Median NIHSS Score Research Articles

Clinical Results of the ANAIS Study: Mechanical Thrombectomy Using the ANA Device in Combination with a Stent Retriever in Subjects with Acute Ischemic Stroke.

The ANA thrombectomy system is a funnel catheter comprising a self-expanding coated funnel that works in conjunction with a standard stent retriever and is designed to locally restrict flow and reduce clot fragmentation. The ANAIS Study to Confirm the Safety and Performance of the ANA 5F Advanced Neurovascular Access investigated the performance of the ANA funnel catheter in patients with stroke. Mechanical thrombectomy using the ANA device in combination with a stent retriever in subjects with acute ischemic stroke. This is a prospective, single-arm, multicenter study with blinded outcome assessment by an independent imaging Core Lab. Patients with anterior circulation stroke undergoing mechanical thrombectomy were eligible. The primary end point was successful reperfusion (expanded TICI 2b50-3) within 3 passes without rescue therapy. The safety end point combined symptomatic intracranial hemorrhage and severe adverse device effect. Forty-three subjects were treated in 3 centers: mean age, 70.5 (SD, 13.1) years, 44.2% (19/43) women; median admission NIHSS score, 16.0 (range, 12.5-19.5). The primary end point was achieved in 70% (30/43) and 81% (26/32) in the intention-to-treat (ITT) and per-protocol (PP) populations, respectively. The rates of first pass expanded TICI 2c-3 were 44% (19/43) and 56% (18/32) in the ITT and PP populations, respectively. There were no severe adverse device effects/symptomatic ICH at 24 hours (0/43). When the funnel was deployed in the C1 segment of the internal carotid artery (Bouthillier Classification), the primary end point (ITT, 36%; PP, 57%) was lower than when deployed in the C2/C3 segments (ITT, 89%; PP, 100%; P < .01), or in the C4 or above segments (ITT, 71%; PP, 77%; P < .05). The primary end point was higher when continuous aspiration was applied from initiation of the retrieval maneuver (ITT, 81%; PP, 92%) compared with end-aspiration only (ITT, 36%; PP, 50%, P < .01). The ANA funnel catheter achieved high rates of reperfusion and first pass success, with a good safety profile. Successful reperfusion was superior when the funnel was deployed above the C1 segment of the ICA and clot retrieval was performed under continuous aspiration.

Seven years of CRAFT: Clinical results of a multicenter cohort of carotid artery relining with the CASPER RX stent.

Seven years of CRAFT: Clinical results of a multicenter cohort of carotid artery relining with the CASPER RX stent.

Aetiology of Acute Respiratory Insufficiency in Patients With Ischaemic Stroke Studied by Chest CT Scan.

Acute respiratory insufficiency (ARI) is considered a serious life-threatening complication after ischaemic stroke. The aim of this study was to identify the most common aetiologies of ARI after stroke and their association with patients' outcome. This retrospective study was conducted at the University Hospital Bonn, involving patients with acute ischaemic stroke who underwent chest CT scans for ARI between 2017 and 2022. We collected clinical and demographic data, laboratory parameters, vital signs, as well as outcome parameters. CT scans were reviewed by a radiologist. The dataset was analysed to identify the most frequent aetiologies and their associations to outcome parameters. We included 236 patients with a median age of 75 years and a median NIHSS score of 11. In-hospital mortality accounted for 30.5%. The most frequent pulmonary conditions on CT, in order of prevalence, included bronchitis/bronchiolitis (66.1%), atelectasis (66.1%), pleural effusion (60.6%), pneumonia (53%), pulmonary oedema (37.3%), and pulmonary artery embolism (27.5%). Bronchitis/bronchiolitis was an independent risk factor for mortality (OR = 3.17, 95% CI: 1.11-8.79, p = 0.03). A higher number of pulmonary conditions decreased the likelihood of discharge to home, and non-survivors had worse vital/laboratory parameters. We identified six key pulmonary aetiologies of ARI after ischaemic stroke, with bronchitis/bronchiolitis notably linked to in-hospital mortality in our study cohort. An increased number of these acute pulmonary conditions decreased the likelihood of discharge to home. Early chest CT/CT-angiography may help to identify patients at high risk for in-hospital mortality and to initiate appropriate treatment early.

Stroke severity influences correlation of fibrinogen with early neurological deterioration after thrombolytic therapy.

Stroke severity influences correlation of fibrinogen with early neurological deterioration after thrombolytic therapy.

Abstract 25: Discovery of Serum Biomarkers to Inform Early Rehabilitation after Acute Ischemic Stroke

Background: Rehabilitation therapy is an important component of acute ischemic stroke (AIS) recovery. A major hinderance is the inability to predict which patients benefit from mobilization during the first 24 hours (ERehab). We hypothesize serum biomarker analyses during the hyperacute phase can bridge the gap. Methods: This is a single center study of 20 AIS patients&amp;14 age/sex matched controls enrolled from 3/2022-6/2023. Serum samples were collected at 4 time points – angiography suite before cerebral reperfusion or Neuro ICU at hospital admission, 12, 24&amp;72 hours. Biomarker candidates were identified using a DisGeNET search for AIS associated proteins; 70% achieved an Evidence Index cutoff score of 1, indicating all publications support human gene-disease or variant-disease associations. Time course of serum proteome changes was evaluated using aptamer-based SomaScan assay, measuring 1500 proteins. NIH Database for Annotation, Visualization&amp;Integrated Discovery (DAVID) Gene Functional Classification Tool compared shared genes and biomarkers for stroke (vs healthy controls)&amp;unfavorable (vs favorable) outcome, characterized by modified Rankin Scale (mRS) score of 3-6 (vs 0-2), at hospital discharge&amp;90 days (90d). Results: The mean age of AIS patients was 59 years, 65% were male. Median NIHSS score was 11, Charlson Comorbidity Index score was 5.5 and the median last known well to hospital admission was 6.6 hrs. The average time to first mobilization was 39 hrs, 25% received ERehab. The mean rehab duration during AIS hospitalization was 438 min; median length of stay was 8.4 days, 40% received post-acute rehabilitation. Median AIS volume was 36mL, 65% of patients had ICA or M1/MCA involvement. Approximately 65% received IV thrombolysis, 80% underwent cerebral reperfusion therapy, 94% achieved modified thrombolysis in Cerebral Infarction score ≥ 2b. The median mRS was 4 at hospital discharge, 3 at 90d. Mortality rate was 10%. DAVID analyses resulted in 22 biomarkers at hospital discharge&amp;35 biomarkers at 90d associated with favorable outcome. Gene expression differences were present at each time point (Figure). Conclusions: We identified multiple serum biomarkers and gene clusters associated with favorable outcomes at hospital discharge and 90d in AIS patients, indicating a need for several biologic targets to predict ERehab response during the hyperacute phase. These findings provide an early framework for tailored stroke recovery interventions.

Anterior Circulation Stroke Mechanical Thrombectomy With Transradial Balloon Guide Catheter: Single-Center Pilot Study

This study evaluates the feasibility, safety, and efficiency of using a balloon guide catheter (BGC) through transradial access (TRA) for mechanical thrombectomy (MT) in patients with anterior circulation strokes. A retrospective case series of patients who underwent MT using BGC through TRA for acute ischemic stroke in the anterior circulation was conducted. Data collected included procedural times (from puncture to revascularization), technical success, complication rates, and clinical outcomes. Patients' baseline characteristics, stroke severity, and post-procedural outcomes were also analyzed. Thirty patients were included, with a mean age of 64.4 ± 13.6 years. The median admission NIHSS score was 13, and 17 % received intravenous thrombolysis before thrombectomy. Right-sided occlusions were more frequent (57 %). TRA was successful in 27 patients (90 %), with 3 (10 %) requiring conversion to femoral access. The median puncture-to-revascularization time was 32 minutes, and first-pass revascularization was achieved in 40 % of cases. A favorable TICI 2b or higher was accomplished in 97 %, with no access site complications. Hemorrhagic conversion occurred in 20 %, including one symptomatic intracerebral hemorrhage (3 %). At discharge, 57 % of patients had favorable outcomes (mRS 0-2), and by 90 days, 54 % achieved functional independence, with a mortality rate of 3 %. This case series highlights the feasibility of using BGC through TRA in MT for anterior circulation strokes, demonstrating promising safety and efficiency. Future multicenter studies with larger cohorts are necessary to compare clinical outcomes of TRA versus transfemoral access and guide standardized protocols for stroke interventions.

Abstract TMP73: Endovascular therapy for acute ischemic stroke beyond 24 hours after onset: Japan Stroke Data Bank

Background: The therapeutic time window of endovascular therapy (EVT) for acute ischemic stroke (AIS) has been expanded up to 24 hours of onset. Patients with AIS beyond 24 hours may also benefit from EVT, but the actual status of this clinical issue is unknown. Purpose: To evaluate the real-world status of EVT for AIS beyond 24 hours of onset using a nation-wide stroke registry, Japan Stroke Data Bank (JSDB). JSDB is an ongoing hospital-based multicenter prospective registry of hospitalized patients with acute stroke or transient ischemic attack within 7 days of onset. Methods: From the JSDB dataset, patients with AIS who underwent EVT from 1996 through 2021 were analyzed. Patients were divided into 3 groups according to time from onset to hospital arrival (early: &lt;4.5 hour; late: 4.5–24 hour; and very late: &gt;24 hour). Outcomes included the favorable outcome (mRS 0–2 or return to pre-stroke mRS at discharge) and in-hospital mortality. Results: Among the 256,293 stroke patients, 91,907 AIS patients available for analysis were included in the present study. EVT was implemented in 6.9% (6,356/91,907) (median age 78 years; 41.6% women; median NIHSS score 16). The EVT rate by time window groups was 11.8% (4,258/36,044) for the early, 5.3% (1,676/31,328) for the late, and 1.7% (422/24,535) for the very late group. In the very late group with EVT, baseline NIHSS score was lowest (median 17 points in the early group, 14 points in the late group, and 5 points in the very late group), cardioembolism was least common (67.2%, 53.5%, and 22.0%, respectively), and large artery atherosclerosis was most common (17.9%, 30.8%, and 55.7%, respectively). Favorable outcome was more frequently achieved in the very late group (52.9%) than in the early (41.6%) and late (36.5%) groups. Symptomatic intracranial hemorrhage was more frequently seen in the very late group (6.0%) compared to the early (2.9%) and late (3.8%) groups, but in-hospital mortality was comparable among the time window groups (8.1% in the early group, 7.1% in the late group, and 6.6% in the very late group). Conclusions: Outcomes after EVT for patients with AIS beyond 24 hours were not necessarily worse than for patients with AIS up to 24 hours, but the patient profile in the very late group with EVT differed significantly from that in the early and late groups; developing optimal patient selection strategies for very late AIS may be required.

Effect of intravenous urokinase vs best medicine treatment on functional outcome for patients with acute minor stroke (TRUST): a randomized controlled trial

BackgroundThe benefits of intravenous thrombolysis in patients with acute minor stroke remain controversial. For the aim of providing a better therapeutic strategy, high-quality trials are required to validate the efficacy of thrombolytic medicine other than intravenous recombinant tissue plasminogen and tenecteplase. In the trial, we evaluate the efficacy and safety of urokinase (UK) in acute minor stroke.MethodsThis multicenter, open-label, blinded-endpoint, randomized controlled clinical trial enrolled patients with minor stroke within 6 h of symptom onset, with a NIHSS score ≤ 5. The trial was conducted at 25 hospitals in China between October 2020 and February 2023. Eligible patients were randomized to the UK group (1,000,000 U) or the best medicine treatment group. The responsible investigator recommended and implemented the best medicine treatment based on guidelines. The primary endpoint was an excellent functional outcome, defined as a modified Rankin scale (mRS) score of 0–1 at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 36 h.ResultsA total of 999 patients were enrolled in the trial, the median age was 64 years, 371 (36.9%) were women; the median (IQR) NIHSS score was 3 (2–4). At 90 days, the primary endpoint was observed in 427 patients (84.9%) in the UK group and 425 patients (85.7%) in the control group (adjusted risk ratio [RR] 1.00, 95% CI 0.96–1.05, p = 0.87). A total of 3 patients in the UK-treated (0.6%) group experienced sICH compared to 1 patient (0.2%) in the control group (RR 1.83, 95% CI 0.16–20.27, p = 0.62).ConclusionsFor patients with acute minor stroke treated within 6 h of symptom onset, UK intravenous thrombolysis treatment was not found to be beneficial in terms of excellent functional outcome at 90 days, whereas it was safe.Trial registrationClinicalTrials.gov Identifier: NCT04420351.

Acute DWI volume is a strong imaging predictor of favorable outcomes in patients with acute stroke and treated with mechanical thrombectomy

Acute DWI volume is a strong imaging predictor of favorable outcomes in patients with acute stroke and treated with mechanical thrombectomy

Efficacy of Mechanical Thrombectomy in Acute Ischemic Stroke: Predictors of Functional Recovery and Mortality

Introduction: Acute ischemic stroke (AIS) remains one of the leading causes of morbidity and mortality globally, with an immense burden on healthcare systems and families. Objective: The basic aim of the study is to find the efficacy of mechanical thrombectomy in acute ischemic stroke as a predictor of functional recovery and mortality. Methodology: The study conducted at Hayatabad Medical Complex in Peshawar analyzed 354 patients who underwent mechanical thrombectomy (MT) from June 2022 to May 2023. Exclusions included those with hemorrhagic stroke, incomplete records, and those who did not undergo MT. Data from patients' medical records included demographics, clinical history, concomitant disorders, radiological data, and therapeutic information. Stent retrievers and aspiration devices were used in MT, based on operator preference and hospital guidelines. Results: The median baseline NIHSS score was 15, indicating moderate to severe stroke severity. A high prevalence of comorbidities was observed, including hypertension (69%), diabetes (31%), and atrial fibrillation (28%). The study found that at 90 days post-procedure, 43% of patients experienced favorable functional recovery, while the mortality rate was 22%. Patients with a door-to-puncture time of 60 minutes or less had a higher recovery rate (48%), emphasizing the importance of timely intervention. Furthermore, successful revascularization (TICI 2b-3) was associated with significantly better recovery outcomes (50%) and a lower mortality rate (17%) compared to incomplete revascularization (TICI &lt; 2b), where recovery was notably lower (20%) and mortality more than doubled (37%). Conclusion: Mechanical thrombectomy significantly improves functional recovery in acute ischemic stroke patients, especially when performed promptly and with successful revascularization tract.

Impact of COVID-19 pandemic on acute stroke care in a tertiary stroke centre

The aim of this study was to evaluate how COVID-19 affected acute stroke care and outcome in patients with acute ischemic or hemorrhagic stroke. We performed a retrospective analysis on patients who were admitted with acute ischemic (AIS) or hemorrhagic (ICH) stroke from September 2020 to May 2021 with and without COVID-19. We recorded demographic and clinical data, imaging parameters, functional outcome and mortality at one year. Beside descriptive statistics we performed χ2-probe, Mann-Witney U-test, Student t-probe and multivariate testing. We found a 29%-reduction in the number of AIS cases during the pandemic. The number of the large vessel occlusions /LVOs/ (N = 83, 41.7%), from them 37 (17.7%) had mechanical thrombectomy (MT), was higher than before the COVID-19 period (p = 0.02 and p = 0.001, respectively). From all patients needing acute revascularization therapy (N = 137) 118 patients received it, among them 20 (16.9%) had COVID-19. Those positive for COVID-19 were more likely to have a higher median NIHSS score at baseline and at 24 h (p = 0.02 and p = 0.03, respectively). They also had a lower rate of favourable outcome at discharge (15% vs. 41.8%; p = 0.024) and at three months (25% vs. 52%, p = 0.02), longer median hospitalization (p < 0.0001), and a higher mortality rate (52% vs. 25%; p = 0.03). The incidence of symptomatic intracerebral hemorrhage (sICH) did not differ between the groups. Regarding the ICH patients, NIHSS score at 24 h (p = 0.036), mortality at 3 months (p = 0.004) and at one year (p = 0.00) were higher in the COVID-19 group. We concluded that the pandemic resulted fewer admission due to AIS with an increased number of LVOs and MTs. AIS patients with concomitant SARS-CoV-2 infection have more severe strokes and unfavorable long term outcome. The risk of sICH was not increased in COVID-19 positive patients therefore reperfusion therapies appear to be safe and beneficial for some individuals. Patients with ICH and comorbid COVID-19 have a very poor prognosis.

Prognostic serum biomarkers of synaptic, neuronal and glial injury in patients with acute ischemic stroke of the anterior circulation.

We aimed to investigate the prognostic role of β-synuclein in comparison to that of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) for predicting functional outcome after acute ischemic stroke (AIS). We measured serum concentrations of β-synuclein, NfL and GFAP 24 h after hospital admission in 213 consecutive patients with moderate-to-severe AIS. We investigated the association between serum biomarkers and radiological/clinical characteristics, 3-months mortality and functional outcome on the modified Rankin Scale (mRS). In 213 patients with AIS [mean age: 76.1 (±12.5) years, 53.1% males, median NIHSS score on admission: 13 (IQR: 9-17)], higher levels of β-synuclein, NfL and GFAP were associated with higher NIHSS scores and with lower Alberta Stroke Program CT Score (ASPECTS) points on admission. Serum β-synuclein levels was significantly correlated with NfL (rho = 0.715, p < 0.001) and GFAP concentrations (rho = 0.684, p < 0.001). The inclusion of serum β-synuclein significantly improved the accuracy of prediction models without biomarkers for overall mortality (AUC: 0.836 vs. 0.752, p < 0.001) and mRS 3-6 vs. 0-2 (AUC: 0.812 vs. 0.624, p < 0.001). Combination models with NfL and/or GFAP showed a similar accuracy. Serum β-synuclein may be used to assess synaptic damage/dysfunction and to predict 3-months clinical outcomes in patients with AIS.

Benefits of early MR-Imaging in patients with acute spontaneous intracerebral hemorrhage: a retrospective study

BackgroundNeuroimaging plays a vital role in the diagnosis of intracerebral hemorrhage (ICH) and in identifying the underlying etiology for appropriate therapeutic approach. This study aims to determine the significance and potential advantages of using early magnetic resonance imaging (MRI) as a diagnostic tool for ICH.MethodsThis retrospective study included 359 patients with ICH treated at the Department of Neurology, Mannheim University Hospital between January 2017 and December 2021. Patient characteristics, stroke severity and imaging procedures were descriptively analyzed. Factors associated with the choice of imaging modalities were evaluated. The etiology of hemorrhage was retrospectively analyzed using the existing data. We recorded the reassignment of ICH etiology by comparing the assessment after first sole review of CT scan and then subsequent MRI review. The overall rate of reassignments and the reassignments per CT-based initial etiology were analyzed.ResultsIn the sample of 359 patients with ICH (mean age 73.1 years, 55.4% male), patients receiving an additional MRI were significantly younger (p < .001) and were less severely affected by stroke (median NIHSS score 5 vs. 15, p < .001). MRI was performed significantly less frequently in patients who died during hospitalization (11.7% vs. 63.9%, p < .001). MRI led to a reassignment of ICH etiology in 48.2% of cases (80/166), uncovering unknown underlying causes in 69% of cases (49/71). Reassignment occurred most frequently in patients with a CT-based diagnosis of hypertensive ICH (18/50). The most frequent reassigned etiologies after MR imaging were cerebral amyloid angiopathy (CAA; 36 patients) and secondary hemorrhage of an ischemic stroke (30 patients).ConclusionsEarly MR imaging in patients with ICH improves the determination of underlying etiology and the conception of an appropriate treatment approach, potentially contributing to better patient outcomes.

Sex Differences in Stroke in a Sri Lankan Cohort

Introduction: Stroke characteristics, subtypes, and risk factors in women may differ from men. Data on sex differences in stroke are scarce in developing countries, especially the South Asian region. We aimed to describe the sex differences in patients with stroke admitted to a tertiary care hospital in Sri Lanka. Methods: Consecutive patients with stroke enrolled in the Ragama Stroke Registry over 3 years (2020–2023) were studied. Sex differences in demographics, presentation delays, clinical characteristics, stroke subtypes, risk factors, stroke severity, and early functional outcomes were compared using χ2 test, independent sample t test and Wilcoxon rank-sum test. Associations of early functional dependence were studied using multiple logistic regression. Results: Of 949 patients with stroke, 387 (40.8%) were women, with a median age of 66 (interquartile range [IQR] 57–73) years compared to 63 (IQR 54–70) years in men (p < 0.001). Women had more ischaemic strokes (85.8% vs. 78.6% in men, p = 0.005). Swallowing difficulty (p = 0.039) and bladder involvement (p = 0.001) were more common in women, whereas dysarthria (p = 0.002) and cerebellar signs (p = 0.005) were more common in men. More women had hypertension (74.4% vs. 59.4%, p < 0.001) and diabetes (52.2% vs. 41.6%, p = 0.001), whereas smoking (0.3% vs. 35.1%, p < 0.001), alcohol use (0.3% vs. 55.0%, p < 0.001), and other substance abuse (0.8% vs. 5.2%, p < 0.001) were almost exclusively seen in men. No differences were noted in delays to hospital admission (delay ≥4.5 h: women 45.4% vs. men 41.3%, p = 0.222). There were no sex differences in the rates of CT scanning (women 100% vs. men 99.6%, p = 0.516) or thrombolysis for ischaemic stroke (women 7.8% vs. men 10.2%, p = 0.458), but more men received stroke unit care (women 37.2% vs. men 45.4%, p = 0.012). No differences were noted between sexes in the clinical (Oxfordshire classification, p = 0.671) or aetiological (TOAST criteria, p = 0.364) subtypes of stroke. Stroke severity on admission was similar between sexes (median NIHSS score; women 8.0 vs. men 8.0, p = 0.897). More women had a discharge Barthel index (BI) <60 than men (62.6% vs. 53.5%, p = 0.007), but female sex was not associated with BI <60 on multivariate logistic regression (p = 0.134). There was no difference in in-hospital mortality (women 5.9% vs. men 5.9%, p = 0.963). Conclusions: Women with stroke in this Sri Lankan cohort were older, had different risk factor profiles and clinical stroke characteristics, and had more ischaemic strokes. Female sex was not independently associated with functional disability on discharge or in-hospital mortality.

Intravenous thrombolysis in young adults with ischemic stroke: A cohort study from the international TRISP collaboration.

Previous observational data indicate that young adults treated with intravenous thrombolysis (IVT) for acute ischemic stroke have more favorable outcomes and less complications when compared to older adults. Given the limited data on this topic, we aimed to provide more evidence on clinical outcomes and safety in such patients, using a large international thrombolysis registry. In this prospective multicenter study, we used data from the Thrombolysis in Ischemic Stroke Patients (TRISP) registry from 1998 to 2020. Patients who received endovascular treatment (EVT), as only treatment or in addition to IVT, were not included in this cohort. Using multivariable regression models, we compared thrombolysed young patients aged 18-49 years with those aged ⩾50 years with regards to the following outcomes: favorable outcome in stroke survivors (modified Rankin Scale ⩽2), symptomatic intracranial hemorrhage (sICH) according to European Cooperative Acute Stroke Study II (ECASS II) criteria, and three-months all-cause death. Of the 16,651 IVT treated patients, 1346 (8.1%) were 18-49 years. Young adults in TRISP were more often male (59.6% vs 54.0%), had a lower median NIHSS score on admission, 7 (4-13) versus 8 (5-15), and had less cardiovascular risk factors except for smoking (42.0% vs 19.0%) when compared to older patients. When compared to thrombolysed patients aged ⩾50 years, a favorable functional outcome was more likely in young adults: 81.9% versus 56.4%, aOR 2.30 (1.80-2.95), whilst sICH 1.6% versus 4.6%, aOR 0.45 (0.23-0.90) and death 2.3% versus 14.2%, aOR 0.21 (0.11-0.39) were less likely. Intravenous thrombolysis in young adults is independently associated with higher rates of favorable outcomes and lower rates of complications.

Time is brain: detection of nonconvulsive seizures and status epilepticus during acute stroke evaluation using point-of-care electroencephalography

Time is brain: detection of nonconvulsive seizures and status epilepticus during acute stroke evaluation using point-of-care electroencephalography

Abstract 454: Use of Intravenous Heparin For Patients With Acute Ischemic Stroke Due to Subocclusive Intracranial Thrombus

Background Sub‐occlusive thrombus in an intracranial artery is a rare cause of acute ischemic stroke, and there is limited data regards to its acute management. Historically, those patients had been treated with heparin drip and then transitioned to oral anticoagulation. We aim to analyze the effect of intravenous heparin in patients with acute ischemic stroke due to sub‐occlusive intracranial thrombus. Method We retrospectively reviewed patients with a diagnosis of acute ischemic stroke from 2019‐2023. We selected patients who met the inclusion criteria: 1) diagnosis of sub‐occlusive thrombus by neuroradiologist using Computed Tomography angiography (CTA), 2) acute treatment with heparin drip. We identified 18 patients with the diagnosis of sub‐occlusive thrombus. Good outcome at 90 days was defined as modified Rankin Score of ≤2, resolution of sub‐occlusive thrombus was evaluated with CTA at 6 months. Results Out of the 18 patients, 50% were females. The mean age was 62.7 years. The median duration of the heparin drip was 42.5 hours. The median NIHSS score on admission was 6. Of the 14 patients with a 90‐day mRS, 7 (50%) had a good outcome (mRS ≤2). In our study, 4 patients (22.2%) had recurrent ischemic stroke, one patient had a systemic hemorrhage, and two patients had an intracranial hemorrhage 10 days after the initial hospitalization. Thirteen patients (72.2%) were transitioned to apixaban, two patients (11.1%) to warfarin, one patient to rivaroxaban. Two were not able to transition secondary to mortality. Upon follow‐up, 39% (n=7) had resolution of thrombus on repeat imaging, 11 (61%) did not undergo repeat imaging. Conclusion The use of heparin drip in acute ischemic strokes associated with intracranial sub‐occlusive thrombus could be an effective and safe treatment. However, in our study, it was not a predictor of good outcome at 90 days. Further studies with bigger samples are needed to evaluate the effectiveness of intravenous heparin in those patients.

Abstract 053: The Red 43 Intermediate Catheter For Aspiration Thrombectomy Of Distal Medium Vessel Occlusions (DMVOs): A Multicenter Experience.

Introduction Recent clinical research has increasingly supported the effectiveness and safety of mechanical thrombectomy (MT) for treating occlusions in distal medium‐sized vessels. This underscores the necessity for specialized MT devices capable of navigating the tortuous anatomy of distal cerebrovascular vessels. The recently introduced RED 43 aspiration catheter can be used as a primary catheter for distal aspiration in acute ischemic stroke. In this multicenter study, we share our collective experience using the RED 43 catheter as the primary aspiration device for thrombectomy of DMVOs. Methods We identified consecutive patients with DMVOs who underwent primary aspiration thrombectomy using the RED 43 catheter from four high‐volume comprehensive stroke centers. We collected baseline clinical data, angiographic and clinical outcomes, as well as procedural complications. Cases with large vessel occlusion that were treated according to the standard of care and subsequently developed a DMVO were labeled as secondary DMVOs. The primary outcomes were the rate of first pass effect (FPE), defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2c or 3 on the first pass, and the rates of successful recanalization, defined as mTICI ≥2b at the end of the procedure. We also obtained rates of good functional outcomes, symptomatic intracerebral hemorrhage (ICH), asymptomatic ICH, subarachnoid hemorrhage (SAH), and in‐hospital mortality. Results We identified 102 consecutive cases of DMVOs undergoing primary aspiration thrombectomy using the RED 43 catheter. The mean age was 70 (SD: 14) years. The medianNIHSS score was 9 (IQR 6‐14), and the median ASPECTS was 9 (IQR 8‐10). Among these, 79 cases were primary DMVOs, and 23 were secondary DMVOs. The primary occlusion locations where the RED 43 catheter was used were as follows: distal M2 MCA segment in 41 cases (40.2%), M3 MCA segment in 29 cases (28.4%), M4 MCA segment in 5 cases (4.9%), A1 ACA in 4 cases (3.9%), A2/A3 ACA in 12 cases (11.8%), and P1 PCA in 8 cases (7.8%). The rate of first pass effect (FPE) (mTICI 2c or 3 on the first pass) using the RED 43 aspiration catheter was 57% (45/79) for primary DMVOs and 61% (14/23) for secondary DMVOs. The rate of successful recanalization (mTICI ≥2b at the end of the procedure) was 83% (66/79) for primary DMVOs and 87% (20/23) for secondary DMVOs. A good functional outcome (mRS 0‐2 at 3 months) was observed in 57% of patients. One patient experienced symptomatic ICH, and two patients died during hospitalization. Asymptomatic ICH and asymptomatic SAH were observed in 5 patients (4.9%) and 7 patients (6.9%), respectively. Conclusion Our study demonstrates the safety and efficacy of the RED 43 catheter for aspiration thrombectomy of both primary and secondary DMVOs, with good rates of FPE and successful recanalization, and an excellent safety profile.

Continuous Blood Pressure Indices During the First 72 Hours and Functional Outcome in Patients with Spontaneous Intracerebral Hemorrhage.

Management of intracerebral hemorrhage (ICH) is challenged by limited therapeutic options and a complex relationship between blood pressure (BP) dynamics, especially BP variability (BPV) and ICH outcome. In an exploratory analysis of prospectively collected data on consecutive patients with nontraumatic ICH between 2015 and 2020, continuous BP accessed via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) was analyzed over the first 72 h post admission. Arterial lines were used as part of standard clinical practice in the intensive care, ensuring high fidelity and real-time data essential for acute care settings. BPV was assessed through successive variation (SV), standard deviation (SD), and coefficient of variation using all available BP measurements. Multivariate regression models were applied to evaluate the association between BPV indices and functional outcome at 3 months. Among 261 patients (mean age 69.6 ± 15.2 years, 47.9% female, median National Institutes of Health Stroke Scale [NIHSS] score 6 [interquartile range 2-12]) analyzed, lower systolic BP upon admission (< 140 mm Hg) and lower systolic BPV were significantly associated with favorable outcome, whereas higher diastolic BPV correlated with improved outcomes. In the multivariate analysis, diastolic BPV (SD, SV) within the first 72 h post admission emerged as an independent predictor of good functional outcome (modified Rankin Scale score < 3; odds ratio 1.123, 95% confidence interval CI 1.008-1.184, p = 0.035), whereas systolic BPV (SD) showed a negative association. Patients with better outcomes also exhibited distinct clinical characteristics, including younger age, lower median NIHSS scores, and less prevalence of anticoagulation therapy upon admission. This study shows the prognostic value of BPV in the acute phase of ICH. Lower systolic BPV (SD) and higher diastolic BPV (SD, SV) were associated with better functional outcomes, challenging traditional BP management strategies. These findings might help to tailor a personalized BP management in ICH.

The Dual-layer CGuard Stent Is Safe and Effective in Emergent Carotid Artery Stenting and in Tandem Occlusions: a Multi-centric Study

BackgroundDual-layer stents have fallen into disrepute after several studies reported high rates of in-stent occlusions in acute stroke treatments. The CGuard stent is a new-generation hybrid dual-layer stent that has been designed to provide less thrombogenicity and to prevent peri- and postinterventional emboli. The aim of the study is to evaluate the safety and efficacy of the CGuard stent for the acute treatment of occlusion or high-grade stenosis of the extracranial internal carotid artery (ICA) in patients with acute ischemic stroke (AIS) with and without concomitant intracranial large vessel occlusion (LVO).MethodsAll patients who underwent emergent carotid artery stenting (CAS) with the CGuard stent were identified and analyzed from the stroke registries from four tertiary German stroke centers. Clinical, procedural, and imaging data were evaluated. Stent patency within 72 h, intracranial hemorrhage, and modified Rankin score (mRS) at discharge were the safety and efficacy end points.ResultsOverall, ninety-six patients were included (mean age 70.2 ± 11.8, 66 males (68.8%), median NIHSS score at admission 11 (7–17), IV lysis: n = 44 (45.8%)). Stent placement was successful in all patients. Eighty-three (86.4%) patients had tandem occlusions. In-stent occlusion occurred in 5 patients (5.2%) and 3 patients developed early in-stent stenosis (3.1%). Median mRS at discharge was 2 (1–4).ConclusionIn this multicenter study, the use of the dual-layer CGuard stent for emergent CAS, particularly in tandem occlusions, was safe and resulted in low rates of in-stent occlusions.