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Does an allied health transdisciplinary stroke assessment save time, improve quality of care, and save costs? Results of a pre-/post- clinical study. 专职医疗跨学科卒中评估是否能节省时间、提高护理质量并节约成本?一项前后临床研究的结果。
IF 6.1 3区 医学 Q1 Medicine Pub Date : 2024-06-10 DOI: 10.1177/23969873241258000
Aleysha K Martin, Alison Griffin, Alexandra L McCarthy, Theresa L Green, P Marcin Sowa, E-Liisa Laakso

Purpose: Demand for stroke services is increasing. To save time and costs, stroke care could be reorganised using a transdisciplinary assessment model embracing overlapping allied health professional skills. The study compares transdisciplinary assessment to discipline-specific allied health assessment on an acute stroke unit, by evaluating assessment time, quality of care, and cost implications.

Method: The pre-/post- clinical study used non-randomised groups and 3-month follow-up after hospital admission. Patients with confirmed/suspected stroke received usual discipline-specific allied health assessment (pre-implementation phase) or the novel transdisciplinary assessment (post-implementation phase). Staff/student assessment times (primary outcome) and medical record data (secondary outcomes) were collected. Time differences were estimated using multivariable linear regression controlling for confounding factors. Cost minimisation and sensitivity analyses estimated change in hospital resource use.

Findings: When the transdisciplinary assessment was used (N = 116), compared to usual assessment (N = 63), the average time saving was 37.6 min (95% CI -47.5, -27.7; p < 0.001) for staff and 62.2 min (95% CI -74.1, -50.3; p < 0.001) for students. The median number of allied health occasions of service reduced from 8 (interquartile range 4-23) to 5 (interquartile range 3-10; p = 0.011). There were no statistically significant or clinically important changes in patient safety, outcomes or stroke guideline adherence. Improved efficiency was associated with an estimated cost saving of $379.45 per patient (probabilistic 95% CI -487.15, -271.48).

Discussion and conclusion: Transdisciplinary stroke assessment has potential for reorganising allied health services to save assessment time and reduce healthcare costs. The transdisciplinary stroke assessment could be considered for implementation in other stroke services.

目的:对中风服务的需求与日俱增。为节省时间和成本,可采用跨学科评估模式对中风护理进行重组,该模式包含重叠的专职医疗人员技能。本研究通过评估评估时间、护理质量和成本影响,对急性中风病房的跨学科评估和特定学科的专职医疗评估进行了比较:临床前/后研究采用非随机分组,入院后进行为期 3 个月的随访。确诊/疑似中风患者接受常规学科专职医疗评估(实施前阶段)或新型跨学科评估(实施后阶段)。收集了工作人员/学生的评估时间(主要结果)和病历数据(次要结果)。使用多变量线性回归对时间差异进行估计,并对混杂因素进行控制。成本最小化和敏感性分析估计了医院资源使用的变化:采用跨学科评估(N = 116)与常规评估(N = 63)相比,平均节约时间 37.6 分钟(95% CI -47.5, -27.7;p p = 0.011)。在患者安全、疗效或卒中指南依从性方面没有统计学意义或临床意义上的重要变化。效率的提高与每名患者节省成本 379.45 美元有关(概率 95% CI -487.15, -271.48):跨学科卒中评估具有重组专职医疗服务以节省评估时间和降低医疗成本的潜力。跨学科卒中评估可考虑在其他卒中服务中实施。
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引用次数: 0
Intravenous tenecteplase for acute ischemic stroke between 4.5 and 6 h of onset (EXIT-BT2): Rationale and Design. 静脉注射替奈普酶治疗发病 4.5 至 6 小时的急性缺血性脑卒中(EXIT-BT2):原理与设计。
IF 6.1 3区 医学 Q1 Medicine Pub Date : 2024-06-10 DOI: 10.1177/23969873241258058
Yi-Han Wang, Zhen-Ni Guo, Ming-Rui Chen, Zhi-Guo Yao, Thanh N Nguyen, Jeffrey L Saver, Yi Yang, Hui-Sheng Chen

Rationale: To date, the benefit of intravenous thrombolysis for acute ischemic stroke (AIS) patients without advanced neuroimaging selection is confined to within 4.5 h of onset. Our phase II EXIT-BT (Extending the tIme window of Thrombolysis by ButylphThalide up to 6 h after onset) trial suggested the safety, feasibility, and potential benefit of intravenous tenecteplase (TNK) in AIS between 4.5 and 6 h of onset. The EXIT-BT2 trial is a pivotal study undertaken to confirm or refute this signal.

Aim: To investigate the efficacy and safety of TNK for AIS between 4.5 and 6 h of onset with or without endovascular treatment.

Sample size estimates: A maximum of 1440 patients are required to test the superiority hypothesis with 80% power according to a two-sided 0.05 level of significance, stratified by age, sex, history of diabetes, location of vessel occlusion, baseline National Institute of Health stroke scale score, stroke etiology, and plan for endovascular treatment.

Design: EXIT-BT2 is a prospective, randomized, open-label, blinded assessment of endpoint (PROBE), and multi-center study. Eligible AIS patients between 4.5 and 6 h of onset are randomly assigned 1:1 into a TNK group or control group. The TNK group will receive TNK (0.25 mg/kg, a single bolus over 5-10 s, maximum 25 mg). The control group will receive standard medical care in compliance with national guidelines for acute ischemic stroke. Both groups will receive standard stroke care from randomization to 90 days after stroke onset according to national guidelines.

Outcome: The primary efficacy endpoint is excellent functional outcome, defined as a modified Rankin Scale score 0-1 at 90 days after randomization, while the primary safety endpoint is symptomatic intracerebral hemorrhage, defined as National Institutes of Health Stroke Scale score increase ⩾4 caused by intracranial hemorrhage within 24 (-6/+12) h after randomization.

Conclusions: The results of EXIT-BT2 may determine whether intravenous TNK has a favorable risk/benefit profile in AIS between 4.5 and 6 h of onset.

理由:迄今为止,静脉溶栓治疗急性缺血性卒中(AIS)患者的获益时间仅限于发病后 4.5 小时内,且未进行晚期神经影像学选择。我们的 EXIT-BT(将丁酰苯胺溶栓的时间窗延长至发病后 6 小时)II 期试验表明,静脉注射替奈普酶 (TNK) 对发病后 4.5 到 6 小时之间的 AIS 具有安全性、可行性和潜在益处。EXIT-BT2试验是一项关键性研究,旨在证实或反驳这一信号。目的:研究TNK治疗发病4.5至6小时之间的AIS的有效性和安全性,无论是否进行血管内治疗:样本量估计:根据年龄、性别、糖尿病史、血管闭塞位置、美国国立卫生研究院卒中量表基线评分、卒中病因和血管内治疗计划进行分层,最多需要1440名患者,以80%的力量检验优越性假设:EXIT-BT2是一项前瞻性、随机、开放标签、终点盲法评估(PROBE)的多中心研究。符合条件的发病时间在4.5到6小时之间的AIS患者将按1:1的比例随机分配到TNK组或对照组。TNK 组将接受 TNK 治疗(0.25 毫克/千克,5-10 秒内单次注射,最多 25 毫克)。对照组将接受符合国家急性缺血性中风指南的标准医疗护理。从随机分组到中风发作后 90 天内,两组都将接受符合国家指南的标准中风治疗:主要疗效终点是极佳的功能预后,定义为随机分组后 90 天的改良 Rankin 量表评分为 0-1;主要安全性终点是无症状性脑出血,定义为随机分组后 24 (-6/+12) h 内因颅内出血导致的美国国立卫生研究院卒中量表评分上升⩾4:EXIT-BT2的结果可确定静脉注射TNK对发病4.5至6小时之间的AIS是否具有有利的风险/收益特征。
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引用次数: 0
Enhancement of STroke REhabilitation with Levodopa (ESTREL): Rationale and design of a randomized placebo-controlled, double blind superiority trial. 左旋多巴促进脑卒中康复(ESTREL):随机安慰剂对照双盲优效试验的原理与设计。
IF 6.1 3区 医学 Q1 Medicine Pub Date : 2024-06-09 DOI: 10.1177/23969873241255867
Annaelle Zietz, Josefin E Kaufmann, Karin Wiesner, Sandro Kevin Fischer, Martina Wiegert, Wilma Dj Verhagen-Kamerbeek, Yannik Rottenberger, Anne Schwarz, Nils Peters, Henrik Gensicke, Friedrich Medlin, Jens Carsten Möller, Bartosz Bujan, Leo H Bonati, Marcel Arnold, Sabine Schaedelin, René M Müri, Lars G Hemkens, Patrik Michel, Philippe A Lyrer, Jeremia P Held, Gary A Ford, Andreas R Luft, Christopher Traenka, Stefan T Engelter

Rationale: Novel therapeutic approaches are needed in stroke recovery. Whether pharmacological therapies are beneficial for enhancing stroke recovery is unclear. Dopamine is a neurotransmitter involved in motor learning, reward, and brain plasticity. Its prodrug levodopa is a promising agent for stroke recovery.

Aim and hypothesis: To investigate the hypothesis that levodopa, in addition to standardized rehabilitation therapy based on active task training, results in an enhancement of functional recovery in acute ischemic or hemorrhagic stroke patients compared to placebo.

Design: ESTREL (Enhancement of Stroke REhabilitation with Levodopa) is a randomized (ratio 1:1), multicenter, placebo-controlled, double-blind, parallel-group superiority trial.

Participants: 610 participants (according to sample size calculation) with a clinically meaningful hemiparesis will be enrolled ⩽7 days after stroke onset. Key eligibility criteria include (i) in-hospital-rehabilitation required, (ii) capability to participate in rehabilitation, (iii) previous independence in daily living.

Intervention: Levodopa 100 mg/carbidopa 25 mg three times daily, administered for 5 weeks in addition to standardized rehabilitation. The study intervention will be initiated within 7 days after stroke onset.

Comparison: Matching placebo plus standardized rehabilitation.

Outcomes: The primary outcome is the between-group difference of the Fugl-Meyer-Motor Assessment (FMMA) total score measured 3 months after randomization. Secondary outcomes include patient-reported health and wellbeing (PROMIS 10 and 29), patient-reported assessment of improvement, Rivermead Mobility Index, modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS), and as measures of harm: mortality, recurrent stroke, and serious adverse events.

Conclusion: The ESTREL trial will provide evidence of whether the use of Levodopa in addition to standardized rehabilitation in stroke patients leads to better functional recovery compared to rehabilitation alone.

理由:中风康复需要新的治疗方法。药物疗法是否有利于促进中风的恢复尚不清楚。多巴胺是一种神经递质,参与运动学习、奖赏和大脑可塑性。其原药左旋多巴是一种有希望促进中风康复的药物:研究假设:与安慰剂相比,左旋多巴在基于主动任务训练的标准化康复治疗的基础上,可促进急性缺血性或出血性中风患者的功能恢复:ESTREL(左旋多巴促进中风康复)是一项随机(比例为 1:1)、多中心、安慰剂对照、双盲、平行组优效试验:610 名参与者(根据样本量计算)将在中风发作后⩽7 天内接受有临床意义的偏瘫治疗。主要资格标准包括:(i) 需要住院康复治疗;(ii) 有能力参加康复治疗;(iii) 以前日常生活自理:左旋多巴 100 毫克/卡比多巴 25 毫克,每日三次,持续 5 周,同时进行标准化康复治疗。研究干预将在中风发作后 7 天内开始:结果:主要结果是随机分组 3 个月后测量的 Fugl-Meyer-Motor Assessment(FMMA)总分的组间差异。次要结果包括患者报告的健康和幸福感(PROMIS 10 和 29)、患者报告的改善评估、Rivermead 活动指数、改良 Rankin 量表、美国国立卫生研究院卒中量表(NIHSS),以及作为危害度量的死亡率、复发性卒中和严重不良事件:ESTREL试验将为中风患者在标准化康复治疗的基础上使用左旋多巴是否会比单独使用康复治疗带来更好的功能恢复提供证据。
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引用次数: 0
Predictive value of thrombus enhancement sign for stroke subtype and recanalization in acute basilar-artery occlusion. 血栓增强标志对急性基底动脉闭塞中风亚型和再通的预测价值。
IF 6.1 3区 医学 Q1 Medicine Pub Date : 2024-06-06 DOI: 10.1177/23969873241256251
Guangchen He, Sheng Guo, Hui Fang, Haoyang Xu, Runjianya Ling, Haitao Lu, Yueqi Zhu

Background: Thrombus enhancement sign (TES) is associated with cardioembolic stroke and first-pass angiographic failure in anterior ischemic stroke. However, the relationship between TES and stroke subtype and recanalization status after endovascular treatment (EVT) in basilar artery occlusion (BAO) remains unknown.

Methods: This retrospective study included consecutive patients with acute BAO who underwent EVT between January 2020 and September 2023. Each patient underwent baseline non-contrast computed tomography (CT) and CT angiography. Two independent readers assessed the presence of TES. Stroke types were classified according to the Trial of ORG 10172 for Acute Stroke Treatment. Successful recanalization was defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3 after EVT. Clinical and interventional parameters, along with histopathological thrombi examination results, were compared between the TES-positive and TES-negative groups. The associations between TES and stroke subtype and recanalization status were analyzed using univariate and multivariate analyses.

Results: A total of 151 patients were included in the analysis, among whom 116 (77%) exhibited TES. TES showed a significant correlation with cardioembolic and cryptogenic strokes (odds ratio [OR]: 8.56; 95% confidence interval: 3.49-22.4; p < 0.001), whereas the TES-positive thrombi were characterized by a higher fibrin/platelet proportion (p = 0.002) and lower erythrocyte proportion (p = 0.044). The TES-positive group demonstrated favorable outcomes compared to the TES-negative group, including a shorter procedure time (p < 0.001), lower number of thrombectomy attempts (p = 0.010), higher incidence of first pass success (p = 0.022), and lower rate of requiring rescue angioplasty and/or stenting (p < 0.001). In multivariate analysis, TES remained independently associated with successful recanalization (OR: 9.63; 95% CI: 2.33, 47.7; p = 0.003) after adjusting for baseline confounders.

Conclusions: Visualization of TES serves as a reliable and easily accessible marker for identifying cardioembolic and cryptogenic strokes and predicting recanalization success in thrombectomy for basilar artery occlusion.

背景:血栓增强征(TES)与心栓性卒中和前部缺血性卒中的首次血管造影失败有关。然而,基底动脉闭塞(BAO)的 TES 与卒中亚型和血管内治疗(EVT)后再通状况之间的关系仍不清楚:这项回顾性研究纳入了 2020 年 1 月至 2023 年 9 月间接受 EVT 的急性 BAO 连续患者。每位患者都接受了基线非对比计算机断层扫描(CT)和 CT 血管造影。两名独立阅读者对是否存在 TES 进行评估。中风类型根据 ORG 10172 急性中风治疗试验进行分类。EVT术后脑梗塞溶栓评分达到2b-3分即为再通成功。对TES阳性组和TES阴性组的临床和介入参数以及组织病理学血栓检查结果进行了比较。采用单变量和多变量分析方法分析了TES与中风亚型和再通状况之间的关系:共有151名患者参与分析,其中116人(77%)表现为TES。TES 与心源性栓塞和隐源性中风有明显相关性(几率比 [OR]:8.56;95% 置信区间:3.49-22.4;P = 0.002),红细胞比例较低(P = 0.044)。在调整基线混杂因素后,TES阳性组与TES阴性组相比显示出良好的结果,包括更短的手术时间(p p = 0.010)、更高的首次通过成功率(p = 0.022)和更低的需要血管成形术和/或支架植入术的比例(p p = 0.003):基底动脉闭塞血栓切除术中,TES的可视化是识别心源性栓塞和隐源性卒中以及预测再通成功率的可靠、易得的标志物。
{"title":"Predictive value of thrombus enhancement sign for stroke subtype and recanalization in acute basilar-artery occlusion.","authors":"Guangchen He, Sheng Guo, Hui Fang, Haoyang Xu, Runjianya Ling, Haitao Lu, Yueqi Zhu","doi":"10.1177/23969873241256251","DOIUrl":"10.1177/23969873241256251","url":null,"abstract":"<p><strong>Background: </strong>Thrombus enhancement sign (TES) is associated with cardioembolic stroke and first-pass angiographic failure in anterior ischemic stroke. However, the relationship between TES and stroke subtype and recanalization status after endovascular treatment (EVT) in basilar artery occlusion (BAO) remains unknown.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients with acute BAO who underwent EVT between January 2020 and September 2023. Each patient underwent baseline non-contrast computed tomography (CT) and CT angiography. Two independent readers assessed the presence of TES. Stroke types were classified according to the Trial of ORG 10172 for Acute Stroke Treatment. Successful recanalization was defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3 after EVT. Clinical and interventional parameters, along with histopathological thrombi examination results, were compared between the TES-positive and TES-negative groups. The associations between TES and stroke subtype and recanalization status were analyzed using univariate and multivariate analyses.</p><p><strong>Results: </strong>A total of 151 patients were included in the analysis, among whom 116 (77%) exhibited TES. TES showed a significant correlation with cardioembolic and cryptogenic strokes (odds ratio [OR]: 8.56; 95% confidence interval: 3.49-22.4; <i>p</i> < 0.001), whereas the TES-positive thrombi were characterized by a higher fibrin/platelet proportion (<i>p</i> = 0.002) and lower erythrocyte proportion (<i>p</i> = 0.044). The TES-positive group demonstrated favorable outcomes compared to the TES-negative group, including a shorter procedure time (<i>p</i> < 0.001), lower number of thrombectomy attempts (<i>p</i> = 0.010), higher incidence of first pass success (<i>p</i> = 0.022), and lower rate of requiring rescue angioplasty and/or stenting (<i>p</i> < 0.001). In multivariate analysis, TES remained independently associated with successful recanalization (OR: 9.63; 95% CI: 2.33, 47.7; <i>p</i> = 0.003) after adjusting for baseline confounders.</p><p><strong>Conclusions: </strong>Visualization of TES serves as a reliable and easily accessible marker for identifying cardioembolic and cryptogenic strokes and predicting recanalization success in thrombectomy for basilar artery occlusion.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute astrocytic reaction is associated with 3-month functional outcome after stroke treated with endovascular therapy. 急性星形胶质细胞反应与血管内治疗脑卒中后 3 个月的功能预后有关。
IF 6.1 3区 医学 Q1 Medicine Pub Date : 2024-06-06 DOI: 10.1177/23969873241256813
Ada Boutelier, Véronique Ollivier, Mikael Mazighi, Maeva Kyheng, Julien Labreuche, Nahida Brikci-Nigassa, Mialitiana Solo Nomenjanahary, Francois Delvoye, Benjamin Maier, Claire Paquet, Benoit Ho-Tin-Noe, Jean-Philippe Desilles

Introduction: More than 50% of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT) remain severely disabled at 3 months. We hypothesized that acute astrocytic inflammatory response may play a pivotal role in post-AIS brain changes associated with poor functional outcome. We proposed to evaluate the level of YKL-40, a glycoprotein mainly released by reactive astrocytes.

Patients and methods: A monocentric prospective cohort study was conducted on consecutive LVO AIS patients treated with EVT. Three blood samples (before, within 1 and 24-hour post-EVT) were collected to measure plasma YKL-40 concentrations. Functional outcome was assessed according to the modified Rankin Scale (mRS) score at 3 months.

Results: Between 2016 and 2020, 120 patients were included. The plasma concentration of YKL-40 before EVT was statistically and independently associated with 3-month worse functional outcome (adjusted cOR, 1.59; 95% CI [1.05-2.44], p = 0.027) but not the two following samples 1-hour and 24-hour post-EVT. Accordingly, we found that excellent functional outcome was associated with a lower level of YKL-40 before and within 1 h after EVT (p = 0.005 and p = 0.003, respectively) but not when measured 24 h after EVT (p = 0.2).

Discussion and conclusion: This study suggests that the astrocytic reaction to acute brain hypoxia, especially before recanalization, is associated with worse functional outcome. Such early biomarker of the astrocytic response in AIS may optimize individualized care in the future.

Clinical trial registration-url: http://www.clinicaltrials.gov. Unique identifier: NCT02900833.

导言:在接受血管内治疗(EVT)的大血管闭塞(LVO)急性缺血性脑卒中(AIS)患者中,超过 50%的患者在 3 个月后仍然严重残疾。我们推测,急性星形胶质细胞炎症反应可能在与不良功能预后相关的 AIS 后脑部变化中起着关键作用。我们提议评估YKL-40的水平,这是一种主要由反应性星形胶质细胞释放的糖蛋白:对连续接受 EVT 治疗的 LVO AIS 患者进行了单中心前瞻性队列研究。收集了三次血液样本(EVT前、EVT后1小时内和24小时内),以测量血浆中YKL-40的浓度。根据3个月后的改良Rankin量表(mRS)评分评估功能预后:结果:2016年至2020年间,共纳入120名患者。EVT前的血浆YKL-40浓度与3个月后较差的功能预后有统计学上的独立相关性(调整后的cOR,1.59;95% CI [1.05-2.44],p = 0.027),但与EVT后1小时和24小时后的两个样本无关。因此,我们发现良好的功能预后与EVT前和EVT后1小时内较低的YKL-40水平相关(分别为p = 0.005和p = 0.003),但与EVT后24小时的测量结果无关(p = 0.2):本研究表明,星形胶质细胞对急性脑缺氧的反应,尤其是在再通之前,与较差的功能预后有关。这种AIS星形胶质细胞反应的早期生物标志物可优化未来的个体化治疗。临床试验注册-url:http://www.clinicaltrials.gov。唯一标识符:NCT02900833。
{"title":"Acute astrocytic reaction is associated with 3-month functional outcome after stroke treated with endovascular therapy.","authors":"Ada Boutelier, Véronique Ollivier, Mikael Mazighi, Maeva Kyheng, Julien Labreuche, Nahida Brikci-Nigassa, Mialitiana Solo Nomenjanahary, Francois Delvoye, Benjamin Maier, Claire Paquet, Benoit Ho-Tin-Noe, Jean-Philippe Desilles","doi":"10.1177/23969873241256813","DOIUrl":"https://doi.org/10.1177/23969873241256813","url":null,"abstract":"<p><strong>Introduction: </strong>More than 50% of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT) remain severely disabled at 3 months. We hypothesized that acute astrocytic inflammatory response may play a pivotal role in post-AIS brain changes associated with poor functional outcome. We proposed to evaluate the level of YKL-40, a glycoprotein mainly released by reactive astrocytes.</p><p><strong>Patients and methods: </strong>A monocentric prospective cohort study was conducted on consecutive LVO AIS patients treated with EVT. Three blood samples (before, within 1 and 24-hour post-EVT) were collected to measure plasma YKL-40 concentrations. Functional outcome was assessed according to the modified Rankin Scale (mRS) score at 3 months.</p><p><strong>Results: </strong>Between 2016 and 2020, 120 patients were included. The plasma concentration of YKL-40 before EVT was statistically and independently associated with 3-month worse functional outcome (adjusted cOR, 1.59; 95% CI [1.05-2.44], <i>p</i> = 0.027) but not the two following samples 1-hour and 24-hour post-EVT. Accordingly, we found that excellent functional outcome was associated with a lower level of YKL-40 before and within 1 h after EVT (<i>p</i> = 0.005 and <i>p</i> = 0.003, respectively) but not when measured 24 h after EVT (<i>p</i> = 0.2).</p><p><strong>Discussion and conclusion: </strong>This study suggests that the astrocytic reaction to acute brain hypoxia, especially before recanalization, is associated with worse functional outcome. Such early biomarker of the astrocytic response in AIS may optimize individualized care in the future.</p><p><strong>Clinical trial registration-url: </strong>http://www.clinicaltrials.gov. Unique identifier: NCT02900833.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Second-dose intravenous thrombolysis with tenecteplase in alteplase-resistant medium-vessel-occlusion strokes: A retrospective and comparative study. 使用替奈替普酶对阿替普酶耐药的中血管闭塞性脑卒中进行第二剂量静脉溶栓治疗:一项回顾性比较研究。
IF 6.1 3区 医学 Q1 Medicine Pub Date : 2024-06-03 DOI: 10.1177/23969873241254936
Nicolas Chausson, Stéphane Olindo, François-Xavier Laborne, Manvel Aghasaryan, Pauline Renou, Djibril Soumah, Sabrina Debruxelles, Tony Altarcha, Mathilde Poli, Yann L'Hermitte, Sharmila Sagnier, Moussa Toudou-Daouda, Nana Rahamatou Aminou-Tassiou, Leila Bentamra, Narimane Benmoussa, Cosmin Alecu, Carole Imbernon, Léonard Smadja, Gary Ouanounou, François Rouanet, Igor Sibon, Didier Smadja

Introduction: In intracranial medium-vessel occlusions (MeVOs), intravenous thrombolysis (IVT) shows inconsistent effectiveness and endovascular interventions remains unproven. We evaluated a new therapeutic strategy based on a second IVT using tenecteplase for MeVOs without early recanalization post-alteplase.

Patients and methods: This retrospective, comparative study included consecutively low bleeding risk MeVO patients treated with alteplase 0.9 mg/kg at two stroke centers. One center used a conventional single-IVT approach; the other applied a dual-IVT strategy, incorporating a 1-h post-alteplase MRI and additional tenecteplase, 0.25 mg/kg, if occlusion persisted. Primary outcomes were 24-h successful recanalization for efficacy and symptomatic intracranial hemorrhage (sICH) for safety. Secondary outcomes included 3-month excellent outcomes (modified Rankin Scale score of 0-1). Comparisons were conducted in the overall cohort and a propensity score-matched subgroup.

Results: Among 146 patients in the dual-IVT group, 103 failed to achieve recanalization at 1 h and of these 96 met all eligible criteria and received additional tenecteplase. Successful recanalization at 24 h was higher in the 146 dual-IVT cohort patients than in the 148 single-IVT cohort patients (84% vs 61%, p < 0.0001), with similar sICH rate (3 vs 2, p = 0.68). Dual-IVT strategy was an independent predictor of 24-h successful recanalization (OR, 2.7 [95% CI, 1.52-4.88]; p < 0.001). Dual-IVT cohort patients achieved higher rates of excellent outcome (69% vs 44%, p < 0.0001). Propensity score matching analyses supported all these associations.

Conclusion: In this retrospective study, a dual-IVT strategy in selected MeVO patients was associated with higher odds of 24-h recanalization, with no safety concerns. However, potential center-level confounding and biases seriously limit these findings' interpretation.

Trial registration: ClinicalTrials.gov Identifier: NCT05809921.

导言:对于颅内中血管闭塞症(MeVOs),静脉溶栓(IVT)的疗效并不一致,而血管内介入治疗仍未得到证实。我们评估了一种新的治疗策略,即使用替奈替普酶(tenecteplase)进行第二次静脉溶栓治疗,以治疗阿替普酶治疗后没有早期再通畅的中血管闭塞症:这项回顾性比较研究包括在两家卒中中心连续接受阿替普酶 0.9 mg/kg 治疗的低出血风险 MeVO 患者。其中一个中心采用了传统的单IVT方法;另一个中心采用了双IVT策略,包括阿替普酶后1小时的磁共振成像,如果闭塞持续存在,则追加0.25 mg/kg的替奈替普酶。主要结果是24小时成功再通的疗效和无症状性颅内出血(sICH)的安全性。次要结果包括 3 个月的优秀结果(修改后的 Rankin 量表评分为 0-1)。比较结果在整个队列和倾向评分匹配亚组中进行:在双通道 IVT 组的 146 名患者中,103 人未能在 1 小时内实现再通畅,其中 96 人符合所有合格标准,接受了额外的替奈普酶治疗。146 名双 IVT 组患者在 24 小时内成功再通畅的比例高于 148 名单 IVT 组患者(84% 对 61%,P = 0.68)。双 IVT 策略是 24 小时成功再通畅的独立预测因素(OR,2.7 [95% CI,1.52-4.88];P P 结论:在这项回顾性研究中,在选定的 MeVO 患者中采用双 IVT 策略可提高 24 小时再通的几率,且无安全性问题。然而,潜在的中心水平混杂因素和偏倚严重限制了这些研究结果的解释:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT05809921。
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引用次数: 0
Outcome of patients with multivessel occlusion stroke after endovascular treatment. 多血管闭塞中风患者接受血管内治疗后的预后。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-06-01 Epub Date: 2023-12-15 DOI: 10.1177/23969873231216811
Natalie E LeCouffe, Kilian M Treurniet, Manon Kappelhof, Ivo Gh Jansen, Merel Boers, Henk A Marquering, Ludo Fm Beenen, Jelis Boiten, Wim H van Zwam, Lonneke Sf Yo, Charles Blm Majoie, Yvo Bwem Roos, Bart J Emmer, Jonathan M Coutinho

Introduction: Little is known about the implications of multivessel occlusions (MVO) in large vessel occlusion stroke patients who undergo endovascular treatment (EVT).

Patients and methods: We report data from the MR CLEAN Registry: a prospective, observational study on all stroke patients who underwent EVT in the Netherlands (March 2014-November 2017). We included patients with an intracranial target occlusion in the anterior circulation. An MVO was defined as an MCA occlusion (M1/M2) or intracranial ICA/ICA-T occlusion, with a concurrent second occlusion in the ACA or PCA territory confirmed on baseline CTA. To compare outcomes, we performed a 10:1 propensity score matching analysis with a logistic regression model including potential confounders. Outcome measures included 90-day functional outcome (modified Rankin Scale, mRS) and mortality.

Results: Of 2946 included patients, 71 patients (2.4%) had an MVO (87% concurrent ACA occlusion, 10% PCA occlusion, 3% ⩾3 occlusions). These patients were matched to 71 non-MVO patients. Before matching, MVO patients had a higher baseline NIHSS (median 18 vs 16, p = 0.001) and worse collateral status (absent collaterals: 17% vs 6%, p < 0.001) compared to non-MVO patients. After matching, MVO patients had worse functional outcome at 90 days (median mRS 5 vs 3, cOR 0.39; 95%CI 0.25-0.62). Mortality was higher in MVO patients (46% vs 27%, OR 2.11, 95%CI 1.24-3.57).

Discussion and conclusion: MVOs on baseline imaging were uncommon in LVO stroke patients undergoing EVT, but were associated with poor functional outcome.

导言:人们对接受血管内治疗(EVT)的大血管闭塞性卒中患者多血管闭塞(MVO)的影响知之甚少:我们报告了 MR CLEAN 注册中心的数据:这是一项前瞻性观察研究,研究对象是在荷兰接受 EVT 的所有中风患者(2014 年 3 月至 2017 年 11 月)。我们纳入了前循环颅内靶点闭塞的患者。MVO定义为MCA闭塞(M1/M2)或颅内ICA/ICA-T闭塞,基线CTA证实ACA或PCA区域同时存在第二个闭塞。为了比较结果,我们使用包括潜在混杂因素在内的逻辑回归模型进行了 10:1 倾向评分匹配分析。结果指标包括90天功能预后(改良Rankin量表,mRS)和死亡率:在纳入的 2946 名患者中,71 名患者(2.4%)患有 MVO(87% 并发 ACA 闭塞,10% 并发 PCA 闭塞,3% 并发 3 闭塞)。这些患者与 71 名非 MVO 患者进行了配对。配对前,MVO 患者的基线 NIHSS 较高(中位数为 18 vs 16,P = 0.001),侧支状态较差(无侧支:17% vs 6%,P 讨论和结论:在接受 EVT 的 LVO 卒中患者中,基线成像显示的 MVO 并不常见,但与不良的功能预后有关。
{"title":"Outcome of patients with multivessel occlusion stroke after endovascular treatment.","authors":"Natalie E LeCouffe, Kilian M Treurniet, Manon Kappelhof, Ivo Gh Jansen, Merel Boers, Henk A Marquering, Ludo Fm Beenen, Jelis Boiten, Wim H van Zwam, Lonneke Sf Yo, Charles Blm Majoie, Yvo Bwem Roos, Bart J Emmer, Jonathan M Coutinho","doi":"10.1177/23969873231216811","DOIUrl":"10.1177/23969873231216811","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about the implications of multivessel occlusions (MVO) in large vessel occlusion stroke patients who undergo endovascular treatment (EVT).</p><p><strong>Patients and methods: </strong>We report data from the MR CLEAN Registry: a prospective, observational study on all stroke patients who underwent EVT in the Netherlands (March 2014-November 2017). We included patients with an intracranial target occlusion in the anterior circulation. An MVO was defined as an MCA occlusion (M1/M2) or intracranial ICA/ICA-T occlusion, with a concurrent second occlusion in the ACA or PCA territory confirmed on baseline CTA. To compare outcomes, we performed a 10:1 propensity score matching analysis with a logistic regression model including potential confounders. Outcome measures included 90-day functional outcome (modified Rankin Scale, mRS) and mortality.</p><p><strong>Results: </strong>Of 2946 included patients, 71 patients (2.4%) had an MVO (87% concurrent ACA occlusion, 10% PCA occlusion, 3% ⩾3 occlusions). These patients were matched to 71 non-MVO patients. Before matching, MVO patients had a higher baseline NIHSS (median 18 vs 16, <i>p</i> = 0.001) and worse collateral status (absent collaterals: 17% vs 6%, <i>p</i> < 0.001) compared to non-MVO patients. After matching, MVO patients had worse functional outcome at 90 days (median mRS 5 vs 3, cOR 0.39; 95%CI 0.25-0.62). Mortality was higher in MVO patients (46% vs 27%, OR 2.11, 95%CI 1.24-3.57).</p><p><strong>Discussion and conclusion: </strong>MVOs on baseline imaging were uncommon in LVO stroke patients undergoing EVT, but were associated with poor functional outcome.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138796030","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}
引用次数: 0
Emergency Medical Services dispatcher recognition of stroke: A systematic review. 紧急医疗服务调度员对中风的识别:系统综述。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-06-01 Epub Date: 2024-01-04 DOI: 10.1177/23969873231223339
Jonathan Wenstrup, Bartal Hofgaard Hestoy, Malini Vendela Sagar, Stig Nikolaj Fasmer Blomberg, Hanne Christensen, Helle Collatz Christensen, Christina Kruuse

Purpose: Stroke treatments are time-sensitive, and thus early and correct recognition of stroke by Emergency Medical Services is essential for outcomes. This is particularly important with the adaption of mobile stroke units. In this systematic review, we therefore aimed to provide a comprehensive overview of Emergency Medical Services dispatcher recognition of stroke.

Methods: The review was registered on PROSPERO and the PRISMA guidelines were applied. We searched PubMed, Embase, and Cochrane Review Library. Screening and data extraction were performed by two observers. Risk of bias was assessed using the QUADAS-2 instrument.

Findings: Of 1200 papers screened, 24 fulfilled the inclusion criteria. Data on sensitivity was reported in 22 papers and varied from 17.9% to 83.0%. Positive predictive values were reported in 12 papers and ranged from 24.0% to 87.7%. Seven papers reported specificity, which ranged from 20.0% to 99.1%. Six papers reported negative predictive value, ranging from 28.0% to 99.4%. In general, the risk of bias was low.

Discussion: Stroke recognition by dispatchers varied greatly, but overall many patients with stroke are not recognised, despite the initiatives taken to improve stroke literacy. The available data are of high quality, however Asian, African, and South American populations are underrepresented.

Conclusion: While the data are heterogenous, this review can serve as a reference for future research in emergency medical dispatcher stroke recognition and initiatives to improve prehospital stroke recognition.

目的:脑卒中治疗具有时间敏感性,因此急救医疗服务对脑卒中的早期正确识别对治疗效果至关重要。这一点在移动卒中单元的应用中尤为重要。因此,在本系统综述中,我们旨在全面概述紧急医疗服务调度员对中风的识别:本综述在 PROSPERO 上注册,并采用了 PRISMA 指南。我们检索了 PubMed、Embase 和 Cochrane Review Library。筛选和数据提取由两名观察员完成。使用 QUADAS-2 工具评估偏倚风险:在筛选出的 1200 篇论文中,有 24 篇符合纳入标准。22篇论文报告了灵敏度数据,灵敏度从17.9%到83.0%不等。12 篇论文报告了阳性预测值,从 24.0% 到 87.7% 不等。7 篇论文报告了特异性,范围从 20.0% 到 99.1%。6 篇论文报告了阴性预测值,范围从 28.0% 到 99.4%。总体而言,偏倚风险较低:讨论:调度员对脑卒中的识别能力差异很大,但总体而言,尽管采取了提高脑卒中知识普及率的措施,许多脑卒中患者仍未被识别。现有数据质量较高,但亚洲、非洲和南美洲人群的代表性不足:尽管数据不尽相同,但本综述可作为今后研究急救调度员卒中识别能力和提高院前卒中识别能力的参考。
{"title":"Emergency Medical Services dispatcher recognition of stroke: A systematic review.","authors":"Jonathan Wenstrup, Bartal Hofgaard Hestoy, Malini Vendela Sagar, Stig Nikolaj Fasmer Blomberg, Hanne Christensen, Helle Collatz Christensen, Christina Kruuse","doi":"10.1177/23969873231223339","DOIUrl":"10.1177/23969873231223339","url":null,"abstract":"<p><strong>Purpose: </strong>Stroke treatments are time-sensitive, and thus early and correct recognition of stroke by Emergency Medical Services is essential for outcomes. This is particularly important with the adaption of mobile stroke units. In this systematic review, we therefore aimed to provide a comprehensive overview of Emergency Medical Services dispatcher recognition of stroke.</p><p><strong>Methods: </strong>The review was registered on PROSPERO and the PRISMA guidelines were applied. We searched PubMed, Embase, and Cochrane Review Library. Screening and data extraction were performed by two observers. Risk of bias was assessed using the QUADAS-2 instrument.</p><p><strong>Findings: </strong>Of 1200 papers screened, 24 fulfilled the inclusion criteria. Data on sensitivity was reported in 22 papers and varied from 17.9% to 83.0%. Positive predictive values were reported in 12 papers and ranged from 24.0% to 87.7%. Seven papers reported specificity, which ranged from 20.0% to 99.1%. Six papers reported negative predictive value, ranging from 28.0% to 99.4%. In general, the risk of bias was low.</p><p><strong>Discussion: </strong>Stroke recognition by dispatchers varied greatly, but overall many patients with stroke are not recognised, despite the initiatives taken to improve stroke literacy. The available data are of high quality, however Asian, African, and South American populations are underrepresented.</p><p><strong>Conclusion: </strong>While the data are heterogenous, this review can serve as a reference for future research in emergency medical dispatcher stroke recognition and initiatives to improve prehospital stroke recognition.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089045","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}
引用次数: 0
Association of covert brain infarct phenotype with stroke recurrence in first-ever manifest ischemic stroke according to etiology. 隐蔽性脑梗死表型与首次显性缺血性脑卒中复发的关系(根据病因)。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-06-01 Epub Date: 2024-01-30 DOI: 10.1177/23969873241229612
Thomas Raphael Meinel, Stefan L Leber, Michael Janisch, Jan Vynckier, Adnan Mujanovic, Anna Boronylo, Johannes Kaesmacher, David Julian Seiffge, Laurent Roten, Marcel Arnold, Christian Enzinger, Thomas Gattringer, Urs Fischer, Markus Kneihsl

Introduction: Covert brain infarcts (CBI) are frequent incidental findings on MRI and associated with future stroke risk in patients without a history of clinically evident cerebrovascular events. However, the prognostic value of CBI in first-ever ischemic stroke patients is unclear and previous studies did not report on different etiological stroke subtypes. We aimed to test CBI phenotypes and their association with stroke recurrence in first-ever ischemic stroke patients according to stroke etiology.

Patients and methods: This study is a pooled data analysis of two prospectively collected cohorts of consecutive first-ever ischemic stroke patients admitted to the comprehensive stroke centers of Bern (Switzerland) and Graz (Austria). CBI phenotypes were identified on brain MRI within 72 h after admission. All patients underwent a routine follow-up (median: 12 months) to identify stroke recurrence.

Results: Of 1577 consecutive ischemic stroke patients (median age: 71 years), 691 patients showed CBI on brain MRI (44%) and 88 patients had a recurrent ischemic stroke (6%). Baseline CBI were associated with stroke recurrence in multivariable analysis (HR 1.9, 95% CI 1.1-3.3). CBI phenotypes with the highest risk for stroke recurrence were cavitatory CBI in small vessel disease (SVD)-related stroke (HR 7.1, 95% CI 1.6-12.6) and cortical CBI in patients with atrial fibrillation (HR 3.0, 95% CI 1.1-8.1).

Discussion and conclusion: This study reports a ≈ 2-fold increased risk for stroke recurrence in first-ever ischemic stroke patients with CBI. The risk of recurrent stroke was highest in patients with cavitatory CBI in SVD-related stroke and cortical CBI in patients with atrial fibrillation.Subject terms: Covert brain infarcts, stroke.

导言:隐匿性脑梗塞(CBI)是磁共振成像中经常出现的偶然发现,与无临床明显脑血管事件史的患者未来的卒中风险有关。然而,CBI 对首次发病的缺血性脑卒中患者的预后价值尚不明确,以往的研究也未报告不同病因的脑卒中亚型。我们旨在根据卒中病因检测首次发病缺血性卒中患者的 CBI 表型及其与卒中复发的关系:本研究是对伯尔尼(瑞士)和格拉茨(奥地利)综合卒中中心连续收治的两个前瞻性收集的首次缺血性卒中患者队列的汇总数据分析。入院后 72 小时内通过脑磁共振成像确定 CBI 表型。所有患者均接受了常规随访(中位数:12 个月),以确定中风是否复发:结果:在 1577 名连续缺血性中风患者(中位年龄:71 岁)中,有 691 名患者在脑部 MRI 上显示出 CBI(44%),88 名患者复发了缺血性中风(6%)。在多变量分析中,基线 CBI 与中风复发相关(HR 1.9,95% CI 1.1-3.3)。中风复发风险最高的 CBI 表型是小血管疾病(SVD)相关中风的空洞型 CBI(HR 7.1,95% CI 1.6-12.6)和心房颤动患者的皮质型 CBI(HR 3.0,95% CI 1.1-8.1):本研究报告显示,首次发生缺血性卒中的 CBI 患者卒中复发风险增加了≈2 倍。讨论与结论:本研究报告显示,患有 CBI 的首次缺血性脑卒中患者脑卒中复发风险增加≈2 倍:隐匿性脑梗塞、中风。
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引用次数: 0
Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study. 急性缺血性卒中中血管闭塞机械取栓术中穿孔的发生率和临床疗效:一项回顾性、多中心和跨国研究。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-26 DOI: 10.1177/23969873231219412
Adam A Dmytriw, Basel Musmar, Hamza Salim, Sherief Ghozy, James E Siegler, Hassan Kobeissi, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N Nguyen, Jeremy J Heit, Robert W Regenhardt, Nicole M Cancelliere, Joshua D Bernstock, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kühn, Ajit S Puri, Christian Dyzmann, Peter T Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R Marotta, Christopher J Stapleton, James D Rabinov, Takahiro Ota, Shogo Dofuku, Leonard Ll Yeo, Benjamin Yq Tan, Anil Gopinathan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Lina Chervak, Achala Vagal, Nimer Adeeb, Hugo H Cuellar-Saenz, Stavropoula I Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, João Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R Gonzalez, Markus A Möhlenbruch, Jessica Jesser, Vincent Costalat, Adrien Ter Schiphorst, Vivek Yedavalli, Pablo Harker, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Ramanathan Kadirvel, Monika Killer-Oberpfalzer, Christoph J Griessenauer, Ajith J Thomas, Cheng-Yang Hsieh, David S Liebeskind, Răzvan Alexandru Radu, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Robert Fahed, Charlotte Weyland, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego

Background: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO.

Methods: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed.

Results: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0-1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0-2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 0.008).

Conclusion: This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.

背景:机械取栓术(MT)彻底改变了大血管闭塞(LVO)导致的急性缺血性卒中(AIS)的治疗方法,但其对中血管闭塞(MeVO)的疗效和安全性的探索仍然较少。这项多中心、回顾性研究旨在调查 MT 治疗 MeVO 引起的 AIS 期间血管穿孔(在血管造影系列中通过血管外渗证实)的发生率和临床结果:2017年9月至2021年7月期间,从北美、亚洲和欧洲的37个学术中心收集了数据。共有 1373 名患有 MeVO 的 AIS 患者接受了 MT。对基线特征、手术细节和临床结果进行了分析:血管穿孔的发生率为 4.8%(66/1373)。值得注意的是,我们的分析表明不同动脉段的穿孔率存在差异:M3段为8.9%,M2段为4.3%,A2段为8.3%(P = 0.612)。穿孔患者的预后明显较差,血管造影结果良好率较低(TICI 2c-3:23% vs 58.9%,p = 0.031;3 个月时 mRS 0-2:28.8% vs 53.9%,p = 0.031):结论:这项研究表明,虽然因MeVO导致的MT治疗AIS时发生血管穿孔的情况相对罕见,但它与不良的功能预后和较高的死亡率有关。研究结果突出表明,在进行MT治疗MeVO时需要更加谨慎,并接受专门培训。需要进一步开展前瞻性研究,以制定风险缓解策略。
{"title":"Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study.","authors":"Adam A Dmytriw, Basel Musmar, Hamza Salim, Sherief Ghozy, James E Siegler, Hassan Kobeissi, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N Nguyen, Jeremy J Heit, Robert W Regenhardt, Nicole M Cancelliere, Joshua D Bernstock, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kühn, Ajit S Puri, Christian Dyzmann, Peter T Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R Marotta, Christopher J Stapleton, James D Rabinov, Takahiro Ota, Shogo Dofuku, Leonard Ll Yeo, Benjamin Yq Tan, Anil Gopinathan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Lina Chervak, Achala Vagal, Nimer Adeeb, Hugo H Cuellar-Saenz, Stavropoula I Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, João Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R Gonzalez, Markus A Möhlenbruch, Jessica Jesser, Vincent Costalat, Adrien Ter Schiphorst, Vivek Yedavalli, Pablo Harker, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Ramanathan Kadirvel, Monika Killer-Oberpfalzer, Christoph J Griessenauer, Ajith J Thomas, Cheng-Yang Hsieh, David S Liebeskind, Răzvan Alexandru Radu, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Robert Fahed, Charlotte Weyland, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego","doi":"10.1177/23969873231219412","DOIUrl":"10.1177/23969873231219412","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO.</p><p><strong>Methods: </strong>Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed.</p><p><strong>Results: </strong>The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (<i>p</i> = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, <i>p</i> < 0.001; TICI 2b-3: 56.5% vs 88.3%, <i>p</i> < 0.001). Functional outcomes were also worse in the perforation group (mRS 0-1 at 3 months: 22.7% vs 36.6%, <i>p</i> = 0.031; mRS 0-2 at 3 months: 28.8% vs 53.9%, <i>p</i> < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, <i>p</i> = 0.008).</p><p><strong>Conclusion: </strong>This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973880","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}
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European Stroke Journal
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