Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS

Snyder, Thomas E.; Agarwal, Shashank; Huang, Jeffrey; Ishida, Koto; Flusty, Brent; Frontera, Jennifer A.; Lord, Aaron; Torres, Jose; Zhang, Cen; Rostanski, Sara; Favate, Albert; Lillemoe, Kaitlyn; Sanger, Matthew; Kim, Sun; Humbert, Kelley; Scher, Erica; Dehkharghani, Seena; Raz, Eytan; Shapiro, Maksim; Nelson, Peter Kim; Gordon, David; Tanweer, Omar; Nossek, Erez; Farkas, Jeffrey; Liff, Jeremy; Turkel‐Parrella, David; Tiwari, Ambooj; Riina, Howard A.; Yaghi, Shadi

doi:10.1111/jon.12729

Cited by 13 publications

(12 citation statements)

References 18 publications

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“…In addition, as is consistent with our results, the delay from hospital arrival to puncture or from onset to reperfusion would worsen the outcome of mechanical thrombectomy for acute stroke (Bourcier et al, 2019;Kaesmacher et al, 2020;Snyder et al, 2020;Zhu et al, 2021). In this study, the model demonstrated the top 5 important variables, two of which are related to time, namely, time from onset to hospital, and time from onset to EVT.…”

Section: Discussionsupporting

confidence: 89%

A Presurgical Unfavorable Prediction Scale of Endovascular Treatment for Acute Ischemic Stroke

Zhu²,

Zhou³

et al. 2022

Front. Aging Neurosci.

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ObjectiveTo develop a prognostic prediction model of endovascular treatment (EVT) for acute ischemic stroke (AIS) induced by large-vessel occlusion (LVO), this study applied machine learning classification model light gradient boosting machine (LightGBM) to construct a unique prediction model.MethodsA total of 973 patients were enrolled, primary outcome was assessed with modified Rankin scale (mRS) at 90 days, and favorable outcome was defined using mRS 0–2 scores. Besides, LightGBM algorithm and logistic regression (LR) were used to construct a prediction model. Then, a prediction scale was further established and verified by both internal data and other external data.ResultsA total of 20 presurgical variables were analyzed using LR and LightGBM. The results of LightGBM algorithm indicated that the accuracy and precision of the prediction model were 73.77 and 73.16%, respectively. The area under the curve (AUC) was 0.824. Furthermore, the top 5 variables suggesting unfavorable outcomes were namely admitting blood glucose levels, age, onset to EVT time, onset to hospital time, and National Institutes of Health Stroke Scale (NIHSS) scores (importance = 130.9, 102.6, 96.5, 89.5 and 84.4, respectively). According to AUC, we established the key cutoff points and constructed prediction scale based on their respective weightings. Then, the established prediction scale was verified in raw and external data and the sensitivity was 80.4 and 83.5%, respectively. Finally, scores >3 demonstrated better accuracy in predicting unfavorable outcomes.ConclusionPresurgical prediction scale is feasible and accurate in identifying unfavorable outcomes of AIS after EVT.

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Section: Discussionsupporting

confidence: 89%

A Presurgical Unfavorable Prediction Scale of Endovascular Treatment for Acute Ischemic Stroke

Zhu²,

Zhou³

et al. 2022

Front. Aging Neurosci.

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“…Endovascular therapy in addition to the medical treatment is now the standard of care for select patients who had a stroke caused by a large vessel occlusion in the anterior circulation. 1 The two main factors associated with a good outcome are time, namely the rapidity of the treatment, 2 and hemodynamic conditions. 3,4…”

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confidence: 99%

General Anesthesia versus Sedation, Both with Hemodynamic Control, during Intraarterial Treatment for Stroke: The GASS Randomized Trial

et al. 2022

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Background It is speculated that the anesthetic strategy during endovascular therapy for stroke may have an impact on the outcome of the patients. The authors hypothesized that conscious sedation is associated with a better functional outcome 3 months after endovascular therapy for the treatment of stroke compared with general anesthesia. Methods In this single-blind, randomized trial, patients received either a standardized general anesthesia or a standardized conscious sedation. Blood pressure control was also standardized in both groups. The primary outcome measure was a modified Rankin score less than or equal to 2 (0 = no symptoms; 5 = severe disability) assessed 3 months after treatment. The main secondary outcomes were complications, mortality, reperfusion results, and National Institutes of Health Stroke Scores at days 1 and 7. Results Of 351 randomized patients, 345 were included in the analysis. The primary outcome occurred in 129 of 341 (38%) of the patients: 63 (36%) in the conscious sedation group and 66 (40%) in the general anesthesia group (relative risk, 0.91 [95% CI, 0.69 to 1.19]; P = 0.474). Patients in the general anesthesia group experienced more intraoperative hypo- or hypertensive episodes, while the cumulative duration was not different (mean ± SD, 36 ± 31 vs. 39 ± 25 min; P = 0.079). The time from onset and from arrival to puncture were longer in the general anesthesia group (mean difference, 19 min [i.e., −00:19] [95% CI, −0:38 to 0] and mean difference, 9 min [95% CI, −0:18 to −0:01], respectively), while the time from onset to recanalization was similar in both groups. Recanalization was more often successful in the general anesthesia group (144 of 169 [85%] vs. 131 of 174 [75%]; P = 0.021). The incidence of symptomatic intracranial hemorrhage was similar in both groups. Conclusions The functional outcomes 3 months after endovascular treatment for stroke were similar with general anesthesia and sedation. Our results, therefore, suggest that clinicians can use either approach. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…38,39 Recent research has shown that even a 15-minute delay in treatment is associated with a 10% decrease in the likelihood of good functional outcome. 40,41 In the past 2 decades, telestroke has become one of the most effective telemedicine applications by showing increased rates of tPA administration, reduced door-to-needle times, and decreased patient death and dependency. 42,43 Telerobotics refers to transmission of data through telecommunication systems to allow the active control of instruments by a remote physician located at a distance from the interventional suite.…”

Section: Teleroboticsmentioning

confidence: 99%

A Review of Robotic Interventional Neuroradiology

Beaman

Kaneko

Meyers

et al. 2021

AJNR Am J Neuroradiol

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Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a lead-shielded cockpit located several feet (or potentially hundreds of miles) from the patient. This has opened up the possibility of expanding telestroke networks to patients without access to life-saving procedures such as stroke thrombectomy and cerebral aneurysm occlusion by highly-experienced physicians. The prototype machines, first developed in the early 2000s, have evolved into machines capable of a broad range of techniques, while incorporating newly automated maneuvers and safety algorithms. In recent years, preliminary clinical research has been published demonstrating the safety and feasibility of the technology in cerebral angiography and intracranial intervention. The next step is to conduct larger, multisite, prospective studies to assess generalizability and, ultimately, improve patient outcomes in neurovascular disease.

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Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS

Cited by 13 publications

References 18 publications

A Presurgical Unfavorable Prediction Scale of Endovascular Treatment for Acute Ischemic Stroke

A Presurgical Unfavorable Prediction Scale of Endovascular Treatment for Acute Ischemic Stroke

General Anesthesia versus Sedation, Both with Hemodynamic Control, during Intraarterial Treatment for Stroke: The GASS Randomized Trial

A Review of Robotic Interventional Neuroradiology

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