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  • 1
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    Abstract TMP17: Serial ASPECTS from Baseline to 24 Hours in SWIFT: A Novel Surrogate Endpoint for Revascularization in Acute Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: ASPECTS on baseline imaging is a known predictor of outcome in acute stroke. Change on serial ASPECTS after revascularization at 24 hrs may provide an early biomarker of therapeutic success or failure. We analyzed ASPECTS on baseline and 24-hr imaging in SWIFT to determine prognostic value and identify subgroups with extensive injury after intervention. Methods: ASPECTS at baseline and 24 hrs was independently scored by 2 imaging experts (disagreements resolved by consensus) in all anterior circulation SWIFT cases, blind to all other trial data. ASPECTS score at baseline, at 24 hrs, and serial changes were analyzed with univariate and multivariate approaches. Results: 138 patients (mean age 67 yrs (SD 12), 52% female, median NIHSS 18 (IQR 8-28)) with full data were studied. Baseline ASPECTS (n=139) was 0-7 in 30 (22%), 8 in 34 (25%), 9 in 42 (30%) and 10 in 33 (24%). 24-hr ASPECTS (n=139) was 0 in 25 (18%), 1-4 in 35 (25%), 5-7 in 35 (25%) and 8-10 in 44 (31%). Baseline ASPECTS of 0-7 was related to worse NIHSS (OR 1.176, p=0.006) and absence of CAD (OR 0.20, p=0.008). Lower 24-hr ASPECTS was related to worse baseline NIHSS (p=0.003) and higher baseline SBP (p=0.033). Interestingly, baseline ASPECTS was linked with Day 7/discharge NIHSS (p=0.008) and Day 90 mRS (p=0.066), yet not TICI 2b/3 reperfusion or hemorrhage. 24-hr ASPECTS was closely linked with these outcome variables (all p 〈 0.01). Multivariate model showed higher 24-hr ASPECTS predicted good clinical outcome (Day 90 mRS 0-2): OR 1.67, p 〈 0.001. Among patients with high baseline ASPECTS scores (8-10; n=109), dramatic infarct progression (decrease in ASPECTS ≥ 6 points at 24 hrs) was noted in 31/109 (28%). Predictors of dramatic infarct progression were higher baseline SBP (p=0.019), higher baseline blood glucose (p=0.133), and failure to acheive TICI 2b/3 reperfusion (p 〈 0.001). Such patients had worse Day 90 mRS outcomes (mean mRS 4.4 vs. 2.7, p 〈 0.001). Conclusions: 24-hr ASPECTS provides better prognostic information than baseline ASPECTS. Predictors of dramatic infarct progression on ASPECTS are hyperglycemia, hypertension and nonreperfusion. Serial ASPECTS score change from baseline to 24 hrs predicts clinical outcome and may serve as a useful, early surrogate endpoint for thrombectomy trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATMP17
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 2
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    Abstract 130: SWIFT! Early Presentation is Associated with Better Collaterals, Smaller Established Infarcts, and Better Clinical Outcomes from Endovascular Recanalization
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Increasing time from symptom onset to presentation may incur greater ischemic injury and decreased likelihood of successful outcomes after acute stroke therapy. The impact of time may be assessed physiologically by degree of accumulated ischemic injury on baseline imaging and status of collateral vessels at angiography; and clinically by final functional outcome. Methods: The SWIFT trial dataset was analyzed with respect to ASPECTS scores, angiographic collaterals, clinical outcome, and time to presentation (defined as stroke onset to hospital arrival). Known determinants of successful angiographic and clinical outcomes were considered as covariates, with main analyses defining the interaction of time to presentation on ASPECTS score, collateral grade, reperfusion and related clinical outcome. Results: 137 patients (mean age 67±12 years, 52% female, median pretreatment NIHSS 18 (range 8-28)) with full data were studied. Time to presentation was median 180 min (IQR 95-250) and was 〈 3 hours in 51% and 〉 3 hours in 49%. Time to presentation was unrelated to age, gender, most risk factors (except atrial fibrillation (present 〈 3 hours in 41.4% vs. 〉 3 hours in 64.2%, p=0.010), NIHSS, glucose or BP. Pre-stroke mRS 0, however, was associated with presentation 〈 3 hours, (82.8% vs. 63.8%, p=0.035). Worse collateral scores were noted with longer times to presentation: collateral grade 0-1 (n=32) mean 232±84 min; 2 (n=48) 164±99 min; 3 (n=35) 155±104 min; 4 (n=4) 54±16 min; p 〈 0.001. Later presentation was associated with more extensive ischemic injury at baseline (median ASPECTS 8 (IQR 7-9) beyond 3 hours vs. 9 (IQR 8-10) within 3 hours, p=0.015). Multivariate analyses identified presentation 〉 3 hours as the sole independent predictor of extensive baseline infarct (ASPECTS ≤ 7), p=0.003. Time to presentation was unrelated with likelihood of successful angiographic reperfusion (p=NS), yet earlier presentation demonstrated a strong influence with better Day 90 mRS outcomes (p 〈 0.001). Conclusions: Time was a critical factor in successful clinical outcomes in SWIFT. Shorter times to presentation were associated with better collaterals, smaller established infarcts and better clinical outcome after revascularization.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.A130
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 3
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    Early arrival at the emergency department is associated with better collaterals, smaller established infarcts and better clinical outcomes with endovascular stroke therapy: SWIFT study
    BMJ ; 2016
    In:  Journal of NeuroInterventional Surgery Vol. 8, No. 6 ( 2016-06), p. 553-558
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 8, No. 6 ( 2016-06), p. 553-558
    Abstract: Increasing time from symptom onset to emergency department arrival may incur greater ischemic injury and decreased likelihood of good outcomes after acute stroke therapy. The impact of time may be assessed bythe extent of acute CT changes, status of collateral vessels, and clinical outcomes. Methods The SOLITAIRE FR With the Intention For Thrombectomy (SWIFT) trial comparing two neurothrombectomy treatments was analyzed by time, Alberta Stroke Program Early CT Scores (ASPECTS), angiographic collaterals, and 90-day modified Rankin Scale outcomes. We determined the interaction of time with ASPECTS, collateral grade, reperfusion, and clinical outcomes, with established determinants of angiographic and clinical outcomes as covariates. Results 137 patients (52% female) of mean age 67±12 years and median pretreatment NIH Stroke Scale score 18 (range 8–28) were enrolled. Median onset to door (OTD) time was 180 min (IQR 95–250). Presentation within 3 h of last known well was associated with absence of any prestroke disability and presence of atrial fibrillation but was unrelated to age, sex, other vascular risk factors, deficit severity, glucose level, or blood pressure. Worse collaterals were noted with longer OTD intervals: collateral grade 0–1 (n=32): mean 232±84 min; grade 2 (n=48): 164±99 min; grade 3 (n=35): 155±104 min; grade 4 (n=4): 54±16 min (p 〈 0.001). Later presentation was associated with more extensive early infarct imaging changes (median ASPECTS 8 (IQR 7–9) 〉 3 h vs 9 (IQR 8–10) 〈 3 h, p=0.015). Multivariable analyses identified time 〉 3 h as the only predictor of extensive infarct on imaging (ASPECTS ≤7), p=0.003. Earlier presentation was strongly associated with better 90-day modified Rankin Scale outcomes (p 〈 0.001). Conclusions Time was a critical factor in successful clinical outcomes for neurothrombectomy in the SWIFT trial. Shorter times to presentation were associated with better collaterals, smaller established infarcts, and better clinical outcome after revascularization.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2015-011758
    Language: English
    Publisher: BMJ
    Publication Date: 2016
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  • 4
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    Abstract 167: Collateral Flow and ASPECTS of Infarct Evolution Dominate Time to Reperfusion in Outcomes of TREVO2
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Definitive reperfusion, or revascularization associated with good clinical outcomes, is likely dependent on key imaging variables. ASPECTS score on imaging before and after revascularization may chronicle the extent of ischemic injury in acute stroke. We hypothesized that ASPECTS and other key imaging variables would be associated with clinical outcome after endovascular therapy in the TREVO2 trial. Methods: TREVO2 utilized independent core labs for CT/MRI and angiography central review. Retrospective review of ASPECTS by expert consensus on baseline and 24 hour imaging was conducted in anterior circulation cases, blinded to all other data. Univariate and multivariate analyses determined the impact of key imaging variables (baseline ASPECTS, ASPECTS ≥ 8, collaterals, time to TICI 2a reperfusion or greater, final TICI, 24-hour ASPECTS) on good clinical outcome (mRS 0-2) and mortality at day 90. Results: 166/177 cases in TREVO2 were anterior circulation occlusions. Baseline ASPECTS was ≤ 7 in 83/166 (50%) cases. Baseline ASPECTS score ≤ 7 was unrelated to age, gender, or any other clinical parameter other than NIHSS score (median 19 (17-23) vs. 17 (13-20) for ASPECTS 〉 7, p 〈 0.001) and clot location (more ICA than M2 occlusions, p=0.044). Baseline ASPECTS ≤ 7 was also unrelated to post-device TICI or post-procedure SICH. Baseline ASPECTS ≤ 7 was associated with asymptomatic hemorrhage at 24 hours (63.9% vs. 37.3%, p=0.001), 90-day mortality (35.4% vs. 19.3%, p=0.024), and less frequent good clinical outcome (21.5% vs. 42.0%, p=0.007). Univariate imaging predictors of good clinical outcome at day 90 included baseline ASPECTS (OR 1.82, p 〈 0.001), baseline ASPECTS ≥ 8 (OR 2.64, p=0.006), collateral grade (OR 1.85, p=0.003), post-procedure TICI (OR 2.11, p 〈 0.001), 24-hour ASPECTS (OR 1.67, p 〈 0.001) and 24-hour ASPECTS ≥ 8 (OR 4.38, p 〈 0.001). Time to TICI 2a or greater was not predictive. Multivariate analyses showed that 24-hour ASPECTS (OR 1.70, p 〈 0.001) and post-procedure TICI (OR 2.49, p=0.003) best predicted good outcome. Conclusions: Better ASPECTS (≥ 8), collaterals, and reperfusion are strongly associated with good clinical outcome whereas the large proportion (50%) of TREVO2 cases with baseline ASPECTS ≤ 7 likely influenced mortality.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.A167
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 5
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    Periprocedural heparin use in acute ischemic stroke endovascular therapy: the TREVO 2 trial
    BMJ ; 2018
    In:  Journal of NeuroInterventional Surgery Vol. 10, No. 7 ( 2018-07), p. 611-614
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 10, No. 7 ( 2018-07), p. 611-614
    Abstract: The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era. Methods A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP−) while undergoing MERCI or TREVO clot retrieval. Results Of 173 patients, 58 (34%) received periprocedural heparin including 40 who received one preprocedural bolus (median 3000 units). Baseline characteristics among HEP+ and HEP− patients were similar except HEP+ patients had a lower NIH Stroke Scale (NIHSS) score (17 vs 19; p=0.04), lower IV tissue plasminogen activator use (38% vs 64%; p 〈 0.01), and a higher median ASPECTS score (8.0 vs 7.0; p=0.02). HEP+ patients were more likely to have vertebrobasilar and middle cerebral artery (MCA)-M1 occlusions but less likely to have internal carotid artery and MCA-M2 occlusions (p=0.04). Time from symptom onset to puncture was similar in the two groups while procedure duration was longer in HEP+ patients (99 vs 83 min; p 〈 0.01). Thrombolysis In Cerebral Infarction (TICI) 2b–3 reperfusion rates, embolization to unaffected territories, access site complications, and intracranial hemorrhages were similar between the groups. In multivariable logistic regression, a good outcome (90-day modified Rankin Scale score 0–2) was independently associated with heparin bolus use (OR 5.30; 95% CI 1.70 to 16.48), TICI 2b–3 reperfusion (OR 6.56; 95% CI 2.29 to 18.83), stent retriever use (OR 3.54; 95% CI 1.38 to 9.03) and inversely associated with intubation (OR 0.10; 95% CI 0.03 to 0.33), diabetes (OR 0.11; 95% CI 0.03 to 0.39), NIHSS (OR 0.84; 95% CI 0.75 to 0.93), time from symptom onset to puncture (OR 0.64; 95% CI 0.45 to 0.89), and heart failure (OR 0.23; 95% CI 0.06 to 0.83). Conclusions The use of periprocedural heparin in stent retriever thrombectomy is associated with a good clinical outcome at 90 days and similar rates of symptomatic intracranial hemorrhage. Further studies are warranted. Clinical trial registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT01270867 ; Post-results.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2017-013441
    Language: English
    Publisher: BMJ
    Publication Date: 2018
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  • 6
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    Abstract WP39: Perfusion Angiography in TREVO2: Quantitative Reperfusion After Endovascular Therapy in Acute Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Effective reperfusion is the ultimate therapeutic strategy for acute ischemic stroke, yet endovascular trials have been limited by the use of categorical scales for angiographic outcomes. Semi-automated perfusion angiography (PA) software can objectively quantify reperfusion from routine angiography. We studied feasibility and performance of PA software to evaluate angiographic and associated clinical outcomes in the multicenter TREVO2 trial. Methods: Core lab angiography DICOM data in TREVO2 was retrospectively used to identify anterior circulation cases with adequate temporal resolution at both baseline and after revascularization with mechanical thrombectomy. CBF was computed by deconvolution of contrast-intensity data up to 3 sec to correlate with TICI and avoid collaterals. Regions of interest (ROI) outlined areas of hypoperfusion on baseline AP and lateral angiography to map reperfusion onto identical post-procedure angiography runs. A nonlinear cross-validation model was used to map output from the ROI to a single reperfusion metric (PA CBF 3 ). Results: 148/178 (83%) patients with anterior circulation stroke in TREVO2 had DICOM angiography data with complete temporal information on serial runs at baseline and post-procedure that could be processed with the software. Core lab TICI scores in this dataset ranged from 0-3 (0, n=6; 1, n=7; 2a, n=40; 2b, n=83; 3, n=12). The continuous PA CBF 3 metric or reperfusion score ranged from 0-8.6 (mean 3.7±1.2), capturing hyperperfusion and heterogeneity. Overall, PA CBF 3 closely correlated with TICI (ρ=0.69, p 〈 0.001), yet provided a continuous measure that better discriminated angiographic outcomes. Software performance and PA CBF 3 results were equivalent in ICA, M1 and M2 occlusions treated in TREVO2. Conclusions: PA can objectively quantify heterogeneity of reperfusion in a multicenter trial, providing a continuous metric that discriminates angiographic outcomes better than TICI.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP39
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 7
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    Abstract 155: Proving CT Angiography of Collaterals Prior to Endovascular Therapy: TREVO & TREVO 2
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: CT angiography (CTA) has become the predominant mode of imaging selection prior to endovascular stroke therapy. The added value of CTA collaterals beyond ASPECTS and validation with digital subtraction angiography (DSA) remain unaddressed. We determined the impact and validity of CTA collateral grade with DSA in the multicenter TREVO and TREVO 2 trials. Methods: Pooled analyses of the TREVO and TREVO 2 CTA dataset prior to endovascular therapy were conducted. CTA collaterals were scored (0-20) with the regional leptomeningeal collateral score (rLMC) and directly compared with the ASITN/SIR (0-4) collateral grade. Statistical analyses included descriptive statistics and Spearman correlation analysis among CTA, DSA collaterals and ASPECTS. Logistic regression analysis was used to model 90-day good outcome and revascularization success. Results: CTA and DSA collaterals were compared in 116 subjects with anterior circulation occlusions. ASPECTS was median 8 (range 3-10; 49% 0-7 versus 51% 8-10), with CTA collaterals on rLMC score of median 16 (range 4-20) and DSA collaterals median 2 (range 1-4; 13% grade 1, 50% grade 2, 26% grade 3 and 11% grade 4). ASPECTS exhibited only moderate correlation with collaterals at CTA (ρ=0.35, p 〈 0.001) and DSA (ρ=0.41, p 〈 0.001). Similarly, only moderate correlation was noted between CTA collaterals and DSA (ρ=0.43, p 〈 0.001). Baseline ASPECTS better predicted (OR 1.50 95%CI [1.08-2.09], p=0.017) good clinical outcome (90-day mRS 0-2) compared to CTA collaterals (OR 1.10 95%CI [1.00-1.22] , p=0.058), whereas DSA collaterals were most predictive (OR 1.99 95%CI [1.20-3.29], p=0.008). Multivariate logistic regression revealed DSA collateral grade 3 or greater as paramount for achieving good outcomes (OR 3.00 95%CI [1.31-6.89] , p=0.01). Conclusions: Single-phase CTA collateral scoring prior to endovascular therapy provides marginal value beyond ASPECTS and limited correlation with the extent of collaterals on DSA. CTA of collaterals may perform differently at very high ASPECTS or with further development of imaging acquisition or post-processing techniques.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.155
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 8
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    Abstract WP10: Peri-procedural Heparin Use in Stent-retriever Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background and Objectives: The use of periprocedural heparin has been reported safe and potentially beneficial during thrombectomy with older generation devices. We aim to investigate the impact of heparin in the era of stent-retrievers. Methods: A TREVO2 trial post-hoc analysis was performed aiming to compare baseline characteristics and clinical outcomes between patients who received [HEP(+)] versus patients that did not receive periprocedural heparin [HEP(-)] . Results: Out of 173 patients treated in the trial, 58 received a mean 3999 units of periprocedural heparin (n=42 received only pre-procedural bolus for a mean of 2952 units). Baseline characteristics amongst HEP(+) and HEP(-) were similar, with the exception of lower NIHSS (17±5 vs 18±6; p=0.04), IV t-PA use (37 vs 64%; p 〈 0.01), and higher baseline ASPECTS (7.6±1.3 vs 7.1±1.7; p=0.02) in the HEP(+) patients. Occlusion site varied amongst HEP(+) and HEP(-) groups: vertebrobasilar 10 vs 5%; ICA 8 vs 21%; MCA-M1 70 vs 55%; MCA-M2 10 vs 17%; p=0.04, respectively. Time from symptom-onset to puncture was similar, while procedure duration was longer in HEP(+) patients (98±47 vs 82±42min; p 〈 0.01). TICI2b-3 reperfusion rate was comparable (65 vs 62%; p=0.74), as well as embolization to unaffected territory, and access-site complications. Hemorrhagic changes were similar (ECASS HI1/HI2 27 vs 24%; p=0.71 and PH1/PH2 22 vs 25%; p=0.85). Good outcome (mRS0-2) and mortality at 90-days were 40 vs 25% (p=0.07) and 29 vs 27% (p=0.85), respectively. Multivariate logistic regression for good outcome identified the following independent predictors: use of heparin bolus (OR:5.30; 95%CI 1.70-0.16.48; p 〈 0.001), intubation (OR:0.10; 95%CI 0.03-0.33; p 〈 0.001), TICI2b-3 reperfusion (OR:6.56; 95%CI 2.29-18.83; p 〈 0.001), diabetes mellitus (OR:0.11; 95%CI 0.03-0.39; p 〈 0.001), NIHSS (OR:0.84; 95%CI 0.75-0.93; p 〈 0.001), stent-retriever device (OR:3.54; 95%CI 1.28-9.03; p 〈 0.001), time from symptom-onset to puncture (OR:0.64; 95%CI 0.45-0.89; p 〈 0.001), and CHF (OR:0.23; 95%CI 0.06-0.83; p 〈 0.001). Conclusions: The use of periprocedural heparin in stent-retriever thrombectomy is safe and may have a positive impact on outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp10
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 9
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    Abstract W MP9: Early Reperfusion with a Stentriever Device: A First Step to Superior Outcomes in TREVO2
    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: TREVO2 showed better outcomes after thrombectomy with the Trevo stentriever compared to Merci. We studied the impact of early reperfusion up to the first pass to explore the impact of device deployment on subsequent outcomes. Methods: Reperfusion during stentriever deployment and after the first pass in both arms (Merci and Trevo) of TREVO2 was quantified by cerebral blood volume (CBV) delivered to the downstream territory using perfusion angiography (perfAngio) software. Automatic, normalized extraction of CBV distal to anterior circulation occlusions was obtained from AP projections during arterial phase. CBV during deployment, after the first pass and sum of CBV up to the first pass (Σ CBV) were analyzed with respect to angiographic and clinical outcomes. Results: CBV was measured from DSA in 83 (34 Trevo, 49 Merci) occlusions in TREVO2. Clinical variables of this cohort were similar between device arms and with respect to others in the trial. During stentriever deployment, 29/34 cases demonstrated delivery of blood volume to downstream territory, averaging about 10% of the amount delivered after the first pass. Change in CBV from deployment to the first pass in 26/29 cases showed a further increase in 15 and decrease in 11, with re-occlusion in 4. CBV only after the first pass did not differ between Merci and Trevo (p=NS). CBV after first pass (p=0.06) and Σ CBV (p=0.03) both predict successful revascularization and demonstrate a moderate correlation with the time to sustained TICI 2a flow. Logistic regression analysis revealed that Σ CBV is a predictor of good clinical outcome (mRS 0-2) at day 90 (p=0.08) and use of Trevo further impacts outcome. Conclusions: Stentriever deployment achieves delivery of blood volume to the ischemic bed downstream. The amount of CBV delivered up to the first pass influences revascularization and good clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.wmp9
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 10
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    Abstract WP29: Clot Size: Speaking the Same Language in Endovascular Stroke Therapy Across the Globe
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Clot size in acute ischemic stroke has been ascribed to time from onset, used in imaging selection with varying techniques or definitions, and cited as a factor in both revascularization success and clinical outcomes. We analyzed clot size on noncontrast CT, CT angiography (CTA) and digital subtraction angiography (DSA) in the multicenter TREVO and TREVO 2 trials. Methods: Imaging core labs of the TREVO and TREVO 2 trials conducted pooled analyses of the CT/CTA and DSA datasets. Clot size was independently measured by hyperdense middle cerebral artery sign (HMCAS) length on noncontrast CT thin-slice reconstruction, CTA length, clot burden score (CBS) and DSA prior to thrombectomy. Statistical analyses included descriptive statistics and correlation analyses among clot size measures, and time from onset to CT or onset to DSA. Logistic regression analysis was used to model 90-day good outcome and revascularization success. Results: 116 TREVO and TREVO 2 subjects from the pooled imaging dataset were analyzed with respect to clot size. Clot size estimated from thin-slice reconstruction of HMCAS was mean 7.6±9.2 mm, however, 41% of cases with proven arterial occlusion did not have HMCAS. CTA length of clots was mean 12.3±7.3 mm, with corresponding HMCAS CTA length in 41%. CBS (range 0-10) was mean 6.7±1.8. DSA clot length was mean 10.6±5.7 mm. Moderate correlations were noted between clot size on CT, CTA and DSA. Time from onset to CT or onset to DSA was unrelated to any clot size, yet worse ASPECTS scores were linked with larger clots (HMCAS length, ρ=-0.290, p=0.004; CTA length, ρ=-0.302, p=0.009). Revascularization success (TICI≥2B) was lower with CTA clot length 〉 8 mm (OR 0.32 [0.11, 0.99], p=0.047) when distal opacification via collaterals was present, yet unrelated to any HMCAS clot length. Good clinical outcome (mRS 0-2 at 90 days) was unrelated to any measure of clot size. Conclusions: Clot size varies depending on imaging technique and definitions, with a substantial proportion of occlusions that cannot be measured on either noncontrast CT or CTA and “time is clot” requires further study. Larger clots are associated with worse ASPECTS, possibly negating potential clinical benefit of successful revascularization.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp29
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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