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  • 1
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    Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischemic Stroke With EmboTrap)
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 5 ( 2018-05), p. 1107-1115
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 5 ( 2018-05), p. 1107-1115
    Kurzfassung: EmboTrap is a novel stent retriever designed to achieve rapid and substantial flow restoration in acute ischemic stroke secondary to large-vessel occlusions. Here, we evaluated EmboTrap’s safety and efficacy compared with established stent retrievers. Methods— ARISE II (Analysis of Revascularization in Ischemic Stroke With EmboTrap) was a single-arm, prospective, multicenter study, comparing the EmboTrap device to a composite performance goal criterion derived using a Bayesian meta-analysis from the pivotal SWIFT (Solitaire device) and TREVO 2 (Trevo device) trials. Patients at 11 US and 8 European sites were eligible for inclusion if they had large-vessel occlusions and moderate-to-severe neurological deficits within 8 hours of symptom onset. The primary efficacy end point was achievement of modified Thrombolysis in Cerebral Ischemia (mTICI) reperfusion scores of ≥2b within 3 EmboTrap passes as adjudicated by the core laboratory. The primary safety end point was a composite of symptomatic intracerebral hemorrhage and serious adverse device effects. Secondary end points included functional independence (modified Rankin Scale, 0–2) and all-cause mortality at 90 days. Results— Between October 2015 and February 2017, 227 patients were enrolled and treated with the EmboTrap device. The primary efficacy end point (mTICI ≥2b within 3 passes) was achieved in 80.2% (95% confidence interval, 74%–85% versus 56% performance goal criterion; P value, 〈 0.0001), and mTICI 2c/3 was 65%. After all interventions, mTICI 2c/3 was achieved in 76%, and mTICI ≥2b was 92.5%. The rate of first pass (mTICI ≥2b following a single pass) was 51.5%. The primary safety end point composite rate of symptomatic intracerebral hemorrhage or serious adverse device effects was 5.3%. Functional independence and all-cause mortality at 90 days were 67% and 9%, respectively. Conclusions— The EmboTrap stent-retriever mechanical thrombectomy device demonstrated high rates of substantial reperfusion and functional independence in patients with acute ischemic stroke secondary to large-vessel occlusions. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT02488915.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.020125
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2018
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
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    The FAST-ED App: A Smartphone Platform for the Field Triage of Patients With Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 5 ( 2017-05), p. 1278-1284
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 5 ( 2017-05), p. 1278-1284
    Kurzfassung: The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. Methods— Review of the application’s platform and its development as well as the different variables, assessments, algorithms, and assumptions involved. Results— The FAST-ED (Field Assessment Stroke Triage for Emergency Destination) application is based on a built-in automated decision-making algorithm that relies on (1) a brief series of questions assessing patient’s age, anticoagulant usage, time last known normal, motor weakness, gaze deviation, aphasia, and hemineglect; (2) a database of all regional stroke centers according to their capability to provide endovascular treatment; and (3) Global Positioning System technology with real-time traffic information to compute the patient’s eligibility for intravenous tissue-type plasminogen activator or endovascular treatment as well as the distances/transportation times to the different neighboring stroke centers in order to assist Emergency Medical Services professionals with the decision about the most suitable destination for any given patient with acute ischemic stroke. Conclusions— The FAST-ED smartphone application has great potential to improve the triage of patients with acute ischemic stroke, as it seems capable to optimize resources, reduce hospital arrivals times, and maximize the use of both intravenous tissue-type plasminogen activator and endovascular treatment ultimately leading to better clinical outcomes. Future field studies are needed to properly evaluate the impact of this tool in stroke outcomes and resource utilization.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.016026
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2017
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    International controlled study of revascularization and outcomes following COVID‐positive mechanical thrombectomy
    Wiley ; 2022
    In:  European Journal of Neurology Vol. 29, No. 11 ( 2022-11), p. 3273-3287
    Details
    In: European Journal of Neurology, Wiley, Vol. 29, No. 11 ( 2022-11), p. 3273-3287
    Kurzfassung: Previous studies suggest that mechanisms and outcomes in patients with COVID‐19‐associated stroke differ from those in patients with non‐COVID‐19‐associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID‐19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors. Methods A cross‐sectional, international multicenter retrospective study was conducted in consecutively admitted COVID‐19 patients with concomitant acute LVO, compared to a control group without COVID‐19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable‐adjusted analysis was conducted. Results In this cohort of 697 patients with acute LVO, 302 had COVID‐19 while 395 patients did not. There was a significant difference ( p   〈  0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID‐19 group. In terms of favorable revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 3), COVID‐19 was associated with lower odds of complete revascularization (odds ratio 0.33, 95% confidence interval [CI] 0.23–0.48; p   〈  0.001), which persisted on multivariable modeling with adjustment for other predictors (adjusted odds ratio 0.30, 95% CI 0.12–0.77; p  = 0.012). Moreover, endovascular complications, in‐hospital mortality, and length of hospital stay were significantly higher among COVID‐19 patients ( p   〈  0.001). Conclusion COVID‐19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID‐19 patients with LVO were more often younger and had higher morbidity/mortality rates.
    Materialart: Online-Ressource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    URL: Article
    DOI: 10.1111/ene.v29.11
    DOI: 10.1111/ene.15493
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2022
    ZDB Id: 2020241-6
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    Abstract 010: Technical Approaches for Intracranial Atherosclerotic Disease Large Vessel Occlusion Strokes
    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)
    Kurzfassung: The optimal management strategy for large vessel occlusion strokes (LVOS) from intracranial atherosclerotic disease (ICAD) remains debated. We aimed to evaluate the efficacy and safety of various acute medical and endovascular management options in patients who underwent mechanical thrombectomy of an ICAD‐related occlusion. Methods Retrospective analysis of ICAD‐related LVOS of a prospective mechanical thrombectomy database at a comprehensive stroke center between November 2010‐May 2023. Endovascular intervention was defined as either angioplasty, stenting, or a combination of both. Acute management was divided into 5 groups: Group#1: proactive antiplatelets (patients who received antiplatelets prior to groin puncture without further endovascular intervention after initial reperfusion); Group#2: reactive antiplatelets (patients who received antiplatelets after groin puncture without further angioplasty and/or stenting after initial reperfusion), Group#3: proactive revascularization (patients treated with angioplasty and/or stenting after initial reperfusion), Group#4: reactive revascularization (patients treated with angioplasty and/or stenting after vessel re‐occlusion after initial reperfusion), and Group #5: rescue revascularization (patients with unsuccessful reperfusion and subsequent angioplasty and/or stenting). Results A total of 200 ICAD‐LVOS MT were identified. Baseline characteristics were comparable between the 5 groups. The rate of TICI2b‐3 final reperfusion was lower in Group 4, while the rate of TICI 2c‐3 final reperfusion was comparable among groups. The rates of in‐hospital re‐occlusion were high even in patients loaded with DAPT before puncture; the rates of re‐occlusion were lower in patients managed with intervention in a proactive manner (Group 3) when compared to those managed in a reactive manner (Group 4) (0% vs 27%, p= 0.005). In ordinal analysis, mRS scores were lowest in Groups 2 and 3.Safety outcomes were comparable with similar rates of symptomatic intracranial hemorrhage (sICH). Conclusion While limited by small subgroup sample size, medical management only was associated with relatively high rates of reocclusion, while proactive angioplasty/stenting with performed best. Symptomatic intracranial hemorrhage was low in medically treated patients. Further studies are warranted.
    Materialart: Online-Ressource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.03.suppl_2.010
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2023
    ZDB Id: 3144224-9
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  • 5
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    Abstract 227: Combined Technique Versus Stent‐Retriever Alone: Angioarchitectural and Technical Analysis
    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)
    Kurzfassung: Combined technique mechanical thrombectomy with contact aspiration with stent‐retriever has been shown to lead to comparable final reperfusion rates compared with stent retriever alone. We aimed to explore if anatomical and technical features could have interaction with the chances of reperfusion by each technique. Methods Retrospective analysis of a prospective mechanical thrombectomy (MT) database. Inclusion criteria: anterior circulation large vessel occlusion(LVO) due to carotid terminus or proximal MCA(M1) occlusion, first‐line stent‐retriever (SR) alone or combined technique (SR plus aspiration), and angiographic run with stent in place. The primary analysis was the interaction between clinical and angiographic characteristics and first‐line MT modality on first‐pass effect (FPE; first‐pass eTICI2c‐3). Secondary analyses aimed to evaluate predictors of FPE. Results A total of 150 patients were included in the analysis (SR alone,n=62 vs. combined technique, n=88). Demographics, vascular risk factors and NIHSS were comparable between groups. The SR group had higher IV‐tPA use (41.9%vs.26.1%,P=0.04), higher rates of FPE(64.5%vs.47.7%,P=0.04) but similar baseline ASPECTS, CTA collateral score, clot burden, as compared to the combined technique. Anatomical and technical variables (reperfusion channel, SR position in dominant MCA division, angle of interaction, diameter of stent proximal to clot, diameter of stent distal to clot, type of extracranial carotid or cavernous carotid tortuosity, clot length were comparable between both groups. None of the anatomical and technical factors were found to have an interaction with the modality (SR alone vs combined technique) on the chances of FPE (Pinteraction 〉 0.05)(Figure). FPE was observed in 54.6% of the entire cohort. Multivariable analysis showed that use of IV‐tPA(OR 156.5,95%CI 4.59‐5334.8,P=0.005), lower angle of interaction (OR 0.94,95%CI 0.89‐0.99,P=0.03), presence of reperfusion channel (OR 145.8,95%CI 1.96‐108277.4),P=0.02), higher clot burden score (OR 8.17,95%CI 1.38 ‐48.21,P=0.02), type‐3 cavernous ICA tortuosity (OR 0.001,95%CI 0‐0.23,P=0.01) were independently associated FPE. Conclusion We could not identify any anatomical or technical features that predisposed to a benefit in adding catheter aspiration to SR thrombectomy. IV r‐TPA, clot burden score, presence of reperfusion channel, type of cavernous carotid tortuosity, and angle of interaction were found independently associated with FPE. Large sample studies are warranted.
    Materialart: Online-Ressource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.03.suppl_2.227
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2023
    ZDB Id: 3144224-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
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    Clinical and Imaging Outcomes of Endovascular Therapy in Patients with Acute Large Vessel Occlusion Stroke and Mild Clinical Symptoms
    S. Karger AG ; 2018
    In:  Interventional Neurology Vol. 7, No. 1-2 ( 2018), p. 91-98
    Details
    In: Interventional Neurology, S. Karger AG, Vol. 7, No. 1-2 ( 2018), p. 91-98
    Kurzfassung: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The minimal stroke severity justifying endovascular intervention remains elusive. However, a significant proportion of patients presenting with large vessel occlusion stroke (LVOS) and mild symptoms go untreated and face poor outcomes. We aimed to evaluate the clinical outcomes of patients presenting with LVOS and low symptom scores (National Institutes of Health Stroke Scale [NIHSS] score ≤8) undergoing endovascular therapy (ET). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We performed a retrospective analysis of a prospectively collected ET database between September 2010 and March 2016. Endovascularly treated patients with LVOS and a baseline NIHSS score ≤8 were included. Baseline patient characteristics, procedural details, and outcome parameters were collected. Efficacy outcomes were the rate of good outcome (90-day modified Rankin Scale score 0-2) and of successful reperfusion (modified Treatment in Cerebral Infarction [mTICI] score 2b-3). Safety was assessed by the rate of parenchymal hematoma (parenchymal hematoma type 1 [PH-1] and parenchymal hematoma type 2 [PH-2]) and 90-day mortality. Logistic regression was used to identify predictors of good clinical outcomes. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 935 patients were considered; 72 patients with an NIHSS score ≤8 were included. Median [IQR] age was 61.5 years [56.2-73.0] ; 39 patients (54%) were men. Mean (SD) baseline NIHSS score, computed tomography perfusion core volume, and ASPECTS were 6.3 (1.5), 7.5 mL (16.1), and 8.5 (1.3), respectively. Twenty-eight patients (39%) received intravenous tissue plasminogen activator. Occlusions locations were as follows: 29 (40%) proximal MCA-M1, 20 (28%) MCA-M2, 6 (8%) ICA terminus, and 9 (13%) vertebrobasilar. Tandem occlusion was documented in 7 patients (10%). Sixty-seven patients (93%) achieved successful reperfusion (mTICI score 2b-3); 52 (72%) had good 90-day outcomes. Mean final infarct volume was 32.2 ± 59.9 mL. Parenchymal hematoma occurred in 4 patients (6%). Ninety-day mortality was 10% ( 〈 i 〉 n 〈 /i 〉 = 7). Logistic regression showed that only successful reperfusion (OR 27.7, 95% CI 1.1-655.5, 〈 i 〉 p 〈 /i 〉 = 0.04) was an independent predictor of good outcomes. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Our findings demonstrate that ET is safe and feasible for LVOS patients presenting with mild clinical syndromes. Future controlled studies are warranted.
    Materialart: Online-Ressource
    ISSN: 1664-9737 , 1664-5545
    URL: Article
    DOI: 10.1159/000481205
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2018
    ZDB Id: 2662855-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    Computed Tomographic Perfusion Selection and Clinical Outcomes After Endovascular Therapy in Large Vessel Occlusion Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 5 ( 2017-05), p. 1271-1277
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 5 ( 2017-05), p. 1271-1277
    Kurzfassung: Different imaging paradigms have been used to select patients for endovascular therapy in stroke. We sought to determine whether computed tomographic perfusion (CTP) selection improves endovascular therapy outcomes compared with noncontrast computed tomography alone. Methods— Review of a prospectively collected registry of anterior circulation stroke patients undergoing stent-retriever thrombectomy at a tertiary care center between September 2010 and March 2016. Patients undergoing CTP were compared with those with noncontrast computed tomography alone. The primary outcome was the shift in the 90-day modified Rankin scale (mRS). Results— A total of 602 patients were included. CTP-selected patients (n=365, 61%) were younger ( P =0.02) and had fewer comorbidities. CTP selection (n=365, 61%) was associated with a favorable 90-day mRS shift (adjusted odds ratio [aOR]=1.49; 95% confidence interval [CI] , 1.06–2.09; P =0.02), higher rates of good outcomes (90-day mRS score 0–2: 52.9% versus 40.4%; P =0.005), modified Thrombolysis in Cerebral Infarction-3 reperfusion (54.8% versus 40.1%; P 〈 0.001), smaller final infarct volumes (24.7 mL [9.8–63.1 mL] versus 34.6 mL [13.1–88 mL] ; P =0.017), and lower mortality (16.6% versus 26.8%; P =0.005). When matched on age, National Institutes of Health Stroke Scale (NIHSS) score, and glucose (n=424), CTP remained associated with a favorable 90-day mRS shift ( P =0.016), lower mortality ( P =0.02), and higher rates of reperfusion ( P 〈 0.001). CTP better predicted functional outcomes in patients presenting after 6 hours (as assessed by comparison of logistic regression models: Akaike information criterion: 199.35 versus 287.49 and Bayesian information criterion: 196.71 versus 283.27) and those with an Alberta Stroke Program Early Computed Tomography Score ≤7 (Akaike information criterion: 216.69 versus 334.96 and Bayesian information criterion: 213.6 versus 329.94). Conclusions— CTP selection is associated with a favorable mRS shift in patients undergoing stent-retriever thrombectomy. Future prospective studies are warranted.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.015636
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2017
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    Early Endovascular Treatment in Intravenous Tissue Plasminogen Activator–Ineligible Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 4 ( 2016-04), p. 1131-1134
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 4 ( 2016-04), p. 1131-1134
    Kurzfassung: Intravenous tissue-type plasminogen activator (tPA) treatment in acute stroke has many exclusion criteria. We aimed to assess the safety and efficacy of endovascular therapy (ET) in intravenous (IV) tPA-ineligible patients. Methods— Retrospective analysis of a prospectively collected database of consecutive patients treated with ET within 6 hours of stroke onset between September 2010 and April 2015. Patients treated with IV-tPA followed by ET were compared with those treated with ET alone because of IV-tPA ineligibility. Efficacy and safety end points included the rates of good outcome (90-day modified Rankin scale score ≤2), successful reperfusion (modified Treatment in Cerebral Ischemia 2b-3), parenchymal hematoma (PH-1 and PH-2), and 90-day mortality. Univariate and logistic regression were performed to identify the predictors of outcomes. Results— A total of 422 patients were included. Two hundred and fifty-three (59%) patients received IV-tPA+ET, and 169 (41%), ET alone. Combined IV-tPA+ET patients were slightly younger (64.9±15.2 versus 67.9±14.9 years; P =0.05), more often males (56% versus 44%; P =0.01), and had less hypertension (70% versus 81%; P =0.02) and vertebrobasilar occlusions (3% versus 8%; P =0.02). The remaining baseline characteristics, including National Institutes of Health Stroke Scale score (20 [15–23] versus 19 [15–24] ; P =0.85), Alberta Stroke Program Early CT Score (ASPECTS; 8 [7–9] versus 8 [7–9] ; P =0.24), and stroke onset to puncture times (235±70 versus 240±81 minutes; P =0.27), were similar across both groups. There were no significant differences in the rates of modified Treatment in Cerebral Ischemia 2b-3 (83% versus 80%; P =0.52), 90-day modified Rankin scale score ≤2 (45% versus 38%; P =0.21), or any PH (3% versus 5%; P =0.21). Unadjusted 90-day mortality was higher with ET alone (21% versus 34%; P 〈 0.01); however, IV-tPA ineligibility was not associated with modified Treatment in Cerebral Ischemia 2b-3, any PH, good outcome, or 90-day mortality on logistic regression. Conclusions— IV-tPA-eligible and -ineligible patients seem to have similar outcomes after early ET.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.012586
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
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    Automated CT Perfusion Ischemic Core Volume and Noncontrast CT ASPECTS (Alberta Stroke Program Early CT Score) : Correlation and Clinical Outcome Prediction in Large Vessel Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 9 ( 2016-09), p. 2318-2322
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 9 ( 2016-09), p. 2318-2322
    Kurzfassung: The semiquantitative noncontrast CT Alberta Stroke Program Early CT Score (ASPECTS) and RAPID automated computed tomography (CT) perfusion (CTP) ischemic core volumetric measurements have been used to quantify infarct extent. We aim to determine the correlation between ASPECTS and CTP ischemic core, evaluate the variability of core volumes within ASPECTS strata, and assess the strength of their association with clinical outcomes. Methods— Review of a prospective, single-center database of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions with pretreatment CTP between September 2010 and September 2015. CTP was processed with RAPID software to identify ischemic core (relative cerebral blood flow 〈 30% of normal tissue). Results— Three hundred and thirty-two patients fulfilled inclusion criteria. Median age was 66 years (55–75), median ASPECTS was 8 (7–9), whereas median CTP ischemic core was 11 cc (2–27). Median time from last normal to groin puncture was 5.8 hours (3.9–8.8), and 90-day modified Rankin scale score 0 to 2 was observed in 54%. The correlation between CTP ischemic core and ASPECTS was fair ( R =−0.36; P 〈 0.01). Twenty-six patients (8%) had ASPECTS 〈 6 and CTP core ≤50 cc (37% had modified Rankin scale score 0–2, whereas 29% were deceased at 90 days). Conversely, 27 patients (8%) had CTP core 〉 50 cc and ASPECTS ≥6 (29% had modified Rankin scale 0–2, whereas 21% were deceased at 90 days). Moderate correlations between ASPECTS and final infarct volume ( R =−0.42; P 〈 0.01) and between CTP ischemic core and final infarct volume ( R =0.50; P 〈 0.01) were observed; coefficients were not significantly influenced by the time from stroke onset to presentation. Multivariable regression indicated ASPECTS ≥6 (odds ratio 4.10; 95% confidence interval, 1.47–11.46; P =0.01) and CTP core ≤50 cc (odds ratio 3.86; 95% confidence interval, 1.22–12.15; P =0.02) independently and comparably predictive of good outcome. Conclusions— There is wide variability of CTP-derived core volumes within ASPECTS strata. Patient selection may be affected by the imaging selection method.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.014117
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
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    Beyond Large Vessel Occlusion Strokes : Distal Occlusion Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 7 ( 2018-07), p. 1662-1668
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 7 ( 2018-07), p. 1662-1668
    Kurzfassung: Endovascular therapy is the standard of care for the treatment of proximal large vessel occlusion strokes. Its safety and efficacy in the treatment of distal intracranial occlusions has not been well studied. Methods— The data that support the findings of this study are available from the corresponding author on reasonable request. Retrospective review of a prospectively collected endovascular database (2010–2015, n=949) for all patients with distal intracranial occlusions treated endovascularly. Distal occlusions were defined as any segment of the anterior cerebral artery (ACA), posterior cerebral artery, or occlusion at or distal to the middle cerebral artery (MCA)-M3 opercular segment. Results— Distal occlusions were treated in 69 patients. The mean age was 66.7±15.8 and 57% were male. Patients (29 [42%]) received intravenous tPA (tissue-type plasminogen activator). The median preprocedure National Institutes of Health Stroke Scale score was 18 (interquartile range, 13–23). The distal occlusion was the primary treatment location in 45 patients, in 23 patients the distal occlusion was treated as a rescue strategy after successful treatment of a proximal large vessel occlusion strokes, and 1 patient had both primary and rescue treatment. The locations of the primary cases were MCA-M3 (n=21), ACA alone (n=8), ACA with a concomitant MCA-M1 or MCA-M2 (n=10), ACA with a concomitant MCA-M3 (n=3), and posterior cerebral artery (n=3). The locations of the rescue cases were MCA-M3 (n=11), ACA (n=7), posterior cerebral artery (n=4), and both MCA-M3 and ACA (n=1). There was a single patient with primary ACA and MCA-M2 occlusions treated, who then had a rescue MCA-M3 thrombectomy addressed after initial reperfusion. The most common treatment modalities used were stent-retrievers (n=37, 54%), intra-arterial tPA (n=36, 52%), and thromboaspiration (n=31, 45%). Near complete or complete reperfusion of the distal territory (modified Treatment In Cerebral Ischemia [mTICI] 2b-3) was achieved in 57 cases (83%). Three parenchymal hematomas (4%) occurred in the territory of the treated distal occlusion with 2 of these patients also receiving intravenous tPA. At 90 days, 21 patients (30%) had a modified Rankin Scale score of 0 to 2 and 14 (20%) had died. Conclusions— Distal intracranial occlusions can be treated safely and successfully with endovascular therapy. These results need to be corroborated by larger prospective controlled studies.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.020567
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2018
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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