scholarly journals Association between flat-panel computed tomography hyperattenuation and clinical outcome after successful recanalization by endovascular treatment

2020 ◽  
pp. 1-8
Author(s):  
Jang-Hyun Baek ◽  
Byung Moon Kim ◽  
Ji Hoe Heo ◽  
Dong Joon Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Area Under The Curve ◽  
Practical Method ◽  
Favorable Outcome ◽  
Flat Panel ◽  
Diffusion Weighted Images ◽  
Intravenous Tissue Plasminogen Activator ◽  
Angiography Suite ◽  
Malignant Infarction

OBJECTIVEHyperattenuation on CT scanning performed immediately after endovascular treatment (EVT) is known to be associated with the final infarct. As flat-panel CT (FPCT) scanning is readily accessible within their angiography suite, the authors evaluated the ability of the extent of hyperattenuation on FPCT to predict clinical outcomes after EVT.METHODSPatients with successful recanalization (modified Thrombolysis in Cerebral Infarction grade 2b or 3) were reviewed retrospectively. The extent of hyperattenuation was assessed by the Alberta Stroke Program Early CT Score on FPCT (FPCT-ASPECTS). FPCT-ASPECTS findings were compared according to functional outcome and malignant infarction. The predictive power of the FPCT-ASPECTS with initial CT images before EVT (CT-ASPECTS) and follow-up diffusion-weighted images (MR-ASPECTS) was also compared.RESULTSA total of 235 patients were included. All patients were treated with mechanical thrombectomy, and 45.5% of the patients received intravenous tissue plasminogen activator. The mean (± SD) time from stroke onset to recanalization was 383 ± 290 minutes. The FPCT-ASPECTS was significantly different between patients with a favorable outcome and those without (mean 9.3 ± 0.9 vs 6.7 ± 2.6) and between patients with malignant infarction and those without (3.4 ± 2.9 vs 8.8 ± 1.4). The FPCT-ASPECTS was an independent factor for a favorable outcome (adjusted OR 3.28, 95% CI 2.12–5.01) and malignant infarction (adjusted OR 0.42, 95% CI 0.31–0.57). The area under the curve (AUC) of the FPCT-ASPECTS for a favorable outcome (0.862, cutoff ≥ 8) was significantly greater than that of the CT-ASPECTS (0.637) (p < 0.001) and comparable to that of the MR-ASPECTS (0.853) (p = 0.983). For malignant infarction, the FPCT-ASPECTS was also more predictive than the CT-ASPECTS (AUC 0.906 vs 0.552; p = 0.001) with a cutoff of ≤ 5.CONCLUSIONSThe FPCT-ASPECTS was highly predictive of clinical outcomes in patients with successful recanalization. FPCT could be a practical method to immediately predict clinical outcomes and thereby aid in acute management after EVT.

Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Jeffrey L Saver ◽  
Mayank Goyal ◽  
David S Liebeskind ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Nihss Score ◽  
Post Procedure ◽  
Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

scholarly journals Flat Panel Computed Tomography Pooled Blood Volume and Infarct Prediction in Endovascular Stroke Treatment

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3274-3276 ◽  
Author(s):  
Aneka Mueller ◽  
Marlies Wagner ◽  
Elke Hattingen ◽  
Alexander Seiler ◽  
Se-Jong You ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Blood Volume ◽  
Cerebral Artery ◽  
Clinical Decision Making ◽  
Infarct Volume ◽  
Multislice Ct ◽  
Flat Panel ◽  
Flat Panel Detector ◽  
Angiography Suite

Background and Purpose— Patients with large-vessel stroke frequently need to be transferred to comprehensive stroke centers for endovascular treatment. An update of physiological perfusion parameters and stroke progression on arrival is desirable. We examined the reliability of preinterventional pooled blood volume (PBV)-maps acquired by flat-panel detector computed tomography (CT) in the interventional angiography suite. Methods— The volumes of preinterventional perfusion deficit in flat-panel detector CT-PBV source images were compared with final infarct volume on follow-up multislice-CT after endovascular treatment of 29 consecutive patients with occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA). Results— Endovascular treatment was successful in 26 patients (Thrombolysis in Cerebral Infarction, 2b-3). Overall, the median preinterventional PBV-deficit was 9×larger than median final infarct volume on multislice-CT (86.4 mL [10.3; 111.6] versus 9.6 mL [3.6; 36.8]). This was especially evident in the subgroup of successful recanalization (PBV-deficit: 87.5 mL [10.6; 115.1], final infarct: 8.7 mL [3.6; 29]). In futile recanalization, the final infarct tended to be underestimated (PBV-deficit: 86.4 mL [5.9; –] and final infarct: 116.4 mL [3.5; –]). Conclusions— Flat panel detector CT-PBV is not reliable in predicting the final infarct volume and should not be used in clinical decision making for endovascular treatment of acute cerebral artery occlusions.

scholarly journals Systemic Inflammatory Response Syndrome and Outcomes in Ischemic Patients Treated with Endovascular Treatment

2020 ◽  
Author(s):  
xiangjun xu ◽  
Lili Yuan ◽  
Wenbing Wang ◽  
Junfeng Xu ◽  
Qian Yang ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Collateral Circulation ◽  
Protective Factor ◽  
Systemic Inflammatory Response ◽  
Favorable Outcome ◽  
Occurrence Rate ◽  
Stroke Severity

Abstract Background The occurrence of systemic inflammatory response syndrome (SIRS) is associated with poor outcomes after ischemic stroke, and the inflammatory response can be significantly attenuated by successful reperfusion, while the SIRS in patients with acute large vessel occlusion stroke (ALVOS) who underwent endovascular treatment (EVT) remain unclear. We aimed to investigate the occurrence rate, predictors, and clinical outcomes of SIRS in patients with ALVOS after EVT. Methods We retrospectively collected EVT data of patients with ALVOS from July 2014 to August 2019 in our center. SIRS in the absence of infection was defined as the presence of ≥2 of the following: (1) heart rate >90 (2) body temperature >38°C or <36°C, (3) white blood cells >12 000/mm or <4000/mm or >10% bands for >24 h or (4) respiratory rate >20. Favorable outcome was defined as obtaining a 90-day modified Rankin Scale (mRS) score ≤2. Results Among the 262 patients who received EVT, 92 (35.1%) developed SIRS, 88 (95.7%) of whom developed SIRS in the first two days after EVT. Patients who developed SIRS had a reduced favorable outcome (OR, 4.112 [95% CI, 1.705–9.920]; P=0.002) and higher mortality (OR, 25.236 [95% CI, 8.578–74.835]; P<0.001) at 90 days. Greater SIRS burden was positively correlated with NIHSS scores at discharge and mRS scores at 90 days (r=0.249, P=0.017; r=0.230, P=0.027). The development of SIRS in patients with ALOVS who underwent EVT was associated with neutrophilic leukocytosis, hyperglycemia, higher admission NIHSS scores, and worse collateral circulation. Conclusions Patients with SIRS had higher odds of poor functional outcomes and higher mortality at 90 days in the EVT-treatment setting. The severity of the inflammatory response was positively correlated with the clinical outcomes of patients. Clinically relevant associations with SIRS were neutrophilic leukocytosis, hyperglycemia and baseline stroke severity, but favorable collateral circulation was a protective factor against SIRS.

Abstract 2627: Outcomes After Endovascular Treatment For Anterior Circulation Stroke Presenting Beyond 8 Hours Of Time Last Seen Well Do Not Differ In Wake-up Strokes Vs. Witnessed Onset Beyond 8 Hours

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amin Aghaebrahim ◽  
Carlos Leiva-Salinas ◽  
Syed Zaidi ◽  
Mouhammad Jumaa ◽  
Xabi Urra ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Favorable Outcome ◽  
Late Time ◽  
Lesion Volume ◽  
Anterior Circulation ◽  
Tandem Occlusion ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: Patients with wake-up stroke are thought to have different outcomes compared to patients with known late time of onset. We thought to verify this hypothesis by determining clinical outcomes, mortality and rate of parenchymal hematoma (PH) in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy at our center. Methods: Retrospective review of a prospectively acquired database from consecutive patients meeting the following criteria: (1) ACLVOS, (2) endovascular treatment initiated beyond 8hrs from time last seen well (TLSW). Treatment selection was based on the presence of a small infarct core/large penumbra assessed through visual inspection on MRI or CTP by the treating physician. In patients undergoing MRI (n=55) pre-procedure infarct volumes on DWI were measured through automated volumetric analysis. Results: We identified 130 patients (mean age 64; mean baseline NIHSS 14, male gender 55%). Patients were divided into three groups. Group 1: patients with wake-up stroke (39%, n=51). Group 2: patients with witnessed onset beyond 8hrs from TLSW (55%, n=72). Group 3: patients without witnessed onset but TLSW>8hrs (5%, n=7). Occlusion locations were as follows: M1-55%, M2-12%, ICA terminus-32% and ICA origin (tandem occlusion)-28%. Successful recanalization (TIMI 2/3) was achieved in 109 patients (84%). The rate of 90 day favorable outcome (modified Rankin score (mRS) ≤ 2) was 55% (n=68/124). PH occurred in 15/130 (12%) patients and the 3 month mortality rate was 18% (n= 22/124). Favorable outcome rates amongst Group 1 (50%, n=24/48), Group 2 (59.5%, n=41/69) and Group 3 (42.9%, n=3/7) were not significantly different (p=0.49, by ANOVA). Mean pre-procedure DWI lesion volume was 18.7 cc in Group 1 vs. 18.3 cc in group 2 (p=0.9). No difference was noted between Group 1, Group 2 and Group3 regarding PH (13.7%, 8.3%, 13.3% respectively, p nonsignificant) or mortality at 3 months (18.7%, 17.4%, 14.3% respectively, p nonsignificant). Multivariate logistic regression model identified only successful recanalization (OR 2.9, p 0.001, CI 1.59-5.44) and age (OR 0.96, p 0.03, CI 0.93-0.99) as predictors of favorable outcome. Conclusion: In patients with ACLVOS presenting beyond 8 hours from TLSW who are selected based on similar imaging characteristics, clinical outcomes following endovascular treatment do not seem to differ according to mode of presentation relative to TLSW.

Abstract 3531: Clinical Outcomes Following Endovascular Stroke Treatment Facilitated via Telestroke Evaluation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Stacie Demel ◽  
Amin Aghaebrahim ◽  
Vivek Reddy ◽  
Maxim Hammer ◽  
Lori Massaro ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Mortality Rates ◽  
Favorable Outcome ◽  
Multivariate Logistic Regression Model ◽  
Small Community ◽  
Stroke Treatment ◽  
Comprehensive Stroke Center ◽  
Stroke Center

BACKGROUND: Most stroke patients present to small community hospitals without established stroke pathways or interventional stroke treatment capability. The advent of 2 way audiovisual telestroke systems gives such patients the opportunity to be assessed rapidly by stroke neurologists. Patients who are not candidates for systemic IV tPA or have failed thrombolytic treatment can be identified and transferred to a comprehensive stroke center for potential endovascular treatment. We compared the clinical outcomes of patients undergoing endovascular stroke treatment at University of Pittsburgh Medical Center triaged either through telestroke or non-telestroke means. METHODS: Prospective data including demographics, co-morbidities, baseline Alberta Stroke Program Early CT (ASPECT) and National Institute of Health Stroke Scale (NIHSS) score, intervention modality (pharmacological, mechanical or both), time to treatment, clinical outcome, and hemorrhage and mortality rates were compared. Favorable outcome was defined as modified rankin score (mRS) of 2 or less. RESULTS: Between 3/2007 and 5/2011, thirty four patients underwent endovascular stroke treatment following telestroke evaluation versus 354 patients who were triaged through other means. Baseline characteristics were similar between the groups. Time to endovascular treatment (595 vs. 767 minutes; p = 0.5), pretreatment with systemic tPA (51.6 vs. 56.9%, p=0.6), recanalization (TIMI ≥ 2; 91.2% vs. 84.8%; p = 0.31), favorable outcome (modified rankin score ≤ 2; 50% vs. 40.4%; p = 0.29) and mortality rates (28.1% vs. 34.9%, p=0.44) were comparable. Multivariate logistic regression model identified young age (OR 0.91, CI 0.88-0.95, p<0.01), successful recanalization (OR 3.3, CI 1.8-6.2, p<0.01), and baseline ASPECT score (OR 6.5, CI 2.4-17.4, p<0.01) as predictors of favorable outcome. CONCLUSION: The results of this study suggest that telestroke guided endovascular stroke treatment is feasible and the outcomes are similar to those patients who were triaged by traditional means. Future randomized studies which specifically compare triage via telemedicine vs. telephone or direct emergency department presentation are needed to substantiate these findings.

scholarly journals Endovascular treatment outcomes using the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program

2017 ◽  
Vol 24 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Ameer E Hassan ◽  
Christina Sanchez ◽  
Angela N Johnson
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Mechanical Thrombectomy ◽  
Treatment Time ◽  
Staff Education ◽  
Stroke Outcomes ◽  
Post Procedure ◽  
Angiography Suite ◽  
Observation Period

Background “Door to treatment” time affects outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, the correlation between staff education and accessible technology with stroke outcomes has not been demonstrated. Objective The objective of this paper is to demonstrate the five-year impact of the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program on time-to-treat and clinical outcomes. Methods The study analyzed a prospectively maintained database of AIS patients who benefited from EVT through implementation of STEPS-T. Demographics, clinical characteristics, and modified Rankin Score at three months were analyzed. Thrombolysis in Cerebral Infarction (TICI) scale was used to grade pre- and post-procedure angiographic recanalization. Using electronic hemodynamic recording, stepwise workflow times were collected for door time (TD), entering angiography suite (TA), groin puncture (TG), first DSA (TDSA), microcatheter placement (TM), and final recanalization (TR). Median intervention time (TA to TR) and recanalization time (TG to TR) were compared through Year 1 to Year 5. Results A total of 230 individuals (age 74 ± 12, between 30 to 95) were enrolled. Median intervention and recanalization times were significantly reduced, from 121 minutes to 52 minutes and from 83 minutes to 36 minutes respectively from Year 1 to Year 5, ( p < 0.001). Across the study period, annual recruitment went up from 12 to 66 patients, and modified Rankin Score between 0 and 2 increased from 36% to 59% ( p = 0.024). Conclusions STEPS-T improved time-to-treat in patients undergoing mechanical thrombectomy for AIS. During the observation period, clinical outcomes significantly improved.

Predictive value on diffusion weighted imaging scores for basilar artery occlusion after endovascular treatment

2020 ◽  
pp. 159101992094051
Author(s):  
Can Wan ◽  
Guangliang Wu ◽  
Xing Jin ◽  
Shaojun Liao ◽  
Foming Zhang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Predictive Value ◽  
Odds Ratio ◽  
Diffusion Weighted Imaging ◽  
Area Under The Curve ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Diffusion Weighted

Purpose To assess the predictive value of three scoring systems based on diffusion weighted imaging in basilar artery occlusion patients after endovascular treatment. Methods We analyzed clinical and radiological data of patients with basilar artery occlusion from January 2010 to June 2019, with modified Rankin Scale of 0–2 and 3–6 defined as favorable outcome and unfavorable outcome at three months. Diffusion weighted imaging posterior circulation ASPECTS Score (DWI pc-ASPECT Score), Renard diffusion weighted imaging Score, and diffusion weighted imaging Brainstem Score were used to evaluate the early ischemic changes. Results There were a total of 88 basilar artery occlusion patients enrolled in the study after endovascular treatment, with 33 of them getting a favorable outcome. According to the analysis, the time from onset to puncture within 12 h (odds ratio: 4.34; 95% confidence interval: 1.55–12.16; P = 0.01), presence of collateral flow via PCoA (odds ratio: 0.31; 95%CI: 0.12–0.79; P = 0.01) or between PICA and SCA (odds ratio: 0.18; 95%CI: 0.07–0.47; P = 0.00), equal or less than 15 points on baseline NIHSS (area under the curve 0.79, 95% CI 0.69–0.89; sensitivity = 69.1%, specificity = 81.8%; P = 0.00), and equal or less than 1.5 points on diffusion weighted imaging Renard score (area under the curve 0.63, 95% CI 0.51–0.75; sensitivity = 83.6%, specificity = 39.4%; P = 0.046) were independently associated with favorable outcome. Conclusions Renard diffusion weighted imaging score may be an independent predictor of functional outcome in basilar artery occlusion patients after endovascular treatment.

scholarly journals Outcome of endovascular treatment within and beyond 6 h without perfusion software

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhen Jing ◽  
Hao Li ◽  
Shengming Huang ◽  
Min Guan ◽  
Yongxin Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Group A ◽  
Group B

AbstractEndovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6–24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6–24 h from symptom onset to groin puncture in this real world study.

Doing More With Less: Pragmatic Implementation of Vancomycin Area-Under-the-Curve (AUC) Monitoring

2021 ◽  
pp. 089719002110272
Author(s):  
Joanne Huang ◽  
Jeannie D. Chan ◽  
Thu Nguyen ◽  
Rupali Jain ◽  
Zahra Kassamali Escobar
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Therapeutic Drug Monitoring ◽  
Paradigm Shift ◽  
Area Under The Curve ◽  
Cost Effective ◽  
Practical Method ◽  
Therapeutic Drug ◽  
Short Term ◽  
Quality Improvement Process

Universal area-under-the-curve (AUC) guided vancomycin therapeutic drug monitoring (TDM) is resource-intensive, cost-prohibitive, and presents a paradigm shift that leaves institutions with the quandary of defining the preferred and most practical method for TDM. We report a step-by-step quality improvement process using 4 plan-do-study-act (PDSA) cycles to provide a framework for development of a hybrid model of trough and AUC-based vancomycin monitoring. We found trough-based monitoring a pragmatic strategy as a first-tier approach when anticipated use is short-term. AUC-guided monitoring was most impactful and cost-effective when reserved for patients with high-risk for nephrotoxicity. We encourage others to consider quality improvement tools to locally adopt AUC-based monitoring.

Sign in / Sign up

Export Citation Format

Share Document