Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Sinha, Akansha; Stanwell, Peter; Beran, Roy G.; Calic, Zeljka; Killingsworth, Murray C.; Bhaskar, Sonu

doi:10.3390/neurolint13040060

Cited by 14 publications

(14 citation statements)

References 44 publications

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“…A higher pc-ASPECT in our analysis was associated with a good clinical outcome at 3 months too. This is reasonable since we know that pc-ASPECT detects the areas of brain tissue that are already ischemic before the treatment [19], probably reflecting the status of the collateral circulation [20]. Anyhow, the evaluation of the score is difficult with CT, due to posterior fossa beam hardening artefacts, particularly in the brainstem; these limits may cause low sensitivity and great interobserver variability [21].…”

Section: Discussionmentioning

confidence: 99%

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre

Valente

Consoli

et al. 2021

Life

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Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion (“functional” BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0–0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0–0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33–16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16–3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.

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Section: Discussionmentioning

confidence: 99%

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre

Valente

Consoli

et al. 2021

Life

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“…Hematoxylin and eosin (H&E) staining was the most commonly performed histological analysis, used by 19 studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Martius Scarlet Blue (MSB) [ 16 , 22 , 23 , 24 , 40 ] and Elastica van Gieson (EVG) [ 18 , 28 , 30 , 32 , 33 , 35 ] staining were both selected in 5 studies, Prussian Blue in 3 [ 18 , 28 , 33 , 35 ], Masson’s trichrome in 2 [ 36 , 37 ], and Ladewig’s trichrome [ 39 ], Von Kossa [ 39 ], naphthol AS-D [ 39 ], chloroacetate [ 39 ], and Mallory’s phosphotungstic acid-hematoxylin [ 18 ] were included once each. One study used scanning electron microscope [ 32 ], and eight studies employed immunohistochemistry in their analyses [ 13 , 15 , 16 , 18 , 22 ,…”

Section: Resultsmentioning

confidence: 99%

“…One study [ 26 ] reported greater WBC content in strokes of non-cardioembolic origin, and another study [ 21 ] reported greater WBC content in cardioembolic strokes. Seven studies found no significant association [ 13 , 14 , 17 , 19 , 20 , 22 , 28 , 30 ]. Eight studies with 339 participants were included in the meta-analysis studying WBC content and aetiology.…”

Section: Resultsmentioning

confidence: 99%

“…This is especially poignant to cryptogenic strokes, which contributes to 30–40% of AIS patients [ 27 ], and poses a huge diagnostic challenge in a real-world setting. Interestingly, a recent meta-analysis from our group also reported significant association of LAA or cardioembolic stroke aetiologies with collateral status in AIS patients receiving reperfusion therapy, with LAA and cardioembolic being associated with increased rate of good and bad collaterals, respectively [ 28 ]. Beyond embolism, other factors such as atrial fibrillation and human immunodeficiency virus (HIV) infection may also cause stroke [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 98%

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Is Composition of Brain Clot Retrieved by Mechanical Thrombectomy Associated with Stroke Aetiology and Clinical Outcomes in Acute Ischemic Stroke?—A Systematic Review and Meta-Analysis

Huang

Killingsworth

Bhaskar

2022

Neurology International

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Background: Brain clots retrieved following endovascular thrombectomy in acute ischemic stroke patients may offer unique opportunities to characterise stroke aetiology and aid stroke decision-making in select groups of patients. However, the evidence around the putative association of clot morphology with stroke aetiology is limited and remains inconclusive. This study aims to perform a systematic review and meta-analysis to delineate the association of brain clot composition with stroke aetiology and post-reperfusion outcomes in patients receiving endovascular thrombectomy. Methods: The authors conducted a systematic literature review and meta-analysis by extracting data from several research databases (MEDLINE/PubMed, Cochrane, and Google Scholar) published since 2010. We used appropriate key search terms to identify clinical studies concerning stroke thrombus composition, aetiology, and clinical outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The authors identified 30 articles reporting on the relationship between stroke thrombus composition or morphology and aetiology, imaging, or clinical outcomes, of which 21 were included in the meta-analysis. The study found that strokes of cardioembolic origin (SMD = 0.388; 95% CI, 0.032–0.745) and cryptogenic origin (SMD = 0.468; 95% CI, 0.172–0.765) had significantly higher fibrin content than strokes of non-cardioembolic origin. Large artery atherosclerosis strokes had significantly lower fibrin content than cardioembolic (SMD = 0.552; 95% CI, 0.099–1.004) or cryptogenic (SMD = 0.455; 95% CI, 0.137–0.774) strokes. Greater red blood cell content was also significantly associated with a thrombolysis in cerebral infarction score of 2b–3 (SMD = 0.450; 95% CI, 0.177–0.722), and a positive hyperdense middle cerebral artery sign (SMD = 0.827; 95% CI, 0.472–1.183). No significant associations were found between red blood cell, platelet, or white blood cell content and aetiology, or between clot composition and bridging thrombolysis. Conclusions: This meta-analysis found that fibrin composition is significantly higher in strokes of cardioembolic and cryptogenic origin, and that red blood cell content is positively associated with the hyperdense middle cerebral artery sign and better reperfusion outcomes. Important advances to stroke clinical workup can be derived from these findings, in which many aspects of stroke workflow remain to be optimised. As data are still limited in terms of the association of various thrombus components with stroke aetiology as well as a standardised method of analysis, further studies are required to validate these findings to guide their use in clinical decision-making.

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“…Therefore, studies aimed at delineating the stroke etiology, acute therapeutic options, biomarkers of prognosis, and poststroke long-term management of IE patients will provide insights to improve clinical outcomes in these high-risk patients. 11 - 13 …”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review

Maheshwari

Cordato

Wardman

et al. 2022

J Cent Nerv Syst Dis

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Background Acute ischemic stroke (AIS) is a common and fatal complication of infective endocarditis (IE); however, there is a lack of understanding regarding treatment efficacy. This systematic review aimed to evaluate the safety and efficacy of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) in IE patients experiencing AIS. Objectives The aim of this study was to perform a systematic review investigating the outcomes of AIS in IE patients receiving IVT and/or EVT as a treatment method and to evaluate the safety and efficacy of these methods of reperfusion therapy. Design A systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted. Data Sources and Methods The EMBASE, Cochrane, and PubMed databases were searched for literature published between 2005 and 2021 investigating outcomes of reperfusion therapy post-AIS in IE and non-IE patients. Descriptive statistics were used to describe the overall frequency of clinical outcomes, and groupwise comparisons were performed using Fisher’s exact test to assess the significance of groupwise differences. Results Three studies were finally included in the systematic review. A total of 13.5% of IE patients compared to 37% of non-IE patients achieved a good functional outcome (modified Rankin Scale score≤ 2) ( P < .001). Furthermore, a larger percentage of the IE cohort achieved good functional outcomes after EVT (22.0%) compared to IVT (10.4%) ( P = .013). The IE cohort also had a higher 3-month postreperfusion mortality rate (48.8%) compared to the non-IE cohort (24.9%) ( P < .001). The rate of intracranial hemorrhage (ICH) postreperfusion was also significantly higher in the IE cohort (23.5%) than in the non-IE cohort (6.5%) ( P < .001). Conclusion AIS patients with IE, treated with IVT, EVT, or a combination of the two, experience worse clinical and safety outcomes than non-IE patients. EVT yielded better functional outcomes, albeit with higher postreperfusion ICH rates, than IVT.

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Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Cited by 14 publications

References 44 publications

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Is Composition of Brain Clot Retrieved by Mechanical Thrombectomy Associated with Stroke Aetiology and Clinical Outcomes in Acute Ischemic Stroke?—A Systematic Review and Meta-Analysis

Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review

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