Predictors of Good Clinical Outcome in Patients with Acute Stroke Undergoing Endovascular Treatment – Results from CERBERUS

2017 ◽  
Vol 80/113 (6) ◽  
pp. 666-674
Author(s):  
Martin Roubec ◽  
Dagmar Krajíčková ◽  
Jolana Hommerová ◽  
Petra Kešnerová ◽  
Sylva Klimošová ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Treatment Results ◽  
Good Clinical Outcome

Abstract TP9: Safety of Endovascular Treatment in Acute Stroke Patients Taking Oral Anticoagulants

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Timo Uphaus ◽  
Oliver C Singer ◽  
Joachim Berkefeld ◽  
Christian H Nolte ◽  
Georg Bohner ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Positive Impact ◽  
Therapeutic Option ◽  
Oral Anticoagulants ◽  
Intravenous Thrombolysis ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Male Patients

Introduction: The endovascular treatment (EVT) of cerebral ischemia in the case of large vessel occlusion has been established over recent years. Randomized trials showed a positive impact on the clinical outcome of endovascular treatment in addition to thrombolysis with respect to clinical outcome and safety, so that this therapeutic option will be implemented in future guidelines. The role of EVT in patients treated with oral anticoagulants remains uncertain. Hypothesis: We assessed the hypothesis that application of EVT is safe with regard to the occurrence of intracranial bleeding and clinical outcome in patients taking anticoagulants. Methods: The ENDOSTROKE-Registry is a commercially independent, prospective observational study in 12 stroke centers in Germany and Austria launched in January 2011. An online tool served for data acquisition of pre-specified variables concerning endovascular stroke therapy. Results: Data from 815 patients (median age 70, 57% male) undergoing EVT and known anticoagulation status were analyzed. A total of 85 (median age 76, 52% male) patients (10.4%) took oral anticoagulants prior to EVT. Anticoagulation status as measured with INR was 2.0-3.0 in 24 patients (29%), <2.0 in 52 patients (63%) and above 3.0 in 7 patients (8%) of 83 patients with valid INR data prior to EVT. Patients taking anticoagulants were significantly older (median age 76 vs. 69, p < 0.001). Comparing those patients taking anticoagulants and those not, there were no differences concerning NIHSS at admission (with anticoagulants Median-NIHSS 17 vs. without Median-NIHSS 15, p = 0.492, Mann Whitney Test) and the rate of intracranial hemorrhage after intervention (with anticoagulants 11.8% vs. without 12.2%, p = 0.538). After adjustment for age and NIHSS at admission there were no significant differences between the two groups with regard to good clinical outcome, as measured with the modified ranking scale (mRS, 90d-mRS 0-2, 39.2% of patients not receiving anticoagulants; 25.9% of those receiving anticoagulants). Conclusion: The application of endovascular treatment in patients taking oral anticoagulants is safe and should be considered in acute stroke treatment as an important alternative to contraindicated intravenous thrombolysis.

Abstract W P48: Flair Vessel Hyper-intensities Could Predict Target Mismatch Signs in Acute Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Manabu Inoue ◽  
Michael Mlynash ◽  
Carlo W Cerada ◽  
Nishant K Mishra ◽  
Soren Christensen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Stroke Patients ◽  
Good Clinical Outcome ◽  
Kappa Score ◽  
Early Reperfusion ◽  
Diffusion Weighted Images ◽  
Fluid Attenuated Inversion Recovery

Background and purpose: Fluid-attenuated inversion recovery (FLAIR) vessel hyper-intensities (FVH) have been hypothesized to have a positive correlation with good collaterals and more favorable clinical outcomes in acute stroke patients. We assessed if FVH predict the Target mismatch profile (TMM) and clinical outcomes in the DEFUSE studies. Methods: Patients with technically adequate baseline diffusion weighted images (DWI), perfusion images (PWI), and FLAIR images were included in this pooled analysis of the DEFUSE 1 and 2 studies. The FVH sign was defined as visible hyper-intense vessels on FLAIR images and assessed at basal ganglia levels by two independent raters. Clinical outcomes were assessed using modified Rankin Scale (mRS) at 90 days. The Target mismatch profile was based on baseline DWI and PWI volumes using automated software (RAPID). Results: Seventy seven patients met the inclusion criteria. Median time (IQR) from symptom onset to baseline MRI was 4.6 hours (3.9 - 5.4) and median (IQR) DWI lesion was 13.1 (5.0 - 32.0) ml. Of these, 66 patients (86%) had the FVH sign. Kappa score for inter-rater agreement was 0.621 (95CI: 0.33 - 0.91). Seventy (74%) cases with FVH had TMM profile vs. 33% of No FVH patients (p=0.023). Good clinical outcome (mRS 0-2) did not differ (50% with FVH vs. 73% without FVH, p=0.203). Only 38% of the patients with FVH had good angiographic collaterals and the rate of early reperfusion did not differ (45% with FVH vs. 25% without FVH, p=0.45). Conclusions: FVH is common in acute stroke patients (86%) and is associated with the Target Mismatch profile. However, FVH was not associated with favorable angiographic collaterals, good clinical outcome or early reperfusion in the DEFUSE 1 and 2 cohorts.

scholarly journals Emergency Carotid Endarterectomy Instead of Carotid Artery Stenting Reduces Delayed Hemorrhage in Thrombectomy Stroke Patients

2020 ◽  
Author(s):  
Raveena Singh ◽  
Sven Dekeyzer ◽  
Arno Reich ◽  
Drosos Kotelis ◽  
Alexander Gombert ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Clinical Outcome ◽  
Acute Stroke ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Dual Antiplatelet Therapy ◽  
Good Clinical Outcome ◽  
Angiography Suite ◽  
Delayed Hemorrhage ◽  
Feasible Alternative

Abstract Purpose Data in the literature suggest that thrombectomy with emergency carotid artery stenting (CAS) in acute stroke is associated with an increased hemorrhage rate. As we perform thrombectomy with the patient under general anesthesia, we avoid emergency CAS and perform emergency carotid endarterectomy (CEA) as an alternative to CAS in the same anesthesia session in our angiography suite whenever needed and possible. Methods We compared 27 thrombectomy patients with emergency CEA and 62 thrombectomy patients with emergency CAS and glycoprotein (Gp) IIb/IIIa inhibitors and/or dual antiplatelet therapy (DAPT) in the same time span. Results The symptomatic hemorrhage rate was 0% (0/27) in the CEA group and 8% (5/62) in the CAS group (p = 0.317). The parenchymal hemorrhage rate (PH2) was 7% (2/27) in the CEA group and 16% (10/62) in the CAS group (p = 0.333). Both cases of PH2 in the CEA group occurred during the intervention and were diagnosed on immediate postinterventional imaging, whereas in the CAS group only 2/10 cases of PH2 occurred during the intervention and the remaining 8 PH2 occurred within 3 days after the intervention (p = 0.048). Clinical outcome at 90 days was comparable with 39% of CEA and 51% of CAS patients achieving good clinical outcome (modified Rankin scale, mRS 0–2, p = 0.452). Conclusion The use of CEA is a feasible alternative to CAS in acute stroke and has the advantage that DAPT/GpIIb/IIIa inhibitors are not needed. All PH2 in CEA patients occurred during the intervention, implying that hemorrhage in this group is likely to be caused by reperfusion injury, whereas delayed hemorrhage is likely to be caused by DAPT/GpIIb/IIIa inhibitors.

Abstract TP26: The Outcome of Patients With Tandem Occlusion Remains Poor Despite Mechanical Thrombectomy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Robert Fahed ◽  
Hocine Redjem ◽  
Raphaël Blanc ◽  
Julien Labreuche ◽  
Stanislas Smajda ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Intravenous Thrombolysis ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tandem Occlusion ◽  
Treatment Data ◽  
Research Gap

Introduction: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Besides, the indications and effects of ICA stenting remain unclear. Hypothesis: To determine the factors associated with favorable outcome at 3-month in this subtype of AIS. Methods: From a prospectively gathered registry, we analyzed the data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, NIHSS, and stroke etiology), imaging (including DWI-ASPECTS), and endovascular treatment data were assessed and reviewed in consensus by two observers. Good clinical outcome was defined as a modified Rankin Scale (mRS) of ≤2 at 3-month follow-up. The mRS at 3 months follow-up was available in 67 patients. Results: At 3-month follow-up, 33 of 67 (49.3%) patients had a good clinical outcome and 34 (50.8%) had a poor clinical outcome, including 9 deaths (13.4%). Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (TICI 2b-3) were associated with a good clinical outcome (P<0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique, including the ICA stenting. Conclusions: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to intravenous thrombolysis, is also difficult to treat by endovascular means.

Endovascular therapy of wake-up strokes in the modern era of stent retriever thrombectomy

2015 ◽  
Vol 8 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Maxim Mokin ◽  
Peter Kan ◽  
Sananthan Sivakanthan ◽  
Erol Veznedaroglu ◽  
Mandy J Binning ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
First Generation ◽  
Good Clinical Outcome ◽  
Aspiration Thrombectomy ◽  
Stent Retrievers ◽  
Favorable Clinical Outcome ◽  
Solitaire Fr ◽  
Modern Era

BackgroundEndovascular treatment of wake-up strokes (WUS) has been previously described, mostly with the use of pharmacological thrombolysis or first generation thrombectomy devices.ObjectiveTo describe outcomes of WUS treated with modern endovascular therapy since the Food and Drug Administration approval of stent retrievers, and to identify predictors of good clinical outcome in this population of stroke patients.MethodsWe performed a multicenter retrospective analysis of consecutive patients with WUS who underwent thrombectomy with stent retrievers Trevo (Stryker, Kalamazoo, Michigan, USA) and Solitaire FR (Covidien, Irvine, California, USA), or primary aspiration thrombectomy. We correlated favorable clinical outcomes with demographic, clinical, and technical characteristics.Results52 patients were included in this study; 46 (88%) cases were treated with stent retrievers and 6 (12%) were treated with primary aspiration thrombectomy alone. Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b/3) was achieved in 36 (69%) patients. Favorable clinical outcome at 3 months, defined as a modified Rankin Scale score of 0–2, was achieved in 25 (48%) patients. Duration of intervention <30 min and its success, defined as TICI 2b/3 recanalization, were strong predictors of favorable clinical outcome at 90 days (p<0.001 and p<0.0001, respectively).ConclusionsOur study indicates that endovascular treatment of WUS with stent retrievers and aspiration thrombectomy is safe and effective.

Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis

2011 ◽  
Vol 123 (5) ◽  
pp. 339-344 ◽  
Author(s):  
D. Šaňák ◽  
R. Herzig ◽  
J. Zapletalová ◽  
D. Horák ◽  
M. Král ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Good Clinical Outcome

Endovascular Management of Acute Ischemic Strokes with Tandem Occlusions

2016 ◽  
Vol 41 (5-6) ◽  
pp. 298-305 ◽  
Author(s):  
Robert Fahed ◽  
Hocine Redjem ◽  
Raphaël Blanc ◽  
Julien Labreuche ◽  
Thomas Robert ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Carotid Stenting ◽  
National Institutes Of Health ◽  
Endovascular Management ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Treatment Data ◽  
Research Gap

Background: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Also, the indications and effects of carotid stenting remain unclear. Methods: From a prospectively gathered registry, we analyzed data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, National Institutes of Health Stroke Scale (NIHSS), and stroke etiology), imaging (including diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score), and endovascular treatment data were assessed and reviewed in consensus by 2 observers. Good clinical outcome was defined as a modified Rankin Scale of ≤2 at 3-month follow-up. Results: At 3-month follow-up, 50.8% had a poor clinical outcome, including death in 13.4%. Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (thrombolysis in cerebral infarction 2b-3) were associated with a good clinical outcome (p < 0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous (IV) tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique including the carotid stenting. Conclusions: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to IV thrombolysis, is also difficult to treat by endovascular means. Guidelines for the endovascular management of tandem occlusions are needed.

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