Does bridging tPA before thrombectomy help (or harm) stroke patients over 80?

 You're measuring the wrong endpoints! Are you that blitheringly stupid that you  don't know that the only survivor goal in stroke is 100% recovery? Are you aren't listening to survivors?

Does bridging tPA before thrombectomy help (or harm) stroke patients over 80?

INTRODUCTION

Endovascular treatment (EVT) is an effective treatment(Effective is 100% recovery; NOT THE INTERMEDIATE STEP OF SUCCESSFUL REPERFUSION!) for patients with acute ischemic stroke (AIS); however, it remains to be determined if treatment with intravenous thrombolysis (IVT) prior to EVT confers any benefit in octogenarians and older. This study aimed to address if bridging tPA has improved functional outcomes or complications in patients 80 years and older.

METHODS

This multicentre retrospective cohort study included patients 80 years old and above who underwent endovascular therapy for large vessel occlusion acute ischaemic stroke in 10 compressive stroke centres across China and Singapore between 2018 and 2024. Clinical and procedural factors of patients in Singapore and China were compared using multivariate binary logistic regression. The primary outcome measured was 3-month functional independence defined as modified rankin scale (mRS) 0-2.(So, declaring failure a success! I'd have you all fired for using the tyranny of low expectations to declare success when it hasn't occurred!) Secondary outcomes included 3-month independent ambulation as defined as mRS 0-3, 3-month mortality rates and achieving successful recanalization. Data on intracranial haemorrhage was also collected.

RESULTS

Bridging IVT was not associated with improvement in 3-month functional independence (24.47% vs. 20.97%; p = 0.505), improvement in 3-month independent ambulation (32.80% vs. 41.49%; p = 0.512), 3-month mortality rates (36.17% vs. 33.33%; p = 0.637) or increased rates of successful recanalisation (89.36% vs. 87.63%; p = 0.672),. Instead, patients who underwent bridging IVT had higher rates of haemorrhage compared to patients who did not undergo bridging IVT even after adjusting for confounding factors (OR = 1.921; 95% CI 1.026-3.596; p = 0.041).

CONCLUSION

The findings of this study suggest that bridging IVT prior to EVT may not improve functional outcomes or mortality rates. However, it appears to be associated with an increase in risk of intracranial haemorrhage.

REFERENCES

1. Efficacy and safety of bridging intravenous thrombolysis prior to endovascular treatment in patients over 80 years old with acute ischemic stroke.

   Chen Y, Siow I, Lee KS, Dai Q, Xiao X, Garg A, Gopinathan A, Yang C.

   Neuroradiology. 2026 May 2 [Epub ahead of print]

Improving “No‐Reflow” After Complete Reperfusion: The Role of Intravenous Thrombolysis in Vertebrobasilar Artery Occlusion Patients Undergoing Endovascular Treatment

Have you even identified the problem properly? 

I'd suggest this needing a solution: Capillaries that don't open due to pericytes

Improving “No‐Reflow” After Complete Reperfusion: The Role of Intravenous Thrombolysis in Vertebrobasilar Artery Occlusion Patients Undergoing Endovascular Treatment

Zhanglin Li, MD https://orcid.org/0009-0001-6813-8589, Yingjie Xu, MD https://orcid.org/0000-0002-4181-7450, Pan Zhang, MD https://orcid.org/0000-0001-6320-6987, Miaomiao Hu, MD https://orcid.org/0009-0006-1821-0534, Ruyue Wang, MD https://orcid.org/0009-0008-4184-744X, Zhixin Huang, PhD, Zuowei Duan, PhD, Xinfeng Liu, PhD https://orcid.org/0000-0002-8182-9632 xfliu2@ustc.edu.cn, and Wen Sun, PhD https://orcid.org/0000-0002-7268-2085 sunwen_medneuro@163.comAuthor Info & Affiliations

Journal of the American Heart Association

Volume 14, Number 16

https://doi.org/10.1161/JAHA.124.039278

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Abstract

Background

Previous studies have found that the use of intravenous thrombolysis (IVT) before endovascular treatment (EVT) could mitigate the “no‐reflow” phenomenon in large‐vessel occlusion of the anterior circulation. However, the effect of preoperative IVT on reducing the “no‐reflow” phenomenon in vertebrobasilar artery occlusion (VBAO) is still uncertain. This study aimed to compare the outcomes of IVT before EVT versus EVT alone in patients with VBAO with complete reperfusion (mTICI [Modified Thrombolysis in Cerebral Infarction] 3).

Methods

We performed a retrospective analysis of patients with acute VBAO at 65 stroke centers in China. Patients with complete reperfusion after EVT were included. These patients were divided into 2 groups on the basis of whether IVT was used before EVT, and propensity score matching was applied to balance the groups. The primary outcome was favorable functional outcome, defined as a modified Rankin Scale score of 0 to 3 at 90 days. Secondary outcomes were functional independence (modified Rankin Scale score of 0–2 at 90 days) and modified Rankin Scale shift at 90 days. Safety end points included symptomatic intracranial hemorrhage and death at 90 days.

Results

Of the 2422 patients with VBAO who received EVT, 1452 patients achieved complete reperfusion. Among these, 273 patients received IVT before EVT. After propensity score matching, 268 patients treated with IVT before EVT were compared with 519 patients without IVT. In the matched cohort, the group that received IVT before EVT showed a higher rate of favorable functional outcome (modified Rankin Scale score, 0–3) (adjusted odds ratio, 1.40 [95% CI, 1.03–1.91]; P=0.033) and a lower mortality rate at 90 days (adjusted odds ratio, 0.72 [95% CI, 0.52–0.99]; P=0.044) compared with the EVT alone group.

Conclusions

Our study indicates that IVT before EVT could improve favorable functional outcomes and reduce death in patients with VBAO who achieve complete reperfusion.

Endovascular Versus Medical Management in Distal Medium Vessel Occlusion Stroke: The DUSK Study

 There's something here but since understandable English was not used; no clue. If we had survivors in charge, we would require readability of all parts of stroke research for survivor understanding. Not this writing for other researchers!

What is the meaning of clinical equipoise?

Clinical equipoise is the assumption that there is not one 'better' intervention present (for either the control or experimental group) during the design of a randomized controlled trial (RCT).

Endovascular Versus Medical Management in Distal Medium Vessel Occlusion Stroke: The DUSK Study

Mahmoud H. Mohammaden,

Lorena Souza Viana,

Hend Abdelhamid,

Marta Olive-Gadea,

Marc Rodrigo-Gisbert,

Manuel Requena,

Pedro N. Martins,

Stavros Matsoukas,

Braxton R. Schuldt,

… See all authors

Originally published24 May 2024https://doi.org/10.1161/STROKEAHA.123.045228Stroke. 2024;55:1489–1497

Abstract

BACKGROUND:

Endovascular treatment (EVT) is part of the usual care for proximal vessel occlusion strokes. However, the safety and effectiveness of EVT for distal medium vessel occlusions remain unclear. We sought to compare the clinical outcomes of EVT to medical management (MM) for isolated distal medium vessel occlusions.

METHODS:

This is a retrospective analysis of prospectively collected data from seven comprehensive stroke centers. Patients were included if they had isolated distal medium vessel occlusion strokes due to middle cerebral artery M3/M4, anterior cerebral artery A2/A3, or posterior cerebral artery P1/P2 segments. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included 90-day good (mRS score, 0–2) and excellent (mRS score, 0–1) outcomes. Safety measures included symptomatic intracranial hemorrhage and 90-day mortality.

RESULTS:

A total of 321 patients were included in the analysis (EVT, 179; MM, 142; 40.8% treated with intravenous thrombolysis). In the inverse probability of treatment weighting model, there were no significant differences between EVT and MM in terms of the overall degree of disability (mRS ordinal shift; adjusted odds ratio [aOR], 1.25 [95% CI, 0.95–1.64]; P=0.110), rates of good (mRS score, 0–2; aOR, 1.32 [95% CI, 0.97–1.80]; P=0.075) and excellent (aOR, 1.32 [95% CI, 0.94–1.85]; P=0.098) outcomes, or mortality (aOR, 1.20 [95% CI, 0.78–1.85]; P=0.395) at 90 days. The multivariable regression model showed similar findings. Moreover, there was no difference between EVT and MM in rates of symptomatic intracranial hemorrhage in the multivariable regression model (aOR, 0.57 [95% CI, 0.21–1.58]; P=0.277), but the inverse probability of treatment weighting model showed a lower likelihood of symptomatic intracranial hemorrhage (aOR, 0.46 [95% CI, 0.24–0.85]; P=0.013) in the EVT group.

CONCLUSIONS:

This multicenter study failed to demonstrate any significant outcome differences among patients with isolated distal medium vessel occlusions treated with EVT versus MM. These findings reinforce clinical equipoise. Randomized clinical trials are ongoing and will provide more definite evidence.

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CTP-Defined Large Core Is a Better Predictor of Poor Outcome for Endovascular Treatment Than ASPECTS-Defined Large Core

 Survivors don't want you uselessly predicting poor outcome! You blithering idiots are supposed to do the research that PREVENTS POOR OUTCOMES!  Do you even have two functioning neurons to rub together for a spark of intelligence?

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with name and my response in my blog. Or are you afraid to engage with my stroke-addled mind?  Survivors would like to know why you are doing useless research.

CTP-Defined Large Core Is a Better Predictor of Poor Outcome for Endovascular Treatment Than ASPECTS-Defined Large Core

Yi Sui,

Wenhuo Chen,

Chushuang Chen,

Yanting Chang,

Andrew Bivard,

Peng Wang,

Yu Geng,

Mark Parsons,

Longting Lin and

on behalf of INSPIRE Investigators

Originally published15 Mar 2024https://doi.org/10.1161/STROKEAHA.123.045091Stroke. 2024;0

Abstract

BACKGROUND:

Recent trials confirmed the effectiveness of endovascular therapy in patients with large ischemic cores. Yet the optimal neuroimaging modalities to define large core remains unclear. We tried to address this question by comparing the functional outcomes in patients receiving thrombectomy selected by either noncontrast computed tomography Alberta Stroke Program Early Computed Tomography Score (ASPECTS) or Computed Tomography perfusion (CTP).

METHODS:

This study retrospectively selected patients enrolled in the International Stroke Perfusion Registry between August 2011 and April 2022. Patients with acute stroke with large vessel occlusion in anterior circulation treated with endovascular therapy were included. All received both CTP and noncontrast computed tomography. The primary outcome was defined as poor functional outcome represented by a modified Rankin Scale score of 5 to 6 at 3 months. Large cores were defined in terms of either (1) noncontrast computed tomography ASPECTS ≤5 or (2) core volume ≥70 mL on CTP.

RESULTS:

A total of 1115 patients were included in the analysis, of which 90 patients had ASPECTS ≤5 (8.1%) and 97 patients CTP core ≥70 mL (8.7%). A fair agreement between ASPECTS and CTP with a κ value of 0.31 (0.21–0.40) was found. Compared with patients with neither CTP nor ASPECTS large cores, those with only ASPECTS-defined large cores (ie, ASPECTS ≤5; n=56) did not have a higher adjusted odds of poor outcome (29%; odds ratio, 1.84 [0.91–3.73]; P=0.089). However, patients with CTP large core but not ASPECTS-defined large core (n=63) had a higher adjusted odds of poor outcome (60%; odds ratio, 3.91 [2.01–7.60]; P<0.001). In time-stratified subgroup analysis (>6 versus ≤6 hours), ASPECTS showed no discriminative difference between ≤5 and >5 in poor outcome for patients receiving endovascular therapy within 6 hours.

CONCLUSIONS:

CTP core ≥70 mL-defined large cores are more predictive of poor outcome than ASPECTS ≤5-defined core in endovascular therapy patients, particularly within 6 hours after stroke onset.

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Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment

 Obviously(at least to me) we need further research in predicting and preventing the problems here. But with NO leadership in stroke, NOTHING WILL GET DONE!

Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment

Apostolos Safouris^1,2,3, Klearchos Psychogios¹, Lina Palaiodimou², Peter Orosz³, George Magoufis^4,5, Odysseas Kargiotis¹, Aikaterini Theodorou², Theodore Karapanayiotides⁶, Stavros Spiliopoulos⁵, Sándor Nardai³, Amrou Sarraj⁷, Thanh N. Nguyen⁸, Shadi Yaghi⁹, Silke Walter¹⁰, Simona Sacco¹¹, Guillaume Turc^12,13,14,15, Georgios Tsivgoulis^2,16

¹Stroke Unit, Metropolitan Hospital, Piraeus, Greece

²Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

³Department of Neurointerventions, National Institute of Mental Health, Neurology and Neurosurgery, Semmelweis University, Department of Neurosurgery, Budapest, Hungary

⁴Interventional Neuroradiology Unit, Metropolitan Hospital, Piraeus, Greece

⁵Second Department of Radiology, Interventional Radiology Unit, “Attikon” University Hospital, Athens, Greece

⁶Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece

⁷Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

⁸Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA

⁹Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA

¹⁰Department of Neurology, Saarland University Medical Centre, Homburg, Germany

¹¹Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy

¹²Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France

¹³INSERM U1266, Paris, France

¹⁴FHU Neurovasc, Paris, France

¹⁵Université Paris Cité, Paris, France

¹⁶Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

Correspondence: Dr. Georgios Tsivgoulis Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens, Greece 12462 Tel: +30-6937178635 Email: tsivgoulisgiorg@yahoo.gr

Received May 15, 2023       Revised November 30, 2023       Accepted December 4, 2023

Copyright © 2024 Korean Stroke Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cardioembolic stroke is a major cause of morbidity, with a high risk of recurrence, and anticoagulation represents the mainstay of secondary stroke prevention in most patients. The implementation of endovascular treatment in routine clinical practice complicates the decision to initiate anticoagulation, especially in patients with early hemorrhagic transformation who are considered at higher risk of hematoma expansion. Late hemorrhagic transformation in the days and weeks following stroke remains a potentially serious complication for which we still do not have any established clinical or radiological prediction tools. The optimal time to initiate therapy is challenging to define since delaying effective secondary prevention treatment exposes patients to the risk of recurrent embolism. Consequently, there is clinical equipoise to define and individualize the optimal timepoint to initiate anticoagulation combining the lowest risk of hemorrhagic transformation and ischemic recurrence in cardioembolic stroke patients. In this narrative review, we will highlight and critically outline recent observational and randomized relevant evidence in different subtypes of cardioembolic stroke with a special focus on anticoagulation initiation following endovascular treatment. We will refer mainly to the commonest cause of cardioembolism, non-valvular atrial fibrillation, and examine the possible risk and benefit of anticoagulation before, during, and shortly after the acute phase of stroke. Other indications of anticoagulation after ischemic stroke will be briefly discussed. We provide a synthesis of available data to help clinicians individualize the timing of initiation of oral anticoagulation based on the presence and extent of hemorrhagic transformation as well as stroke severity.

 

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Costs and health effects of CT perfusion-based selection for endovascular thrombectomy within 6 hours of stroke onset: a model-based health economic evaluatin

'Costs'? 

Survivors want to know the efficacy of getting to 100% recovery. Work on what survivors want instead of 'cost'!

Costs and health effects of CT perfusion-based selection for endovascular thrombectomy within 6 hours of stroke onset: a model-based health economic evaluatin

1. http://orcid.org/0000-0002-2647-3557Henk van Voorst1,2,
2. http://orcid.org/0000-0003-3310-3973Jan W Hoving1,
3. http://orcid.org/0000-0003-4709-0130Miou S Koopman1,
4. Jasper D Daems3,4,
5. Daan Peerlings5,
6. Erik Buskens6,
7. Hester Lingsma7,
8. Henk A Marquering1,8,
9. Hugo W A M de Jong9,
10. Olvert A Berkhemer10,10,
11. Wim H van Zwam11,
12. Marianne A A van Walderveen12,
13. Ido R van den Wijngaard13,14,
14. http://orcid.org/0000-0002-9234-3515Diederik W J Dippel15,
15. Albert J Yoo16,
16. Bruce Campbell17,
17. Wolfgang G Kunz18,
18. Charles B Majoie1,
19. Bart J Emmer1,
20. CLEOPATRA,
21. MR CLEAN Registry
22. CONTRAST Consortium Investigators

1. Correspondence to Dr Henk van Voorst, Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, 1034, The Netherlands; h.vanvoorst@amsterdamumc.nl

Abstract

Background Although CT perfusion (CTP) is often incorporated in acute stroke workflows, it remains largely unclear what the associated costs and health implications are in the long run of CTP-based patient selection for endovascular treatment (EVT) in patients presenting within 6 hours after symptom onset with a large vessel occlusion.

Methods Patients with a large vessel occlusion were included from a Dutch nationwide cohort (n=703) if CTP imaging was performed before EVT within 6 hours after stroke onset. Simulated cost and health effects during 5 and 10 years follow-up were compared between CTP based patient selection for EVT and providing EVT to all patients. Outcome measures were the net monetary benefit at a willingness-to-pay of €80 000 per quality-adjusted life year, incremental cost-effectiveness ratio), difference in costs from a healthcare payer perspective (ΔCosts) and quality-adjusted life years (ΔQALY) per 1000 patients for 1000 model iterations as outcomes.

Results Compared with treating all patients, CTP-based selection for EVT at the optimised ischaemic core volume (ICV≥110 mL) or core-penumbra mismatch ratio (MMR≤1.4) thresholds resulted in losses of health (median ΔQALYs for ICV≥110 mL: −3.3 (IQR: −5.9 to −1.1), for MMR≤1.4: 0.0 (IQR: −1.3 to 0.0)) with median ΔCosts for ICV≥110 mL of −€348 966 (IQR: −€712 406 to −€51 158) and for MMR≤1.4 of €266 513 (IQR: €229 403 to €380 110)) per 1000 patients. Sensitivity analyses did not yield any scenarios for CTP-based selection of patients for EVT that were cost-effective for improving health, including patients aged ≥80 years

Conclusion In EVT-eligible patients presenting within 6 hours after symptom onset, excluding patients based on CTP parameters was not cost-effective and could potentially harm patients.

Data availability statement

Data are available upon reasonable request. The complete de-identified patient data sets from the MR CLEAN-NO IV, and MR CLEAN-MED trials will be available from 18 months after publication until 15 years from publication. Data can be obtained from https://www.contrast-consortium.nl/data-request-form/. The data will be made available to researchers who are CONTRAST consortium members or collaborators, and whose proposed use of the data has been approved by the CONTRAST data access and writing committee. The data will be made available for specified purposes, as defined in the substudy proposal and approved by the CONTRAST data access and writing committee. The data will be made available after approval of the proposal by the CONTRAST data access and writing committee. To ensure publication transparency and quality, researchers should adhere to the CONTRAST publication policy, accessible on https://www.contrast-consortium.nl/publication-policy-contrast/. For the patients included in the MR CLEAN Registry and the local cohort, individual patient data cannot be made available under Dutch law since we did not obtain patient approval for sharing individual patient data. All syntax files and output of statistical analyses are available on reasonable request to the corresponding author.

https://doi.org/10.1136/jnnp-2023-331862

Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment

You described a problem, offered NO solution. YOU'RE FIRED! The whole point of stroke research is to solve stroke! If your mentors and senior researchers don't know that find better ones.

 Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment

Dixia Zhang Qiuru Li Jun Liu Lijuan Ma Jing Ye Guifen Hu Guangzong Li^*

• Department of Neurology, The Sixth People's Hospital of Chengdu, Chengdu, China

Background and purpose: The impact of calculated plasma volume status (PVS) on the prognosis of acute ischemic stroke treated with endovascular treatment (EVT) remains undetermined. This study aimed to investigate the association between PVS and 90 days functional outcomes after EVT.

Methods: We enrolled patients treated with EVT in the anterior circulation from a prospective registry. The endpoint was a modified Rankin scale score of ≥3 points at 90 days after EVT. We used multivariable logistic regression models to investigate the association between PVS and poor outcomes. We used the restricted cubic spline to present the linearity between PVS and poor outcomes.

Results: Among the 187 enrolled patients (median age, 65 years; 35.8% women), a total of 81 patients (43.3%) experienced poor outcomes at 90 days. In multivariable analyses, PVS was associated with poor outcomes despite increasing confounding factors (odds ratio, 3.157; 95% confidence interval, 1.942–5.534; P < 0.001). The restricted cubic spline revealed a positive correlation between PVS and the risk of poor outcomes after EVT (P for nonlinearity = 0.021).

Conclusion: Our study found that an elevated PVS value was associated with poor outcomes after EVT. Further prospective cohorts were warranted to evaluate the utility of PVS in AIS treated with EVT.

Introduction

Ischemic stroke is the most common cause of death and long-term disability in China (1, 2). Randomized controlled trials have shown that endovascular treatment (EVT) is associated with improved functional independence and can extend the time window for acute ischemic stroke (AIS) patients with large-vessel occlusions in the anterior circulation (3–6). Despite the higher rates of successful recanalization, approximately 50% of AIS patients treated with EVT could not achieve functional independence during the process of rehabilitation (7). Previous studies suggested that the benefits from EVT could be attenuated by the stroke severity, pre-stroke disability, and major complications caused by EVT such as symptomatic intracranial hemorrhage (SICH) (8–10). Hence, it is warranted to have a better understanding of potential predictors to help physicians identify AIS patients with high risks of poor outcomes at the early stage after EVT.

Heart failure is an important risk factor for the short- and long-term prognosis of ischemic stroke. Previous studies have revealed that heart failure was associated with a 2-fold increased risk of mortality (11) and poor functional outcomes at 90 days in patients with ischemic stroke (12). Plasma volume (PV) is a marker of systemic congestion, which is a major complication of heart failure (13). However, accurate measurement of the PV could be challenging in clinical practice due to the technical difficulty and the requirement of invasive tools (14, 15). Notably, plasma volume status (PVS), which is calculated from non-invasive biomarkers of hematocrit and body weight, has been shown to be moderately correlated with gold-standard measurements using radioisotope assays (16). Previous studies have revealed that PVS was associated with clinical outcomes of heart failure (17), transcatheter aortic valve implantation (18), and cardiovascular diseases (19). However, few research studies have investigated the association between PVS and the risk of poor outcomes in AIS patients treated with EVT.

Hence, we performed the current study to investigate the potential association between PVS and poor outcomes in AIS patients treated with EVT.

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Association of periprocedural perfusion non-improvement with recurrent stroke after endovascular treatment for Intracranial Atherosclerotic Stenosis

This says something but I can't tell what.

Association of periprocedural perfusion non-improvement with recurrent stroke after endovascular treatment for Intracranial Atherosclerotic Stenosis

Long Yan, Zhikai Hou, […], and Ning Ma https://orcid.org/0000-0002-4909-7048 maning_03@hotmail.com+5View all authors and affiliations

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https://doi.org/10.1177/17562864221143178

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Abstract

Background:

Predictors of recurrent stroke after endovascular treatment for symptomatic intracranial atherosclerotic stenosis (ICAS) remain uncertain.

Objectives:

Among baseline characteristics, lesion features, and cerebral perfusion changes, we try to explore which factors are associated with the risk of recurrent stroke in symptomatic ICAS after endovascular treatment.

Design:

Consecutive patients with symptomatic ICAS of 70–99% receiving endovascular treatment were enrolled. All patients underwent whole-brain computer tomography perfusion (CTP) within 3 days before and 3 days after the endovascular treatment. Baseline characteristics, lesion features, and cerebral perfusion changes were collected.

Methods:

Cerebral perfusion changes were evaluated with RAPID software and calculated as preprocedural cerebral blood flow (CBF) < 30%, time to maximum of the residue function (Tmax) > 6 s, and Tmax > 4 s volumes minus postprocedural. Cerebral perfusion changes were divided into periprocedural perfusion improvement (>0 ml) and non-improvement (⩽ 0 ml). Recurrent stroke within 180 days was collected. The Cox proportional hazards analysis analyses were performed to evaluate factors associated with recurrent stroke.

Results:

From March 2021 to December 2021, 107 patients with symptomatic ICAS were enrolled. Of the 107 enrolled patients, 30 (28.0%) patients underwent balloon angioplasty alone and 77 patients (72.0%) underwent stenting. The perioperative complications occurred in three patients. Among CBF < 30%, Tmax > 6 s, and Tmax > 4 s volumes, Tmax > 4 s volume was available to evaluate cerebral perfusion changes. Periprocedural perfusion improvement was found in 77 patients (72.0%) and non-improvement in 30 patients (28.0%). Nine patients (8.4%) suffered from recurrent stroke in 180-day follow-up. In Cox proportional hazards analysis adjusted for age and sex, perfusion non-improvement was associated with recurrent stroke [hazards ratio (HR): 4.472; 95% CI: 1.069–18.718; p = 0.040].

Conclusion:

In patients with symptomatic ICAS treated with endovascular treatment, recurrent stroke may be related to periprocedural cerebral perfusion non-improvement.

Registration:

http://www.chictr.org.cn. Unique identifier: ChiCTR2100052925.

Introduction

Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of ischemic stroke worldwide.^1–3 Patients with 70–99% symptomatic ICAS are at high risk of recurrent stroke (12.2%) at 1 year despite aggressive medical management (AMM),⁴ and especially higher (37%) in those patients with impaired hemodynamics.⁵ Endovascular treatment remains an alternative therapy for patients with symptomatic ICAS refractory to AMM.^6–8 In two recent multiple registries focusing on endovascular treatment for symptomatic ICAS, the 1-year recurrent stroke declined to 6.3% and 8.5% compared with 20% in Stenting Versus Aggressive Medical Therapy for Intracranial Atherosclerosis (SAMMPRIS) trial.^9,10

So far, the predictors of the risk of recurrent stroke after endovascular treatment for symptomatic ICAS remain uncertain. We hypothesize that some baseline characteristics, lesion features, or cerebral perfusion parameters (preprocedural, postprocedural, or periprocedural changes) might be related to the risk of recurrent stroke after endovascular treatment. As for the evaluation of cerebral perfusion parameters, RAPID software (iSchemia View) which is an automatic software for post-processing computer tomography perfusion (CTP) images can quantitatively evaluate cerebral perfusion parameters, and it had been used to identify potential beneficiary with acute large vessel occlusion through endovascular thrombectomy.^11,12 Furthermore, RAPID software was used to assess impaired perfusion for patients with ICAS.¹³

In this study, we collected baseline characteristics, lesion features, and preprocedural and postprocedural cerebral perfusion parameters of patients with symptomatic ICAS treated with endovascular therapy in a high-volume stroke center and evaluated which factors were associated with the 180-day outcome of recurrent stroke.