Stroke (Hoboken, N.J.)最新文献

Background: The characterization of hemorrhage following acute stroke intervention has largely been CT-based. We sought to compare MRI- and CT-based scoring of hemorrhage after acute endovascular therapy (EVT) applying the Heidelberg Bleeding Classification (HBC) to assess inter-modal agreement and quantify inter-rater agreement.

Methods: Consecutive acute stroke patients were included in this retrospective study if they: i) had MRI and CT ≤12 hours of each other OR ii) had CT bracketed by MRI pre- and post-CT [i.e. MRI-CT-MRI] ≤7 days post-EVT. The concordance of the HBC ratings by consensus panel were compared between CT and T2*GRE MRI.

Results: For the 87 EVT-treated patients included, median age was 68 years [60-74], admit NIHSS 18 [13-23], 47% were treated with IV/IA thrombolytics, and 93% were successfully recanalized (mTICI 2b/3). Hemorrhage was detected on at least one modality in 60% (52/87) of patients. We found a 68% (59/87, 95% CI [57-77%]) agreement overall between CT and MRI for hemorrhage classification post-EVT. MRI had the best inter-rater agreement for HBC 0 (no hemorrhage) with excellent concordance (κ=0.882), compared to CT (κ=0.683). T2*GRE MRI tended to have increased sensitivity to scattered petechial hemorrhage (HBC 1a) as compared to CT with 17% (2/12) inter-modal agreement. The inter-rater agreement of HBC class 2 (i.e. PH-2) was substantial for MRI (κ=0.781) and excellent in CT (κ=0.951), with 67% (8 /12) inter-modal agreement. SAH was detected in 24% (21/87) of patients on CT and/or MRI with 29% (6/21) inter-modal agreement.

Conclusions: With the exception of SAH and minor petechial hemorrhagic transformation, we found that MRI and CT are overall interchangeable for detecting and classifying hemorrhage after endovascular therapy, reassuring findings for both clinical-decision making and research application. Given the complexity of hemorrhage subtypes post-EVT, work to further refine a post-EVT hemorrhage classification scale with clinical correlation would be beneficial.

Background: Currently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported Raymond-Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow-up occlusion effectiveness for the treatment of unruptured saccular ICAs.

Methods: A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and follow-up RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates.

Results: A total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The complete occlusion probability (RROC-I) was analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The RROC-I rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The follow-up RROC-I probability was homogenous in all analyzed devices.

Conclusions: We observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon-assisted coils. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of follow-up complete occlusion (~18 months). Overall, the GDCs remain the gold standard for endovascular treatment of unruptured saccular aneurysms.

Background: Untreated intracranial aneurysms can rupture and result in high rates of morbidity and mortality. Although there are numerous approved endovascular aneurysm treatment devices, most require dual anti-platelet therapy, are minimally biocompatible, or are prone to recanalization. Neurovascular Controlled Uniform Rapid Embolic (NeuroCURE) is an innovative polymer gel material with long-term stability, biocompatibility, and hemocompatibility developed for the treatment of large, wide-neck aneurysms.

Methods: Sidewall aneurysms were surgically created in 10 canines and NeuroCURE was injected through a 0.025 microcatheter under a single balloon inflation period. Aneurysm treatment was angiographically assessed post-embolization and pre-term with Raymond-Roy occlusion classification and a qualitative flow grade scale. Aneurysm neck stability and biocompatibility was histologically assessed to grade platelet/fibrin thrombus, percent endothelialization, and neointimal formation. Aneurysm sac stability was assessed by NeuroCURE sac content, inflammation, and neo-angiogenesis scales.

Results: Explanted aneurysms exhibited a smooth surface at the aneurysm neck with nearly complete neointimal coverage at 3-months. By 6-months, neck endothelialization was 100% in all animals (average Raymond-Roy occlusion classification of 1.2), with no instances of aneurysm recanalization or parent vessel flow compromise. Biocompatibility assessments verified a lack of inflammatory response, neo-angiogenesis, and platelet/fibrin thrombus formation.

Conclusion: The NeuroCURE material promotes progressive occlusion of wide-necked side wall aneurysms over time without the need for dual antiplatelet agents. NeuroCURE also promotes neointimal tissue infill without dependence on thrombus formation and thus resists aneurysm recanalization. NeuroCURE remains a compelling investigational device for the treatment of intracranial aneurysms.