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Azriel A, Horev A, Avraham E, Alguayn F, Zlotnik Y, Ifergane G, Sufaro YZ, Dizitzer Y, Melamed I, Shelef I, Cohen JE, Leker RR, Honig A. Visualization of both proximal M2-MCA segments in patients (the Tilted-V Sign) with acute M1-MCA occlusion stroke is associated with better procedural and prognostic outcomes. Front Neurol 2022; 13:1041585. [PMID: 36582610 PMCID: PMC9792472 DOI: 10.3389/fneur.2022.1041585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction We aimed to assess the clinical significance of M1-MCA occlusion with visualization of both MCA-M2 segments ["Tilted-V sign" (TVS)] on initial CT angiography (CTA) in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT). Methods Data for patients with consecutive AIS undergoing EVT for large vessel occlusion (LVO) in two academic centers are recorded in ongoing databases. Patients who underwent EVT for M1-MCA occlusions ≤ 6 h from symptom onset were included in this retrospective analysis. Results A total of 346 patients met the inclusion criteria; 189 (55%) had positive TVS. Patients with positive TVS were younger (68 ± 14 vs. 71 ± 14 years, P = 0.028), with similar rates of vascular risk factors and baseline modified Rankin scores (mRS) 0-2. The rates of achieving thrombolysis in cerebral ischemia (TICI) 2b-3 were similar to the two groups (79%), although successful first-pass recanalization was more common with TVS (64 vs. 36%, p = 0.01). On multivariate analysis, higher collateral score [odds ratio (OR) 1.38 per unit increase, p = 0.008] and lower age (OR 0.98 per year increase, p = 0.046) were significant predictors of TVS. Patients with positive TVS had higher post-procedural Alberta Stroke Program Early CT Score (ASPECTS; 6.9 ± 2.2 vs. 5.2 ± 2.3, p = 0.001), were discharged with lower National Institutes of Health Stroke Score (NIHSS; 6±6 vs. 9±7, p = 0.003) and higher rates of mRS 0-2 (29.5 vs. 12%, p = 0.001), and had lower rates of 90-day mortality (13.2 vs. 21.6%, p = 0.038). However, TVS was not an independent predictor of functional independence (OR 2.51; 95% CI 0.7-8.3). Conclusion Tilted-V Sign, an easily identifiable radiological marker, is associated with fewer recanalization attempts, better functional outcomes, and reduced mortality.
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Affiliation(s)
- Amit Azriel
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Anat Horev
- Department of Neurology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elad Avraham
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Farouq Alguayn
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yair Zlotnik
- Department of Neurology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gal Ifergane
- Department of Neurology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yuval Zeev Sufaro
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yotam Dizitzer
- Department of Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Israel Melamed
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilan Shelef
- Department of Radiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - José E. Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen R. Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel,*Correspondence: Asaf Honig
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Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Heldner MR, Kurmann CC, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Pereira VM, Gralla J, Fischer U. Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry. J Neurol 2019; 266:598-608. [PMID: 30617997 PMCID: PMC6394689 DOI: 10.1007/s00415-018-09172-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/22/2018] [Accepted: 12/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE If patients presenting with large vessel occlusions (LVO) and mild symptoms should be treated with endvoascular treatment (EVT) remains unclear. Aims of this study were (1) assessing the safety and technical efficacy of EVT in patients with NIHSS < 8 as opposed to a comparison group of patients presenting with NIHSS ≥ 8 and (2) evaluation of the clinical effect of reperfusion in patients with NIHSS < 8. METHODS Patients included into the retrospective multicenter BEYOND-SWIFT registry (NCT03496064) were analyzed. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 (N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Primary outcome was excellent functional outcome (modified Rankin Scale, mRS 0-1) at day 90. Safety and efficacy of mechanical thrombectomy in patients with NIHSS < 8 was compared to patients presenting with NIHSS ≥ 8 (N = 1423). RESULTS Among patients with NIHSS < 8 (N = 193, 77/193, 39.9% receiving pre-interventional IV-tPA), successful reperfusion was significantly related to mRS 0-1 (aOR 3.217, 95%-CI 1.174-8.816) and reduced the chances of non-hemorrhagic neurological worsening (aOR 0.194, 95%-CI 0.050-0.756) after adjusting for prespecified confounders. In interaction analyses, the relative merits of achieving successful reperfusion were mostly comparable between patients presenting with NIHSS < 8 and NIHSS ≥ 8 as evidenced by non-significantly different aOR. Interventional safety and efficacy metrics were similar between patients with NIHSS < 8 and NIHSS ≥ 8. CONCLUSIONS Achieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening.
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Affiliation(s)
- Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Christoph C Kurmann
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, CHUV Lausanne, Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Radiology, CHUV Lausanne, Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | | | | | - Joanna Schaafsma
- Department of Neurology, Toronto Western Hospital, Toronto, ON, Canada
| | - Vitor Mendes Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
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Borggrefe J, Glück B, Maus V, Onur Ö, Abdullayev N, Barnikol U, Kabbasch C, Fink GR, Mpotsaris A. Clinical Outcome After Mechanical Thrombectomy in Patients with Diabetes with Major Ischemic Stroke of the Anterior Circulation. World Neurosurg 2018; 120:e212-e220. [PMID: 30121406 DOI: 10.1016/j.wneu.2018.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Among patients with acute ischemic stroke treated with mechanical thrombectomy (MT), patients with diabetes (DP) show a poorer outcome compared with patients without diabetes (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation. METHODS This study included 317 of 498 consecutive patients who received interventional treatment for acute ischemic stroke in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP. The study data included pre- and posttreatment stroke computed tomography, including perfusion data, collateral status, treatment data including treatment times, pre-existing cardiovascular risk factors, cerebrovascular events, comorbidities, laboratory parameters, and medication. Neurologic status was assessed at baseline (National Institute of Health Stroke Scale [NIHSS]/modified Rankin Scale [mRS]) and after 90 days (mRS 90). RESULTS Compared with NDP, DP showed a significantly poorer outcome (mRS90 >2) (P < 0.05). Collateralization and infarct core size did not differ between groups, whereas the penumbra was significantly smaller in DP than in NDP (P < 0.05). The poorer mRS90 outcome (mRS90 > 2) in DP was associated with poor collaterals (P = 0.01) and hyperglycemia on admission (P < 0.05). Shorter time to reperfusion was associated with favorable mRS90 in the NDP (P < 0.001) but not the DP (P = 0.49) group. In univariate logistic regression, the following parameters were significantly associated with mRS90: diabetes, hyperglycemia at admission, time to reperfusion, and the NIHSS score (P < 0.05 each). In multivariate analyses and partition regression models of all variables, DP with admission hyperglycemia (≥132 mg/dL) and older age (≥66 years) showed a particularly poor outcome. CONCLUSIONS The main factors for an unfavorable outcome of DP after MT are admission hyperglycemia, age, and NIHSS score.
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Affiliation(s)
- Jan Borggrefe
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Cologne, Germany.
| | - Berit Glück
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Cologne, Germany
| | - Volker Maus
- Department of Neuroradiology, University Hospital of Göttingen, Göttingen, Germany
| | - Özgür Onur
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Cologne, Germany
| | - Utako Barnikol
- Medical Ethics, University Hospital of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
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Maus V, Abdullayev N, Sack H, Borggrefe J, Mpotsaris A, Behme D. Carotid Artery Stenosis Contralateral to Intracranial Large Vessel Occlusion: An Independent Predictor of Unfavorable Clinical Outcome After Mechanical Thrombectomy. Front Neurol 2018; 9:437. [PMID: 29946292 PMCID: PMC6005855 DOI: 10.3389/fneur.2018.00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/24/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Clinical outcome in patients undergoing mechanical thrombectomy (MT) due to intracranial large vessel occlusion (LVO) in the anterior circulation is influenced by several factors. The impact of a concomitant extracranial carotid artery stenosis (CCAS) contralateral to the intracranial lesion remains unclear. Methods: Retrospective analysis of 392 consecutive patients treated with MT due to intracranial LVO in the anterior circulation in two comprehensive stroke centers between 2014 and 2017. Clinical (including demographics and NIHSS), imaging (including angiographic evaluation of CCAS via NASCET criteria), and procedural data were evaluated. Primary endpoint was an unfavorable clinical outcome defined as modified Rankin Scale 3-6 at 90 days. Results: In 27/392 patients (7%) pre-interventional imaging exhibited a CCAS (>50%) contralateral to the intracranial lesion compared to 365 patients without relevant stenosis. Median baseline NIHSS, procedural timings, and reperfusion success did not differ between groups. Median volume of the final infarct core was larger in CCAS patients (176 cm3, IQR 32-213 vs. 11 cm3, 1-65; p < 0.001). At 90 days, unfavorable outcome was documented in 25/27 CCAS patients (93%) vs. 211/326 (65%; p = 0.003) with a mortality of 63 vs. 19% (p = 0.001), respectively. Presence of CCAS was associated with an unfavorable outcome at 90 days independent of age and baseline NIHSS in multivariate logistic regression (OR 2.2, CI 1.1-4.7; p < 0.05). Conclusion: For patients undergoing MT due to intracranial vessel occlusion in the anterior circulation, the presence of a contralateral CCAS >50% is a predictor of unfavorable clinical outcome at 90 days.
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Affiliation(s)
- Volker Maus
- Department of Diagnostic and Interventional Neuroradiology University Medical Center, Göttingen, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology University Hospital, Cologne, Germany
| | - Henrik Sack
- Department of Diagnostic and Interventional Neuroradiology University Medical Center, Göttingen, Germany
| | - Jan Borggrefe
- Department of Diagnostic and Interventional Radiology University Hospital, Cologne, Germany
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Neuroradiology University Hospital, Aachen, Germany
| | - Daniel Behme
- Department of Diagnostic and Interventional Neuroradiology University Medical Center, Göttingen, Germany
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Mechanical Thrombectomy in Basilar Artery Occlusion. Clin Neuroradiol 2017; 29:153-160. [DOI: 10.1007/s00062-017-0651-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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Castier J, Portella T, Ricolfi F, Thouant P. Metastatic fusiform aneurysms from atrial myxoma: A case report and literature review. J Neuroradiol 2017; 44:400-403. [DOI: 10.1016/j.neurad.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/20/2017] [Accepted: 06/30/2017] [Indexed: 11/29/2022]
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Hennerici MG. Endovascular Therapy: More Questions to be Answered for Best Personalized Interventional Treatment. Cerebrovasc Dis 2017; 44:I-II. [PMID: 28934738 DOI: 10.1159/000481448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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