Rate Of Good Clinical Outcome Research Articles

Dual Antiplatelet Therapy after Intravenous Thrombolysis for Acute Minor Ischemic Stroke

Objective: To verify the efficacy and safety of dual antiplatelet therapy after intravenous thrombolysis for acute minor ischemic stroke (AMIS). Methods: AMIS patients who received recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis from January to October 2018 were retrospectively analyzed and divided into the aspirin (ASP) and ASP + clopidogrel (ASP-CLO) groups based on the type of antiplatelet therapy to compare the rates of good clinical outcome, symptomatic intracranial hemorrhage (SICH) after thrombolysis, and mortality in 90 days. Results: A total of 207 patients were included (group ASP, 105 patients; group ASP-CLO, 102 patients). There was no significant difference in the baseline clinical data between the 2 groups. The ­90-day modified Rankin scale scores (66.7 vs. 82.4%, p = 0.009) showed a statistically significant difference, but SICH (1.0 vs. 1.0%, p = 0.917) and 90-day mortality (1.9 vs. 1.0%, p = 0.585) showed no significant difference between the 2 groups. Conclusions: Short-term (21 days) dual antiplatelet therapy after rt-PA intravenous thrombolysis for AMIS can improve the prognosis, reduce the risk of stroke recurrence, without increasing the risk of bleeding and mortality.

Feasibility of Distal Mechanical Thrombectomy in M3, A3 and P3 Segments via a 0.013-inch Delivery System: Preliminary Experience.

To assess the safety and efficacy of distal thrombectomy (DT) using a Catch View mini (CVm) device via a microcatheter with a 0.013-inch inner diameter. Nine of 246 acute ischemic stroke patients who underwent mechanical thrombectomy developed distal emboli and were included in the study. In all nine subjects (mean age, 64.5 ± 11.6; range, 39?77 years), a combination of CVm and a 0.013-inch microcatheter was used in distal mechanical thrombectomy. Modified Thrombolysis in Cerebral Ischemia scores of 2c and 3 were considered to indicate successful recanalization, and patients with a Modified Rankin Score of ? 2 on the 90th day were considered to have good clinical outcomes. Eleven DT maneuvers were performed using the same stent retriever and microcatheter. The mean National Institutes of Health Stroke Scale score was 13 ± 3.4. Thrombectomy was performed from M3 in six patients, A3 in four, and P3 in one. Successful recanalization was achieved in all of the procedures. The rate of good clinical outcome was 55.5%. Advances in technology in the endovascular field enable access to more distal vessels in acute ischemic stroke. As the profile of the instruments used during access decreases, the risk of complications may decrease. The CVm stent retriever could become a useful tool in DT based on its compatibility with a 0.013-inch lumen delivery system.

Rapid Apparent Diffusion Coefficient Evolution After Early Revascularization.

Background and Purpose- In this era of endovascular therapy (EVT) with early, complete recanalization and reperfusion, we have observed an even more rapid apparent diffusion coefficient (ADC) normalization within the acute ischemic lesion compared with the natural history or IV-tPA-treated patient. In this study, we aimed to evaluate the effect of revascularization on ADC evolution within the core lesion in the first 24 hours in acute ischemic stroke patients. Methods- This retrospective study included anterior circulation acute ischemic stroke patients treated with EVT with or without intravenous tPA (IVT) from 2015 to 2017 compared with a consecutive cohort of IVT-only patients treated before 2015. Diffusion-weighted imaging and ADC maps were used to quantify baseline core lesions. Median ADC value change and core reversal were determined at 24 hours. Diffusion-weighted imaging lesion growth was measured at 24 hours and 5 days. Good clinical outcome was defined as modified Rankin Scale score of 0 to 2 at 90 days. Results- Twenty-five patients (50%) received IVT while the other 25 patients received EVT (50%) with or without IVT. Between these patient groups, there were no differences in age, sex, baseline National Institutes of Health Stroke Scale, interhospital transfer, or IVT rates. Thirty-two patients (64%) revascularized with 69% receiving EVT. There was a significant increase in median ADC value of the core lesion at 24 hours in patients who revascularized compared with further ADC reduction in nonrevascularization patients. Revascularization patients had a significantly higher rate of good clinical outcome at 90 days, 63% versus 9% (P=0.003). Core reversal at 24 hours was significantly higher in revascularization patients, 69% versus 22% (P=0.002). Conclusions- ADC evolution in acute ischemic stroke patients with early, complete revascularization, now more commonly seen with EVT, is strikingly different from our historical understanding. The early ADC normalization we have observed in this setting may include a component of secondary injury and serve as a potential imaging biomarker for the development of future adjunctive therapies. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00009243.

Thrombocytopenia and declines in platelet counts: predictors of mortality and outcome after mechanical thrombectomy.

Acute ischemic stroke (AIS) has well-known risk factors. The role of platelets in patients treated using mechanical thrombectomy (MT) has not been studied. The aim of this study was to study if there is an association of initial thrombocytopenia (TP) and a decline of platelets counts (DPC) with the clinical outcomes, mortality and intracranial hemorrhage (ICH) rates in AIS patients treated with MT. In a case-control study consecutive MT-stroke patients were analyzed. A multivariate logistic regression model was used to test for good clinical outcome (mRS 90days <= 2) and mortality adjusting for age, initial NIHSS, pretreatment with tPA, statins and platelet inhibitors, occlusion site, time from symptom onset to recanalization, initial TP (< 150 × 109/L) and DPC (> 26%). Additionally, rates of ICH were compared. Of 294 patients included, 9.6% had an initial TP and 23.8% a DPC > 26%. The mortality rate in patients with normal platelet counts was 26.1% vs. 48.3% (p = 0.002) in patients with initial TP with an aOR of 3.47 (CI 1.28-9.4, p = 0.005). No difference regarding the rate of good clinical outcome (p = 0.204) and ICH (p = 0.18) was observed. A DPC of more than 26% during the first 5 days of hospitalization predicted the rate of mortality (aOR 2.4 CI 1.14-5.04, p = 0.021) and the chances of a good clinical outcome (aOR 0.291 CI 0.128-0.666, p = 0.003) without significant differences of ICH rates (p = 0.735). In AIS patients treated with MT an initial TP was independently associated with higher mortality rates and a marked DPC with higher mortality rates as well as poorer clinical outcomes.

Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome.

Background Acute stroke because of basilar artery occlusion (BAO) represents 1% of all ischemic strokes. However, recanalization rates and treatment outcome for the different pathologic subtypes of BAO stroke are not fully understood. Purpose To compare the recanalization rate and clinical outcomes of mechanical thrombectomy in different subtypes of BAO. Materials and Methods Eighty-two patients (46 men and 36 women; mean age, 73 years; age range, 20-90 years; mean age in men, 70 years [age range, 20-90 years]; mean age in women, 75 years [age range; 61-90 years]) with acute BAO who underwent mechanical thrombectomy between March 2010 and December 2017 were retrospectively analyzed. Patients were classified into three groups: embolism without vertebral artery (VA) steno-occlusion (group 1), embolism from tandem VA steno-occlusion (group 2), and in situ atherosclerotic thrombosis (group 3). Clinical and angiographic characteristics, recanalization rate, procedure times, and clinical outcomes were compared between groups by using the Kruskal-Wallis, Pearson χ2, and Fisher exact tests. Results The incidence of BAO according to stroke mechanism were as follows: group 1, n = 34 (41%); group 2, n = 28 (34%), group 3, n = 20 (24%). Overall, successful recanalization (modified Thrombolysis in Cerebral Infarction grade 2b or 3) was achieved in 78% (64 of 82) and favorable outcome (90-day modified Rankin Scale score, 0-2) in 37% (30 of 82) of the patients. The procedure time was shorter in group 1 than in group 2 (49 vs 66 minutes, respectively; P = .01). Group 1 showed a higher successful recanalization rate than group 3 (29 of 34 [85%] vs 11 of 20 [55%], respectively; P = .01). Good clinical outcome rate was higher in group 1 than in group 3 (18 of 34 [53%] vs four of 20 [20%], respectively; P = .02). Conclusion The outcome of mechanical thrombectomy for basilar artery occlusion differs according to the pathologic mechanism of stroke; the best outcomes and recanalization rate occurred in patients with embolism without vertebral artery steno-occlusion. © RSNA, 2019 See also the editorial by Hetts in this issue.

Meta-Analysis of Endovascular Treatment for Acute M2 Occlusion.

ObjectiveEndovascular treatment (EVT) outcomes for acute M2 segment of middle cerebral artery occlusion remains unclear because most results are obtained from patients with large artery occlusion in the anterior circulation. The objective of this study was to assess procedural outcomes for acute M2 occlusion and compare outcomes according to thrombus location (M1 vs. M2). MethodsA systematic review was performed for online literature published from January 2004 to December 2016. Primary outcome was successful recanalization rate and symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used if heterogeneity was less than 50%. ResultsEight articles were included. EVT showed successful recanalization rate of 69.1% (95% confidence interval [CI], 54.9–80.4%) and S-ICH rate of 6.1% (95% CI, 4.5–8.3%). The rates of good clinical outcome at 3 months and mortality were 59.4% (95% CI, 49.9–68.2%) and 14.9% (95% CI, 11.4–19.3%), respectively. According to thrombus location (M1 vs. M2), successful recanalization (odds ratio [OR], 1.539; 95% CI, 0.293–8.092; p=0.610) and S-ICH (OR, 1.313; 95% CI, 0.603–2.861; p=0.493) did not differ significantly. Good clinical outcome was more evident in M2 occlusion after EVT than that in M1 occlusion (OR, 1.639; 95% CI, 1.135–2.368; p=0.008). However, mortality did not differ significantly according to thrombus location (OR, 0.788; 95% CI, 0.486–1.276; p=0.332).ConclusionEVT seems to be technically feasible for acute M2 occlusion. Direct comparative studies between EVT and medical treatment are needed further to find specific beneficiary group after EVT in patient with M2 occlusion.

Abstract TP7: Isolated Basal Ganglia Strokes Undergoing Thrombectomy Have High Rates of Good Clinical Outcomes

Background and Purpose: Isolated basal ganglia strokes are thought to have worse clinical outcomes as compared to mixed and cortical infarcts. Methods: Review of a prospectively collected database of endovascular patients with anterior circulation Large vessel occlusion strokes from January 2014-June 2018. Only patients with an ASPECT score of 6 to 9 were included. Patients were dichotomized into 2 groups according to ASPECT region involvement: (i) isolated basal ganglia and (iBG) (ii) other stroke patterns. Baseline characteristics and Clinical outcomes were compared. Results: 465 patients qualified for the study of which 324 (70%) were iBG strokes. Baseline characteristics were comparable between the 2 groups except for higher rates of hypertension (73.8%vs63.8%,p=0.03) and larger CTP core infarct (3.6 cc[0-13] vs 3[0-10.85], p&lt;0.001) in the iBG group. There were no differences between groups in rates of successful reperfusion (mTICI 2b-3) (97.2% for iBG vs96.5%, p=0.66), any parenchymal hematomas (9.4%vs11.4%, p=0.49) and rates of good outcomes (mRS 0-2) (53.7% vs 50.4%, p=0.55). iBG patients had lower 90-day mortality rates (13.1%vs23.3, p=0.01). This persisted as non-statistically significant trend after adjusting for potential confounders (OR 0.54 95%CI [0.277-1.03],p=0.06) Conclusions: iBG strokes carry similar procedural and clinical outcomes as other stroke patterns with a trend towards lower mortality.

Effect of routing paradigm on patient centered outcomes in acute ischemic stroke

BackgroundTo compare performance of routing paradigms for patients with acute ischemic stroke using clinical outcomes.MethodsWe simulated different routing paradigms in a system comprising one primary stroke center (PSC) and one...

Percutaneous injection of calcium phosphate composite in pediatric unicameral bone cysts: a minimum 5-year follow-up study

Unicameral bone cyst (UBC) is a common lesion in skeletally immature patients. Multiple treatments are proposed as curettage and autologous bone graft, percutaneous local corticoids injections, decompression with internal fixation, and injection of bioresorbable cement. Decompression, curettage, and percutaneous bioresorbable cement injection showed interesting results, but until now, no long-term follow-up was reported in pediatric patients with UBC. We retrospectively evaluated 13 pediatric patients with UBC treated with curettage, decompression, and injection of a calcium phosphate composite (CPC) at a single institution with an average F-U of 5.46 years (range 5–7 years). Functional outcomes were evaluated according to the Musculoskeletal Tumour Society (MSTS) Score. Radiographic healing was assessed with the modified Neer Outcome Rating System. Complications were recorded. The mean MSTS score was 29.61 (range 28–30). No joint limitation or any pain was recorded. All patients returned to their previous level of activity. Complete healed cysts were observed in 76.9% of patients (10 of 13) and partially healed in 23.1% (3 of 13). Three fractures of the humerus occurred without any further consequence. In two cases, CPC overflow in the surrounding soft tissues was reported on post-operative X-rays, but at last follow-up, no CPC remained in the soft tissues. Our observations suggest that the use of curettage, decompression, and injection of CPC results in a high rate of good clinical outcomes with low recurrence rates and complications in the pediatric population with UBC at a long-term follow-up.

Recanalization Rate per Retrieval Attempt in Mechanical Thrombectomy for Acute Ischemic Stroke.

Background and Purpose- In acute ischemic stroke, mechanical thrombectomy allows flow restoration in the majority of cases. In case of an unsuccessful retrieval, little is known about how many retrieval attempts should be performed before stopping the procedure. This study assessed the recanalization rate and clinical outcome per retrieval maneuver. Methods- In this analysis, 330 patients with acute large vessel occlusion treated exclusively with stentrieval devices were included. Successful recanalization was defined as Thrombolysis in Cerebral Infarction 2b-3, a good clinical outcome was defined as modified Rankin Scale at 90 days of ≤2. Results- The median number of retrieval attempts was 1 (interquartile range, 1-2, maximum 8). Recanalization rates per retrieval attempt were highest for the first retrieval (46.8%) and lowest for the fifth retrieval (22.7%). After 3 retrieval attempts, 67.9% of patients were successfully recanalized. Patients with 1 to 3 retrieval attempts had higher rates of good clinical outcome (28.9% versus 7.4%; P=0.018). The number of passes was an independent negative predictor of good clinical outcome (adjusted odds ratio, 0.65; 95% CI, 0.435-0.970; P=0.035). Conclusions- Two-thirds of occlusions were successfully recanalized with up to 3 retrieval attempts. Further attempts had good recanalization rates, but the rate of favorable clinical outcome did not improve.

Real-world stent retriever thrombectomy for acute ischemic stroke beyond 6 hours of onset: analysis of the NASA and TRACK registries

BackgroundThe DEFUSE 3 and DAWN trials have shown the benefit of thrombectomy beyond 6 hours of stroke symptom onset in carefully selected patients.ObjectiveTo evaluate the real-world outcomes of stent retriever...

Endovascular Therapy Strategy for Acute Embolic Tandem Occlusion: The Pass-Thrombectomy-Protective Thrombectomy (Double PT) Technique

Embolic occlusions of the common carotid artery (CCA)/internal carotid artery (ICA) and intracranial artery occlusions in acute ischemic stroke are associated with high morbidity and can benefit from endovascular therapy. However, the optimal endovascular strategy for these conditions is unclear. This study aimed to evaluate the feasibility of the pass-thrombectomy-protective thrombectomy (double PT) technique and the clinical outcome of treated patients. We collected data on embolic occlusion of the CCA/ICA and intracranial artery occlusion in our prospective stroke registry database between January 2015 and February 2017. Clinical and angiographic data were retrospectively analyzed. Clinical outcome was evaluated at 3 months (modified Rankin scale [mRS] score), and an mRS score of 2 or lower was defined as a good clinical outcome. A total of 7 patients with tandem occlusion were included, with a mean age of 66 years. The median admission National Institutes of Health Stroke Scale score was 20, and 6 of 7 patients (85.7%) underwent successful recanalization. The median reperfusion time of the affected intracranial artery was 61 minutes. The rate of good clinical outcome was 42.9% (3/7), the mortality rate was 14.3% (1/7), and the embolic event rate was 14.3% (1/7) when the proximal clot was retrieved. The double PT technique is feasible and safe in treating initial embolic tandem occlusion of the CCA/ICA.

Effects of Posterior Fossa Decompression in Patients with Hunt and Hess Grade 5 Subarachnoid Hemorrhage After Endovascular Trapping of Ruptured Vertebral Artery Dissecting Aneurysms

A ruptured vertebral artery dissecting aneurysm (VADA) with a high clinical grade (Hunt and Hess grade 5) has a devastating prognosis. Because of the high rebleeding rate and location, rapid mortality can occur in patients owing to brainstem compression. Adjuvant decompression of the posterior fossa after securing the aneurysm may improve the outcomes of these patients. Between January 2011 and December 2016, 22 patients who presented with Hunt and Hess grade 5 ruptured VADA underwent endovascular treatment. Patients were divided into 2 groups: group 1 (n= 12) received conventional endovascular treatment of VADA and external ventricular drainage, and group 2 (n= 10) received external ventricular drainage and suboccipital craniectomy for posterior fossa decompression after rapid endovascular trapping of VADA. In group 2, the survival rate and good clinical outcome rate (modified Rankin scale score ≤2) were 80% and 60%, respectively, which were favorable to the corresponding rates in group 1 (66.67% and 16.67%). Moreover, 80% of patients (8/10) in group 2 regained consciousness compared with 50% of patients in group1. Adjuvant decompression of the posterior fossa can improve outcomes in patients with Hunt and Hess grade V ruptured VADA.

Effect of routing paradigm on patient-centered outcomes in acute ischemic stroke

This article has been retracted

Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke

Objective Embolism due to coagulopathy might be the main pathomechanism underlying cancer-related stroke (CRS). CRS patients with a large artery occlusion could be candidates for endovascular recanalization therapy (ERT), although its procedural and clinical outcomes are not well known. This study aimed to investigate the procedural and clinical outcomes of ERT in CRS patients and the characteristics associated with outcomes compared with those of conventional stroke patients. Methods A registry of consecutive acute ischemic stroke patients who underwent ERT between January 2011 and October 2015 was retrospectively reviewed. CRS patients are described as those who had (a) cryptogenic stroke with advanced or metastatic cancer; (b) no other possible causes of stroke such as cardioembolism (CE) and large artery atherosclerosis (LAA); and (c) elevated D-dimer levels or diffusion-restricted lesions in multiple vascular territories. We compared procedural and clinical outcomes at discharge among CRS, CE, and LAA patients. Results A total of 329 patients were finally enrolled in this study; of these, 19 were CRS patients. The rate of successful recanalization, defined as modified treatment in cerebral infarction grade 2b or 3, was lower in the CRS group than in the LAA and CE groups (63% versus 84% versus 84%, p = .06). CRS subtype was an independent predictor for successful recanalization after ERT in the multivariate analysis (odds ratio, 0.317; 95% confidence interval, 0.116-0.867; p < .001). No significant difference in the rate of good clinical outcomes at discharge was observed among groups. Conclusions Although clinical outcomes at discharge were similar for CE and LAA patients, complete recanalization seemed more difficult to achieve in CRS patients than in conventional stroke patients.

Computed Tomographic Perfusion Predicts Poor Outcomes in a Randomized Trial of Endovascular Therapy.

In the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times), patients with large vessel occlusions and small infarct cores identified with computed tomography (CT)/CT angiography were randomized to endovascular therapy or standard of care. CT perfusion (CTP) was obtained in some cases but was not used to select patients. We tested the hypothesis that patients with penumbral CTP patterns have higher rates of good clinical outcome. All CTP data acquired in ESCAPE patients were analyzed centrally using a semiautomated perfusion threshold-based approach. A penumbral pattern was defined as an infarct core <70 mL, penumbral volume >15 mL, and a total hypoperfused volume:core volume ratio of >1.8. The primary outcome was good functional outcome at 90 days (modified Rankin Scale score, 0-2). CTP was acquired in 138 of 316 ESCAPE patients. Penumbral patterns were present in 116 of 128 (90.6%) of patients with interpretable CTP data. The rate of good functional outcome in penumbral pattern patients (53 of 114; 46%) was higher than that in nonpenumbral patients (2 of 12; 17%; P=0.041). In penumbral patients, endovascular therapy increased the likelihood of a good clinical outcome (34 of 58; 57%) compared with those in the control group (19 of 58; 33%; odds ratio, 2.68; 95% confidence interval, 1.25-5.76; P=0.011). Only 3 of 12 nonpenumbral patients were randomized to the endovascular group, preventing an analysis of treatment effect. The majority of patients with CTP imaging in the ESCAPE trial had penumbral patterns, which were associated with better outcomes overall. Patients with penumbra treated with endovascular therapy had the greatest odds of good functional outcome. Nonpenumbral patients were much less likely to achieve good outcomes.

Solumbra thrombectomy as intravascular recanalization for treatment of acute ischemic stroke due to large cerebral artery occlusion

Objective To investigate the feasibility, effectiveness, and technical superiority of Solumbra thrombectomy for treatment of acute large cerebral artery occlusion stroke. Methods 32 patients who had acute large cerebral artery occlusion stroke and received mechanical thrombectomy in TEDA Hospital of Tianjin between January 2013 and August 2016, were divided into two groups: stent group(with conventional stent-retrievers, n=21)and Solumbra group(with Solumbra thrombectomy, n=11). Clinical characteristics, variables correlated with operation, and clinical outcomes were compared and analyzed retrospectively. Results There were no differences in basic clinical and radiographic parameters between stent group versus Solumbra group(all P>0.05). Moreover, there were no differences between Solumbra group versus Stent group in rates of embolus to new territory(18.2% vs.28.6%, P=0.425), in times of thrombectomy(2.2±1.0 vs.2.4±1.3, P=0.657), in non-symptomatic intracranial hemorrhage(18.2% vs.14.3%, P=0.572), in symptomatic intracranial hemorrhage(18.2% vs.9.5%, P=0.427), in TICI 2b/3 revascularization(81.8% vs.81.0%, P=0.670), in puncture-to-reperfusion time[(66.4±39.0)min vs.(51.6±34.5)min, P=0.279], and in NIHSS at 7 days(11.6±7.7 vs.11.3±7.2, P=0.925). A modified Rankin Scale(mRS ≤2)is a variable of recovery of function and good clinical outcome at 90 days.The levels of mRS were similar(P=0.490)between Solumbra and stent groups, but there was a tendency to higher rate of good clinical outcome at 90 days in Solumbra group(63.6%, 7/11)than in stent group(47.6%, 10/21). Conclusions Solumbra thrombectomy as intravascular revascularization technique is an effective and safe strategy for endovascular recanalization of acute large cerebral artery occlusion stroke.Compared with conventional Stent-Retriever thrombectomy, Solumbra thrombectomy has a good clinical outcome tendency at 90 days after operation. Key words: Brain infarction; Solumbra technique

Abstract 115: CT Perfusion Identifies Patients with Poor Outcomes in The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE) Trial

Background: In the ESCAPE trial, patients with large vessel occlusions and small infarct cores identified with CT/CT angiography were randomized to endovascular therapy or standard of care. CT Perfusion (CTP) was obtained in some cases, but was not utilized to select patients. We tested the hypothesis that patients with penumbral CTP patterns have higher rates of good clinical outcome. Methods: All CTP data acquired in ESCAPE patients was analyzed centrally using a semi-automated perfusion threshold based approach. A penumbral pattern was defined as an infarct core&lt;70 mL, penumbral volume &gt;15 mL, and a total hypoperfused volume:core volume ratio of &gt;1.8. The primary outcome was a good functional outcome at 90 days (mRS 0-2). Results: CTP was acquired in 138 of 316 ESCAPE patients. Motion degraded CTP images from 9 patients were excluded. Penumbral patterns were present in 110/129 (85.3%) of patients. The rate of good functional outcome in penumbral pattern patients (53/108; 49.1%) was higher than that in non-penumbral patients (3/19; 15.8%, p=0.011). In penumbral patients, endovascular therapy increased the likelihood of good outcome (35/58; 60.3%) over those in the control group (18/50; 36%, OR=2.71, p=0.013). Only 4 of 19 non-penumbral patients were randomized to the endovascular group, preventing an analysis of treatment effect. Conclusion: The majority of patients with CTP imaging in the ESCAPE trial had penumbral patterns, which were associated with better outcomes overall. Patients with penumbra treated with endovascular therapy had the greatest odds of good functional outcome. Non-penumbral patients were much less likely to achieve good outcomes.

Borderline Alberta Stroke Programme Early CT Score Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion May Find Benefit with Endovascular Thrombectomy.

Selection of patients with acute ischemic stroke for endovascular thrombectomy (EVT) is complex and time-critical. Benefits of EVT are well established for patients with small core infarcts. The aim of this study was to compare clinical outcomes of EVT in patients with larger established infarcts (Alberta Stroke Programme Early CT Score [ASPECTS] ≤6) with patients with smaller infarcts (ASPECTS 7-10). The study included 355 patients with acute ischemic stroke due to large vessel occlusion who underwent EVT. ASPECTS was assigned to baseline noncontrast computed tomography, and collateral perfusion scores were assigned to multiphase computed tomography angiography. Baseline stroke severity, collateral grading, and clinical outcome data (complication rate, symptomatic intracranial hemorrhage and 90-day modified Rankin Scale score) were compared between patients with borderline (≤6) and high (7-10) ASPECTS. There were 34 (10%) patients with borderline ASPECTS. There was no difference in rate of good clinical outcome (37% vs. 46%, P= 0.852), symptomatic intracerebral hemorrhage (9% vs. 9%, P= 0.984), or mortality (20% vs. 22%, P= 0.818) between patients with borderline ASPECTS and high ASPECTS at 90 days. Moreover, there was no significant difference in collateral perfusion grade. This study identifies similar clinical benefit of EVT in patients with acute large vessel occlusion stroke with borderline ASPECTS and high ASPECTS.

Primary suction thrombectomy for acute ischemic stroke: A meta-analysis of the current literature

ObjectivesWe conducted a meta-analysis to assess the angiographic and clinical outcomes for ischemic stroke patients treated with primary suction thrombectomy and to compare the procedural outcomes based on the treatment strategies (primary suction vs. stent retriever thrombectomy). Patients and methodsWe conducted a systemic literature review through an online data base from January 2004 through December 2016. The primary outcomes were rate of successful recanalization on final angiogram and good outcome three months after stroke onset. We used a fixed-effect model in cases with heterogeneity <50%. ResultsFifteen articles were included. Primary suction thrombectomy achieved a successful recanalization rate of 85.2% (95% confidence interval [CI]: 79.9%–89.3%), a good clinical outcome rate of 52.7% (95% CI: 49.3%–56.2%) after the three-month follow-up, a mortality rate of 13.0% (95% CI: 8.9%–18.5%) and a symptomatic intracranial hemorrhage rate of 6.2% (95% CI: 4.8%–8.0%). The rates of recanalization (odds ratio [OR], 1.064; 95% CI: 0.202–5.608; p=0.571) and good outcomes (OR, 0.920; 95% CI: 0.570–1.486; p=0.735) did not differ significantly between primary suction thrombectomy and stent retriever thrombectomy. ConclusionPrimary suction thrombectomy produced higher recanalization and good clinical outcome rates than did stent retriever thrombectomy. Larger-scale studies are necessary that consider factors such as occlusion site, stroke severity, and concomitant use of endovascular devices.