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Your search keyword '"Maali, L"' showing total 11 results
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11 results on '"Maali, L"'

1. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19

Author

Marto, J, Strambo, D, Ntaios, G, Nguyen, T, Herzig, R, Czlonkowska, A, Demeestere, J, Mansour, O, Salerno, A, Wegener, S, Baumgartner, P, Cereda, C, Bianco, G, Beyeler, M, Arnold, M, Carrera, E, Machi, P, Altersberger, V, Bonati, L, Gensicke, H, Bolognese, M, Peters, N, Wetzel, S, Magrico, M, Ramos, J, Sargento-Freitas, J, Machado, R, Maia, C, Machado, E, Nunes, A, Ferreira, P, Pinho E Melo, T, Dias, M, Paula, A, Correia, M, Castro, P, Azevedo, E, Albuquerque, L, Alves, J, Ferreira-Pinto, J, Meira, T, Pereira, L, Rodrigues, M, Araujo, A, Rocha, M, Pereira-Fonseca, A, Ribeiro, L, Varela, R, Malheiro, S, Cappellari, M, Zivelonghi, C, Sajeva, G, Zini, A, Gentile, M, Forlivesi, S, Migliaccio, L, Sessa, M, La Gioia, S, Pezzini, A, Sangalli, D, Zedde, M, Pascarella, R, Ferrarese, C, Beretta, S, Diamanti, S, Schwarz, G, Frisullo, G, Marcheselli, S, Seners, P, Sabben, C, Escalard, S, Piotin, M, Maier, B, Charbonnier, G, Vuillier, F, Legris, L, Cuisenier, P, Vodret, F, Marnat, G, Liegey, J, Sibon, I, Flottmann, F, Broocks, G, Gloyer, N, Bohmann, F, Schaefer, J, Nolte, C, Audebert, H, Siebert, E, Sykora, M, Lang, W, Ferrari, J, Mayer-Suess, L, Knoflach, M, Gizewski, E, Stolp, J, Stolze, L, Coutinho, J, Nederkoorn, P, Van Den Wijngaard, I, De Meris, J, Lemmens, R, De Raedt, S, Vandervorst, F, Rutgers, M, Guilmot, A, Dusart, A, Bellante, F, Calleja-Castano, P, Ostos, F, Gonzalez-Ortega, G, Martin-Jimenez, P, Garcia-Madrona, S, Cruz-Culebras, A, Vera, R, Matute, M, Fuentes, B, Alonso-De-Lecinana, M, Rigual, R, Diez-Tejedor, E, Perez-Sanchez, S, Montaner, J, Diaz-Otero, F, Perez-De-La-Ossa, N, Flores-Pina, B, Munoz-Narbona, L, Chamorro, A, Rodriguez-Vazquez, A, Renu, A, Ayo-Martin, O, Hernandez-Fernandez, F, Segura, T, Tejada-Meza, H, Sagarra-Mur, D, Serrano-Ponz, M, Hlaing, T, See, I, Simister, R, Werring, D, Kristoffersen, E, Nordanstig, A, Jood, K, Rentzos, A, Simunek, L, Krajickova, D, Krajina, A, Mikulik, R, Cvikova, M, Vinklarek, J, Skoloudik, D, Roubec, M, Hurtikova, E, Hruby, R, Ostry, S, Skoda, O, Pernicka, M, Jurak, L, Eichlova, Z, Jira, M, Kovar, M, Pansky, M, Mencl, P, Palouskova, H, Tomek, A, Jansky, P, Olserova, A, Sramek, M, Havlicek, R, Maly, P, Trakal, L, Fiksa, J, Slovak, M, Karlinski, M, Nowak, M, Sienkiewicz-Jarosz, H, Bochynska, A, Wrona, P, Homa, T, Sawczynska, K, Slowik, A, Wlodarczyk, E, Wiacek, M, Tomaszewska-Lampart, I, Sieczkowski, B, Bartosik-Psujek, H, Bilik, M, Bandzarewicz, A, Dorobek, M, Zielinska-Turek, J, Nowakowska-Kotas, M, Obara, K, Urbanowski, P, Budrewicz, S, Guzinski, M, Switonska, M, Rutkowska, I, Sobieszak-Skura, P, Labuz-Roszak, B, Debiec, A, Staszewski, J, Stepien, A, Zwiernik, J, Wasilewski, G, Tiu, C, Terecoasa, E, Radu, R, Negrila, A, Dorobat, B, Panea, C, Tiu, V, Petrescu, S, Ozdemir, A, Mahmoud, M, El-Samahy, H, Abdelkhalek, H, Al-Hashel, J, Ismail, I, Salmeen, A, Ghoreishi, A, Sabetay, S, Gross, H, Klein, P, Abdalkader, M, Jabbour, P, El Naamani, K, Tjoumakaris, S, Abbas, R, Mohamed, G, Chebl, A, Min, J, Hovingh, M, Tsai, J, Khan, M, Nalleballe, K, Onteddu, S, Masoud, H, Michael, M, Kaur, N, Maali, L, Abraham, M, Khandelwal, P, Bach, I, Ong, M, Babici, D, Khawaja, A, Hakemi, M, Rajamani, K, Cano-Nigenda, V, Arauz, A, Amaya, P, Llanos, N, Arango, A, Vences, M, Barrientos Guerra, J, Caetano, R, Martins, R, Scollo, S, Yalung, P, Nagendra, S, Gaikwad, A, Seo, K, Georgiopoulos, G, Nogueira, R, Michel, P, Marto J. P., Strambo D., Ntaios G., Nguyen T. N., Herzig R., Czlonkowska A., Demeestere J., Mansour O. Y., Salerno A., Wegener S., Baumgartner P., Cereda C. W., Bianco G., Beyeler M., Arnold M., Carrera E., Machi P., Altersberger V., Bonati L., Gensicke H., Bolognese M., Peters N., Wetzel S., Magrico M., Ramos J. N., Sargento-Freitas J., Machado R., Maia C., Machado E., Nunes A. P., Ferreira P., Pinho E Melo T., Dias M. C., Paula A., Correia M. A., Castro P., Azevedo E., Albuquerque L., Alves J. N., Ferreira-Pinto J., Meira T., Pereira L., Rodrigues M., Araujo A. P., Rocha M., Pereira-Fonseca A., Ribeiro L., Varela R., Malheiro S., Cappellari M., Zivelonghi C., Sajeva G., Zini A., Gentile M., Forlivesi S., Migliaccio L., Sessa M., La Gioia S., Pezzini A., Sangalli D., Zedde M., Pascarella R., Ferrarese C., Beretta S., Diamanti S., Schwarz G., Frisullo G., Marcheselli S., Seners P., Sabben C., Escalard S., Piotin M., Maier B., Charbonnier G., Vuillier F., Legris L., Cuisenier P., Vodret F. R., Marnat G., Liegey J. -S., Sibon I., Flottmann F., Broocks G., Gloyer N. -O., Bohmann F. O., Schaefer J. H., Nolte C., Audebert H. J., Siebert E., Sykora M., Lang W., Ferrari J., Mayer-Suess L., Knoflach M., Gizewski E. R., Stolp J., Stolze L. J., Coutinho J. M., Nederkoorn P., Van Den Wijngaard I., De Meris J., Lemmens R., De Raedt S., Vandervorst F., Rutgers M. P., Guilmot A., Dusart A., Bellante F., Calleja-Castano P., Ostos F., Gonzalez-Ortega G., Martin-Jimenez P., Garcia-Madrona S., Cruz-Culebras A., Vera R., Matute M. C., Fuentes B., Alonso-De-Lecinana M., Rigual R., Diez-Tejedor E., Perez-Sanchez S., Montaner J., Diaz-Otero F., Perez-De-La-Ossa N., Flores-Pina B., Munoz-Narbona L., Chamorro A., Rodriguez-Vazquez A., Renu A., Ayo-Martin O., Hernandez-Fernandez F., Segura T., Tejada-Meza H., Sagarra-Mur D., Serrano-Ponz M., Hlaing T., See I., Simister R., Werring D., Kristoffersen E. S., Nordanstig A., Jood K., Rentzos A., Simunek L., Krajickova D., Krajina A., Mikulik R., Cvikova M., Vinklarek J., Skoloudik D., Roubec M., Hurtikova E., Hruby R., Ostry S., Skoda O., Pernicka M., Jurak L., Eichlova Z., Jira M., Kovar M., Pansky M., Mencl P., Palouskova H., Tomek A., Jansky P., Olserova A., Sramek M., Havlicek R., Maly P., Trakal L., Fiksa J., Slovak M., Karlinski M. A., Nowak M., Sienkiewicz-Jarosz H., Bochynska A., Wrona P., Homa T., Sawczynska K., Slowik A., Wlodarczyk E., Wiacek M., Tomaszewska-Lampart I., Sieczkowski B., Bartosik-Psujek H., Bilik M., Bandzarewicz A., Dorobek M., Zielinska-Turek J., Nowakowska-Kotas M., Obara K., Urbanowski P., Budrewicz S., Guzinski M., Switonska M., Rutkowska I., Sobieszak-Skura P., Labuz-Roszak B. M., Debiec A., Staszewski J., Stepien A., Zwiernik J., Wasilewski G., Tiu C., Terecoasa E. O., Radu R. A., Negrila A., Dorobat B., Panea C., Tiu V., Petrescu S., Ozdemir A., Mahmoud M., El-Samahy H., Abdelkhalek H., Al-Hashel J., Ismail I. I., Salmeen A., Ghoreishi A., Sabetay S. I., Gross H., Klein P., Abdalkader M., Jabbour P., El Naamani K., Tjoumakaris S., Abbas R., Mohamed G. A., Chebl A., Min J., Hovingh M., Tsai J. P., Khan M., Nalleballe K., Onteddu S., Masoud H., Michael M., Kaur N., Maali L., Abraham M. G., Khandelwal P., Bach I., Ong M., Babici D., Khawaja A. M., Hakemi M., Rajamani K., Cano-Nigenda V., Arauz A., Amaya P., Llanos N., Arango A., Vences M. A., Barrientos Guerra J. D., Caetano R., Martins R. T., Scollo S. D., Yalung P. M., Nagendra S., Gaikwad A., Seo K. -D., Georgiopoulos G., Nogueira R. G., Michel P., Marto, J, Strambo, D, Ntaios, G, Nguyen, T, Herzig, R, Czlonkowska, A, Demeestere, J, Mansour, O, Salerno, A, Wegener, S, Baumgartner, P, Cereda, C, Bianco, G, Beyeler, M, Arnold, M, Carrera, E, Machi, P, Altersberger, V, Bonati, L, Gensicke, H, Bolognese, M, Peters, N, Wetzel, S, Magrico, M, Ramos, J, Sargento-Freitas, J, Machado, R, Maia, C, Machado, E, Nunes, A, Ferreira, P, Pinho E Melo, T, Dias, M, Paula, A, Correia, M, Castro, P, Azevedo, E, Albuquerque, L, Alves, J, Ferreira-Pinto, J, Meira, T, Pereira, L, Rodrigues, M, Araujo, A, Rocha, M, Pereira-Fonseca, A, Ribeiro, L, Varela, R, Malheiro, S, Cappellari, M, Zivelonghi, C, Sajeva, G, Zini, A, Gentile, M, Forlivesi, S, Migliaccio, L, Sessa, M, La Gioia, S, Pezzini, A, Sangalli, D, Zedde, M, Pascarella, R, Ferrarese, C, Beretta, S, Diamanti, S, Schwarz, G, Frisullo, G, Marcheselli, S, Seners, P, Sabben, C, Escalard, S, Piotin, M, Maier, B, Charbonnier, G, Vuillier, F, Legris, L, Cuisenier, P, Vodret, F, Marnat, G, Liegey, J, Sibon, I, Flottmann, F, Broocks, G, Gloyer, N, Bohmann, F, Schaefer, J, Nolte, C, Audebert, H, Siebert, E, Sykora, M, Lang, W, Ferrari, J, Mayer-Suess, L, Knoflach, M, Gizewski, E, Stolp, J, Stolze, L, Coutinho, J, Nederkoorn, P, Van Den Wijngaard, I, De Meris, J, Lemmens, R, De Raedt, S, Vandervorst, F, Rutgers, M, Guilmot, A, Dusart, A, Bellante, F, Calleja-Castano, P, Ostos, F, Gonzalez-Ortega, G, Martin-Jimenez, P, Garcia-Madrona, S, Cruz-Culebras, A, Vera, R, Matute, M, Fuentes, B, Alonso-De-Lecinana, M, Rigual, R, Diez-Tejedor, E, Perez-Sanchez, S, Montaner, J, Diaz-Otero, F, Perez-De-La-Ossa, N, Flores-Pina, B, Munoz-Narbona, L, Chamorro, A, Rodriguez-Vazquez, A, Renu, A, Ayo-Martin, O, Hernandez-Fernandez, F, Segura, T, Tejada-Meza, H, Sagarra-Mur, D, Serrano-Ponz, M, Hlaing, T, See, I, Simister, R, Werring, D, Kristoffersen, E, Nordanstig, A, Jood, K, Rentzos, A, Simunek, L, Krajickova, D, Krajina, A, Mikulik, R, Cvikova, M, Vinklarek, J, Skoloudik, D, Roubec, M, Hurtikova, E, Hruby, R, Ostry, S, Skoda, O, Pernicka, M, Jurak, L, Eichlova, Z, Jira, M, Kovar, M, Pansky, M, Mencl, P, Palouskova, H, Tomek, A, Jansky, P, Olserova, A, Sramek, M, Havlicek, R, Maly, P, Trakal, L, Fiksa, J, Slovak, M, Karlinski, M, Nowak, M, Sienkiewicz-Jarosz, H, Bochynska, A, Wrona, P, Homa, T, Sawczynska, K, Slowik, A, Wlodarczyk, E, Wiacek, M, Tomaszewska-Lampart, I, Sieczkowski, B, Bartosik-Psujek, H, Bilik, M, Bandzarewicz, A, Dorobek, M, Zielinska-Turek, J, Nowakowska-Kotas, M, Obara, K, Urbanowski, P, Budrewicz, S, Guzinski, M, Switonska, M, Rutkowska, I, Sobieszak-Skura, P, Labuz-Roszak, B, Debiec, A, Staszewski, J, Stepien, A, Zwiernik, J, Wasilewski, G, Tiu, C, Terecoasa, E, Radu, R, Negrila, A, Dorobat, B, Panea, C, Tiu, V, Petrescu, S, Ozdemir, A, Mahmoud, M, El-Samahy, H, Abdelkhalek, H, Al-Hashel, J, Ismail, I, Salmeen, A, Ghoreishi, A, Sabetay, S, Gross, H, Klein, P, Abdalkader, M, Jabbour, P, El Naamani, K, Tjoumakaris, S, Abbas, R, Mohamed, G, Chebl, A, Min, J, Hovingh, M, Tsai, J, Khan, M, Nalleballe, K, Onteddu, S, Masoud, H, Michael, M, Kaur, N, Maali, L, Abraham, M, Khandelwal, P, Bach, I, Ong, M, Babici, D, Khawaja, A, Hakemi, M, Rajamani, K, Cano-Nigenda, V, Arauz, A, Amaya, P, Llanos, N, Arango, A, Vences, M, Barrientos Guerra, J, Caetano, R, Martins, R, Scollo, S, Yalung, P, Nagendra, S, Gaikwad, A, Seo, K, Georgiopoulos, G, Nogueira, R, Michel, P, Marto J. P., Strambo D., Ntaios G., Nguyen T. N., Herzig R., Czlonkowska A., Demeestere J., Mansour O. Y., Salerno A., Wegener S., Baumgartner P., Cereda C. W., Bianco G., Beyeler M., Arnold M., Carrera E., Machi P., Altersberger V., Bonati L., Gensicke H., Bolognese M., Peters N., Wetzel S., Magrico M., Ramos J. N., Sargento-Freitas J., Machado R., Maia C., Machado E., Nunes A. P., Ferreira P., Pinho E Melo T., Dias M. C., Paula A., Correia M. A., Castro P., Azevedo E., Albuquerque L., Alves J. N., Ferreira-Pinto J., Meira T., Pereira L., Rodrigues M., Araujo A. P., Rocha M., Pereira-Fonseca A., Ribeiro L., Varela R., Malheiro S., Cappellari M., Zivelonghi C., Sajeva G., Zini A., Gentile M., Forlivesi S., Migliaccio L., Sessa M., La Gioia S., Pezzini A., Sangalli D., Zedde M., Pascarella R., Ferrarese C., Beretta S., Diamanti S., Schwarz G., Frisullo G., Marcheselli S., Seners P., Sabben C., Escalard S., Piotin M., Maier B., Charbonnier G., Vuillier F., Legris L., Cuisenier P., Vodret F. R., Marnat G., Liegey J. -S., Sibon I., Flottmann F., Broocks G., Gloyer N. -O., Bohmann F. O., Schaefer J. H., Nolte C., Audebert H. J., Siebert E., Sykora M., Lang W., Ferrari J., Mayer-Suess L., Knoflach M., Gizewski E. R., Stolp J., Stolze L. J., Coutinho J. M., Nederkoorn P., Van Den Wijngaard I., De Meris J., Lemmens R., De Raedt S., Vandervorst F., Rutgers M. P., Guilmot A., Dusart A., Bellante F., Calleja-Castano P., Ostos F., Gonzalez-Ortega G., Martin-Jimenez P., Garcia-Madrona S., Cruz-Culebras A., Vera R., Matute M. C., Fuentes B., Alonso-De-Lecinana M., Rigual R., Diez-Tejedor E., Perez-Sanchez S., Montaner J., Diaz-Otero F., Perez-De-La-Ossa N., Flores-Pina B., Munoz-Narbona L., Chamorro A., Rodriguez-Vazquez A., Renu A., Ayo-Martin O., Hernandez-Fernandez F., Segura T., Tejada-Meza H., Sagarra-Mur D., Serrano-Ponz M., Hlaing T., See I., Simister R., Werring D., Kristoffersen E. S., Nordanstig A., Jood K., Rentzos A., Simunek L., Krajickova D., Krajina A., Mikulik R., Cvikova M., Vinklarek J., Skoloudik D., Roubec M., Hurtikova E., Hruby R., Ostry S., Skoda O., Pernicka M., Jurak L., Eichlova Z., Jira M., Kovar M., Pansky M., Mencl P., Palouskova H., Tomek A., Jansky P., Olserova A., Sramek M., Havlicek R., Maly P., Trakal L., Fiksa J., Slovak M., Karlinski M. A., Nowak M., Sienkiewicz-Jarosz H., Bochynska A., Wrona P., Homa T., Sawczynska K., Slowik A., Wlodarczyk E., Wiacek M., Tomaszewska-Lampart I., Sieczkowski B., Bartosik-Psujek H., Bilik M., Bandzarewicz A., Dorobek M., Zielinska-Turek J., Nowakowska-Kotas M., Obara K., Urbanowski P., Budrewicz S., Guzinski M., Switonska M., Rutkowska I., Sobieszak-Skura P., Labuz-Roszak B. M., Debiec A., Staszewski J., Stepien A., Zwiernik J., Wasilewski G., Tiu C., Terecoasa E. O., Radu R. A., Negrila A., Dorobat B., Panea C., Tiu V., Petrescu S., Ozdemir A., Mahmoud M., El-Samahy H., Abdelkhalek H., Al-Hashel J., Ismail I. I., Salmeen A., Ghoreishi A., Sabetay S. I., Gross H., Klein P., Abdalkader M., Jabbour P., El Naamani K., Tjoumakaris S., Abbas R., Mohamed G. A., Chebl A., Min J., Hovingh M., Tsai J. P., Khan M., Nalleballe K., Onteddu S., Masoud H., Michael M., Kaur N., Maali L., Abraham M. G., Khandelwal P., Bach I., Ong M., Babici D., Khawaja A. M., Hakemi M., Rajamani K., Cano-Nigenda V., Arauz A., Amaya P., Llanos N., Arango A., Vences M. A., Barrientos Guerra J. D., Caetano R., Martins R. T., Scollo S. D., Yalung P. M., Nagendra S., Gaikwad A., Seo K. -D., Georgiopoulos G., Nogueira R. G., and Michel P.

Abstract

Background and Objectives COVID-19–related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. Methods This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Results Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16–2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20–2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23–1.99), 24-hour mortality (OR 2.47; 95% CI 1.58–3.86), and 3-month mortality (OR 1.88; 95% CI 1.52–2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26–1.60). Discussion Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non–COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment r

Published
2023

2. Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Author

Nguyen, Tn, Qureshi, Mm, Klein, P, Yamagami, H, Mikulik, R, Etminan, N, Abdalkader, M, Mansour, Oy, Czlonkowska, A, Lo, H, Sathya, A, Demeestere, J, Tsivgoulis, G, Sakai, N, Sedova, P, Kristoffersen, Es, Mohammaden, M, Lereis, Vp, Scollo, Sd, Ma, A, Rahman, A, Bonnet, T, Cortier, J, De Raedt, S, Lemmens, R, Ligot, N, Hidalgo, Rct, Cuervo, Dlm, Neves, Ld, Rezende, Mts, Santiago, Ib, Sirakov, A, Sirakov, S, Cora, Ea, Kelly, Me, Lavoie, P, Peeling, L, Pikula, A, Rivera, R, Chen, Hs, Chen, Ym, Fang, Hl, Bedekovic, Mr, Budincevic, H, Strossmayer, Jj, Hrabanovska, E, Jurak, L, Cabal, M, Kadlckova, J, Karpowicz, I, Palouskova, H, Reiser, M, Klecka, L, Kovar, M, Neumann, J, Rekova, P, Sramek, M, Vitkova, E, Skorna, M, Zakova, L, Sobh, K, Alpay, K, Rautio, R, Strbian, D, Gentric, Jc, Magro, E, Naggara, O, Reiner, P, Abdulazim, A, Bohmann, Fo, Boskamp, S, Gerber, Jc, Kaiser, Dpo, Kestner, Ri, Mbroh, J, Neyazi, M, Rosenkranz, M, Sani, Af, Poli, S, Thomalla, G, Karapanayiotides, T, Kargiotis, O, Koutroulou, I, Palaiodimou, L, Guerra, Jdb, Huded, V, Nagendra, S, Prajapati, C, Krishna, A, Ghoreishi, A, Ilkhchi, Rb, Jalili, J, Sabetay, Si, Abu Raya, T, Acampa, M, Longoni, M, Bigliani, Cr, Castellan, L, Ornello, R, Renieri, L, Romoli, M, Sacco, S, Sangalli, D, Vigano, M, Zini, A, Tokimura, H, Sonoda, K, Todo, K, Fukuda, H, Fujita, K, Sakaguchi, M, Uno, M, Kan, I, Kosuke, M, Kono, R, Kimura, N, Yamamoto, N, Yamamoto, R, Doijiri, R, Shindo, S, Ohara, N, Imamura, H, Ogawa, T, Uwatoko, T, Kanamaru, T, Fujinaka, T, Takenobu, Y, Toyoda, K, Matsumaru, Y, Yazawa, Y, Sugiura, Y, Baek, Jh, Sunmonu, Ta, Kwon, Ys, Lee, Yh, Seo, Kd, Sohn, Si, Chan, Yc, Zaidi, Waw, Barrientos-Prieto, J, Gongora-Rivera, F, Martinez-Marino, M, Calderon-Vallejo, A, Groppa, S, Pavel, L, Coutinho, Jm, Dippel, D, Rinkel, L, Van Dam-Nolen, Dhk, Nwazor, Eo, Al Hashimi, Am, Ahmad, S, Rashid, U, Rodriguez-Kadota, L, Vences, Ma, Yalung, Pm, Jsh, Dy, Brola, W, Dorobek, M, Karlinski, Ma, Labuz-Roszak, Bm, Lasek-Bal, A, Sienkiewicz-Jarosz, H, Staszewski, J, Sobolewski, P, Zielinska-Turek, J, Araujo, Ap, Fonseca, L, Debiec, A, Silva, Ml, Castro, P, Rocha, M, Falup-Pecurariu, Rc, Venketasubramanian, N, Mako, Gkm, Ayo-Martin, O, Wiacek, M, Blasco, J, Cruz-Culebras, A, Hernandez-Fernandez, F, Fernandez, Cr, Lopez, Je, Rodriguez, A, Bolognese, M, Karwacki, Gm, Keller, E, Machi, P, Bernava, G, Boonyakarnkul, S, Churojana, A, Hammami, N, Bajrami, A, Senadim, S, Hussain, Si, John, S, Dow, G, Krishnan, K, Lenthall, R, Wong, K, Zhang, Lq, Altschul, D, Asif, Ks, Aziz-Sultan, Ma, Bach, I, Below, K, Biller, J, Cervantes-Arslanian, Am, Chaudhry, Sa, Chebl, A, Chen, M, Colasurdo, M, Czap, A, Dasenbrock, H, Bahiru, Z, de Havenon, Ah, Dharmadhikari, S, Dmytriw, Aa, Eskey, Cj, Etherton, M, Ezepue, C, Fink, L, Gasimova, U, Goyal, N, Grimmett, Kb, Hakemi, M, Hester, T, Inoa, V, Kan, Pt, Kasper, Em, Khandelwal, P, Khatri, R, Khoury, Nn, Kim, Bs, Kolikonda, M, Kuhn, Al, Linares, G, Linfante, I, Loochtan, Ai, Lukovits, Tg, Male, Ss, Khawaja, Am, Maali, L, Galecio-Castillo, Em, Min, Jy, Mohamed, Ga, Nalleballe, K, Ortega-Gutierrez, S, Radaideh, Y, Ramakrishnan, P, Masoud, He, Reddy, Ab, Ruland, S, Omran, Ss, Sheth, Sa, Puri, As, Rahangdale, Rh, Siegler, Je, Starosciak, Ak, Tarlov, Ne, Taylor, Ra, Tsai, J, Wang, Mj, Wong, Kh, Zaidat, Oo, Hv, Le, Phan, Ht, Ton, Md, Tran, Ad, Sirakova, K, Pham, Tn, Mohlenbruch, Ma, Nagel, S, Raymond, J, Nogueira, Rg, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders

Subjects
Psychiatry and Mental health, SDG 3 - Good Health and Well-being, COVID-19, SUBARACHNOID HAEMORRHAGE, CEREBROVASCULAR DISEASE, Surgery, Neurology (clinical)
Abstract

BackgroundPrior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year.MethodsWe conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021.ResultsOver the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (−6.4% (95% CI −7.0% to −5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild: −5% (95% CI −5.9% to –4.3%), p=0.06; moderate: −8.3% (95% CI −10.2% to –6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12).ConclusionDuring the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality.Trial registration numberNCT04934020.

Published
2022

3. Critical Care Decisions After Large Core Cerebral Infarctions: A Secondary Analysis From the SELECT2 Trial.

Author

Kasner SE, Mullen MT, DeGeorgia M, Blackburn S, George DK, Kumar M, Messe S, Abraham MG, Chen M, Ortega-Gutierrez S, Sitton CW, Burkhardt JK, Hussain MS, Churilov L, Sundararajan S, Hu YC, Herial NA, Jabbour P, Gibson D, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Hanel RA, Aghaebrahim AN, Wu TY, Portela PC, de la Ossa NP, Schaafsma JD, Blasco J, Sangha N, Warach S, Gandhi CD, Kleinig TJ, Sahlein D, Samaniego EA, Maali L, Abdulrazzak MA, Amuluru K, Pujara DK, Shaker F, Johns H, Moussa R, Al-Shaibi F, Duncan KR, Tjoumakaris S, Opaskar A, Xiong W, Ray A, Amin-Hanjani S, Nguyen TN, Fifi JT, Davis S, Wechsler L, Furlan A, Sila C, Bambakidis N, Hill MD, Mendes Pereira V, Lansberg MG, Grotta JC, Ribo M, Albers GW, Campbell BC, Hassan AE, and Sarraj A

Abstract

Objective: Among patients with large vessel occlusion (LVO) and large ischemic cores, critical decisions often need to be made about decompressive hemicraniectomy (DHC) or early withdrawal of life-sustaining therapy (WLST). In this study, we aimed to evaluate utilization of DHC and early WLST and factors associated with them in patients with large strokes from the SELECT2 trial., Methods: We analyzed the entire SELECT2 trial population, which randomized 352 patients with stroke due to LVO and large ischemic cores to endovascular thrombectomy (EVT) or medical management. We used the as-treated principle to compare the use of DHC and early WLST within 7 days after randomization. We further assessed functional outcomes (modified Rankin Score) after these decisions., Results: Of 352 patients enrolled in this study, 55 received DHC and 81 transitioned to early WLST. Patients treated with EVT were as likely to undergo DHC (16% vs 15%, adjusted relative risk [aRR] = 1.19, 95% CI:0.75-1.88, p = 0.46) or WLST (22% vs 24%, aRR = 0.94, 95% CI: 0.66-1.34, p = 0.72) as those given medical management. DHC was used more frequently in younger patients and WLST more in older patients. EVT efficacy was maintained after adjusting for DHC (adjusted generalized odds ratio [aGenOR] = 1.68, 95% CI: 1.24-2.11, p < 0.001), with no interaction between DHC and treatment (p-interaction = 0.93). At 1 year, 21% of DHC-treated patients were ambulatory; the outcomes were universally poor after early WLST., Interpretation: In the SELECT2 trial of patients with large ischemic core, DHC was performed in ~1 of 6 patients and early WLST in ~1 of 5 patients, without differences based on treatment with EVT or medical management, nor successful reperfusion. DHC or WLST did not detract from thrombectomy treatment benefit. Additionally, ~20% of patients achieved independent ambulation despite receiving DHC by the 1-year follow-up. The similar distribution of these critical care decisions provides reassurance that the overall trial outcomes were not biased by open-label treatment allocation. ANN NEUROL 2024., (© 2024 American Neurological Association.)

Published
2024
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4. Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles.

Author

Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Churilov L, Johns H, Sitton CW, Yogendrakumar V, Ng FC, Pujara DK, Blackburn S, Sundararajan S, Hu YC, Herial NA, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Cheung A, Hanel RA, Aghaebrahim AN, Wu TY, Portela PC, Gandhi CD, Al-Mufti F, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Kleinig TJ, Shaker F, Al Shaibi F, Toth G, Abdulrazzak MA, Sharma G, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Samaniego EA, Maali L, Lechtenberg CG, Renú A, Vora N, Nguyen T, Fifi JT, Tjoumakaris SI, Jabbour P, Tsivgoulis G, Pereira VM, Lansberg MG, DeGeorgia M, Sila CA, Bambakidis N, Hill MD, Davis SM, Wechsler L, Grotta JC, Ribo M, Albers GW, and Campbell BC

Subjects
Adult, Humans, Female, Aged, Male, Thrombectomy adverse effects, Thrombectomy methods, Brain diagnostic imaging, Stroke diagnostic imaging, Stroke surgery, Ischemic Stroke diagnostic imaging, Ischemic Stroke surgery, Brain Ischemia diagnostic imaging, Brain Ischemia surgery
Abstract

Importance: Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain., Objective: To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect., Design, Setting, and Participants: An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022., Intervention: EVT vs MM., Main Outcomes and Measures: Primary outcome was functional outcome-90-day mRS score (0, no symptoms, to 6, death) assessed by adjusted generalized OR (aGenOR; values >1 represent more favorable outcomes). Benefit of EVT vs MM was assessed across levels of ischemic injury defined by noncontrast CT using ASPECTS score and by the volume of brain with severely reduced blood flow on CT perfusion or restricted diffusion on MRI., Results: Among 352 patients randomized, 336 were analyzed (median age, 67 years; 139 [41.4%] female); of these, 168 (50%) were randomized to EVT, and 2 additional crossover MM patients received EVT. In an ordinal analysis of mRS at 90 days, EVT improved functional outcomes compared with MM within ASPECTS categories of 3 (aGenOR, 1.71 [95% CI, 1.04-2.81]), 4 (aGenOR, 2.01 [95% CI, 1.19-3.40]), and 5 (aGenOR, 1.85 [95% CI, 1.22-2.79]). Across strata for CT perfusion/MRI ischemic core volumes, aGenOR for EVT vs MM was 1.63 (95% CI, 1.23-2.16) for volumes ≥70 mL, 1.41 (95% CI, 0.99-2.02) for ≥100 mL, and 1.47 (95% CI, 0.84-2.56) for ≥150 mL. In the EVT group, outcomes worsened as ASPECTS decreased (aGenOR, 0.91 [95% CI, 0.82-1.00] per 1-point decrease) and as CT perfusion/MRI ischemic core volume increased (aGenOR, 0.92 [95% CI, 0.89-0.95] per 10-mL increase). No heterogeneity of EVT treatment effect was observed with or without mismatch, although few patients without mismatch were enrolled., Conclusion and Relevance: In this exploratory analysis of a randomized clinical trial of patients with extensive ischemic stroke, EVT improved clinical outcomes across a wide spectrum of infarct volumes, although enrollment of patients with minimal penumbra volume was low. In EVT-treated patients, clinical outcomes worsened as presenting ischemic injury estimates increased., Trial Registration: ClinicalTrials.gov Identifier: NCT03876457.

Published
2024
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5. Endovascular Thrombectomy Treatment Effect in Direct vs Transferred Patients With Large Ischemic Strokes: A Prespecified Analysis of the SELECT2 Trial.

Author

Sarraj A, Hill MD, Hussain MS, Abraham MG, Ortega-Gutierrez S, Chen M, Kasner SE, Churilov L, Pujara DK, Johns H, Blackburn S, Sundararajan S, Hu YC, Herial NA, Budzik RF, Hicks WJ, Arenillas JF, Tsai JP, Kozak O, Cordato DJ, Hanel RA, Wu TY, Portela PC, Gandhi CD, Al-Mufti F, Maali L, Gibson D, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Kleinig TJ, Shaker F, Sitton CW, Nguyen T, Fifi JT, Jabbour P, Furlan A, Lansberg MG, Tsivgoulis G, Sila C, Bambakidis N, Davis S, Wechsler L, Albers GW, Grotta JC, Ribo M, Campbell BC, Hassan AE, Vora N, Manning NW, Cheung A, Aghaebrahim AN, Paipa Merchán AJ, Sahlein D, Requena Ruiz M, Elijovich L, Arthur A, Al-Shaibi F, Samaniego EA, Duncan KR, Opaskar A, Ray A, Xiong W, Sunshine J, DeGeorgia M, Tjoumakaris S, and Mendes Pereira V

Abstract

Importance: Patients with large ischemic core stroke have poor clinical outcomes and are frequently not considered for interfacility transfer for endovascular thrombectomy (EVT)., Objective: To assess EVT treatment effects in transferred vs directly presenting patients and to evaluate the association between transfer times and neuroimaging changes with EVT clinical outcomes., Design, Setting, and Participants: This prespecified secondary analysis of the SELECT2 trial, which evaluated EVT vs medical management (MM) in patients with large ischemic stroke, evaluated adults aged 18 to 85 years with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) as well as an Alberta Stroke Program Early CT Score (ASPECTS) of 3 to 5, core of 50 mL or greater on imaging, or both. Patients were enrolled between October 2019 and September 2022 from 31 EVT-capable centers in the US, Canada, Europe, Australia, and New Zealand. Data were analyzed from August 2023 to January 2024., Interventions: EVT vs MM., Main Outcomes and Measures: Functional outcome, defined as modified Rankin Scale (mRS) score at 90 days with blinded adjudication., Results: A total of 958 patients were screened and 606 patients were excluded. Of 352 enrolled patients, 145 (41.2%) were female, and the median (IQR) age was 66.5 (58-75) years. A total of 211 patients (59.9%) were transfers, while 141 (40.1%) presented directly. The median (IQR) transfer time was 178 (136-230) minutes. The median (IQR) ASPECTS decreased from the referring hospital (5 [4-7]) to an EVT-capable center (4 [3-5]). Thrombectomy treatment effect was observed in both directly presenting patients (adjusted generalized odds ratio [OR], 2.01; 95% CI, 1.42-2.86) and transferred patients (adjusted generalized OR, 1.50; 95% CI, 1.11-2.03) without heterogeneity (P for interaction = .14). Treatment effect point estimates favored EVT among 82 transferred patients with a referral hospital ASPECTS of 5 or less (44 received EVT; adjusted generalized OR, 1.52; 95% CI, 0.89-2.58). ASPECTS loss was associated with numerically worse EVT outcomes (adjusted generalized OR per 1-ASPECTS point loss, 0.89; 95% CI, 0.77-1.02). EVT treatment effect estimates were lower in patients with transfer times of 3 hours or more (adjusted generalized OR, 1.15; 95% CI, 0.73-1.80)., Conclusions and Relevance: Both directly presenting and transferred patients with large ischemic stroke in the SELECT2 trial benefited from EVT, including those with low ASPECTS at referring hospitals. However, the association of EVT with better functional outcomes was numerically better in patients presenting directly to EVT-capable centers. Prolonged transfer times and evolution of ischemic change were associated with worse EVT outcomes. These findings emphasize the need for rapid identification of patients suitable for transfer and expedited transport., Trial Registration: ClinicalTrials.gov Identifier: NCT03876457.

Published
2024
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6. Trial of Endovascular Thrombectomy for Large Ischemic Strokes.

Author

Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Blackburn S, Sitton CW, Churilov L, Sundararajan S, Hu YC, Herial NA, Jabbour P, Gibson D, Wallace AN, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Hanel RA, Aghaebrahim AN, Wu TY, Cardona-Portela P, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Gandhi CD, Kleinig TJ, Sahlein D, Elijovich L, Tekle W, Samaniego EA, Maali L, Abdulrazzak MA, Psychogios MN, Shuaib A, Pujara DK, Shaker F, Johns H, Sharma G, Yogendrakumar V, Ng FC, Rahbar MH, Cai C, Lavori P, Hamilton S, Nguyen T, Fifi JT, Davis S, Wechsler L, Pereira VM, Lansberg MG, Hill MD, Grotta JC, Ribo M, Campbell BC, and Albers GW

Subjects
Humans, Fibrinolytic Agents adverse effects, Fibrinolytic Agents therapeutic use, Prospective Studies, Stroke diagnostic imaging, Stroke drug therapy, Stroke surgery, Treatment Outcome, Infarction, Middle Cerebral Artery complications, Carotid Artery Diseases complications, Recovery of Function, Cerebral Hemorrhage chemically induced, Cerebral Hemorrhage etiology, Brain Ischemia diagnostic imaging, Brain Ischemia drug therapy, Brain Ischemia surgery, Endovascular Procedures adverse effects, Endovascular Procedures methods, Ischemic Stroke diagnostic imaging, Ischemic Stroke drug therapy, Ischemic Stroke surgery, Thrombectomy adverse effects, Thrombectomy methods
Abstract

Background: Trials of the efficacy and safety of endovascular thrombectomy in patients with large ischemic strokes have been carried out in limited populations., Methods: We performed a prospective, randomized, open-label, adaptive, international trial involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery to assess endovascular thrombectomy within 24 hours after onset. Patients had a large ischemic-core volume, defined as an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower scores indicating larger infarction) or a core volume of at least 50 ml on computed tomography perfusion or diffusion-weighted magnetic resonance imaging. Patients were assigned in a 1:1 ratio to endovascular thrombectomy plus medical care or to medical care alone. The primary outcome was the modified Rankin scale score at 90 days (range, 0 to 6, with higher scores indicating greater disability). Functional independence was a secondary outcome., Results: The trial was stopped early for efficacy; 178 patients had been assigned to the thrombectomy group and 174 to the medical-care group. The generalized odds ratio for a shift in the distribution of modified Rankin scale scores toward better outcomes in favor of thrombectomy was 1.51 (95% confidence interval [CI], 1.20 to 1.89; P<0.001). A total of 20% of the patients in the thrombectomy group and 7% in the medical-care group had functional independence (relative risk, 2.97; 95% CI, 1.60 to 5.51). Mortality was similar in the two groups. In the thrombectomy group, arterial access-site complications occurred in 5 patients, dissection in 10, cerebral-vessel perforation in 7, and transient vasospasm in 11. Symptomatic intracranial hemorrhage occurred in 1 patient in the thrombectomy group and in 2 in the medical-care group., Conclusions: Among patients with large ischemic strokes, endovascular thrombectomy resulted in better functional outcomes than medical care but was associated with vascular complications. Cerebral hemorrhages were infrequent in both groups. (Funded by Stryker Neurovascular; SELECT2 ClinicalTrials.gov number, NCT03876457.)., (Copyright © 2023 Massachusetts Medical Society.)

Published
2023
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7. Mediation of Successful Reperfusion Effect through Infarct Growth and Cerebral Edema: A Pooled, Patient-Level Analysis of EXTEND-IA Trials and SELECT Prospective Cohort.

Author

Sarraj A, Pujara DK, Churilov L, Sitton CW, Ng F, Hassan AE, Abraham MG, Blackburn SL, Sharma G, Yassi N, Kleinig T, Shah D, Wu TY, Tekle WG, Budzik RF, Hicks WJ 2nd, Vora N, Edgell RC, Haussen D, Ortega-Gutierrez S, Toth G, Maali L, Abdulrazzak MA, Al-Shaibi F, AlMaghrabi T, Yogendrakumar V, Shaker F, Mir O, Arora A, Duncan K, Sundararajan S, Opaskar A, Hu Y, Ray A, Sunshine J, Bambakidis N, Martin-Schild S, Hussain MS, Nogueira R, Furlan A, Sila CA, Grotta JC, Parsons M, Mitchell PJ, Donnan GA, Davis SM, Albers GW, and Campbell BCV

Subjects
Humans, Treatment Outcome, Prospective Studies, Cerebral Infarction diagnostic imaging, Cerebral Infarction therapy, Cerebral Infarction complications, Reperfusion methods, Stroke diagnostic imaging, Stroke therapy, Stroke complications, Brain Edema etiology, Brain Edema complications, Brain Ischemia diagnostic imaging, Brain Ischemia therapy, Brain Ischemia complications, Endovascular Procedures methods
Abstract

Objective: Reperfusion therapy is highly beneficial for ischemic stroke. Reduction in both infarct growth and edema are plausible mediators of clinical benefit with reperfusion. We aimed to quantify these mediators and their interrelationship., Methods: In a pooled, patient-level analysis of the EXTEND-IA trials and SELECT study, we used a mediation analysis framework to quantify infarct growth and cerebral edema (midline shift) mediation effect on successful reperfusion (modified Treatment in Cerebral Ischemia ≥ 2b) association with functional outcome (modified Rankin Scale distribution). Furthermore, we evaluated an additional pathway to the original hypothesis, where infarct growth mediated successful reperfusion effect on midline shift., Results: A total 542 of 665 (81.5%) eligible patients achieved successful reperfusion. Baseline clinical and imaging characteristics were largely similar between those achieving successful versus unsuccessful reperfusion. Median infarct growth was 12.3ml (interquartile range [IQR] = 1.8-48.4), and median midline shift was 0mm (IQR = 0-2.2). Of 249 (37%) demonstrating a midline shift of ≥1mm, median shift was 2.75mm (IQR = 1.89-4.21). Successful reperfusion was associated with reductions in both predefined mediators, infarct growth (β = -1.19, 95% confidence interval [CI] = -1.51 to -0.88, p < 0.001) and midline shift (adjusted odds ratio = 0.36, 95% CI = 0.23-0.57, p < 0.001). Successful reperfusion association with improved functional outcome (adjusted common odds ratio [acOR] = 2.68, 95% CI = 1.86-3.88, p < 0.001) became insignificant (acOR = 1.39, 95% CI = 0.95-2.04, p = 0.094) when infarct growth and midline shift were added to the regression model. Infarct growth and midline shift explained 45% and 34% of successful reperfusion effect, respectively. Analysis considering an alternative hypothesis demonstrated consistent results., Interpretation: In this mediation analysis from a pooled, patient-level cohort, a significant proportion (~80%) of successful reperfusion effect on functional outcome was mediated through reduction in infarct growth and cerebral edema. Further studies are required to confirm our findings, detect additional mediators to explain successful reperfusion residual effect, and identify novel therapeutic targets to further enhance reperfusion benefits. ANN NEUROL 2023;93:793-804., (© 2022 American Neurological Association.)

Published
2023
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8. Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well: The SELECT Late Study.

Author

Sarraj A, Kleinig TJ, Hassan AE, Portela PC, Ortega-Gutierrez S, Abraham MG, Manning NW, Siegler JE, Goyal N, Maali L, Blackburn S, Wu TY, Blasco J, Renú A, Sangha NS, Arenillas JF, McCullough-Hicks ME, Wallace A, Gibson D, Pujara DK, Shaker F, de Lera Alfonso M, Olivé-Gadea M, Farooqui M, Vivanco Suarez JS, Iezzi Z, Khalife J, Lechtenberg CG, Qadri SK, Moussa RB, Abdulrazzak MA, Almaghrabi TS, Mir O, Beharry J, Krishnaiah B, Miller M, Khalil N, Sharma GJ, Katsanos AH, Fadhil A, Duncan KR, Hu Y, Martin-Schild SB, Tsivgoulis GK, Cordato D, Furlan A, Churilov L, Mitchell PJ, Arthur AS, Parsons MW, Grotta JC, Sitton CW, Ribo M, Albers GW, and Campbell BCV

Subjects
Humans, Female, Aged, Retrospective Studies, Thrombectomy methods, Intracranial Hemorrhages etiology, Treatment Outcome, Endovascular Procedures methods, Stroke surgery, Stroke etiology, Brain Ischemia therapy
Abstract

Importance: The role of endovascular thrombectomy is uncertain for patients presenting beyond 24 hours of the time they were last known well., Objective: To evaluate functional and safety outcomes for endovascular thrombectomy (EVT) vs medical management in patients with large-vessel occlusion beyond 24 hours of last known well., Design, Setting, and Participants: This retrospective observational cohort study enrolled patients between July 2012 and December 2021 at 17 centers across the United States, Spain, Australia, and New Zealand. Eligible patients had occlusions in the internal carotid artery or middle cerebral artery (M1 or M2 segment) and were treated with EVT or medical management beyond 24 hours of last known well., Interventions: Endovascular thrombectomy or medical management (control)., Main Outcomes and Measures: Primary outcome was functional independence (modified Rankin Scale score 0-2). Mortality and symptomatic intracranial hemorrhage (sICH) were safety outcomes. Propensity score (PS)-weighted multivariable logistic regression analyses were adjusted for prespecified clinical characteristics, perfusion parameters, and/or Alberta Stroke Program Early CT Score (ASPECTS) and were repeated in subsequent 1:1 PS-matched cohorts., Results: Of 301 patients (median [IQR] age, 69 years [59-81]; 149 female), 185 patients (61%) received EVT and 116 (39%) received medical management. In adjusted analyses, EVT was associated with better functional independence (38% vs control, 10%; inverse probability treatment weighting adjusted odds ratio [IPTW aOR], 4.56; 95% CI, 2.28-9.09; P < .001) despite increased odds of sICH (10.1% for EVT vs 1.7% for control; IPTW aOR, 10.65; 95% CI, 2.19-51.69; P = .003). This association persisted after PS-based matching on (1) clinical characteristics and ASPECTS (EVT, 35%, vs control, 19%; aOR, 3.14; 95% CI, 1.02-9.72; P = .047); (2) clinical characteristics and perfusion parameters (EVT, 35%, vs control, 17%; aOR, 4.17; 95% CI, 1.15-15.17; P = .03); and (3) clinical characteristics, ASPECTS, and perfusion parameters (EVT, 45%, vs control, 21%; aOR, 4.39; 95% CI, 1.04-18.53; P = .04). Patients receiving EVT had lower odds of mortality (26%) compared with those in the control group (41%; IPTW aOR, 0.49; 95% CI, 0.27-0.89; P = .02)., Conclusions and Relevance: In this study of treatment beyond 24 hours of last known well, EVT was associated with higher odds of functional independence compared with medical management, with consistent results obtained in PS-matched subpopulations and patients with presence of mismatch, despite increased odds of sICH. Our findings support EVT feasibility in selected patients beyond 24 hours. Prospective studies are warranted for confirmation.

Published
2023
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9. Thrombectomy Outcomes With General vs Nongeneral Anesthesia: A Pooled Patient-Level Analysis From the EXTEND-IA Trials and SELECT Study.

Author

Sarraj A, Albers GW, Mitchell PJ, Hassan AE, Abraham MG, Blackburn S, Sharma G, Yassi N, Kleinig TJ, Shah DG, Wu TY, Hussain MS, Tekle WG, Gutierrez SO, Aghaebrahim AN, Haussen DC, Toth G, Pujara D, Budzik RF, Hicks W, Vora N, Edgell RC, Slavin S, Lechtenberg CG, Maali L, Qureshi A, Rosterman L, Abdulrazzak MA, AlMaghrabi T, Shaker F, Mir O, Arora A, Martin-Schild S, Sitton CW, Churilov L, Gupta R, Lansberg MG, Nogueira RG, Grotta JC, Donnan GA, Davis SM, and Campbell BCV

Subjects
Humans, Prospective Studies, Treatment Outcome, Randomized Controlled Trials as Topic, Anesthesia, General adverse effects, Thrombectomy methods
Abstract

Background and Objectives: The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice., Methods: In a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) - Tmax > 10 seconds/Tmax > 6 seconds (good collaterals - HIR < 0.4, poor collaterals - HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes., Results: Of 725 treated with EVT, 299 (41%) received GA and 426 (59%) non-GA. The baseline characteristics differed in presentation National Institutes of Health Stroke Scale score (median [interquartile range] GA: 18 [13-22], non-GA: 16 [11-20], p < 0.001) and ischemic core volume (GA: 15.0 mL [3.2-38.0] vs non-GA: 9.0 mL [0.0-31.0], p < 0.001). In addition, GA was associated with longer last known well to arterial access (203 minutes [157-267] vs 186 minutes [138-252], p = 0.002), but similar procedural time (35.5 minutes [23-59] vs 34 minutes [22-54], p = 0.51). Of 182 matched pairs using propensity scores, baseline characteristics were similar. In the propensity score-matched pairs, GA was independently associated with worse functional outcomes (adjusted common odds ratio [adj. cOR]: 0.64, 95% CI: 0.44-0.93, p = 0.021) and higher neurologic worsening (GA: 14.9% vs non-GA: 8.9%, aOR: 2.10, 95% CI: 1.02-4.33, p = 0.045). Patients with poor collaterals had worse functional outcomes with GA (adj. cOR: 0.47, 95% CI: 0.29-0.76, p = 0.002), whereas no difference was observed in those with good collaterals (adj. cOR: 0.93, 95% CI: 0.50-1.74, p = 0.82), p interaction : 0.07. No difference was observed in infarct growth overall and in patients with good collaterals, whereas patients with poor collaterals demonstrated larger infarct growth with GA with a significant interaction between collaterals and anesthesia type on infarct growth rate ( p interaction : 0.020)., Discussion: GA was associated with worse functional outcomes after EVT, particularly in patients with poor collaterals in a propensity score-matched analysis from a pooled patient-level cohort from 3 randomized trials and 1 prospective cohort study. The confounding by indication may persist despite the doubly robust nature of the analysis. These findings have implications for randomized trials of GA vs non-GA and may be of utility for clinicians when making anesthesia type choice., Classification of Evidence: This study provides Class III evidence that use of GA is associated with worse functional outcome in patients undergoing EVT., Trial Registration Information: EXTEND-IA: ClinicalTrials.gov (NCT01492725); EXTEND-IA TNK: ClinicalTrials.gov (NCT02388061); EXTEND-IA TNK part II: ClinicalTrials.gov (NCT03340493); and SELECT: ClinicalTrials.gov (NCT02446587)., (© 2022 American Academy of Neurology.)

Published
2023
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10. Thrombectomy versus Medical Management in Mild Strokes due to Large Vessel Occlusion: Exploratory Analysis from the EXTEND-IA Trials and a Pooled International Cohort.

Author

Sarraj A, Albers GW, Blasco J, Arenillas JF, Ribo M, Hassan AE, de la Ossa NP, Wu TY, Cardona Portela P, Abraham MG, Chen M, Maali L, Kleinig TJ, Cordato D, Wallace AN, Schaafsma JD, Sangha N, Gibson DP, Blackburn SL, De Lera Alfonso M, Pujara D, Shaker F, McCullough-Hicks ME, Moreno Negrete JL, Renu A, Beharry J, Cappelen-Smith C, Rodríguez-Esparragoza L, Olivé-Gadea M, Requena M, Almaghrabi T, Mendes Pereira V, Sitton C, Martin-Schild S, Song S, Ma H, Churilov L, Mitchell PJ, Parsons MW, Furlan A, Grotta JC, Donnan GA, Davis SM, and Campbell BCV

Subjects
Cerebral Hemorrhage, Humans, Prospective Studies, Thrombectomy methods, Treatment Outcome, Brain Ischemia surgery, Endovascular Procedures methods, Stroke drug therapy, Stroke surgery
Abstract

Objective: This study was undertaken to evaluate functional and safety outcomes for endovascular thrombectomy (EVT) versus medical management (MM) in patients with large vessel occlusion (LVO) and mild neurological deficits, stratified by perfusion imaging mismatch., Methods: The pooled cohort consisted of patients with National Institutes of Health Stroke Scale (NIHSS) < 6 and internal carotid artery (ICA), M1, or M2 occlusions from the Extending the Time for Thrombolysis in Emergecy Neurological Deficits - Intra-Arterial (EXTEND-IA) Trial,  Tenecteplase vs Alteplase before Endovascular Thrombectomy in Ischemic Stroke (EXTEND-IA TNK) trials Part I/II and prospective data from 15 EVT centers from October 2010 to April 2020. RAPID software estimated ischemic core and mismatch. Patients receiving primary EVT (EVT pri ) were compared to those who received primary MM (MM pri ), including those who deteriorated and received rescue EVT, in overall and propensity score (PS)-matched cohorts. Patients were stratified by target mismatch (mismatch ratio ≥ 1.8 and mismatch volume ≥ 15ml). Primary outcome was functional independence (90-day modified Rankin Scale = 0-2). Secondary outcomes included safety (symptomatic intracerebral hemorrhage [sICH], neurological worsening, and mortality)., Results: Of 540 patients, 286 (53%) received EVT pri and demonstrated larger critically hypoperfused tissue (Tmax > 6 seconds) volumes (median [IQR]: 64 [26-96] ml vs MM pri : 40 [14-76] ml, p < 0.001) and higher presentation NIHSS (median [IQR]: 4 [2-5] vs MM pri : 3 [2-4], p < 0.001). Functional independence was similar (EVT pri : 77.4% vs MM pri : 75.6%, adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] = 0.82-2.03, p = 0.27). EVT had worse safety regarding sICH (EVT pri : 16.3% vs MM pri : 1.3%, p < 0.001) and neurological worsening (EVT pri : 19.6% vs MM pri : 6.7%, p < 0.001). In 414 subjects (76.7%) with target mismatch, EVT was associated with improved functional independence (EVT pri : 77.4% vs MM pri : 72.7%, aOR = 1.68, 95% CI = 1.01-2.81, p = 0.048), whereas there was a trend toward less favorable outcomes with primary EVT (EVT pri : 77.4% vs MM pri : 83.3%, aOR = 0.39, 95% CI = 0.12-1.34, p = 0.13) without target mismatch (p interaction  = 0.06). Similar findings were observed in a propensity score-matched subpopulation., Interpretation: Overall, EVT was not associated with improved clinical outcomes in mild strokes due to LVO, and sICH was increased. However, in patients with target mismatch profile, EVT was associated with increased functional independence. Perfusion imaging may be helpful to select mild stroke patients for EVT. ANN NEUROL 2022;92:364-378., (© 2022 American Neurological Association.)

Published
2022
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11. Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

Author

Nguyen TN, Qureshi MM, Klein P, Yamagami H, Abdalkader M, Mikulik R, Sathya A, Mansour OY, Czlonkowska A, Lo H, Field TS, Charidimou A, Banerjee S, Yaghi S, Siegler JE, Sedova P, Kwan J, de Sousa DA, Demeestere J, Inoa V, Omran SS, Zhang L, Michel P, Strambo D, Marto JP, Nogueira RG, Kristoffersen ES, Tsivgoulis G, Lereis VP, Ma A, Enzinger C, Gattringer T, Rahman A, Bonnet T, Ligot N, De Raedt S, Lemmens R, Vanacker P, Vandervorst F, Conforto AB, Hidalgo RCT, Mora Cuervo DL, de Oliveira Neves L, Lameirinhas da Silva I, Martíns RT, Rebello LC, Santiago IB, Sakelarova T, Kalpachki R, Alexiev F, Cora EA, Kelly ME, Peeling L, Pikula A, Chen HS, Chen Y, Yang S, Roje Bedekovic M, Čabal M, Tenora D, Fibrich P, Dušek P, Hlaváčová H, Hrabanovska E, Jurák L, Kadlčíková J, Karpowicz I, Klečka L, Kovář M, Neumann J, Paloušková H, Reiser M, Rohan V, Šimůnek L, Skoda O, Škorňa M, Šrámek M, Drenck N, Sobh K, Lesaine E, Sabben C, Reiner P, Rouanet F, Strbian D, Boskamp S, Mbroh J, Nagel S, Rosenkranz M, Poli S, Thomalla G, Karapanayiotides T, Koutroulou I, Kargiotis O, Palaiodimou L, Barrientos Guerra JD, Huded V, Nagendra S, Prajapati C, Sylaja PN, Sani AF, Ghoreishi A, Farhoudi M, Sadeghi Hokmabadi E, Hashemilar M, Sabetay SI, Rahal F, Acampa M, Adami A, Longoni M, Ornello R, Renieri L, Romoli M, Sacco S, Salmaggi A, Sangalli D, Zini A, Sakai K, Fukuda H, Fujita K, Imamura H, Kosuke M, Sakaguchi M, Sonoda K, Matsumaru Y, Ohara N, Shindo S, Takenobu Y, Yoshimoto T, Toyoda K, Uwatoko T, Sakai N, Yamamoto N, Yamamoto R, Yazawa Y, Sugiura Y, Baek JH, Lee SB, Seo KD, Sohn SI, Lee JS, Arsovska AA, Chieh CY, Wan Zaidi WA, Wan Yahya WNN, Gongora-Rivera F, Martinez-Marino M, Infante-Valenzuela A, Dippel D, van Dam-Nolen DHK, Wu TY, Punter M, Adebayo TT, Bello AH, Sunmonu TA, Wahab KW, Sundseth A, Al Hashmi AM, Ahmad S, Rashid U, Rodriguez-Kadota L, Vences MÁ, Yalung PM, Dy JSH, Brola W, Dębiec A, Dorobek M, Karlinski MA, Labuz-Roszak BM, Lasek-Bal A, Sienkiewicz-Jarosz H, Staszewski J, Sobolewski P, Wiącek M, Zielinska-Turek J, Araújo AP, Rocha M, Castro P, Ferreira P, Nunes AP, Fonseca L, Pinho E Melo T, Rodrigues M, Silva ML, Ciopleias B, Dimitriade A, Falup-Pecurariu C, Hamid MA, Venketasubramanian N, Krastev G, Haring J, Ayo-Martin O, Hernandez-Fernandez F, Blasco J, Rodríguez-Vázquez A, Cruz-Culebras A, Moniche F, Montaner J, Perez-Sanchez S, García Sánchez MJ, Guillán Rodríguez M, Bernava G, Bolognese M, Carrera E, Churojana A, Aykac O, Özdemir AÖ, Bajrami A, Senadim S, Hussain SI, John S, Krishnan K, Lenthall R, Asif KS, Below K, Biller J, Chen M, Chebl A, Colasurdo M, Czap A, de Havenon AH, Dharmadhikari S, Eskey CJ, Farooqui M, Feske SK, Goyal N, Grimmett KB, Guzik AK, Haussen DC, Hovingh M, Jillela D, Kan PT, Khatri R, Khoury NN, Kiley NL, Kolikonda MK, Lara S, Li G, Linfante I, Loochtan AI, Lopez CD, Lycan S, Male SS, Nahab F, Maali L, Masoud HE, Min J, Orgeta-Gutierrez S, Mohamed GA, Mohammaden M, Nalleballe K, Radaideh Y, Ramakrishnan P, Rayo-Taranto B, Rojas-Soto DM, Ruland S, Simpkins AN, Sheth SA, Starosciak AK, Tarlov NE, Taylor RA, Voetsch B, Zhang L, Duong HQ, Dao VP, Le HV, Pham TN, Ton MD, Tran AD, Zaidat OO, Machi P, Dirren E, Rodríguez Fernández C, Escartín López J, Fernández Ferro JC, Mohammadzadeh N, Suryadevara NC, de la Cruz Fernández B, Bessa F, Jancar N, Brady M, and Scozzari D

Abstract

Background and Purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year., Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020)., Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths., Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Published
2022
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