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  • 1
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    A Novel Approach to Diagnose Reversible Cerebral Vasoconstriction Syndrome: A Case Series
    Elsevier BV ; 2015
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 24, No. 1 ( 2015-01), p. e31-e37
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 24, No. 1 ( 2015-01), p. e31-e37
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.023
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 1131675-5
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  • 2
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    Longer procedural times are independently associated with symptomatic intracranial hemorrhage in patients with large vessel occlusion stroke undergoing thrombectomy
    BMJ ; 2016
    In:  Journal of NeuroInterventional Surgery Vol. 8, No. 12 ( 2016-12), p. 1217-1220
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 8, No. 12 ( 2016-12), p. 1217-1220
    Abstract: Time to reperfusion is an essential factor in determination of outcomes in acute ischemic stroke (AIS). Objective To establish the effect of the procedural time on the clinical outcomes of patients with AIS. Methods Data from all consecutive patients who underwent mechanical thrombectomy between September 2010 and July 2012 were analysed retrospectively. The variable of interest was procedural time (defined as time from groin puncture to final recanalization time). Outcome measures included the rates of symptomatic intracranial hemorrhage (sICH, defined as any parenchymal hematoma—eg, PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale 0–2) at 90 days. Results The cohort included 242 patients with a mean age of 65.5±14.2 and median baseline National Institutes of Health Stroke Scale score 20. 51% of the patients were female. The mean procedure time was significantly shorter in patients with a good outcome (86.7 vs 73.1 min, respectively, p=0.0228). Patients with SICH had significantly higher mean procedure time than patients without SICH (79.67 vs 104.5 min, respectively; p=0.0319), which remained significant when controlling for the previous factors (OR=0.974, 95% CI 0.957 to 0.991). No correlation was found between the volume of infarction and the procedure time (r=0.10996, p=0.0984). No association was seen between procedure time and 90-day mortality (77.8 vs 88.2 min in survivals vs deaths, respectively; p=0.0958). Conclusions Our data support an association between the risk of SICH and a longer procedure time, but no association between procedural times and the final infarction volume or long-term functional outcomes was found.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2015-012157
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 2506028-4
    detail.hit.zdb_id: 2514982-9
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  • 3
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    Clinical, angiographic and radiographic outcome differences among mechanical thrombectomy devices: initial experience of a large-volume center
    BMJ ; 2015
    In:  Journal of NeuroInterventional Surgery Vol. 7, No. 3 ( 2015-03), p. 176-181
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 7, No. 3 ( 2015-03), p. 176-181
    Abstract: Higher reperfusion rates have been established with endovascular treatment of acute ischemic stroke (AIS). There are limited data on the comparative performance of mechanical thrombectomy devices. Methods A retrospective single-center analysis was undertaken of all consecutive patients who underwent thrombectomy using Merci, Penumbra or stent retrievers (SR) from September 2010 to November 2012. Baseline characteristics, rates of successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) score 2b–3), symptomatic intracerebral hemorrhage (sICH), final infarct volume, 90-day mortality and independent functional outcomes at 90 days were compared across the three devices. Results Our cohort included 287 patients. There were mild imbalances in baseline characteristics with trends towards higher National Institutes of Health Stroke Scale (NIHSS) score in patients in the Merci group (SR=18 vs Merci=21 vs Penumbra=19, p=0.06) and lower Alberta Stroke Program Early CT Score (ASPECTS) in patients in the SR group ( 〉 7: SR=51% vs Merci=61% vs Penumbra=62%, p=0.12). On univariate analysis there were no differences in the rate of sICH (SR=7% vs Merci=7% vs Penumbra=6%, p=0.921) and infarct volume (SR=61.5 mL vs Merci=69.5 mL vs Penumbra=59.2 mL, p=0.621). Trends towards better functional outcomes were found with Penumbra and SR vs Merci (41% vs 36% vs 25%, respectively, p=0.079). Complete or near complete reperfusion (mTICI 2b–3) was higher in the SR and Penumbra groups than in the Merci group (86% vs 78% vs 70%, respectively, p=0.027). Binary logistic regression showed that SR was an independent predictor of good functional outcome (OR 2.27, 95% CI 1.018 to 5.048; p=0.045). Conclusions Although our initial data confirm the superiority of SR technology over the Merci device, there was no significant difference in near complete/complete reperfusion, final infarct volumes or clinical outcomes between SR and Penumbra thromboaspiration.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2013-011037
    Language: English
    Publisher: BMJ
    Publication Date: 2015
    detail.hit.zdb_id: 2506028-4
    detail.hit.zdb_id: 2514982-9
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  • 4
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    Periprocedural Cost-Effectiveness Analysis of Mechanical Thrombectomy for Acute Ischemic Stroke in the Stent Retriever Era
    S. Karger AG ; 2014
    In:  Interventional Neurology Vol. 3, No. 2 ( 2014), p. 107-113
    Details
    In: Interventional Neurology, S. Karger AG, Vol. 3, No. 2 ( 2014), p. 107-113
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Early reperfusion is critical for favorable outcomes in acute ischemic stroke (AIS). Stent retrievers lead to faster and more complete reperfusion than previous technologies. Our aim is to compare the cost-effectiveness of stent retrievers to the previous mechanical thrombectomy devices. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Retrospective review of endovascularly treated large-vessel AIS. Data from all consecutive patients who underwent thrombectomy from January 2012 through November 2012 were collected. Baseline characteristics, the total procedural cost, the rates of successful recanalization [modified thrombolysis in cerebral ischemia (mTICI) scores of 2b or 3], and the length of stay at the hospital were compared between the stent retriever (SR) and the non-stent retriever (NSR) groups. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 After excluding the patients who underwent concomitant extracranial stenting (n = 22) or received intra-arterial tissue plasminogen activator only (n = 6), the entire cohort included 150 patients. The cost of the reperfusion procedure was significantly higher in the SR compared to the NSR group (USD 13,419 vs. 9,308, p 〈 0.001). We were unable to demonstrate a statistically significant difference in the rates of mTICI 2b/3 reperfusion (81 vs. 74%, p = 0.337) or the length of stay (11.1 ± 9.1 vs. 12.8 ± 9.6 days, p = 0.260) amongst the SR and the NSR patients. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The procedural costs of thrombectomy for AIS are increasing and account for the bulk of hospitalization reimbursement. The impact of these expenditures in the long-term sustainability of stroke centers deserves greater consideration. While it is likely that the SR technology results in higher rates of optimal reperfusion, better clinical outcomes, and shorter lengths of stay, larger studies are needed to prove its cost-effectiveness.
    Type of Medium: Online Resource
    ISSN: 1664-9737 , 1664-5545
    URL: Article
    DOI: 10.1159/000371729
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 2643214-6
    detail.hit.zdb_id: 2662855-7
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  • 5
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    Abstract TP20: Longer Procedural Times Are Independently Associated with Symptomatic Intracranial Hemorrhage in Large Vessels Occlusion Stroke Patients Undergoing Thrombectomy
    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 and Purpose: Time to reperfusion is an essential factor in determination of outcomes in (AIS). We sought to establish the effect of the procedural time on the clinical and radiographic outcomes of AIS patients undergoing intra-arterial therapy. Methods: Retrospective review of a prospectively collected database of endovascularly treated large vessel AIS in a large academic center. Data from all consecutive patients who underwent mechanical thrombectomy from September 2010 to July 2012 were analyzed. The variable of interest was procedural time (defined as time from groin puncture to end of procedure). Outcome measures included the rates of symptomatic intracebral hemorrhage (sICH, defined as any parenchymal hematoma e.g. PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale, mRS 0-2) at 90 days. Results: The entire cohort included 242 patients with a mean age of 65.5+/- 14.2 and median baseline NIHSS 20. Of the patients 49.38% were females. The median ASPECTS score was 8. The mean procedure time was significantly shorter in patients with good outcome (86.73 vs. 73.13 respectively, P-value: 0.0228). However, after controlling for ASPECTS score, type of retrieval device, TICI score, volume of infarct, interval from symptoms onset to puncture, and co-morbidities, this association did not prove to be significant (P-value = 0.7101). Patients with SICH had significantly higher mean procedure time than patients without SICH (79.65 vs. 104.5 respectively; P-value: 0.0319) which remained significant when controlling to the previous factors (OR = 0.974 with a 95 % CI of (0.957, 0.991). There was no correlation between the volume of infarction and the procedure time (r = 0.10996, P-value: 0.0984). There was no association between procedure time and 90-day mortality (77.8 vs. 88.2 minutes in survivals vs. deaths respectively; P-value: 0.0958). Conclusion: Our data support an association between the risk of SICH and a longer procedure time while no definite association between procedural times and the final infarction volume or long-term functional outcomes was found after adjustment for multiple imbalances.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATP20
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Abstract WP430: Utility of Prolonged Transcranial Doppler Monitoring in the Detection of Vasospasm and Stroke after Subarachnoid Hemorrhage: Is 10 days enough?
    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: Transcranial Doppler (TCD) monitoring is commonly used to identify cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) though its utility after day 10 has been questioned. The objective of our study was to determine the frequency of vasospasm by TCD in SAH patients who underwent prolonged monitoring (beyond day 10). Methods: We retrospectively identified all SAH patients seen at Emory University Hospital in 2011 who underwent TCD monitoring beyond 10 days. Outcomes of interest included cerebral vasospasm on TCD and delayed ischemic neurological deficit (DIND) beyond day 10. Results: Of 93 patients who met inclusion criteria, 66 (71%) experienced vasospasm and 28 (31%) developed DIND beyond day 10; of patients with DIND, TCD identified vasospasm in 24 (86%). Vasospasm on TCD was a predictor of DIND in univariate analysis (OR 3.29; 95% CI 1.015 to 10.63) but was not significant in multivariable analysis when adjusted for admission Hunt and Hess score. Conclusion: Prolonged TCD monitoring (beyond day 10) identified a high frequency of cerebral vasospasm in our subset of patients though was not a significant predictor of DIND in multivariable analysis. Prolonged TCD monitoring needs to be evaluated in a prospective study to determine its utility as a predictor of DIND.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP430
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Abstract WMP7: Clinical, Angiographic, and Radiographic Outcomes Differences Amongst Mechanical Thrombectomy Devices: Initial Experience of a Large-Volume Center
    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 and Purpose: Early reperfusion is the keystone in (AIS) therapy. Here, we compare the angiographic, radiographic, and clinical outcomes amongst the three device categories currently available. Methods: Retrospective review of a prospective collected database of large vessel AIS in a large academic center. Data from all consecutive patients who underwent clot retrieval using Merci, Penumbra, or Stent-Retrievers (Solitaire, n=31 or Trevo, n=20) from September 2010 to July 2012 were analyzed. Baseline characteristics were compared across the 3 groups. The outcome measures included the rates of recanalization (TICI 2b-3), symptomatic intracebral hemorrhage (sICH, defined as any parenchymal hematoma e.g. PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale, mRS 0-2) at 90 days. Results: The entire cohort included 242 patients with a mean age of 65.5 and median baseline NIHSS 20. The median ASPECTS score was 8. There were no significant differences in terms of baseline characteristics amongst the 3 device groups. No differences in the rate of sICH (5.9% vs. 6.02% vs. 7.41%, for Stent retrieval, Penumbra and Merci respectively, P= 0.91), mean procedure time (90.6, 76.23 and 75.3 min for Stent retrieval, Penumbra and Merci respectively, P= 0.05), and the volume of infarction (70.4, 58.02, and 65.61 cc for Stent retrieval, Penumbra and Merci respectively, P = 0.47) between the Stent-Retriever, Penumbra, and Merci groups, respectively. However, the rates of reperfusion (88.2 % vs. 77.1% vs. 69.1 %, p= 0.041) and 90-day functional independence (54.9 % vs. 43.4 % vs. 24.7%, p=0.0015) were significantly higher with Stent-Retrievers as compared to Penumbra or Merci treatments. There was no significant difference in the rate of 90-day mortality amongst the different devices (33.33%, 26.51% and 40.74% for Stent-Retriever, Penumbra, and Merci groups, respectively, P= 0.1549). Conclusion: Our initial data suggest a potential superiority of the Stent-Retriever technology to both Penumbra and Merci devices. Differences between Stent-Retrievers and Penumbra were much smaller in our experience and additional comparison in a randomized prospective fashion is warranted.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWMP7
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Abstract 23: Neuroimaging and Echocardiographic Predictors of Paroxysmal Atrial Fibrillation on Outpatient Mobile Cardiac Outpatient Telemetry in Cryptogenic Ischemic Stroke and TIA Patients
    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 objective of our study was to identify factors on MRI neuroimaging and echocardiography as part of routine workup of patients with cryptogenic ischemic stroke (IS) or transient ischemic attack (TIA) to identify those patients who are likely to have paroxysmal atrial fibrillation (PAF) as detected by subsequent outpatient mobile cardiac outpatient telemetry (MCOT). Methods: All cryptogenic IS or TIA patients seen at Emory University Hospital and The Emory Clinic from 2009-2013 and who underwent outpatient MCOT were included in this analysis.Using logistic regression, we analyzed the association between lesions seen on MRI FLAIR sequences with PAF and categorized them as the following: Cortical lesions (CL), defined as T2-hyperintense cortical-based infarcts; high subcortical (HS) T2-hyperintense lesions, defined as 〈 5mm beneath the cortex without any cortical involvement, or none. Left atrium (LA) functional and dimensional echocardiographic parameters were evaluated to determine their association with PAF. Results: Of 132 patients included in this analysis, 17 (13%) had evidence of newly diagnosed PAF on MCOT (mean duration of monitoring=25 days); median age was 72 (IQR: 64-79), 50% were women, diabetes was present in 23%, hypertension in 76%, dyslipidemia in 64%, and active tobacco use in 8%. CL seen on baseline MRI were found to be significant predictors of PAF (OR 5.2, 95 % CI: 1.3-19; p=0.01). HS lesions were not found to be a significant predictor of PAF. On baseline echocardiography, patients who had PAF (vs non-PAF) had significantly higher mean LA diameter (4.2 vs 3.7 cm, p=0.03), lower tissue Doppler velocity (a’) (5.5 vs 13.5 cm/s, p=0.03), a trend toward higher left atrium volume index (LAVI) (37.5 vs 29.2, p=0.07) and mean LAVI/late diastolic Doppler velocity (A) (0.67 vs. 0.37, P= 0.006). The Areas under the Curve (AUC) for the parameters were: LA diameter 71.4%, a’ 92.6%, LAVI 74.6%, LAVI/A 62.5%, LAVI/a’ 67.9%. Conclusion: Cortical-based infarcts seen on MRI FLAIR sequences and baseline echocardiographic variables may help to predict cryptogenic ischemic stroke or TIA patients who are likely to have PAF identified on outpatient MCOT.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.23
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Abstract 137: Endovascular Intervention versus Standard Medical Therapy for Patients Presenting with Large Acute Ischemic Strokes - A Large Single Center Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Objective. Endovascular interventions for acute ischemic stroke have been widely adopted on the basis of single-arm registries that reported high recanalization rates with limited complications. We conducted a retrospective cohort study to compare the clinical outcomes in acute ischemic stroke patients who underwent endovascular treatment with patients who were treated with standard medical therapy alone at our institution. Methods. The study group consisted of two cohorts of patients with acute ischemic stroke over a 4-year period: 260 patients underwent endovascular treatment and 597 patients were treated with best medical therapy alone. All patients from the medical group presented with a NIHSS score of 〉 8 and were ineligible for IV tPA. Clinical outcomes at discharge and at 3 months were compared. Results. Compared with the medical group, the endovascular group had a significantly greater proportion of patients who were discharged home (21.2% vs 8.7%, p 〈 0.001) and who could ambulate independently at discharge (32.1% vs 16.8%, p 〈 0.001). Of the patients with follow-up, the proportion of patients with a good outcome (mRS score of 〈 =2) at 3 months was also significantly higher in the endovascular group (51.9% vs 35.7%, p 〈 0.05). Conversely, the endovascular group had a significantly smaller proportion of patients who was discharged to nursing home (11.9% vs 24.1%, p 〈 0.01) and hospice (6.9% vs 14.1%, p=0.003). Mortality rate at discharge was not different (21.2% vs 18.9%, p=0.451). The rate of symptomatic ICH was 9.2% in the intervention group. Conclusion. In our study, endovascular therapy provides a better functional outcome compared with standard medical therapy in select patients. Ultimately, determination of efficacy of endovascular therapy for acute ischemic stroke compared with best medical therapy will depend on results of randomized trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A137
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Abstract TP1: Recanalization and Clinical Outcomes correlation in Acute Stroke: Meta Analysis
    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: Objective: Intravenous thrombolysis is still the only FDA approved therapy for acute ischemic stroke since the NINDS trial. The introduction of more aggressive and alternative acute stroke interventions and techniques has given rise to wide body of contemporary literature reporting patient outcomes across the various treatment modalities; these outcomes have yet to be comprehensively quantified and reviewed. The existing data is still lacking solid evidence of correlation between successful recanalization and good outcome. Methods: Data were collected through Medline search. Analysis of 140 articles published between the years 1985 - 2011 was done to compare clinical outcomes, complication and mortality rates between non-revascularized and revascularized groups in the setting of acute stroke therapy. Search key words included recanalization, reperfusion, thrombolysis, modified Rankin Scale (mRS), in combination with ischemic stroke and cerebral ischemia. Results: Pooled analysis of 140 studies including 4,313 patients conveyed recanalization rate. Based on recanalization status, mRS was accessible in 110 studies, Symptomatic Intracranial Hemorrhage (sICH) in 60 studies and mortality rate in 86 studies. Patients with successful recanalization had better chance of having good functional outcome measured by mRS at 90 days (OR, 4.99; 95% CI, 4.21 to 5.91). sICH rate was not statistically different between the two groups (OR, 1.25; 95% CI, 0.90 to 1.73). Mortality rate was less in patients with successful recanalization compared with non-recanalized (OR, 2.77; 95% CI, 2.27 to 3.38). Interpretation: Our results suggest a strong relationship between successful revascularization and better functional outcome with less mortality rate.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATP1
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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