Successful reperfusion is only the first step in stroke recovery. What are the EXACT followup steps to 100% recovery? NO followup, your stroke medical 'professional' is a complete fucking failure!
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? If you don't have 100% recovery protocols, you get them created. Competent persons would accomplish that.
Acute Ischemic Stroke With LVO Outcomes Depend on Occlusion Site and Reperfusion Technique
Reperfusion and clinical outcomes after acute ischemic stroke (AIS) with large vessel occlusion (LVO) depend on both occlusion site and reperfusion technique, according to results of a study published in Stroke: Vascular and Interventional Neurology.
The 3 major reperfusion techniques are stent retriever (SR) classic, SR in combination with aspiration (SR combination), and direct aspiration (DA) without SR.
Data for this study were sourced from the ASSIST registry (ClinicalTrials.gov: NCT03845491) which is a prospective, multinational initiative focused on AIS and LVO. In this study, patients (N=1477) with anterior circulation AIS with LVO who received reperfusion were evaluated for outcomes on the basis of occlusion site and reperfusion technique. Successful reperfusion was defined as expanded thrombolysis in cerebral infarction (eTICI) 2c or 3 recanalization in the first pass and a good clinical outcome was defined as a modified Rankin Scale (mRS) score of 0 to 2 at 90 days.
The patients with a clot in the M1 segment of the middle cerebral artery (M1) who received SR classic (n=145), SR combination (n=341), and DA (n=300) differed by age (P =.0009) and National Institutes of Health Stroke Scale (NIHSS) score (P =.04) but not by gender. The patients with a clot in the M2 segment of the middle cerebral artery (M2) who received SR classic (n=63), SR combination (n=215), and DA (n=90) did not differ by age, gender, or NIHSS score. The patients with a clot in the internal carotid artery (ICA) who received SR classic (n=38), SR combination (n=129), and DA (n=156) differed by age (P =.04) but not gender or NIHSS score.
In M1, primary successful reperfusion rates ranged between 46.2% and 49.4% and good clinical outcome rates ranged between 50.2% and 56.1%, which did not differ significantly on the basis of reperfusion technique (both P ³.61). Patients who were treated with DA were more likely to require a bailout technique (P <.001). However, DA was associated with the shortest time from groin puncture to end of the procedure compared with SR techniques (mean, 28.6 vs 36.8-38.6 min, respectively; P =.02).
In M2, primary successful reperfusion rates ranged between 35.6% and 48.3% and good clinical outcome rates ranged between 59.7% and 71.0%, which did not differ significantly between techniques (both P ³.24).
In ICA, the primary successful reperfusion rate was highest with SR combination (43.3%; P <.0001), followed by SR classic (38.2%) and DA (18.2%). However, no difference in final successful reperfusion rates (60.5%-76.3%; P =.25) or good clinical outcome rates (46.0%-48.6%; P =.91) were observed.
In the multivariate analyses, first pass efficacy in ICA was worse with DA compared with SR classic (odds ratio [OR], 0.29; P =.007). No other significant trends with regard to first pass efficacy and reperfusion technique were observed.
This study may have been limited by combining data from multiple centers which may have differing operator expertise and preferences.
Study authors concluded, “…our analysis within the ASSIST registry provides valuable insights into the impact of reperfusion techniques on clinical outcomes in patients with acute ischemic stroke with different occlusion sites.”
Disclosure: This research was supported by Stryker Neurovascular. Please see the original reference for a full list of disclosures
This article originally appeared on The Cardiology Advisor
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