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  • 1
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    Critical Angiographic and Sonographic Analysis of Intra Aneurysmal and Downstream Hemodynamic Changes After Flow Diversion
    Frontiers Media SA ; 2022
    In:  Frontiers in Neurology Vol. 13 ( 2022-3-10)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 13 ( 2022-3-10)
    Abstract: Successful treatment of intracranial aneurysms after flow diversion (FD) is dependent on the flow modulating effect of the device. We aimed to investigate the intra-aneurysmal and parent vessel hemodynamic changes, as well as the incidence of silent emboli following treatment with various FD devices. Methods We evaluated the appearance of the eclipse sign in nine distinct phases of cerebral angiography before and immediately after FD placement in correlation with aneurysm occlusion. Angiographic and clinical data of consecutive procedures were analyzed retrospectively. Patients who had successful FD procedure without adjunctive coiling, visible eclipse sign on post embolization angiography, and reliable follow-up angiographic data were included in the analysis. Detailed analysis of hemodynamic data from transcranial doppler after FD was performed in selected patients, such as monitoring for silent emboli. Results Among all patients ( N = 65) who met inclusion criteria, complete aneurysm occlusion at 12 months was achieved in 89% (58/65). Eclipse sign prior to FD was observed in 42% (27/65) with unchanged appearance in 4.6% (3/65) of the treated patients. None of these three patients achieved complete aneurysm occlusion. Among all analyzed variables, such as aneurysm size, device type used, age, and appearance of the eclipse sign pre- and post-FD, the most reliable predictor of permanent aneurysm occlusion at 12 months was earlier, prolonged, and sustained eclipse sign visibility in more than three angiographic phases in comparison to the baseline ( p & lt; 0.001). Elevation in flow velocities within the ipsilateral vascular territory was noted in 70% (9/13), and bilaterally in 54% (7/13) of the treated patients. None of the patients had silent emboli. Conclusions Intra-aneurysmal and parent vessel hemodynamic changes after FD can be reliably assessed by the cerebral angiography and transcranial doppler with important implications for the prediction of successful treatment.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2022.813101
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 2
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    Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion
    Elsevier BV ; 2021
    In:  World Neurosurgery Vol. 148 ( 2021-04), p. e321-e325
    Details
    In: World Neurosurgery, Elsevier BV, Vol. 148 ( 2021-04), p. e321-e325
    Type of Medium: Online Resource
    ISSN: 1878-8750
    URL: Article
    DOI: 10.1016/j.wneu.2020.12.142
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2530041-6
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  • 3
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    Predictors and Functional Outcomes of Fast, Intermediate, and Slow Progression Among Patients With Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 8 ( 2020-08), p. 2553-2557
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 8 ( 2020-08), p. 2553-2557
    Abstract: We aimed to delineate the determinants of the initial speed of infarct progression and the association of speed of infarct progression (SIP) with procedural and functional outcomes. Methods: From a prospectively maintained stroke center registry, consecutive anterior circulation ischemic stroke patients with large artery occlusion, National Institutes of Health Stroke Scale score ≥4, and multimodal vessel, ischemic core, and tissue-at-risk imaging within 24 hours of onset were included. Initial SIP was calculated as ischemic core volume at first imaging divided by the time from stroke onset to imaging. Results: Among the 88 patients, SIP was median 2.2 cc/h (interquartile range, 0–8.7), ranging most widely within the first 6 hours after onset. Faster SIP was positively independently associated with a low collateral score (odds ratio [OR], 3.30 [95% CI, 1.25–10.49] ) and arrival by emergency medical services (OR, 3.34 [95% CI, 1.06–10.49]) and negatively associated with prior ischemic stroke (OR, 0.12 [95% CI, 0.03–0.50] ) and coronary artery disease (OR, 0.32 [95% CI, 0.10–1.00]). Among the 67 patients who underwent endovascular thrombectomy, slower SIP was associated with a shift to reduced levels of disability at discharge (OR, 3.26 [95% CI, 1.02–10.45] ), increased substantial reperfusion by thrombectomy (OR, 8.30 [95% CI, 0.97–70.87]), and reduced radiological hemorrhagic transformation (OR, 0.34 [95% CI, 0.12–0.94] ). Conclusions: Slower SIP is associated with a high collateral score, prior ischemic stroke, and coronary artery disease, supporting roles for both collateral robustness and ischemic preconditioning in fostering tissue resilience to ischemia. Among patients undergoing endovascular thrombectomy, the speed of infarct progression is a major determinant of clinical outcome.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030010
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 4
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    Abstract Number ‐ 110: Case Report of Glue Embolism Complication after Lingual Artery Embolization and Rescue Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke: Vascular and Interventional Neurology Vol. 3, No. S1 ( 2023-03)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. S1 ( 2023-03)
    Abstract: 68‐year‐old right‐handed female with right tongue‐base squamous cell carcinoma status‐post wide surgical‐excision and flap reconstruction, whopresented with large volume right‐sided orolingual hemorrhage. Due to concerns of impending airway compromise and a history of difficult intubation, Interventional Neuroradiology was consulted to perform an angiogram and embolization. Methods A 6FrEnvoy was advanced into the external carotid artery and the origin of the lingual artery. Despite repeated attempts using a variety of microsystems, distal access within the lingual artery could not be achieved (Fig. 1B). N‐butyl‐2‐cyanoacrylate was prepared and injected with adequate penetration. Negative pressure was applied to the microcatheter and withdrawn. The guide catheter was aspirated and rapidly withdrawn under negative pressure. A control angiogram was being prepared when an intracranial glue cast was seen and confirmed to be a proximal M2‐occlusion. 4000U of Heparin werebolusedat this time. An Advantage Exchange wire facilitated an exchange for an 8Fr groin sheath and a Walrus catheter. The glue was crossed with a microsystem microsystem and a Solitaire‐4×40mm was deployed. A ZOOM55 was advanced to the face of the glue caste and together these were pulled into the Walrus catheter. Serial angiograms revealed stenosis, but patency. Results Initial post‐thrombectomy exam revealed mild left‐hand paresis. However, the patient’s neurologic status declined and progressed to left arm hemiparesis, facial droop, and right gaze‐preference. An angiogram was performed, which revealed re‐occlusion of the left M2 trunk. Using aTrevo‐3×32mmstentriever, the M2‐occlusion was recanalized with persistent stenosis. Serial angiograms were concerning for progressing re‐occlusion. The patient improved with residual distal left hemiparesis. Conclusions •Distal access may be extremely difficult in select cases. The proximal location of the microcatheter relative to the origin of the lingual artery and the external carotid artery off the common carotid artery, likely contributed to the embolic event. The use of progressively smaller microcatheters to facilitate distal access in turn biased the choice of embolization materials. Lastly, there was evidence of vasospasm in the lingual artery, which may have contributed to proximal polymerization and adherence to the catheters during their removal. •After successful retrieval of the glue material, there was residual stenosis of unclear etiology, possibly due to denuded endothelium, dissection, or residual glue promoting in‐situ thrombosis. The eventual clearing of thebolusedheparin may have contributed to the delayed re‐occlusion. Recanalization after re‐occlusion was only possible after thrombectomy. •The use of an intermediate catheter may mitigate the risk of glue embolization by facilitating distal access and/or by providing an additional conduit for aspirating refluxed glue. If distal access into a culprit vessel can not be achieved, coil embolization may be a safer choice. Re‐canalized glue embolisms may be prone to re‐occlusion. Continuing a heparin drip may be prudent practice to prevent re‐occlusion.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.03.suppl_1.110
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 5
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    Abstract 081: Clinical Presentation and Treatment of 26 Spinal Epidural Arteriovenous Fistulas: A Single Center Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke: Vascular and Interventional Neurology Vol. 3, No. S2 ( 2023-11)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. S2 ( 2023-11)
    Abstract: Spinal epidural arteriovenous fistulas (SEAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy. Methods This is a single center, retrospective case series of patients with SEAVF who underwent observation or treatment at UCLA medical center from 1993 to 2023. Results A total of 26 patients were found to have a SEAVF at UCLA from 1993 to 2023. The median age at treatment was 59 years (range 4 months to 91 years). 16 of 26 patients (55.2%) were male. 12 were located in the cervical spine, 2 in the thoracic spine, 11 in the lumbar spine, and 1 in the sacral spine. Sacral, lumbar, and thoracic SEAVFs demonstrated a strong male predominance (12 of 14, 85.7%), while cervical SEAVFs were more common in women (8 of 12, 66.7%). The median duration of symptoms prior to treatment was 6.5 months (range 1 day to 8 years). Possible triggers included prior spinal surgery (n=3), turning neck (n=1), trauma to the neck (n=1), lifting a heavy box (n=1), prolonged period of bending over (n=1). The remaining patients did not have any particular trigger. All patients with lumbar and thoracic SEAVFs (except the 3‐month‐old) demonstrated flow voids and cord edema. Patients with cervical SEAVF did not demonstrate cord edema and only 5 of 12 explicitly mentioned flow voids. 22 patients were treated strictly endovascularly, 1 patient endovascularly and then surgically, 1 patient surgically, and 2 patients refused treatment. No patients treated endovascularly experienced complications. 19 of 23 patients (82.6%) treated endovascularly received complete cure after the first treatment. 1 patient had a successful subsequent embolization 2 days later. Of the 3 other incomplete treatments, one patient received subsequent successful surgery, one patient was a 3‐month‐old patient with Parkes‐Weber syndrome who subsequently died of other medical issues, and one was lost to follow‐up. One patient underwent surgical treatment alone due to the feeding arteries being too small to catheterize and unfortunately experienced a failed surgery on the first attempt and developed a surgical site infection after the second successful attempt at treatment. Onyx was used in 10 cases (9 of 10 successful). 2 cases treated with NBCA were unsuccessful. Cervical and Sacral SEAVFs were treated successfully (mostly prior to 2006) with coils and/or detachable balloons. Conclusion SEAVF is a rare disease that can be treated effectively and safely with endovascular embolization in most cases. Pre‐operative MRI demonstrated abnormalities in all cases. We found a strong male predominance in our cohort.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.03.suppl_2.081
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 6
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    Abstract 024: Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula: A Single Center experience
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke: Vascular and Interventional Neurology Vol. 3, No. S2 ( 2023-11)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. S2 ( 2023-11)
    Abstract: The cavernous sinus dural arteriovenous fistula(CS‐DAVF) is a vascular condition that is a result of an unusual connection between the carotid artery branches and the cavernous sinus. This condition could be the result of trauma, infection, or other medical problems. In the case that conservative therapy fails or patients need emergency intervention, endovascular treatment (EVT) has been proposed as a main option for the treatment of these patients. In this study, we aimed to investigate the outcomes of the patients who underwent EVT for CS‐DAVF. Methods To gather information on patient demographics, symptoms, clinical and imaging characteristics, as well as the type of EVT and their outcomes after EVT, we recruited records of patients of our center from 2007. We used descriptive analyses to assess the characteristics of the included cases. Besides, inferential statistics were used to develop univariate and multivariate logistic regression models to identify factors linked to procedural success and symptom resolution at the follow‐up. Results Overall, 59 patients with a mean age of 64.37 years, a female‐to‐male ratio of 2.71, and a mean follow‐up time of 42.64 months were included. Chemosis, ptosis, and diplopia were the most frequent symptoms, and most of the patients were classified as Barrow classification type D based on angiographic features (30/58). In terms of EVT, most of the patients (54/59) underwent transvenous embolization, and liquids (Onyx 34 and 18) were the most frequent materials that were used for embolization (55/59). Also, in 34 cases, additional coiling was performed. Overall, the procedural success rate was 84% (50 out of 59), and a complete resolution of symptoms was observed in 46 cases at the follow‐up, with the occurrence of eight complications overall (13.5%), including two strokes, two alopecia, one seizure, one cranial nerve palsy, one diplopia and one worsening of symptom events. Multiple logistic regression showed that the use of Onyx 34 was associated with procedural success. Conclusion Our results showed that EVT might be a safe and effective option for the treatment of patients with CS‐DAVF. Also, the results showed that the application of Onyx 34 might associate with the procedural success rate.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.03.suppl_2.024
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 7
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    Abstract MP10: Aneurysmal Subarachnoid Hemorrhage in Pregnancy: National Trends of Treatment and Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Abstract: Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a rare event associated with significant pregnancy-associated maternal and neonatal morbidity and mortality. With advances in neurosurgical and neurocritical care, there have been significant improvement in survival and clinical outcome of patients with aSAH. We aimed to investigate the treatment utilizations and outcomes of aSAH in pregnancy. Methods: Retrospective analysis using the Nationwide Inpatient Sample identified women 18-45 years-old hospitalized between 2010-2015. We identified pregnancy state, subarachnoid hemorrhage, and aneurysm treatments in this cohort. The mode of aneurysm treatment, mortality, and discharge destination was compared in pregnant versus non-pregnant cohorts. Results: 9,667 aSAH with treatment were identified, of which 341 were associated with pregnancy. Mortality in the pregnancy and non-pregnancy were not different (7.37% vs 7.39%, p=0.97). However, pregnancy-related admissions were more likely to be discharged to home or short-term facility (71.9% vs 63.8%, p=0.002). Endovascular treatment for aSAH was more prevalent in pregnancy vs non-pregnancy (73% vs 66.3%, p=0.004). During the study epoch, there was a significant increase in endovascular treatment in pregnancy related aSAH (p 〈 0.001). Surgical clipping was associated with higher mortality in pregnancy compared to non-pregnancy (15.9% vs 6.8%, p 〈 0.001). There was no difference in mortality following endovascular treatment in pregnancy vs non-pregnancy (6.1% vs 7.8%, p=0.26). Favorable discharge outcome was significantly higher for pregnancy vs non-pregnancy with endovascular treatment (75.8% vs 63.9%, p 〈 0.001), whereas no significant difference was observed in rate of favorable outcome for pregnancy and non-pregnancy with surgical clipping (57.9% vs 61.2%, p=0.29). Conclusions: Pregnancy does not alter mortality from aSAH. Among interventions for aSAH, surgical clipping is associated with higher mortality in pregnancy compared to non-pregnancy. However, pregnancy is associated with more favorable discharge outcomes (vs controls) and no change in mortality in this cohort. Consideration for endovascular intervention with aSAH in this cohort should be considered.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.MP10
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 8
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    Abstract 170: Impact of Eloquent Motor Cortex-Tissue Reperfusion Beyond the Traditional TICI Scoring After Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Background: Targeted eloquence-based tissue reperfusion within the primary motor cortex may have differential effect on disability as compared to the traditional volume-based (TICI) reperfusion after endovascular thrombectomy (EVT) in setting of acute ischemic stroke (AIS). Methods: We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (mRS) in AIS patients undergoing EVT. ER was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (MCA - precentral, central, anterior parietal; ACA- pericallosal) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariable analysis was conducted to assess the impact of ER on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2 a and b). Results: Among the 125 patients who met study criteria, median age was 73, median NIHSS was 16, median ASPECTS was 7, 48% (60/125) were female, and 36.8% achieved functional independence (mRS 0-2) at 90 days. ER distribution was: Absent (0) in 19/125 (15.2%); Partial (1) in 52/125 (41.6%), and Complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER was substantially higher in those patients (p 〈 0.001). In multivariate analysis, in addition to age and sICH, ER had a profound independent impact on 90-day disability (OR 6.10, p=0.001 for ER 1 vs 0; and OR 9.87, p 〈 0.001 for ER 2 vs 0). In contrast, extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day disability. Conclusions: Our findings support that eloquent PMC-tissue reperfusion is a major determinant of functional outcome, more impactful than volume-based degree of partial reperfusion. More aggressive, PMC-targeted revascularization among patients with non-eloquent partial reperfusion may further improve post-stroke disability after EVT.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.170
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 9
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    Abstract TP108: Intracranial Artery Calcification: Frequency, Determinants, And Modification Of Outcomes From Endovascular Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Introduction: Intracranial artery calcification (ICAC) is a common finding on CTA in patients presenting with LVO acute ischemic stroke and could potentially serve as a useful biomarker of intracranial atherosclerosis and altered intracranial vessel pliability in patients undergoing endovascular thrombectomy (EVT). However, ICAC frequency, determinants, and outcome associations have not been well delineated. Methods: In a prospectively maintained database, we analyzed consecutive patients undergoing CTA immediately prior to EVT from Mar 2016 - Aug 2020. Extent of ICAC in the intracranial ICA or VA proximal to the target vessel was scored using a validated grading scale (Babiarz et al, AJNR 2003: 5 levels for greatest calcific thickness and 5 levels for greatest circumferential extent). Example cases in Figure 1. Patients were stratified into low (0-2), medium (3-4), and high (5-6) ICAC groups. Results: Among 91 patients, mean age was 73, 54% female, and mean NIHSS 17. Median ICAC score was 3 [IQR 0-4]. Baseline characteristics associated with higher ICAC scores were: CAD (3.8 vs. 2.4, p = 0.02), HTN (3.1 vs. 2.1, p = 0.07), and age ( r = 0.50, p 〈 0.001). There was a U-shaped association between ICAC score and successful reperfusion (mTICI 2b-3): 90.9%, 65.7%, and 95.0% in low, medium, and high ICAC score groups, respectively ( p = 0.006). Need for rescue intervention (angioplasty/stenting, IA thrombolysis, or GpIIb/IIIa inhibitor) was higher in the high ICAC group: 5.9% vs. 5.6% vs. 28.6% ( p = 0.01). Functional independence (mRS 0-2) at discharge (29.4% vs. 22.2% vs. 19.0%, p = 0.64) or 90 days (40.0% vs. 30.0% vs. 21.4%, p = 0.22) did not differ, nor did symptomatic intracranial hemorrhage ( p = 0.96). Conclusions: Calcification of intracranial vessels is frequently seen on CTA in LVO patients and is associated with age and vascular risk factors. Degree of calcification has important associations with rates of successful reperfusion and need for rescue intervention during EVT.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.TP108
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 10
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    Abstract WP174: Frequency, Predicators, and Outcomes of Pre-Intervention Thrombus Migration in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Background: In patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion (LVO), between initial CTA/MRA and catheter angiography performed for intervention, the occlusive thrombus may persist unchanged, fragment and migrate distally, or resolve completely, with or without bridging intravenous fibrinolytic treatment. The frequency, predictors, and outcomes of pre-intervention thrombus migration not been well delineated. Methods: We analyzed a prospectively maintained registry of AIS-LVO patients at an academic medical center over a 2.8 year period (Dec 2014-Oct 2017). Comparing occlusion sites on arrival CTA/MRA with immediately following interventional angiogram, patients were classified as having: 1) thrombus persistence (TP), 2) thrombus migration (TM), or 3) thrombus resolution (TR). Results: In the 220 patients, mean age was 70.7, 42.7% were female, NIHSS was 13.8, onset to first imaging was 156 minutes, and initial occlusion sites on MRA/CTA were: ICA-20.5%; MCA-67.3%; VA/BA-12.3%. Frequencies of thrombus evolution patterns were: TP-59.5%; TM-30.5%; TR-10.0%. On multivariate analysis, independent predictors of TM were: higher NIHSS (OR 1.06 per 1 pt), cardioembolic mechanism (OR 2.40), and longer time from last known well to first CTA/MRA imaging (OR 1.08 per 60 min). While rates of substantial reperfusion (TICI 2b-3) were similar (85.2% vs 83.7%), patients with TM rather than TP had lower rates of excellent reperfusion (TICI 2C-3), 24.1% vs 44.2%, p = 0.02. Symptomatic intracranial hemorrhage occurred more often in TM than TP, 17.9% vs 8.4%, p = 0.05. In multivariate analysis, TM was independently associated with reduced rates of good functional outcome (mRS 0-2), both at discharge (OR 0.41, 95% CI 0.19 to 0.90; p=0.03) and at 3 months (OR 0.43, 95% CI 0.19 to 0.94; p=0.03). Conclusions: Early TM between initial noninvasive imaging and interventional angiography occurs in nearly one-third of patients, is paradoxically associated with poorer outcomes, including more symptomatic hemorrhage and reduced final functional independence. Better understanding of dynamic clot changes early after arrival and their effects on outcome may aid further development of reperfusion therapeutics.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.WP174
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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