Nanthiya Sujijantarat, Andrew B. Koo, I. Jambor, A. Malhotra, Mercy H. Mazurek, Nethra R Parasuram, Vineetha Yadlapalli, Isha R Chavva, Dheeraj Lalwani, Julia Zabinska, J. M. Roy, J. Antonios, Aladine A. Elsamadicy, D. Renedo, R. Hebert, J. Schindler, E. Gilmore, L. Sansing, A. D. de Havenon, M. Olexa, S. Schiff, J. E. Iglesias, M. Rosen, W. Kimberly, N. Petersen, K. Sheth, C. Matouk
Timely imaging is essential for patients undergoing mechanical thrombectomy (MT). Our objective was to evaluate the safety and feasibility of low‐field portable magnetic resonance imaging (pMRI) for bedside evaluation following MT. Patients with suspected large‐vessel occlusion undergoing MT were screened for eligibility. All pMRI examinations were conducted in the standard ferromagnetic environment of the interventional radiology suite. Clinical characteristics, procedural details, and pMRI features were collected. Subsequent high‐field conventional MRI within 72±12 hours was analyzed. If a conventional MRI was not available for comparison, computed tomography within the same time frame was used for validation. Twenty‐four patients were included (63% women; median age, 76 years [interquartile range, 69–84 years]). MT was performed with a median access to revascularization time of 15 minutes (interquartile range, 8–19 minutes), and with a successful outcome as defined by a thrombolysis in cerebral infarction score of ≥2B in 90% of patients. The median time from the end of the procedure to pMRI was 22 minutes (interquartile range, 16–32 minutes). The median pMRI examination time was 30 minutes (interquartile range, 17–33 minutes). Of 23 patients with available subsequent imaging, 9 had infarct progression compared with immediate post‐MT pMRI and 14 patients did not have progression of their infarct volume. There was no adverse event related to the examination. Low‐field pMRI is safe and feasible in a post‐MT environment and enables timely identification of ischemic changes in the interventional radiology suite. This approach can facilitate the assessment of baseline infarct burden and may help guide physiological interventions following MT.
{"title":"Low‐Field Portable Magnetic Resonance Imaging for Post‐Thrombectomy Assessment of Ongoing Brain Injury","authors":"Nanthiya Sujijantarat, Andrew B. Koo, I. Jambor, A. Malhotra, Mercy H. Mazurek, Nethra R Parasuram, Vineetha Yadlapalli, Isha R Chavva, Dheeraj Lalwani, Julia Zabinska, J. M. Roy, J. Antonios, Aladine A. Elsamadicy, D. Renedo, R. Hebert, J. Schindler, E. Gilmore, L. Sansing, A. D. de Havenon, M. Olexa, S. Schiff, J. E. Iglesias, M. Rosen, W. Kimberly, N. Petersen, K. Sheth, C. Matouk","doi":"10.1161/svin.123.000921","DOIUrl":"https://doi.org/10.1161/svin.123.000921","url":null,"abstract":"\u0000 \u0000 Timely imaging is essential for patients undergoing mechanical thrombectomy (MT). Our objective was to evaluate the safety and feasibility of low‐field portable magnetic resonance imaging (pMRI) for bedside evaluation following MT.\u0000 \u0000 \u0000 \u0000 Patients with suspected large‐vessel occlusion undergoing MT were screened for eligibility. All pMRI examinations were conducted in the standard ferromagnetic environment of the interventional radiology suite. Clinical characteristics, procedural details, and pMRI features were collected. Subsequent high‐field conventional MRI within 72±12 hours was analyzed. If a conventional MRI was not available for comparison, computed tomography within the same time frame was used for validation.\u0000 \u0000 \u0000 \u0000 Twenty‐four patients were included (63% women; median age, 76 years [interquartile range, 69–84 years]). MT was performed with a median access to revascularization time of 15 minutes (interquartile range, 8–19 minutes), and with a successful outcome as defined by a thrombolysis in cerebral infarction score of ≥2B in 90% of patients. The median time from the end of the procedure to pMRI was 22 minutes (interquartile range, 16–32 minutes). The median pMRI examination time was 30 minutes (interquartile range, 17–33 minutes). Of 23 patients with available subsequent imaging, 9 had infarct progression compared with immediate post‐MT pMRI and 14 patients did not have progression of their infarct volume. There was no adverse event related to the examination.\u0000 \u0000 \u0000 \u0000 Low‐field pMRI is safe and feasible in a post‐MT environment and enables timely identification of ischemic changes in the interventional radiology suite. This approach can facilitate the assessment of baseline infarct burden and may help guide physiological interventions following MT.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41960080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Kamiya, Kentaro Suzuki, Yoshifumi Miyauchi, A. Kuriki, K. Mizuma, W. Tsuruta, Y. Matsumaru, K. Kimura
It remains unclear whether intravenous thrombolysis (IVT) influences the incidence of the first pass effect (FPE) in patients with acute large vessel occlusion treated with mechanical thrombectomy (MT). Therefore, this study investigated the effects of IVT on FPE in patients treated with MT. This is a post hoc analysis of the SKIP (Direct Mechanical Thrombectomy in Acute LVO Stroke) study, which was an investigator‐initiated, multicenter, randomized, open‐label clinical trial performed in 23 hospital networks in Japan from January 1, 2017, to July 31, 2019. Among 204 patients, 24 were excluded because they did not undergo MT. Patients treated with MT alone were compared with those treated with MT+IVT for the incidence of FPE (achieving a modified treatment in cerebral ischemia score of 2c or 3 after the first MT pass). Additional subgroup analyses were performed to investigate factors more closely related to the association between IVT and FPE. Among the 180 patients, 91 were treated with MT alone and 89 were treated with MT+IVT. FPE was achieved in 56 patients (31.1%). The incidence of FPE was significantly higher in patients treated with MT+IVT than in those treated with MT alone (39.3% versus 23.0%, respectively; P =0.02). In the subgroup analyses, IVT markedly increased FPE in female patients and tended to increase FPE in patients with first‐segment middle cerebral artery distal occlusion and onset to hospital arrival time >100 minutes. IVT using alteplase increased the incidence of FPE in Japanese patients with acute ischemic stroke treated with MT. : Trial registration umin.ac.jp/ctr identifier: UMIN000021488
{"title":"Intravenous Thrombolysis Increases the First Pass Effect for Large Vessel Occlusion Treated With Mechanical Thrombectomy","authors":"Y. Kamiya, Kentaro Suzuki, Yoshifumi Miyauchi, A. Kuriki, K. Mizuma, W. Tsuruta, Y. Matsumaru, K. Kimura","doi":"10.1161/svin.122.000577","DOIUrl":"https://doi.org/10.1161/svin.122.000577","url":null,"abstract":"\u0000 \u0000 It remains unclear whether intravenous thrombolysis (IVT) influences the incidence of the first pass effect (FPE) in patients with acute large vessel occlusion treated with mechanical thrombectomy (MT). Therefore, this study investigated the effects of IVT on FPE in patients treated with MT.\u0000 \u0000 \u0000 \u0000 This is a post hoc analysis of the SKIP (Direct Mechanical Thrombectomy in Acute LVO Stroke) study, which was an investigator‐initiated, multicenter, randomized, open‐label clinical trial performed in 23 hospital networks in Japan from January 1, 2017, to July 31, 2019. Among 204 patients, 24 were excluded because they did not undergo MT. Patients treated with MT alone were compared with those treated with MT+IVT for the incidence of FPE (achieving a modified treatment in cerebral ischemia score of 2c or 3 after the first MT pass). Additional subgroup analyses were performed to investigate factors more closely related to the association between IVT and FPE.\u0000 \u0000 \u0000 \u0000 \u0000 Among the 180 patients, 91 were treated with MT alone and 89 were treated with MT+IVT. FPE was achieved in 56 patients (31.1%). The incidence of FPE was significantly higher in patients treated with MT+IVT than in those treated with MT alone (39.3% versus 23.0%, respectively;\u0000 P\u0000 =0.02). In the subgroup analyses, IVT markedly increased FPE in female patients and tended to increase FPE in patients with first‐segment middle cerebral artery distal occlusion and onset to hospital arrival time >100 minutes.\u0000 \u0000 \u0000 \u0000 \u0000 IVT using alteplase increased the incidence of FPE in Japanese patients with acute ischemic stroke treated with MT.\u0000 \u0000 \u0000 \u0000 : Trial registration umin.ac.jp/ctr identifier: UMIN000021488\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45137007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Siegler, Catherine Albin, E. Jones, Anamarie Schluntz, Jonathan Schultz, A. Jadhav
The social media platform Twitter has increasingly been leveraged to disseminate clinical and academic content, including scientific research. Launched in November 2021 as an exclusively online open access journal, the Stroke: Vascular and Interventional Neurology journal was not indexed on PubMed for its first year of publication. We aimed to evaluate the impact of the journal's Twitter presence by tracking social media posts and article metrics over the first year since the journal's inception. Measures of Twitter influence from the @SVINJournal account were associated with the academic impact of articles published in the associated journal during the first 13 months of the journal's publication record. Descriptive statistics and the Pearson correlation coefficient were used to quantify measures of association, with the primary outcome being unique article requests (downloads). There were 174 unique articles published during the study period, with 367 unique tweets. Articles referenced in tweets from @SVINJournal had nearly twice as many requests as articles without tweets (median 967 [interquartile range, 683–1357] versus 497 [interquartile range, 331–711]; P <0.01), with a mild correlation between number of tweets and article requests when @SVINJournal cited the article in tweets ( r =0.20; P =0.009). There was a fair correlation between article request counts and any Twitter mentions ( r =0.41; P <0.001), and a poor correlation between article requests and altmetric score ( r =0.15; P =0.04). There was a small correlation between the number of citations and number of tweets from @SVINJournal ( r =0.21; P =0.006). There was a statistically significant, but small, association between tweets and article requests as well as citations. Highly tweeted articles had a higher number of citations. In the absence of PubMed indexing and print distribution, social media platforms can have an impact in promoting peer‐reviewed content and may increase content access and citations.
{"title":"Impact of a Digital Strategy Team in an Academic Stroke Journal: 1 Year in Review","authors":"J. Siegler, Catherine Albin, E. Jones, Anamarie Schluntz, Jonathan Schultz, A. Jadhav","doi":"10.1161/svin.123.000872","DOIUrl":"https://doi.org/10.1161/svin.123.000872","url":null,"abstract":"\u0000 \u0000 \u0000 The social media platform Twitter has increasingly been leveraged to disseminate clinical and academic content, including scientific research. Launched in November 2021 as an exclusively online open access journal, the\u0000 Stroke: Vascular and Interventional Neurology\u0000 journal was not indexed on PubMed for its first year of publication. We aimed to evaluate the impact of the journal's Twitter presence by tracking social media posts and article metrics over the first year since the journal's inception.\u0000 \u0000 \u0000 \u0000 \u0000 Measures of Twitter influence from the @SVINJournal account were associated with the academic impact of articles published in the associated journal during the first 13 months of the journal's publication record. Descriptive statistics and the Pearson correlation coefficient were used to quantify measures of association, with the primary outcome being unique article requests (downloads).\u0000 \u0000 \u0000 \u0000 \u0000 There were 174 unique articles published during the study period, with 367 unique tweets. Articles referenced in tweets from @SVINJournal had nearly twice as many requests as articles without tweets (median 967 [interquartile range, 683–1357] versus 497 [interquartile range, 331–711];\u0000 P\u0000 <0.01), with a mild correlation between number of tweets and article requests when @SVINJournal cited the article in tweets (\u0000 r\u0000 =0.20;\u0000 P\u0000 =0.009). There was a fair correlation between article request counts and any Twitter mentions (\u0000 r\u0000 =0.41;\u0000 P\u0000 <0.001), and a poor correlation between article requests and altmetric score (\u0000 r\u0000 =0.15;\u0000 P\u0000 =0.04). There was a small correlation between the number of citations and number of tweets from @SVINJournal (\u0000 r\u0000 =0.21;\u0000 P\u0000 =0.006).\u0000 \u0000 \u0000 \u0000 \u0000 There was a statistically significant, but small, association between tweets and article requests as well as citations. Highly tweeted articles had a higher number of citations. In the absence of PubMed indexing and print distribution, social media platforms can have an impact in promoting peer‐reviewed content and may increase content access and citations.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47159728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Siegler, H. Shaikh, J. Khalife, S. Oak, Linda Zhang, M. Abdalkader, P. Klein, Thanh N. Nguyen, T. Kass-Hout, R. Morsi, J. Heit, R. Regenhardt, J. Diestro, N. Cancelliere, S. Ghozy, A. Sweid, K. Naamani, A. Amllay, L. Meyer, A. Dusart, F. Bellante, G. Forestier, A. Rouchaud, S. Saleme, C. Mounayer, J. Fiehler, A. Kühn, A. Puri, Christian Dyzmann, Peter T Kan, M. Colasurdo, G. Marnat, J. Berge, X. Barreau, I. Sibon, S. Nedelcu, N. Henninger, T. Marotta, A. Das, C. Stapleton, J. Rabinov, T. Ota, Shogo Dofuku, L. Yeo, B. Tan, J. C. Martinez‐Gutierrez, S. Salazar-Marioni, Sunil A. Sheth, L. Renieri, Carolina Capirossi, A. Mowla, S. Tjoumakaris, P. Jabbour, P. Khandelwal, A. Biswas, F. Clarençon, M. Elhorany, K. Premat, I. Valente, A. Pedicelli, J. Filipe, R. Varela, Miguel D. Quintero-Consuegra, N. Gonzalez, M. Möhlenbruch, J. Jesser, V. Costalat, Adrien ter Schiphorst, Vivek S Yedavalli, P. Harker, Lina M. Chervak, Yasmin N. Aziz, M. Bullrich, L. Sposato, B. Gory, C. Hecker, M. Killer-Oberpfalzer, C. Gries
For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry. Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups. Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P <0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P =0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P =0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98]; P =0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09]; P =0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18]; P =0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models. In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy.
对于急性颅内近端动脉闭塞，接触穿刺在一线再灌注治疗中可能比支架回收器更有效。由于缺乏关于中血管闭塞血栓切除术的数据，我们根据一线技术在大型多中心登记中评估结果。根据一线血管内技术(支架回收器与吸入法)，分析了10个国家37个部位的急性近端中血管闭塞(M2、A1或P1)或远端中血管闭塞(M3、A2、P2或更远)患者的影像学、手术和临床结果。使用多变量logistic回归和倾向评分匹配来估计治疗组之间的主要结局、脑梗死扩大溶栓评分2b-3(“成功再通”)以及次要结局(一次通过效应、脑梗死扩大溶栓评分2c - 3、脑出血、90天修正兰金量表、90天死亡率)的几率。在440例纳入的患者中(44.5%支架置换器对55.5%吸入性支架置换器)，接受支架置换器治疗的患者基线阿尔伯塔卒中项目早期计算机断层扫描评分较低(中位数为8比9;P <0.01)，美国国立卫生研究院卒中量表得分较高(中位数13比11;P =0.02)，中远端闭塞(M3、A2、P2或其他:17.4%比23.8%;P = 0.10)。使用支架回收器与再通成功几率降低15%相关(优势比[OR]， 0.85;[95% ci 0.74-0.98];P =0.02)，但在整个队列中进行多变量调整后，这一差异不显著(调整OR为0.88;[95% ci 0.72-1.09];P =0.24)，或倾向评分匹配的队列(每组n=105)(调整or为0.94;[95% ci 0.75-1.18];P = 0.60)。在倾向得分匹配调整模型中，技术和次要结果之间没有显著关联。在这个大型的、多样化的、跨国的中等血管闭塞队列中，我们发现抽吸与支架取栓术在影像学或临床结果上没有显著差异。
{"title":"Aspiration Versus Stent‐Retriever as First‐Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity‐Score Matched Multicenter Analysis","authors":"J. Siegler, H. Shaikh, J. Khalife, S. Oak, Linda Zhang, M. Abdalkader, P. Klein, Thanh N. Nguyen, T. Kass-Hout, R. Morsi, J. Heit, R. Regenhardt, J. Diestro, N. Cancelliere, S. Ghozy, A. Sweid, K. Naamani, A. Amllay, L. Meyer, A. Dusart, F. Bellante, G. Forestier, A. Rouchaud, S. Saleme, C. Mounayer, J. Fiehler, A. Kühn, A. Puri, Christian Dyzmann, Peter T Kan, M. Colasurdo, G. Marnat, J. Berge, X. Barreau, I. Sibon, S. Nedelcu, N. Henninger, T. Marotta, A. Das, C. Stapleton, J. Rabinov, T. Ota, Shogo Dofuku, L. Yeo, B. Tan, J. C. Martinez‐Gutierrez, S. Salazar-Marioni, Sunil A. Sheth, L. Renieri, Carolina Capirossi, A. Mowla, S. Tjoumakaris, P. Jabbour, P. Khandelwal, A. Biswas, F. Clarençon, M. Elhorany, K. Premat, I. Valente, A. Pedicelli, J. Filipe, R. Varela, Miguel D. Quintero-Consuegra, N. Gonzalez, M. Möhlenbruch, J. Jesser, V. Costalat, Adrien ter Schiphorst, Vivek S Yedavalli, P. Harker, Lina M. Chervak, Yasmin N. Aziz, M. Bullrich, L. Sposato, B. Gory, C. Hecker, M. Killer-Oberpfalzer, C. Gries","doi":"10.1161/svin.123.000931","DOIUrl":"https://doi.org/10.1161/svin.123.000931","url":null,"abstract":"\u0000 \u0000 For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry.\u0000 \u0000 \u0000 \u0000 Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups.\u0000 \u0000 \u0000 \u0000 \u0000 Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9;\u0000 P\u0000 <0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11;\u0000 P\u0000 =0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%;\u0000 P\u0000 =0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98];\u0000 P\u0000 =0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09];\u0000 P\u0000 =0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18];\u0000 P\u0000 =0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models.\u0000 \u0000 \u0000 \u0000 \u0000 In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43706348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Elfil, Hazem S. Ghaith, M. F. Doheim, P. Aboutaleb, Dominic J. Romeo, M. Salem, M. Aladawi, B. Jankowitz, J. Burkhardt, Thanh N. Nguyen, F. Al‐Mufti, R. Nogueira
In patients undergoing mechanical thrombectomy for acute ischemic stroke, a few studies have compared transradial access (TRA) to transfemoral access (TFA) with inconsistent results. We conducted this systematic review and meta‐analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of TRA versus TFA in patients with acute ischemic stroke undergoing mechanical thrombectomy. We performed a comprehensive literature search of 4 electronic databases from inception until May 1, 2022. After title and full text screening, relevant data were extracted and then analyzed. For outcomes that constituted continuous data, the mean difference between the 2 groups and its SD were pooled. For outcomes that constituted dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the 2 groups. Nine observational studies were included in this meta‐analysis. The population of the studies was homogenous comprising a total of 2161 patients undergoing mechanical thrombectomy, including 446 patients via TRA and 1715 patients via TFA. There were no significant differences across the 2 groups in terms of successful recanalization (OR, 0.83 [95% CI, 0.55–1.25]; P =0.36), complete recanalization (OR 1.16 [95% CI, 0.50–2.68]; P =0.73), favorable functional outcomes (OR, 0.86 [95% CI, 0.53–1.41]; P =0.56), first‐pass reperfusion (OR, 0.88 [95% CI, 0.64–1.19]; P =0.41), number of passes (mean difference, 0.12 [95% CI, −0.18 to 0.42]; P =0.43), access‐to‐reperfusion time (mean difference, −3.92 minutes [95% CI, −9.49 to 1.65]; P =0.17), or symptomatic intracranial hemorrhage (OR, 0.86 [95% CI, 0.47–1.57]; P =0.62). However, access site complications were significantly less frequent in the TRA group as compared with the TFA group (OR, 0.18 [95% CI, 0.06–0.51; P =0.001). In patients undergoing mechanical thrombectomy for acute ischemic stroke, the collective evidence suggests that TRA seems to result in lower rates of access site complications than TFA without significant compromise in other clinical or procedural metrics. Randomized or prospective studies are warranted to confirm these results.
{"title":"Transradial Versus Transfemoral Access for Mechanical Thrombectomy: A Systematic Review and Meta‐Analysis","authors":"Mohamed Elfil, Hazem S. Ghaith, M. F. Doheim, P. Aboutaleb, Dominic J. Romeo, M. Salem, M. Aladawi, B. Jankowitz, J. Burkhardt, Thanh N. Nguyen, F. Al‐Mufti, R. Nogueira","doi":"10.1161/svin.122.000758","DOIUrl":"https://doi.org/10.1161/svin.122.000758","url":null,"abstract":"\u0000 \u0000 In patients undergoing mechanical thrombectomy for acute ischemic stroke, a few studies have compared transradial access (TRA) to transfemoral access (TFA) with inconsistent results. We conducted this systematic review and meta‐analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of TRA versus TFA in patients with acute ischemic stroke undergoing mechanical thrombectomy.\u0000 \u0000 \u0000 \u0000 We performed a comprehensive literature search of 4 electronic databases from inception until May 1, 2022. After title and full text screening, relevant data were extracted and then analyzed. For outcomes that constituted continuous data, the mean difference between the 2 groups and its SD were pooled. For outcomes that constituted dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the 2 groups.\u0000 \u0000 \u0000 \u0000 \u0000 Nine observational studies were included in this meta‐analysis. The population of the studies was homogenous comprising a total of 2161 patients undergoing mechanical thrombectomy, including 446 patients via TRA and 1715 patients via TFA. There were no significant differences across the 2 groups in terms of successful recanalization (OR, 0.83 [95% CI, 0.55–1.25];\u0000 P\u0000 =0.36), complete recanalization (OR 1.16 [95% CI, 0.50–2.68];\u0000 P\u0000 =0.73), favorable functional outcomes (OR, 0.86 [95% CI, 0.53–1.41];\u0000 P\u0000 =0.56), first‐pass reperfusion (OR, 0.88 [95% CI, 0.64–1.19];\u0000 P\u0000 =0.41), number of passes (mean difference, 0.12 [95% CI, −0.18 to 0.42];\u0000 P\u0000 =0.43), access‐to‐reperfusion time (mean difference, −3.92 minutes [95% CI, −9.49 to 1.65];\u0000 P\u0000 =0.17), or symptomatic intracranial hemorrhage (OR, 0.86 [95% CI, 0.47–1.57];\u0000 P\u0000 =0.62). However, access site complications were significantly less frequent in the TRA group as compared with the TFA group (OR, 0.18 [95% CI, 0.06–0.51;\u0000 P\u0000 =0.001).\u0000 \u0000 \u0000 \u0000 \u0000 In patients undergoing mechanical thrombectomy for acute ischemic stroke, the collective evidence suggests that TRA seems to result in lower rates of access site complications than TFA without significant compromise in other clinical or procedural metrics. Randomized or prospective studies are warranted to confirm these results.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49197694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. R. Knapen, M. L. Bernsen, L. Langezaal, Susanne G H Olthuis, P. Michel, J. Hofmeijer, J. Vos, S. V. van Kuijk, C. Majoie, B. Emmer, G. Lycklama à Nijeholt, J. Boiten, V. Puetz, J. Gerber, M. Mazighi, O. Pontes-Neto, F. MONT’ALVERNE, A. Yoo, P. V. van Doormaal, Diederik W.J. Van Dippel, C. van der Leij, R. V. van Oostenbrugge, W. V. van Zwam, W. Schonewille
Both aspiration and stent retriever thrombectomy are safe and effective in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation. Little is known on the outcomes of these techniques in patients with basilar artery occlusion. This study aimed to compare clinical, technical, and safety outcomes of aspiration and stent retriever thrombectomy as first‐line treatment for basilar artery occlusion in the BASICS (Basilar artery International Cooperation Study) trial. For this post hoc analysis of the BASICS trial, all patients with a basilar artery occlusion who received endovascular treatment with either direct aspiration or stent retriever thrombectomy as first‐line approach were included. When both techniques were registered as first choice, patients were considered to have been treated with stent retriever. The primary outcome was favorable functional outcome, defined as a modified Rankin scale score of 0–3 at 90 days follow‐up, and analyzed using binary logistic regression analysis. Secondary outcomes included the modified Rankin scale score at 90 days (ranging from 0 to 6), procedure duration, mortality at 90 days, and symptomatic intracranial hemorrhage. Secondary outcomes were analyzed using binary, linear, or ordinal regression analyses. All analyses were adjusted for predefined variables. Among 158 BASICS patients treated with endovascular treatment,127 were treated with either stent retriever (N=67, 53%), or aspiration (N=60, 47%) as the first‐line treatment modality. We observed no significant difference in favorable functional outcome between patients treated with aspiration and stent retriever thrombectomy as first modality (adjusted odds ratio, 1.80; [95% CI, 0.68–4.76]). Also modified Rankin scale score at 90 days (adjusted common odds ratio, 0.62; [95% CI, 0.30–1.27]) and incidence of symptomatic intracranial hemorrhage (adjusted odds ratio, 0.61; [95% CI, 0.08–4.76]) showed no significant differences between both techniques. Procedure time was shorter with a median of 32 versus 47 minutes (26%; 95% CI, −42 to −6) and mortality rates at 90 days were lower (adjusted odds ratio, 0.36; [95% CI: 0.13–1.00]) in the direct aspiration group. This study shows no difference in favorable functional outcome in patients with a basilar artery occlusion treated with direct aspiration compared with patients treated with stent retriever thrombectomy within the BASICS trial, despite a shorter procedure time and lower mortality rate at 90 days.
{"title":"Aspiration Versus Stent Retriever Thrombectomy in Basilar‐Artery Occlusion; Results From the BASICS Trial","authors":"R. R. Knapen, M. L. Bernsen, L. Langezaal, Susanne G H Olthuis, P. Michel, J. Hofmeijer, J. Vos, S. V. van Kuijk, C. Majoie, B. Emmer, G. Lycklama à Nijeholt, J. Boiten, V. Puetz, J. Gerber, M. Mazighi, O. Pontes-Neto, F. MONT’ALVERNE, A. Yoo, P. V. van Doormaal, Diederik W.J. Van Dippel, C. van der Leij, R. V. van Oostenbrugge, W. V. van Zwam, W. Schonewille","doi":"10.1161/svin.122.000768","DOIUrl":"https://doi.org/10.1161/svin.122.000768","url":null,"abstract":"\u0000 \u0000 Both aspiration and stent retriever thrombectomy are safe and effective in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation. Little is known on the outcomes of these techniques in patients with basilar artery occlusion. This study aimed to compare clinical, technical, and safety outcomes of aspiration and stent retriever thrombectomy as first‐line treatment for basilar artery occlusion in the BASICS (Basilar artery International Cooperation Study) trial.\u0000 \u0000 \u0000 \u0000 For this post hoc analysis of the BASICS trial, all patients with a basilar artery occlusion who received endovascular treatment with either direct aspiration or stent retriever thrombectomy as first‐line approach were included. When both techniques were registered as first choice, patients were considered to have been treated with stent retriever. The primary outcome was favorable functional outcome, defined as a modified Rankin scale score of 0–3 at 90 days follow‐up, and analyzed using binary logistic regression analysis. Secondary outcomes included the modified Rankin scale score at 90 days (ranging from 0 to 6), procedure duration, mortality at 90 days, and symptomatic intracranial hemorrhage. Secondary outcomes were analyzed using binary, linear, or ordinal regression analyses. All analyses were adjusted for predefined variables.\u0000 \u0000 \u0000 \u0000 Among 158 BASICS patients treated with endovascular treatment,127 were treated with either stent retriever (N=67, 53%), or aspiration (N=60, 47%) as the first‐line treatment modality. We observed no significant difference in favorable functional outcome between patients treated with aspiration and stent retriever thrombectomy as first modality (adjusted odds ratio, 1.80; [95% CI, 0.68–4.76]). Also modified Rankin scale score at 90 days (adjusted common odds ratio, 0.62; [95% CI, 0.30–1.27]) and incidence of symptomatic intracranial hemorrhage (adjusted odds ratio, 0.61; [95% CI, 0.08–4.76]) showed no significant differences between both techniques. Procedure time was shorter with a median of 32 versus 47 minutes (26%; 95% CI, −42 to −6) and mortality rates at 90 days were lower (adjusted odds ratio, 0.36; [95% CI: 0.13–1.00]) in the direct aspiration group.\u0000 \u0000 \u0000 \u0000 This study shows no difference in favorable functional outcome in patients with a basilar artery occlusion treated with direct aspiration compared with patients treated with stent retriever thrombectomy within the BASICS trial, despite a shorter procedure time and lower mortality rate at 90 days.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43880003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hassan, W. Tekle, Sohum K Desai, D. Haussen, Mahmoud H. Mohammaden, R. Nogueira, Sunil A. Sheth, S. Salazar-Marioni, Alexandra L. Czap, I. Linfante, G. Dabus, A. Starosciak, Thanh N. Nguyen, M. Abdalkader, P. Klein, J. Siegler, M. Heslin, L. Thau, S. Oak, S. Ortega‐Gutierrez, M. Farooqui, J. Vivanco-Suarez, S. Majidi, J. Fifi, S. Matsoukas, W. Gordon, G. Linares, Wilson Rodriguez, Brijesh Mehta, R. Sugg, Mohammed Jumaa, D. Liebeskind
Clinical and radiographic outcomes after mechanical thrombectomy in the setting of COVID‐19 infection remain poorly characterized. We sought to determine how COVID‐19 status affects mechanical thrombectomy outcomes in the real‐world setting in the United States. The prospectively maintained multicenter mechanical thrombectomy registry from the Society of Vascular and Interventional Neurology was queried for baseline clinical characteristics among patients with and without COVID‐19 who underwent mechanical thrombectomy between March 1 and December 31, 2020 at 12 sites. Primary outcome was the likelihood of good neurological outcomes (90 day modified Rankin scale 0–2) among patients with COVID‐19 treated with endovascular thrombectomy, which was assessed using multivariable logistic regression adjusted for age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and substantial reperfusion (modified Thrombolysis in Cerebral Infarction 2b, 2c, and 3). Secondary outcomes included National Institutes of Health Stroke Scale at 24 hours. Among 915 patients who underwent mechanical thrombectomy during the study period, 51 patients were positive for COVID‐19 (5.6%). Univariate analysis revealed that compared with patients who were COVID‐19 negative, patients who were positive for COVID‐19 were more likely to be male, nonsmokers, have lower Alberta Stroke Program Early CT Score, and present with intracranial internal carotid artery occlusions (Table 1). They were also less likely to achieve successful reperfusion. Multivariable analysis, however, failed to identify any independent associations with COVID‐19 positive status. In our cohort, patients postive for COVID‐19 with acute ischemic stroke who undergo mechanical thrombectomy have similar baseline characteristics, imaging features, procedural, and clinical outcomes compared to patients who are negative for COVID‐19 in multivariate analysis. Further analyses are warranted.
{"title":"The Society of Vascular and Interventional Neurology (SVIN) Mechanical Thrombectomy Registry: Outcomes in Patients With Acute Ischemic Stroke and COVID‐19","authors":"A. Hassan, W. Tekle, Sohum K Desai, D. Haussen, Mahmoud H. Mohammaden, R. Nogueira, Sunil A. Sheth, S. Salazar-Marioni, Alexandra L. Czap, I. Linfante, G. Dabus, A. Starosciak, Thanh N. Nguyen, M. Abdalkader, P. Klein, J. Siegler, M. Heslin, L. Thau, S. Oak, S. Ortega‐Gutierrez, M. Farooqui, J. Vivanco-Suarez, S. Majidi, J. Fifi, S. Matsoukas, W. Gordon, G. Linares, Wilson Rodriguez, Brijesh Mehta, R. Sugg, Mohammed Jumaa, D. Liebeskind","doi":"10.1161/svin.122.000329","DOIUrl":"https://doi.org/10.1161/svin.122.000329","url":null,"abstract":"\u0000 \u0000 Clinical and radiographic outcomes after mechanical thrombectomy in the setting of COVID‐19 infection remain poorly characterized. We sought to determine how COVID‐19 status affects mechanical thrombectomy outcomes in the real‐world setting in the United States.\u0000 \u0000 \u0000 \u0000 The prospectively maintained multicenter mechanical thrombectomy registry from the Society of Vascular and Interventional Neurology was queried for baseline clinical characteristics among patients with and without COVID‐19 who underwent mechanical thrombectomy between March 1 and December 31, 2020 at 12 sites. Primary outcome was the likelihood of good neurological outcomes (90 day modified Rankin scale 0–2) among patients with COVID‐19 treated with endovascular thrombectomy, which was assessed using multivariable logistic regression adjusted for age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and substantial reperfusion (modified Thrombolysis in Cerebral Infarction 2b, 2c, and 3). Secondary outcomes included National Institutes of Health Stroke Scale at 24 hours.\u0000 \u0000 \u0000 \u0000 Among 915 patients who underwent mechanical thrombectomy during the study period, 51 patients were positive for COVID‐19 (5.6%). Univariate analysis revealed that compared with patients who were COVID‐19 negative, patients who were positive for COVID‐19 were more likely to be male, nonsmokers, have lower Alberta Stroke Program Early CT Score, and present with intracranial internal carotid artery occlusions (Table 1). They were also less likely to achieve successful reperfusion. Multivariable analysis, however, failed to identify any independent associations with COVID‐19 positive status.\u0000 \u0000 \u0000 \u0000 In our cohort, patients postive for COVID‐19 with acute ischemic stroke who undergo mechanical thrombectomy have similar baseline characteristics, imaging features, procedural, and clinical outcomes compared to patients who are negative for COVID‐19 in multivariate analysis. Further analyses are warranted.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45300216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Isenberg, Joseph Herres, E. Brandler, Huaqing Zhao, C. Kraus, Daniel Ackerman, A. Sigal, Alexander Kuc, J. Nomura, D. Cooney, Michael T. Mullen, J. Shahan, K. Murphy, T. Deaner, S. Wojcik, N. Gentile
Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are both important treatments for large‐vessel occlusion stroke. However, it is still unclear how the timing of IVT, EVT, and the need for transfer of a patient to an endovascular stroke center for EVT affect outcomes. In this investigation, we study the interaction between IVT, rapidity to EVT, and need for transfer among patients with large‐vessel occlusion stroke. This investigation is an analysis of the OPUS‐REACH (Optimizing the Use Prehospital Stroke Systems of Care–Reacting to Changing Paradigms) registry of patients with large‐vessel occlusion stroke from 9 endovascular centers in the United States. Using the database, we extracted baseline characteristics of patients, whether the patient received IVT, and time intervals in the patients’ care. Patient demographics and characteristics were compared between 2 groups using the χ 2 test for categorical variables and 2‐sample t ‐tests or Wilcoxon rank‐sum tests for continuous variables. Multivariable logistic regression was performed to determine the adjusted associations of the variables with 90‐day dichotomized modified Rankin Scale outcome. A total of 1171 patients were included in the final analysis, and 38.9% had good functional outcome at 90 days. Male sex and lower initial National Institutes of Health Stroke Scale score were nonmodifiable factors associated with good clinical outcomes. We saw no differences in outcome whether a patient underwent primary or secondary transport. On multiple variable analysis, the receipt of IVT was the only modifiable factor associated with good outcomes. We found no overall effect of time from last known well to EVT on 90‐day outcomes unless the patient received IVT. In this investigation, receipt of IVT was independently associated with improved outcomes at 90 days with an odds ratio of 1.51. Neither shorter time from last known well to EVT nor direct transport to an endovascular stroke center versus transfer to an endovascular stroke center was associated with improved outcomes. We therefore conclude that prehospital algorithms must account for the timely administration of IVT over time to EVT.
{"title":"Intravenous Thrombolysis Is Associated With Better Outcomes in Large‐Vessel Occlusion Requiring Endovascular Therapy","authors":"D. Isenberg, Joseph Herres, E. Brandler, Huaqing Zhao, C. Kraus, Daniel Ackerman, A. Sigal, Alexander Kuc, J. Nomura, D. Cooney, Michael T. Mullen, J. Shahan, K. Murphy, T. Deaner, S. Wojcik, N. Gentile","doi":"10.1161/svin.122.000814","DOIUrl":"https://doi.org/10.1161/svin.122.000814","url":null,"abstract":"\u0000 \u0000 Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are both important treatments for large‐vessel occlusion stroke. However, it is still unclear how the timing of IVT, EVT, and the need for transfer of a patient to an endovascular stroke center for EVT affect outcomes. In this investigation, we study the interaction between IVT, rapidity to EVT, and need for transfer among patients with large‐vessel occlusion stroke.\u0000 \u0000 \u0000 \u0000 \u0000 This investigation is an analysis of the OPUS‐REACH (Optimizing the Use Prehospital Stroke Systems of Care–Reacting to Changing Paradigms) registry of patients with large‐vessel occlusion stroke from 9 endovascular centers in the United States. Using the database, we extracted baseline characteristics of patients, whether the patient received IVT, and time intervals in the patients’ care. Patient demographics and characteristics were compared between 2 groups using the χ\u0000 2\u0000 test for categorical variables and 2‐sample\u0000 t\u0000 ‐tests or Wilcoxon rank‐sum tests for continuous variables. Multivariable logistic regression was performed to determine the adjusted associations of the variables with 90‐day dichotomized modified Rankin Scale outcome.\u0000 \u0000 \u0000 \u0000 \u0000 A total of 1171 patients were included in the final analysis, and 38.9% had good functional outcome at 90 days. Male sex and lower initial National Institutes of Health Stroke Scale score were nonmodifiable factors associated with good clinical outcomes. We saw no differences in outcome whether a patient underwent primary or secondary transport. On multiple variable analysis, the receipt of IVT was the only modifiable factor associated with good outcomes. We found no overall effect of time from last known well to EVT on 90‐day outcomes unless the patient received IVT.\u0000 \u0000 \u0000 \u0000 In this investigation, receipt of IVT was independently associated with improved outcomes at 90 days with an odds ratio of 1.51. Neither shorter time from last known well to EVT nor direct transport to an endovascular stroke center versus transfer to an endovascular stroke center was associated with improved outcomes. We therefore conclude that prehospital algorithms must account for the timely administration of IVT over time to EVT.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45450376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wendy Dusenbury, G. Tsivgoulis, Jason J. Chang, N. Goyal, Victoria Swatzell, A. Alexandrov, P. Lyden, A. Alexandrov
We sought to determine if the National Institutes of Health Stroke Scale (NIHSS) has a greater discriminative power than Glasgow coma scale (GCS) to identify patients at risk of poor early functional outcomes and large hematoma volumes. We prospectively collected clinical assessments, imaging, and outcome data in consecutive patients with intracerebral hemorrhage, and determined the ability of GCS and NIHSS to predict poor functional outcome (modified Rankin scale 3–6) and hematoma volume >30 cm 3 using receiver operating characteristics analysis, C‐statistics, and the DeLong test. We studied 672 patients with intracerebral hemorrhage (mean age 62±14 years; 56% men; median intracerebral hemorrhage score=1, interquartile range (IQR) 0–2; median intracerebral hemorrhage volume 7 cm 3 , IQR 2–19) with median NIHSS of 8 (IQR 3–18) and GCS 15 (IQR 7–15). NIHSS correlated strongly to GCS (r=−0.773; P <0.001). Admission NIHSS (C‐statistic: 0.91; 95% CI, 0.89–0.93) predicted better than GCS (0.78; 95% CI, 0.75–0.81) discharge poor functional outcome (DeLong test P <0.001). NIHSS (0.82; 95% CI, 0.78–0.86) also discriminated better than GCS (0.78; 95% CI, 0.73–0.83) patients with large hematoma volume (DeLong test P =0.029). The NIHSS has a greater discriminative power than GCS to identify patients at risk of poor early functional outcomes and large hematoma volumes.
我们试图确定美国国立卫生研究院卒中量表（NIHSS）是否比格拉斯哥昏迷量表（GCS）具有更大的判别力，以识别早期功能不良和血肿体积大的患者。我们前瞻性地收集了连续脑出血患者的临床评估、影像学和结果数据，并使用受试者操作特征分析、C‐统计量和DeLong检验确定了GCS和NIHSS预测不良功能结果（改良Rankin量表3-6）和血肿体积>30 cm 3的能力。我们研究了672名脑出血患者（平均年龄62±14岁；56%为男性；脑出血中位得分=1，四分位数间距（IQR）0-2；中位脑出血量7 cm 3，IQR 2–19），中位NIHSS为8（IQR 3–18），GCS为15（IQR 7–15）。NIHSS与GCS密切相关（r=−0.773；P<0.001）。入院NIHSS（C统计：0.91；95%CI，0.89–0.93）比GCS（0.78；95%CI，0.75–0.81）更好地预测出院不良功能结果（DeLong检验P<0.001在识别早期功能不良和血肿体积大的风险患者方面，GCS具有比GCS更大的辨别力。
{"title":"Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage","authors":"Wendy Dusenbury, G. Tsivgoulis, Jason J. Chang, N. Goyal, Victoria Swatzell, A. Alexandrov, P. Lyden, A. Alexandrov","doi":"10.1161/svin.123.000834","DOIUrl":"https://doi.org/10.1161/svin.123.000834","url":null,"abstract":"\u0000 \u0000 We sought to determine if the National Institutes of Health Stroke Scale (NIHSS) has a greater discriminative power than Glasgow coma scale (GCS) to identify patients at risk of poor early functional outcomes and large hematoma volumes.\u0000 \u0000 \u0000 \u0000 \u0000 We prospectively collected clinical assessments, imaging, and outcome data in consecutive patients with intracerebral hemorrhage, and determined the ability of GCS and NIHSS to predict poor functional outcome (modified Rankin scale 3–6) and hematoma volume >30 cm\u0000 3\u0000 using receiver operating characteristics analysis, C‐statistics, and the DeLong test.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 We studied 672 patients with intracerebral hemorrhage (mean age 62±14 years; 56% men; median intracerebral hemorrhage score=1, interquartile range (IQR) 0–2; median intracerebral hemorrhage volume 7 cm\u0000 3\u0000 , IQR 2–19) with median NIHSS of 8 (IQR 3–18) and GCS 15 (IQR 7–15). NIHSS correlated strongly to GCS (r=−0.773;\u0000 P\u0000 <0.001). Admission NIHSS (C‐statistic: 0.91; 95% CI, 0.89–0.93) predicted better than GCS (0.78; 95% CI, 0.75–0.81) discharge poor functional outcome (DeLong test\u0000 P\u0000 <0.001). NIHSS (0.82; 95% CI, 0.78–0.86) also discriminated better than GCS (0.78; 95% CI, 0.73–0.83) patients with large hematoma volume (DeLong test\u0000 P\u0000 =0.029).\u0000 \u0000 \u0000 \u0000 \u0000 The NIHSS has a greater discriminative power than GCS to identify patients at risk of poor early functional outcomes and large hematoma volumes.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45268280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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