Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients: a position paper endorsed by ESMINT and ESNR

Fiehler, Jens; Söderman, Michael; Turjman, Francis; White, Phil; Bakke, Søren Jacob; Mangiafico, Salvatore; Kummer, Ruediger von; Muto, Mario; Cognard, Christophe; Gralla, Jan

doi:10.1007/s00234-012-1075-z

Cited by 12 publications

(6 citation statements)

References 62 publications

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“…Interventional treatment of acute stroke patients with proximal artery occlusion of the anterior circulation remains a major focus of current endovascular trials. 1 With technical advancements of mechanical thrombectomy, higher and more consistent rates of recanalization are achieved compared with intravenous (IV) therapy alone. However, endovascular treatment has not unequivocally translated into a measureable patient benefit in randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Kemmling

Flottmann

Forkert

et al. 2015

J Cereb Blood Flow Metab

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Benefit of endovascular recanalization beyond established treatment time windows likely exists in select stroke patients. However, there is currently no imaging model that predicts infarction adjusting for elapsed time between the pathologic snapshot of admission imaging until endovascular recanalization. We trained and cross validated a multivariate generalized linear model (GLM) that uses computer tomography perfusion and clinical data to quantify patient-specific dynamic change of tissue infarction depending on degree and time of recanalization. Multicenter data of 161 patients with proximal anterior circulation occlusion undergoing endovascular therapy were included. Multivariate voxelwise infarct probability was calculated within the GLM. The effect of increasing time to treatment and degree of recanalization on voxelwise infarction was calculated in each patient. Tissue benefit of successful relative to unsuccessful recanalization was shown up to 15 hours after onset in individual patients and decreased nonlinearly with time. On average, the relative reduction of infarct volume at the treatment interval of 5 hours was 53% and this salvage effect decreased by 5% units per hour to o 5% after 10 additional hours to treatment. Treatment time-adjusted multivariate prediction of infarction by perfusion and clinical status may identify patients who benefit from extended time to recanalization therapy.

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Section: Introductionmentioning

confidence: 99%

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Kemmling

Flottmann

Forkert

et al. 2015

J Cereb Blood Flow Metab

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“…At launch, the study employed a ‘target mismatch’ strategy, using multimodal computed tomography (CT) or magnetic resonance imaging (MRI), including perfusion sequences, to identify patients with salvageable tissue (10). Subsequently, to accommodate sites with limited perfusion imaging capability and ensure accelerated treatment delivery (11), Revision F of the study changed imaging entry criteria to employ a ‘small to moderate core’ strategy, using Alberta Stroke Program Early CT score (ASPECTS) ratings of CT or magnetic resonance (MR) images (12).…”

Section: Methodsmentioning

confidence: 99%

Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) Trial: Protocol for a Randomized, Controlled, Multicenter Study Comparing the Solitaire Revascularization Device with IV tPA with IV tPA Alone in Acute Ischemic Stroke

Saver

Goyal

Bonafé

et al. 2015

International Journal of Stroke

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249

157

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RationaleEarly reperfusion in patients experiencing acute ischemic stroke is critical, especially for patients with large vessel occlusion who have poor prognosis without revascularization. Solitaire™ stent retriever devices have been shown to immediately restore vascular perfusion safely, rapidly, and effectively in acute ischemic stroke patients with large vessel occlusions.AimThe aim of the study was to demonstrate that, among patients with large vessel, anterior circulation occlusion who have received intravenous tissue plasminogen activator, treatment with Solitaire revascularization devices reduces degree of disability 3 months post stroke.DesignThe study is a global multicenter, two-arm, prospective, randomized, open, blinded end-point trial comparing functional outcomes in acute ischemic stroke patients who are treated with either intravenous tissue plasminogen activator alone or intravenous tissue plasminogen activator in combination with the Solitaire device. Up to 833 patients will be enrolled.ProceduresPatients who have received intravenous tissue plasminogen activator are randomized to either continue with intravenous tissue plasminogen activator alone or additionally proceed to neurothrombectomy using the Solitaire device within six-hours of symptom onset.Study OutcomesThe primary end-point is 90-day global disability, assessed with the modified Rankin Scale (mRS). Secondary outcomes include mortality at 90 days, functional independence (mRS ≤ 2) at 90 days, change in National Institutes of Health Stroke Scale at 27 h, reperfusion at 27 h, and thrombolysis in cerebral infarction 2b/3 flow at the end of the procedure.AnalysisStatistical analysis will be conducted using simultaneous success criteria on the overall distribution of modified Rankin Scale (Rankin shift) and proportions of subjects achieving functional independence (mRS 0–2).

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“…However, when the denominator in equation ( 1) is the minimum, it will lead to the instability of backpropagation and derivation. In order to solve this problem, the weighted binary cross entropy (WBCE) loss function [8] is introduced, and its expression is…”

Section: Wbce-tversky Loss Functionmentioning

confidence: 99%

Evaluation of Ischemic Penumbra in Stroke Patients Based on Deep Learning and Multimodal CT

Liu

Qin

Liu

2021

Journal of Healthcare Engineering

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In order to investigate the value of multimodal CT for quantitative assessment of collateral circulation, ischemic semidark zone, core infarct volume in patients with acute ischemic stroke (AIS), and prognosis assessment in intravenous thrombolytic therapy, segmentation model which is based on the self-attention mechanism is prone to generate attention coefficient maps with incorrect regions of interest. Moreover, the stroke lesion is not clearly characterized, and lesion boundary is poorly differentiated from normal brain tissue, thus affecting the segmentation performance. To address this problem, a primary and secondary path attention compensation network structure is proposed, which is based on the improved global attention upsampling U-Net model. The main path network is responsible for performing accurate lesion segmentation and outputting segmentation results. Likewise, the auxiliary path network generates loose auxiliary attention compensation coefficients, which compensate for possible attention coefficient errors in the main path network. Two hybrid loss functions are proposed to realize the respective functions of main and auxiliary path networks. It is experimentally demonstrated that both the improved global attention upsampling U-Net and the proposed primary and secondary path attention compensation networks show significant improvement in segmentation performance. Moreover, patients with good collateral circulation have a small final infarct area volume and a good clinical prognosis after intravenous thrombolysis. Quantitative assessment of collateral circulation and ischemic semidark zone by multimodal CT can better predict the clinical prognosis of intravenous thrombolysis.

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Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients: a position paper endorsed by ESMINT and ESNR

Cited by 12 publications

References 62 publications

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) Trial: Protocol for a Randomized, Controlled, Multicenter Study Comparing the Solitaire Revascularization Device with IV tPA with IV tPA Alone in Acute Ischemic Stroke

Evaluation of Ischemic Penumbra in Stroke Patients Based on Deep Learning and Multimodal CT

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