Degree Of Recanalization Research Articles

Overestimation of the Ischemic Core Is Associated With Higher Core Lesion Volume and Degree of Reperfusion After Thrombectomy.

Background CT perfusion (CTP)-derived baseline ischemic core volume (ICV) can overestimate the true extent of infarction, which may result in exclusion of patients with ischemic stroke from endovascular treatment (EVT). Purpose To determine whether ischemic core overestimation is associated with larger ICV and degree of recanalization. Materials and Methods This retrospective multicenter cohort study included patients with acute ischemic stroke triaged at multimodal CT who underwent EVT between January 2015 and January 2022. The primary outcome was ischemic core overestimation, which was assumed when baseline CTP-derived ICV was larger than the final infarct volume at follow-up imaging. The secondary outcome was functional independence defined as modified Rankin Scale scores of 0-2 90 days after EVT. Successful vessel recanalization was defined as extended Thrombolysis in Cerebral Infarction score of 2b or higher. Categorical variables were compared between patients with ICV of 50 mL or less versus large ICV greater than 50 mL with use of the χ2 test. Adjusted multivariable logistic regression analyses were used to assess the primary and secondary outcomes. Results In total, 721 patients (median age, 76 years [IQR, 64-83 years]; 371 female) were included, of which 162 (22%) demonstrated ischemic core overestimation. Core overestimation occurred more often in patients with ICV greater than 50 mL versus 50 mL or less (48% vs 16%; P < .001) and those with successful versus unsuccessful vessel recanalization (26% vs 13%; P < .001). In an adjusted model, successful recanalization after EVT (odds ratio [OR], 3.14 [95% CI: 1.65, 5.95]; P < .001) and larger ICV (OR, 1.03 [95% CI: 1.02, 1.04]; P < .001) were independently associated with core overestimation, while the time from symptom onset to imaging showed no association (OR, 0.99; P = .96). Core overestimation was independently associated with functional independence (adjusted OR, 2.83 [95% CI: 1.66, 4.81]; P < .001) after successful recanalization. Conclusion Ischemic core overestimation occurred more frequently in patients presenting with large CTP-derived ICV and successful vessel recanalization compared with those with unsuccessful recanalization. © RSNA, 2024 Supplemental material is available for this article.

Surgical outcomes for occluded venous thoracic outlet syndrome following transaxillary first rib resection

ObjectiveSurgical decompression via transaxillary first rib resection (TFRR) is often performed in patients presenting with venous thoracic outlet syndrome (VTOS). We aimed to evaluate the outcomes of TFRR based on chronicity of completely occluded axillosubclavian veins in VTOS. MethodsWe performed a retrospective institutional review of all patients who underwent TFRR for VTOS and had a completely occluded axillosubclavian vein between 2003 and 2022. Patients were categorized into three groups based on the time of inciting VTOS event to TFRR acuity of their venous occlusion: <4 weeks, 4 to 12 weeks, and >12 weeks. We evaluated the association of TFRR timing with 1-year outcomes, including patency and symptomatic improvement. We used the χ2 test to compare baseline characteristics and postoperative outcomes. ResultsOverall, 103 patients underwent TFRR for VTOS with a completely occluded axillosubclavian vein (median age, 30.0 years; 42.7% female; 8.8% non-White), of whom 28 had occlusion at <4 weeks, 36 had occlusion at 4 to 12 weeks, and 39 had occlusion at >12 weeks. Postoperative venogram performed 2 to 3 weeks after TFRR demonstrated that 78.6% in the <4 weeks group, 72.2% in the 4- to 12-weeks group, and 61.5% in the >12 weeks group had some degree of recanalization (P = .76). Postoperative balloon angioplasty was successfully performed in 60 patients with stenosed or occluded axillosubclavian vein at the time of postoperative venogram. At the 10- to 14-month follow-up, 79.2% of the <4 weeks group, 73.3% of the 4- to 12-weeks group, and 73.3% of the >12 weeks group had patent axillosubclavian veins based on duplex ultrasound examination (P = .86). Among patients who underwent postoperative balloon angioplasty, 80.0%, 85.0% and 100% in the <4 weeks, 4- to 12-weeks, and >12 weeks groups respectively demonstrated patency at 10 to 14 months (P = .31). Symptomatic improvement was reported in 95.7% in the <4 weeks group, 96.7% in the 4- to 12-weeks group, and 93.5% in the >12 weeks group (P = .84). ConclusionsTFRR offers excellent postoperative outcomes for patients with symptomatic VTOS, even in cases of completely occluded axillosubclavian veins, regardless of the chronicity of the occlusion. By 14 months, 95.2% of patients experienced symptomatic improvement, and 75% attained venous patency.

Abstract WP115: Patient Reported Outcomes to Improve the Accuracy of Disability Evaluation After Endovascular Treatment-Successful Recanalization

Background: Complete recanalization is a well-known predictor of functional outcome among patients who undergo MT. However, trying to improve recanalization from successful (eTICI ≥ 2b) to complete (eTICI2c-3) with more passes is under debate. PROMS allow an accurate assessment of patients status in different domains after AIS. Hypothesis: In AIS patients undergoing MT, PROMS may allow a more precise characterization of the long-term outcome than the usual mRS according to different degrees of recanalization. Methods: Patients with anterior circulation AIS, treated with MT who achieved a successful recanalization (eTICI ≥ 2b) were included. Patients were classified in two groups according to the degree of recanalization: eTICI 2b (successful) vs eTICI 2c-3 (complete). The collected study variables were baseline, procedural characteristics, and 90 days outcome measures including: assessment of disability by a certified clinician blinded to recanalization status (mRS) and PROMS (PROMIS 10- Physical and Mental, HAD depression and Anxiety, visual EQ-5D scale) Results: From Jan 2020 to Dec 2022, 96 patients with PROMS collection at 90 days were identified: 21 had a final eTICI 2b and 75 a final eTICI2c-3. No differences in terms of age, sex and other baseline and procedural characteristic were observed between groups. Median 90-days mRS was similar in both groups (2 [IQR 1-3]; p= 0.517). At 90 days patients achieving TICI 2c-3 had significantly lower HAD depression score: 7 [3-10] vs 10 [7-15] (p=0.02). All other median PROMS values were numerically favourable for patients who achieved TICI 2c-3: visual EQ-5D scale: 64 [10-80] vs 50 [42-65] (p= 0.1), PROMIS 10-Physical and Mental (eTICI 2b: 12 [10-14] and 12 [9-15] versus eTICI 2c-3: 9[7-12] and 9 [7-12]; p=0.8 and p=0.6 respectively), except for HAD-anxiety score (eTICI 2b: 6 [3-9] versus eTICI 2c-3: 7 [4-9]), p=0.520). More than 250 patients will complete the 90 days follow-up in the next 6 months, analyses will be updated for presentation at the conference Conclusion: The differences observed between patients achieving successful versus complete recanalization indicate that PROMs may be more adequate tool than the usual mRS for a fine-tune characterization of long-term outcome in different quality of life domains

Abstract WMP87: Characteristics and Outcome of Endovascular Treatment for Intracranial Atherosclerotic Occlusion: Comparison With Cardiogenic Cerebral Embolism in the K-NET Registry

Purpose: The technique and efficacy of endovascular treatment (EVT) for intracranial atherosclerotic occlusion (ICAD) have not been established. The purpose of this study was to compare the outcomes of EVT for ICAD with those of cardiogenic cerebral embolism (CE) based on real-world data from a multicenter, prospective registry study (K-NET registry) involving 40 centers in Japan. Methods: The K-NET study enrolled 3187 EVTs in 2018-2021, of which 358 (11%) were ICAD and 1870 (59%) were CE. Medium vessel occlusion and tandem lesions were excluded. Indications and methods of treatment were performed at the discretion of each center. The primary endpoint was mRS: 0-2 at 90 days, and secondary endpoints included degree of recanalization, symptomatic intracranial hemorrhage. Results: The ICAD and CE groups showed significant differences in median age 73 and 78 years, 36% and 51% female, and baseline NIHSS 16 and 19, respectively. The occluded vessels were ICA 15% and 25%, MCA (M1/M2) 71% and 68%, and BA/VA 14% and 7%. Recanalization rates (TICI2b/3) were 75% and 91%. Time from puncture to recanalization was 68 and 42 minutes, and symptomatic intracranial hemorrhage was significantly different between 1.4% and 4.2%, while good outcome was similar between 40% and 38%. Balloon angioplasty was the treatment technique in 35% and 1.1%, and intracranial stents in 6.4% and 0.05%, respectively. Reocclusion was 3.1% and 0%, recurrent stroke 6.4% and 2.8%, and repeat endovascular treatment 5% and 0.6%, respectively. Factors significantly associated with good outcome in both groups were age, NIHSS, ASPECTS, recanalization, time from presentation to recanalization, and intracranial hemorrhage; in the ICAD group, additional significant factors were intravenous tPA and time from puncture to recanalization. Conclusion: EVT for ICAD was characterized by younger age, lower NIHSS, lower recanalization rate, longer puncture-recanalization time, but outcomes were similar to the CE group. The ICAD group had more additional procedures for recanalization, re-occlusion, and recurrence than the CE group.

Relevance of Carotid Reocclusion in Tandem Lesions.

Carotid reocclusion (CRO) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to tandem lesion (TL) or isolated internal carotid occlusion (ICO) is associated with worse clinical outcomes. Our aim was to analyze the predictors and clinical impact of CRO. A retrospective single-center analysis of all patients with anterior circulation strokes who underwent MT prospectively included in a registry between 2017 and 2020 was performed. ICO and TL as stroke causes were included. Stent deployment was left to the discretion of the interventionist. All patients received at least intravenous aspirin during MT. CRO was assessed using ultrasound within the first 24 h after MT. Efficacy and safety of stenting were assessed. Among 1304 AIS cases, 218 (16.7%) were related to TL or ICO. Of them, 5% (n=11) were associated with internal CRO 24 h after the endovascular procedure. After adjusting per confounders, multivariate analysis showed that the independent variables associated with CRO were the TICI recanalization grade [TICI 2b-3; OR 0.1, 95% confidence interval (CI) 0.01-0.89, p=0.040], pial collateral circulation presence (OR 0.09, 95% CI 0.02-0.45, p=0.03), stent deployment during MT (OR 0.17, 95% CI 0.03-0.84, p=0.030), and general anesthesia use (OR 2.92, 95% CI 1.13-7.90, p=0.034). CRO showed a trend toward worst outcomes (modified Rankin scale 3-6) at 3 months (OR 3.4, 95% CI 0.96-12, p=0.057). After multivariate analysis, variables independently associated with worse outcomes at 90 days were intrastent platelet aggregation phenomena during endovascular therapy, admission National Institute of Health Stroke Scale, and age. Conversely, intravenous thrombolysis and TICI 2b-3 recanalization grade were identified as independent predictors of good outcomes at 90 days. CRO has a relevant clinical impact in our study, associating lower rates of good functional outcomes at 3 months. Independent factors of CRO were the recanalization degree, presence of pial collateral circulation, use of a stent as a protective factor, and use of general anesthesia during thrombectomy.

Thrombectomy in M2 occlusion compared to M1 occlusion: treatment effects of Thrombolysis In Cerebral Infarction (TICI) 2b and TICI 3 recanalization on functional outcome

BackgroundEmerging data suggest that mechanical thrombectomy (MT) might also be safe and efficient for medium and distal occlusions. This study aims to compare average treatment effects on functional outcome of...

Recanalization and outcomes after cerebral venous thrombosis: a systematic review and meta-analysis

BackgroundRecanalization in cerebral venous thrombosis (CVT) can begin as early as 1 week after initiating therapeutic anticoagulation. The clinical significance of recanalization remains uncertain. ObjectivesWe aimed to investigate the association between recanalization and functional outcomes and explored predictors of recanalization. MethodsA systematic literature search was conducted (EMBASE, MEDLINE, Cochrane library) to identify: (1) patients with CVT aged ≥18 years treated with anticoagulation only; (2) case series, cohort, or randomized controlled trial studies; and (3) reported recanalization rates and functional outcomes using either a modified Rankin Scale (mRS) or sequelae of CVT at last follow-up. Meta-analysis was performed using pooled odds ratios (ORs) with exploration of sex and age effects using meta-regression. ResultsTwenty-three studies were eligible with 1418 individual patients in total. Timing of reimaging and clinical reassessment was variable. Absence of recanalization was associated with increased odds of an unfavorable functional outcome (mRS 2-6 versus 0-1; OR, 3.66; 95% CI, 1.73-7.74; p = 0.001), CVT recurrence (OR, 8.81; 95% CI, 1.63-47.7; p = 0.01), and chronic headache (OR, 2.78; 95% CI, 1.16-6.70; p = 0.02). On meta-regression, the relationship between recanalization and mRS differed by the proportion of female patients, where lower proportions of women were associated with higher likelihood of a worse outcome, but not by mean participant age. There was no incremental benefit of full compared with partial recanalization with respect to favorable mRS or recurrence, but odds of chronic headache were higher with partial versus full recanalization (OR, 3.80; 95% CI, 1.43-10.11; p = 0.008). Epilepsy and visual sequelae were not associated with recanalization. ConclusionsAbsence of recanalization was associated with worse functional outcomes, CVT recurrence, and headache, but outcomes were modified by sex. The degree of recanalization was significant in relation to headache outcomes, where partial compared with complete recanalization resulted in a greater likelihood of residual headache. Prospective studies with common timing of repeat clinical-neuroimaging assessments will help to better ascertain the relationship and directionality between the degree of recanalization and outcomes.

Abstract Number ‐ 241: Simultaneous IV tPA During Thrombectomy Reduces Post‐Procedure Hypoperfusion Volumes in Anterior LVO Patients

Introduction Simultaneous tPA administration during mechanical thrombectomy may induce synergistic benefits (1). We aimed to characterize the hypoperfusion status after thrombectomy according to the timing of tPA administration and the degree of final recanalization. Methods We studied consecutive anterior circulation large vessel occlusion (LVO) stroke patients treated with mechanical thrombectomy who received a CT perfusion (CTP) immediately after endovascular procedure (2). Patients were divided in three groups according to: no iv tPA treatment (non‐tPA), tPA administration before 120 minutes (tPA&gt;120) or iv tPA administration within 120 min (tPA&lt; 120) of groin puncture. The extend of post‐procedure hypoperfusion (volume Tmax&gt;6s) and relative hypoperfusion reduction compared with admission CTP (volume post‐procedure – admission Tmax&gt;6s/admission Tmax&gt;6s) according to final TICI scores were compared between the three study groups. Results One hundred and sixty‐nine patients were included in the study, mean age 72 years and median baseline NIHSS of 15. Thirty (17.8%) patients received iv tPA more than 2h before groin puncture (tPA&gt;120), 32(18.9%) within 2h of the puncture (tPA &lt; 120) and 107(63.3%) were non‐tPA. No difference on stroke severity, pre‐procedure hypoperfusion volume or occlusion location before thrombectomy were detected between groups. The rate of complete recanalization (TICI 3, 38.5%) was also similar in the 3 study groups (p = 0.12). Overall, the post‐procedure hypoperfusion volume was significantly lower in the tPA&lt; 120 group (19.9±4.6cc vs 35.0±5.5, p = 0.04), and the relative hypoperfusion reduction was higher in tPA&lt; 120 (0.86 vs 0.66, p = 0.05) as compared to non‐tPA. No significant differences were detected between non‐tPA and tPA&gt;120 groups. For each final TICI score the post‐procedure hypoperfusion tended to be lower in the tPA&lt; 120‐group, with a stronger reduction in patients with lower degree of recanalization (Figure). Conclusions A reduction of post‐thrombectomy hypoperfusion volumes was detected in patients treated with iv tPA during or shortly before thrombectomy, which could be a surrogate marker of the beneficial effect of tPA on the microcirculation. The specific reperfusion synergistic effect of tPA and mechanical thrombectomy beyond LVO recanalization warrants future studies.

Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis

PurposeCompletely occlusive acute–subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute–subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective treatment. Here, we aimed to evaluate the outcome of EVTs of completely occlusive acute–subacute PVMVT with severe complications in patients without cirrhosis.Materials and methodsNineteen patients (nine men and 10 women; age, 60.1 ± 16.8 years) with completely occlusive acute–subacute PVMVT were retrospectively assessed. Acute–subacute PVMVT was defined as symptom onset within 40 days, with no cavernous transformation observed on contrast-enhanced computed tomography. The patients were treated with EVTs, a combination of thrombectomy (including aspiration thrombectomy, plain old balloon angioplasty, single injection of thrombolytic agents, and stent placement) and continuous catheter-directed thrombolysis. Kaplan–Meier analyses were performed to assess all-cause mortality, acute–subacute PVMVT-related mortality, and portal vein (PV) patency. The degree of recanalization and patency of PV, complications, factors related to acute–subacute PVMVT-related mortality, and factors related to patency of PV were also evaluated.ResultsThe all-cause and acute–subacute PVMVT-related mortality rates were 36.8% (7/19) and 31.6% (6/19), respectively. Seven (36.8%) and 11 (57.9%) patients achieved complete and partial recanalization, respectively. Among the 18 patients who achieved recanalization, follow-up images after 608.7 ± 889.5 days confirmed recanalization in 83.3% (15/18) patients, and 53.3% (8/15) of these patients achieved patency of PV. Seven patients (36.8%) developed complications, and two (10.5%) required interventional treatment for complications. Deterioration of liver function significantly worsened the prognosis (P = 0.046), while anticoagulation therapy significantly maintained portal patency (P = 0.03).ConclusionThis endovascular method for acute–subacute PVMVT, which combines thrombectomy and continuous catheter-directed thrombolysis EVT approach was effective for thrombus resolution. However, further studies must define conditions that improve patient prognosis.

Rescue stenting after the failure of mechanical thrombectomy to treat acute intracranial atherosclerotic occlusion.

Acute ischemic stroke (AIS) with intracranial large vessel occlusion (LVO) is refractory to reperfusion because of the underlying intracranial atherosclerosis (ICAS), and this condition often requires salvage methods such as balloon angioplasty and rescue stenting (RS). In this study, we investigated the short-term outcomes of RS after failed mechanical thrombectomy (MT) for the treatment of acute intracranial atherosclerotic occlusion. We retrospectively evaluated the clinical data of 127 patients who underwent MT for acute intracranial atherosclerotic occlusion in our hospital between August 2018 and January 2022. The degree of recanalization was evaluated immediately after the treatment by Modified Thrombolysis in Cerebral Infarction (mTICI). The modified Rankin Scale (mRS) was used 90 days after treatment to evaluate the neurological functions. In addition, the incidence of symptomatic intracranial hemorrhage (sICH) and postoperative mortality within 90 days of treatment were calculated. Among the 127 patients, 86 patients (67.7%) had revascularization (mTICI 2b-3) immediately after MT (non-RS group), and RS was performed in 41 patients (32.3%) after MT failure (RS group). No difference in the sICH rate was observed between the two groups (17.1 vs. 16.3%, p = 0.91). There was a slightly higher mortality rate in the RS group (14.6 vs. 12.8%, p = 0.71); however, the difference was not significant. There was no difference in the proportion of patients in the RS and non-RS groups who had a 90-day mRS score of 0-2 (48.8 vs. 52.3%, p = 0.76). Rescue stenting after MT failure might be a feasible rescue modality for treating acute intracranial atherosclerotic occlusion.

Effectiveness and Safety of Tecneplase vs. Alteplase in the Acute Treatment of Ischemic Stroke

Not all hospitals have interventional radiology services. This fact implies that in centers where this resource is not available, the treatment of stroke in the acute phase must be adapted and individualized. The aim of the study is to determine and compare the combined effect of thrombolysis and thrombectomy effectiveness and safety of tenecteplase versus alteplase in the acute treatment of ischemic stroke in patients who are candidates for endovascular therapy according to clinical practice guidelines. This paper details a retrospective multicenter cohort study of patients with ischemic stroke admitted in three hospitals between 2018 and 2020. The main outcome variables were the degree of recanalization and the functional outcome at 3 months; safety variables were mortality and the occurrence of intracranial hemorrhage (ICH). In total, 100 patients were included, 20 of which were treated with tenecteplase (TNK) and 80 with alteplase (rtPA). Of those treated with TNK, 75% obtained a successful recanalization compared to 83.8% in those treated with rtPA (OR 0.58; 95% CI 0.18–1.88; p = 0.56). No differences were found in obtaining an excellent functional result at 3 months (35% TNK vs. 58.8% rtPA; p = 0.38). Tenecteplase showed worse neurological results after 24 h (unfavorable result of 70% with TNK vs. 45% with rtPA; OR = 5.4; 95% CI 1.57–18.6). No significant differences were identified in mortality; 17.5% with rtPA and 20% with TNK (p = 0.79), nor in the appearance of intracranial hemorrhage ICH (15.2% with rtPA vs. 30% with TNK (p = 0.12). In our series, there were not significant differences shown regarding effectiveness and safety between tenecteplase and alteplase.

Does thrombus imaging characteristics predict the degree of recanalisation after endovascular thrombectomy in acute ischaemic stroke?

BackgroundIdentification of computed tomography (CT) thrombus imaging characteristics can predict the degree of recanalization and outcome after endovascular thrombectomy (EVT) in patients with acute ischaemic stroke and large vessel occlusion. AimWe analyzed the thrombus imaging characteristics and procedural factors and correlated with the degree of recanalization and functional outcome after EVT. MethodsWe evaluated the thrombus imaging characteristics (hyperdense MCA sign, thrombus location, length and thrombus permeability) from thin slice CT and CT angiogram. In addition, groin to recanalization time, number of passes, and EVT technique were documented. The primary outcome was degree of recanalization (mTICI score) and secondary outcome was modified Rankin scale (mRS) at 3 months. ResultsThe mean age of 102 patients was 60.5±11.8 years. Patients with hyperdense MCA sign (90 % vs 75%, p=0.07) and permeable thrombus (86 % vs 70 %, p=0.09) had good recanalization (mTICI grade 2b,2c or 3). The requirement of <3 passes (90 % vs 62 %, p= 0.001) was associated with good recanalization. Multiple logistic regression analysis showed thrombus permeability (OR 5.9; 95% CI 1.3-26.6, p=0.02), use of stent retreiver alone (without aspiration) (OR 5.4; 95% CI 1.3-22.5, p=0.02) and a puncture to recanalization ≤60 minutes (OR 7.9; 95% CI 1.7-36.8; p=0.008) were associated with good recanalization. The requirement of ≥3 passes was associated with poor functional outcome (OR 3.4;95% CI 1.2-9.8; p=0.02). ConclusionsThrombus permeability was a predictor of successful recanalization after EVT. The requirement of three or more passes during EVT was associated with poor recanalization and poor functional outcome.

Angiographic Revascularization after Bariatric Embolization in a Swine Model

This study evaluated fundal arteriole angiographic revascularization after embolization with embolic microspheres of 3 different diameters in a swine model (16 swine, 31 arterioles). In the 50-μm group, 7 of 11 (64%) arterioles recanalized completely, 3 of 11 (27%) arterioles recanalized partially, and 1 of 11 (9%) arterioles had collateralization (no recanalization). In the 100- to 300-μm group, 7 of 10 (70%) arterioles recanalized completely and 3 of 10 (30%) arterioles) recanalized partially. In the 300- to 500-μm group, 7 of 10 (70%) arterioles recanalized completely, 1 of 10 (10%) arterioles recanalized partially, and 2 of 10 (20%) arterioles had collateralization. No difference was found between the groups in the degree of recanalization (P = .64). All embolized arterioles exhibited some degree of angiographic revascularization, irrespective of the microsphere size.

Comparative Study of Deep Vein Thrombosis Recanalization Using Doppler Ultrasound in Different Post-Treatment Intervals in Traumatic Patients

Deep vein thrombosis (DVT) is a prevalent vascular disease characterized by pelvic and limb deep vein thrombophlebitis, and it has a high incidence in traumatic patients. Contrary to older studies, recent research has reported that recanalization in DVT is not a slow process. The present study aimed at the comparative examination of DVT recanalization with Doppler ultrasound in different intervals following treatment with heparin or enoxaparin. This prospective study was conducted on all traumatic patients hospitalized in Imam Reza Hospital of Kermanshah, Iran, with the clinical and sonographic diagnosis of DVT in limb veins. Doppler ultrasound was performed two weeks, one month, and three months following treatment in order to examine recanalization. Data were analyzed using statistical tests in SPSS16 at the significance level of &lt;0.05. Based on Doppler ultrasound, a significant difference was found between the degree of recanalization in patients aged &lt;45 years and those aged &gt;45 years, between male and female patients, and between different DVT locations (P&lt;0.05). After three months of treatment with heparin and enoxaparin, the degree of recanalization was increased in DVT. Moreover, it was found that Doppler ultrasound is a useful tool for the diagnosis of recanalization in patients with DVT.

PREVALENCE AND CHARACTERISTICS OF PORTAL VEIN RECANALIZATION IN CIRRHOTIC PATIENTS ADMITTED WITH PORTAL THROMBOSIS IN A THIRD LEVEL CARE CENTER

Portal vein thrombosis (PVT) refers to the formation of blood clots within the trunk of the portal vein (PV) or its main branches, which can spread to the superior mesenteric (SMV) and splenic (VE) veins. The natural history of liver cirrhosis is a complication with a "rebalanced" coagulation system that can promote bleeding or a thrombotic tendency. The prevalence in compensated cirrhotic is 1% in and 8-25% in decompensated patients. To determine the prevalence and characteristics of PV recanalization in cirrhotic patients with PVT. Descriptive, cross-sectional/prevalence. We reviewed medical records of all cirrhotic patients admitted with PVT diagnosis from January 2019 to April 2021. We included patients with a diagnosis of PVT. Qualitative variables were expressed as frequencies and percentages. The numerical variables were expressed as means and standard deviations. We use X2, Fisher's exact, Student's t, and Mann-Whitney U to compare groups as appropriate. Of 553 cirrhotic patients admitted from January 2019 to April 2021, 48(8.67%) patients with PVT diagnoses were included. Of these, 27(56.3%) were women, with a mean age of 59.37±12.67 years, 9(18%) with a diagnosis of cancer, of which 8(16.7%) were hepatocellular carcinoma, 2(33.3%) extended to the two arms, 6(12.5%) received treatment, 100% of the treatment was based on low molecular weight heparin. According to the degree of recanalization: 37(77.08%) recanalized, 27(56.3%) did so partially, of them, 24(88.9%) were spontaneous; 10(20.8%) recanalized utterly, of which 90% were without treatment, with no significant difference between recanalization to free progression vs. treatment ( p =0.179) and 11(22.9%) did not recanalize. Regarding the characteristics of the thrombosis by imaging studies, 26(54.2%) were chronic, 28(58%) partial, only 9(18.8%) with cavernomatous transformation, 30(62.5%) were located in the main trunk, 6(12.5%) extended to the SLM and 11(22.9%) presented flow <15cm/s. In cirrhotics with recent or partial occlusion (> 50% of the lumen) or thrombosis of the main PV or SMV, therapy should be considered. Anticoagulant or interventional therapy has no benefit complete chronic occlusion of the main PV or cavernomatous transformation. Spontaneous recanalization occurs in 40% in 3 months, and with therapy, it is 80%. Several cohort studies reported that near 50% recanalize partially or totally in the next three months, and up to 80% recanalize at 12 months. Clinical trial data are weak regarding the indications for treatment for PVT without ischemic symptoms. Our study showed that 77.08% of cirrhotic patients with PVT recanalized, most partially during follow-up and more than 80% spontaneously, and only a low percentage presented with cavernomatous transformation. In addition, more than 70% of the patients who recanalized have a low risk of re-thrombosis related to flow. The prevalence of PVT in cirrhotic patients was relatively low (10%), complete or partial recanalization was very high, even spontaneously, there was no difference in the degree of recanalization with or without anticoagulation. The authors declares that there is no conflict of interest

Mechanical Thrombectomy in Acute Ischemic Stroke: Angiographic Predictors of Outcome.

In patients with acute ischemic stroke with large vessel occlusion, various angiographic features are important in patient selection and predicting outcome. We evaluated angiographic features like collaterals, clot burden score, angiographic recanalization, number of passes, and intracranial atherosclerotic disease (ICAD) with the functional outcome at 90 days. This was a retrospective analysis of prospectively collected data of 163 patients with acute ischemic stroke with large vessel occlusion who underwent mechanical thrombectomy within 24 hours of symptom onset. Angiographic data were reviewed blinded to clinical data. The outcome was defined as modified Rankin scale (mRS) at 90 days (good outcome mRS ≤2). The median age of patients was 60 years and 34.4% were females. The median National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Programme Early CT Score (ASPECTS) at admission were 17 and 6, respectively. On bivariate analysis, ASPECTS was >6, clot burden score was ≥7, recanalization of TICI was ≥2b, absence of ICAD, showed a positive correlation with the good outcome at 90 days (P-values of 0.003, 0.0001, and 0.03, respectively). Multiple attempts of device passes were associated with poor recanalization (P = 0.001) and it was seen more in ICAD patients. On multivariate analysis, independent predictors of poor outcome were clot burden score <7 (P = 0.043) and TICI score <2b (P = 0.048). Out of 41 patients (26%) with ICAD, 29 had a poor outcome at 90 days. Lower clot burden and less degree of recanalization were associated with poor outcome in acute ischemic stroke due to Large vessel occlusion (LVO). The presence of ICAD also predicted poor outcome.

Quantitative Lesion Water Uptake as Stroke Imaging Biomarker: A Tool for Treatment Selection in the Extended Time Window?

Patients presenting in the extended time window may benefit from mechanical thrombectomy. However, selection for mechanical thrombectomy in this patient group has only been performed using specialized image processing platforms, which are not widely available. We hypothesized that quantitative lesion water uptake calculated in acute stroke computed tomography (CT) may serve as imaging biomarker to estimate ischemic lesion progression and predict clinical outcome in patients undergoing mechanical thrombectomy in the extended time window. All patients with ischemic anterior circulation stroke presenting within 4.5 to 24 hours after symptom onset who received initial multimodal CT between August 2014 and March 2020 and underwent mechanical thrombectomy were analyzed. Quantitative lesion net water uptake was calculated from the admission CT. Prediction of clinical outcome was assessed using univariable receiver operating characteristic curve analysis and logistic regression analyses. One hundred two patients met the inclusion criteria. In the multivariable logistic regression analysis, net water uptake (odds ratio, 0.78 [95% CI, 0.64-0.95], P=0.01), age (odds ratio, 0.94 [95% CI, 0.88-0.99]; P=0.02), and National Institutes of Health Stroke Scale (odds ratio, 0.88 [95% CI, 0.79-0.99], P=0.03) were significantly and independently associated with favorable outcome (modified Rankin Scale score ≤1), adjusted for degree of recanalization and Alberta Stroke Program Early CT Score. A multivariable predictive model including the above parameters yielded the highest diagnostic ability in the classification of functional outcome, with an area under the curve of 0.88 (sensitivity 92.3%, specificity 82.9%). The implementation of quantitative lesion water uptake as imaging biomarker in the diagnosis of patients with ischemic stroke presenting in the extended time window might improve clinical prognosis. Future studies could test this biomarker as complementary or even alternative tool to CT perfusion.

Hemodynamic and Morphologic Factors Related to Coil Compaction in Basilar Artery Tip Aneurysms

Coil compaction is directly related to the degree of cerebral aneurysmal recanalization. The degree of recanalization (DoR) was quantified by measuring the volume vacated by coil deformation. The purpose of this study was to clarify the hemodynamic and morphologic factors associated with coil compaction. Computational fluid dynamics simulations were performed on 28 middle-size (5-10 mm) unruptured basilar artery tip aneurysms. The DoR was measured by comparing the coil mass shape obtained from three-dimensional digital subtraction angiography data immediately after coil embolization and again within 1-2 years of follow-up. Deployed coils were modeled using a virtual coiling technique for computational fluid dynamics simulations. Hemodynamic and morphologic factors to predict the DoR were derived using multiple linear regression. Aneurysmal neck area, the maximum pressure generated on the neck surface after coil embolization, and the high-pressure position on the neck surface predicted DoR with statistic significance (P < 0.001, P < 0.001, P= 0.004, respectively). The DoR tended to increase when the neck areawas large, the pressure generated on the coils was high, and the high-pressure position was close to the center of the neck surface. The volume embolization ratio was not statistically relevant for the DoR in the cases of this study. Coil compaction occurs in cerebral aneurysms with a wide neck, high pressure generated on the coils, and high pressure in the center of the neck surface. Establishing the DoR can contribute to the prediction of recanalization after coil embolization.

Reversible Ischemic Lesion Hypodensity in Acute Stroke CT Following Endovascular Reperfusion.

In acute stroke, early ischemic lesion hypodensity on CT is considered the imaging hallmark of brain infarction, representing a state of irreversible tissue damage with a continual increase of net water uptake. This dogma, however, is challenged by rare cases of apparently reversed early lesion hypodensity after complete reperfusion. The purpose of this study was to investigate the occurrence of reversible ischemic edema after endovascular treatment. One hundred eighty-four patients with acute ischemic anterior circulation stroke were included after consecutive screening. Ischemic brain edema was determined with quantitative lesion net water uptake (NWU) in admission CT and follow-up CT based on CT densitometry, and ΔNWU was calculated as the difference. The association of edema progression to imaging and clinical parameters was investigated. Clinical outcome was assessed with the modified Rankin Scale (mRS) scores at day 90. Of 184 patients, 27 (14.7%) showed edema arrest and 3 (1.6%) exhibited significant edema reversibility. Higher degree of recanalization (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.46-6.01, p < 0.01) and shorter time from imaging to recanalization (OR per hour 0.32, 95% CI 0.18-0.54, p < 0.0001) were significantly associated with edema arrest or reversibility. Clinical outcome was significantly better in patients without edema progression (median mRS score 2 vs 5, p = 0.004). Although rare, lesion hypodensity considered to be representative of early infarct in acute stroke CT may be reversible after complete recanalization. Arrest of edema progression of acute brain infarct lesions may occur after successful rapid vessel recanalization, resulting in improved functional outcome. Future research is needed to investigate conditions in which early revascularization may halt or even reverse vasogenic edema of ischemic tissue.

Prestroke Glucose Control and Functional Outcome in Patients With Acute Large Vessel Occlusive Stroke and Diabetes After Thrombectomy.

OBJECTIVETo evaluate whether prestroke glucose control is associated with functional outcomes in patients with acute large vessel occlusive stroke and diabetes who underwent intra-arterial thrombectomy (IAT).RESEARCH DESIGN AND METHODSFrom the Clinical Research Center for Stroke–Korea registry, we included patients with emergent large vessel occlusive stroke with diabetes who underwent IAT between January 2009 and March 2020. The association between the HbA1c level at admission and functional outcomes (modified Rankin Scale at 3 months after the index stroke) was assessed.RESULTSA total of 1,351 patients were analyzed. Early neurological deterioration was more common in patients with higher levels of HbA1c at admission (P = 0.02 according to HbA1c quintiles, P = 0.003 according to an HbA1c cutoff value of 7.0%) than in those with lower HbA1c levels. Higher HbA1c levels at admission were significantly associated with decreased odds of favorable functional outcomes at a threshold of 7.0–7.1%. The association was consistently observed in subgroups divided according to age, sex, stroke subtype, occlusion site, degree of recanalization, thrombolysis modalities, time from symptom onset to groin puncture, and treatment period.CONCLUSIONSPrestroke glucose control with a target HbA1c of ≤7.0% may be beneficial for neurological recovery in patients with diabetes undergoing IAT for large vessel occlusive stroke, regardless of stroke subtype, bridging intravenous thrombolysis, occlusion site, degree of recanalization, and treatment period.