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.

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.

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.

Abstract TP54: Topographical Aspects Collateral Score is a Useful Prognostic Factor in Thrombolysed Anterior Circulation Acute Ischemic Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Leonard Yeo ◽  
Prakash Paliwal ◽  
Teoh Hock Luen ◽  
Rahul Rathakrishnan ◽  
Derek Soon ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Intravenous Thrombolysis ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Multivariable Logistic Regression

Background: the ASPECTS- collateral score on CT-angiograms was shown to be successful in prognosticating functional outcomes and complications during intravenous thrombolysis in acute ischemic stroke (AIS). We studied predetermined topological information to see if any specific region had more prognostic value. Methods: consecutive patients from 2010-2014 with intracranial internal carotid artery, M1 or M2 middle carotid artery occlusions treated with intravenous thrombolysis were included. The primary outcome measure was good clinical outcome (3-month modified Rankin Scale score 0-1). We scored each region as 0= no collaterals, 1= poor compared to contralateral and 2= good collaterals. Prognostic value of the 6 cortical ASPECTS-collateral regions in predicting outcomes was determined by multivariable logistic regression. Results: 310 patients were included (Median age, 66.1±14.5 years; median National Institutes of Health Stroke Scale (NIHSS)- 18 points (range 3-36). Inter-rater reliability for ASPECTS-collaterals was good (κ=0.78). There was no Statistical collinearity among ASPECTS-collateral regions. Using multivariable logistic regression, only the M5 region (odds ratio, 2.72, 95%CI 1.52-4.84, p =0.001), age (OR 0.957 per yr 95%CI 0.936-0.978, p <0.001), Diabetes (OR 0.367, 95%CI 0.193- 0.700, p =0.002) and NIHSSS (OR 0.878 per point, 95%CI 0.836-0.922, p=0.001) were significantly associated with good outcomes. When compared with NIHSS, the receiver operating characteristic curves for NIHSS+M5 (area under the curve, 0.749) correlated well with clinical severity scores. Addition of M5 collateral score showed a statistically significant additive effect to the NIHSS score for predicting good outcomes (Z score: -1.684, p=0.045). Conclusions: Involvement of the parietal region (M5) regions is a reliable predictor of clinical outcome in anterior circulation large artery occlusion. This simple radiological marker can strengthen the clinical NIHSS score and may be considered during prognostication

INTERNAL CAROTID ARTERY STENTING WITH SIMULTANEOUS THROMBECTOMY IN TANDEM OCCLUSION WITH ACUTE ISCHEMIC STROKE

Vestnik ◽  
2021 ◽  
pp. 126-130
Author(s):  
Р.М. Кастей ◽  
Е.К. Дюсембеков ◽  
Е.С. Жуков ◽  
С.Т. Калдыбаев ◽  
К.А. Никатов
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Circulation ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Anterior Circulation ◽  
Tandem Occlusion ◽  
Large Vessels

Механическая тромбэктомия в настоящее время является золотым стандартом в лечении острого ишемического инсульта при окклюзии крупных сосудов передней циркуляции мозгового кровообращения. Однако проблема лечения так называемой тандемной окклюзии - это одновременная окклюзия или критический стенозэкстракраниальной части внутренней сонной артерии (ВСА) в комбинации с окклюзией крупныхвнутримозговых сосудов передней циркуляции мозгового кровообращения в настоящее времяостается актуальной. В данной статье представлен клинический случай успешного лечения тандемной окклюзии внутренней сонной артерии и средней мозговой артерии путем проведения механической тромбэктомии с одномоментным стентированием внутренней сонной артерии. Однако для разработки единого стандарта лечения тандемных окклюзийнеобходимо проведение дальнейших исследований. Mechanical thrombectomy is currently the gold standard in the treatment of acute ischemic stroke with occlusion of large vessels of the anterior circulation of cerebral circulation. However, the problem of treating the so-called tandem occlusion is simultaneous occlusion or extracranial part of the internal carotid artery (ICA) critical stenosis in combination with occlusion of large intracerebral vessels of the anterior cerebral circulation currently remains relevant. This article presents a clinical case of successful treatment of tandem occlusion of the internal carotid artery and middle cerebral artery by mechanical thrombectomy with simultaneous ICA stenting. However, further research is needed to develop a unified standard for the tandem occlusions treatment.

scholarly journals Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eung-Joon Lee ◽  
Jeonghoon Bae ◽  
Hae-Bong Jeong ◽  
Eun Ji Lee ◽  
Han-Yeong Jeong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Elevated Serum ◽  
Unfavorable Outcome ◽  
Control Group ◽  
Nihss Score ◽  
And Control ◽  
D Dimer

Abstract Background The effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We also explored the factors that independently affect functional outcomes of patients with CRS after MT. Methods We retrospectively reviewed 341 patients who underwent MT after acute ischemic stroke onset between May 2014 and May 2020. We classified the patients into CRS (n = 34) and control (n = 307) groups and compared their clinical details. Among CRS patients, we analyzed the groups with and without good outcomes (3-months modified Rankin scale [mRS] score 0, 1, 2). Multivariate analysis was performed to investigate the independent predictors of unfavorable outcomes in patients with CRS after MT. Results A total of 341 acute ischemic stroke patients received MT, of whom 34 (9.9%) had CRS. Although the baseline National institute of health stroke scale (NIHSS) score and the rate of successful recanalization was not significantly different between CRS patients and control group, CRS patients showed more any cerebral hemorrhage after MT (41.2% vs. controls 23.8%, p = 0.037) and unfavorable functional outcome at 3 months (CRS patients median 3-month mRS score 4, interquartile range [IQR] 2 to 5.25 vs. controls median 3-month mRS score 3, IQR 1 to 4, [p = 0.026]). In the patients with CRS, elevated serum D-dimer level and higher baseline NIHSS score were independently associated with unfavorable functional outcome at 3 months (adjusted odds ratio [aOR]: 1.524, 95% confidence interval [CI]: 1.043–2.226; aOR: 1.264, 95% CI: 1.010–1.582, respectively). Conclusions MT is an appropriate therapeutic treatment for revascularization in CRS patients. However, elevated serum D-dimer levels and higher baseline NIHSS scores were independent predictors of unfavorable outcome. Further research is warranted to evaluate the significance of these predictors.

Middle Cerebral Artery M2 Thrombectomy in the STRATIS Registry

Stroke ◽  
2021 ◽  
Author(s):  
Mouhammad A. Jumaa ◽  
Alicia C. Castonguay ◽  
Hisham Salahuddin ◽  
Ashutosh P. Jadhav ◽  
Kaustubh Limaye ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Good Functional Outcome ◽  
First Choice

Background and Purpose: The safety and benefit of mechanical thrombectomy in the treatment of acute ischemic stroke patients with M2 segment middle cerebral artery occlusions remain uncertain. Here, we compare clinical and angiographic outcomes in M2 versus M1 occlusions in the STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) Registry. Methods: The STRATIS Registry was a prospective, multicenter, nonrandomized, observational study of acute ischemic stroke large vessel occlusion patients treated with the Solitaire stent-retriever as the first-choice therapy within 8 hours from symptoms onset. Primary outcome was defined as functional disability at 3 months measured by dichotomized modified Rankin Scale. Secondary outcomes included reperfusion rates and rates of symptomatic intracranial hemorrhage. Results: A total of 984 patients were included, of which 538 (54.7%) had M1 and 170 (17.3%) had M2 occlusions. Baseline demographics were well balanced within the groups, with the exception of mean baseline National Institutes of Health Stroke Scale score which was significantly higher in the M1 population (17.3±5.5 versus 15.7±5.0, P ≤0.001). No difference was seen in mean puncture to revascularization times between the cohorts (46.0±27.8 versus 45.1±29.5 minutes, P =0.75). Rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction≥2b) were similar between the groups (91% versus 95%, P =0.09). M2 patients had significantly increased rates of symptomatic ICH at 24 hours (4% versus 1%, P =0.01). Rates of good functional outcome (modified Rankin Scale score of 0–2; 58% versus 59%, P =0.83) and mortality (15% versus 14%, P =0.75) were similar between the 2 groups. There was no difference in the association of outcome and onset to groin puncture or onset to successful reperfusion in M1 and M2 occlusions. Conclusions: In the STRATIS Registry, M2 occlusions achieved similar rates of successful reperfusion, good functional outcome, and mortality, although increased rates of symptomatic ICH were demonstrated when compared with M1 occlusions. The time dependence of benefit was also similar between the 2 groups. Further studies are needed to understand the benefit of mechanical thrombectomy for M2 occlusions. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02239640.

scholarly journals The golden 35 min of stroke intervention with ADAPT: effect of thrombectomy procedural time in acute ischemic stroke on outcome

2017 ◽  
Vol 10 (3) ◽  
pp. 213-220 ◽  
Author(s):  
Ali Alawieh ◽  
Alyssa K Pierce ◽  
Jan Vargas ◽  
Aquilla S Turk ◽  
Raymond D Turner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Good Outcome ◽  
First Pass ◽  
Procedural Time

IntroductionIn acute ischemic stroke (AIS), extending mechanical thrombectomy procedural times beyond 60 min has previously been associated with an increased complication rate and poorer outcomes.ObjectiveAfter improvements in thrombectomy methods, to reassess whether this relationship holds true with a more contemporary thrombectomy approach: a direct aspiration first pass technique (ADAPT).MethodsWe retrospectively studied a database of patients with AIS who underwent ADAPT thrombectomy for large vessel occlusions. Patients were dichotomized into two groups: ‘early recan’, in which recanalization (recan) was achieved in ≤35 min, and ‘late recan’, in which procedures extended beyond 35 min.Results197 patients (47.7% women, mean age 66.3 years) were identified. We determined that after 35 min, a poor outcome was more likely than a good (modified Rankin Scale (mRS) score 0–2) outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score was similar between ‘early recan’ (n=122) (14.7±6.9) and ‘late recan’ patients (n=75) (15.9±7.2). Among ‘early recan’ patients, recanalization was achieved in 17.8±8.8 min compared with 70±39.8 min in ‘late recan’ patients. The likelihood of achieving a good outcome was higher in the ‘early recan’ group (65.2%) than in the ‘late recan’ group (38.2%; p<0.001). Patients in the ‘late recan’ group had a higher likelihood of postprocedural hemorrhage, specifically parenchymal hematoma type 2, than those in the ‘early recan’ group. Logistic regression analysis showed that baseline NIHSS, recanalization time, and atrial fibrillation had a significant impact on 90-day outcomes.ConclusionsOur findings suggest that extending ADAPT thrombectomy procedure times beyond 35 min increases the likelihood of complications such as intracerebral hemorrhage while reducing the likelihood of a good outcome.

scholarly journals Serum Interleukin-37 Increases in Patients after Ischemic Stroke and Is Associated with Stroke Recurrence

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ying Zhang ◽  
Chengbi Xu ◽  
Haitao Wang ◽  
Shanji Nan
Keyword(s):  
Ischemic Stroke ◽  
Serum Level ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Recurrent Stroke ◽  
Clinical Severity ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Nihss Score ◽  
Poor Outcome

Background. This study seeks to assess interleukin-37 (IL-37) serum level in acute ischemic stroke and the value of predicting 3-month stroke recurrence and functional outcome in acute ischemic stroke. Methods. From January 1, 2018, to June 30, 2019, all consecutive first-ever acute ischemic stroke patients from our hospital, China, were included. Serum samples, clinical information, and stroke severity (defined by the National Institute of Health stroke scale (NIHSS) score) were collected at baseline. Serum IL-37 level was measured by the enzyme-linked immunosorbent assay (ELISA) method. Functional impairment (defined by the modified Rankin scale (mRS)) and recurrent stroke were assessed 3 months after admission. The relation of IL-37 with either clinical severity at baseline, unfavorable functional outcome, or stroke recurrence at follow-up was evaluated by logistic regression analysis, and the results were presented as odds ratios (OR) with 95% confidence intervals (CI). Results. Three hundred and ten stroke patients were included. The median IL-37 serum level in those patients was 344.1 pg/ml (interquartile range (IQR), 284.4-405.3 vs. control cases: 122.3 pg/ml (IQR, 104.4-1444.0); P < 0.001 ). At 3 months, a total of 36 (11.6%) patients had a stroke recurrence. IL-37 serum levels in those patients were higher than in those patients without stroke recurrence (417.0 pg/ml (IQR, 359.3-436.1) vs. 333.3 pg/ml (279.0-391.0)). In a logistic model adjusted for other factors, IL-37 in the highest quartile (>405.3 pg/ml) was still associated with recurrent stroke ( OR = 3.32 ; 95 % CI = 2.03 – 6.13 ; P < 0.001 ). IL-37 could promote the NIHSS score (area under the curve (AUC) of the IL-37/NIHSS, 0.75; 95% CI, 0.67–0.83; P < 0.001 ), corresponding to a difference of 0.085 (0.005). Serum IL-37 increases in patients with poor outcome, and an IL-37 in the highest quartile is related to poor outcome ( OR = 4.85 ; 95 % CI = 3.11 − 8.22 ; P < 0.001 ). Conclusion. Serum IL-37 increased in patients after ischemic stroke and was associated with stroke recurrence events and poor stroke outcomes. Large randomized controlled trials should be carried out to confirm whether IL-37 lowering treatment improves stroke prognosis.

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