scholarly journals Frequency of Aortic Arch Variants in Patients with Large Vessel Stroke in the Anterior Circulation

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Omid Nikoubashman ◽  
Maryam Feiz
Keyword(s):  
Aortic Arch ◽  
Large Vessel ◽  
Anterior Circulation ◽  
Large Vessel Stroke

Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes

2019 ◽  
Vol 11 (9) ◽  
pp. 874-878 ◽  
Author(s):  
Stephanie H Chen ◽  
Brian M Snelling ◽  
Samir Sur ◽  
Sumedh Subodh Shah ◽  
David J McCarthy ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Mechanical Thrombectomy ◽  
Vascular Anatomy ◽  
Patient Characteristics ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Cohort Differences ◽  
Number Of Passes

BackgroundA transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. Nonetheless, TRA may confer added benefits in MT since navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory.ObjectiveTo compare outcomes in patients who underwent MT via TRA versus TFA.MethodsWe performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2018. Patient characteristics, procedural techniques, and outcomes were recorded. TFA and TRA cohorts were compared.ResultsOf the 51 patients, 18 (35%) underwent MT via TRA. There were no significant cohort differences in patient characteristics, clot location, or aortic arch type and presence of carotid tortuosity. There were no significant differences in outcomes between the two cohorts, including single-pass recanalization rate (54.5% vs 55.6%, p=0.949) and average number of passes (1.9 vs 1.7, p=0.453). Mean access-to-reperfusion time (61.9 vs 61.1 min, p=0.920), successful revascularization rates (Thrombolysis in Cerebral Infarction score ≥2b 87.9% vs 88.9%, p=1.0) and functional outcomes (modified Rankin Scale score≤2, 39.4% vs 33.3%, p=0.669) were similar between TFA and TRA cohorts, respectively.ConclusionsOur results demonstrate equivalence in efficacy and efficiency between TRA and TFA for MT of anterior circulation large vessel occlusion in patients with challenging vascular anatomy. TRA may be better than TFA in well-selected patients undergoing MT.

Abstract TP44: Trans-Radial Approach in Mechanical Thrombectomy in Anterior Circulation Large Vessel Stroke; Two Center Experience

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Priyank Khandelwal ◽  
NIrav Bhatt ◽  
Vasu Saini ◽  
Marie Brunet ◽  
Ryan Bo ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Anterior Circulation ◽  
Radial Approach ◽  
Large Vessel Stroke

Abstract T P8: Comparison of Large Vessel Stroke Patient Outcomes Before and After Initiation of On-Site Endovascular Stroke Treatment Services

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yamin Shwe ◽  
Santiago Ortega-Gutierrez ◽  
Ahmed Otokiti ◽  
David Altschul ◽  
Srinivasan Paramasivam ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Endovascular Treatment ◽  
Patient Outcomes ◽  
Transportation Systems ◽  
Large Vessel ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Discharge Disposition ◽  
Before And After ◽  
Large Vessel Stroke

Rational: Availability of an on-site endovascular program for large vessel stroke decreases the time to acute treatment. Since expanding our program to a Manhattan hospital in July 2009, we have seen a decreased time to treatment. We hypothesize that the expansion was associated with improved discharge outcomes in patients with anterior circulation large vessel strokes. Methods: A retrospective chart review of consecutive patients before and after the initiation of the program was conducted. Adults presenting to the hospital with an NIHSS greater than 8, within 6 hours from stroke onset, and with carotid terminus or middle cerebral artery occlusion were included. Exclusion criteria were INR or creatinine >3 and premorbid modified Rankin score (MRS) >1. Comparison was made between the groups before and after initiation of the program. Modified Rankin at discharge was set as a primary outcome. Secondary outcomes included admission-discharge delta NIHSS, discharge disposition, mortality and stroke volume on MRI or CT scan. P<0.05 was set as statistically significant. Results: 70 patients were included in the study. 30 were admitted before July 2009 and 40 after. There was no difference between patient demographics. Only 3/30 patient received endovascular treatment prior to July 2009 versus 34/40 after that. Patients admitted after availability of on-site endovascular treatment were less likely to be dependent (OR: 0.14; 95% CI: 0.019-1) or discharged other than home (OR: 0.233; 95% CI: 0.062-0.876) after adjusting for age and admission NIHSS. In addition there was a significant increase in median admission-discharge NIHSS change in patients treated after July 2009 (p=0.007). No difference between median stroke volume was observed (66 vs 57.2 cm3; p=0.8) Discussion: For every 30 minutes until reperfusion, the probability of good recovery after a large vessel stroke is decreased by about 10%. Transfer delays may impede or limit the benefit of endovascular recanalization. In the absence of strategic air transportation systems, rapid deployment of an endovascular team might decrease the time to recanalization and improve patient outcomes.

Abstract P318: Ischemic Core Overestimation on Computed Tomography Perfusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alvaro Garcia-Tornel Garcia-Camba ◽  
Campos Daniel ◽  
Marta Rubiera ◽  
Boned Sandra ◽  
Marta Olive-Gadea ◽  
...  
Keyword(s):  
Time Window ◽  
Ct Perfusion ◽  
Large Vessel ◽  
Multivariable Logistic Regression Analysis ◽  
Relative Reduction ◽  
Anterior Circulation ◽  
Imaging Time ◽  
Hemodynamic State ◽  
Ischemic Core ◽  
Large Vessel Stroke

Introduction: Different studies have pointed that CT perfusion(CTP) could overestimate ischemic core in early time window. We aim to evaluate the influence of time and collateral status on ischemic core overestimation. Methods: Retrospective single-center study including patients with anterior circulation large-vessel stroke that achieved reperfusion after endovascular treatment. Ischemic core and collateral status were automatically estimated on baseline CTP using available software. CTP-derived core was considered as tissue with a relative reduction of cerebral blood flow <30%. Collateral status was assessed using the hypoperfusion intensity ratio(defined by the proportion of the Tmax>6 seconds with Tmax>10 seconds, HIR). Final infarct was measured on 24-48 hours non-contrast CT. Ischemic core overestimation was considered when CTP-derived core was larger than final infarct. Results: Four-hundred and seven patients were included in the analysis. Median CTP-derived core and final infarct were 7mL(IQR 0-27) and 20mL(IQR 5-55), respectively. Median HIR was 0.46(IQR 0.23-0.59). 83 patients(21%) presented ischemic core overestimation(median overestimation, 12mL(IQR 5-41)). Multivariable logistic regression analysis adjusted by CTP-derived core and confounding variables showed that poor collateral status (per 0.1 HIR increase, adjusted odds ratio(aOR) 1.41, 95% confidence interval(CI)1.20-1.65) and earlier onset to imaging time(per 60 minutes earlier, aOR 1.14, CI1.04-1.25) were independently associated with ischemic core overestimation. No significant association was found with imaging to reperfusion time(per 30 minutes earlier, aOR 1.17 CI0.96-1.44). Poor collateral status influence on ischemic core overestimation differed according to onset to imaging time, with a stronger size of effect on early imaging patients(pinteraction<0.01). Conclusion: In patients with large vessel stroke that achieve reperfusion after endovascular therapy, poor collateral status might induce higher rates of ischemic core overestimation on CTP, especially in patients in earlier window time. CTP reflects a hemodynamic state rather than tissue fate; collateral status and onset to imaging time are important factors to estimate ischemic core on CTP.

scholarly journals Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hai-fei Jiang ◽  
Yi-qun Zhang ◽  
Jiang-xia Pang ◽  
Pei-ning Shao ◽  
Han-cheng Qiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Large Vessel ◽  
Susceptibility Weighted Imaging ◽  
Regression Analyses ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Factors Associated ◽  
Univariate Analyses

AbstractThe prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.

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.

Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis

2021 ◽  
pp. 1-9
Author(s):  
Jong-Hoon Kim ◽  
Young-Jin Jung ◽  
Chul-Hoon Chang
Keyword(s):  
Functional Outcomes ◽  
Medical Center ◽  
Large Vessel ◽  
Intracranial Atherosclerosis ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stent Retrieval ◽  
First Pass ◽  
Solitaire Fr

OBJECTIVEThe optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%–77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO.METHODSThe authors retrospectively reviewed consecutive patients with acute ischemic stroke and intracranial ELVO of the anterior circulation who underwent EVT between January 2017 and December 2019 at Yeungnam University Medical Center. Large-vessel occlusion (LVO) of the anterior circulation was classified by etiology as follows: 1) no significant stenosis after recanalization (embolic group) and 2) remnant stenosis > 70% or lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during EVT (ICAS group). The ICAS group was divided into the SR thrombectomy group (SR thrombectomy) and the FRESH group.RESULTSA total of 105 patients (62 men and 43 women; median age 71 years, IQR 62.5–79 years) were included. The embolic, SR thrombectomy, and FRESH groups comprised 66 (62.9%), 26 (24.7%), and 13 (12.4%) patients, respectively. There were no significant differences between the SR thrombectomy and FRESH groups in symptom onset–to-door time, but puncture-to-recanalization time was significantly shorter in the latter group (39 vs 54 minutes, p = 0.032). There were fewer stent retrieval passes but more first-pass recanalizations in the FRESH group (p < 0.001). Favorable functional outcomes were significantly more frequent in the FRESH group (84.6% vs 42.3%, p = 0.017).CONCLUSIONSThis study’s findings suggest that FRESH, rather than rescue stenting, could be a treatment option for ICAS-related ELVO.

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