A. Pan, T. Potter, A. Bako, Jonika Tannous, C. D. McCane, T. Garg, R. Gadhia, V. Misra, John Volpi, D. Chiu, F. Vahidy
Impact of mediating factors on the relationship between socioeconomic disadvantage and outcomes among patients with acute ischemic stroke has not been well characterized. Data on patients with acute ischemic stroke were extracted from electronic medical records, and 90‐day modified Rankin scale (mRS) scores were collected as part of a prospective stroke registry. Exact patient addresses were geocoded and characterized using Area Deprivation Index (ADI) ranks. The 90‐day modified Rankin scale scores ≥3 were categorized as poor outcomes. Logistic regression models (adjusted for treatment with intravenous tissue plasminogen activator or intraarterial therapy, sociodemographics, and comorbidities) were fitted to compute adjusted odds ratios (aORs) and 95% CIs for total effect of high ADI on poor outcomes. In‐hospital mortality (versus survived) and unfavorable (versus favorable) discharge disposition were also evaluated as outcomes. Structural equation modeling was used to report the average causal mediation effects of stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and treatment (intravenous tissue plasminogen activator or intraarterial therapy). Between May 2016 and December 2021, 13 641 patients with acute ischemic stroke (median age, 69 years; 50.1% women) were included. Among 3002 patients with functional outcomes data, a high ADI was significantly associated with poor 90‐day modified Rankin scale score (aOR, 1.16 [95% CI, 1.04–1.29]). Patients in higher ADI neighborhoods had increased odds of having higher NIHSS scores (aOR, 1.19 [95% CI, 1.07–1.32]). Likewise, a higher NIHSS score was associated with poor 90‐day modified Rankin scale score (aOR, 9.34 [95% CI, 7.64–11.5]). The effect of neighborhood disadvantage on poor 90‐day modified Rankin scale score was 59% mediated by NIHSS score (average causal mediation effects: P <0.001). NIHSS score also accounted for 93% of the pathway for unfavorable discharges. In‐hospital mortality was not associated with ADI, and treatment did not significantly mediate any outcomes. Neighborhood disadvantage leads to unfavorable hospital discharges and worse 90‐day disability, mediated via stroke severity. Tracking social determinants of health may identify opportunities for reducing the onset of severe strokes and poor outcomes.
{"title":"Stroke Severity Mediates the Association Between Socioeconomic Disadvantage and Poor Outcomes Among Patients With Acute Ischemic Stroke","authors":"A. Pan, T. Potter, A. Bako, Jonika Tannous, C. D. McCane, T. Garg, R. Gadhia, V. Misra, John Volpi, D. Chiu, F. Vahidy","doi":"10.1161/svin.122.000487","DOIUrl":"https://doi.org/10.1161/svin.122.000487","url":null,"abstract":"\u0000 \u0000 Impact of mediating factors on the relationship between socioeconomic disadvantage and outcomes among patients with acute ischemic stroke has not been well characterized.\u0000 \u0000 \u0000 \u0000 Data on patients with acute ischemic stroke were extracted from electronic medical records, and 90‐day modified Rankin scale (mRS) scores were collected as part of a prospective stroke registry. Exact patient addresses were geocoded and characterized using Area Deprivation Index (ADI) ranks. The 90‐day modified Rankin scale scores ≥3 were categorized as poor outcomes. Logistic regression models (adjusted for treatment with intravenous tissue plasminogen activator or intraarterial therapy, sociodemographics, and comorbidities) were fitted to compute adjusted odds ratios (aORs) and 95% CIs for total effect of high ADI on poor outcomes. In‐hospital mortality (versus survived) and unfavorable (versus favorable) discharge disposition were also evaluated as outcomes. Structural equation modeling was used to report the average causal mediation effects of stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and treatment (intravenous tissue plasminogen activator or intraarterial therapy).\u0000 \u0000 \u0000 \u0000 \u0000 Between May 2016 and December 2021, 13 641 patients with acute ischemic stroke (median age, 69 years; 50.1% women) were included. Among 3002 patients with functional outcomes data, a high ADI was significantly associated with poor 90‐day modified Rankin scale score (aOR, 1.16 [95% CI, 1.04–1.29]). Patients in higher ADI neighborhoods had increased odds of having higher NIHSS scores (aOR, 1.19 [95% CI, 1.07–1.32]). Likewise, a higher NIHSS score was associated with poor 90‐day modified Rankin scale score (aOR, 9.34 [95% CI, 7.64–11.5]). The effect of neighborhood disadvantage on poor 90‐day modified Rankin scale score was 59% mediated by NIHSS score (average causal mediation effects:\u0000 P\u0000 <0.001). NIHSS score also accounted for 93% of the pathway for unfavorable discharges. In‐hospital mortality was not associated with ADI, and treatment did not significantly mediate any outcomes.\u0000 \u0000 \u0000 \u0000 \u0000 Neighborhood disadvantage leads to unfavorable hospital discharges and worse 90‐day disability, mediated via stroke severity. Tracking social determinants of health may identify opportunities for reducing the onset of severe strokes and poor outcomes.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41696609","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}
Niklas Helwig, F. Şeker, M. Möhlenbruch, R. Deichmann, U. Nöth, R. Gracien, E. Hattingen, Marlies Wagner, A. Seiler
Collaterals are the main determinants of the severity of cerebral ischemia and control the pace of the ischemic tissue damage in acute ischemic stroke. Assessment of collateral status remains a major challenge in stroke imaging. We evaluated a signal variance–based collateral vessel index in perfusion‐weighted imaging (CVI PWI ) in terms of its association with initial stroke severity, presence of a mismatch for endovascular thrombectomy (EVT), and early functional outcome in patients with large‐vessel occlusion. T2*‐weighted time series from dynamic susceptibility contrast perfusion imaging were processed to calculate the CVI PWI . Ischemic cores were segmented automatically on apparent diffusion coefficient maps. The relationship between collateral status and the fulfilment of mismatch criteria for EVT as well as the association between the CVI PWI and functional outcome in patients undergoing EVT were analyzed. Furthermore, spatial patterns of pial collateralization were investigated. A total of 156 patients with large‐vessel occlusion were included in the final analysis. Higher CVI PWI and thus better collateral supply was associated with lower baseline National Institutes of Health Stroke Scale and smaller baseline infarct volumes ( P =0.022 and P =0.002, respectively), and the CVI PWI varied significantly among groups according to fulfillment of mismatch criteria for EVT ( P <0.001). In patients undergoing EVT (n=105), the CVI PWI was an independent predictor of favorable functional outcome (modified Rankin scale score of 0–2) at discharge in multivariate analysis ( P =0.031). In patients with EVT who had successful reperfusion (n=79), good collateral status was associated with a higher rate of early neurological improvement ( P =0.026) and better functional outcome at discharge ( P =0.04) in shift analysis. Signal variance–based CVI PWI represents a semiquantitative and objective, thus observer‐independent parameter for direct assessment of collateral status with clinical relevance. Its use may inform clinical decision‐making and may be of interest for clinical stroke trials.
{"title":"Leptomeningeal Collateral Status by Signal Variance in Perfusion Magnetic Resonance Imaging: Association With Initial Stroke Severity and Early Functional Outcome After Thrombectomy","authors":"Niklas Helwig, F. Şeker, M. Möhlenbruch, R. Deichmann, U. Nöth, R. Gracien, E. Hattingen, Marlies Wagner, A. Seiler","doi":"10.1161/svin.122.000776","DOIUrl":"https://doi.org/10.1161/svin.122.000776","url":null,"abstract":"\u0000 \u0000 \u0000 Collaterals are the main determinants of the severity of cerebral ischemia and control the pace of the ischemic tissue damage in acute ischemic stroke. Assessment of collateral status remains a major challenge in stroke imaging. We evaluated a signal variance–based collateral vessel index in perfusion‐weighted imaging (CVI\u0000 PWI\u0000 ) in terms of its association with initial stroke severity, presence of a mismatch for endovascular thrombectomy (EVT), and early functional outcome in patients with large‐vessel occlusion.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 T2*‐weighted time series from dynamic susceptibility contrast perfusion imaging were processed to calculate the CVI\u0000 PWI\u0000 . Ischemic cores were segmented automatically on apparent diffusion coefficient maps. The relationship between collateral status and the fulfilment of mismatch criteria for EVT as well as the association between the CVI\u0000 PWI\u0000 and functional outcome in patients undergoing EVT were analyzed. Furthermore, spatial patterns of pial collateralization were investigated.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 A total of 156 patients with large‐vessel occlusion were included in the final analysis. Higher CVI\u0000 PWI\u0000 and thus better collateral supply was associated with lower baseline National Institutes of Health Stroke Scale and smaller baseline infarct volumes (\u0000 P\u0000 =0.022 and\u0000 P\u0000 =0.002, respectively), and the CVI\u0000 PWI\u0000 varied significantly among groups according to fulfillment of mismatch criteria for EVT (\u0000 P\u0000 <0.001). In patients undergoing EVT (n=105), the CVI\u0000 PWI\u0000 was an independent predictor of favorable functional outcome (modified Rankin scale score of 0–2) at discharge in multivariate analysis (\u0000 P\u0000 =0.031). In patients with EVT who had successful reperfusion (n=79), good collateral status was associated with a higher rate of early neurological improvement (\u0000 P\u0000 =0.026) and better functional outcome at discharge (\u0000 P\u0000 =0.04) in shift analysis.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Signal variance–based CVI\u0000 PWI\u0000 represents a semiquantitative and objective, thus observer‐independent parameter for direct assessment of collateral status with clinical relevance. Its use may inform clinical decision‐making and may be of interest for clinical stroke trials.\u0000 \u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42078013","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}
C. Beaman, Smit D. Patel, K. Nael, G. Colby, D. Liebeskind
Vascular imaging is an essential tool to appropriately diagnose and treat intracranial saccular aneurysms. There is extensive heterogeneity in aneurysm characteristics including location, size, shape, patient demographics, and clinical status that leads to a great diversity in both surgical and endovascular treatment options. This variability may elicit confusion when deciding the most appropriate imaging paradigm for an individual patient at particular time points. A collection of pre‐ and posttreatment scales and grades exist, but there is no current consensus on which one to implement. In this review, we discuss the key advantages and disadvantages of the available imaging modalities and how each can guide management. We also review novel imaging tools that are likely to alter the diagnostic landscape of intracranial aneurysms in the coming years.
{"title":"Imaging of Intracranial Saccular Aneurysms","authors":"C. Beaman, Smit D. Patel, K. Nael, G. Colby, D. Liebeskind","doi":"10.1161/svin.122.000757","DOIUrl":"https://doi.org/10.1161/svin.122.000757","url":null,"abstract":"Vascular imaging is an essential tool to appropriately diagnose and treat intracranial saccular aneurysms. There is extensive heterogeneity in aneurysm characteristics including location, size, shape, patient demographics, and clinical status that leads to a great diversity in both surgical and endovascular treatment options. This variability may elicit confusion when deciding the most appropriate imaging paradigm for an individual patient at particular time points. A collection of pre‐ and posttreatment scales and grades exist, but there is no current consensus on which one to implement. In this review, we discuss the key advantages and disadvantages of the available imaging modalities and how each can guide management. We also review novel imaging tools that are likely to alter the diagnostic landscape of intracranial aneurysms in the coming years.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43146831","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. Benali, Jianhai Zhang, Najratun Nayem Pinky, F. Bala, I. Alhabli, Rotem Golan, Luis A Souto Maior Neto, Ibukun Elebute, Chris C. Duszynski, Wu Qiu, B. Menon
We recently developed a novel machine learning‐based algorithm using multiphase computed tomography angiography (mCTA) to generate perfusion maps of the brain, similar to computed tomography perfusion (CTP) (ie, multiphase CTA perfusion [mCTAp]). Here, we aim to validate the clinical utility of mCTAp in detection of brain ischemia and its side, extent, and location. In this prospective multi‐reader‐multi‐case analysis, we included baseline images: mCTAp ( StrokeSENS ‐algorithm) and CTP (4D; GE Healthcare) from 121 randomly selected patients whose scans were not part of algorithm‐development. After excluding 2/121 scans because of poor image‐quality, 3 experienced radiologists read time to maximum, and relative cerebral blood flow‐maps generated by the test (mCTAp) and reference (CTP) modality. The 2 reading sessions were separated by 5 days although the reading order was randomized. Core laboratory imaging assessments – that used non contrast computed tomography, mCTA, and CTP – were considered as ground‐truth. A mixed‐effects statistical model with “reader” as random effects variable was used to calculate the area under the curve (with 95% CI), sensitivity, and specificity for both modalities (mCTAp/CTP) for ischemia detection, affected side, and occlusion location. The time required for interpretation and inter‐rater variability in assessments were compared across the 2 modalities. Area under the curves (95% CI) for detecting ischemia using mCTAp and CTP were 0.85 (95% CI, 0.8–0.9) and 0.84 (0.8–0.9) respectively ( P =0.43). Area under the curves for the affected side were 0.94 (0.92–0.97) and 0.96 (0.94–0.98) ( P =0.69), respectively; for detecting large vessel occlusion were 0.84 (0.8–0.9) and 0.86 (0.8–0.9), ( P =0.31), respectively; M2‐or‐distal occlusion were 0.79 (0.73–0.84) and 0.88 (0.83–0.92) ( P =0.22), respectively, for anterior cerebral artery‐occlusion 0.82 (0.66–0.98) and 0.93 (0.82–1.00) ( P =0.15), respectively, and for posterior cerebral artery‐occlusions 0.9 (0.8–1) and 0.99 (0.98–0.99) ( P =0.01), respectively. The median (interquartile range [IQR]) time for image interpretation was 62 seconds (IQR, 46–78) and 59 seconds (IQR, 42–69) for mCTAp and CTP, respectively, ( P =0.15). Fleiss` Kappa‐values for inter‐rater reliability in detecting ischemia were 0.5 and 0.8 for mCTAp and CTP, respectively. mCTAp shows similar performance and interpretation times compared to CTP in assisting readers to detect brain ischemia, affected side, and occlusion location, but mainly as it relates to proximal vessel occlusions. The proposed tool still needs further refinement for distal vessel occlusions. Nonetheless, mCTAp is a promising tool as it allows for acquisition of brain perfusion maps with lower radiation exposure, acquisition time, and contrast dose compared with additional CTP.
{"title":"Validation of a Novel Multiphase CTA Perfusion Tool Compared to CTP in Patients With Suspected Acute Ischemic Stroke","authors":"F. Benali, Jianhai Zhang, Najratun Nayem Pinky, F. Bala, I. Alhabli, Rotem Golan, Luis A Souto Maior Neto, Ibukun Elebute, Chris C. Duszynski, Wu Qiu, B. Menon","doi":"10.1161/svin.122.000811","DOIUrl":"https://doi.org/10.1161/svin.122.000811","url":null,"abstract":"\u0000 \u0000 We recently developed a novel machine learning‐based algorithm using multiphase computed tomography angiography (mCTA) to generate perfusion maps of the brain, similar to computed tomography perfusion (CTP) (ie, multiphase CTA perfusion [mCTAp]). Here, we aim to validate the clinical utility of mCTAp in detection of brain ischemia and its side, extent, and location.\u0000 \u0000 \u0000 \u0000 \u0000 In this prospective multi‐reader‐multi‐case analysis, we included baseline images: mCTAp (\u0000 StrokeSENS\u0000 ‐algorithm) and CTP (4D; GE Healthcare) from 121 randomly selected patients whose scans were not part of algorithm‐development. After excluding 2/121 scans because of poor image‐quality, 3 experienced radiologists read time to maximum, and relative cerebral blood flow‐maps generated by the test (mCTAp) and reference (CTP) modality. The 2 reading sessions were separated by 5 days although the reading order was randomized. Core laboratory imaging assessments – that used non contrast computed tomography, mCTA, and CTP – were considered as ground‐truth. A mixed‐effects statistical model with “reader” as random effects variable was used to calculate the area under the curve (with 95% CI), sensitivity, and specificity for both modalities (mCTAp/CTP) for ischemia detection, affected side, and occlusion location. The time required for interpretation and inter‐rater variability in assessments were compared across the 2 modalities.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Area under the curves (95% CI) for detecting ischemia using mCTAp and CTP were 0.85 (95% CI, 0.8–0.9) and 0.84 (0.8–0.9) respectively (\u0000 P\u0000 =0.43). Area under the curves for the affected side were 0.94 (0.92–0.97) and 0.96 (0.94–0.98) (\u0000 P\u0000 =0.69), respectively; for detecting large vessel occlusion were 0.84 (0.8–0.9) and 0.86 (0.8–0.9), (\u0000 P\u0000 =0.31), respectively; M2‐or‐distal occlusion were 0.79 (0.73–0.84) and 0.88 (0.83–0.92) (\u0000 P\u0000 =0.22), respectively, for anterior cerebral artery‐occlusion 0.82 (0.66–0.98) and 0.93 (0.82–1.00) (\u0000 P\u0000 =0.15), respectively, and for posterior cerebral artery‐occlusions 0.9 (0.8–1) and 0.99 (0.98–0.99) (\u0000 P\u0000 =0.01), respectively. The median (interquartile range [IQR]) time for image interpretation was 62 seconds (IQR, 46–78) and 59 seconds (IQR, 42–69) for mCTAp and CTP, respectively, (\u0000 P\u0000 =0.15). Fleiss` Kappa‐values for inter‐rater reliability in detecting ischemia were 0.5 and 0.8 for mCTAp and CTP, respectively.\u0000 \u0000 \u0000 \u0000 \u0000 mCTAp shows similar performance and interpretation times compared to CTP in assisting readers to detect brain ischemia, affected side, and occlusion location, but mainly as it relates to proximal vessel occlusions. The proposed tool still needs further refinement for distal vessel occlusions. Nonetheless, mCTAp is a promising tool as it allows for acquisition of brain perfusion maps with lower radiation exposure, acquisition time, and contrast dose compared with additional CTP.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41385669","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. Catapano, Katriel E. Lee, S. Desai, India C. Rangel, H. Stonnington, K. Rumalla, C. Rutledge, V. Srinivasan, J. Baranoski, T. Cole, E. Winkler, A. Ducruet, F. Albuquerque, A. Jadhav
Endovascular thrombectomy is the gold‐standard treatment for large vessel occlusions (LVOs). A novel metric is introduced: the number needing review (NNR) to assess the triage efficiency of LVO detection systems. Patients with suspected ischemic stroke and images processed by RapidAI LVO detection software over 6 months were reviewed. Only patients with LVOs of the M1 segment were included. The NNR was calculated for an M1 occlusion. Of 559 patients, M1 occlusion was detected in 42 patients (7.5%). RapidAI LVO had a sensitivity of 71%, specificity of 94%, positive predictive value of 49%, and negative predictive value of 92% for M1 occlusion. When gaze deviation and hyperdense sign were combined with RapidAI LVO, the specificity and positive predictive value increased to 100% for an M1 occlusion. A negative RapidAI LVO result combined with a low (<15 mL, T max >6 seconds) or high (<50 mL, T max >6 seconds) T max threshold was found to have a specificity and positive predictive value of 100% for no occlusion. The combination of gaze deviation, hyperdense sign, positive RapidAI LVO, and negative RapidAI LVO with low T max threshold yielded an NNR of 24 per 100 cases. When combined with a negative RapidAI LVO and a high T max threshold, the NNR was 16 per 100 cases. Adding National Institutes of Health Stroke Scale score <7 decreased the NNR to 9 per 100 cases. Adding gaze deviation and hyperdense sign to the RapidAI LVO increases the specificity and positive predictive value for an M1 occlusion. When combined with a negative RapidAI LVO detection and either a low or high T max >6 seconds threshold, the NNR is significantly reduced.
{"title":"Number Needing Review: A Novel Metric to Assess Triage Efficiency of Large Vessel Occlusion Detection Systems","authors":"J. Catapano, Katriel E. Lee, S. Desai, India C. Rangel, H. Stonnington, K. Rumalla, C. Rutledge, V. Srinivasan, J. Baranoski, T. Cole, E. Winkler, A. Ducruet, F. Albuquerque, A. Jadhav","doi":"10.1161/svin.122.000527","DOIUrl":"https://doi.org/10.1161/svin.122.000527","url":null,"abstract":"\u0000 \u0000 Endovascular thrombectomy is the gold‐standard treatment for large vessel occlusions (LVOs). A novel metric is introduced: the number needing review (NNR) to assess the triage efficiency of LVO detection systems.\u0000 \u0000 \u0000 \u0000 Patients with suspected ischemic stroke and images processed by RapidAI LVO detection software over 6 months were reviewed. Only patients with LVOs of the M1 segment were included. The NNR was calculated for an M1 occlusion.\u0000 \u0000 \u0000 \u0000 \u0000 Of 559 patients, M1 occlusion was detected in 42 patients (7.5%). RapidAI LVO had a sensitivity of 71%, specificity of 94%, positive predictive value of 49%, and negative predictive value of 92% for M1 occlusion. When gaze deviation and hyperdense sign were combined with RapidAI LVO, the specificity and positive predictive value increased to 100% for an M1 occlusion. A negative RapidAI LVO result combined with a low (<15 mL, T\u0000 max\u0000 >6 seconds) or high (<50 mL, T\u0000 max\u0000 >6 seconds) T\u0000 max\u0000 threshold was found to have a specificity and positive predictive value of 100% for no occlusion. The combination of gaze deviation, hyperdense sign, positive RapidAI LVO, and negative RapidAI LVO with low T\u0000 max\u0000 threshold yielded an NNR of 24 per 100 cases. When combined with a negative RapidAI LVO and a high T\u0000 max\u0000 threshold, the NNR was 16 per 100 cases. Adding National Institutes of Health Stroke Scale score <7 decreased the NNR to 9 per 100 cases.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Adding gaze deviation and hyperdense sign to the RapidAI LVO increases the specificity and positive predictive value for an M1 occlusion. When combined with a negative RapidAI LVO detection and either a low or high T\u0000 max\u0000 >6 seconds threshold, the NNR is significantly reduced.\u0000 \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":"48981893","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}
Jennifer L. Patterson, Wendy Dusenbury, A. Stanfill, B. Brewer, A. Alexandrov, A. Alexandrov
Transfer times from primary stroke centers and acute stroke–ready hospitals to higher levels of care are often excessive, prompting some to suggest ambulance bypass regulations. Since barriers to rapid transfer have never been fully explored, we sought to understand stroke coordinators’ experiences with transfer of patients with hyperacute stroke from lower to higher levels of stroke centers. We conducted a national focus group study with primary stroke center stroke coordinators who had recent experience overseeing transfer of a patient with hyperacute stroke to a higher‐level stroke center. Interviews were conducted using prescripted open‐ended questions; information was recorded and data were transcribed for theme identification. A total of 23 stroke coordinators participated representing the Northeast, Mid‐Atlantic, Southeast, Midwest, and Western United States. Findings were grouped into 3 main categories: Internal Primary Stroke Center Factors, Transport Factors, and External Comprehensive Stroke Center Factors. Within the primary stroke center group, themes slowing transfer were exclusively physician based, whereas themes emerging from the transport category were associated with poor transport company processes. Within the comprehensive stroke center category, themes were all associated with complex hospital processes and communication. Important contributors to efficient transfer of patients with hyperacute stroke are beyond the control of stroke coordinators, requiring cross‐system collaboration and improved administrative management to resolve. Quantification of these factors is warranted to support transfer system redesign for rapid access to care for patients with stroke.
{"title":"Transferring Patients From a Primary Stroke Center to Higher Levels of Care: A Qualitative Study of Stroke Coordinators’ Experiences","authors":"Jennifer L. Patterson, Wendy Dusenbury, A. Stanfill, B. Brewer, A. Alexandrov, A. Alexandrov","doi":"10.1161/svin.122.000678","DOIUrl":"https://doi.org/10.1161/svin.122.000678","url":null,"abstract":"\u0000 \u0000 Transfer times from primary stroke centers and acute stroke–ready hospitals to higher levels of care are often excessive, prompting some to suggest ambulance bypass regulations. Since barriers to rapid transfer have never been fully explored, we sought to understand stroke coordinators’ experiences with transfer of patients with hyperacute stroke from lower to higher levels of stroke centers.\u0000 \u0000 \u0000 \u0000 We conducted a national focus group study with primary stroke center stroke coordinators who had recent experience overseeing transfer of a patient with hyperacute stroke to a higher‐level stroke center. Interviews were conducted using prescripted open‐ended questions; information was recorded and data were transcribed for theme identification.\u0000 \u0000 \u0000 \u0000 A total of 23 stroke coordinators participated representing the Northeast, Mid‐Atlantic, Southeast, Midwest, and Western United States. Findings were grouped into 3 main categories: Internal Primary Stroke Center Factors, Transport Factors, and External Comprehensive Stroke Center Factors. Within the primary stroke center group, themes slowing transfer were exclusively physician based, whereas themes emerging from the transport category were associated with poor transport company processes. Within the comprehensive stroke center category, themes were all associated with complex hospital processes and communication.\u0000 \u0000 \u0000 \u0000 Important contributors to efficient transfer of patients with hyperacute stroke are beyond the control of stroke coordinators, requiring cross‐system collaboration and improved administrative management to resolve. Quantification of these factors is warranted to support transfer system redesign for rapid access to care for patients with stroke.\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":"48843227","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. Benali, J. Fladt, T. Jaroenngarmsamer, F. Bala, N. Singh, I. Alhabli, J. Ospel, M. Tymianski, Michael D. Hill, M. Goyal, A. Ganesh
Patients with white matter disease (WMD) – a key marker of cerebral small vessel disease – may have less brain reserve to cope with ischemic injury. The relationship of WMD to functional recovery after endovascular thrombectomy is uncertain. We aim to explore the association between WMD and functional outcome, assessed at multiple time‐points postendovascular thrombectomy. In this post hoc analysis, we analyzed noncontrast computed tomography‐imaging from the ESCAPE‐NA1 (Safety and Efficacy of Nerinetide [NA‐1] in Subjects Undergoing Endovascular Thrombectomy for Stroke) trial and assessed WMD by using the total Fazekas‐score (score range: 0–6). The primary outcome was repeated measurements of the modified Rankin scale (mRS) scores (i.e., day‐5/discharge, day‐30, and day‐90). Secondary outcome measures were the ordinal‐mRS at 90‐days, 90‐day‐mRS0–2, and 90‐day‐mortality. Mixed‐linear and binary/ordinal logistic regressions were performed, adjusting for age, sex, baseline National Institutes of Health Stroke Scale, cortical atrophy, chronic infarctions, stroke laterality, follow‐up infarct volume, and alteplase–nerinetide interaction. Sensitivity analyses were done including only those patients for whom magnetic resonance imaging was available. We included 1102 patients with noncontrast computed tomography (median age 71, interquartile range: 61–80; median National Institutes of Health Stroke Scale 17, interquartile range: 12–21). The median total Fazekas‐score was 1(interquartile range: 0–2). Out of 1202 patients, 566 had follow‐up magnetic resonance imaging. We observed heterogeneity in functional recovery with varying degrees of WMD‐burden ( P <0.001). Patients with Fazekas=3–6 fared worse at every time‐point after endovascular thrombectomy, compared with patients with Fazekas=0–1. At 30‐days, the adjusted difference of the mean mRS=0.47; 95% CI, 0.22–0.72 and at 90‐days: adjusted difference=0.60 (95% CI, 0.36–0.85). Higher WMD‐burdens were also associated with worse 90‐day mRS (adjusted common odds ratio for Fazekas=3–6 versus 0–1: 1.42; 95% CI, 1.03–1.96). Similar results were found in magnetic resonance imaging‐only sensitivity analyses. Patients with more WMD showed worse functional recovery after endovascular thrombectomy, compared with patients without WMD, even after adjusting for age and chronic disease markers like atrophy and chronic infarctions. These data may further help inform treatment expectations and recovery‐related planning, by using simple visual ratings on routinely acquired noncontrast computed tomography.
{"title":"Association of White Matter Disease With Functional Recovery and 90‐Day Outcome After EVT: Beyond Chronological Age","authors":"F. Benali, J. Fladt, T. Jaroenngarmsamer, F. Bala, N. Singh, I. Alhabli, J. Ospel, M. Tymianski, Michael D. Hill, M. Goyal, A. Ganesh","doi":"10.1161/svin.122.000734","DOIUrl":"https://doi.org/10.1161/svin.122.000734","url":null,"abstract":"\u0000 \u0000 Patients with white matter disease (WMD) – a key marker of cerebral small vessel disease – may have less brain reserve to cope with ischemic injury. The relationship of WMD to functional recovery after endovascular thrombectomy is uncertain. We aim to explore the association between WMD and functional outcome, assessed at multiple time‐points postendovascular thrombectomy.\u0000 \u0000 \u0000 \u0000 In this post hoc analysis, we analyzed noncontrast computed tomography‐imaging from the ESCAPE‐NA1 (Safety and Efficacy of Nerinetide [NA‐1] in Subjects Undergoing Endovascular Thrombectomy for Stroke) trial and assessed WMD by using the total Fazekas‐score (score range: 0–6). The primary outcome was repeated measurements of the modified Rankin scale (mRS) scores (i.e., day‐5/discharge, day‐30, and day‐90). Secondary outcome measures were the ordinal‐mRS at 90‐days, 90‐day‐mRS0–2, and 90‐day‐mortality. Mixed‐linear and binary/ordinal logistic regressions were performed, adjusting for age, sex, baseline National Institutes of Health Stroke Scale, cortical atrophy, chronic infarctions, stroke laterality, follow‐up infarct volume, and alteplase–nerinetide interaction. Sensitivity analyses were done including only those patients for whom magnetic resonance imaging was available.\u0000 \u0000 \u0000 \u0000 \u0000 We included 1102 patients with noncontrast computed tomography (median age 71, interquartile range: 61–80; median National Institutes of Health Stroke Scale 17, interquartile range: 12–21). The median total Fazekas‐score was 1(interquartile range: 0–2). Out of 1202 patients, 566 had follow‐up magnetic resonance imaging. We observed heterogeneity in functional recovery with varying degrees of WMD‐burden (\u0000 P\u0000 <0.001). Patients with Fazekas=3–6 fared worse at every time‐point after endovascular thrombectomy, compared with patients with Fazekas=0–1. At 30‐days, the adjusted difference of the mean mRS=0.47; 95% CI, 0.22–0.72 and at 90‐days: adjusted difference=0.60 (95% CI, 0.36–0.85). Higher WMD‐burdens were also associated with worse 90‐day mRS (adjusted common odds ratio for Fazekas=3–6 versus 0–1: 1.42; 95% CI, 1.03–1.96). Similar results were found in magnetic resonance imaging‐only sensitivity analyses.\u0000 \u0000 \u0000 \u0000 \u0000 Patients with more WMD showed worse functional recovery after endovascular thrombectomy, compared with patients without WMD, even after adjusting for age and chronic disease markers like atrophy and chronic infarctions. These data may further help inform treatment expectations and recovery‐related planning, by using simple visual ratings on routinely acquired noncontrast computed tomography.\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":"45587396","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}
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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：