European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS)

Fiehler, Jens; Cognard, Christophe; Gargiulo, Mauro; Jansen, Olav; Kobayashi, Adam; Mattle, Heinrich; Muir, Keith W.; Mazighi, Mikaël; Schaller, Karl; Schellinger, Peter D.

doi:10.1177/1747493016647735

Cited by 112 publications

(99 citation statements)

References 74 publications

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“…19,20 This is because recanalization is one of the most important predictors of prognosis in AIS, 21,22 and proximal occlusions insufficiently respond to IV thrombolysis in many cases. 23 Endovascular stroke trials have mostly excluded patients with posterior circulation strokes.…”

Section: Discussionmentioning

confidence: 99%

Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke

Rotzinger

Mosimann

Meuli

et al. 2017

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:CTA can rapidly and accurately detect and localize occlusive disease in patients with ischemic stroke. We have used CTA to assess arterial stenosis and occlusion in an ischemic stroke population arriving at a tertiary stroke center within 24 hours of symptom onset in order to obtain a comprehensive picture of occlusive disease pattern, and to determine the proportion of eligible candidates for endovascular treatment.

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Section: Discussionmentioning

confidence: 99%

Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke

Rotzinger

Mosimann

Meuli

et al. 2017

AJNR Am J Neuroradiol

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“…29 Clinical and imaging criteria that should prompt patient transfer to a neuro-interventional stroke centre will vary with population density and regional distribution of facilities and expertise. 30 …”

Section: Mechanical Endovascular Thrombectomymentioning

confidence: 99%

Thrombolysis and thrombectomy for acute ischaemic stroke

Tawil

Muir

2017

Clinical Medicine

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The likelihood of disability-free recovery after acute ischemic stroke is significantly improved by reperfusion either by intravenous thrombolytic drug treatment or with endovascular mechanical thrombectomy in selected cases. The use of intravenous thrombolysis is limited by the short treatment window and you need to assess individual balance of benefit and risk of symptomatic intracranial haemorrhage. Benefit is greater for shorter onset-to-reperfusion time intervals, requiring optimisation of pre-hospital and inhospital pathways. Symptomatic haemorrhage is more likely with more severe strokes, but a greater proportion of patients are left free of disability than suffer a treatmentrelated haemorrhage at all levels of severity. Extracranial haemorrhage and orolingual angioedema are less common complications. Endovascular mechanical thrombectomy can be used in selected patients with imaging-proven large artery occlusion. Successful therapy depends on well-organised services that can deliver treatment within a short time window at centres with adequate expertise to perform the procedure.

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“…Antihypertensive treatments used were either nicardipine or urapidil, and norepinephrine was the drug of choice to treat any BP drops 5. Since no randomized control trial have assessed the efficacy of a treatment to reduce BP variability during MT, no effective measure was prescribed to reduce BP variability.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, BP variability was mainly assessed within the first 24 hours and not before recanalization occurs, period in which BP variability might highly influence the penumbra's survival and clinical outcome. Although recent guidelines recommend avoiding excessive BP drops during MT,5 there is currently no evidence suggesting an association between per‐procedural BP variability and functional outcome. In this context, pulse pressure (PP) may be a better parameter than SBP to describe BP variability because it describes more accurately the pulsatile component of BP 6.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Maïer

Turc

Taylor

et al. 2018

JAHA

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BackgroundStudies on the role of blood pressure (BP) variability specifically during mechanical thrombectomy (MT) are sparse and limited. Moreover, pulse pressure (PP) has not been considered as a potent hemodynamic parameter to describe BP variability during MT. We assessed the impact of PP variability on functional outcome in acute ischemic stroke patients with large vessel occlusion during MT.Methods and ResultsAcute ischemic stroke patients presenting with large vessel occlusion from January 2012 to June 2016 were included. BP data during MT were prospectively collected in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Logistic regression models were used to assess the association between PP coefficients of variation and functional outcome at 3 months (modified Rankin Scale). Among the 343 included patients, PP variability was significantly associated with worse 3‐month modified Rankin Scale in univariable (odds ratio [OR]=1.56, 95% confidence interval [CI]: 1.24–1.96 per 1‐unit increase, P=0.0002) and multivariable ordinal logistic regression (adjusted OR=1.40, 95% CI: 1.09–1.79, P=0.008). PP variability was also associated with unfavorable outcome (modified Rankin Scale 3–6) in univariable (OR=1.53, 95% CI: 1.17–2.01, P=0.002) and multivariable analysis (adjusted OR=1.42, 95% CI: 1.02–1.98, P=0.04). There was an association between PP variability and 3‐month all‐cause mortality in univariable analysis (OR= 1.37, 95% CI: 1.01–1.85 per 1‐unit increase of the coefficient of variation of the PP, P=0.04), which did not remain significant after adjustment for potential confounders.Conclusions PP variability during MT is an independent predictor of worse clinical outcome in acute ischemic stroke patients. These findings support the need for a close monitoring of BP variability during MT. Whether pharmacological interventions aiming at reducing BP variability during MT could impact functional outcome needs to be determined.

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European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS)

Cited by 112 publications

References 74 publications

Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke

Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke

Thrombolysis and thrombectomy for acute ischaemic stroke

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

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