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  • 1
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    Online Resource
    Abstract 59: Predictors of Intracranial Hemorrhage in SWIFT
    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: Introduction: The main aim of this study is to investigate the mechanistic and clinical factors contributing to the beneficial effect of Solitaire over Merci in lowering symptomatic intracranial hemorrhage (SICH) in the SWIFT trial. We also sought to determine which radiographic ICH subtype affects clinical outcome. Methods: The SWIFT trial database was analyzed for incidence of different ICH subtypes in all 144 enrolled patients. Each ICH subtype was correlated with baseline clinical and imaging characteristics, procedural factors, and clinical outcome. Multivariate logistic regression model was used to identify the most significant predictors of the individual ICH subtypes. Results: Table Among all analyzed clinical and procedural factors for each ICH subtype, rescue therapy with TPA was the most common ICH predictor and occurred more frequently in the Merci group, although this difference was not statistically significant (10.9% vs. 3.4%; p = 0.085). Basal ganglia ICH was the only radiographic subtype associated with worsened outcome at 90 days (OR 3.33; p = 0.025). SICH was associated with higher mortality (OR 5.73; p = 0.048), mRS shift (OR 2.41; p = 0.011), and high NIHSS (ME 22.35 points; p = 0.004) at 90 days. Conclusions: The higher rate of ICH in the Merci arm was mainly due to increased occurrence of SAH, and to a lesser degree of IVH, PH2, and cortical ICH. Each one of these ICH subtypes was strongly associated with TPA rescue therapy. In comparison to Merci device, Solitaire likely offsets SICH due to lower incidence of vascular injury and decreased need for additional TPA administration. Other predictors of PH2, SAH, and SICH were high baseline INR, ASPECTS, and NIHSS, respectively, none of which differed between the two treatment arms. Basal ganglia ICH was the only radiographic subtype affecting clinical outcome. This type of hemorrhage was associated with higher reperfusion, prolonged time to treatment, and was also influenced by rescue therapy with TPA.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.A59
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Abstract 3198: Procedural Outcomes in Mechanical Thrombectomy for Acute Stroke: Atrial Fibrillation Predicts Single Device Therapy
    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: Background Timely and efficient reperfusion is associated with better outcome from acute cerebral ischemia. The predictors of procedural success in patients treated with multimodal mechanical device strategies (Merci ± Penumbra ± angioplasty and stenting) have not been well delineated. Methods In a prospectively maintained database, we analyzed consecutive patients with acute ICA and M1 occlusions treated with endovascular recanalization following multimodal MRI. We investigated the pretreatment clinical and imaging factors affecting three procedural outcomes: number of passes, single device-type therapy, and presence of SAH after the procedure. We also sought to determine the relationship between these procedural variables with substantial recanalization (TICI≥2b) and clinical outcome. Results Among 105 patients meeting study entry criteria, mean age was 66.6 (±17.8), 65% were female and 34% had history of atrial fibrillation. The median pretreatment NIHSS was 18 (range 2-31), mean baseline DWI volume was 30.6cc (SD±35.1), and mean time to groin puncture was 412min (SD±207.6). The median number of mechanical device passes was 2 (range 0-8). 73 (70%) patients were treated with a single device. IV tPA was used in 43 patients (41%). Substantial recanalization occurred in 43 patients (41%). In the final binary logistic regression multivariate analysis, among all baseline clinical and imaging variables, history of atrial fibrillation was the most significant factor associated with a single device therapy (OR 0.249; p=0.024). Age, gender, baseline DWI volumes, arterial occlusion site and time to recanalization did not correlate with the number of attempts, single or multiple device usage, or presence of SAH after the procedure. None of the procedural or baseline variables correlated with recanalization rates. The strongest predictors of poor outcome (mRS≥3 at discharge) were high baseline NIHSS (OR 0.87; p 〈 0.001) and presence of SAH after the procedure (OR 0.05; p=0.001). However, the presence of SAH did not correlate with the number of attempts or devices used. Conclusions: A history of atrial fibrillation predicts single device usage in mechanical thrombectomy for acute ischemic stroke treatment. This is likely due to the fibrin-rich histological composition of the clot. In contrast to prior studies involving a single type of device, increased number of passes with multiple different mechanical devices was not associated with lower recanalization rates and did not worsen clinical outcome.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A3198
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Fenestration of the Basilar Artery Associated with Aneurysm Treated by the Support of a Temporary Bridging Device—Comaneci: A Case Report
    Elsevier BV ; 2018
    In:  World Neurosurgery Vol. 119 ( 2018-11), p. 306-310
    Details
    In: World Neurosurgery, Elsevier BV, Vol. 119 ( 2018-11), p. 306-310
    Type of Medium: Online Resource
    ISSN: 1878-8750
    URL: Article
    DOI: 10.1016/j.wneu.2018.08.047
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2530041-6
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  • 4
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    The Phial of Galadriel
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology Vol. 96, No. 16 ( 2021-04-20), p. 729-730
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 16 ( 2021-04-20), p. 729-730
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000011824
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 5
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    Physiologic predictors of collateral circulation and infarct growth during anesthesia – Detailed analyses of the GOLIATH trial
    SAGE Publications ; 2020
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 40, No. 6 ( 2020-06), p. 1203-1212
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 40, No. 6 ( 2020-06), p. 1203-1212
    Abstract: Collateral circulation plays a pivotal role in acute ischemic stroke due to large vessel occlusion (LVO) and may be affected by multiple variables during sedation for endovascular therapy (EVT). We conducted detailed analyses of the GOLIATH trial to identify predictors of collateral circulation grade and infarct growth. We also modified the ASITN collateral grading scale and sought to determine its impact on clinical outcome and infarct growth. Multivariable analysis was used to identify predictors of collaterals and infarct growth. Ordinal analysis demonstrated nominal, but non-significant association between modified ASITN scale and infarct growth. Among all analyzed baseline clinical and procedural variables, the most significant predictors of infarct growth at 24 h were phenylephrine dose (estimate 6.78; p = 0.014) and baseline infarct volume (estimate 0.93; p = 0.03). The most significant predictors of worse collateral grade were mean arterial pressure (MAP) 〈 70 mmHg (OR 0.35; p = 0.048) and baseline infarct volume (OR 0.96; p = 0.003). Hypotension during sedation for EVT for LVO negatively impacts collateral circulation, while higher pressor dose is a strong predictor of infarct growth. Avoidance of anesthesia-induced hypotension and consequent need for pressor therapy may prevent collateral failure and minimize infarct growth.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1177/0271678X19865219
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2039456-1
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  • 6
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    Online Resource
    Elucidating the Mechanism of Posterior Reversible Encephalopathy Syndrome : A Case of Transient Blindness After Central Venous Catheterization
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  The Neurologist Vol. 18, No. 6 ( 2012-11), p. 391-394
    Details
    In: The Neurologist, Ovid Technologies (Wolters Kluwer Health), Vol. 18, No. 6 ( 2012-11), p. 391-394
    Type of Medium: Online Resource
    ISSN: 1074-7931
    URL: Article
    DOI: 10.1097/NRL.0b013e31826a9954
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 2070987-0
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  • 7
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    The Frequency of Substantial Salvageable Penumbra in Thrombectomy‐ineligible Patients with Acute Stroke
    Wiley ; 2018
    In:  Journal of Neuroimaging Vol. 28, No. 6 ( 2018-11), p. 676-682
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 28, No. 6 ( 2018-11), p. 676-682
    Abstract: Endovascular therapy (ET) has become the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, many LVO or medium vessel occlusion (MVO) patients are ineligible for ET, including some who harbor salvageable tissues. To develop complementary therapies for these patients, it is important to delineate their prevalence, clinical features, and outcomes. METHODS In a prospectively maintained database, we reviewed consecutive AIS patients between December 2015 and September 2016. Based on the first multimodal computed tomography or magnetic resonance imaging, patients were categorized as having substantial penumbra if perfusion lesion volume ( T max  〉 6 seconds) exceeded ischemic core volume (relative cerebral blood flow  〈 30% on CT perfusion or apparent diffusion coefficient  〈 620 on diffusion weighted image) by ≥20%. RESULTS Among 174 consecutive AIS patients presenting within 24 hours of last known well time, 29 (17%) had LVO or MVO and substantial penumbra, but were deemed ET ineligible. Among these patients, mean age was 81 (±13), 45% were female, and median National Institute of Health Stroke Scale score was 11 (interquartile range [IQR]: 5–19). The most common reasons for not pursuing ET were: distal occlusion (28%), mild neurologic deficit (16%), and temporally advanced core injury (16%). Ischemic core volume was 20 mL (±31), penumbral volume was 54 mL (±63), and mismatch ratio median was 5.6 (IQR: 2‐infinite). Severe disability or death at discharge (modified Rankin scale: 4–6) occurred in 72% of the patients. CONCLUSION Even in the modern stent retriever era, 1 in 6 AIS patients presents with substantial penumbra judged not appropriate for ET. This population may benefit from the development of alternative therapies, including collateral enhancement, neuroprotection, and thrombectomy devices deployable in distal arteries.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.2018.28.issue-6
    DOI: 10.1111/jon.12544
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2035400-9
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  • 8
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    Intracranial atherosclerotic disease mechanistic subtypes drive hypoperfusion patterns
    Wiley ; 2021
    In:  Journal of Neuroimaging Vol. 31, No. 4 ( 2021-07), p. 686-690
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 31, No. 4 ( 2021-07), p. 686-690
    Abstract: In symptomatic intracranial atherosclerotic stenosis (ICAS), borderzone infarct pattern and perfusion mismatch are associated with increased risk of recurrent strokes, which may reflect the shared underlying mechanism of hypoperfusion distal to the intracranial atherosclerosis. Accordingly, we hypothesized a correlation between hypoperfusion volumes and ICAS infarct patterns based on the respective underlying mechanistic subtypes. Methods We conducted a retrospective analysis of consecutive symptomatic ICAS cases, acute strokes due to subocclusive (50%–99%) intracranial stenosis. The following mechanistic subtypes were assigned based on the infarct pattern on the diffusion‐weighted imaging: Branch occlusive disease (BOD), internal borderzone (IBZ), and thromboembolic (TE). Perfusion parameters, obtained concurrently with the MRI, were studied in each group. Results A total of 42 patients (57% women, mean age 71 ± 13 years old) with symptomatic ICAS received MRI within 24 h of acute presentation. Fourteen IBZ, 11 BOD, and 17 TE patterns were identified. IBZ pattern yielded higher total T max 〉  4 s and T max 〉  6 s perfusion delay volumes, as well as corresponding T max   〉  4 s and T max   〉  6 s mismatch volume, compared to BOD. TE pattern exhibited greater median T max   〉  6 s hypoperfusion delay in volume compared to BOD. In IBZ versus TE, the volume difference between T max 〉  4 s and T max 〉  6 s (Δ T max   〉  4 s – T max   〉  6 s) was substantially greater. Conclusion ICAS infarct patterns, in keeping with their respective underlying mechanisms, may correlate with distinct perfusion profiles.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.v31.4
    DOI: 10.1111/jon.12863
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2035400-9
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  • 9
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    Impaired Distal Perfusion Predicts Length of Hospital Stay in Patients with Symptomatic Middle Cerebral Artery Stenosis
    Wiley ; 2021
    In:  Journal of Neuroimaging Vol. 31, No. 3 ( 2021-05), p. 475-479
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 31, No. 3 ( 2021-05), p. 475-479
    Abstract: Perfusion imaging can risk stratify patients with symptomatic intracranial stenosis. We aim to determine the association between perfusion delay and length of hospital stay (LOS) in symptomatic middle cerebral artery (MCA) stenosis patients. METHODS This is a retrospective study of consecutive patients admitted to a comprehensive stroke center over 5 years with ischemic stroke or transient ischemic attack (TIA) within 7 days of symptom onset due to MCA stenosis (50‐99%) and underwent perfusion imaging. Patients were divided into three groups: mismatch volume ≥ 15 cc based on T max 〉 6 second delay, T max 4‐6 second delay, and 〈 4 second delay. The outcome was LOS, both as a continuous variable and categorical (≥7 days [prolonged LOS] vs. 〈 7 days). We used adjusted regression analyses to determine the association between perfusion categories and LOS. RESULTS One hundred and seventy eight of 194 patients met the inclusion criteria. After adjusting for age and NIHSS, T max 〉 6 second mismatch was associated with prolonged LOS (OR 2.94 95% CI 1.06‐8.18; P = .039), but T max 4‐6 second was not (OR 1.45 95% CI .46‐4.58, P = .528). We found similar associations when LOS was a continuous variable for T max 〉 6 second (β coefficient = 2.01, 95% CI .05‐3.97, P = .044) and T max 4‐6 second (β coefficient = 1.24, 95% CI –.85 to 3.34, P = .244). CONCLUSION In patients with symptomatic MCA stenosis, T max 〉 6 second perfusion delay is associated with prolonged LOS. Prospective studies are needed to validate our findings.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.v31.3
    DOI: 10.1111/jon.12839
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2035400-9
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  • 10
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    Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms
    BMJ ; 2020
    In:  Journal of NeuroInterventional Surgery Vol. 12, No. 3 ( 2020-03), p. 303-307
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 12, No. 3 ( 2020-03), p. 303-307
    Abstract: Temporary placement of a retrievable neck bridging device, allowing parent vessel flow, is an attractive alternative to balloon remodeling for treatment of ruptured intracranial aneurysms. Objective To present, in a single-center study, our initial experience with Cascade (Perflow, Israel) in the treatment of ruptured intracranial aneurysms. Methods During a period of 1.5 months, 12 patients with aneurysmal subarachnoid hemorrhage underwent coil embolization in conjunction with Cascade in our center. Retrospective analysis of prospectively collected angiographic and clinical data was conducted to assess the safety and efficacy of the device. Results Among all treated patients, 41.7% (5/12) were female, the median age was 55 (47–77) years, the median aneurysm dome size was 5.75 mm (3–9.1), and the median neck size was 3.55 mm (2.3–7.9). Complete obliteration (Raymond 1) was achieved in 75% (9/12) of cases, and intentional residual neck (Raymond 2) was left in three cases (25%). None of the patients received any oral or intravenous antiplatelet therapy perioperatively. No thromboembolic complications, device-related spasm, vessel perforation, or coil entanglement were detected in any of the treated patients. Conclusions In our initial experience, treatment of wide-neck ruptured intracranial aneurysms with Cascade is safe and effective, without the need for adjuvant antiplatelet therapy. Long-term follow-up data in larger cohorts are needed to confirm these preliminary findings.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2019-015338
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2506028-4
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