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1

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Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data

Román, Luis San ; Menon, Bijoy K ; Blasco, Jordi ; [et al.]

Elsevier BV ; 2018

In: The Lancet Neurology Vol. 17, No. 10 ( 2018-10), p. 895-904

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In: The Lancet Neurology, Elsevier BV, Vol. 17, No. 10 ( 2018-10), p. 895-904

Type of Medium: Online Resource

ISSN: 1474-4422

URL: Article

DOI: 10.1016/S1474-4422(18)30242-4

Language: English

Publisher: Elsevier BV

Publication Date: 2018

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Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Campbell, Bruce C V ; Majoie, Charles B L M ; Albers, Gregory W ; [et al.]

Elsevier BV ; 2019

In: The Lancet Neurology Vol. 18, No. 1 ( 2019-01), p. 46-55

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In: The Lancet Neurology, Elsevier BV, Vol. 18, No. 1 ( 2019-01), p. 46-55

Type of Medium: Online Resource

ISSN: 1474-4422

URL: Article

DOI: 10.1016/S1474-4422(18)30314-4

Language: English

Publisher: Elsevier BV

Publication Date: 2019

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3

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Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Campbell, Bruce C V ; van Zwam, Wim H ; Goyal, Mayank ; [et al.]

Elsevier BV ; 2018

In: The Lancet Neurology Vol. 17, No. 1 ( 2018-01), p. 47-53

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In: The Lancet Neurology, Elsevier BV, Vol. 17, No. 1 ( 2018-01), p. 47-53

Type of Medium: Online Resource

ISSN: 1474-4422

URL: Article

DOI: 10.1016/S1474-4422(17)30407-6

Language: English

Publisher: Elsevier BV

Publication Date: 2018

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4

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Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core

Gory, Benjamin ; Finitsis, Stephanos ; Desilles, Jean-Philippe ; [et al.]

Elsevier BV ; 2023

In: World Neurosurgery Vol. 178 ( 2023-10), p. e282-e291

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In: World Neurosurgery, Elsevier BV, Vol. 178 ( 2023-10), p. e282-e291

Type of Medium: Online Resource

ISSN: 1878-8750

URL: Article

DOI: 10.1016/j.wneu.2023.07.043

Language: English

Publisher: Elsevier BV

Publication Date: 2023

detail.hit.zdb_id: 2530041-6

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5

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Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results

Couture, Marie ; Finitsis, Stephanos ; Marnat, Gaultier ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Stroke Vol. 52, No. 12 ( 2021-12), p. 3864-3872

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 12 ( 2021-12), p. 3864-3872

Abstract: The influence of prior antiplatelet therapy (APT) uses on the outcomes of patients with acute ischemic stroke treated with endovascular therapy is unclear. We compared procedural and clinical outcomes of endovascular therapy in patients on APT or not before stroke onset. Methods: We analyzed 2 groups from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke registry in France: patients on prior APT (APT+) and patients without prior APT (APT−) treated by endovascular therapy, with and without intravenous thrombolysis. Multilevel mixed-effects logistic models including center as random effect were used to compare angiographic (rates of reperfusion at the end of procedure, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to APT subgroups. Comparisons were adjusted for prespecified confounders (age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, intravenous thrombolysis, and time from onset to puncture), as well as for meaningful baseline between-group differences. Results: A total of 2939 patients were analyzed, of whom 877 (29.8%) were on prior APT. Patients with prior APT were older, had more frequent vascular risk factors, cardioembolic stroke mechanism, and prestroke disability. Rates of complete reperfusion (37.9% in the APT− group versus 42.7 % in the APT+ group; aOR, 1.09 [95% CI, 0.88–1.34]; P =0.41) and periprocedural complication (16.9% versus 13.3%; aOR, 0.90 [95% CI, 0.7–1.2]; P =0.66) did not differ between the two groups. Symptomatic intracerebral hemorrhage (aOR, 0.93 [95% CI, 0.63–1.37]; P =0.73), 3 months favorable clinical outcome (modified Rankin Scale score of 0–2; aOR, 0.98 [95% CI, 0.77–1.25]; P =0.89), and mortality (aOR, 0.95 [95% CI, 0.72–1.26]; P =0.76) at 90 days did not differ between the groups. Conclusions: Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/STROKEAHA.121.034670

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 1467823-8

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6

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Thrombectomy Complications in Large Vessel Occlusions: Incidence, Predictors, and Clinical Impact in the ETIS Registry

Happi Ngankou, Emmanuel ; Gory, Benjamin ; Marnat, Gaultier ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Stroke Vol. 52, No. 12 ( 2021-12)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 12 ( 2021-12)

Abstract: Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice. Methods: We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications. Results: Procedural complications occurred in 7.99% (95% CI, 7.17%–8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03–12.31] ; P 〈 0.001) and an increased total number of passes (OR, 1.22 [95% CI, 1.05–1.41]; P =0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0–2; adjusted OR, 0.4 [95% CI, 0.25–0.63]; P 〈 0.001), increased mortality (adjusted OR, 1.74 [95% CI, 1.2–2.53]; P 〈 0.001), and symptomatic intracerebral hemorrhage (adjusted OR, 1.87 [95% CI, 1.15–3.03]; P =0.011). Perforations occurred in 1.69% (95% CI, 1.31%–2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%; P =0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%–1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years; P =0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique. Conclusions: Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03776877.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/STROKEAHA.121.034865

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 1467823-8

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7

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Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0–5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke

Panni, Pietro ; Lapergue, Bertrand ; Maïer, Benjamin ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Clinical Neuroradiology Vol. 32, No. 4 ( 2022-12), p. 939-950

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In: Clinical Neuroradiology, Springer Science and Business Media LLC, Vol. 32, No. 4 ( 2022-12), p. 939-950

Type of Medium: Online Resource

ISSN: 1869-1439 , 1869-1447

URL: Article

DOI: 10.1007/s00062-022-01156-z

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2232347-8

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8

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Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial

Darsaut, Tim E. ; Magro, Elsa ; Bojanowski, Michel W. ; [et al.]

Journal of Neurosurgery Publishing Group (JNSPG) ; 2022

In: Journal of Neurosurgery ( 2022-09-01), p. 1-9

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In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), ( 2022-09-01), p. 1-9

Abstract: The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. METHODS TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score 〉 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score 〉 2. RESULTS From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I–II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%–93%) and 105/110 low-grade (95%, 95% CI 90%–98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%–18%) had reached the primary safety outcome of mRS score 〉 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%–28%). Permanent treatment-related complications leading to mRS score 〉 2 occurred in 6/139 patients (4%, 95% CI 2%–9%), 5 (83%) of whom had complications due to preoperative embolization. CONCLUSIONS The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 ( ClinicalTrials.gov )

Type of Medium: Online Resource

ISSN: 0022-3085 , 1933-0693

URL: Article

DOI: 10.3171/2022.7.JNS22813

RVK:

XA 10000

RVK:

XA 55270

Language: Unknown

Publisher: Journal of Neurosurgery Publishing Group (JNSPG)

Publication Date: 2022

detail.hit.zdb_id: 2026156-1

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9

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Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke

Girot, Jean-Baptiste ; Richard, Sébastien ; Gariel, Florent ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2020

In: Stroke Vol. 51, No. 10 ( 2020-10), p. 2943-2950

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 10 ( 2020-10), p. 2943-2950

Abstract: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. Methods: Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score 〉 5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. Results: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32–3.56] ), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09–4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51–4.30] ), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01–1.20]), age (OR, 1.38 [95% CI, 1.14–1.67] ), number of passes (OR, 1.16 [95% CI, 1.04–1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30–0.81] ), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52–0.81]). Conclusions: Severely impaired AIS patients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/STROKEAHA.120.029494

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2020

detail.hit.zdb_id: 1467823-8

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10

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Impact of Strategy on Clinical Outcome in Large Vessel Occlusion Stroke Successfully Reperfused: ETIS Registry Results

Douarinou, Marian ; Gory, Benjamin ; Consoli, Arturo ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Stroke Vol. 53, No. 1 ( 2022-01)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 1 ( 2022-01)

Abstract: Approximately half of the patients with acute ischemic stroke due to anterior circulation large vessel occlusion do not achieve functional independence despite successful reperfusion. We aimed to determine influence of reperfusion strategy (bridging therapy, intravenous thrombolysis alone, or mechanical thrombectomy alone) on clinical outcomes in this population. Methods: From ongoing, prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke registry in France, all patients with anterior circulation large vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3) following reperfusion therapy were included. Primary end point was favorable outcome, defined as 90-day modified Rankin Scale score ≤2. Patient groups were compared using those treated with bridging therapy as reference. Differences in baseline characteristics were reduced after propensity score-matching, with a maximum absolute standardized difference of 14% for occlusion site. Results: Among 1872 patients included, 970 (51.8%) received bridging therapy, 128 (6.8%) received intravenous thrombolysis alone, and the remaining 774 (41.4%) received MT alone. The rate of favorable outcome was comparable between groups. Excellent outcome (90-day modified Rankin Scale score 0–1) was achieved more frequently in the bridging therapy group compared with the MT alone (odds ratio after propensity score-matching, 0.70 [95% CI, 0.50–0.96]). Regarding safety outcomes, hemorrhagic complications were similar between the groups, but 90-day mortality was significantly higher in the MT alone group compared with the bridging therapy group (odds ratio, 1.60 [95% CI, 1.09–2.37] ). Conclusions: This real-world observational study of patients with anterior circulation large vessel occlusion demonstrated a similar rate of favorable outcome following successful reperfusion with different therapeutic strategies. However, our results suggest that bridging therapy compared with MT alone is significantly associated with excellent clinical outcome and lower mortality. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03776877.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/STROKEAHA.121.034422

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

detail.hit.zdb_id: 1467823-8

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