Mechanical Thrombectomy for Minor Stroke Patients (NIHSS <6) With Large Vessel Occlusion

Introduction : Emergent Large Vessel Occlusion (ELVO) strokes are devastating ischemic vascular events that can cause severe and permanent impairment. The purpose of the current study is to investigate interactions among different proteins at the time of mechanical thrombectomy (MT) which correlates to Montreal Cognitive Assessment (MOCA) scores at discharge and at 90‐day follow‐up. Methods : The Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC) study is a continually enrolling tissue bank (clinicaltrials.gov NCT03153683) and registry from stroke patients undergoing mechanical thrombectomy. Blood samples from systemic arterial blood (internal carotid artery) of twenty‐three patients were collected and sent to Olink Proteomics (Olink Proteomics, Boston, Massachusetts, USA) for analysis of protein expression of 92 cardiometabolic proteins and 92 inflammatory proteins. To determine which proteins had the most significant changes based on MOCA scoring, a series of 184 paired t‐tests were performed. Within each panel, proteins were then ranked based on the associated p values. Benjamini and Hochberg’s linear step‐up procedure was used to control the false discovery rate at 0.05. Pearson Correlation revealed proteins that were significantly related to the patients’ s discharge MOCA score as well as 90‐day follow‐up MOCA. Data and network analyses were performed using IBM SPSS Statistics, SAS v 9.4, and STRING V11. Common proteins between the discharge day miniMoCA and 90 days MOCA were identified. Network of these protein associations was created and biological processes correlating with these networks were identified. Results : Twenty‐two patients (15 with discharge day MiniMOCA and 7 with 90 days MOCA) were included in the analysis. Of these patients, 14 were females, and 9 were obese (BMI>30). 2 had minor stroke (NIHSS: 1–4), 13 had moderate stroke at admission (NIHSS: 5–15), 4 had moderate to severe stroke (NIHSS: 16–20), and 2 patients had severe stroke (NIHSS > 21). 19 patients had associated comorbidities (hypertension, diabetes, and hyperlipidemia). Mean last known normal to thrombectomy completion time was 621 + 333 minutes and mean infarct volume was 18,271 + 16,534 mm3. The 9 overlapping proteins from discharge to 90‐day follow up were later analyzed using interconnected STRING to determine association network and proteomic biological functions. Nine proteins include: DPP4, NCAM1, TGFBI, PRCP, APOM, TIE1, QPCT, MEGF9, and IGFBP3. Biological processes relating to the network of 9 proteins are depicted in table 1. Conclusions : This study uncovers network proteins that play a significant role in cognitive outcomes following ischemic stroke. This will allow future studies to develop predictive biomarkers for treatment and proteomic targets for adjunctive therapies to thrombectomy to improve our ability to treat cognitive dysfunction in ELVO stroke patients.

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Mechanical Thrombectomy for Minor and Mild Stroke Patients Harboring Large Vessel Occlusion in the Anterior Circulation

Stroke ◽

10.1161/strokeaha.117.018113 ◽

2017 ◽

Vol 48 (12) ◽

pp. 3274-3281 ◽

Cited By ~ 38

Author(s):

Cyril Dargazanli ◽

Caroline Arquizan ◽

Benjamin Gory ◽

Arturo Consoli ◽

Julien Labreuche ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Mild Stroke

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Non-invasive markers of liver fibrosis and outcome in large vessel occlusion stroke

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211037239 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110372

Author(s):

Simon Fandler-Höfler ◽

Rudolf E. Stauber ◽

Markus Kneihsl ◽

Gerit Wünsch ◽

Melanie Haidegger ◽

...

Keyword(s):

Atrial Fibrillation ◽

Liver Fibrosis ◽

Intracranial Hemorrhage ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion ◽

Post Stroke ◽

Non Invasive

Background: Liver fibrosis has been identified as an outcome predictor in cardiovascular disease and has been associated with hematoma expansion and mortality in patients with primary intracerebral hemorrhage. We aimed to explore whether clinically inapparent liver fibrosis is related to neurological outcome, mortality, and intracranial hemorrhage risk in ischemic stroke patients after mechanical thrombectomy. Methods: We included consecutive patients with anterior circulation large vessel occlusion stroke treated at our center with mechanical thrombectomy between January 2011 and April 2019. Clinical data had been collected prospectively; laboratory data were extracted from our electronic hospital information system. We calculated the Fibrosis-4 index (FIB-4), an established non-invasive liver fibrosis test. The main outcomes were postinterventional intracranial hemorrhage, unfavorable functional status (modified Rankin scale scores of 3–6), and mortality three months post-stroke. Results: In the 460 patients (mean age 69 years, 49.3% female) analyzed, FIB-4 indicated advanced liver fibrosis in 22.6%. Positive FIB-4 was associated with unfavorable neurological outcomes and mortality three months post-stroke, even after correction for co-factors [Odds Ratio (OR) 2.15 for unfavorable outcome in patients with positive FIB-4, 95% confidence interval (CI) 1.21–3.83, p = 0.009, and 2.16 for mortality, 95% CI 1.16–4.03, p = 0.01]. However, FIB-4 was neither related to hemorrhagic transformation nor symptomatic intracranial hemorrhage. Moreover, atrial fibrillation was more frequent in patients with liver fibrosis ( p < 0.001). Two further commonly-used liver fibrosis indices (Forns index and the Easy Liver Fibrosis Test) yielded comparable results regarding outcome and atrial fibrillation. Conclusions: Clinically inapparent liver fibrosis (based on simple clinical and laboratory parameters) represents an independent risk factor for unfavorable outcomes, including mortality, at three months after stroke thrombectomy. Elevated liver fibrosis indices warrant further hepatological work-up and thorough screening for atrial fibrillation in stroke patients.

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Mechanical thrombectomy techniques for acute ischemic stroke

Romanian Neurosurgery ◽

10.33962/roneuro-2020-007 ◽

2020 ◽

pp. 46-51

Author(s):

A. Chiriac ◽

Georgiana Ion ◽

N. Dobrin ◽

Dana Turliuc ◽

I. Poeata

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion ◽

Current Trends

Mechanical thrombectomy technique was introduced as an effective and secure method in acute ischemic stroke patients suffering from intracranial large vessel occlusion (LVO). In this article, we will review the main mechanical thrombectomy techniques and current trends in this type of treatment for acute ischemic stroke.

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Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy

Journal of the American Heart Association ◽

10.1161/jaha.119.014425 ◽

2019 ◽

Vol 8 (21) ◽

Cited By ~ 7

Author(s):

Aristeidis H. Katsanos ◽

Konark Malhotra ◽

Nitin Goyal ◽

Lina Palaiodimou ◽

Peter D. Schellinger ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mortality Risk ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion

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E-098 Mechanical thrombectomy in the extended 24 hour time window for acute ischemic stroke patients with large vessel occlusion

10.1136/neurintsurg-2020-snis.131 ◽

2020 ◽

Author(s):

S Salam ◽

C Powers ◽

S Nimjee ◽

P Youssef ◽

S Heaton ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Time Window ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion

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Rationale and design of combination of an immune modulator Fingolimod with Alteplase bridging with Mechanical Thrombectomy in Acute Ischemic Stroke (FAMTAIS) trial

International Journal of Stroke ◽

10.1177/1747493017710340 ◽

2017 ◽

Vol 12 (8) ◽

pp. 906-909 ◽

Cited By ~ 12

Author(s):

Sheng Zhang ◽

Ying Zhou ◽

Ruiting Zhang ◽

Meixia Zhang ◽

Bruce Campbell ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Reperfusion Injury ◽

Mechanical Thrombectomy ◽

Disease Onset ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Bridging Therapy ◽

Vessel Occlusion

Rationale In acute ischemic stroke patients with large vessel occlusion, although reperfusion within 6 h after stroke onset using combined intravenous alteplase and mechanical thrombectomy (bridging therapy) can improve functional outcome, still approximately 50% patients suffer disability which may result from reperfusion injury. Proof-of-concept clinical trials have indicated that the sphingosine-1-phosphate receptor modulator fingolimod may be efficacious in attenuating brain inflammation and improving clinical outcomes in acute ischemic stroke patients as a single therapy beyond 4.5 h of disease onset, or in combination with alteplase within 4.5 h of disease onset. Aim To assess whether the treatment of fingolimod combined with bridging therapy in large vessel occlusion acute ischemic stroke patients is effective and safe. Design and sample size estimates Fingolimod with Alteplase bridging with Mechanical Thrombectomy in Acute Ischemic Stroke (FAMTAIS) study is a randomized, open-label, multiple central trial. This study includes 98 patients with anterior circulation large vessel occlusion acute ischemic stroke who are eligible for bridging therapy, providing 80% power to reject the null hypothesis that, combined with fingolimod, the bridging therapy has an at least 15% higher penumbra tissue salvage index than receiving bridging therapy alone. Study outcomes The primary outcome is the penumbra tissue salvage index. Key secondary outcomes focus on: infarct growth and extent of clinical improvement from day 1 to day 7, frequency of parenchymal hemorrhage at day 1. Discussion If the hypothesis of FAMTAIS is confirmed, combination of fingolimod with bridging therapy is effective in attenuating reperfusion injury in patients with large vessel occlusion treated with 6 h of stroke onset.

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Abstract WMP11: Safety and Efficacy of Mechanical Thrombectomy in Patients With Minor Stroke Due to Large Vessel Occlusion- Insights From the STAR Registry

Stroke ◽

10.1161/str.51.suppl_1.wmp11 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sami Al Kasab ◽

Eyad Almallouhi ◽

Ali Alawieh ◽

Reda M Chalhoub ◽

Marios Psychogios ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Severe Symptom ◽

Large Vessel ◽

Minor Stroke ◽

Complication Rates ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Excellent Outcome ◽

Symptom Group

Introduction: Mechanical thrombectomy (MT) is the current standard of care treatment for patients presenting with severe symptoms due to large vessel occlusion (LVO); approximately 30% of patients with LVO however present with mild symptoms (NIHSS < 6). The safety and efficacy of MT in this group has not yet been established. The purpose of this study is to evaluate the safety of MT in patients presenting with mild symptoms due to LVO in a large multicenter registry. Methods: STAR registry combined the prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe and Asia. Patients who underwent MT were included in these analyses. Baseline features, risk factors, location of occlusion, time from symptom onset, tPA receipt, procedural complication rates, symptomatic hemorrhage, and long-term functional outcome were compared between patients with mild symptoms (NIHSS < 6) to those with severe symptoms (NIHSS ≥ 6). Results: Total of 2,114 patients were included in this analysis. Of those, 162 patients presented with NIHSS ≥ 6. Baseline features and outcomes are summarized in table 1. There was no difference in age, or sex, tPA receipt, number of attempts, rate of successful revascularization, symptomatic hemorrhage, or length of hospital stay. Median ASPECTS score was 9 in the mild Vs 8 in the severe symptom group (p=< 0.001), there was a higher percentage of patients in the mild symptom group with hypertension, hyperlipidemia, and LVO in the posterior circulation. Conversely there were more patients with atrial fibrillation in the severe symptom group. Excellent outcome (mRS 0-2 at 90 days) was achieved in 69.8% patients in the mild group compared to 38.3% in the severe group, p=<0.001) Conclusion: In patients with minor symptoms due to large vessel occlusion, mechanical thrombectomy appears to be safe with low complication rates. Approximately seventy percent of patients achieved excellent functional recovery. Table 1:

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