Prognosis and risk factors for reocclusion after mechanical thrombectomy

Li, Weili; Ding, Jiayue; Sui, Xueqin; Qi, Zhifeng; Wu, Longfei; Sun, Chenghe; Ji, Kangxiang; Ma, Qingfeng; Ji, Xunming; Liu, Ke Jian

doi:10.1002/acn3.50999

Cited by 26 publications

(27 citation statements)

References 25 publications

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“…Previous studies have confirmed that elevated plasma D-dimer levels can predict early neurological deterioration 21 and that D-dimer levels are associated with reocclusion. 22 Therefore, the high D-dimer levels in the patients with stroke may be related to the risk of reocclusion or secondary acute stroke. These findings suggest the importance of dynamic detection of D-dimer levels and implementation of corresponding preventive measures.…”

Section: Discussionmentioning

confidence: 99%

Clinical Course and Mortality of Stroke Patients With Coronavirus Disease 2019 in Wuhan, China

Zhang

Sun

Wang

et al. 2020

Stroke

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Background and Purpose: No studies have reported the effect of the coronavirus disease 2019 (COVID-19) epidemic on patients with preexisting stroke. We aim to study the clinical course of COVID-19 patients with preexisting stroke and to investigate death-related risk factors. Methods: We consecutively included 651 adult inpatients with COVID-19 from the Central Hospital of Wuhan between January 2 and February 15, 2020. Data on the demography, comorbidities, clinical manifestations, laboratory findings, treatments, complications, and outcomes (ie, discharged or death) of the participants were extracted from electronic medical records and compared between patients with and without preexisting stroke. The association between risk factors and mortality was estimated using a Cox proportional hazards regression model for stroke patients infected with severe acute respiratory syndrome coronavirus 2. Results: Of the 651 patients with COVID-19, 49 with preexisting stroke tended to be elderly, male, had more underlying comorbidities and greater severity of illness, prolonged length of hospital stay, and greater hospitalization expenses than those without preexisting stroke. Cox regression analysis indicated that the patients with stroke had a higher risk of developing critical pneumonia (adjusted hazard ratio, 2.01 [95% CI, 1.27–3.16]) and subsequent mortality (adjusted hazard ratio, 1.73 [95% CI, 1.00–2.98]) than the patients without stroke. Among the 49 stroke patients, older age and higher score of Glasgow Coma Scale or Sequential Organ Failure Assessment were independent risk factors associated with in-hospital mortality. Conclusions: Preexisting stroke patients infected with severe acute respiratory syndrome coronavirus 2 were readily predisposed to death, providing an important message to individuals and health care workers that preventive measures must be implemented to protect and reduce transmission in stroke patients in this COVID-19 crisis.

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Section: Discussionmentioning

confidence: 99%

Clinical Course and Mortality of Stroke Patients With Coronavirus Disease 2019 in Wuhan, China

Zhang

Sun

Wang

et al. 2020

Stroke

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“…6 Patients with COVID-19 may have high D-dimer levels 32 ; high D-dimer levels increase the risk of reocclusion. 33 While COVID-19 patients may have renal dysfunction, 32 there is conflicting evidence on the effects of renal dysfunction on outcome after thrombectomy for acute ischemic stroke. 34, 35…”

Section: Survey Results and Recommendationsmentioning

confidence: 99%

Stroke Care During the COVID-19 Pandemic: Asian Stroke Advisory Panel Consensus Statement

Pandian

Kusuma

Nilanont

2021

Journal of Stroke Medicine

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The COVID-19 pandemic has impacted the health system worldwide. Stroke is one of the leading causes of death and disability in the world. Asia has a diverse health system and more than two-thirds of strokes occur in this region. The Asian Stroke Advisory Panel (ASAP) conducted a survey among the member countries to explore the impact of COVID-19 on stroke care. The stroke admission numbers have fallen, as have the number of patients who received thrombolysis and mechanical thrombectomy. The stroke unit and rehabilitation beds have been reallocated for COVID-19 care. ASAP recommends emergency department screening of stroke patients for COVID-19 and protected stroke code to be activated for COVID-19 suspect stroke patients. Noncontrast computed tomography (CT), CT angiography, and CT chest are the imaging modalities of choice. All health care professionals involved in triaging, imaging, and stroke care should wear appropriate personal protective equipment. All eligible stroke patients (COVID suspect/positive/non-COVID) should receive intravenous thrombolysis/mechanical thrombectomy. Mobile stroke units and robots can be used wherever available for evaluation and triaging. All stroke patients should receive standard stroke unit care. Limited rehabilitation should be offered to patients and training of caregivers if needed. Telemedicine/telestroke should be used for rehabilitation and follow-up. The ASAP consensus statement can be adapted to suit local and national health care systems.

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“…[ 44 ] Other negative predictors include baseline NIH Stroke Scale score, distal clot migration, D-dimer levels, history of transient ischemic attack or stroke, terminal ICA occlusion, number of thrombectomy passes, and age. [ 45 46 47 ] Vascular tortuosity, presents in nearly 40% of patients, and arterial kinks also correlate with worse outcomes, but this is due to thrombectomy failure from the inability to reach the thrombus. [ 48 49 ] COVID-19 status also plays a crucial role in EVT outcomes.…”

Section: Current Horizons Of Endovascular Mechanical Thrombectomymentioning

confidence: 99%

Vascular tortuosity in endovascular mechanical thrombectomy

Farooq

Lee

2021

Brain Circ

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Endovascular mechanical thrombectomy effectively removes occlusive thrombi from the arterial lumen; however, there is little literature supporting the relevance of vascular geometry on surgical outcomes. Critical vessel characteristics including the degree of angulation and tortuosity influence the ability to advance stent retriever devices toward the site of occlusion. Therefore, it is crucial to evaluate the impact of carotid artery catheter pathway accessibility on the thrombectomy outcomes in acute ischemic stroke (AIS) patients. Traditional imaging modalities generate incomplete pictures of the vascular tortuosity and are prone to clinical judgment errors. Recent three-dimensional computed tomography angiography image analysis techniques circumvent these limitations to calculate accurate tortuosity and angulation measurements. These novel images facilitate classifying common anatomical variant patients into groups that may be treated with specially designed catheter devices. Importantly, this image analysis method reveals significant angulation in the common carotid artery and extracranial internal carotid artery that correlates with delays in reaching the occlusion site. Increased age, which is associated with increased risk of stroke, also increases the incidence of severe tortuosity. The semi-automated measurements technique also demonstrate that full 360° arterial loops are present in nearly 3% of catheter pathways and that the overall degree of angulation differs bilaterally. In this review, we examine the utility of this novel image analysis procedure and evaluate the recent literature relevant to neuroendovascular thrombectomy in AIS patients. Three literature databases – PubMed, Embase, and Web of Science were queried for original articles investigating both preclinical and clinical thrombectomy applications.

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Prognosis and risk factors for reocclusion after mechanical thrombectomy

Cited by 26 publications

References 25 publications

Clinical Course and Mortality of Stroke Patients With Coronavirus Disease 2019 in Wuhan, China

Clinical Course and Mortality of Stroke Patients With Coronavirus Disease 2019 in Wuhan, China

Stroke Care During the COVID-19 Pandemic: Asian Stroke Advisory Panel Consensus Statement

Vascular tortuosity in endovascular mechanical thrombectomy

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