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  • 1
    Online Resource
    Online Resource
    Benefit from mechanical thrombectomy in acute ischemic stroke with fast and slow progression
    BMJ ; 2020
    In:  Journal of NeuroInterventional Surgery Vol. 12, No. 2 ( 2020-02), p. 132-135
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 12, No. 2 ( 2020-02), p. 132-135
    Abstract: The rate of progression of the ischemic lesion is variable in patients with stroke. We tested the hypothesis that the tissue saving effect of mechanical thrombectomy (MT) is greater in fast progressors. Methods A single-center cohort of consecutive patients (n=242) with occlusions of the terminal internal carotid or M1 segment of the middle cerebral artery treated with MT (n=195) or best medical treatment (n=47), known time from onset, and full imaging (baseline CT perfusion and follow-up MRI) available was studied. The estimated infarct progression rate (eIPR) was calculated at baseline and patients were categorized as fast/slow progressors according to the median eIPR of 4.8 mL/hour. The primary outcome measure was the interaction between eIPR category and MT on infarct growth. The secondary outcomes assessed the effect of MT on final infarct volume and functional status in relation to the eIPR category. The safety outcomes were mortality and symptomatic intracranial hemorrhage. Results The eIPR category had a modifying effect (Pi=0.017) of MT on infarct growth that was significantly reduced with MT only in fast progressors (median (IQR) 3.8 mL (−11–55) vs 41 mL (11–107) with medical treatment; p=0.009, adjusted p=0.045). There was also a significant interaction on final infarct volume (Pi=0.005), with a greater reduction after MT in fast progressors. The functional status improved with MT both in fast and slow progressors, with no significant modifying effect of eIPR category (Pi=0.201). There were also no significant interactions on safety outcomes. Conclusion MT in stroke patients with large vessel occlusion limits infarct growth more significantly in fast progressors.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2019-015064
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2506028-4
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  • 2
    Online Resource
    Online Resource
    Clinical improvement within 24 hours from mechanical thrombectomy as a predictor of long-term functional outcome in a multicenter population-based cohort of patients with ischemic stroke
    BMJ ; 2021
    In:  Journal of NeuroInterventional Surgery Vol. 13, No. 2 ( 2021-02), p. 119-123
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 13, No. 2 ( 2021-02), p. 119-123
    Abstract: Single-center studies have suggested that the early clinical course after mechanical thrombectomy (MT) in patients with ischemic stroke is a clinical predictor of long-term outcome. Objective To analyze the prognostic value of clinical improvement within 24 hours in a population-based multicenter cohort. Methods From a total of 3792 patients with acute ischemic stroke in Catalonia (CICAT registry), 1951 patients were treated with MT. The National Institutes of Health Stroke Scale (NIHSS) score within 24 hours, and follow-up was available in 1666 patients. Percentage variation in the NIHSS score was calculated in relation to a baseline assessment. Good outcome was defined as a modified Rankin Scale score ≤2 at 90 days. Predictive values of clinical improvement and adjusted OR to predict good outcomes were assessed in the whole cohort and the subgroup of patients with posterior circulation stroke (n=166). Results Good outcome was achieved in 656/1666 patients (39%) overall. Percentage improvements both at the end of MT and at 24 hours predicted good outcome, with higher predictive capacity at 24 hours (C-statistic, 0.85 vs 0.73, p 〈 0.001). Positive and negative predictive values were 70% and 74% for the 〉 30% cut-off point at the end of MT, and 69% and 84% for the 〉 50% cut-off point at 24 hours, respectively. The adjusted OR for good outcome was 5.8 (95% CI 4.2 to 8.1) and 12.9 (95% CI 9.7 to 17.1), respectively. In patients with posterior circulation stroke, the predictive value of the improvement at 24 hours was similar (C-statistic 0.90). Conclusion Clinical improvement of patients within 24 hours of MT is a reliable and robust predictor of long-term prognosis, including patients with posterior circulation occlusions.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-015934
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2506028-4
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  • 3
    Online Resource
    Online Resource
    Greater infarct growth limiting effect of mechanical thrombectomy in stroke patients with poor collaterals
    BMJ ; 2019
    In:  Journal of NeuroInterventional Surgery Vol. 11, No. 10 ( 2019-10), p. 989-993
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 11, No. 10 ( 2019-10), p. 989-993
    Abstract: Stroke patients with good collateral circulation achieve the best recovery after mechanical thrombectomy (MT) but strict imaging selection may result in untreated patients that could benefit from MT. We assessed whether the extent of collaterals had modifying effects on the amount of ischemic tissue saved from infarction with MT over best medical treatment (BMT). Methods This was a single center cohort of consecutive patients (n=339) with proximal occlusions in the carotid territory. Patients were categorized according to a four point category scale on CT angiography as having good (scores 2–3) or poor (scores 0–1) collaterals. The primary outcome measure was the interaction between collaterals and MT on infarct growth. The secondary outcome assessed the treatment effect of MT over BMT on functional status in relation to collateral status. Safety outcomes were mortality and symptomatic intracranial hemorrhage. Results Collaterals had a modifying effect of MT on infarct growth (P=0.004), with a greater reduction in 96 patients with poor collaterals (38.8 mL) than in 243 patients with good collaterals (1.9 mL). There was also a significant (P 〈 0.001) interaction between the effect of MT and functional outcome in relation to collateral status, with more benefits of MT in patients with poor collaterals. MT was associated with lower mortality than BMT in patients with poor collaterals only. Conclusion Compared with BMT, the use of MT in the early time window in large vessel stroke results in a more substantial limitation of infarct growth in patients with poor collaterals.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2018-014668
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2506028-4
    Location Call Number Limitation Availability
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