Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) and intracerebral hemorrhage (ICH) are main forms of hemorrhagic stroke. Data regarding cerebral small vessel disease (SVD) burden and incidental small lesions on diffusion-weighted imaging (DWI) following aSAH are sparse.
Patients and methods: We retrospectively analyzed a prospective cohort of aSAH and ICH patients with brain MRI within 30 days after onset from March 2015 to January 2023. White matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed (CMB), total SVD score, and incidental DWI lesions were assessed and compared between aSAH and ICH. Clinical and radiological characteristics associated with small DWI lesions in aSAH were investigated.
Results: We included 180 patients with aSAH (median age [IQR] 53 [47-61] years) and 299 with ICH (63 [53-73] years). DWI lesions were more common in aSAH than ICH (47.8% vs 14.4%, p < 0.001). Higher total SVD score was associated with ICH versus aSAH irrespective of hematoma location, whereas DWI lesions and strictly lobar CMBs were correlated with aSAH. Multivariable analysis showed that shorter time from onset to MRI, anterior circulation aneurysm rupture, CMB ⩾ 5, and total SVD score were associated with DWI lesions in aSAH.
Discussion and conclusion: Incidental DWI lesions and strictly lobar CMBs were more frequent in aSAH versus ICH whereas ICH had higher SVD burden. Incidental DWI lesions in aSAH were associated with multiple clinical and imaging factors. Longitudinal studies to investigate the dynamic change and prognostic value of the covert hemorrhagic and ischemic lesions in aSAH seem justified.
导言:动脉瘤性蛛网膜下腔出血(aSAH)和脑内出血(ICH)是出血性卒中的主要形式。有关蛛网膜下腔出血后脑小血管疾病(SVD)负担和弥散加权成像(DWI)中偶然出现的小病灶的数据非常稀少:我们对2015年3月至2023年1月期间发病后30天内进行脑磁共振成像的前瞻性队列中的aSAH和ICH患者进行了回顾性分析。我们评估了白质高密度(WMH)、裂隙、血管周围间隙、脑微出血(CMB)、SVD 总分和附带 DWI 病变,并对 aSAH 和 ICH 进行了比较。结果:我们共纳入了180例ASAH患者:我们纳入了 180 名 aSAH 患者(中位年龄 [IQR] 53 [47-61] 岁)和 299 名 ICH 患者(63 [53-73] 岁)。与 ICH 相比,DWI 病变在 aSAH 中更为常见(47.8% 对 14.4%,P 讨论和结论:aSAH 与 ICH 相比,偶发 DWI 病变和严格意义上的叶状 CMB 更为常见,而 ICH 的 SVD 负荷更高。aSAH 中的偶发 DWI 病变与多种临床和影像学因素有关。似乎有必要进行纵向研究,以探讨隐匿性出血性和缺血性病变在 aSAH 中的动态变化和预后价值。
{"title":"Prevalence of small vessel disease and incidental DWI-positive lesions in patients with aneurysmal subarachnoid hemorrhage versus intracerebral hemorrhage.","authors":"Zi-Jie Wang, Xiao Hu, Yan-Fang Xie, Wen-Jun Yao, Lan Deng, Zuo-Qiao Li, Ming-Jun Pu, Xin-Ni Lv, Zi-Cheng Hu, Jiang-Tao Zhang, Qi Li","doi":"10.1177/23969873241232327","DOIUrl":"10.1177/23969873241232327","url":null,"abstract":"<p><strong>Introduction: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) and intracerebral hemorrhage (ICH) are main forms of hemorrhagic stroke. Data regarding cerebral small vessel disease (SVD) burden and incidental small lesions on diffusion-weighted imaging (DWI) following aSAH are sparse.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed a prospective cohort of aSAH and ICH patients with brain MRI within 30 days after onset from March 2015 to January 2023. White matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed (CMB), total SVD score, and incidental DWI lesions were assessed and compared between aSAH and ICH. Clinical and radiological characteristics associated with small DWI lesions in aSAH were investigated.</p><p><strong>Results: </strong>We included 180 patients with aSAH (median age [IQR] 53 [47-61] years) and 299 with ICH (63 [53-73] years). DWI lesions were more common in aSAH than ICH (47.8% vs 14.4%, <i>p</i> < 0.001). Higher total SVD score was associated with ICH versus aSAH irrespective of hematoma location, whereas DWI lesions and strictly lobar CMBs were correlated with aSAH. Multivariable analysis showed that shorter time from onset to MRI, anterior circulation aneurysm rupture, CMB ⩾ 5, and total SVD score were associated with DWI lesions in aSAH.</p><p><strong>Discussion and conclusion: </strong>Incidental DWI lesions and strictly lobar CMBs were more frequent in aSAH versus ICH whereas ICH had higher SVD burden. Incidental DWI lesions in aSAH were associated with multiple clinical and imaging factors. Longitudinal studies to investigate the dynamic change and prognostic value of the covert hemorrhagic and ischemic lesions in aSAH seem justified.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"639-647"},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1177/23969873241276357
Maurizio Acampa, Pietro Enea Lazzerini
{"title":"Searching for biomarkers of atrial cardiomyopathy at high risk of cardioembolism: What are the missing pieces of the puzzle?","authors":"Maurizio Acampa, Pietro Enea Lazzerini","doi":"10.1177/23969873241276357","DOIUrl":"10.1177/23969873241276357","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241276357"},"PeriodicalIF":5.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1177/23969873241276358
Hooman Kamel, Mitchell Sv Elkind, Richard A Kronmal, W T Longstreth, Pamela Plummer, Rebeca Aragon Garcia, Joseph P Broderick, Qi Pauls, Jordan J Elm, Fadi Nahab, L Scott Janis, Marco R Di Tullio, Elsayed Z Soliman, Jeff S Healey, David L Tirschwell
Background: ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.
Methods: Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V1 (PTFV1), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m2. For this analysis, the outcome was AF detected per routine care.
Results: Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13), PTFV1 (RR per SD, 1.15; 95% CI, 1.03-1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20-1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09-1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67-2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14-1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79-0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF.
Conclusions: Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.
背景ARCADIA 比较了阿哌沙班和阿司匹林对隐源性卒中和心房性心脏病患者进行卒中二级预防的效果。中性结果的一个可能原因是所使用的生物标志物不能最佳地识别心房性心脏病。我们研究了生物标志物水平与随后发现房颤(心房颤动的标志)之间的关系:如果患者符合心房性心脏病的标准,即心电图 V1 导联(PTFV1)P 波终末力>5000 μV*ms、NT-proBNP>250 pg/mL,或左心房直径指数(LADI)⩾3 cm/m2,则对其进行随机分组。本次分析的结果是在常规护理中发现房颤:在 3745 名同意接受心房病变筛查的患者中,有 254 人随后被确诊为房颤;其中 96 人在接受随机化之前,158 人在接受随机化之后。在未经调整的分析中,ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13)、PTFV1 (RR per SD, 1.15; 95% CI, 1.03-1.28)和 LADI (RR per SD, 1.34; 95% CI, 1.20-1.50)与房颤相关。在包含所有三种生物标志物、人口统计学特征和房颤风险因素的模型中,年龄(每 10 年的 RR 值为 1.24;95% CI 为 1.09-1.41)、ln(NT-proBNP)(每 SD 的 RR 值为 1.88;95% CI 为 1.67-2.11)和 LADI(每 SD 的 RR 值为 1.25;95% CI 为 1.14-1.37)与房颤相关。这三个变量加在一起的 c 统计量为 0.82(95% CI,0.79-0.85),但校准度不高。在对符合随机化条件的患者进行的敏感性分析中,对房颤进行更密切随访的识别率有所降低:结论:在 ARCADIA 中用于识别房颤的生物标志物对后续房颤有一定的预测作用。
{"title":"Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial.","authors":"Hooman Kamel, Mitchell Sv Elkind, Richard A Kronmal, W T Longstreth, Pamela Plummer, Rebeca Aragon Garcia, Joseph P Broderick, Qi Pauls, Jordan J Elm, Fadi Nahab, L Scott Janis, Marco R Di Tullio, Elsayed Z Soliman, Jeff S Healey, David L Tirschwell","doi":"10.1177/23969873241276358","DOIUrl":"10.1177/23969873241276358","url":null,"abstract":"<p><strong>Background: </strong>ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.</p><p><strong>Methods: </strong>Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V<sub>1</sub> (PTFV<sub>1</sub>), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m<sup>2</sup>. For this analysis, the outcome was AF detected per routine care.</p><p><strong>Results: </strong>Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13), PTFV<sub>1</sub> (RR per SD, 1.15; 95% CI, 1.03-1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20-1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09-1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67-2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14-1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79-0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF.</p><p><strong>Conclusions: </strong>Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241276358"},"PeriodicalIF":5.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia.
Patients and methods: We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC.
Results: There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome.
Discussion and conclusion: Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.
导言:制定有效的中风预防策略对于老年心房颤动 (AF) 痴呆患者至关重要。这是因为这方面的证据有限且不一致。在这项基于人群的全国性队列研究中,我们旨在比较直接口服抗凝药(DOACs)和华法林对老年痴呆房颤患者的有效性和安全性:我们从 2010 年至 2019 年期间的台湾国民健康保险研究数据库中识别了 50 岁或以上的房颤痴呆患者。主要结果是缺血性中风、急性心肌梗死、颅内出血或大出血导致的住院治疗以及全因死亡率的复合结果。在比较华法林和DOAC(阿哌沙班、达比加群、依度沙班或利伐沙班)使用者之间或华法林和每种DOAC使用者之间的结果时,我们使用了1:1倾向得分匹配和Cox比例危险模型来调整混杂因素:DOAC与华法林匹配队列中有2952名患者。阿哌沙班、达比加群、依度沙班和利伐沙班-华法林匹配队列分别有 2346、2554、1684 和 2938 名患者。与华法林相比,DOAC组发生复合结局(危险比(HR)0.81;95% 置信区间(CI)0.69-0.95)和缺血性卒中(HR 0.65;95% CI 0.48-0.87)的风险较低。阿哌沙班(HR 0.79;95% CI 0.66-0.94)、达比加群(HR 0.64;95% CI 0.53-0.77)和利伐沙班(HR 0.82;95% CI 0.70-0.97)也与较低的综合结果风险相关:与华法林相比,DOACs(无论是作为一组药物还是阿哌沙班、达比加群或利伐沙班单独使用)与并发房颤和痴呆的老年患者的综合结局风险降低相关。
{"title":"Comparative effectiveness and safety of direct oral anticoagulants and warfarin in atrial fibrillation patients with dementia.","authors":"Chen-Wen Fang, Cheng-Yang Hsieh, Hsin-Yi Yang, Ching-Fang Tsai, Sheng-Feng Sung","doi":"10.1177/23969873241274598","DOIUrl":"10.1177/23969873241274598","url":null,"abstract":"<p><strong>Introduction: </strong>Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia.</p><p><strong>Patients and methods: </strong>We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC.</p><p><strong>Results: </strong>There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome.</p><p><strong>Discussion and conclusion: </strong>Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241274598"},"PeriodicalIF":5.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1177/23969873241274512
Anna Andriana Kyselyova, Caspar Brekenfeld, Lucas Meyer, Helena Guerreiro, Gabriel Broocks, Susan Klapproth, Tobias Faizy, Christian Heitkamp, Malte Issleib, Jens Fiehler, Fabian Flottmann
Introduction: Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy.
Patients and methods: Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b.
Results: Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, p = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; p < 0.001). No diastolic pressure changes were significant.
Discussion and conclusions: Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.
导言:大血管闭塞患者的血压管理会影响梗死面积和临床预后。我们研究了在机械血栓切除术中恢复血流如何影响全身血压:筛选了 2016 年 6 月至 2018 年 1 月间接受机械血栓切除术的前循环大血管闭塞患者。我们纳入了在局部麻醉或有意识镇静下接受治疗的患者,并分析了标准化麻醉方案,以评估整个手术过程中的收缩压和舒张压水平。主要结果是血压的变化,比较最后一次再灌注尝试前 5 分钟和尝试后 5 分钟的血压变化。脑梗塞溶栓评分⩾ 2b 定义为再灌注成功:134例患者中,117例(87%)血管再灌注成功,血流恢复后5分钟收缩压明显下降(10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg,p = 0.009)。在多变量逻辑回归中,血管再灌注成功是导致血压下降的重要预测因素:OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299)。在 66 名未服用影响循环药物的患者中,也观察到收缩压显著降低(从 155 ± 17 mm Hg 降至 148 ± 17 mm Hg;p 讨论和结论:在局部麻醉或有意识镇静状态下接受机械再通术的患者,血流恢复与收缩压值的立即降低有关。这表明血管内卒中治疗与心血管血流动力学之间存在复杂的相互作用。
{"title":"Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure.","authors":"Anna Andriana Kyselyova, Caspar Brekenfeld, Lucas Meyer, Helena Guerreiro, Gabriel Broocks, Susan Klapproth, Tobias Faizy, Christian Heitkamp, Malte Issleib, Jens Fiehler, Fabian Flottmann","doi":"10.1177/23969873241274512","DOIUrl":"10.1177/23969873241274512","url":null,"abstract":"<p><strong>Introduction: </strong>Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy.</p><p><strong>Patients and methods: </strong>Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b.</p><p><strong>Results: </strong>Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, <i>p</i> = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, <i>p</i> = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; <i>p</i> < 0.001). No diastolic pressure changes were significant.</p><p><strong>Discussion and conclusions: </strong>Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241274512"},"PeriodicalIF":5.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1177/23969873241272744
Jasmin Helbach, Falk Hoffmann, Nina Hecht, Christoph Heesen, Götz Thomalla, Denise Wilfling, Anne Christin Rahn
Purpose: We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention.
Methods: In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews.
Findings: We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early.
Conclusion: PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.
{"title":"Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review.","authors":"Jasmin Helbach, Falk Hoffmann, Nina Hecht, Christoph Heesen, Götz Thomalla, Denise Wilfling, Anne Christin Rahn","doi":"10.1177/23969873241272744","DOIUrl":"10.1177/23969873241272744","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention.</p><p><strong>Methods: </strong>In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews.</p><p><strong>Findings: </strong>We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early.</p><p><strong>Conclusion: </strong>PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272744"},"PeriodicalIF":5.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1177/23969873241272507
Damjan Mirkov, Ekkehart Jenetzky, Andrea S Thieme, Adeeb Qabalan, Christoph Gumbinger, Wolfgang Wick, Peter A Ringleb, Timolaos Rizos
Introduction: Patients with acute ischemic stroke (AIS) and large-vessel occlusion are frequently transferred by emergency physicians (EPs) from primary to comprehensive stroke centers (CSC) for thrombectomy, particular when thrombolysed. Data on complications during such transfers are highly limited.
Patients and methods: Consecutive AIS patients transferred between 01/2015 and 10/2021 to our CSC were included. Associations of major (MACO) and minor (MICO) complications with clinical and imaging data were assessed.
Results: In total, 985 patients were included in the analysis (58.5% thrombolysed). MACO developed in 1.6%, MICO in 14.6%. Compared to patients without complications (NOCO), patients with MACO did not differ in terms of demographics, cerebrovascular risk factors, or site of vessel occlusion. They had more severe strokes (p = 0.026), neurological worsening was more severe (p = 0.008), and transport duration was longer (p = 0.050) but geographical distances did not differ. Thrombolysed patients had any complication more often than patients without thrombolysis (20.3% vs 10.5%; p< 0.001); however, this finding was driven by patients with MICO (p< 0.001) only (MACO: p = 0.804). No associations were observed between stroke severity and complications in either thrombolysed or nonthrombolysed patients. Neurological deterioration during transfer was observed in 21.2%, but multivariate analysis revealed no association with thrombolysis (OR 0.962; 95%CI 0.670-1.380, p = 0.832). Asymptomatic intracerebral hemorrhage was present in 1.1%, symptomatic in 0.1%.
Discussion and conclusion: In this large cohort, no patient-specific factor increasing the risk of complications during interhospital transfer was identified. Specifically, our results do not indicate that thrombolysis increases MACO. Hence, interhospital transfer without EPs appears reasonable in most patients.
{"title":"Medical complications during interhospital transfer for thrombectomy in patients with acute ischemic stroke.","authors":"Damjan Mirkov, Ekkehart Jenetzky, Andrea S Thieme, Adeeb Qabalan, Christoph Gumbinger, Wolfgang Wick, Peter A Ringleb, Timolaos Rizos","doi":"10.1177/23969873241272507","DOIUrl":"10.1177/23969873241272507","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with acute ischemic stroke (AIS) and large-vessel occlusion are frequently transferred by emergency physicians (EPs) from primary to comprehensive stroke centers (CSC) for thrombectomy, particular when thrombolysed. Data on complications during such transfers are highly limited.</p><p><strong>Patients and methods: </strong>Consecutive AIS patients transferred between 01/2015 and 10/2021 to our CSC were included. Associations of major (MACO) and minor (MICO) complications with clinical and imaging data were assessed.</p><p><strong>Results: </strong>In total, 985 patients were included in the analysis (58.5% thrombolysed). MACO developed in 1.6%, MICO in 14.6%. Compared to patients without complications (NOCO), patients with MACO did not differ in terms of demographics, cerebrovascular risk factors, or site of vessel occlusion. They had more severe strokes (<i>p</i> = 0.026), neurological worsening was more severe (<i>p</i> = 0.008), and transport duration was longer (<i>p</i> = 0.050) but geographical distances did not differ. Thrombolysed patients had any complication more often than patients without thrombolysis (20.3% vs 10.5%; <i>p</i> <i><</i> 0.001); however, this finding was driven by patients with MICO (<i>p</i> <i><</i> 0.001) only (MACO: <i>p</i> = 0.804). No associations were observed between stroke severity and complications in either thrombolysed or nonthrombolysed patients. Neurological deterioration during transfer was observed in 21.2%, but multivariate analysis revealed no association with thrombolysis (OR 0.962; 95%CI 0.670-1.380, <i>p</i> = 0.832). Asymptomatic intracerebral hemorrhage was present in 1.1%, symptomatic in 0.1%.</p><p><strong>Discussion and conclusion: </strong>In this large cohort, no patient-specific factor increasing the risk of complications during interhospital transfer was identified. Specifically, our results do not indicate that thrombolysis increases MACO. Hence, interhospital transfer without EPs appears reasonable in most patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272507"},"PeriodicalIF":5.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1177/23969873241272542
Victor Schulze-Zachau, Nikki Rommers, Nikolaos Ntoulias, Alex Brehm, Nadja Krug, Ioannis Tsogkas, Matthias Mutke, Thilo Rusche, Amedeo Cervo, Claudia Rollo, Markus Möhlenbruch, Jessica Jesser, Kornelia Kreiser, Katharina Althaus, Manuel Requena, Marc Rodrigo-Gisbert, Tomas Dobrocky, Bettina L Serrallach, Christian H Nolte, Christoph Riegler, Jawed Nawabi, Errikos Maslias, Patrik Michel, Guillaume Saliou, Nathan Manning, Alexander McQuinn, Alon Taylor, Christoph J Maurer, Ansgar Berlis, Daniel Po Kaiser, Ani Cuberi, Manuel Moreu, Alfonso López-Frías, Carlos Pérez-García, Riitta Rautio, Ylikotila Pauli, Nicola Limbucci, Leonardo Renieri, Isabel Fragata, Tania Rodriguez-Ares, Jan S Kirschke, Julian Schwarting, Sami Al Kasab, Alejandro M Spiotta, Ahmad Abu Qdais, Adam A Dmytriw, Robert W Regenhardt, Aman B Patel, Vitor Mendes Pereira, Nicole M Cancelliere, Carsten Schmeel, Franziska Dorn, Malte Sauer, Grzegorz M Karwacki, Jane Khalife, Ajith J Thomas, Hamza A Shaikh, Christian Commodaro, Marco Pileggi, Roland Schwab, Flavio Bellante, Anne Dusart, Jeremy Hofmeister, Paolo Machi, Edgar A Samaniego, Diego J Ojeda, Robert M Starke, Ahmed Abdelsalam, Frans van den Bergh, Sylvie De Raedt, Maxim Bester, Fabian Flottmann, Daniel Weiss, Marius Kaschner, Peter T Kan, Gautam Edhayan, Michael R Levitt, Spencer L Raub, Mira Katan, Urs Fischer, Marios-Nikos Psychogios
Introduction: Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.
Patients and methods: In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models.
Results: 459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, p = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, p = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, p = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, p < 0.001).
Discussion and conclusion: Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.
{"title":"\"Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis\".","authors":"Victor Schulze-Zachau, Nikki Rommers, Nikolaos Ntoulias, Alex Brehm, Nadja Krug, Ioannis Tsogkas, Matthias Mutke, Thilo Rusche, Amedeo Cervo, Claudia Rollo, Markus Möhlenbruch, Jessica Jesser, Kornelia Kreiser, Katharina Althaus, Manuel Requena, Marc Rodrigo-Gisbert, Tomas Dobrocky, Bettina L Serrallach, Christian H Nolte, Christoph Riegler, Jawed Nawabi, Errikos Maslias, Patrik Michel, Guillaume Saliou, Nathan Manning, Alexander McQuinn, Alon Taylor, Christoph J Maurer, Ansgar Berlis, Daniel Po Kaiser, Ani Cuberi, Manuel Moreu, Alfonso López-Frías, Carlos Pérez-García, Riitta Rautio, Ylikotila Pauli, Nicola Limbucci, Leonardo Renieri, Isabel Fragata, Tania Rodriguez-Ares, Jan S Kirschke, Julian Schwarting, Sami Al Kasab, Alejandro M Spiotta, Ahmad Abu Qdais, Adam A Dmytriw, Robert W Regenhardt, Aman B Patel, Vitor Mendes Pereira, Nicole M Cancelliere, Carsten Schmeel, Franziska Dorn, Malte Sauer, Grzegorz M Karwacki, Jane Khalife, Ajith J Thomas, Hamza A Shaikh, Christian Commodaro, Marco Pileggi, Roland Schwab, Flavio Bellante, Anne Dusart, Jeremy Hofmeister, Paolo Machi, Edgar A Samaniego, Diego J Ojeda, Robert M Starke, Ahmed Abdelsalam, Frans van den Bergh, Sylvie De Raedt, Maxim Bester, Fabian Flottmann, Daniel Weiss, Marius Kaschner, Peter T Kan, Gautam Edhayan, Michael R Levitt, Spencer L Raub, Mira Katan, Urs Fischer, Marios-Nikos Psychogios","doi":"10.1177/23969873241272542","DOIUrl":"10.1177/23969873241272542","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.</p><p><strong>Patients and methods: </strong>In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models.</p><p><strong>Results: </strong>459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, <i>p</i> = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, <i>p</i> = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, <i>p</i> = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, <i>p</i> < 0.001).</p><p><strong>Discussion and conclusion: </strong>Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272542"},"PeriodicalIF":5.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1177/23969873241272631
Isuru Induruwa, Shiv Bhakta, Rahul Herlekar, Akangsha Sur Roy, Saur Hajiev, Elizabeth A Warburton, Kayvan Khadjooi, John J McCabe
Introduction: Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients.
Patients and methods: We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms.
Results: 583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank p = 0.03).
Discussion and conclusion: These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.
{"title":"Recurrent vascular events and mortality outcomes in patients with known atrial fibrillation, compared to atrial fibrillation detected early after stroke.","authors":"Isuru Induruwa, Shiv Bhakta, Rahul Herlekar, Akangsha Sur Roy, Saur Hajiev, Elizabeth A Warburton, Kayvan Khadjooi, John J McCabe","doi":"10.1177/23969873241272631","DOIUrl":"10.1177/23969873241272631","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients.</p><p><strong>Patients and methods: </strong>We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms.</p><p><strong>Results: </strong>583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank <i>p</i> = 0.03).</p><p><strong>Discussion and conclusion: </strong>These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272631"},"PeriodicalIF":5.8,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1177/23969873241272517
Ghil Schwarz, Angelo Cascio Rizzo, Marius Matusevicius, Tiago Moreira, Aleksandras Vilionskis, Andrea Naldi, Nicolas Martinez-Majander, Guido Bigliardi, Danilo Toni, Christine Roffe, Elio Clemente Agostoni, Niaz Ahmed
Introduction: Endovascular treatment (EVT) improves outcomes for basilar artery occlusion (BAO) with moderate-to-severe symptoms. However, the best treatment for mild symptoms (NIHSS score 0-10 and 0-5) remains unclear. This study compared EVT ± IVT to IVT alone in BAO patients with mild symptoms.
Patients and methods: From the SITS-International Stroke Treatment Register, we included BAO patients with available baseline NIHSS score, treated by EVT, IVT, or both within 6 h of symptom onset from 2013 to 2021. Using the Doubly Robust approach (propensity score matching plus multivariable logistic regression), we analyzed efficacy (3-month mRS) and safety (SICH and 3-month death) outcomes for EVT ± IVT versus IVT alone in BAO patients with NIHSS scores 0-10 and 0-5.
Results: 1426 patients were included. For NIHSS scores 0-10 (180 matched, 1:1 ratio), outcomes were similar between EVT ± IVT and IVT alone groups. For NIHSS scores 0-5 (89 matched, 1:1 ratio), EVT ± IVT was associated with worse outcomes compared to IVT alone (mRS 0-2, aOR 0.20 [95% CI 0.06-0.61]; p = 0.005; mRS 0-3, aOR 0.27 [95% CI 0.08-0.89]; p = 0.031), but safety outcomes were similar.
Discussion: In early-treated BAO patients with mild symptoms, defined as NIHSS 0-10, there were no significant differences in outcomes between EVT ± IVT and IVT alone. However, for very mild symptoms, defined as NIHSS 0-5, IVT alone was associated with better outcomes compared to EVT ± IVT.Conclusion: Randomized trials are crucial to determine the optimal reperfusion therapy for BAO patients with mild symptoms.
{"title":"Reperfusion treatment in basilar artery occlusion presenting with mild symptoms.","authors":"Ghil Schwarz, Angelo Cascio Rizzo, Marius Matusevicius, Tiago Moreira, Aleksandras Vilionskis, Andrea Naldi, Nicolas Martinez-Majander, Guido Bigliardi, Danilo Toni, Christine Roffe, Elio Clemente Agostoni, Niaz Ahmed","doi":"10.1177/23969873241272517","DOIUrl":"10.1177/23969873241272517","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular treatment (EVT) improves outcomes for basilar artery occlusion (BAO) with moderate-to-severe symptoms. However, the best treatment for mild symptoms (NIHSS score 0-10 and 0-5) remains unclear. This study compared EVT ± IVT to IVT alone in BAO patients with mild symptoms.</p><p><strong>Patients and methods: </strong>From the SITS-International Stroke Treatment Register, we included BAO patients with available baseline NIHSS score, treated by EVT, IVT, or both within 6 h of symptom onset from 2013 to 2021. Using the Doubly Robust approach (propensity score matching plus multivariable logistic regression), we analyzed efficacy (3-month mRS) and safety (SICH and 3-month death) outcomes for EVT ± IVT versus IVT alone in BAO patients with NIHSS scores 0-10 and 0-5.</p><p><strong>Results: </strong>1426 patients were included. For NIHSS scores 0-10 (180 matched, 1:1 ratio), outcomes were similar between EVT ± IVT and IVT alone groups. For NIHSS scores 0-5 (89 matched, 1:1 ratio), EVT ± IVT was associated with worse outcomes compared to IVT alone (mRS 0-2, aOR 0.20 [95% CI 0.06-0.61]; <i>p</i> = 0.005; mRS 0-3, aOR 0.27 [95% CI 0.08-0.89]; <i>p</i> = 0.031), but safety outcomes were similar.</p><p><strong>Discussion: </strong>In early-treated BAO patients with mild symptoms, defined as NIHSS 0-10, there were no significant differences in outcomes between EVT ± IVT and IVT alone. However, for very mild symptoms, defined as NIHSS 0-5, IVT alone was associated with better outcomes compared to EVT ± IVT.<b>Conclusion:</b> Randomized trials are crucial to determine the optimal reperfusion therapy for BAO patients with mild symptoms.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272517"},"PeriodicalIF":5.8,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}