scholarly journals EARLY NEUROLOGIC DETERIORATION AFTER MECHANICAL THROMBECTOMY IN ANTERIOR CIRCULATION ACUTE ISCHEMIC STROKE PATIENTS WITH UNFAVOURABLE COMBINATION OF CIRCLE OF WILLIS CONFIGURATION AND OCCLUSION LOCALIZATION

2018 ◽  
Author(s):  
Givi Lengvenis
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Circle Of Willis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Neurologic Deterioration

Abstract WP372: Hydration Status and Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mona N Bahouth ◽  
Rebecca Gottesman
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Blood Urea Nitrogen ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Hydration Status ◽  
Creatinine Ratio ◽  
Stroke Patients ◽  
Anterior Circulation

Introduction: Impaired hydration measured by elevated blood urea nitrogen (BUN) to creatinine ratio has been associated with worsened outcome after acute ischemic stroke. Whether hydration status is relevant for patients with acute ischemic stroke treated with mechanical thrombectomy remains unknown. Materials and Methods: We conducted a retrospective review of consecutive acute ischemic stroke patients who underwent endovascular procedures for anterior circulation large artery occlusion at Johns Hopkins Comprehensive Stroke Centers between 2012 and 2017. A volume contracted state (VCS), was determined based on surrogate lab markers and defined as blood urea nitrogen (BUN) to creatinine ratio greater than 15. Endpoints were achievement of successful revascularization (TICI 2b or 3), early re-occlusion, and short term clinical outcomes including development of early neurological worsening and functional outcome at 3 months. Results: Of the 158 patients who underwent an endovascular procedure, 102 patients had a final diagnosis of anterior circulation large vessel occlusion and met the inclusion criteria for analysis. Volume contracted state was present in 62/102 (61%) of patients. Successful revascularization was achieved in 75/102 (74%) of the cohort. There was no relationship between VCS and successful revascularization, but there was a 1.13 increased adjusted odds (95% CI 1.01, 1.27) of re-occlusion within 24 hours for every point higher BUN/creatinine ratio in the subset of patients who underwent radiological testing for pre-procedure planning (n=57). There was no relationship between VCS and clinical outcomes including early neurological worsening and 3 month outcome. Conclusions: Patients with VCS and large vessel anterior circulation stroke may have a higher odds of early re-occlusion after mechanical thrombectomy than their non-VCS counterparts, but no differences in successful revascularization nor clinical outcomes were present in this cohort. These results may suggest an opportunity for the exploration of pre-procedure hydration to improve outcomes.

scholarly journals Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access

2020 ◽  
pp. 1-11
Author(s):  
Branden J. Cord ◽  
Sreeja Kodali ◽  
Sumita Strander ◽  
Andrew Silverman ◽  
Anson Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Vascular Access ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Nihss Score

OBJECTIVEWhile the benefit of mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonged. In this study, the authors evaluated safety as well as radiographic and functional outcomes in stroke patients treated with MT via direct carotid puncture (DCP) for prohibitive vascular access.METHODSThe authors retrospectively studied patients from their prospective AIS-LVO database who underwent attempted MT between 2015 and 2018. Patients with prohibitive vascular access were divided into two groups: 1) aborted MT (abMT) after failed transfemoral access and 2) attempted MT via DCP. Functional outcome was assessed using the modified Rankin Scale at 3 months. Associations with outcome were analyzed using ordinal logistic regression.RESULTSOf 352 consecutive patients with anterior circulation AIS-LVO who underwent attempted MT, 37 patients (10.5%) were deemed to have prohibitive vascular access (mean age [± SD] 82 ± 11 years, mean National Institutes of Health Stroke Scale [NIHSS] score 17 ± 5, with females accounting for 75% of the patients). There were 20 patients in the DCP group and 17 in the abMT group. The two groups were well matched for the known predictors of clinical outcome: age, sex, and admission NIHSS score. Direct carotid access was successfully obtained in 19 of 20 patients. Successful reperfusion (thrombolysis in cerebral infarction score 2b or 3) was achieved in 16 (84%) of 19 patients in the DCP group. Carotid access complications included an inability to catheterize the carotid artery in 1 patient, neck hematomas in 4 patients, non–flow-limiting common carotid artery (CCA) dissections in 2 patients, and a delayed, fatal carotid blowout in 1 patient. The neck hematomas and non–flow-limiting CCA dissections did not require any subsequent interventions and remained clinically silent. Compared with the abMT group, patients in the DCP group had smaller infarct volumes (11 vs 48 ml, p = 0.04), a greater reduction in NIHSS score (−4 vs +2.9, p = 0.03), and better functional outcome (shift analysis for 3-month modified Rankin Scale score: adjusted OR 5.2, 95% CI 1.02–24.5; p = 0.048).CONCLUSIONSDCP for emergency MT in patients with anterior circulation AIS-LVO and prohibitive vascular access is safe and effective and is associated with higher recanalization rates, smaller infarct volumes, and improved functional outcome compared with patients with abMT after failed transfemoral access. DCP should be considered in this patient population.

Abstract WP25: Gender Disparity in Mechanical Thrombectomy Outcomes: The Role of Arterial Caliber

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mark A Davison ◽  
Kavantissa M Keppetipola ◽  
Bichun Ouyang ◽  
Michael Chen
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Vascular Anatomy ◽  
Gender Disparity ◽  
Circle Of Willis ◽  
Large Vessel ◽  
Consecutive Series ◽  
Anterior Circulation ◽  
Men And Women

Introduction: Despite level 1a evidence demonstrating the clinical benefit of mechanical thrombectomy in selected large vessel ischemic stroke patients, a gender disparity exists. Women not only have less favorable clinical outcomes after all stroke types, but the causes of this disparity remain elusive. Gender differences in cerebral vascular anatomy have been previously published. We hypothesize that differences in circle of Willis diameters may contribute to the gender disparity seen in clinical outcomes after mechanical thrombectomy for acute ischemic stroke. Methods: Clinical and radiographic data from a consecutive series undergoing mechanical thrombectomy for anterior circulation large vessel ischemic strokes were reviewed. Measurements of the proximal middle cerebral artery (M1) segment and supraclinoid internal carotid artery (ICA) diameters were obtained in a standardized fashion from the thrombectomy procedure angiogram. All M1 measurements were recorded at 3 mm of the vessel origin while ICA measurements were taken 3 mm proximal to the ICA terminus. Covariates included age, occlusion location, vascular risk factors, admission NIHSS score and final TICI grade. Modified Rankin score (mRS) at 90 days was the dependent variable. Variable significance between male and female cohorts was determined using student T-Tests. Multivariate regression analysis was also performed. Results: Ninety-four patients (41 female) between 6/2013 and 6/2016 fit the inclusion criteria. ICA terminus measurements for men and women were 3.07 mm (SD=0.46) and 2.88 mm (SD=0.47), respectively. M1 origin measurements for men and women were 2.46 mm (SD=0.31) and 2.21 mm (SD=0.37), respectively. Male ICA terminus and M1 origin measurements were larger than female (p = 0.05 and p < 0.001, respectively). 61% of men vs. 25% of women had 90-day mRS ≤ 2. Multivariate analysis indicated that only age was significantly associated with 90-day mRS ≤ 2. Conclusions: Our single center series suggests that differences in intracranial vessel diameter may contribute to the gender disparity in outcomes after mechanical thrombectomy. Smaller circle of Willis arterial diameters may compromise collateral blood flow and increase the difficulty in achieving sufficient reperfusion.

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

scholarly journals Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

2018 ◽  
Vol 7 (18) ◽  
Author(s):  
Benjamin Maïer ◽  
Guillaume Turc ◽  
Guillaume Taylor ◽  
Raphaël Blanc ◽  
Michael Obadia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Pulse Pressure ◽  
Mechanical Thrombectomy ◽  
Prognostic Significance ◽  
Stroke Patients

116 Effect of Annual Hospital Procedure Volume on Outcomes After Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Neurosurgery ◽  
2016 ◽  
Vol 63 ◽  
pp. 149 ◽  
Author(s):  
Vishal B. Jani ◽  
Chiu Yuen To ◽  
Achint Patel ◽  
Prashant S. Kelkar ◽  
Boyd Richards ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Patients ◽  
Procedure Volume

scholarly journals Anestezijos metodo reikšmė pacientų, sergančių ūminiu išeminiu insultu ir gydytų mechanine trombektomija, ankstyvai neurologinei būklei Relevance of anaesthesia type on early neurological outcome in acute ischemic stroke patients undergoing mechanical thrombectomy

2019 ◽  
Vol 22 (78) ◽  
pp. 325-329
Author(s):  
L. Šalaševičius ◽  
A. Vilionskis
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Outcome ◽  
Mechanical Thrombectomy ◽  
Stroke Patients

Įvadas. Sąmonės sedacija (SS) ir bendroji endotrachėjinė anestezija (BETA) – anestezijos metodai, taikomi mechaninės trombektomijos (MTE) metu. Tikslių rekomendacijų dėl anestezijos metodo pasirinkimo MTE metu nėra. Retrospektyviniai tyrimai teigia, kad BETA yra susijusi su blogesnėmis pacientų išeitimis, tačiau naujuose klinikiniuose tyrimuose tokio skirtumo nestebima. Darbo tikslas buvo nustatyti anestezijos metodo įtaką mechaninės trombektomijos efektyvumui ir saugumui ligoniams, patyrusiems ūminį išeminį insultą. Tiriamieji ir tyrimo metodai. Į tyrimą įtraukti dviejuose Vilniaus centruose gydyti ūminį išeminį insultą patyrę ligoniai, kuriems buvo atlikta MTE. Ligoniai suskirstyti į 2 grupes pagal taikytą anestezijos metodą: bendroji endotrachėjinė anestezija (BETA) ir sąmonės sedacija (SS). Abiejose grupėse vertinti demografiniai, klinikiniai ir logistiniai rodikliai. Pirminiu vertinimo kriterijumi pasirinkta gera baigtis po 24 valandų. MTE saugumas vertintas pagal 7 parų mirštamumą ir simptominių intrasmegeninių kraujosruvų (sISK) dažnį. Rezultatai. Į tyrimą įtraukta 248 pacientai. 105 pacientams (42,3 %) taikyta BETA ir 143 (57,7 %) – SS. Pagal pradines charakteristikas abi grupės statistiškai nesiskyrė, išskyrus prieširdžių virpėjimo dažnį (55,9 % – SS vs 37,1 % – BETA grupėje, p = 0,003) ir intraveninės trombolizės taikymą iki MTE (66,4 % – SS grupėje ir 46,7 % – BETA grupėje, p = 0,003). Gera baigtis po 24 val. nustatyta 51,4 % (n = 54) ligonių – BETA grupėje ir 58,7 % (n = 84) ligonių – SS grupėje (p = 0,252). 7 parų mirštamumo sISK dažnis abiejose grupėse statistiškai reikšmingai nesiskyrė. Regresinė analizė parodė, kad geros baigties nepriklausomi prognoziniai veiksniai yra laikas nuo atvykimo į stacionarą iki rekanalizacijos ir sėkminga rekanalizacija. Išvados. Anestezijos tipas nėra reikšmingas mechaninės trombektomijos efektyvumo ir saugumo veiksnys ankstyvai pacientų baigčiai. Siekiant tiksliau įvertinti anestezijos reikšmę mechaninės trombektomijos baigčiai ir nustatyti procedūros baigties prognozinius veiksnius, reikalingi papildomi atsitiktinės atrankos tyrimai.

Abstract TP215: Machine Learning Analysis of Gene Expression Data and Predictive Stroke Outcomes in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sarah R Martha ◽  
Qiang Cheng ◽  
Liyu Gong ◽  
Lisa Collier ◽  
Stephanie Davis ◽  
...  
Keyword(s):  
Gene Expression ◽  
Machine Learning ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Inflammatory Genes ◽  
Patient Demographics ◽  
Edema Volume

Background and Purpose: The ability to predict ischemic stroke outcomes in the first day of admission could be vital for patient counseling, rehabilitation, and care planning. The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC; clinicaltrials.gov NCT03153683) collects blood samples distal and proximal to the intracranial thrombus during mechanical thrombectomy. These samples are a novel resource in evaluating acute gene expression changes at the time of ischemic stroke. The purpose of this study was to identify inflammatory genes and patient demographics that are predictive of stroke outcomes (infarct and/or edema volume) in acute ischemic stroke patients. Methods: The BACTRAC study is a non-probability, convenience sampling of subjects (≥ 18 year olds) treated with mechanical thrombectomy for emergent large vessel occlusion. We evaluated relative concentrations of mRNA for gene expression in 84 inflammatory molecules in static blood distal and proximal to the intracranial thrombus from adults who underwent thrombectomy. We employed a machine learning method, Random Forest, utilizing the first set of enrolled subjects, to predict which inflammatory genes and patient demographics were important features for infarct and edema volumes. Results: We analyzed the first 28 subjects (age = 66 ± 15.48, 11 males) in the BACTRAC registry. Results from machine learning analyses demonstrate that the genes CCR4, IFNA2, IL9, CXCL3, Age, DM, IL7, CCL4, BMI, IL5, CCR3, TNF, and IL27 predict infarct volume. The genes IFNA2, IL5, CCL11, IL17C, CCR4, IL9, IL7, CCR3, IL27, DM, and CSF2 predict edema volume. There is an intersection of genes CCR4, IFNA2, IL9, IL7, IL5, CCR3 to both infarct and edema volumes. Overall, these genes depicts a microenvironment for chemoattraction and proliferation of autoimmune cells, particularly Th2 cells and neutrophils. Conclusions: Machine learning algorithms can be employed to develop predictive biomarker signatures for stroke outcomes in ischemic stroke patients, particularly in regard to identifying acute gene expression changes that occur during stroke.

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