Susceptibility Vessel Sign on MRI Predicts Favorable Clinical Outcome in Patients with Anterior Circulation Acute Stroke Treated with Mechanical Thrombectomy

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

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Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0037-1612600 ◽

2017 ◽

Vol 01 (03) ◽

pp. 139-143 ◽

Cited By ~ 2

Author(s):

Yosuke Tajima ◽

Michihiro Hayasaka ◽

Koichi Ebihara ◽

Masaaki Kubota ◽

Sumio Suda

Keyword(s):

Clinical Outcome ◽

Cerebral Artery ◽

Mechanical Thrombectomy ◽

Infarct Volume ◽

Complete Revascularization ◽

Anterior Circulation ◽

Clinical Imaging ◽

Good Outcome ◽

Poor Outcome ◽

Favorable Clinical Outcome

AbstractSuccessful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

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Favorable revascularization therapy in patients with ASPECTS ≤ 5 on DWI in anterior circulation stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013358 ◽

2017 ◽

Vol 10 (1) ◽

pp. 5-9 ◽

Cited By ~ 33

Author(s):

Isabelle Mourand ◽

Eitan Abergel ◽

Daniel Mantilla ◽

Xavier Ayrignac ◽

Tzvika Sacagiu ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Intravenous Thrombolysis ◽

Reperfusion Therapy ◽

Control Group ◽

Anterior Circulation ◽

Malignant Infarction ◽

Baseline Characteristics ◽

Revascularization Therapy ◽

Favorable Clinical Outcome

BackgroundA low baseline Alberta Stroke Programme Early CT Score (ASPECTS) is strongly associated with low rates of favorable outcome in patients with acute stroke.ObjectiveTo evaluate the efficacy and safety of revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct.MethodsWe retrospectively analyzed 108 consecutive patients presenting low ASPECTS on diffusion-weighted imaging. Sixty patients were treated by mechanical thrombectomy, including 34 patients who received simultaneously intravenous thrombolysis. A control group of 48 patients not eligible for reperfusion therapy gave us a perspective on the natural history. Clinical outcome was evaluated at 90 days using the modified Rankin Scale (mRS) score. Hemicraniectomy after malignant infarction, mortality, and symptomatic intracranial haemorrhage (sICH) were also reported.ResultsThrombolysis in Cerebral Infarction 2b–3 was assessed in 75% of treated patients. Reperfusion therapy led to significantly reduced disability (mRS score 0–2) at 90 days compared with the control group (30% vs 2.1%, p<0.001), hemicraniectomy (3.3% vs 22.9%, p=0.002), and death at 90 days (25% vs 47.9%, p=0.01). The sICH level was similar in treated patients and in the control group (p=0.78). Patients aged ≤70 years in the thrombectomy group had a significantly better clinical outcome than older patients (37.5% vs 10%, p=0.02), regardless of baseline characteristics or recanalization rate.ConclusionsIn patients with acute stroke in the anterior circulation and ASPECTS ≤5 revascularization therapy contributes to a favorable clinical outcome at 90 days, especially in patients younger than 70 years.

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Abstract P354: SWAN-DWI Mismatch Predicts Clinical Outcome After Mechanical Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p354 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Francois Rusch ◽

Serge Bracard

Keyword(s):

Clinical Outcome ◽

Odds Ratio ◽

Diffusion Weighted Imaging ◽

Mechanical Thrombectomy ◽

Ischemic Penumbra ◽

Multivariate Logistic Regression ◽

Anterior Circulation ◽

Diffusion Weighted ◽

Hemorrhagic Complications ◽

Favorable Clinical Outcome

Objectives: Asymmetrically prominent veins on magnetic susceptibility sequences are thought to reflect the ischemic penumbra, by detecting high levels of desoxyheglobin. We investigated the relation between star-weighted angiography (SWAN)-diffusion weighted imaging (DWI) mismatch and clinical outcome after mechanical thrombectomy. Methods: We performed a retrospective study on patients who experienced anterior circulation stroke and for whom 1.5-Tesla MRI DWI and SWAN were performed upstream of mechanical thrombectomy. Mismatch was determined by using the Alberta Stroke Program Early CT Score (ASPECTS) on the diffusion-weighted and SWAN sequences. Three subgroups were defined in terms of mismatch level: high mismatch (HM), moderate mismatch (MM) and low mismatch (LM). Favorable outcome was defined as a modified Rankin score of 0-2 at three months. Multivariate logistic regression was used to examine associations between mismatch profiles and favorable outcomes. Results: The study included 108 patients who underwent mechanical thrombectomy. High mismatch was significantly associated with favorable clinical outcome (67% in the HM subgroup vs. 51% and 28% in the MM and LM subgroups respectively; odds ratio 1.25; 95 CI 1.02-1.56; p=0.037). No significant associations between SWAN-DWI mismatch and severe hemorrhagic complications or recanalization quality were brought to light by the present study. Conclusion: SWAN-DWI mismatch is a competent predictor of clinical outcome following mechanical thrombectomy.

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Mechanical thrombectomy for anterior circulation stroke: 5-year experience in a statewide service with differences in pretreatment time metrics across two hospitals sites

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012304 ◽

2016 ◽

Vol 9 (6) ◽

pp. 535-540 ◽

Cited By ~ 4

Author(s):

Ruchi Kabra ◽

Timothy J Phillips ◽

Jacqui-Lyn Saw ◽

Constantine C Phatouros ◽

Tejinder P Singh ◽

...

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Stroke Onset ◽

Anterior Circulation ◽

Stroke Treatment ◽

Patient Demographics ◽

Organizational Differences ◽

Tertiary Hospitals ◽

Pretreatment Time

ObjectiveTo audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.MethodsA database of 100 MT cases was maintained throughout May 2010—February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded. The following time points in stroke treatment were recorded: stroke onset, hospital presentation, CT imaging, arteriotomy, and recanalization. Statistical analysis of outcomes, predictors of outcome, and differences between the hospitals was carried out.ResultsThrombolysis in Cerebral Infarction (TICI) 2b/3 reperfusion was 79%. Forty-nine per cent of patients had good clinical outcomes (mRS 0–2). In a subgroup analysis of 76 patients with premorbid mRS 0–1 and first CT performed ≤4.5 h after stroke onset, 60% had good clinical outcomes. Patient and disease characteristics were matched between the two hospitals. H1 had shorter times between hospital presentation and CT (32 vs 55 min, p=0.01), CT and arteriotomy (33 vs 69 min, p=0.00), and stroke onset and recanalization (198 vs 260 min, p=0.00). These time metrics independently predicted good clinical outcome. Median days spent at home in the first 90 days was greater at H1 (61 vs 8, p=0.04) than at H2. A greater proportion of patients treated at H1 were independent (mRS 0–2) at 90 days (54% vs 42%); however, this was not statistically significant (p=0.22).ConclusionsOutcomes similar to randomized controlled trials are attainable in ‘real-world’ settings. Workflow time metrics were independent predictors of clinical outcome, and differed between the two hospitals owing to site-specific organizational differences.

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Characterization of Subarachnoid Hyperdensities After Thrombectomy for Acute Stroke Using Dual-Energy CT

Neurology ◽

10.1212/wnl.0000000000013198 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013198

Author(s):

Arturo Renú ◽

Carlos Laredo ◽

Alejandro Rodríguez-Vázquez ◽

Daniel Santana ◽

Mariano Werner ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Mechanical Thrombectomy ◽

Dual Energy ◽

Common Finding ◽

Dual Energy Ct ◽

Consecutive Series ◽

Contrast Extravasation ◽

Logistic Regression Models ◽

Increased Risk

Background and Objectives:The presence of post-interventional subarachnoid hyperdensities (SA-HD) is a relatively common finding after mechanical thrombectomy (MT). We aimed to assess the incidence, characteristics, clinical relevance and predictors of SA-HD after MT as categorized through the use of post-interventional Dual Energy-CT (DE-CT).Methods:A single-center consecutive series of acute stroke patients treated with MT were retrospectively reviewed. Post-treatment SA-HD were defined as incident extra-axial hyperdensities in a follow-up DE-CT performed within a median of 8 hours after MT. SA-HD were further classified according to their content (isolated contrast extravasation versus blood extravasation) and extension [diffuse (hyperdensities in more than one extraparenchymal compartments) versus non-diffuse]. Adjusted logistic regression models assessed the association of SA-HD with pretreatment and procedural variables and with bad clinical outcome (shift towards worse categories in the ordinal Rankin Scale at 90 days).Results:SA-HD were observed in 120 (28%) of the 424 included patients (isolated contrast extravasation n=22, blood extravasation n=98). In this group, SA-HD were diffuse in 72 (60%) patients (isolated contrast extravasation n=7, blood extravasation n=65) and non-diffuse in 48 (40%) patients (isolated contrast extravasation n=15, blood extravasation n=33). Diffuse SA-HD were significantly associated with worse clinical outcome in adjusted models (cOR=2.3, 95%CI=1.36-4.00, p=0.002), unlike the specific SA-HD content alone. In contrast with the absence of SA-HD, only the diffuse pattern with blood extravasation was significantly associated with worse clinical outcome (cOR=2.4, 95%CI=1.36-4.15, p=0.002). Diffuse SA-HD patterns were predicted by M2 occlusions, more thrombectomy passes and concurrent parenchymal hematomas.Discussion:In our cohort of patients imaged within a median of 8 hours after MT, post-interventional SA-HD showed a diffuse pattern in 17% of thrombectomies and were associated with more arduous procedures. Diffuse SA-HD but not local collections of blood or contrast extravasations were associated with an increased risk of poor outcome and death. These findings reinforce the need for improvement in reperfusion strategies.Classification of Evidence:This study provides Class II evidence that in individuals with proximal carotid artery territory occlusions treated with mechanical thrombectomy, diffuse post-interventional subarachnoid hyperdensities on imaging 8 hours post-procedure are associated with worse clinical outcomes at 90 days.

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Abstract WP148: Functional Independence Score of Acute Stroke Patients Can Predict Favorable Clinical Outcome at 3 Months After Stroke Onset

Stroke ◽

10.1161/str.49.suppl_1.wp148 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Takashi Johno ◽

Hiroyuki Kawano ◽

Masataka Torii ◽

Hiroshi Kamiyama ◽

Tatsuo Amano ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Functional Independence ◽

Stroke Onset ◽

Stroke Patients ◽

Favorable Clinical Outcome

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TREVO and Capture LP have equal technical success rates in mechanical thrombectomy of proximal and distal anterior circulation occlusions

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012354 ◽

2016 ◽

Vol 9 (7) ◽

pp. 644-649 ◽

Cited By ~ 6

Author(s):

Sara Protto ◽

Juha-Pekka Pienimäki ◽

Janne Seppänen ◽

Ira Matkaselkä ◽

Jyrki Ollikainen ◽

...

Keyword(s):

Clinical Outcome ◽

Mechanical Thrombectomy ◽

Randomized Study ◽

Success Rates ◽

Technical Success ◽

Good Clinical Outcome ◽

Anterior Circulation ◽

Excellent Outcome ◽

Proximal Internal Carotid Artery ◽

Device Selection

PurposeMechanical thrombectomy (MT) is a proven method to treat large vessel occlusions in acute anterior circulation stroke. We compared the technical, imaging, and clinical outcomes of MT performed with either TREVO or Capture LP devices.MethodsThere were 42 and 43 patients in the TREVO and Capture LP groups, respectively. Baseline variables, technical outcome (Thrombolysis In Cerebral Infarction, TICI), 24 hours imaging outcome, and 3-month clinical outcome (modified Rankin Scale, mRS) were prospectively recorded. The patients were stratified according to clot location, groups compared, and logistic regression models devised to study the effect of device selection on the clinical outcome.ResultsThe technical success rates were equal in both proximal (internal carotid artery and proximal M1 segment) and distal occlusions (distal M1 and M2 segments). The proportion of TICI 2b or 3 was 96% and 87% with TREVO and 87% and 89% with Capture LP (p=0.25 and p=0.80, respectively). Device selection did not significantly predict good clinical outcome (mRS ≤2) in either proximal or distal occlusions. In multivariate analysis, selecting Capture LP borderline significantly increased the odds of an excellent outcome close to sixfold both in proximal and distal occlusions (OR 6.7, 95% CI 0.82 to 53.7, p=0.08 and OR 5.7, 95% CI 0.88 to 37.8, p=0.07, respectively).ConclusionsTREVO and Capture LP perform equally well in proximal and distal occlusions in the anterior circulation when technical and good clinical outcome are considered. Capture LP may have a small advantage in reaching mRS ≤1 at 3 months. However, this needs to be confirmed in a randomized study.

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