O. Zaidat, S. A. Kasab, Sunil A. Sheth, S. Ortega‐Gutierrez, A. Rai, C. Given, R. Grandhi, M. Mokin, J. Katz, A. Maud, Rishi Gupta, Wade S. Smith, D. Dippel, D. Gress, Thanh N. Nguyen, S. Brown, A. Jadhav, Lucas Eljovich, C. Majoie, Mary S. Patterson, H. Slight, Kristine Below, A. Yoo
Mechanical thrombectomy has been shown to be effective in patients with acute ischemic stroke secondary to large‐vessel occlusion and small to moderate infarct volume. However, there are no randomized clinical trials for large‐core infarct volume comparing mechanical thrombectomy to medical therapy in the population selected based solely on noncontrast computed tomography brain scan. The TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke) randomized clinical trial is designed to address this clinical question. The TESLA trial aim is to demonstrate the efficacy (3‐month and 1‐year disability following stroke) and safety of intraarterial mechanical thrombectomy in patients with large‐volume infarction assessed with a noncontrast computed tomography scan. The TESLA trial design is a prospective, randomized controlled, multicenter, open‐label, assessor‐blinded anterior circulation acute ischemic stroke trial with adaptive enrichment design, enrolling up to 300 patients. Patients with anterior circulation large‐vessel occlusion who meet the imaging and clinical eligibility criteria with a large‐core infarction on the basis of noncontrast computed tomography Alberta Stroke Program Early CT Score (2–5) adjudicated by a site investigator will be randomized in a 1:1 ratio to undergo intraarterial thrombectomy or best medical management up to 24 hours from last known well. The primary efficacy outcome is utility‐weighted modified Rankin Scale (mRS) score distribution at 90 days between the groups. The results will be based on an intention‐to‐treat analysis that will examine the Bayesian posterior probability that, adjusted for Alberta Stroke Program Early CT Score, patients with large‐core infarct volume treated with intra‐arterial thrombectomy have higher expected utility‐weighted mRS than those treated with best medical management alone. The primary safety outcome is the 90‐day death rate. Key secondary outcomes are dichotomized mRS 0 to 2 and 0 to 3 outcomes, ordinal mRS scores, and quality of life (EuroQol 5 Dimension 5 Level survey) at 90 days and 1 year, utility‐weighted mRS at 1 year, hemicraniectomy rate, and rate of 24‐hour symptomatic intracranial hemorrhage in both groups. TESLA is a pragmatic trial, designed to address the unanswered question of the efficacy and safety of intra‐arterial thrombectomy in patients with large infarcts diagnosed by the site investigator only on noncontrast computed tomography scan secondary to anterior circulation large‐vessel occlusion up to 24 hours from stroke symptoms onset.
{"title":"TESLA Trial: Rationale, Protocol, and Design","authors":"O. Zaidat, S. A. Kasab, Sunil A. Sheth, S. Ortega‐Gutierrez, A. Rai, C. Given, R. Grandhi, M. Mokin, J. Katz, A. Maud, Rishi Gupta, Wade S. Smith, D. Dippel, D. Gress, Thanh N. Nguyen, S. Brown, A. Jadhav, Lucas Eljovich, C. Majoie, Mary S. Patterson, H. Slight, Kristine Below, A. Yoo","doi":"10.1161/svin.122.000787","DOIUrl":"https://doi.org/10.1161/svin.122.000787","url":null,"abstract":"\u0000 \u0000 Mechanical thrombectomy has been shown to be effective in patients with acute ischemic stroke secondary to large‐vessel occlusion and small to moderate infarct volume. However, there are no randomized clinical trials for large‐core infarct volume comparing mechanical thrombectomy to medical therapy in the population selected based solely on noncontrast computed tomography brain scan. The TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke) randomized clinical trial is designed to address this clinical question.\u0000 \u0000 \u0000 \u0000 The TESLA trial aim is to demonstrate the efficacy (3‐month and 1‐year disability following stroke) and safety of intraarterial mechanical thrombectomy in patients with large‐volume infarction assessed with a noncontrast computed tomography scan. The TESLA trial design is a prospective, randomized controlled, multicenter, open‐label, assessor‐blinded anterior circulation acute ischemic stroke trial with adaptive enrichment design, enrolling up to 300 patients. Patients with anterior circulation large‐vessel occlusion who meet the imaging and clinical eligibility criteria with a large‐core infarction on the basis of noncontrast computed tomography Alberta Stroke Program Early CT Score (2–5) adjudicated by a site investigator will be randomized in a 1:1 ratio to undergo intraarterial thrombectomy or best medical management up to 24 hours from last known well.\u0000 \u0000 \u0000 \u0000 The primary efficacy outcome is utility‐weighted modified Rankin Scale (mRS) score distribution at 90 days between the groups. The results will be based on an intention‐to‐treat analysis that will examine the Bayesian posterior probability that, adjusted for Alberta Stroke Program Early CT Score, patients with large‐core infarct volume treated with intra‐arterial thrombectomy have higher expected utility‐weighted mRS than those treated with best medical management alone. The primary safety outcome is the 90‐day death rate. Key secondary outcomes are dichotomized mRS 0 to 2 and 0 to 3 outcomes, ordinal mRS scores, and quality of life (EuroQol 5 Dimension 5 Level survey) at 90 days and 1 year, utility‐weighted mRS at 1 year, hemicraniectomy rate, and rate of 24‐hour symptomatic intracranial hemorrhage in both groups.\u0000 \u0000 \u0000 \u0000 TESLA is a pragmatic trial, designed to address the unanswered question of the efficacy and safety of intra‐arterial thrombectomy in patients with large infarcts diagnosed by the site investigator only on noncontrast computed tomography scan secondary to anterior circulation large‐vessel occlusion up to 24 hours from stroke symptoms onset.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46995562","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}
F. Sheriff, J. Lavezo, R. Floresca, M. Chaudhury, Gabriela Colina, R. Regenhardt, V. Gupta, G. Rodriguez, A. Maud
Acute ischemic stroke secondary to large vessel occlusion is among the most serious complications associated with COVID‐19 infection resulting in worse morbidity and mortality. We sought to study the association between COVID‐19 infection and large vessel occlusion thrombus pathology to better define the etiopathogenesis of this atypical cause of stroke. Thrombi were collected during mechanical thrombectomy and stained using hematoxylin and eosin. Blinded analysis of pathology was prospectively performed by a board‐certified neuropathologist. Red blood cell, fibrin, and white blood cell predominance was ascertained. Concomitant peripheral blood counts and clinical and imaging data were collected and analyzed. All samples underwent performance of reverse transcription polymerase chain reaction for SARS‐CoV2. Between January 2020 and February 2022, a total of 952 acute ischemic stroke admissions were seen at the University Medical Center of El Paso, TX. Of these, 195 patients (20.5%) had large vessel occlusions and underwent mechanical thrombectomy and 53 patients had thrombus collected and analyzed. Seven patients (3.6%) tested positive for SARS‐CoV2. COVID‐19 positive patients were more likely to be younger (mean 57.4 years; P =0.07), male (85.7%; P =0.03), and have red blood cell predominant thrombi (85.7%; P =0.03). There was a statistically significant association between peripheral neutrophil count and white blood cell lysis in the overall cohort ( P =0.015), who did not differ according to COVID‐19 status. Thrombi retrieved from patients who were COVID‐19 positive and had stroke demonstrated red blood cell predominance. This finding requires further investigation using appropriate immunohistochemical techniques in a larger cohort of patients.
{"title":"Clinicopathologic Analysis of COVID‐19 Associated Thrombi in the Setting of Large Vessel Occlusion: A Prospective Case–Control Study","authors":"F. Sheriff, J. Lavezo, R. Floresca, M. Chaudhury, Gabriela Colina, R. Regenhardt, V. Gupta, G. Rodriguez, A. Maud","doi":"10.1161/svin.123.000840","DOIUrl":"https://doi.org/10.1161/svin.123.000840","url":null,"abstract":"\u0000 \u0000 Acute ischemic stroke secondary to large vessel occlusion is among the most serious complications associated with COVID‐19 infection resulting in worse morbidity and mortality. We sought to study the association between COVID‐19 infection and large vessel occlusion thrombus pathology to better define the etiopathogenesis of this atypical cause of stroke.\u0000 \u0000 \u0000 \u0000 Thrombi were collected during mechanical thrombectomy and stained using hematoxylin and eosin. Blinded analysis of pathology was prospectively performed by a board‐certified neuropathologist. Red blood cell, fibrin, and white blood cell predominance was ascertained. Concomitant peripheral blood counts and clinical and imaging data were collected and analyzed. All samples underwent performance of reverse transcription polymerase chain reaction for SARS‐CoV2.\u0000 \u0000 \u0000 \u0000 \u0000 Between January 2020 and February 2022, a total of 952 acute ischemic stroke admissions were seen at the University Medical Center of El Paso, TX. Of these, 195 patients (20.5%) had large vessel occlusions and underwent mechanical thrombectomy and 53 patients had thrombus collected and analyzed. Seven patients (3.6%) tested positive for SARS‐CoV2. COVID‐19 positive patients were more likely to be younger (mean 57.4 years;\u0000 P\u0000 =0.07), male (85.7%;\u0000 P\u0000 =0.03), and have red blood cell predominant thrombi (85.7%;\u0000 P\u0000 =0.03). There was a statistically significant association between peripheral neutrophil count and white blood cell lysis in the overall cohort (\u0000 P\u0000 =0.015), who did not differ according to COVID‐19 status.\u0000 \u0000 \u0000 \u0000 \u0000 Thrombi retrieved from patients who were COVID‐19 positive and had stroke demonstrated red blood cell predominance. This finding requires further investigation using appropriate immunohistochemical techniques in a larger cohort of patients.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49513083","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}
Yong Soo Kim, B. Kim, B. Menon, J. Yoo, J. Han, B. Kim, C. Kim, J. Kim, Joon-Tae Kim, Hyungjong Park, S. H. Baik, Moon‐Ku Han, Jihoon Kang, J. Kim, K. Lee, H. Jeong, Jong-Moo Park, K. Kang, Soo‐Joo Lee, J. Cha, Dae-Hyun Kim, Jin-Heon Jeong, T. Park, Sang-Soon Park, K. Lee, Jun Lee, K. Hong, Yong‐Jin Cho, Hong‐Kyun Park, Byung‐Chul Lee, K. Yu, M. Oh, Dong-Eog Kim, W. Ryu, K. Choi, J. Choi, Joong-Goo Kim, J. Kwon, Wook-Joo Kim, Dong-Ick Shin, K. Yum, S. Sohn, Jeong‐Ho Hong, Chulho Kim, Sang-Hwa Lee, Juneyoung Lee, H. Bae
Approximately 10% of patients with acute ischemic stroke with large‐vessel occlusion (LVO) have mild neurological deficits. Although leptomeningeal collaterals (LMCs) are the major determinant of clinical outcomes for patients with acute ischemic stroke with LVO, the contribution of baseline LMC status to subsequent infarct progression in patients with mild stroke with LVO is poorly defined. This observational study included patients with acute anterior circulation LVO and mild stroke symptoms (National Institutes of Health Stroke Scale < 6) from a prospectively collected, multicenter, national stroke registry. The Alberta Stroke Program Early Computed Tomography Score was quantified on the initial and follow‐up images. An infarct progression, defined as any Alberta Stroke Program Early Computed Tomography Score decrease between the initial versus follow‐up scans, was categorized as either 0/1/2+. The LMCs on the baseline images were graded as good, fair, or poor. Of the 623 included patients (mean age, 67.6±13.4 years; 380 [61.0%] men; 186 [29.9%] with reperfusion treatment), the baseline LMC was graded as good in 331 (53.1%), fair in 219 (35.2%), and poor in 73 (11.7%). The Alberta Stroke Program Early Computed Tomography Score decrement was noted as 0 in 288 (46%) patients, 1 in 154 (24%), and 2+ in 181 (29%). A poor LMC was associated with an infarct progression (adjusted odds ratio, 2.05 [95% CI, 1.22–3.47]). Poor collateral blood flow was associated with infarct progression in patients with acute ischemic stroke with LVO and mild symptoms. In this selective population, early assessment of collateral blood flow status can help in early detection of patients susceptible to infarct progression.
{"title":"Leptomeningeal Collaterals and Infarct Progression in Patients With Acute Large‐Vessel Occlusion and Low NIHSS","authors":"Yong Soo Kim, B. Kim, B. Menon, J. Yoo, J. Han, B. Kim, C. Kim, J. Kim, Joon-Tae Kim, Hyungjong Park, S. H. Baik, Moon‐Ku Han, Jihoon Kang, J. Kim, K. Lee, H. Jeong, Jong-Moo Park, K. Kang, Soo‐Joo Lee, J. Cha, Dae-Hyun Kim, Jin-Heon Jeong, T. Park, Sang-Soon Park, K. Lee, Jun Lee, K. Hong, Yong‐Jin Cho, Hong‐Kyun Park, Byung‐Chul Lee, K. Yu, M. Oh, Dong-Eog Kim, W. Ryu, K. Choi, J. Choi, Joong-Goo Kim, J. Kwon, Wook-Joo Kim, Dong-Ick Shin, K. Yum, S. Sohn, Jeong‐Ho Hong, Chulho Kim, Sang-Hwa Lee, Juneyoung Lee, H. Bae","doi":"10.1161/svin.122.000819","DOIUrl":"https://doi.org/10.1161/svin.122.000819","url":null,"abstract":"\u0000 \u0000 Approximately 10% of patients with acute ischemic stroke with large‐vessel occlusion (LVO) have mild neurological deficits. Although leptomeningeal collaterals (LMCs) are the major determinant of clinical outcomes for patients with acute ischemic stroke with LVO, the contribution of baseline LMC status to subsequent infarct progression in patients with mild stroke with LVO is poorly defined.\u0000 \u0000 \u0000 \u0000 This observational study included patients with acute anterior circulation LVO and mild stroke symptoms (National Institutes of Health Stroke Scale < 6) from a prospectively collected, multicenter, national stroke registry. The Alberta Stroke Program Early Computed Tomography Score was quantified on the initial and follow‐up images. An infarct progression, defined as any Alberta Stroke Program Early Computed Tomography Score decrease between the initial versus follow‐up scans, was categorized as either 0/1/2+. The LMCs on the baseline images were graded as good, fair, or poor.\u0000 \u0000 \u0000 \u0000 Of the 623 included patients (mean age, 67.6±13.4 years; 380 [61.0%] men; 186 [29.9%] with reperfusion treatment), the baseline LMC was graded as good in 331 (53.1%), fair in 219 (35.2%), and poor in 73 (11.7%). The Alberta Stroke Program Early Computed Tomography Score decrement was noted as 0 in 288 (46%) patients, 1 in 154 (24%), and 2+ in 181 (29%). A poor LMC was associated with an infarct progression (adjusted odds ratio, 2.05 [95% CI, 1.22–3.47]).\u0000 \u0000 \u0000 \u0000 Poor collateral blood flow was associated with infarct progression in patients with acute ischemic stroke with LVO and mild symptoms. In this selective population, early assessment of collateral blood flow status can help in early detection of patients susceptible to infarct progression.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48345124","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}
M. Grove, Mani Paliwal, Anne Shearin, Jane Kaiser, Eun Sun Koo, Danielle Howey, M. Galati, Bozena Czekalski, Jennifer Dumawal, Briana DeCarvalho, Jackie Dwyer, G. Tsivgoulis, A. Alexandrov, A. Alexandrov
Automatic noninvasive oscillometric blood pressure (NIBP) devices measure mean arterial pressure (MAP); systolic and diastolic blood pressure (SBP, DBP) are algorithmically derived from MAP. The most invalid NIBP measure is SBP, yet stroke practitioners use it to manage blood pressure (BP) in accordance with thrombolysis guidelines. We determined agreement between SBP, DBP, and MAP measured manually and by NIBP in patients treated with alteplase. A multisite prospective observational study of NIBP and manual BP agreement was conducted in patients treated with alteplase immediately after bolus and infusion initiation using methods established in guidelines for the assessment of device agreement. Dual auscultatory stethoscopes were used by 2 investigators to ensure agreement with each manual BP variable and MAP was calculated using the standard formula for manual BP measures. Data were analyzed using Bland–Altman analyses and Lin concordance correlation coefficient. A total of 7 hospitals participated, collecting 5 sets of manual/NIBP BPs in 95 patients treated with alteplase (475 paired measures). Range in limits of agreement were SBP: −28.91 to 21.41 mmHg with Lin's concordance correlation coefficient 0.8; DBP: −21.0 to 19.0 mmHg with Lin's concordance correlation coefficient 0.69; and MAP: −27.5 to 16.5 mmHg with Lin's concordance correlation coefficient 0.7. There was no difference in device agreement by BP device manufacturer brand. Differences in SBP, DBP, and MAP between NIBP and manual sphygmomanometry failed to reach guideline recommendations requiring 80% of measures to fall within a 5 mmHg difference and 95% of measures to fall within a 10 mmHg difference. NIBP devices produce significantly different BP measures then manual sphygmomanometry auscultated BP. Because NIBP devices rely on the MAP and do not directly measure SBP and DBP, definition of what constitutes safe MAP boundaries in patients treated with alteplase should be determined when automatic BP measurement is used in clinical practice.
{"title":"Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement?","authors":"M. Grove, Mani Paliwal, Anne Shearin, Jane Kaiser, Eun Sun Koo, Danielle Howey, M. Galati, Bozena Czekalski, Jennifer Dumawal, Briana DeCarvalho, Jackie Dwyer, G. Tsivgoulis, A. Alexandrov, A. Alexandrov","doi":"10.1161/svin.122.000711","DOIUrl":"https://doi.org/10.1161/svin.122.000711","url":null,"abstract":"\u0000 \u0000 Automatic noninvasive oscillometric blood pressure (NIBP) devices measure mean arterial pressure (MAP); systolic and diastolic blood pressure (SBP, DBP) are algorithmically derived from MAP. The most invalid NIBP measure is SBP, yet stroke practitioners use it to manage blood pressure (BP) in accordance with thrombolysis guidelines. We determined agreement between SBP, DBP, and MAP measured manually and by NIBP in patients treated with alteplase.\u0000 \u0000 \u0000 \u0000 A multisite prospective observational study of NIBP and manual BP agreement was conducted in patients treated with alteplase immediately after bolus and infusion initiation using methods established in guidelines for the assessment of device agreement. Dual auscultatory stethoscopes were used by 2 investigators to ensure agreement with each manual BP variable and MAP was calculated using the standard formula for manual BP measures. Data were analyzed using Bland–Altman analyses and Lin concordance correlation coefficient.\u0000 \u0000 \u0000 \u0000 A total of 7 hospitals participated, collecting 5 sets of manual/NIBP BPs in 95 patients treated with alteplase (475 paired measures). Range in limits of agreement were SBP: −28.91 to 21.41 mmHg with Lin's concordance correlation coefficient 0.8; DBP: −21.0 to 19.0 mmHg with Lin's concordance correlation coefficient 0.69; and MAP: −27.5 to 16.5 mmHg with Lin's concordance correlation coefficient 0.7. There was no difference in device agreement by BP device manufacturer brand. Differences in SBP, DBP, and MAP between NIBP and manual sphygmomanometry failed to reach guideline recommendations requiring 80% of measures to fall within a 5 mmHg difference and 95% of measures to fall within a 10 mmHg difference.\u0000 \u0000 \u0000 \u0000 NIBP devices produce significantly different BP measures then manual sphygmomanometry auscultated BP. Because NIBP devices rely on the MAP and do not directly measure SBP and DBP, definition of what constitutes safe MAP boundaries in patients treated with alteplase should be determined when automatic BP measurement is used in clinical practice.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48256641","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}
H. Zeineddine, Bryden H. Dawes, M. Mullarkey, J. C. Martinez‐Gutierrez, P. Chen
Cervical vertebral arteriovenous fistula is a rare entity that is typically managed with endovascular techniques. We describe 2 consecutive cases of spontaneous obliteration of high flow cervical vertebral arteriovenous fistulas following angiography. Our cases pose an interesting natural history course, and we review the role of angiography in the unusual phenomenon of spontaneous obliteration of vascular malformations. These 2 cases bring forward the possibility of conservative management in such lesions.
{"title":"Spontaneous Resolution of 2 High Flow Cervical Vertebral Arteriovenous Fistulas","authors":"H. Zeineddine, Bryden H. Dawes, M. Mullarkey, J. C. Martinez‐Gutierrez, P. Chen","doi":"10.1161/svin.122.000827","DOIUrl":"https://doi.org/10.1161/svin.122.000827","url":null,"abstract":"Cervical vertebral arteriovenous fistula is a rare entity that is typically managed with endovascular techniques. We describe 2 consecutive cases of spontaneous obliteration of high flow cervical vertebral arteriovenous fistulas following angiography. Our cases pose an interesting natural history course, and we review the role of angiography in the unusual phenomenon of spontaneous obliteration of vascular malformations. These 2 cases bring forward the possibility of conservative management in such lesions.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48806668","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}
V. D. Del Brutto, Jacob A. Sambursky, Nastajjia A Krementz, Faisal J Gondal, H. Gardener, F. Cabrera, Yosdely Cabrera, F. S. Saleh Velez, J. Romano, S. Koch
Almost half of large‐vessel occlusion strokes have unfavorable outcomes despite successful endovascular therapy. We aim to investigate whether postrevascularization cerebral hemodynamics, determined by transcranial Doppler (TCD), associate with hospitalization outcomes in this population. The current observational cohort study analyzed 155 patients with successfully revascularized anterior circulation large‐vessel occlusion stroke (mean age, 68.3±15.4 years; 55% women) who had TCD within 48 hours from endovascular therapy. TCD parameters (mean flow velocity, peak systolic velocity, and pulsatility index) were recorded at the ipsilateral middle cerebral artery, and blood flow signals were categorized using the Thrombolysis in Brain Ischemia grades into normal (grade 5), stenotic (grade 4), or dampened (grade ≤3). Hospitalization outcomes comprised favorable discharge modified Rankin Scale score (0–2), favorable discharge destination (home or acute inpatient rehabilitation), and in‐hospital mortality. Logistic regression models adjusted for age, initial National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT [Computed Tomography] Score were fit to determine TCD findings in association with study outcomes. Abnormal TCD‐derived blood flow was found in 54 (35%) cases, including 35 (23%) with Thrombolysis in Brain Ischemia grade 4 and 19 (12%) with Thrombolysis in Brain Ischemia grade ≤3. Overall, 31% had favorable discharge modified Rankin Scale score, 65% had favorable destination, and 14% died. Thrombolysis in Brain Ischemia grade ≤3 was associated with lower likelihood of both favorable discharge modified Rankin Scale score (adjusted odds ratio [OR], 0.09 [95% CI, 0.01–0.81]) and favorable destination (adjusted OR, 0.22 [95% CI, 0.07–0.71]). Mean flow velocity and peak systolic velocity were not associated with study outcomes. Conversely, increased pulsatility index was inversely associated with favorable destination (adjusted OR, 0.34 [95% CI, 0.13–0.87]). TCD after successful endovascular therapy identified abnormal blood flow in one‐third of cases. Dampened flow and markers of increased microvascular resistance were associated with unfavorable hospitalization outcomes. TCD could provide valuable prognostic information in this population and identify potential therapeutic targets.
{"title":"Transcranial Doppler After Successful Endovascular Revascularization and Hospitalization Outcomes","authors":"V. D. Del Brutto, Jacob A. Sambursky, Nastajjia A Krementz, Faisal J Gondal, H. Gardener, F. Cabrera, Yosdely Cabrera, F. S. Saleh Velez, J. Romano, S. Koch","doi":"10.1161/svin.122.000785","DOIUrl":"https://doi.org/10.1161/svin.122.000785","url":null,"abstract":"\u0000 \u0000 Almost half of large‐vessel occlusion strokes have unfavorable outcomes despite successful endovascular therapy. We aim to investigate whether postrevascularization cerebral hemodynamics, determined by transcranial Doppler (TCD), associate with hospitalization outcomes in this population.\u0000 \u0000 \u0000 \u0000 The current observational cohort study analyzed 155 patients with successfully revascularized anterior circulation large‐vessel occlusion stroke (mean age, 68.3±15.4 years; 55% women) who had TCD within 48 hours from endovascular therapy. TCD parameters (mean flow velocity, peak systolic velocity, and pulsatility index) were recorded at the ipsilateral middle cerebral artery, and blood flow signals were categorized using the Thrombolysis in Brain Ischemia grades into normal (grade 5), stenotic (grade 4), or dampened (grade ≤3). Hospitalization outcomes comprised favorable discharge modified Rankin Scale score (0–2), favorable discharge destination (home or acute inpatient rehabilitation), and in‐hospital mortality. Logistic regression models adjusted for age, initial National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT [Computed Tomography] Score were fit to determine TCD findings in association with study outcomes.\u0000 \u0000 \u0000 \u0000 Abnormal TCD‐derived blood flow was found in 54 (35%) cases, including 35 (23%) with Thrombolysis in Brain Ischemia grade 4 and 19 (12%) with Thrombolysis in Brain Ischemia grade ≤3. Overall, 31% had favorable discharge modified Rankin Scale score, 65% had favorable destination, and 14% died. Thrombolysis in Brain Ischemia grade ≤3 was associated with lower likelihood of both favorable discharge modified Rankin Scale score (adjusted odds ratio [OR], 0.09 [95% CI, 0.01–0.81]) and favorable destination (adjusted OR, 0.22 [95% CI, 0.07–0.71]). Mean flow velocity and peak systolic velocity were not associated with study outcomes. Conversely, increased pulsatility index was inversely associated with favorable destination (adjusted OR, 0.34 [95% CI, 0.13–0.87]).\u0000 \u0000 \u0000 \u0000 TCD after successful endovascular therapy identified abnormal blood flow in one‐third of cases. Dampened flow and markers of increased microvascular resistance were associated with unfavorable hospitalization outcomes. TCD could provide valuable prognostic information in this population and identify potential therapeutic targets.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47597772","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. Vivanco-Suarez, A. Rodriguez-Calienes, M. Farooqui, Margarita Rabinovich, M. Abouelleil, D. Altschul, C. Feigen, J. Fifi, S. Matsoukas, F. Al‐Mufti, M. Malaga, M. Galecio-Castillo, A. Wakhloo, J. Singer, S. Ortega‐Gutierrez
Flow diverters are now considered first‐line tools for treating intracranial aneurysms. However, few devices are available for patients with large‐diameter vessels (LDVs). Hence, we evaluated the performance of the largest diameter Surpass Streamline for aneurysms in LDVs. We performed a subanalysis of the SESSIA (Safety and Efficacy of the Surpass Streamline for Intracranial Aneurysms) multicenter cohort study of patients treated with Surpass Streamline between 2018 and 2021. Patients in whom a 5‐mm diameter Surpass Streamline was implanted were divided into 2 groups according to vessel diameter at the landing zones (LDV, ≥5.3 mm versus non‐LDV [N‐LDV], <5.3 mm). Efficacy was complete occlusion at final follow‐up. Safety was ischemic/hemorrhagic events and mortality up to 30 days. Thirty patients harboring 30 aneurysms were included. Fifteen cases were included per group (LDV versus N‐LDV). Baseline demographics, clinical characteristics, median aneurysm size (LDV, 11 mm versus N‐LDV, 10 mm), and location were similar. Vessel diameters at the proximal (LDV, 5.3 mm versus N‐LDV, 4.2 mm; P <0.001) and distal (5.6 versus 4.0 mm; P <0.001) flow diverter landing zones were different. Procedural characteristics (including balloon‐assisted angioplasty and stenting) were similar. At the final follow‐up (12±6 months), complete occlusion (LDV, 75% versus N‐LDV, 84%; P =0.548), and ischemic/hemorrhagic events (1 per group; P =1.00) were not different. The use of large‐diameter flow diverters for treating complex intracranial aneurysms arising in LDVs is technically feasible and safe. Comparative studies evaluating devices suitable for this patient population will provide valuable insights for the best device selection.
分流器现在被认为是治疗颅内动脉瘤的一线工具。然而，很少有设备可用于大直径血管(ldv)患者。因此，我们评估了最大直径超越流线在ldv动脉瘤中的表现。我们对2018年至2021年间接受超过流线治疗的患者进行了SESSIA(安全性和有效性的超过流线治疗颅内动脉瘤)多中心队列研究的亚分析。5 - mm直径的“超越流线”植入患者根据着陆区血管直径分为两组(LDV，≥5.3 mm vs非LDV [N - LDV]， <5.3 mm)。疗效为最终随访时完全闭塞。安全性是30天内的缺血/出血性事件和死亡率。30例患者包含30个动脉瘤。每组15例(LDV vs N - LDV)。基线人口统计学、临床特征、中位动脉瘤大小(LDV, 11 mm vs N - LDV, 10 mm)和位置相似。近端LDV的血管直径为5.3 mm, N - LDV为4.2 mm;P <0.001)和远端(5.6 vs 4.0 mm;P <0.001)。手术特征(包括球囊辅助血管成形术和支架置入术)相似。在最后随访(12±6个月)时，完全闭塞(LDV, 75% vs N - LDV, 84%;P =0.548)，缺血/出血性事件(每组1例;P =1.00)差异无统计学意义。使用大直径分流器治疗ldv产生的复杂颅内动脉瘤在技术上是可行和安全的。比较研究评估适合该患者群体的设备将为最佳设备选择提供有价值的见解。
{"title":"Flow Diversion for Intracranial Aneurysms in Large‐Diameter Vessels: A Subanalysis From the SESSIA Study","authors":"J. Vivanco-Suarez, A. Rodriguez-Calienes, M. Farooqui, Margarita Rabinovich, M. Abouelleil, D. Altschul, C. Feigen, J. Fifi, S. Matsoukas, F. Al‐Mufti, M. Malaga, M. Galecio-Castillo, A. Wakhloo, J. Singer, S. Ortega‐Gutierrez","doi":"10.1161/svin.123.000846","DOIUrl":"https://doi.org/10.1161/svin.123.000846","url":null,"abstract":"\u0000 \u0000 Flow diverters are now considered first‐line tools for treating intracranial aneurysms. However, few devices are available for patients with large‐diameter vessels (LDVs). Hence, we evaluated the performance of the largest diameter Surpass Streamline for aneurysms in LDVs.\u0000 \u0000 \u0000 \u0000 We performed a subanalysis of the SESSIA (Safety and Efficacy of the Surpass Streamline for Intracranial Aneurysms) multicenter cohort study of patients treated with Surpass Streamline between 2018 and 2021. Patients in whom a 5‐mm diameter Surpass Streamline was implanted were divided into 2 groups according to vessel diameter at the landing zones (LDV, ≥5.3 mm versus non‐LDV [N‐LDV], <5.3 mm). Efficacy was complete occlusion at final follow‐up. Safety was ischemic/hemorrhagic events and mortality up to 30 days.\u0000 \u0000 \u0000 \u0000 \u0000 Thirty patients harboring 30 aneurysms were included. Fifteen cases were included per group (LDV versus N‐LDV). Baseline demographics, clinical characteristics, median aneurysm size (LDV, 11 mm versus N‐LDV, 10 mm), and location were similar. Vessel diameters at the proximal (LDV, 5.3 mm versus N‐LDV, 4.2 mm;\u0000 P\u0000 <0.001) and distal (5.6 versus 4.0 mm;\u0000 P\u0000 <0.001) flow diverter landing zones were different. Procedural characteristics (including balloon‐assisted angioplasty and stenting) were similar. At the final follow‐up (12±6 months), complete occlusion (LDV, 75% versus N‐LDV, 84%;\u0000 P\u0000 =0.548), and ischemic/hemorrhagic events (1 per group;\u0000 P\u0000 =1.00) were not different.\u0000 \u0000 \u0000 \u0000 \u0000 The use of large‐diameter flow diverters for treating complex intracranial aneurysms arising in LDVs is technically feasible and safe. Comparative studies evaluating devices suitable for this patient population will provide valuable insights for the best device selection.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46613965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Galecio-Castillo, J. Sequeiros, Cynthia B. Zevallos, M. Farooqui, F. Siddiqui, S. Ortega‐Gutierrez
When mechanical thrombectomy (MT) fails to achieve successful reperfusion, rescue stenting (RS) has proven to be a feasible rescue therapy. However, the available evidence remains underpowered to assess clinical outcomes. We aimed to compare the safety and efficacy of RS versus routine medical management in patients with failed MT using an aggregated meta‐analysis. A systematic review was performed from inception to July 2022 of all studies using RS after failed MT. Outcomes of interest included a modified Rankin scale score of 0–2 at 90 days, successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3) after RS and symptomatic intracranial hemorrhage. A random‐effects meta‐analysis between the RS and medical treatment arms was performed to calculate pooled odds ratios (OR) for each outcome. We assessed the certainty of evidence using the Grading of Recommendation, Assessment, Development, and Evaluation approach. Statistical heterogeneity across studies was assessed with I2 statistics. A total of 12 studies included 1855 participants, 729 in the RS arm and 1126 in the medical treatment arm. The pooled results indicated that RS was associated with a significantly higher proportion of patients with a modified Rankin scale score of 0–2 at 90 days (RS: 41% versus 21%; OR,3.27; [95% CI 2.08–5.16]; I2=64%; moderate‐certainty evidence) and a decreased risk of mortality at 90 days (RS: 22.5% versus 33.8%; OR, 0.47; [95% CI 0.32–0.69]; I2=45%; low‐certainty evidence), compared with medical treatment after failed MT. The pooled rate of successful reperfusion after RS was 87% (95% CI 82–91; I2=57%; low‐certainty evidence). The rate of symptomatic intracranial hemorrhage did not differ between groups (RS: 8.5% versus 11.7%; OR, 0.85; [95% CI 0.59–1.20]; I2=7%; low‐certainty evidence). RS is a promising strategy for maximizing recovery in acute stroke patients after first line MT fails to achieve meaningful reperfusion. However, randomized trials using a standardized approach/technique and MT failure definition are warranted to confirm these results.
当机械取栓(MT)不能成功实现再灌注时，抢救支架(RS)已被证明是一种可行的抢救治疗方法。然而，现有的证据仍然不足以评估临床结果。我们的目的是通过汇总meta分析来比较RS与常规医疗管理在MT失败患者中的安全性和有效性。从开始到2022年7月，对所有MT失败后使用RS的研究进行了系统回顾。感兴趣的结果包括90天时0-2的改良Rankin评分，RS后成功再灌注(改良脑梗死2b-3溶栓)和症状性颅内出血。在RS组和药物治疗组之间进行随机效应荟萃分析，计算每个结果的合并优势比(OR)。我们使用推荐、评估、发展和评价分级方法评估证据的确定性。采用I2统计评估各研究的统计异质性。共有12项研究包括1855名参与者，其中729人在RS组，1126人在医疗组。合并结果表明，RS与90天改良Rankin量表评分为0-2的患者比例显著升高相关(RS: 41%对21%;或者,3.27;[95% ci 2.08-5.16];I2 = 64%;中等确定性证据)和90天死亡风险降低(RS: 22.5% vs 33.8%;或者,0.47;[95% ci 0.32-0.69];I2 = 45%;低确定性证据)，与MT失败后的药物治疗相比。RS后再灌注成功的合并率为87% (95% CI 82-91;I2 = 57%;低量确定的证据)。两组间症状性颅内出血发生率无差异(RS: 8.5% vs 11.7%;或者,0.85;[95% ci 0.59-1.20];I2 = 7%;低量确定的证据)。急性脑卒中患者在一线MT不能实现有意义的再灌注后，RS是一种很有希望的恢复策略。然而，使用标准化方法/技术和MT失败定义的随机试验有必要证实这些结果。
{"title":"Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: Systematic Review and Meta‐analysis","authors":"A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Galecio-Castillo, J. Sequeiros, Cynthia B. Zevallos, M. Farooqui, F. Siddiqui, S. Ortega‐Gutierrez","doi":"10.1161/svin.123.000881","DOIUrl":"https://doi.org/10.1161/svin.123.000881","url":null,"abstract":"\u0000 \u0000 When mechanical thrombectomy (MT) fails to achieve successful reperfusion, rescue stenting (RS) has proven to be a feasible rescue therapy. However, the available evidence remains underpowered to assess clinical outcomes. We aimed to compare the safety and efficacy of RS versus routine medical management in patients with failed MT using an aggregated meta‐analysis.\u0000 \u0000 \u0000 \u0000 A systematic review was performed from inception to July 2022 of all studies using RS after failed MT. Outcomes of interest included a modified Rankin scale score of 0–2 at 90 days, successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3) after RS and symptomatic intracranial hemorrhage. A random‐effects meta‐analysis between the RS and medical treatment arms was performed to calculate pooled odds ratios (OR) for each outcome. We assessed the certainty of evidence using the Grading of Recommendation, Assessment, Development, and Evaluation approach. Statistical heterogeneity across studies was assessed with I2 statistics.\u0000 \u0000 \u0000 \u0000 A total of 12 studies included 1855 participants, 729 in the RS arm and 1126 in the medical treatment arm. The pooled results indicated that RS was associated with a significantly higher proportion of patients with a modified Rankin scale score of 0–2 at 90 days (RS: 41% versus 21%; OR,3.27; [95% CI 2.08–5.16]; I2=64%; moderate‐certainty evidence) and a decreased risk of mortality at 90 days (RS: 22.5% versus 33.8%; OR, 0.47; [95% CI 0.32–0.69]; I2=45%; low‐certainty evidence), compared with medical treatment after failed MT. The pooled rate of successful reperfusion after RS was 87% (95% CI 82–91; I2=57%; low‐certainty evidence). The rate of symptomatic intracranial hemorrhage did not differ between groups (RS: 8.5% versus 11.7%; OR, 0.85; [95% CI 0.59–1.20]; I2=7%; low‐certainty evidence).\u0000 \u0000 \u0000 \u0000 RS is a promising strategy for maximizing recovery in acute stroke patients after first line MT fails to achieve meaningful reperfusion. However, randomized trials using a standardized approach/technique and MT failure definition are warranted to confirm these results.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47578802","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}
Pub Date : 2023-05-10DOI: 10.1101/2023.05.06.23289239
Satoshi Koizumi, M. Shojima, T. Ota, Shogo Dofuku, S. Miyawaki, S. Kiyofuji, K. Maeda, Takashi Ochi, Akihiro Ito, Yukihiro Hidaka, S. Oya, Akira Saito, Gakushi Yoshikawa, Kei Yanai, Tomohiro Inoue, Sho Tsunoda, K. Hoya, Nobuhito Saito
Background: Although endovascular parent artery occlusion (PAO) of the intracranial artery is a well-established treatment option, the long-term stability of cerebral blood flow remains a concern. This study aimed to evaluate the long-term clinical and radiological outcomes of patients who underwent PAO. Methods: The patients who underwent endovascular PAO of their internal carotid or vertebral artery (VA) between April 2011 and March 2022 were included in this observational study. Information about patient characteristics, details of the endovascular treatment, and clinical and radiological follow-up were collected. Results: The study included a total of 104 cases (average age 52.9{+/-}12.6 years old, male 73 (70.2%) cases, 95 (91.3%) VA PAO cases) from eight centers. Most cases were performed in an emergency condition, such as ruptured vertebral artery dissecting aneurysm (73 cases [70.2%]). PAO was successful in all cases. Early stroke (within 30 days) occurred in 33 (31.7%) cases (31 cases in VA PAO and two cases in internal carotid PAO) with ischemic stroke (29 cases) comprising the largest group. Clinical follow-up over 12 months was available in 78 cases. During an average follow-up period of 49.5 {+/-} 24.3 months, one case in VA PAO experienced a stroke without functional deterioration. Imaging follow-up was performed in 73 cases. Recanalization of the occluded VA was observed in two cases. The remaining image change was contralateral VA stenosis after VA PAO. The incidence of clinical and radiological events was 0.95 and 1.1% per patient-year, respectively. Conclusions: Once the patients surpass the acute phase after PAO, their mid-to-long term course was stable. The risk of late stroke or de novo aneurysm formation was lower than expected in the literature, and the direct comparison to novel reconstructive techniques is warranted in future studies. Registration: https://www.umin.ac.jp/ctr/index.html, trial ID: UMIN000045160
背景:虽然颅内动脉血管内母动脉闭塞(PAO)是一种成熟的治疗选择，但脑血流的长期稳定性仍然是一个问题。本研究旨在评估PAO患者的长期临床和放射学结果。方法:2011年4月至2022年3月期间接受颈内动脉或椎动脉(VA)血管内PAO的患者纳入本观察性研究。收集了患者特征、血管内治疗细节、临床和放射学随访等信息。结果:共纳入8个中心104例患者，平均年龄52.9{+/-}12.6岁，男性73例(70.2%)，VA PAO 95例(91.3%)。大多数病例是在紧急情况下进行的，如椎动脉夹层动脉瘤破裂(73例，70.2%)。PAO在所有病例中都是成功的。早期卒中(30天内)发生33例(31.7%)(VA PAO 31例，颈内动脉PAO 2例)，缺血性卒中(29例)占最大比例。78例临床随访超过12个月。在49.5{+/-}24.3个月的平均随访期间，1例VA PAO发生脑卒中，无功能恶化。影像学随访73例。在2例中观察到闭塞的VA再通。其余影像学改变为VA PAO后对侧VA狭窄。临床和放射事件的发生率分别为0.95和1.1% /患者年。结论:PAO术后患者一旦过急性期，其中长期病程是稳定的。晚期中风或新生动脉瘤形成的风险比文献中预期的要低，在未来的研究中，与新型重建技术的直接比较是有必要的。注册:https://www.umin.ac.jp/ctr/index.html，试用号:UMIN000045160
{"title":"Long term stability of patients undergoing endovascular parent artery occlusion of their intracranial artery","authors":"Satoshi Koizumi, M. Shojima, T. Ota, Shogo Dofuku, S. Miyawaki, S. Kiyofuji, K. Maeda, Takashi Ochi, Akihiro Ito, Yukihiro Hidaka, S. Oya, Akira Saito, Gakushi Yoshikawa, Kei Yanai, Tomohiro Inoue, Sho Tsunoda, K. Hoya, Nobuhito Saito","doi":"10.1101/2023.05.06.23289239","DOIUrl":"https://doi.org/10.1101/2023.05.06.23289239","url":null,"abstract":"Background: Although endovascular parent artery occlusion (PAO) of the intracranial artery is a well-established treatment option, the long-term stability of cerebral blood flow remains a concern. This study aimed to evaluate the long-term clinical and radiological outcomes of patients who underwent PAO. Methods: The patients who underwent endovascular PAO of their internal carotid or vertebral artery (VA) between April 2011 and March 2022 were included in this observational study. Information about patient characteristics, details of the endovascular treatment, and clinical and radiological follow-up were collected. Results: The study included a total of 104 cases (average age 52.9{+/-}12.6 years old, male 73 (70.2%) cases, 95 (91.3%) VA PAO cases) from eight centers. Most cases were performed in an emergency condition, such as ruptured vertebral artery dissecting aneurysm (73 cases [70.2%]). PAO was successful in all cases. Early stroke (within 30 days) occurred in 33 (31.7%) cases (31 cases in VA PAO and two cases in internal carotid PAO) with ischemic stroke (29 cases) comprising the largest group. Clinical follow-up over 12 months was available in 78 cases. During an average follow-up period of 49.5 {+/-} 24.3 months, one case in VA PAO experienced a stroke without functional deterioration. Imaging follow-up was performed in 73 cases. Recanalization of the occluded VA was observed in two cases. The remaining image change was contralateral VA stenosis after VA PAO. The incidence of clinical and radiological events was 0.95 and 1.1% per patient-year, respectively. Conclusions: Once the patients surpass the acute phase after PAO, their mid-to-long term course was stable. The risk of late stroke or de novo aneurysm formation was lower than expected in the literature, and the direct comparison to novel reconstructive techniques is warranted in future studies. Registration: https://www.umin.ac.jp/ctr/index.html, trial ID: UMIN000045160","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46992371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In Situ Measurement of Vascular Resistance to Evaluate Cerebral Microcirculation","authors":"Y. Chau, E. Lammens, S. Lachaud, J. Sédat","doi":"10.1161/svin.123.000870","DOIUrl":"https://doi.org/10.1161/svin.123.000870","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48876467","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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