Deans' stroke musings: Carotid Artery Stenosis Contralateral to Intracranial Large Vessel Occlusion: An Independent Predictor of Unfavorable Clinical Outcome After Mechanical Thrombectomy

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, June 28, 2018

Carotid Artery Stenosis Contralateral to Intracranial Large Vessel Occlusion: An Independent Predictor of Unfavorable Clinical Outcome After Mechanical Thrombectomy

No clue, ask your doctor. I was interested in this because I had 80% carotid occlusion that was never found by my initial doctors. So someplace in here there must be a protocol that has doctors checking carotid arteries.

Carotid Artery Stenosis Contralateral to Intracranial Large Vessel Occlusion: An Independent Predictor of Unfavorable Clinical Outcome After Mechanical Thrombectomy

Volker Maus¹^*,

Nuran Abdullayev²,

Henrik Sack¹,

Jan Borggrefe²,

Anastasios Mpotsaris³^† and

Daniel Behme¹^†

¹Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Göttingen, Germany
²Department of Diagnostic and Interventional Radiology, University Hospital, Cologne, Germany
³Department of Diagnostic and Interventional Neuroradiology, University Hospital, Aachen, Germany

Background: Clinical outcome in patients undergoing mechanical thrombectomy (MT) due to intracranial large vessel occlusion (LVO) in the anterior circulation is influenced by several factors. The impact of a concomitant extracranial carotid artery stenosis (CCAS) contralateral to the intracranial lesion remains unclear.

Methods: Retrospective analysis of 392 consecutive patients treated with MT due to intracranial LVO in the anterior circulation in two comprehensive stroke centers between 2014 and 2017. Clinical (including demographics and NIHSS), imaging (including angiographic evaluation of CCAS via NASCET criteria), and procedural data were evaluated. Primary endpoint was an unfavorable clinical outcome defined as modified Rankin Scale 3–6 at 90 days.

Results: In 27/392 patients (7%) pre-interventional imaging exhibited a CCAS (>50%) contralateral to the intracranial lesion compared to 365 patients without relevant stenosis. Median baseline NIHSS, procedural timings, and reperfusion success did not differ between groups. Median volume of the final infarct core was larger in CCAS patients (176 cm³, IQR 32-213 vs. 11 cm³, 1-65; p < 0.001). At 90 days, unfavorable outcome was documented in 25/27 CCAS patients (93%) vs. 211/326 (65%; p = 0.003) with a mortality of 63 vs. 19% (p = 0.001), respectively. Presence of CCAS was associated with an unfavorable outcome at 90 days independent of age and baseline NIHSS in multivariate logistic regression (OR 2.2, CI 1.1-4.7; p < 0.05).

Conclusion: For patients undergoing MT due to intracranial vessel occlusion in the anterior circulation, the presence of a contralateral CCAS >50% is a predictor of unfavorable clinical outcome at 90 days.

Much more at link.