Ume ◽

Sudeepta Dandapat ◽

Matthew Weber ◽

Cynthia Zevallos ◽

Abigail Levy ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Functional Outcome ◽

Electronic Medical Records ◽

Cerebral Artery ◽

Medical Records ◽

Mechanical Thrombectomy ◽

Group Versus ◽

Hounsfield Units ◽

Poor Functional Outcome ◽

Group 4

Introduction: The hyper-dense middle cerebral artery sign (HMCAS) on computed tomography (CT) is associated with ischemic stroke involving the middle cerebral artery (MCA) territory. While its presence is indicative of acute thromboembolic disease, the clinical implications of its absence in patients presenting with M1 occlusions have not been widely studied. Methods: We retrospectively analyzed104 consecutive patients presenting with acute M1 occlusions undergoing mechanical thrombectomy. Pertinent clinical/radiological variables were obtained from the electronic medical records and review of angiographic images. Presence of HMCAS was defined as a difference of >5 Hounsfield units (HU) between the occlusion site and the corresponding contralateral MCA segment. Patients were stratified based on the presence (HD group) vs. absence (nHD group) of HMCAS. Primary outcomes included mortality, reperfusion status (TICI), and 3-month Modified Rankin Scale (mRS). Other relevant clinical variables were statistically analyzed and compared. Statistical analyses were two-tailed and considered significant if p<0.05. Results: Out of the 104 patients with M1 occlusions, 78 had a measurable HMCAS (HD group), while 22 patients did not (nHD group). 4 patients were excluded due to CT artifacts. Age (69.2 ± 16.0), presenting NIHSS (15.8 ± 5.1), and time to groin (347.0 ± 282.6 min) were similar in the two groups. Mortality and 3-month mRS were 50% and 4.4 (±1.9) in the nHD group versus 27% and 3.1 (±2.2) in the HD group, both significant, with p=0.0201. and p=0.0152, respectively. The nHD patients had significantly higher incidence of diabetes (40.9% vs. 19.2%, p=0.0178). TICI score was unfavorable (2A, 1, or 0) in 31.8% of the nHD- and 24.4% of the HD patients, although not statistically significant. Lesions were presumed to be atherosclerotic (based on cerebral angiography) in 40.9% of nHD- and 7.7% of HD cases (p=0.00006). Conclusion: Absent HMCAS - defined as a <5 HU difference between bilateral corresponding MCA segments on initial CT - is associated with poor functional outcome after mechanical thrombectomy in patients presenting with M1 occlusion. There is a significantly higher incidence of atherosclerotic occlusions in this patient population.

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A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015247 ◽

2019 ◽

Vol 12 (4) ◽

pp. 363-369 ◽

Cited By ~ 4

Author(s):

Arnaud Valent ◽

Amard Sajadhoussen ◽

Benjamin Maier ◽

Bertrand Lapergue ◽

Marc-Antoine Labeyrie ◽

...

Keyword(s):

Ischemic Stroke ◽

Arterial Pressure ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Reference Value ◽

Poor Functional Outcome ◽

Neurological Outcomes ◽

Anesthetic Drugs ◽

Linear Association ◽

Exposure Variable

BackgroundMechanical thrombectomy (MT) for acute ischemic stroke can be performed under local anesthesia, with or without conscious sedation (CS), or under general anesthesia (GA). The hemodynamic consequence of anesthetic drugs may explain why GA may be associated with worse outcomes. We evaluated the association between hypotension duration during MT and the 90 day functional outcome under both anesthetic regimens.MethodsPatients were included in this retrospective study if they had an ischemic stroke treated by MT under GA or CS. The main exposure variable was the time below 90% of the reference value of arterial pressure measured before MT. The primary outcome was poor functional outcome defined as a 90 day modified Rankin Score ≥3.Results371 patients were included in the study. GA was performed in 42%. A linear association between the duration of arterial hypotension and outcome was observed. The odds ratio for poor functional outcome of 10 min under 90% of the baseline mean arterial pressure was 1.13 (95% CI 1.06 to 1.21) without adjustment and 1.11 (95% CI 1.02 to 1.21) after adjustment for confounding factors. The functional outcome was poorer for patients treated under GA compared with CS, but the association with the depth of hypotension remained similar under both conditions.ConclusionIn this study, we observed a linear association between the duration of hypotension during MT and the functional outcome at 90 days. An aggressive and personalized strategy for the treatment of hypotension should be considered. Further trials should be conducted to address this question.

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Elevated Red Blood Cell Distribution Width May Be a Novel Independent Predictor of Poor Functional Outcome in Patients Treated with Mechanical Thrombectomy

Neurointervention ◽

10.5469/neuroint.2020.00262 ◽

2020 ◽

Author(s):

Cetin Kursad Akpinar ◽

Erdem Gurkaş ◽

Ozlem Aykac ◽

Zehra Uysal ◽

Atilla Ozcan Ozdemir

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Independent Predictor ◽

Cell Distribution ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Distribution Width ◽

Red Blood Cell Distribution

Purpose: Red blood cell distribution width (RDW) evaluates the variation (size heterogeneity) in red blood cells. Elevated RDW has been identified as a predictor of poor functional outcomes for acute ischemic stroke. The association between elevated RDW level and poor functional outcome in stroke patients undergoing mechanical thrombectomy has not been reported before. This study aims to investigate this relationship.Materials and Methods: This was a multicenter retrospective study involving the prospectively and consecutively collected data of 205 adult stroke patients who underwent mechanical thrombectomy for anterior circulation large vessel occlusion (middle cerebral artery M1, anterior cerebral artery A1, tandem ICA-MCA, carotid T) between July 2017 and December 2019. RDW cut off levels were accepted as >16%. The effect of elevated RDW on poor functional outcome (modified Rankin scale 3–6) was investigated using bivariate and multivariate regression analysis.Results: Elevated RDW was significantly associated with poor functional outcome in bivariate and multivariate analysis (odds ratio [OR] for RDW >16%, 2.078; 95% confidence interval [95% CI], 1.083–3.966; P=0.027 and OR for RDW >16%, 2.873; 95% CI, 1.342–6.151; P=0.007; respectively).Conclusion: These findings suggest that elevated RDW may be an independent predictor of poor functional outcomes in ischemic stroke patients undergoing mechanical thrombectomy.

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Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.602037 ◽

2021 ◽

Vol 12 ◽

Author(s):

Tao Xu ◽

You Wang ◽

Jinxian Yuan ◽

Yangmei Chen ◽

Haiyan Luo

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Functional Outcome ◽

Intracranial Hemorrhage ◽

Mechanical Thrombectomy ◽

Small Vessel Disease ◽

Meta Analysis ◽

Poor Functional Outcome ◽

Vessel Disease

Background: Cerebral small vessel disease (SVD) is prevalent in the population, especially among elderly individuals. Substantial uncertainties remain about the clinical relevance of SVD with outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS).Objectives: This systematic review and meta-analysis was performed to evaluate the association between SVD and clinical outcomes in patients with AIS undergoing MT.Methods: We systematically searched the Medline, Embase, and Cochrane databases for relevant clinical studies. The exposure of SVD mainly included leukoaraiosis, cerebral microbleeds (CMBs), and lacunes. The pooled OR was used to calculate the association between each subtype of SVD and outcomes of MT. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥3 at 90 days after MT. The secondary outcomes included mortality at 90 days, in-hospital mortality, intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), successful recanalization and futile recanalization (FR), early neurological improvement, and early neurological deterioration (END) after MT.Results: Overall, 20 studies with 5,189 patients with AIS undergoing MT were included. High leukoaraiosis burden (HLB) at baseline was associated with increased risks of poor functional outcome at 90 days (OR 2.70, 95% CI 2.01–3.63; p < 0.001; 10 studies; n = 2,004), in-hospital mortality (OR 4.06, 95% CI 1.48–11.13; p = 0.006; 2 studies; n = 314), FR (OR 5.00, 95% CI 2.86–8.73; p < 0.001; 3 studies; n = 493), and END (OR 2.65, 95% CI 1.09–6.45; 1 study; n = 273) after MT. HLB (VSS 3–4 or FS ≥ 2) at baseline was not associated with mortality at 90 days, ICH, or sICH after MT. CMBs at baseline were found to be associated with increased risks of poor functional outcome at 90 days (OR 1.84, 95% CI 1.17–2.90; p = 0.008; 2 studies; n = 1,924) after MT. We found no association between the presence of lacunes and poor functional outcome at 90 days after MT.Conclusions: In patients with AIS undergoing MT, HLB and CMBs were associated with increased risks of unfavorable outcomes after MT.

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O-024 Four or more thrombectomy passes, tPA use, and high initial stress glucose ratio are independently associated with malignant cerebral edema after mechanical thrombectomy: a single-center, retrospective study

10.1136/neurintsurg-2020-snis.24 ◽

2020 ◽

Author(s):

G Cannarsa ◽

A Wessell ◽

T Chryssikos ◽

K Kim ◽

J Stokum ◽

...

Keyword(s):

Retrospective Study ◽

Initial Stress ◽

Cerebral Edema ◽

Mechanical Thrombectomy ◽

Single Center ◽

Glucose Ratio

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Moderate to Severe Anemia Is Associated with Poor Functional Outcome in Acute Stroke Patients Treated with Mechanical Thrombectomy

Interventional Neurology ◽

10.1159/000480642 ◽

2017 ◽

Vol 7 (1-2) ◽

pp. 12-18 ◽

Cited By ~ 2

Author(s):

Cetin Kursad Akpinar ◽

Erdem Gurkas ◽

Emrah Aytac

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Functional Outcome ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Multiple Logistic Regression Analysis ◽

Severe Anemia ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Moderate Anemia

Background: Anemia will negatively affect cerebral collaterals and penumbra. Eventually, it may cause worse clinical outcomes and even increase mortality rates in stroke patients. Anemia has recently been suggested to be an independent risk factor for ischemic stroke. Therefore, we aimed to investigate the effects of the presence of anemia on clinical outcomes in ischemic stroke patients undergoing mechanical thrombectomy. Methods: This was a retrospective study involving the prospectively and consecutively collected data of 90 adult patients between January 2015 and August 2016. Hemoglobin (Hb) cutoff levels were accepted as 12 g/dL for women and 13 g/dL for men. Patients having anemia were further divided into three subgroups as severe anemia (Hb <8 g/dL for both genders), moderate anemia (Hb <10 g/dL for both genders), and mild anemia (Hb <13 g/dL for men and Hb <12 g/dL for women). Results: Forty of the subjects (44.4%) had anemia. Moderate anemia was detected in 14 out of 90 patients (15.5%) and severe anemia was found in only four of them (4.4%). Poor functional outcome (mRS 3-6) was similar in both anemic and non-anemic patients (37.5% vs. 38%, respectively, p = 0.08), but poor functional outcome was found to be statistically significant with severe anemic group (Hb <8 mg/dL) (p = 0.003). In multiple logistic regression analysis, moderate and severe anemia has been found to increase the mortality (p = 0.032). Conclusions: Our study demonstrated a poor functional outcome only in moderate to severe anemic patients. Clinicians should keep in mind the negative effect of moderate to severe anemia in the clinical course of acute stroke patients treated with mechanical thrombectomy.

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Abstract TP332: Intracerebral Hemorrhage Volume to Edema Volume Ratio Predicts Poor Functional Outcome in Young Patients with Non-Lobar Primary Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.tp332 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Angela Hays Shapshak ◽

April Sisson ◽

Mini Singh ◽

Michael J Lyerly ◽

Karen Albright

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Cerebral Edema ◽

Young Patients ◽

Volume Ratio ◽

Midline Shift ◽

Poor Functional Outcome ◽

Edema Volume ◽

Imaging Characteristics ◽

Ich Score

Background and Purpose: Cerebral edema is known to contribute to clinical decline in patients with spontaneous ICH. We sought to evaluate the significance of cerebral edema on outcome in young patients with primary ICH. Methods: We performed a retrospective review of patients presenting to our CSC center from 2014-2015 with primary ICH, excluding patients with lobar ICH and age 55 and above. Patients were grouped according to functional outcome at discharge (mRS 0-3 vs. 4-6). Imaging characteristics of those with poor short-term functional outcome (mRS 4-6) were compared to those with mRS 0-3. Receiver Operating Characteristics curves were used to evaluate the discriminatory ability of imaging characteristics with regards to poor functional outcome. Results: A total of 38 patients met inclusion criteria (mean age 47, 42% black, 55% male). On presentation, patients with poor functional outcome had larger mean ICH volume (26 vs 9cc; p=0.020), higher ICH volume to edema volume ratios (2.0 vs. 0.7, p=0.010), more evidence of midline shift (38% vs. 6%, p=0.026), and IVH (52% vs. 17%, p=0.043). Groups did not differ in terms of edema volume, amount of midline shift, evidence of hydrocephalus, or herniation. ICH volume to edema volume ratio was a better discriminator of poor outcome (AUC=0.813, p=0.006) than ICH volume (AUC=0.802, p=0.008, Figure 1a). Further, ICH volume to edema volume ratio was a better discriminator of poor outcome (AUC=0.801, p=0.009) than ICH score (AUC=0.724, p=0.051, Figure 1b). Discussion: Among young patients with non-lobar primary ICH we observed that the ICH to edema ratio was a better predictor of poor functional status at discharge than ICH volume or ICH score.

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