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  • 1
    Online Resource
    Online Resource
    Pivotal trial of the Neuroform Atlas stent for treatment of posterior circulation aneurysms: one-year outcomes
    BMJ ; 2022
    In:  Journal of NeuroInterventional Surgery Vol. 14, No. 2 ( 2022-02), p. 143-148
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 14, No. 2 ( 2022-02), p. 143-148
    Abstract: Stent-assisted coiling of wide-necked intracranial aneurysms (IAs) using the Neuroform Atlas Stent System (Atlas) has shown promising results. Objective To present the primary efficacy and safety results of the ATLAS Investigational Device Exemption (IDE) trial in a cohort of patients with posterior circulation IAs. Methods The ATLAS trial is a prospective, multicenter, single-arm, open-label study of unruptured, wide-necked, IAs treated with the Atlas stent and adjunctive coiling. This study reports the results of patients with posterior circulation IAs. The primary efficacy endpoint was complete aneurysm occlusion (Raymond-Roy (RR) class I) on 12-month angiography, in the absence of re-treatment or parent artery stenosis 〉 50%. The primary safety endpoint was any major ipsilateral stroke or neurological death within 12 months. Adjudication of the primary endpoints was performed by an imaging core laboratory and a Clinical Events Committee. Results The ATLAS trial enrolled and treated 116 patients at 25 medical centers with unruptured, wide-necked, posterior circulation IAs (mean age 60.2±10.5 years, 81.0% (94/116) female). Stents were placed in all patients with 100% technical success rate. A total of 95/116 (81.9%) patients had complete angiographic follow-up at 12 months, of whom 81 (85.3%) had complete aneurysm occlusion (RR class I). The primary effectiveness outcome was achieved in 76.7% (95% CI 67.0% to 86.5%) of patients. Overall, major ipsilateral stroke and secondary persistent neurological deficit occurred in 4.3% (5/116) and 1.7% (2/116) of patients, respectively. Conclusions In the ATLAS IDE posterior circulation cohort, the Neuroform Atlas Stent System with adjunctive coiling demonstrated high rates of technical and safety performance. Trial registration number https://clinicaltrials.gov/ct2/show/NCT02340585 .
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-017115
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2506028-4
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  • 2
    Online Resource
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    Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct
    Massachusetts Medical Society ; 2018
    In:  New England Journal of Medicine Vol. 378, No. 1 ( 2018-01-04), p. 11-21
    Details
    In: New England Journal of Medicine, Massachusetts Medical Society, Vol. 378, No. 1 ( 2018-01-04), p. 11-21
    Type of Medium: Online Resource
    ISSN: 0028-4793 , 1533-4406
    URL: Article
    DOI: 10.1056/NEJMoa1706442
    RVK:
    XA 10000
    Language: English
    Publisher: Massachusetts Medical Society
    Publication Date: 2018
    detail.hit.zdb_id: 1468837-2
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  • 3
    Online Resource
    Online Resource
    Endovascular recanalization of complete subacute to chronic atherosclerotic occlusions of intracranial arteries
    BMJ ; 2014
    In:  Journal of NeuroInterventional Surgery Vol. 6, No. 9 ( 2014-11), p. 645-648
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 6, No. 9 ( 2014-11), p. 645-648
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2013-010842
    Language: English
    Publisher: BMJ
    Publication Date: 2014
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  • 4
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    Online Resource
    Venous sinus stenting shortens the duration of medical therapy for increased intracranial pressure secondary to venous sinus stenosis
    BMJ ; 2018
    In:  Journal of NeuroInterventional Surgery Vol. 10, No. 3 ( 2018-03), p. 310-314
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 10, No. 3 ( 2018-03), p. 310-314
    Abstract: Medical treatment, cerebrospinal fluid (CSF) shunting, and optic nerve sheath fenestration are standard treatments for increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). Venous sinus stenting provides a novel alternative surgical treatment in cases of venous sinus stenosis with elevated ICP. Methods 12 consecutive subjects with papilledema, increased ICP, and radiological signs of dural sinus stenosis underwent cerebral venography and manometry. All subjects had papilledema and demonstrated radiological evidence of dural venous sinus stenosis. Results Six subjects chose venous stenting (Group A) and six declined and were managed conservatively with oral acetazolamide (Group B). The relative pressure gradient across the venous narrowing was 29±16.3 mm Hg in Group A and 17.6±9.3 mm Hg in Group B (p=0.09). The mean lumbar puncture opening pressure was 40.4±7.6 cm H 2 O in Group A and 35.6±10.6 cm H 2 O in Group B (p=0.4). Spectral domain optical coherence tomography (SD-OCT) showed mean average retinal nerve fiber layer (RNFL) thickness of 210±44.8 µm in Group A and 235±124.7 µm in Group B. However, the mean average RNFL thickness at 6 months was 85±9 µm in Group A and 95±24 µm in Group B (p=0.6). The total duration of acetazolamide treatment was 188±209 days in Group A compared with 571±544 days in Group B (p=0.07). Conclusions In subjects with venous sinuses stenosis, endovascular stenting offers an effective treatment option for intracranial hypertension which may shorten the duration of medical therapy.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2017-013103
    Language: English
    Publisher: BMJ
    Publication Date: 2018
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  • 5
    Online Resource
    Online Resource
    Monitored Anesthesia Care vs Intubation for Vertebrobasilar Stroke Endovascular Therapy
    American Medical Association (AMA) ; 2017
    In:  JAMA Neurology Vol. 74, No. 6 ( 2017-06-01), p. 704-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 74, No. 6 ( 2017-06-01), p. 704-
    Type of Medium: Online Resource
    ISSN: 2168-6149
    URL: Article
    DOI: 10.1001/jamaneurol.2017.0192
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2017
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  • 6
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    Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 12 ( 2017-12), p. 3252-3257
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 12 ( 2017-12), p. 3252-3257
    Abstract: Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. Methods— We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. Results— A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23–5.56; P =0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04–1.13; P 〈 0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36–85.96; P =0.025) were associated with good outcome. Conclusions— In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.018270
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Thrombectomy 24 hours after stroke: beyond DAWN
    BMJ ; 2018
    In:  Journal of NeuroInterventional Surgery Vol. 10, No. 11 ( 2018-11), p. 1039-1042
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 10, No. 11 ( 2018-11), p. 1039-1042
    Abstract: The results of the DAWN trial support the benefit of thrombectomy in patients with anterior circulation large vessel occlusion (LVO) acute stroke presenting within 6–24 hours from time last known well (TLKW). We sought to evaluate the characteristics and outcomes of patients who met DAWN criteria but underwent thrombectomy beyond 24 hours of TLKW. Methods A retrospective review of endovascular thrombectomy databases at three comprehensive stroke centers was performed to identify all patients who received thrombectomy beyond 24 hours of TLKW and otherwise met the DAWN criteria. Baseline characteristics, efficacy, and safety outcomes were compared with patients in the DAWN trial intervention arm. Results Twenty-one patients met the inclusion criteria. Rates of successful reperfusion (mTICI2b–3: 81% vs 84%, P=0.72), 90-day functional independence (modified Rankin Scale score 0–2, 43% vs 48%, P=0.68), and symptomatic intracranial hemorrhage (5% vs 6%, P=0.87) were comparable across the two groups. Conclusion Thrombectomy appears to be safe and feasible in patients with acute ischemic stroke due to LVO meeting all DAWN trial criteria but treated beyond 24 hours of TLKW with outcomes comparable to patients in the DAWN trial intervention arm. Further studies are warranted to validate these findings.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2018-013923
    Language: English
    Publisher: BMJ
    Publication Date: 2018
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  • 8
    Online Resource
    Online Resource
    Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke
    S. Karger AG ; 2017
    In:  Interventional Neurology Vol. 6, No. 1-2 ( 2017), p. 16-24
    Details
    In: Interventional Neurology, S. Karger AG, Vol. 6, No. 1-2 ( 2017), p. 16-24
    Abstract: 〈 b 〉 〈 i 〉 Background and Purpose: 〈 /i 〉 〈 /b 〉 Stent retriever thrombectomy and manual aspiration thrombectomy (MAT) have each been shown to lead to high rates of recanalization as single-modality endovascular stroke therapy. We sought to describe the safety and efficacy of a multimodal approach combining these two techniques termed ‘stent retriever-mediated manual aspiration thrombectomy' (SMAT) and compared them to MAT alone. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Retrospective review of a prospectively acquired acute endovascular stroke database. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 195 consecutive patients with large-vessel occlusion were identified between July 2013 and April 2015. Occlusion distribution was as follows: 52% middle cerebral artery segment 1 (M1), 6% M2, 29% internal carotid artery, and 13% vertebrobasilar. Median onset to treatment time was 278 min. Intravenous rtPA was administered in 33% of cases, whereas 34% of cases had symptom onset beyond 8 h. Effective recanalization (TICI 2b/3) was achieved in 91% of patients and in 49% of patients, only a single pass was necessary. Median groin puncture to recanalization time was 40 min. Symptomatic intracerebral hemorrhage occurred in 5% of patients. Favorable outcomes defined as a modified Rankin Scale score of 0-2 were noted in 42% of patients. Compared with MAT alone, SMAT achieved a similar rate of effective recanalization (91 vs. 88%, p = n.s.) but was associated with faster access to reperfusion times (49 vs. 77 min, p 〈 0.00001). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 SMAT is a safe and efficacious method to achieve rapid revascularization that leads to faster recanalization compared to manual aspiration alone. Future prospective comparisons are necessary to establish the most clinically effective therapy for acute thrombectomy.
    Type of Medium: Online Resource
    ISSN: 1664-9737 , 1664-5545
    URL: Article
    DOI: 10.1159/000449321
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 9
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    Online Resource
    Duration of Ischemia Impacts Postreperfusion Clinical Outcomes Independent of Follow‐Up Infarct Volume
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke: Vascular and Interventional Neurology Vol. 2, No. 5 ( 2022-09)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 5 ( 2022-09)
    Abstract: Time to reperfusion is believed to influence clinical outcomes following thrombectomy mainly through reduction of infarct growth. In this study, we aim to understand whether clinical outcomes can be influenced by ischemia duration (penumbral time) independent of postintervention infarct volume by comparing outcomes following thrombectomy in patients with similar (and small) follow‐up infarct volumes. Methods We performed a retrospective analysis of a prospectively maintained large‐vessel occlusion stroke thrombectomy database across 3 US centers. Demographic, clinical, radiological, and outcomes data of patients with anterior circulation large‐vessel occlusion (internal carotid or middle cerebral artery M1) stroke who had a witnessed‐onset stroke, had substantial penumbral volumes, achieved successful reperfusion (modified thrombolysis in cerebral infarction 2b‐3), and had a follow‐up infarct volume of 〈 20 mL were analyzed. Results A total of 233 patients (center A, 25; center B, 33; center C, 175) were included. Mean age was 71±16 years, and median National Institutes of Health Stroke Scale was 15 (10–20). Median penumbral time was 4.7 (2.9–10) hours, and median follow‐up infarct volume was 4.7 (0.2–9.4) mL. Despite comparable baseline characteristics and 24‐hour infarct volumes, patients reperfused in the 0‐ to 6‐hour time window had significantly higher rates of modified Rankin scale 0 to 2 (61% versus 40%; P =0.002) and numerically lower rates of mortality (11% versus 17%; P =0.16) at 90 days when compared with patients reperfused in the 6‐ to 24‐hour time window. Duration of ischemia is an independent predictor of modified Rankin scale 0 to 2 (odds ratio, 0.91 [0.80–0.99]; P =0.012). In multivariable analysis accounting for age and baseline National Institutes of Health Stroke Scale score, the association between penumbral time and modified Rankin scale 0 to 2 remained significant (absolute risk difference, −1.2% [(95% CI, −1.9 to −0.4)]/h delay). Conclusion Longer penumbral duration is associated with a lower likelihood of functional independence among large‐vessel occlusion strokes with small and comparable 24‐hour follow‐up infarct volume. Our findings indicate that delays in time to reperfusion affect clinical outcomes through mechanisms mediated by factors not solely limited to infarct reduction.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.121.000153
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 3144224-9
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  • 10
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    Online Resource
    Abstract WMP1: DWI ASPECT Scores And Infarct Volume As Predictors Of Outcome After Recanalization In Middle Cerebral Artery Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background and Purpose: Final infarct volume has previously been shown to be a major predictor of outcome after endovascular therapy for middle cerebral artery (MCA) occlusion. However, the importance of specific location of infarct within the MCA territory has not been described. We sought to assess the predictive value of specific topographic regions as predictors of outcomes in a homogeneous cohort of patients treated with endovascular therapy of M1 occlusive disease who underwent post procedure MRI. Methods: A retrospective review of our prospectively maintained single center endovascular database was performed. Automated software was used to measure infarct volume and the DWI ASPECT score was assessed by visual inspection using standard templates. Univariate and multivariate analysis was performed to determine predictors of favorable outcomes using each of the 10 regions as part of the ASPECT score as well as total ASPECT score. Results: 100 patients were identified. 56% were female. Median age was 70. Successful recanalization was achieved with TIMI 2/3 flow in 87% of patients and TICI 2B/3 in 61% of patients. Good outcomes (mRS 0-2 at 3 months) in 46% of patients. There was no difference between outcomes based on the hemisphere involved. Median final infarct on DWI MRI at 24 hours was 39 cc. Median ASPECT score was 6. In multivariate analysis, strong predictors of good outcomes included: age (OR 0.88, 95% CI 0.8-0.96, p=0.006), serum glucose on admission (OR 0.98, 95% CI 0.97-1, p=0.046) and ASPECT score on MRI (OR 0.7, 95% CI 0.03-1.05, p=0.03). There was a high correlation between the volume of infarct and ASPECT score on the post recanalization MRI (Spearman’s rho of -0.76). Conclusions: Quantitative (automated software) and semi-quantitative (ASPECT score values) measurements of infarct size are highly predictive of outcomes after recanalization therapy in middle cerebral artery infarcts. No single topographic region or combination of regions is predictive of outcome, whereas total ASPECT scores are highly predictive. These data support the role of post procedural MRI in guiding prognosis after anterior circulation infarct.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWMP1
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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