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1. Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke—Insights from the STAR Collaboration

Author

Ilko Maier, Jonathan A Grossberg, Vasu Saini, Maya Eid, Ansaar T Rai, Stacey Q Wolfe, Travis M. Dumont, Marios-Nikos Psychogios, Nitin Goyal, Mohammad Anadani, Jan Liman, J Mocco, Mithun G. Sattur, Ali Alawieh, Robert M. Starke, Kyle M Fargen, Alejandro M Spiotta, W. Christopher Fox, Michelle Allen, Fábio A. Nascimento, Adam S Arthur, Jonathan Lena, Lucas Elijovich, Reade De Leacy, Salah G. Keyrouz, Benjamin Gory, Wuwei Feng, Johanna T Fifi, David J McCarthy, Peter Kan, James A Giles, Roberto Crosa, Medical University of South Carolina [Charleston] (MUSC), Emory University School of Medicine, Emory University [Atlanta, GA], University Medical Center Göttingen (UMG), The University of Tennessee Health Science Center [Memphis] (UTHSC), University of Miami Leonard M. Miller School of Medicine (UMMSM), West Virginia University [Morgantown], Wake Forest University, University Hospital Basel [Basel], Mount Sinai Health System, Washington University School of Medecine [Saint Louis, MO], University of Arizona, Baylor College of Medicine (BCM), Baylor University, University of Florida [Gainesville] (UF), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)

Subjects
Male, medicine.medical_specialty, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Diabetes mellitus, Occlusion, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, 030212 general & internal medicine, Stroke, Aged, Retrospective Studies, Thrombectomy, Stent retriever, business.industry, Endovascular Procedures, Retrospective cohort study, Middle Aged, medicine.disease, Combined approach, 3. Good health, Mechanical thrombectomy, Treatment Outcome, Cardiology, Female, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Abstract BACKGROUND Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies. OBJECTIVE To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques. METHODS In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6). RESULTS We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P

Published
2020
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2. Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Author

Jan Liman, Ali Alawieh, Ovais Inamullah, Yser Orabi, Shareena Rahman, Fábio A. Nascimento, Adam S Arthur, Peter Kan, Christa B. Swisher, Andrei V. Alexandrov, Marios-Nikos Psychogios, Mohammad Anadani, Alejandro M Spiotta, Sébastien Richard, Joon-Tae Kim, Pierre De Marini, James A Giles, Stacey Q Wolfe, Chesney S Oravec, Ilko Maier, Saleh G. Keyrouz, Georgios Tsivgoulis, Michelle Allen, Nitin Goyal, Abhi Pandhi, Adam de Havenon, Sreeja Kodali, Nils H Petersen, Benjamin Gory, Bradley A. Cagle, Medical University of South Carolina [Charleston] (MUSC), The University of Tennessee Health Science Center [Memphis] (UTHSC), University Medical Center Göttingen (UMG), Chonnam National University [Gwangju], Washington University School of Medecine [Saint Louis, MO], University of Utah, Yale University [New Haven], Duke University Medical Center, Wake Forest School of Medicine [Winston-Salem], Wake Forest Baptist Medical Center, University of Athens Medical School [Athens], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Baylor College of Medicine (BCM), Baylor University, and Service de neurologie [CHRU Nancy]

Subjects
Male, medicine.medical_specialty, Blood Pressure, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Endovascular therapy, Article, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, Mixed linear model, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Stroke, Aged, Retrospective Studies, Thrombectomy, Intracerebral hemorrhage, Aged, 80 and over, business.industry, Endovascular Procedures, Retrospective cohort study, Blood Pressure Determination, General Medicine, Middle Aged, medicine.disease, 3. Good health, Blood pressure, Treatment Outcome, Multicenter study, Hypertension, Reperfusion, Cardiology, Surgery, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

BackgroundElevated systolic blood pressure (SBP) after mechanical thrombectomy (MT) correlates with worse outcome. However, the association between SBP reduction (SBPr) and outcome after successful reperfusion with MT is not well established.ObjectiveTo investigate the association between SBPr in the first 24 hours after successful reperfusion and the functional and safety outcomes of MT.MethodsA multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients with acute ischemic stroke and anterior circulation large vessel occlusions who achieved successful reperfusion via MT were included. SBPr was calculated using the formula 100×([admission SBP−mean SBP]/admission SBP). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 90 days. Safety endpoints included symptomatic intracerebral hemorrhage, mortality, and requirement for hemicraniectomy during admission. A generalized mixed linear model was used to study the association between SBPr and outcomes.ResultsA total of 1361 patients were included in the final analysis. SBPr as a continuous variable was inversely associated with poor outcome (OR=0.97; 95% CI 0.95 to 0.98; p20%), the rate of poor outcome was highest in the first group.ConclusionSBPr in the first 24 hours after successful reperfusion was inversely associated with poor outcome. No association between SBPr and safety outcome was found.

Published
2020
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3. Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study

Author

Kit N. Simpson, Nitin Goyal, Salah G. Keyrouz, Alejandro M Spiotta, Ovais Inamullah, Andrei V. Alexandrov, Christa B. Swisher, Shreyash Shah, Kyle M Fargen, Eyad Almallouhi, Mohammad Anadani, James A Giles, Fábio A. Nascimento, Stacey Q Wolfe, Benjamin Gory, Sébastien Richard, Adam S Arthur, Ilko Maier, Shareena Rahman, Marios-Nikos Psychogios, Peter Kan, Georgios Tsivgoulis, Daniel L. Brinton, Michelle Allen, Sreeja Kodali, Nils H Petersen, Jan Liman, Akash P. Kansagra, Yser Orabi, Pierre De Marini, Ali Alawieh, Medical University of South Carolina [Charleston] (MUSC), The University of Tennessee Health Science Center [Memphis] (UTHSC), National and Kapodistrian University of Athens (NKUA), University Medical Center Göttingen (UMG), Duke University Medical Center, Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Wake Forest University, Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Baylor College of Medicine (BCM), Baylor University, Yale New Haven Hospital, and Service de neurologie [CHRU Nancy]

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, Blood Pressure, Subgroup analysis, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Revascularization, Endovascular therapy, Brain Ischemia, Odds, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Internal medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Medicine, Thrombolytic Therapy, cardiovascular diseases, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Cerebral Revascularization, business.industry, Endovascular Procedures, Thrombolysis, Middle Aged, Prognosis, medicine.disease, 3. Good health, Treatment Outcome, 030104 developmental biology, Blood pressure, Neurology, Multicenter study, Hypertension, Cardiology, Female, Neurology (clinical), business, Goals, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, circulatory and respiratory physiology
Abstract

OBJECTIVE Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SBP goals after EVT with SR. METHODS This international multicenter study included 8 comprehensive stroke centers and patients with anterior circulation large vessel occlusion who were treated with EVT and achieved SR. SR was defined as modified thrombolysis in cerebral ischemia 2b to 3. Patients were divided into 3 groups based on SBP goal in the first 24 hours after EVT. Inverse probability of treatment weighting (IPTW) propensity analysis was used to assess the effect of different SBP goals on clinical outcomes. RESULTS A total of 1,019 patients were included. On IPTW analysis, the SBP goal of

Published
2020
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4. Blood Pressure and Outcome After Mechanical Thrombectomy With Successful Revascularization

Author

Mohammad, Anadani, Mohamad Y, Orabi, Ali, Alawieh, Nitin, Goyal, Andrei V, Alexandrov, Nils, Petersen, Sreeja, Kodali, Ilko L, Maier, Marios-Nikos, Psychogios, Christa B, Swisher, Ovais, Inamullah, Akash P, Kansagra, James A, Giles, Stacey Q, Wolfe, Jasmeet, Singh, Benjamin, Gory, Pierre, De Marini, Peter, Kan, Fábio A, Nascimento, Luis Idrovo, Freire, Abhi, Pandhi, Hunter, Mitchell, Joon-Tae, Kim, Kyle M, Fargen, Sami, Al Kasab, Jan, Liman, Shareena, Rahman, Michelle, Allen, Sébastien, Richard, Alejandro M, Spiotta, Medical University of South Carolina [Charleston] (MUSC), Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), The University of Tennessee Health Science Center [Memphis] (UTHSC), Yale University School of Medicine, University Medical Center Göttingen (UMG), Duke University Medical Center, Wake Forest University, Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Baylor College of Medicine (BCM), Baylor University, Leeds General Infirmary (LGI), Leeds Teaching Hospitals NHS Trust, Chonnam National University [Gwangju], Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), and Service de neurologie [CHRU Nancy]

Subjects
Aged, 80 and over, Male, Endovascular Procedures, Blood Pressure, Blood Pressure Determination, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Middle Aged, Brain Ischemia, Stroke, Treatment Outcome, Hypertension, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Female, cardiovascular diseases, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Aged, Cerebral Hemorrhage, Thrombectomy, circulatory and respiratory physiology
Abstract

International audience; Background and Purpose— Successful reperfusion can be achieved in more than two-thirds of patients treated with mechanical thrombectomy. Therefore, it is important to understand the effect of blood pressure (BP) on clinical outcomes after successful reperfusion. In this study, we investigated the relationship between BP on admission and during the first 24 hours after successful reperfusion with clinical outcomes. Methods— This was a multicenter study from 10 comprehensive stroke centers. To ensure homogeneity of the studied cohort, we included only patients with anterior circulation who achieved successful recanalization at the end of procedure. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage (sICH), mortality, and hemicraniectomy. Results— A total of 1245 patients were included in the study. Mean age was 69±14 years, and 51% of patients were female. Forty-nine percent of patients had good functional outcome at 90-days, and 4.7% suffered sICH. Admission systolic BP (SBP), mean SBP, maximum SBP, SBP SD, and SBP range were associated with higher risk of sICH. In addition, patients in the higher mean SBP groups had higher rates of sICH. Similar results were found for hemicraniectomy. With respect to functional outcome, mean SBP, maximum SBP, and SBP range were inversely associated with the good outcome (modified Rankin Scale score, 0–2). However, the difference in SBP parameters between the poor and good outcome groups was modest. Conclusions— Higher BP within the first 24 hours after successful mechanical thrombectomy was associated with a higher likelihood of sICH, mortality, and requiring hemicraniectomy.

Published
2019
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