Indication and outcomes of the reperfusion therapy for acute ischemic stroke patients: comparison between pre- and post-mechanical thrombectomy periods in a single stroke center

Background: Traditionally, patients undergoing acute ischemic strokes were candidates for mechanical thrombectomy if they were within the 6-h window from onset of symptoms. This timeframe would exclude many patient populations, such as wake-up strokes. However, the most recent clinical trials, DAWN and DEFUSE3, have expanded the window of endovascular treatment for acute ischemic stroke patients to within 24 h from symptom onset. This expanded window increases the number of potential candidates for endovascular intervention for emergent large vessel occlusions and raises the question of how to efficiently screen and triage this increase of patients. Summary: Abbreviated pre-hospital stroke scales can be used to guide EMS personnel in quickly deciding if a patient is undergoing a stroke. Telestroke networks connect remote hospitals to stroke specialists to improve the transportation time of the patient to a comprehensive stroke center for the appropriate level of care. Mobile stroke units, mobile interventional units, and helistroke reverse the traditional hub-and-spoke model by bringing imaging, tPA, and expertise to the patient. Smartphone applications and social media aid in educating patients and the public regarding acute and long-term stroke care. Key Messages: The DAWN and DEFUSE3 trials have expanded the treatment window for certain acute ischemic stroke patients with mechanical thrombectomy and subsequently have increased the number of potential candidates for endovascular intervention. This expansion brings patient screening and triaging to greater importance, as reducing the time from symptom onset to decision-to-treat and groin puncture can better stroke patient outcomes. Several strategies have been employed to address this issue by reducing the time of symptom onset to decision-to-treat time.

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National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016

International Journal of Stroke ◽

10.1177/1747493019884526 ◽

2019 ◽

pp. 174749301988452 ◽

Cited By ~ 1

Author(s):

Akiko Kada ◽

Kuniaki Ogasawara ◽

Takanari Kitazono ◽

Kunihiro Nishimura ◽

Nobuyuki Sakai ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Temporal Trends ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Outcomes ◽

Comprehensive Stroke Center ◽

Stroke Center

Background Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

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Mechanical thrombectomy: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center

Neurologia i Neurochirurgia Polska ◽

10.1016/j.pjnns.2017.12.010 ◽

2018 ◽

Vol 52 (3) ◽

pp. 359-363 ◽

Cited By ~ 1

Author(s):

Marcin Wiącek ◽

Rafał Kaczorowski ◽

Bartosz Sieczkowski ◽

Natalia Kanas ◽

Halina Bartosik-Psujek

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Patients ◽

Stroke Center

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Mechanical thrombectomy for reperfusion of acute ischemic stroke in a Stroke Unit in Argentina

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190150 ◽

2020 ◽

Vol 78 (1) ◽

pp. 39-43

Author(s):

Matías ALET ◽

Federico Rodríguez LUCCI ◽

Sebastián AMERISO

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Time Window ◽

Demographic Data ◽

Reperfusion Therapy ◽

Intravenous Tissue Plasminogen Activator ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Iv Tpa

Abstract Stroke is an important cause of morbidity and mortality worldwide. Reperfusion therapy with intravenous tissue plasminogen activator (IV-tPA) was first implemented in 1996. More recently, endovascular reperfusion with mechanical thrombectomy (MT) demonstrated a robust beneficial effect, extending the 4.5 h time window. In our country, there are difficulties to achieve the implementation of both procedures. Objective: Our purpose is to report the early experience of a Comprehensive Stroke Center in the use of MT for acute stroke. Methods: Analysis of consecutive patients from January 2015 to September 2018, who received reperfusion treatment with MT. Demographic data, treatment times, previous use of IV-tPA, site of obstruction, recanalization, outcomes and disability after stroke were assessed. Results: We admitted 891 patients with acute ischemic stroke during this period. Ninety-seven received IV-tPA (11%) and 27 were treated with MT (3%). In the MT group, mean age was 66.0±14.5 years. Median NIHSS before MT was 20 (range:14‒24). The most prevalent etiology was cardioembolic stroke (52%). Prior to MT, 16 of 27 patients (59%) received IV-tPA. Previous tPA treatment did not affect onset to recanalization time or door-to-puncture time. For MT, door-to-puncture time was 104±50 minutes and onset to recanalization was 289±153 minutes. Successful recanalization (mTICI grade 2b/3) was achieved in 21 patients (78%). At three-month follow-up, the median NIHSS was 5 (range:4‒15) and mRS was 0‒2 in 37%, and ≥3 in 63%. Conclusions: With adequate logistics and strict selection criteria, MT can be implemented in our population with results like those reported in large clinical trials.

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SYSTOLIC BLOOD PRESSURE VARIABILITY DURING MECHANICAL THROMBECTOMY IS ASSOCIATED WITH EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

10.26226/morressier.58e389aed462b80292385662 ◽

2017 ◽

Author(s):

João Pedro Marto

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Mechanical Thrombectomy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Early Neurological Deterioration ◽

Systolic Blood Pressure Variability

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Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

Interventional Neuroradiology ◽

10.1177/15910199211039403 ◽

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.

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Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Journal of the American Heart Association ◽

10.1161/jaha.118.009378 ◽

2018 ◽

Vol 7 (18) ◽

Cited By ~ 10

Author(s):

Benjamin Maïer ◽

Guillaume Turc ◽

Guillaume Taylor ◽

Raphaël Blanc ◽

Michael Obadia ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Pulse Pressure ◽

Mechanical Thrombectomy ◽

Prognostic Significance ◽

Stroke Patients

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116 Effect of Annual Hospital Procedure Volume on Outcomes After Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Neurosurgery ◽

10.1227/01.neu.0000489687.21464.9f ◽

2016 ◽

Vol 63 ◽

pp. 149 ◽

Cited By ~ 6

Author(s):

Vishal B. Jani ◽

Chiu Yuen To ◽

Achint Patel ◽

Prashant S. Kelkar ◽

Boyd Richards ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Patients ◽

Procedure Volume

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Anestezijos metodo reikšmė pacientų, sergančių ūminiu išeminiu insultu ir gydytų mechanine trombektomija, ankstyvai neurologinei būklei Relevance of anaesthesia type on early neurological outcome in acute ischemic stroke patients undergoing mechanical thrombectomy

Neurologijos seminarai ◽

10.29014/ns.2018.34 ◽

2019 ◽

Vol 22 (78) ◽

pp. 325-329

Author(s):

L. Šalaševičius ◽

A. Vilionskis

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Neurological Outcome ◽

Mechanical Thrombectomy ◽

Stroke Patients

Įvadas. Sąmonės sedacija (SS) ir bendroji endotrachėjinė anestezija (BETA) – anestezijos metodai, taikomi mechaninės trombektomijos (MTE) metu. Tikslių rekomendacijų dėl anestezijos metodo pasirinkimo MTE metu nėra. Retrospektyviniai tyrimai teigia, kad BETA yra susijusi su blogesnėmis pacientų išeitimis, tačiau naujuose klinikiniuose tyrimuose tokio skirtumo nestebima. Darbo tikslas buvo nustatyti anestezijos metodo įtaką mechaninės trombektomijos efektyvumui ir saugumui ligoniams, patyrusiems ūminį išeminį insultą. Tiriamieji ir tyrimo metodai. Į tyrimą įtraukti dviejuose Vilniaus centruose gydyti ūminį išeminį insultą patyrę ligoniai, kuriems buvo atlikta MTE. Ligoniai suskirstyti į 2 grupes pagal taikytą anestezijos metodą: bendroji endotrachėjinė anestezija (BETA) ir sąmonės sedacija (SS). Abiejose grupėse vertinti demografiniai, klinikiniai ir logistiniai rodikliai. Pirminiu vertinimo kriterijumi pasirinkta gera baigtis po 24 valandų. MTE saugumas vertintas pagal 7 parų mirštamumą ir simptominių intrasmegeninių kraujosruvų (sISK) dažnį. Rezultatai. Į tyrimą įtraukta 248 pacientai. 105 pacientams (42,3 %) taikyta BETA ir 143 (57,7 %) – SS. Pagal pradines charakteristikas abi grupės statistiškai nesiskyrė, išskyrus prieširdžių virpėjimo dažnį (55,9 % – SS vs 37,1 % – BETA grupėje, p = 0,003) ir intraveninės trombolizės taikymą iki MTE (66,4 % – SS grupėje ir 46,7 % – BETA grupėje, p = 0,003). Gera baigtis po 24 val. nustatyta 51,4 % (n = 54) ligonių – BETA grupėje ir 58,7 % (n = 84) ligonių – SS grupėje (p = 0,252). 7 parų mirštamumo sISK dažnis abiejose grupėse statistiškai reikšmingai nesiskyrė. Regresinė analizė parodė, kad geros baigties nepriklausomi prognoziniai veiksniai yra laikas nuo atvykimo į stacionarą iki rekanalizacijos ir sėkminga rekanalizacija. Išvados. Anestezijos tipas nėra reikšmingas mechaninės trombektomijos efektyvumo ir saugumo veiksnys ankstyvai pacientų baigčiai. Siekiant tiksliau įvertinti anestezijos reikšmę mechaninės trombektomijos baigčiai ir nustatyti procedūros baigties prognozinius veiksnius, reikalingi papildomi atsitiktinės atrankos tyrimai.

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