Characteristic and prognosis of acute large vessel occlusion in anterior and posterior circulation after endovascular treatment: the ANGEL registry real world experience

Huo, Xiaochuan; Raynald, -; Gao, Feng; Ma, Ning; Mo, Dapeng; Sun, Xuan; Song, Ligang; Jia, Baixue; Pan, Yuesong; Wang, Yilong; Liu, Liping; Zhao, Xingquan; Miao, Zhongrong; investigators, Angel

doi:10.1007/s11239-020-02054-2

Cited by 29 publications

(41 citation statements)

References 19 publications

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“…The etiology of LVO in the posterior circulation and the composition of such thrombi (including the proportion of leukocytes) are different from those of the anterior circulation LVO [18,19]. In our study higher median neutrophil and slightly higher lymphocyte and monocyte counts in the posterior LVO group may be related to these conditions.…”

Section: Discussioncontrasting

confidence: 57%

Relationship Between Leukocyte Counts and Large Vessel Occlusion in Acute Ischemic Stroke

Tarkanyi

Karadi

Szabó

et al. 2020

Preprint

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Background: Neuroinflammation plays an important role in the pathogenesis of acute ischemic stroke (AIS) and peripheral leukocyte counts have proved to be independent predictors of stroke severity and outcomes. Clinical significance of large vessel occlusion (LVO) in AIS is increasing, as these patients are potential candidates for endovascular thrombectomy and likely to have worse outcomes if not treated urgently. The aim of our study was to assess the relationship between on admission leukocyte counts and the presence of LVO in the early phase of AIS.Methods: We have conducted a cross-sectional, observational study based on a registry of consecutive AIS patients admitted up to 4.5 hours after stroke onset. Blood samples were taken at admission and leukocyte counts were measured immediately. The presence of LVO was verified based on the computed tomography angiography scan on admission.Results: Total white blood cell (WBC) and neutrophil counts were significantly higher in patients with LVO than those without LVO (P<0.001 respectively). After adjustment for potential confounders total WBC counts (adjusted OR: 1.405 per 1x109/L increase, 95% CI: 1.209 to 1.632) and neutrophil counts (adjusted OR: 1.344 per 1x109/L increase, 95% CI: 1.155 to 1.564) were found to have the strongest associations with the presence of LVO. Total WBC and neutrophil counts had moderate ability to discriminate an LVO in AIS (AUC: 0.667 and 0.655 respectively). No differences were recorded in leukocyte counts according to the size of the occluded vessel and the status of collateral circulation in the anterior vascular territory. However, total WBC and neutrophil counts tended to be higher in patients with LVO in the posterior circulation (p= 0.005 and 0.010 respectively).Conclusion: Higher admission total WBC and neutrophil counts are strongly associated with the presence of LVO and has moderate ability to discriminate an LVO in AIS. Detailed evaluation of stroke-evoked inflammatory mechanisms and changes according to the presence of LVO demands further investigation.

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Section: Discussioncontrasting

confidence: 57%

Relationship Between Leukocyte Counts and Large Vessel Occlusion in Acute Ischemic Stroke

Tarkanyi

Karadi

Szabó

et al. 2020

Preprint

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“…As a reason for high mortality in PCLVO, we propose a subtle progressive-over-time damage or a non-life supporting damage in the posterior circulation, possibly due to the gravity and irreversible nature of the damage to support life despite neurorehabilitation. Such damages have been described as a comatose state or locked-in syndrome, dysphagia, tracheostomy, hypostatic pneumonia, and complications as a result of being long-term bedridden (42). However, this hypothesis cannot be supported by the present study and we therefore encourage further studies to detect causes of higher mortality of MT in PCLVO.…”

Section: Discussioncontrasting

confidence: 55%

“…Sixteen eligible studies that met the study inclusion criteria were therefore included in our meta-analysis (Figure 1). Data from 11 studies (26,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) were acquired from multiple centers and data from 5 studies (44-48) were acquired from single centers. Among these studies, 6 were retrospective (35,39,(44)(45)(46)(47) and 10 were prospective studies (26, 34, 36-38, 40-43, 48).…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Comparison of Risk Factors, Safety, and Efficacy Outcomes of Mechanical Thrombectomy in Posterior vs. Anterior Circulation Large Vessel Occlusion

et al. 2021

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Background and Purpose: It is believed that stroke occurring due to posterior circulation large vessel occlusion (PCLVO) and that occurring due to anterior circulation large vessel occlusion (ACLVO) differ in terms of their pathophysiology and the outcome of their acute management in relation to endovascular mechanical thrombectomy (MT). Limited sample size and few randomized controlled trials (RCTs) with respect to PCLVO make the safety and efficacy of MT, which has been confirmed in ACLVO, difficult to assess in the posterior circulation. We therefore conducted a meta-analysis to study to which extent MT in PCLVO differs from ACLVO.Materials and Methods: We searched the databases PubMed, Cochrane, and EMBASE for studies published between 2010 and January 2021, with information on risk factors, safety, and efficacy outcomes of MT in PCLVO vs. ACLVO and conducted a systematic review and meta-analysis; we compared baseline characteristics, reperfusion treatment profiles [including rates of intravenous thrombolysis (IVT) and onset-to-IVT and onset-to-groin puncture times], recanalization success [Thrombolysis In Cerebral Infarction scale (TICI) 2b/3], symptomatic intracranial hemorrhage (sICH), and favorable functional outcome [modified Rankin Score (mRS) 0–2] and mortality at 90 days.Results: Sixteen studies with MT PCLVO (1,172 patients) and ACLVO (7,726 patients) were obtained from the search. The pooled estimates showed higher baseline National Institutes of Health Stroke Scale (NIHSS) score (SMD 0.32, 95% CI 0.15–0.48) in the PCLVO group. PCLVO patients received less often IVT (OR 0.65, 95% CI 0.53–0.79). Onset-to-IVT time (SMD 0.86, 95% CI 0.45–1.26) and onset-to-groin puncture time (SMD 0.59, 95% CI 0.33–0.85) were longer in the PCLVO group. The likelihood of obtaining successful recanalization and favorable functional outcome at 90 days was comparable between the two groups. PCLVO was, however, associated with less sICH (OR 0.56, 95% CI 0.37–0.85) but higher mortality (OR 1.92, 95% CI 1.46–2.53).Conclusions: This meta-analysis indicates that MT in PCLVO may be comparably efficient in obtaining successful recanalization and 90 day favorable functional outcome just as in ACLVO. Less sICH in MT-treated PCLVO patients might be the result of the lower IVT rate in this group. Higher baseline NIHSS and longer onset-to-IVT and onset-to-groin puncture times may have contributed to a higher 90 day mortality in PCLVO patients.

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“…Our meta-analysis also found that atrial fibrillation does not affect the clinical outcome of posterior circulation occlusion. This is attributable to the following: (1) due to obvious differences in vascular anatomy and hemodynamics [58], embolisms caused by atrial fibrillation are more commonly seen in anterior cerebral circulation [59], and the cardiogenic embolization rate of the posterior circulation is significantly lower than that of anterior circulation [59]. (2) Most patients with atrial fibrillation have been treated actively and properly before and after ischemic stroke [60], thereby slashing the original effect of atrial fibrillation on ischemic stroke prognosis.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

Xun

Ruan

et al. 2020

Cerebrovasc Dis

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Background: Posterior circulation stroke is characterized by poor prognosis because its optimal thrombolysis “time window” is always missed. After mechanical thrombectomy (MT), the recanalization rate of posterior circulation obstruction is significantly increased, but prognosis remains poor. To best manage patients, prognostic factors are needed to inform MT triaging after posterior circulation stroke. Methods: A systematic literature search was done for the period through April 2020. Studies included those with posterior circulation stroke cases that underwent MT. The primary outcome measure in this study was the modified Rankin Scale on day 90. Results: No outcome differences were found in gender, atrial fibrillation, smoking, and coronary artery disease (OR = 1.07, 95% CI: 0.90–1.28; OR = 1.02, 95% CI: 0.82–1.26; OR = 1.26, 95% CI: 0.94–1.68; and OR = 0.84, 95% CI: 0.58–1.22, respectively). Hypertension, diabetes mellitus, and previous stroke correlated with poorer prognosis (OR = 0.61, 95% CI: 0.48–0.77; OR = 0.60, 95% CI: 0.50–0.73; and OR = 0.74, 95% CI: 0.55–0.99, respectively). However, hyperlipidemia correlated with better prognosis (OR = 1.28, 95% CI: 1.04–1.58). Conclusion: Our analysis indicates that hypertension, diabetes mellitus, or previous stroke correlate with poorer outcomes. Intriguingly, hyperlipidemia correlates with better prognosis. These factors may help inform triage decisions when considering MT for posterior circulation stroke patients. However, large, multicenter, randomized controlled trials are needed to validate these observations.

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Characteristic and prognosis of acute large vessel occlusion in anterior and posterior circulation after endovascular treatment: the ANGEL registry real world experience

Cited by 29 publications

References 19 publications

Relationship Between Leukocyte Counts and Large Vessel Occlusion in Acute Ischemic Stroke

Relationship Between Leukocyte Counts and Large Vessel Occlusion in Acute Ischemic Stroke

Comparison of Risk Factors, Safety, and Efficacy Outcomes of Mechanical Thrombectomy in Posterior vs. Anterior Circulation Large Vessel Occlusion

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

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