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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.
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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
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Uchida K, Rinkel LA, Ospel JM, Diprose WK, Goyal M. A systematic review of randomized controlled trials of endovascular therapy for stroke on mortality and disability. J Neurol Sci 2024; 460:122991. [PMID: 38579415 DOI: 10.1016/j.jns.2024.122991] [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: 01/11/2024] [Revised: 03/01/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Endovascular treatment (EVT) has become standard of care for patients with anterior circulation large vessel occlusion (LVO) stroke, with indications having recently expanded to late time-window and large ischemic core patients. There is conflicting evidence on whether EVT reduces mortality or only disability. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of EVT on mortality and severe disability. METHODS We systematically searched PubMed, Web of Science, Scopus, and Embase on November 15, 2023, to identify phase 3 RCTs comparing EVT to best medical treatment (BMT) in patients with anterior circulation LVO stroke in a common effects meta-analysis. The primary outcome was mortality at 3 months. Secondary outcomes were moderately severe or severe disability (modified Rankin Scale (mRS) score 4-5) at 3 months. RESULTS 18 studies comparing EVT to BMT were included, with a total of 4309 patients; 2159 that were treated with EVT, and 2150 treated with BMT. Mortality was significantly lower in the EVT group than in the BMT group (odds ratio (OR): 0.81, 95% CI: 0.70-0.94). Proportions of moderately severe or severe disability (OR: 0.55, 95% CI: 0.48-0.62) were also significantly lower in patients treated with EVT. CONCLUSIONS This meta-analysis suggests that EVT reduces both mortality and moderately severe or severe disability in patients with anterior circulation LVO stroke.
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Affiliation(s)
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan; Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Leon A Rinkel
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, AB, Canada; Departments of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Johanna M Ospel
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, AB, Canada; Department of Neuroradiology, University Hospital of Basel, Switzerland
| | - William K Diprose
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, AB, Canada; Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mayank Goyal
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, AB, Canada.
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Alhazmi H, Ameen OK, Almalki Z, Alanazi A, Albalawi A, Alshanqiti M, Almalki K, Alsaleh A, Khayat A, Ibrahim H, Almulhim IA, Jubran A, Almodarra N, Almansour N, Alnaaim SA, Al-Senani F, Shuaib A, Muthana J, Alotaibi M. Endovascular thrombectomy for acute ischemic stroke in Saudi Arabia: A single-center experience. J Stroke Cerebrovasc Dis 2024; 33:107552. [PMID: 38277959 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107552] [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: 07/23/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024] Open
Abstract
PURPOSE This study aimed to investigate the outcomes of endovascular thrombectomy-treated patients in King Fahad Medical City, Riyadh, Saudi Arabia. METHODS A retrospective cohort study of acute ischemic stroke patients treated with endovascular thrombectomy. Patients were included in the study between January 2015 and December 2022. Good outcomes were defined as a modified Rankin Scale (mRS) of 0-2 at 90 days. Multivariate logistic regression analysis was performed to identify the independent factors associated with good outcomes. RESULTS During the study period, 369 patients with acute ischemic stroke (mean ± SD age, 61/- 15.1 yrs; 55.4 % male) underwent mechanical thrombectomy. Median National Institute of Health Stroke Scale (NIHSS) 15. Intravenous thrombolysis was administered to 34.5 % of the patients. Successful recanalization in the anterior circulation was achieved in 84.8 % of patients. Data from mRS performed after 90 days in the anterior circulation were available for 71.2 % of the patients. Of these, 41 % showed a good outcome, and the mortality rate was 22.4 %. The significant factors associated with good outcomes were age, NIHSS score, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and short arterial puncture to recanalization. CONCLUSION The number of patients who underwent endovascular thrombectomy has increased over time. The treatment outcomes and mortality were comparable with those of previous endovascular thrombectomy registries despite the high prevalence of DM, lower ASPECT score, and prolonged onset-to-recanalization time.
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Affiliation(s)
- Hanan Alhazmi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Omar K Ameen
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ziyad Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Abdulmajeed Alanazi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Albalawi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mahmoud Alshanqiti
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Almalki
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Alsaleh
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alaa Khayat
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hatim Ibrahim
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim A Almulhim
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Interventional Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Jubran
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nehal Almodarra
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nouf Almansour
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saud A Alnaaim
- Assistant professor, College of Medicine, Clinical Neuroscience department, King Faisal University, Hofuf, Saudi Arabia
| | - Fahmi Al-Senani
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ashfaq Shuaib
- Stroke Program, Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jamal Muthana
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Neurology Section, Department of Medicine, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Knapen RR, Pirson FAV, Langezaal LC, Brouwer J, Majoie CB, Emmer BJ, Vos JA, van Doormaal PJ, Yoo AJ, Bruggeman AA, Lycklama à Nijeholt GJ, van der Leij C, van Oostenbrugge RJ, van Zwam WH, Schonewille WJ. Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions: A MR CLEAN Registry Study. Stroke 2024; 55:403-412. [PMID: 38174571 PMCID: PMC10802980 DOI: 10.1161/strokeaha.123.043777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The effectiveness of intravenous thrombolysis (IVT) before endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT before EVT in posterior circulation occlusions in a nationwide registry. METHODS Patients were included from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), a nationwide, prospective, multicenter registry of patients with acute ischemic stroke due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift toward better functional outcome on the modified Rankin Scale at 90 days. Secondary outcomes were favorable functional outcome (modified Rankin Scale scores, 0-3), occurrence of symptomatic intracranial hemorrhages, successful reperfusion (extended Thrombolysis in Cerebral Ischemia ≥2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariable analyses and literature were applied. RESULTS A total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) before EVT. Results show no differences in a shift on the modified Rankin Scale (adjusted common odds ratio, 1.04 [95% CI, 0.61-1.76]). Although symptomatic intracranial hemorrhages occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (adjusted odds ratio, 1.65 [95% CI, 0.33-8.35]). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT. CONCLUSIONS We found no significant differences in clinical, technical, and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT before EVT. Our results are in line with the literature on the anterior circulation.
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Affiliation(s)
- Robrecht R.M.M. Knapen
- Department of Radiology and Nuclear Medicine (R.R.M.M.K., C.v.d.L., W.H.v.Z.), Maastricht University Medical Center, the Netherlands
- School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, the Netherlands (R.R.M.M.K., R.J.v.O., W.H.v.Z.)
| | - F. Anne V. Pirson
- Department of Neurology (F.A.V.P.), Haaglanden MC, Hague, the Netherlands
| | - Lucianne C.M. Langezaal
- Department of Radiology (L.C.M.L., J.-A.V.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Josje Brouwer
- Department of Neurology (J.B.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Charles B.L.M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands (C.B.L.M.M., A.A.E.B.)
| | - Bart J. Emmer
- Department of Radiology and Nuclear Medicine (B.J.E.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Jan-Albert Vos
- Department of Radiology (L.C.M.L., J.-A.V.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Pieter-Jan van Doormaal
- Department of Radiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands (P.-J.v.D.)
| | - Albert J. Yoo
- Department of Radiology/Neurointervention, Texas Stroke Institute, Dallas-Fort Worth (A.J.Y)
| | - Agnetha A.E. Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands (C.B.L.M.M., A.A.E.B.)
| | | | - Chirstiaan van der Leij
- Department of Radiology and Nuclear Medicine (R.R.M.M.K., C.v.d.L., W.H.v.Z.), Maastricht University Medical Center, the Netherlands
| | - Robert J. van Oostenbrugge
- Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands
- School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, the Netherlands (R.R.M.M.K., R.J.v.O., W.H.v.Z.)
| | - Wim H. van Zwam
- Department of Radiology and Nuclear Medicine (R.R.M.M.K., C.v.d.L., W.H.v.Z.), Maastricht University Medical Center, the Netherlands
- School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, the Netherlands (R.R.M.M.K., R.J.v.O., W.H.v.Z.)
| | - Wouter J. Schonewille
- Department of Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein, the Netherlands
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Samuels N, van de Graaf RA, Roos YBWM, Dippel D, van der Lugt A. Advancements in diagnostic and interventional radiology for stroke treatment: the path from trial to bedside through the pre-MR CLEAN, MR CLEAN, and MR CLEAN II eras. Insights Imaging 2024; 15:30. [PMID: 38289430 PMCID: PMC10828318 DOI: 10.1186/s13244-023-01597-1] [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: 08/31/2023] [Accepted: 11/20/2023] [Indexed: 02/02/2024] Open
Abstract
The stroke field is inevitably connected with imaging in which radiologists fulfill a central role. Our landmark MR CLEAN trial led to the implementation of baseline computed tomography angiography or magnetic resonance angiography in the acute stroke workup and subsequent endovascular treatment (EVT) for ischemic stroke patients with a large vessel occlusion in the anterior circulation, resulting in numerous patients worldwide currently being treated often successfully. A reversal of the pathophysiologic process behind an acute cerebrovascular event was made possible. Subsequently, in the MR CLEAN II trials, the clinical impact of both diagnostic and interventional radiologists remained a cornerstone of our research, which means value-based radiology. Within these MR CLEAN II trials, we proved that aspirin and heparin during EVT should be avoided due to increased symptomatic intracranial hemorrhage risk (MR CLEAN-MED). We concluded there is additional benefit of EVT in the 6-to-24-h window after stroke in the presence of good collaterals on baseline CTA (MR CLEAN-LATE). The impactful success of our stroke trials that changed many guidelines was mainly attributable to (1) the societal burden of the disease, with two thirds of patients dying or being independent at 3 months; (2) the fact that stroke is a common disease, (3) the relatively simple and pragmatic approach of the trials resembling real-world setting; (4) the acceleration of implementation in clinical practice facilitated by a structured approach to guideline development and conditional funding; and foremost (5) the excellent collaboration on a professional level between-disciplines, i.e., diagnostic radiologists, interventionalists, and neurologists.Critical relevance statement The MR CLEAN and MR CLEAN II trials have had tremendous impact on clinical practice, directly by more patients being treated with an effective intervention and indirectly through adoption of evidence-based guidelines. It is in this setting of stroke treatment that diagnostic and interventional radiologists have played a crucial role and created clinical impact.
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Affiliation(s)
- Noor Samuels
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rob A van de Graaf
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Yvo B W M Roos
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Diederik Dippel
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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Cruts JMH, Giezen JA, van Gaalen K, Beurskens R, Ridwan Y, Dijkshoorn ML, van Beusekom HMM, Boodt N, van der Lugt A, de Vries JJ, de Maat MPM, Gijsen FJH, Cahalane RME. The association between human blood clot analogue computed tomography imaging, composition, contraction, and mechanical characteristics. PLoS One 2023; 18:e0293456. [PMID: 37956141 PMCID: PMC10642823 DOI: 10.1371/journal.pone.0293456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Clot composition, contraction, and mechanical properties are likely determinants of endovascular thrombectomy success. A pre-interventional estimation of these properties is hypothesized to aid in selecting the most suitable treatment for different types of thrombi. Here we determined the association between the aforementioned properties and computed tomography (CT) characteristics using human blood clot analogues. METHODS Clot analogues were prepared from the blood of 4 healthy human donors with 5 red blood cell (RBC) volume suspensions: 0%, 20%, 40%, 60% and 80% RBCs. Contraction was measured as the weight of the contracted clots as a percentage of the original suspension. The clots were imaged using CT with and without contrast to quantify clot density and density increase. Unconfined compression was performed to determine the high strain compressive stiffness. The RBC content was analysed using H&E staining. RESULTS The 5 RBC suspensions formed only two groups of clots, fibrin-rich (0% RBCs) and RBC-rich (>90% RBCs), as determined by histology. The density of the fibrin-rich clots was significantly lower (31-38HU) compared to the RBC-rich clots (72-89HU), and the density increase of the fibrin-rich clots was significantly higher (82-127HU) compared to the RBC-rich clots (3-17HU). The compressive stiffness of the fibrin-rich clots was higher (178-1624 kPa) than the stiffness of the RBC-rich clots (6-526 kPa). Additionally, the degree of clot contraction was higher for the fibrin-rich clots (89-96%) compared to the RBC-rich clots (11-77%). CONCLUSIONS CT imaging clearly reflects clot RBC content and seems to be related to the clot contraction and stiffness. CT imaging might be a useful tool in predicting the thrombus characteristics. However, future studies should confirm these findings by analysing clots with intermediate RBC and platelet content.
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Affiliation(s)
- Janneke M. H. Cruts
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jo-Anne Giezen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Kim van Gaalen
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robert Beurskens
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yanto Ridwan
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Molecular Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marcel L. Dijkshoorn
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Nikki Boodt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Judith J. de Vries
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Frank J. H. Gijsen
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Rachel M. E. Cahalane
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
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7
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Majoie CB, Cavalcante F, Gralla J, Yang P, Kaesmacher J, Treurniet KM, Kappelhof M, Yan B, Suzuki K, Zhang Y, Li F, Morimoto M, Zhang L, Miao Z, Rinkel LA, Huang J, Otsuka T, Wang S, Davis S, Cognard C, Hong B, Coutinho JM, Song J, Chen W, Emmer BJ, Eker O, Zhang L, Dobrocky T, Nguyen HT, Bush S, Peng Y, LeCouffe NE, Takeuchi M, Han H, Matsumaru Y, Strbian D, Lingsma HF, Nieboer D, Yang Q, Meinel T, Mitchell P, Kimura K, Zi W, Nogueira RG, Liu J, Roos YB, Fischer U. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet 2023; 402:965-974. [PMID: 37640037 DOI: 10.1016/s0140-6736(23)01142-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Intravenous thrombolysis is recommended before endovascular treatment, but its value has been questioned in patients who are admitted directly to centres capable of endovascular treatment. Existing randomised controlled trials have indicated non-inferiority of endovascular treatment alone or have been statistically inconclusive. We formed the Improving Reperfusion Strategies in Acute Ischaemic Stroke collaboration to assess non-inferiority of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment. METHODS We conducted a systematic review and individual participant data meta-analysis to establish non-inferiority of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment. We searched PubMed and MEDLINE with the terms "stroke", "endovascular treatment", "intravenous thrombolysis", and synonyms for articles published from database inception to March 9, 2023. We included randomised controlled trials on the topic of interest, without language restrictions. Authors of the identified trials agreed to take part, and individual participant data were provided by the principal investigators of the respective trials and collated centrally by the collaborators. Our primary outcome was the 90-day modified Rankin Scale (mRS) score. Non-inferiority of endovascular treatment alone was assessed using a lower boundary of 0·82 for the 95% CI around the adjusted common odds ratio (acOR) for shift towards improved outcome (analogous to 5% absolute difference in functional independence) with ordinal regression. We used mixed-effects models for all analyses. This study is registered with PROSPERO, CRD42023411986. FINDINGS We identified 1081 studies, and six studies (n=2313; 1153 participants randomly assigned to receive endovascular treatment alone and 1160 randomly assigned to receive intravenous thrombolysis and endovascular treatment) were eligible for analysis. The risk of bias of the included studies was low to moderate. Variability between studies was small, and mainly related to the choice and dose of the thrombolytic drug and country of execution. The median mRS score at 90 days was 3 (IQR 1-5) for participants who received endovascular treatment alone and 2 (1-4) for participants who received intravenous thrombolysis plus endovascular treatment (acOR 0·89, 95% CI 0·76-1·04). Any intracranial haemorrhage (0·82, 0·68-0·99) occurred less frequently with endovascular treatment alone than with intravenous thrombolysis plus endovascular treatment. Symptomatic intracranial haemorrhage and mortality rates did not differ significantly. INTERPRETATION We did not establish non-inferiority of endovascular treatment alone compared with intravenous thrombolysis plus endovascular treatment in patients presenting directly at endovascular treatment centres. Further research could focus on cost-effectiveness analysis and on individualised decisions when patient characteristics, medication shortages, or delays are expected to offset a potential benefit of administering intravenous thrombolysis before endovascular treatment. FUNDING Stryker and Amsterdam University Medical Centers, University of Amsterdam.
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Affiliation(s)
- Charles B Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands.
| | - Fabiano Cavalcante
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - 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
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Kilian M Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands; Department of Radiology, Haaglanden Medical Center, The Hague, Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Yongwei Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Masafumi Morimoto
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgery Hospital, Kanagawa, Japan
| | - Lei Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Leon A Rinkel
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Shouchun Wang
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Stephen Davis
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bo Hong
- Department of Neurovascular Intervention, Clinical Center of Neuroscience, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Omer Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital of Shandong First Medical University, Liaocheng, China
| | - Tomas Dobrocky
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | | | - Steven Bush
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Ya Peng
- Department of Neurology, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Natalie E LeCouffe
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | | | - Hongxing Han
- Department of Neurology, Linyi People's Hospital of Qingdao University, Linyi, China
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Thomas Meinel
- Department of Neurology, University Hospital of Bern, University of Bern, Stroke Research Center Bern, Bern, Switzerland
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Raul G Nogueira
- UPMC Stroke Institute, Department of Neurology and Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - 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
| | - Yvo B Roos
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Urs Fischer
- Department of Neurology, University Hospital of Bern, University of Bern, Stroke Research Center Bern, Bern, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
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8
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Bourcier R, Consoli A, Desilles JP, Labreuche J, Kyheng M, Desal H, Alias Q, Gory B, Dargazanli C, Janot K, Zhu F, Lapergue B, Marnat G. Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study. Eur Stroke J 2023; 8:655-666. [PMID: 37288701 PMCID: PMC10472952 DOI: 10.1177/23969873231180338] [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: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Technical improvements in devices, changes in angiographic grading scales and various confounding factors have made difficult the detection of the temporal evolution of angiographic and clinical results after endovascular treatment (EVT) for acute ischemic Stroke (AIS). We analyzed this evolution in time using the Endovascular Treatment in Ischemic Stroke (ETIS) registry. MATERIALS AND METHODS We analyzed the efficacy outcomes of EVT performed from January 2015 to January 2022, and modelized the temporal trends using mixed logistic regression models, further adjusted for age, intravenous thrombolysis prior to EVT, general anesthesia, occlusion site, balloon catheter use and the type of first-line EVT strategy. We assessed heterogeneity in temporal trends according to occlusion site, balloon catheter use, cardio embolic etiology, age (<80 years vs ⩾80 years) and first-line EVT strategy. RESULTS Among 6104 patients treated from 2015 to 2021, the rates of successful reperfusion (71.1%-89.6%) and of complete first pass effect (FPE) (4.6%-28.9%) increase, whereas the rates of patients with >3 EVT device passes (43.1%-17.5%) and favorable outcome (35.8%-28.9%) decrease significantly over time. A significant heterogeneity in temporal trends in successful reperfusion according to the first-line EVT strategy was found (p-het = 0.018). The temporal trend of increasing successful reperfusion rate was only significant in patients treated with contact aspiration in first-line (adjusted overall effect p = 0.010). CONCLUSION In this 7-year-old large registry of ischemic stroke cases treated with EVT, we observed a significant increase with time in the rate of recanalization whereas there was a tendency toward a decrease in the rate of favorable outcome over the same period.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Arturo Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Saint Quentin-en-Yvelines, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, INSERM unit 1148, Paris-Cité University, Paris, France
| | - Julien Labreuche
- EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, Lille, France
| | - Maeva Kyheng
- EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, Lille, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Quentin Alias
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Benjamin Gory
- IADI, University of Lorraine, INSERM U1254, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Guy de Chauliac University Hospital, Montpellier, France
| | - Kévin Janot
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Tours, Tours, France
| | - François Zhu
- IADI, University of Lorraine, INSERM U1254, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Bordeaux, France
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9
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van Voorst H, Bruggeman AAE, Yang W, Andriessen J, Welberg E, Dutra BG, Konduri PR, Arrarte Terreros N, Hoving JW, Tolhuisen ML, Kappelhof M, Brouwer J, Boodt N, van Kranendonk KR, Koopman MS, Hund HM, Krietemeijer M, van Zwam WH, van Beusekom HMM, van der Lugt A, Emmer BJ, Marquering HA, Roos YBWEM, Caan MWA, Majoie CBLM. Thrombus radiomics in patients with anterior circulation acute ischemic stroke undergoing endovascular treatment. J Neurointerv Surg 2023; 15:e79-e85. [PMID: 35882552 DOI: 10.1136/jnis-2022-019085] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thrombus radiomics (TR) describe complex shape and textural thrombus imaging features. We aimed to study the relationship of TR extracted from non-contrast CT with procedural and functional outcome in endovascular-treated patients with acute ischemic stroke. METHODS Thrombi were segmented on thin-slice non-contrast CT (≤1 mm) from 699 patients included in the MR CLEAN Registry. In a pilot study, we selected 51 TR with consistent values across two raters' segmentations (ICC >0.75). Random forest models using TR in addition or as a substitute to baseline clinical variables (CV) and manual thrombus measurements (MTM) were trained with 499 patients and evaluated on 200 patients for predicting successful reperfusion (extended Thrombolysis in Cerebral Ischemia (eTICI) ≥2B), first attempt reperfusion, reperfusion within three attempts, and functional independence (modified Rankin Scale (mRS) ≤2). Three texture and shape features were selected based on feature importance and related to eTICI ≥2B, number of attempts to eTICI ≥2B, and 90-day mRS with ordinal logistic regression. RESULTS Random forest models using TR, CV or MTM had comparable predictive performance. Thrombus texture (inverse difference moment normalized) was independently associated with reperfusion (adjusted common OR (acOR) 0.85, 95% CI 0.72 to 0.99). Thrombus volume and texture were also independently associated with the number of attempts to successful reperfusion (acOR 1.36, 95% CI 1.03 to 1.88 and acOR 1.24, 95% CI 1.04 to 1.49). CONCLUSIONS TR describing thrombus volume and texture were associated with more attempts to successful reperfusion. Compared with models using CV and MTM, TR had no added value for predicting procedural and functional outcome.
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Affiliation(s)
- Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Wenjin Yang
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Neurosurgery, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jurr Andriessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Elise Welberg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Bruna G Dutra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Praneeta R Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Jan W Hoving
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Manon L Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Josje Brouwer
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nikki Boodt
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Katinka R van Kranendonk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Miou S Koopman
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Hajo M Hund
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Center Bronovo, Den Haag, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Menno Krietemeijer
- Department of Radiology and Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Biomedical Engineering and Physics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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10
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Sluis WM, Hinsenveld WH, Goldhoorn RJB, Potters LH, Bruggeman AAE, van der Hoorn A, Bot JCJ, van Oostenbrugge RJ, Lingsma HF, Hofmeijer J, van Zwam WH, BLM Majoie C, Bart van der Worp H. Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke. Eur Stroke J 2022; 8:215-223. [PMID: 37021180 PMCID: PMC10069200 DOI: 10.1177/23969873221143210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction: Endovascular thrombectomy (EVT) increases the chance of good functional outcome after ischemic stroke caused by a large vessel occlusion, but the risk of death in the first 90 days is still considerable. We assessed the causes, timing and risk factors of death after EVT to aid future studies aiming to reduce mortality. Patients and methods: We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and November 2017. We assessed causes and timing of death and risk factors for death in the first 90 days after treatment. Causes and timing of death were determined by reviewing serious adverse event forms, discharge letters, or other written clinical information. Risk factors for death were determined with multivariable logistic regression. Results: Of 3180 patients treated with EVT, 863 (27.1%) died in the first 90 days. The most common causes of death were pneumonia (215 patients, 26.2%), intracranial hemorrhage (142 patients, 17.3%), withdrawal of life-sustaining treatment because of the initial stroke (110 patients, 13.4%) and space-occupying edema (101 patients, 12.3%). In total, 448 patients (52% of all deaths) died in the first week, with intracranial hemorrhage as most frequent cause. The strongest risk factors for death were hyperglycemia and functional dependency before the stroke and severe neurological deficit at 24–48 h after treatment. Discussion and conclusion: When EVT fails to decrease the initial neurological deficit, strategies to prevent complications like pneumonia and intracranial hemorrhage after EVT could improve survival, as these are often the cause of death.
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Affiliation(s)
- Wouter M Sluis
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wouter H Hinsenveld
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert-Jan B Goldhoorn
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lianne H Potters
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Agnetha AE Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, Medical Imaging Center (MIC), University Medical Center Groningen, Groningen, The Netherlands
| | - Joseph CJ Bot
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hester F Lingsma
- Public Health Department, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, and Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Charles BLM Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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11
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Bruggeman AAE, Aberson N, Kappelhof M, Dutra BG, Hoving JW, Brouwer J, Tolhuisen ML, Terreros NA, Konduri PR, Boodt N, Roos YBWEM, van Zwam WH, Bokkers R, Martens J, Marquering HA, Emmer BJ, Majoie CBLM. Association of thrombus density and endovascular treatment outcomes in patients with acute ischemic stroke due to M1 occlusions. Neuroradiology 2022; 64:1857-1867. [PMID: 35570210 PMCID: PMC9365751 DOI: 10.1007/s00234-022-02971-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to study the association of non-contrast CT (NCCT) thrombus density with procedural and clinical outcomes in patients with acute ischemic stroke who underwent endovascular treatment (EVT). Since thrombus density is associated with thrombus location, we focused on M1 occlusions only. METHODS Patients with available thin-slice (< 2.5 mm) NCCT were included from a nationwide registry. Regression models were used to assess the relation between thrombus density (per Hounsfield unit [HU]) and the following outcomes. For reperfusion grade, adjusted common odds ratios (acOR) indicated a 1-step shift towards improved outcome per HU increase in thrombus density. For the binary outcomes of first-pass reperfusion (first-pass extended thrombolysis in cerebral infarction [eTICI] 2C-3, FPR), functional independence [90-day modified Rankin Scale (mRS) score of 0-2] and mortality), aORs were reported. Adjusted β coefficients (aβ) were reported for 24-h NIHSS and procedure duration in minutes. Outcome differences between first-line treatment devices (stent retriever versus aspiration) were assessed with interaction terms. RESULTS In 566 patients with M1 occlusions, thrombus density was not associated with reperfusion (acOR 1.01, 95% CI 0.99-1.02), FPR (aOR 1.01, 95% CI 0.99-1.03), mortality (aOR 0.98, 95% CI 0.95-1.00), 24-h NIHSS (aβ - 0.7%, 95% CI - 1.4-0.2), or procedure duration (aβ 0.27, 95% CI - 0.05-0.58). In multivariable analysis, thrombus density was associated with functional independence (aOR 1.02, 95% CI 1.00-1.05). No interaction was found between thrombus density and first-line treatment device for any outcome. CONCLUSION In patients with M1 occlusions, thrombus density was not clearly associated with procedural and clinical outcomes after EVT.
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Affiliation(s)
- Agnetha A. E. Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Nyk Aberson
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands ,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bruna G. Dutra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands ,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan W. Hoving
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Josje Brouwer
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Manon L. Tolhuisen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands ,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands ,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Praneeta R. Konduri
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands ,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Nikki Boodt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands ,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yvo B. W. E. M. Roos
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim H. van Zwam
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Reinoud Bokkers
- Department of Radiology and Nuclear Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Martens
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Henk A. Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands ,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart J. Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Charles B. L. M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
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