Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

Goyal, Mayank; Demchuk, Andrew M.; Menon, Bijoy K; Eesa, Muneer; Rempel, Jeremy; Thornton, John; Roy, Daniel; Jovin, Tudor G; Willinsky, Robert A.; Sapkota, Biggya; Dowlatshahi, Dar; Frei, Donald; Kamal, Noreen; Montanera, Walter; Poppe, Alexandre Y; Ryckborst, Karla J; Silver, Frank L.; Shuaib, Ashfaq; Tampieri, Donatella; Williams, David; Bang, Oh Young; Baxter, Blaise; Burns, Paul; Choe, Hana; Heo, Ji-Hoe; Holmstedt, Christine A; Jankowitz, Brian T.; Kelly, Michael; Linares, Guillermo; Mandzia, Jennifer; Shankar, Jai Jai Shiva; Sohn, Sung‐Il; Swartz, Richard H.; Barber, Philip A.; Coutts, Shelagh B.; Smith, Eric E.; Morrish, William F.; Weill, Alain; Subramaniam, Suresh; Mitha, Alim P.; Wong, John H.; Lowerison, Mark; Sajobi, Tolulope T.; Hill, Michael D

doi:10.1056/nejmoa1414905

Cited by 5,300 publications

(4,046 citation statements)

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“…2015; Goyal et al. 2015). Our analysis did not show a significant interaction of reperfusion and collaterals on outcome, that is, the effect of reperfusion on outcome seemed to be independent of the collaterals rated on CTA.…”

Section: Discussionmentioning

confidence: 99%

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

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Section: Discussionmentioning

confidence: 99%

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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“…Reducing the size of the lesion to potentially promote better functional outcomes is the driving force behind interventions such as intravenous tissue plasminogen activator8 and mechanical embolectomy 9. However, most studies have indicated that the correlation between infarct volume and functional outcomes are only moderate,7, 10 if related at all 4, 11.…”

Section: Introductionmentioning

confidence: 99%

Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery

Hawe

Findlater

Kenzie

et al. 2018

JAHA

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BackgroundUnderstanding how the size of acute lesions and white matter hyperintensities (WMH) impact stroke recovery can improve our ability to predict outcomes and tailor treatments. The aim of this exploratory study was to investigate the role of acute lesion volume and WMH volume on longitudinal recovery of specific sensory, motor, and cognitive impairments after stroke using robotic and clinical measures.Methods and ResultsEighty‐two individuals were assessed at 1, 6, 12, and 26 weeks poststroke with robotic tasks and commonly used clinical measures. The volumes of acute lesions and WMH were measured on fluid‐attenuated inversion recovery images. Linear mixed models were used to investigate the role of acute lesions and WMH on parameters derived from the robotic tasks and clinical measures. Regression analysis determined the added value of acute lesion and WMH volumes along with measures of initial performance to predict outcomes at 6 months. Acute lesion volume has widespread effects on sensory, motor, and overall functional recovery poststroke. The impact of WMH was specific to cognitive impairments. Apart from the robotic position sense task, neither lesion volume nor WMH measure had significant ability to predict outcomes at 6 months over using initial impairment as measured by robotic assessments alone.ConclusionsWhile acute lesion volume and WMH may impact different impairments poststroke, their clinical utility in predicting outcomes at 6 months poststroke is limited.

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“…Recently it was shown that intra‐arterial treatment (IAT) is highly effective in patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, and it has revolutionized stroke treatment 1, 2, 3, 4, 5, 6…”

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confidence: 99%

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

Autar

Hund

Ramlal

et al. 2018

JAHA

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BackgroundCurrently, acute ischemic stroke is still a leading cause of mortality and morbidity. Approximately 2 years ago, mechanical thrombectomy was proven beneficial as a revolutionary new therapy for stroke in the MR‐CLEAN trial (A Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). However, the mechanisms by which the thrombectomy device, or stent‐retriever, interacts with the thrombus are largely unknown. A better understanding could lead to improved efficacy of mechanical thrombectomy devices.Methods and ResultsSeven stent‐retrievers with thrombi still entrapped were collected directly after thrombectomy. The stent‐retrievers were studied using micro computed tomography, followed by scanning electron microscopy and light microscopy. Two independent observers rated interaction type and thrombus surface structure (porous filamentous or dense) at the interaction sites.A total of 79 interaction sites between thrombus and stent‐retriever were categorized. Thrombus‐stent‐retriever interaction was found to be adhesive (n=44; 56%) or mechanical (n=35; 44%). Adhesive interaction was most frequently observed at interaction sites with a dense surface, compared with interaction sites with a porous filamentous fibrin surface (38/58; 66% versus 6/21; 29%, P=0.011).ConclusionsThe interaction between thrombus and stent‐retriever was predominantly adhesive, not mechanical. Adhesive interaction was strongly associated with the presence of a dense thrombus surface without a porous filamentous fibrin network.

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Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

Cited by 5,300 publications

References 37 publications

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

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