Acute Ischemic Stroke

Manning, Nathan; Campbell, Bruce C.V.; Oxley, Tom; Chapot, René

doi:10.1161/strokeaha.113.003798

Cited by 99 publications

(38 citation statements)

References 52 publications

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“…Yet, factors that were independently associated with poor outcome in our cohort were higher age, higher morbidity, and stroke-related factors, including higher initial NIHSS values and particularly poor recanalization rates. This corresponds well to previous analyses in MT trials reporting poorer outcome in older patients [28], in patients with more severe strokes [19], and in patients with poor recanalization results [29]. However, we identified an association of lower GFR with mortality at 3 months, a result that corresponded to a large analysis on the influence of RD in stroke patients receiving systemic thrombolysis with rtPA [3] and another observational study [27].…”

Section: Discussionsupporting

confidence: 91%

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Laible

Möhlenbruch²,

Pfaff³

et al. 2017

Cerebrovasc Dis

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Background: Renal dysfunction (RD) may be associated with poor outcome in ischemic stroke patients treated with mechanical thrombectomy (MT), but data concerning this important and emerging comorbidity do not exist so far. Here, we investigated the influence of RD on postprocedural intracerebral hemorrhage (ICH), clinical outcome, and mortality in a large prospectively collected cohort of acute ischemic stroke patients treated with MT. Methods: Consecutive patients with anterior-circulation stroke treated with MT between October 2010 and January 2016 were included. RD was defined as glomerular filtration rate (GFR) <60 mL/min/1.73 m². In a prospective database, clinical characteristics were recorded and brain images were analyzed for the presence of ICH after treatment in all patients. Clinical outcome was assessed by the modified Rankin Scale (mRS) after 3 months. To evaluate associations between clinical factors and outcomes uni- and multivariate regression analyses were conducted. Results: In total, 505 patients fulfilled all inclusion criteria (female: 49.7%, mean age: 71.0 years). RD at admission was present in 20.2%. RD patients were older and had cardiovascular risk factors more often. Multivariate regression analysis after adjustment for age, stroke severity, diabetes, hypertension, GFR, previous stroke, MT alone, or additional thrombolysis and recanalization results revealed that lower GFR was not independently associated with poor outcome (mRS 3-6; OR 1.13, 95% CI 0.99-1.28; p = 0.072) or ICH. However, lower GFR at admission was associated with a higher risk of mortality (OR 1.15, 95% CI 1.01-1.31; p = 0.038). Compared to admission, GFR values were higher at discharge (mean: 77.9 vs. 80.8 mL/min/1.73 m²; p = 0.046). Conclusions: We did not find evidence for an association of lower GFR with an increased risk of poor outcome and ICH, but lower GFR was a determinant of 90-day mortality after endovascular stroke treatment. Our findings encourage also performing MT in this relevant subgroup of acute ischemic stroke patients.

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Section: Discussionsupporting

confidence: 91%

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Laible

Möhlenbruch²,

Pfaff³

et al. 2017

Cerebrovasc Dis

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“…In DEFUSE-2, average patient enrollment was only 5.1 per site per year and in MR RESCUE only 0.8. This likely reflected a lack of clinical equipoise [14] . All Dutch centres offering endovascular stroke surgery were included in MR CLEAN and from 2013 reimbursement for endovascular stroke surgery was possible only within the trial [2] .…”

Section: Mr Clean and Revascat [2 4]mentioning

confidence: 99%

“…This was further investigated in DEFUSE-2 with the use of intra-arterial tPA and penumbral imaging [11][12][13] . The recent successful endovascular trials demonstrate the importance of timely, quality reperfusion of the ischaemic penumbra [14] . They have now established endovascular mechanical thrombectomy as the treatment of choice for ischaemic stroke secondary to a large vessel occlusion.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Stroke Management: Key Elements of Success

2016

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Background: In the last 12 months, treatment of acute ischaemic stroke secondary to large vessel occlusion has undergone a paradigm shift. The success of endovascular surgery, and in particular, the use of stent-retrievers, is remarkable. Summary: Beyond percentages and p values, the endovascular trials demonstrated, in their similarities and their differences, the critical elements of successful intervention in acute ischaemic stroke. Patient selection based on non-invasive neuroimaging has emerged as a critical step in acute ischaemic stroke management. The more sophisticated imaging-based selection, those assessing collateral blood flow or ischaemic penumbra appear to be associated with better outcomes and possibly fewer complications. The importance of achieving effective, quality reperfusion is also demonstrated, in a remarkably linear fashion, across the 5 published trials. This may emerge as the single most important determinant of functional outcomes. While reperfusion may succeed time as the preeminent modifiable variable, it remains clear that achieving quality reperfusion in a timely manner should remain the goal of all acute stroke programs. Key Message: Comparing the recent successful endovascular stroke trials, both between one another, and to their unsuccessful predecessors, emphasizes the importance of patient selection, time and reperfusion. Highlighting these factors allows for a better understanding of the challenges facing clinicians and the changes required to be made in hospital systems in order to achieve a new standard of care in treating acute ischaemic stroke.

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“…1 The penumbra, or peri-infarct region, is the structurally intact but functionally compromised cerebral tissue surrounding the region of infarct, 2 which can potentially be protected by interventions delivered in a timely manner. 3 Sustained hypoperfusion of the penumbra leads to cellular death through several mechanisms, such as excitotoxicity and free-radical generation.…”

Section: Introductionmentioning

confidence: 99%

Improving neurovascular outcomes with bilateral forepaw stimulation in a rat photothrombotic ischemic stroke model

et al. 2014

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Abstract. Restoring perfusion to the penumbra during the hyperacute phase of ischemic stroke is a key goal of neuroprotection. Thrombolysis is currently the only approved treatment for ischemic stroke. However, its use is limited by the narrow therapeutic window and side effect of bleeding. Therefore, other interventions are desired that could potentially increase the perfusion of the penumbra. Here, we hypothesized that bilateral peripheral electrical stimulation will improve cerebral perfusion and restore cortical neurovascular response. We assess the outcomes of bilateral forepaw electrical stimulation at intensities of 2 and 4 mA, administered either unilaterally or bilaterally. We developed a combined electrocorticogram (ECoG)-functional photoacoustic microscopy (fPAM) system to evaluate the relative changes in cerebral hemodynamic function and electrophysiologic response to acute, focal stroke. The fPAM system is used for cerebral blood volume (CBV) and hemoglobin oxygen saturation (SO 2 ) and the ECoG for neural activity, namely somatosensory-evoked potential (SSEP), interhemispheric coherence, and alpha-delta ratio (ADR) in response to forepaw stimulation. Our results confirmed the neuroprotective effect of bilateral forepaw stimulation at 2 mA as indicated by the 82% recovery of ADR and 95% improvement in perfusion into the region of penumbra. This experimental model can be used to study other potential interventions such as therapeutic hypertension and hypercarbia.

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Acute Ischemic Stroke

Cited by 99 publications

References 52 publications

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Endovascular Stroke Management: Key Elements of Success

Improving neurovascular outcomes with bilateral forepaw stimulation in a rat photothrombotic ischemic stroke model

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