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6. Left Ventricular Diastolic Dysfunction Is Associated with Poor Functional Outcomes after Endovascular Thrombectomy

Author

Li, Tony Y. W., primary, Toh, Emma M. S., additional, Koh, Ying Ying, additional, Leow, Aloysius S. T., additional, Chan, Bernard P. L., additional, Teoh, Hock-Luen, additional, Seet, Raymond C. S., additional, Gopinathan, Anil, additional, Yang, Cunli, additional, Sharma, Vijay K., additional, Yeo, Leonard L. L., additional, Chan, Mark Y., additional, Kong, William K. F., additional, Poh, Kian-Keong, additional, Tan, Benjamin Y. Q., additional, and Sia, Ching-Hui, additional

Published
2024
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7. Endovascular coiling versus neurosurgical clipping in the management of aneurysmal subarachnoid haemorrhage in the elderly: a multicenter cohort study

Author

Lee, Keng Siang, primary, Siow, Isabel, additional, Yang, Lily WY, additional, Foo, Aaron SC, additional, Zhang, John JY, additional, Mathews, Ian, additional, Goh, Chun Peng, additional, Teo, Colin, additional, Nagarjun, Bolem, additional, Chen, Vanessa, additional, Lwin, Sein, additional, Teo, Kejia, additional, Low, Shiong Wen, additional, Sun, Ira SY, additional, Pang, Boon Chuan, additional, Yang, Eugene WR, additional, Yang, Cunli, additional, Gopinathan, Anil, additional, Yeo, Tseng Tsai, additional, and Nga, Vincent DW, additional

Published
2024
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8. Revolutionizing the Management of Large-Core Ischaemic Strokes: Decoding the Success of Endovascular Therapy in the Recent Stroke Trials

Author

Lim, Gareth Zigui, primary, Lai, Jonathan Yexian, additional, Seet, Christopher Ying Hao, additional, Tham, Carol Huilian, additional, Venketasubramanian, Narayanaswamy, additional, Tan, Benjamin Yong Qiang, additional, Jing, Mingxue, additional, Yeo, Joshua Yee Peng, additional, Myint, May Zin, additional, Sia, Ching-Hui, additional, Teoh, Hock Luen, additional, Sharma, Vijay Kumar, additional, Chan, Bernard, additional, Yang, Cunli, additional, Makmur, Andrew, additional, Ong, Shao Jin, additional, and Leong, Leonard Litt Yeo, additional

Published
2023
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9. Revolutionizing the Management of Large-Core Ischaemic Strokes: Decoding the Success of Endovascular Therapy in the Recent Stroke Trials.

Author

Lim, Gareth Zigui, Lai, Jonathan Yexian, Seet, Christopher Ying Hao, Tham, Carol Huilian, Venketasubramanian, Narayanaswamy, Tan, Benjamin Yong Qiang, Jing, Mingxue, Yeo, Joshua Yee Peng, Myint, May Zin, Sia, Ching-Hui, Teoh, Hock Luen, Sharma, Vijay Kumar, Chan, Bernard Poon Lap, Yang, Cunli, Makmur, Andrew, Ong, Shao Jin, and Yeo, Leonard Leong Litt

Published
2023
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10. Direct dotterising or angioplasty of acute stroke due to tandem atherosclerotic occlusions

Author

Leonard L. L. Yeo, Davide Simonato, Pervinder Bhogal, Anil Gopinathan, Yang Cunli, Samuel W. Q. Ong, Mingxue Jing, Benjamin Y. Q. Tan, Ching-Hui Sia, Tom Jia, Giacomo Cester, Joseph-Domenico Gabrieli, and Tommy Andersson

Abstract

BackgroundTandem occlusions cause 10–15% of LVO acute ischemic strokes but are difficult to treat endovascularly and frequently excluded from clinical trials. The optimum endovascular method is still debated, however going directly through the carotid occlusion can speed up the procedure and reduce procedural risk by eliminating an exchange maneuver.MethodUsing retrospective data from three centers, we compared treating atherosclerotic tandem occlusions using a 0.035'-guidewire and direct dotterisation or angioplasty with a peripheral vascular balloon suitable for the wire, vs. the usual technique of an 0.014'wire. We compared the successful recanalization (mTICI 2b-3) rates, 90 days' functional outcomes (mRS 0–2), and puncture-to-recanalization times between both procedures.ResultsForty-two consecutive patients with atherosclerotic tandem occlusions were included; 25 were treated with the 0.014'wire technique and 17 with the 0.035'-guidewire and direct dotterisation or angioplasty with a peripheral vascular balloon technique. The direct technique achieved a higher rate of successful recanalization (100 vs. 72%, P = 0.018), better functional outcome (88.4 vs. 48.0%, P = 0.044), and faster procedure times (mean 65.1 mins vs. 114.8 mins, P < 0.001). The number of attempts was similar between both groups (median 2 vs 3 attempts, P = 0.101). There was no significant difference in the complication rate between both groups (5.9 vs. 12.0%, P = 0.462).ConclusionCompared to previous endovascular techniques for treating atherosclerotic tandem occlusions, the direct technique using standard 0.035' guidewires and dotterisation or a peripheral vascular balloon is significantly faster with better outcomes. However, this will require further external validation in larger cohorts.

Published
2023

11. Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta- analysis of 1096 patients.

Author

Lee, Keng Siang, Siow, Isabel, Zhang, John JY, Syn, Nicholas, Gillespie, Conor S., Yuen, Linus ZH, Anil, Gopinathan, Yang, Cunli, Chan, Bernard PL, Sharma, Vijay Kumar, Teoh, Hock- Luen, Mingxue, Jing, Teo, Kevin Soon Hwee, Myint, May Zin, Bhogal, Pervinder, and Meyer, Lukas

Subjects
MEDICAL databases, RELATIVE medical risk, META-analysis, MEDICAL information storage & retrieval systems, CONFIDENCE intervals, ISCHEMIC stroke, SYSTEMATIC reviews, INTRACRANIAL hemorrhage, THROMBOLYTIC therapy, BASILAR artery, SURVIVAL rate, TREATMENT effectiveness, SUBARACHNOID hemorrhage, MEDICAL emergencies, MEDICAL protocols, THROMBECTOMY, DESCRIPTIVE statistics, DISABILITIES, MEDLINE, ODDS ratio, DATA analysis software, CEREBRAL arteriosclerosis, DISEASE complications
Abstract

Background Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO). Objective To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta- analysis of the current literature. Methods Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90- day modified Rankin Scale score 0--2 was the primary outcome measure. Secondary outcome measures were 90- day mortality, successful post- thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH). Results Three studies reporting 1096 patients with BAO AIS were included in the meta- analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90- day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post- treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563). Conclusions In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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12. Thrombectomy for distal medium vessel occlusion stroke: Combined vs. single-device techniques - A systematic review and meta-analysis

Author

Loh, Enver De Wei, primary, Kwok, Gabriel Yi Ren, additional, Toh, Keith Zhi Xian, additional, Koh, Ming Yi, additional, Teo, Yao Hao, additional, Teo, Yao Neng, additional, Chan, Bernard P. L., additional, Sharma, Vijay Kumar, additional, Ng, Megan Bi-Jia, additional, Lim, Hui Shi, additional, Soon, Betsy, additional, Gopinathan, Anil, additional, Yang, Cunli, additional, Sia, Ching-Hui, additional, Bhogal, Pervinder, additional, Brouwer, Patrick A., additional, Meyer, Lukas, additional, Fiehler, Jens, additional, Andersson, Tommy, additional, Tan, Benjamin Y. Q., additional, and Yeo, Leonard L. L., additional

Published
2023
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14. The Role of Interventional Radiology in the Diagnosis and Treatment of Pulmonary Arteriovenous Malformations

Author

Yap, Chee Woei, primary, Wee, Bernard B. K., additional, Yee, Sze Ying, additional, Tiong, Vincent, additional, Chua, Yi Xiu, additional, Teo, Lycia, additional, Lohan, Rahul, additional, Tan, Amos, additional, Singh, Pavel, additional, Rajendran, Prapul Chander, additional, Yang, Cunli, additional, Yee, Yong Chen, additional, Anil, Gopinathan, additional, and Ong, Shao Jin, additional

Published
2022
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15. Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients

Author

Lee, Keng Siang, primary, Siow, Isabel, additional, Zhang, John JY, additional, Syn, Nicholas L, additional, Gillespie, Conor S, additional, Yuen, Linus ZH, additional, Anil, Gopinathan, additional, Yang, Cunli, additional, Chan, Bernard PL, additional, Sharma, Vijay Kumar, additional, Teoh, Hock-Luen, additional, Mingxue, Jing, additional, Teo, Kevin Soon Hwee, additional, Myint, May Zin, additional, Bhogal, Pervinder, additional, Meyer, Lukas, additional, Schob, Stefan, additional, Sia, Ching-Hui, additional, Mpotsaris, Anastasios, additional, Maus, Volker, additional, Andersson, Tommy, additional, Arnberg, Fabian, additional, Gontu, Vamsi Krishna, additional, Lee, Tsong-Hai, additional, Tan, Benjamin Y Q, additional, and Yeo, Leonard LL, additional

Published
2022
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16. Effect of frailty on outcomes of endovascular treatment for acute ischaemic stroke in older patients

Author

Tan, Benjamin Y Q, primary, Ho, Jamie S Y, additional, Leow, Aloysius S, additional, Chia, Magdalene L J, additional, Sia, Ching Hui, additional, Koh, Ying Ying, additional, Seetharaman, Santhosh K, additional, Yang, Cunli, additional, Gopinathan, Anil, additional, Teoh, Hock Luen, additional, Sharma, Vijay K, additional, Seet, Raymond C S, additional, Chan, Bernard P L, additional, Yeo, Leonard L L, additional, and Tan, Li Feng, additional

Published
2022
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17. Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion

Author

Siow, Isabel Tan, Benjamin Y. Q. Lee, Keng Siang Ong, Natalie Toh, Emma Gopinathan, Anil Yang, Cunli Bhogal, Pervinder Lam, Erika Spooner, Oliver Meyer, Lukas Fiehler, Jens Papanagiotou, Panagiotis Kastrup, Andreas Alexandrou, Maria Zubel, Seraphine Wu, Qingyu Mpotsaris, Anastasios Maus, Volker Anderson, Tommy Gontu, Vamsi Arnberg, Fabian Lee, Tsong Hai Chan, Bernard P. L. Seet, Raymond C. S. Teoh, Hock Luen Sharma, Vijay K. Yeo, Leonard L. L.

Abstract

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT. METHODS: This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0-3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH). RESULTS: Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not as Comorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013). CONCLUSIONS: Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.

Published
2022

18. Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis

Author

Teo, Yao Neng, primary, Sia, Ching-Hui, additional, Tan, Benjamin Y Q, additional, Mingxue, Jing, additional, Chan, Bernard, additional, Sharma, Vijay Kumar, additional, Makmur, Andrew, additional, Gopinathan, Anil, additional, Yang, Cunli, additional, Loh, Stanley, additional, Ng, Sheldon, additional, Ong, Shao Jin, additional, Teoh, Hock-Luen, additional, Rathakrishnan, Rahul, additional, Andersson, Tommy, additional, Arnberg, Fabian, additional, Gontu, Vamsi Krishna, additional, Lee, Tsong-hai, additional, Maus, Volker, additional, Meyer, Lukas, additional, Bhogal, Pervinder, additional, Spooner, Oliver, additional, Li, Tony YW, additional, Soh, Rodney YH, additional, and Yeo, Leonard LL, additional

Published
2022
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19. Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion

Author

Siow, Isabel, primary, Tan, Benjamin Y.Q., additional, Lee, Keng Siang, additional, Ong, Natalie, additional, Toh, Emma, additional, Gopinathan, Anil, additional, Yang, Cunli, additional, Bhogal, Pervinder, additional, Lam, Erika, additional, Spooner, Oliver, additional, Meyer, Lukas, additional, Fiehler, Jens, additional, Papanagiotou, Panagiotis, additional, Kastrup, Andreas, additional, Alexandrou, Maria, additional, Zubel, Seraphine, additional, Wu, Qingyu, additional, Mpotsaris, Anastasios, additional, Maus, Volker, additional, Anderson, Tommy, additional, Gontu, Vamsi, additional, Arnberg, Fabian, additional, Lee, Tsong Hai, additional, Chan, Bernard P.L., additional, Seet, Raymond C.S., additional, Teoh, Hock Luen, additional, Sharma, Vijay K., additional, and Yeo, Leonard L.L., additional

Published
2022
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20. Effect of Sex on Outcomes of Mechanical Thrombectomy in Basilar Artery Occlusion: A Multicentre Cohort Study

Author

Tan, Benjamin Y.Q., primary, Siow, Isabel, additional, Lee, Keng Siang, additional, Chen, Vanessa, additional, Ong, Natalie, additional, Gopinathan, Anil, additional, Yang, Cunli, additional, Bhogal, Pervinder, additional, Lam, Erika, additional, Spooner, Oliver, additional, Meyer, Lukas, additional, Fiehler, Jens, additional, Papanagiotou, Panagiotis, additional, Kastrup, Andreas, additional, Alexandrou, Maria, additional, Zubel, Seraphine, additional, Wu, Qingyu, additional, Mpotsaris, Anastasios, additional, Maus, Volker, additional, Andersson, Tommy, additional, Gontu, Vamsi, additional, Arnberg, Fabian, additional, Lee, Tsong-Hai, additional, Chan, Bernard, additional, Teoh, Hock Luen, additional, Seet, Raymond C.S., additional, Sharma, Vijay, additional, and Yeo, Leonard L.L., additional

Published
2022
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21. Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis.

Author

Yao Neng Teo, Ching-Hui Sia, Tan, Benjamin Y. Q., Jing Mingxue, Chan, Bernard, Sharma, Vijay Kumar, Makmur, Andrew, Gopinathan, Anil, Yang, Cunli, Loh, Stanley, Ng, Sheldon, Shao Jin Ong, Hock-Luen Teoh, Rathakrishnan, Rahul, Andersson, Tommy, Arnberg, Fabian, Gontu, Vamsi Krishna, Tsong-hai Lee, Maus, Volker, and Meyer, Lukas

Subjects
ONLINE information services, MEDICAL databases, META-analysis, MEDICAL information storage & retrieval systems, CONFIDENCE intervals, ISCHEMIC stroke, SYSTEMATIC reviews, INTRACRANIAL hemorrhage, SURGICAL stents, SURGICAL complications, TREATMENT effectiveness, THROMBECTOMY, CATHETERIZATION, REPERFUSION, MEDLINE, ODDS ratio, CATHETERS, CEREBRAL ischemia
Abstract

Background The use of a combination of balloon guide catheter (BGC), aspiration catheter, and stent retriever in acute ischemic stroke thrombectomy has not been shown to be better than a stent retriever and BGC alone, but this may be due to a lack of power in these studies. We therefore performed a meta-analysis on this subject. Methods A systematic literature search was performed on PubMed, Scopus, Embase/Ovid, and the Cochrane Library from inception to October 20, 2021. Our primary outcomes were the rate of successful final reperfusion (Treatment in Cerebral Ischemia (TICI) 2c-3) and first pass effect (FPE, defined as TICI 2c-3 in a single pass). Secondary outcomes were 3 month functional independence (modified Rankin Scale score of 0-2), mortality, procedural complications, embolic complications, and symptomatic intracranial hemorrhage (SICH). A meta-analysis was performed using RevMan 5,4, and heterogeneity was assessed using the I2 test. Results Of 1629 studies identified, five articles with 2091 patients were included. For the primary outcomes, FPE (44.9% vs 45.4%, OR 1.04 (95% CI 0.90 to 1.22), I²=57%) or final successful reperfusion (64.5% vs 68.6%, OR 0.98 (95% CI 0.81% to 1.20%), I²=85%) was similar between the combination technique and stent retriever only groups. However, the combination technique had significantly less rescue treatment (18.8% vs 26.9%; OR 0.70 (95% CI 0.54 to 0.91), I²=0%). This did not translate into significant differences in secondary outcomes in functional outcomes, mortality, emboli, complications, or SICH. Conclusion There was no significant difference in successful reperfusion and FPE between the combined techniques and the stent retriever and BGC alone groups. Neither was there any difference in functional outcomes, complications, or mortality. [ABSTRACT FROM AUTHOR]

Published
2023
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22. Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis

Author

Teo, Yao Neng, Sia, Ching-Hui, Tan, Benjamin Y Q, Mingxue, Jing, Chan, Bernard, Sharma, Vijay Kumar, Makmur, Andrew, Gopinathan, Anil, Yang, Cunli, Loh, Stanley, Ng, Sheldon, Ong, Shao Jin, Teoh, Hock-Luen, Rathakrishnan, Rahul, Andersson, Tommy, Arnberg, Fabian, Gontu, Vamsi Krishna, Lee, Tsong-hai, Maus, Volker, Meyer, Lukas, Bhogal, Pervinder, Spooner, Oliver, Li, Tony YW, Soh, Rodney YH, and Yeo, Leonard LL

Abstract

BackgroundThe use of a combination of balloon guide catheter (BGC), aspiration catheter, and stent retriever in acute ischemic stroke thrombectomy has not been shown to be better than a stent retriever and BGC alone, but this may be due to a lack of power in these studies. We therefore performed a meta-analysis on this subject.MethodsA systematic literature search was performed on PubMed, Scopus, Embase/Ovid, and the Cochrane Library from inception to October 20, 2021. Our primary outcomes were the rate of successful final reperfusion (Treatment in Cerebral Ischemia (TICI) 2c–3) and first pass effect (FPE, defined as TICI 2c–3 in a single pass). Secondary outcomes were 3 month functional independence (modified Rankin Scale score of 0–2), mortality, procedural complications, embolic complications, and symptomatic intracranial hemorrhage (SICH). A meta-analysis was performed using RevMan 5,4, and heterogeneity was assessed using the I2test.ResultsOf 1629 studies identified, five articles with 2091 patients were included. For the primary outcomes, FPE (44.9% vs 45.4%, OR 1.04 (95% CI 0.90 to 1.22), I2=57%) or final successful reperfusion (64.5% vs 68.6%, OR 0.98 (95% CI 0.81% to 1.20%), I2=85%) was similar between the combination technique and stent retriever only groups. However, the combination technique had significantly less rescue treatment (18.8% vs 26.9%; OR 0.70 (95% CI 0.54 to 0.91), I2=0%). This did not translate into significant differences in secondary outcomes in functional outcomes, mortality, emboli, complications, or SICH.ConclusionThere was no significant difference in successful reperfusion and FPE between the combined techniques and the stent retriever and BGC alone groups. Neither was there any difference in functional outcomes, complications, or mortality.

Published
2023
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23. The effectiveness of the Safety in Interventional Radiology (SIR) Shield in reducing droplet transmission and its effect on image quality and radiation dose.

Author

Ong, Shao Jin, Anil, Gopinathan, Chia, Koon Liang, Khoo, Deborah, Lee, Joseph KT, Chen, Priscilla XH, Nares, Teddy M, Koh, Calvin J, Su, Peijing, Yang, Cunli, Singh, Pavel, Rajendran, Prapul C, Fotheringham, Timothy, Quek, Swee T, and Renfrew, Ian

Subjects
INTERVENTIONAL radiology, IMAGE transmission, RADIATION doses, SUPINE position, COUGH
Abstract

To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre. [ABSTRACT FROM AUTHOR]

Published
2022
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24. Internal cerebral vein asymmetry is an independent predictor of poor functional outcome in endovascular thrombectomy

Author

Myint, May Zin, Yeo, Leonard LL, Tan, Benjamin Y Q, The, Ei Zune, Lim, Mei Chin, Sia, Ching-Hui, Teoh, Hock-Luen, Sharma, Vijay Kumar, Chan, Bernard, Ahmad, Aftab, Paliwal, Prakash, Gopinathan, Anil, Yang, Cunli, Makmur, Andrew, Andersson, Tommy, Arnberg, Fabian, and Holmin, Staffan

Abstract

BackgroundEndovascular thrombectomy (EVT) in large vessel occlusion (LVO) in anterior circulation acute ischaemic stroke (AIS) results in good functional outcomes in only approximately 60% of the patients. Internal cerebral veins (ICVs) are easily visible, with a consistent midline location, and are linked to stroke outcomes. We hypothesize that ICV asymmetry on multiphasic CT angiogram (mCTA) can be an adjunctive predictor for poor functional outcomes.MethodsWe studied consecutive AIS patients from 2017 to 2019 with anterior circulation LVO treated with EVT regardless of intravenous thrombolysis. Asymmetrical ICV was defined as the presence of hypodensity (less opacification) on the ipsilateral occlusion side as compared with the contralateral side. The primary outcome was modified Rankin Score (mRS) score at 3 months. Secondary outcomes were good recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3), symptomatic hemorrhage, and mortality.ResultsA total of 185 patients were included with a median age of 70 years (IQR 59–77); 87 patients (47%) were female. 82 patients (44.3%) achieved good functional outcomes (mRS 0–2) at 3 months. On multivariate analysis, National Institutes of Health Stroke Scale (NIHSS) (OR 1.076, 95% CI 1.015 to 1.140; p<0.013), poor collateral score (OR 0.285, 95% CI 0.162 to 0.501; p<0.001), asymmetrical ICV on the peak venous phase (OR 2.47, 95% CI 1.115 to 5.471; p<0.026), and late venous phase of the mCTA (OR 2.642, 95% CI 1.161 to 6.016; p<0.021) were independent risks factors of poor outcomes.ConclusionICV asymmetry is a novel radiological sign which is independently associated with poor functional outcomes in EVT, even after correction for collateral circulation. Further studies are needed to validate this finding.

Published
2022
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