N. Sakai, Shuhei Kawabata, Takayuki Funatsu, Tomohiro Okuda, R. Akiyama, Mikiya Beppu, Y. Matsui, Hiromasa Adachi, K. Horiuchi, H. Imamura, C. Sakai, S. Tani, H. Adachi, N. Sasaki, Soji Tokunaga, R. Fukumitsu, T. Shigematsu
The authors present the long‐term (4 year) results of a first‐in‐man, single‐center case series with the Nautilus Intrasaccular System for the embolization of wide‐neck intracranial aneurysms. From February 2018 to July 2018, the authors enrolled 5 patients into a first‐in‐human study of the Nautilus device. After treatment, patients underwent 6 months with digital subtraction angiography and 3 years with magnetic resonance angiography according to institutional standard of care. Occlusion rates were core‐laboratory adjudicated for the digital subtraction angiography and independently assessed by a neurointerventionalist not part of the care team for the magnetic resonance angiography. Neurological outcome (modified Ranking scale score) was evaluated at 24 hours, 7 days, 6 months, and 1, 2, 3, and 4 years, and adverse events were collected during the first 6 months post treatment. Five patients with unruptured, wide‐necked aneurysms were treated and followed up for 4 years. Aneurysm locations included basilar bifurcation (2 of 5), internal carotid artery terminus (1 of 5), superior cerebellar artery (1 of 5), and the anterior communicating artery (1 of 5). The average aneurysm size was 7.6 mm and the average neck diameter was 5.2 mm. Immediate complete and near‐complete occlusion (Raymond–Roy classification class I and II) was achieved in 80% (4 of 5) of the aneurysms. Occlusion results improved at 6 months and remained stable at 3 years, without retreatment (Raymond–Roy classification class I 80%, class I and II 100%). All patients maintained good neurological outcome at all follow‐ups (modified Ranking scale 0). This initial clinical experience provides early evidence of the long‐term safety and effectiveness of the new intrasaccular neck bridging device, Nautilus. The Nautilus appears to add a simple, safe, and effective option and solution to the coil embolization of the wide‐neck aneurysm.
{"title":"Four‐Year Follow‐Up on the First‐in‐Human Experience With Nautilus Intrasaccular System Assisted Coiling for Unruptured Intracranial Aneurysms","authors":"N. Sakai, Shuhei Kawabata, Takayuki Funatsu, Tomohiro Okuda, R. Akiyama, Mikiya Beppu, Y. Matsui, Hiromasa Adachi, K. Horiuchi, H. Imamura, C. Sakai, S. Tani, H. Adachi, N. Sasaki, Soji Tokunaga, R. Fukumitsu, T. Shigematsu","doi":"10.1161/svin.122.000770","DOIUrl":"https://doi.org/10.1161/svin.122.000770","url":null,"abstract":"\u0000 \u0000 The authors present the long‐term (4 year) results of a first‐in‐man, single‐center case series with the Nautilus Intrasaccular System for the embolization of wide‐neck intracranial aneurysms.\u0000 \u0000 \u0000 \u0000 From February 2018 to July 2018, the authors enrolled 5 patients into a first‐in‐human study of the Nautilus device. After treatment, patients underwent 6 months with digital subtraction angiography and 3 years with magnetic resonance angiography according to institutional standard of care. Occlusion rates were core‐laboratory adjudicated for the digital subtraction angiography and independently assessed by a neurointerventionalist not part of the care team for the magnetic resonance angiography. Neurological outcome (modified Ranking scale score) was evaluated at 24 hours, 7 days, 6 months, and 1, 2, 3, and 4 years, and adverse events were collected during the first 6 months post treatment.\u0000 \u0000 \u0000 \u0000 Five patients with unruptured, wide‐necked aneurysms were treated and followed up for 4 years. Aneurysm locations included basilar bifurcation (2 of 5), internal carotid artery terminus (1 of 5), superior cerebellar artery (1 of 5), and the anterior communicating artery (1 of 5). The average aneurysm size was 7.6 mm and the average neck diameter was 5.2 mm. Immediate complete and near‐complete occlusion (Raymond–Roy classification class I and II) was achieved in 80% (4 of 5) of the aneurysms. Occlusion results improved at 6 months and remained stable at 3 years, without retreatment (Raymond–Roy classification class I 80%, class I and II 100%). All patients maintained good neurological outcome at all follow‐ups (modified Ranking scale 0).\u0000 \u0000 \u0000 \u0000 This initial clinical experience provides early evidence of the long‐term safety and effectiveness of the new intrasaccular neck bridging device, Nautilus. The Nautilus appears to add a simple, safe, and effective option and solution to the coil embolization of the wide‐neck aneurysm.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42134919","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 : 2023-03-17DOI: 10.1101/2023.03.15.23287338
H. Ishihara, Takuma Nishimoto, M. Shimokawa, F. Oka, N. Sakai, H. Yamagami, K. Toyoda, Y. Matsumaru, Y. Matsumoto, K. Kimura, R. Ishikura, M. Inoue, K. Uchida, Fumihiro Sakakibara, T. Morimoto, S. Yoshimura
Background: The effectiveness of endovascular thrombectomy (EVT) has been proven even in patients with large cerebral infarction in early time window. However, the association of the time course with the treatment effect is unknown. The aim of this analysis was to evaluate the influence of the time course from stroke onset to reperfusion on the therapeutic effect of EVT.Methods: The subjects were patients with occlusion of large vessels and sizable strokes on imaging (ASPECTS 3 to 5) in RESCUE-Japan LIMIT (a multicenter, randomized clinical open-label trial of EVT vs. medical care alone). In the current analysis, the clinical and time course characteristics associated with a favorable outcome (modified Rankin Scale (mRS) 0-2 and 0-3 at 90 days) were examined in patients treated with EVT. Results: The analysis included 71 patients (median age, 77 years; median NIHSS score on admission, 21). Occlusion sites were the internal carotid artery (48%), M1 segment of the middle cerebral artery (72%) and tandem lesions (20%). Of these patients, 23 (32%) had mRS 0-3 and 12 (17%) had mRS 0-2 at 90 days. In multivariate analysis, there were independent associations of onset to reperfusion time (OR, 0.991; 95% CI, 0.984-0.999, P = 0.01) and puncture to reperfusion time (OR, 0.952; 95% CI, 0.917-0.988, P < 0.001) with mRS 0-3 at 90 days, and of puncture to reperfusion time (OR, 0.930; 95% CI, 0.872-0.991, P = 0.004) with mRS 0-2 at 90 days. Conclusions: Earlier reperfusion was related to a favorable outcome in patients with acute large vessel occlusion with a large ischemic region. Onset to reperfusion time and especially puncture to reperfusion time were independently associated with a favorable outcome. These results suggest the importance of timing and uninterrupted EVT in this patient population.
{"title":"Association of Time Course of Thrombectomy and Outcomes for Large Acute Ischemic Region: RESCUE-Japan LIMIT Sub-Analysis","authors":"H. Ishihara, Takuma Nishimoto, M. Shimokawa, F. Oka, N. Sakai, H. Yamagami, K. Toyoda, Y. Matsumaru, Y. Matsumoto, K. Kimura, R. Ishikura, M. Inoue, K. Uchida, Fumihiro Sakakibara, T. Morimoto, S. Yoshimura","doi":"10.1101/2023.03.15.23287338","DOIUrl":"https://doi.org/10.1101/2023.03.15.23287338","url":null,"abstract":"Background: The effectiveness of endovascular thrombectomy (EVT) has been proven even in patients with large cerebral infarction in early time window. However, the association of the time course with the treatment effect is unknown. The aim of this analysis was to evaluate the influence of the time course from stroke onset to reperfusion on the therapeutic effect of EVT.Methods: The subjects were patients with occlusion of large vessels and sizable strokes on imaging (ASPECTS 3 to 5) in RESCUE-Japan LIMIT (a multicenter, randomized clinical open-label trial of EVT vs. medical care alone). In the current analysis, the clinical and time course characteristics associated with a favorable outcome (modified Rankin Scale (mRS) 0-2 and 0-3 at 90 days) were examined in patients treated with EVT. Results: The analysis included 71 patients (median age, 77 years; median NIHSS score on admission, 21). Occlusion sites were the internal carotid artery (48%), M1 segment of the middle cerebral artery (72%) and tandem lesions (20%). Of these patients, 23 (32%) had mRS 0-3 and 12 (17%) had mRS 0-2 at 90 days. In multivariate analysis, there were independent associations of onset to reperfusion time (OR, 0.991; 95% CI, 0.984-0.999, P = 0.01) and puncture to reperfusion time (OR, 0.952; 95% CI, 0.917-0.988, P < 0.001) with mRS 0-3 at 90 days, and of puncture to reperfusion time (OR, 0.930; 95% CI, 0.872-0.991, P = 0.004) with mRS 0-2 at 90 days. Conclusions: Earlier reperfusion was related to a favorable outcome in patients with acute large vessel occlusion with a large ischemic region. Onset to reperfusion time and especially puncture to reperfusion time were independently associated with a favorable outcome. These results suggest the importance of timing and uninterrupted EVT in this patient population.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47623583","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}
K. Limaye, Andrew B. Koo, A. Havenon, S. A. Kasab, B. Bohnstedt, I. Maier, M. Psychogios, S. Wolfe, A. Arthur, Peter T Kan, Joon-Tae Kim, R. Leacy, J. Osbun, A. Rai, P. Jabbour, M. Park, R. Crosa, J. Mascitelli, M. Levitt, A. Polifka, W. Casagrande, S. Yoshimura, R. Williamson, B. Gory, M. Mokin, Isabel Fragata, D. Romano, S. Chowdry, A. Shaban, M. Moss, D. Behme, A. Spiotta, C. Matouk
Mechanical thrombectomy of middle cerebral artery M2 segment occlusion of the middle cerebral artery has reported safety and efficacy in recent post‐hoc and observational studies. However, there is no known benefit of mechanical thrombectomy for patients with M2 segment occlusions in the delayed time window (>6 hours). The Stroke Thrombectomy and Aneurysm Registry (STAR) is a prospective, multicenter, nonrandomized observational study registry for acute ischemic stroke thrombectomy and aneurysm treatment. We analyzed all patients who underwent mechanical thrombectomy within the late time window (>6 hours from symptom onset) involving isolated M2 occlusions. We used propensity score matching to select a comparison group of patients who underwent mechanical thrombectomy for M1 occlusion in the same time window. Of 1083 consecutive patients analyzed, propensity matching yielded 180 well matched M1 and M2 pairs. Baseline demographics were well balanced between the groups (M1 and M2). Alberta stroke program early CT score (7.6±1.7 versus 8.3±1.5; P <0.001) was higher in the M2 group. There was a trend towards less complete recanalization (Thrombolysis in Cerebral Infarction 3) 46.1% versus 39.9% ( P =0.053) in the middle cerebral artery M2 segment cohort. However, successful recanalization (Thrombolysis in Cerebral Infarction 2b‐3) was better in middle cerebral artery M2 segment cohort (85% versus 90.5%; P =0.053). Postprocedural asymptomatic hemorrhage rates were similar (29.4% versus 27.8%; P =0.816), but symptomatic hemorrhage rates were higher in the M1 group (7.2% versus 2.2%; P =0.047). Rates of good clinical outcome (modified Rankin scale 0–2) were similar at final follow‐up (43.9% versus 46.7%; P =0.672). The overall mortality was also similar between the cohorts (12.8% versus 13.9%; P =0.877). In our analysis of the Stroke Thrombectomy and Aneurysm Registry, M2 occlusions not only achieved similar rates of recanalization and good functional outcome compared with M1 occlusions in a delayed time window (6–24 hours from last normal) but also had less symptomatic intracranial hemorrhage.
在最近的事后和观察性研究中，大脑中动脉M2段闭塞的机械取栓术已经报道了安全性和有效性。然而，对于延迟时间窗(bbb6小时)的M2段闭塞患者，机械取栓并没有已知的益处。卒中血栓切除术和动脉瘤登记(STAR)是一项前瞻性、多中心、非随机观察性研究，用于急性缺血性卒中血栓切除术和动脉瘤治疗。我们分析了所有在晚时间窗(症状出现后6小时)内进行机械取栓的患者，包括孤立的M2闭塞。我们使用倾向评分匹配法选择在同一时间窗内接受机械取栓治疗M1闭塞的患者作为对照组。在1083例连续分析的患者中，倾向匹配产生了180对匹配良好的M1和M2对。基线人口统计数据在各组(M1和M2)之间很好地平衡。阿尔伯塔卒中项目早期CT评分(7.6±1.7比8.3±1.5);P <0.001)， M2组较高。在大脑中动脉M2段队列中，再通不完全的趋势(脑梗死3期溶栓)为46.1%比39.9% (P =0.053)。然而，在大脑中动脉M2段队列中，成功的再通(脑梗死2b‐3溶栓)更好(85%对90.5%;P = 0.053)。术后无症状出血率相似(29.4% vs 27.8%;P =0.816)，但M1组的症状性出血率更高(7.2%比2.2%;P = 0.047)。在最终随访时，良好临床转归率(改良Rankin量表0-2)相似(43.9% vs 46.7%;P = 0.672)。队列之间的总体死亡率也相似(12.8%对13.9%;P = 0.877)。在我们对脑卒中取栓和动脉瘤登记的分析中，与M1闭塞相比，M2闭塞不仅在延迟的时间窗(距离上一次正常6-24小时)内实现了相似的再通率和良好的功能结果，而且症状性颅内出血也更少。
{"title":"Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry","authors":"K. Limaye, Andrew B. Koo, A. Havenon, S. A. Kasab, B. Bohnstedt, I. Maier, M. Psychogios, S. Wolfe, A. Arthur, Peter T Kan, Joon-Tae Kim, R. Leacy, J. Osbun, A. Rai, P. Jabbour, M. Park, R. Crosa, J. Mascitelli, M. Levitt, A. Polifka, W. Casagrande, S. Yoshimura, R. Williamson, B. Gory, M. Mokin, Isabel Fragata, D. Romano, S. Chowdry, A. Shaban, M. Moss, D. Behme, A. Spiotta, C. Matouk","doi":"10.1161/svin.122.000664","DOIUrl":"https://doi.org/10.1161/svin.122.000664","url":null,"abstract":"\u0000 \u0000 Mechanical thrombectomy of middle cerebral artery M2 segment occlusion of the middle cerebral artery has reported safety and efficacy in recent post‐hoc and observational studies. However, there is no known benefit of mechanical thrombectomy for patients with M2 segment occlusions in the delayed time window (>6 hours).\u0000 \u0000 \u0000 \u0000 The Stroke Thrombectomy and Aneurysm Registry (STAR) is a prospective, multicenter, nonrandomized observational study registry for acute ischemic stroke thrombectomy and aneurysm treatment. We analyzed all patients who underwent mechanical thrombectomy within the late time window (>6 hours from symptom onset) involving isolated M2 occlusions. We used propensity score matching to select a comparison group of patients who underwent mechanical thrombectomy for M1 occlusion in the same time window.\u0000 \u0000 \u0000 \u0000 \u0000 Of 1083 consecutive patients analyzed, propensity matching yielded 180 well matched M1 and M2 pairs. Baseline demographics were well balanced between the groups (M1 and M2). Alberta stroke program early CT score (7.6±1.7 versus 8.3±1.5;\u0000 P\u0000 <0.001) was higher in the M2 group. There was a trend towards less complete recanalization (Thrombolysis in Cerebral Infarction 3) 46.1% versus 39.9% (\u0000 P\u0000 =0.053) in the middle cerebral artery M2 segment cohort. However, successful recanalization (Thrombolysis in Cerebral Infarction 2b‐3) was better in middle cerebral artery M2 segment cohort (85% versus 90.5%;\u0000 P\u0000 =0.053). Postprocedural asymptomatic hemorrhage rates were similar (29.4% versus 27.8%;\u0000 P\u0000 =0.816), but symptomatic hemorrhage rates were higher in the M1 group (7.2% versus 2.2%;\u0000 P\u0000 =0.047). Rates of good clinical outcome (modified Rankin scale 0–2) were similar at final follow‐up (43.9% versus 46.7%;\u0000 P\u0000 =0.672). The overall mortality was also similar between the cohorts (12.8% versus 13.9%;\u0000 P\u0000 =0.877).\u0000 \u0000 \u0000 \u0000 \u0000 In our analysis of the Stroke Thrombectomy and Aneurysm Registry, M2 occlusions not only achieved similar rates of recanalization and good functional outcome compared with M1 occlusions in a delayed time window (6–24 hours from last normal) but also had less symptomatic intracranial hemorrhage.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64515560","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. Ballout, Grace Prochilo, N. Kaneko, Chuanlong Li, Ryan Apfel, J. Hinman, D. Liebeskind
Recurrent stroke risk in intracranial atherosclerotic disease remains high despite aggressive medical therapy. While hemodynamic insufficiency appears to be a strong marker of stroke recurrence, natural history studies using various unimodal imaging modalities have shown mixed results, as they likely do not adequately capture the complex local hemodynamic environment generated by a focal stenosis. Computational fluid dynamics, a multimodal tool used to simulate fluid flow and the interactions between fluids and surfaces, has recently been used to illustrate the complex hemodynamic environment surrounding intracranial atherosclerotic lesions and to risk‐stratify patients on the basis of simulated outputs. We aimed to summarize the literature pertaining to computational fluid dynamics use in intracranial atherosclerotic disease and to describe its future potential use in generating more targeted therapies.
{"title":"Computational Fluid Dynamics in Intracranial Atherosclerotic Disease","authors":"A. Ballout, Grace Prochilo, N. Kaneko, Chuanlong Li, Ryan Apfel, J. Hinman, D. Liebeskind","doi":"10.1161/svin.122.000792","DOIUrl":"https://doi.org/10.1161/svin.122.000792","url":null,"abstract":"Recurrent stroke risk in intracranial atherosclerotic disease remains high despite aggressive medical therapy. While hemodynamic insufficiency appears to be a strong marker of stroke recurrence, natural history studies using various unimodal imaging modalities have shown mixed results, as they likely do not adequately capture the complex local hemodynamic environment generated by a focal stenosis. Computational fluid dynamics, a multimodal tool used to simulate fluid flow and the interactions between fluids and surfaces, has recently been used to illustrate the complex hemodynamic environment surrounding intracranial atherosclerotic lesions and to risk‐stratify patients on the basis of simulated outputs. We aimed to summarize the literature pertaining to computational fluid dynamics use in intracranial atherosclerotic disease and to describe its future potential use in generating more targeted therapies.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46603445","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}
Héloïse Lebas, Alexandre Boutigny, Clémence Maupu, Jonas Salfati, Cyrille Orset, Mikael Mazighi, Philippe Bonnin, Yacine Boulaftali
Background: During the past few decades, several pathophysiological processes contributing to intracranial aneurysm (IA) rupture have been identified, including irregular IA shape, altered hemodynamic stress within the IA, and vessel wall inflammation. The use of preclinical models of IA and imaging tools is paramount to better understand the underlying disease mechanisms.
Methods: We used 2 established mouse models of IA, and we analyzed the progression of the IA by magnetic resonance imaging, transcranial Doppler, and histology.
Results: In both models of IA, we observed, by transcranial Doppler, a significant decrease of the blood velocities and wall shear stress of the internal carotid arteries. We also observed the formation of tortuous arteries in both models that were correlated with the presence of an aneurysm as confirmed by magnetic resonance imaging and histology. A high grade of tortuosity is associated with a significant decrease of the mean blood flow velocities and a greater artery dilation.
Conclusions: Transcranial Doppler is a robust and convenient imaging method to evaluate the progression of IA. Detection of decreased blood flow velocities and increased tortuosity can be used as reliable indicators of IA.
{"title":"Imaging Cerebral Arteries Tortuosity and Velocities by Transcranial Doppler Ultrasound Is a Reliable Assessment of Brain Aneurysm in Mouse Models.","authors":"Héloïse Lebas, Alexandre Boutigny, Clémence Maupu, Jonas Salfati, Cyrille Orset, Mikael Mazighi, Philippe Bonnin, Yacine Boulaftali","doi":"10.1161/SVIN.122.000476","DOIUrl":"https://doi.org/10.1161/SVIN.122.000476","url":null,"abstract":"<p><strong>Background: </strong>During the past few decades, several pathophysiological processes contributing to intracranial aneurysm (IA) rupture have been identified, including irregular IA shape, altered hemodynamic stress within the IA, and vessel wall inflammation. The use of preclinical models of IA and imaging tools is paramount to better understand the underlying disease mechanisms.</p><p><strong>Methods: </strong>We used 2 established mouse models of IA, and we analyzed the progression of the IA by magnetic resonance imaging, transcranial Doppler, and histology.</p><p><strong>Results: </strong>In both models of IA, we observed, by transcranial Doppler, a significant decrease of the blood velocities and wall shear stress of the internal carotid arteries. We also observed the formation of tortuous arteries in both models that were correlated with the presence of an aneurysm as confirmed by magnetic resonance imaging and histology. A high grade of tortuosity is associated with a significant decrease of the mean blood flow velocities and a greater artery dilation.</p><p><strong>Conclusions: </strong>Transcranial Doppler is a robust and convenient imaging method to evaluate the progression of IA. Detection of decreased blood flow velocities and increased tortuosity can be used as reliable indicators of IA.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"3 2","pages":"e000476"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/a8/SVI2-3-e000476.PMC10368188.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9879707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1161/svin.03.suppl_1.156
Mohamed Elfil, M. F. Doheim, Hazem S. Ghaith, M. Salem, P. Aboutaleb, M. Aladawi, F. Al‐Mufti, R. Nogueira
Previous studies have compared the transradial access (TRA) with the transfemoral access (TFA) in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We conducted this meta‐analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of the TRA versus the TFA in AIS patients undergoing MT. We performed a comprehensive literature search of four electronic databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL) from inception until 1 May 2022. All duplicates were removed, and all references of the included studies were screened manually for any eligible studies. The full‐text articles of eligible abstracts were retrieved and screened for continued eligibility. Relevant data were extracted and then analyzed. For outcomes that constitute continuous data, the mean difference (MD) between the two groups and its standard deviation (SD) were pooled. For outcomes that constitute dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the two groups. Nine studies were included in this meta‐analysis, all of which were observational studies. The population of the studies was homogenous comprising a total of 2,161 patients who underwent MT, including 446 in the TRA group and 1,715 in the TFA group. There were no significant differences across the two groups in terms of successful recanalization (Thrombolysis in cerebral Infarction [TICI] score of 2b‐3: OR 0.83, 95% CI [0.55 to 1.25], P = 0.36) (Figure 1, A), complete recanalization (TICI 3: OR 1.16, 95% CI [0.50 to 2.68], P = 0.73), favorable functional outcome (90‐day modified Rankin scale [mRS] score of 0–2 (OR 0.86, 95% CI [0.53 to 1.41], P = 0.56), first‐pass reperfusion (OR 0.88, 95% CI [0.64 to 1.19], P = 0.41), number of passes (MD 0.12, 95% CI [‐0.18 to 0.42], P = 0.43) (Figure 1, B), access‐to‐reperfusion time (MD ‐3.92 minutes, 95% CI [‐9.49 to 1.65], P = 0.17), the amount of contrast used (MD 5.03 mL, 95% CI [‐20.27 to 30.33], P = 0.70), or symptomatic intracranial hemorrhage (OR 0.86, 95% CI [0.47 to 1.57], P = 0.62). However, access‐site complications were significantly less frequent in the TRA group as compared to the TFA group (OR 0.18, 95% CI [0.06 to 0.51], P = 0.001) (Finger 1, C). In patients undergoing MT for AIS, the collective evidence suggests that the TRA seems to result in lower rates of access‐site complications than the TFA without any significant compromise in other clinical or procedural metrics. Large prospective studies are warranted.
先前的研究比较了急性缺血性卒中(AIS)机械取栓(MT)患者的经桡动脉通路(TRA)和经股动脉通路(TFA)。我们进行了这项荟萃分析，以提供关于AIS患者接受MT的TRA与TFA的程序和临床结果比较的综合证据。我们从建立到2022年5月1日对四个电子数据库(PubMed, Scopus, Web of Science, Cochrane CENTRAL)进行了全面的文献检索。删除所有重复，并对纳入研究的所有参考文献进行人工筛选，以确定是否有符合条件的研究。检索符合条件的摘要的全文文章，并对其继续进行筛选。提取相关数据并进行分析。对于构成连续数据的结局，将两组间的平均差异(MD)及其标准差(SD)汇总。对于构成二分类数据的结局，将每组的事件发生频率和患者总数合并为两组间的比值比(OR)。本meta分析纳入了9项研究，均为观察性研究。研究的人群是均匀的，共有2161名患者接受了MT，其中TRA组446名，TFA组1715名。两组在成功再通(脑梗死溶栓[TICI]评分2b‐3:OR 0.83, 95% CI [0.55 ~ 1.25]， P = 0.36)(图1,A)、完全再通(TICI 3:或1.16,95%可信区间(0.50到2.68),P = 0.73),良好的功能结果(90天量改良Rankin规模(夫人)0 - 2分(或0.86,95%可信区间(0.53到1.41),P = 0.56),首先还是通过再灌注(或0.88,95%可信区间(0.64到1.19),P = 0.41),程数(MD 0.12, 95%可信区间(高0.18到0.42),P = 0.43)(图1,B),访问~公/再灌注时间(MD高3.92分钟95%可信区间(高9.49到1.65),P = 0.17),对比的用量(MD 5.03毫升,95%可信区间(高20.27到30.33),P = 0.70),或症状性颅内出血(or 0.86, 95% CI [0.47 ~ 1.57]， P = 0.62)。然而，与TFA组相比，TRA组的通路部位并发症明显更少(OR 0.18, 95% CI[0.06至0.51]，P = 0.001) (fig .1, C)。在接受AIS MT的患者中，集体证据表明，TRA似乎比TFA导致通路部位并发症的发生率更低，而其他临床或手术指标没有任何明显的损害。有必要进行大规模的前瞻性研究。
{"title":"Abstract Number ‐ 156: Transradial versus Transfemoral Access for Mechanical Thrombectomy: A Meta‐Analysis of Nine Studies (2,161 Patients)","authors":"Mohamed Elfil, M. F. Doheim, Hazem S. Ghaith, M. Salem, P. Aboutaleb, M. Aladawi, F. Al‐Mufti, R. Nogueira","doi":"10.1161/svin.03.suppl_1.156","DOIUrl":"https://doi.org/10.1161/svin.03.suppl_1.156","url":null,"abstract":"\u0000 \u0000 Previous studies have compared the transradial access (TRA) with the transfemoral access (TFA) in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We conducted this meta‐analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of the TRA versus the TFA in AIS patients undergoing MT.\u0000 \u0000 \u0000 \u0000 We performed a comprehensive literature search of four electronic databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL) from inception until 1 May 2022. All duplicates were removed, and all references of the included studies were screened manually for any eligible studies. The full‐text articles of eligible abstracts were retrieved and screened for continued eligibility. Relevant data were extracted and then analyzed. For outcomes that constitute continuous data, the mean difference (MD) between the two groups and its standard deviation (SD) were pooled. For outcomes that constitute dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the two groups.\u0000 \u0000 \u0000 \u0000 Nine studies were included in this meta‐analysis, all of which were observational studies. The population of the studies was homogenous comprising a total of 2,161 patients who underwent MT, including 446 in the TRA group and 1,715 in the TFA group. There were no significant differences across the two groups in terms of successful recanalization (Thrombolysis in cerebral Infarction [TICI] score of 2b‐3: OR 0.83, 95% CI [0.55 to 1.25], P = 0.36) (Figure 1, A), complete recanalization (TICI 3: OR 1.16, 95% CI [0.50 to 2.68], P = 0.73), favorable functional outcome (90‐day modified Rankin scale [mRS] score of 0–2 (OR 0.86, 95% CI [0.53 to 1.41], P = 0.56), first‐pass reperfusion (OR 0.88, 95% CI [0.64 to 1.19], P = 0.41), number of passes (MD 0.12, 95% CI [‐0.18 to 0.42], P = 0.43) (Figure 1, B), access‐to‐reperfusion time (MD ‐3.92 minutes, 95% CI [‐9.49 to 1.65], P = 0.17), the amount of contrast used (MD 5.03 mL, 95% CI [‐20.27 to 30.33], P = 0.70), or symptomatic intracranial hemorrhage (OR 0.86, 95% CI [0.47 to 1.57], P = 0.62). However, access‐site complications were significantly less frequent in the TRA group as compared to the TFA group (OR 0.18, 95% CI [0.06 to 0.51], P = 0.001) (Finger 1, C).\u0000 \u0000 \u0000 \u0000 In patients undergoing MT for AIS, the collective evidence suggests that the TRA seems to result in lower rates of access‐site complications than the TFA without any significant compromise in other clinical or procedural metrics. Large prospective studies are warranted.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42546973","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 : 2023-03-01DOI: 10.1161/svin.03.suppl_1.053
S. Nedelcu, N. Henninger
Distal and medium vessel occlusion (DMVO) strokes account for 25–40% of all acute ischemic strokes1 and are associated with long‐term disability in as many as 77% of patients2. Approximately one third of DMVO stroke patients have a low National Institute of Stroke Scale (NIHSS) (≤6)3. Multiple randomized controlled trials showed superiority of endovascular therapy (EVT) over best medical management (BMT) in patients presenting with proximal LVO involving the anterior circulation and NIHSS of >64. The efficacy and safety of EVT for DMVO patients is uncertain, especially in patients with low NIHSS. A better understanding of this issue is important because many patients with DMVO and low NIHSS scores suffer disabling deficits while procedural risk are increased due to the target vessels’ small caliber, tortuosity, and thinner walls. We conducted a retrospective single center study to compare clinical and safety outcomes of DMVO patients with NIHSS ≤ 6 that were treated with EVT versus BMT. We retrospectively analyzed consecutive patients with acute mild (NIHSS ≤ 6) DMVO stroke that presented between January 2018 and December 2021. We defined DMVO stroke as stroke caused by an occlusion of the M2‐4 segments of the MCA, A2‐3 segments of the ACA, P1‐2 segments of the PCA. Outcomes of interest were the NIHSS at day one and at discharge, the change in NIHSS from admission to discharge (ΔNIHSS) and the mRS at 90‐days. Safety outcomes were clinical deterioration, defined as an increase in the NIHSS by 4 or more points and the occurrence of symptomatic intracranial hemorrhage (sICH), defined as any type of ICH causing an increase in the NIHSS by 4 or more points. Overall, we included 80 subjects that fulfilled our study criteria. Of these, 41 were treated with BMT and 39 were selected to undergo EVT. Clinical characteristics of subjects selected for BMT versus EVT were overall similar except for more frequent diabetes (p = 0.035) and antiplatelet use (p = 0.045) as well as less frequent anticoagulation (p = 0.019) in the BMT group. Moreover, subjects selected for EVT had a lower pre‐stroke mRS (p = 0.025) and a lower ASPECT score on the admission head CT (p = 0.044). Overall, there was no statistical difference between NIHSS at day 1 (p = 0.654), NIHSS at discharge (p = 0.244), and ΔNIHSS from Day 0 to Day 1 (p = 0.08). There was further no difference in the discharge (p = 0.895) and 3‐month (p = 0.957) mRS between groups. Regarding safety outcomes, there was no difference in the number of all types of ICHs combined between the two groups (p = 0.229) and there was no difference in the number of patients who had clinical deterioration (p = 0.258). Our analysis shows that in patients who present with mild DMVO strokes, early and 3‐month clinical outcomes were comparable between EVT and BMT groups. Moreover, risk of intracranial hemorrhage, clinical deterioration, and death were similar between groups. Nevertheless, given the low numbe
{"title":"Abstract Number ‐ 53: Endovascular therapy versus medical management for mild strokes due to medium and distal vessel occlusions","authors":"S. Nedelcu, N. Henninger","doi":"10.1161/svin.03.suppl_1.053","DOIUrl":"https://doi.org/10.1161/svin.03.suppl_1.053","url":null,"abstract":"\u0000 \u0000 Distal and medium vessel occlusion (DMVO) strokes account for 25–40% of all acute ischemic strokes1 and are associated with long‐term disability in as many as 77% of patients2. Approximately one third of DMVO stroke patients have a low National Institute of Stroke Scale (NIHSS) (≤6)3. Multiple randomized controlled trials showed superiority of endovascular therapy (EVT) over best medical management (BMT) in patients presenting with proximal LVO involving the anterior circulation and NIHSS of >64. The efficacy and safety of EVT for DMVO patients is uncertain, especially in patients with low NIHSS. A better understanding of this issue is important because many patients with DMVO and low NIHSS scores suffer disabling deficits while procedural risk are increased due to the target vessels’ small caliber, tortuosity, and thinner walls. We conducted a retrospective single center study to compare clinical and safety outcomes of DMVO patients with NIHSS ≤ 6 that were treated with EVT versus BMT.\u0000 \u0000 \u0000 \u0000 We retrospectively analyzed consecutive patients with acute mild (NIHSS ≤ 6) DMVO stroke that presented between January 2018 and December 2021. We defined DMVO stroke as stroke caused by an occlusion of the M2‐4 segments of the MCA, A2‐3 segments of the ACA, P1‐2 segments of the PCA. Outcomes of interest were the NIHSS at day one and at discharge, the change in NIHSS from admission to discharge (ΔNIHSS) and the mRS at 90‐days. Safety outcomes were clinical deterioration, defined as an increase in the NIHSS by 4 or more points and the occurrence of symptomatic intracranial hemorrhage (sICH), defined as any type of ICH causing an increase in the NIHSS by 4 or more points.\u0000 \u0000 \u0000 \u0000 Overall, we included 80 subjects that fulfilled our study criteria. Of these, 41 were treated with BMT and 39 were selected to undergo EVT. Clinical characteristics of subjects selected for BMT versus EVT were overall similar except for more frequent diabetes (p = 0.035) and antiplatelet use (p = 0.045) as well as less frequent anticoagulation (p = 0.019) in the BMT group. Moreover, subjects selected for EVT had a lower pre‐stroke mRS (p = 0.025) and a lower ASPECT score on the admission head CT (p = 0.044). Overall, there was no statistical difference between NIHSS at day 1 (p = 0.654), NIHSS at discharge (p = 0.244), and ΔNIHSS from Day 0 to Day 1 (p = 0.08). There was further no difference in the discharge (p = 0.895) and 3‐month (p = 0.957) mRS between groups. Regarding safety outcomes, there was no difference in the number of all types of ICHs combined between the two groups (p = 0.229) and there was no difference in the number of patients who had clinical deterioration (p = 0.258).\u0000 \u0000 \u0000 \u0000 Our analysis shows that in patients who present with mild DMVO strokes, early and 3‐month clinical outcomes were comparable between EVT and BMT groups. Moreover, risk of intracranial hemorrhage, clinical deterioration, and death were similar between groups. Nevertheless, given the low numbe","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42665264","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 : 2023-03-01DOI: 10.1161/svin.03.suppl_1.lba11
Zaid R Najdawi, Nithin Kurra, Mohamed Elfil, M. Aladawi, P. Fayad
Cerebral Autosomal Dominant Arteriopathy with subcortical Infarcts and leuko‐encephalopathy (CADASIL) is a genetic condition characterized by migraine, ischemic strokes, mood disturbances, and cognitive impairment. Since COVID‐19 pandemic started in late 2019, six patients (including our case) were reported to present with neurological symptoms associated with CADASIL mutation and four of them were diagnosed while hospitalized for COVID‐19 illness. A case report anda systematic literature review done via PubMed search that was performed up to Oct 15, 2022. Studies reporting on CADASIL and COVID‐19 infection were included. In addition to our case report, 5 case‐reports were identified, and full articles were reviewed and summarized. Including our case, the mean age of patients was 45.44 years, and all of them were females. The diagnosis of CADASIL was established after COVID‐19 infection in four of the cases including ours, while the diagnosis of CADASIL was established in the other two patients after neurological symptoms and prior strokes warranting investigations and stroke workup. CADASIL diagnosis was confirmed with genetic testing in all of them. Two cases had history of migraines with aura, three cases had hypertension, and two patients had unremarkable past medical history. Four cases reported dysarthria as one of the initial symptoms at presentation. The initial MRI brain reported involvement of corona radiata in two cases, centrum semiovale in two cases, cerebellum in one case. All cases reported bilateral changes on imaging. Aspirin, clopidogrel, statins, intravenous immunoglobulins, and steroids were the medical treatment modalities used amongst those patients. Four cases had mild‐complete recovery of symptoms, one case was reported to have partial resolution of deficits, and one patient had complete resolution of motor deficit and persistent mild neurocognitive dysfunction. COVID‐19 infection might be a triggering factor forCADASIL flare. Although it is unclear whether CADASIL mutations would be the only etiology behind the neurological deficits in these patients, as COVID‐19 infection has been reported to be associated with many neurological manifestations, the reported imaging findings along with the genetic confirmation weighs more towards COVID‐19 infection acting as a trigger for CADASIL flare.
{"title":"Abstract Number: LBA11 CADASIL revealed by COVID‐19: A case report and systematic review","authors":"Zaid R Najdawi, Nithin Kurra, Mohamed Elfil, M. Aladawi, P. Fayad","doi":"10.1161/svin.03.suppl_1.lba11","DOIUrl":"https://doi.org/10.1161/svin.03.suppl_1.lba11","url":null,"abstract":"\u0000 \u0000 Cerebral Autosomal Dominant Arteriopathy with subcortical Infarcts and leuko‐encephalopathy (CADASIL) is a genetic condition characterized by migraine, ischemic strokes, mood disturbances, and cognitive impairment. Since COVID‐19 pandemic started in late 2019, six patients (including our case) were reported to present with neurological symptoms associated with CADASIL mutation and four of them were diagnosed while hospitalized for COVID‐19 illness.\u0000 \u0000 \u0000 \u0000 A case report anda systematic literature review done via PubMed search that was performed up to Oct 15, 2022. Studies reporting on CADASIL and COVID‐19 infection were included.\u0000 \u0000 \u0000 \u0000 In addition to our case report, 5 case‐reports were identified, and full articles were reviewed and summarized. Including our case, the mean age of patients was 45.44 years, and all of them were females. The diagnosis of CADASIL was established after COVID‐19 infection in four of the cases including ours, while the diagnosis of CADASIL was established in the other two patients after neurological symptoms and prior strokes warranting investigations and stroke workup. CADASIL diagnosis was confirmed with genetic testing in all of them. Two cases had history of migraines with aura, three cases had hypertension, and two patients had unremarkable past medical history. Four cases reported dysarthria as one of the initial symptoms at presentation. The initial MRI brain reported involvement of corona radiata in two cases, centrum semiovale in two cases, cerebellum in one case. All cases reported bilateral changes on imaging. Aspirin, clopidogrel, statins, intravenous immunoglobulins, and steroids were the medical treatment modalities used amongst those patients. Four cases had mild‐complete recovery of symptoms, one case was reported to have partial resolution of deficits, and one patient had complete resolution of motor deficit and persistent mild neurocognitive dysfunction.\u0000 \u0000 \u0000 \u0000 COVID‐19 infection might be a triggering factor forCADASIL flare. Although it is unclear whether CADASIL mutations would be the only etiology behind the neurological deficits in these patients, as COVID‐19 infection has been reported to be associated with many neurological manifestations, the reported imaging findings along with the genetic confirmation weighs more towards COVID‐19 infection acting as a trigger for CADASIL flare.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42703952","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 : 2023-03-01DOI: 10.1161/svin.03.suppl_1.018
Javier Lagos-Servellon, Dulce Bonifacio-Delgadillo, M. Ribó, Cristina Granés Santamaria, Victor Salvia Punsoda, Agustina Urtasun, F. N. Diaz, Cristian Martí Pou
Early and accurate identification of large vessel occlusion (LVO) and intracranial hemorrhage (ICH) on initial neuroimaging is essential in a stroke network. A machine learning algorithm (MLA) able to predict LVO or ICH on non‐contrast computed tomography (NCCT) may accelerate workflows.We performed a validation analysis to measure the MLA accuracy among suspected stroke patients transferred to a Comprehensive Stroke Centre (CSC) in Mexico and the possible impact on the workflow in low and middle income countries (LMIC) . From February 2021 to March 2022 consecutive patients with suspected acute stroke who underwent NCCT and computed tomography angiography (CTA) were included. MLA prediction of LVO and ICH was tested against expert physicians readings and clinical follow‐up. We calculated sensitivity, specificity, positive predictive value and negative predictive value. Receiver operating curves were generated for MLA‐LVO, MLA‐ICH and; areas under the curve were calculated. Potential time savings and impact on workflow times were calculated for a scenario in which MLA could analyse initial NCCT at PSC avoiding imaging repetition at CSC. 140 consecutive patients admitted from march 2021 to February 2022 were included in the study, final physicians diagnostics were: 22 ICH (15.7%) and 53 LVO (37.8%) MLA detected 22 ICH (15.7%) and 58 LVO (41.4%).The area under the curve for the identification of ICH with MLA was 0.97 (sensitivity: 94%, specificity: 91%, positive predictive value: 83.3%[MR1][JL2], negative predictive value: 100%). The area under the curve for the identification of LVO with MLA was 0.91 (sensitivity: 100%, specificity: 95.8%, positive predictive value: 85.7%, negative predictive value: 96.4%). Implementation of MLA‐LVO in the network could save CTA acquisition times of 40 (IQR 26) minutes by taking patients directly to the angiosuite for endovascular treatment. In patients with suspected acute stroke, a MLA can quickly and reliably predict ICH and LVO. Such a tool could accelerate the diagnosis, mitigate the contrast imaging dependency and improve the workflow efficiency in stroke networks in LMIC where access to contrast imaging is often limited.
{"title":"Abstract Number ‐ 18: Potential impact in low and middle‐income countries stroke networks of a deep learning triage tool","authors":"Javier Lagos-Servellon, Dulce Bonifacio-Delgadillo, M. Ribó, Cristina Granés Santamaria, Victor Salvia Punsoda, Agustina Urtasun, F. N. Diaz, Cristian Martí Pou","doi":"10.1161/svin.03.suppl_1.018","DOIUrl":"https://doi.org/10.1161/svin.03.suppl_1.018","url":null,"abstract":"\u0000 \u0000 Early and accurate identification of large vessel occlusion (LVO) and intracranial hemorrhage (ICH) on initial neuroimaging is essential in a stroke network. A machine learning algorithm (MLA) able to predict LVO or ICH on non‐contrast computed tomography (NCCT) may accelerate workflows.We performed a validation analysis to measure the MLA accuracy among suspected stroke patients transferred to a Comprehensive Stroke Centre (CSC) in Mexico and the possible impact on the workflow in low and middle income countries (LMIC) .\u0000 \u0000 \u0000 \u0000 From February 2021 to March 2022 consecutive patients with suspected acute stroke who underwent NCCT and computed tomography angiography (CTA) were included. MLA prediction of LVO and ICH was tested against expert physicians readings and clinical follow‐up. We calculated sensitivity, specificity, positive predictive value and negative predictive value. Receiver operating curves were generated for MLA‐LVO, MLA‐ICH and; areas under the curve were calculated. Potential time savings and impact on workflow times were calculated for a scenario in which MLA could analyse initial NCCT at PSC avoiding imaging repetition at CSC.\u0000 \u0000 \u0000 \u0000 140 consecutive patients admitted from march 2021 to February 2022 were included in the study, final physicians diagnostics were: 22 ICH (15.7%) and 53 LVO (37.8%) MLA detected 22 ICH (15.7%) and 58 LVO (41.4%).The area under the curve for the identification of ICH with MLA was 0.97 (sensitivity: 94%, specificity: 91%, positive predictive value: 83.3%[MR1][JL2], negative predictive value: 100%). The area under the curve for the identification of LVO with MLA was 0.91 (sensitivity: 100%, specificity: 95.8%, positive predictive value: 85.7%, negative predictive value: 96.4%). Implementation of MLA‐LVO in the network could save CTA acquisition times of 40 (IQR 26) minutes by taking patients directly to the angiosuite for endovascular treatment.\u0000 \u0000 \u0000 \u0000 In patients with suspected acute stroke, a MLA can quickly and reliably predict ICH and LVO. Such a tool could accelerate the diagnosis, mitigate the contrast imaging dependency and improve the workflow efficiency in stroke networks in LMIC where access to contrast imaging is often limited.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48283347","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 : 2023-03-01DOI: 10.1161/svin.03.suppl_1.138
Y. Lodi, J. Campos
16.4 percent of patients diagnosed with fibromuscular dysplasia (FMD) are found to have internal carotid artery (ICA) dissection [1] which may lead to life threatening ICA dissecting pseudoaneurysm (ICADPA). Endovascular repair of ICADPA may be urgent when ICADPA is symptomatic, potential for rupture with no good alternatives. Tortuous anatomy with FMD and ICADS can represent a significant endovascular challenge, especially if there is an aneurysmal inflow‐zone stenosis.Objective: We present a unique case of right ICADPA with an inflow‐zone parent artery stenosis underwent angioplasty and repair with surpass evolve flow diverter (SEFD). Case report and chart review. 49‐year‐old man history of hypertension, hyperlipidemia, and left ICADPA status post stenting/stent‐assisted coiling in 2017, who presented with right‐sided pulsatile tinnitus after a facial injury. Cerebral angiography revealed a tortuous right ICA with FMD, and presence of a right ICADPA at the skull base measuring 16×8 mm with inflow zone stenosis and a post‐stenotic dilatation. An emergency repair was performed with an informed consent under general anesthesia. In order for the SEFD to deploy properly, an angioplasty of inflow‐zone parent artery stenosis was performed with a 3×20mm Maverick balloon. Subsequently, a SEFD measuring 5×40 mm was deployed to cover the dissecting pseudoaneurysm, and a second SEFD measuring 5×20 mm was deployed covering the ICADS resulting in good apposition of SEFD and securement of ICADS.Use of a metal self‐deployable stent prior to flow diversion was not an option due to the presence of extreme tortuosity and acute angulations on the parent artery.patient was discharged home after 24 hours with 325 mg of aspirin and 75 mg of clopidogrel and good blood pressure control. 90‐days follow‐up, demonstrated good recovery with modified Rankin score of 0 with no symptoms. ICADPA with aneurysmal inflow zone parent artery stenosis and the presence of extream tortuosity and acute angulations, may require angioplasty prior to the flow diversion for successful repair. Further studies are required.
{"title":"Abstract Number ‐ 138: Complex symptomatic dissecting pseudoaneurysm with inflow zone stenosis required angioplasty before flow‐diversion‐a technical report.","authors":"Y. Lodi, J. Campos","doi":"10.1161/svin.03.suppl_1.138","DOIUrl":"https://doi.org/10.1161/svin.03.suppl_1.138","url":null,"abstract":"\u0000 \u0000 16.4 percent of patients diagnosed with fibromuscular dysplasia (FMD) are found to have internal carotid artery (ICA) dissection [1] which may lead to life threatening ICA dissecting pseudoaneurysm (ICADPA). Endovascular repair of ICADPA may be urgent when ICADPA is symptomatic, potential for rupture with no good alternatives. Tortuous anatomy with FMD and ICADS can represent a significant endovascular challenge, especially if there is an aneurysmal inflow‐zone stenosis.Objective: We present a unique case of right ICADPA with an inflow‐zone parent artery stenosis underwent angioplasty and repair with surpass evolve flow diverter (SEFD).\u0000 \u0000 \u0000 \u0000 Case report and chart review.\u0000 \u0000 \u0000 \u0000 49‐year‐old man history of hypertension, hyperlipidemia, and left ICADPA status post stenting/stent‐assisted coiling in 2017, who presented with right‐sided pulsatile tinnitus after a facial injury. Cerebral angiography revealed a tortuous right ICA with FMD, and presence of a right ICADPA at the skull base measuring 16×8 mm with inflow zone stenosis and a post‐stenotic dilatation. An emergency repair was performed with an informed consent under general anesthesia. In order for the SEFD to deploy properly, an angioplasty of inflow‐zone parent artery stenosis was performed with a 3×20mm Maverick balloon. Subsequently, a SEFD measuring 5×40 mm was deployed to cover the dissecting pseudoaneurysm, and a second SEFD measuring 5×20 mm was deployed covering the ICADS resulting in good apposition of SEFD and securement of ICADS.Use of a metal self‐deployable stent prior to flow diversion was not an option due to the presence of extreme tortuosity and acute angulations on the parent artery.patient was discharged home after 24 hours with 325 mg of aspirin and 75 mg of clopidogrel and good blood pressure control. 90‐days follow‐up, demonstrated good recovery with modified Rankin score of 0 with no symptoms.\u0000 \u0000 \u0000 \u0000 ICADPA with aneurysmal inflow zone parent artery stenosis and the presence of extream tortuosity and acute angulations, may require angioplasty prior to the flow diversion for successful repair. Further studies are required.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48297916","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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