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  • 1
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    Abstract W MP22: Hyperdense MCA Sign as a Recanalization and Outcomes Predictor of IA Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Background: The hyperdense MCA sign (HMCAS) is related to poor clinical outcomes and low recanalization rates after IV TPA. We explored the association between presence of HMCAS and clinical /procedural outcomes in patients with M1 MCA occlusion treated at our institution with endovascular therapy within the last five years. Methods: We retrospectively collected from our mechanical thrombectomy database a total of 193 patients with M1 occlusion, of which 107 patients were found to have HMCAS (55%). Eligible patients were treated with IV TPA prior to the intra-arterial thrombectomy. A blinded stroke neurologist evaluated baseline head CT done for possible HMCAS and measured the MCA Hounsfield Units (HU). Procedure times and other clinical and radiographic parameters were calculated. Results: A positive correlation between presence of HMCAS and procedure duration (mean time with HMCAS 112.3 min versus 89.89 min in the non HMCAS group P 〈 0.05) was found. Intraprocedural perforation was 8% (n=9) in the HMCAS group versus 1% (n=1) in the non HMCAS group (P 〈 0.05).Hounsfield Unit analysis (ratio of ipsilateral side/contralateral side), showed a linear correlation (p 〈 0.05) between this ratio and procedure duration (Graph 1). Conclusions: HMCAS is associated with slower recanalization, higher rate of complications and lack of differences in clinical outcomes possibly explained by low power after endovascular therapy. This association may reflect differences in thrombus composition or thrombus burden which should be taken into account when choosing recanalization strategies.Further studies focused on clot analysis and better understanding of clot's structure, may serve a future role in selecting special treatment options for acute stroke patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.wmp22
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Abstract P79: Decline in Mild Stroke Presentations and Intravenous Thrombolysis During the Covid-19 Pandemic: The Society of Vascular and Interventional Neurology Registry
    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: To evaluate overall ischemic stroke rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. Methods: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period), March-May 2019 (seasonal pre-COVID period) and November 2019-January 2020 (immediate pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate (8-14), and severe ( 〉 14) symptoms. Secondary outcomes were number of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and disposition. Results: Of the 7,969 patients diagnosed with acute stroke during the study period, 933 (12%) presented in the COVID-19 period, 1319 (17%), and 1254 (16%) presented in the seasonal pre-COVID-19 and immediate pre-COVID-19 periods, respectively. Significant decline was observed in the weekly mean volume of newly diagnosed strokes (98±7.3 vs 50±20, p 〈 0.01 and 95±10.5 vs 50±20, p 〈 0.01), LVOs (16.5±3.8 vs 8.3±5.9, p 〈 0.01 and 14.3± 4.5 vs 8.3±5.9, p 〈 0.01), and IV-tPA (5.3±2.9 vs 10.9±3.4 and 12.7±4.1, p 〈 0.01). Mean weekly proportion of LVOs remained the same, when compared with seasonal pre-COVID-19 period (18%±5 vs 16%±7, p=0.24) and immediate pre-COVID-19 period (17.4%±4 vs. 16%±7, p=0.32). Additionally, these patients presented with less severe disease (NIHSS 〈 14; aOR: 0.63, 95%CI: 0.41-0.97, p=0.035) during the COVID-19 period as compared to immediate pre-COVID-19 period. Conclusions: We observed a decrease in newly diagnosed stroke cases and rates of IV-tPA administration, while the LVO frequency remained unchanged during the COVID-19 pandemic. Additionally, these stroke patients had more severe presentations.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P79
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Transradial versus transfemoral approaches for diagnostic cerebral angiography: a prospective, single-center, non-inferiority comparative effectiveness study
    BMJ ; 2020
    In:  Journal of NeuroInterventional Surgery Vol. 12, No. 10 ( 2020-10), p. 993-998
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 12, No. 10 ( 2020-10), p. 993-998
    Abstract: Interventional cardiology produced level 1 evidence recommending radial artery-first for coronary angiography given lower vascular complications. Neuroendovascular surgeons have not widely adopted the transradial approach. This prospective, single center, non-inferiority comparative effectiveness study aims to compare the transradial and transfemoral approaches for diagnostic cerebral angiography with respect to efficacy, safety and patient satisfaction. Methods Consecutive patients presenting for diagnostic cerebral angiography were selected to undergo right radial or femoral access based on date of presentation. Primary outcome was ability to answer the predefined diagnostic goal of the cerebral angiogram using the initial access site and was assessed with a non-inferiority design. Secondary outcomes included technical success per vessel, complications, procedure times and patient satisfaction. Results A total of 312 patients were enrolled, 158 and 154 for right radial and femoral access, respectively. The diagnostic goal of the angiogram was achieved in 152 of 154 (99%) patients who underwent attempted femoral access compared with 153 of 158 (97%) patients who underwent radial access, confirming non-inferiority of the transradial approach. Secondary outcomes showed equivalent technical success by vessel, no major complications, and similar frequency of minor complications between the two approaches. In-room time was similar between approaches, though post-procedure recovery room time was significantly shorter for transradial patients. Patient satisfaction results significantly favored the radial approach. Conclusions In patients undergoing diagnostic cerebral angiography, transfemoral and transradial access achieve procedural goals with similar effectiveness and safety, though patients strongly prefer the radial approach. Findings support consideration of adopting a radial-first strategy for diagnostic cerebral angiography.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2019-015642
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2506028-4
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  • 4
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    Online Resource
    Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic
    Elsevier BV ; 2021
    In:  Clinical Neurology and Neurosurgery Vol. 201 ( 2021-02), p. 106436-
    Details
    In: Clinical Neurology and Neurosurgery, Elsevier BV, Vol. 201 ( 2021-02), p. 106436-
    Type of Medium: Online Resource
    ISSN: 0303-8467
    URL: Article
    DOI: 10.1016/j.clineuro.2020.106436
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2004613-3
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  • 5
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    Abstract P467: Clinical Effectiveness of Endovascular Stroke Treatment in the Early and Extended Time Windows
    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: Background and Purpose: The clinical efficacy of mechanical thrombectomy (MT) has been unequivocally demonstrated in multiple randomized clinical trials (RCTs). However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. We aim to assess the clinical effectiveness of MT by comparing the specific RCT populations with corresponding patient cohorts derived from a prospective registry. Methods: A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label MT registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials based on the age, baseline NIHSS, occlusion site, IV tPA use, pre-morbid mRS and time to treatment criteria used in the RCTs without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups. Results: As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of IV tPA and general anesthesia were higher in DAWN- and DEFUSE 3-registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS 0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding RCTs (SWIFT-Prime, 64.5% vs 60.2%; DAWN, 50.4% vs 48.6%; Beyond-DAWN: 52.4% vs 48.6%; DEFUSE 3, 52% vs 44.6%, respectively; all P 〉 0.05). Registry-derived patients had significant less disability than the corresponding RCT controls (ordinal mRS shift OR, P 〈 0.05 for all). Conclusion: Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the “real-world” setting and supports that patients may be safely treated outside the constraints of RCTs and strict guidelines.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P467
    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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    Abstract TMP7: Endovascular Recanalization of Intracranial Arterial Stenosis in Patients With Recurrent or Progressive Symptoms Despite Medical Management
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Background and Objective: The optimal management of intracranial arterial stenosis is unclear, particularly in patients who have failed medical management. We report a multicenter real-world experience of endovascular recanalization of intracranial atherosclerotic stenosis refractory to aggressive medical therapy. Methods: Retrospective multicenter case series of consecutive endovascularly treated patients presenting with symptomatic (TIA or stroke) who had failed medical therapy were identified. All of the patients were considered to be at high risk with unstable symptomatic intracranial stenosis and progression or recurrence of symptoms despite the best medical management and underwent endovascular intervention either with stenting and/or balloon angioplasty. Results: 98 patients presented with recurrent TIAs (n= 40) or recurrent or progressive strokes (n= 58) and were treated in 8 stroke centers from 2009 to 2017. All patients were treated either with dual antiplatelet therapy (84%) or anticoagulation and all had statin therapy prior to recurrence or progression of their symptoms. There was one periprocedural perforation resulting in patient death. There were 3 patients who had periprocedural strokes and 2 patients had symptomatic intraparenchymal hemorrhage with a total of four (4%) periprocedural mortality. The all-cause mortality rate at discharge was 6%. At 90-day follow-up, 7 (10%) patients had TIAs and 2 (3%) patients had ipsilateral strokes, and 78% of patients had mRS of 2 or less. Conclusion: Endovascular recanalization of unstable intracranial atherosclerotic stenosis who have failed medical therapy is feasible and safe.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TMP7
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 7
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    Abstract 132: Projections Of Endovascular Therapy-eligible Patients For The Us Population In 2021
    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: Endovascular (EVT) eligibility estimates using population-based, NIH-funded Greater Cincinnati Northern Kentucky (GCNK) Stroke Study 2010 data have been reported. Given the evolving EVT landscape, we present updated estimates of annual EVT eligibility using the 2015 GCNK epidemiological data and extrapolate to the 2021 US census. We project the potential increase in eligible patients in the US for each possible expanded indication with a randomized trial currently planned/underway. Methods: We ascertained all hospitalized AIS patients ≥18 years old in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 within GCNK population; all cases were physician-reviewed. Patients presenting within 0-5 hrs of last known well (LKW) were considered EVT eligible if they had a pre-stroke mRS 〈 2, NIHSS ≥6 and ASPECTS ≥6. Those within 5-23 hrs of LKW were considered EVT-eligible if they had a pre-stroke mRS 〈 3, NIHSS≥6, and favorable perfusion imaging. Expanded EVT eligible patients were defined as those with NIHSS 〈 6, and pre-stroke mRS 〉 1 (for 0-5 hrs) or ≥2 (for 5-23 hrs), or larger core. Estimates of vessel occlusion and favorable imaging were applied based on literature review and expert opinions. The derived estimates were age, race and sex-adjusted to the 2015 US adult population and extrapolated to 2021 population. Results: Among the 1.3 million total (1.05m adult) GCNK population in 2015, 2741 adults had an ischemic stroke and 2176 had data available for this analysis. A total of 1978 presented within 23 hrs of LKW, and 1233 within 0-5 hrs of LKW. Further results are outlined in the figure. Conclusions: It is estimated 18,484 adult patients in the US in 2021 meet strict EVT eligibility criteria. An estimated 15,699 patients with low NIHSS, 9621 with unfavorable imaging, and 28,107 with pre-stroke disability may become eligible for EVT in the future annually. US stroke systems should be optimized to handle all EVT-eligible stroke patients both now and in the future.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.132
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 8
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    Abstract 78: Time to Endovascular Treatment and Outcomes in the DAWN Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: It is well-established that, within 0-6 hours, the benefit of thrombectomy rapidly decays over time. The DAWN trial demonstrated that, in the presence of clinical-core mismatch (CCM), thrombectomy remains beneficial within 6-24 hours. We aim to assess the effect of time to randomization on outcomes in the DAWN. Methods: We used traditional multivariate logistic regression controlling age and NIHSS at baseline adding an interaction between Trevo and Time last seen well and then generated the odds ratio of the interaction of Trevo and time at particular time points. Results: Each 1-hour delay to treatment markedly impacted functional independence (OR,0.89 [95% CI 0.75 to 1.03]). Although the odds of functional independence at 90 days (mRS 0-2) with thrombectomy declined with longer time from last seen well (TLSW) to puncture, treatment benefit was observed through 24 hours : cOR at 8 hours, 6.8 (95% CI, 2.1 to 22.0), absolute risk difference (ARD) for mRS 0-2, 24.4%; cOR at 12 hours, 9.4 (95% CI, 4.1 to 21.6), ARD, 35.1%; cOR at 16 hours, 13.0 (95% CI, 4.1 to 41.3), ARD, 37.2%; cOR at 20 hours, 17.8 (95% CI, 2.9 to 110.4), ARD, 36.5%; cOR at 24 hours, 24.6 (95% CI, 1.9 to 322), ARD, 35.5% (Figure). Comparable analysis using time from symptoms first observed (TSFO) yielded similar results. Conclusion: In patients selected based on CCM, treatment benefit persists all the way to 24 hours; however, both the chances of good outcome and the overall treatment effect continuously drop over time.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.78
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Abstract 2: Acute Stroke Care During The Covid-19 Pandemic: The Society Of Vascular And Interventional Neurology Collaboration
    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: Background: We sought to evaluate whether the coronavirus disease 2019 (COVID-19) pandemic may have contributed to delays in acute stroke management at Comprehensive Stroke Centers (CSCs). Methods: Pooled clinical data of consecutive adult stroke patients from 12 U.S. CSCs (1/1/2019-5/31/2020) were queried. The rate of thrombolysis for non-transferred patients within the Target: Stroke goal of 60min was compared between patients admitted 3/1/2019-5/31/2019 (pre-COVID-19) and 3/1/2020-5/31/2020 (COVID-19). The time from arrival to imaging and treatment with thrombolysis or thrombectomy, as continuous variables, were also assessed. Results: Of the 7906 patients included, 1319 were admitted pre-COVID-19 and 933 were admitted during COVID-19, 15% of whom underwent intravenous thrombolysis. There was no difference in the rate of thrombolysis within 60min during COVID-19 (OR 0.88, 95%CI 0.42-1.86, p=0.74), despite adjustment for variables associated with earlier treatment (adjusted OR 0.82, 95%CI 0.38-1.76, p=0.61). There was no significant overall delay to thrombolysis during the COVID-19 period vs. pe-COVID-19 (p=0.42), even after multivariable adjustment (p=0.63) or after comparison across months leading to COVID-19 (Figure). The only independent predictor of delayed treatment time between periods was the use of emergency medical services (adjusted β=-6.93, 95%CI -12.83 - -1.04, p=0.03). There was no significant delay from hospital arrival to imaging in all patients, or imaging to skin puncture in patients who underwent thrombectomy. Conclusions: There was no independent effect of the COVID-19 period on delays in acute care with respect to thrombolysis or thrombectomy in this multicenter observational cohort. Further studies are warranted to externally validate these findings, and determine if site volume or center accreditation may mediate a collateral effect of the pandemic on stroke care paradigms.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.2
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Online Resource
    Pittsburgh Outcomes After Stroke Thrombectomy Score Predicts Outcomes After Endovascular Therapy for Anterior Circulation Large Vessel Occlusions
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 8 ( 2014-08), p. 2298-2304
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 8 ( 2014-08), p. 2298-2304
    Abstract: Prognostication tools that predict good outcome in patients with anterior circulation large vessel occlusions after endovascular therapy are lacking. We aim to develop a tool that incorporates clinical and imaging data to predict outcomes after endovascular therapy. Methods— In a derivation cohort of anterior circulation large vessel occlusion stroke patients treated with endovascular therapy within 8 hours from time last seen well (n=247), we performed logistic regression to identify independent predictors of good outcome (90-day modified Rankin Scale, 0–2). Factors were weighted based on β-coefficients to derive the Pittsburgh Outcomes After Stroke Thrombectomy (POST) score. POST was validated in an institutional endovascular database (University of Pittsburgh Medical Center, n=393) and the Diffusion-Weighted Imaging Evaluation for Understanding Stroke Evolution Study-2 (DEFUSE-2) data set (n=105), as well as in patients treated beyond 8 hours (n=194) and in octogenarians (n=111). Results— In the derivation cohort, independent predictors ( P 〈 0.1) of good outcome included 24- to 72-hour final infarct volume (in cm 3 , P 〈 0.001), age (years, P 〈 0.001), and parenchymal hematoma types 1 and 2 (H, P =0.01). POST was calculated as age+0.5×final infarct volume+15×H. Patients with POST score 〈 60 had a 91% chance of good outcome compared with 4% with POST score ≥120. POST accurately predicted good outcomes in the derivation (area under the curve [AUC]=0.85) and validation cohorts (University of Pittsburgh Medical Center, AUC=0.81; DEFUSE-2, AUC=0.86), as well as in patients treated beyond 8 hours (AUC, 0.85) and octogenarians (AUC=0.76). POST had better predictive accuracy for good and poor outcome than the ischemic stroke predictive risk score (iSCORE). Conclusions— POST score is a validated predictor of outcome in patients with anterior circulation large vessel occlusions after endovascular therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.005595
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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