scholarly journals Distance to Thrombus in Endovascular Treatment of Middle Cerebral Artery M1 Occlusion Predicts Recanalization Success and Clinical Outcome

2021 ◽  
Vol 24 (2) ◽  
pp. 113-117
Author(s):  
Nihat Sengeze ◽  
Semih Giray
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Internal Carotid ◽  
Measurement Techniques ◽  
Digital Subtraction ◽  
Stroke Patients ◽  
The Relationship ◽  
Distance To Thrombus

Background: The occlusion site of the cerebral artery can help to determine recanalization success, treatment and prognosis in acute stroke patients. In current studies, different measurement techniques and different length values have been considered. We aimed to determine the relationship between the location of occlusion and recanalization success following endovascular therapy of acute middle cerebral artery (MCA) M1 occlusion. Methods: This study was conducted from January 2015 to March 2019. The "M1 distance-to-thrombus length" was determined on curve-linear reformat reconstruction of the MCA, and measured from the center of internal carotid artery (ICA) bifurcation to the beginning of the thrombus on digital subtraction angiography (DSA). A successful recanalization was defined as ≥ modified thrombolysis in cerebral infarction (mTICI) 2b and full recanalization as mTICI 3. Evaluation of patients at the end of the third month was carried out with modified Rankin Scale (mRS) and mortality. Results: We eventually included 95 patients treated with endovascular therapy. The patients with distance to thrombus (DT) ≤13.2 mm showed significantly higher rates of full recanalization (AUC = 0.639 ± 0.06; P=0.014, 95% confidence interval [CI]). Additionally, DT could predict successful recanalization with an AUC of 0.639. The possibility to distinguish unsuccessful recanalization cases after the endovascular treatment by considering DT had 85.7% sensitivity (95% CI). Of the 82 (86.3%) patients who were treated with successful recanalization (≥mTICI 2b), 46 (48.4%) achieved mRS (0–3) and 38 (40%) expired at the end of the 3 months. Conclusion: Shorter DT was associated with higher rate of full recanalization (mTICI 3) after endovascular therapy. Having a longer DT reduces the chance of successful recanalization without distal embolism. However, there was no statistically significant effect for DT on a favorable outcome at third months or mortality with endovascular treatment of MCA M1 occlusions.

THE RELATIONSHIP BETWEEN TIMING OF RECANALIZATION AND CLINICAL OUTCOME OF ISCHEMIC STROKE DUE TO ACUTE MIDDLE CEREBRAL ARTERY OCCLUSION AFTER ULTRASOUND-ENHANCED THROMBOLYSIS

2017 ◽  
pp. 38-43
Author(s):  
Quang Thang Tran ◽  
Dat Anh Nguyen ◽  
Van Chi Nguyen ◽  
Duy Ton Mai ◽  
Van Thinh Le
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Stroke Patients ◽  
Tissue Plasminogen ◽  
Cerebral Artery Occlusion ◽  
The Relationship

Purpose: The relationship between arterial recanalization after use of intravenous recombinant tissue plasminogen activator (rtPA) and outcome is still uncertain. The aim of our study was to evaluate the association between the timing and impact of recanalization on functional outcomes in ischemic stroke patients due to acute middle cerebral artery occlusion. Subjects and methods: Nonrandomized 40 stroke patients with proximal middle arterial occlusion on a prebolus TCD receiving intravenously 0.6 mg/kg rtPA within 4.5 hours after stroke onset were monitored with portable diagnostic TCD equipment and a standard headframe. Complete recanalization was defined as thrombolysis in brain ischemia (TIBI) flow grades 4-5. Results: 40 patients (mean age 67±14 years, NIH Stroke Scale [NIHSS] 16.15±8.6 points) were treated at 180±80 minutes from symptom onset. TCD was monitored continously for 120 minutes. Complete recanalization on TCD within 2 hours after bolus was found in 13 patients (32.5%). In this group, NIHSS decreased quickly at 2 hours and 24 hours. Modified Rankins 0-1point was seen in 92.3% of patients with complete recanalization compared to 37.0% of patients with uncomplete recanalization at 90 days. Non-symptomatic intracranial hemorrhage was seen in 1 patient in the group of complete recanalization. Conclusions: Complete recanalization of middle cerebral arteries within 2 hours after IV rtPA treatment plays a role in predicting the good functional and clinical outcomes after ultrasound-enhanced thrombolysis in acute ischemic stroke patients due to acute middle cerebral artery occlusion. Key words: stroke, recombinant tissue plasminogen activator, transcranial Doppler sonography

Abstract 58: Prediction of Malignant Edema Formation After Endovascular Treatment for Middle Cerebral Artery Infarction: The Added Value of Intracranial Cerebrospinal Fluid Volume

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Frans Kauw ◽  
Marie Louise E Bernsen ◽  
Hugo W de Jong ◽  
L. Jaap Kappelle ◽  
Birgitta K Velthuis ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Extended Model ◽  
Stroke Patients ◽  
Middle Cerebral Artery Infarction ◽  
Edema Formation ◽  
Contrast Ct

Introduction: Prediction models may guide decisions in the management of patients at risk for malignant middle cerebral artery infarction. The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a predictor of malignant edema in ischemic stroke patients treated with intravenous thrombolysis. The added predictive value in stroke patients who received endovascular treatment is unknown. Methods: Patients with available thin-slice non-contrast CT data on admission were selected from the MR CLEAN Registry, which is a prospective national multicenter registry of patients with large vessel occlusion who were treated with endovascular treatment between 2014 and 2017. Baseline characteristics and CT imaging data were collected. The CSF/ICV ratio was automatically measured on baseline thin-slice non-contrast CT. The primary outcome was the formation of malignant edema based on clinical and imaging features on follow-up. A previously built logistic regression model was fitted and included the following baseline predictors: age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT score, poor collateral filling and reperfusion. An extended model with the CSF/ICV ratio was compared to the previous model by using the likelihood ratio test. Odds ratios (OR), areas under the receiver operating characteristic curve (AUROC) and 95% confidence intervals (CI) were reported. Results: Of the included 683 patients 40 (6%) developed malignant edema. The CSF/ICV ratio of the group with malignant edema (mean 9±5%) was lower than the group without malignant edema (mean 14±6%, P<0.001). In the extended model, the CSF/ICV ratio was associated with the formation of malignant edema (per one percent decrease OR 1.2, 95% CI 1.1-1.3, P<0.001). In addition, the discriminative performance of the model with the CSF/ICV ratio (AUROC 0.87, 95% CI 0.82-0.91) was higher than that of the model without the CSF/ICV ratio (AUROC 0.84, 0.78-0.89, P<0.001). Conclusions: The CSF/ICV ratio improves the prediction of malignant edema formation in ischemic stroke patients who received endovascular treatment.

Abstract 134: Endovascular Revascularization Is Associated With Better Outcomes Than Systemic Throbmolysis Alone For Tandem Internal Carotid And Middle Cerebral Artery Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Joshua Pepper ◽  
Rashmi Pashankar ◽  
Joseph Schindler ◽  
Ketan Bulsara
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Internal Carotid ◽  
Complication Rates ◽  
Modified Rankin Scale ◽  
Systemic Thrombolysis ◽  
Iatrogenic Complications ◽  
Significant Difference

Background and Purpose: Tandem Internal Carotid Artery and Middle Cerebral Artery or “TIM” occlusions are highly resistant to conventional therapy (systemic thrombolysis) and independently predicts poor patient outcome. Recent evidence suggests that patients treated more aggressively with either endovascular stenting of occluded carotid arteries and/or intra-arterial tissue plasminogen activator (tPA) may have superior outcomes. Here we evaluate all the available data to help assess the best intervention for this patient population that currently has limited treatment options. Methods: Data from Medline and the Cochrane database of systemic reviews was searched. The search terms used includes (tandem OR combined) AND (middle cerebral OR internal carotid) AND (OCCLU* or lesion or stenos* or blocka*). All studies had to be in English. All duplicates were identified and removed. To be included the studies needed to report on three key aspects: 1) baseline characteristics (age; NIHSS at presentation); 2) treatment (time to treatment; modality); and 3) outcome (report of patient state at discharge or follow up on the Modified Rankin Scale). Patients were grouped according to whether they received endovascular intervention or stand alone IV tPA. Patients were considered independent if they had a Modified Rankin Scale score of ≤ 2 at follow up or discharge. Results: Over 2,500 studies were evaluated. Seventeen studies met the inclusion criteria, with a total of 219 patients. Patients treated with endovascular therapy (n=60) (stenting and/or intra-arterial tPA) were 32% more likely to be independent (p<0.0001) and 28% less likely to have a significant disability (p= 0.0004) compared to patients given systemic thrombolysis (n=139). There was no significant difference in mortality or complication rates between the groups. Conclusion: Endovascular therapy appears to be superior compared with systemic thrombolysis in treating patients with TIM occlusions. The risk of iatrogenic complications with more aggressive intervention does not appear to outweigh the outcome benefit. Further and larger studies are needed to assess the benefits and risks of endovascular therapy in patients with TIM lesions.

Abstract 210: Is Endovascular Treatment Beneficial in Acute Ischemic Stroke Patients With M2 Segment Middle Cerebral Artery Occlusion?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Muhammad A Saleem
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Functional Independence ◽  
Neurological Deterioration ◽  
Stroke Patients

Background: The benefit of endovascular treatment in acute ischemic stroke patients with occlusion of distal middle cerebral artery (M2 segment) is unclear. Methods: We analyzed data from subjects with occlusion of M2 segment of middle cerebral artery confirmed with computed tomographic (CT) angiogram who were randomized to either intravenous (IV) recombinant tissue plasminogen activator (rt-PA) alone or in combination with endovascular treatment. We compared the rates of neurological deterioration within 24 hours; symptomatic intracranial hemorrhage (ICH) within 30 hours; good quality of life (defined by EQ-5D index score of ≥0.6) and functional independence (defined by modified Rankin scale of 0-2) at 3 months among subjects who underwent endovascular treatment with subjects who received IV rt-PA alone. Results: Of these 51 subjects (mean age ±SD; 68.3±11.8 years) with M2 segment occlusion, 34 and 17 subjects received IV rt-PA followed by endovascular treatment and IV rt-PA alone, respectively. There was a non-significantly lower rate of neurological deterioration (14.7% versus 25.0%) and symptomatic intracranial hemorrhages (5.9% versus 17.6%) among subjects who received IV rt-PA followed by endovascular treatment. At 3 months, the rates of independent functional outcome (52.9% versus 41.2%, odds ratio [OR] 1.6; 95 % confidence interval [CI] 0.5-5.2; P = 0.46) and good quality of life (50.0% vs 35.3% OR 1.9; 95% CI 0.5-7.2; p=0.37) were non-significantly higher among subjects with M2 segment occlusion who received IV rt-PA followed by endovascular treatment. The rate of death within 3 months was significantly lower among those who received IV rt-PA followed by endovascular treatment (5.9% vs 35.3%; OR 0.2; 95% CI 0.1-0.9; p=0.048). Conclusions: A randomized clinical trial should be considered based on the significant reduction in mortality and non-significant increase in functional independence and good quality of life following endovascular treatment in among acute ischemic stroke patients with M2 segment occlusion.

Endovascular treatment of acute stroke with tandem occlusion of internal carotid and middle cerebral artery

2015 ◽  
Vol 357 ◽  
pp. e368-e369
Author(s):  
M. Černá ◽  
M. Köcher ◽  
D. Šaňák ◽  
V. Prášil ◽  
T. Veverka
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Tandem Occlusion

Middle Cerebral Artery Residual Contrast Stagnation on Noncontrast CT Scan Following Endovascular Treatment in Acute Ischemic Stroke Patients

2015 ◽  
Vol 25 (6) ◽  
pp. 946-951 ◽  
Author(s):  
Seyedmehdi Payabvash ◽  
Mushtaq H. Qureshi ◽  
Shayandokht Taleb ◽  
Swaroop Pawar ◽  
Adnan I. Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Ct Scan ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Stroke Patients ◽  
Noncontrast Ct
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