Emergent Large Vessel Occlusion Patients Research Articles

Stroke vision, aphasia, neglect (VAN) assessment—a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices

BackgroundIdentification of emergent large vessel occlusion (ELVO) stroke has become increasingly important with the recent publications of favorable acute stroke thrombectomy trials. Multiple screening tools exist but the length of...

Abstract WMP66: Minnesota Prehospital Stroke Scale For Prediction of Emergent Large Vessel Occlusion

Intro: Recent randomized clinical trials have demonstrated the benefit of endovascular mechanical thrombectomy in acute ischemic stroke patients with Emergent Large Vessel Occlusion (ELVO). Cincinnati Prehospital Stroke Scale is widely used tool by EMS but not specifically designed to predict ELVO. Previously reported prehospital stroke scales for ELVO have been limited, and not widely used. It is imperative to establish a simple and accurate tool for EMS to predict ELVO facilitating rapid patient transport to hospitals capable of endovascular intervention. Hypothesis: Minnesota Prehospital Stroke Scale (MPSS) can predict the presence of ELVO with high accuracy comparable to NIHSS. Methods: The MPSS assesses five parameters: Facial weakness, Arm weakness, Leg weakness, Speech difficulty and Eye deviation, with total score ranging 0-10 (See Table). We set MPSS 6 or above and NIHSS 7 or above as a cutoff for ELVO. We retrospectively analyzed all the stroke code patients seen in ED between January 2015 and April 2015 at a primary stroke center (n=120). We selected patients arriving in less than 6 hours with prehospital stroke alert activated by EMS. Hemorrhagic stroke patients were excluded. The following data were collected: 1) Presence of ELVO, 2) Initial NIHSS in ED, and 3) MPSS abstracted from initial ER NIHSS, then assessed the results using 2x2 table for ELVO and MPSS vs. NIHSS. Results: Of 28 patients meeting criteria, 6 (21%) had ELVO (ICA, M1/M2): Mean MPSS was 7.5, whereas mean NIHSS was 15 for ELVO patients. Mean HPSS was 1.6, whereas mean NIHSS was 5.1 for non-ELVO patients. Sensitivity 83%, specificity 100%, PPV 100%, NPV 96%, and accuracy 96% for HPSS; sensitivity 83%, specificity 77%, PPV 50%, NPV 94% and accuracy 79% for NIHSS. Conclusion: MPSS may be a useful tool for predicting ELVO. Further studies are necessary to validate the efficacy of the scale.

Mechanical thrombectomy for emergent large vessel occlusion: a critical appraisal of recent randomized controlled clinical trials.

Background and PurposeAfter numerous attempts to prove efficacy for endovascular treatment of ischemic stroke, a series of recent randomized controlled clinical trials (RCTs) established fast mechanical thrombectomy (MT) as a safe and effective novel treatment for emergent large vessel occlusion (ELVO) in the anterior cerebral circulation.MethodsWe reviewed five recent RCTs that evaluated the safety and efficacy of MT in ELVO patients and captured available information on recanalization/reperfusion, symptomatic intracranial hemorrhage (sICH), clinical outcome, and mortality. MT was performed with stent retrievers, aspiration techniques, or a combination of these endovascular approaches. We applied meta‐analytical methodology to evaluate the pooled effect of MT on recanalization/reperfusion, sICH, functional independence (modified Rankin scale score of 0–2) and 3‐month mortality rates in comparison to best medical therapy (BMT).Results MT was associated with increased likelihood of complete recanalization/reperfusion (RR: 2.22; 95%CI: 1.89–2.62; P < 0.00001) and 3‐month functional independence (RR: 1.72; 95%CI: 1.48–1.99; P < 0.00001) without any heterogeneity across trials (I 2 = 0%). The absolute benefit increase in MT for complete recanalization/reperfusion and functional independence was 44 (NNT = 2) and 16 (NNT = 6), respectively. MT was not associated with increased risk of 3‐month mortality (15% with MT vs. 19% with BMT) and sICH (4.6% with MT vs. 4.3% with BMT), while small heterogeneity was detected across the included trials (I 2 < 25%).Conclusions MT is a safe and highly effective treatment for patients with ELVO in the anterior circulation. For every six ELVO patients treated with MT three more will achieve complete recanalization at 24 h following symptom onset and one more will be functionally independent at 3 months in comparison to BMT.

Use of General Anesthesia for Emergent Large Vessel Occlusion Patients

Use of General Anesthesia for Emergent Large Vessel Occlusion Patients