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Ni H, Zhou C, Hang Y, Jia ZY, Cao YZ, Shi HB, Liu S, Zhao LB. Endovascular treatment for acute ischaemic stroke caused by isolated internal carotid artery occlusion: treatment strategies, outcomes, and prognostic factors. Clin Radiol 2023; 78:451-458. [PMID: 36932006 DOI: 10.1016/j.crad.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
AIM To describe the experience of endovascular treatment (EVT) of acute ischaemic stroke caused by isolated internal carotid artery (ICA) occlusion, with emphasis on treatment strategies, outcomes, and prognostic factors. MATERIALS AND METHODS A retrospective examination was performed of 66 consecutive patients with acute moderate-to-severe stroke who underwent EVT for isolated ICA occlusion from July 2016 to June 2021. The modified thrombolysis in cerebral ischaemia (mTICI) score was used to evaluate reperfusion outcomes. A multivariate analysis was performed to identify risk factors associated with poor 90-day outcome (modified Rankin Scale [mRS] 3-6). RESULTS The National Institutes of Health Stroke Scale (NIHSS) median score of the 66 patients at admission was 15. Twelve patients (18.2%) showed thrombus migration to the M1 segment or proximal M2 during EVT and underwent additional intracranial thrombectomy. Successful reperfusion (mTICI 2b-3) was achieved in 60 patients (90.9%) and complete reperfusion (mTICI 3) in 42 (63.6%). A poor functional outcome was seen in 27 patients (40.9%). The rate of 90-day mortality was 9.1% (6/66). Higher NIHSS scores and a lower Alberta Stroke Program Early CT Score (ASPECTS) were independently associated with poor outcomes. Complete reperfusion was the only treatment factor with a significant predictive value (adjusted odds ratio [OR] 0.03; 95% CI = 0.01 to 0.25; p=0.001). CONCLUSION Endovascular therapy is safe and effective in patients with acute ischaemic stroke due to isolated ICA occlusion. Prevention of thrombus migration and complete reperfusion should be the aim of EVT.
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Affiliation(s)
- H Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - C Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Y Hang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Z-Y Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Y-Z Cao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H-B Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - S Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - L-B Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Hou Y, Ren L, Cao C, Zhang H, Zhao W, Zhu J, Guo Z, Xia S. The additional value of high-resolution vessel wall imaging in screening suitable chronic internal carotid artery occlusion candidates for endovascular recanalization: comparison with digital subtraction angiography. Acta Radiol 2022; 64:1702-1711. [PMID: 36148918 DOI: 10.1177/02841851221127563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND High-resolution vessel wall imaging (HR-VWI) can provide information about exact occluded length, etiology, and the presence of intraluminal thrombus or residual cavity. PURPOSE To investigate the extra value of HR-VWI in screening patients with chronic internal carotid artery occlusion (CICAO) for recanalization suitability in comparison with digital subtraction angiography (DSA). MATERIAL AND METHODS We retrospectively reviewed patients who underwent endovascular recanalization with no internal carotid artery signal on magnetic resonance angiography (MRA) and whose both preoperative DSA and HR-VWI data were available. Patients were classified into type I (focal occlusion distal to ophthalmic artery), type II or III (occlusion proximal or at/distal to clinoid segment), and near-occlusion. Occlusion etiology and suitability for recanalization were analyzed both on preoperative DSA and HR-VWI. Accuracy of occlusion classification and differences in the modified Rankin scale scores between the baseline and follow-up were estimated. RESULTS A total of 20 patients were included. With intraoperative DSA as the gold standard, we found HR-VWI could additionally show intraluminal thrombi. Preoperative DSA misclassified one near-occlusion, one type I occlusion, and one type II occlusion as type III occlusions, and one near-occlusion as a type II occlusion. Therefore, compared with the preoperative DSA, three additional cases were successfully recanalized based on HR-VWI. The accuracy of HR-VWI was higher than preoperative DSA (100% vs. 80%). Prognosis improvement of type I was significantly better than type II and near-occlusion (P<0.05). CONCLUSION HR-VWI can identify occluded etiology, extent, and classification of CICAO. This information is potentially useful in screening candidates for endovascular recanalization and helpful to indicate prognosis.
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Affiliation(s)
- Yanwei Hou
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, PR China
| | - Lei Ren
- Medical Imaging Department, 74770First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, PR China
| | - Chen Cao
- Department of Radiology, Key Laboratory for Cerebral Artery and Neural Degeneration of Tianjin, Tianjin Huanhu Hospital, Tianjin, PR China
| | - Heliang Zhang
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, PR China
| | - Wei Zhao
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, PR China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, PR China
| | - Zaiyu Guo
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, PR China
| | - Shuang Xia
- Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, PR China
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Abstract
Objective: The high mortality rate associated with acute respiratory distress syndrome (ARDS) is a major challenge for intensive care units. In the present study, we applied bioinformatics and animal models to identify core genes and potential corresponding pathways in ARDS. Results: Using bioinformatics analysis, IL-1β was identified as the core gene of ARDS. Cell experiments showed that up-regulation of IL-1β downregulates claudin18 to promote lung barrier function damage by regulating the IL-1β-HER2/HER3 axis, further promoting the development of ARDS. This was validated in the animal models. Conclusion: IL-1β promotes the development of ARDS by regulating the IL-1β-HER2/HER3 axis. These findings deepen the understanding of the pathological mechanisms of ARDS. Methods: Transcription data sets related to ARDS were subjected to differential expression gene analysis, functional enrichment analysis, and receiver operating characteristic curve analysis and, so as to identify core genes in ARDS. Cell experiments were used to further explore the effects of core genes on lung barrier function damage. Animal models were applied to validate the effects of core gene in mediating biological signal pathways in ARDS.
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Song Y, Lee D, Suh DC, Kim JG, Kim JK, Han M, Liu H, Zhao L, Kim EH, Jung SC, Lee DG, Koo HJ, Kim MJ, Baek S, Hwang SM, Kim BJ, Kim YJ, Cho HJ, Kim SJ, Jeon SB, Kim JS. Cigarette Smoking Preferentially Affects Intracranial Vessels in Young Males: A Propensity-Score Matching Analysis. Neurointervention 2019; 14:43-52. [PMID: 30827064 PMCID: PMC6433193 DOI: 10.5469/neuroint.2018.01123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/18/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors. Materials and Methods All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups. Results Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup. Conclusion In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.
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Affiliation(s)
- Yunsun Song
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dongwhane Lee
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Joong-Goo Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hairi Liu
- Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, China
| | - Lingbo Zhao
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Eun Hye Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung Chul Jung
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dong-Geun Lee
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Marnat G, Bühlmann M, Eker OF, Gralla J, Machi P, Fischer U, Riquelme C, Arnold M, Bonafé A, Jung S, Costalat V, Mordasini P. Multicentric Experience in Distal-to-Proximal Revascularization of Tandem Occlusion Stroke Related to Internal Carotid Artery Dissection. AJNR Am J Neuroradiol 2018; 39:1093-1099. [PMID: 29700047 DOI: 10.3174/ajnr.a5640] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Internal carotid dissection is a frequent cause of ischemic stroke in young adults. It may cause tandem occlusions in which cervical carotid obstruction is associated with intracranial proximal vessel occlusion. To date, no consensus has emerged concerning endovascular treatment strategy. Our aim was to evaluate our endovascular "distal-to-proximal" strategy in the treatment of this stroke subtype in the first large multicentric cohort. MATERIALS AND METHODS Prospectively managed stroke data bases from 2 separate centers were retrospectively studied between 2009 and 2014 for records of tandem occlusions related to internal carotid dissection. Atheromatous tandem occlusions were excluded. The first step in the revascularization procedure was intracranial thrombectomy. Then, cervical carotid stent placement was performed depending on the functionality of the circle of Willis and the persistence of residual cervical ICA occlusion, severe stenosis, or thrombus apposition. Efficiency, complications, and radiologic and clinical outcomes were recorded. RESULTS Thirty-four patients presenting with tandem occlusion stroke secondary to internal carotid dissection were treated during the study period. The mean age was 52.5 years, the mean initial NIHSS score was 17.29 ± 6.23, and the mean delay between onset and groin puncture was 3.58 ± 1.1 hours. Recanalization TICI 2b/3 was obtained in 21 cases (62%). Fifteen patients underwent cervical carotid stent placement. There was no recurrence of ipsilateral stroke in the nonstented subgroup. Twenty-one patients (67.65%) had a favorable clinical outcome after 3 months. CONCLUSIONS Endovascular treatment of internal carotid dissection-related tandem occlusion stroke using the distal-to-proximal recanalization strategy appears to be feasible, with low complication rates and considerable rates of successful recanalization.
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Affiliation(s)
- G Marnat
- From the Interventional and Diagnostic Neuroradiology Department (G.M.), Bordeaux University Hospital, Bordeaux, France
| | - M Bühlmann
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - O F Eker
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - J Gralla
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - P Machi
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - U Fischer
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - C Riquelme
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - M Arnold
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - A Bonafé
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - S Jung
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - V Costalat
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - P Mordasini
- From the Interventional and Diagnostic Neuroradiology Department (G.M.), Bordeaux University Hospital, Bordeaux, France
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Lee SH, Suh DC, Cho SH, Sheen JJ, Lee DH, Kim JS. Subacute endovascular recanalization of symptomatic cerebral artery occlusion: a propensity score-matched analysis. J Neurointerv Surg 2017; 10:536-542. [PMID: 28899866 DOI: 10.1136/neurintsurg-2017-013219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The interval between the onset of cerebral vessel occlusion and recanalization has been shown to be an independent predictor of poor outcomes. However, endovascular recanalization of symptomatic cerebral vessel occlusion in the subacute period has not been well documented. We investigated the safety and efficacy of subacute recanalization of occluded cerebral vessels in patients with ischemic stroke or transient ischemic attacks (TIAs). METHODS Between 2014 and 2015, 98 patients were admitted to the emergency room for ischemic stroke or TIA with a small infarct core, which was defined as modest early ischemic change on non-contrast CT or overt diffusion-perfusion mismatch. All patients underwent pre-transfemoral cerebral angiography and post-endovascular treatment. The patients were classified according to acute (onset-to-groin puncture time ≤6 hours) or subacute (onset-to-groin puncture time >6 hours) recanalization. Using propensity score analysis, recipients of acute and subacute recanalization underwent 1:1 matching. RESULTS Following 1:1 propensity score matching, 32 patients who underwent acute and 32 who underwent subacute intra-arterial thrombolysis were matched. There were no significant differences in National Institutes of Health Stroke Scale at discharge, modified Rankin scale (mRS), the proportion of patients with an mRS value of 0-2, mortality at discharge, intracerebral bleeding, postprocedural infarct extension, newly detected infarction, and hyperintense acute reperfusion marker on follow-up images between the acute and subacute recanalization groups. CONCLUSIONS In selected patients with clinically unstable cerebral artery occlusions, a diffusion-perfusion mismatch and small CT lesions, subacute and acute recanalization has comparable safety and efficacy rates.
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Affiliation(s)
- Sang Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.,Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Hee Cho
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jae Jon Sheen
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Leng X, Fang H, Leung TWH, Mao C, Miao Z, Liu L, Wong KS, Liebeskind DS. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87:537-44. [PMID: 26063928 DOI: 10.1136/jnnp-2015-310965] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/19/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to investigate the role of pretreatment collateral status in predicting the efficacy and safety of endovascular treatment (EVT) in acute ischaemic stroke due to cervical and/or cerebral arterial occlusions. METHODS Relevant full-text articles published since 1 January 2000, investigating correlations between collateral status and any efficacy or safety outcome in patients undergoing EVT in cohort or case-control studies, or randomised clinical trials, were retrieved by PubMed and manual search. Two authors extracted data from eligible studies and assessed study quality. Risk ratios (RR) were pooled for good versus poor collaterals for outcomes based on a random-effects model. Sensitivity and subgroup analyses were conducted. RESULTS In total, 35 (3542 participants) and 23 (2652 participants) studies were included in qualitative review and quantitative meta-analysis, respectively. Overall, good pretreatment collaterals increased the rate of favourable functional outcome at 3 months (RR=1.98, 95% CI 1.64 to 2.38; p<0.001), and reduced the risks of periprocedural symptomatic intracranial haemorrhage (RR=0.59, 95% CI 0.43 to 0.81; p=0.001) and 3-month mortality (RR=0.49, 95% CI 0.38 to 0.63; p<0.001), as compared with poor collaterals, in patients with acute ischaemic stroke under EVT. No individual study could alter the estimate of overall effect of collateral status, but there were moderate to significant heterogeneities between subgroups of studies with different modes of EVT, different arterial occlusions and different collateral grading methods. CONCLUSIONS Good pretreatment collateral status is associated with higher rates of favourable functional outcome, and lower rates of symptomatic intracranial haemorrhage and mortality, in patients with acute ischaemic stroke receiving endovascular therapies.
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Affiliation(s)
- Xinyi Leng
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Hui Fang
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Chen Mao
- Division of Epidemiology, the Hong Kong Branch of the Chinese Cochrane Center, School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong
| | - Zhongrong Miao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ka Sing Wong
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - David S Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, California, USA
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Marnat G, Mourand I, Eker O, Machi P, Arquizan C, Riquelme C, Ayrignac X, Bonafé A, Costalat V. Endovascular Management of Tandem Occlusion Stroke Related to Internal Carotid Artery Dissection Using a Distal to Proximal Approach: Insight from the RECOST Study. AJNR Am J Neuroradiol 2016; 37:1281-8. [PMID: 26965467 DOI: 10.3174/ajnr.a4752] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/03/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Internal carotid artery dissection is a common cause of stroke in young adults. It may be responsible for tandem occlusion defined by a cervical steno-occlusive carotid wall hematoma associated with an intracranial large-vessel stroke. Intravenous thrombolysis is associated with a poor clinical outcome in these cases, and endovascular treatment has not been specifically evaluated to date. Our aim was to evaluate endovascular treatment technical and clinical efficiency in this specific occlusion topography, in comparison with treatment of isolated anterior circulation stroke. MATERIALS AND METHODS As part of our ongoing prospective stroke data base started in August 2009 (Prognostic Factors Related to Clinical Outcome Following Thrombectomy in Ischemic Stroke [RECOST] Study), we analyzed all carotid artery dissection tandem occlusion strokes and isolated anterior circulation occlusions. All patients were selected for endovascular treatment according to clinical-radiologic mismatch, NIHSS ≥ 7 and DWI-ASPECTS ≥5, within 6 hours after onset. For carotid artery dissection, the revascularization procedure consisted first of distal recanalization by a stent retriever in the intracranial vessel. Following assessment of the circle of Willis, internal carotid artery stent placement was only performed in case of insufficiency. Carotid artery dissection treatment efficacy, safety, and clinical outcome were compared with the results of the isolated anterior circulation occlusion cohort. RESULTS Two hundred fifty-eight patients with an anterior circulation stroke were analyzed, including 57 with tandem occlusions (22%); among them, 20 were carotid artery dissection-related occlusions (7.6%). The median age of patients with tandem occlusions with internal carotid dissection was 52.45 versus 66.85 years for isolated anterior circulation occlusion (P < .05); the mean initial NIHSS score was 17.53 ± 4.11 versus 17.55 ± 4.8 (P = .983). The median DWI-ASPECTS was 6.05 versus 6.64 (P = .098), and the average time from onset to puncture was 4.38 for tandem occlusions versus 4.53 hours in isolated anterior circulation occlusion (P = .704). Complication rates and symptomatic intracranial hemorrhage were comparable in both groups (5% versus 3%, P = .49). The duration of the procedure was significantly prolonged in case of tandem occlusion (80.69 versus 65.45 minutes, P = .030). Fourteen patients with carotid artery dissection (70%) had a 3-month mRS of ≤ 2, without a significant difference from patients with an isolated anterior circulation occlusion (44%, P = .2). Only 5 carotid artery dissections (25%) necessitated cervical stent placement. No early ipsilateral stroke recurrence was recorded, despite the absence of stent placement in 15 patients (75%) with carotid artery dissection. CONCLUSIONS Mechanical endovascular treatment of carotid artery dissection tandem occlusions is safe and effective compared with isolated anterior circulation occlusion stroke therapy. Hence, a more conservative approach with stent placement only in cases of circle of Willis insufficiency may be a reliable and safe strategy.
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Affiliation(s)
- G Marnat
- From the Department of Interventional and Diagnostic Neuroradiology (G.M.), Bordeaux University Hospital, Bordeaux, France
| | - I Mourand
- Departments of Neurology (I.M., C.A., X.A.)
| | - O Eker
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - P Machi
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - C Arquizan
- Departments of Neurology (I.M., C.A., X.A.)
| | - C Riquelme
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - X Ayrignac
- Departments of Neurology (I.M., C.A., X.A.)
| | - A Bonafé
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - V Costalat
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
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Yang Y, Liang C, Zhang Q, Shen C, Ma S, Mao J, Xu R. Analysis of prognostic factors of endovascular therapy in 59 patients with acute anterior circulation stroke: a retrospective cohort study – observational. Int J Surg 2015; 16:36-41. [PMID: 25743387 DOI: 10.1016/j.ijsu.2015.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/02/2015] [Accepted: 02/16/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Endovascular therapy (ET) is increasingly used for stroke patients out of the time window, based on the multimodal treatment (MMT) it can be used alone or in combination. The purpose of this study was to assess the outcome of intra-arterial thrombolysis (IAT) and MMT for acute anterior circulation ischemic stroke (ACIS), and reveal prognostic factors of ET in the authors' stroke center. METHODS A retrospective analysis of the data of 59 patients with ACIS who received ET from 2010 to 2014 in the stroke center was performed. A univariate analysis was conducted to reveal the differences between IAT and MMT, and the distinctions between favorable and unfavorable outcomes, logistic regression analysis was performed to determine the predictors of outcomes. RESULTS Thirty-four patients who accepted MMT had a higher baseline National Institutes of Health Stroke Scale score on admission (18.3 ± 4.2) compared with 25 patients who were treated with IAT (12.6 ± 4.3). The MMT group had a higher patent flow (23/34) (thrombolysis in myocardial infarction grade 2-3) compared with the IAT group (10/25). Moreover, the MMT group had a longer time for emergency department (ED) (5.8 ± 1.4) than the IAT group (5.2 ± 0.8). In multivariate analysis, age, time to ED, and NIHSS score at discharge are predictors for poor outcome, whereas perfect recanalization was associated with favorable outcome. CONCLUSION MMT might be suitable for patients with a severe admission NIHSS and a higher patency rate than IAT. Vessel recanalization was the only predictor for favorable outcome.
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Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital of Beijing Military Region, Beijing, China
| | - Chunyang Liang
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital of Beijing Military Region, Beijing, China.
| | - Qiang Zhang
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital of Beijing Military Region, Beijing, China
| | - Chunsen Shen
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital of Beijing Military Region, Beijing, China
| | - Shang Ma
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital of Beijing Military Region, Beijing, China
| | - Jinlong Mao
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital of Beijing Military Region, Beijing, China
| | - Ruxiang Xu
- Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital of Beijing Military Region, Beijing, China
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Liu H, Lee DG, Jung SC, Koo HJ, Kim EH, Hwang SM, Kim BJ, Kim Y, Cho HJ, Kim MJ, Baek SH, Jeon SB, Kim JS, Suh DC. A Study Design to Evaluate Association between Smoking and Intracranial Atherosclerotic Stenosis. Neurointervention 2014; 9:89-93. [PMID: 25426304 PMCID: PMC4239414 DOI: 10.5469/neuroint.2014.9.2.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/02/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose Smoking is a well known risk factor for stroke. The cerebral arteries may be uniquely susceptible to the atherosclerotic effects of smoking, such that it has a different risk profile for stroke compared with other atherosclerosis risk factors. It remains uncertain whether smoking is associated specifically with intracranial (IC) or extracranial (EC) atherosclerotic cerebrovascular disease. The aim of this study design will be to evaluate the association between smoking and severe IC stenosis, adjusting for other atherosclerosis risk factors, particularly age distribution. Study design This is a retrospective cohort study design. Participants are patients (n=1714) with severe atherosclerotic stenosis undergoing cerebral catheter angiography because of stroke or transient ischaemic attack. All atherosclerotic steno-occlusive lesions are described in terms of location (anterior versus posterior circulation, IC versus EC, or intradural versus extradural). The atherosclerotic or stroke risk factors for analysis include age, gender, smoking history, number of lesions (single versus multiple), cardiac disease, diabetes mellitus, hypertension, family history, dyslipidemia, history of previous stroke, alcohol intake, metabolic syndrome and body mass index. Statistical analysis includes univariate analysis followed by multivariate logistic regression. The relationship between IC atherosclerotic stenosis and smoking will be assessed. Differences in risk factor distribution is analysed according to age at intervals of 10 years. Significant risk factors associated with IC atherosclerotic stenosis will also be assessed by multivariate logistic regression analysis. Summary This is an analytical study design that intends to measure the association between IC or EC atherosclerotic stenosis and smoking and other risk factors. We anticipate that it will have the power to detect any relationship between smoking and IC atherosclerotic lesions especially in younger patients.
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Affiliation(s)
- Hairi Liu
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. ; Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province 225300, P. R. China
| | - Dong-Geun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Chul Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Hye Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yeonjung Kim
- Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hong Jun Cho
- Department of Family Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Hee Baek
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang-Beom Jeon
- Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Sung Kim
- Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Kappelhof M, Marquering HA, Berkhemer OA, Majoie CBLM. Intra-arterial treatment of patients with acute ischemic stroke and internal carotid artery occlusion: a literature review. J Neurointerv Surg 2014; 7:8-15. [DOI: 10.1136/neurintsurg-2013-011004] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kwak JH, Zhao L, Kim JK, Park S, Lee DG, Shim JH, Lee DH, Kim JS, Suh DC. The outcome and efficacy of recanalization in patients with acute internal carotid artery occlusion. AJNR Am J Neuroradiol 2013; 35:747-53. [PMID: 24091441 DOI: 10.3174/ajnr.a3747] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Acute occlusion of the ICA is often associated with poor outcomes and severe neurologic deficits. This study was conducted to evaluate outcome of the occluded ICA and efficacy of recanalization under protective flow arrest. MATERIALS AND METHODS Fifty consecutive patients who underwent endovascular treatment for acute ICA occlusion were identified from the prospectively collected data base. We assessed NIHSSo, occlusion type (cardioembolism vs atherosclerosis), occlusion level (supraclinoid-terminal, petrocavernous, or bulb-cervical), recanalization degree (TICI), and efficacy of recanalization (protective flow arrest vs nonprotection) leading to better outcome. RESULTS Successful recanalization (TICI ≥ 2) was obtained in 90% of patients and good recovery (mRS ≤ 2) in 60% of patients. Good outcome was related to National Institutes of Health Stroke Scale score on admission (P < .001), TICI (P < .007), occlusion type (P = .022), and occlusion level (P = .038). Poor initial patient status, less recanalization, cardioembolism, and supraclinoid-terminal occlusion were associated with poor prognosis. Application of protective flow arrest led to better outcome in the distal ICA segment than in the bulb-cervical segment. CONCLUSIONS In addition to the initial patient status and successful recanalization, the occlusion level or type of the occluded ICA could affect clinical outcome. In this study, treatment benefits of protective flow arrest were accentuated in patients with ICA occlusion above the bulb-cervical segment.
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Affiliation(s)
- J H Kwak
- From the Department of Radiology and Research Institute of Radiology (J.H.K., L.Z., S.P., D.-g.L., J.H.S., D.H.L., D.C.S.)
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Park S, Kim JH, Kwak JK, Baek HJ, Kim BH, Lee DG, Lee DH, Kim JS, Suh DC. Intracranial stenting for severe symptomatic stenosis: self-expandable versus balloon-expandable stents. Interv Neuroradiol 2013; 19:276-82. [PMID: 24070075 DOI: 10.1177/159101991301900303] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 02/08/2013] [Indexed: 11/15/2022] Open
Abstract
Intracranial atherosclerosis against optimal medical treatment requires reperfusion therapy to improve the clinical outcome. We compared outcomes between self-expandable stent (SES) and/or balloon-expandable stent (BES) and present the potential advantages of using each stent. During the same time frame before and after Wingspan introduction to our institute, 115 consecutive patients underwent intracranial stenting for symptomatic severe intracranial stenosis against optimal medical treatment using BES alone (n = 71) vs. BES or SES (n = 44). We analyzed 15 factors including outcome related to an adverse event (AE), modified Rankin Scale (mRS) and restenosis at six months and retrospectively compared the potential advantages of using each stent. BES or SES groups had a significantly lower AE rate (2.3%) than the BES only group (14%) (P = 0.049) revealing mRS of ≤ 2 in all patients at six months compared to 93% of the patients in the BES group. Analysis of BES or SES subgroups revealed that BES was associated with less residual stenosis after stenting than SES (18 vs. 32%; P < 0.001). Both SES and BES can improve the clinical outcome of intracranial stenting especially with a selective choice of SES or BES. Further study is needed to analyse the difference in long-term outcome and the restenosis rate between SES and BES.
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Affiliation(s)
- Soonchan Park
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center; Songpa-gu, Seoul, Korea - E-mail:
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Abstract
BACKGROUND In 2003, Higashida et al proposed the Thrombolysis In Cerebral Infarction scale to evaluate angiographic intracranial flow. Our aim is to review how subsequently published studies define TICI. MATERIALS AND METHODS We used the ISI Web of Knowledge and SciVerse Scopus databases to search for "TICI" and "thrombolysis in cerebral infarction" and for articles that cited the original TICI paper from January 2004 through May 2012. Articles were categorized according to their definition of the TICI categories, typically grades 0-4, with grade 2 (partial reperfusion) subdivided into 2a and 2b, and rate of contrast entry to the perfused area. In addition, we catalogued the type of redefinitions of TICI subcategory 2 and additions of new categories. RESULTS Of 236 articles screened, 74 were included. Eight (11%) explicitly followed the TICI scale as originally defined. Thirty-seven (50%) cited Higashida but did not define their scale. Fifteen (21%) used and explained modified scales. Thirteen (18%) used the term TICI, but did not define the scale and did not cite Higashida. Eighteen (24%) specified a 2a subcategory. Nine defined grade 2a as <67% filling, 6 defined it as <50%, and 3 did not offer a percentage. Two studies added a 2c subcategory. Fifty-two (70%) used a cutoff level to define "successful reperfusion." Of these, 65% used TICI ≥2, 33% used TICI ≥2b, and 2% used TICI = 3. CONCLUSIONS There is substantial variability in the definition and/or application of the TICI scale in the literature. This variability could considerably impact our understanding of results of revascularization studies.
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Kwak HS, Hwang SB, Jin GY, Hippe DS, Chung GH. Predictors of functional outcome after emergency carotid artery stenting and intra-arterial thrombolysis for treatment of acute stroke associated with obstruction of the proximal internal carotid artery and tandem downstream occlusion. AJNR Am J Neuroradiol 2012; 34:841-6. [PMID: 23139078 DOI: 10.3174/ajnr.a3304] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients who develop severe stroke symptoms due to acute internal carotid artery occlusion eventually in combination with a thromboembolic obstruction of the middle cerebral artery incur a major risk of developing extensive MCA infarction with a poor outcome. The purpose of this study was to evaluate the outcome for patients with tandem occlusions in the MCA and/or distal ICA, retrospectively, who had undergone stent implantation in the proximal segment of the ICA in addition to intra-arterial thrombolysis. MATERIALS AND METHODS Thirty-five patients with tandem occlusions of the MCA and/or distal ICA and acute occlusion of the proximal ICA underwent stent implantation for the proximal ICA occlusion and IAT for the tandem occlusion. Clinical outcome measures were assessed on admission and at discharge by using the National Institutes of Health Stroke Scale as well as 3 months after treatment by using the modified Rankin Scale. RESULTS The median NIHSS score on admission was 12 (range, 6-22). All patients had patent flow into the M1 and ICA after carotid artery stent placement and IAT. After the procedure, 19 patients (54.3%) were TICI grade III; 7 (20.0%), TICI grade IIb; and 9 (25.7%), TICI grade IIa. Symptomatic intracerebral hemorrhage occurred in 1 patient (2.9%). The overall mortality rate was 11.4% (4/35). At 3-month follow-up, the median NIHSS score was 4 (range, 1-17). NIHSS score at admission and TICI grade were all found to be independently associated with an unfavorable outcome at 3 months. CONCLUSIONS Initial stroke severity, degree of successful revascularization, and the side of ischemia were found to independently predict the functional outcome at 3 months after treatment.
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Affiliation(s)
- H S Kwak
- Department of Radiology and Research Institute of Medical Science, Chonbuk National University Medical School and Hospital, Chonbuk, South Korea.
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Li AH, Wang YH, Kao HF, Yang LH, Chan L, Chu SH, Liu HM. Aggressive revascularization of acute internal carotid artery occlusion in patients with NIHSS>20 and poor collateral circulation: Preliminary report. Int J Cardiol 2012; 161:97-102. [DOI: 10.1016/j.ijcard.2011.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 04/06/2011] [Accepted: 05/06/2011] [Indexed: 11/30/2022]
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Mokin M, Kass-Hout T, Kass-Hout O, Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI. Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. Stroke 2012; 43:2362-8. [PMID: 22811456 DOI: 10.1161/strokeaha.112.655621] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with extremely poor prognosis. The best treatment approach to acute stroke in this setting is unknown. We sought to determine clinical outcomes in patients with acute ischemic stroke attributable to ICA occlusion treated with intravenous (IV) systemic thrombolysis or intra-arterial endovascular therapy. METHODS Using the PubMed database, we searched for studies that included patients with acute ischemic stroke attributable to ICA occlusion who received treatment with IV thrombolysis or intra-arterial endovascular interventions. Studies providing data on functional outcomes beyond 30 days and mortality and symptomatic intracerebral hemorrhage (sICH) rates were included in our analysis. We compared the proportions of patients with favorable functional outcomes, sICH, and mortality rates in the 2 treatment groups by calculating χ(2) and confidence intervals for odds ratios. RESULTS We identified 28 studies with 385 patients in the IV thrombolysis group and 584 in the endovascular group. Rates of favorable outcomes and sICH were significantly higher in the endovascular group than the IV thrombolysis-only group (33.6% vs 24.9%, P=0.004 and 11.1% vs 4.9%, P=0.001, respectively). No significant difference in mortality rate was found between the groups (27.3% in the IV thrombolysis group vs 32.0% in the endovascular group; P=0.12). CONCLUSIONS According to our systematic review, endovascular treatment of acute ICA occlusion results in improved clinical outcomes. A higher rate of sICH after endovascular treatment does not result in increased overall mortality rate.
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Affiliation(s)
- Maxim Mokin
- FAHA, University at Buffalo Neurosurgery, State University of New York, 100 High Street, B4, Buffalo, NY 14203, USA
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Jeong YG, Kim EH, Hwang SM, Lee GY, Kim JW, Choi YJ, Kwak JH, Suh DC. Outpatient (Same-day care) Neuroangiography and Neurointervention. Neurointervention 2012; 7:17-22. [PMID: 22454780 PMCID: PMC3299945 DOI: 10.5469/neuroint.2012.7.1.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 01/20/2012] [Indexed: 11/24/2022] Open
Abstract
Purpose There have been few reports regarding same-day discharge following uncomplicated procedures such as cerebral angiography and neurointervention. We present same-day experience with cerebral angiography and neurointervention during the past three years. Materials and Methods Four hundred and fifty-three patients underwent cerebral angiography or neurointervention at Asan Medical Center between January 2009 and December 2011. Of these patients, 249 (55%) underwent diagnostic catheter cerebral angiography and 204 patients (45%) underwent neurointerventional procedures as same-day procedures. We analyzed any complications, the modified patient-care process, the yearly trend in patient increases, disease categories, and the additional duration of admission for these procedures. Results The number of overall patients increased by an average of 51% annually. The disease categories included aneurysm (51%), atherosclerosis (11%) and arteriovenous malformation (10%), etc. for which the patient underwent angiography, and aneurysm (42%), venous malformation (28%), and arteriovenous malformation (17%), etc. for which patients underwent neurointervention. Same-day care patients were admitted to the intermediary care unit in the angiosuite. Neurointervention patients were sent to the neurology intensive unit after the procedure. The same-day care patients stayed in angiosuite for six hours following the transfemoral procedure. The mean admission duration for neurointervention was 2.4 days. There were no reported complications for the same-day care procedures. Conclusion Our study revealed an increasing tendency toward same-day care for patients who require angiography and neurointervention. Further studies will be required to better define the cost-minimization effects of outpatient practice as well as the patient perception of this fast-tracking method. We propose that outpatient angiography and neurointervention will undoubtedly continue to increase over the next decade.
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Affiliation(s)
- Yun-Gyeong Jeong
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Park S, Kwak JH, Baek HJ, Park JW, Kim JS, Suh DC. The Use of Protection Device in Landmark-wire Technique of Symptomatic Subclavian Artery Occlusion with Combined Approach via Trans-femoral vs. Trans-brachial Arteries: Technical note. Neurointervention 2011; 6:89-94. [PMID: 22125755 PMCID: PMC3214817 DOI: 10.5469/neuroint.2011.6.2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/29/2011] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Since we reported about a landmark technique to reopen an occluded subclavian artery, we have faced difficulty in using protection devices in the vertebral artery to protect against thromboembolism from the reversed steal phenomenon after angioplasty and stenting. Therefore, we are presenting an optimal solution in using a protection device while recanalizing the occluded subclavian artery. MATERIALS AND METHODS Among 21 cases of stenting for subclavian artery steno-occlusion, we applied the landmark technique at the opposite end of an occluded segment in 4 patients and used a protection device in two patients. Because the embolic protection device was placed in the vertebral artery via the brachial artery, optimal angioplasty and stenting via the brachial route were limited. Therefore, angioplasty via the trans-brachial approach was needed to be followed by stenting through a trans-femoral approach. We estimated the safe and optimal steps for placement and retrieval of the protection devices in addition to stenting. RESULTS The procedure was safely performed when a stent was introduced via the femoral artery and a protection device was used via the brachial artery. However, in cases when a guidewire wasn't passed via the transfemoral route, simultaneous use of two systems via the brachial route could cause friction of devices or trapping of protection devices in a stent. When a protection device was trapped in a deployed stent, we retrieved the protection device with a 4F angiocatheter by selectively rotating the catheter tip. To avoid such procedural difficulty, we recommend using a transbrachial angioplasty followed by trans-femoral stenting while placing the protection device in the vertebral artery via the trans-brachial route. CONCLUSION If a guidewire is not passed through using a trans-femoral approach while performing the landmark technique, changing the stenting route from brachial to the femoral artery can be useful after securing the lumen in the occluded subclavian artery after angioplasty via the brachial artery.
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Affiliation(s)
- Soonchan Park
- Department of Diagnostic Radiology, Ajou University School of Medicine, Yeongtong-gu, Suwon, Korea
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Lü PH, Park JW, Park S, Kim JL, Lee DH, Kwon SU, Kim JS, Yun SC, Suh DC. Intracranial stenting of subacute symptomatic atherosclerotic occlusion versus stenosis. Stroke 2011; 42:3470-6. [PMID: 21940974 DOI: 10.1161/strokeaha.111.622282] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Limited data are available concerning the outcome of angioplasty/stenting for subacute atherosclerotic intracranial artery occlusion, which is often associated with progressive symptom development in the salvageable brain under ischemic threat due to poor collateral blood supply. METHODS Among 177 patients who underwent angioplasty and/or stenting for severe symptomatic intracranial steno-occlusion, 26 had subacute atherosclerotic intracranial artery occlusion. Outcome after stenting (N=22) was assessed according to procedural success (return of antegrade flow and residual stenosis<50%), adverse event (any stroke or death) rate, and restenosis (>50%) using weighted Cox proportional hazards regression in the overall cohort and in separate subgroups. RESULTS Successful recanalization was achieved in 95%. Three adverse events (13.6%) occurred among patients undergoing stenting for occlusion, including 2 major strokes and 1 nonprocedure-related death. Good outcome (modified Rankin Scale≤2) was achieved in 73%. In the overall cohort, no significant difference was observed between the occlusion and stenosis groups in terms of the risk of adverse events (hazard ratio for the occlusion group, 1.055; 95% CI, 0.29-3.90) or the risk of restenosis (hazard ratio for the occlusion group, 1.2; 95% CI, 0.19-7.72). A trend toward a higher rate of adverse events was observed in older age (>65 years), progressive worsening, balloon-expandable stent, and no history of a preprocedural P2Y12 assay. CONCLUSIONS In a cohort of patients undergoing angioplasty/stenting for subacute atherosclerotic intracranial artery occlusion, no significant difference in the rates of adverse events was observed. However, several factors, including age, tended to be associated with a higher event rate.
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Affiliation(s)
- Peng-Hua Lü
- Department of Radiology, University of Ulsan, College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
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Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg 2011; 54:e1-31. [PMID: 21889701 DOI: 10.1016/j.jvs.2011.07.031] [Citation(s) in RCA: 434] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 06/21/2011] [Accepted: 07/12/2011] [Indexed: 11/30/2022]
Affiliation(s)
- John J Ricotta
- Washington Hospital Center, Georgetown University School of Medicine, Washington, DC 20010, USA.
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Choi BS, Park JW, Shin JE, Lü PH, Kim JK, Kim SJ, Lee DH, Kim JS, Kim HJ, Suh DC. Outcome evaluation of carotid stenting in high-risk patients with symptomatic carotid near occlusion. Interv Neuroradiol 2010; 16:309-16. [PMID: 20977866 PMCID: PMC3277987 DOI: 10.1177/159101991001600314] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 06/07/2010] [Indexed: 11/15/2022] Open
Abstract
Management of symptomatic carotid near occlusion especially in high-risk patients is different from outcome analysis of NASCET. We evaluated outcome in high-risk patients with symptomatic near occlusion. For 48 patients with near occlusion out of 166 symptomatic high-risk patients who underwent carotid stenting, we assessed the procedural success defined as residual stenosis <30%, modified Rankin Scale (mRS) at one and six months following stenting, and the 13 cerebrovascular factors related to the outcome. Initial National Institutes of Health Stroke Scale (NIHSS) ≥4, 1-3 and 0 were 13, 14 and 21 patients each. We compared the outcome with patients who underwent CAS (n=118) due to symptomatic stenosis without near occlusion during the same period. Our procedural success rate was 98%. A good outcome (mRS ≤2) was achieved in 44 patients (92%) at six months. There were five events (10%) within six months, i.e. three minor strokes, one major stroke caused by hemorrhage, and one death excluding two deaths not related to stroke. Hyperperfusion (n=4) was the most common cause of events leading to two minor strokes and a major stroke. Although initial NIHSS (P = .012) was related to poor outcome (mRS >2) compared to the CAS group, there was no statistical significance between two groups in the event rate of stroke, death or restenosis. The outcome of carotid stenting in high-risk patients with symptomatic near occlusion did not reveal any difference compared with CAS. Poor outcome was related to the initial NIHSS (≥4). Hyperperfusion tended to be more commonly related to an event occurring after stenting.
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Affiliation(s)
- B S Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan, Seoul, Korea
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Arkadir D, Eichel R, Cohen JE, Itshayek E, Gomori JM, Ben-Hur T, Rosenthal G, Leker RR. Decompressive hemicraniectomy improves outcome in patients with failed arterial recanalization after acute carotid artery occlusion. Neurol Res 2010; 32:1077-82. [PMID: 20483027 DOI: 10.1179/016164110x12700393823372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Decompressive hemicraniectomy reduces morbidity and mortality in patients with large hemispheric stroke. However, its role in patients that underwent failed endovascular reperfusion remains unknown. METHODS Patients with acute stroke secondary to internal carotid artery occlusion who underwent endovascular multimodal reperfusion therapy were evaluated. Patients with failed revascularization who were referred for decompressive hemicraniectomy were compared with patients with failed reperfusion who did not undergo decompressive hemicraniectomy. Functional outcome was assessed with the modified Rankin Score (mRS) and neurological disability with the NIH Stroke Scale Score (NIHSS) at 90 days from stroke onset. RESULTS Six decompressive hemicraniectomy-treated patients were included (four females, mean age: 36.7 years, mean NIHSS: 24.5). None of the decompressive hemicraniectomy-treated patients died compared to six of seven patients with failed multi-modal reperfusion therapy that did not undergo decompressive hemicraniectomy. All decompressive hemicraniectomy-treated patients were discharged to a rehabilitation facility whereas the only surviving non-decompressive hemicraniectomy-treated patient was discharged to a nursing facility. Five of the six decompressive hemicraniectomy-treated (84%) and none of the non-decompressive hemicraniectomy-treated patients had an mRS ≤ 3 at 90 days post-stroke. DISCUSSION Decompressive hemicraniectomy can significantly improve functional outcome in patients with large carotid artery strokes that failed to recanalize following multi-modal reperfusion therapy. These results imply that decompressive hemicraniectomy should be planned in patients who undergo multi-modal reperfusion therapy for large carotid artery stroke.
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Affiliation(s)
- David Arkadir
- Department of Neurology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Liu S, Hee Jung J, Kwon HJ, Kim SM, Suh DC. Landmark-wire technique of symptomatic subclavian artery occlusion. Interv Neuroradiol 2010; 15:401-5. [PMID: 20465876 DOI: 10.1177/159101990901500404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 09/05/2009] [Indexed: 11/15/2022] Open
Abstract
SUMMARY The landmark at the opposite end of an occluded segment can be used for probing the occluded subclavian artery to be recanalized. Using this technique in three patients with symptomatic subclavian artery occlusion, we found the landmark-wire technique to be safe and effective for reopening completely occluded subclavian arteries. We also introduced a technique in which a protective device can be safely used throughout the stenting procedure.
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Affiliation(s)
- S Liu
- Asan Medical Center, University of Ulsan, College of Medicine; Seoul, Korea - The First Affiliated Hospital of Nanjing Medical University, Nanjing, China -
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Oh TS, Ko YB, Park ST, Yoon K, Lee SW, Park JW, Kim JL, Kim B, Park SO, Kim JS, Suh DC. Computational Flow Dynamics Study in Severe Carotid Bulb Stenosis with Ulceration. Neurointervention 2010. [DOI: 10.5469/neuroint.2010.5.2.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tack Sun Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Korea
| | - Young Bae Ko
- Department of Mechanical Engreering, Dankook University, Korea
| | - Sung-Tae Park
- Department of Radiology, Soonchunhyang University Hospital, Korea
| | - Kyunghwan Yoon
- Department of Mechanical Engreering, Dankook University, Korea
| | - Sang-Wook Lee
- School of Mechanical and Automotive Engineering University of Ulsan, Korea
| | - Jee Won Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Korea
| | - Jong Lim Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Korea
| | - Bohyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Korea
| | - Sang-Ok Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Korea
| | - Jong Sung Kim
- Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Korea
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Park S, Lim OK, Youn JH, Kim TI, Hwang SM, Kim HS, Shim J, Kim EH, Jeong YG, Lee HY, Kim B, Lee DH, Suh DC. Optimization of Exposure Condition and Photographic Techniques for Specimen and Devices in Neuroangiographic Suites. Neurointervention 2010. [DOI: 10.5469/neuroint.2010.5.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Soonchan Park
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ok Kyun Lim
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Ho Youn
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae il Kim
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Han Soo Kim
- E-med Team, Asan Medical Center, Seoul, Korea
| | - Jaegeun Shim
- Digital Imaging Community Photo some, Shinsa-dong, Gangnam-gu, Seoul, Korea
| | - Eun Hye Kim
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yun Gyeong Jeong
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ha Young Lee
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Suh DC, Kim EH. The therapeutic time window related to the presenting symptom pattern, that is, stable versus unstable patients, can affect the adverse event rate of intracranial stenting. Stroke 2009; 40:e588-9; author reply e590. [PMID: 19745184 DOI: 10.1161/strokeaha.109.558817] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Korea.
| | - A-Hyun Cho
- Department of Neurology, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea.
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Choi JW, Kim JK, Choi BS, Kim JH, Hwang HJ, Kim JS, Kim SJ, Suh DC. Adjuvant revascularization of intracranial artery occlusion with angioplasty and/or stenting. Neuroradiology 2009; 51:33-43. [DOI: 10.1007/s00234-008-0462-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 09/10/2008] [Indexed: 10/21/2022]
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Affiliation(s)
- David M. Pelz
- From the University Hospital (D.M.P.), London Health Sciences Centre, Departments of Diagnostic Radiology and Nuclear Medicine, and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada; Department of Neurosurgery (E.I.L., L.N.H.), Millard Fillmore Gates Hospital, Kaleida Health; Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University New York, Buffalo, New York,
| | - Elad I. Levy
- From the University Hospital (D.M.P.), London Health Sciences Centre, Departments of Diagnostic Radiology and Nuclear Medicine, and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada; Department of Neurosurgery (E.I.L., L.N.H.), Millard Fillmore Gates Hospital, Kaleida Health; Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University New York, Buffalo, New York,
| | - L. Nelson Hopkins
- From the University Hospital (D.M.P.), London Health Sciences Centre, Departments of Diagnostic Radiology and Nuclear Medicine, and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada; Department of Neurosurgery (E.I.L., L.N.H.), Millard Fillmore Gates Hospital, Kaleida Health; Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University New York, Buffalo, New York,
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