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Siddiqi AZ, Kashani N, Dmytriw AA, Yavagal D, Saposnik G, Tymianski M, Adams C, Hill MD, Dowlatshahi D, Katsanos AH, Menon BK, Ganesh A, Singh N. Understanding physician preferences about combined thrombolysis and thrombectomy in patients with large vessel occlusion: An international cross-sectional survey. J Stroke Cerebrovasc Dis 2024; 33:108022. [PMID: 39306059 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 09/12/2024] [Accepted: 09/17/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND A recently published individual participant-level meta-analysis found that EVT alone was not non-inferior to combined intravenous thrombolysis (IVT) and EVT. Our aim was to determine factors that influence physicians' treatment choice of IVT-alone versus EVT-alone versus a combined approach. METHODS We performed an international, structured, invite-only survey among physicians treating patients presenting with AIS. Respondents were asked 16 multiple choice questions. Fourteen questions involved the respondent being provided with a clinical scenario. In each scenario, a patient was presenting with an AIS with LVO, varying a single clinical or imaging feature. RESULTS A total of 282 stroke physicians (mean age 46 years, 75 % males) participated in the survey. In LVO stroke, eligible for both IVT and EVT, without other qualifiers, 220 (85.9 %) respondents chose to pursue a combined approach. For age over 80 years, 191 (74 %) participants opted for combined approach, which decreased to 121 (48.2 %) with dementia and 148 (57.4 %) if the patient was on dual anti-platelet therapy (DAPT). Of respondents choosing combination therapy in a patient above the age of 80, only 105 (56.8 %) would pursue the same in a patient with dementia. For imaging factors, 177 (72.8 %) opted for a combined approach for intracranial carotid occlusion, which decreased to 160 (65.3 %) in tandem occlusions. Overall, 88 (38 %) respondents agreed to the statement "I am uncomfortable with uncertainty in patient care". CONCLUSIONS In a typical patient with AIS due to LVO, most respondents still choose a combined revascularization approach but discrepancy in decision-making increases in complex scenarios.
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Affiliation(s)
- A Z Siddiqi
- Section of Neurology, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - N Kashani
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - D Yavagal
- Cerebral Vascular Disease Research Laboratories, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - G Saposnik
- Division of Neurology, St Michael's Hospital, University of Toronto, Canada; Stroke Program, St Michael's Hospital, University of Toronto, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada; Research Department, NeuroEconSolutions (Neuroeconsolutions.com), Toronto, Canada.
| | | | - C Adams
- Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - M D Hill
- Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Dar Dowlatshahi
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ontario.
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University & Population Health Research Institute, Hamilton, ON L8S 4L8, Canada.
| | - B K Menon
- Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A Ganesh
- Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - N Singh
- Section of Neurology, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Chahine A, Morsi RZ, Thind S, Kass-Hout O, Becske T, Khaldi A, Karar L, Baskaran A, Carrión-Penagos J, Desai H, Kothari SA, Rana R, Verhagen Metman O, Zakaria J, Shah AP, Paul JD, Nathan S, Siegler JE, Mendelson SJ, Mansour A, Hurley MC, Prabhakaran S, Gupta R, Kass-Hout T. Use of Onyx Frontier ™ for intracranial stenting in stroke patients: A multicenter retrospective study. Interv Neuroradiol 2024:15910199241286922. [PMID: 39429004 PMCID: PMC11559875 DOI: 10.1177/15910199241286922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 09/05/2024] [Indexed: 10/22/2024] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) due to intracranial atherosclerotic disease (ICAD) carries a high risk of recurrence despite aggressive medical management. The aim of our study is to present our initial experience with the Onyx Frontier™ balloon-mounted drug-eluting stent (Medtronic, Santa Rosa, CA) for AIS due to ICAD. METHODS We conducted a multicenter retrospective cohort study describing the technical feasibility, safety, and performance of using the Onyx Frontier™ balloon-mounted drug-eluting stent in patients with acute intracranial vessel occlusion due to ICAD across three comprehensive stroke centers in the United States. RESULTS We included 23 patients in our study (mean age 67.3 [10.7]; females: n = 13/23, 56.5%). Most patients were Black (n = 14/23, 60.9%). The most common site of vessel occlusion was the M1 branch of the middle cerebral artery (MCA) (n = 14/23, 60.9%), followed by the vertebrobasilar system (n = 5/23, 21.7%), and the internal carotid artery (n = 3/23, 13.0%). Treatment with the Onyx Frontier™ stent was associated with a final mTICI score ≥2b for 100% of patients, with no vessel perforations or distal embolization. None of the patients had any restenosis or re-treatment over a median follow-up of 3.5 months (interquartile range [IQR] 7.8). All cases required a single stent except for one, where two were deployed. Transfemoral access was used in most cases (n = 18/23, 78.3%), with one in-hospital death due to access site complication (n = 1/23, 4.3%). CONCLUSIONS This is the largest multicenter cohort study demonstrating the feasibility and safety of using the Onyx Frontier™ balloon-mounted zotarolimus-eluting stent to treat symptomatic AIS due to ICAD.
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Affiliation(s)
- Ahmad Chahine
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Rami Z. Morsi
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Sonam Thind
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Omar Kass-Hout
- Department of Neurology, Access TeleCare, Dallas, TX, USA
| | - Tibor Becske
- Department of Neurology, UNC REX Healthcare, Raleigh, NC, USA
| | - Ahmad Khaldi
- Department of Neurosurgery, WellStar Health System, Marietta, GA, USA
| | - Lina Karar
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Archit Baskaran
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | | | - Harsh Desai
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | | | - Rohini Rana
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | | | - Jehad Zakaria
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Atman P. Shah
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Jonathan D. Paul
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Sandeep Nathan
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - James E. Siegler
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | | | - Ali Mansour
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | | | | | - Rishi Gupta
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, IL, USA
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3
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Matsukawa H, Crosa R, Cunningham C, Maier I, Al Kasab S, Jabbour P, Kim JT, Wolfe SQ, Rai A, Starke RM, Psychogios MN, Shaban A, Goyal N, Yoshimura S, Cuellar H, Howard B, Alawieh A, Alaraj A, Ezzeldin M, Romano DG, Tanweer O, Mascitelli J, Fragata I, Polifka A, Siddiqui F, Osbun J, Matouk C, Park MS, Levitt MR, Brinjikji W, Moss M, Williamson R, Navia P, Kan P, Leacy RD, Chowdhry S, Spiotta AM. Earlier Endovascular Thrombectomy and Mortality in Patients with Anterior Circulation Large Vessel Occlusion: A Propensity-Matched Analysis of the Stroke Thrombectomy and Aneurysm Registry. World Neurosurg 2024; 189:e435-e441. [PMID: 38908685 DOI: 10.1016/j.wneu.2024.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/16/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND The definitive impact of onset to arterial puncture time (OPT) on 90-day mortality after endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) caused by anterior circulation large vessel occlusion (LVO) remains unknown. The present study aimed to evaluate the influence of OPT on 90-day mortality in anterior circulation AIS-LVO patients who underwent EVT. METHODS Data from 33 international centers were retrospectively analyzed. The receiver operating characteristic curve analysis was used to identify a cutoff for OPT. A propensity score-matched analysis was performed. The primary outcome was 90-day mortality (modified Rankin Scale [mRS] 6). Secondary outcomes included mortality at discharge, 90-day good outcome (mRS 0-2), 90-day poor outcome (mRS 5-6), successful recanalization (defined as postprocedure modified Thrombolysis in Cerebral Infarction scale ≥2b), and intracranial hemorrhage. RESULTS A total of 2842 AIS-LVO patients with EVT were included. The cutoff for OPT for 90-day mortality was 180 min. Of these 378 patients had OPT <180 min and 378 patients had OPT ≥180 min in the propensity score-matched cohort (n = 756). Patients with OPT <180 min were less likely to have 90-day mortality (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.51-0.96) and poor outcome (OR 0.71, 95% CI 0.53-0.96), and more likely to have 90-day good outcome (OR 1.55, 95% CI 1.16-2.08). Other outcomes showed no significant differences. CONCLUSIONS This study showed that OPT <180 min was less related to 90-day mortality and poor outcome, and more to 90-day good outcome in AIS-LVO patients who underwent EVT.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Roberto Crosa
- Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay.
| | - Conor Cunningham
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ilko Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Stacey Quintero Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ansaar Rai
- Department of Radiology, West Virginia School of Medicine, Morgantown, Virginia, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Miami Health System, Miami, Florida, USA
| | - Marios-Nikos Psychogios
- Department of interventional and diagnostical Neuroradiology, University of Basel, Basel, Switzerland
| | - Amir Shaban
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nitin Goyal
- Department of Neurosurgery, University of Tennessee Health Science Center/Semmes Murphey Foundation, Memphis, Tennessee, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Hugo Cuellar
- Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, Louisiana, USA
| | - Brian Howard
- Department of Neurosurgery, Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, Houston, Texas, USA
| | - Daniele G Romano
- Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School, UNL, Lisbon, Portugal
| | - Adam Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Fazeel Siddiqui
- Department of Neuroscience, University of Michigan Health West, Wyoming, Michigan, USA
| | - Joshua Osbun
- Department of Neurological Surgery, Washington University, St Louis, Missouri, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Mark Moss
- Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, Arkansas, USA
| | - Richard Williamson
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | - Peter Kan
- Department of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Reade De Leacy
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Shakeel Chowdhry
- Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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4
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Alysha D, Blair C, Thomas P, Pham T, Nguyen T, Cordato TR, Badge H, Chappelow N, Lin L, Edwards L, Thomas J, Hodgkinson S, Cappelen-Smith C, McDougall A, Cordato DJ, Parsons M. Comparative Prevalence of Cerebrovascular Disease in Vietnamese Communities in South-Western Sydney. J Cardiovasc Dev Dis 2024; 11:164. [PMID: 38921664 PMCID: PMC11203452 DOI: 10.3390/jcdd11060164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in these communities may improve health outcomes. We aimed to compare the rates of transient ischaemic attack (TIA), ischaemic stroke (IS), intracerebral haemorrhage (ICH), intracranial atherosclerosis (ICAD), and stroke risk factors in Vietnamese-born residents of South-Western Sydney (SWS) with those of an Australian-born cohort. A 10-year retrospective analysis (2011-2020) was performed using data extracted from the Health Information Exchange database characterising stroke presentations and risk factor profiles. The rates of hypertension (83.7% vs. 70.3%, p < 0.001) and dyslipidaemia (81.0% vs. 68.2%, p < 0.001) were significantly higher in Vietnamese patients, while the rates of ischaemic heart disease (10.4% vs. 20.3%, p < 0.001), smoking (24.4% vs. 40.8%, p < 0.001), and alcohol abuse (>1 drink/day) (9.6% vs. 15.9%, p < 0.001) were lower. The rates of ICAD and ICH were higher in Vietnamese patients (30.9% vs. 6.9%, p < 0.001 and 24.7% vs. 14.4%, p = 0.002). Regression analysis revealed that diabetes (OR: 1.86; 95% CI: 1.14-3.04, p = 0.014) and glycosylated haemoglobin (OR: 1.51; 95% CI: 1.15-1.98, p = 0.003) were predictors of ICAD in Vietnamese patients. Vietnamese patients had higher rates of symptomatic ICAD and ICH, with unique risk factor profiles. Culturally specific interventions arising from these findings may more effectively reduce the community burden of disease.
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Affiliation(s)
- Deena Alysha
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Christopher Blair
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Peter Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Timmy Pham
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Tram Nguyen
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Theodore Ross Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Helen Badge
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Nicola Chappelow
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Longting Lin
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Leon Edwards
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - James Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Suzanne Hodgkinson
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Cecilia Cappelen-Smith
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Alan McDougall
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Dennis John Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Mark Parsons
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
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5
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Uchida K, Yamagami H, Sakai N, Iihara K, Imamura H, Ishii A, Matsumaru Y, Sakai C, Satow T, Sakakibara F, Shirakawa M, Yoshimura S. Early neurological changes following endovascular therapy for acute stroke due to intracranial atherosclerotic disease. J Neurol Sci 2024; 460:122978. [PMID: 38599028 DOI: 10.1016/j.jns.2024.122978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/27/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Endovascular therapy (EVT) reduces functional disability in patients with acute large vessel occlusion (LVO). However, the early neurological change after EVT may be limited in patients with intracranial atherosclerotic disease (ICAD). METHODS We analyzed the Japanese Registry of NeuroEndovascular Therapy (JR-NET) 4 which was a retrospective, nationwide, multicenter registry of patients with LVO between 2015 and 2019. We compared the early neurological change, efficacy and safety of EVT for acute LVO in ICAD and other etiologies. The primary outcome was NIHSS improvement ≥10 points, and secondary outcome were NIHSS worsening ≥4 points 7 days after EVT, effective reperfusion rate, 30-day functional outcomes, and safety outcomes. RESULTS Among the 6710 enrolled patients, 610 (9.1%) had ICAD. The ICAD group was younger (mean 72.0 vs. 75.8 years) and predominantly male (63.4% vs. 56.0%), had lower NIHSS scores before EVT (median 16 vs. 18), and underwent percutaneous transluminal angioplasty and stenting more frequently (43.0% vs. 4.4%, 12.3% vs. 4.4%). In the ICAD group, NIHSS improvement was significantly lower (adjusted odds ratio (aOR) [95% confidence interval (95%CI)] 0.52 [0.41-0.65]), NIHSS worsening was significantly higher (aOR [95%CI] 1.76 [1.31-2.34]), and effective reperfusion was significantly lower (aOR [95%CI] 0.47 [0.36-0.60]). Fewer patients with ICAD had modified Rankin scale 0-2 at 30 days (aOR [95%CI] 0.60 [0.47-0.77]). The risk of acute reocclusion was more prominent in the ICAD group (aOR [95%CI] 4.03 [1.98-8.21]). CONCLUSIONS Improvement in neurological severity after EVT was lower in patients with LVO and ICAD.
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Affiliation(s)
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan; Division of Stroke Prevention and Treatment, Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuyuki Sakai
- Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University, Kyoto, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chiaki Sakai
- Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tetsu Satow
- Department of Neurosurgery, Kindai University, Osaka-Sayama, Japan
| | | | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
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