Association of Successful Recanalization and Functional Outcomes in Minor Ischemic Stroke With Proven Occlusion: A Secondary Analysis of TEMPO-2 Trial

 Success is 100% recovery, you didn't describe that, SO THIS WAS ALL A FUCKING FAILURE!

Association of Successful Recanalization and Functional Outcomes in Minor Ischemic Stroke With Proven Occlusion: A Secondary Analysis of TEMPO-2 Trial

Nishita Singh, MD https://orcid.org/0000-0003-3647-0904 nishitaneurology@gmail.com, Daniel Strbian, MD https://orcid.org/0000-0001-9095-2344, 

Shabnam Vatanpour, MSc https://orcid.org/0000-0002-2398-5039, Thalia S. Field, MD https://orcid.org/0000-0002-1176-0633, 

Amy Y.X. Yu, MD https://orcid.org/0000-0002-7276-9551, Aravind Ganesh, MD https://orcid.org/0000-0001-5520-2070, 

Philip A. Barber, MD https://orcid.org/0000-0002-6051-1078, … Show All … , 

and Shelagh B. Coutts, MD https://orcid.org/0000-0001-5090-5105Author Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.125.052872

 

Abstract

 Complete recanalization of cerebral arteries is strongly associated with good functional outcome in ischemic stroke. We hypothesize that successful recanalization results in better functional outcomes.

METHODS:

This is a secondary observational cohort analysis of TEMPO-2 (Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion), a randomized controlled trial comparing tenecteplase with standard of care (control) in minor stroke (National Institutes of Health Stroke Scale score ≤5) with intracranial occlusion/focal perfusion abnormality ≤12 hours of onset. Among those enrolled based on computed tomography angiography with visible occlusion, a follow-up computed tomography angiography was done at 4 to 8 hours after randomization. The primary outcome was return to baseline functional outcomes using the modified Rankin Scale score at 90 days. Safety outcomes included stroke progression (National Institutes of Health Stroke Scale score ≥2 worsening), bleeding events, and mortality. Patients with successful recanalization, defined as revised Arterial Occlusive Lesion score ≥2b/3, were compared with those with unsuccessful recanalization on follow-up computed tomography angiography. Regression analysis was used to assess the association of successful recanalization with outcomes after adjusting for age, sex, baseline stroke severity, and onset-to-randomization time.Of the 886 enrolled patients, 517 (58.3%) with follow-up computed tomography angiography were included. Of these, 178 (34.6%) had successful recanalization (122 [68.5%]: tenecteplase, 56 (31.5%): control), and 336 (65.4%) did not achieve successful recanalization (unsuccessful recanalization; 134: tenecteplase, 202: control). Baseline characteristics were similar between patients with and without successful recanalization. Successful recanalization was significantly associated with the primary outcome as compared with unsuccessful recanalization (adjusted risk ratio, 1.21 [95% CI, 1.07–1.34]). Patients with successful recanalization had significantly lower rates of stroke progression as compared with unsuccessful recanalization (2.8% versus 13.1%, adjusted risk ratio, 0.21 [95% CI, 0.08–0.52]). Multivariable analysis showed that tenecteplase treatment was the strongest independent predictor of successful recanalization (odds ratio, 3.48 [95% CI, 2.33–5.18]).

CONCLUSIONS:

Successful recanalization is a critical determinant of early and 90-day functional recovery in patients with minor stroke with intracranial occlusion, regardless of treatment modality. Tenecteplase significantly increases the odds of achieving successful recanalization compared with standard care.

REGISTRATION:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02398656.

Graphical Abstract

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Intra-Arterial Alteplase Safe but Fails to Improve Functional Outcome After Basilar Artery Recanalization: JAMA

 Probably because you blithering idiots haven't figured out that the neuronal cascade of death continues occurring even if the artery was totally blown clear! My God, the absolute stupidity in stroke is mind blowing!

Intra-Arterial Alteplase Safe but Fails to Improve Functional Outcome After Basilar Artery Recanalization: JAMA

The protective effect of neurointerventional recanalization on the neurovascular unit in acute ischemic stroke and its correlation with serum GFAP and NfL levels

Predictions DO NOTHING FOR STROKE RECOVERY, and with NO protocols written, COMPLETELY FUCKING USELESS! You're fired!

 The protective effect of neurointerventional recanalization on the neurovascular unit in acute ischemic stroke and its correlation with serum GFAP and NfL levels

Ju Luo^†Yang Yang^*†Jingmin Zhou

• Department of Neurology, Huai’an Hospital Affiliated to Yangzhou University (The Fifth People’s Hospital of Huai’an), Huai’an, Jiangsu, China

Aim: This study aimed to investigate the neuroprotective mechanisms of mechanical thrombectomy (MT) by evaluating its effects on the neurovascular unit (NVU) and correlating these effects with dynamic changes in serum biomarkers in patients with acute ischemic stroke (AIS).

Methods: A prospective cohort of 128 AIS patients with anterior circulation large vessel occlusion was enrolled. Participants were divided into MT (n = 68) and intravenous thrombolysis (IVT) (n = 60) groups. Serum levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were measured at baseline (T0), 24 h (T1), and 72 h (T2) post-treatment. Clinical outcomes included recanalization rate (mTICI grade), NIHSS improvement, and 90-day modified Rankin Scale (mRS) score.

Results: The MT group showed significantly higher recanalization rates (94.1% vs. 36.7%, p < 0.001) and greater neurological improvement (median NIHSS improvement: 8 vs. 4, p < 0.001) compared to the IVT group. Serum NfL, GFAP, IL-1β, and TNF-α levels were markedly lower in the MT group at T1 and T2 (all p < 0.01). Strong correlations were identified between T2 NfL/GFAP levels and clinical outcomes (NIHSS improvement: r = −0.728/−0.663; 90-day mRS: r = 0.705/0.641; all p < 0.001).

Conclusion: Successful recanalization with MT is associated with mitigated axonal injury, astrocyte activation, and neuroinflammation, findings consistent with better preservation of NVU integrity. Serum NfL and GFAP represent promising biomarkers for predicting stroke prognosis and tailoring therapeutic strategies.

More at link.

Longer Thrombectomy Times Increase Mortality Risk and Stroke Care Costs

 What this means is that followup interventions need to be prioritized to get survivors fully recovered.  Change the failed status quo! Or is everyone in stroke completely BRAIN DEAD and willing to live with failure?

Longer Thrombectomy Times Increase Mortality Risk and Stroke Care Costs

Puncture to recanalization time was significantly associated with discharge outcome, wherein each 15-minute increase was linked to a higher likelihood of death or hospice discharge. Patients with acute ischemic stroke who experience longer puncture to recanalization (PTR) times during thrombectomy have worse outcomes and greater acute care costs. These findings were published in Stroke: Vascular and Interventional Neurology Researchers conducted a retrospective analysis of 721 patients who underwent mechanical thrombectomy for large vessel occlusion at a high-volume neuroendovascular practice between January 2011 and June 2020. The researchers examined the effect of PTR time on immediate poststroke disposition and associated costs. The analysis included patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction≥2B) and excluded those with missing data or those with extreme time outliers. Patients were categorized into 4 discharge groups: transfer to acute or subacute rehabilitation, home or home with physical therapy (PT), in-hospital death or hospice, and long-term care placement. The researchers employed a multinomial logistic regression model to assess how incremental increases in PTR time influenced these outcomes. [R]educing procedural time should be prioritized not only to improve individual patient outcomes but also to support institutional cost efficiency and inform national stroke care policies. The median PTR time was 34.7 minutes, and the cohort was 50% women, with a mean age of 67.0 years. Most patients (95%) presented with anterior circulation occlusions. Common comorbidities included hypertension (78.8%), hyperlipidemia (51.5%), atrial fibrillation (38.4%), and diabetes (29.3%). At discharge, 54.2% of patients were transferred to rehabilitation, 21.9% were discharged home or home with PT, 18.7% died or were transitioned to hospice, and 5.1% required long-term care placement. There was a significant association between PTR and discharge disposition (P= .003). Each 15-minute increase in PTR was linked to a 2% to 4.6% higher likelihood of death or hospice discharge and a 1.5% to 2.5% lower likelihood of being discharged home or home with PT. In adjusted analyses, longer PTR was independently associated with greater odds of death or hospice disposition (odds ratio [OR], 1.020; 95% CI, 1.008-1.032;P=.001). From an economic standpoint, every 15-minute increase in PTR was associated with an average increase in direct acute care costs of $190.04 per stroke episode (95% CI, $184.74-$196.20;P<.001). When extrapolated to an estimated 39,000 annual thrombectomies nationwide, the researchers estimated a $7.4 million annual increase in acute stroke care costs for each 15-minute increase in mean PTR (95% CI, $7.2–$7.7 million). Study limitations include a single-center design, exclusion of patients with incomplete data, and reliance on modeled cost estimates that did not capture postacute or indirect costs. “These results suggest that procedural speed remains a crucial determinant of clinical outcome, and reducing procedural time should be prioritized not only to improve individual patient outcomes but also to support institutional cost efficiency and inform national stroke care policies,” the study authors concluded.  Disclosures: This research was supported by Microvention. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Risk factors and impact on outcomes of high-density shadow on immediate cerebral CT after successful interventional recanalization in acute ischemic stroke with large vessel occlusion

FYI.

 Risk factors and impact on outcomes of high-density shadow on immediate cerebral CT after successful interventional recanalization in acute ischemic stroke with large vessel occlusion

Wensheng Zhang^1,2,3,4†Weifang Xing^1†Jiyun Feng^5†Yangchun Wen¹Minzhen Zhu^1,4Haiping Lan¹Xiaojing Zhong^1*Zhenqin Jiang^1*Li Ling^2,3*

• ¹Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, Guangdong, China
• ²Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
• ³Shenzhen School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
• ⁴Heyuan Key Laboratory of Molecular Diagnosis & Disease Prevention and Treatment, Doctors Station of Guangdong Province, Heyuan People's Hospital, Heyuan, Guangdong, China
• ⁵Department of Neurology, Lianzhou People's Hospital, Lianzhou, Guangdong, China

Objective: To explore the risk factors, classification, relation with hemorrhage and clinical significance of high-density shadow on immediate cerebral CT in patients with large vessel occlusion acute ischemic stroke after successful interventional recanalization.(Your definition of successful does not correspond with a survivor's definition and that is 100% recovery! The only goal in stroke!)

Methods: A retrospective analysis was conducted on patients with acute ischemic stroke due to anterior circulation large vessel occlusion who received interventional recanalization from January 2019 to December 2023 in Heyuan People’s Hospital. The main inclusion criteria included NIHSS score ≥ 6 points at the time of onset, the time from onset to femoral artery puncture ≤ 24 h and so on. The main exclusion criteria included pre onset mRS score > 2 points, the vital signs were unstable during the onset of the disease and so on. Variables we studied included NIHSS score at admission, preoperative ASPECT score, blood flow reperfusion eTICI grading, surgical methods and so on. According to the distribution, density, volume, etc. of cerebral hyperdensity, high-density shadow was divided into cortical type, soft type, metallic type, and diffuse type.

Results: 318 patients showed high-density shadow on cerebral CT immediately after successful interventional recanalization. In multiple logistic regression analysis, the history of hypertension and preoperative ASPECT score were correlated independently with the occurrence of high-density shadow. 27 patients experienced symptomatic intracranial hemorrhage. It was found that high-density shadow was not independent with symptomatic intracranial hemorrhage in univariate logistic regression analysis (p > 0.05). In the classification of high-density shadow, there were 16 cases of cortical type, 85 cases of soft type, 80 cases of metallic type, and 137 cases of diffuse type. Patients with diffuse type had the highest incidence of futile recanalization, symptomatic intracranial hemorrhage, malignant brain edema, and highest mortality rate within 3 months after surgery (p < 0.05).

Conclusion: A low preoperative ASPECT score was an independent risk factor of high-density shadow on immediate cerebral CT after successful interventional recanalization, while a history of hypertension, mere use of balloon angioplasty and combination of balloon angioplasty and stent implantation may serve as a protective factor. Patients with diffuse high-density shadow had the worst prognosis and the highest incidence of symptomatic intracranial hemorrhage and malignant brain edema.

Thrombolysis-to-puncture time greater than 70 minutes decreases odds of successful thrombectomy

Successful thrombectomy IS NOT JUST PULLING THE CLOT OUT!  Survivors want 100% recovery! Recanalization is NOT THE SURVIVORS' GOAL! When will you GET THERE?

Thrombolysis-to-puncture time greater than 70 minutes decreases odds of successful thrombectomy

Predicting vessel recanalization in extracranial internal carotid artery dissection: a nomogram based on ultrasonography and clinical features

 Collaterals grew around my blocked right carotid artery 13 years post stroke. Now 6 years later I still haven't had another stroke. This research told me nothing, what is the objective identification of a high risk patient? I'd have everyone fired!

Predicting vessel recanalization in extracranial internal carotid artery dissection: a nomogram based on ultrasonography and clinical features

Xinchun Xu^1,2,3Yanhong Yan^1,2Yafeng Qu³Lianlian Zhang^1,2Pinjing Hui^1,2*

• ¹Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
• ²Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
• ³Department of Ultrasound, The Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China

Background: Extracranial internal carotid artery dissection (EICAD) is a prominent factor in ischemic stroke in young patients, and vessel recanalization is correlated with stroke recurrence. We propose to determine the possible association between carotid duplex ultrasound (CDU) features, clinical factors, and vessel recanalization in EICAD patients.

Methods: In the current retrospective study, data from 202 patients diagnosed with EICAD by CDU and confirmed by computed tomography angiography (CTA) or high-resolution magnetic resonance imaging (HRMRI) were encompassed. Patients were randomized 7:3 into training cohort (n = 142) and validation cohort (n = 60). The least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis were used to build a nomogram to predict recanalization. At last, we assessed the performance of the nomogram with an area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC).

Results: The nomogram included CDU features (intramural hematoma, Intraluminal thrombus, and stenosis degree) and age, with AUC values of 0.906 (95% CI: 0.857–0.946) and 0.903 (95% CI: 0.820–0.963) in the training cohort and the validation cohort, respectively. Using a probability cutoff of 0.5 derived from the Youden index, patients were stratified into high-risk (recanalization probability <50%) and low-risk groups (≥50%). DCA showed that the nomogram performed significantly better across various threshold probabilities, and CIC demonstrated that the nomogram offers superior net benefit across a broad range of threshold probabilities, indicating its significant predictive value.

Conclusion: A nomogram depended on CDU and clinical features could accurately predict(Then what is the prediction protocol? Didn't create one? You're fucking useless!) recanalization in EICAD patients. The nomogram may facilitate early identification of high-risk patients and personalized therapeutic strategies.

Introduction

Extracranial internal carotid artery dissection (EICAD) is a disorder characterized by the passage of blood via a rip in the arterial wall layers, resulting in the blood entering the space between these layers, causing the carotid wall to separate into two layers and interfering with blood flow, which can lead to secondary stenosis or aneurysmal dilatation (1). Carotid artery dissection (CAD) accounts for around 25% of strokes in young individuals, making it a significant factor in stroke occurrence among individuals in their youth and middle age (2). Therefore, the accurate diagnosis and effective treatment of carotid artery dissection, as well as the enhancement of patients’ prognosis, are of crucial in clinical practice. Digital subtraction angiography (DSA) has traditionally been considered the most reliable method for diagnosing EICAD. However, this technique is an invasive examination and cannot clearly show the morphology of arterial wall, so it has certain limitations in the clinical diagnosis and treatment process (3). In recent times, high-resolution magnetic resonance imaging (HRMRI) has been increasingly employed in clinical practice. It has a high detection rate for intramural hematoma and can clearly show the structure of the vessel wall. However, it is time-consuming (4). Carotid Doppler ultrasound (CDU) has emerged as a valuable diagnostic modality for the evaluation of EICAD. It offers several advantages over other imaging techniques, such as being non-invasive and cost-effective, and it can observe the lumen and artery wall of the extracranial internal carotid artery in real-time. Therefore, CDU is of great value in evaluating the variations in vascular wall structure of EICAD patients.

Previous studies have been conducted on the recanalization rate of CAD (5–7), while limited attention has been given to the influence factors of recanalization. Furthermore, the nomogram is progressively employed as a visual aid for the purpose of illness prevention. However, few studies have combined CDU characteristics and clinical factors to establish a nomogram to evaluate the recanalization of EICAD. We aim to combine CDU features and clinical factors to identify those factors that are significantly correlated to vessel recanalization and to establish a nomogram to forecast the recanalization probability.

More at link.

Role of Neuroprotective Approaches in the Recanalization Era

This is the Michael Tymianski that years ago stated this.

Dr. Michael Tymianski, of the Toronto Western Hospital Research Institute in Canada states;  over the last half-century, there have been more than 1,000 drugs (So what are they?)aimed at preventing brain damage that have failed to work in people, even though they worked well in mice or rats. If you called it by the correct name, neuronal cascade of death, it sounds like it needs solving immediately rather than the milquetoast term 'neuroprotection'.

NOW WE JUST NEED STROKE LEADERSHIP to solve the neuronal cascade of death.

It's that fucking simple, solve that and you'll save hundreds of millions to billions of neurons from dying for each patient. I bet a lot of patients could easily recover if they didn't lose so many neurons due to the neuronal cascade of death.

Role of Neuroprotective Approaches in the Recanalization Era

Michael Tymianski

Originally published7 Feb 2024https://doi.org/10.1161/STROKEAHA.123.044229Stroke. 2024;0

Radial Versus Femoral Access for Mechanical Thrombectomy in Stroke Patients: A Non-Inferiority Randomized Clinical Trial

 Useless research. NO MEASUREMENT OF 100% RECOVERY! I'd fire you all.

Successful recanalization is only the first step to recovery, if you have nothing after that you're completely incompetent!

Radial Versus Femoral Access for Mechanical Thrombectomy in Stroke Patients: A Non-Inferiority Randomized Clinical Trial

David Hernandez,

Manuel Requena,

Marta Olivé Gadea,

Marta De Dios Lascuevas,

Laura Ludovica Gramegna,

Marian Muchada,

Álvaro García-Tornel,

Francesco Diana,

… See all authors

Originally published1 Feb 2024https://doi.org/10.1161/STROKEAHA.124.046360Stroke. 2024;0

Abstract

Background: Transfemoral access is predominantly used for mechanical thrombectomy in stroke patients with a large vessel occlusion. Following the interventional cardiology guidelines, routine transradial access has been proposed as an alternative, although its safety and efficacy remain controversial. We aim to explore the non-inferiority of radial access in terms of final recanalization.

Methods: The study was an investigator-initiated, single-center, evaluator-blinded randomized clinical trial. Stroke patients undergoing mechanical thrombectomy, with a patent femoral artery and a radial artery diameter ≥2.5mm, were randomly assigned (1:1) to either transradial (60 patients) or transfemoral access (60 patients). The primary binary outcome was the successful recanalization (eTICI 2b-3) assigned by blinded evaluators. We established a non-inferiority margin of -13.2%, considering an acceptable reduction of 15% in the expected recanalization rates.

Results:From September 2021 to July 2023, 120 patients were randomly assigned and 116 (58 transradial access, 58 transfemoral access) with confirmed intracranial occlusion on the initial angiogram were included in the intention-to-treat analysis. Successful recanalization(NOT GOOD ENOUGH!) was achieved in 51 (87.9%) patients assigned to transfemoral access and in 56/58 (96.6%) patients assigned to transradial (adjusted one side risk difference -5.0% (95% CI, -6.61% to +13.1%) showing non-inferiority of transradial access. Median time from angiosuite arrival to first pass (femoral: 30 (IQR 25-37) minutes versus radial: 41 (IQR 33-62) minutes, p<0.001) and from angiosuite arrival to recanalization (femoral: 42 (IQR 28-74) versus radial: 59.5 (IQR 44-81) minutes, p<0.050) were longer in the transradial access group. Both groups presented one severe access complication and there was no difference in the rate of access conversion: transradial 7 (12.1%) versus transfemoral 5 (8.6%) (p=0.751).

Conclusion: Among patients who underwent mechanical thrombectomy, transradial access was non-inferior to transfemoral access in terms of final recanalization. Procedural delays may favor transfemoral access as the default firstline approach.

Aspiration thrombectomy with the Penumbra System for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Contrary to their bleating this was obviously a failure since no mention is made of 100% recovery. I don't accept their tyranny of low expectations that recanalization is the end goal of survivors; 100% recovery is the only goal in stroke! Why aren't you measuring that?

Aspiration thrombectomy with the Penumbra System for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Ameer E. Hassan^1* Johanna T. Fifi² Osama O. Zaidat³

• ¹Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, United States
• ²Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
• ³Department of Endovascular Neurosurgery, Mercy Health St. Vincent Medical Center, Toledo, OH, United States

Background: The purpose of this study was to report the safety and performance of aspiration thrombectomy with the Penumbra System for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) and late onset to treatment.

Methods: This is a retrospective subset analysis of a global prospective multicenter registry (COMPLETE) that enrolled adults with AIS due to LVO and a pre-stroke modified Rankin Scale score (mRS) of 0 or 1 who were treated first-line with aspiration thrombectomy either alone (A Direct Aspiration First Pass Technique [ADAPT]) or in combination with the 3D Revascularization Device (ADAPT + 3D). This subset analysis included all patients in the registry who had anterior circulation LVO, an Alberta Stroke Program Early CT Score of at least 6, and late onset to treatment (>6 h from stroke onset to puncture).

Results: Of the 650 patients in the COMPLETE registry, 167 were included in this subset analysis. The rate of successful revascularization (Since you don't mention 100% recovery, the only conclusion possible is complete failure!)(modified thrombolysis in cerebral infarction score 2b-3 achieved) at the end of the procedure was 83.2%, the rate of good functional outcome (mRS 0–2) at 90 days was 55.4%, and the all-cause mortality rate at 90 days was 14.4%. No device-related serious adverse events (SAEs) occurred. Procedure-related SAEs occurred in 9 patients (5.4%) within 24 h and in 12 patients (7.2%) overall. The rate of successful revascularization was higher for patients treated first-line with ADAPT (88.0%) than for patients treated first-line with ADAPT + 3D (75.0%; p = 0.035); no significant difference was observed between the ADAPT and ADAPT + 3D groups for any other primary or secondary outcome.

Conclusion: For patients with AIS due to anterior circulation LVO and with late onset to treatment, aspiration thrombectomy with the Penumbra System appears to be safe and effective. (Nope, nope, nope!) The rates of good functional outcome and all-cause mortality from this study compared favorably with those rates from the medical management arms of the DAWN and DEFUSE-3 studies.

Clinical trial registration: https://www.clinicaltrials.gov, NCT03464565.

A visualized nomogram to online predict futile recanalization after endovascular thrombectomy in basilar artery occlusion stroke

 What will you do with those patients you determine are futile? Leave them to rot? Figure out how to recover on their own with no help from medical 'professionals'?

A visualized nomogram to online predict futile recanalization after endovascular thrombectomy in basilar artery occlusion stroke

ShiTeng Lin^1,2†, XinPing Lin^1,2†, Juan Zhang^3†, Meng Wan^2,4, Chen Chen^2,4, Qiong Jie^2,4, YueZhang Wu^2,4, RunZe Qiu^2,4, XiaoLi Cui³, ChunLian Jiang^5*, JianJun Zou^2,4* and ZhiHong Zhao^6*

• ¹School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
• ²Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ³Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ⁴Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
• ⁵Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ⁶Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan), Hunan Normal University, Changsha, China

Background and purpose: Futile recanalization occurs in a significant proportion of patients with basilar artery occlusion (BAO) after endovascular thrombectomy (EVT). Therefore, our goal was to develop a visualized nomogram model to early identify patients with BAO who would be at high risk of futile recanalization, more importantly, to aid neurologists in selecting the most appropriate candidates for EVT.

Methods: Patients with BAO with EVT and the Thrombolysis in Cerebral Infarction score of ≥2b were included in the National Advanced Stroke Center of Nanjing First Hospital (China) from October 2016 to June 2021. The exclusion criteria were lacking the 3-month Modified Rankin Scale (mRS), age <18 years, the premorbid mRS score >2, and unavailable baseline CT imaging. Potential predictors were selected for the construction of the nomogram model and the predictive and calibration capabilities of the model were assessed.

Results: A total of 84 patients with BAO were finally enrolled in this study, and patients with futile recanalization accounted for 50.0% (42). The area under the curve (AUC) of the nomogram model was 0.866 (95% CI, 0.786–0.946). The mean squared error, an indicator of the calibration ability of our prediction model, was 0.025. A web-based nomogram model for broader and easier access by clinicians is available online at https://trend.shinyapps.io/DynNomapp/.

Conclusion: We constructed a visualized nomogram model to accurately and online predict the risk of futile recanalization for patients with BAO, as well as assist in the selection of appropriate candidates for EVT.

More at link.

Cerebral Circulation Time After Thrombectomy: A Potential Predictor of Outcome After Recanalization in Acute Stroke

 As is, this is totally fucking useless. NOTHING on how to increase the cerebral circulation levels  to the proper level. My god, does no one in stroke know how to do research?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

 

Cerebral Circulation Time After Thrombectomy: A Potential Predictor of Outcome After Recanalization in Acute Stroke

Jia‐Qi Wang

,

Ying‐Jia Wang

,

Jin Qiu

,

Wei Li

,

Xian‐Hui Sun

,

Yong‐Gang Zhao

,

Xin Liu

,

Zi‐Ai Zhao

,

Liang Liu

,

Thanh N. Nguyen

and

Hui‐Sheng Chen

Originally published27 May 2022https://doi.org/10.1161/JAHA.122.025853Journal of the American Heart Association. 2022;11:e025853

• Other version(s) of this article

Abstract

Background

Despite successful recanalization, up to half of patients with acute ischemic stroke caused by large‐vessel occlusion treated with endovascular treatment (EVT) do not recover to functional independence. We aim to evaluate the role of cerebral circulation time (CCT) as outcome predictor after EVT.

Methods and Results

We retrospectively enrolled consecutive patients with acute ischemic stroke–large‐vessel occlusion undergoing EVT. Three categories of CCT based on digital subtraction angiography were studied: CCT of the stroke side, CCT of the healthy side), and change of CCT of the stroke side versus CCT of the healthy side. Dramatic clinical recovery was defined as a 24‐hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome. Logistic regression analysis was performed to evaluate the prediction of CCT on prognosis. One hundred patients were enrolled, of which 38 (38.0%) experienced a dramatic clinical recovery and 43 (43.0%) achieved a favorable outcome. Logistic regression analysis found that shorter change of CCT of the stroke side versus CCT of the healthy side and CCT of the stroke side were independent positive prognostic factors for dramatic clinical recovery (odds ratio [OR], 0.189; P=0.033; OR, 0.581; P=0.035) and favorable outcomes (OR, 0.142; P=0.020; OR, 0.581; P=0.046) after adjustment for potential confounders. A model including the change of CCT of the stroke side versus CCT of the healthy side also had significantly higher area under the curve values compared with the baseline model in patients with dramatic clinical recovery (0.780 versus 0.742) or favorable outcome (0.759 versus 0.713).

Conclusions

To our knowledge, this is the first report that CCT based on digital subtraction angiography data exhibits an independent predictive performance for clinical outcome in patients with acute ischemic stroke–large‐vessel occlusion after EVT. Given that this readily available CCT can provide alternative perfusion information during EVT, a prospective, multicenter trial is warranted.

 

Cerebral Circulation Time After Thrombectomy: A Potential Predictor of Outcome After Recanalization in Acute Stroke

 As is, this is totally fucking useless. NOTHING on how to increase the cerebral circulation levels  to the proper level. My god, does no one in stroke know how to do research?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

Cerebral Circulation Time After Thrombectomy: A Potential Predictor of Outcome After Recanalization in Acute Stroke

Jia‐Qi Wang

,

Ying‐Jia Wang

,

Jin Qiu

,

Wei Li

,

Xian‐Hui Sun

,

Yong‐Gang Zhao

,

Xin Liu

,

Zi‐Ai Zhao

,

Liang Liu

,

Thanh N. Nguyen

and

Hui‐Sheng Chen

Originally published27 May 2022https://doi.org/10.1161/JAHA.122.025853Journal of the American Heart Association. 2022;0:e025853

Abstract

Background

Despite successful recanalization, up to half of patients with acute ischemic stroke caused by large‐vessel occlusion treated with endovascular treatment (EVT) do not recover to functional independence. We aim to evaluate the role of cerebral circulation time (CCT) as outcome predictor after EVT.

Methods and Results

We retrospectively enrolled consecutive patients with acute ischemic stroke–large‐vessel occlusion undergoing EVT. Three categories of CCT based on digital subtraction angiography were studied: CCT of the stroke side, CCT of the healthy side), and change of CCT of the stroke side versus CCT of the healthy side. Dramatic clinical recovery was defined as a 24‐hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome. Logistic regression analysis was performed to evaluate the prediction of CCT on prognosis. One hundred patients were enrolled, of which 38 (38.0%) experienced a dramatic clinical recovery and 43 (43.0%) achieved a favorable outcome. Logistic regression analysis found that shorter change of CCT of the stroke side versus CCT of the healthy side and CCT of the stroke side were independent positive prognostic factors for dramatic clinical recovery (odds ratio [OR], 0.189; P=0.033; OR, 0.581; P=0.035) and favorable outcomes (OR, 0.142; P=0.020; OR, 0.581; P=0.046) after adjustment for potential confounders. A model including the change of CCT of the stroke side versus CCT of the healthy side also had significantly higher area under the curve values compared with the baseline model in patients with dramatic clinical recovery (0.780 versus 0.742) or favorable outcome (0.759 versus 0.713).

Conclusions

To our knowledge, this is the first report that CCT based on digital subtraction angiography data exhibits an independent predictive performance for clinical outcome in patients with acute ischemic stroke–large‐vessel occlusion after EVT. Given that this readily available CCT can provide alternative perfusion information during EVT, a prospective, multicenter trial is warranted.

 

Association of Blood Pressure Within 6 h After Endovascular Thrombectomy and Functional Outcomes in Ischemic Stroke Patients With Successful Recanalization

Yes, we already know blood pressure management is important, but you did nothing to create a protocol on it, so this research did nothing. 

Association of Blood Pressure Within 6 h After Endovascular Thrombectomy and Functional Outcomes in Ischemic Stroke Patients With Successful Recanalization

Xuening Zhang¹, Ting Cui¹, Qiange Zhu², Changyi Wang^3,4, Anmo Wang¹, Yuan Yang¹, Shucheng Li¹, Fayun Hu^1*† and Bo Wu^1*†

• ¹Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
• ²Second Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, China
• ³Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
• ⁴Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China

Background and Purpose: Blood pressure in the days following endovascular thrombectomy (EVT) can influence functional outcomes of patients who have suffered an acute ischemic stroke, but whether the same is true of blood pressure during the first few hours after EVT is unclear.

Methods: Several blood pressure parameters were retrospectively analyzed in acute ischemic stroke patients who underwent EVT at West China Hospital from March 2016 to December 2019. Baseline blood pressure, speed of blood pressure reduction, postoperative blood pressure, degree of blood pressure reduction, and quality of blood pressure management were evaluated during the first 24 h after EVT. We explored whether these parameters during different time windows correlated significantly with patients' modified Rankin Scale (mRS) score at 90 days.

Results: Analysis of 163 patients showed that poor functional outcome (mRS scores 3–6) correlated significantly with higher postoperative blood pressure and worse blood pressure management during the first 6 h after EVT. Postoperative systolic blood pressure at 37 min after EVT was significantly higher in patients with poor outcome (141 mmHg) than in those with good outcome (mRS scores 0–2; 122 mmHg, p = 0.006), and systolic pressure >136 mmHg at this time point was associated with a significantly higher risk of poor outcome, before and after adjusting for other risk factors (adjusted OR 0.395, 95% CI 0.20–0.79).

Conclusions: Among acute ischemic patients who successfully undergo recanalization, adequate blood pressure management during the first 30–40 min after EVT may be important for ensuring good 90-day functional outcomes.

Introduction

Since its description in 2015, endovascular thrombectomy (EVT) has become a standard method for treating large-vessel acute ischemic stroke within 6 h of onset (1), and large clinical trials suggest that it remains effective even when performed up to 24 h after onset (2, 3). How blood pressure management before and after EVT affects patient outcomes remains uncertain, which makes it difficult to optimize such management.

Several studies have suggested that lower blood pressure during 24 h after EVT is associated with a better prognosis (4–6), but we are unaware of studies examining whether blood pressure sooner after EVT is also important. This is an important question, given that the blood pressure of most acute ischemic stroke patients stabilizes at 6–8 h after EVT (7).

Therefore, we performed a retrospective observational study to explore whether blood pressure parameters during the first 6 h after EVT significantly influence functional outcomes.