Endovascular Therapy for Ischemic Stroke

Berkhemer, Olvert A.; Majoie, Charles B. L. M.; Dippel, Diederik W.J.

doi:10.1056/nejmc1504715

Cited by 89 publications

(28 citation statements)

References 62 publications

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“…In accordance with the latest trials on MT, 5,[35][36][37][38][39] our study population demonstrated a significant benefit from successful recanalization with significantly better clinical and imaging outcomes than nonsuccessfully recanalized patients. Although selection of our patient population was not ideal compared with the controlled thrombectomy trials, 5,35,38 our study has the advantage of reflecting daily clinical routine better.…”

Section: Estimation As Malignant Mismatch Profilesupporting

confidence: 86%

Comparison of Perfusion CT Software to Predict the Final Infarct Volume After Thrombectomy

Austein

Riedel

Kerby

et al. 2016

Stroke

197

158

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Background and Purpose-Computed tomographic perfusion represents an interesting physiological imaging modality to select patients for reperfusion therapy in acute ischemic stroke. The purpose of our study was to determine the accuracy of different commercial perfusion CT software packages (Philips (A), Siemens (B), and RAPID (C)) to predict the final infarct volume (FIV) after mechanical thrombectomy. Methods-Single-institutional computed tomographic perfusion data from 147 mechanically recanalized acute ischemic stroke patients were postprocessed. Ischemic core and FIV were compared about thrombolysis in cerebral infarction (TICI) score and time interval to reperfusion. FIV was measured at follow-up imaging between days 1 and 8 after stroke. Results-In 118 successfully recanalized patients (TICI 2b/3), a moderately to strongly positive correlation was observed between ischemic core and FIV. The highest accuracy and best correlation are shown in early and fully recanalized patients (Pearson r for A=0.42, B=0.64, and C=0.83; P<0.001). Bland-Altman plots and boxplots demonstrate smaller ranges in package C than in A and B. Significant differences were found between the packages about over-and underestimation of the ischemic core. Package A, compared with B and C, estimated more than twice as many patients with a malignant stroke profile (P<0.001). Package C best predicted hypoperfusion volume in nonsuccessfully recanalized patients. Conclusions-Our study demonstrates best accuracy and approximation between the results of a fully automated software (RAPID) and FIV, especially in early and fully recanalized patients. Furthermore, this software package overestimated the FIV to a significantly lower degree and estimated a malignant mismatch profile less often than other software.

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Section: Estimation As Malignant Mismatch Profilesupporting

confidence: 86%

Comparison of Perfusion CT Software to Predict the Final Infarct Volume After Thrombectomy

Austein

Riedel

Kerby

et al. 2016

Stroke

197

158

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“…[7][8][9] For this study, home-time was defined as the total number of days alive and out of acute care hospitals, inpatient rehabilitation, or skilled nursing facilities from the first day forward of index hospital admission for acute ischemic stroke. Inpatient days in these settings were identified in Medicare inpatient and skilled nursing facility claims.…”

Section: Discussionmentioning

confidence: 99%

“…5 This has been proposed as a graded and objective functional outcome measure for international acute ischemic stroke trials and has been shown to correlate with mRS in clinical trial populations and demonstrate gains in response to effective stroke therapies, such as intravenous tissue-type plasmiogen activator and mechanical thrombectomy treatment. [5][6][7] More recently, stroke survivors have identified home-time as a meaningful and highly prioritized outcome. [8][9][10] Home-time may thus represent an outcome measure that is more easily understood by patients with stroke, their families, and clinicians.…”

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confidence: 99%

Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries

Fonarow

Thomas

et al. 2016

Stroke

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Background and Purpose-Stroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. Methods-Patients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0-2) was assessed by c-index. Results-There

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“…After successful clinical trials in patients with occlusion of a major intracranial artery, mechanical thrombectomy (MT) with stent retrievers adds a novel therapeutic option in patients with acute ischemic stroke (AIS) [ 1 , 2 , 3 ]. As MT is only applicable in approximately 5%–10% of patients with ischemic stroke, intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator is still the treatment of choice for most patients with AIS [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke

Schuhmann

Gunreben

Kleinschnitz

et al. 2016

IJMS

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Mechanical thrombectomy is a novel treatment option for patients with acute ischemic stroke (AIS). Only a few studies have previously suggested strategies to categorize retrieved clots according to their histologic composition. However, these reports did not analyze potential biomarkers that are of importance in stroke-related inflammation. We therefore histopathologically investigated 37 intracerebral thrombi mechanically retrieved from patients with AIS, and focused on the composition of immune cells and platelets. We also conducted correlation analyses of distinctive morphologic patterns (erythrocytic, serpentine, layered, red, white, mixed appearance) with clinical parameters. Most T cells and monocytes were detected in erythrocytic and red clots, in which the distribution of these cells was random. In contrast, von Willebrand factor (vWF)-positive areas co-localized with regions of fibrin and collagen. While clots with huge amounts of vWF seem to be associated with a high National Institute of Health Stroke Scale score at admission, histologic findings could not predict the clinical outcome at discharge. In summary, we provide the first histologic description of mechanically retrieved intracerebral thrombi regarding biomarkers relevant for inflammation in ischemic stroke.

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Endovascular Therapy for Ischemic Stroke

Cited by 89 publications

References 62 publications

Comparison of Perfusion CT Software to Predict the Final Infarct Volume After Thrombectomy

Comparison of Perfusion CT Software to Predict the Final Infarct Volume After Thrombectomy

Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries

Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke

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