Preprocedural Imaging

Jing, Mingxue; Yeo, Joshua; Holmin, Staffan; Andersson, Tommy; Arnberg, Fabian; Bhogal, Paul; Yang, Chao; Gopinathan, Anil; Tu, Tian Ming; Tan, Benjamin Yong Qiang; Sia, Ching‐Hui; Teoh, Hock Luen; Paliwal, Prakash; Chan, Bernard P.L.; Sharma, Vijay K; Yeo, Leonard Leong‐Litt

doi:10.1007/s00062-021-01095-1

Cited by 4 publications

(2 citation statements)

References 88 publications

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“…However, these vessels were not included in the field-of-view of the CTA scans. Hard or resistant occlusions can be another reason for unsuccessful revascularization, 36 but whether characteristics on pre-intervention CT, such as hyperdense vessel sign, are related to treatment success is not clear 37 and thrombus density measures are only recently improved for use in clinical practice. 38 Both factors were therefore outside the scope of our analyses.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Holswilder

Stuart

Dompeling

et al. 2022

European Stroke Journal

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Introduction Vascular anatomy might affect endovascular treatment success in acute ischemic stroke patients with large vessel occlusion. We investigated the prognostic value of extracranial vascular characteristics on procedural time and revascularization success in patients with large vessel occlusion in the anterior cerebral circulation. Patients and methods We included 828 patients endovascularly treated within 6.5 hours of symptom onset from the Dutch MR CLEAN-Registry. We evaluated aortic arch configuration, stenosis and tortuosity of supra-aortic arteries, and internal carotid arteries (ICAs) on pre-intervention CTA. We constructed logistic prediction models for outcome variables procedural duration (≥60 minutes) and non-successful revascularization (extended thrombolysis in cerebral infarction (eTICI) of 0–2A) using baseline characteristics and assessed the effect of extracranial vascular characteristics on model performance. Results Cervical ICA tortuosity and stenosis ≥99% improved prediction of long procedural duration compared with baseline characteristics from area under the curve of 0.61 (95% CI: 0.57–0.65) to 0.66 (95% CI: 0.62–0.70) ( P < 0.001). Cervical ICA tortuosity was significantly associated with non-successful recanalization. Prediction of non-successful revascularization did not improve after including aortic arch elongation, acute take-off angle, aortic variant, origin stenosis of supra-aortic arteries, and cervical ICA tortuosity, with an area under the curve of 0.63 (95% CI: 0.59–0.67) compared with 0.59 (95% CI: 0.55–0.63) ( P = 0.11). Conclusion Extracranial vascular characteristics have additional prognostic value for procedural duration, but not for revascularization success, compared with baseline characteristics. Performance of both prediction models is limited in patients treated for large vessel occlusion.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Holswilder

Stuart

Dompeling

et al. 2022

European Stroke Journal

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“… 30 Therefore, the use of different radiological parameters should be evaluated to predict the outcome after thrombectomy. 31 …”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy in ischemic stroke after cardiovascular procedures: a propensity-matched cohort analysis

Bay

Gloyer

Remmel

et al. 2022

J NeuroIntervent Surg

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BackgroundStroke after a cardiovascular procedure (CVP) is a devastating complication adversely affecting outcome. Mechanical thrombectomy (MT) has not been investigated systematically in this population.ObjectiveTo carry out a retrospective study in patients undergoing MT for early stroke after CVP, aiming to further characterize this cohort of patients, and to evaluate the efficacy, safety, procedural characteristics, and outcome of MT.MethodsA single-center stroke registry of patients who received MT was analyzed. Baseline and procedural parameters, mortality, functional outcome, recanalization rates, and complications were evaluated. Propensity score matching was carried out, identifying a control cohort with non-periprocedural large vessel occlusion (LVO).ResultsOverall 913 patients were included (mean age 73.0 (±13.0) years, 52.5% female, median National Institutes of Health Stroke Scale score 15 (10–19)). Eleven patients with a LVO after a recent (<30 days postoperatively) CVP were identified (n=3 transcatheter aortic valve and n=1 surgical aortic valve replacements (SAVR), n=3 coronary bypass grafting (CABG) surgeries, n=2 SAVR+CABG, and n=2 aortic surgeries). After matching, 8 patients in the CVP group were compared with 16 patients in the matched cohort. Comparable rates of reperfusion were achieved. Time from symptom onset to groin puncture (171.5 min (136.3, 178.3) vs 284.0 min (215.0, 490.5); p=0.039), as well as recanalization (195.0 min (146.0, 201.0) vs 419.0 min (274.0, 613.0); p=0.028) was faster in the CVP group. However, this was not reflected by an improved outcome (modified Rankin Scale score after 90 days: 5.5 (3.3, 6.0) vs 5.0 (4.0, 6.0), mortality after 90 days 50.0% vs 37.5%). Complications did not differ between the groups.ConclusionsUse of MT for LVO stroke in patients after a recent CVP is a safe and efficient treatment in comparison with patients with a non-periprocedural LVO undergoing MT.

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Extended Imaging Protocols to Elucidate Sources of Cardiovascular Embolism in the Work-up of Ischemic Stroke

et al. 2021

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Preprocedural Imaging

Cited by 4 publications

References 88 publications

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Mechanical thrombectomy in ischemic stroke after cardiovascular procedures: a propensity-matched cohort analysis

Extended Imaging Protocols to Elucidate Sources of Cardiovascular Embolism in the Work-up of Ischemic Stroke

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