Amir M Molaie, Sibylle Wilfling, Mustafa Kilic, C. Wendl, Ralf A. Linker, F. Schlachetzki, David S. Liebeskind
Early recognition of large‐vessel occlusion in acute ischemic stroke is pivotal to ensuring timely and effective treatment. However, current prehospital evaluation strategies largely rely on stroke scales that lack sensitivity and specificity. Recently, a novel, portable, noninvasive brain perfusion ultrasound device (SONAS) was developed as a diagnostic aid and demonstrated robust correlation with magnetic resonance imaging–based brain perfusion imaging. The present study aimed to investigate the feasibility and diagnostic performance of the SONAS device in identifying alterations in cerebral blood flow in patients with acute ischemic stroke with suspected or known perfusion deficits. We performed a phase II, single‐arm, prospective study using SONAS in a close timely relation to computed tomography perfusion imaging in subjects diagnosed with acute ischemic stroke and suspected or known large‐vessel pathology, presenting within 24 hours of symptom onset between April 2019 through December 2019. Performance end points included successful measurement of time‐to‐peak in each hemisphere and comparison of perfusion deficits measured by SONAS to the reference standard computed tomography perfusion imaging. Safety end points included frequency, severity, and outcome of adverse events. A total of 20 subjects were enrolled. Eighteen subjects (90%) had microbubble signals successfully detected on initial assessment by SONAS. The diagnostic accuracy of the SONAS device in identifying a perfusion deficit was 88.9%. The sensitivity was 14 of 15 (93.3%), and the specificity was 2 of 3 (66.7%). No adverse events were reported secondary to SONAS or the contrast agent used. In this clinical study, we demonstrated that the SONAS system is a safe tool that can aid in identifying cerebral perfusion deficits in this selected population of patients with acute ischemic stroke with suspected or known perfusion deficits. Future studies should assess the efficacy and impact on clinical outcomes of using SONAS in a real‐world “in the field” setting on a large subset of patients with suspected stroke and in addition to prehospital stroke scales.
{"title":"Use of the SONAS Ultrasound Device for the Assessment of Cerebral Perfusion in Acute Ischemic Stroke","authors":"Amir M Molaie, Sibylle Wilfling, Mustafa Kilic, C. Wendl, Ralf A. Linker, F. Schlachetzki, David S. Liebeskind","doi":"10.1161/svin.123.001092","DOIUrl":"https://doi.org/10.1161/svin.123.001092","url":null,"abstract":"\u0000 \u0000 Early recognition of large‐vessel occlusion in acute ischemic stroke is pivotal to ensuring timely and effective treatment. However, current prehospital evaluation strategies largely rely on stroke scales that lack sensitivity and specificity. Recently, a novel, portable, noninvasive brain perfusion ultrasound device (SONAS) was developed as a diagnostic aid and demonstrated robust correlation with magnetic resonance imaging–based brain perfusion imaging. The present study aimed to investigate the feasibility and diagnostic performance of the SONAS device in identifying alterations in cerebral blood flow in patients with acute ischemic stroke with suspected or known perfusion deficits.\u0000 \u0000 \u0000 \u0000 We performed a phase II, single‐arm, prospective study using SONAS in a close timely relation to computed tomography perfusion imaging in subjects diagnosed with acute ischemic stroke and suspected or known large‐vessel pathology, presenting within 24 hours of symptom onset between April 2019 through December 2019. Performance end points included successful measurement of time‐to‐peak in each hemisphere and comparison of perfusion deficits measured by SONAS to the reference standard computed tomography perfusion imaging. Safety end points included frequency, severity, and outcome of adverse events.\u0000 \u0000 \u0000 \u0000 A total of 20 subjects were enrolled. Eighteen subjects (90%) had microbubble signals successfully detected on initial assessment by SONAS. The diagnostic accuracy of the SONAS device in identifying a perfusion deficit was 88.9%. The sensitivity was 14 of 15 (93.3%), and the specificity was 2 of 3 (66.7%). No adverse events were reported secondary to SONAS or the contrast agent used.\u0000 \u0000 \u0000 \u0000 In this clinical study, we demonstrated that the SONAS system is a safe tool that can aid in identifying cerebral perfusion deficits in this selected population of patients with acute ischemic stroke with suspected or known perfusion deficits. Future studies should assess the efficacy and impact on clinical outcomes of using SONAS in a real‐world “in the field” setting on a large subset of patients with suspected stroke and in addition to prehospital stroke scales.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"8 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140418154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Katsanos, L. Catanese, Demetrios J. Sahlas, A. Srivastava, A. Veroniki, Kanjana Perera, Kelvin K. H. Ng, Raed A Joundi, B. van Adel, Ramiro Larrazabal, Christine Hawkes, A. Deshmukh, Kanchana Ratnayake, L. Palaiodimou, G. Tsivgoulis, Oscar R. Benavente, Robert G Hart, Mukul A Sharma, A. Shoamanesh
Although postprocedure blood pressure (BP) correlates with outcome in patients undergoing endovascular thrombectomy (EVT), the optimal target is unknown. We performed a pilot randomized‐controlled clinical trial enrolling participants with persistently elevated BP after successful EVT. Participants were randomized within 1 hour from the end of EVT to either intensive (systolic BP target <140 mmHg) or standard BP target (systolic BP <180 mmHg) for 48 hours. The main end point was feasibility, which was assessed with the enrollment rate and adherence to allocated BP target. Exploratory end points included neurologic deterioration, functional improvement, intracranial hemorrhage, and flow dynamics detected by transcranial Doppler ultrasonography. We included the outcomes of our trial in an aggregate data meta‐analysis of randomized‐controlled clinical trials evaluating the utility of BP control after successful EVT. The primary outcome of the meta‐analysis was 3‐month good functional outcome, defined as a modified Rankin Scale score of ≤2. Between October 23, 2020, and February 4, 2023, 221 patients were screened and 30 were randomized (14%; average recruitment of 1.2 participants/month). Participants in the intensive BP arm had a mean±SD systolic BP of 131±18 mm Hg over 48 hours (75% of the readings were <140 mm Hg), whereas participants in the standard BP arm had a mean±SD 48‐hour systolic BP of 139±18 mm Hg (48% of the readings were between 140 and 180 mm Hg). No differences between the 2 groups were documented in any of the predefined exploratory end points. In a meta‐analysis of 5 randomized‐controlled clinical trials involving 1558 participants, intensive BP control was associated with lower probability for 3‐month good functional outcome (odds ratio, 0.66 [95% CI, 0.53–0.82]; I 2 = 8%) when compared with standard BP control. The natural course of BP normalization following successful recanalization poses challenges to the conduct and success of randomized‐controlled clinical trials evaluating different BP thresholds after EVT. Meta‐analysis of existing trials suggests harm associated with active BP lowering.
{"title":"Blood Pressure Management Following Endovascular Stroke Treatment: A Feasibility Trial and Meta‐Analysis of Outcomes","authors":"A. Katsanos, L. Catanese, Demetrios J. Sahlas, A. Srivastava, A. Veroniki, Kanjana Perera, Kelvin K. H. Ng, Raed A Joundi, B. van Adel, Ramiro Larrazabal, Christine Hawkes, A. Deshmukh, Kanchana Ratnayake, L. Palaiodimou, G. Tsivgoulis, Oscar R. Benavente, Robert G Hart, Mukul A Sharma, A. Shoamanesh","doi":"10.1161/svin.123.001287","DOIUrl":"https://doi.org/10.1161/svin.123.001287","url":null,"abstract":"\u0000 \u0000 Although postprocedure blood pressure (BP) correlates with outcome in patients undergoing endovascular thrombectomy (EVT), the optimal target is unknown.\u0000 \u0000 \u0000 \u0000 We performed a pilot randomized‐controlled clinical trial enrolling participants with persistently elevated BP after successful EVT. Participants were randomized within 1 hour from the end of EVT to either intensive (systolic BP target <140 mmHg) or standard BP target (systolic BP <180 mmHg) for 48 hours. The main end point was feasibility, which was assessed with the enrollment rate and adherence to allocated BP target. Exploratory end points included neurologic deterioration, functional improvement, intracranial hemorrhage, and flow dynamics detected by transcranial Doppler ultrasonography. We included the outcomes of our trial in an aggregate data meta‐analysis of randomized‐controlled clinical trials evaluating the utility of BP control after successful EVT. The primary outcome of the meta‐analysis was 3‐month good functional outcome, defined as a modified Rankin Scale score of ≤2.\u0000 \u0000 \u0000 \u0000 \u0000 Between October 23, 2020, and February 4, 2023, 221 patients were screened and 30 were randomized (14%; average recruitment of 1.2 participants/month). Participants in the intensive BP arm had a mean±SD systolic BP of 131±18 mm Hg over 48 hours (75% of the readings were <140 mm Hg), whereas participants in the standard BP arm had a mean±SD 48‐hour systolic BP of 139±18 mm Hg (48% of the readings were between 140 and 180 mm Hg). No differences between the 2 groups were documented in any of the predefined exploratory end points. In a meta‐analysis of 5 randomized‐controlled clinical trials involving 1558 participants, intensive BP control was associated with lower probability for 3‐month good functional outcome (odds ratio, 0.66 [95% CI, 0.53–0.82]; I\u0000 2\u0000 = 8%) when compared with standard BP control.\u0000 \u0000 \u0000 \u0000 \u0000 The natural course of BP normalization following successful recanalization poses challenges to the conduct and success of randomized‐controlled clinical trials evaluating different BP thresholds after EVT. Meta‐analysis of existing trials suggests harm associated with active BP lowering.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140430370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michele Romoli, Soma Banerjee, F. Cordici, K. Lobotesis, M. Longoni, E. Lafe, I. Casetta, A. Katsanos, L. Palaiodimou, Andrea Zini, M. Ruggiero, Thanh N Nguyen, G. Tsivgoulis, L. D’Anna
Women are underrepresented in stroke thrombectomy trials, and the impact of sex differences in outcomes after stroke thrombectomy is unclear. We performed a multicenter propensity matching study to define sex‐related differences in outcome after endovascular thrombectomy and integrated results in a meta‐analysis. We included patients with anterior circulation large vessel occlusion consecutively treated with thrombectomy at 2 Comprehensive Stroke Centres (2016–2023). Selection criteria reflected international guidelines. Through systematic review we selected all studies reporting endovascular thrombectomy outcomes in anterior circulation large vessel occlusion stroke, applying propensity score matching. MEDLINE, EMBASE, and Cochrane CENTRAL were searched up to August 15, 2023 according to predefined protocol (OSF.io/je3da). Data were extracted by 2 independent raters, pooled estimates calculated according to random‐effect modeling meta‐analysis and reported as odds ratio (OR) and standard 95% CI. Outcomes were good functional outcome, defined as modified Rankin Scale score 0–2 at 90 days after stroke, and symptomatic intracranial hemorrhage, adjudicated according to European Cooperative Acute Stroke Study II criteria. After matching, 698 patients (349 women versus 349 men) had similar cardiovascular risk factors, baseline features, and treatment approach. No significant differences were found for good functional outcome (OR = 0.89, 95% CI = 0.66–1.2) and symptomatic intracranial hemorrhage (OR = 1.00, 95% CI = 0.44–2.26) in the cohort study by sex. Systematic review identified 3 studies (n = 3706), all of high quality. No differences emerged in rates of good functional outcome (OR = 1.00, 95% CI = 0.79–1.21) or symptomatic intracranial hemorrhage (OR = 0.85, 95% CI = 0.60–1.19) depending on sex. Women receiving endovascular thrombectomy for anterior circulation large vessel occlusion related stroke have similar rates of good functional outcome and symptomatic intracranial hemorrhage compared to men.
女性在中风血栓切除术试验中的代表性不足，而性别差异对中风血栓切除术后预后的影响尚不清楚。我们进行了一项多中心倾向匹配研究，以确定血管内血栓切除术后与性别相关的预后差异，并将结果纳入荟萃分析。 我们纳入了在 2 个综合卒中中心连续接受血栓切除术治疗的前循环大血管闭塞患者（2016-2023 年）。选择标准反映了国际指南。通过系统性回顾，我们选择了所有报告前循环大血管闭塞卒中血管内血栓切除术疗效的研究，并应用倾向评分匹配法。根据预定方案（OSF.io/je3da），我们检索了MEDLINE、EMBASE和Cochrane CENTRAL，检索期截至2023年8月15日。数据由两名独立评分员提取，根据随机效应模型荟萃分析计算出汇总估计值，并以几率比（OR）和标准 95% CI 的形式报告。研究结果包括良好的功能预后（定义为卒中后 90 天修改的 Rankin 量表评分 0-2 分）和无症状性颅内出血（根据欧洲急性卒中合作研究 II 标准判定）。 配对后，698 名患者（349 名女性与 349 名男性）的心血管风险因素、基线特征和治疗方法相似。在队列研究中，良好功能预后（OR = 0.89，95% CI = 0.66-1.2）和无症状性颅内出血（OR = 1.00，95% CI = 0.44-2.26）在性别上无明显差异。系统综述确定了 3 项研究（n = 3706），均为高质量研究。良好功能预后率（OR = 1.00，95% CI = 0.79-1.21）或无症状颅内出血率（OR = 0.85，95% CI = 0.60-1.19）因性别而异。 与男性相比，接受血管内血栓切除术治疗前循环大血管闭塞相关中风的女性在良好功能预后率和无症状性颅内出血率方面与男性相似。
{"title":"Impact of Sex on Thrombectomy Outcomes in Ischemic Stroke: A Propensity Score‐Matched Study, Systematic Review, and Meta‐Analysis","authors":"Michele Romoli, Soma Banerjee, F. Cordici, K. Lobotesis, M. Longoni, E. Lafe, I. Casetta, A. Katsanos, L. Palaiodimou, Andrea Zini, M. Ruggiero, Thanh N Nguyen, G. Tsivgoulis, L. D’Anna","doi":"10.1161/svin.123.001196","DOIUrl":"https://doi.org/10.1161/svin.123.001196","url":null,"abstract":"\u0000 \u0000 Women are underrepresented in stroke thrombectomy trials, and the impact of sex differences in outcomes after stroke thrombectomy is unclear. We performed a multicenter propensity matching study to define sex‐related differences in outcome after endovascular thrombectomy and integrated results in a meta‐analysis.\u0000 \u0000 \u0000 \u0000 We included patients with anterior circulation large vessel occlusion consecutively treated with thrombectomy at 2 Comprehensive Stroke Centres (2016–2023). Selection criteria reflected international guidelines. Through systematic review we selected all studies reporting endovascular thrombectomy outcomes in anterior circulation large vessel occlusion stroke, applying propensity score matching. MEDLINE, EMBASE, and Cochrane CENTRAL were searched up to August 15, 2023 according to predefined protocol (OSF.io/je3da). Data were extracted by 2 independent raters, pooled estimates calculated according to random‐effect modeling meta‐analysis and reported as odds ratio (OR) and standard 95% CI. Outcomes were good functional outcome, defined as modified Rankin Scale score 0–2 at 90 days after stroke, and symptomatic intracranial hemorrhage, adjudicated according to European Cooperative Acute Stroke Study II criteria.\u0000 \u0000 \u0000 \u0000 After matching, 698 patients (349 women versus 349 men) had similar cardiovascular risk factors, baseline features, and treatment approach. No significant differences were found for good functional outcome (OR = 0.89, 95% CI = 0.66–1.2) and symptomatic intracranial hemorrhage (OR = 1.00, 95% CI = 0.44–2.26) in the cohort study by sex. Systematic review identified 3 studies (n = 3706), all of high quality. No differences emerged in rates of good functional outcome (OR = 1.00, 95% CI = 0.79–1.21) or symptomatic intracranial hemorrhage (OR = 0.85, 95% CI = 0.60–1.19) depending on sex.\u0000 \u0000 \u0000 \u0000 Women receiving endovascular thrombectomy for anterior circulation large vessel occlusion related stroke have similar rates of good functional outcome and symptomatic intracranial hemorrhage compared to men.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"139 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140429260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yazan Ashouri, Alexandra R. Paul, Thanh N. Nguyen, A. Castonguay, Mohammad AlMajali, Ahmad Armouti, Raul G Nogueira, Jaafar Kashef Al‐Ghetaa, Joey D. English, H. Farid, K. Asif, Varun Chaubal, Batool Al Masaid, Benedict Tan, E. Lin, Qasem N. Alshaer, Rishi Gupta, C. Martin, Diogo C. Haussen, N. Mueller-Kronast, S. Satti, M. Mokin, Osama O. Zaidat
Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and potentially effective, predominantly in the non‐White population. The aim of this study was to identify predictors of good functional outcome in posterior circulation strokes in US population after mechanical thrombectomy from the TRACK (Trevo Stent‐Retriever Acute Stroke) and the NASA (North American Solitaire Stent Retriever Acute Stroke) registries from North America. Patient‐level data from the TRACK and NASA registries were pooled, and patients with posterior circulation stroke were included in this analysis. Patients were dichotomized into those with 90‐day good functional outcome (modified Rankin scale [mRS] score 0–2) and poor functional outcome (mRS score ≥3). Baseline and procedural data were compared between the 2 cohorts. Multivariate logistic regression was performed to identify predictors of functional outcome. P < 0.05 was considered significant. Of 119 posterior stroke patients (99 [83.2%] basilar artery, 16 [13.4%] vertebral artery, and 4 [3.4%] posterior cerebral artery), 110 patients had 90‐day mRS data available on follow‐up. Good functional outcome was observed in 44 patients (40%). Patients with mRS score 0–2 were less likely to have hypertension (61.4% versus 83.3%; P = 0.01), hyperlipidemia (38.6% versus 62.1%; P = 0.016), and diabetes (18.2% versus 36.4%; P = 0.040). Patients with mRS score 0–2 had a lower mean presentation National Institutes of Health Stroke Scale score (15.2±9.95 versus 22.6±9.50; P < 0.001) and more likelihood of achieving Thrombolysis in Cerebral Infarction 3 (79.5% versus 42.2%; P < 0.001). There was no difference between 2 cohorts in time to puncture, use of balloon guide catheter, use of general anesthesia, and number of passes. On multivariate analysis, higher presentation National Institutes of Health Stroke Scale and hypertension were associated with worse functional outcomes. Complete recanalization and the receipt of intravenous tissue‐type plasminogen activator were associated with higher odds of achieving good functional outcomes. In this pooled analysis of the NASA and TRACK registries, patients with posterior circulation stroke achieving good outcomes were more likely to have lower presentation National Institutes of Health Stroke Scale and fewer comorbidities. Use of intravenous tissue‐type plasminogen activator, hypertension, final Thrombolysis in Cerebral Infarction 3, and lower baseline National Institutes of Health Stroke Scale score were independent predictors of functional outcome.
{"title":"Predictors of Good Functional Outcomes in Posterior Circulation Stroke After Mechanical Thrombectomy With Stent Retrievers: An Individual Patient‐Data Pooled Analysis From the TRACK and NASA Registries","authors":"Yazan Ashouri, Alexandra R. Paul, Thanh N. Nguyen, A. Castonguay, Mohammad AlMajali, Ahmad Armouti, Raul G Nogueira, Jaafar Kashef Al‐Ghetaa, Joey D. English, H. Farid, K. Asif, Varun Chaubal, Batool Al Masaid, Benedict Tan, E. Lin, Qasem N. Alshaer, Rishi Gupta, C. Martin, Diogo C. Haussen, N. Mueller-Kronast, S. Satti, M. Mokin, Osama O. Zaidat","doi":"10.1161/svin.123.001017","DOIUrl":"https://doi.org/10.1161/svin.123.001017","url":null,"abstract":"\u0000 \u0000 Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and potentially effective, predominantly in the non‐White population. The aim of this study was to identify predictors of good functional outcome in posterior circulation strokes in US population after mechanical thrombectomy from the TRACK (Trevo Stent‐Retriever Acute Stroke) and the NASA (North American Solitaire Stent Retriever Acute Stroke) registries from North America.\u0000 \u0000 \u0000 \u0000 \u0000 Patient‐level data from the TRACK and NASA registries were pooled, and patients with posterior circulation stroke were included in this analysis. Patients were dichotomized into those with 90‐day good functional outcome (modified Rankin scale [mRS] score 0–2) and poor functional outcome (mRS score ≥3). Baseline and procedural data were compared between the 2 cohorts. Multivariate logistic regression was performed to identify predictors of functional outcome.\u0000 P\u0000 < 0.05 was considered significant.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Of 119 posterior stroke patients (99 [83.2%] basilar artery, 16 [13.4%] vertebral artery, and 4 [3.4%] posterior cerebral artery), 110 patients had 90‐day mRS data available on follow‐up. Good functional outcome was observed in 44 patients (40%). Patients with mRS score 0–2 were less likely to have hypertension (61.4% versus 83.3%;\u0000 P\u0000 = 0.01), hyperlipidemia (38.6% versus 62.1%;\u0000 P\u0000 = 0.016), and diabetes (18.2% versus 36.4%;\u0000 P\u0000 = 0.040). Patients with mRS score 0–2 had a lower mean presentation National Institutes of Health Stroke Scale score (15.2±9.95 versus 22.6±9.50;\u0000 P\u0000 < 0.001) and more likelihood of achieving Thrombolysis in Cerebral Infarction 3 (79.5% versus 42.2%;\u0000 P\u0000 < 0.001). There was no difference between 2 cohorts in time to puncture, use of balloon guide catheter, use of general anesthesia, and number of passes. On multivariate analysis, higher presentation National Institutes of Health Stroke Scale and hypertension were associated with worse functional outcomes. Complete recanalization and the receipt of intravenous tissue‐type plasminogen activator were associated with higher odds of achieving good functional outcomes.\u0000 \u0000 \u0000 \u0000 \u0000 In this pooled analysis of the NASA and TRACK registries, patients with posterior circulation stroke achieving good outcomes were more likely to have lower presentation National Institutes of Health Stroke Scale and fewer comorbidities. Use of intravenous tissue‐type plasminogen activator, hypertension, final Thrombolysis in Cerebral Infarction 3, and lower baseline National Institutes of Health Stroke Scale score were independent predictors of functional outcome.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"12 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140450685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huanwen Chen, Uttam K. Bodanapally, M. Colasurdo, Ajay Malhotra, Dheeraj Gandhi
Acute ischemic stroke is a leading cause for neurological disability worldwide, and treatment strategies are rapidly evolving. Patient selection for recanalization therapy and postintervention management relies heavily on diagnostic imaging. In this narrative review, we searched the existing literature for clinical applications of dual‐energy computed tomography for acute ischemic stroke. We summarized the current clinical evidence on the use of dual‐energy computed tomography for identifying early cerebral ischemia, detecting and predicting hemorrhagic transformations, and characterizing clots and stenotic plaques. We also highlight future opportunities for dual‐energy computed tomography to be used to address important diagnostic challenges during acute stroke triage and postintervention management. Dual‐energy computed tomography is a powerful tool that can be used to improve the diagnostic accuracy of ischemia, hemorrhage, and vascular lesions in the context of acute ischemic stroke.
{"title":"Clinical Applications of Dual‐Energy Computed Tomography for Acute Ischemic Stroke","authors":"Huanwen Chen, Uttam K. Bodanapally, M. Colasurdo, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1161/svin.123.001193","DOIUrl":"https://doi.org/10.1161/svin.123.001193","url":null,"abstract":"Acute ischemic stroke is a leading cause for neurological disability worldwide, and treatment strategies are rapidly evolving. Patient selection for recanalization therapy and postintervention management relies heavily on diagnostic imaging. In this narrative review, we searched the existing literature for clinical applications of dual‐energy computed tomography for acute ischemic stroke. We summarized the current clinical evidence on the use of dual‐energy computed tomography for identifying early cerebral ischemia, detecting and predicting hemorrhagic transformations, and characterizing clots and stenotic plaques. We also highlight future opportunities for dual‐energy computed tomography to be used to address important diagnostic challenges during acute stroke triage and postintervention management. Dual‐energy computed tomography is a powerful tool that can be used to improve the diagnostic accuracy of ischemia, hemorrhage, and vascular lesions in the context of acute ischemic stroke.","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"276 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140450958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurointerventional Advances in 2023","authors":"Amol Mehta, Ashutosh P. Jadhav, Sunil A. Sheth","doi":"10.1161/svin.123.001251","DOIUrl":"https://doi.org/10.1161/svin.123.001251","url":null,"abstract":"","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"54 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Umemura, Yuko Tanaka, Toru Kurokawa, Ryo Miyaoka, M. Idei, Hirotsugu Ohta, J. Yamamoto
Endovascular treatment of large ischemic cores is challenging. The severity of ischemic stress is assessed using the apparent diffusion coefficient (ADC). We aimed to evaluate the ADC in patients with a low Alberta Stroke Program Early CT [Computed Tomography] Score using diffusion‐weighted imaging and whether it correlates with clinical outcomes. This study included consecutive patients with acute large ischemic stroke (Alberta Stroke Program Early CT Score‐diffusion‐weighted imaging ≤5) who underwent endovascular treatment with successful recanalization between April 2014 and March 2023. The most frequent ADC (peak ADC) and diffusion‐weighted imaging lesion volumes were assessed. The primary outcome was the 3‐month modified Rankin Scale (mRS) score. Good (mRS score, 0–3) and poor clinical outcomes (mRS score, 4–6) were compared to confirm whether ADC was associated with clinical outcomes. In total, 78 patients were enrolled in this study; 30 had an mRS score of 0 to 3 at 3 months. The peak ADC in these patients was significantly higher than that in patients with mRS scores of 4 to 6 ( P = 0.0002). In multivariate analysis, peak ADC was strongly associated with good clinical outcomes (odds ratio, 1.231; P = 0.0135) rather than onset‐to‐recanalization time and ischemic core volume. The optimal peak ADC threshold for discriminating between the mRS groups was 520×10 −6 mm 2 /s with a sensitivity of 75% and a specificity of 73%. Good clinical outcomes were more frequently observed in patients with peak ADC ≥520×10 −6 mm 2 /s ( P <0.0001). In large ischemic cores, diffusion‐weighted imaging lesions with peak ADCs ≥520×10 −6 mm 2 /s are associated with favorable outcomes. Evaluation of the ischemic core is necessary to confirm endovascular treatment.
{"title":"Evaluation of Large Ischemic Cores to Predict Outcomes of Thrombectomy: A Proposal of a Novel Treatment Phase","authors":"T. Umemura, Yuko Tanaka, Toru Kurokawa, Ryo Miyaoka, M. Idei, Hirotsugu Ohta, J. Yamamoto","doi":"10.1161/svin.123.001293","DOIUrl":"https://doi.org/10.1161/svin.123.001293","url":null,"abstract":"\u0000 \u0000 Endovascular treatment of large ischemic cores is challenging. The severity of ischemic stress is assessed using the apparent diffusion coefficient (ADC). We aimed to evaluate the ADC in patients with a low Alberta Stroke Program Early CT [Computed Tomography] Score using diffusion‐weighted imaging and whether it correlates with clinical outcomes.\u0000 \u0000 \u0000 \u0000 This study included consecutive patients with acute large ischemic stroke (Alberta Stroke Program Early CT Score‐diffusion‐weighted imaging ≤5) who underwent endovascular treatment with successful recanalization between April 2014 and March 2023. The most frequent ADC (peak ADC) and diffusion‐weighted imaging lesion volumes were assessed. The primary outcome was the 3‐month modified Rankin Scale (mRS) score. Good (mRS score, 0–3) and poor clinical outcomes (mRS score, 4–6) were compared to confirm whether ADC was associated with clinical outcomes.\u0000 \u0000 \u0000 \u0000 \u0000 In total, 78 patients were enrolled in this study; 30 had an mRS score of 0 to 3 at 3 months. The peak ADC in these patients was significantly higher than that in patients with mRS scores of 4 to 6 (\u0000 P\u0000 = 0.0002). In multivariate analysis, peak ADC was strongly associated with good clinical outcomes (odds ratio, 1.231;\u0000 P\u0000 = 0.0135) rather than onset‐to‐recanalization time and ischemic core volume. The optimal peak ADC threshold for discriminating between the mRS groups was 520×10\u0000 −6\u0000 mm\u0000 2\u0000 /s with a sensitivity of 75% and a specificity of 73%. Good clinical outcomes were more frequently observed in patients with peak ADC ≥520×10\u0000 −6\u0000 mm\u0000 2\u0000 /s (\u0000 P\u0000 <0.0001).\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 In large ischemic cores, diffusion‐weighted imaging lesions with peak ADCs ≥520×10\u0000 −6\u0000 mm\u0000 2\u0000 /s are associated with favorable outcomes. Evaluation of the ischemic core is necessary to confirm endovascular treatment.\u0000 \u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"30 44","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139962390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Galecio-Castillo, Mahmoud Dibas, Bradley A. Gross, M. Farooqui, O. Algın, Türker Kılıç, Yasin Celal Gunes, C. Feigen, Edgar A. Samaniego, David Altschul, S. Ortega‐Gutierrez
The optimal endovascular approach for acutely ruptured wide‐neck intracranial aneurysms remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks. Various techniques have been developed to address these challenges, including balloon‐assisted coiling (BAC) and intrasaccular flow‐disruption. The Woven EndoBridge (WEB) is an intrasaccular device that has shown a favorable efficacy and safety profile for ruptured aneurysms with minimal rebleeding rates. We aimed to compare the clinical and radiological outcomes between WEB and BAC in a cohort of patients with ruptured wide‐necked intracranial aneurysms. In this international multicenter cohort study, we included consecutive patients treated for ruptured wide‐neck intracranial aneurysms with either WEB or BAC at 4 neurovascular centers. The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow‐up using the Raymond–Roy scale. Secondary outcomes included a composite of periprocedural hemorrhagic/ischemia‐related complications and favorable functional outcome. The study included 104 patients treated with WEB and 107 patients treated with BAC. Of the patients, 60.5% in the WEB group and 53% in the BAC group achieved complete occlusion, with no significant difference between the 2 groups after adjusting for covariates (adjusted odds ratio [OR] = 1.02; 95% CI 0.46–2.25; P = 0.964). The odds of favorable functional outcome did not significantly differ between the WEB (74.8%) and BAC groups (77.4%, adjusted OR = 1.45; 95% CI 0.65–3.24; P = 0.368). Procedure‐related complications were similar in both groups (WEB: 9.6%, BAC: 10.3%, P = 0.872), with no significant difference observed in the rates of ischemic events (WEB: 6.7% versus BAC: 2.8%; P = 0.180) and hemorrhagic events (WEB: 3.8% versus BAC: 7.5%; P = 0.255) between the 2 groups. In conclusion, both WEB and BAC techniques showed similar effectiveness and safety outcomes in treating ruptured wide‐neck intracranial aneurysms. Further prospective comparative studies are needed to better guide treatment decisions for this patient population.
{"title":"Comparison of Angiographic Outcomes of Woven EndoBridge and Balloon‐Assisted Coiling for the Treatment of Ruptured Wide‐Necked Aneurysms: A Multicentric Study","authors":"A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Galecio-Castillo, Mahmoud Dibas, Bradley A. Gross, M. Farooqui, O. Algın, Türker Kılıç, Yasin Celal Gunes, C. Feigen, Edgar A. Samaniego, David Altschul, S. Ortega‐Gutierrez","doi":"10.1161/svin.123.001233","DOIUrl":"https://doi.org/10.1161/svin.123.001233","url":null,"abstract":"\u0000 \u0000 The optimal endovascular approach for acutely ruptured wide‐neck intracranial aneurysms remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks. Various techniques have been developed to address these challenges, including balloon‐assisted coiling (BAC) and intrasaccular flow‐disruption. The Woven EndoBridge (WEB) is an intrasaccular device that has shown a favorable efficacy and safety profile for ruptured aneurysms with minimal rebleeding rates. We aimed to compare the clinical and radiological outcomes between WEB and BAC in a cohort of patients with ruptured wide‐necked intracranial aneurysms.\u0000 \u0000 \u0000 \u0000 In this international multicenter cohort study, we included consecutive patients treated for ruptured wide‐neck intracranial aneurysms with either WEB or BAC at 4 neurovascular centers. The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow‐up using the Raymond–Roy scale. Secondary outcomes included a composite of periprocedural hemorrhagic/ischemia‐related complications and favorable functional outcome.\u0000 \u0000 \u0000 \u0000 \u0000 The study included 104 patients treated with WEB and 107 patients treated with BAC. Of the patients, 60.5% in the WEB group and 53% in the BAC group achieved complete occlusion, with no significant difference between the 2 groups after adjusting for covariates (adjusted odds ratio [OR] = 1.02; 95% CI 0.46–2.25;\u0000 P\u0000 = 0.964). The odds of favorable functional outcome did not significantly differ between the WEB (74.8%) and BAC groups (77.4%, adjusted OR = 1.45; 95% CI 0.65–3.24;\u0000 P\u0000 = 0.368). Procedure‐related complications were similar in both groups (WEB: 9.6%, BAC: 10.3%,\u0000 P\u0000 = 0.872), with no significant difference observed in the rates of ischemic events (WEB: 6.7% versus BAC: 2.8%;\u0000 P\u0000 = 0.180) and hemorrhagic events (WEB: 3.8% versus BAC: 7.5%;\u0000 P\u0000 = 0.255) between the 2 groups.\u0000 \u0000 \u0000 \u0000 \u0000 In conclusion, both WEB and BAC techniques showed similar effectiveness and safety outcomes in treating ruptured wide‐neck intracranial aneurysms. Further prospective comparative studies are needed to better guide treatment decisions for this patient population.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"71 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139774872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Galecio-Castillo, Mahmoud Dibas, Bradley A. Gross, M. Farooqui, O. Algın, Türker Kılıç, Yasin Celal Gunes, C. Feigen, Edgar A. Samaniego, David Altschul, S. Ortega‐Gutierrez
The optimal endovascular approach for acutely ruptured wide‐neck intracranial aneurysms remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks. Various techniques have been developed to address these challenges, including balloon‐assisted coiling (BAC) and intrasaccular flow‐disruption. The Woven EndoBridge (WEB) is an intrasaccular device that has shown a favorable efficacy and safety profile for ruptured aneurysms with minimal rebleeding rates. We aimed to compare the clinical and radiological outcomes between WEB and BAC in a cohort of patients with ruptured wide‐necked intracranial aneurysms. In this international multicenter cohort study, we included consecutive patients treated for ruptured wide‐neck intracranial aneurysms with either WEB or BAC at 4 neurovascular centers. The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow‐up using the Raymond–Roy scale. Secondary outcomes included a composite of periprocedural hemorrhagic/ischemia‐related complications and favorable functional outcome. The study included 104 patients treated with WEB and 107 patients treated with BAC. Of the patients, 60.5% in the WEB group and 53% in the BAC group achieved complete occlusion, with no significant difference between the 2 groups after adjusting for covariates (adjusted odds ratio [OR] = 1.02; 95% CI 0.46–2.25; P = 0.964). The odds of favorable functional outcome did not significantly differ between the WEB (74.8%) and BAC groups (77.4%, adjusted OR = 1.45; 95% CI 0.65–3.24; P = 0.368). Procedure‐related complications were similar in both groups (WEB: 9.6%, BAC: 10.3%, P = 0.872), with no significant difference observed in the rates of ischemic events (WEB: 6.7% versus BAC: 2.8%; P = 0.180) and hemorrhagic events (WEB: 3.8% versus BAC: 7.5%; P = 0.255) between the 2 groups. In conclusion, both WEB and BAC techniques showed similar effectiveness and safety outcomes in treating ruptured wide‐neck intracranial aneurysms. Further prospective comparative studies are needed to better guide treatment decisions for this patient population.
{"title":"Comparison of Angiographic Outcomes of Woven EndoBridge and Balloon‐Assisted Coiling for the Treatment of Ruptured Wide‐Necked Aneurysms: A Multicentric Study","authors":"A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Galecio-Castillo, Mahmoud Dibas, Bradley A. Gross, M. Farooqui, O. Algın, Türker Kılıç, Yasin Celal Gunes, C. Feigen, Edgar A. Samaniego, David Altschul, S. Ortega‐Gutierrez","doi":"10.1161/svin.123.001233","DOIUrl":"https://doi.org/10.1161/svin.123.001233","url":null,"abstract":"\u0000 \u0000 The optimal endovascular approach for acutely ruptured wide‐neck intracranial aneurysms remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks. Various techniques have been developed to address these challenges, including balloon‐assisted coiling (BAC) and intrasaccular flow‐disruption. The Woven EndoBridge (WEB) is an intrasaccular device that has shown a favorable efficacy and safety profile for ruptured aneurysms with minimal rebleeding rates. We aimed to compare the clinical and radiological outcomes between WEB and BAC in a cohort of patients with ruptured wide‐necked intracranial aneurysms.\u0000 \u0000 \u0000 \u0000 In this international multicenter cohort study, we included consecutive patients treated for ruptured wide‐neck intracranial aneurysms with either WEB or BAC at 4 neurovascular centers. The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow‐up using the Raymond–Roy scale. Secondary outcomes included a composite of periprocedural hemorrhagic/ischemia‐related complications and favorable functional outcome.\u0000 \u0000 \u0000 \u0000 \u0000 The study included 104 patients treated with WEB and 107 patients treated with BAC. Of the patients, 60.5% in the WEB group and 53% in the BAC group achieved complete occlusion, with no significant difference between the 2 groups after adjusting for covariates (adjusted odds ratio [OR] = 1.02; 95% CI 0.46–2.25;\u0000 P\u0000 = 0.964). The odds of favorable functional outcome did not significantly differ between the WEB (74.8%) and BAC groups (77.4%, adjusted OR = 1.45; 95% CI 0.65–3.24;\u0000 P\u0000 = 0.368). Procedure‐related complications were similar in both groups (WEB: 9.6%, BAC: 10.3%,\u0000 P\u0000 = 0.872), with no significant difference observed in the rates of ischemic events (WEB: 6.7% versus BAC: 2.8%;\u0000 P\u0000 = 0.180) and hemorrhagic events (WEB: 3.8% versus BAC: 7.5%;\u0000 P\u0000 = 0.255) between the 2 groups.\u0000 \u0000 \u0000 \u0000 \u0000 In conclusion, both WEB and BAC techniques showed similar effectiveness and safety outcomes in treating ruptured wide‐neck intracranial aneurysms. Further prospective comparative studies are needed to better guide treatment decisions for this patient population.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"345 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139834598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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