Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre, Andrea; Valente, Iacopo; Consoli, Arturo; Trombatore, Pietro; Scarcia, Luca; Piano, Mariangela; Limbucci, Nicola; Gabrieli, Joseph; Russo, Riccardo; Caragliano, Antonio Armando; Ruggiero, Maria; Saletti, Andrea; Lazzarotti, G; Pileggi, Marco; Cosottini, Mirco; Pilato, Fabio; Słomka, Artur; Colò, Francesca; Giubbolini, Francesca; Frisullo, Giovanni; Marca, Giacomo Della; Broccolini, Aldobrando; Pedicelli, Alessandro

doi:10.3390/life11121423

Cited by 14 publications

(8 citation statements)

References 41 publications

(44 reference statements)

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“…Early neurological improvement was shown to be a strong independent predictor of good outcome both in patients treated with EVT for LVO and in patients with BAO, which was also confirmed by Wang et al, Guenego et al, Alexandre et al, and the present study’s authors [ 39 , 40 , 41 ].…”

Section: Discussionsupporting

confidence: 89%

Predictors of Outcome after Direct Aspiration of Basilar Artery Occlusion

Mako,

Krastev,

Nosáľ

et al. 2024

JCM

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Background: Basilar artery occlusion (BAO) is a serious disease with a poor prognosis if left untreated. Endovascular therapy (EVT) is the most effective treatment that is able to reduce mortality and disability. Treatment results are influenced by a wide range of factors that have not been clearly identified. In the present study, direct aspiration was chosen as a first-line treatment. The safety and effectiveness of direct aspiration in BAO were determined, and factors affecting patient outcomes were identified. Methodology: Data for patients with BAO treated between November 2013 and December 2021 were evaluated using a database. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 89 patients with BAO were identified. Full recanalization was achieved in 69.7% of cases and partial recanalization in 19.1%. Intracranial hemorrhage was detected in 11 (12.4%) patients, of which, eight (9.0%) patients experienced symptomatic intracranial hemorrhage. Patients with good outcomes presented with milder strokes (mean NIHSS score of 12.58 vs. 24.00, p < 0.001), had higher collateral scores (6.79 vs. 5.88, p = 0.016), more often achieved complete recanalization (87.9% vs. 58.9%, p = 0.009), and more often experienced early neurological improvement (66.7% vs. 26.8%, p < 0.001). On the contrary, patients with worse outcomes had higher serum glucose levels (p = 0.05), occlusion of the middle portion of the basilar artery (MAB) (30.3% vs. 53.6%, p = 0.033), longer thrombus lengths (10.51 vs. 16.48 mm, p = 0.046), and intracranial hemorrhage (p = 0.035). Conclusions: The present study results suggest that direct aspiration is a safe and effective treatment for patients with BAO. We identified several factors affecting the patients’ outcome.

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Section: Discussionsupporting

confidence: 89%

Predictors of Outcome after Direct Aspiration of Basilar Artery Occlusion

Mako,

Krastev,

Nosáľ

et al. 2024

JCM

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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: 69%

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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“…MT has become the cornerstone of managing AIS patients with LVO in both anterior and posterior circulation. [38,39] Early detection of AIS patients with LVO is essential, as they are potential candidates for MT. Few previous studies in the past have examined in AIS the connection between counts and ratios of leukocytes and the existence of LVO.…”

Section: Discussionmentioning

confidence: 99%

Leukocyte counts and ratios as potential predictors of large vessel occlusion in acute ischemic stroke: A retrospective cohort study

Wang,

Zhang,

Dai

et al. 2024

Medicine

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Leukocyte counts and ratios are independent biomarkers to determine the severity and prognosis of acute ischemic stroke (AIS). In AIS, the connection between leukocytes and large vessel occlusion (LVO) is uncertain. This study aims to determine the relationship between the existence of LVO and leukocyte counts and ratios on admission to AIS. Patients were retrospectively evaluated within six hours of AIS starting between January 2019 and April 2023. On admission, blood specimens were collected, and leukocyte subtype counts were promptly analyzed. Computed tomography or digital subtraction angiography were utilized to verify the existence of LVO. Regression analysis and receiver operating characteristic (ROC) curves were employed to investigate the connections between the counts and ratios of leukocytes and the existence of LVO, as well as the discriminatory ability of these variables in predicting LVO. Total white blood cell (WBC) count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR) were substantially higher in the LVO existence group compared to the LVO absence group, whereas the ratio of eosinophils to neutrophils (ENR × 102) was lower (P < .001, respectively). Significant associations were observed between total WBC counts, neutrophil counts, NLR, and ENR × 102 and the existence of LVO (P < .001, respectively). Total WBC counts, neutrophil counts, NLR, and ENR × 102 had respective areas under the curves (AUC) of 0.730, 0.748, 0.704, and 0.680 for identifying LVO. Our results show that in AIS patients, the existence of LVO is independently associated with elevated total WBC and neutrophil counts, high NLR, and low ENR × 102 levels. Neutrophil and total WBC counts, as well as NLR and levels of ENR × 102, may serve as potential biomarkers for predicting LVO. Neuroinflammation, based on the existence of LVO, should be given particular attention in future investigations.

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Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Cited by 14 publications

References 41 publications

Predictors of Outcome after Direct Aspiration of Basilar Artery Occlusion

Predictors of Outcome after Direct Aspiration of Basilar Artery Occlusion

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

Leukocyte counts and ratios as potential predictors of large vessel occlusion in acute ischemic stroke: A retrospective cohort study

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