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  • 1
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    Abstract WP1: Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent-Retriever, Aspiration, MERCI: Multi-Center Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: Recent trials demonstrated that mechanical thrombectomy improve functional outcome in anterior circulation acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) of the middle cerebral artery (MCA) M1 segment. However, such data regarding AIS due to MCA M2 segment ELVO is limited. Analysis of the STAR, SWIFT, and SWIFT-PRIME trials found thrombectomy in MCA M2 occlusion to be feasible in achieving successful reperfusion. The most optimal technique and/or device used for such reperfusion is not clearly defined. We aim to compare the outcome for the contemporary techniques and devices used for thrombectomy of AIS patients due to MCA M2 ELVO. Methods: A retrospective review of AIS patients with MCA M2 ELVO receiving thrombectomy from three tertiary care academic medical centers was conducted. Thrombectomy technique and thrombectomy device utilized were recorded. Outcomes were successful angiographic reperfusion (TICI ≥2b), favorable modified Rankin Scale (mRS≤2) at discharge and at 90 days, and rate of symptomatic intracerebral hemorrhage (sICH). Results: From October 1999 through June 2016, 253 AIS patients underwent thrombectomy for MCA M2 ELVO. Thrombectomy methods utilized were Stent-retriever (n=118), Aspiration only [manual or Penumbra device] (n=83), and MERCI retriever (n=52). Table 1 shows rate of outcomes measured. There was no difference in baseline NIHSS or in stroke onset to groin puncture time. Stent-retriever group showed a significantly higher recanalization rate, lower sICH rate, and favorable 90-day mRS versus Aspiration group or MERCI group, respectively. No significant difference was seen in discharge mRS between the groups. Conclusions: Thrombectomy for AIS patients with MCA M2 ELVO with Stent-retriever appears to be feasible with a significantly higher rate of recanalization, lower sICH rate, and favorable 90-day mRS when compared to Aspiration and MERCI.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wp1
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 2
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    Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration: A Multicenter Experience
    S. Karger AG ; 2019
    In:  Interventional Neurology Vol. 8, No. 2-6 ( 2019), p. 180-186
    Details
    In: Interventional Neurology, S. Karger AG, Vol. 8, No. 2-6 ( 2019), p. 180-186
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever ( 〈 i 〉 n 〈 /i 〉 = 120) or aspiration only ( 〈 i 〉 n 〈 /i 〉 = 77). The aspiration-only group utilized either manual ( 〈 i 〉 n 〈 /i 〉 = 38) or pump aspiration ( 〈 i 〉 n 〈 /i 〉 = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02–9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03–0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5–9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.
    Type of Medium: Online Resource
    ISSN: 1664-9737 , 1664-5545
    URL: Article
    DOI: 10.1159/000500198
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 2662855-7
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  • 3
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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
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  • 4
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    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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  • 5
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    Comparison of CT Perfusion Software Packages for Thrombectomy Eligibility
    Wiley ; 2023
    In:  Annals of Neurology
    Details
    In: Annals of Neurology, Wiley
    Abstract: Computed tomography perfusion (CTP) has played an important role in patient selection for mechanical thrombectomy (MT) in acute ischemic stroke. We aimed to investigate the agreement between perfusion parametric maps of 3 software packages – RAPID (RapidAI‐IschemaView), Viz CTP(Viz.ai), and e‐CTP(Brainomix) – in estimating baseline ischemic core volumes of near completely/completely reperfused patients. Methods We retrospectively reviewed a prospectively maintained MT database to identify patients with anterior circulation large vessel occlusion strokes (LVOS) involving the internal carotid artery or middle cerebral artery M1‐segment and interpretable CTP maps treated during September 2018 to November 2019. A subset of patients with near‐complete/complete reperfusion (expanded thrombolysis in cerebral infarction [eTICI] 2c–3) was used to compare the pre‐procedural prediction of final infarct volumes. Results In this analysis of 242 patients with LVOS, RAPID and Viz CTP relative cerebral blood flow (rCBF) 〈  30% values had substantial agreement ( ρ  = 0.767 [95% confidence interval [CI] = 0.71–0.81] ) as well as for RAPID and e‐CTP ( ρ  = 0.668 [95% CI = 0.61–0.71]). Excellent agreement was seen for time to maximum of the residue function ( T max ) 〉  6 seconds between RAPID and Viz CTP ( ρ  = 0.811 [95% CI = 0.76–0.84]) and substantial for RAPID and e‐CTP ( ρ  = 0.749 [95% CI = 0.69–0.79]). Final infarct volume (FIV) prediction (n = 136) was substantial in all 3 packages (RAPID ρ  = 0.744; Viz CTP ρ  = 0.711; and e‐CTP ρ  = 0.600). Conclusion Perfusion parametric maps of the RAPID, Viz CTP, and e‐CTP software have substantial agreement in predicting final infarct volume in near‐completely/completely reperfused patients. ANN NEUROL 2023
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Article
    DOI: 10.1002/ana.26748
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2037912-2
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  • 6
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    Endovascular reperfusion outcomes in patients with a stroke and low ASPECTS is highly dependent on baseline infarct volumes
    BMJ ; 2022
    In:  Journal of NeuroInterventional Surgery Vol. 14, No. 2 ( 2022-02), p. 117-121
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 14, No. 2 ( 2022-02), p. 117-121
    Abstract: Patients with large vessel occlusion stroke (LVOS) and a low Alberta Stroke Program Early CT Score (ASPECTS) are often not offered endovascular therapy (ET) as they are thought to have a poor prognosis. Objective To compare the outcomes of patients with low and high ASPECTS undergoing ET based on baseline infarct volumes. Methods Review of a prospectively collected endovascular database at a tertiary care center between September 2010 and March 2020. All patients with anterior circulation LVOS and interpretable baseline CT perfusion (CTP) were included. Subjects were divided into groups with low ASPECTS (0–5) and high ASPECTS (6-10) and subsequently into limited and large CTP-core volumes (cerebral blood flow 30% 〉 70 cc). The primary outcome measure was the difference in rates of 90-day good outcome as defined by a modified Rankin Scale (mRS) score of 0 to 2 across groups. Results 1248 patients fit the inclusion criteria. 125 patients had low ASPECTS, of whom 16 (12.8%) had a large core (LC), whereas 1123 patients presented with high ASPECTS, including 29 (2.6%) patients with a LC. In the category with a low ASPECTS, there was a trend towards lower rates of functional independence (90-day modified Rankin Scale (mRS) score 0-2) in the LC group (18.8% vs 38.9%, p=0.12), which became significant after adjusting for potential confounders in multivariable analysis (aOR=0.12, 95% CI 0.016 to 0.912, p=0.04). Likewise, LC was associated with significantly lower rates of functional independence (31% vs 51.9%, p=0.03; aOR=0.293, 95% CI 0.095 to 0.909, p=0.04) among patients with high ASPECTS. Conclusions Outcomes may vary significantly in the same ASPECTS category depending on infarct volume. Patients with ASPECTS ≤5 but baseline infarct volumes ≤70 cc may achieve independence in nearly 40% of the cases and thus should not be excluded from treatment.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-017184
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 7
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    Longer stent retrievers enhance thrombectomy performance in acute stroke
    BMJ ; 2019
    In:  Journal of NeuroInterventional Surgery Vol. 11, No. 1 ( 2019-01), p. 6-8
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 11, No. 1 ( 2019-01), p. 6-8
    Abstract: Longer stent retrievers have recently become available and have theoretical advantages over their shorter counterparts. We aim to evaluate whether stent retriever length impacts reperfusion rates in stroke thrombectomy. Methods This was a retrospective analysis of a prospectively collected thrombectomy database in which equal diameter (4 mm) stent retrievers were used as the first-line strategy for intracranial internal carotid or middle cerebral artery M1 or M2 occlusions along with a balloon guide catheter from June 2011 to March 2017. The population was dichotomized into long (Trevo 4×30 mm/Solitaire 4×40 mm) or short (Trevo 4×20 mm/Solitaire 4×20 mm) retrievers. The primary outcome was first-pass modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 reperfusion. Results Of 1126 thrombectomies performed within the study period, 420 were included. Age, gender, National Institutes of Health Stroke Scale, ASPECTS, IV tissue plasminogen activator use, stroke etiology, occlusion site, time from last-known-normal to puncture, distribution of Trevo and Solitaire, and the use of newer generation local thromboaspiration devices were comparable between the long and short retrievers. The short retriever group had more frequent hypertension, dyslipidemia, and atrial fibrillation. First-pass mTICI 2b/3 reperfusion was more common in the long retriever group (62% vs 50%; P=0.01). Parenchymal hematomas type 2, subarachnoid hemorrhage, 90-day modified Rankin Scale score 0–2, and mortality were comparable. Multivariable analysis indicated that long retriever (OR 2.2; 95% CI 1.3 to 3.6; P=0.001), radiopaque device (OR 2.1; 95% CI 1.2 to 3.4; P=0.003), and adjuvant local aspiration (OR 2.4; 95% CI 1.3 to 4.3; P=0.003) were independently associated with first-pass reperfusion. Conclusions The use of longer stent retrievers is an independent predictor of first-pass mTICI 2b/3 reperfusion. First-pass reperfusion was also associated with the use of radiopaque devices and adjuvant local aspiration.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2018-013918
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 8
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    Baseline Characteristics of Patients with Symptomatic Carotid Webs: A Matched Case Control Study
    Elsevier BV ; 2021
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 30, No. 8 ( 2021-08), p. 105823-
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 30, No. 8 ( 2021-08), p. 105823-
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2021.105823
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2052957-0
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  • 9
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    Carotid Web (Intimal Fibromuscular Dysplasia) Has High Stroke Recurrence Risk and Is Amenable to Stenting
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 11 ( 2017-11), p. 3134-3137
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 11 ( 2017-11), p. 3134-3137
    Abstract: Carotid webs have been increasingly recognized as a cause of recurrent stroke, but evidence remains scarce. We aim to report the clinical outcomes and first series of carotid stenting in a cohort of patients with strokes from symptomatic carotid webs. Methods— Prospective and consecutive data of patients 〈 65 years old with cryptogenic stroke admitted within September 2014 to May 2017. Carotid web was defined by a shelf-like/linear filling defect in the posterior internal carotid artery bulb by computed tomographic angiography. Results— Twenty-four patients were identified (91.6% strokes/8.4% transient ischemic attacks [TIAs]). Median age was 46 (41–59) years, 61% were female, and 75% were black. Median National Institutes of Health Stroke Scale score was 10.5 (3.0–16.0) and ASPECTS (Alberta Stroke Program Early CT Score) was 8 (7–8). There were no parenchymal hemorrhages, and 96% of patients were independent at 3 months. All webs caused 〈 50% stenosis. In patients with bilateral webs (58%), median ipsilateral web length was larger than contralateral (3.1 [3.0–4.5] mm versus 2.6 [1.85–2.9] mm; P =0.01), respectively. Twenty-nine percent of patients had thrombus superimposed on the symptomatic carotid web. A recurrent stroke/TIA involving the territory of the previously symptomatic web occurred in 7 (32%; 6 strokes/1 TIA) patients: 3 〈 1 week, 2 〈 first year, and 3 〉 1 year of follow-up. Two recurrences occurred on dual antiplatelet therapy, 3 on antiplatelet monotherapy, 1 within 24 hours of thrombolysis, and 1 off antithrombotics. Median follow-up was 12.2 (8.0–18.0) months. Sixteen (66%) patients were stented at a median 12.2 (7.0–18.7) days after stroke with no periprocedural complications. No recurrent strokes/TIAs occurred in stented individuals (median follow-up of 4 [2.4–12.0] months). Conclusions— Carotid web is associated with high recurrent stroke/TIA risk, despite antithrombotic use, and is amenable to carotid stenting.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.019020
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 10
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    Online Resource
    Computed Tomographic Perfusion Selection and Clinical Outcomes After Endovascular Therapy in Large Vessel Occlusion Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 5 ( 2017-05), p. 1271-1277
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 5 ( 2017-05), p. 1271-1277
    Abstract: Different imaging paradigms have been used to select patients for endovascular therapy in stroke. We sought to determine whether computed tomographic perfusion (CTP) selection improves endovascular therapy outcomes compared with noncontrast computed tomography alone. Methods— Review of a prospectively collected registry of anterior circulation stroke patients undergoing stent-retriever thrombectomy at a tertiary care center between September 2010 and March 2016. Patients undergoing CTP were compared with those with noncontrast computed tomography alone. The primary outcome was the shift in the 90-day modified Rankin scale (mRS). Results— A total of 602 patients were included. CTP-selected patients (n=365, 61%) were younger ( P =0.02) and had fewer comorbidities. CTP selection (n=365, 61%) was associated with a favorable 90-day mRS shift (adjusted odds ratio [aOR]=1.49; 95% confidence interval [CI] , 1.06–2.09; P =0.02), higher rates of good outcomes (90-day mRS score 0–2: 52.9% versus 40.4%; P =0.005), modified Thrombolysis in Cerebral Infarction-3 reperfusion (54.8% versus 40.1%; P 〈 0.001), smaller final infarct volumes (24.7 mL [9.8–63.1 mL] versus 34.6 mL [13.1–88 mL] ; P =0.017), and lower mortality (16.6% versus 26.8%; P =0.005). When matched on age, National Institutes of Health Stroke Scale (NIHSS) score, and glucose (n=424), CTP remained associated with a favorable 90-day mRS shift ( P =0.016), lower mortality ( P =0.02), and higher rates of reperfusion ( P 〈 0.001). CTP better predicted functional outcomes in patients presenting after 6 hours (as assessed by comparison of logistic regression models: Akaike information criterion: 199.35 versus 287.49 and Bayesian information criterion: 196.71 versus 283.27) and those with an Alberta Stroke Program Early Computed Tomography Score ≤7 (Akaike information criterion: 216.69 versus 334.96 and Bayesian information criterion: 213.6 versus 329.94). Conclusions— CTP selection is associated with a favorable mRS shift in patients undergoing stent-retriever thrombectomy. Future prospective studies are warranted.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.015636
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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