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  • 1
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    Online Resource
    Predictors for Mortality after Mechanical Thrombectomy of Acute Basilar Artery Occlusion
    S. Karger AG ; 2018
    In:  Cerebrovascular Diseases Vol. 45, No. 1-2 ( 2018), p. 61-67
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 45, No. 1-2 ( 2018), p. 61-67
    Abstract: Background: Modern endovascular thrombectomy (MET), using stent retrievers or large-bore distal aspiration catheters in stroke patients with acute basilar artery occlusion (BAO), is routinely performed to date. However, more than 35% of BAO patients treated with MET die within 90 days despite high recanalization rates. The purpose of this study is to investigate the parameters associated with 90-day mortality in patients with BAO after MET. Methods: We analyzed 117 consecutive BAO patients included in the Endovascular Treatment in Ischemic Stroke prospective clinical registry of consecutive acute ischemic stroke patients treated with MET (60 patients [51.3%] treated with a stent retriever as first-line technique) between March 2010 and April 2017. Successful recanalization was defined as modified thrombolysis In cerebral infarction scores 2b-3 at the end of MET, and mortality was defined as modified Rankin Scale 6 at 90 days. Associations of baseline characteristics (patient and treatment characteristics) and intermediate outcomes (recanalization, complications) with 90-day mortality were investigated in univariate and multivariate analyses. Results: Overall successful recanalization rate was 79.5, and 41.9% (95% CI 32.8–51.0%) of patients died within 90 days after MET. Patients with successful recanalization had a lower mortality rate (32.9 vs. 74.4%; p 〈 0.001). Failure of successful recanalization was an independent predictor of mortality (OR 5.1; 95% CI 1.34–19.33). In multivariate analysis, age ≥60 years (OR 6.37; 95% CI 1.74–23.31), admission National Institute of Health Stroke Scale (NIHSS) ≥13 (OR 4.62; 95% CI 1.42–15.03), lower posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS; OR 1.71; 95% CI 1.19–2.44), use of antithrombotic medication prior to stroke onset (OR 3.38; 95% CI 1.03–11.08), absence of intravenous thrombolysis (OR 3.36; 95% CI 1.12–10.03), and angioplasty/stenting of the basilar artery (OR 4.71; 95% CI 1.34–16.54) were independent predictors for mortality after MET. Conclusions: Failure of successful recanalization was a strong predictor for mortality. In the setting of recanalization, age, admission NIHSS, pc-ASPECTS, absence of intravenous thrombolysis, and angioplasty/stenting of the basilar artery were also independent predictors for mortality after MET of BAO patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000486690
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1482069-9
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  • 2
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    Impact of a Combined Intravenous/ Intra-Arterial Approach in Octogenarians
    S. Karger AG ; 2011
    In:  Cerebrovascular Diseases Vol. 31, No. 6 ( 2011), p. 559-565
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 31, No. 6 ( 2011), p. 559-565
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Intravenous (IV) alteplase is not currently recommended in octogenarian patients, and the benefit/risk ratio of endovascular (intra-arterial, IA) therapy remains to be determined. The aim of this study was to determine the impact of a combined IV-IA approach in octogenarians. 〈 i 〉 Methods: 〈 /i 〉 From a single-centre interventional study, we report age-specific outcomes of patients treated by a combined IV-IA thrombolytic approach. Patients ≧80 years with documented arterial occlusion treated by conventional IV thrombolysis constituted the control group. 〈 i 〉 Results: 〈 /i 〉 Among 84 patients treated by the IV-IA approach, those ≧80 years (n = 25) had a similar rate of early neurological improvement to that of patients 〈 80 years, whereas the 90-day favourable outcome rate was lower in octogenarians (adjusted odds ratio, OR, 0.21; 95% confidence interval, CI, 0.06–0.75). No difference in symptomatic intracranial haemorrhage was observed whereas a higher rate of 90-day mortality (adjusted OR, 3.27; 95% CI, 0.76–14.14) and asymptomatic intracranial haemorrhage (adjusted OR, 6.39; 95% CI, 1.54–26.63) were found in patients ≧80 years old. Among octogenarians, and compared to IV-thrombolysis-treated patients (n = 24), patients treated by the IV-IA approach had a higher rate of recanalization (76 vs. 33%, p = 0.003) associated with increased early neurological improvement (32 vs. 8%, p = 0.07). Although there was a higher rate of asymptomatic intracranial haemorrhage (44 vs. 8%, p = 0.005) observed in the IV-IA group, no difference existed in symptomatic intracranial haemorrhage rates and 90-day favourable outcome. 〈 i 〉 Conclusion: 〈 /i 〉 The IV-IA approach in octogenarians was associated with lower efficacy at 3 months and higher mortality and asymptomatic haemorrhagic complications than in patients 〈 80 years old. Definite recommendations cannot be given, but an endovascular approach may cause more harm than positive effects in patients over 80 years and should not be considered outside an approved protocol.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000324626
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482069-9
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  • 3
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    Online Resource
    Age and Outcome after Endovascular Treatment in Anterior Circulation Large-Vessel Occlusion Stroke: ETIS Registry Results
    S. Karger AG ; 2021
    In:  Cerebrovascular Diseases Vol. 50, No. 1 ( 2021), p. 68-77
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 50, No. 1 ( 2021), p. 68-77
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Increasing patient age has been identified in clinical trials as a poor prognostic factor for functional independence after endovascular treatment (EVT) for acute ischemic stroke. These findings may not be fully generalizable to clinical practice due to strict inclusion and exclusion criteria in these trials. We aim to assess and quantify the association of patient age, especially in patients & #x3e;80 and & #x3e;90 years old, with functional outcome after EVT in current, everyday clinical practice. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 The ETIS (Endovascular Treatment in Ischemic Stroke) Registry is an ongoing, prospective, observational study of 6 comprehensive stroke centers in France. We analyzed 1,708 patients treated between January 2017 and December 2018 and assessed the association of patient age with functional outcome adjusting for demographic and procedural predictors of functional outcome. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The positive effect of mechanical thrombectomy diminished significantly with increasing age: compared to the 18–80 years age group, the odds for achieving a good functional outcome at 90 days after the procedure decreased in the 80–90 and & #x3e;90 years groups (multilevel OR: 0.38, 95% CI: 0.28–0.51 and OR: 0.2, 95% CI: 0.09–0.45, respectively, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Increasing age was associated with increased mortality (multilevel OR: 2.46, 95% CI: 1.72–3.54 for the 80–90 years group and multilevel OR: 5.49, 95% CI: 2.97–10.16 for the & #x3e;90 years group). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Patient age is strongly associated with functional outcome after EVT for acute ischemic stroke. The positive effect of thrombectomy persists in older age groups, even after adjustment for prognostic factors related to poor functional outcome. Stroke physicians should provide EVT irrespective of the patient’s age.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000512203
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1482069-9
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  • 4
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    Online Resource
    Diagnostic Yield of Venous Thrombosis and Pulmonary Embolism by Combined CT Venography and Pulmonary Angiography in Patients with Cryptogenic Stroke and Patent Foramen Ovale
    S. Karger AG ; 2015
    In:  European Neurology Vol. 74, No. 1-2 ( 2015), p. 69-72
    Details
    In: European Neurology, S. Karger AG, Vol. 74, No. 1-2 ( 2015), p. 69-72
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Paradoxical embolism via a patent foramen ovale (PFO) has been suggested as a potential stroke mechanism. Combined CT venography and pulmonary angiography (CVPA) is a simple, validated and accurate technique to diagnose deep venous thrombosis (DVT) or pulmonary embolism (PE). We sought to assess the prevalence of DVT or PE among patients with PFO and cryptogenic stroke (CS) by CVPA. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Patients were identified retrospectively from a clinical registry of consecutive patients with stroke admitted to our Stroke Unit. The following criteria were required for inclusion in this study: CS, PFO identified by transthoracic echography using contrast medium and CVPA performed during the hospitalization following stroke. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 114 patients with PFO underwent a CVPA within 7 days (interquartile range 4-9) from stroke symptom onset. On cerebral imaging, 11% had multiple infarcts. CVPA documented deep vein thrombosis (DVT) in 10 patients (8.8%) and PE in 5 patients (4.4%), that is, a total of 12 patients with prevalence of 10.5% (95% CI 5.5-17.7). Patients with PE-DVT had higher 〈 smlcap 〉 D 〈 /smlcap 〉 -dimers and C reactive protein level than patients without PE-DVT (p 〈 0.05). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 CVPA may be used by the stroke team in the work-up of suspected paradoxical embolism among cryptogenic ischemic stroke patients with PFO.
    Type of Medium: Online Resource
    ISSN: 0014-3022 , 1421-9913
    URL: Article
    DOI: 10.1159/000437261
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 1482237-4
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  • 5
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    Direct Admission versus Secondary Transfer for Acute Stroke Patients Treated with Intravenous Thrombolysis and Thrombectomy: Insights from the Endovascular Treatment in Ischemic Stroke Registry
    S. Karger AG ; 2019
    In:  Cerebrovascular Diseases Vol. 47, No. 3-4 ( 2019), p. 112-120
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 47, No. 3-4 ( 2019), p. 112-120
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 To date, thrombectomy for large vessel occlusion (LVO) strokes can be performed only in comprehensive stroke centers with thrombectomy capacity. We compared the clinical outcome of patients first referred to a primary stroke center to those admitted directly to a comprehensive stroke center and treated on site in the multicentric observational Endovascular Treatment in Ischemic Stroke (ETIS) registry. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 From our perspective, multicenter, observational ETIS registry, we analyzed anterior circulation stroke patients, treated within 8 h, who underwent thrombectomy after thrombolysis and were admitted to a comprehensive stroke center either with drip and ship or mothership. Clinical and safety outcomes were compared between 2 groups. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 971 patients were analyzed: 298 were treated with the mothership approach and 673 with drip and ship. Significantly more functional independence (90-day modified Rankin Scale [mRS] 0–2) was achieved in mothership (60.1%) than in drip and ship patients (52.6%; adjusted relative risk [RR] 0.87, 95% CI 0.77–0.98, 〈 i 〉 p 〈 /i 〉 = 0.018). Excellent outcome (90-day mRS 0–1) was achieved in 45.3% of the mothership group, compared to 37.9% of the drip and ship group (RR 0.84, 95% CI 0.71–0.98; 〈 i 〉 p 〈 /i 〉 = 0.026). According to the distance between the primary stroke center and the comprehensive stroke center, greater functional independence was achieved in mothership than in drip and ship & #x3e;12.5 miles patients (adjusted RR 0.82; 95% CI 0.71–0.94). Results in the drip-ship group stratified according to time between cerebral imaging and groin puncture (categorized according to the median cut-off: 140 min) were similar. Symptomatic intracerebral hemorrhage rate and mortality within 90 days was similar in both groups (7.5 vs. 5.9%, 〈 i 〉 p 〈 /i 〉 = 0.40; 17.4 vs. 16.1%, 〈 i 〉 p 〈 /i 〉 = 0.63). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Our study suggests that LVO stroke patients directly admitted to a comprehensive stroke center present a higher chance of functional independence, especially when the distance between the primary stroke center and comprehensive stroke center is & #x3e;12.5 miles or when the time between cerebral imaging and groin puncture is ≥140 min.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000499112
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 1482069-9
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  • 6
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    Is Reperfusion Useful in Ischaemic Stroke Patients Presenting with a Low National Institutes of Health Stroke Scale and a Proximal Large Vessel Occlusion of the Anterior Circulation?
    S. Karger AG ; 2017
    In:  Cerebrovascular Diseases Vol. 43, No. 5-6 ( 2017), p. 305-312
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 43, No. 5-6 ( 2017), p. 305-312
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 In population-based studies, patients presenting with minor or mild stroke symptoms represent about two-thirds of stroke patients, and almost one-third of these patients are unable to ambulate independently at the time of discharge. Although mechanical thrombectomy (MT) has become the standard of care for acute ischaemic stroke with proximal large vessel occlusion (LVO) in the anterior circulation, the management of patients harbouring proximal occlusion and minor-to-mild stroke symptoms has not yet been determined by recent trials. The purpose of this study was to evaluate the impact of reperfusion on clinical outcome in low National Institutes of Health Stroke Scale (NIHSS) patients treated with MT. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We analysed 138 consecutive patients with acute LVO of the anterior circulation (middle cerebral artery M1 or M2 segment, internal carotid artery or tandem occlusion) with NIHSS 〈 8, having undergone MT in 3 different centres. Reperfusion was graded using the modified thrombolysis in cerebral infarction (TICI) score and 3 grades were defined, ranging from failed or poor reperfusion (TICI 0, 1, 2A) to complete reperfusion (TICI 3). The primary clinical endpoint was an excellent outcome defined as a modified Rankin score (mRs) 0-1 at 3-months. The impact of reperfusion grade was assessed in univariate and multivariate analyses. The secondary endpoints included favourable functional outcome (90-day mRS 0-2), death and safety concerns. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Successful reperfusion was achieved in 81.2% of patients (TICI 2B, 〈 i 〉 n 〈 /i 〉 = 47; TICI 3, 〈 i 〉 n 〈 /i 〉 = 65). Excellent outcome (mRs 0-1) was achieved in 69 patients (65.0%) and favourable outcome (mRs ≤2) in 108 (78.3%). Death occurred in 7 (5.1%). Excellent outcome increased with reperfusion grades, with a rate of 34.6% in patients with failed/poor reperfusion, 61.7% in patients with TICI 2B reperfusion, and 78.5% in patients with TICI 3 reperfusion ( 〈 i 〉 p 〈 /i 〉 〈 0.001). In multivariate analysis adjusted for patient characteristics associated with excellent outcome, the reperfusion grade remained significantly associated with an increase in excellent outcome; the OR (95% CI) was 3.09 (1.06-9.03) for TICI 2B and 6.66 (2.27-19.48) for TICI 3, using the failed/poor reperfusion grade as reference. Similar results were found regarding favourable outcome (90-day mRs 0-2) or overall mRS distribution (shift analysis). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Successful reperfusion is strongly associated with better functional outcome among patients with proximal LVO in the anterior circulation and minor-to-mild stroke symptoms. Randomized controlled studies are mandatory to assess the benefit of MT compared with optimal medical management in this subset of patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000468995
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 1482069-9
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  • 7
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    Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes
    S. Karger AG ; 2019
    In:  Interventional Neurology Vol. 8, No. 2-6 ( 2019), p. 92-100
    Details
    In: Interventional Neurology, S. Karger AG, Vol. 8, No. 2-6 ( 2019), p. 92-100
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 We aim to evaluate the speed and rates of reperfusion in tandem large vessel occlusion acute stroke patients undergoing upfront cervical lesion treatment (Neck-First: angioplasty and/or stent before thrombectomy) as compared to direct intracranial occlusion therapy (Head-First) in a large international multicenter cohort. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 The Thrombectomy In TANdem Lesions (TITAN) collaboration pooled individual data of prospectively collected thrombectomy international databases for all consecutive anterior circulation tandem patients who underwent emergent thrombectomy. The co-primary outcome measures were rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) and time from groin puncture to successful reperfusion. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In total, 289 patients with tandem atherosclerotic etiology were included in the analysis (182 Neck-First and 107 Head-First patients). Except for differences in the Alberta Stroke Program Early CT Score (ASPECTS; median 8 [range 7–10] Neck-First vs. 7 [range 6–8] Head-First; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60–2.17]). The time to successful reperfusion from groin puncture was sig nificantly shorter in the Head-First group after adjustments (median 56 min [range 39–90] vs. 70 [range 50–102] ; 〈 i 〉 p 〈 /i 〉 = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The upfront approach of the intracranial lesion in patients with tandem large vessel occlusion strokes leads to similar reperfusion rates but faster reperfusion as compared to initial cervical revascularization followed by mechanical thrombectomy. Controlled studies are warranted.
    Type of Medium: Online Resource
    ISSN: 1664-9737 , 1664-5545
    URL: Article
    DOI: 10.1159/000496292
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 2662855-7
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