Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke

Ma, Gaoting; Yu, Zequan; Jia, Baixue; Xian, Ying; Ren, Zeguang; Mo, Dapeng; Ma, Ning; Gao, Feng; Tong, Xu; Shi, Xiaodong; Li, Ling; Pan, Yuesong; Miao, Zhongrong

doi:10.1007/s00062-022-01178-7

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…As far as we know, we are the first to report that the time from puncture to reperfusion in the EVT procedure is an independent risk factor for the development of DVT in stroke patients, with a longer duration associated with a higher risk. A longer time from puncture to reperfusion in stroke patients has been already associated with poor recovery within 3 months and an increase in malignant cerebral edema and symptomatic intracranial hemorrhage within 24 h after successful EVT ( 31 – 33 ). Our study indicated that prolonged performance of EVT not only affects the brain locally but also systemically affects the coagulation system.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study

Han,

Yang,

Qian

et al. 2023

Front. Neurol.

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BackgroundDeep vein thrombosis (DVT) in lower extremities as a common complication of acute ischemic stroke (AIS) has long been studied. However, as the therapeutic options for AIS continue to advance, the pathogenic mechanisms behind DVT may change. Endovascular thrombectomy (EVT) has replaced intravenous thrombolysis and become the preferred treatment for AIS patients with large vessel occlusions. Therefore, it is important to update our understanding of DVT and its management. This study aimed to determine the prevalence and risk factors of DVT in AIS patients following EVT.MethodsIn this retrospective study, 245 AIS patients who had received EVT were recruited between January 2020 and December 2021. Within 10 days (median 4 days) of thrombectomy, DVT was diagnosed by ultrasonography. Demographic characteristics, clinical findings, and therapeutic procedures were compared between patients with and without DVT using univariate analysis. Cutoff points were defined for EVT time and plasma D-dimer concentration. Multivariable logistic regression was then used to determine the independent risk factors for DVT and evaluate their predictive power.ResultsThe prevalence of DVT in AIS patients after EVT was 27.3%. Multifactorial logistic regression analysis showed that age (OR 1.036, 95% CI 1.001–1.073; P = 0.045), female sex (OR 3.015, 95% CI 1.446–6.289; P = 0.003), lower limb muscle strength less than grade three (OR 7.015, 95% CI 1.887–26.080; P = 0.004), longer EVT time (OR 1.012, 95% CI 1.004–1.020; P = 0.003), and higher D-dimer levels (OR 1.350, 95% CI 1.150–1.585; P < 0.001) were independently associated with higher DVT risk in AIS patients following EVT. The cutoff points for operative time of EVT and plasma D-dimer were 65.5 min and 1.62 mg/L, respectively, above which the risk for DVT was dramatically increased with OR > 4 in AIS patients.ConclusionAIS patients are at increased risk of developing DVT following EVT particularly if they have undergone prolonged thrombectomy procedures and exhibit high plasma levels of D-dimers. However, the results of our study need to be validated by a multicenter prospective study with a larger population of stroke patients.

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Section: Discussionmentioning

confidence: 99%

Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study

Han,

Yang,

Qian

et al. 2023

Front. Neurol.

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“…The time from symptom onset to imaging is still a major factor to guide treatment decision-making in ischemic stroke for both IVT and EVT. 24,25 On admission of an ischemic stroke patient in daily clinical practice, the time window is usually reported as a main variable besides clinical severity. In the past, strict time windows were used as obligatory criteria, for instance a required time frame of 3 hours or less to administer IVT, which was subsequently extended to 4.5 hours.…”

Section: Discussionmentioning

confidence: 99%

Investigating Neurologic Improvement After IV Thrombolysis

Broocks,

Meyer,

Bechstein

et al. 2023

Neurology

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Background and Objectives:Time from stroke onset is associated with clinical response to intravenous thrombolysis with alteplase (IVT) and is therefore used to select patients for treatment. Alternatively, neuroimaging may be used for treatment in the uncertain or extended time window. We hypothesized that the patient-specific imaging indicator of ischemic lesion progression (“tissue clock”) using CT-perfusion (CTP) or quantitative net water uptake (NWU) is a predictor of early neurological improvement (ENI) independent of time.Methods:Observational study of anterior circulation ischemic stroke patients with proximal vessel occlusion and known time from symptom onset triaged by multimodal-CT undergoing endovascular treatment. Quantitative NWU using an established threshold (11.5%) or CTP lesion-core mismatch (EXTEND criteria) were used to estimate ischemic lesion progression. The treatment effect of IVT depending on lesion progression defined by tissue clock versus time clock was assessed by inverse-probability weighting (IPW). Endpoints were binarized ENI and functional independence at day-90.Results:409 patients were included, of which 223 (54.5%) received IVT. The proportion of patients within an early time window (<4.5h), low NWU, and CTP-mismatch were 45.0%/86.5%/80.3%. In IPW, IVT was associated with higher rates of ENI (%-difference: 7.3%,p=0.02). For patients with CTP-mismatch or low NWU, IVT was associated with a 9.6%/7.2% higher rate of ENI, which was different than the effect of IVT in patients without CTP-mismatch or high NWU (-9.3%/-7.3%; p=0.004/p=0.03), while early treatment window did not modifiy the effect of IVT.Discussion:CT-based measures of the “tissue clock” might identify patients who benefit from IVT more accurately than conventional time windows. Considering the high number of patients with early “tissue clock” (low NWU/CTP-mismatch) within an extended time window, considerable benefit from IVT using imaging indicators of the “tissue clock” may be achieved.

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“…To define the volume of the ischemic core, the apparent diffusion coefficient (ADC) was multiplied by 620, and the volume of hypoperfusion was defined as cerebral blood flow (CBF) < 40% on ASL (22). The time to maximum (Tmax) > 6 s volume represents hypoperfusion, and a CBF < 30% of volume represents the ischemic core in CTP (23,24). Details of the hypoperfusion and ischemic core images are illustrated in Figure 2.…”

Section: Image Analysismentioning

confidence: 99%

Comparison of clinical outcomes in patients with acute ischemic stroke who underwent endovascular treatment using different perfusion modalities: a real-world multicenter study

Gao,

Jing,

Huang

et al. 2023

Front. Neurol.

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BackgroundAdvanced perfusion modalities are increasingly popular for various diseases. However, few studies have focused on contrasting perfusion patterns.ObjectiveThis study aimed to compare the time efficiency and clinical outcomes of patients with acute ischemic stroke (AIS) who underwent endovascular treatment (EVT) before one-stop arterial spin labeling (ASL) and computed tomography perfusion (CTP) protocols.MethodsThis study retrospectively included 326 patients with AIS who had accepted EVT within 24 h of onset from four comprehensive stroke centers between October 2017 and September 2022. After 1:1 matching of the propensity scores, 202 patients were separated into two groups: the ASL group (n = 101) and the CTP group (n = 101).ResultsFunctional independence at 90 days (modified Rankin Scale [mRS] 0–2; p = 0.574), onset-to-puncture time (p = 0.231), door-to-puncture time (p = 0.136), and door-to-perfusion time (p = 0.646) were not significantly different between the two groups. The proportion of EVT complications (31.7% in the ASL group vs. 14.9% in the CTP group, p = 0.005) and symptomatic intracranial hemorrhage (sICH) at 24 h (23.8% in the ASL group vs. 9.9% in the CTP group, p = 0.008) in the CTP group were lower than the ASL group. The ischemic core volume was a common predictor of favorable outcomes in both ASL (p < 0.001) and CTP (p < 0.001) groups.ConclusionThere were no significant differences in time efficiency and efficacy outcomes between the two groups of patients receiving one-stop ASL and CTP. The proportion of sICH at 24 h and EVT complications of patients in the CTP group was lower than the ASL group. The ischemic core volume was an independent predictor for favorable outcomes.

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Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke

Cited by 10 publications

References 23 publications

Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study

Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study

Investigating Neurologic Improvement After IV Thrombolysis

Comparison of clinical outcomes in patients with acute ischemic stroke who underwent endovascular treatment using different perfusion modalities: a real-world multicenter study

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