Mechanical Thrombectomy in Acute Ischemic Stroke: Angiographic Predictors of Outcome

Rajan, Jayadevan Enakshy; Kannath, Santhosh Kumar; Sabarish, Sekar; Arun, K; Varma, P Ravi P; Sreedharan, Sapna Erat; Sukumaran, Sajith; Sylaja, P N

doi:10.4103/0028-3886.355085

Cited by 3 publications

(5 citation statements)

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“…In addition to comprehensiveness, an important difference of our analysis as compared to previously published studies is the prolonged follow-up interval after stroke. Most published studies evaluated clinical outcome using mRS at day 90 [ 3 , 10 , 12 , 26 , 28 , 31 – 33 , 37 , 38 , 46 , 47 , 50 – 52 ]. Only a few studies assessed the clinical outcome beyond 90 days after the index event [ 5 , 14 , 16 , 36 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the outcome is highly dependent on the time course of EVT. Shorter time from stroke onset to reperfusion and successful recanalisation are important prognostic parameters [ 10 , 37 , 38 , 47 , 52 ]. Fuhrer et al [ 14 ] described a decline in mRS after one year compared to mRS at day 90 in patients with right hemispheric infarctions.…”

Section: Discussionmentioning

confidence: 99%

“…without multimodal imaging) urges the need for identifying predictors of complete recanalisation and good clinical outcome. The assessment of clinical outcome as well as outcome prediction usually are based on the mRS at day 90 [ 3 , 10 , 12 , 26 , 28 , 31 – 33 , 37 , 38 , 46 , 47 , 50 – 52 ], the standard outcome measure in AIS studies. Only a few studies have investigated factors influencing long-term outcome beyond day 90 [ 5 , 14 , 16 , 36 , 53 ].…”

Section: Introductionmentioning

confidence: 99%

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Functional long-term outcome following endovascular thrombectomy in patients with acute ischemic stroke

Rogalewski,

Klein,

Friedrich

et al. 2024

Neurol. Res. Pract.

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Endovascular thrombectomy (EVT) is the most effective treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Yet, long-term outcome (LTO) and health-related quality of life (HRQoL) in these patients have rarely been addressed, as opposed to modified Rankin scale (mRS) recordings. We analysed demographic data, treatment and neuroimaging parameters in 694 consecutive stroke patients in a maximum care hospital. In 138 of these patients with respect on receipt of written informed consent, LTO and HRQoL were collected over a period of 48 months after EVT using a standardised telephone survey (median 2.1 years after EVT). Age < 70 years (OR 4.82), lower NIHSS on admission (OR 1.11), NIHSS ≤ 10 after 24 h (OR 11.23) and complete recanalisation (mTICI3) (OR 7.79) were identified as independent predictors of favourable LTO. Occurrence of an infection requiring treatment within the first 72 h was recognised as a negative predictor for good long-term outcome (OR 0.22). Patients with mRS > 2 according to the telephone survey more often had complaints regarding mobility, self‐care, and usual activity domains of the HRQoL. Our results underline a sustainable positive effect of effective EVT on the quality of life in LVO stroke. Additionally, predictive parameters of outcome were identified, that may support clinical decision making in LVO stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional long-term outcome following endovascular thrombectomy in patients with acute ischemic stroke

Rogalewski,

Klein,

Friedrich

et al. 2024

Neurol. Res. Pract.

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“…[ 7 8 9 ] A recent study identified ICAS as a predictor of poor outcomes in ILAO. [ 10 ] Nevertheless, various studies have reported MT as a safe measure and beneficial in attaining functional outcomes (FOCs) comparable to the patients with ILAO of embolic origin. [ 8 11 ] Furthermore, angiographic success and time metrics are also comparable with ILAO of embolic origin.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of large artery occlusion-related stroke due to intracranial atherostenosis: An experience from a single center in Saudi Arabia

Zafar,

Shahid,

Albakr

et al. 2024

Journal of Family and Community Medicine

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BACKGROUND: Literature on the frequency, response to treatment, and outcomes of acute ischemic stroke (AIS) due to intracranial atherostenosis (ICAS)-related intracranial large artery occlusion (ILAO) from Saudi Arabia is scarce. The aim of this study was to identify the percentage, describe the characteristics, and observe the treatment response in patients with AIS attributed to ICAS-related ILAO. MATERIALS AND METHODS: This cross-sectional study included all adult patients from 2017-2021 who fulfilled the inclusion criteria for the diagnosis of ICAS-related AIS. Patients were dichotomized based on ILAO. Mortality and functional outcomes (FOCs) based on 90 days’ dependence level were compared between the two groups. The association between ILAO and other variables was assessed using the Chi-squared test, odds ratios (OR), and 95% confidence interval (CI). RESULTS: ILAO was found in 38.7% of patients with ICAS-related AIS. Men comprised three-fourths of the cohort and were more frequent in the ILAO group. Smoking was associated with increased (P = 0.04) likelihood of ILAO. Patients with ILAO had more severe strokes (P ≤ 0.001) than patients without. Middle cerebral artery was the most common occluded vessel (52%). Functional dependence (P = 0.003, OR = 2.87, CI = 1.42–5.77), malignant transformation (P = 0.001, OR = 8.0, CI = 1.82–35.9), and mortality (P ≤ 0.001, OR = 7.67, CI = 2.40–24.5) were significantly higher among ILAO group. Patients with ILAO with unfavorable FOC were older than those who achieved better FOC (P ≤ 0.001). Thrombolysis (P = 0.02, OR = 2.50, CI = 1.15–5.41) and mechanical thrombectomy (MT) improved FOC in patients with ILAO (P = 0.04, OR = 2.33, CI = 1.10–4.92). CONCLUSION: ILAO is common in patients with ICAS-related AIS. Timely hyperacute stroke treatment can help improve the FOC of otherwise disabling stroke due to ILAO. Raising awareness of the community about stroke is needed, so that a higher number of patients can arrive at hospital within the golden hours. Further data from the region are required to recognize the efficacy of MT in ICAS-related ILAO.

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“…Several studies have separately evaluated angiographic features like collaterals, clot burden, recanalization, number of device passes, and the presence of intracranial atherosclerotic disease (ICAD) in predicting the outcome after MT. 8 Evaluation of variables related to good angiographic recanalization can help with better patient triage and treatment and portend a better prognosis. The study aims to investigate the notable factors that affect the angiographic recanalization during MT after LVO in patients with acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Insights into Angiographic Recanalization of Large Arterial Occlusion: Institutional Experience with Mechanical Thrombectomy for Acute Ischemic Stroke

Charan,

Gaikwad,

Jain

et al. 2024

Asian J Neurosurg

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Stroke is a leading cause of morbidity and mortality in humans. Most strokes are ischemic in nature and early recanalization of occluded vessels determines good outcomes. Recanalization of occluded vessels depends on many angiographic and demographic features. These factors need to be identified for better patient overall outcomes. Better preoperative knowledge of factors can help in customizing our treatment approach and explaining the prognosis to the guardians of the patients. We aim to share our institutional experience with mechanical thrombectomy (MT) for stroke and studied factors that affect an angiographic recanalization of vessels. A retrospective single-center study was conducted involving 104 patients who underwent MT at our institution between January 2016 and December 2019. Patient demographics, baseline characteristics, pre- and postprocedural imaging findings, and other clinical data were meticulously reviewed. We divided patients into successful recanalization (modified thrombolysis in cerebral ischemia [mTICI] 2b or 3) and unsuccessful recanalization (mTICI 2a or 1) groups and various factors were analyzed to evaluate their impact on recanalization rates. In the univariate analysis, a significant association was observed between successful recanalization and several factors: the absence of rheumatic heart disease (RHD) as a risk factor (p = 0.035), the presence of a hyperdense vessel sign (p = 0.003), and the use of treatment methods including aspiration (p = 0.031), stent retriever (p = 0.001), and Solumbra (p = 0.019). However, in the multivariate analysis, none of these factors exhibited statistical significance. The presence of RHD is a risk factor associated with poor angiographic recanalization in all three MT treatment modalities. Based on the above variables we can guide the patients/relatives prior to MT procedure for their better outcome and risk–benefit ratio.

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Mechanical Thrombectomy in Acute Ischemic Stroke: Angiographic Predictors of Outcome

Cited by 3 publications

References 1 publication

Functional long-term outcome following endovascular thrombectomy in patients with acute ischemic stroke

Functional long-term outcome following endovascular thrombectomy in patients with acute ischemic stroke

Characteristics and outcomes of large artery occlusion-related stroke due to intracranial atherostenosis: An experience from a single center in Saudi Arabia

Insights into Angiographic Recanalization of Large Arterial Occlusion: Institutional Experience with Mechanical Thrombectomy for Acute Ischemic Stroke

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