Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation-a single center study

Mechanical thrombectomy (MT) is the current standard treatment for strokes in the anterior cerebral circulation (AMT) and has recently been proven to be beneficial in the posterior circulation strokes (PMT). Our study aims to evaluate parameters for favorable outcomes in PMT-patients and to compare the clinical characteristics of individuals who received AMT and PMT. For this purpose, we confronted AMT and PMT-receipients and performed a multivariate regression analysis to assess the influence of factors on favorable outcomes in the study group and in the AMT and PMT subgroups. When analysing 623 MT-patients, those who received PMT had significantly lower admission National Institutes of Health Stroke Scale (NIHSS) scores (9 vs. 13; p < 0.001) and 24 h post-MT (7 vs. 12; p = 0.006). Key parameters influencing the favorable outcomes of PMT at discharge and at 90th day include: NIHSS scores (OR: 0.865, 95% CI: 0.813-0.893, and OR: 0.900, 95% CI: 0.861-0.925), MT time (OR: 0.993, 95% CI: 0.987-0.998 and OR: 0.993, 95% CI: 0.990-0.997), and leukocytosis (OR: 0.961, 95% CI: 0.928-0.988 and OR: 0.974, 95% CI: 0.957-0.998). Different clinical profiles exist between AMT and PMT-recipients, with the neurological status post-MT being decisive for the prognosis. Several factors play an important role in predicting outcome, especially in the PMT group.

Epileptiform activity in the acute phase of stroke predicts the outcomes in patients without seizures

Background and purpose

The abnormalities in EEG of stroke-patients increase the risk of epilepsy but their significancy for poststroke outcome is unclear. This presented study was aimed at determining the prevalence and nature of changes in EEG recordings from the stroke hemisphere and from the contralateral hemisphere. Another objective was to determine the significance of abnormalities in EEG in the first days of stroke for the post-stroke functional status on the acute and chronic phase of disease.

Methods

In all qualified stroke-patients, EEG was performed during the first 3 days of hospitalization and at discharge. The correlation between EEG abnormalities both in the stroke hemisphere and in the collateral hemisphere with the neurological and functional state in various time points was performed.

Results

One hundred thirty-one patients were enrolled to this study. Fifty-eight patients (44.27%) had abnormal EEG. The sporadic discharges and generalized rhythmic delta activity were the most common abnormalities in the EEG. The neurological status on the first day and the absence of changes in the EEG in the hemisphere without stroke were the independent factors for good neurological state (0–2 mRS) at discharge. The age-based analysis model (OR 0.981 CI 95% 0.959–1.001, p = 0.047), neurological status on day 1 (OR 0.884 CI 95% 0.82–0.942, p &lt; 0.0001) and EEG recording above the healthy hemisphere (OR 0.607 CI 95% 0.37–0.917, p = 0.028) had the highest prognostic value in terms of achieving good status 90 days after stroke.

Conclusions

Abnormalities in EEG without clinical manifestation are present in 40% of patients with acute stroke. Changes in EEG in acute stroke are associated with a poor neurological status in the first days and poor functional status in the chronic period of stroke.

Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients

INTRODUCTION

The relevance of diabetes mellitus (DM) to the efficacy of mechanical thrombectomy (MT) has been the subject of few studies and with only inconclusive results.

OBJECTIVES

This study aimed to evaluate the effect of DM and admission hyperglycaemia on the efficacy and safety of MT in stroke patients.

MATERIAL AND METHODS

This retrospective study analysis focused on the relevance of admission hyperglyacemia and DM to the functional status of patients treated with MT at the Upper Silesian Medical Centre of the Silesian Medical University in Katowice, Poland.

RESULTS

417 stroke patients (median age 70 years) were qualified for the study. There were 103 patients (24.70%) with DM. Admission hyperglycaemia ≥ 140 mg% was found in 91 patients (21.82%), of whom 69 were diagnosed with DM before or during hospitalisation. The parameters with the strongest effect on the functional status on days 7, 90 and 365 were: age, and neurological status according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of ischaemic stroke before MT. The angiographic effect indirect after MT and patient functional status on days 7, 90 and 365 were comparable between the groups, regardless of the DM burden. The frequency of symptomatic intracranial bleeding 24 hours after MT was comparable between patients with and patients without DM (p = 0.092). Model based on parameters were age, NIHSS on the first day of ischaemic stroke, an when score in Thrombolysis In Cerebral Infarct (TICI) showed good predictive attributes for the functional status of patients in the acute period (day 7). Age, a lack of admission hyperglycaemia, and the neurological state on day 1 of ischaemic stroke (before MT) were the key parameters for a favourable outcome (≤ 2 points on the modified Rankin Scale, mRS) on day 90. Admission hyperglycaemia ≥ 140 mg/dL, regardless of the presence or absence of DM, had a negative effect on achieving a good functional status one week after stroke onset.

CONCLUSIONS

Diabetes mellitus has a neutral effect on the angiographic and clinical outcomes of mechanical thrombectomy in stroke patients. It does not increase the risk of intracranial haemorrhage after instrumental therapy. It is admission hyperglycaemia, rather than diabetes mellitus, that is a predictor of poor functional status in patients treated with thrombectomy. According to our results, the patient's neurological status, age, and the outcome of thrombectomy are relevant to the functional status in the acute ischaemic stroke period.

The relevance of atrial fibrillation to the safety and efficacy of mechanical thrombectomy in stroke patients

INTRODUCTION

The relevance of atrial fibrillation (AF) to the effect of mechanical thrombectomy (MT) in stroke patients is undetermined.

OBJECTIVES

This study aimed to evaluate the effect of AF on MT in stroke patients.

PATIENTS AND METHODS

The patients who were qualified for the study underwent MT for stroke; the study analysis focused on the relevance of AF to the safety and efficacy of MT.

RESULTS

417 stroke patients (median 70 years) were qualified for the retrospective study. There were 108 patients with AF (25.89%). The mean age of AF patients was significantly higher than that of the patients without AF (mean 73.77 (8.97) vs 65.70 (18.88). The percentage of patients whose functional status was poor on days 10, 30 and 90 was higher among AF patients than that of the patients without AF. There were no statistically significant differences between the groups in relation to the percentage of patients with intracranial bleeding or deaths. These parameters had the strongest effect on the functional status on days 10, 30 and 90 following stroke: age, neurological status, and TICI score.

CONCLUSIONS

AF has a neutral effect on the outcome of MT in patients treated due to acute stroke. Age, degree of post-interventional reperfusion and neurological status in the ultra-acute phase of stroke are crucial for functional status of patients who were subjected to MT. The exposure to anticoagulant therapy before stroke does not increase significantly the risk of intracranial bleeding after MT.

Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

To date, inconsistent results evaluating the effect of parameters on mechanical thrombectomy (MT) outcomes in stroke-patients have been published. This study aimed to identify the key parameters for functional status after MT in stroke-patients in short and long-term follow-up.

METHOD

The study analysis focused on the relevance of selected clinical and non-clinical parameters to the functional status of the patients after MT.

RESULTS

417 stroke-patients (mean age 67.8 ± 13.2 years) were qualified. Atrial fibrillation, and leukocytosis were significant for the neurological status on the first day of stroke (p = 0.036, and p = 0.0004, respectively). The parameters with the strongest effect on the functional status on day 10 were: age (p = 0.009), NIHSS (p = 0.002), hyperglycemia (p = 0.009), the result in TICI (p = 0.046), and first pass effect (p = 0.043). The parameters with the strongest effect on the functional status on day 365 were: age and NIHSS on the first day of stroke (p = 0.0002 and 0.002, respectively). Leukocytosis and the neurological status at baseline were key parameters associated with ICB after MT (p = 0.007 and p = 0.003, respectively).

CONCLUSIONS

Age and neurological status in the ultra-acute phase of stroke are crucial for the functional status in short and long-term observations of patients treated with mechanical thrombectomy. Atrial fibrillation, hyperglycemia, and inflammatory state are relevant to the short-term post-stroke functional status. First pass effect and the degree of post-interventional reperfusion are important technical parameters to the short-term functional status. Neurological status and white blood count during the acute phase are associated with a high rate of post-procedural intracranial bleeding.

Recanalisation of cerebral artery aneurysms treated endovascularly - a midterm follow-up

Endovascular methods of aneurysm treatment, as an alternative to neurosurgical clipping, have proved a welcome opportunity to treat patients with unruptured aneurysms or those disqualified from neurosurgical intervention. This paper presents our own experience of endovascular treatment of cerebral aneurysms in 107 patients. It includes clinical and technical data from the perioperative period and a 12-month radiological follow-up of 78 patients.

METHOD

Our retrospective evaluation covered patients with intracranial aneurysms treated endovascularly. The following were analysed: age, sex, neurological symptoms, and familial burden of intracranial aneurysm. Multivariate analysis was performed to determine independent factors of recanalisation of the cerebral aneurysm 12 months after embolisation.

RESULTS

The data of 107 patients at a mean age of 61 years [57.09 ± 14.27] treated with embolisation was analysed. The indication for intervention in 16 patients was subarachnoid haemorrhage; in the remaining 91 cases, aneurysms were revealed during diagnostic procedures for different symptoms or during imaging examinations. The intracranial segment of the internal carotid artery and the anterior communicating artery were the most common locations for aneurysms. After embolisation, subarachnoid haemorrhage occurred in one patient, ischaemic stroke in two patients, and one patient died because of acute circulatory insufficiency. The functional status of 94 patients on the day of discharge from the department (on days 4-21) was very good. 78 patients completed a 12-month follow-up period. In 11 of those, a follow-up MR angiography revealed recanalisation 12 months after the intervention. Except for one patient reporting vertigo, aneurysm recanalisation procedures were asymptomatic. The only independent risk factor for recanalisation was the size of aneurysm > 10 mm; OR 3.0; CI [1.15-7.83] p = 0.0255.

CONCLUSIONS

Embolisation of cerebral aneurysms is a safe method with few perioperative complications, and most of these are mild and transient.The size of the aneurysm during qualification for embolisation is a risk factor for recanalisation in the subsequent 12 months. Recanalisation of embolised cerebral aneurysms concerns less than 20% of patients in a one-year follow-up and is most often asymptomatic.