Mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in the anterior circulation and low baseline National Institute of Health Stroke Scale score: a multicenter retrospective matched analysis

Alexandre, Andrea; Valente, Iacopo; Pedicelli, Alessandro; Pezzullo, Angelo Maria; Colò, Francesca; Scarcia, Luca; Romi, Andrea M.; Piano, Mariangela; Macera, Antonio; Gabrieli, Joseph; Cester, Giacomo; Caragliano, Antonio Armando; Vinci, Sergio Lucio; Ruggiero, Maria; Commodaro, Christian; Saletti, Andrea; Lazzarotti, G; Cosottini, Mirco; Ros, Valerio Da; Bellini, Luigi; Lozupone, Emilio; Paladini, Adriana; Brunetti, Valerio; Morosetti, Roberta; Frisullo, Giovanni; Calabresi, Paolo; Marca, Giacomo Della; Broccolini, Aldobrando

doi:10.1007/s10072-021-05771-5

Cited by 22 publications

(24 citation statements)

References 35 publications

(41 reference statements)

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“…Nevertheless, we found that the significant association of eosinophils with SAP/poor outcome was independent of general anesthesia in the multivariate analysis (SAP: OR, 0.00; 95% CI, 0.00-0.38; P = 0.0263; poor outcome: OR, 0.00; 95% CI, 0.00-0.10; P = 0.0091) when general anesthesia was included as confounding factors, which did not change the main results of our study. In addition, further studies from other samples of patients with AIS are needed to validate our results (Alexandre et al, 2021a , b ). Fourth, our study was designed to be cross-sectional; therefore, causality cannot be established.…”

Section: Discussionmentioning

confidence: 70%

Eosinophils, Stroke-Associated Pneumonia, and Outcome After Mechanical Thrombectomy for Acute Ischemic Stroke

Guo

Hou

et al. 2022

Front. Aging Neurosci.

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BackgroundEosinophils contribute to antibacterial defense by releasing mitochondrial DNA, which are decreased in patients with acute ischemic stroke (AIS). However, the impact of eosinophils on stroke-associated pneumonia (SAP) among patients with AIS remains unclear. Moreover, whether SAP is in the path of the association between eosinophils and clinical outcomes also remains unclear. We aimed to assess the relationships between eosinophils, SAP, and clinical outcome after mechanical thrombectomy in patients with AIS.MethodsA total of 328 consecutive patients with AIS who underwent mechanical thrombectomy between May 2017 and March 2021 were analyzed. Their baseline data and peripheral eosinophil counts were recorded on admission. Regression analysis was used to assess the effect of eosinophils on SAP, and its effect on poor outcome is defined as a modified Rankin Scale score of 3–6 at month 3 after admission. Mediation analysis was utilized to assess the proportion of the total effect of SAP on the association between eosinophils and poor outcomes.ResultsMultivariate analysis revealed that eosinophils was independently associated with SAP after adjusting for potential confounders (odds ratio, 0.00; 95% CI, 0.00–0.38; P = 0.0267), which are consistent with the result of eosinophils (dichotomous) as a categorical variable (odds ratio, 0.54; 95% CI, 0.31–0.96; P = 0.0342). A non-linear relationship was detected between eosinophils and SAP, whose inflection point was 0.06. Subgroup analyses further confirmed these associations. Eosinophils were also associated with poor outcomes (odds ratio, 0.00; 95% CI, 0.00–0.14; P = 0.0124). Additionally, mediation analysis found that SAP partially mediated the negative relationship between eosinophils and poor outcome (indirect effect = −0.169; 95% CI:−0.339 –−0.040, P < 0.001).ConclusionOur findings suggested that a lower eosinophil level was associated with higher SAP and poorer outcome, and SAP might play an important effect in the association between eosinophils and poor outcomes.

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Section: Discussionmentioning

confidence: 70%

Eosinophils, Stroke-Associated Pneumonia, and Outcome After Mechanical Thrombectomy for Acute Ischemic Stroke

Guo

Hou

et al. 2022

Front. Aging Neurosci.

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“…Unfortunately, the specific distribution of border zone infarcts was not available for the majority of studies which we included in our systematic review. Because of the relatively low frequency of large vessel occlusion, it is expected that clinically severe strokes and need for emergent endovascular treatment [14] are infrequent in these patients. This was demonstrated in the study by Tennenbaum et al, in…”

Section: Discussionmentioning

confidence: 99%

Imaging patterns of cerebral ischemia in hypereosinophilic syndrome: case report and systematic review

et al. 2022

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Introduction Ischemic stroke is a potential complication of hypereosinophilic syndromes (HES), and little is known about underlying pathophysiological mechanisms. We aimed to describe the imaging patterns of cerebral ischemia in patients with HES. Methods An individual case is reported. A systematic PubMed review of all records reporting adult patients with HES who suffered ischemic stroke and for whom neuroimaging details of ischemic lesions were available was performed. Results A 60-year-old man presented with progressive subacute gait difficulty and psychomotor slowing as well as an absolute eosinophilia (2.2 × 109/L) at admission. Brain magnetic resonance tomography revealed multiple acute and subacute internal and external border zone infarcts. Cardiac diagnostic suggested the presence of endomyocarditis. After extensive diagnostic workup, idiopathic HES was diagnosed. The systematic review yielded 183 studies, of which 40 fulfilled the inclusion criteria: a total of 64 patients (31.3% female), with mean age 51.1 years and a median absolute eosinophile count at diagnosis of 10.2 × 109/L were included in the analyses. A border zone pattern of cerebral ischemic lesions was reported in 41 patients (64.1%). Isolated peripheral infarcts were reported in 7 patients (10.9%). Sixteen patients had multiple acute infarcts with no border zone distribution (25.0%). An intracardiac thrombus was reported in 15/60 patients (25%), and findings suggestive of endomyocarditis or endomyocardial fibrosis were found in 31/60 patients (51.7%). Conclusions Border zone distribution of cerebral ischemia without hemodynamic compromise is the most frequent imaging pattern in patients with HES, occurring in 2/3 of patients who develop ischemic stroke.

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“…The time from LKW to END occurrence was shorter in patients who had EVT (median 6.7 h [IQR, 4.0-12.2] when compared to a median of 26.2 h (16-39), [41-44] in those who were treated (P-for-difference, <0.01). The NIHSS at END occurrence was a median of 9 (7)(8)(9)(10)(11)(12)(13) in those who received EVT and a median of 7 (4-10) in medically managed patients (P-for-difference, 0.27). In the multivariable logistic regression model in which the location of occlusion was mutually exclusive, the presence of extracranial ICA occlusion (adjusted OR 1.72, 95% CI [1.09-2.73]), presence of tandem occlusion (adjusted OR, 2.79 [1.57-4.95]), history of hypertension (adjusted OR, 1.49 [1.03-2.14]) and a higher NIHSS (adjusted OR 1.12 per 1-point increase, [1.02-1.23]) were significantly associated with higher odds of END occurrence (for full results, see Supplementary Table III).…”

Section: Early Neurological Deteriorationmentioning

confidence: 99%

“…Several recent observational studies have reported that EVT may be associated with increased hemorrhagic complications and no overall clinical benefit in these patients (4)(5)(6). However, other observational studies have suggested potential benefits of EVT in these patients (7)(8)(9)(10)(11). More robust evidence from large high-quality registries is needed to help physicians make treatment decisions in these patients until ongoing trials present their results in a few years.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of EVT in patients with acute LVO and low NIHSS

et al. 2022

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Background and purposeThere is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits.MethodsFrom a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months.ResultsAmong 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6–12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63–1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59–12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5–41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23–1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0–1 in mild LVO patients without END (adjusted OR, 0.63 [0.40–0.99]).ConclusionsThe use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.

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Mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in the anterior circulation and low baseline National Institute of Health Stroke Scale score: a multicenter retrospective matched analysis

Cited by 22 publications

References 35 publications

Eosinophils, Stroke-Associated Pneumonia, and Outcome After Mechanical Thrombectomy for Acute Ischemic Stroke

Eosinophils, Stroke-Associated Pneumonia, and Outcome After Mechanical Thrombectomy for Acute Ischemic Stroke

Imaging patterns of cerebral ischemia in hypereosinophilic syndrome: case report and systematic review

Effectiveness and safety of EVT in patients with acute LVO and low NIHSS

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