Frequency and Clinical Course of Stroke and Transient Ischemic Attack Patients With Intracranial Nonocclusive Thrombus on Computed Tomographic Angiography

Puetz, Volker; Dzialowski, Imanuel; Coutts, Shelagh B.; Hill, Michael D.; Krol, Andrea; O’Reilly, Christine; Goyal, Mayank; Demchuk, Andrew M.

doi:10.1161/strokeaha.108.526277

Cited by 35 publications

(33 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although large artery occlusions make up a significant proportion of strokes, the number of cases of endovascular clot retrieval performed make up a small fraction of the approximately 700 000 strokes occurring each year in the United States. 16,17 Inaccurate coding might lead to an underestimate of the number of cases, a likely possibility in the early period after introduction of a new ICD-9 code. Cases of intra-arterial thrombolysis without clot retrieval were not included in our study, which probably led to an underestimation of the overall number of stroke cases treated with an intra-arterial intervention.…”

Section: Discussionmentioning

confidence: 99%

Patient Outcomes With Endovascular Embolectomy Therapy for Acute Ischemic Stroke

Brinjikji

Rabinstein

Kallmes

et al. 2011

Stroke

View full text Add to dashboard Cite

Background and Purpose— Maturing techniques have spurred widespread implementation of endovascular embolectomy therapy for ischemic stroke. We evaluated a large administrative database to determine outcomes in patients treated with endovascular embolectomy in the general population. Methods— Using the National Inpatient Sample, we evaluated outcomes of patients treated for acute ischemic stroke in the United States from 2006 to 2008. Patients who had an ischemic stroke and underwent endovascular clot retrieval were identified. Morbidity, defined as “discharge to long-term facility,” and mortality were evaluated as a function of patient age and of concomitant thrombolytic agent administration. Results— For 2006 to 2008, a total of 3864 patients received endovascular clot retrieval with 266 (6.9%) patients in 2006, 800 (20.7) patients in 2007, and 2798 (72.4%) patients in 2008. The discharge to a long-term facility rate was 51.3% (1983 of 3864). The in-hospital mortality rate was 24.3% (940 of 3864). For patients <65 years old, the rate of in-hospital death was 17.1% (283 of 1658) as compared with a rate of 29.7% (656 of 2206) for patients ≥65 years old ( P <0.0001). The rate of discharge to a long-term facility was 47.6% (789 of 1658) for patients <65 years old and 54.1% (1193 of 2206) for patients ≥65 years old ( P <0.0001). The rate of intracranial hemorrhage was 15.5% without concomitant thrombolysis and 20.0% with concomitant thrombolysis ( P =0.0009). Conclusions— Rates of morbidity and mortality remain high for patients with acute stroke, even in the setting of endovascular embolectomy. Advanced age portends a worse outcome and patients treated with concomitant use of thrombolytic agent had higher rates of intracranial hemorrhage than those without such therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Patient Outcomes With Endovascular Embolectomy Therapy for Acute Ischemic Stroke

Brinjikji

Rabinstein

Kallmes

et al. 2011

Stroke

View full text Add to dashboard Cite

show abstract

“…35,36 CTA is also sufficient for detecting acute intracranial nonocclusive thrombi, a rare though potential predictor of subsequent clinical decline. 37 The clot-burden score has been developed to quantify extent of intracranial thrombosis visualized on CTA. It is a 10 point score that is calculated by subtracting points for the presence of occlusive or nonocclusive clot in certain locations: 2 points are deducted for the presence within supraclinoid ICA, proximal MCA trunk/ MCA-first segment (M1) or distal M1; 1 point deducted for presence within infraclinoid ICA, anterior cerebral artery or MCA-second segment division ( Figure 3).…”

Section: Intracranial Laomentioning

confidence: 99%

Acute Ischemic Stroke Therapy Overview

Catanese

Tarsia

Fisher

2017

Circulation Research

288

178

View full text Add to dashboard Cite

A cute ischemic stroke (AIS) is a common disorder with almost 700 000 new or recurrent events per year in the United States. The risk of AIS varies by region, with the highest incidence occurring in the so-called stroke belt in the southern part of the country.1 The risk of AIS varies among African Americans, Latinos, and Caucasians, with the highest risk in African Americans. The risk of AIS increases with age, and the ageing of the US population portends an increase in AIS incidence and prevalence over the next several decades, despite increasingly effective efforts to treat stroke risk factors and the use of other preventive strategies.2 The incidence of AIS is also increasing in many other countries, largely related to potentially modifiable risk factors, especially in the developing world.3 The incidence of AIS is also greater among women beginning with an increased risk in the perimenopausal period and continuing into older age groups. Abstract: The treatment of acute ischemic stroke has undergone dramatic changes recently subsequent to the demonstrated efficacy of intra-arterial (IA) device-based therapy in multiple trials. The selection of patients for both intravenous and IA therapy is based on timely imaging with either computed tomography or magnetic resonance imaging, and if IA therapy is considered noninvasive, angiography with one of these modalities is necessary to document a large-vessel occlusion amenable for intervention. More advanced computed tomography and magnetic resonance imaging studies are available that can be used to identify a small ischemic core and ischemic penumbra, and this information will contribute increasingly in treatment decisions as the therapeutic time window is lengthened. Intravenous thrombolysis with tissue-type plasminogen activator remains the mainstay of acute stroke therapy within the initial 4.5 hours after stroke onset, despite the lack of Food and Drug Administration approval in the 3-to 4.5-hour time window. In patients with proximal, large-vessel occlusions, IA device-based treatment should be initiated in patients with small/moderate-sized ischemic cores who can be treated within 6 hours of stroke onset. The organization and implementation of regional stroke care systems will be needed to treat as many eligible patients as expeditiously as possible. Novel treatment paradigms can be envisioned combining neuroprotection with IA device treatment to potentially increase the number of patients who can be treated despite long transport times and to ameliorate the consequences of reperfusion injury. Acute stroke treatment has entered a golden age, and many additional advances can be anticipated. (Circ Res. 2017;120:541-558.

show abstract

“…Patients with intraluminal thrombosis of the intracranial vasculature are also at high risk for stroke recurrence and deterioration [38]. A case series included 18 patients with non-occlusive intraluminal thrombus in the intracranial and extracranial circulation receiving intravenous unfractionated heparin given at a mean time of 7 h after stroke onset for a [27,28] a TOAST noted reduced risk of hemorrhage if NIHSS <15 [5] b Case series of intraluminal thrombus patients by Mokin: median number of days of anticoagulation prior to reimaging was 3.5 days [29•] median time of 3.5 days.…”

Section: Intracranial Diseasementioning

confidence: 99%

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?

Ruff

Jindal

2015

Curr Atheroscler Rep

View full text Add to dashboard Cite

Heparin has long been a contested therapy in acute ischemic stroke (AIS). In current practice, heparin is considered on a case-by-case basis, but there is no consensus as to the appropriate timing of anticoagulation or for which ischemic stroke subtypes heparin may be beneficial. To provide better clarity on this issue, we review current research focusing on the use of heparin in AIS in each stroke subtype and subsequently make recommendations to provide readers with a systematic approach to managing complex stroke patients for which acute anticoagulation may be valuable. We conclude that there are certain subpopulations of ischemic stroke patients that may derive benefit from heparin when given acutely, including patients with symptomatic large artery stenosis >70 %, non-occlusive intraluminal thrombus, and in patients with high-risk cardiac conditions including left ventricular thrombus, left ventricular assist devices, and mechanical heart valves.

show abstract

Frequency and Clinical Course of Stroke and Transient Ischemic Attack Patients With Intracranial Nonocclusive Thrombus on Computed Tomographic Angiography

Abstract: Background and Purpose-We sought to determine the frequency and clinical course of patients with acute ischemic stroke or transient ischemic attack (TIA) who had intracranial nonocclusive thrombus (iNOT) on CT angiography (CTA

Cited by 35 publications

References 28 publications

Patient Outcomes With Endovascular Embolectomy Therapy for Acute Ischemic Stroke

Patient Outcomes With Endovascular Embolectomy Therapy for Acute Ischemic Stroke

Acute Ischemic Stroke Therapy Overview

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?

Contact Info

Product

Resources

About