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Liang Q, Feng M, Galecio-Castillo M, Awad A, Chen J, Luo L, Liang W, Ma J, Zhou S, Dmytriw AA, Pico F, Lai Y, Liu L, Chen Y, Sun Y, Yang S. Predictors of favorable functional outcomes for elderly patients undergoing endovascular thrombectomy for acute ischemic stroke. Eur J Med Res 2024; 29:429. [PMID: 39169421 PMCID: PMC11337892 DOI: 10.1186/s40001-024-02027-8] [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: 05/18/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE The aim of this study was to identify factors that predict favorable functional outcomes in elderly patients with large-vessel occlusion acute ischemic stroke (LVO-AIS) who underwent mechanical thrombectomy (MT). METHODS We conducted a retrospective observational study using the prospectively maintained Bigdata Observatory for Stroke of China (BOSC) to identify eligible patients who underwent MT for LVO-AIS at four comprehensive stroke centers between August 2019 and February 2022. Inclusion criteria included patients aged 80 years or older with a baseline modified Rankin Scale (mRS) 0-2, baseline National Institutes of Health Stroke Scale (NIHSS) > 6, baseline Alberta Stroke Program Early CT Score (ASPECTS) > 6 who received treatment within 24 h from symptom onset. Pertinent demographic, clinical, and procedural variables were collected. Multivariable regression analyses were performed to identify predictors of favorable long-term functional outcomes, defined as mRS 0-2 at 90 days. RESULTS A total of 63 patients were included in the study with a mean age of 83 years. Patients with previous diagnosis of atrial fibrillation were more likely to have a favorable functional outcome (OR 2.09, 95% CI 2.09-407.33, p = 0.012), while a higher baseline NIHSS was associated with a less favorable functional outcome (OR 0.64, 95% CI 0.46-0.89, p = 0.007). In addition, there was an observed trend suggesting an association between higher baseline ASPECTS and favorable functional outcomes. This association did not reach statistical significance (OR 2.49, 95% CI 0.94-6.54, p = 0.065). CONCLUSION In this study, we identified factors that predicted a favorable functional outcome in elderly LVO-AIS patients undergoing MT. A higher baseline NIHSS decreased the odds of mRS 0-2 at 90 days, whereas a history of atrial fibrillation increased the odds of a favorable functional outcome. These results emphasize the complex relationship between clinical factors and functional recovery in this vulnerable population.
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Affiliation(s)
- Qingjia Liang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
- Department of Internal Medicine, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Mingzhu Feng
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Milagros Galecio-Castillo
- Cerebrovascular & Neurointerventional Lab, Department of Neurology, University of Iowa, Hospitals & Clinics, Iowa, USA
| | - Amine Awad
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jincheng Chen
- Medical Intern of Neurology, Foshan Sanshui District People's Hospital, Foshan, 528100, Guangdong Province, China
| | - Lanzhu Luo
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Wenjun Liang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Jicai Ma
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China
| | - Sijie Zhou
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernando Pico
- Department of Neurology and Stroke Center, Versailles Mignot Hospital, Paris, France
| | - Yuzheng Lai
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, 528000, Guangdong Province, People's Republic of China
| | - Lingjuan Liu
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Yu Sun
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China.
- Department of Neurology, Xiapu County Hospital, Ningde, Fujian Province, China.
| | - Shuiquan Yang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China.
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Gupta D, D’Anna L, Klein P, Araujo-Contreras R, Kaliaev A, Abdalkader M, Hu W, Nguyen TN. Endovascular Treatment for Basilar Artery Occlusion. J Clin Med 2024; 13:4153. [PMID: 39064193 PMCID: PMC11278164 DOI: 10.3390/jcm13144153] [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: 05/10/2024] [Revised: 06/24/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Basilar artery occlusion (BAO) is a neurological emergency associated with a high risk for adverse outcomes. This review provides evidence on the therapeutic efficacy of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in the treatment of BAO. Historically considered the primary intervention for acute ischemic stroke, IVT has been progressively combined with EVT, which has emerged from recent studies demonstrating clinical benefits, notably in patients presenting with severe stroke. Several randomised controlled trials have shown that EVT improves patient outcomes in select clinical contexts. Future research directions could address therapeutic treatment thresholds, combination strategies, and long-term outcomes.
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Affiliation(s)
- Devansh Gupta
- Smt. Kashibai Navale Medical College and General Hospital, Pune 411041, India;
| | | | - Piers Klein
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA; (P.K.); (R.A.-C.)
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA; (A.K.); (M.A.)
| | - Robert Araujo-Contreras
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA; (P.K.); (R.A.-C.)
| | - Artem Kaliaev
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA; (A.K.); (M.A.)
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA; (A.K.); (M.A.)
| | - Wei Hu
- The First Affiliated Hospital of University of Science and Technology of China, Hefei 230026, China;
| | - Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA; (P.K.); (R.A.-C.)
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA; (A.K.); (M.A.)
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Klein P, Huo X, Chen Y, Abdalkader M, Qiu Z, Nagel S, Raymond J, Liu L, Siegler JE, Strbian D, Field TS, Yaghi S, Qureshi MM, Demeestere J, Puetz V, Berberich A, Michel P, Fischer U, Kaesmacher J, Yamagami H, Alemseged F, Tsivgoulis G, Schonewille WJ, Hu W, Liu X, Li C, Ji X, Drumm B, Banerjee S, Sacco S, Sandset EC, Kristoffersen ES, Slade P, Mikulik R, Romoli M, Diana F, Krishnan K, Dhillon P, Lee JS, Kasper E, Dasenbrock H, Ton MD, Masiliūnas R, Arsovska AA, Marto JP, Dmytriw AA, Regenhardt RW, Silva GS, Siepmann T, Sun D, Sang H, Diestro JD, Yang P, Mohammaden MH, Li F, Masoud HE, Ma A, Raynald, Ganesh A, Liu J, Meyer L, Dippel DWJ, Thomalla G, Parsons M, Qureshi AI, Goyal M, Yoo AJ, Lapergue B, Zaidat OO, Chen HS, Campbell BCV, Jovin TG, Nogueira RG, Miao Z, Saposnik G, Nguyen TN. Specialist Perspectives on the Imaging Selection of Large Vessel Occlusion in the Late Window. Clin Neuroradiol 2023; 33:801-811. [PMID: 37010551 PMCID: PMC10069362 DOI: 10.1007/s00062-023-01284-0] [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: 01/04/2023] [Accepted: 02/23/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The proper imaging modality for use in the selection of patients for endovascular thrombectomy (EVT) presenting in the late window remains controversial, despite current guidelines advocating the use of advanced imaging in this population. We sought to understand if clinicians with different specialty training differ in their approach to patient selection for EVT in the late time window. METHODS We conducted an international survey of stroke and neurointerventional clinicians between January and May 2022 with questions focusing on imaging and treatment decisions of large vessel occlusion (LVO) patients presenting in the late window. Interventional neurologists, interventional neuroradiologists, and endovascular neurosurgeons were defined as interventionists whereas all other specialties were defined as non-interventionists. The non-interventionist group was defined by all other specialties of the respondents: stroke neurologist, neuroradiologist, emergency medicine physician, trainee (fellows and residents) and others. RESULTS Of 3000 invited to participate, 1506 (1027 non-interventionists, 478 interventionists, 1 declined to specify) physicians completed the study. Interventionist respondents were more likely to proceed directly to EVT (39.5% vs. 19.5%; p < 0.0001) compared to non-interventionist respondents in patients with favorable ASPECTS (Alberta Stroke Program Early CT Score). Despite no difference in access to advanced imaging, interventionists were more likely to prefer CT/CTA alone (34.8% vs. 21.0%) and less likely to prefer CT/CTA/CTP (39.1% vs. 52.4%) for patient selection (p < 0.0001). When faced with uncertainty, non-interventionists were more likely to follow clinical guidelines (45.1% vs. 30.2%) while interventionists were more likely to follow their assessment of evidence (38.7% vs. 27.0%) (p < 0.0001). CONCLUSION Interventionists were less likely to use advanced imaging techniques in selecting LVO patients presenting in the late window and more likely to base their decisions on their assessment of evidence rather than published guidelines. These results reflect gaps between interventionists and non-interventionists reliance on clinical guidelines, the limits of available evidence, and clinician belief in the utility of advanced imaging.
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Affiliation(s)
- Piers Klein
- Neurology, Boston Medical Center, Boston, USA
- Radiology, Boston Medical Center, Boston, USA
| | - Xiaochuan Huo
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Yimin Chen
- Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mohamad Abdalkader
- Radiology, Boston Medical Center, Boston, USA
- Neurology, St. Elizabeth's Medical Center, Boston, USA
| | - Zhongming Qiu
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Simon Nagel
- Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
- Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jean Raymond
- Interventional Neuroradiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Liping Liu
- Neurology, Beijing Tiantan Hospital, Beijing, China
| | | | - Daniel Strbian
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Thalia S Field
- Neurology, University of British Columbia, Vancouver, Canada
| | - Shadi Yaghi
- Neurology, Rhode Island Hospital, Providence, USA
| | | | | | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | | | - Patrik Michel
- Stroke Center/Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Urs Fischer
- Neurology, Basel University Hospital, Basel, Switzerland
| | - Johannes Kaesmacher
- Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | | | | | | | | | - Wei Hu
- Stroke Center, The First Affiliated Hospital of USTC, Hefei, China
| | - Xinfeng Liu
- Stroke Center, The First Affiliated Hospital of USTC, Hefei, China
| | | | - Xunming Ji
- Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Brian Drumm
- Stroke Medicine, Imperial College Healthcare, London, UK
| | - Soma Banerjee
- Stroke Medicine, Imperial College Healthcare, London, UK
| | - Simona Sacco
- Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Peter Slade
- Morriston Hospital, Swansea Hospital, Swansea, Wales, UK
| | - Robert Mikulik
- Neurology, St Anne's University Hospital, Brno, Czech Republic
| | | | - Francesco Diana
- Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Kailash Krishnan
- Stroke, Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Permesh Dhillon
- Interventional Neuroradiology, Nottingham University Hospitals, Nottingham, UK
| | - Jin Soo Lee
- Neurology, Ajou University Hospital, Suwon, Korea (Republic of)
| | - Ekkehard Kasper
- Neurosurgery, Boston Medical Center, Boston, USA
- Neurosurgery, St. Elizabeth's Medical Center, Boston, USA
| | - Hormuzdiyar Dasenbrock
- Neurosurgery, Boston Medical Center, Boston, USA
- Neurosurgery, St. Elizabeth's Medical Center, Boston, USA
| | - Mai Duy Ton
- Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam
- Neurology, Vietnam National University of Medicine and Pharmacy, Hanoi, Vietnam
| | | | | | | | - Adam A Dmytriw
- Neurointerventional, London Health Sciences Centre, London, Canada
- Neuroendovascular, Massachusetts General Hospital, Boston, USA
| | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo (UNIFESP) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Dapeng Sun
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Hongfei Sang
- Neurology, Affiliated Hangzhou First People's Hospital, Hangzhou, China
| | - Jose Danilo Diestro
- Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Pengfei Yang
- Neurosurgery, Changhai Hospital, Shanghai, China
| | | | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | | | - Alice Ma
- Royal North Shore Hospital, Sydney, Australia
| | - Raynald
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | | | - Jianmin Liu
- Neurosurgery, Changhai Hospital, Shanghai, China
| | - Lukas Meyer
- Interventionelle Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Götz Thomalla
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Parsons
- South Western Sydney Clinical School, Liverpool Hospital, Liverpool, Australia
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, USA
| | - Mayank Goyal
- Radiology, University of Calgary, Calgary, Canada
| | - Albert J Yoo
- Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, USA
| | | | - Osama O Zaidat
- Neuroscience, Mercy Health St Vincent Hospital, Toledo, OH, USA
| | - Hui-Sheng Chen
- Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Bruce C V Campbell
- Royal Melbourne Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | | | - Raul G Nogueira
- Neurology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Zhongrong Miao
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit, University of Toronto, Toronto, Canada
| | - Thanh N Nguyen
- Neurology, Boston Medical Center, Boston, USA.
- Radiology, Boston Medical Center, Boston, USA.
- Neurology, St. Elizabeth's Medical Center, Boston, USA.
- Neurosurgery, Boston Medical Center, Boston, USA.
- Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center, 85 East Concord Street, 02118, Boston, MA, USA.
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Räty S, Nguyen TN, Nagel S, Puetz V, Alemseged F, Abdalkader M, Schonewille WJ, Strbian D. What Is the Evidence for Endovascular Thrombectomy in Posterior Circulation Stroke? Semin Neurol 2023; 43:345-355. [PMID: 37595603 DOI: 10.1055/s-0043-1771210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Posterior circulation infarcts comprise approximately 25% of ischemic strokes but are less often treated with recanalization therapy and have longer treatment delays compared with anterior circulation strokes. Among posterior circulation strokes, basilar artery occlusion is associated with the most severe deficits and the worst prognosis. Endovascular thrombectomy is a standard of care for patients with anterior circulation large vessel occlusion, but not until recently were the first randomized controlled trials on endovascular thrombectomy in basilar artery occlusion published. Two of the trials were neutral, whereas two others showed better functional outcome after thrombectomy up to 24 hours of symptom onset compared with best medical treatment, which in most cases had low rates of intravenous thrombolysis. According to observational data, thrombectomy seems to be safe also in isolated posterior cerebral artery occlusions and might be an option for selected patients, even if its outcome benefit is yet to be demonstrated.
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Affiliation(s)
- Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen/Rhein, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Fana Alemseged
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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