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Colangelo G, Ribo M, Montiel E, Dominguez D, Olivé-Gadea M, Muchada M, Garcia-Tornel Á, Requena M, Pagola J, Juega J, Rodriguez-Luna D, Rodriguez-Villatoro N, Rizzo F, Taborda B, Molina CA, Rubiera M. PRERISK: A Personalized, Artificial Intelligence-Based and Statistically-Based Stroke Recurrence Predictor for Recurrent Stroke. Stroke 2024; 55:1200-1209. [PMID: 38545798 DOI: 10.1161/strokeaha.123.043691] [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] [Received: 04/26/2023] [Accepted: 01/31/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND Predicting stroke recurrence for individual patients is difficult, but individualized prediction may improve stroke survivors' engagement in self-care. We developed PRERISK: a statistical and machine learning classifier to predict individual risk of stroke recurrence. METHODS We analyzed clinical and socioeconomic data from a prospectively collected public health care-based data set of 41 975 patients admitted with stroke diagnosis in 88 public health centers over 6 years (2014-2020) in Catalonia-Spain. A new stroke diagnosis at least 24 hours after the index event was considered as a recurrent stroke, which was considered as our outcome of interest. We trained several supervised machine learning models to provide individualized risk over time and compared them with a Cox regression model. Models were trained to predict early, late, and long-term recurrence risk, within 90, 91 to 365, and >365 days, respectively. C statistics and area under the receiver operating characteristic curve were used to assess the accuracy of the models. RESULTS Overall, 16.21% (5932 of 36 114) of patients had stroke recurrence during a median follow-up of 2.69 years. The most powerful predictors of stroke recurrence were time from previous stroke, Barthel Index, atrial fibrillation, dyslipidemia, age, diabetes, and sex, which were used to create a simplified model with similar performance, together with modifiable vascular risk factors (glycemia, body mass index, high blood pressure, cholesterol, tobacco dependence, and alcohol abuse). The areas under the receiver operating characteristic curve were 0.76 (95% CI, 0.74-0.77), 0.60 (95% CI, 0.58-0.61), and 0.71 (95% CI, 0.69-0.72) for early, late, and long-term recurrence risk, respectively. The areas under the receiver operating characteristic curve of the Cox risk class probability were 0.73 (95% CI, 0.72-0.75), 0.59 (95% CI, 0.57-0.61), and 0.67 (95% CI, 0.66-0.70); machine learning approaches (random forest and AdaBoost) showed statistically significant improvement (P<0.05) over the Cox model for the 3 recurrence time periods. Stroke recurrence curves can be simulated for each patient under different degrees of control of modifiable factors. CONCLUSIONS PRERISK is a novel approach that provides a personalized and fairly accurate risk prediction of stroke recurrence over time. The model has the potential to incorporate dynamic control of risk factors.
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Affiliation(s)
- Giorgio Colangelo
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Nora Health, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., E.M.)
| | - Marc Ribo
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Estefanía Montiel
- Nora Health, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., E.M.)
| | - Didier Dominguez
- Programa d'Analítica de Dades per a la Recerca i la Innovació en Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya, Departament de Salut, Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain (D.D.)
| | - Marta Olivé-Gadea
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Marian Muchada
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Álvaro Garcia-Tornel
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Manuel Requena
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Jorge Pagola
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Jesús Juega
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - David Rodriguez-Luna
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Noelia Rodriguez-Villatoro
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Federica Rizzo
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Belén Taborda
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Carlos A Molina
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Marta Rubiera
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
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Hernandez D, Requena M, Olivé-Gadea M, de Dios M, Gramegna LL, Muchada M, García-Tornel Á, Diana F, Rizzo F, Rivera E, Rubiera M, Piñana C, Rodrigo-Gisbert M, Rodríguez-Luna D, Pagola J, Carmona T, Juega J, Rodríguez-Villatoro N, Molina C, Ribo M, Tomasello A. Radial Versus Femoral Access for Mechanical Thrombectomy in Patients With Stroke: A Noninferiority Randomized Clinical Trial. Stroke 2024; 55:840-848. [PMID: 38527149 DOI: 10.1161/strokeaha.124.046360] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/25/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Transfemoral access is predominantly used for mechanical thrombectomy in patients with stroke with a large vessel occlusion. Following the interventional cardiology guidelines, routine transradial access has been proposed as an alternative, although its safety and efficacy remain controversial. We aim to explore the noninferiority of radial access in terms of final recanalization. METHODS The study was an investigator-initiated, single-center, evaluator-blinded, noninferiority randomized clinical trial. Patients with stroke undergoing mechanical thrombectomy, with a patent femoral artery and a radial artery diameter ≥2.5 mm, were randomly assigned (1:1) to either transradial (60 patients) or transfemoral access (60 patients). The primary binary outcome was the successful recanalization (expanded Treatment in Cerebral Ischemia score, 2b-3) assigned by blinded evaluators. We established a noninferiority margin of -13.2%, considering an acceptable reduction of 15% in the expected recanalization rates. RESULTS From September 2021 to July 2023, 120 patients were randomly assigned and 116 (58 transradial access and 58 transfemoral access) with confirmed intracranial occlusion on the initial angiogram were included in the intention-to-treat analysis. Successful recanalization was achieved in 51 (87.9%) patients assigned to transfemoral access and in 56/58 (96.6%) patients assigned to transradial (adjusted 1 side risk difference [RD], -5.0% [95% CI, -6.61% to +13.1%]) showing noninferiority of transradial access. Median time from angiosuite arrival to first pass (femoral, 30 [interquartile range, 25-37] minutes versus radial: 41 [interquartile range, 33-62] minutes; P<0.001) and from angiosuite arrival to recanalization (femoral: 42 (IQR, 28-74) versus radial: 59.5 (IQR, 44-81) minutes; P<0.050) were longer in the transradial access group. Both groups presented 1 severe access complication and there was no difference in the rate of access conversion: transradial 7 (12.1%) versus transfemoral 5 (8.6%) (P=0.751). CONCLUSIONS Among patients who underwent mechanical thrombectomy, transradial access was noninferior to transfemoral access in terms of final recanalization. Procedural delays may favor transfemoral access as the default first-line approach. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05225636.
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Affiliation(s)
- David Hernandez
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Manuel Requena
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marta Olivé-Gadea
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marta de Dios
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Laura Ludovica Gramegna
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marian Muchada
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Álvaro García-Tornel
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Francesco Diana
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Federica Rizzo
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Eila Rivera
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marta Rubiera
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Carlos Piñana
- Interventional Radiology Unit, Hospital Clínico Universitario de Valencia, Spain (C.P.)
| | - Marc Rodrigo-Gisbert
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - David Rodríguez-Luna
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Jorge Pagola
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Tomás Carmona
- Neurosurgery Department, Hospital San Pablo, Coquimbo, Chile (T.C.)
| | - Jesús Juega
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Noelia Rodríguez-Villatoro
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Carlos Molina
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marc Ribo
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Alejandro Tomasello
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
- Departament de Medicina, Universitat Autonoma de Barcelona, Spain (A.T.)
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Sousa JA, Achutegui MI, Juega-Mariño J, Requena M, Bernardo-Castro S, Rodrigo-Gisbert M, Rizzo F, Olivé M, Garcia-Tornel Á, Chaves AC, Rodriguez-Villatoro N, Muchada M, Pagola J, Rodriguez-Luna D, Rubiera M, Martins AI, Silva F, Veiga R, Nunes C, Machado E, Diana F, de Dios M, Hernández D, Ribo M, Molina C, Sargento-Freitas J, Tomasello A. Acute management of cerebral venous thrombosis: Indications, technique, and outcome of endovascular treatment in two high-volume centers. Interv Neuroradiol 2024:15910199241236819. [PMID: 38556254 DOI: 10.1177/15910199241236819] [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: 04/02/2024] Open
Abstract
INTRODUCTION After several uncontrolled studies and one randomized clinical trial, there is still uncertainty regarding the role of endovascular treatment (EVT) in cerebral venous thrombosis (CVT). This study aims to describe and assess different acute management strategies in the treatment of CVT. METHODS We performed a retrospective analysis of an international two-center registry of CVT patients admitted since 2019. Good outcome was defined as a return to baseline modified Rankin scale at three months. We described and compared EVT versus no-EVT patients. RESULTS We included 61 patients. Only one did not receive systemic anticoagulation. EVT was performed in 13/61 (20%) of the cases, with a median time from diagnosis to puncture of 4.5 h (1.25-28.5). EVT patients had a higher median baseline NIHSS [6 (IQR 2-17) vs 0 (0-2.7), p = 0.002)] and a higher incidence of intracerebral hemorrhage (53.8% vs 20.3%, p = 0.03). Recanalization was achieved in 10/13 (77%) patients. Thrombectomy was performed in every case with angioplasty in 7 out of 12 patients and stenting in 3 cases. No postprocedural complication was reported. An improvement of the median NIHSS from baseline to discharge [6 (2-17) vs 1(0-3.75); p < 0.001] was observed in EVT group. A total of 31/60 patients (50.8%) had good outcomes. Adjusting to NIHSS and ICH, EVT had a non-significant increase in the odds of a good outcome [aOR 1.42 (95%CI 0.73-2.8, p = 0.307)]. CONCLUSIONS EVT in combination with anticoagulation was safe in acute treatment of CVT as suggested by NIHSS improvement. Selected patients may benefit from this treatment.
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Affiliation(s)
- João André Sousa
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Maider Iza Achutegui
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Jesus Juega-Mariño
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Sara Bernardo-Castro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta Olivé
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Álvaro Garcia-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ana Carolina Chaves
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | | | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ana Inês Martins
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Fernando Silva
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Ricardo Veiga
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Cesar Nunes
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Egídio Machado
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Francesco Diana
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta de Dios
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - David Hernández
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - João Sargento-Freitas
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Alejandro Tomasello
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
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Rodríguez I, Gramegna LL, Requena M, Rizzuti M, Elosua I, Mayol J, Olivé-Gadea M, Diana F, Rodrigo-Gisbert M, Muchada M, Rivera E, García-Tornel Á, Rizzo F, De Dios M, Rodríguez-Luna D, Piñana C, Pagola J, Hernández D, Juega J, Rodríguez N, Quintana M, Molina C, Ribo M, Tomasello A. Safety and efficacy of early carotid artery stenting in patients with symptomatic stenosis. Interv Neuroradiol 2024:15910199241239204. [PMID: 38515363 DOI: 10.1177/15910199241239204] [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: 03/23/2024] Open
Abstract
BACKGROUND Symptomatic carotid artery stenosis is a significant contributor to ischemic strokes. Carotid artery stenting (CAS) is usually indicated for secondary stroke prevention. This study evaluates the safety and efficacy of CAS performed within a short time frame from symptom onset. METHODS We conducted a single-center, retrospective study of consecutive patients who underwent CAS for symptomatic carotid stenosis within eight days of symptom onset from July 2019 to January 2022. Data on demographics, medical history, procedural details, and follow-up outcomes were analyzed. The primary outcome measure was the recurrence of the stroke within the first month post-procedure. Secondary outcomes included mortality, the rate of intra-procedural complications, and hyperperfusion syndrome. RESULTS We included 93 patients with a mean age of 71.7 ± 11.7 years. The median time from symptom onset to CAS was 96 h. The rate of stroke recurrence was 5.4% in the first month, with a significant association between the number of stents used and increased recurrence risk. Mortality within the first month was 3.2%, with an overall mortality rate of 11.8% after a median follow-up of 19 months. Intra-procedural complications were present in five (5.4%) cases and were related to the number of stents used (p = 0.002) and post-procedural angioplasty (p = 0.045). Hyperperfusion syndrome occurred in 3.2% of cases. CONCLUSION Early CAS within the high-risk window post-symptom onset is a viable secondary stroke prevention strategy in patients with symptomatic carotid artery stenosis. The procedure rate of complication is acceptable, with a low recurrence of stroke. However, further careful selection of patients for this procedural strategy is crucial to optimize outcomes.
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Affiliation(s)
- Isabel Rodríguez
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Laura Ludovica Gramegna
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Requena
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Radiology, Interventional Neuroradiology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | | | - Iker Elosua
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Jordi Mayol
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Marta Olivé-Gadea
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Francesco Diana
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Radiology, Interventional Neuroradiology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Marián Muchada
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Eila Rivera
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Álvaro García-Tornel
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Federica Rizzo
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Marta De Dios
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Radiology, Interventional Neuroradiology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - David Rodríguez-Luna
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Carlos Piñana
- Interventional Radiology, Hospital Clínico Valencia, Barcelona, Spain
| | - Jorge Pagola
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - David Hernández
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Radiology, Interventional Neuroradiology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jesús Juega
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Noelia Rodríguez
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Molina
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Marc Ribo
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona Spain, Barcelona, Spain
| | - Alejandro Tomasello
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Radiology, Interventional Neuroradiology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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5
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Yaghi S, Shu L, Mandel DM, Leon Guerrero CR, Henninger N, Muppa J, Affan M, Ul Haq Lodhi O, Heldner MR, Antonenko K, Seiffge DJ, Arnold M, Salehi Omran S, Crandall RC, Lester E, Lopez Mena D, Arauz A, Nehme A, Boulanger M, Touzé E, Sousa JA, Sargento-Freitas J, Barata V, Castro-Chaves P, Brito MTÁP, Khan M, Mallick D, Rothstein A, Khazaal O, Kaufmann J, Engelter ST, Traenka C, Aguiar de Sousa D, Soares M, Rosa SD, Zhou LW, Gandhi P, Field TS, Mancini S, Metanis I, Leker RR, Pan K, Dantu V, Baumgartner KV, Burton TM, Freiin von Rennenberg R, Nolte CH, Choi RK, MacDonald JA, Bavarsad Shahripour R, Guo X, Ghannam M, AlMajali M, Samaniego EA, Sanchez S, Rioux B, Zine-Eddine F, Poppe AY, Fonseca AC, Baptista M, Cruz D, Romoli M, De Marco G, Longoni M, Keser Z, Griffin KJ, Kuohn L, Frontera JA, Amar J, Giles JA, Zedde M, Pascarella R, Grisendi I, Nzwalo H, Liebeskind DS, Molaie AM, Cavalier A, Kam W, Mac Grory B, Al Kasab S, Anadani M, Kicielinski KP, Eltatawy AR, Chervak LM, Chulluncuy-Rivas R, Aziz YN, Bakradze E, Tran TL, Rodrigo-Gisbert M, Requena M, Saleh Velez FG, Ortiz Garcia JG, Muddasani V, de Havenon A, Vishnu VY, Yaddanapudi SS, Adams L, Browngoehl A, Ranasinghe T, Dunston R, Lynch Z, Penckofer M, Siegler JE, Mayer SV, Willey JZ, Zubair AS, Cheng YK, Sharma R, Marto JP, Mendes Ferreira V, Klein P, Nguyen TN, Asad SD, Sarwat Z, Balabhadra A, Patel S, Secchi TL, Martins SC, Mantovani GP, Kim YD, Krishnaiah B, Elangovan C, Lingam S, Qureshi AY, Fridman S, Alvarado-Bolaños A, Khasiyev F, Linares G, Mannino M, Terruso V, Vassilopoulou S, Tentolouris-Piperas V, Martínez-Marino M, Carrasco Wall VA, Indraswari F, El Jamal S, Liu S, Alvi M, Ali F, Sarvath MM, Morsi RZ, Kass-Hout T, Shi F, Zhang J, Sokhi D, Said J, Simpkins AN, Gomez R, Sen S, Ghani MR, Elnazeir M, Xiao H, Kala NS, Khan F, Stretz C, Mohammadzadeh N, Goldstein ED, Furie KL. Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study. Stroke 2024. [PMID: 38335240 DOI: 10.1161/strokeaha.123.045731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Background: Small, randomized trials of cervical artery dissection (CAD) patients showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with CAD treated with antiplatelets versus anticoagulation. Methods: This is a multi-center observational retrospective international study (16 countries, 63 sites) that included CAD patients without major trauma. The exposure was antithrombotic treatment type (anticoagulation vs. antiplatelets) and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with Inverse Probability of Treatment Weighting (IPTW) to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an "as treated" cross-over approach and only included outcomes occurring on the above treatments. Results: The study included 3,636 patients [402 (11.1%) received exclusively anticoagulation and 2,453 (67.5%) received exclusively antiplatelets]. By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with IPTW, compared to antiplatelet therapy, anticoagulation was associated with a non-significantly lower risk of subsequent ischemic stroke by day 30 (adjusted HR 0.71 95% CI 0.45-1.12, p=0.145) and by day 180 (adjusted HR 0.80 95% CI 0.28-2.24, p=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR 1.39 95% CI 0.35-5.45, p=0.637) but was by day 180 (adjusted HR 5.56 95% CI 1.53-20.13, p=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR 0.40 95% CI 0.18-0.88) (Pinteraction=0.009). Conclusions: Our study does not rule out a benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.
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Affiliation(s)
- Shadi Yaghi
- Neurology, Alpert Medical School at Brown University, UNITED STATES
| | - Liqi Shu
- Neurology, Alpert Medical School of Brown University, UNITED STATES
| | - Daniel M Mandel
- Neurology, University of Miami Miller School of Medicine, UNITED STATES
| | | | - Nils Henninger
- Departments of Neurology and Psychiatry, University of Massachusetts Medical School, UNITED STATES
| | | | | | | | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, SWITZERLAND
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland, SWITZERLAND
| | - David J Seiffge
- Neurology, Inselspital, Bern University Hospital, University of Bern, SWITZERLAND
| | - Marcel Arnold
- Department of Neurology, University hospital of Bern, SWITZERLAND
| | | | | | | | - Diego Lopez Mena
- National Institute of Neurology and Neurosurgery of Mexico, MEXICO
| | - Antonio Arauz
- stroke clinic, Instituto Nacional de Neurologia, MEXICO
| | | | - Marion Boulanger
- Service de neurologie,, Universite Caen Normandie, CHU Caen Normandie, INSERM U1237, CYCERON, boulevard Henri Becquerel, Caen, France, Blood and Brain @ Caen-Normandie Institute (BB@C), Caen, France, FRANCE
| | | | | | | | | | | | | | - Muhib Khan
- Department of Neurology, Mayo Clinic, UNITED STATES
| | | | - Aaron Rothstein
- Department of Neurology, University of Pennsylvania, UNITED STATES
| | - Ossama Khazaal
- Department of Neurology, University of Pennsylvania, UNITED STATES
| | | | | | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel, SWITZERLAND
| | | | - Mafalda Soares
- Lisbon Central University Hospital, University of Lisbon, PORTUGAL
| | - Sara Db Rosa
- Neuroradiology, Lisbon Central University Hospital, PORTUGAL
| | - Lily W Zhou
- Neurology, The University of British Columbia, CANADA
| | | | - Thalia S Field
- Centre for Brain Health, Division of Neurology, Vancouver Stroke Program, University of British Columbia, CANADA
| | | | - Issa Metanis
- Hebrew University-Hadassah Medical Center, ISRAEL
| | - Ronen R Leker
- Neurology, Hadassah-Hebrew University Medical Center, ISRAEL
| | - Kelly Pan
- Rhode Island Hospital, UNITED STATES
| | - Vishnu Dantu
- Barrow Neurological Institute - St. Joseph's Hospital and Medical Center, UNITED STATES
| | | | - Tina M Burton
- Neurology, The Warren Alpert Medical School of Brown University, UNITED STATES
| | - Regina Freiin von Rennenberg
- Department of Neurology (Klinik und Hochschulambulanz für Neurologie), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | | | | | | | - Reza Bavarsad Shahripour
- University of California San Diego Comprehensive Stroke Center, Department of Neurosciences, University of California, San Diego, USA., UNITED STATES
| | - Xiaofan Guo
- Neurology, Department of Neurology, Loma Linda University Health, UNITED STATES
| | - Malik Ghannam
- Neurology, University of Iowa Hospitals and Clinics, UNITED STATES
| | | | - Edgar A Samaniego
- Neurology, Neurosurgery & Radiology, University of Iowa, UNITED STATES
| | | | | | | | | | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), University of Lisbon, PORTUGAL
| | - Maria Baptista
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto
| | - Diana Cruz
- Neurology, Hospital Santa Maria - CHULN, PORTUGAL
| | | | - Giovanna De Marco
- Neurology and Stroke Unit, Department of Neuroscience,, Bufalini Hospital, ITALY
| | | | | | | | - Lindsey Kuohn
- Department of Neurology, NYU Langone Health, UNITED STATES
| | | | - Jordan Amar
- Keck School of Medicine of the University of Southern California, UNITED STATES
| | - James A Giles
- Neurology, Yale University School of Medicine, UNITED STATES
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia
| | | | - Ilaria Grisendi
- Neuromotor physiology, Azienda USL-IRCCS di Reggio Emilia, ITALY
| | - Hipólito Nzwalo
- Ageing and Cerebrovascular Research Group, Algarve Biomedical Research Institute, PORTUGAL
| | - David S Liebeskind
- Neurovascular Imaging Research Core & Neurology, University of California, Los Angeles, UNITED STATES
| | - Amir M Molaie
- Neurology, University of California at Los Angeles Medical Center, UNITED STATES
| | - Annie Cavalier
- Neurology, Duke University School of Medicine, UNITED STATES
| | - Wayneho Kam
- Duke University Hospital; UNC Health Rex Comprehensive Stroke Center, UNITED STATES
| | - Brian Mac Grory
- Neurology, Duke University School of Medicine, UNITED STATES
| | - Sami Al Kasab
- Neurosurgery and Neurology, Medical University of south Carolina, UNITED STATES
| | - Mohammad Anadani
- Neurology, Medical University of South Carolina, College of Medicine, UNITED STATES
| | | | | | - Lina M Chervak
- Department of Neurology, University of Cincinnati Medical Center, UNITED STATES
| | | | - Yasmin Ninette Aziz
- Neurology and Rehabilitation Medicine, University of Cincinnati, UNITED STATES
| | | | | | - Marc Rodrigo-Gisbert
- Hospital Universitari Vall d'Hebron. Departament de Medicina, Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Manuel Requena
- Neurology. Universitat Autònoma de Barcelona, Univ Hosp Vall d'Hebron, SPAIN
| | - Faddi Ghassan Saleh Velez
- Department of Neurology, Vascular Division, The University of Oklahoma Health Sciences Center, UNITED STATES
| | - Jorge G Ortiz Garcia
- Department of Neurology, Division of Critical Care Neurology, Division of Stroke and Cerebrovascular Disorders, The University of Oklahoma Health Sciences Center, UNITED STATES
| | | | - Adam de Havenon
- Department of Neurology, Yale University School of Medicine, UNITED STATES
| | | | | | | | | | | | - Randy Dunston
- Wake Forest University Baptist Medical Center, UNITED STATES
| | | | - Mary Penckofer
- Cooper Medical School of Rowan University, UNITED STATES
| | - James E Siegler
- Department of Neurology, University of Chicago, UNITED STATES
| | | | | | | | | | | | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, PORTUGAL
| | | | - Piers Klein
- Neurology, Boston University Chobanian & Avedisian School of Medicine, UNITED STATES
| | - Thanh N Nguyen
- Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, UNITED STATES
| | | | | | - Anvesh Balabhadra
- Neurology, Hartford Hospital & University of Connecticut, UNITED STATES
| | - Shivam Patel
- Neurology, UConn School of Medicine, UNITED STATES
| | | | - Sheila Co Martins
- Stroke Unit, Neurology Service, Hospital de Clinicas de Porto Alegre, BRAZIL
| | | | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, KOREA, REPUBLIC OF
| | - Balaji Krishnaiah
- Neurology, University of Tennnessee Health Science Center, UNITED STATES
| | | | | | - Abid Y Qureshi
- Department of Neurology, University of Kansas Medical Center, UNITED STATES
| | - Sebastian Fridman
- Department of Clinical Neurological Sciences, University of Western Ontario - London Health Science Centre, CANADA
| | | | - Farid Khasiyev
- Neurology, Saint Louis University School of Medicine, UNITED STATES
| | - Guillermo Linares
- Souers Stroke Institute, Saint Louis University School of Medicine, UNITED STATES
| | | | | | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, GREECE
| | | | | | | | | | - Sleiman El Jamal
- Neurology, Rhode Island Hospital & Alpert Medical School of Brown University, UNITED STATES
| | - Shilin Liu
- University of Science and Technology, CHINA
| | | | | | | | - Rami Z Morsi
- Department of Neurology, University of Chicago, UNITED STATES
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, UNITED STATES
| | - Feina Shi
- Department of Neurology, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, CHINA
| | - Jinhua Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, CHINA
| | | | | | | | | | - Shayak Sen
- Cedars Sinai Medical Center, UNITED STATES
| | | | - Marwa Elnazeir
- Department of Neurology, University of Louisville, UNITED STATES
| | - Han Xiao
- Economics, University of California Santa Barbara, UNITED STATES
| | | | - Farhan Khan
- Neurology, Alpert Medical School, Brown University, UNITED STATES
| | - Christoph Stretz
- Neurology, Warren Alpert Medical School of Brown University, UNITED STATES
| | | | - Eric D Goldstein
- Neurology, Warren Alpert Medical School of Brown University, UNITED STATES
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, UNITED STATES
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6
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Rodrigo-Gisbert M, García-Tornel A, Requena M, Vielba-Gómez I, Bashir S, Rubiera M, De Dios Lascuevas M, Olivé-Gadea M, Piñana C, Rizzo F, Muchada M, Rodriguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Hernández D, Molina CA, Terceño M, Tomasello A, Ribo M. Clinico-radiological features of intracranial atherosclerosis-related large vessel occlusion prior to endovascular treatment. Sci Rep 2024; 14:2945. [PMID: 38316891 PMCID: PMC10844212 DOI: 10.1038/s41598-024-53354-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
The identification of large vessel occlusion with underlying intracranial atherosclerotic disease (ICAS-LVO) before endovascular treatment (EVT) continues to be a challenge. We aimed to analyze baseline clinical-radiological features associated with ICAS-LVO that could lead to a prompt identification. We performed a retrospective cross-sectional study of consecutive patients with stroke treated with EVT from January 2020 to April 2022. We included anterior LVO involving intracranial internal carotid artery and middle cerebral artery. We analyzed baseline clinical and radiological variables associated with ICAS-LVO and evaluated the diagnostic value of a multivariate logistic regression model to identify ICAS-LVO before EVT. ICAS-LVO was defined as presence of angiographic residual stenosis or a trend to re-occlusion during EVT procedure. A total of 338 patients were included in the study. Of them, 28 patients (8.3%) presented with ICAS-LVO. After adjusting for confounders, absence of atrial fibrillation (OR 9.33, 95% CI 1.11-78.42; p = 0.040), lower hypoperfusion intensity ratio (HIR [Tmax > 10 s/Tmax > 6 s ratio], (OR 0.69, 95% CI 0.50-0.95; p = 0.025), symptomatic intracranial artery calcification (IAC, OR .15, 95% CI 1.64-26.42, p = 0.006), a more proximal occlusion (ICA, MCA-M1: OR 4.00, 95% CI 1.23-13.03; p = 0.021), and smoking (OR 2.91, 95% CI 1.08-7.90; p = 0.035) were associated with ICAS-LVO. The clinico-radiological model showed an overall well capability to identify ICAS-LVO (AUC = 0.88, 95% CI 0.83-0.94; p < 0.001). In conclusion, a combination of clinical and radiological features available before EVT can help to identify an ICAS-LVO. This approach could be useful to perform a rapid assessment of underlying etiology and suggest specific pathophysiology-based measures. Prospective studies are needed to validate these findings in other populations.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro García-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Isabel Vielba-Gómez
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marta Olivé-Gadea
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Piñana
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Alejandro Tomasello
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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7
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Fladt J, Kaesmacher J, Meinel TR, Bütikofer L, Strbian D, Eker OF, Albucher JF, Desal H, Marnat G, Papagiannaki C, Richard S, Requena M, Lapergue B, Pagano P, Ernst M, Wiesmann M, Boulanger M, Liebeskind DS, Gralla J, Fischer U. MRI vs CT for Baseline Imaging Evaluation in Acute Large Artery Ischemic Stroke: A Subanalysis of the SWIFT-DIRECT Trial. Neurology 2024; 102:e207922. [PMID: 38165324 DOI: 10.1212/wnl.0000000000207922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/30/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Whether MRI or CT is preferable for the evaluation of patients with suspected stroke remains a matter of debate, given that the imaging modality acquired at baseline may be a relevant determinant of workflow delays and outcomes with it, in patients with stroke undergoing acute reperfusion therapies. METHODS In this post hoc analysis of the SWIFT-DIRECT trial that investigated noninferiority of thrombectomy alone vs IV thrombolysis (IVT) + thrombectomy in patients with an acute ischemic anterior circulation large vessel occlusive stroke eligible to receive IVT within 4.5 hours after last seen well, we tested for a potential interaction between baseline imaging modality (MRI/MR-angiography [MRA] vs CT/CT-angiography [CTA]) and the effect of acute treatment (thrombectomy vs IVT + thrombectomy) on clinical and safety outcomes and procedural metrics (primary analysis). Moreover, we examined the association between baseline imaging modality and these outcomes using regression models adjusted for age, sex, baseline NIH Stroke Scale (NIHSS), occlusion location, and Alberta Stroke Program Early CT Score (ASPECTS) (secondary analysis). Endpoints included workflow times, the modified Rankin scale (mRS) score at 90 days, the rate of successful reperfusion, the odds for early neurologic deterioration within 24 hours, and the risk of symptomatic intracranial hemorrhage. The imaging modality acquired was chosen at the discretion of the treating physicians and commonly reflects center-specific standard procedures. RESULTS Four hundred five of 408 patients enrolled in the SWIFT-DIRECT trial were included in this substudy. Two hundred (49.4%) patients underwent MRI/MRA, and 205 (50.6%) underwent CT/CTA. Patients with MRI/MRA had lower NIHSS scores (16 [interquartile range (IQR) 12-20] vs 18 [IQR 14-20], p = 0.012) and lower ASPECTS (8 [IQR 6-9] vs 8 [IQR 7-9], p = 0.021) compared with those with CT/CTA. In terms of the primary analysis, we found no evidence for an interaction between baseline imaging modality and the effect of IVT + thrombectomy vs thrombectomy alone. Regarding the secondary analysis, MRI/MRA acquisition was associated with workflow delays of approximately 20 minutes, higher odds of functional independence at 90 days (adjusted odds ratio [aOR] 1.65, 95% CI 1.07-2.56), and similar mortality rates (aOR 0.73, 95% CI 0.36-1.47) compared with CT/CTA. DISCUSSION This post hoc analysis does not suggest treatment effect heterogeneity of IVT + thrombectomy vs thrombectomy alone in large artery stroke patients with different imaging modalities. There was no evidence that functional outcome at 90 days was less favorable following MRI/MRA at baseline compared with CT/CTA, despite significant workflow delays. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT03192332.
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Affiliation(s)
- Joachim Fladt
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Johannes Kaesmacher
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Thomas R Meinel
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Lukas Bütikofer
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Daniel Strbian
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Omer F Eker
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Jean-Francois Albucher
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Hubert Desal
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Gaultier Marnat
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Chrysanthi Papagiannaki
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Sebastien Richard
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Manuel Requena
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Bertrand Lapergue
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Paolo Pagano
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Marielle Ernst
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Martin Wiesmann
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Marion Boulanger
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - David S Liebeskind
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Jan Gralla
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Urs Fischer
- From the Stroke Center and Department of Neurology (J.F., U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G.), and Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital and University of Bern; CTU Bern (L.B.), University of Bern, Switzerland; Department of Neurology (D.S.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neuroradiology (O.F.E.), Hospices Civils de Lyon; Department of Diagnostic and Therapeutic Neuroradiology (J.-F.A.), Centre Hospitalier Universitaire de Toulouse; Department of Diagnostic and Interventional Neuroradiology (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes Université; Interventional and Diagnostic Neuroradiology (G.M.), CHU Bordeaux, University of Bordeaux; Department of Radiology (C.P.), CHU Rouen; Stroke Unit (S.R.), Department of Neurology, CHRU-Nancy, Université de Lorraine, France; Stroke Unit (M.R.), Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain; Department of Stroke and Diagnostic and Interventional Neuroradiology (B.L.), Foch Hospital, Suresnes, France; Department of Neuroradiology (P.P.), CHU Reims, France; Department of Neuroradiology (M.E.), University Medical Center Goettingen; Department of Neuroradiology (M.W.), University Hospital RWTH Aachen, Germany; Department of Neurology (M.B.), CHU Caen Normandie, University Caen Normandie, INSERM U1237, France; and Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles
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8
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Flores A, Garcia-Tornel A, Seró L, Ustrell X, Requena M, Pellisé A, Rodriguez P, Monterde A, Lara L, Gonzalez-de-Echavarri JM, Molina CA, Doncel-Moriano A, Dorado L, Cardona P, Cánovas D, Krupinski J, Más N, Purroy F, Zaragoza-Brunet J, Palomeras E, Cocho D, Garcia J, Colom C, Silva Y, Gomez-Cocho M, Jiménez X, Ros-Roig J, Abilleira S, Pérez de la Ossa N, Ribo M. Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis. J Neurointerv Surg 2024; 16:143-150. [PMID: 37068936 DOI: 10.1136/jnis-2023-020125] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
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Affiliation(s)
- Alan Flores
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | | | - Laia Seró
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Xavier Ustrell
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Anna Pellisé
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Paula Rodriguez
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Angela Monterde
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Lidia Lara
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Jose María Gonzalez-de-Echavarri
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Doncel-Moriano
- Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Laura Dorado
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Pedro Cardona
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - David Cánovas
- Department of Neurology, Consorci Sanitari Parc Taulí, Barcelona, Spain
| | | | - Natalia Más
- Department of Neurology, Hospital Althaia, Manresa, Manresa, Catalunya, Spain
| | | | - Jose Zaragoza-Brunet
- Stroke Unit, Department of Neurology, Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
| | - Ernesto Palomeras
- Department of Neurology, Hospital de Mataró, Mataro, Catalunya, Spain
| | - Dolores Cocho
- Department of Neurology, Hospital General de Granollers, Granollers, Catalunya, Spain
| | - Jessica Garcia
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedes, Catalunya, Spain
| | - Carla Colom
- Department of Neurology, Hospital Universitario de Igualada, Igualada, Catalunya, Spain
| | - Yolanda Silva
- Neurology Department, Stroke Unit, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain
| | - Manuel Gomez-Cocho
- Department of Neurology, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Josep Ros-Roig
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Sonia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
- Catalan Stroke Program, Barcelona, Spain
| | - Marc Ribo
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Requena M, Vanden Bavière H, Verma S, Gerrits C, Kokhuis T, Tomasello A, Molina CA, Ribo M. Cost-utility of direct transfer to angiography suite (DTAS) bypassing conventional imaging for patients with acute ischemic stroke in Spain: results from the ANGIOCAT trial. J Neurointerv Surg 2024; 16:138-142. [PMID: 37105721 PMCID: PMC10850729 DOI: 10.1136/jnis-2023-020275] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The ANGIOCAT trial showed a clinical benefit of direct to angiography suite (DTAS) for patients with large vessel occlusion (LVO) stroke admitted within 6 hours after symptom onset in decreased hospital workflow time and improved clinical outcome. However, the impact of DTAS implementation on hospital costs is unknown. This economic evaluation aims to assess the cost-utility of DTAS from the provider (hospital) perspective. METHODS A cost-utility analysis was applied to compare DTAS with the standard direct to CT (DTCT) suite approach using direct cost and health outcomes data. The time horizon was 90 days. One-way sensitivity analysis as well as probabilistic sensitivity analysis was performed, varying the model parameters by ±25%. Measures included costs, quality-adjusted life years, and incremental cost-effectiveness ratios. Health outcomes, classified according to the modified Rankin Scale, were obtained from the ANGIOCAT trial. Respective utilities were obtained from the literature. RESULTS DTAS is the dominant strategy. The incremental cost-effectiveness ratio is -€89 110 (-$97 600) with cost saving per patient of -€2848 (-$3120). The improved clinical outcome is directly related with a decrease in costs for the hospital, mainly due to the decrease in costs of hospital stay, improved clinical outcome and fewer complications. CONCLUSIONS For patients with LVO admitted within 6 hours after symptom onset, the DTAS not only improves clinical outcome but also decreases the costs (dominant option) compared with the standard DTCT. Multicentric international randomized clinical trials are ongoing to determine the replicability of our findings.
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Affiliation(s)
- Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Stroke Unit, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Sanjay Verma
- Chief Medical Office, Philips, Amsterdam, The Netherlands
| | - Carin Gerrits
- Image Guided Therapy, Philips Healthcare, Best, The Netherlands
| | - Tom Kokhuis
- Image Guided Therapy, Philips Healthcare, Best, The Netherlands
| | - Alejandro Tomasello
- Department of Neurology, Vall d'Hebron University Hospital, Stroke Unit, Barcelona, Spain
| | - Carlos A Molina
- Department of Neurology, Vall d'Hebron University Hospital, Stroke Unit, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Stroke Unit, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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10
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Diana F, Peschillo S, Requena M, Romano DG, Frauenfelder G, de Dios Lascuevas M, Hernandez D, Ribó M, Tomasello A, Romoli M. Correlation between intravascular pressure gradients and ultrasound velocities in carotid artery stenosis: An exploratory study. Interv Neuroradiol 2023:15910199231224007. [PMID: 38155483 DOI: 10.1177/15910199231224007] [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: 12/30/2023] Open
Abstract
INTRODUCTION Grading of carotid stenosis is routinely performed with non-invasive techniques, such as carotid ultrasound (CUS) and computerized tomography angiography (CTA), which have limitations in grading definition. Moreover, the actual hemodynamic impact of a stenosis remains poorly defined. Preliminary studies explored the application of the resting full-cycle ratio (RFR), measured with pressure wire (PW), but the correlation between RFR and morphological/hemodynamic parameters is still undefined. This study aims to test the correlation between RFR and CUS-CTA-DSA based degree of stenosis, to define the suitability of RFR as carotid stenosis index. METHODS We included patients with symptomatic carotid stenosis receiving carotid artery stenting (CAS), between November 2022 and May 2023. We performed CUS and PW measurements before and after stenting, at four different sites (trans-lesion, distal cervical, petrous and supraclinoid internal carotid artery [ICA] segments). We compared CUS and PW parameters by Pearson's or Spearman test for continuous variables. RESULTS Among 15 patients included the mean stenosis degree was 81.3%. Trans-lesion RFR was significantly higher than other sites (0.72 ± 0.2 trans-lesion vs. 0.69 ± 0.18 distal cervical ICA vs. 0.66 ± 0.2 petrous ICA vs. 0.6 ± 0.2 intracranial ICA, p < 0.05). All RFR values significantly increased after treatment; the highest relative increase was registered at stenosis site (0.72 ± 0.2 pre-stent vs. 1.01 ± 0.1 post-stent, p < 0.01). Trans-lesion RFR was significantly associated with the CTA and DSA stenosis degree and CUS measurements. CONCLUSIONS Pressure wire in carotid artery stenosis seems safe and suitable. Resting full-cycle ratio has a significant correlation with CUS values and stenosis degree and might be used as carotid stenosis index during CAS.
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Affiliation(s)
- Francesco Diana
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Simone Peschillo
- Unicamillus International University of Health Sciences, Rome, Italy
| | - Manuel Requena
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Daniele G Romano
- Interventional Neuroradiology, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giulia Frauenfelder
- Interventional Neuroradiology, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribó
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
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11
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Gramegna LL, Ortega G, Dinia L, Aixut S, Rosati S, Vega P, Lüttich A, Remollo S, González A, Murias E, Chirife Chaparro O, Moreu M, Requena M, de Dios Lascuevas M, Hernandez D, Quintana M, Puig J, Rovira A, Tomasello A. Cognitive improvement following endovascular embolization in patients with intracranial dural arteriovenous fistula: The Neuropsychology in dural ArterIal Fistula (NAIF) Study. J Neurointerv Surg 2023:jnis-2023-021033. [PMID: 38071581 DOI: 10.1136/jnis-2023-021033] [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] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Cognitive improvement after endovascular embolization of an intracranial dural arteriovenous fistula (dAVF) remains unexplored. We aim to investigate cognitive changes following endovascular embolization of dAVFs. METHODS Neuropsychology in dural ArterIal Fistula (NAIF) was a prospective multicentric study including patients with an angiographic diagnosis of dAVF who underwent endovascular embolization over the course of 4 years. A complete neuropsychological evaluation comprising five cognitive domains (attention and executive functions, memory, language, praxis, gnosis) was performed at baseline and 3 months follow-up. Mean Z scores for cognitive tests were compared pre- and post-treatment using paired sample t-tests, where higher Z scores indicate better cognition. Effect sizes were computed as Cohen's d. RESULTS A total of 32 patients (mean age 61.1±15.4 years, 10 (31.3%) females) were included. Patients exhibited improved performance in attention and executive functions: executive functions-attention (+0.282, P=0.009, d=0.29), executive functions-fluencies (+0.283, P=0.029, d=0.4), and executive functions-processing speed (+0.471, P=0.039, d=0.41). There was an increase in memory: verbal learning and verbal delayed recall scores (+0.513, P<0.001, d=0.55, and +0.385, P=0.001, d=0.41, respectively), while verbal recognition parameters (+0.839, P=0.086, d=0.37) and visual memory (delayed recall) (+0.430, P=0.060, d=0.35) displayed trends toward improved performance. Regarding language, there was significant overall improvement (+0.300, P=0.014, d=0.24), but neither praxis nor gnosis changed significantly. These cognitive outcomes were independent of the severity (measured as Cognard classification), and no patient experienced cognitive worsening. CONCLUSION This study suggests that endovascular embolization confers cognitive benefits on dAVF patients undergoing endovascular embolization and may be beneficial even for patients with a low risk of hemorrhage.
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Affiliation(s)
- Laura Ludovica Gramegna
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Servicio de Radiología, Unidad de Neurorradiología, Hospital del Mar, Barcelona, Spain
| | - Gemma Ortega
- Universitat Internacional de Catalunya, Research Center and Memory clinic Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Lavinia Dinia
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Interventional Neuroradiology Section, Barcelona, Spain
| | - Sonia Aixut
- Department of Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Santiago Rosati
- Department of Radiology, Clinical San Carlos Hospital, Interventional Neuroradiology Unit, Madrid, Spain
| | - Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Interventional Neuroradiology, Oviedo, Spain
| | - Alex Lüttich
- Department of Radiology, Donostia University Hospital, Interventional Neuroradiology Section, Donostia-San Sebastián, Spain
| | - Sebastian Remollo
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Badalona, Spain
| | - Alejandro González
- Department of Radiology, Hospital Universitario Virgen del Rocío, Interventional Neuroradiology, Seville, Spain
| | - Eduardo Murias
- Department of Radiology, Hospital Universitario Central de Asturias, Interventional Neuroradiology, Oviedo, Spain
| | - Oscar Chirife Chaparro
- Department of Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Manuel Moreu
- Department of Radiology, Hospital Clínico Universitario San Carlos, Interventional Neuroradiology Unit, Madrid, Spain
| | - Manuel Requena
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Quintana
- Department of Neurology, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Epilepsy Unit, Barcelona, Spain
| | - Josep Puig
- Radiology Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alex Rovira
- Department of Radiology, Neuroradiology Section, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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12
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures. Neurologia 2023; 38:647-652. [PMID: 37858895 DOI: 10.1016/j.nrleng.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHODS We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Fonseca
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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13
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Requena M, Piñana C, Olive-Gadea M, Hernández D, Boned S, De Dios M, Rodrigo M, Rivera E, Muchada M, Cuevas JL, Rubiera M, García-Tornel Á, Gramegna LL, Molina C, Ribo M, Tomasello A. Combined technique as first approach in mechanical thrombectomy: Efficacy and safety of REACT catheter combined with stent retriever. Interv Neuroradiol 2023; 29:504-509. [PMID: 35491662 PMCID: PMC10549706 DOI: 10.1177/15910199221095798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mechanical thrombectomy (MT) with combined treatment including both a stent retriever and distal aspiration catheter may improve recanalization rates in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Here, we evaluated the effectiveness and safety of the REACT aspiration catheter used with a stent retriever. METHODS This prospective study included consecutive adult patients who underwent MT with a combined technique using REACT 68 and/or 71 between June 2020 and July 2021. The primary endpoints were final and first pass mTICI 2b-3 and mTICI 2c-3 recanalization. Analysis was performed after first pass and after each attempt. Secondary safety outcomes included procedural complications, symptomatic intracranial hemorrhage (sICH) at 24 h, in-hospital mortality, and 90-day functional independence (modified Rankin Scale [mRS] 0-2). RESULTS A total of 102 patients were included (median age 78; IQR: 73-87; 50.0% female). At baseline, median NIHSS score was 19 (IQR: 11-21), and ASPECTS was 9 (IQR: 8-10). Final mTICI 2b-3 recanalization was achieved in 91 (89.2%) patients and mTICI 2c-3 was achieved in 66 (64.7%). At first pass, mTICI 2b-3 was achieved in 55 (53.9%) patients, and mTICI 2c-3 in 37 (36.3%). The rate of procedural complications was 3.9% (4/102), sICH was 6.8% (7/102), in-hospital mortality was 12.7% (13/102), and 90-day functional independence was 35.6% (36/102). CONCLUSION A combined MT technique using a stent retriever and REACT catheter resulted in a high rate of successful recanalization and first pass recanalization in a sample of consecutive patients with AIS due to LVO in clinical use.
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Affiliation(s)
- Manuel Requena
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Carlos Piñana
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Marta Olive-Gadea
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - David Hernández
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Sandra Boned
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Marta De Dios
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Marc Rodrigo
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Eila Rivera
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Marián Muchada
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - José Luis Cuevas
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
- Servicio Neurocirugía, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Marta Rubiera
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Álvaro García-Tornel
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Laura Ludovica Gramegna
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Molina
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Marc Ribo
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Alejandro Tomasello
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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14
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Meinel TR, Kaesmacher J, Buetikofer L, Strbian D, Eker OF, Cognard C, Mordasini P, Deppeler S, Mendes Pereira V, Albucher JF, Darcourt J, Bourcier R, Guillon B, Papagiannaki C, Costentin G, Sibolt G, Räty S, Gory B, Richard S, Liman J, Ernst M, Boulanger M, Barbier C, Mechtouff L, Zhang L, Marnat G, Sibon I, Nikoubashman O, Reich A, Consoli A, Weisenburger D, Requena M, Garcia-Tornel A, Saleme S, Moulin S, Pagano P, Saliou G, Carrera E, Janot K, Boix M, Pop R, Della Schiava L, Luft A, Piotin M, Gentric JC, Pikula A, Pfeilschifter W, Arnold M, Siddiqui A, Froehler MT, Furlan AJ, Chapot R, Wiesmann M, Machi P, Diener HC, Kulcsar Z, Bonati L, Bassetti C, Escalard S, Liebeskind D, Saver JL, Fischer U, Gralla J. Time to treatment with bridging intravenous alteplase before endovascular treatment:subanalysis of the randomized controlled SWIFT-DIRECT trial. J Neurointerv Surg 2023; 15:e102-e110. [PMID: 35902234 DOI: 10.1136/jnis-2022-019207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/01/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT). METHODS We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours. RESULTS We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64-81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall, there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short. CONCLUSIONS We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials. TRIAL REGISTRATION NUMBER URL: https://www. CLINICALTRIALS gov ; Unique identifier: NCT03192332.
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Affiliation(s)
- Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Omer Faruk Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sandro Deppeler
- Neuro Clinical Trial Unit, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Vitor Mendes Pereira
- Division of Neuroradiology and Division of Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Jean Darcourt
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Benoit Guillon
- Department of Neurology, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | | | | | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, INSERM U1254, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, CHRU-Nancy, Université de Lorraine, INSERM U1116, Nancy, France
| | - Jan Liman
- Department of Neurology, Klinikum Nürnberg, Nürnberg, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Gottingen, Germany
| | - Marion Boulanger
- Deparment of Neurology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Charlotte Barbier
- Department of Neuroradiology, CHU Caen Normandie, University Caen Normandie, INSERM U1237, Caen, France
| | - Laura Mechtouff
- Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France
| | - Liqun Zhang
- Department of Neurology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arno Reich
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arturo Consoli
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - David Weisenburger
- Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Heborn, Barcelona, Spain
- Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Heborn, Barcelona, Spain
| | | | - Suzana Saleme
- Department of Neuroradiology, CHU Limoges, Limoges, France
| | | | - Paolo Pagano
- Department of Neuroradiology, CHU Reims, Reims, France
| | - Guillaume Saliou
- Service of Interventional and Diagnostic Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Kevin Janot
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, Tours, France
| | - Marti Boix
- Stroke Unit, Department of Neurosciences, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Raoul Pop
- Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
| | | | - Andreas Luft
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Michel Piotin
- Department of interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Aleksandra Pikula
- Department of Neurology, University Health Network - Toronto Western Hospital - University of Toronto, Toronto, Ontario, Canada
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Michael T Froehler
- Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony J Furlan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Paolo Machi
- Department of Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Essen, Germany
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Leo Bonati
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Claudio Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Escalard
- Department of interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - David Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, UCLA, University of California, Los Angeles, California, USA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, UCLA, University of California, Los Angeles, California, USA
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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15
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Rodriguez-Luna D, Pancorbo O, Coscojuela P, Lozano P, Rizzo F, Olivé-Gadea M, Requena M, García-Tornel Á, Rodríguez-Villatoro N, Juega JM, Boned S, Muchada M, Pagola J, Rubiera M, Ribo M, Tomasello A, Molina CA. Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities. Eur Radiol 2023; 33:6045-6053. [PMID: 37059906 DOI: 10.1007/s00330-023-09621-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To derivate and validate three scores for the prediction of intracerebral hemorrhage (ICH) expansion depending on the use of non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers of hematoma expansion, and to evaluate the added value of single-phase and multiphase CTA over NCCT. METHODS After prospectively deriving NCCT, single-phase CTA, and multiphase CTA hematoma expansion scores in 156 patients with ICH < 6 h, we validated them in 120 different patients. Discrimination and calibration of the three scores was assessed. Primary outcome was substantial hematoma expansion > 6 mL or > 33% at 24 h. RESULTS The evaluation of single-phase and multiphase CTA markers gave a steadily increase in discrimination for substantial hematoma expansion over NCCT markers. The C-index (95% confidence interval) in derivation and validation cohorts was 0.69 (0.58-0.80) and 0.59 (0.46-0.72) for NCCT score, significantly lower than 0.75 ([0.64-0.87], p = 0.038) and 0.72 ([0.59-0.84], p = 0.016) for single-phase CTA score, and than 0.79 ([0.68-0.89], p = 0.033) and 0.73 ([0.62-0.85], p = 0.031) for multiphase CTA score, respectively. The three scores showed good calibration in both derivation and validation cohorts: NCCT (χ2 statistic 0.389, p = 0.533; and χ2 statistic 0.352, p = 0.553), single-phase CTA (χ2 statistic 2.052, p = 0.359; and χ2 statistic 2.230, p = 0.328), and multiphase CTA (χ2 statistic 0.559, p = 0.455; and χ2 statistic 0.020, p = 0.887) scores, respectively. CONCLUSION This study shows the added prognostic value of more advanced CT modalities in acute ICH evaluation. NCCT, single-phase CTA, and multiphase CTA scores may help to refine the selection of patients at risk of expansion in different decision-making scenarios. KEY POINTS • This study shows the added prognostic value of more advanced CT modalities in acute intracerebral hemorrhage evaluation. • The evaluation of single-phase and multiphase CTA markers provides a steadily increase in discrimination for intracerebral hemorrhage expansion over non-contrast CT markers. • Non-contrast CT, single-phase CTA, and multiphase CTA scores may help clinicians and researchers to refine the selection of patients at risk of intracerebral hemorrhage expansion in different decision-making scenarios.
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Affiliation(s)
- David Rodriguez-Luna
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain.
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
| | - Olalla Pancorbo
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Prudencio Lozano
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Federica Rizzo
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Olivé-Gadea
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Álvaro García-Tornel
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Noelia Rodríguez-Villatoro
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jesús M Juega
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Sandra Boned
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marián Muchada
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jorge Pagola
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Rubiera
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos A Molina
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Piñana C, Remollo S, Zamarro J, Werner M, Espinosa de Rueda M, Vega P, Hernandez D, Murias E, Rivera E, Olier J, San Roman L, Páez-Carpio A, Requena M, Aixut S, de Dios Lascuevas M, Moreu M, Rosati S, Gramegna LL, Castaño C, Tomasello A. Derivo embolization device for intracranial aneurysms: a Spanish multicenter retrospective study. J Neurointerv Surg 2023; 15:871-875. [PMID: 35999049 DOI: 10.1136/jnis-2022-019220] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diverters have emerged in recent years as a safe and effective treatment for intracranial aneurysms, with expanding indications. The Derivo embolization device (DED) is a second-generation flow diverter with a surface finish that may reduce thrombogenicity. We report our multicenter experience evaluating its safety and efficacy. METHODS We retrospectively analyzed all patients treated with the DED in eight centers in Spain between 2016 and 2020. Demographics, clinical data, procedural complications, morbidity and aneurysm occlusion rates were collected. RESULTS A total of 209 patients with 250 aneurysms were treated (77.5% women). The majority of aneurysms were located in the internal carotid artery (86.8%) and most (69.2%) were small (<10 mm) with a median maximum diameter of 5.85 mm and median neck size of 4 mm. DED deployment was successful in all cases, despite two malfunctioning devices (1%). Major complications occurred in nine patients (4.3%), while mild neurologic clinical events were registered in 23 (11%); four patients died (1.9%). A total of 194 aneurysms had an angiographic follow-up at 6 months and showed complete aneurysm occlusion in 75% of cases. Twelve-month follow-up was available for 112 of the treated aneurysms, with a total occlusion rate of 83%. CONCLUSION The DED is a second-generation surface-modified flow diverter that presents an option for treatment of intracranial aneurysms with comparable safety and efficacy to other available flow diverter devices. Nonetheless, risks are not negligible, and must be balanced against the natural history risk of cerebral aneurysms, considering the tendency to widen indications for treatment of smaller and less complex lesions in day-to-day use.
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Affiliation(s)
- Carlos Piñana
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquín Zamarro
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Werner
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mariano Espinosa de Rueda
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eila Rivera
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jorge Olier
- Interventional Neuroradiology, Hospital de Navarra, Pamplona, Spain
| | - Luis San Roman
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alfredo Páez-Carpio
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sonia Aixut
- Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Moreu
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Santiago Rosati
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Bologna, Italy
- Instituto delle Scienze Neurologiche di Bologna (IRCCS), Bologna, Italy
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
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17
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Requena M, Li J, Tiberi R, Canals P, Olive Gadea M, de Dios Lascuevas M, Jabłońska M, Cendrero J, Garcia-Tornel A, Tomasello A, Ribo M. Impact on collateral flow of devices used for endovascular treatment of stroke: an in-vitro flow model. J Neurointerv Surg 2023:jnis-2023-020602. [PMID: 37648434 DOI: 10.1136/jnis-2023-020602] [Citation(s) in RCA: 1] [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: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Collateral blood supply of distal vessels has been linked to clinical outcome, infarct volume and recanalization rates in patients with large vessel occlusion. Our study aimed to explore the effects of catheterization during mechanical thrombectomy in collaterals. METHODS We quantified the flow diversion effect secondary to arterial occlusions in an in vitro model which was connected in a flow-loop setup with a saline reservoir and a pump supplying pulsatile flow. Clot analogs were embolized to the middle cerebral artery (MCA) M1 or M2 segments. We used the same model with a clamped anterior communicating artery (AComA) to simulate its absence. An ultrasound flow sensor was placed at the vessel of interest. Flow rates and pressures were evaluated according to the following catheter locations: baseline (1) before and (2) after the occlusion; (3) 8F guiding catheter at the internal carotid artery (ICA) bulb; (4) at the cavernous segment; (5) at the cavernous segment a 0.071" distal access catheter at proximal M1; (6) 8F balloon guide catheter inflated. RESULTS Collateral blood flow measured at distal anterior cerebral artery (ACA) (M1-MCA occlusion) and M2-MCA (M2-MCA occlusion) was progressively reduced as catheters were advanced through the ICA and MCA. In the lacking AComA model, the flow was further diminished as compared with the model with a patent AComA. CONCLUSION Our in vitro study showed a progressive reduction of collateral blood flow due to the advance of catheters during mechanical thrombectomy.
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Affiliation(s)
- Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jiahui Li
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Pere Canals
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Olive Gadea
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Magda Jabłońska
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Radiology, Gdanski Uniwersytet Medyczny, Gdansk, Poland
| | - Judith Cendrero
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alvaro Garcia-Tornel
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alejandro Tomasello
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain
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18
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Juega J, Li J, Palacio-Garcia C, Rodriguez M, Tiberi R, Piñana C, Rodriguez-Luna D, Requena M, García-Tornel Á, Rodriguez-Villatoro N, Rubiera M, Muchada M, Olivé-Gadea M, Rizzo F, Hernandez D, Dios-Lascuevas M, Hernandez-Perez M, Dorado L, Quesada H, Cardona P, De La Torre C, Gallur L, Camacho J, Ramon-Y-Cajal S, Tomasello A, Ribó M, Molina CA, Pagola J. Granulocytes-Rich Thrombi in Cerebral Large Vessel Occlusion Are Associated with Increased Stiffness and Poorer Revascularization Outcomes. Neurotherapeutics 2023; 20:1167-1176. [PMID: 37212981 PMCID: PMC10457261 DOI: 10.1007/s13311-023-01385-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
We aim to identify a profile of intracranial thrombus resistant to recanalization by mechanical thrombectomy (MT) in acute stroke treatment. The first extracted clot of each MT was analyzed by flow cytometry obtaining the composition of the main leukocyte populations: granulocytes, monocytes, and lymphocytes. Demographics, reperfusion treatment, and grade of recanalization were registered. MT failure (MTF) was defined as final thrombolysis in cerebral infarction score IIa or lower and/or need of permanent intracranial stenting as a rescue therapy. To explore the relationship between stiffness of intracranial clots and cellular composition, unconfined compression tests were performed in other cohorts of cases. Thrombi obtained in 225 patients were analyzed. MTF were observed in 30 cases (13%). MTF was associated with atherosclerosis etiology (33.3% vs. 15.9%; p = 0.021) and higher number of passes (3 vs. 2; p < 0.001). Clot analysis of MTF showed higher percentage of granulocytes [82.46 vs. 68.90% p < 0.001] and lower percentage of monocytes [9.18% vs.17.34%, p < 0.001] in comparison to successful MT cases. The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01-1.14) remained an independent marker of MTF. Among thirty-eight clots mechanically tested, there was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson's r = 0.35, p = 0.032), with a median clot stiffness of 30.2 (IQR, 18.9-42.7) kPa. Granulocytes-rich thrombi are harder to capture by mechanical thrombectomy due to increased stiffness, so a proportion of intracranial granulocytes might be useful to guide personalized endovascular procedures in acute stroke treatment.
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Affiliation(s)
- Jesús Juega
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Jiahui Li
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | | | - Maite Rodriguez
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Riccardo Tiberi
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Carlos Piñana
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Álvaro García-Tornel
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Noelia Rodriguez-Villatoro
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Marta Olivé-Gadea
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - David Hernandez
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marta Dios-Lascuevas
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Laura Dorado
- Department of Neurology, Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Helena Quesada
- Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Pere Cardona
- Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Carolina De La Torre
- Proteomics Unit, Josep Carreras Leukaemia Research Institute (IJC), Badalona, Spain
| | - Laura Gallur
- Hematology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jessica Camacho
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Alejandro Tomasello
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain.
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute. Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
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19
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Diana F, Romoli M, Sabuzi F, Rouchaud A, Mounayer C, Forestier G, Tomasello A, Requena M, Hernández D, Lascuevas MDD, Cuevas JL, Peschillo S, Caroff J, Nguyen TN, Abdalkader M, Da Ros V. Neurophysiological monitoring during endovascular treatment of brain arteriovenous malformations: A meta-analysis. Interv Neuroradiol 2023:15910199231175195. [PMID: 37170611 DOI: 10.1177/15910199231175195] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Treatment of brain arteriovenous malformations (b-AVM) carries a risk of iatrogenic injury to eloquent brain regions. Intraoperative neuro-monitoring (IONM) has increasingly been used to monitor spontaneous or evoked neural activity during neurosurgery, but its use is not as well characterized in the endovascular treatment (EVT) of b-AVMs. We aimed to provide a systematic review and meta-analysis of studies reporting any neurological deficit after b-AVM embolization with IONM, with or without provocative test (PT), and no-IONM. METHODS This systematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from conception until March 1, 2022 for studies evaluating EVT with IONM and PT. Primary outcome was the rate of postoperative neurological deficits in EVT with IONM versus no-IONM, while secondary outcome was the subanalysis of IONM with or without PT. Meta-analysis was performed using the Mantel-Haenszel method and random effects modeling. RESULTS Six studies reached synthesis. Out of a total of 192 EVT, 14 events occurred. Results demonstrated a nonsignificant trend favoring IONM compared to no-IONM to prevent neurological deficits (OR 0.09, 95% CI 0-4.68). Among the EVT with IONM, PT was done in 411 branches with 10 events (0.2%) despite a negative PT. There was a nonsignificant trend favoring IONM plus PT compared to IONM without PT (OR 0.16, 95% CI 0.02-1.07). CONCLUSIONS Our study suggests that b-AVM EVT with IONM plus PT might reduce rates of postprocedural neurological deficits compared with EVT without IONM. Further studies are needed to confirm these results.
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Affiliation(s)
- Francesco Diana
- Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Grupo de Recerca en Ictus, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Federico Sabuzi
- Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Aymeric Rouchaud
- Department of Interventional Neuroradiology, Limoges University Hospital, Limoges, France
- XLim, CNRS UMR 7252, Limoges University, Limoges, France
| | - Charbel Mounayer
- Department of Interventional Neuroradiology, Limoges University Hospital, Limoges, France
- XLim, CNRS UMR 7252, Limoges University, Limoges, France
| | - Géraud Forestier
- Department of Interventional Neuroradiology, Limoges University Hospital, Limoges, France
| | - Alejandro Tomasello
- Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Grupo de Recerca en Ictus, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Manuel Requena
- Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Grupo de Recerca en Ictus, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - David Hernández
- Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Grupo de Recerca en Ictus, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Marta De Dios Lascuevas
- Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Grupo de Recerca en Ictus, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - José Luis Cuevas
- Neurosurgery and Interventional Neuroradiology, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Simone Peschillo
- UniCamillus International Medical University, Rome, Italy
- Endovascular Neurosurgery, Pia Fondazione Cardinale G Panico Hospital, Tricase, Italy
| | - Jildaz Caroff
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy
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20
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Sanjuan E, Pancorbo O, Santana K, Miñarro O, Sala V, Muchada M, Boned S, Juega JM, Pagola J, García-Tornel Á, Requena M, Rodríguez-Villatoro N, Rodríguez-Luna D, Deck M, Ribo M, Molina CA, Meler P, Romero V, Dalmases G, Rodríguez-Samaniego MT, Calleja L, Gutierrez T, Peña L, Gallego JC, Lorenzo E, Gonzalez Y, Moreno R, Rubiera M. Management of acute stroke. Specific nursing care and treatments in the stroke unit. Neurologia 2023:S2173-5808(23)00022-6. [PMID: 37120108 DOI: 10.1016/j.nrleng.2020.07.026] [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] [Received: 06/04/2020] [Accepted: 07/29/2020] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.
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Affiliation(s)
- E Sanjuan
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - O Pancorbo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - K Santana
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - O Miñarro
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - V Sala
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Muchada
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - S Boned
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J M Juega
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J Pagola
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Á García-Tornel
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Requena
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - N Rodríguez-Villatoro
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - D Rodríguez-Luna
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Deck
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Ribo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - C A Molina
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - P Meler
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - V Romero
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - G Dalmases
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M T Rodríguez-Samaniego
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - L Calleja
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - T Gutierrez
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - L Peña
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J C Gallego
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - E Lorenzo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Y Gonzalez
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - R Moreno
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Rubiera
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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21
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Rodrigo-Gisbert M, Requena M, Rubiera M, Khalife J, Lozano P, De Dios Lascuevas M, García-Tornel Á, Olivé-Gadea M, Piñana C, Rizzo F, Boned S, Muchada M, Rodríguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Hernández D, Molina CA, Tomasello A, Ribo M. Intracranial Artery Calcifications Profile as a Predictor of Recanalization Failure in Endovascular Stroke Treatment. Stroke 2023; 54:430-438. [PMID: 36689597 DOI: 10.1161/strokeaha.122.041257] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute ischemic stroke with large or medium-vessel occlusion associated with intracranial artery calcification (IAC) is an infrequent phenomenon presumably associated with intracranial atherosclerotic disease. We aimed to characterize IAC and its impact on endovascular treatment outcomes. METHODS We performed a retrospective cross-sectional study of consecutive patients with stroke treated with thrombectomy from January 2020 to July 2021 in our institution. We described IAC findings (length, density, and location pattern) on baseline noncontrast computed tomography. Patients were divided into 3 groups: IAC related to the occlusion location (symptomatic-IAC group), unrelated to the occlusion (asymptomatic-IAC group), and absence of any IAC (non-IAC group). We analyzed the association between the IAC profile and outcomes using logistic regression models. Intracranial angioplasty and stenting were considered rescue treatments. RESULTS Of the 393 patients included, 26 (6.6%) patients presented a symptomatic-IAC, 77 (19.6%) patients an asymptomatic-IAC, and in 290 (73.8%) patients no IAC was observed. The rate of failed recanalization (expanded Thrombolysis in Cerebral Infarction 0-2a) before rescue treatment was higher in symptomatic-IAC (65.4%) than in asymptomatic-IAC (15.6%; P<0.001) or non-IAC (13.4%; P<0.001). Rescue procedures were more frequently performed in symptomatic-IAC (26.9%) than in asymptomatic-IAC (1.3%; P<0.001) and non-IAC (4.1%; P<0.001). After adjusting for identifiable clinical and radiological confounders, symptomatic-IAC emerged as an independent predictor of failed recanalization (odds ratio, 11.89 [95% CI, 3.94-35.91]; P<0.001), adoption of rescue procedures (odds ratio, 12.38 [95% CI, 2.22-69.09]; P=0.004), and poor functional outcome (90-day modified Rankin Scale score ≥3; odds ratio, 3.51 [95% CI, 1.02-12.00]; P=0.046). CONCLUSIONS The presence of IAC related to the occlusion location is associated with worse angiographic and functional outcomes. Therefore, identification of symptomatic-IAC on baseline imaging may guide optimal endovascular treatment strategy, predicting the need for intracranial stenting and angioplasty.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Jane Khalife
- Department of Neurosurgery, Cooper University Health Care, Camden, NJ (J.K.)
| | - Prudencio Lozano
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Marta De Dios Lascuevas
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Álvaro García-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Marta Olivé-Gadea
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Carlos Piñana
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (C.P., D.H.)
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Sandra Boned
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Noelia Rodríguez-Villatoro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - David Rodríguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Jesús Juega
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - David Hernández
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (C.P., D.H.)
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Alejandro Tomasello
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.R.-G., M. Requena, M. Rubiera, P.L., M.D.D.L., Á.G.-T., M.O.-G., F.R., S.B., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., A.T., M.R.)
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22
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Juega J, Li J, Palacio C, Rodriguez M, Tiberi R, Pinana Plaza C, Rodriguez-Luna D, Requena M, Garcia-Tornel Garcia A, Rodriguez-Villatoro N, Rubiera M, Muchada M, Olive-Gadea M, Rizzo F, Hernandez Morales D, de Dios Lascuevas M, Lozano P, boned S, Hernandez-Perez M, Dorado L, Quesada H, Cardona P, de la Torre C, Gallur LA, Camacho J, Ramon y Cajal S, Tomasello A, Ribo M, Molina CA, Pagola J. Abstract 95: High Proportion Of Granulocytes Form Intracranial Thrombus Is Associated With Increased Stiffness And Resistance To Endovascular Recanalization. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.95] [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] [Indexed: 02/05/2023]
Abstract
Hypothesis:
We aim to identify a profile of intracranial thrombus resistant to recanalization by standard mechanical thrombectomy (MT) in acute stroke treatment.
Methods:
First extracted clot of each MT were analyzed by Flow Cytometry obtaining composition of main leukocyte populations: granulocytes, monocytes and lymphocytes. Demographics, reperfusion treatment and grade of recanalization were registered. MT Failure ( MTF) was defined as final Thrombolysis in Cerebral Infarction score IIa or lower and/ or need of permanent intracranial stenting as a rescue therapy after standard MT. In other cohort of cases, unconfined compression tests were performed to explore stiffness of retrieved clots . We looked for correlation between mechanical characterization tests and clot composition.
Results:
Among 225 patients, there were 13 % of MTF that were significantly associated to atherosclerosis etiology ( 33.3% vs. 15.9% ; p 0.021) , more passes ( 3 vs. 2; p <0.001), higher proportion of clot granulocytes ( 82.46% vs. 68.90% ; p <0.001) and lower proportion of clot monocytes ( 9.18% vs.17.34% ; p<0.001). The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01-1.14) remained as an independent marker of MTF. Among Thirty eight clots tested by unconfined compression median clot stiffness was 30.2 (IQR, 18.9-42.7) kPa. There was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson’s r=0.35, p=0.032).
Conclusions:
There is a positive correlation between granulocyte proportion and thrombi stiffness that may explain endovascular resistance to recanalization. Influence of granulocytes within thrombus may be a target for future reperfusion treatments.
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Affiliation(s)
- Jesus Juega
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona, Spain
| | - Jiahui Li
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - LAura Gallur
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona, Spain
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23
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Piñana C, Díaz L, Carmona T, Requena M, Hernández D, De Dios Lascuevas M, Tomasello A. Abstract TP146: Remote Teleproctoring Enabling Vascular Interventionists In Primary Stroke Centres To Perform Mechanical Thrombectomy With Comparable Results To Comprehensive Stroke Centres. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp146] [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] [Indexed: 02/05/2023]
Abstract
Background:
Increasing efficacy of endovascular thrombectomy for ischemic stroke entails a rising demand for intervention outside Comprehensive Stroke Centers (CSC), in regions where time to treatment and transfer delays result in worse outcomes. We explore the use of a remote teleproctoring system to support vascular interventionists in a remote Local Stroke Center (LSC) to safely perform mechanical thrombectomy (MT) in patients with acute ischemic stroke.
Methods:
Since November 2020, a Tegus Medical Teleproctoring System was installed in a LSC (Arnau de Vilanova Hospital, Lleida) where the potential MT population could be 80-100 procedures/year, however only half that figure is currently being treated, with most patients transferred to the CSC (Vall d’Hebron Hospital, Barcelona) 160 kms away. Since the implementation of this technology, thrombectomy procedures have been performed by vascular interventionists with moderate neurovascular experience at the LSC, remotely assisted by expert neurointerventionists from the CSC. We retrospectively analyzed the safety and effectiveness of MT with the aid of this proctoring System, comparing with procedures performed in the CSC.
Results:
Ten MT were performed in the LSC, comprising 50% of the acute stroke cases taken to the angiosuite in one year. The thrombectomy technique was combined distal aspiration with stent-retriever in all cases. Seven thrombectomies resulted successful after the first pass (70%), achieving complete/near complete recanalization (TICI 2c/3) in 80% of the cases. Comparing with CSC, median puncture to recanalization time was 31 (26-62) vs 42 (27-67) and the rate of final succesful reperfusion (90% in LSC vs 86.5% in CSC) was similar. No technical or procedural complications were reported. At 90 days, 40% of the patients had a mRS 0-2. A survey exploring the personal experience showed that communication was considered optimal and confidence in decision making was considered high at both ends of the system.
Conclusion:
Tegus system seems a valuable tool to support vascular interventionists facing a rise in thrombectomy demands in distant LSCs maintaining enough safety, effectiveness and confidence during the procedures. These data should be challenged by prospective studies.
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Affiliation(s)
- Carlos Piñana
- Interventional Neuroradiology, Radiology, Vall d'Hebron Univ Hosp, Barcelona, Spain
| | - Lourdes Díaz
- Radiology, Arnau de Vilanova Hosp, Lleida, Spain
| | - Tomás Carmona
- Interventional Neuroradiology, Radiology, Vall d'Hebron Univ Hosp, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Neurology, Vall d'Hebron Univ Hosp, Barcelona, Spain
| | - David Hernández
- Interventional Neuroradiology, Radiology, Vall d'Hebron Univ Hosp, Barcelona, Spain
| | | | - Alejandro Tomasello
- Interventional Neuroradiology, Radiology, Vall d'Hebron Univ Hosp, Barcelona, Spain
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24
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Olive-Gadea M, Requena M, Garcia-Tornel A, Rizzo F, Rubiera M, Muchada M, Juega J, PAGOLA JORGE, Rodriguez-Luna D, Rodriguez Villatoro N, tomasello A, Molina CA, Ribo M. Abstract TP2: Iv-thrombolysis Improves Perfusion Profiles In Patients With Anterior Circulation Occlusion Regardless Of Recanalization. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp2] [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] [Indexed: 02/05/2023]
Abstract
Introduction:
Recent publications suggest a positive added effect of iv-thrombolysis (IVT) in patients that undergo endovascular treatment (EVT). It is hypothesized that thrombolytics might have a beneficial impact on microcirculation beyond recanalization. We aim to analyze the potential impact of IVT in patients who underwent a repeated CTP after interhospital transfer.
Methods:
We retrospectively screened 116 patients transferred to our comprehensive stroke center from a primary stroke center capable to perform CTP from June 2021 to August 2022. We collected clinical and radiological data of patients that underwent CTP at both centers, which were analyzed with Rapid software. A neurointerventionalist assessed the occlusion location in CTA.
Results:
Twenty-eight patients with anterior circulation occlusion underwent two multimodal studies, median time between CTPs was 168[142-190]min. Fifteen (53.6%) patients received IVT in the primary stroke center and 13(46.4%) received EVT. Reperfusion occurred in 3(10.7%) cases, migration to distal segments in 5(17.9%). Among the 20 patients without changes in the occlusion location, CTP volumes remained stable (Tmax>6s 61[41-141]ml vs 62[24-178], p=0.72; Tmax>10s 19[8-96] vs 13[0-105], p=0.55; CBF30 0[0-66] vs 0[0-65], p=0.99). CTP volumes tended to decrease with IVT, but a modest increase was observed in patients that did not receive IVT (Tmax>6s -17[-29,+8]ml vs +22[-8,+42], p=0.08; Tmax>10s -8[-16,+6] vs +6[0,+37], p=0.10; CBF<30% 0[-6,0] vs 0[0,+4], p=0.14) (figure). In a linear regression to predict CTP volumes in the second center, interaction between baseline values and IVT was significant for Tmax>10s (p=0.06) and CBF<30% (p<0.05).
Conclusion:
In acute stroke patients with a LVO, no substantial changes are expected in CTP volumes in the absence of recanalization. However, patients that receive IVT tend to present reduced hypoperfusion volumes as compared with patients that do not receive IVT.
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25
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Rodriguez-Luna D, Pancorbo O, Coscojuela P, Lozano P, Rizzo F, Olive-Gadea M, Requena M, Garcia-Tornel A, Rodriguez-Villatoro N, Juega J, Boned S, Muchada M, Pagola J, Rubiera M, Ribo M, Tomasello A, Molina CA. Abstract TP120: Noncontrast Ct, Single-phase Cta, And Multiphase Cta Intracerebral Hemorrhage Expansion Scores. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp120] [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] [Indexed: 02/05/2023]
Abstract
Background:
Several noncontrast computed tomography (NCCT), single-phase computed tomography angiography (CTA), and multiphase CTA markers of intracerebral hemorrhage (ICH) expansion have been previously proposed. We derived and validated three scores for the prediction of hematoma expansion depending on the use of NCCT, single-phase CTA, or multiphase CTA markers of hematoma expansion.
Methods:
We prospective studied 276 consecutive patients with ICH within 6 hours from symptom onset. After deriving NCCT, single-phase CTA, and multiphase CTA scores in a 5-year period population (n=156), we validated them in a different 3-year period population (n=120). Outcome parameters included substantial hematoma expansion >6 mL or >33% at 24 hours (primary outcome) and poor outcome (mRS score >2) at 90 days.
Results:
The most accurate marker of hematoma expansion was spot sign in phase 1 of multiphase CTA (80.3%). The four independent predictors of substantial hematoma expansion included in the different scores were ultraearly hematoma growth (uHG) >5 mL/h, heterogeneous density, spot sign in phase 1 of multiphase CTA, and spot sign in any phase of multiphase CTA (Table). On each of the three scores, the proportion of patients that experienced substantial hematoma expansion increased with each point increase. C-index for both substantial hematoma expansion and poor outcome in the derivation and validation cohort was lower in NCCT expansion score than in single-phase CTA expansion score which, in turn, was lower than in multiphase CTA expansion score (Table).
Conclusions:
This study demonstrates the added prognostic value of more advanced CT modalities in acute ICH evaluation. Single-phase CTA score and, especially, multiphase CTA score, are more robust than NCCT score in the prediction of hematoma expansion and poor outcome. These scores may help to refine the selection of patients at risk of expansion and poorest outcomes in different decision-making scenarios.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Ribo
- Vall d'Hebron Univ Hosp, Barcelona, Spain
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Garcia-Tornel Garcia-Camba A, Lozano P, Requena M, Rodriguez-Luna D, Rodriguez-Villatoro N, Rubiera M, Muchada M, Olive-Gadea M, Rizzo F, boned S, Ribo M, Molina CA, Pagola J, Juega J, Dorado L, Jimenez-Fabrega X, Cardona P, Urra X, Purroy F, Terceño M, Flores AF, Chamorro A, Silva Y, Ustrell X, Zaragoza J, Roquer J, Krupinski J, Cocho D, Palomeras E, Gomez-Choco MJ, Canovas D, Martí-Fàbregas J, Mas N, Fagundez O, Abilleira S, Molina CA, Perez de la Ossa N. Abstract WP4: Intravenous Thrombolysis And Outcomes In Patients With Large-vessel Stroke Directly Admitted Or Transferred To A Thrombectomy-capable Center. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp4] [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] [Indexed: 02/05/2023]
Abstract
Objective:
To assess whether the effect of intravenous thrombolysis in patients with large-vessel occlusion differed between patients directly admitted to thrombectomy-capable centers and patients transferred from local stroke centers without thrombectomy capabilities.
Methods:
We included 3206 patients with an acute ischemic large-vessel stroke with first imaging within 7 hours after onset that were directly admitted to thrombectomy-capable centers and treated with thrombectomy, or transferred from local stroke centers for thrombectomy evaluation, between 2017 and 2021 in Catalonia, Spain. Primary outcome was the degree of disability at 90 days, as evaluated by the shift analysis on the mRs score. Secondary outcomes included mortality at 90 days and the rate of parenchymal hemorrhage and successful reperfusion. Inverse-probability weighting clustered at the type of stroke center was used to estimate the effects.
Results:
The analysis included 2268 patients (975[49%] treated with thrombolysis) directly admitted to thrombectomy-capable centers and 938 patients (580[66%] treated with thrombolysis and 616[67%] treated with thrombectomy) transferred from local stroke centers (mean age 72±13 years, median NIHSS score 17[IQR 12-21], 1363 female[48%]). Patients treated with intravenous thrombolysis were younger, had shorter time from onset to first image acquisition, and higher rates of wake-up stroke, atrial fibrillation and anticoagulation intake. The effect of intravenous thrombolysis on the primary outcome was similar in patients directly admitted to thrombectomy-capable centers (acOR 1.50, 95% CI 1.24-1.81) and patients transferred from local stroke centers (acOR 1.44, 95% CI 1.04 to 2.01)(p
interaction
=0.68). Patients treated with intravenous thrombolysis had lower mortality rate, higher rate of parenchymal hematoma and similar rate of successful reperfusion, with no difference according to type of center (p
interaction
>0.1).
Conclusion:
Administration of intravenous thrombolysis in patients with a large-vessel stroke with intention to thrombectomy was associated with higher odds of good functional outcome and higher rates of parenchymal hematoma, independently of the type of stroke center were it was administered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jesús Juega
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona
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27
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Pancorbo Rosal O, Sanjuan E, Requena M, García Tornel Á, Rodriguez Villatoro N, Juega J, Boned S, Muchada M, Pagola J, Rubiera M, Molina CA, Rodriguez-Luna D. Abstract WP21: Staged Implementation Of A Rapid, Intensive And Sustained Blood Pressure Protocol In Patients With Acute Intracerebral Hemorrhage. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp21] [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] [Indexed: 02/05/2023]
Abstract
Background and Purpose:
The potential benefit of blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients is time-dependent and is an easy and modifiable treatment applicable to different hospital scenarios. However, previous clinical trials did not establish consensus about the best BP strategy to achieve a rapid and sustained BP control. We aimed to assess the impact of learning a staged implementation of rapid-intensive-sustained BP protocol on time targets and BP control rate over the first 24 hours of ICH.
Methods:
We conducted a retrospective analysis of data prospectively collected of consecutive patients with spontaneous ICH (<6h) and systolic BP (SBP) >150 mmHg under a rapid (antihypertensive IV bolus by a stroke nurse at CT scan), intensive (SBP target <140 mmHg within 1 hour after BP agent onset),and sustained (antihypertensive continuous infusion immediately after IV bolus) 24-hour BP protocol during a 6-year period. BP was recorded regularly according to the following schedule: every 15 minutes (0-6 hours); every 30 minutes (6h to 12h), and every 60 minutes (12h to 24h). We recorded the time from BP treatment onset to SBP target achievement and the rate of SBP sustention below target (<140 mm Hg) at all time frames. The protocol implementation was divided in 6 consecutive year periods.
Results:
A total of 207 patients were included in the study. Compared between the periods, the frequency of SBP target achievement during the first hour was increased steadily over different periods(33.3% vs. 54.5% vs. 69.2% vs 69.4% vs 75% and 59.7%;
P=0.024
); median time to SBP target achievement tended to be lower during the evolution of protocol assessment (120 [45-240] min; 49.5 [30-101] min; 53 [29-82] min; 47 [28-74] min; 48 [27-66] min; 50 [30-85] min;
P=0.054
) and SBP sustention rate below the target improve during the acute phase at different time frames, including 2h (26.3% vs. 71.9% vs 60% vs 73.9% vs. 57,7% vs 59.5%;
P= 0.012
), 4h (57.1% vs. 63.3% vs 87.5% vs 85% vs. 61.5% vs. 69.2%;
P= 0.05
), 6h (60.9% vs. 58.6%, vs 95.5% vs 84.4% vs 58.3% vs. 75%;
P=0.009
).
Conclusions:
Rapid-intensive-sustained BP protocol is a good intervention to both achieve a rapid BP target and reduce time delays,and improve the rates of BP control over the acute phase of ICH patients.
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28
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Mowla A, Shakibajahromi B, Shahjouei S, Baharvahdat H, Harandi AA, Rahmani F, Mondello S, Rahimian N, Cernigliaro A, Hokmabadi ES, Ebrahimzadeh SA, Ramezani M, Mehrvar K, Farhoudi M, Naderi S, Fenderi SM, Pishjoo M, Alizada O, Purroy F, Requena M, Tsivgoulis G, Zand R. SARS-CoV-2 infection might be a predictor of mortality in intracerebral hemorrhage. J Neurol Sci 2023; 444:120497. [PMID: 36455388 PMCID: PMC9683865 DOI: 10.1016/j.jns.2022.120497] [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] [Received: 06/28/2022] [Revised: 10/10/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND SARS-CoV-2 infection may be associated with uncommon complications such as intracerebral hemorrhage (ICH), with a high mortality rate. We compared a series of hospitalized ICH cases infected with SARS-CoV-2 with a non-SARS-CoV-2 infected control group and evaluated if the SARS-CoV-2 infection is a predictor of mortality in ICH patients. METHODS In a multinational retrospective study, 63 cases of ICH in SARS-CoV-2 infected patients admitted to 13 tertiary centers from the beginning of the pandemic were collected. We compared the clinical and radiological characteristics and in-hospital mortality of these patients with a control group of non-SARS-CoV-2 infected ICH patients of a previous cohort from the country where the majority of cases were recruited. RESULTS Among 63 ICH patients with SARS-CoV-2 infection, 23 (36.5%) were women. Compared to the non-SARS-CoV-2 infected control group, in SARS-CoV-2 infected patients, ICH occurred at a younger age (61.4 ± 18.1 years versus 66.8 ± 16.2 years, P = 0.044). These patients had higher median ICH scores ([3 (IQR 2-4)] versus [2 (IQR 1-3)], P = 0.025), a more frequent history of diabetes (34% versus 16%, P = 0.007), and lower platelet counts (177.8 ± 77.8 × 109/L versus 240.5 ± 79.3 × 109/L, P < 0.001). The in-hospital mortality was not significantly different between cases and controls (65% versus 62%, P = 0.658) in univariate analysis; however, SARS-CoV-2 infection was significantly associated with in-hospital mortality (aOR = 4.3, 95% CI: 1.28-14.52) in multivariable analysis adjusting for potential confounders. CONCLUSION Infection with SARS-CoV-2 may be associated with increased odds of in-hospital mortality in ICH patients.
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Affiliation(s)
- Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, California, USA
| | | | - Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA, USA
| | - Humain Baharvahdat
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Amini Harandi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Rahmani
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Nasrin Rahimian
- Department of Neurology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Seyed Amir Ebrahimzadeh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mahtab Ramezani
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Mehrvar
- Department of Neurology, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Mehdi Farhoudi
- Neurosciences Resarch Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheil Naderi
- Neurosurgery Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Mahmoudnejad Fenderi
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Pishjoo
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Orkhan Alizada
- Department of Neurosurgery, Baskent University, Faculty of Medicine, Istanbul, Turkey
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLeida), Universitat de Lleida UdL Lleida, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA, USA.
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Pagola J, Juega J, Francisco-Pascual J, Rodriguez M, Dorado L, Martinez R, De Lera-Alfonso M, Arenillas JF, Cabezas JA, Moniche F, de Torres R, Montaner J, Muchada M, Boned S, Requena M, García-Tornel A, Rodríguez-Villatoro N, Rodríguez-Luna D, Deck M, Olivé M, Rubiera M, Ribó M, Alvarez-Sabin J, Molina CA. Intensive 90-day textile wearable Holter monitoring: an alternative to detect paroxysmal atrial fibrillation in selected patients with cryptogenic stroke. Heart Vessels 2023; 38:114-121. [PMID: 35882656 DOI: 10.1007/s00380-022-02141-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/15/2022] [Indexed: 01/06/2023]
Abstract
We aimed to demonstrate the feasibility of 90-day cardiac monitoring with an external Holter device and to find a target population able to benefit from such a technique. Cryptogenic stroke patients were continuously monitored for 90 days with a textile wearable Holter (TWH). Compliance and quality of the monitoring were assessed by the number of hours of ECG stored per month. Mean predictors of pAF, including age, gender, stroke severity, and atrial size (LAVI), were evaluated. One-year follow-up assessed pAF detection outside per protocol monitoring. Out of 224 patients included in 5 stroke centers, 163 patients (72.76%) fulfilled the criteria for the protocol. Median monitoring time was similar among the three months. Per protocol pAF detection reached 35.37% at 90 days. The age (OR 1.095; 95% CI 1.03-1.14) and the LAVI (OR 1.055; 95% CI 1.01-1.09) independently predicted pAF. The cut-off point of 70 years (AUC 0.68) (95% CI 0.60-0.76) predicted pAF with a sensitivity of 75.8% and specificity of 50.5%. The LAVI cut-off point of 28.5 (AUC 0.67) (95% CI 0.56-0.77) had a sensitivity of 63.6% and a specificity of 61.8% to detect pAF. The combination of both markers enhanced the validity of pAF detection sensitivity to 89.6%, with a specificity of 27.59%. These patients had increased risk of pAF during the 90-day monitoring HR 3.23 (χ2 7.15) and beyond 90 days (χ2 5.37). Intensive 90-days TWH monitoring detected a high percentage of pAF. However, a significant number of patients did not complete the monitoring. Patients older than 70 years and with enlarged left atria benefitted more from the protocol.
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Affiliation(s)
- Jorge Pagola
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
| | - Jesus Juega
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit-Cardiology Department, Vall d'Hebrón Hospital and CIBER-CV, Barcelona, Spain
| | - Maite Rodriguez
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Laura Dorado
- Stroke Unit Germans Trias I Pujol Hospital, Badalona, Spain
| | | | | | | | | | | | | | - Joan Montaner
- Stroke Unit, Virgen Macarena Hospital, Sevilla, Spain
| | - Marian Muchada
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Sandra Boned
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Manuel Requena
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Alvaro García-Tornel
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Noelia Rodríguez-Villatoro
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - David Rodríguez-Luna
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Matías Deck
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Marta Olivé
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Marta Rubiera
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Marc Ribó
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Jose Alvarez-Sabin
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Carlos A Molina
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
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30
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Olive-Gadea M, Cano D, Rodrigo-Gisbert M, Muchada M, Montiel E, Baladas M, Sanchez-Gavilan E, Paredes C, Garcia-Tornel A, Rubiera M, Requena M, Ribo M, Molina CA. Redefining Disability: Patient-Reported Outcome Measures After Minor Stroke and Transient Ischemic Attack. Stroke 2023; 54:144-150. [PMID: 36300370 DOI: 10.1161/strokeaha.122.040409] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/07/2023]
Abstract
BACKGROUND Long-term outcome assessment patients with stroke is not fully captured by usual clinical scales such as the modified Rankin Scale (mRS). Patient-reported outcome measures (PROMs) are standardized and validated assessments that consider clinical outcomes from the patient perspective. We aim to analyze the added value of PROMs in patients with transient ischemic attack and minor stroke. METHODS We included consecutive patients with minor stroke or transient ischemic attack (National Institutes of Health Stroke Scale score 0-5) from April 2020 to October 2021 that participated in the PROMs-through-App program (NORA, NoraHealth Barcelona Spain). Clinician and self-evaluated outcomes were assessed at 90 days: clinician-evaluated mRS, self-reported mRS, the 10-item patient-reported outcome measures questionnaire global health survey (v1.2), Hospital Anxiety and Depression Scale, and the Fatigue Assessment Scale. We evaluated the acceptability (response rate), reliability (internal consistency), and construct validity (correlation with mRS and between scales) of each questionnaire. RESULTS We included 355 patients in the analysis, response rate was patient-reported outcome measures questionnaire 71.3% (253), Hospital Anxiety and Depression Scale 70.7% (251), Fatigue Assessment Scale 71.8% (255), and self-assessed mRS 66.8% (237). PROMS internal consistency was good or excellent, while agreement between clinician and self-reported mRS was fair (k=0.34). Rate of abnormal PROMS scores were as follows (all responders versus clinician-reported mRS score 0-2): patient-reported outcome measures questionnaire mental health (43.1% versus 36.3%), physical health (48.6% versus 43.6%); Hospital Anxiety and Depression Scale-anxiety (21.9% versus 17.7%) and depression (17.1% versus 13.3%); and Fatigue Assessment Scale (40.8% versus 36.4%). PROMs scores correlated with clinician and self-reported mRS at 90 days. CONCLUSIONS Evaluation of PROMs using a mobile-app-based communication system is a reliable and valid strategy to assess the outcome of patients from their perspective after a mild stroke or transient ischemic attack.
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Affiliation(s)
- Marta Olive-Gadea
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - David Cano
- Vall d'Hebron Institut de Recerca, Barcelona, Spain (D.C.)
| | - Marc Rodrigo-Gisbert
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Marian Muchada
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Estefania Montiel
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Maria Baladas
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Ester Sanchez-Gavilan
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Carolina Paredes
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Alvaro Garcia-Tornel
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Marta Rubiera
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Manuel Requena
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Marc Ribo
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
| | - Carlos A Molina
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.)
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31
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Rius-Peris JM, Tambe P, Chilet Sáez M, Requena M, Prada E, Mateo J. Incidence and Severity of Community- and Hospital-Acquired Hyponatremia in Pediatrics. J Clin Med 2022; 11:jcm11247522. [PMID: 36556138 PMCID: PMC9782113 DOI: 10.3390/jcm11247522] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Hyponatremia is the most common electrolyte disturbance in hospitalized children, with a reported incidence of 15-30%, but its overall incidence and severity are not well known. The objective of our study was to determine the incidence, severity, and associated risk factors of community- and hospital-acquired hyponatremia on a general pediatric ward. Data of 5550 children admitted from June 2012 to December 2019 on plasma sodium and discharge diagnosis were analyzed by logistic regression model. Clinically relevant diagnostic groups were created. Hyponatremia was classified as mild, moderate, and severe. The incidence of community- and hospital-acquired hyponatremia was 15.8% and 1.4%, respectively. Most of the cases were mild (90.8%) to moderate (8.6%), with only two cases of severe community-acquired hyponatremia. There were no clinical complications in any of the hyponatremic children. Age and diagnosis at discharge were principal factors significantly correlated with hyponatremia. Community-acquired hyponatremia is more common than hospital-acquired hyponatremia in clinical practice. Severe cases of both types are rare. Children from 2 to 11 years of age presenting with infections, cardiovascular disorders, and gastrointestinal disorders are at risk of developing hyponatremia.
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Affiliation(s)
- J. M. Rius-Peris
- Pediatric Department, Virgen de la Luz Hospital, 16002 Cuenca, Spain
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - P. Tambe
- Pediatric Department, Southland Hospital, Invercargill 9812, New Zealand
| | - M. Chilet Sáez
- Analysis and Microbiology Department, Virgen de la Luz Hospital, 16002 Cuenca, Spain
| | - M. Requena
- Computer Analysis Department, Virgen de la Luz Hospital, 16002 Cuenca, Spain
| | - E. Prada
- Clinical Analysis Department, Virgen de la Luz Hospital, 16002 Cuenca, Spain
| | - J. Mateo
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Correspondence:
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Olive-Gadea M, Requena M, Diaz F, Boned S, Garcia-Tornel A, Muchada M, Deck M, Lozano P, Rodriguez-Villatoro N, Juega J, Pagola J, Rodriguez-Luna D, Rubiera M, Marti C, Molina CA, Piñana C, Hernandez D, Tomasello A, Ribo M. Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates. J Neurointerv Surg 2022; 14:1270-1273. [PMID: 34857668 DOI: 10.1136/neurintsurg-2021-018241] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 09/16/2021] [Accepted: 11/21/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND In patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols. METHODS From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) >6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO). RESULTS Of the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax >6s: 73 (29-127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax >6s: 102 (63-160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax >6s: 69 (46-99.5) mL). CONCLUSION Systematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.
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Affiliation(s)
- Marta Olive-Gadea
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain.,Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain.,Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | | | - Sandra Boned
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | | | - Marian Muchada
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Matias Deck
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Prudencio Lozano
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | | | - Jesus Juega
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | | | - Marta Rubiera
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | | | - Carlos A Molina
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Carlos Piñana
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain .,Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
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Rodrigo-Gisbert M, Requena M, De Dios Lascuevas M, García-Tornel Á, Olivé-Gadea M, Boned S, Muchada M, Deck M, Rodríguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Tomasello A, Piñana C, Hernández D, Coscojuela P, Ribó M, Molina CA, Rubiera M. Multiparametric Neuroimaging and Its Association with Non-Contrast Computed Tomography in Late-Window Large Vessel Occlusion Acute Stroke. Cerebrovasc Dis 2022; 52:344-352. [PMID: 36318888 DOI: 10.1159/000526477] [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] [Received: 02/18/2022] [Accepted: 07/20/2022] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 and 24 h is established as a standard of care among patients selected by multiparametric neuroimaging. We aimed to explore neuroimaging parameters in late-window large vessel occlusion (LVO) patients and its association with non-contrast computed tomography (NCCT) findings. METHODS We included consecutive AIS patients within 6-24 h from the symptoms onset with LVO. We described multiparametric imaging findings, the rate of patients who fulfilled imaging perfusion criteria according to the DAWN and DEFUSE-3 trials that define the computed tomography perfusion mismatch (CTP-MM) group and its association with NCCT focused on Alberta Stroke Program Early CT Score (ASPECTS). We also analyzed the association between neuroimaging parameters and the clinical outcome determined by the 90-day modified Rankin scale (mRS). RESULTS We included 206 patients, of them, 176 (85.4%) presented CTP-MM and 184 (89.3%) presented an ASPECTS ≥6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥6, compared with 40.9% in those with low ASPECTS. ASPECTS was moderately correlated with ischemic core determined by cerebral blood flow <30% volume (rS = -0.557, p < 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR: 3.38; 95% CI: 1.01-11.29; p = 0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR: 1.39; 95% CI: 0.58-3.34; p = 0.459). CONCLUSIONS A great majority of patients who presented a LVO in the late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥6). Our data suggest that NCCT with CT angiography could be a reasonable approach for AIS treatment selection also in the late window.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain,
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta De Dios Lascuevas
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro García-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Olivé-Gadea
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Boned
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matías Deck
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Noelia Rodríguez-Villatoro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Juega
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Piñana
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Garcia-Tornel A, Millan M, Rubiera M, Bustamante A, Requena M, Dorado L, Olivé-Gadea M, Jiménez X, Soto A, Querol M, Hernández-Pérez M, Gomis M, Cardona P, Urra X, Purroy F, Silva Y, Ustrell X, Esteve P, Salvat-Plana M, Gallofré M, Molina C, Dávalos A, Jovin T, Abilleira S, Ribo M, Pérez de la Ossa N. Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas. Stroke 2022; 53:3728-3740. [PMID: 36259411 DOI: 10.1161/strokeaha.122.040768] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). METHODS Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. RESULTS The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2-5] versus 3 [1-5], common odds ratio, 1.25 [95% CI, 1.06-1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08-1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81-1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16-1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51-0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25-52]) and thrombectomy(mean difference 66 minutes [95% CI, 37-95]). CONCLUSIONS In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02795962.
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Affiliation(s)
- Alvaro Garcia-Tornel
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Monica Millan
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Marta Rubiera
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Alejandro Bustamante
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Manuel Requena
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Laura Dorado
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Marta Olivé-Gadea
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | - Angels Soto
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | - Marisol Querol
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | | | - Meritxell Gomis
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Pere Cardona
- Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain (P.C.)
| | - Xabier Urra
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U.)
| | - Francesc Purroy
- Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova de Lleida, Lleida, IRBLleida, UdL, Spain (F.P.)
| | - Yolanda Silva
- Department of Neurology, Stroke Unit, Hospital Josep Trueta, Girona, Spain (Y.S.)
| | - Xavier Ustrell
- Department of Neurology, Stroke Unit, Hospital Joan XXIII, Tarragona, Spain (X.U.)
| | - Patricia Esteve
- Department of Neurology, Stroke Unit, Hospital Verge de la Cinta, Tortosa, Spain (P.E.)
| | - Mercè Salvat-Plana
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (M.S.-P., N.P.d.l.O.)
| | | | - Carlos Molina
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | | | - Tudor Jovin
- Neurological Institute, Cooper University Hospital, Camden, New Jersey (T.J.)
| | | | - Marc Ribo
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Natalia Pérez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.).,Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (M.S.-P., N.P.d.l.O.)
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Sarraj A, Albers GW, Blasco J, Arenillas JF, Ribo M, Hassan AE, de la Ossa NP, Wu TYH, Cardona Portela P, Abraham MG, Chen M, Maali L, Kleinig TJ, Cordato D, Wallace AN, Schaafsma JD, Sangha N, Gibson DP, Blackburn SL, De Lera Alfonso M, Pujara D, Shaker F, McCullough-Hicks ME, Moreno Negrete JL, Renu A, Beharry J, Cappelen-Smith C, Rodríguez-Esparragoza L, Olivé-Gadea M, Requena M, Almaghrabi T, Mendes Pereira V, Sitton C, Martin-Schild S, Song S, Ma H, Churilov L, Mitchell PJ, Parsons MW, Furlan A, Grotta JC, Donnan GA, Davis SM, Campbell BCV. Thrombectomy versus Medical Management in Mild Strokes due to Large Vessel Occlusion: Exploratory Analysis from the EXTEND-IA Trials and a Pooled International Cohort. Ann Neurol 2022; 92:364-378. [PMID: 35599458 DOI: 10.1002/ana.26418] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate functional and safety outcomes for endovascular thrombectomy (EVT) versus medical management (MM) in patients with large vessel occlusion (LVO) and mild neurological deficits, stratified by perfusion imaging mismatch. METHODS The pooled cohort consisted of patients with National Institutes of Health Stroke Scale (NIHSS) < 6 and internal carotid artery (ICA), M1, or M2 occlusions from the Extending the Time for Thrombolysis in Emergecy Neurological Deficits - Intra-Arterial (EXTEND-IA) Trial, Tenecteplase vs Alteplase before Endovascular Thrombectomy in Ischemic Stroke (EXTEND-IA TNK) trials Part I/II and prospective data from 15 EVT centers from October 2010 to April 2020. RAPID software estimated ischemic core and mismatch. Patients receiving primary EVT (EVTpri ) were compared to those who received primary MM (MMpri ), including those who deteriorated and received rescue EVT, in overall and propensity score (PS)-matched cohorts. Patients were stratified by target mismatch (mismatch ratio ≥ 1.8 and mismatch volume ≥ 15ml). Primary outcome was functional independence (90-day modified Rankin Scale = 0-2). Secondary outcomes included safety (symptomatic intracerebral hemorrhage [sICH], neurological worsening, and mortality). RESULTS Of 540 patients, 286 (53%) received EVTpri and demonstrated larger critically hypoperfused tissue (Tmax > 6 seconds) volumes (median [IQR]: 64 [26-96] ml vs MMpri : 40 [14-76] ml, p < 0.001) and higher presentation NIHSS (median [IQR]: 4 [2-5] vs MMpri : 3 [2-4], p < 0.001). Functional independence was similar (EVTpri : 77.4% vs MMpri : 75.6%, adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] = 0.82-2.03, p = 0.27). EVT had worse safety regarding sICH (EVTpri : 16.3% vs MMpri : 1.3%, p < 0.001) and neurological worsening (EVTpri : 19.6% vs MMpri : 6.7%, p < 0.001). In 414 subjects (76.7%) with target mismatch, EVT was associated with improved functional independence (EVTpri : 77.4% vs MMpri : 72.7%, aOR = 1.68, 95% CI = 1.01-2.81, p = 0.048), whereas there was a trend toward less favorable outcomes with primary EVT (EVTpri : 77.4% vs MMpri : 83.3%, aOR = 0.39, 95% CI = 0.12-1.34, p = 0.13) without target mismatch (pinteraction = 0.06). Similar findings were observed in a propensity score-matched subpopulation. INTERPRETATION Overall, EVT was not associated with improved clinical outcomes in mild strokes due to LVO, and sICH was increased. However, in patients with target mismatch profile, EVT was associated with increased functional independence. Perfusion imaging may be helpful to select mild stroke patients for EVT. ANN NEUROL 2022;92:364-378.
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Affiliation(s)
- Amrou Sarraj
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Stroke Division, University Hospitals Neurological institute, Cleveland, OH, USA
| | | | - Jordi Blasco
- Department of Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Juan F Arenillas
- Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ameer E Hassan
- Department of Neurology, Valley Baptist Medical Center, Harlingen, TX, USA
| | | | - Teddy Yuan-Hao Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | | | - Michael G Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michael Chen
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Laith Maali
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis Cordato
- Department of Neurology, University of New South Wales South Western Sydney Clinical School, Liverpool Hospital, Liverpool, NSW, Australia
| | | | - Joanna D Schaafsma
- Neurology, Department of Internal Medicine, Toronto Western Hospital-University Health Network, Toronto, ON, Canada
| | - Navdeep Sangha
- Department of Neurology, Kaiser Permanente, Los Angeles, CA, USA
| | - Daniel P Gibson
- Department of Neurosurgery, Ascension Wisconsin, Milwaukee, WI, USA
| | - Spiros L Blackburn
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | | | - Deep Pujara
- Stroke Division, University Hospitals Neurological institute, Cleveland, OH, USA
| | - Faris Shaker
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | | | | | - Arturo Renu
- Department of Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - James Beharry
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Cecilia Cappelen-Smith
- Department of Neurology, University of New South Wales South Western Sydney Clinical School, Liverpool Hospital, Liverpool, NSW, Australia
| | | | - Marta Olivé-Gadea
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tareq Almaghrabi
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Clark Sitton
- Department of Diagnostic and Interventional Radiology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Sheryl Martin-Schild
- Department of Neurology, Touro Infirmary and New Orleans East Hospital, New Orleans, LA, USA
| | - Sarah Song
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Henry Ma
- Department of Neurology, Monash University, Melbourne, Vic., Australia
| | - Leonid Churilov
- Department of Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Mark W Parsons
- Department of Neurology, University of New South Wales South Western Sydney Clinical School, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anthony Furlan
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Stroke Division, University Hospitals Neurological institute, Cleveland, OH, USA
| | - James C Grotta
- Department of Clinical Innovation and Research, Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
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García‐Tornel Á, Seró L, Urra X, Cardona P, Zaragoza J, Krupinski J, Gómez‐Choco M, Mas Sala N, Catena E, Palomeras E, Serena J, Hernandez‐Perez M, Boned S, Olivé‐Gadea M, Requena M, Muchada M, Tomasello A, Molina CA, Salvat‐Plana M, Escudero M, Jimenez X, Davalos A, Jovin TG, Purroy F, Abilleira S, Ribó M, Perez de la Ossa N, Jacobi MR, Sanjuan E, Santana K, Molina C, Rubiera M, Rodríguez N, Pagola J, Rodriguez‐Luna D, Maisterra O, Santamarina E, Muchada M, Juega J, Boned S, Franco AP, García‐Tornel Á, Gadea MO, Deck M, Requena M, Sala V, de la Ossa NP, Muñoz L, Millán M, Gomis M, López‐Cancio E, Dorado L, Hernández‐Pérez M, Ciurans J, Samaniego D, Canento T, Martin L, Planas A, Broto J, Sorrentino A, Paré M, Zhu N, Garrido A, Grau L, Crespo AM, Presas S, Almendrote M, Ramos A, Lucente G, Ispierto L, Lozano M, Becerra JL, Jiménez M, Rolán DV, Guanyabens N, Sanchez‐Ojanguren J, Martínez‐Piñeiro A, Forcén S, Gea M, Álvarez M, Ramos A, Lizarbe MD, Sara, Guerra R, Bragado I, Arbex A, Rodríguez L, Bustamante A, Portela PC, García HQ, Rodríguez BL, Cayuela N, Miró J, Marzal C, Paipa A, Campoy S, Núñez A, Arroyo P, Besora S, Adell V, Campdelacreu J, Martí MA, González B, Vila LB, Crespo MF, Berbel A, Urbaneja CV, Guillen N, Vidal N, Santamaria PVV, Navarro DH, Simó M, Falip M, Matas E, Ochoa NM, Gifreu A, Muñoz A, Romero L, Portell E, Perez GH, Esteve FR, Teixidor S, Talavera AS, Gómez R, Nuin XU, Vargas M, Chamorro Á, Amaro S, Llull L, Renú A, Rudilosso S, del Valle RS, Ariño H, Solà N, la Puma D, Gil F, Gómez JB, Matos N, Falgàs N, Borrego S, Sánchez A, Balasa M, Montejo C, Guasp M, Reyes D, Cervilla PS, Contador JM, Monge VAV, Ramos O, Manzanera LSR, Rodríguez A, Campello AR, Ballester GR, Trujillano ML, Steinhauer EG, Godia EC, Santiago AJO, Conde JJ, Fábregas JM, Guisado D, Prats L, Camps P, Delgado R, Domeño AM, Marín R, Cànovas D, Estela J, Ros M, Aranceta S, Espinosa J, Rubio M, Lafuente C, Barrachina O, Anguita A, Reverter A, García C, Sansa G, Hervas M, Crosas M, Delgado T, Krupinski J, Folch DSH, Gamito GM, Alvarez JT, Subirana T, Molina J, Besora S, Romero LC, Valls GG, Jover M, Sotova JJ, Sánchez SMG, Valenzuela S, Gómez‐Choco M, Mengual JJ, Font MÀ, Ruiz MIG, Zubizarreta I, González SF, Gubieras L, Cobos CE, Romo LM, Caballol N, Cano L, Leal JS, Blas YS, Izarra MT, Trigo IB, Viturro SB, Albiñana LP, Garrido MR, Cazcarra CM, Uscamaita KE, Márquez F, Coll C, Villlas MIL, Vila BS, Perna BA, Domínguezl DL, de Lera M, Foraster AC, Monge VAV, Bojaryn U, García FP, Benabdelhak I, Capdevila GM, Montesinos JS, Vázquez D, Hervás JV, González C, Quílez A, Pascual MV, Ruiz M, Riba Y, Villar MPG, García C, Roig XU, Mora MB, Guinjoan AP, Borras J, Martínez AM, Marés R, Viñas i Gaya J, Seró L, Flores A, Rodríguez DP, Castilho G, Ortega AM, Reverté S, Zaragoza J, Baiges JJ, Zaragoza J, Ozaeta GM, Escalante S, Belloch PE, Payo I, Salvado JS, Sala NM, Soler Insa JM, Vilamala ET, Navarro JA, Tabuenca HC, Sánchez TC, Ros M, Matos N, Roldán E, Rubiol EP, Franquet E, Fuentes L, Donaire J, Martí E, Giménez L, Vázquez JG, Ambrós ENCG, Rodríguez P, Oletta JF, Mellado PP, Catena, Gómez B, Raileau V, Ruíz EC, Pardina O, Mercadal J, López‐Diéguez M, Pérez P, Gabarró L, Orriols M, Molina JC, Canet JJ, Roca M, Álvaro M, Boneu F, Giménez G, Albà J, Gibert F, Garcia J, Barragan P, Jurado G, Pascual V, Ortega JS, Solano JAM, Fernández V, Torres M, Alvaredo ABM, Parejo LR, Aragonés JM, Bullón A, Loste C, González P, Bejarano N, Sanchez F, Lucchetti G, Pla X, Gimeno J, Reynaga E, Barcons M, Celedón G, Ortiz J, Anastasovski G, Mascaró O, de los Ríos JD, Feliu M, Ribera A, Ruiz C, Corominas G, Nunes DD, Roca C, Latorre N, Yataco L, Cruz M, Blanco N, Castejón S, Calderón DC, Sunyer CP, Garcia JE, Martin RP, de Luis Sanchez A, Vivas DE, Molina JV, Palome GP, Chaume LT, Vilella AV, Bustamante M, Boltes A, Rodríguez F, Arrieta I, Molist JC, Andreu B, Soler EP, Buscà NG, López MD, Farreres JB, Ruiz VC, Batiste DM, Cartagena MPS, de Vega EC, Real JB, Roman HP, Socolich C, Camp JMA, Orgaz ATC, Felip MPF, Morón N, Bacca S, Molina M, Casarramona F, Elias L, Bukaei MZ, Gutierrez JAM, Escuin JL, Olaizola C, Vargas YL, Oyonarte JJ, Soultana R, Golpe ES, Salvador E, Vila G, Serrano M, Claverol MNL, Lamolla M, Amate M, Rodriguez A, Romero R, del Carpio M, Hernandez AI, Martín J, Rosas MC, Nogueroles A, Encarnación S, Robles A, Herrera JA, Gavilán R, Mameghani T, Araujo G, Morales MAG, Segui ERA, Climent EF, Pujol FP, Seira MJG, Pía LG, Nuñez FS, Peñalver CA, Lopes CV, Tasa ER, Vilchez CR, Zambrana MS, Ribas BS, Panés IV, Planavila MV, Lorenzo AV, Guixes MS, Medina J, Sambrano D, Zamarreño J, Pirela C, Vélez P, Cajamarca L, Pérez H, Martínez Y, Gonçalves JA, Regordosa C, Mormeneo C, Griu L, Colina MF, Farik E, Duch DC, Badenas C, Bernal O, Agramunt N, Morales S, Reynoso V, Guerrero M, Cid PR, Folqué M, Pedroza C, Hachem A, Martínez ÍS, García XV, Amorós ML, Subirós XC, Benet MC, Eendenburg CV, Osuna T, Santos DG, Pallisera DM, Oliva LG, Sanchez DG, Basurto X, Vivoda L, Van der Kleyn R, Robles DL, Barranco AC, Almendros MC, Oliveras MP, Álvarez AF, Rybyeva M, Viñas A, Barcons M, Tavera JDA, Burbano P, López C, Cruz D, Bisbe P, Fernández N, Palacio JC, Fraiz E, Aguiló O, Amorodjo R, Velázquez J, Sánchez E, Español J, de Celis JP, Coll A, Díaz G, Vergés i Sala M, Capdevila MÁC, Ferrini YY, Gorriz A, Navarro DC, Velásquez D, Soler JP, González J, Higuera JD, Cuellar L, Miniello LM, Pujol L, Cracan S, Angela MVM, Anabel LL, Molist MG, Anna D, Muñoz SS, Yolanda F, Pujalte C, Marín ET, Casas YF, Luque SH, Sendra JM, Valero FM, Olga CE, Carles GDL, Enric LD, Paramio C, Xavier, Xavier CE, Jaime EM, Jordi CM, Antonio CA, Elena CNM, Lluis CRP, Anna DF, Pere FSJ, Ana FG, Antoni FBJ, Carlos GHJ, Sergio HP, Zulma IT, Rafael MR, Albert OG, Marta OC, Soledad QGM, RodriguezJavier R, Joaquin RS, Ramon RMJ, Pere SV, Jose SAM, Angeles SGM, Francisco TE, José TGP, Isabel VCM, Jose VLJ, Angeles LCM, Isaac LG, Arnulfo MAJ, Olga MF, Teresa SGM, Miquel TM, Mercedes VLM, Manuel PRJ, Marta RF, Dominica RT, Jose SG, Meritxell SG, Sheila AR, Falip AG, Vanessa AO, Stella BP, Miriam CM, Monica CF, Estefani CM, Nuria DM, Laura DM, Margarita FP, Sylvia FC, Georgina GT, del Mar GGA, de Jesus LAD, Pilar LS, Monica LV, Jordi MC, de la Cruz Raquel M, Arantxa MB, Marcos OO, Núria PS, Sergi PM, Carlos RGJ, Virginia RP, Anna SP, Mireia SV, Rossana SL, Judit TR, Anna TC, Maria VA, Teresa AGM, Silvia BV, Maria CGR, Antonio ECJ, Agusti EM, Helena GF, Sar HL, Sonia JD, Angel MGM, Pau OS, Noemi PF, Jesus SF, Carlos SAA, Giovanna TL, Sandra VH, Marta TG, Ada AV, Sonia AA, Laura AN, Mar AB, Cristina AM, Angels AO, Jeannette AC, Miriam AP, Vanessa ACM, Remedios AGE, Silvia AS, Izaskun AS, Nuria BG, Sergio BB, Teresa BT, Roser BP, Ariadna BP, Isabel BG, Nuria BS, Laia BA, Salvador CC, Arnau CC, Iren CM, Nuria CB, Daniel CF, Marc CS, Teresa CM, Cristina CB, Sandra CC, Borrego AJLC, Orri AC, Vilanova GC, Sole AC, Torres MC, Estepa NC, de Sostoa Graell M, del Rio Lopez L, Sandra BDC, Carmen DB, Lucia DMA, Carme DPM, Javier DCP, Laura DM, Khadija EA, Pau EM, David EC, Daniel FP, Sergi FQ, Sergio FE, Anna FA, del Valle Africa F, del Valle Mª Luisa F, Maria FQS, Teresa FRM, Rut GF, Alicia GG, Laura GC, Marina GR, Gemma C, Manuela GA, Xavier GG, Beatriz GF, Marta GG, Ricardo GG, Flor GL, Maria GO, Marta GB, Susana GR, Albert GE, Gemma HS, Dolça HC, Lluis HA, Marta HR, Paula IB, Alessandro I, Marta IC, Etxetxikia JU, Jordi JG, Rajaa KA, Gustavo LG, Anna LM, de Jesus LAD, Lourdes LMM, Aida LC, Monica LB, Laura LM, Cristian LR, Pedro LR, Tania LM, Ruth LM, Jessica LC, Alexia LN, Antonio MDJ, Morales MTP, Albert MC, Natanael MCD, David MG, Paula MG, Quesada M, Marzà Fusté Mireia CM, Marta ML, Jordi MM, Pastalle MP, Silvia MV, Emma MM, Christian MP, Olga MF, Helena MC, Mireia MV, Guillem MS, Aldara MQ, Natalia NR, Asuncion NIM, Pilar NMM, Judith OM, Roger PR, Xenia PT, Ivana PB, Anna PG, Mireia PO, Alejandra PRM, Raquel PY, Anna PM, Sergi PM, Alba PC, Lourdes QB, Cristina RB, Helena RF, del Carmen RGM, Joaquim RP, Inma RF, Amalia RF, Mariola RF, Raquel RM, Yolanda RN, Alicia RI, Albert RG, Silvia RB, de Eugenio Ramon R, Priscila RBARL, Julia SL, Carolina SJA, Daniel SS, Jordi SS, Marta SS, Enriqueta SP, Maria SB, Ruth SD, Ignacio TM, Cristina TV, Ines TSE, Soledad TT, Lluis TF, Marina TR, Anna TG, Nuria TE, Florenc U, Garazi VB, De la Paz Angel V, Fernando VG, Ingrit VG, Natalia VM, Eva VC, Jose VJM, Angela VF, Carla VG, Elisabeth VV, Jose CJF, Agusti GV, Albert GG, Laura JM, Jose MC, Felix MO, Jose MBM, Manuel ML, Jesus MRM, Carles MG, Ricardo MH, Eva MO, Ramon PP, Camilo PC, Antonio PAJ, Pol QM, Jordi RM, Sonia AA, Celia AA, Lorena AF, Joan BP, Laia BA, Francisco CV, Jaume CH, Gloria CGM, Gonzalo CM, Xavier CE, Enric CG, Montserrat CS, Carlos DS, Javier ER, del Mar ECM, Joaquin FA, Carlos FG, Patricia FP, Laura FE, Cristina FG, Marta GP, Ainhoa GG, Rafael HS, Dolça HC, Marta HR, Sonia JA, Pedro JR, Angeles LCM, Alejandro LL, Aleix LO, Rosa MRM, Daniel MM, Marta MM, Noelia ME, Olga MF, Sandra MJ, Matilde MR, Jessica NR, Maria NIR, Raquel NV, Alba PTM, Montserrat PVC, Alba PC, Angels RM, Alejandro RT, Merce RO, Mariola RF, Baltasar SG, Paola SP, Enriqueta SP, Cristina SB, Angeles SGM, Meritxell TF, Gemma TB, Jose TA, Agusti EM, Purificacion FM, Luis HP, Laura JM, Pedro LF, Alfonso LG, Felix MO, Jose MBM, Carles MG, Eva MO, Ricardo PL, Ramon PP, Joan QA, Miguel VL, Consuelo AD, Jeannette AC, Miguel AM, Anna AC, Raquel BG, Antonio BC, Del Mar CGM, Montserrat CO, Daniel CF, Marc CS, Isabel CMC, Alexander CB, Gloria CGM, Gonzalo CM, Sergio CC, Alexandre CO, Lidia CP, Rita CO, Carles DE, Javier DCP, del Mar ECM, Raquel FM, Luis GLP, Marta GP, Vallve GA, Manuela GA, Xavier GG, Carlos GM, Elena HV, Dolça HC, Cristina HG, Rafael MR, Marta MM, Daniel MM, Sergi MB, Xavier MP, Isabel MD, Maria MC, Pastalle MP, de la Cruz Raquel M, Olga MF, Javier MSF, Roger PR, Alba PTM, Feliciano PB, Monica PA, Cristina RB, Obed RP, Javier RPF, Mar RT, Sandra RP, Laura SS, Yolanda SM, Sheila SM, Eduardo SC, Soledad TT, Lluis TF, José TGP, Ricard TT, Narcis VD, Olga VE, Nuria VP, Andres BG, Marc BP, Cristina BS, Victor BA, Gemma BB, Estel BC, Alejandro CG, Esther CC, Sanchez CF, Toledo EJF, Roger ER, Xavier ERF, Mireia FS, Jordi GL, Daniel GL, Jorge HL, Alicia JLS, Joel LO, Samuel LY, Marta LV, Soto LS, Nicolas MC, Jesus MCD, Arich MP, Susana MS, Raul MM, Isabel MHM, Jose OFM, Bàrbara PB, Pedro PS, Judith RC, Marc RL, Verònica RL, Silvina RL, Gerard SC, Marc SL, Manel SR, Meritxell SG, Albert SC, Noemí SD, Gabriel SMG, Miquel TM, Maria VPA, Silvia VM, Salvat‐Plana M, Roig J, Hidalgo V, Vivanco‐Hidalgo RM, Gallofré M, Cobo E. Workflow times and outcomes in patients triaged for a suspected severe stroke. Ann Neurol 2022; 92:931-942. [DOI: 10.1002/ana.26489] [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] [Received: 05/05/2022] [Revised: 07/21/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Álvaro García‐Tornel
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Laia Seró
- Department of Neurology Hospital Universitari Joan XXIII Tarragona Spain
| | | | - Pere Cardona
- Stroke Unit Hospital Universitari Bellvitge, L'Hospitalet de Llobregat Spain
| | - Josep Zaragoza
- Department of Neurology Hospital Verge de la Cinta Tortosa Spain
| | | | - Manuel Gómez‐Choco
- Department of Neurology Complex Hospitalari Hospital Moisés Broggi Sant Joan Despí Spain
| | - Natalia Mas Sala
- Department of Neurology Hospital Sant Joan de Déu ‐ Fundació Althaia Manresa Spain
| | - Esther Catena
- Department of Neurology Consorci Sanitari Alt Penedès‐Garraf Spain
| | | | - Joaquin Serena
- Stroke Unit Hospital Universitari Josep Trueta Girona Spain
| | | | - Sandra Boned
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Marta Olivé‐Gadea
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Requena
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
- Department of Interventional Neurorradiology. Hospital Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Marian Muchada
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Alejandro Tomasello
- Department of Interventional Neurorradiology. Hospital Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Carlos A. Molina
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Mercè Salvat‐Plana
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | | | | | - Antoni Davalos
- Stroke Unit Hospital Germans Trias i Pujol Badalona Barcelona Spain
| | - Tudor G Jovin
- Neurological Institute Cooper University Hospital Camden New Jersey
| | - Francesc Purroy
- Stroke Unit. Department of Neurology Hospital Universitari Arnau de Vilanova de Lleida Lleida Spain
| | - Sonia Abilleira
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Marc Ribó
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
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Dmytriw AA, Ghozy S, Sweid A, Piotin M, Bekelis K, Sourour N, Raz E, Vela-Duarte D, Linfante I, Dabus G, Kole M, Martínez-Galdámez M, Nimjee SM, Lopes DK, Hassan AE, Kan P, Ghorbani M, Levitt MR, Escalard S, Missios S, Shapiro M, Clarençon F, Elhorany M, Tahir RA, Youssef PP, Pandey AS, Starke RM, El Naamani K, Abbas R, Mansour OY, Galvan J, Billingsley JT, Mortazavi A, Walker M, Dibas M, Settecase F, Heran MKS, Kuhn AL, Puri AS, Menon BK, Sivakumar S, Mowla A, D'Amato S, Zha AM, Cooke D, Vranic JE, Regenhardt RW, Rabinov JD, Stapleton CJ, Goyal M, Wu H, Cohen J, Turkel-Parella D, Xavier A, Waqas M, Tutino V, Siddiqui A, Gupta G, Nanda A, Khandelwal P, Tiu C, Portela PC, Perez de la Ossa N, Urra X, de Lera M, Arenillas JF, Ribo M, Requena M, Piano M, Pero G, De Sousa K, Al-Mufti F, Hashim Z, Nayak S, Renieri L, Du R, Aziz-Sultan MA, Liebeskind D, Nogueira RG, Abdalkader M, Nguyen TN, Vigilante N, Siegler JE, Grossberg JA, Saad H, Gooch MR, Herial NA, Rosenwasser RH, Tjoumakaris S, Patel AB, Tiwari A, Jabbour P. International Controlled Study of Revascularization and Outcomes Following COVID-Positive Mechanical Thrombectomy. Eur J Neurol 2022; 29:3273-3287. [PMID: 35818781 PMCID: PMC9349405 DOI: 10.1111/ene.15493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose Previous studies suggest that mechanisms and outcomes in patients with COVID‐19‐associated stroke differ from those in patients with non‐COVID‐19‐associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID‐19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors. Methods A cross‐sectional, international multicenter retrospective study was conducted in consecutively admitted COVID‐19 patients with concomitant acute LVO, compared to a control group without COVID‐19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable‐adjusted analysis was conducted. Results In this cohort of 697 patients with acute LVO, 302 had COVID‐19 while 395 patients did not. There was a significant difference (p < 0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID‐19 group. In terms of favorable revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 3), COVID‐19 was associated with lower odds of complete revascularization (odds ratio 0.33, 95% confidence interval [CI] 0.23–0.48; p < 0.001), which persisted on multivariable modeling with adjustment for other predictors (adjusted odds ratio 0.30, 95% CI 0.12–0.77; p = 0.012). Moreover, endovascular complications, in‐hospital mortality, and length of hospital stay were significantly higher among COVID‐19 patients (p < 0.001). Conclusion COVID‐19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID‐19 patients with LVO were more often younger and had higher morbidity/mortality rates.
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Affiliation(s)
- Adam A Dmytriw
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA.,Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sherief Ghozy
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Kimon Bekelis
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Daniel Vela-Duarte
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA
| | - Italo Linfante
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA
| | - Guilherme Dabus
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA
| | - Max Kole
- Department of Neurosurgery, Henry Ford Hospital, Michigan, USA
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Spain
| | - Shahid M Nimjee
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Demetrius K Lopes
- Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA
| | - Ameer E Hassan
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB, Houston, Texas, USA
| | | | - Michael R Levitt
- Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Simon Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Symeon Missios
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Maksim Shapiro
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Fréderic Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Mahmoud Elhorany
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Rizwan A Tahir
- Department of Neurosurgery, Henry Ford Hospital, Michigan, USA
| | - Patrick P Youssef
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert M Starke
- Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Jorge Galvan
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Spain
| | | | - Abolghasem Mortazavi
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Melanie Walker
- Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Mahmoud Dibas
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fabio Settecase
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna L Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Bijoy K Menon
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sanjeev Sivakumar
- Department of Medicine (Neurology), Prisma Health Upstate, USC, Greenville, South Carolina, USA
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Salvatore D'Amato
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Alicia M Zha
- Department of Neurology, UT Health Science Center, Houston, Texas, USA
| | - Daniel Cooke
- Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA
| | - Justin E Vranic
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Mayank Goyal
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hannah Wu
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Jake Cohen
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - David Turkel-Parella
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Andrew Xavier
- Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA.,Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Vincent Tutino
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Gaurav Gupta
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Anil Nanda
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Priyank Khandelwal
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Cristina Tiu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Pere C Portela
- Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, Spain
| | - Natalia Perez de la Ossa
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xabier Urra
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Mercedes de Lera
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain; Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain; Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Mariangela Piano
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Guglielmo Pero
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Keith De Sousa
- Department of Neurology, Eastern Region, Northwell Health, Long Island, New York, New York, USA
| | - Fawaz Al-Mufti
- Department of Neurology, Radiology, and Neurosurgery, Westchester Medical Center at NY Medical College, Valhalla, New York, USA
| | - Zafar Hashim
- Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Sanjeev Nayak
- Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Leonardo Renieri
- Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | - Rose Du
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohamed A Aziz-Sultan
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Liebeskind
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohamad Abdalkader
- Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
| | - Thanh N Nguyen
- Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
| | - Nicholas Vigilante
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | | | - Hassan Saad
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Aman B Patel
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Ambooj Tiwari
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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38
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Hernández D, Serrano E, Molins G, Zarco F, Chirife O, Werner M, Lara B, Ramos A, Llull L, Requena M, Cuevas MDDL, Remollo S, Piñana C, López-Rueda A. Comparison of First-Pass Effect in Aspiration vs. Stent-Retriever for Acute Intracranial ICA Occlusion. Front Neurol 2022; 13:925159. [PMID: 35847206 PMCID: PMC9279887 DOI: 10.3389/fneur.2022.925159] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retriever) and the impact of stent retriever size and length on clinical and angiographic outcomes in patients with acute intracranial ICA occlusion. We conducted a retrospective analysis of a prospective database of consecutive patients with acute intracranial ICA occlusion undergoing endovascular treatment in four Comprehensive Stroke Center between June-2019 and December-2020. We include 121 patients; Stent-retriever (SR) was used as first technical approach in 107 patients (88.4%) and aspiration was used in 14 patients (11.6%). SR group had higher rate of FPE compared to aspiration group (29 vs. 0%, p = 0.02). In SR subgroup, treatment highlighted higher FPE in the 6 × 50 SR (37.7%), than in the rest of the SR which are 21.2% (4–5 mm size and 20–50 mm length SR) and 19% (6 mm size and 25–40 mm length SR), but it was not found to be statistically significant. There were no other significant differences across the groups regarding primary angiographic or clinical outcomes. In our intracranial ICA occlusion series, stent retrievers were superior to direct aspiration in obtaining FPEs and mFPEs, and longer devices achieved better results with no statistically significant difference. Further studies evaluating the effects of different ICA clot removal approaches are warranted to confirm these results.
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Affiliation(s)
| | | | - Gemma Molins
- Institute for Medical Engineering and Science (IMES), Massachusetts Institute of Technology (MIT), Cambridge, MA, United States
| | | | - Oscar Chirife
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mariano Werner
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Blanca Lara
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Ramos
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Laura Llull
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | | | | | - Carlos Piñana
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - Antonio López-Rueda
- Hospital Clínic de Barcelona, Barcelona, Spain
- *Correspondence: Antonio López-Rueda
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39
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Hernández D, Cuevas JL, Gramegna LL, Requena M, Piñana C, de Dios M, Coscojuela P, Esteves M, Li J, Gil A, Ribó M, Tomasello A. Correction to: Increased Number of Passes and Double Stent Retriever Technique Induces Cumulative Injury on Arterial Wall After Mechanical Thrombectomy in a Swine Model. Transl Stroke Res 2022; 14:434. [PMID: 35749034 DOI: 10.1007/s12975-022-01054-z] [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: 11/30/2022]
Affiliation(s)
- David Hernández
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119‑129, 08035, Barcelona, Spain
| | - José Luis Cuevas
- Neurosurgery and Interventional Neuroradiology, Hospital de Puerto Montt, Puerto Montt, Chile.,Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Motor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Manuel Requena
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119‑129, 08035, Barcelona, Spain.,Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Piñana
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119‑129, 08035, Barcelona, Spain
| | - Marta de Dios
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119‑129, 08035, Barcelona, Spain
| | - Pilar Coscojuela
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119‑129, 08035, Barcelona, Spain
| | - Marielle Esteves
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jiahui Li
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alberto Gil
- Interventional Neuroradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marc Ribó
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119‑129, 08035, Barcelona, Spain.
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40
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Hernández D, Cuevas JL, Gramegna LL, Requena M, Piñana C, de Dios M, Coscojuela P, Esteves M, Li J, Gil A, Ribó M, Tomasello A. Increased Number of Passes and Double Stent Retriever Technique Induces Cumulative Injury on Arterial Wall After Mechanical Thrombectomy in a Swine Model. Transl Stroke Res 2022; 14:425-433. [PMID: 35672562 DOI: 10.1007/s12975-022-01044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/22/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
The number of stentriever passes during endovascular thrombectomy impacts clinical outcomes in acute ischemic stroke. Previous studies suggest that the simultaneous double stent retriever technique (DSRT) could improve the efficacy and reduce the number of passes. We aim to analyze the degree of vessel wall injury according to the number of passes and technique (single vs. simultaneous devices). Histological changes were evaluated in renal arteries (RAs) of swine models after thrombectomy (1, 2, or 3 passes) with single stent (SSRT) and DSRT. Thrombectomy passes were performed in 12 RA: 3 samples from each artery were studied by optical microscopy to assess a vascular damage score. All thirty-six samples showed endothelial denudation and different degrees of damage in the deepest layers of the arterial wall; however, all arteries remained patent by the time of assessment. In all cases, the degree of vascular injury increased with the number of passes. Compared with a SSRT, DSRT showed a higher severity of histological damage corresponding to the damage caused by 1.4 SSRT passes. However, in distal arteries, vascular damage was relatively similar when comparing SSRT with multiple passes and DSRT with one pass. The degree of vessel injury increases with the number of passes. Even though histological damage per pass was 1.4 higher with DSRT than SSRT, short-term vessel patency was not compromised after up to 3 DSRT passes. Further studies are needed to characterize the risk-benefit ratio of the DSRT in routine clinical practice.
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Affiliation(s)
- David Hernández
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José Luis Cuevas
- Neurosurgery and Interventional Neuroradiology, Hospital de Puerto Montt, Puerto Montt, Chile
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Motor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Manuel Requena
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Piñana
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marta de Dios
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Pilar Coscojuela
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marielle Esteves
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jiahui Li
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alberto Gil
- Interventional Neuroradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marc Ribó
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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41
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Jabbour P, Dmytriw AA, Sweid A, Piotin M, Bekelis K, Sourour N, Raz E, Linfante I, Dabus G, Kole M, Martínez-Galdámez M, Nimjee SM, Lopes DK, Hassan AE, Kan P, Ghorbani M, Levitt MR, Escalard S, Missios S, Shapiro M, Clarençon F, Elhorany M, Vela-Duarte D, Tahir RA, Youssef PP, Pandey AS, Starke RM, El Naamani K, Abbas R, Hammoud B, Mansour OY, Galvan J, Billingsley JT, Mortazavi A, Walker M, Dibas M, Settecase F, Heran MKS, Kuhn AL, Puri AS, Menon BK, Sivakumar S, Mowla A, D'Amato S, Zha AM, Cooke D, Goyal M, Wu H, Cohen J, Turkel-Parrella D, Xavier A, Waqas M, Tutino VM, Siddiqui A, Gupta G, Nanda A, Khandelwal P, Tiu C, Portela PC, Perez de la Ossa N, Urra X, de Lera M, Arenillas JF, Ribo M, Requena M, Piano M, Pero G, De Sousa K, Al-Mufti F, Hashim Z, Nayak S, Renieri L, Aziz-Sultan MA, Nguyen TN, Feineigle P, Patel AB, Siegler JE, Badih K, Grossberg JA, Saad H, Gooch MR, Herial NA, Rosenwasser RH, Tjoumakaris S, Tiwari A. Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study. Neurosurgery 2022; 90:725-733. [PMID: 35238817 PMCID: PMC9514728 DOI: 10.1227/neu.0000000000001902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.
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Affiliation(s)
- Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Adam A. Dmytriw
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France;
| | - Kimon Bekelis
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Italo Linfante
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA
| | - Guilherme Dabus
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA
| | - Max Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA;
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain;
| | - Shahid M. Nimjee
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
| | - Demetrius K. Lopes
- Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA
| | - Ameer E. Hassan
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Michael R. Levitt
- Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA;
| | - Simon Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France;
| | - Symeon Missios
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Maksim Shapiro
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Mahmoud Elhorany
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Daniel Vela-Duarte
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA
| | - Rizwan A. Tahir
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA;
| | - Patrick P. Youssef
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
| | - Aditya S. Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert M. Starke
- Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA;
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Bassel Hammoud
- Department of Biomedical Engineering, American University of Beirut, Beirut, Lebanon;
| | - Ossama Y. Mansour
- Department of Neurology and Neuroradiology, Alexandria University Hospital, Al Attarin, Egypt;
| | - Jorge Galvan
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain;
| | | | - Abolghasem Mortazavi
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Melanie Walker
- Departments of Neurological Surgery and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA;
| | - Mahmoud Dibas
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabio Settecase
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, USA
| | - Manraj K. S. Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, USA
| | - Anna L. Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Ajit S. Puri
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Bijoy K. Menon
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sanjeev Sivakumar
- Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA;
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Salvatore D'Amato
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia M. Zha
- Department of Neurology, UT Health Science Center, Houston, Texas, USA
| | - Daniel Cooke
- Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA
| | - Mayank Goyal
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hannah Wu
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Jake Cohen
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - David Turkel-Parrella
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Andrew Xavier
- Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA
- Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Vincent M. Tutino
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Gaurav Gupta
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Anil Nanda
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Priyank Khandelwal
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Cristina Tiu
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | - Pere C. Portela
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Natalia Perez de la Ossa
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain;
| | - Xabier Urra
- Department of Neurology, Hospital Clínic, Barcelona, Spain;
| | - Mercedes de Lera
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain;
| | - Juan F. Arenillas
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain;
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain;
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain;
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Mariangela Piano
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | - Guglielmo Pero
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | - Keith De Sousa
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Fawaz Al-Mufti
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain;
| | - Zafar Hashim
- Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Sanjeev Nayak
- Department of Neurology, Hospital Clínic, Barcelona, Spain;
| | - Leonardo Renieri
- Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | - Mohamed A. Aziz-Sultan
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Thanh N. Nguyen
- Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA;
| | - Patricia Feineigle
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Aman B. Patel
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - James E. Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Khodr Badih
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | | | - Hassan Saad
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - M. Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Nabeel A. Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Robert H. Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Ambooj Tiwari
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
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Cano D, Montiel E, Baladas M, Sanchez-Gavilan E, Paredes C, Rubiera M, Requena M, Muchada M, Olive Gadea M, Garcia-Tornel A, Molina CA, Ribo M. Patient-reported outcome measures after thrombectomy in patients with acute stroke: fine-tuning the modified Rankin Scale. J Neurointerv Surg 2022:neurintsurg-2022-018840. [PMID: 35508380 DOI: 10.1136/neurintsurg-2022-018840] [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] [Received: 02/23/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with stroke undergoing endovascular treatment (EVT), long-term outcome is usually only evaluated by the modified Rankin Scale (mRS). Patient-reported outcomes (PROMs) are standardized assessments that consider clinical outcomes from the perspective of the patient. We aimed to evaluate PROMs through a smartphone-based communication platform in patients with stroke who received EVT. METHODS Consecutive patients with stroke who underwent EVT were offered to participate in the PROMs-through-App program (NORA). A set of standardized PROMs were collected at 7, 30 and 90 days after discharge. Disability was determined by clinicians (mRS) at 90 days. To characterize the potential ceiling effect of mRS in the assessment of different domains, the rate of abnormal PROMs among patients with excellent outcome (mRS 0-1) was calculated. RESULTS From June 2020 to October 2021, 186 patients were included. The median PROMs collection rate per patient was 80% (50-100%). A correlation was consistently seen between disability measured by mRS and the different PROMs. The rate of abnormal PROMs ranged from 20.83% (HADS at 7 days) to 59.61% (Mental PROMIS at 7 days). At 90 days, among patients with an excellent outcome, the rate of abnormal PROMs ranged from 8.7% (HADS) to 47.83% (Physical PROMIS). CONCLUSIONS A specifically designed digital platform allows a high collection rate of PROMs among stroke patients who underwent EVT. The mRS score shows a ceiling effect and seems insufficient to fine-tune long-term clinical results. The use of PROMs may allow a better characterization of long-term outcome profiles after EVT.
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Affiliation(s)
- David Cano
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Estefanía Montiel
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maria Baladas
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Esther Sanchez-Gavilan
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carolina Paredes
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marta Olive Gadea
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Alvaro Garcia-Tornel
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
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Li J, Tomasello A, Requena M, Canals P, Tiberi R, Galve I, Engel E, Kallmes DF, Castaño O, Ribo M. Trackability of distal access catheters: an in vitro quantitative evaluation of navigation strategies. J Neurointerv Surg 2022; 15:496-501. [PMID: 35450927 DOI: 10.1136/neurintsurg-2022-018889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/04/2022] [Accepted: 04/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND In mechanical thrombectomy (MT), distal access catheters (DACs) are tracked through the vascular anatomy to reach the occlusion site. The inability of DACs to reach the occlusion site has been reported as a predictor of unsuccessful recanalization. This study aims to provide insight into how to navigate devices through the vascular anatomy with minimal track forces, since higher forces may imply more risk of vascular injuries. METHODS We designed an experimental setup to monitor DAC track forces when navigating through an in vitro anatomical model. Experiments were recorded to study mechanical behaviors such as tension buildup against vessel walls, DAC buckling, and abrupt advancements. A multiple regression analysis was performed to predict track forces from the catheters' design specifications. RESULTS DACs were successfully delivered to the target M1 in 60 of 63 in vitro experiments (95.2%). Compared to navigation with unsupported DAC, the concomitant coaxial use of a microcatheter/microguidewire and microcatheter/stent retriever anchoring significantly reduced the track forces by about 63% and 77%, respectively (p<0.01). The presence of the braid pattern in the reinforcement significantly reduced the track forces regardless of the technique used (p<0.05). Combined coil and braid reinforcement configuration, as compared with coil alone, and a thinner distal wall were predictors of lower track force when navigating with unsupported DAC. CONCLUSIONS The use of microcatheter and stent retriever facilitate smooth navigation of DACs through the vascular tortuosity to reach the occlusion site, which in turn improves the reliability of tracking when positioning the DAC closer to the thrombus interface.
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Affiliation(s)
- Jiahui Li
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Catalunya, Spain
| | - Alejandro Tomasello
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Manuel Requena
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain.,Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Pere Canals
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain.,Materials Science and Engineering, Universitat Politecnica de Catalunya, Barcelona, Catalunya, Spain
| | - Iñaki Galve
- Department of Research and Development, Anaconda Biomed, Barcelona, Spain
| | - Elisabeth Engel
- Materials Science and Engineering, Universitat Politecnica de Catalunya, Barcelona, Catalunya, Spain.,CIBER en Bioingeniería, Biomateriales y Nanomedicina, CIBER, Madrid, Comunidad de Madrid, Spain
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Oscar Castaño
- Electronics and Biomedical Engineering, University of Barcelona, Barcelona, Catalunya, Spain.,Biomaterials for Regenerative Therapies, Institute for Bioengineering in Catalonia, Barcelona, Catalunya, Spain
| | - Marc Ribo
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain .,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Catalunya, Spain
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Requena M, Ribo M, Zamarro J, Vega P, Blasco J, González EM, Del Mar Freijo M, Mendez Cendón JC, de Miquel MÁ, Hernández D, Moreu M, Remollo S, Sánchez S, Liebeskind DS, Andersson T, Cognard C, Nogueira R, Tomasello A. Clinical Results of the Advanced Neurovascular Access Catheter System Combined With a Stent Retriever in Acute Ischemic Stroke (SOLONDA). Stroke 2022; 53:2211-2219. [PMID: 35360928 PMCID: PMC9232250 DOI: 10.1161/strokeaha.121.037577] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Advanced Neurovascular Access (ANA) thrombectomy system is a novel stroke thrombectomy device comprising a self-expanding funnel designed to reduce clot fragmentation by locally restricting flow while becoming as wide as the lodging artery. Once deployed, the ANA device allows distal aspiration combined with a stent retriever to mobilize the clot into the funnel where it remains copped during extraction. We investigated the safety and efficacy of ANA catheter system. METHODS SOLONDA (Solitaire in Combination With the ANA Catheter System as Manufactured by Anaconda) was a prospective, open, single-arm, multicenter trial with blinded assessment of the primary outcome by an independent core lab. Patients with anterior circulation vessel occlusion admitted within 8 hours from symptom onset were eligible. The primary end point was successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b-3) with ≤3 passes of the ANA device in combination with stent retriever, before the use of rescue therapy in the intention to treat population. Primary predefined analysis was noninferiority as compared to the performance end point observed in HERMES (High Effective Reperfusion Using Multiple Endovascular Devices). RESULTS After enrollment of 74 patients, an interim analysis was conducted, and the trial Steering Committee decided to terminate recruitment due to safety and performance objectives were reached. Mean age was 71.6 (SD 8.9) years, 46.6% women and median National Institutes of Health Stroke Scale on admission 14 (interquartile range, 10-19). Successful reperfusion within 3 passes before rescue therapy was achieved in 60/72 (83.3% [95% CI, 74.7%-91.9%]) with a rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 2c-3) of 60% (95% CI, 48.4%-71.1%; 43/72 patients). After noninferiority was confirmed (P<0.01), the ANA device also showed superiority in the rate of successful reperfusion with ≤3 passes (P=0.02). First-pass successful recanalization rate was 55.6% (95% CI, 44.1%-67.0%), with a first-pass complete recanalization rate of 38.9% (95% CI, 27.6%-50.1%). Rescue therapy to obtain a modified Thrombolysis in Cerebral Infarction score 2b-3 was needed in 12/72 (17%) patients. At 90 days, the rate of favorable functional outcome (modified Rankin Scale score 0-2) was 57.5% (95% CI, 46.2%-68.9%), and the rate of excellent functional outcome (modified Rankin Scale score 0-1) was 45.2% (95% CI, 33.8%-56.6%). The rate of severe adverse device related was 1.4%. CONCLUSIONS In this clinical experience, the ANA device achieved a high rate of complete recanalization with a preliminary good safety profile and favorable 90 days clinical outcomes.
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Affiliation(s)
- Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. (M. Requena, M. Ribo).,Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. (M. Requena, D.H., A.T.)
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. (M. Requena, M. Ribo)
| | - Joaquin Zamarro
- Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain (J.Z.)
| | - Pedro Vega
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Central de Asturias, Spain (P.V.)
| | - Jordi Blasco
- Department of Radiology, Hospital Clínic, Barcelona, Spain (J.B.)
| | - Eva María González
- Interventional Neuroradiology, Department of Radiology, Hospital Cruces, Bilbao, Spain. (E.M.G.)
| | | | | | | | - David Hernández
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. (M. Requena, D.H., A.T.)
| | - Manuel Moreu
- Neurointerventional Radiology, Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain (M.M.)
| | - Sebastià Remollo
- Neurointerventional Radiology Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, Badalona, Spain (S.R.)
| | - Sonia Sánchez
- Anaconda Biomed, Barcelona, St Cugat del Valles, Spain (S.S.)
| | - David S Liebeskind
- Neurovascular Imaging Research Core and University of California Los Angeles Stroke Center, Department of Neurology, University of California (D.S.L.)
| | - Tommy Andersson
- Department of Medical Imaging, Groeninge Hospital, Kortrijk, Belgium (T.A.).,Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (T.A.)
| | - Christophe Cognard
- Hôpital Purpan, Diagnostic and Therapeutic Neuroradiology, Toulouse, France (C.C.)
| | - Raul Nogueira
- Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Department of Neurology, Atlanta, GA (R.N.)
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. (M. Requena, D.H., A.T.)
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Brehm A, Tsogkas I, Ospel JM, Appenzeller-Herzog C, Aoki J, Kimura K, Pfaff JA, Möhlenbruch MA, Requena M, Ribo MJ, Sarraj A, Spiotta AM, Sporns P, Psychogios MN. Direct to angiography suite approaches for the triage of suspected acute stroke patients: a systematic review and meta-analysis. Ther Adv Neurol Disord 2022; 15:17562864221078177. [PMID: 35251309 PMCID: PMC8894963 DOI: 10.1177/17562864221078177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Increasing evidence suggests improved time metrics leading to better clinical outcomes when stroke patients with suspected large vessel occlusion (LVO) are transferred directly to the angiography suite (DTAS) compared with cross-sectional imaging followed by transfer to the angiography suite. We performed a systematic review and meta-analysis on the efficacy and safety of DTAS approaches. Methods: We searched Embase, Medline, Scopus, and clinicaltrials.gov for studies comparing outcomes of DTAS and conventional triage. Eligible studies were assessed for risk of bias. We performed a random-effects meta-analysis on the differences of median door-to-groin and door-to-reperfusion times between intervention and control group. Secondary outcomes included good outcome at 90 days (modified Rankin Scale ⩽ 2) rate of symptomatic intracranial hemorrhage (sICH) and mortality within 90 days. Results: Eight studies (one randomized, one cluster-randomized trial and six observational studies) with 1938 patients were included. Door-to-groin and door-to-reperfusion times in the intervention group were on median 29.0 min [95% confidence interval (CI): 14.3–43.6; p < 0.001] and 32.1 min (95% CI: 15.1–49.1; p < 0.001) shorter compared with controls. Prespecified subgroup analyses for transfer (n = 1753) and mothership patients (n = 185) showed similar reductions of the door-to-groin and door-to-reperfusion times in response to the intervention. The odds of good outcome did not differ significantly between both groups but were numerically higher in the intervention group (odds ratio: 1.38, 95% CI: 0.97–1.95; p = 0.07). There was no significant difference for mortality and sICH between the groups. Conclusion: DTAS approaches for the triage of suspected LVO patients led to a significant reduction in door-to-groin and door-to-reperfusion times but an effect on functional outcome was not detected. The subgroup analysis showed similar results for transfer and mothership patients. Registration: This study was registered in PROSPERO (CRD42020213621).
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Affiliation(s)
- Alex Brehm
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Ioannis Tsogkas
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Johanna M. Ospel
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Johannes A.R. Pfaff
- Department of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | | | - Manuel Requena
- Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Marc J. Ribo
- Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Amrou Sarraj
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Alejandro M. Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Peter Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, SwitzerlandDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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46
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Ribo M, Requena M. Disentangling Workflow Paradigms and Treatment Decision-Making in Acute Ischemic Stroke-Reply. JAMA Neurol 2022; 79:312. [PMID: 35129613 DOI: 10.1001/jamaneurol.2021.5346] [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: 11/14/2022]
Affiliation(s)
- Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.,Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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47
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Garcia-tornel Garcia A, Rubiera M, Olive-gadea M, Requena M, boned S, Muchada M, Pagola J, Rodriguez-luna D, deck M, Juega JM, Rodriguez-Villatoro N, tomasello A, Piñana C, Hernandez D, Purroy F, Perez de la Ossa N, Abilleira S, Molina CA, Ribo M. Abstract 26: Timing The Optimal Transfer Modality For Suspected Large-vessel Stroke Patients: A Post-hoc Analysis Of The Racecat Trial. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.26] [Citation(s) in RCA: 1] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Current recommendations for regional stroke destination suggest that patients with an acute severe stroke should be triaged based on estimated time to arrival to a thrombectomy-capable center. We aimed to evaluate which time period available at the time that patient is triaged is able to discriminate which transfer modality should be chosen.
Methods:
We built and ordered logistic regression model adjusted for multiple comparisons with the RACECAT trial population using time periods available during triage: time from onset to emergency medical services (EMS) evaluation, estimated time of arrival to the thrombectomy-capable center and between centers distance. Estimated times were computed using a distance matrix API. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin score.
Results:
Of the 1369 patients evaluated, median time from onset to EMS evaluation, estimated time to arrival to the thrombectomy-capable center and between centers distances were 65 minutes (interquartile ratio (IQR) 43 to 138), 61 minutes (IQR 36 to 80) and 62 minutes (IQR 36 to 73), respectively. In patients transferred to local stroke centers, delay in EMS evaluation was associated with higher degrees of disability (for each 30 minutes delay, adjusted common odds ratio (acOR) 1.035, 97.5% confidence interval (CI) 1.005 to 1.066), with no influence in patients directly transferred to thrombectomy-capable centers (for each 30 minutes delay, acOR 0.999, 97.5% CI 0.981 to 1.018) (p
interaction
=0.048). In patients evaluated by EMS above 120 minutes after stroke onset, direct transfer to a thrombectomy-capable center was associated with lower degrees of disability (acOR 1.494, 95% CI 1.026 to 2.174).
Conclusion:
In the RACECAT trial, delay in EMS evaluation was associated with higher degrees of disability in patients transferred to local stroke centers and may serve as a potential biomarker for prehospital triage optimization.
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Pagola J, Juega J, Camacho J, Dorado L, Rodriguez M, Hernandez-Perez M, Quesada Garcia H, Cardona P, de la Torre C, Deck M, Garcia-Tornel A, Requena M, Rubiera M, Boned S, Muchada M, Olive M, Ribo M, Piñana C, Hernandez D, Rodriguez-luna D, Rodriguez Villatoro N, SANJUAN E, tomasello A, Alvarez Sabin J, Ramon y Cajal S, Molina CA. Abstract TP255: Lymphocytes And Platelets In Extracted Thrombus May Indicate The Etiology Of The Thrombus. Results From The Itacat Multicentric Registry. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp255] [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] [Indexed: 11/16/2022]
Abstract
Aim:
We performed a histological and immune analysis of the clot in acute stroke patients to detect surrogates of stroke etiology.
Methods:
We conducted a prospective observational study of consecutive patients with acute stroke who underwent thrombectomy that obtained extracted thrombus (ITACAT study). Several staining were performed to evaluate red blood cells/fibrin (hematoxylin/eosin), platelets (CD61) and leucocytes (CD4, CD8 and CD20). All patients received CT angio to detect extra/intracranial vascular stenosis and 30-day cardiac monitoring to diagnose AF. According to TOAST classification the thrombi were classified in cardioembolic etiology CE (T-CE), due to symptomatic atherosclerosis (T-AT) and without any cause (T-CRYP). We excluded strokes due to double cause or incomplete workup.
Results:
Of the 117 patients: 30 were T-AT, 55 were T-CE and 32 were T-CRYP. T-AT patients were younger: T-AT 68 years (60-77) Vs. T-CE 75 years (68-80) Vs. T-CRYP 72 years (55-81) (p=0.034). T-AT group had higher percentage of CD4: T-AT 6.52% (4-13) Vs. T-CE (3.31% (12.9) Vs .T-CRYP 3.72% (1.5-12) (p=0.015) and lower percentage of CD61: T-AT 51.18% (34-68) Vs. CE 64.70% (19.56) Vs. CRYP 70.3% (19) (p=0.001). There were no correlation between CD4 and platelets. Both CD4 OR 1.05 (1-1.10) (p=0.020) and CD61 (OR 0.96 (0.94-0.98) (p=0.01) independently predicted T-AT from the age. Final analysis (n=400 cases) will be ended in September 2021.
Conclusions:
Patients with high percentage of CD4 and low percentage of CD61 are related to atherosclerosis etiology.
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Olive-Gadea M, García- Tornel A, Requena M, De Dios Lascuevas M, Boned S, Boned S, Rubiera M, Molina CA, tomasello A, Hernandez D, Piñana C, Marti C, Granés C, Garcia A, Facundo D, Ribo M. Abstract WMP63: Artificial Intelligence Assessment Of Non-contrast Ct Increases Intracranial Occlusion Detection As Compared With Ct-angiograhy Readings. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp63] [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] [Indexed: 11/16/2022]
Abstract
Artificial Intelligence (AI) can assist in vessel occlusion (VO) identification in acute stroke patients. We aim to investigate the impact of using an AI-based software for automated VO detection on non-contrast CT (AI-VO) as compared to CT-Aangiograpphy (CTA).
Methods:
From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT / CTA / CTP and were treated accordingly. Hypoperfusion areas defined as Tmax>6s on CTP (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO: ground truth). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated CT and CTA to identify intracranial VO (CTA-VO). AI-VO was automatically determined by an AI-based software (Methinks).
Results:
Of the 338 patients included, 157 (46.5%) showed a CTP-VO (median Tmax>6s: 73[29-127]ml). Overall sensitivity to detect CTP-VO was 50.3% for CTA-VO and 66.9% for AI-VO; specificity was 97.8% for CTA-VO and 86.2% for AI-VO. EVT was performed in 103 patients (EVT-VO: 65.6% of CTP-VO; Tmax>6s: 102[63-160]ml); sensitivity to detect EVT-VO was 69% for CTA-VO and 79.6% for AI-VO; specificity was 95.3% for CTA-VO and 79.6% for AI-VO. The probability to detect a CTP-VO was higher with AI than with CTA for distal occlusions (figure). Accordingly, AI-VO sensitivity was higher than CTA-VO for angiographically confirmed M2/M3-MCA occlusions (80.7% vs 34.6%; p=0.002) but not for M1-MCA/ICA occlusions (82.1% Vs 88.1%;p=0.467).
Conclusion:
AI-assisted vessel occlusion identification on non-contrast CT may be a useful tool in acute stroke evaluation, especially for distal VO identification, potentially increasing endovascular treatment in these cases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Ribo
- HOSPITAL VALL D HEBRON, Barcelona, Spain
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50
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Rodrigo-Gisbert M, Requena M, De Dios Lascuevas M, Garcia-Tornel A, Olive-gadea M, Boned S, Muchada M, Deck M, Rodriguez-Villatoro N, Rodriguez-Luna D, Juega JM, Pagola J, tomasello A, Piñana C, Hernandez D, Coscojuela P, Ribo M, Molina CA, Rubiera M. Abstract WMP66: Multiparametric Neuroimaging And Its Association With Non-Contrast Computed Tomography In Late Window Large Vessel Occlusion Acute Stroke. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp66] [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] [Indexed: 11/16/2022]
Abstract
Background:
Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 to 24 hours is established as a standard of care among patients selected by multiparametric neuroimaging. Therefore, we aimed to explore neuroimaging parameters in late window AIS large vessel occlusion (LVO) patients and the association between findings in non-contrast computed tomography (NCCT) and multiparametric CT.
Methods:
We included consecutive AIS patients within 6-24 hours from symptoms onset with CTA-LVO. We studied potential associations between computed tomography mismatch defined by DAWN and/or DEFUSE-3 neuroimaging criteria (CTP-MM), infarct volume on CTP, and ASPECTS on NCCT. We also analyzed the association between neuroimaging parameters and outcome determined by 90-day mRS.
Results:
We included 206 patients, of which 176 (85.4%) presented CTP-MM and 184 (89.3%) presented with an ASPECTS ≥ 6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥ 6, as compared with 40.9% in those with low ASPECTS
[Figure 1A]
. The ASPECTS correlated with infarct core, determined by Cerebral Blood Flow <30% volume (rP=-0.575, P<0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR 3.38; 95%CI 1.01-11.29; P=0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR 1.39; 95% CI 0.58-3.34; P=0.459)
[Figure 1B]
.
Conclusions:
A great majority of patients who presented a LVO in late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥ 6). Our data suggest that NCCT with CT angiography is a reasonable approach for acute ischemic stroke treatment selection also in the late window.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jorge Pagola
- Stroke Unit, Vall d'Hebron Hosp, Barcelona, Spain
| | | | - Carlos Piñana
- Neuroradiology, Vall d'Hebron Hosp, Barcelona, Spain
| | | | | | - Marc Ribo
- Stroke Unit, Vall d'Hebron Hosp, Barcelona, Spain
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