INTRACEREBRAL BLEEDING UNDER DUAL ANTIPLATELETS AFTER EMERGENCY RECANALIZATION OF INTRACRANIAL AND EXTRACRANIAL LARGE ARTERY OCCLUSION

Objective: We investigated whether intravenous thrombolysis (IVT) affected the outcomes and complications of mechanical thrombectomy (MT), specifically focusing on thrombus fragmentation. Methods: The patients who underwent MT for large artery occlusion (LAO) were classified into two groups: MT with prior IVT (MT+IVT) group and MT without prior IVT (MT-IVT) group. The clinical outcome, successful recanalization with other radiological outcomes, and complications were compared, between two groups. Subgroup analysis was also performed for patients with simultaneous application of stent retriever and aspiration. Results: There were no significant differences in clinical outcome and successful recanalization rate, between both groups. However, the ratio of pre- to peri-procedural thrombus fragmentation was significantly higher in the MT+IVT group (14.6% and 16.2%, respectively; P=0.004) compared to the MT-IVT group (5.1% and 6.8%, respectively; P=0.008). The MT+IVT group required more second stent retriever (16.2%), more stent passages (median value = 2), and more occurrence of distal emboli (3.9%) than the MT-IVT group (7.9%, median value = 1, and 8.1%, respectively) (P=0.004, 0.008 and 0.018, respectively). In subgroup analysis, the results were similar to those of the entire patients. Conclusion: Thrombus fragmentation of IVT with t-PA before MT resulted in an increased need for additional rescue therapies, and it could induce more distal emboli. The use of IVT prior to MT does not affect the clinical outcome and successful recanalization, compared with MT without prior IVT. Therefore, we need to reconsider the need for IVT before MT.

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Efficacy and safety of rescue angioplasty and/or stenting for acute large artery occlusion with underlying intracranial atherosclerosis: A systematic review and meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106538 ◽

2021 ◽

Vol 203 ◽

pp. 106538

Author(s):

Pengfei Zhang ◽

Yongguo Xing ◽

Hongbin Li ◽

Qingping Yao ◽

Jie Shen ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Artery Occlusion ◽

Large Artery ◽

Intracranial Atherosclerosis ◽

Efficacy And Safety

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In Hyperacute Recanalization Therapy, Early Hospital Arrival Improves Outcome in Patients with Large Artery Occlusion

European Neurology ◽

10.1159/000490461 ◽

2018 ◽

Vol 79 (5-6) ◽

pp. 335-341

Author(s):

Junya Aoki ◽

Kentaro Suzuki ◽

Satoshi Suda ◽

Seiji Okubo ◽

Masahiro Mishina ◽

...

Keyword(s):

Regression Analysis ◽

Clinical Outcome ◽

Multivariate Regression ◽

Intravenous Thrombolysis ◽

Multivariate Regression Analysis ◽

Artery Occlusion ◽

Favorable Outcome ◽

Large Artery ◽

Independent Factor ◽

Hospital Arrival

Background: It is unknown whether the effect of onset-to-door (OTD) time on clinical outcomes differs between patients with and without large artery occlusion (LAO) who undergo hyperacute recanalization therapy. Methods: Hyperacute recanalization therapy includes intravenous thrombolysis tissue-plasminogen activator (tPA), and endovascular therapy (EVT). Favorable clinical outcome was defined as modified Rankin Scale of ≤2 at discharge. Results: Among 164 patients, 117 (71%) patients received tPA, 86 (52%) received EVT, and 39 (24%) received tPA and EVT. One hundred and fifteen patients (70%) were classified into the LAO group and 49 (30%) into the non-LAO group. In the total cohort, multivariate regression analysis showed OTD time (OR 0.809 [95% CI 0.693–0.944], p = 0.007) was an independent factor related to the favorable outcome. Similarly, among patients with LAO, OTD was an independent negative factor for the favorable outcome (0.779 [0.646–0.940], p = 0.009). On the contrary, OTD was not associated with the favorable outcome (1.5 [0.7–2.5] vs. 1.7 [1.1–3.2], p = 0.155) in patients without LAO. This was confirmed with multivariate regression analysis, which did not show OTD to be an independent factor for the favorable outcome (0.900 [0.656–1.236], p = 0.516). Conclusion: The effect of early hospital arrival on clinical outcome differed between patients with and without LAO.

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Efficacy and Safety of Emergency Extracranial-Intracranial Bypass for Revascularization within 24 hours in Resolving Large Artery Occlusion with Intracranial Stenosis

World Neurosurgery ◽

10.1016/j.wneu.2021.07.010 ◽

2021 ◽

Author(s):

Yun Ho Noh ◽

Jae woo Chung ◽

Jung Ho Ko ◽

Hae Won Koo ◽

Ji Young Lee ◽

...

Keyword(s):

Artery Occlusion ◽

Intracranial Stenosis ◽

Large Artery ◽

Efficacy And Safety

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Abstract WP21: Primary Thrombectomy Within 3 Hours of Onset in Acute Ischemic Stroke From Large Artery Occlusion (PAST3-LAO)- A Pilot Study

Stroke ◽

10.1161/str.47.suppl_1.wp21 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Yahia M Lodi ◽

Varun Reddy ◽

George Petro ◽

Anas Hourani ◽

Chun-An Chou

Keyword(s):

Pilot Study ◽

Artery Occlusion ◽

Primary Objective ◽

Stent Retriever ◽

Large Artery ◽

Good Outcome ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

New Generation ◽

Number Of Passes

Background: Based on recent trials, AIS due to large artery occlusion (LAO) is resistant to IV thrombolysis and adjunctive stent retriever thrombectomy (SRT) is associated with better recanalization rates and outcomes.Despite the benefit with endovascular therapy 39% to 68% of patients were either disabled or dead.Thrombectomy in AIS with LAO within 3 hours (IV t-PA window) is performed as secondary therapy after IV thrombolysis, which may be associated with delay in enrollment and recanalization. Objective: Primary objective is to evaluate the safety, feasibility and recanalization rate of primary SRT (without IV tPA) within 3 hours in AIS with NIHSS >10 from LAO.Secondary objective is to determine the functional outcome in 30-days and 90-days. Methods: Based on institutionally approved protocol patients with LAO with LCB within 3 hours were offered primary SRT alone as an alternative to IV rtPA, after informed consent.Consecutive patients who underwent primary SRT for LAO within 3 hours from 2012 to 2014 were enrolled.Outcomes were measured using modified Rankin Scale. Results: 18 patients with LAO; mean age 62.8±15.3 years and mean NIHSS 16±5; chose primary SRT after informed consent.Thrombectomy was performed using new generation stent-retriever device in addition to small intra-arterial rtPA (2-10 mg).Number of passes was 1.6±0.9.Near complete (TICI2b in 1) and complete (TICI3 in 17) recanalization was observed in all (100%) patients.Mean time to recanalization from symptoms onset was 188.5±82.7 and from groin puncture was 64.61±40.14 minutes.Immediate post-thrombectomy, 24 hour and 30 day NIHSS score was 4.4±3.7, 1.9±3.2 and 0.3±0.9 respectively.There was no procedure related complication.Asymptomatic perfusion related hemorrhage developed in 6 patients (33%).30 days good outcome was observed in all cases (mRS0= 38.9%, mRS1=44.4%, mRS2=16.7%). 90 days good outcome was observed as follows (mRS0= 50.0%, mRS1=44.4%, mRS2=5.6%). Conclusion: Our pilot study demonstrates that primary SRT in AIS due LAO occlusion with LCB is not only safe and feasible, but associated with complete recanalization and good functional outcome.Larger randomized controlled studies are needed.

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Safety of Endovascular Therapy in Progressive Ischemic Stroke and Anterior Circulation Large Artery Occlusion

World Neurosurgery ◽

10.1016/j.wneu.2018.10.059 ◽

2019 ◽

Vol 122 ◽

pp. e383-e389 ◽

Cited By ~ 1

Author(s):

Wen-Huo Chen ◽

Ting-yu Yi ◽

Yan-Min Wu ◽

Mei-Fang Zhang ◽

Ding-lai Lin ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Therapy ◽

Artery Occlusion ◽

Large Artery ◽

Anterior Circulation

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Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion

Stroke ◽

10.1161/strokeaha.115.012482 ◽

2016 ◽

Vol 47 (7) ◽

pp. 1772-1776 ◽

Cited By ~ 103

Author(s):

Sidsel Hastrup ◽

Dorte Damgaard ◽

Søren Paaske Johnsen ◽

Grethe Andersen

Keyword(s):

Acute Stroke ◽

Artery Occlusion ◽

Stroke Severity ◽

Large Artery ◽

Severity Scale

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Abstract WP33: Reperfusion Therapy in Carotid Artery Occlusion with Collaterals Through the Circle of Willis

Stroke ◽

10.1161/str.48.suppl_1.wp33 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Seong Hwan Ahn ◽

In Sung Choo ◽

Hyun Gu Kang ◽

Ji Yeon Jung ◽

Sang Woo Ha

Keyword(s):

Carotid Artery ◽

Endovascular Treatment ◽

Recurrent Stroke ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Circle Of Willis ◽

Carotid Occlusion ◽

Large Artery ◽

Clinical Worsening

Introduction: In large artery occlusion, endovascular treatment shows better recanalization rate than intravenous tPA alone. In reperfusion therapy, excellent collaterals through the circle of Willis has better prognosis. We hypothesized that intravenous tPA only is comparable to endovascular therapy in carotid occlusion with patent ‘T’. Methods: Between January 2010 and December 2015, in acute stroke patients who had received a reperfusion therapy, carotid artery occlusion with good collateral via the circle of Willis were selected. In all patients, non-contrast CT and CT angiography were conducted before reperfusion therapy and at 24 (+/-6) hours and/or clinical worsening. Stroke severity was assessed with NIHSS at baseline and discharge. The prognosis of reperfusion therapy was assessed by modified Rankin Scales at 3 months. Results: In 529 patients treated by reperfusion therapy, 29 patients (5.5%, male 21, median age 76) had internal carotid artery occlusion with patent ‘T’. In tPA alone (24 patients, 82.8%), baseline NIHSS were non-significantly lower than in endovascular treatment (10 vs 15, p=0.224). Recurrent stroke, which was confirmed with follow up angiography, was developed in 8 of tPA alone. In endovascular treatment, one had a distal embolization. In 22 patients who could be assessed by MRS, 10 patients (45.5%, tPA in 9, IA in 1) had good mRS and 6 patients (27.3%) were expired. Conclusions: Carotid occlusion with good collaterals via the circle of Willis was uncommon. tPA alone resulted in recurrent stroke with clinical worsening. Endovascular treatment may be better option in carotid occlusion with patent ‘T’.

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Abstract TP165: Mortality After Large Artery Occlusion Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp165 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Rahul R Karamchandani ◽

Jeremy Rhoten ◽

Edwin Strong ◽

Brenda Chang ◽

Sam Singh ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Prediction Models ◽

Univariate Analysis ◽

Female Gender ◽

Artery Occlusion ◽

Large Artery ◽

Multivariable Logistic Regression Model ◽

Factors Associated ◽

Social Security Death Index

Introduction: Despite randomized trials demonstrating the benefit of endovascular therapy (EVT), large artery occlusion (LAO) acute ischemic stroke (AIS) remains associated with high mortality. Identifying factors associated with mortality for patients presenting with LAO AIS can assist in therapeutic decision-making and prognostication. Hypothesis: Among patients with LAO AIS, factors associated with 90-day mortality include older age, higher presenting NIHSS score, and lower final Thrombolysis in Cerebral Infarction (TICI) score. Methods: From November 2016 to April 2019, we conducted a retrospective analysis from a large healthcare system’s stroke network registry of patients presenting with ICA and/or MCA occlusions. Ninety-day mortality status from registry follow-up was corroborated with the Social Security Death Index. A multivariable logistic regression model was fitted to determine demographic and clinical characteristics associated with 90-day mortality. Results: Among 796 patients with 800 encounters, mean age was 68 years, 52% were women, mean presenting NIHSS was 14, and 97% presented within 24 hours of last known well time. Fifty-one percent were treated with EVT. Mortality rate for the entire cohort was 25%. In a univariate analysis, there were significant differences in age, gender, race, blood glucose, presenting NIHSS, hypertension, atrial fibrillation, CTP core volume, CTP delayed perfusion volume, EVT treatment, number of passes for EVT, final TICI score, and discharge mRS, between patients with and without 90-day mortality. In the multivariable model, increasing age (per 10 years, OR 1.54, 95% CI 1.20, 1.97) and higher discharge mRS (per 1 point, OR 4.47, 95% CI 3.05, 6.55) were associated with 90-day mortality. Female gender (OR 0.57, 95% CI 0.27, 1.18) and final TICI score of 2B or better (OR 0.42, 95% CI 0.18, 1.01) were protective against 90-day mortality. Conclusions: Increasing age and worse discharge functional outcome are associated with 90-day mortality after LAO AIS. Female gender and better revascularization after EVT are associated with lower mortality. Additional studies are required to refine mortality outcome prediction models for patients presenting with LAO AIS.

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