May endovascular thrombectomy without CT perfusion improve clinical outcome?

Alexandre, Andrea; Pedicelli, Alessandro; Valente, Iacopo; Scarcia, Luca; Giubbolini, Francesca; D’Argento, Francesco; Lozupone, Emilio; Distefano, Marisa; Pilato, Fabio; Colosimo, Cesare

doi:10.1016/j.clineuro.2020.106207

Cited by 19 publications

(12 citation statements)

References 19 publications

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“…The recruitment of immune cells following an ischemic event may be a contributing factor to this association [ 33 ]. This study used arterial spin labelling (ASL) to characterise PLH, demonstrating how advanced imaging, such as computed tomography perfusion (CTP) [ 34 , 35 ], CT angiography (CTA) [ 36 ] and ASL [ 19 ], have allowed quantitative estimation and characterisation of cerebral perfusion and the delineation of angiographic features including collateral status in AIS patients [ 14 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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Background: The interplay between collateral status and stroke aetiology may be crucial in the evaluation and management of acute ischemic stroke (AIS). Our understanding of this relationship and its level of association remains sub-optimal. This study sought to examine the association of pre-intervention collateral status with stroke aetiology, specifically large artery atherosclerosis (LAA) and cardio-embolism (CE), in AIS patients receiving reperfusion therapy, by performing a meta-analysis. Methods: Relevant search terms were explored on Medline/PubMed, Embase and Cochrane databases. Studies were included using the following inclusion criteria: (a) patients aged 18 or above; (b) AIS patients; (c) patients receiving reperfusion therapy; (d) total cohort size of >20, and (e) qualitative or quantitative assessment of pre-intervention collateral status on imaging using a grading scale. Random-effects meta-analysis was performed to investigate the association of aetiology with pre-intervention collateral status, and forest plots of risk ratio (RR) were generated. Results: A meta-analysis was conducted on seven studies, with a cumulative cohort of 1235 patients, to assess the association of pre-intervention collateral status with stroke aetiology. Patients with LAA were associated significantly with an increased rate of good collaterals (RR 1.24; 95% CI 1.04–1.50; p = 0.020, z = 2.33). Contrarily, CE aetiology was associated significantly with a decreased rate of good collaterals (RR 0.83; 95% CI 0.71–0.98; p = 0.027, z = −2.213). Conclusions: This study demonstrates that, in AIS patients receiving reperfusion therapy, LAA and CE aetiologies are associated significantly with collateral status.

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Section: Discussionmentioning

confidence: 99%

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

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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“…It does not change the undisputable fact that NECT and CTA are very fast and straightforward, and with the help of artificial intelligence, basic evaluation suitable for treatment decision making is relatively fast. In our opinion, NECT for hemorrhage detection and ASPECTS evaluation, and CTA for occlusion detection, is all that is needed in the acute setting especially in the early time window … Although recent guidelines and recommendations favor CTP or MRI for the ischemic core evaluation in the late and unknown time window [ 10 , 11 ]; there are some data that suggest that we probably could manage without it and stick only to ASPECTS and CTA [ 39 , 40 , 49 , 50 ]. From our personal experience with ASPECTS > 6, additional significant findings on CTP or MRI are rather unlikely.…”

Section: Discussionmentioning

confidence: 99%

“…Desai et al analyzed clinical outcomes of subjects who did not meet DAWN and DEFUSE 3 inclusion criteria and received off-label EVT in the late time window; 30% of treated patients achieved functional independence at 3 months [ 49 ]. Moreover, Alexandre et al treated 49 patients with LVO in anterior circulation in the time window longer than 6 h and did not use CPT at all [ 50 ]. In 77% of subjects, recanalization was successful and 18 of 49 treated patients achieved functional independence at 3 months after treatment [ 50 ].…”

Section: The Third Task: To Estimate the Ischemic Corementioning

confidence: 99%

“…Moreover, Alexandre et al treated 49 patients with LVO in anterior circulation in the time window longer than 6 h and did not use CPT at all [ 50 ]. In 77% of subjects, recanalization was successful and 18 of 49 treated patients achieved functional independence at 3 months after treatment [ 50 ]. The possibilities with MRI are similar to CTP, and MRP is also one of the methods available in the diagnostic spectrum.…”

Section: The Third Task: To Estimate the Ischemic Corementioning

confidence: 99%

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Diagnosis of Ischemic Stroke: As Simple as Possible

Malíková

Weichet

2022

Diagnostics

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The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke survivors impose substantial direct and indirect costs of care as well as costs due to productivity loss. We review of diagnostic possibilities of individual imaging methods such as computed tomography and magnetic resonance imaging, and discuss their pros and cons in the imaging of AIS. The goals of non-invasive imaging in AIS are as follows: (a) to rule out intracranial hemorrhage and to quickly exclude hemorrhagic stroke and contraindications for intravenous thrombolysis; (b) to identify potential LVO and its localization and to quickly provide guidance for endovascular treatment; (c) to assess/estimate the volume or size of the ischemic core. We suggest fast diagnostic management, which is able to quickly satisfy the above-mentioned diagnostic goals in AIS with LVO.

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“…Given that the persistence of a minimal neurological impairment in patients with LVO is due to the recruitment of efficient leptomeningeal collaterals, these patients may also benefit from a prolonged time window for MT [11,12,17,19,26,27,33] as they can maintain a small ischemic core and a significant amount of salvageable brain tissue beyond 6 hours from onset (the so-called "slow progressors") [34,35]. Indeed, in our series, 9 out of 17 patients (53%) were treated beyond the initial 6 hours from onset.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy in patients with stroke due to large vessel occlusion in the anterior circulation and low scale score

Alexandre

Valente

Frisullo

et al. 2021

Journal of Integrative Neuroscience

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We sought to verify the benefit of mechanical thrombectomy in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation and low National Institute of Health stroke scale score at presentation. The prospective database of our stroke center was screened for patients with acute ischemic stroke due to large vessel occlusion and a baseline National Institute of Health stroke scale score ≤5 that had undergone mechanical thrombectomy. Outcome measures were the modified Rankin Scale (mRS) score at 90 days, brain bleeding events and death at 90 days. Out of 459 patients, 17 (12 females, mean age 70 ± 14 years) with occlusion of M1 or M2 segment of middle cerebral artery and baseline National Institute of Health stroke scale score ≤5 underwent mechanical thrombectomy. Eight patients (47%) were treated within 6 hours from the onset, 5 (29%) were treated beyond 6 hours, and 4 (24%) were wakeup strokes. Effective mechanical thrombectomy was achieved in 16 patients (94%) and associated with excellent functional outcomes at 3 months (mRS 0-1) in 13 (76%). The asymptomatic brain-bleeding event was observed in one patient 4 days after effective mechanical thrombectomy concerning safety issues. One patient died 1 month after mechanical thrombectomy of a cause unrelated to stroke. Our findings favor a potential benefit of mechanical thrombectomy in patients with stroke due to large vessel occlusion and low National Institute of Health stroke scale score at presentation. These patients may also benefit from a prolonged time window for treatment.

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May endovascular thrombectomy without CT perfusion improve clinical outcome?

Cited by 19 publications

References 19 publications

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

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

Diagnosis of Ischemic Stroke: As Simple as Possible

Mechanical thrombectomy in patients with stroke due to large vessel occlusion in the anterior circulation and low scale score

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