Outcomes Of Mechanical Thrombectomy Research Articles

Effect of intravenous thrombolytic therapy on mechanical thrombectomy outcomes in acute ischemic stroke patients with basilar artery occlusion

Effect of intravenous thrombolytic therapy on mechanical thrombectomy outcomes in acute ischemic stroke patients with basilar artery occlusion

Long-term outcomes of mechanical thrombectomy in acute ischaemic stroke patients with concomitant malignancy.

Patients with cancer (CP) need a different approach to acute ischaemic stroke (AIS) treatment as intravenous thrombolysis (IVT) may be contraindicated. Mechanical thrombectomy (MT) is a treatment of choice for otherwise eligible patients, although the literature on its long-term outcomes in CP is limited. Assessing outcomes of MT-treated AIS patients with concomitant malignancy in a year-long follow-up. The study included 593 MT-treated AIS patients admitted in 2019-2021. The group was divided into CP (defined as a diagnosis of malignancy and undergoing/qualified for cancer treatment within previous 5 years) and a control group. The profile of cardiovascular risk factors, stroke severity and discharge, 90-day and 365-day outcomes were compared between the groups. CP and controls had a similar profile of cardiovascular risk factors and comparable stroke severity. CP were less frequently treated with IVT (25.7% vs. 59.1%, p < 0.001). There were no differences between the groups in the successful reperfusion rate and occurrence of haemorrhagic complications. Discharge and 90-day outcomes were similar. CP had higher 365-day mortality (48.6% vs. 29.9%, p = 0.024) but the percentage of patients achieving good functional outcome in a year-long observation was comparable. Treatment with MT seems beneficial for AIS patients with concomitant malignancy both in short- and long-term observation.

Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation

We aim to compare the outcomes in patients with atrial fibrillation detected after stroke (AFDAS) and their counterparts with known AF (KAF) presenting with large vessel occlusion (LVO) treated with mechanical thrombectomy (MT). This observational, prospective study included consecutive patients with acute LVO ischemic stroke of the anterior circulation with AFDAS, KAF and without AF. The primary study outcome was functional independence at 90 days after stroke. The secondary study outcomes were variation of the NIHSS score at 24 h, rate of successful reperfusion, death at 90 days and rate of immediate complications post-procedure. Overall, our cohort included 518 patients with acute ischemic stroke and LVO treated with MT, with 289 (56.8%) without a diagnosis of AF; 107 (21%) with AFDAS; 122 (22.2%) with KAF. There was no significant difference in terms of functional independence at 90 days after stroke between the three groups. Regarding the secondary study outcome, the rate of symptomatic intracranial haemorrhage (sICH) and/or parenchymal hematoma (PH) were significantly higher in the group of patients without AF (respectively, P = 0.030 and < 0.010). Logistic regression analysis showed that the subtypes of AF were not statistically significantly associated with functional independence at 90 days after stroke and with the likelihood of any ICH. Our results suggest that the subtypes of AF are not associated with clinical and safety outcomes of MT in patients with acute stroke and LVO. Further studies are needed to confirm our findings.

Comparative Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Patients with ASPECTS 2-3 vs. 4-5

BackgroundThe influence of Alberta Stroke Program Early CT Score (ASPECTS) on outcomes following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients with low ASPECTS remains unknown. In this study, we compared the outcomes of AIS patients treated with MT for large vessel occlusion (LVO) categorized by ASPECTS value. MethodsWe conducted a retrospective analysis involving 305 patients with AIS caused by LVO, defined as the occlusion of the internal carotid artery and/or the M1 segments of the middle cerebral artery, stratified into two groups: ASPECTS 2-3 and 4-5. The primary outcome was favorable outcome defined as a 90-day modified Rankin Scale (mRS) score of 0-3. Secondary outcomes were 90-day mRS 0-2, 90-day mortality, any intracerebral hemorrhage (ICH), and symptomatic ICH (sICH). We performed multivariable logistic regression analysis to evaluate the impact of ASPECTS 2-3 vs. 4-5 on outcomes. ResultsFifty-nine patients (19.3%) had ASPECTS 2-3 and 246 (80.7%) had ASPECTS 4-5. Favorable outcomes showed no significant difference between the two groups (adjusted odds ratio [aOR]= 1.13, 95% confidence interval [CI]: 0.52-2.41, p=0.80). There were also no significant differences in 90-day mRS 0-2 (aOR= 1.65, 95% CI: 0.66-3.99, p=0.30), 90-day mortality (aOR= 1.14, 95% CI: 0.58-2.20, p=0.70), any ICH (aOR= 0.54, 95% CI: 0.28-1.00, p=0.06), and sICH (aOR= 0.70, 95% CI: 0.27-1.63, p = 0.40) between the groups. ConclusionsAIS patients with LVO undergoing MT with ASPECTS 2-3 had similar outcomes compared to ASPECTS 4-5.

Impact of Cervical Vertebral Artery Tortuosity on the Outcome After Mechanical Thrombectomy for Basilar Artery Occlusion

Background Vascular tortuosity affects the outcomes of mechanical thrombectomy (MT). We classified vertebral artery (VA) tortuosity into 3 types and investigated the effect of VA tortuosity on the outcomes in patients with basilar artery occlusion. Methods We retrospectively included patients who underwent MT for basilar artery occlusion between January 2012 and May 2022. Clinical and procedure‐related factors were obtained. VA tortuosity was classified into 3 types: type I: nontortuous VA; type II: S‐shaped vessel or a VA with a single acute angulation (&lt;90°); and type III: coiled vessel, kinked vessel, or a VA with acute angulation in &gt;1 location. The 3‐month modified Rankin scale, procedural outcomes, and post‐MT intracranial hemorrhage were assessed. Results A total of 106 patients with basilar artery occlusion were included. Age, baseline stroke severity, and 3‐month modified Rankin scale score were significantly different according to VA tortuosity ( P = 0.003, P = 0.002, and P &lt;0.001, respectively). A multivariable analysis demonstrated that the VA tortuosity was a predictor for the achievement of modified Rankin scale score of 0 to 3 (type I: reference; type II: odds ratio [OR] = 0.26, 95% CI = 0.07–0.95, P = 0.041; type III: OR = 0.12, 95% CI = 0.02–0.82, P = 0.031). Moreover, type III was associated with less successful recanalization (type I: reference; type III: OR = 0.12, 95% CI = 0.02–0.84, P = 0.032) and had a potential trend for post‐MT intracranial hemorrhage (type I: reference; type III: OR = 3.09, 95% CI = 0.83–11.56, P = 0.094). Conclusion We classified VA tortuosity into 3 types and showed the association between VA tortuosity and stroke outcomes after MT for basilar artery occlusion. Particularly, the mechanisms of poor outcomes in highly tortuous VA might be associated with baseline stroke severity, recanalization failure, and post‐MT intracranial hemorrhage.

Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core

BackgroundRecent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of...

Dynamic and visual nomograms to online predict unfavorable outcome of mechanical thrombectomy for acute basilar artery occlusion.

The evidence of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) was limited. This study aimed to develop dynamic and visual nomogram models to predict the unfavorable outcome of MT in BAO online. BAO patients treated with MT were screened. Preoperative and postoperative nomogram models were developed based on clinical parameters and imaging features. An independent dataset was collected to perform external validation. Web-based calculators were constructed to provide convenient access. A total of 127 patients were included in the study, and 117 of them were eventually included in the analysis. The nomogram models showed robust discrimination, with an area under the receiver operating characteristic (ROC) of 0.841 (preoperative) and 0.916 (postoperative). The calibration curves showed good agreement. The preoperative predictors of an unfavorable outcome were previous stroke, the National Institutes of Health Stroke Scale (NIHSS) at admission, and the posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS). The postoperative predictors were previous stroke, NIHSS at 24h, and pc-ASPECTS. Dynamic and visual nomograms were constructed and validated for the first time for BAO patients treated with MT, which provided precise predictions for the risk of an unfavorable outcome. The preoperative model may assist clinicians in selecting eligible patients, and the postoperative model may facilitate individualized poststroke management.

Abstract 272: Effect of Level of Education on Outcomes of Mechanical Thrombectomy

Introduction Multiple epidemiological studies have investigated the association between stroke clinical outcomes and education level. However, the relationship between the level of education in patients who underwent mechanical thrombectomy (MT) is limited. We aim to assess if the level of education is associated with poor functional outcome, defined as a modified Rankin Scale (mRS) score of ≥3, in patients following MT. Methods We reviewed 257 patients with large vessel occlusion (LVO) who underwent MT between 2018 and June 2023, education levels were available on 106 patients. Education level was defined as “less than high school” (n=15, 14.2%), “high school” (n=54, 50.9%), and “college or higher” (n=36, 34%), 1 of these with “other” education level was excluded from the analysis. Chi‐square and Kruskal Wallis tests were used to examine potential differences in education level and outcomes. All analyses were conducted in IBM SPSS Statistics version 29. Results Compared to those with a college or higher education, those with a less than high school education were more likely to have a poor functional outcome (mRS ≥3) at 90 days. (p=0.03). Black patients were more likely to have a less than high school education than white patients (30.0% vs 4.8%) p&lt;0.001. There were no significant differences in mortality, length of hospitalization, comorbid conditions, Alberta stroke program early CT score (ASPECTS), or initial National Institutes of Health Stroke Scale (NIHSS). Conclusion In our cohort, patients with less than a high school education are more likely to have poorer functional outcomes 90 days post‐MT compared with patients with a college education or higher. Interestingly, there was no significant statistical difference noted in initial NIHSS, ASPECTS, and length of hospitalization between these cohorts. Larger post‐thrombectomy cohorts should be used to further investigate these initial results. In addition, it is important to note that education and race are intertwined in this study, though our relatively small sample of post‐thrombectomy patients limited our analyses. Future research should evaluate this relationship further.

Abstract 246: Effect of platelet count on outcome in ischemic stroke patients with LVO undergoing MT;a meta‐analysis

Introduction Large randomized clinical trials have established the superiority of Mechanical Thrombectomy (MT) for the treatment of Large Vessel occlusion (LVO) in patients with Acute Ischemic stroke (AIS) in terms of revascularization rates and clinical outcomes as compared to IV‐tPA alone.(1, 2, 3) However, Data regarding outcomes of mechanical thrombectomy in patients with low platelets is limited and shows conflicting results. (4, 5, 6, 7, 8) Methods This meta‐analysis was performed according to the preferred reporting items for systematic review and meta‐analysis (PRISMA) guidelines.(9) We defined thrombocytopenia as platelet count &lt; 150,000 /μL. We further classified these patients into two groups: 1) Mild thrombocytopenia (Platelet count 100,000 – 149,000 /μL) and 2) Moderate to severe thrombocytopenia (Platelet count &lt;100,000 /μL). The favourable outcome was 90‐day functional independence, designated as an Modified Rankin Score (MRS) ≤ 2 at 90 days. Unfavorable outcomes were 1) Symptomatic Intracranial hemorrhage (sICH) and 2) Mortality at 90 days. Results All studies were determined to be of good/high quality (Newcastle Ottawa scale).(10) Compared to patients with normal platelets, Patients with low platelets (&lt; 150,000 /μL) had a statistically significant worse outcome (mRS &gt;2 )at 90 days (RR 0.80 [95% CI: 0.69 ‐ 0.94] p = 0.006). However, on analysis based on different platelet cutoff values, the difference in mRS score was not statistically significant in patients with Mild low platelets (100,000 – 149,000 /μL) (RR 0.84 [95% CI: 0.70 ‐ 1.00] p = 0.05) and moderate/severely low platelets (&lt; 100,000 /μL) (RR 0.71 [95% CI: 0.48 ‐ 1.06] p = 0.09) when compared to patients with normal platelets. Similarly, Mortality was significantly increased in patients in the low platelet group (RR 1.95 [95% CI: 1.62 ‐ 2.36] p &lt; 0.00001). Mortality was also significantly increased in the mild low platelet subgroup (RR 1.88 [ 95% CI: 1.34 ‐ 2.63] p = 0.0002) and moderate/severe low platelet subgroup (RR 2.07 [95% CI: 1.46 ‐ 2.92] p &lt; 0.0001) when compared to patients with normal platelets. Furthermore, sICH events were significantly increased in patients in the low platelet group (RR 2.47 [95% CI: 1.51 ‐ 4.05] p = 0.0003). Similarly, on analysis based on different platelet cutoff values, sICH was also significantly increased in the mild low platelet subgroup (RR 2.34 [ 95% CI: 1.24 ‐ 4.40] p = 0.008) and moderate/severe low platelet subgroup (RR 4.13 [95% CI: 2.00 ‐ 8.50] p = 0.0001). Conclusion Our meta‐analysis revealed that compared to individuals with normal platelet count, those with platelet count (&lt; 150,000 /μL) had worse functional outcomes (MRS ≤ 2) , higher mortality rates, and a greater incidence of sICH. However, on analysis based on different platelet cutoffs, difference in MRS score was insignificant while the mortality rates and sICH incidence remained significantly higher. This may be attributed to smaller number of studies in the “cut‐off” groups leading to decreased power. Nevertheless, our findings suggest that MT for LVO in patients with low platelets leads to worse outcomes, however these risk were not significant in group with mild thrombocytopenia. Hence, Clinicians should carefully monitor for these risks while performing procedure or post procedure care.

Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up

Introduction The 2015 American Heart Association Guidelines recommended mechanical thrombectomy with stent‐retriever devices. A prior published analysis of national trends after one year in mechanical thrombectomy use and outcomes for stroke before and after publication of the 2015 US guideline update showed improved functional outcomes and lower peri‐procedural mortality. We analyze the national trends in mechanical thrombectomy use and outcomes for stroke five years after publication of the US guideline update. Methods We analyzed the National Inpatient Sample from 2012‐2019. ICD‐9 and ICD‐10 codes identified Ischemic stroke and mechanical thrombectomy patients. Similar to the previous study, discharge to home was the primary efficacy outcome measure in this study since it strongly correlates with mild degree of disability at discharge and 3 months post‐stroke. Safety outcomes include in‐hospital medical complications and mortality. We utilized multivariate logistic regression to assess outcomes. Results From 2012‐2019, 4,003,405 individuals with a diagnosis of ischemic stroke were recorded, 103,605 (2.6%) of which were treated with mechanical thrombectomy, proportionally increased from 4,910/452,905 (1.1%) in 2012 to 26,365/552,780 (4.8%) in 2019. The proportion of endovascular thrombectomy performing hospitals nearly doubled during the study period from 2012 (295/4,378; 6.7%) to 2019 (582/4,568; 12.7%). Odds of a mild disability outcome increased from 16% to 20%, OR 0.65 (0.57, 0.74), while mortality decreased from 15% to 12%, OR 0.69 (0.61, 0.78). Compared with 2012‐2014, the 2015‐2019 cohort showed increased odds of ICH and shock while the odds of DVT, pulmonary embolism, pneumonia, and UTI were significantly lower. The presence of septicemia, shock, and cardiac arrest were unchanged. Conclusion The number of large vessel occlusion stroke patients receiving mechanical thrombectomy treatment in the United States is increasing rapidly each year after the 2015 US guideline update. As the use of mechanical thrombectomy expands, included patients have more medical complications at baseline, but experience fewer complications, peri‐procedural mortality and overall improved outcomes.

Abstract 210: Mechanical Thrombectomy Outcomes for Tele‐Stroke Inter‐Hospital Transfers vs Direct Admit Patients

Introduction Mechanical thrombectomy (MT) is the standard of care for patients with large vessel occlusion and salvageable tissue. Whether the benefit of thrombectomy is maintained for patients transferred to a thrombectomy‐capable center in a real‐world setting remains unknown. In this study, we sought to assess clinical outcomes of MT following inter‐hospital transfer. Methods We collected data for all patients who underwent MT at a single center between May 2016 and July 2021. Outcomes were compared between transferred and direct admit patients. Our outcomes measurements included National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at 90 days. We used Mann‐Whitney U and chi‐square tests for univariate analysis. Multivariate regression analysis was also carried out to assess the relationship between transfer status and long‐term functional independence (90 days mRS 0‐2) controlling for age, sex, symptom‐onset to groin time, IV thrombolysis, and baseline NIHSS. Results 246/620 (40%) patients undergoing MT were transferred and 374/620 (60%) presented directly to our institution. There was no difference in age (68 vs. 70 years, P=0.58), baseline NIHSS (16 vs. 15, P=0.20), or ASPECTs score (7 vs. 8, P=0.06) in the transferred and direct admit groups, respectively. The duration from symptom‐onset to groin was longer (393 vs. 270 min, P&lt;0.01) and rate of IV thrombolysis was more (48.4% vs. 37.4%, P=0.007) in the transferred patients. Functional independence (mRS 0‐2) at 90 days was observed in 44.6% of the patients in the transferred group compared to 49.2% in the direct thrombectomy group (P=0.928). On multivariate analysis, transfer status was not an independent predictor of long‐term functional independence (ARR 1.976, 95% CI 0.807‐4.838, P=0.136). Conclusion In the included cohort, no difference was found in long‐term functional independence between stroke patients who received mechanical thrombectomy following inter‐hospital transfer compared to patients who present directly to a thrombectomy‐capable center. These findings emphasize that optimizing telestroke workflow can mitigate the adverse effects of delay during transportation for patients that present to remote hospitals in rural areas.

The Use of CHA2DS2-VASc Score to Predict Functional Outcomes of Mechanical Thrombectomy

Background: Mechanical thrombectomy is widely used for revascularization of acute ischemic strokes from large vessel occlusions. Functional outcomes following mechanical thrombectomy are typically assessed using the modified Rankin scale. CHA2DS2-VASc score is commonly used to estimate the stroke risk of patients with atrial fibrillation, but studies have verified its use in other various situations. Our study aimed to assess the utility of CHA2DS2-VASc score in predicting outcomes of patients undergoing mechanical thrombectomy. Methods: We performed a single center retrospective study. Of patients with acute ischemic stroke who underwent mechanical thrombectomy for large vessel occlusion (n = 448). CHA2DS2-VASc score was calculated on each patient and the study population was grouped based on low-risk ≤ 2, intermediate risk 3-4 and high-risk ≥ 5. Association between CHA2DS2-VASc score and 90-day modified Rankin score as well as in-hospital, 30-day, and 1-year mortality was evaluated and compared between the three groups. Results: A total of 312 patients met criteria for the study. Patients in the high-risk CHA2DS2-VASc score had a significantly higher modified Rankin score (4.48) when compared to low (2.57) and intermediate (3.82) risk groups. Higher CHA2DS2-VASc scores were also associated with a significantly higher in-hospital, 30-day, and one year mortality. Conclusion: CHA2DS2-VASc score, a simple bed-side tool, can predict higher mortality and worse functional outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy for large vessel occlusions.

No Sex Differences in Mechanical Thrombectomy Time Metrics and Outcomes in Saskatchewan.

Numerous studies have shown longer pre-hospital and in-hospital workflow times and poorer outcomes in women after acute ischemic stroke (AIS) in general and after endovascular treatment (EVT) in particular. We investigated sex differences in acute stroke care of EVT patients over 5 years in a comprehensive Canadian provincial registry. Clinical data of all AIS patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan were captured in the Canadian OPTIMISE registry and supplemented with patient data from administrative data sources. Patient baseline characteristics, transport time metrics, and technical EVT outcomes between female and male EVT patients were compared. Three-hundred-three patients underwent EVT between 2017 and 2022: 144 (47.5%) women and 159 (52.5%) men. Women were significantly older (median age 77.5 [interquartile range: 66-85] vs.71 [59-78], p < 0.001), while men had more intracranial internal carotid artery occlusions (48/159 [30.2%] vs. 26/142 [18.3%], p = 0.03). Last-known-well to comprehensive stroke center (CSC)-arrival time (median 232 min [interquartile range 90-432] in women vs. 230 min [90-352] in men), CSC-arrival-to-reperfusion time (median 108 min [88-149] in women vs. 102 min [77-141] in men), reperfusion status (successful reperfusion 106/142 [74.7%] in women vs. 117/158 [74.1%] in men) as well as modified Rankin score at 90 days did not differ significantly. This held true after adjusting for baseline variables in multivariable analyses. While women undergoing EVT in the province of Saskatchewan were on average older than men, they were treated just as fast and achieved similar technical and clinical outcomes compared to men.

Post‐Market Registry of Stroke Patients Treated With Medtronic Neurothrombectomy Devices in Southeast Asia: PROSPR‐SEA

Background Southeast Asia accounts for approximately 10% of stroke‐related mortalities worldwide, yet there are limited data regarding mechanical thrombectomy (MT) outcomes in this region. PROSPR‐SEA (Post‐Market Registry of Stroke Patients Treated With Medtronic Neurothrombectomy Devices to Collect Real‐World Data in Southeast Asia) assessed post‐market clinical outcomes of MT using the Solitaire Revascularization Device in southeast Asia. Methods PROSPR‐SEA is a prospective, multicenter, nonrandomized, observational registry of patients who underwent MT using Solitaire as first line treatment at 1 of 10 centers in Vietnam, Thailand, and Singapore between January 2018 and July 2019. The primary end point was functional independence (modified Rankin scale 0–2) at 90 days. Safety end points included symptomatic intracerebral hemorrhage, emboli in new territory at 24 hours, and all‐cause mortality at 90 days. Secondary end points were successful revascularization (modified thrombolysis in cerebral infarction ≥2b), workflow metrics, National Institutes of Health Stroke Scale score at discharge, and patient disposition at 90 days. Results A total of 183 patients (64.9±13.7, 49.7% [91/183] female) were included in the study and underwent MT; 79.2% (145/183) had occlusions in the middle cerebral artery. Median baseline National Institutes of Health Stroke Scale was 15.0 (range 1–31) and median baseline Alberta Stroke Program Early CT Score was 8.0 (range 0–10). Functional independence at 90 days was achieved in 62.2% (112/180). Mean puncture‐to‐revascularization time was 53.3±53.9 minutes, and mean onset‐to‐revascularization time was 330.0±110.4 minutes. Revascularization was successful in 94.0% (172/183) of patients. Median National Institutes of Health Stroke Scale improved at discharge (−8.0, range −22, 25) and 90 days (−13.0, range −22, 0). Within 24 hours, symptomatic intracerebral hemorrhage occurred in 7.7% (14/183) and emboli in new territory in 3.3% (6/183). At 90 days, the all‐cause mortality rate was 7.7% (14/183). Most patients were discharged to home by 90 days (84.1%, 154/183). Conclusion PROSPR‐SEA demonstrated high rates of positive functional outcomes and procedural success with a low mortality rate and indicates that the technical and clinical outcomes of landmark MT trials using Solitaire as the first‐line device are reproducible in real‐world southeast Asian settings.

Clot-based time attenuation curve as a novel imaging predictor of mechanical thrombectomy functional outcome in acute ischemia stroke.

To investigate whether a novel assessment of thrombus permeability obtained from perfusion computed tomography (CTP) can act as a more accurate predictor of clinical response to mechanical thrombectomy (MT) in acute ischemic stroke (AIS). We performed a study including two cohorts of AIS patients who underwent MT admitted to a single-center between April 2018 and February 2022: a retrospective development cohort (n = 71) and a prospective independent validation cohort (n = 96). Thrombus permeability was determined in terms of entire thrombus time-attenuation curve (TAC) on CTP. Association between thrombus TAC distributions and histopathological results was analyzed in the development cohort. Logistic regression was used to assess the performance of the TAC for predicting 90-day modified Rankin Scale (mRS) score, and good outcome was defined as a mRS score of ≤ 2. Basic clinical characteristics was used to build a routine clinical model. A combined model gathered TAC and basic clinical characteristics was also developed. The performance of the three models is compared on the independent validation set. Two TAC distributions were observed-unimodal (uTAC) and linear (lTAC). TAC distributions achieved strong correlations (|r|= 0.627, p < 0.001) with histopathological results, in which uTAC associated with fibrin- and platelet-rich clot while lTAC associated with red blood cell-rich clot. The uTAC was independently associated with poor outcome (odds ratio, 0.08 [95% confidence interval (CI), 0.02-0.31]; p < 0.001). TAC distributions yielded an AUC of 0.78 (95% CI, 0.70-0.87) for predicting clinical outcome. When combined clinical characteristics, the performance was significantly improved (AUC, 0.85 [95% CI, 0.76-0.93]; p < 0.001) and higher than routine clinical model (AUC, 0.69 [95% CI, 0.59-0.83]; p < 0.001). Thrombus TAC on CTP were found to be a promising new imaging biomarker to predict the outcomes of MT in AIS. This study revealed that clot-based time attenuation curve based on admission perfusion CT could reflect the permeability and composition of thrombus and, also, provide valuable information to predict the clinical outcomes of mechanical thrombectomy in patients with acute ischemia stroke. • Two time-attenuation curves distributions achieved strong correlations (|r|= 0.627, p < 0.001) with histopathological results. • The unimodal time-attenuation curve was independently associated with poor outcome (odds ratio, 0.08 [0.02-0.31]; p < 0.001). • The time-attenuation curve distributions yielded a higher performance for detecting clinical outcome than routine clinical model (AUC, 0.78 [0.70-0.87] vs 0.69 [0.59-0.83]; p < 0.001).

Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions: a meta-analysis.

Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions: a meta-analysis.

Outcomes of mechanical thrombectomy in orally anticoagulated patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Imperial College Thrombectomy Registry

BackgroundMechanical thrombectomy (MT) remains an effective treatment for patients with acute ischemic stroke receiving oral anticoagulation (OAC) and large vessel occlusion (LVO). However, to date, it remains unclear whether MT is safe in patients on treatment with OAC.AimsIn our study, we performed a propensity-matched analysis to investigate the safety and efficacy of MT in patients with acute ischemic stroke receiving anticoagulants. A propensity score method was used to target the causal inference of the observational study design.MethodsThis observational, prospective, single-centre study included consecutive patients with acute LVO ischemic stroke of the anterior circulation. Demographic, neuro-imaging and clinical data were collected and compared according to the anticoagulation status at baseline, patients on OAC vs those not on OAC. The primary study outcomes were the occurrence of any intracerebral haemorrhage (ICH) and symptomatic ICH. The secondary study outcomes were functional independence at 90 days after stroke (defined as modified Rankin Scale (mRS) scores of 0 through 2), mortality at 3 months and successful reperfusion rate according to the modified treatment in cerebral infarction (mTICI) score.ResultsOverall, our cohort included 573 patients with acute ischemic stroke and LVO treated with MT. After propensity score matching, 495 patients were matched (99 OAC group vs 396 no OAC group). There were no differences in terms of clinical characteristics between the two groups, except for the rate of intravenous thrombolysis less frequently given in the OAC group. There was no significant difference in terms of the rate of any ICH and symptomatic ICH between the two groups. With regards to the secondary study outcome, there was no significant difference in terms of the rate of successful recanalization post-procedure and functional independence at 3 months between the two groups. Patients in the OAC group showed a reduced mortality rate at 90 days compared to the patients with no previous use of anticoagulation (20.2% vs 21.2%, p = 0.031). Logistic regression analysis did not reveal a statistically significant influence of the anticoagulation status on the likelihood of any ICH (OR = 0.95, 95% CI = 0.46–1.97, p = 0.900) and symptomatic ICH (OR = 4.87, 95% CI = 0.64–37.1, p = 0.127). Our analysis showed also that pre-admission anticoagulant use was not associated with functional independence at 90 days after stroke (OR = 0.76, 95% CI = 0.39–1.48, p = 0.422) and rate of successful reperfusion (OR = 0.81, 95% CI = 0.38–1.72, p = 0.582).ConclusionAccording to our findings anticoagulation status at baseline did not raise any suggestion of safety and efficacy concerns when MT treatment is provided according to the standard guidelines. Confirmation of these results in larger controlled prospective cohorts is necessary.

Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry.

Mechanical thrombectomy for the treatment of deep vein thrombosis (DVT) is being increasingly utilized to reduce symptoms and prevent postthrombotic syndrome (PTS), but more data on clinical outcomes are needed. Mechanical thrombectomy was studied in the ClotTriever Outcomes (CLOUT) registry with 6-month full analysis outcomes reported herein. The CLOUT registry is a prospective, all-comer study that enrolled 500 lower extremity DVT patients across 43 US sites treated with mechanical thrombectomy using the ClotTriever System. Core-lab assessed Marder scores and physician-assessed venous patency by duplex ultrasound, PTS assessment using Villalta score, venous symptom severity, pain, and quality of life scores through 6months were analyzed. Adverse events were identified and independently adjudicated. All-cause mortality at 30days was 0.9%, and 8.6% of subjects experienced a serious adverse event (SAE) within the first 30days, 1 of which (0.2%) was device related. SAE rethrombosis/residual thrombus incidence was 4.8% at 30days and 8.0% at 6months. Between baseline and 6months, venous flow increased from 27.2% to 92.5% of limbs (P < 0.0001), and venous compressibility improved from 28.0% to 91.8% (P < 0.0001), while median Villalta scores improved from 9.0 at baseline to 1.0 at 6months (P < 0.0001). Significant improvements in venous symptom severity, pain, and quality of life were also demonstrated. Outcomes from iliofemoral and isolated femoral-popliteal segments showed similar improvements. Outcomes from the CLOUT study, a large prospective registry for DVT, indicate that mechanical thrombectomy is safe and demonstrates significant improvement in symptoms and health status through 6months. Level of Evidence 3: Non-randomized controlled cohort/follow-up study.

Efficacy, safety, and predictors for functional outcomes of mechanical thrombectomy in patients aged over 90 years with acute ischemic stroke and literature review

BackgroundNo evidence supports the efficacy and safety of mechanical thrombectomy (MT) in patients aged ≥ 90 years with acute ischemic stroke (AIS). This study clarifies the efficacy, safety, and predictors of MTs in patients aged ≥ 90 years by investigating our results and reviewing previous studies. MethodsWe retrospectively investigated data from 80 consecutive patients who underwent MT at our hospital between 2018 and 2021. We analyzed outcomes using the modified Thrombolysis in the Cerebral Infarction (mTICI) scale and modified Rankin Scale (mRS). Functional outcomes were investigated at 90 days or discharge. ResultsWe obtained functional outcomes mRS ≤ 3 patients in 41.6%. The mortality rate was 16.6%. The rate of successful recanalization was 75%. Comparison mRS ≤ 3 and mRS ≥ 4 at 90 days or discharge showed statistical significance in the National Institute of Health Stroke Scale, the location of occluded vessels, and mTICI ≥ 2b at the first pass. Univariable logistic regression analysis indicated that the Alberta Stroke Program Early Computed Tomography Score was a predictor of mRS ≤ 3. ConclusionsThe efficacy is lower than that of patients aged < 90; however, MT is effective even in patients aged ≥ 90 years. The safety of MT in patients aged ≥ 90 years was similar to that in those aged < 90 years. Neuro-interventionalists should consider predictors and take the best strategies to achieve successful recanalization in patients aged ≥ 90 years with AIS.

Low (0–5) Alberta Stroke Program Early Computed Tomography Score on admission predictive of worse functional outcome after mechanical thrombectomy for anterior circulation large vessel occlusion

Background and purposeWe examined functional outcomes of mechanical thrombectomy (MT) procedures following anterior circulation large vessel occlusion (ACLVO)-related acute ischemic strokes (AIS). Results were based on admission non-contrast computed tomography (NCCT) studies, using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as standard metric.MethodsQualifying subjects were consecutive patients (N = 343) at a single center undergoing MT for ACLVO-related AIS. Each was grouped according to ASPECTS status on admission, determined from NCCT images by two physicians. Primary clinical endpoint was functional independence, assessed via modified Rankin Scale (mRS) at 90 days. Secondary endpoints were vessel recanalization (i.e., modified Thrombolysis in Cerebral Infarction [mTICI] score), symptomatic intracranial hemorrhage (sICH), and mortality.ResultsIn this study population (mean age, 63.6 ± 12.6 years; women, 30.3%; median baseline National Institute of Health Stroke Scale [NIHSS] score, 15.2 ± 4.5), patients were stratified by ASPECTS tier at presentation, either 0–5 (n = 50) or 6–10 (n = 293). Multivariate logistic regression showed a relation between ASPECTS values ≤ 5 and lesser chance of 90-day functional improvement (OR = 2.309, 95% confidence interval [CI] 1.012–5.271; p = 0.047), once adjusted for age, baseline NIHSS score, diabetes mellitus, HbA1c concentration, D-dimer level, occlusive location, numbers of device passes, and successful recanalization.ConclusionsASPECTS values ≤ 5 correspond with worse long-term functional improvement (mRS scores > 2) in patients undergoing MT for ACLVO-related AIS. Other independent determinants of functional outcomes after MT are age, baseline NIHSS score, HbA1c concentration, and successful recanalization.