1
|
Singh N, Kashani N, Zea Vera AG, Tkach A, Ganesh A. Worldwide Survey on Approach to Thrombolysis in Acute Ischemic Stroke With Large Vessel Occlusion. Neurol Clin Pract 2024; 14:e200317. [PMID: 38863660 PMCID: PMC11164043 DOI: 10.1212/cpj.0000000000200317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/02/2024] [Indexed: 06/13/2024]
Abstract
Background and Objectives With recent trials suggesting that endovascular thrombectomy (EVT) alone may be noninferior to combined intravenous thrombolysis (IVT) with alteplase and EVT and that tenecteplase is non-inferior to alteplase in treating acute ischemic stroke, we sought to understand current practices around the world for treating acute ischemic stroke with large vessel occlusion (LVO) depending on the center of practice (IVT-capable vs IVT and EVT-capable stroke center). Methods The electronic survey launched by the Practice Current section of Neurology: Clinical Practice included 6 clinical and 8 demographic questions. A single-case scenario was presented of a 65-year-old man presenting with right hemiplegia with aphasia with a duration of 1 hour. Imaging showed left M1-MCA occlusion with no early ischemic changes. The respondents were asked about their treatment approach in 2 settings: the patient presented to (1) the IVT-only capable center and (2) the IVT and EVT-capable center. They were also asked about the thrombolytic agent of choice in current and ideal circumstances for these settings. Results A total of 203 physicians (42.9% vascular neurologists) from 44 countries completed the survey. Most participants (55.2%) spent ≥50% of their time delivering stroke care. The survey results showed that in current practice, more than 90% of respondents would offer IVT + EVT to patients with LVO stroke presenting to either an EVT-capable (91.1%) or IVT-only-capable center (93.6%). Although nearly 80% currently use alteplase for thrombolysis, around 60% would ideally like to switch to tenecteplase independent of the practice setting. These results were similar between stroke and non-stroke neurologists. Discussion Most physicians prefer IVT before EVT in patients with acute ischemic stroke attributable to large vessel occlusion independent of the practice setting.
Collapse
Affiliation(s)
- Nishita Singh
- Department of Internal Medicine (NS), Neurology Division, University of Manitoba, Winnipeg, Canada; Department of Clinical Neurosciences (NS, NK, AG), University of Calgary, Alberta, Canada; Department of Diagnostic and Interventional Neuroradiology (NK), Royal University Hospital, University of Saskatchewan, Saskatoon, Canada; Division of Neurology (AGZV), Children's National Hospital, Washington, DC; and Kelowna General Hospital (AT), University of British Columbia, Canada
| | - Nima Kashani
- Department of Internal Medicine (NS), Neurology Division, University of Manitoba, Winnipeg, Canada; Department of Clinical Neurosciences (NS, NK, AG), University of Calgary, Alberta, Canada; Department of Diagnostic and Interventional Neuroradiology (NK), Royal University Hospital, University of Saskatchewan, Saskatoon, Canada; Division of Neurology (AGZV), Children's National Hospital, Washington, DC; and Kelowna General Hospital (AT), University of British Columbia, Canada
| | - Alonso G Zea Vera
- Department of Internal Medicine (NS), Neurology Division, University of Manitoba, Winnipeg, Canada; Department of Clinical Neurosciences (NS, NK, AG), University of Calgary, Alberta, Canada; Department of Diagnostic and Interventional Neuroradiology (NK), Royal University Hospital, University of Saskatchewan, Saskatoon, Canada; Division of Neurology (AGZV), Children's National Hospital, Washington, DC; and Kelowna General Hospital (AT), University of British Columbia, Canada
| | - Aleksander Tkach
- Department of Internal Medicine (NS), Neurology Division, University of Manitoba, Winnipeg, Canada; Department of Clinical Neurosciences (NS, NK, AG), University of Calgary, Alberta, Canada; Department of Diagnostic and Interventional Neuroradiology (NK), Royal University Hospital, University of Saskatchewan, Saskatoon, Canada; Division of Neurology (AGZV), Children's National Hospital, Washington, DC; and Kelowna General Hospital (AT), University of British Columbia, Canada
| | - Aravind Ganesh
- Department of Internal Medicine (NS), Neurology Division, University of Manitoba, Winnipeg, Canada; Department of Clinical Neurosciences (NS, NK, AG), University of Calgary, Alberta, Canada; Department of Diagnostic and Interventional Neuroradiology (NK), Royal University Hospital, University of Saskatchewan, Saskatoon, Canada; Division of Neurology (AGZV), Children's National Hospital, Washington, DC; and Kelowna General Hospital (AT), University of British Columbia, Canada
| |
Collapse
|
2
|
Gerschenfeld G, Turc G, Obadia M, Chausson N, Consoli A, Olindo S, Caroff J, Marnat G, Blanc R, Ben Hassen W, Seners P, Guillon B, Wiener E, Bourcier R, Yger M, Cho TH, Checkouri T, Gory B, Smadja D, Sibon I, Richard S, Piotin M, Eker OF, Pico F, Lapergue B, Alamowitch S. Functional Outcome and Hemorrhage Rates After Bridging Therapy With Tenecteplase or Alteplase in Patients With Large Ischemic Core. Neurology 2024; 103:e209398. [PMID: 38862134 DOI: 10.1212/wnl.0000000000209398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES IV tenecteplase is an alternative to alteplase before mechanical thrombectomy (MT) in patients with large-vessel occlusion (LVO) ischemic stroke. Little data are available on its use in patients with large ischemic core. We aimed to compare the efficacy and safety of both thrombolytics in this population. METHODS We conducted a retrospective analysis of patients with anterior circulation LVO strokes and diffusion-weighed imaging Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≤5 treated with tenecteplase or alteplase before MT from the TETRIS (tenecteplase) and ETIS (alteplase) French multicenter registries. Primary outcome was reduced disability at 3 months (ordinal analysis of the modified Rankin scale [mRS]). Safety outcomes were 3-month mortality, parenchymal hematoma (PH), and symptomatic intracranial hemorrhage (sICH). We used propensity score overlap weighting to reduce baseline differences between treatment groups. RESULTS We analyzed 647 patients (tenecteplase: n = 194; alteplase: n = 453; inclusion period 2015-2022). Median (interquartile range) age was 71 (57-81) years, with NIH Stroke Scale score 19 (16-22), DWI-ASPECTS 4 (3-5), and last seen well-to-IV thrombolysis and puncture times 165 minutes (130-226) and 260 minutes (203-349), respectively. After MT, the successful reperfusion rate was 83.1%. After propensity score overlap weighting, all baseline variables were well balanced between both treatment groups. Compared with patients treated with alteplase, patients treated with tenecteplase had better 3-month mRS (common odds ratio [OR] for reduced disability: 1.37, 1.01-1.87, p = 0.046) and lower 3-month mortality (OR 0.52, 0.33-0.81, p < 0.01). There were no significant differences between thrombolytics for PH (OR 0.84, 0.55-1.30, p = 0.44) and sICH incidence (OR 0.70, 0.42-1.18, p = 0.18). DISCUSSION Our data are encouraging regarding the efficacy and reassuring regarding the safety of tenecteplase compared with that of alteplase in bridging therapy for patients with LVO strokes and a large ischemic core in routine clinical care. These results support its consideration as an alternative to alteplase in bridging therapy for patients with large ischemic cores. TRIALS REGISTRATION INFORMATION NCT03776877 (ETIS registry) and NCT05534360 (TETRIS registry). CLASSIFICATION OF EVIDENCE This study provides Class III evidence that patients with anterior circulation LVO stroke and DWI-ASPECTS ≤5 treated with tenecteplase vs alteplase before MT experienced better functional outcomes and lower mortality at 3 months.
Collapse
Affiliation(s)
- Gaspard Gerschenfeld
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Guillaume Turc
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Michael Obadia
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Nicolas Chausson
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Arturo Consoli
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Stephane Olindo
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Jildaz Caroff
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Gaultier Marnat
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Raphael Blanc
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Wagih Ben Hassen
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Pierre Seners
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Benoit Guillon
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Emmanuel Wiener
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Romain Bourcier
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Marion Yger
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Tae-Hee Cho
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Thomas Checkouri
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Benjamin Gory
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Didier Smadja
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Igor Sibon
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Sebastien Richard
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Michel Piotin
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Omer F Eker
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Fernando Pico
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Bertrand Lapergue
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Sonia Alamowitch
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| |
Collapse
|
3
|
Song SS, Warach S. Tenecteplase Is a Better Alternative to Alteplase for Patients With Large Vessel Occlusion Stroke Receiving Bridging Therapy. Neurology 2024; 103:e209581. [PMID: 38865680 DOI: 10.1212/wnl.0000000000209581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Affiliation(s)
- Shlee S Song
- From the Department of Neurology (S.S.S.), Cedars Sinai Medical Center, Los Angeles, CA; and Department of Neurology (S.W.), Seton Dell Medical School Stroke Institute, Austin, TX
| | - Steven Warach
- From the Department of Neurology (S.S.S.), Cedars Sinai Medical Center, Los Angeles, CA; and Department of Neurology (S.W.), Seton Dell Medical School Stroke Institute, Austin, TX
| |
Collapse
|
4
|
Kaesmacher J, Cavalcante F, Fischer U. Time to IVT Treatment and Functional Outcomes in Acute Ischemic Stroke-Reply. JAMA 2024; 331:2049. [PMID: 38776102 DOI: 10.1001/jama.2024.7979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/19/2024]
Affiliation(s)
- Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Fabiano Cavalcante
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
5
|
Tomasello A, Hernández D, Li J, Tiberi R, Rivera E, Vargas JD, Losada C, Jablonska M, Esteves M, Diaz ML, Cendrero J, Requena M, Diana F, De Dios M, Singh T, Gramegna LL, Ribo M. Modeling Robotic-Assisted Mechanical Thrombectomy Procedures with the CorPath GRX Robot: The Core-Flow Study. AJNR Am J Neuroradiol 2024; 45:721-726. [PMID: 38663990 DOI: 10.3174/ajnr.a8205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/12/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Endovascular robotic devices may enable experienced neurointerventionalists to remotely perform endovascular thrombectomy. This study aimed to assess the feasibility, safety, and efficacy of robot-assisted endovascular thrombectomy compared with manual procedures by operators with varying levels of experience, using a 3D printed neurovascular model. MATERIALS AND METHODS M1 MCA occlusions were simulated in a 3D printed neurovascular model, linked to a CorPath GRX robot in a biplane angiography suite. Four interventionalists performed manual endovascular thrombectomy (n = 45) and robot-assisted endovascular thrombectomy (n = 37) procedures. The outcomes included first-pass recanalization (TICI 2c-3), the number and size of generated distal emboli, and procedural length. RESULTS A total of 82 experimental endovascular thrombectomies were conducted. A nonsignificant trend favoring the robot-assisted endovascular thrombectomy was observed in terms of final recanalization (89.2% versus manual endovascular thrombectomy, 71.1%; P = .083). There were no differences in total mean emboli count (16.54 [SD, 15.15] versus 15.16 [SD, 16.43]; P = .303). However, a higher mean count of emboli of > 1 mm was observed in the robot-assisted endovascular thrombectomy group (1.08 [SD, 1.00] versus 0.49 [SD, 0.84]; P = .001) compared with manual endovascular thrombectomy. The mean procedural length was longer in robot-assisted endovascular thrombectomy (6.43 [SD, 1.71] minutes versus 3.98 [SD, 1.84] minutes; P < .001). Among established neurointerventionalists, previous experience with robotic procedures did not influence recanalization (95.8% were considered experienced; 76.9% were considered novices; P = .225). CONCLUSIONS In a 3D printed neurovascular model, robot-assisted endovascular thrombectomy has the potential to achieve recanalization rates comparable with those of manual endovascular thrombectomy within competitive procedural times. Optimization of the procedural setup is still required before implementation in clinical practice.
Collapse
Affiliation(s)
- Alejandro Tomasello
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
- Departamento de Medicina (A.T.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jiahui Li
- Stroke Research (J.L., RT., M.J., J.C., M. Requena, M. Ribo), Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Research (J.L., RT., M.J., J.C., M. Requena, M. Ribo), Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Eila Rivera
- Vall d'Hebron Institut de Recerca (E.R., F.D., L.L.G.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Joan Daniel Vargas
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Losada
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Magda Jablonska
- Stroke Research (J.L., RT., M.J., J.C., M. Requena, M. Ribo), Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- 2nd Department of Radiology (M.J.), Medical University of Gdańsk, Gdańsk, Poland
| | - Marielle Esteves
- Experimental Surgery Unit (M.E.), Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Lourdes Diaz
- Departament De Radiologia Vascular Interventista (M.L.D.), Hospital General Universitario Arnau de Villanova, Lleida, Spain
| | - Judith Cendrero
- Stroke Research (J.L., RT., M.J., J.C., M. Requena, M. Ribo), Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Requena
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Research (J.L., RT., M.J., J.C., M. Requena, M. Ribo), Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit (M. Requena, M. Ribo), Neurology Department Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesco Diana
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (E.R., F.D., L.L.G.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta De Dios
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Trisha Singh
- From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Vall d'Hebron Institut de Recerca (E.R., F.D., L.L.G.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marc Ribo
- Stroke Research (J.L., RT., M.J., J.C., M. Requena, M. Ribo), Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit (M. Requena, M. Ribo), Neurology Department Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| |
Collapse
|
6
|
Han L, Lan K, Kou D, Meng Z, Feng J, Maitland E, Nicholas S, Wang J. Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula. HEALTH ECONOMICS REVIEW 2024; 14:37. [PMID: 38836982 PMCID: PMC11154974 DOI: 10.1186/s13561-024-00513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China. METHOD We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model. RESULTS EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER. CONCLUSIONS EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.
Collapse
Affiliation(s)
- Lu Han
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Kuixu Lan
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dejian Kou
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Zehua Meng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jin Feng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, England, United Kingdom
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, NSW, Australia
| | - Jian Wang
- Center for Health Economics and Management, School of Economics and Management, Wuhan University, Wuhan, China.
| |
Collapse
|
7
|
Cai L, Wang L, Campbell BCV, Wu Y, Abdalkader M, Alemseged F, Kaesmacher J, Puetz V, Nagel S, Strbian D, Knapen RRMM, Li C, Ye S, Tian P, Chen J, Li R, Hu W, Qiu Z, Nguyen TN, Schonewille WJ, Guo Q, Dai Z. Endovascular thrombectomy with versus without intravenous thrombolysis in patients with acute basilar artery occlusion: a systematic review and meta-analysis. J Neurol 2024; 271:3039-3049. [PMID: 38597945 DOI: 10.1007/s00415-024-12353-w] [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: 01/19/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND PURPOSE The benefit and safety of intravenous thrombolysis before endovascular thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion (BAO) remains unclear. This article aims to investigate the clinical outcomes and safety of endovascular thrombectomy with versus without intravenous thrombolysis in acute BAO stroke patients. METHODS We conducted a comprehensive search of PubMed, Embase, Cochrane, and Web of Science databases to identify relevant literature pertaining to patients with acute BAO who underwent endovascular thrombectomy alone or intravenous thrombolysis bridging with endovascular thrombectomy (bridging therapy), until January 10, 2024. The primary outcome was functional independence, defined as a score of 0-2 on the modified Rankin Scale at 90 days. The safety outcome was mortality at 90 days and symptomatic intracranial hemorrhage within 48 h. Effect sizes were computed as risk ratio (RR) with random-effect models. This study was registered in PROSPERO (CRD42023462293). RESULTS A total of 528 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded. Finally, 2 RCTs and 10 cohort studies met the inclusion criteria. The findings revealed that the endovascular thrombectomy alone group had a lower rate of functional independence compared to the bridging therapy group (29% vs 38%; RR 0.78, 95% CI 0.68-0.88, p < 0.001), lower independent ambulation (39% vs 45%; RR 0.89, 95% CI 0.82-0.98, p = 0.01), and higher mortality (36% vs 28%, RR 1.22, 95% CI 1.08-1.37, p = 0.001). However, no differences were detected in symptomatic intracranial hemorrhage between the two groups (6% vs 4%; RR 1.12, 95% CI 0.74-1.71, p = 0.58). CONCLUSION Intravenous thrombolysis plus endovascular thrombectomy seemed to led to better functional independence, independent ambulation, and lower risk of mortality without increasing the incidence of intracranial hemorrhage compared to endovascular thrombectomy alone. However, given the non-randomized nature of this study, further studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Lingyu Cai
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Liaoyuan Wang
- The Third District of Air Force Special Service Sanatorium, Hangzhou, 310002, Zhejiang, China
| | - Bruce C V Campbell
- Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VC, Australia
| | - Yuelu Wu
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Mohamad Abdalkader
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Fana Alemseged
- Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VC, Australia
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Volker Puetz
- Dresden Neurovascular Center, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Robrecht R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Chuanhui Li
- Department of Neurology, The Stroke Center, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Shitai Ye
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Pengli Tian
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Jingjing Chen
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Ruitian Li
- Community Health Service Center of Sandun Town, Hangzhou, China
| | - Wei Hu
- Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Zhongming Qiu
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Thanh N Nguyen
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | | | - Qifeng Guo
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
| | - Zhao Dai
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
| |
Collapse
|
8
|
LeCouffe NE, Treurniet KM, Kappelhof M, Jansen IG, Boers M, Marquering HA, Beenen LF, Boiten J, van Zwam WH, Yo LS, Majoie CB, Roos YB, Emmer BJ, Coutinho JM. Outcome of patients with multivessel occlusion stroke after endovascular treatment. Eur Stroke J 2024; 9:312-319. [PMID: 38102770 DOI: 10.1177/23969873231216811] [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] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Little is known about the implications of multivessel occlusions (MVO) in large vessel occlusion stroke patients who undergo endovascular treatment (EVT). PATIENTS AND METHODS We report data from the MR CLEAN Registry: a prospective, observational study on all stroke patients who underwent EVT in the Netherlands (March 2014-November 2017). We included patients with an intracranial target occlusion in the anterior circulation. An MVO was defined as an MCA occlusion (M1/M2) or intracranial ICA/ICA-T occlusion, with a concurrent second occlusion in the ACA or PCA territory confirmed on baseline CTA. To compare outcomes, we performed a 10:1 propensity score matching analysis with a logistic regression model including potential confounders. Outcome measures included 90-day functional outcome (modified Rankin Scale, mRS) and mortality. RESULTS Of 2946 included patients, 71 patients (2.4%) had an MVO (87% concurrent ACA occlusion, 10% PCA occlusion, 3% ⩾3 occlusions). These patients were matched to 71 non-MVO patients. Before matching, MVO patients had a higher baseline NIHSS (median 18 vs 16, p = 0.001) and worse collateral status (absent collaterals: 17% vs 6%, p < 0.001) compared to non-MVO patients. After matching, MVO patients had worse functional outcome at 90 days (median mRS 5 vs 3, cOR 0.39; 95%CI 0.25-0.62). Mortality was higher in MVO patients (46% vs 27%, OR 2.11, 95%CI 1.24-3.57). DISCUSSION AND CONCLUSION MVOs on baseline imaging were uncommon in LVO stroke patients undergoing EVT, but were associated with poor functional outcome.
Collapse
Affiliation(s)
- Natalie E LeCouffe
- Amsterdam UMC, Amsterdam Neuroscience, Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kilian M Treurniet
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Haaglanden MC, Department of Radiology, The Hague, The Netherlands
| | - Manon Kappelhof
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Ivo Gh Jansen
- Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - Merel Boers
- Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk A Marquering
- Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - Ludo Fm Beenen
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Jelis Boiten
- Haaglanden MC, Department of Neurology, The Hague, The Netherlands
| | - Wim H van Zwam
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Department of Radiology, Maastricht, The Netherlands
| | - Lonneke Sf Yo
- Catharina Hospital Eindhoven, Department of Radiology, Eindhoven, The Netherlands
| | - Charles Blm Majoie
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Yvo Bwem Roos
- Amsterdam UMC, Amsterdam Neuroscience, Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart J Emmer
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonathan M Coutinho
- Amsterdam UMC, Amsterdam Neuroscience, Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Qin B, Wei T, Gao W, Qin HX, Liang YM, Qin C, Chen H, Yang MX. Real-world setting comparison of bridging therapy versus direct mechanical thrombectomy for acute ischemic stroke: A meta-analysis. Clinics (Sao Paulo) 2024; 79:100394. [PMID: 38820696 PMCID: PMC11177057 DOI: 10.1016/j.clinsp.2024.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/15/2024] [Accepted: 05/13/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND PURPOSE Intravenous Thrombolysis (IVT) prior to Mechanical Thrombectomy (MT) for Acute Ischaemic Stroke (AIS) due to Large-Vessel Occlusion (LVO) remains controversial. Therefore, the authors performed a meta-analysis of the available real-world evidence focusing on the efficacy and safety of Bridging Therapy (BT) compared with direct MT in patients with AIS due to LVO. METHODS Four databases were searched until 01 February 2023. Retrospective and prospective studies from nationwide or health organization registry databases that compared the clinical outcomes of BT and direct MT were included. Odds Ratios (ORs) and 95 % Confidence Intervals (CIs) for efficacy and safety outcomes were pooled using a random-effects model. RESULTS Of the 12 studies, 86,695 patients were included. In patients with AIS due to LVO, BT group was associated with higher odds of achieving excellent functional outcome (modified Rankin Scale score 0-1) at 90 days (OR = 1.48, 95 % CI 1.25-1.75), favorable discharge disposition (to the home with or without services) (OR = 1.33, 95 % CI 1.29-1.38), and decreased mortality at 90 days (OR = 0.62, 95 % CI 0.56-0.70), as compared with the direct MT group. In addition, the risk of symptomatic intracranial hemorrhage did not increase significantly in the BT group. CONCLUSION The present meta-analysis indicates that BT was associated with favorable outcomes in patients with AIS due to LVO. These findings support the current practice in a real-world setting and strengthen their validity. For patients eligible for both IVT and MT, BT remains the standard treatment until more data are available.
Collapse
Affiliation(s)
- Bin Qin
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China; Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Tao Wei
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Wen Gao
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Hui-Xun Qin
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Yu-Ming Liang
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Cheng Qin
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Hong Chen
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Ming-Xiu Yang
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China.
| |
Collapse
|
10
|
Yuan G, Zhang J, Ye Z, Sun J, Huo X, Pan Y, Wang M, Peng X, Zheng C, Lei X, Miao Z, Cai X. Effectiveness and safety of bridging therapy and endovascular therapy in patients with large cerebral infarctions: from ANGEL-ASPECT. Stroke Vasc Neurol 2024:svn-2024-003120. [PMID: 38777348 DOI: 10.1136/svn-2024-003120] [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: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND PURPOSE The benefits of thrombolytic therapy before endovascular thrombectomy in cases of acute ischaemic stroke, with a large infarction volume, remain unclear. This analysis aims to evaluate the effectiveness and safety of bridging therapy and endovascular therapy among patients with large cerebral infarctions. METHODS In this post-hoc analysis of the multicentre prospective study of ANGEL-ASPECT (Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core), participants were divided into two groups: an endovascular therapy group and a bridging therapy group. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. The primary safety outcome was symptomatic intracranial haemorrhage. Ordinal logistic regression was performed to compare the primary endpoint between the two groups. Subgroup analyses were conducted to further explore potential risk factors associated with the outcomes. RESULTS 122 patients were included, of whom 77 (63%) underwent endovascular therapy and 45 (37%) underwent bridging therapy. The median scores on mRS at 90 days of the bridging therapy group and the endovascular therapy group were 3 (2-5) and 4 (2-6), with no significant differences (common OR 1.36; 95% CI 0.71 to 2.61). Symptomatic intracranial haemorrhage was reported in three patients who were in the endovascular and bridging therapy groups (relative risk (RR) 1.71; 95% CI 0.36 to 8.12). The mortality between two groups did not differ (RR 0.75; 95% CI 0.37 to 1.54). CONCLUSIONS Our study indicated that endovascular therapy alone might be a viable option for patients with large cerebral infarctions, displaying no noticeable disparity in outcomes compared with bridging therapy.
Collapse
Affiliation(s)
- Guangxiong Yuan
- Emergency, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Jun Zhang
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zekang Ye
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Jingping Sun
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiao Peng
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Chanjuan Zheng
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Xueyao Lei
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| |
Collapse
|
11
|
Safouris A, Palaiodimou L, Katsanos AH, Kargiotis O, Bougioukas KI, Psychogios K, Sidiropoulou T, Spiliopoulos S, Psychogios MN, Magoufis G, Turc G, Tsivgoulis G. Overview of systematic reviews comparing endovascular to best medical treatment for large-vessel occlusion acute ischaemic stroke: an umbrella review. Ther Adv Neurol Disord 2024; 17:17562864241246938. [PMID: 38685935 PMCID: PMC11057347 DOI: 10.1177/17562864241246938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
Background The literature on endovascular treatment (EVT) for large-vessel occlusion (LVO) acute ischaemic stroke (AIS) has been rapidly increasing after the publication of positive randomized-controlled clinical trials (RCTs) and a plethora of systematic reviews (SRs) showing benefit compared to best medical therapy (BMT) for LVO. Objectives An overview of SRs (umbrella review) and meta-analysis of primary RCTs were performed to summarize the literature and present efficacy and safety of EVT. Design and methods MEDLINE via Pubmed, Embase and Epistemonikos databases were searched from January 2015 until 15 October 2023. All SRs of RCTs comparing EVT to BMT were included. Quality was assessed using Risk of Bias in Systematic Reviews scores and the RoB 2 Cochrane Collaboration tool, as appropriate. GRADE approach was used to evaluate the strength of evidence. Data were presented according to the Preferred Reporting Items for Overviews of Reviews statement. The primary outcome was 3-month good functional outcome [modified Rankin scale (mRS) score 0-2]. Results Three eligible SRs and 4 additional RCTs were included in the overview, comprising a total of 24 RCTs, corresponding to 5968 AIS patients with LVO (3044 randomized to EVT versus 2924 patients randomized to BMT). High-quality evidence shows that EVT is associated with an increased likelihood of good functional outcome [risk ratio (RR) 1.78 (95% confidence interval (CI): 1.54-2.06); 166 more per 1000 patients], independent ambulation [mRS-scores 0-3; RR 1.50 (95% CI: 1.37-1.64); 174 more per 1000 patients], excellent functional outcome [mRS-scores 0-1; RR 1.90 (95% CI: 1.62-2.22); 118 more per 1000 patients] at 3 months. EVT was associated with reduced 3-month mortality [RR 0.81 (95% CI: 0.74-0.88); 61 less per 1000 patients] despite an increase in symptomatic intracranial haemorrhage [sICH; RR 1.65 (95% CI: 1.23-2.21); 22 more per 1000 patients]. Conclusion In patients with AIS due to LVO in the anterior or posterior circulation, within 24 h from symptom onset, EVT improves functional outcomes and increases the chance of survival despite increased sICH risk. Registration PROSPERO Registration Number CRD42023461138.
Collapse
Affiliation(s)
- Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | | | - Konstantinos I. Bougioukas
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Klearchos Psychogios
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Tatiana Sidiropoulou
- Second Department of Anesthesiology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- Interventional Radiology Unit, Second Department of Radiology, ‘Attikon’ University General Hospital, Athens, Greece
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Georgios Magoufis
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Department of Neurology, Université Paris Cité, Paris, France
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neurology, FHU NeuroVasc, Paris, France
| | - Georgios Tsivgoulis
- Second Department of Neurology, ‘Attikon’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens 12462, Greece
| |
Collapse
|
12
|
Tan KS, Pandian JD, Liu L, Toyoda K, Leung TWH, Uchiyama S, Kuroda S, Suwanwela NC, Aaron S, Chang HM, Venketasubramanian N. Stroke in Asia. Cerebrovasc Dis Extra 2024; 14:58-75. [PMID: 38657577 DOI: 10.1159/000538928] [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: 11/20/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a significant burden of stroke in Asia. Asia has the largest population in the world in 2023, estimated at 4.7 billion. Approximately 9.5-10.6 million strokes will be anticipated annually in the backdrop of a diverse group of well-developed and less developed countries with large disparities in stroke care resources. In addition, Asian countries are in varying phases of epidemiological transition. SUMMARY In this review, we examined recent epidemiological features of ischaemic stroke and intracerebral haemorrhage in Asia with recent developments in hyperacute stroke reperfusion therapy and technical improvements in intracerebral haemorrhage. The article also discussed the spectrum of cerebrovascular diseases in Asia, which include intracranial atherosclerosis, intracerebral haemorrhage, infective aetiologies of stroke, moyamoya disease, vascular dissection, radiation vasculopathy, and cerebral venous thrombosis. KEY MESSAGES The review of selected literature and recent updates calls for attention to the different requirements for resources within Asia and highlights the breadth of cerebrovascular diseases still requiring further research and more effective therapies.
Collapse
Affiliation(s)
- Kay Sin Tan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Thomas Wai Hon Leung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Shinichiro Uchiyama
- Centre for Brain and Cerebral Vessels, Sanno Medical Centre, International University of Health and Welfare, Tokyo, Japan
| | - Sathoshi Kuroda
- Department of Neurosurgery, Toyama University, Toyama, Japan
| | - Nijasri C Suwanwela
- Chulalongkorn Stroke Centre, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sanjith Aaron
- Department of Medicine, Christian Medical College, Vellore, India
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | | |
Collapse
|
13
|
Franx B, Dijkhuizen RM, Dippel DWJ. Acute Ischemic Stroke in the Clinic and the Laboratory: Targets for Translational Research. Neuroscience 2024:S0306-4522(24)00159-3. [PMID: 38670254 DOI: 10.1016/j.neuroscience.2024.04.006] [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: 01/03/2024] [Revised: 03/26/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Ischemic stroke research has enabled significant advancements in diagnosis, treatment, and management of this debilitating disease, yet challenges remain standing in the way of better patient prognoses. In this narrative review, a fictional case illustrates challenges and uncertainties that medical professionals still face - penumbra identification, lack of neuroprotective agents, side-effects of tissue plasminogen activator, dearth of molecular biomarkers, incomplete microvascular reperfusion or no-reflow, post-recanalization hyperperfusion, blood pressure management and procedural anesthetic effects. The current state of the field is broadly reviewed per topic, with the aim to introduce a broad audience (scientist and clinician alike) to recent successes in translational stroke research and pending scientific queries that are tractable for preclinical assessment. Opportunities for co-operation between clinical and experimental stroke experts are highlighted to increase the size and frequency of strides the field makes to improve our understanding of this disease and ways of treating it.
Collapse
Affiliation(s)
- Bart Franx
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Rick M Dijkhuizen
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Diederik W J Dippel
- Stroke Center, Dept of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
14
|
Seners P, Ter Schiphorst A, Wouters A, Yuen N, Mlynash M, Arquizan C, Heit JJ, Kemp S, Christensen S, Sablot D, Wacongne A, Lalu T, Costalat V, Albers GW, Lansberg MG. Clinical change during inter-hospital transfer for thrombectomy: Incidence, associated factors, and relationship with outcome. Int J Stroke 2024:17474930241246952. [PMID: 38576067 DOI: 10.1177/17474930241246952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Patients with acute ischemic stroke with a large vessel occlusion (LVO) admitted to non endovascular-capable centers often require inter-hospital transfer for thrombectomy. We aimed to describe the incidence of substantial clinical change during transfer, the factors associated with clinical change, and its relationship with 3-month outcome. METHODS We analyzed data from two cohorts of acute stroke patients transferred for thrombectomy to a comprehensive center (Stanford, USA, November 2019 to January 2023; Montpellier, France, January 2015 to January 2017), regardless of whether thrombectomy was eventually attempted. Patients were included if they had evidence of an LVO at the referring hospital and had a National Institute of Health Stroke Scale (NIHSS) score documented before and immediately after transfer. Inter-hospital clinical change was categorized as improvement (⩾4 points and ⩾25% decrease between the NIHSS score in the referring hospital and upon comprehensive center arrival), deterioration (⩾4 points and ⩾25% increase), or stability (neither improvement nor deterioration). The stable group was considered as the reference and was compared to the improvement or deterioration groups separately. RESULTS A total of 504 patients were included, of whom 22% experienced inter-hospital improvement, 14% deterioration, and 64% were stable. Pre-transfer variables independently associated with clinical improvement were intravenous thrombolysis use, more distal occlusions, and lower serum glucose; variables associated with deterioration included more proximal occlusions and higher serum glucose. On post-transfer imaging, clinical improvement was associated with arterial recanalization and smaller infarct growth and deterioration with larger infarct growth. As compared to stable patients, those with clinical improvement had better 3-month functional outcome (adjusted common odds ratio (cOR) = 2.43; 95% confidence interval (CI) = 1.59-3.71; p < 0.001), while those with deterioration had worse outcome (adjusted cOR = 0.60; 95% CI = 0.37-0.98; p = 0.044). CONCLUSION Substantial inter-hospital clinical changes are frequently observed in LVO-related ischemic strokes, with significant impact on functional outcome. There is a need to develop treatments that improves the clinical status during transfer. DATA ACCESS STATEMENT The data that support the findings of this study are available upon reasonable request.
Collapse
Affiliation(s)
- Pierre Seners
- Stanford Stroke Center, Palo Alto, CA, USA
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
| | | | - Anke Wouters
- Stanford Stroke Center, Palo Alto, CA, USA
- Division of Experimental Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | | | | | - Jeremy J Heit
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | | | | | - Denis Sablot
- Neurology Department, CH Perpignan, Perpignan, France
| | | | | | - Vincent Costalat
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | | |
Collapse
|
15
|
Liao J, Gong L, Xu Q, Wang J, Yang Y, Zhang S, Dong J, Lin K, Liang Z, Sun Y, Mu Y, Chen Z, Lu Y, Zhang Q, Lin Z. Revolutionizing Neurocare: Biomimetic Nanodelivery Via Cell Membranes. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2402445. [PMID: 38583077 DOI: 10.1002/adma.202402445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/01/2024] [Indexed: 04/08/2024]
Abstract
Brain disorders represent a significant challenge in medical science due to the formidable blood-brain barrier (BBB), which severely limits the penetration of conventional therapeutics, hindering effective treatment strategies. This review delves into the innovative realm of biomimetic nanodelivery systems, including stem cell-derived nanoghosts, tumor cell membrane-coated nanoparticles, and erythrocyte membrane-based carriers, highlighting their potential to circumvent the BBB's restrictions. By mimicking native cell properties, these nanocarriers emerge as a promising solution for enhancing drug delivery to the brain, offering a strategic advantage in overcoming the barrier's selective permeability. The unique benefits of leveraging cell membranes from various sources is evaluated and advanced technologies for fabricating cell membrane-encapsulated nanoparticles capable of masquerading as endogenous cells are examined. This enables the targeted delivery of a broad spectrum of therapeutic agents, ranging from small molecule drugs to proteins, thereby providing an innovative approach to neurocare. Further, the review contrasts the capabilities and limitations of these biomimetic nanocarriers with traditional delivery methods, underlining their potential to enable targeted, sustained, and minimally invasive treatment modalities. This review is concluded with a perspective on the clinical translation of these biomimetic systems, underscoring their transformative impact on the therapeutic landscape for intractable brain diseases.
Collapse
Affiliation(s)
- Jun Liao
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Lidong Gong
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Qingqiang Xu
- Department of Pharmaceutics, School of Pharmacy, Naval Medical University, Shanghai, 200433, China
| | - Jingya Wang
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Yuanyuan Yang
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Shiming Zhang
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Junwei Dong
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Kerui Lin
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Zichao Liang
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Yuhan Sun
- Department of Pharmaceutics, School of Pharmacy, Naval Medical University, Shanghai, 200433, China
| | - Yongxu Mu
- The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014040, China
| | - Zhengju Chen
- Pooling Medical Research Institutes of 100Biotech, Beijing, 100006, China
| | - Ying Lu
- Department of Pharmaceutics, School of Pharmacy, Naval Medical University, Shanghai, 200433, China
| | - Qiang Zhang
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Zhiqiang Lin
- Institute of Systems Biomedicine, Beijing Key Laboratory of Tumor Systems Biology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| |
Collapse
|
16
|
Sedghi A, Kaiser DPO, Cuberi A, Schreckenbauer S, Wojciechowski C, Friehs I, Reichmann H, Barlinn J, Barlinn K, Puetz V, Siepmann T. Intravenous Thrombolysis Before Thrombectomy Improves Functional Outcome After Stroke Independent of Reperfusion Grade. J Am Heart Assoc 2024; 13:e031854. [PMID: 38456409 PMCID: PMC11009998 DOI: 10.1161/jaha.123.031854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND We studied the association of bridging intravenous thrombolysis (IVT) before thrombectomy for anterior circulation large-vessel occlusion and functional outcome and scrutinized its dependence on grade of reperfusion and distal thrombus migration. METHODS AND RESULTS We included consecutive patients with anterior circulation large-vessel occlusion from our prospective registry of thrombectomy-eligible patients treated from January 1, 2017 to January 1, 2023 at a tertiary stroke center in Germany in this retrospective cohort study. To evaluate the association of bridging IVT and functional outcome quantified via modified Rankin Scale score at 90 days we used multivariable logistic and lasso regression including interaction terms with grade of reperfusion quantified via modified Thrombolysis in Cerebral Infarction (mTICI) scale and distal thrombus migration adjusted for demographic and cardiovascular risk profiles, clinical and imaging stroke characteristics, onset-to-recanalization time and distal thrombus migration. We performed sensitivity analysis using propensity score matching. In our study population of 1000 thrombectomy-eligible patients (513 women; median age, 77 years [interquartile range, 67-84]), IVT emerged as a predictor of favorable functional outcome (modified Rankin Scale score, 0-2) independent of modified mTICI score (adjusted odds ratio, 0.49 [95% CI, 0.32-0.75]; P=0.001). In those who underwent thrombectomy (n=812), the association of IVT and favorable functional outcome was reproduced (adjusted odds ratio, 0.49 [95% CI, 0.31-0.74]; P=0.001) and was further confirmed on propensity score analysis, where IVT led to a 0.35-point decrease in 90-day modified Rankin Scale score (ß=-0.35 [95 CI%, -0.68 to 0.01]; P=0.04). The additive benefit of IVT remained independent of modified mTICI score (ß=-1.79 [95% CI, -3.43 to -0.15]; P=0.03) and distal thrombus migration (ß=-0.41 [95% CI, -0.69 to -0.13]; P=0.004) on interaction analysis. Consequently, IVT showed an additive association with functional outcome in the subpopulation of patients undergoing thrombectomy who achieved successful reperfusion (mTICI ≥2b; ß=-0.46 [95% CI, -0.74 to -0.17]; P=0.002) and remained beneficial in those with unsuccessful reperfusion (mTICI ≤2a; ß=-0.47 [95% CI, -0.96 to 0.01]; P=0.05). CONCLUSIONS In thrombectomy-eligible patients with anterior circulation large-vessel occlusion, IVT improves functional outcome independent of grade of reperfusion and distal thrombus migration.
Collapse
Affiliation(s)
- Annahita Sedghi
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
- Division of Health Care SciencesDresden International UniversityDresdenGermany
| | - Daniel P. O. Kaiser
- Dresden Neurovascular Center, Institute of Neuroradiology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of TechnologyDresdenGermany
| | - Ani Cuberi
- Institute of Radiology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of TechnologyDresdenGermany
| | - Sonja Schreckenbauer
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
| | - Claudia Wojciechowski
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
| | - Ingeborg Friehs
- Department of Cardiac SurgeryBoston Children’s Hospital, Harvard Medical SchoolBostonMAUSA
| | - Heinz Reichmann
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
| | - Jessica Barlinn
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
| | - Kristian Barlinn
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
| | - Volker Puetz
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
| | - Timo Siepmann
- Dresden Neurovascular Center, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusDresden University of TechnologyDresdenGermany
| |
Collapse
|
17
|
Kaesmacher J, Cavalcante F, Kappelhof M, Treurniet KM, Rinkel L, Liu J, Yan B, Zi W, Kimura K, Eker OF, Zhang Y, Piechowiak EI, van Zwam W, Liu S, Strbian D, Uyttenboogaart M, Dobrocky T, Miao Z, Suzuki K, Zhang L, van Oostenbrugge R, Meinel TR, Guo C, Seiffge D, Yin C, Bütikofer L, Lingsma H, Nieboer D, Yang P, Mitchell P, Majoie C, Fischer U, Roos Y, Gralla J. Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke: A Meta-Analysis. JAMA 2024; 331:764-777. [PMID: 38324409 PMCID: PMC10851137 DOI: 10.1001/jama.2024.0589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Importance The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke declines with longer time from symptom onset, but it is not known whether a similar time dependency exists for IVT followed by thrombectomy. Objective To determine whether the benefit associated with IVT plus thrombectomy vs thrombectomy alone decreases with treatment time from symptom onset. Design, Setting, and Participants Individual participant data meta-analysis from 6 randomized clinical trials comparing IVT plus thrombectomy vs thrombectomy alone. Enrollment was between January 2017 and July 2021 at 190 sites in 15 countries. All participants were eligible for IVT and thrombectomy and presented directly at thrombectomy-capable stroke centers (n = 2334). For this meta-analysis, only patients with an anterior circulation large-vessel occlusion were included (n = 2313). Exposure Interval from stroke symptom onset to expected administration of IVT and treatment with IVT plus thrombectomy vs thrombectomy alone. Main Outcomes and Measures The primary outcome analysis tested whether the association between the allocated treatment (IVT plus thrombectomy vs thrombectomy alone) and disability at 90 days (7-level modified Rankin Scale [mRS] score range, 0 [no symptoms] to 6 [death]; minimal clinically important difference for the rates of mRS scores of 0-2: 1.3%) varied with times from symptom onset to expected administration of IVT. Results In 2313 participants (1160 in IVT plus thrombectomy group vs 1153 in thrombectomy alone group; median age, 71 [IQR, 62 to 78] years; 44.3% were female), the median time from symptom onset to expected administration of IVT was 2 hours 28 minutes (IQR, 1 hour 46 minutes to 3 hours 17 minutes). There was a statistically significant interaction between the time from symptom onset to expected administration of IVT and the association of allocated treatment with functional outcomes (ratio of adjusted common odds ratio [OR] per 1-hour delay, 0.84 [95% CI, 0.72 to 0.97], P = .02 for interaction). The benefit of IVT plus thrombectomy decreased with longer times from symptom onset to expected administration of IVT (adjusted common OR for a 1-step mRS score shift toward improvement, 1.49 [95% CI, 1.13 to 1.96] at 1 hour, 1.25 [95% CI, 1.04 to 1.49] at 2 hours, and 1.04 [95% CI, 0.88 to 1.23] at 3 hours). For a mRS score of 0, 1, or 2, the predicted absolute risk difference was 9% (95% CI, 3% to 16%) at 1 hour, 5% (95% CI, 1% to 9%) at 2 hours, and 1% (95% CI, -3% to 5%) at 3 hours. After 2 hours 20 minutes, the benefit associated with IVT plus thrombectomy was not statistically significant and the point estimate crossed the null association at 3 hours 14 minutes. Conclusions and Relevance In patients presenting at thrombectomy-capable stroke centers, the benefit associated with IVT plus thrombectomy vs thrombectomy alone was time dependent and statistically significant only if the time from symptom onset to expected administration of IVT was short.
Collapse
Affiliation(s)
- Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Fabiano Cavalcante
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Kilian M. Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
- Department of Radiology, Haaglanden Medical Center, the Hague, the Netherlands
| | - Leon Rinkel
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jianmin Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
- Oriental Pan-Vascular Devices Innovations College, University of Shanghai for Science and Technology, Shanghai, China
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Omer F. Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Yongwei Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Eike I. Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Wim van Zwam
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Sheng Liu
- Department of Radiology, Jiangsu Provincial People’s Hospital of Nanjing Medical University, Nanjing, China
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Tomas Dobrocky
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Lei Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Robert van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Thomas R. Meinel
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - David Seiffge
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Congguo Yin
- Department of Neurology, Hangzhou First People’s Hospital of Zhejiang University, Hangzhou, China
| | | | - Hester Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherland
| | - Daan Nieboer
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherland
| | - Pengfei Yang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
- Oriental Pan-Vascular Devices Innovations College, University of Shanghai for Science and Technology, Shanghai, China
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Yvo Roos
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
18
|
Abdalkader M, Ning S, Qureshi MM, Haussen DC, Strbian D, Nagel S, Demeestere J, Puetz V, Mohammaden MH, Olive Gadea M, Winzer S, Yamagami H, Tanaka K, Marto JP, Tomppo L, Henon H, Sheth SA, Ortega-Gutierrez S, Martinez-Majander N, Caparros F, Lemmens R, Dusart A, Bellante F, Zaidi SF, Siegler JE, Nannoni S, Kaesmacher J, Dobrocky T, Farooqui M, Salazar-Marioni S, Virtanen P, Vandewalle L, Wouters A, Jesser J, Ventura R, Castonguay AC, Uchida K, Puri AS, Masoud HE, Klein P, Mansoor Z, Bui J, Kang M, Mujanovic A, Rizzo F, Kokkonen T, Ramos JN, Strambo D, Michel P, Möhlenbruch MA, Lin E, Kaiser DPO, Yoshimura S, Sakai N, Cordonnier C, Ringleb PA, Roy D, Zaidat OO, Fischer U, Ribo M, Raymond J, Nogueira RG, Nguyen TN. Sex Differences in Outcomes of Late-Window Endovascular Stroke Therapy. Stroke 2024; 55:278-287. [PMID: 38252759 DOI: 10.1161/strokeaha.123.045015] [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: 09/02/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The association between sex and outcome after endovascular thrombectomy of acute ischemic stroke is unclear. The aim of this study was to compare the clinical and safety outcomes between men and women treated with endovascular thrombectomy in the late 6-to-24-hour window period. METHODS This multicenter, retrospective observational cohort study included consecutive patients who underwent endovascular thrombectomy of anterior circulation stroke in the late window from 66 clinical sites in 10 countries from January 2014 to May 2022. The primary outcome was the 90-day ordinal modified Rankin Scale score. Secondary outcomes included 90-day functional independence (FI), return of Rankin (RoR) to prestroke baseline, FI or RoR, symptomatic intracranial hemorrhage, and mortality. Multivariable and inverse probability of treatment weighting methods were used. We explored the interaction of sex with baseline characteristics on the outcomes ordinal modified Rankin Scale and FI or RoR. RESULTS Of 1932 patients, 1055 were women and 877 were men. Women were older (77 versus 69 years), had higher rates of atrial fibrillation, hypertension, and greater prestroke disability, but there was no difference in baseline National Institutes of Health Stroke Scale score. Inverse probability of treatment weighting analysis showed no difference between women and men in ordinal modified Rankin Scale (odds ratio, 0.98 [95% CI, 0.79-1.21]), FI or RoR (odds ratio, 0.98 [95% CI, 0.78-1.22]), severe disability or mortality (odds ratio, 0.99 [95% CI, 0.80-1.23]). The multivariable analysis of the above end points was concordant. There were no interactions between baseline characteristics and sex on the outcomes of ordinal modified Rankin Scale and FI or RoR. CONCLUSIONS In late presenting patients with anterior circulation stroke treated with endovascular thrombectomy in the 6 to 24-hour window, there was no difference in clinical or safety outcomes between men and women.
Collapse
Affiliation(s)
- Mohamad Abdalkader
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Shen Ning
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Muhammad M Qureshi
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Radiation Oncology (M.M.Q.), Boston Medical Center
| | - Diogo C Haussen
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
| | - Daniel Strbian
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Germany (S. Nagel)
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Jelle Demeestere
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Volker Puetz
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | | | - Marta Olive Gadea
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Simon Winzer
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Hiroshi Yamagami
- Department of Stroke Neurology, NHO Osaka National Hospital, Japan (H.Y.)
| | - Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - João Pedro Marto
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Liisa Tomppo
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Hilde Henon
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Sunil A Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston (S.A.S., S.S.-M.)
| | | | | | - Francois Caparros
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Robin Lemmens
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Syed F Zaidi
- Department of Neurology, University of Toledo, Toledo (S.F.Z., A.C.C.)
| | | | - Stefania Nannoni
- Clinical Neurosciences, University of Cambridge, United Kingdom (S. Nannoni)
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | | | | | - Pekka Virtanen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - Lieselotte Vandewalle
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anke Wouters
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Jessica Jesser
- Radiology (J.J., M.A.M.). Heidelberg University Hospital, Germany
| | - Rita Ventura
- Departments of Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | | | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Ajit S Puri
- Interventional Neuroradiology, University of Massachusetts Memorial Medical Center (A.S.P.)
| | - Hesham E Masoud
- Department of Neurology, State University of New York (H.E.M.)
| | - Piers Klein
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Zain Mansoor
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Jenny Bui
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Matthew Kang
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Adnan Mujanovic
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Federica Rizzo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Tatu Kokkonen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - João Nuno Ramos
- Radiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | - Davide Strambo
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | | | - Eugene Lin
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Daniel P O Kaiser
- Institute of Neuroradiology (D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Nobuyuki Sakai
- Neurovascular Research, Kobe City Medical Center General Hospital, Japan (N.S.)
| | - Charlotte Cordonnier
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Peter A Ringleb
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Daniel Roy
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, Switzerland (U.F.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Jean Raymond
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Raul G Nogueira
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
- Department of Neurology, University of Pittsburgh Medical Center (R.G.N.)
| | - Thanh N Nguyen
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Neurology (T.N.N.), Boston Medical Center
| |
Collapse
|
19
|
van Voorst H, Pitkänen J, van Poppel L, de Vries L, Mojtahedi M, Martou L, Emmer BJ, Roos YBWEM, van Oostenbrugge R, Postma AA, Marquering HA, Majoie CBLM, Curtze S, Melkas S, Bentley P, Caan MWA. Deep learning-based white matter lesion volume on CT is associated with outcome after acute ischemic stroke. Eur Radiol 2024:10.1007/s00330-024-10584-z. [PMID: 38285103 DOI: 10.1007/s00330-024-10584-z] [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: 08/03/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) before endovascular treatment (EVT) for acute ischemic stroke might induce intracerebral hemorrhages which could negatively affect patient outcomes. Measuring white matter lesions size using deep learning (DL-WML) might help safely guide IVT administration. We aimed to develop, validate, and evaluate a DL-WML volume on CT compared to the Fazekas scale (WML-Faz) as a risk factor and IVT effect modifier in patients receiving EVT directly after IVT. METHODS We developed a deep-learning model for WML segmentation on CT and validated with internal and external test sets. In a post hoc analysis of the MR CLEAN No-IV trial, we associated DL-WML volume and WML-Faz with symptomatic-intracerebral hemorrhage (sICH) and 90-day functional outcome according to the modified Rankin Scale (mRS). We used multiplicative interaction terms between WML measures and IVT administration to evaluate IVT treatment effect modification. Regression models were used to report unadjusted and adjusted common odds ratios (cOR/acOR). RESULTS In total, 516 patients from the MR CLEAN No-IV trial (male/female, 291/225; age median, 71 [IQR, 62-79]) were analyzed. Both DL-WML volume and WML-Faz are associated with sICH (DL-WML volume acOR, 1.78 [95%CI, 1.17; 2.70]; WML-Faz acOR, 1.53 95%CI [1.02; 2.31]) and mRS (DL-WML volume acOR, 0.70 [95%CI, 0.55; 0.87], WML-Faz acOR, 0.73 [95%CI 0.60; 0.88]). Only in the unadjusted IVT effect modification analysis WML-Faz was associated with more sICH if IVT was given (p = 0.046). Neither WML measure was associated with worse mRS if IVT was given. CONCLUSION DL-WML volume and WML-Faz had a similar relationship with functional outcome and sICH. Although more sICH might occur in patients with more severe WML-Faz receiving IVT, no worse functional outcome was observed. CLINICAL RELEVANCE STATEMENT White matter lesion severity on baseline CT in acute ischemic stroke patients has a similar predictive value if measured with deep learning or the Fazekas scale. Safe administration of intravenous thrombolysis using white matter lesion severity should be further studied. KEY POINTS White matter damage is a predisposing risk factor for intracranial hemorrhage in patients with acute ischemic stroke but remains difficult to measure on CT. White matter lesion volume on CT measured with deep learning had a similar association with symptomatic intracerebral hemorrhages and worse functional outcome as the Fazekas scale. A patient-level meta-analysis is required to study the benefit of white matter lesion severity-based selection for intravenous thrombolysis before endovascular treatment.
Collapse
Affiliation(s)
- Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
| | - Johanna Pitkänen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura van Poppel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Lucas de Vries
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Mahsa Mojtahedi
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Martou
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, England
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, School for Mental health and sciences (Mhens), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paul Bentley
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, England
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Rinkel LA, Ospel JM, Uchida K, Diprose WK, Goyal M. Intravenous Thrombolysis Prior to Endovascular Treatment for Large Ischemic Cores: Need for Qualitative Assessment of the Ischemic Core. Radiology 2024; 310:e232827. [PMID: 38289214 DOI: 10.1148/radiol.232827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Leon A Rinkel
- Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4
| | - Johanna M Ospel
- Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4
| | - Kazutaka Uchida
- Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4
| | - William K Diprose
- Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4
| | - Mayank Goyal
- Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4
| |
Collapse
|
21
|
Martins SCO, Pontes-Neto OM, Pille A, Secchi TL, Miranda Alves MAD, Rebello LC, Oliveira-Filho J, Lange MC, de Freitas GR, de Andrade JBC, Rocha LJDA, Bezerra DDC, Souza ACD, Carbonera LA, Nogueira RG, Silva GS. Reperfusion therapy for acute ischemic stroke: where are we in 2023? ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1030-1039. [PMID: 38157871 PMCID: PMC10756810 DOI: 10.1055/s-0043-1777721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.
Collapse
Affiliation(s)
- Sheila Cristina Ouriques Martins
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
| | | | - Arthur Pille
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Wang C, Li T, Jia Z, Qiu K, Jiang R, Hang Y, Ni H, Cao Y, Zhao L, Li M, Jiao J, Shi H, Zhang J, Liu S. Radiomics features on computed tomography reflect thrombus histological age prior to endovascular treatment of acute ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107358. [PMID: 37716105 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107358] [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: 06/16/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE To investigate the role of radiomics features in thrombus age identification and establish a CT-based radiomics model for predicting thrombus age of large vessel occlusion stroke patients. METHODS We retrospectively reviewed patients with middle cerebral artery occlusion receiving mechanical thrombectomy from July 2020 to March 2022 at our center. The retrieved clots were stained with Hematoxylin and Eosin (H&E) and determined as fresh or older thrombi based on coagulation age. Clot-derived radiomics features were selected by least absolute shrinkage and selection operator (LASSO) regression analysis, by which selected radiomics features were integrated into the Rad-score via the corresponding coefficients. The prediction performance of Rad-score in thrombus age was evaluated with the area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis. RESULTS A total of 104 patients were included in our analysis, with 52 in training and 52 in validation cohort. Older thrombi were characterized with delayed procedure time, worse functional outcome and marginally associated with more attempts of device. We extracted 982 features from NCCT images. Following T test and LASSO analysis in training cohort, six radiomics features were selected, based on which the Rad-score was generated by the linear combination of features. The Rad-score showed satisfactory performance in distinguishing fresh with older thrombi, with the AUC of 0.873 (95 %CI: 0.777-0.956) and 0.773 (95 %CI: 0.636-0.910) in training and validation cohort, respectively. CONCLUSION This study established and validated a CT-based radiomics model that could accurately differentiate fresh with older thrombi for stroke patients receiving mechanical thrombectomy.
Collapse
Affiliation(s)
- Chendong Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Tao Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing 210029, China
| | - Zhenyu Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Kai Qiu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Runhao Jiang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Yu Hang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Heng Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Yuezhou Cao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Linbo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing 210029, China
| | - Jincheng Jiao
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing 210029, China
| | - Haibin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China
| | - Jiulou Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd Gulou District, Nanjing, Jiangsu 210029, China.
| |
Collapse
|
23
|
Shindo S, Uchida K, Yoshimura S, Sakai N, Yamagami H, Toyoda K, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Inoue M, Sakakibara F, Nakajima M, Ueda M, Morimoto T. Intravenous alteplase before endovascular therapy for acute large vessel occlusion with large ischemic core: subanalysis of a randomized clinical trial. J Neurointerv Surg 2023:jnis-2023-020846. [PMID: 37890987 DOI: 10.1136/jnis-2023-020846] [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: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The efficacy of endovascular therapy (EVT) in patients with large ischemic core has been reported, but it remains unclear whether IV alteplase (IVT) has beneficial effects in addition to EVT in such patients. We evaluated the efficacy and safety of EVT with or without IVT. METHODS The RESCUE-Japan LIMIT was an open-label, prospective, multicenter, randomized clinical trial to evaluate the efficacy and safety of EVT in stroke patients with large ischemic core, defined as Alberta Stroke Program Early CT Score (ASPECTS) 3-5. This subanalysis evaluated the differences in the effects of EVT with medical care (EVT group) compared with medical care alone (No-EVT group) between those who received IVT (IVT stratum) and those who did not (No-IVT stratum) before EVT. RESULTS Among 202 enrolled patients, 147 (73%) did not receive IVT. In the No-IVT stratum, the modified Rankin Scale (mRS) score of 0-3 at 90 days was significantly higher in the EVT group than in the No-EVT group (31.1% vs 12.3%, OR 3.21 (95% CI 1.37 to 7.53)). In the IVT stratum, the mRS score of 0-3 was 30.8% in the EVT group and 13.8% in the No-EVT group (OR 2.78 (95% CI 0.72 to 10.7)) (interaction p=0.77). The incidence of symptomatic intracranial hemorrhage was not different between the two groups in the No-IVT stratum (OR 1.20 (95% CI 0.35 to 4.12)), but it was significantly higher in the EVT group than in the No-EVT group in the IVT stratum (11.5% vs 0%, p=0.03). CONCLUSIONS There was no difference in efficacy of EVT with or without IVT, while IVT before EVT might increase symptomatic intracranial hemorrhage in patients with large ischemic core. TRIAL REGISTRATION INFORMATION NCT03702413.
Collapse
Affiliation(s)
- Seigo Shindo
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Matsumoto
- Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Japan
| | - Reiichi Ishikura
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Makoto Nakajima
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| |
Collapse
|