Recanalization In Acute Ischemic Stroke Research Articles

Prognostic significance of serum inflammatory markers in patients with acute ischemic stroke undergoing revascularization therapy.

This study aimed to evaluate the prognostic significance of serum inflammatory factor levels in patients with acute ischemic stroke undergoing revascularization therapy. The study included 94 patients with acute ischemic stroke who underwent revascularization therapy at our hospital. The primary outcome was the modified Rankin scale (mRS) score assessed three months post-treatment. Patients were categorized into two groups: those with a poor prognosis (mRS score > 2) and those with a good prognosis (mRS score≤2). The patients were divided into two groups based on the type of revascularization treatment received: thrombus extraction or intravenous thrombolysis. Logistic regression analysis was used to identify independent risk factors associated with the prognosis of patients treated with recanalization for acute ischemic stroke. Among the 94 patients, 59 had a good prognosis, and 35 had a poor prognosis. At admission, the patients in the good prognosis group exhibited lower NIHSS scores, shorter hospital stays, fewer previous cardiac events, lower LDL levels, fasting glucose, IL-6, and TNF-a compared to those in the poor prognosis group (all P < 0.05). Logistic regression analysis identified TNF-a (odd ratio (OD), 1.623; 95% confidence interval (CI), 1.282-1.933; P = 0.035) and IL-6 (OD, 1.055; 95% CI, 1.024-1.088, P = 0.023) as independent risk factors for poor prognosis in patients after revascularization. Additionally, pre-hospital NIHSS scores, IL-6, and TNF-a levels were significantly lower in the good prognosis group compared to the poor prognosis group, with these differences being statistically significant. IL-6 and TNF-α may serve as prognostic markers for outcomes following revascularization therapy in patients with acute ischemic stroke, including those receiving intravenous thrombolysis.

Analysis of Factors Associated to Hemorrhagic Transformation After Recanalization of Acute Ischemic Stroke

Ischemic stroke is associated with high rates of mortality and disability, making it an urgent issue that requires immediate attention. However, patients with acute ischemic stroke (AIS) can open the occluded cerebral vessels timelier, restore cerebral perfusion, save the ischemic penumbra, and bring better prognosis. However, a considerable number of patients still have poor clinical outcome due to complications such as hemorrhagic transformation (HT) after vascular reopening. The specific mechanism of HT after recanalization treatment is currently not fully understood. Studies have shown that multiple factors are associated with bleeding transformation after mechanical thrombectomy in AIS patients. Some studies suggest that the damage of ischemia and reperfusion and vascular permeability may play a role. This paper summarizes the possible mechanisms and related influencing factors of HT after vascular recanalization treatment of AIS patients to further guide the treatment and management decisions of AIS patients.

Effects of thrombus characteristics on clinical outcome and success of recanalization in acute ischemic stroke

Background: Despite current developments in mechanical thrombectomy (MT), successful recanalization cannot be achieved in all patients. One of the factors related to this is the characteristics of the thrombus. In this study, we aimed to evaluate the effects of thrombus length and permeability on procedural success and clinical outcome. Methods: Patients with intracranial ICA, middle cerebral artery M1, or M2 occlusions, who underwent MT between November 2019 and January 2022 were included in the study. Thrombus length, density and permeability were calculated and the relationship between recanalization success and modified Rankin Scores (mRS) at the 3rd month was evaluated. Good clinical outcome was defined as an mRS score of 2 or less. Results: Forty-six of the 79 patients included in the study had a good clinical outcome. Although thrombus length was shorter and permeability was higher in patients with good clinical outcome, statistical significance was not achieved. There was a positive correlation between thrombus density, thrombus length and the number of passes, and a negative correlation between permeability. There was no significant difference in thrombus length, density and permeability between patients with and without successful recanalisation. Thrombus length was found to be a predictor of clinical outcome at 3 months in univariate analysis, whereas only age was found to be an independent predictor in multivariate analysis. Conclusions: In conclusion, despite certain findings not achieving statistical significance, the observed trends offer valuable insights for future research. A comprehensive understanding of thrombus nature could guide personalized stroke treatment strategies in the future.

The combination model of serum occludin and clinical risk factors improved the efficacy for predicting hemorrhagic transformation in stroke patients with recanalization

Backgroundand Purpose: Hemorrhagic transformation (HT) is one of the severe complications in acute ischemic stroke, especially for the patients who undergo recanalization treatment. It is crucial to screen patients who have high risk of HT before recanalization. However, current prediction models based on clinical factors are not ideal for clinical practice. Serum occludin, a biomarker for cerebral ischemia-induced blood-brain barrier disruption, has potential for predicting HT. This study was to investigate whether the combination of serum occludin and clinical risk factors improved the efficacy of predicting HT. MethodsThis was a single-center prospective observational study. Baseline clinical data and blood samples of recanalization patients were collected upon admission to our hospital. The level of serum occludin was measured using enzyme-linked immunosorbent assay. The diagnosis of HT was confirmed by CT scans within 36 h post recanalization. ResultsA total of 324 patients with recanalization were enrolled and 68 patients presented HT occurrence. HT patients had the higher level of baseline occludin than patients without HT (p < 0.001). Multivariate regression analysis showed that serum occludin level, Alberta Stroke Program Early CT Scores and endovascular therapy were independent risk factors (p < 0.05) for HT after adjusting potential confounders. The combination of serum occludin and clinical risk factors significantly improved the accuracy of predicting HT [area under the curve (AUC, 0.821 vs 0.701, p < 0.001), and net reclassification improvement (31.1 %), integrated discrimination improvement (21.5 %), p < 0.001] compared to a model employing only clinical risk factors. The modified AUC (0.806) of combined model based on 10-fold-cross-validation was still higher than clinical risk model (0.701). ConclusionThe combination of serum occludin and clinical risk factors significantly improved the prediction efficacy for HT, providing a novel potential prediction model to screen for patients with high risk of HT before recanalization in acute ischemic stroke.

Severely Hypoperfused Brain Tissue Correlates with Final Infarct Volume Despite Recanalization in DMVO Stroke.

We sought to assess whether there were any parameter(s) on baseline computed-tomography-perfusion (CTP) strongly correlating with final-infarct-volume, and infarct volume progression after endovascular recanalization of acute ischemic stroke (AIS) with primary distal, medium vessel occlusion (DMVO). We performed a retrospective analysis of consecutive AIS patients who were successfully recanalized by thrombectomy for DMVO. By comparing baseline CTP and follow-up MRI, we evaluated the correlation between baseline infarct and hypoperfusion volumes, and final infarct volume and infarct volume progression. We also examined their effect on good clinical outcome at 3 months (defined as an mRS score of 0 to 2). Between January 2018 and January 2021, 38 patients met the inclusion criteria (76% [29/38] female, median age 75 [66-86] years). Median final infarct volume and infarct volume progression were 8.4 mL [IQR: 5.2-44.4] and 7.2 mL [IQR: 4.3-29.1] respectively. TMax > 10 sec volume was strongly correlated with both (r = 0.831 and r = 0.771 respectively, p < 0.0001), as well as with good clinical outcome (-0.5, p = 0.001). A higher baseline TMax > 10 sec volume increased the probability of a higher final-infarct-volume (r2 = 0.690, coefficient = 0.83 [0.64-1.00], p < 0.0001), whereas it decreased the probability of good clinical outcome at 3 months (odds ratio = -0.67 [-1.17 to -0.18], p = 0.008). TMax > 10 sec volume on baseline CTP correlates strongly with final infarct volume as well as with clinical outcome after mechanical thrombectomy for an AIS with DMVO.

Lymphocyte to Monocyte Ratio is Independently Associated with Futile Recanalization in Acute Ischemic Stroke After Endovascular Therapy.

Acute ischemic stroke (AIS) caused by large artery occlusion (LAO) poses considerable risks in terms of mortality and disability. Endovascular treatment (EVT) has emerged as a primary intervention for this condition. However, the occurrence of futile recanalization (FR) following EVT remains common, necessitating the identification of predictive markers for treatment outcomes. Although the lymphocyte to monocyte ratio (LMR) has been linked to various diseases, its association with FR after EVT in AIS patients has not been investigated. An analysis was conducted on patients with AIS who underwent EVT within 24 hours of symptom onset. The success of reperfusion was evaluated using the modified Thrombolysis in Cerebral Infarction (mTICI) scale, with patients achieving an mTICI score of ≥2b being included in the study. Various clinical, radiological, and laboratory variables, including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were collected. Logistic regression analysis was used to determine factors associated with FR, and receiver operating characteristic (ROC) analysis was performed to assess the predictive value of LMR. Among the cohort of 101 patients, it was observed that 52.4% experienced FR. Upon admission, lower levels of lymphocyte-to-monocyte ratio (LMR) were found to be associated with older age, higher baseline NIHSS scores, lower ASPECTS, and poorer mRS scores at 90 days. Both univariate and multivariate logistic regression analyses indicated that low LMR independently predicted FR, with an adjusted odds ratio of 0.64 (95% CI = 0.412-0.984, p = 0.042). ROC analysis further demonstrated that LMR had an area under the curve (AUC) of 0.789 for predicting FR. This study establishes the potential value of the lymphocyte-to-monocyte ratio (LMR) as a prognostic marker for predicting FR in patients with AIS undergoing EVT. Decreased LMR levels are associated with unfavorable clinical outcomes.

No-reflow phenomenon following stroke recanalization therapy: Clinical assessment advances: A narrative review.

The no-reflow phenomenon (NRP) after successful vascular recanalization in acute ischemic stroke (AIS) has become a major cause of poor clinical prognosis and ineffective recanalization. However, there is currently no clear definition or unified clinical assessment method for the NRP. Therefore, it is urgent to clarify the clinical evaluation criteria for the NRP and develop new no-reflow evaluation techniques so that remedial treatment can be applied to AIS patients suffering from the NRP. In this brief review, a variety of NRP assessment methods and defining criteria for clinical practice are presented.

Exploring sex differences for acute ischemic stroke clinical, imaging and thrombus characteristics in the INTERRSeCT study.

Women, especially following menopause, are known to have worse outcomes following acute ischemic stroke. One primary postulated biological mechanism for worse outcomes in older women is a reduction in the vasculoprotective effects of estrogen. Using the INTERRseCT cohort, a multicentre international observational cohort studying recanalization in acute ischemic stroke, we explored the effects of sex, and modifying effects of age, on neuroradiological predictors of recanalization including robustness of leptomeningeal collaterals, thrombus burden and thrombus permeability. Ordinal regression analyses were used to examine the relationship between sex and each of the neuroradiological markers. Further, we explored both multiplicative and additive interactions between age and sex. All patients (n = 575) from INTERRseCT were included. Mean age was 70.2 years (SD: 13.1) and 48.5% were women. In the unadjusted model, female sex was associated with better collaterals (OR 1.37, 95% CIs: 1.01-1.85), however this relationship was not significant after adjusting for age and relevant comorbidities. There were no significant interactions between age and sex. In a large prospective international cohort, we found no association between sex and radiological predictors of recanalization including leptomeningeal collaterals, thrombus permeability and thrombus burden.

No-reflow phenomenon in acute ischemic stroke: an angiographic evaluation.

Futile recanalization (FR) is de fined as a poor 90-day outcome or lack of neurological improvement at 24h despite successful recanalization in acute ischemic stroke (AIS) with large vessel occlusion (LVO) treated by mechanical throbectomy (MT). The No-reflow phenomenon (NRP) could be a possible cause of FR, but its evidence in AIS patients is scarce. We retrospectively analyzed 185 digital subtraction angiographies (DSA) of AIS patients with anterior circulation LVO after endovascular treatment. To better define NRP, we designed a score called the modified capillary index score (mCIS). The score is obtained by dividing the middle cerebral artery territory in three segments. For each segment, we gave 2 points if the capillary blush was present without any delay, 1 if delayed, and 0 if absent. The primary endpoint was to use mCIS to identify NRP on post-interventional DSA and to test whether this marker may predict FR and failure of early neurological improvement (fENI). The secondary endpoint was to search for a correlation between NRP, lesion volume, and hemorrhagic transformation. We used the ROC curve to define mCIS ≤ 3 as the cut-off and marker of NRP. NRP was present in 35.1% of patients. NRP predicted fENI at 24h (aOR 2.825, 95% CI 1.265-6.308, P = 0.011) and at 7days (aOR 2.191, 95% CI 1.008-4.762, P = 0.048), but not 90-day FR. Moreover, NRP predicted hemorrhagic transformation (aOR 2.444, 95% CI 1.266-4.717, P = 0.008). The modified capillary index score (mCIS) seems useful in identifying NRP in AIS. In addition, mCIS was able to predict NRP that correlated with early clinical outcome and hemorrhagic transformation of the ischemic lesion. An external validation of the score is warranted.

Intravenous thrombolysis and mechanical recanalization for acute ischemic stroke in deep brain stimulation patients: a case series

BackgroundIntravenous thrombolysis (IVT) and endovascular mechanical thrombectomy therapy (MT) are well established in the treatment of acute ischemic stroke. It is currently unclear whether these treatments can be applied in patients with previous deep brain stimulation (DBS) surgery and how long the interval to the DBS operation should be.MethodsFour patients with ischemic stroke and IVT or MT were included in this retrospective case series. Data on demographics, genesis, severity and course of the stroke and the DBS indication were extracted and evaluated. Furthermore, a literature review was conducted. Outcomes and hemorrhagic complications after IVT, MT or intra-arterial thrombolysis in patients with prior deep brain stimulation surgery and intracranial surgery were analyzed.ResultsFour patients with acute ischaemic stroke and previous DBS surgery were treated with IVT (2 patients), MT (1) or a combined therapy of IVT and MT (1). The time interval to the previous DBS surgery was between 6 and 135 months. In these four patients, no bleeding complications occurred. The literature review revealed four publications with a total of 18 patients, who were treated with IVT, MT or intra-arterial thrombolysis. Of these 18 patients, only 1 had undergone deep brain stimulation surgery, the other 17 patients had received brain surgery for other reasons. Bleeding complications occurred in four of the 18 reported patients, but not in the DBS case. All four patients with bleeding complications were reported to have died as a result. In three of the four patients with fatal outcome, surgery was less than 90 days before the onset of stroke.ConclusionIVT and MT were tolerated by four patients with ischemic stroke more than 6 months after DBS surgery without bleeding complications.

Intra-arterial tenecteplase is safe and may improve the first-pass recanalization for acute ischemic stroke with large-artery atherosclerosis: the BRETIS-TNK trial.

The first-pass recanalization of endovascular treatment (EVT) is closely correlated with clinical outcome of patients with large vessel occlusion (LVO) stroke. The aim of the study was to explore whether intra-arterial tenecteplase (TNK) during the first pass of EVT can increase first-pass successful reperfusion and improve the neurological outcome in AIS-LVO patients. The BRETIS-TNK trial (ClinicalTrials.gov Identifier: NCT04202458) was a prospective, single-arm, single center study. Twenty-six eligible AIS-LVO patients with large-artery atherosclerosis etiology were consecutively enrolled from December 2019 to November 2021. Intra-arterial TNK (4 mg) after microcatheter navigation through the clot was administered, followed by TNK (0.4 mg/min) given continuously for 20 min after the first retrieval attempt of EVT without confirmation of the reperfusion status by DSA. The 50 control patients comprised of a historical cohort before the BRETIS-TNK trial (from March 2015 to November 2019). Successful reperfusion was defined as modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b. The first-pass successful reperfusion rate was higher in the BRETIS-TNK vs. control group (53.8% vs. 36%, p = 0.14), and the difference became statistically significant after propensity score matching (53.8% vs. 23.1%, p = 0.03). There was no difference in symptomatic intracranial hemorrhage between the BRETIS-TNK and control groups (7.7% vs. 10.0%, p = 0.92). There was a trend toward higher proportion of functional independence at 90 days in the BRETIS-TNK comparing with the control group (50% vs. 32%, p = 0.11). This is the first study to report that intra-arterial TNK during the first pass of EVT seems safe and feasible in AIS-LVO patients.

Deep Learning-based Assessment of Internal Carotid Artery Anatomy to Predict Difficult Intracranial Access in Endovascular Recanalization of Acute Ischemic Stroke

BackgroundEndovascular thrombectomy (EVT) duration is an important predictor for neurological outcome. Recently it was shown that an angle of ≤ 90° of the internal carotid artery (ICA) is predictive for longer EVT duration. As manual angle measurement is not trivial and time-consuming, deep learning (DL) could help identifying difficult EVT cases in advance.MethodsWe included 379 CT angiographies (CTA) of patients who underwent EVT between January 2016 and December 2020. Manual segmentation of 121 CTAs was performed for the aortic arch, common carotid artery (CCA) and ICA. These were used to train a nnUNet. The remaining 258 CTAs were segmented using the trained nnUNet with manual verification afterwards. Angles of left and right ICAs were measured resulting in two classes: acute angle ≤ 90° and > 90°. The segmentations together with angle measurements were used to train a convolutional neural network (CNN) determining the ICA angle. The performance was evaluated using Dice scores. The classification was evaluated using AUC and accuracy. Associations of ICA angle and procedural times was explored using median and Whitney‑U test.ResultsMedian EVT duration for cases with ICA angle > 90° was 48 min and with ≤ 90° was 64 min (p = 0.001). Segmentation evaluation showed Dice scores of 0.94 for the aorta and 0.86 for CCA/ICA, respectively. Evaluation of ICA angle determination resulted in an AUC of 0.92 and accuracy of 0.85. ConclusionThe association between ICA angle and EVT duration could be verified and a DL-based method for semi-automatic assessment with the potential for full automation was developed. More anatomical features of interest could be examined in a similar fashion.

What You Always Wanted to Know about Endovascular Therapy in Acute Ischemic Stroke but Never Dared to Ask: A Comprehensive Review.

In 2015, mechanical thrombectomy (MT) in combination with intravenous thrombolysis was demonstrated to be superior to best medical treatment alone in patients with anterior circulation stroke. This finding resulted in an unprecedented boost in endovascular stroke therapy, and MT became widely available. MT was initially approved for patients presenting with large vessel occlusion in the anterior circulation (intracranial internal carotid artery or proximal middle cerebral artery) within a 6-hour time window. Eventually, it was shown to be beneficial in a broader group of patients, including those without known symptom-onset, wake-up stroke, or patients with posterior circulation stroke. Technical developments and the implementation of novel thrombectomy devices further facilitated endovascular recanalization for acute ischemic stroke. However, some aspects remain controversial. Is MT suitable for medium or very distal vessel occlusions? Should emergency stenting be performed for symptomatic stenosis or recurrent occlusion? How should patients with large vessel occlusion without disabling symptoms be treated? Do certain patients benefit from MT without intravenous thrombolysis? In the era of personalized decision-making, some of these questions require an individualized approach based on comorbidities, imaging criteria, and the severity or duration of symptoms. Despite its successful development in the past decade, endovascular stroke therapy will remain a challenging and fascinating field in the years to come. This review aims to provide an overview of patient selection, and the indications for and execution of MT in patients with acute ischemic stroke.

The Utility of Vessel Wall Imaging in the Postulation of Acute Ischemic Stroke With Spontaneous Recanalization Pathophysiology

:Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible. Spontaneous recanalization in acute ischemic stroke (AIS) is a known but understudied phenomenon. Available literature has looked at this phenomenon and postulated the occurrence based on conventional cross-sectional imaging and angiography; however, objective evidence pointing to the occurrence of this phenomenon is scarce. We would like to share our experience using VWI in a patient who was clinically suspected to have a middle cerebral artery syndrome at onset, with resolution of the symptoms 3 hours after initial presentation. VWI showed vessel wall enhancement at the suspected vessel involved, with evidence of acute infarcts at the vascular territory supplied. A presumptive diagnosis of AIS with spontaneous recanalization was made. Our experience could potentially aid in the understanding of spontaneous recanalization in patients with AIS, particularly in the postulation of the pathophysiology.

Hypoperfusion Intensity Ratio Predicts Infarct Growth After Successful Thrombectomy for Distal Medium Vessel Occlusion.

This study evaluated whether quantitative measurement of collaterals by the hypoperfusion intensity ratio (HIR) on baseline computed tomography perfusion (CTP) correlated with infarct growth and clinical outcome after successful endovascular recanalization of acute ischemic stroke (AIS) caused by primary distal medium vessel occlusions (DMVO). We performed aretrospective analysis of consecutive AIS patients who underwent an initial CTP and were successfully recanalized by thrombectomy (modified thrombolysis In cerebral infarction2b or3) for DMVO. We evaluated the association of baseline HIR with infarct growth and clinical outcome. Between January 2018 and January 2021, 40patients with an AIS caused by aDMVO were successfully recanalized by MT (65%, 26/40 female, median age 72 years, range 65-83 years). Baseline HIR was strongly correlated with infarct growth after successful recanalization (r = 0.501, p = 0.001). An HIR<0.3 was the optimal threshold for good collaterals using ROC analysis. Patients with HIR ≥ 0.3 had higher infarct growth compared to HIR < 0.3 (23.8 mL, IQR: 9.1-45.1 vs. 7.2 mL, interquartile range (IQR): 4.2-11.7, relative risk 7.9, p = 0.024 in multivariate analysis); their clinical outcome was poorer in univariate analysis (75%, 21/28patients with a3months modified Rankin scale of 0-2 vs. 33%,4/12, p < 0.017, odds ratio (OR) 6.0, 1.37-26.20) but it did not remain significant in multivariate analysis (p = 0.107). Good collaterals on initial CTP assessed by an HIR < 0.3 are associated with less infarct growth after successful recanalization of AIS caused by aDMVO.

Abstract TP102: Hypoperfusion Intensity Ratio Predicts Infarct Growth After Successful Thrombectomy For Distal Medium Vessel Occlusions

Background and Purpose: We evaluated whether quantitative measurement of collaterals by the hypoperfusion-intensity-ratio (HIR) on baseline computed-tomography-perfusion (CTP) was correlated with infarct growth after successful endovascular recanalization of acute ischemic stroke (AIS) with primary distal, medium vessel occlusions (DMVO), as well as clinical outcome. Methods: We performed a retrospective analysis of consecutive AIS patients who underwent an initial CTP and were successfully recanalized by thrombectomy for DMVO. We evaluated the association of baseline HIR with infarct growth and clinical outcome. Results: Between January 2018 and January 2021, 40 patients suffering from an AIS with DMVO were successfully recanalized by MT (65% [26/40] female, median age 72 [65-83] years). Baseline HIR was strongly correlated with Infarct growth after successful recanalization (r=0.501, p=0.001). ROC analysis determined that a HIR&lt;0.306 was an optimal threshold, it was associated with lower infarct growth compared to HIR≥0.306 (respectively 7.2 mL [IQR: 4.2-11.7] vs. 23.8 mL [IQR: 9.1-45.1], relative-risk of 0.38 [0.08-0.68], p = 0.015); as-well-as higher rates of good clinical outcome (75% [21/28] vs. 33% [4/12], p &lt; 0.017, Odds ratio 6.0 [1.37-26.20]). Conclusion: Good collaterals on initial CTP assessed by an HIR&lt;0.306 may be associated with less infarct growth and better clinical outcomes after MT recanalization for AIS with DMVO.

Influence of single pass recanalization in acute ischemic stroke with large vessel occlusion in patients of Asian ethnicity

Background and purposeA previous report revealed single pass recanalization was associated with better functional outcome for patients with acute ischemic stroke with large vessel occlusion in real-world settings. However, the effect of single pass recanalization in acute large vessel occlusion based on the largest registry in real-world settings in Asian population are not well scrutinized. Materials and methodsRESCUE-Japan Registry-2 was a physician-initiated prospective multicenter registry that enrolled consecutive patients with acute large vessel occlusion who were admitted within 24 h of onset. We compared patients who underwent endovascular therapy and achieved good recanalization in single or multiple device passes (single-pass group and multiple-passes group, respectively) in terms of the good outcome defined as modified Rankin Scale of 0–2 at 90 days after onset. We estimated the odds ratios, safety and mortality adjusting for confounders. ResultsAmong 2420 patients registered, 1281 patients treated with endovascular therapy. 829 patients were analyzed (557 patients in single-pass and 272 patients in multiple-passes group). Patient characteristics were almost similar between two groups. The good outcome was more observed of patients in the single groups (51.5% vs 39.3%). The adjusted odds ratio of single pass of good outcome was 1.92 (95% confidence interval, 1.37–2.69). The frequencies of symptomatic intracranial hemorrhage were similar between the two groups. ConclusionSingle pass recanalization was associated with good clinical outcome on real-world settings in Asian population.

Prediction of mTICI 3 recanalization and clinical outcomes in endovascular thrombectomy for acute ischemic stroke: a retrospective study in the Taiwan registry.

Early recanalization for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) by endovascular thrombectomy (EVT) is strongly related to improved functional outcomes. With data obtained from the Taiwan registry, the factors associated with mTICI 3 recanalization and clinical outcomes in EVT are investigated. From January 2014 to September 2016, 108 patients who underwent EVT for AIS due to LVO in 11 medical centers throughout Taiwan were included. Complete recanalization is defined as achieving modified thrombolysis in cerebral infarction (mTICI) grade 3. Good clinical outcomes are defined by the modified Rankin scale (mRS) 0-2 at 3months after EVT. Clinical and imaging parameters for predicting mTICI 3 recanalization and good clinical outcomes are analyzed. Of the 108 patients who received EVT, 54 (50%) patients had mTICI 3 recanalization. Having received aspiration only and the use of IV-tPA are shown to be significant predictors for mTICI 3 recanalization with odds ratios of 2.61 and 2.53 respectively. Forty-six (42.6%) patients experienced good 3-month clinical outcomes (mRS 0-2). Pretreatment collateral statuses, NIHSS scores, time lapses between symptoms to needle, and the occurrence of hemorrhage at 24h are all significant predictors for good outcomes with odds ratios of 2.88, 0.91, 0.99, and 0.31 respectively. Prediction of mTICI 3 recanalization and clinical outcomes offer valuable clinical information for treatment planning in EVT.

Clot-Based Radiomics Predict a Mechanical Thrombectomy Strategy for Successful Recanalization in Acute Ischemic Stroke.

Mechanical thrombectomy (MTB) is a reference treatment for acute ischemic stroke, with several endovascular strategies currently available. However, no quantitative methods are available for the selection of the best endovascular strategy or to predict the difficulty of clot removal. We aimed to investigate the predictive value of an endovascular strategy based on radiomic features extracted from the clot on preinterventional, noncontrast computed tomography to identify patients with first-attempt recanalization with thromboaspiration and to predict the overall number of passages needed with an MTB device for successful recanalization. We performed a study including 2 cohorts of patients admitted to our hospital: a retrospective training cohort (n=109) and a prospective validation cohort (n=47). Thrombi were segmented on noncontrast computed tomography, followed by the automatic computation of 1485 thrombus-related radiomic features. After selection of the relevant features, 2 machine learning models were developed on the training cohort to predict (1) first-attempt recanalization with thromboaspiration and (2) the overall number of passages with MTB devices for successful recanalization. The performance of the models was evaluated on the prospective validation cohort. A small subset of radiomic features (n=9) was predictive of first-attempt recanalization with thromboaspiration (receiver operating characteristic curve-area under the curve, 0.88). The same subset also predicted the overall number of passages required for successful recanalization (explained variance, 0.70; mean squared error, 0.76; Pearson correlation coefficient, 0.73; P<0.05). Clot-based radiomics have the ability to predict an MTB strategy for successful recanalization in acute ischemic stroke, thus allowing a potentially better selection of the MTB strategy, as well as patients who are most likely to benefit from the intervention.

Contact aspiration compared to stent retriever as sole intention to treat large-vessel occlusion in ischemic stroke

Background and purposeA direct aspiration first-pass technique (ADAPT) was recently evaluated in three retrospective trials as the primary method for large-vessel recanalization in acute ischemic stroke. This study sought to evaluate the clinical and angiographic outcome of ADAPT when used as the first and only method of clot retrieval compared to the accepted mechanical approach. Materials and methodsPatients with acute ischemic stroke associated with large-vessel occlusion who underwent ADAPT as the first and only intention-to-treat endovascular approach in 2010–2017 were matched 1-to-2 with patients treated by stent retriever thrombectomy. Demographic, imaging, procedural, and clinical data were collected retrospectively for between-group analysis. ResultsThe study group included 39 patients (51% male) of mean age 67 years; median National Institute of Health Stroke Scale score was 16. Compared to the stent-retriever group (N = 80), the ADAPT group had a significantly shorter puncture-to-recanalization time (58 min vs 76 min, P = 0.05), higher rate of good recanalization (TICI 2B/3 95% vs 86%, P = 0.15), and significantly higher rate of early neurological improvement (64% vs 43% of patients, P < 0.03). Procedure-related symptomatic intracerebral hemorrhage occurred in 8 patients, all in the control group (P = 0.05). At 3 months, a favorable outcome (mRS ≤ 2) was documented in 58% of the ADAPT group and 32% of the control group (P = 0.005); the respective mortality rates were 5% and 18% (P < 0.05). ConclusionsADAPT is a safe and an effective technique that has facilitated our approach to acute ischemic stroke thrombectomy, achieving better angiographic and clinical outcomes.