1-O14 Assessment of the evolution of CTP based penumbra after successful endovascular recanalization for intracranial large vessel occlusion

2021 ◽  
Author(s):  
Bence Nemeth
Keyword(s):  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Recanalization

Abstract P497: Comparison of Recanalization and Early Clinical Outcomes of Large Vessel Occlusion With Endovascular Therapy Following Alteplase versus Tenecteplase

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jefferson T Miley ◽  
James S Waldron ◽  
Ramsey Ashour ◽  
Steven J Warach ◽  
Keyword(s):  
Clinical Outcomes ◽  
Randomized Trials ◽  
Clinical Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Open Label ◽  
Vessel Occlusion ◽  
Endovascular Recanalization ◽  
Label Sample ◽  
Early Clinical Outcomes

Background: Randomized trials comparing alteplase (ALT) to tenecteplase (TNK) in large vessel occlusion have reported higher rates of recanalization with evidence of better clinical outcomes. Our 10-hospital network (2 CSCs, 2PSCs, 6 non-SCs) switched the standard stroke thrombolytic from alteplase (ALT) to tenecteplase (TNK; 0.25 mg/kg) in September 2019. We describe our results in a subgroup analysis of an on-going prospective cohort study of TNK-treated vs two years of ALT treated cases. Methods: All cases in whom a mechanical endovascular recanalization procedure was initiated following thrombolytic therapy. Cases will be reviewed and adjudicated independently by three neurointerventionalists for partial or complete recanalization on initial angiogram compared to pretreatment CTA or MRA. Cases that could not be assessed for technical reasons (e.g., sufficient imaging studies were not present in PACS) were excluded from the recanalization analysis. All cases were included in the clinical analysis. Preliminary recanalization results available at the time of submission are presented here. Results: 42 TNK-treated (median age 68.5y, median NIHSS 16, median Last Known Well to Groin 198 minutes) and 77 ALT (median age 67y, median NIHSS 18, median Last Known Well to Groin 198 minutes) were included. Early clinical outcomes and preliminary results on recanalization (partial or complete) are summarized in the Table. Approximately twice the rate of recanalization was seen in the TNK vs ALT cases (not statistically significant). Rates of discharge to home, in-hospital mortality/discharge to hospice, or symptomatic ICH were not different. Conclusion: In this non-randomized, open-label sample, a nominally higher rate of partial or complete recanalization of LVO with TNK relative to ALT, without significant differences on early indices of clinical outcome. Adjudicated analyses of recanalization on an updated TNK sample will be presented at the conference.

Impact of basal ganglia damage after successful endovascular recanalization for acute ischemic stroke involving lenticulostriate arteries

2020 ◽  
Vol 132 (6) ◽  
pp. 1880-1888
Author(s):  
Nobutaka Horie ◽  
Yoichi Morofuji ◽  
Yusuke Iki ◽  
Eisaku Sadakata ◽  
Tadashi Kanamoto ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basal Ganglia ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Lentiform Nucleus ◽  
Lenticulostriate Arteries ◽  
Endovascular Recanalization

OBJECTIVERegional ischemic vulnerability of the brain reportedly differs between the cortex and basal ganglia and has been poorly assessed in the setting of endovascular mechanical thrombectomy. This study was conducted to determine the fate of an ischemic basal ganglia and its contribution to the clinical outcome after successful endovascular recanalization for acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries.METHODSClinical and radiological findings were retrospectively analyzed in consecutive patients with acute ischemic stroke characterized by large vessel occlusion involving the lenticulostriate arteries. Mechanical thrombectomy was performed in all patients using a stent retriever. The fate of ischemic basal ganglia based on location (lentiform nucleus, caudate nucleus, and internal capsule) and insular cortex was assessed according to the Alberta Stroke Programme Early CT Score (ASPECTS).RESULTSOf 170 patients with large intracranial vessel occlusion who achieved successful endovascular recanalization, defined as a thrombolysis in cerebral infarction grade of ≥ 2B, involvement of the lenticulostriate arteries was seen in 55 patients (internal carotid artery, n = 35; proximal middle cerebral artery, n = 20). Preoperative infarction was detected in the lentiform nucleus (66.7%), internal capsule (11.1%), and caudate nucleus (33.3%), all of which showed secondary advancement despite successful recanalization (85.4%, 27.3%, and 54.5%, respectively; p < 0.05). Lenticulostriate arteries with a lateral proximal and/or medial proximal origin significantly affected the development of mature infarction in the lentiform nucleus. Postoperative hemorrhagic transformation was detected in 25 of 55 patients, mostly in the lentiform nucleus. Involvement of insular ribbon infarction was significantly high in patients with hemorrhagic transformation in the basal ganglia. Age, initial National Institutes of Health Stroke Scale (NIHSS) score, initial ASPECTS, postoperative ASPECTS, postoperative infarction in the insular ribbon, and lesions in the middle cerebral artery area (M1–M6) were significantly different between patients with good and poor modified Rankin Scale scores. Interestingly, no differences were detected in postoperative infarction or hemorrhagic transformation in the basal ganglia. Multivariate analysis showed that only age (p = 0.02, OR 0.88) and the initial NIHSS score (p = 0.01, OR 0.86) independently affected favorable clinical outcomes.CONCLUSIONSThe basal ganglia are vulnerable and readily develop secondary infarction and hemorrhagic transformation despite successful recanalization. However, this does not have a significant impact on the clinical outcome of acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries.

Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration

2020 ◽  
Vol 132 (4) ◽  
pp. 1202-1208 ◽  
Author(s):  
Dong-Hun Kang ◽  
Woong Yoon ◽  
Byung Hyun Baek ◽  
Seul Kee Kim ◽  
Yun Young Lee ◽  
...  
Keyword(s):  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Large Vessel ◽  
Binary Logistic Regression Analysis ◽  
Large Vessel Occlusion ◽  
Front Line ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Atherosclerotic Stenosis ◽  
Antegrade Flow

OBJECTIVEThe optimal front-line thrombectomy choice for primary recanalization of a target artery remains unknown for patients with acute large-vessel occlusion (LVO) and an underlying intracranial atherosclerotic stenosis (ICAS). The authors aimed to compare procedural characteristics and outcomes between patients who received a stent-retriever thrombectomy (SRT) and patients who received a contact aspiration thrombectomy (CAT), as the front-line approach for treating LVO due to severe underlying ICAS.METHODSOne hundred thirty patients who presented with acute LVO and underlying severe ICAS at the occlusion site were included. Procedural characteristics and treatment outcomes were compared between patients treated with front-line SRT (n = 70) and those treated with front-line CAT (n = 60). The primary outcomes were the rate of switching to an alternative thrombectomy technique, time from groin puncture to initial reperfusion, and duration of the procedure. Initial reperfusion was defined as revealing the underlying culprit stenosis with an antegrade flow after thrombectomy.RESULTSThe rate of switching to an alternative thrombectomy after failure of the front-line technique was significantly higher in the CAT group than in the SRT group (40% vs 4.3%; OR 2.543, 95% CI 1.893–3.417, p < 0.001). The median time from puncture to initial reperfusion (17 vs 31 minutes, p < 0.001) and procedure duration (39 vs 75.5 minutes, p < 0.001) were significantly shorter in the SRT group than in the CAT group. In the binary logistic regression analysis, a longer time from puncture to initial reperfusion was an independent predictor of a 90-day poor (modified Rankin Scale score 3–6) functional outcome (per 1-minute increase; OR 1.029, 95% CI 1.008–1.050, p = 0.006).CONCLUSIONSThe authors’ results suggest that SRT may be more effective than CAT for identifying underlying culprit stenosis and therefore considered the optimal front-line thrombectomy technique in acute stroke patients with LVO and severe underlying ICAS.

scholarly journals Diagnostic value of transcranial ultrasonography for selecting subjects with large vessel occlusion: a systematic review

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Daria Antipova ◽  
Leila Eadie ◽  
Ashish Stephen Macaden ◽  
Philip Wilson
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Acute Stroke ◽  
Clinical Assessment ◽  
Assessment Tools ◽  
Large Vessel ◽  
Cochrane Library ◽  
Direct Transfer ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Abstract Introduction A number of pre-hospital clinical assessment tools have been developed to triage subjects with acute stroke due to large vessel occlusion (LVO) to a specialised endovascular centre, but their false negative rates remain high leading to inappropriate and costly emergency transfers. Transcranial ultrasonography may represent a valuable pre-hospital tool for selecting patients with LVO who could benefit from rapid transfer to a dedicated centre. Methods Diagnostic accuracy of transcranial ultrasonography in acute stroke was subjected to systematic review. Medline, Embase, PubMed, Scopus, and The Cochrane Library were searched. Published articles reporting diagnostic accuracy of transcranial ultrasonography in comparison to a reference imaging method were selected. Studies reporting estimates of diagnostic accuracy were included in the meta-analysis. Results Twenty-seven published articles were selected for the systematic review. Transcranial Doppler findings, such as absent or diminished blood flow signal in a major cerebral artery and asymmetry index ≥ 21% were shown to be suggestive of LVO. It demonstrated sensitivity ranging from 68 to 100% and specificity of 78–99% for detecting acute steno-occlusive lesions. Area under the receiver operating characteristics curve was 0.91. Transcranial ultrasonography can also detect haemorrhagic foci, however, its application is largely restricted by lesion location. Conclusions Transcranial ultrasonography might potentially be used for the selection of subjects with acute LVO, to help streamline patient care and allow direct transfer to specialised endovascular centres. It can also assist in detecting haemorrhagic lesions in some cases, however, its applicability here is largely restricted. Additional research should optimize the scanning technique. Further work is required to demonstrate whether this diagnostic approach, possibly combined with clinical assessment, could be used at the pre-hospital stage to justify direct transfer to a regional thrombectomy centre in suitable cases.

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