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4. A novel proposed grading system for cerebellar arteriovenous malformations.

Author

Nisson, Peyton L, Fard, Salman A, Walter, Christina M, Johnstone, Cameron M, Mooney, Michael A, Tayebi Meybodi, Ali, Lang, Michael, Kim, Helen, Jahnke, Heidi, Roe, Denise J, Dumont, Travis M, Lemole, G Michael, Spetzler, Robert F, and Lawton, Michael T

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Patient Safety, Clinical Research, Cancer, Rare Diseases, Neurosciences, cerebellar, arteriovenous malformations, grading system, risk assessment, prognosis, outcomes, vascular disorders, Neurology & Neurosurgery, Clinical sciences
Abstract

ObjectiveThe objective of this study was to evaluate the existing Spetzler-Martin (SM), Spetzler-Ponce (SP), and Lawton-Young (LY) grading systems for cerebellar arteriovenous malformations (AVMs) and to propose a new grading system to estimate the risks associated with these lesions.MethodsData for patients with cerebellar AVMs treated microsurgically in two tertiary medical centers were retrospectively reviewed. Data from patients at institution 1 were collected from September 1999 to February 2013, and at institution 2 from October 2008 to October 2015. Patient outcomes were classified as favorable (modified Rankin Scale [mRS] score 0-2) or poor (mRS score 3-6) at the time of discharge. Using chi-square and logistic regression analysis, variables associated with poor outcomes were assigned risk points to design the proposed grading system. The proposed system included neurological status prior to treatment (poor, +2 points), emergency surgery (+1 point), age > 60 years (+1 point), and deep venous drainage (deep, +1 point). Risk point totals of 0-1 comprised grade 1, 2-3 grade 2, and 4-5 grade 3.ResultsA total of 125 cerebellar AVMs of 1328 brain AVMs were reviewed in 125 patients, 120 of which were treated microsurgically and included in the study. With our proposed grading system, we found poor outcomes differed significantly between each grade (p < 0.001), while with the SM, SP, and LY grading systems they did not (p = 0.22, p = 0.25, and p = 1, respectively). Logistic regression revealed grade 2 had 3.3 times the risk of experiencing a poor outcome (p = 0.008), while grade 3 had 9.9 times the risk (p < 0.001). The proposed grading system demonstrated a superior level of predictive accuracy (area under the receiver operating characteristic curve [AUROC] of 0.72) compared with the SM, SP, and LY grading systems (AUROC of 0.61, 0.57, and 0.51, respectively).ConclusionsThe authors propose a novel grading system for cerebellar AVMs based on emergency surgery, venous drainage, preoperative neurological status, and age that provides a superior prognostication power than the formerly proposed SM, SP, and LY grading systems. This grading system is clinically predictive of patient outcomes and can be used to better guide vascular neurosurgeons in clinical decision-making.

Published
2020

8. Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)

Author

Froehler, Michael T, Saver, Jeffrey L, Zaidat, Osama O, Jahan, Reza, Aziz-Sultan, Mohammad Ali, Klucznik, Richard P, Haussen, Diogo C, Hellinger, Frank R, Yavagal, Dileep R, Yao, Tom L, Liebeskind, David S, Jadhav, Ashutosh P, Gupta, Rishi, Hassan, Ameer E, Martin, Coleman O, Bozorgchami, Hormozd, Kaushal, Ritesh, Nogueira, Raul G, Gandhi, Ravi H, Peterson, Eric C, Dashti, Shervin R, Given, Curtis A, Mehta, Brijesh P, Deshmukh, Vivek, Starkman, Sidney, Linfante, Italo, McPherson, Scott H, Kvamme, Peter, Grobelny, Thomas J, Hussain, Muhammad S, Thacker, Ike, Vora, Nirav, Chen, Peng Roc, Monteith, Stephen J, Ecker, Robert D, Schirmer, Clemens M, Sauvageau, Eric, Abou-Chebl, Alex, Derdeyn, Colin P, Maidan, Lucian, Badruddin, Aamir, Siddiqui, Adnan H, Dumont, Travis M, Alhajeri, Abdulnasser, Taqi, M Asif, Asi, Khaled, Carpenter, Jeffrey, Boulos, Alan, Jindal, Gaurav, Puri, Ajit S, Chitale, Rohan, Deshaies, Eric M, Robinson, David H, Kallmes, David F, Baxter, Blaise W, Jumaa, Mouhammad A, Sunenshine, Peter, Majjhoo, Aniel, English, Joey D, Suzuki, Shuichi, Fessler, Richard D, Almandoz, Josser E Delgado, Martin, Jerry C, and Mueller-Kronast, Nils H

Subjects
Stroke, Clinical Research, Brain Disorders, Endovascular Procedures, Hospitals, Humans, Ischemia, Patient Transfer, Prospective Studies, Registries, Survival Analysis, Thrombectomy, Time Factors, Treatment Outcome, emergency medical services, endovascular treatment, ischemic stroke, stent retriever, systems of care, STRATIS Investigators, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

BackgroundEndovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation.MethodsSTRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours. Patients underwent MT with or without intravenous tissue plasminogen activator and were admitted to endovascular-capable centers via either interhospital transfer or direct presentation. The primary clinical outcome was functional independence (modified Rankin Score 0-2) at 90 days. We assessed (1) real-world time metrics of stroke care delivery, (2) outcome differences between direct and transfer patients undergoing MT, and (3) the potential impact of local hospital bypass.ResultsA total of 984 patients were analyzed. Median onset-to-revascularization time was 202.0 minutes for direct versus 311.5 minutes for transfer patients (P

Published
2017

16. Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core

Author

Almallouhi, Eyad, primary, Zandpazandi, Sara, additional, Anadani, Mohammad, additional, Cunningham, Conor, additional, Sowlat, Mohammad-Mahdi, additional, Matsukawa, Hidetoshi, additional, Orscelik, Atakan, additional, Elawady, Sameh Samir, additional, Maier, Ilko, additional, Al Kasab, Sami, additional, Jabbour, Pascal, additional, Kim, Joon-tae, additional, Wolfe, Stacey Q, additional, Rai, Ansaar, additional, Starke, Robert M, additional, Psychogios, Marios-Nikos, additional, Samaniego, Edgar A, additional, Arthur, Adam S, additional, Yoshimura, Shinichi, additional, Cuellar, Hugo, additional, Grossberg, Jonathan A, additional, Alawieh, Ali, additional, Romano, Daniele G, additional, Tanweer, Omar, additional, Mascitelli, Justin, additional, Fragata, Isabel, additional, Polifka, Adam J, additional, Osbun, Joshua W, additional, Crosa, Roberto Javier, additional, Matouk, Charles, additional, Park, Min S, additional, Levitt, Michael R, additional, Brinjikji, Waleed, additional, Moss, Mark, additional, Dumont, Travis M, additional, Williamson, Richard, additional, Navia, Pedro, additional, Kan, Peter, additional, De Leacy, Reade, additional, Chowdhry, Shakeel A, additional, Ezzeldin, Mohamad, additional, and Spiotta, Alejandro M, additional

Published
2023
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17. Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

Author

Dabhi, Nisha, primary, Kumar, Jeyan Sathia, additional, Ironside, Natasha, additional, Kellogg, Ryan T, additional, Sowlat, Mohammad-Mahdi, additional, Uchida, Kazutaka, additional, Maier, Ilko, additional, Al Kasab, Sami, additional, Jabbour, Pascal, additional, Kim, Joon-tae, additional, Wolfe, Stacey Q, additional, Rai, Ansaar, additional, Starke, Robert M, additional, Psychogios, Marios-Nikos, additional, Samaniego, Edgar A, additional, Arthur, Adam S, additional, Yoshimura, Shinichi, additional, Cuellar, Hugo, additional, Howard, Brian M, additional, Alawieh, Ali, additional, Romano, Daniele G, additional, Tanweer, Omar, additional, Mascitelli, Justin, additional, Fragata, Isabel, additional, Polifka, Adam J, additional, Osbun, Joshua W, additional, Crosa, Roberto Javier, additional, Matouk, Charles, additional, Levitt, Michael R, additional, Brinjikji, Waleed, additional, Moss, Mark, additional, Dumont, Travis M, additional, Williamson, Richard, additional, Navia, Pedro, additional, Kan, Peter, additional, De Leacy, Reade, additional, Chowdhry, Shakeel A, additional, Ezzeldin, Mohamad, additional, Spiotta, Alejandro M, additional, and Park, Min S, additional

Published
2023
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18. Comprehensive analysis of the impact of procedure time and the ‘golden hour’ in subpopulations of stroke thrombectomy patients

Author

Ash, Makenna, primary, Dimisko, Laurie, additional, Chalhoub, Reda M, additional, Howard, Brian M, additional, Cawley, C Michael, additional, Matouk, Charles, additional, Pabaney, Aqueel, additional, Spiotta, Alejandro M, additional, Jabbour, Pascal, additional, Maier, Ilko, additional, Wolfe, Stacey Q, additional, Rai, Ansaar T, additional, Kim, Joon-tae, additional, Psychogios, Marios-Nikos, additional, Mascitelli, Justin R, additional, Starke, Robert M, additional, Shaban, Amir, additional, Yoshimura, Shinichi, additional, De Leacy, Reade, additional, Kan, Peter, additional, Fragata, Isabel, additional, Polifka, Adam J, additional, Arthur, Adam S, additional, Park, Min S, additional, Crosa, Roberto Javier, additional, Williamson, Richard, additional, Dumont, Travis M, additional, Levitt, Michael R, additional, Al Kasab, Sami, additional, Tjoumakaris, Stavropoula I, additional, Liman, Jan, additional, Saad, Hassan, additional, Samaniego, Edgar A, additional, Fargen, Kyle M, additional, Grossberg, Jonathan A, additional, and Alawieh, Ali, additional

Published
2023
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24. Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours.

Author

Shaban, Amir, Al Kasab, Sami, Chalhoub, Reda M., Bass, Eric, Maier, Ilko, Psychogios, Marios-Nikos, Alawieh, Ali, Wolfe, Stacey Q., Arthur, Adam S., Dumont, Travis M., Kan, Peter, Joon-tae Kim, de De Leacy, Rea, Osbun, Joshua W., Rai, Ansaar T., Jabbour, Pascal, Min S. Park, Crosa, Roberto Javier, Mascitelli, Justin R., and Levitt, Michael R.

Subjects
REPORTING of diseases, STROKE, TIME, MULTIVARIATE analysis, RETROSPECTIVE studies, CEREBRAL arteries, TREATMENT effectiveness, FUNCTIONAL assessment, THROMBECTOMY, RESEARCH funding, DESCRIPTIVE statistics, ODDS ratio
Abstract

Background Recent clinical trials have shown that mechanical thrombectomy is superior to medical management for large vessel occlusion for up to 24 hours from onset. Our objective is to examine the safety and efficacy of thrombectomy beyond the standard of care window. Methods A retrospective review was undertaken of the multicenter Stroke Thrombectomy and Aneurysm Registry (STAR). We identified patients who underwent mechanical thrombectomy for large vessel occlusion beyond 24 hours. We selected a matched control group from patients who underwent thrombectomy in the 6-24-hour window. We used functional independence at 3 months as our primary outcome measure. results We identified 121 patients who underwent thrombectomy beyond 24 hours and 1824 in the 6-24-hour window. We selected a 2:1 matched group of patients with thrombectomy 6-24 hours as a comparison group. Patients undergoing thrombectomy beyond 24 hours were less likely to be independent at 90 days (18 (18.8%) vs 73 (34.9%), P=0.005). They had higher odds of mortality at 90 days in the adjusted analysis (OR 2.34, P=0.023). Symptomatic intracerebral hemorrhage and other complications were similar in the two groups. In a multivariate analysis only lower number of attempts was associated with good outcomes (OR 0.27, P=0.022). Conclusions Mechanical thrombectomy beyond 24 hours appears to be safe and tolerable with no more hemorrhages or complications compared with standard of care thrombectomy. Outcomes and mortality in this time window are worse compared with an earlier time window, but the rates of good outcomes may justify this therapy in selected patients. [ABSTRACT FROM AUTHOR]

Published
2023
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30. Comprehensive analysis of the impact of procedure time and the ‘golden hour’ in subpopulations of stroke thrombectomy patients

Author

Ash, Makenna, Dimisko, Laurie, Chalhoub, Reda M, Howard, Brian M, Cawley, C Michael, Matouk, Charles, Pabaney, Aqueel, Spiotta, Alejandro M, Jabbour, Pascal, Maier, Ilko, Wolfe, Stacey Q, Rai, Ansaar T, Kim, Joon-tae, Psychogios, Marios-Nikos, Mascitelli, Justin R, Starke, Robert M, Shaban, Amir, Yoshimura, Shinichi, De Leacy, Reade, Kan, Peter, Fragata, Isabel, Polifka, Adam J, Arthur, Adam S, Park, Min S, Crosa, Roberto Javier, Williamson, Richard, Dumont, Travis M, Levitt, Michael R, Al Kasab, Sami, Tjoumakaris, Stavropoula I, Liman, Jan, Saad, Hassan, Samaniego, Edgar A, Fargen, Kyle M, Grossberg, Jonathan A, and Alawieh, Ali

Abstract

ObjectiveTo evaluate the effect of procedure time on thrombectomy outcomes in different subpopulations of patients undergoing endovascular thrombectomy (EVT), given the recently expanded indications for EVT.MethodsThis multicenter study included patients undergoing EVT for acute ischemic stroke at 35 centers globally. Procedure time was defined as time from groin puncture to successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) or abortion of procedure. Patients were stratified based on stroke location, use of IV tissue plasminogen activator (tPA), Alberta Stroke Program Early CT score, age group, and onset-to-groin time. Primary outcome was the 90-day modified Rankin Scale (mRS) score, with scores 0–2 designating good outcome. Secondary outcome was postprocedural symptomatic intracranial hemorrhage (sICH). Multivariate analyses were performed using generalized linear models to study the impact of procedure time on outcomes in each subpopulation.ResultsAmong 8961 patients included in the study, a longer procedure time was associated with higher odds of poor outcome (mRS score 3–6), with 10% increase in odds for each 10 min increment. When procedure time exceeded the ‘golden hour’, poor outcome was twice as likely. The golden hour effect was consistent in patients with anterior and posterior circulation strokes, proximal or distal occlusions, in patients with large core infarcts, with or without IV tPA treatment, and across age groups. Procedures exceeding 1 hour were associated with a 40% higher sICH rate. Posterior circulation strokes, delayed presentation, and old age were the variables most sensitive to procedure time.ConclusionsIn this work we demonstrate the universality of the golden hour effect, in which procedures lasting more than 1 hour are associated with worse clinical outcomes and higher rates of sICH across different subpopulations of patients undergoing EVT.

Published
2024
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31. Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion

Author

Orscelik, Atakan, Kallmes, David F, Bilgin, Cem, Musmar, Basel, Senol, Yigit Can, Kobeissi, Hassan, Elawady, Sameh Samir, Cunningham, Conor, Matsukawa, Hidetoshi, Zandpazandi, Sara, Sowlat, Mohammad-Mahdi, Maier, Ilko, Al Kasab, Sami, Jabbour, Pascal, Kim, Joon-tae, Wolfe, Stacey Q, Rai, Ansaar, Starke, Robert M, Psychogios, Marios-Nikos, Samaniego, Edgar A, Arthur, Adam S, Yoshimura, Shinichi, Cuellar, Hugo, Howard, Brian M, Alawieh, Ali, Romano, Daniele G, Tanweer, Omar, Mascitelli, Justin, Fragata, Isabel, Polifka, Adam J, Osbun, Joshua W, Crosa, Roberto Javier, Matouk, Charles, Park, Min S, Levitt, Michael R, Moss, Mark, Dumont, Travis M, Williamson, Richard, Navia, Pedro, Kan, Peter, De Leacy, Reade, Chowdhry, Shakeel A, Ezzeldin, Mohamad, Spiotta, Alejandro M, and Brinjikji, Waleed

Abstract

BackgroundSeveral studies have established the safety and efficacy of balloon guide catheters (BGCs) for large vessel occlusions. However, the utility of BGCs remains largely unexplored for distal medium vessel occlusions (DMVOs). In this study, we aim to compare the outcomes of BGC vs. Non-BGC in patients undergoing mechanical thrombectomy (MT) for DMVO.MethodThis retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) encompassed adult patients with acute anterior cerebral artery, posterior cerebral artery, and middle cerebral artery-M2–3–4 occlusions. Procedure times, safety, recanalization, and neurological outcomes were compared between the two groups, with subgroup analysis based on first-line thrombectomy techniques.ResultsA total of 1508 patients were included, with 231 patients (15.3%) in the BGC group and 1277 patients (84.7%) in the non-BGC group. The BGC group had a lower modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2C (43.2% vs 52.7%, P=0.01), longer time from puncture to intracranial access (15 vs 8 min, P<0.01), and from puncture to final recanalization (97 vs 34 min, P<0.01). In the Solumbra subgroup, the first pass effect (FPE) rate was lower in the BGC group (17.4% vs 30.7%, P=0.03). Regarding clinical outcomes, the BGC group had a lower rate of distal embolization (8.8% vs 14.9%, P=0.03).ConclusionOur study found that use of BGC in patients with DMVO was associated with lower mTICI scores, decreased FPE rates, reduced distal embolization, and longer procedure times.

Published
2024
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32. Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry

Author

Zaidat, Osama O., Mueller-Kronast, Nils H., Hassan, Ameer E., Haussen, Diogo C., Jadhav, Ashutosh P., Froehler, Michael T., Jahan, Reza, Ali Aziz-Sultan, Mohammad, Klucznik, Richard P., Saver, Jeffrey L., Hellinger, Frank R., Jr, Yavagal, Dileep R., Yao, Tom L., Gupta, Rishi, Martin, Coleman O., Bozorgchami, Hormozd, Kaushal, Ritesh, Nogueira, Raul G., Gandhi, Ravi H., Peterson, Eric C., Dashti, Shervin, Given, Curtis A., II, Mehta, Brijesh P., Deshmukh, Vivek, Starkman, Sidney, Linfante, Italo, McPherson, Scott H., Kvamme, Peter, Grobelny, Thomas J., Hussain, Muhammad Shazam, Thacker, Ike, Vora, Nirav, Chen, Peng Roc, Monteith, Stephen J., Ecker, Robert D., Schirmer, Clemens M., Sauvageau, Eric, Chebl, Alex Bou, Derdeyn, Colin P., Maidan, Lucian, Badruddin, Aamir, Siddiqui, Adnan H., Dumont, Travis M., Alhajeri, Abdulnasser, Taqi, Muhammad A., Asi, Khaled, Carpenter, Jeffrey, Boulos, Alan, Jindal, Gaurav, Puri, Ajit S., Chitale, Rohan, Deshaies, Eric M., Robinson, David, Kallmes, David F., Baxter, Blaise W., Jumaa, Mouhammed, Sunenshine, Peter, Majjhoo, Aniel, English, Joey D., Suzuki, Shuichi, Fessler, Richard D., Delgado-Almandoz, Josser, Martin, Jerry C., and Liebeskind, David S.

Published
2019
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33. Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique.

Author

Alawieh, Ali M., Chalhoub, Reda M., Al Kasab, Sami, Jabbour, Pascal, Psychogios, Marios-Nikos, Starke, Robert M., Arthur, Adam S., Fargen, Kyle M., de De Leacy, Rea, Kan, Peter, Dumont, Travis M., Rai, Ansaar, Crosa, Roberto Javier, Maier, Ilko, Goyal, Nitin, Wolfe, Stacey Q., Cawley, C. Michael, Mocco, J., Tjoumakaris, Stavropoula I., and Howard, Brian M.

Subjects
ARTERIAL occlusions, ISCHEMIC stroke, MULTIPLE regression analysis, MULTIVARIATE analysis, RETROSPECTIVE studies, ACQUISITION of data, TREATMENT effectiveness, THROMBECTOMY, MEDICAL records, DESCRIPTIVE statistics, ODDS ratio, ENDOVASCULAR surgery, EVALUATION
Abstract

Background Endovascular thrombectomy (EVT) is the standard-of-care for proximal large vessel occlusion (LVO) stroke. Data on technical and clinical outcomes in distal vessel occlusions (DVOs) remain limited. Methods This was a retrospective study of patients undergoing EVT for stroke at 32 international centers. Patients were divided into LVOs (internal carotid artery/M1/vertebrobasilar), medium vessel occlusions (M2/A1/P1) and isolated DVOs (M3/M4/A2/A3/P2/P3) and categorized by thrombectomy technique. Primary outcome was a good functional outcome (modified Rankin Scale ≤2) at 90 days. Secondary outcomes included recanalization, procedure-time, thrombectomy attempts, hemorrhage, and mortality. Multivariate logistic regressions were used to evaluate the impact of technical variables. Propensity score matching was used to compare outcome in patients with DVO treated with aspiration versus stent retriever Results We included 7477 patients including 213 DVOs. Distal location did not independently predict good functional outcome at 90 days compared with proximal (p=0.467). In distal occlusions, successful recanalization was an independent predictor of good outcome (adjusted odds ratio (aOR) 5.11, p<0.05) irrespective of technique. Younger age, bridging therapy, and lower admission National Institutes of Health Stroke Scale (NIHSS) were also predictors of good outcome. Procedure time ≤1 hour or ≤3 thrombectomy attempts were independent predictors of good outcomes in DVOs irrespective of technique (aOR 4.5 and 2.3, respectively, p<0.05). There were no differences in outcomes in a DVO matched cohort of aspiration versus stent retriever. Rates of hemorrhage and good outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group and attempts in the stent retriever group. Conclusions Outcomes following EVT for DVO are comparable to LVO with similar results between techniques. Techniques may exhibit different futility metrics; stent retriever thrombectomy was influenced by attempts whereas aspiration was more dependent on procedure time. [ABSTRACT FROM AUTHOR]

Published
2023
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34. Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Author

Ironside, Natasha, primary, Chen, Ching-Jen, additional, Chalhoub, Reda M, additional, Kellogg, Ryan T, additional, Ding, Dale, additional, Maier, Ilko, additional, Al Kasab, Sami, additional, Jabbour, Pascal, additional, Kim, Joon-tae, additional, Wolfe, Stacey Q, additional, Rai, Ansaar, additional, Starke, Robert M, additional, Psychogios, Marios-Nikos, additional, Shaban, Amir, additional, Arthur, Adam S, additional, Yoshimura, Shinichi, additional, Grossberg, Jonathan A, additional, Alawieh, Ali, additional, Fragata, Isabel, additional, Polifka, Adam J, additional, Mascitelli, Justin R, additional, Osbun, Joshua W, additional, Matouk, Charles, additional, Levitt, Michael R, additional, Dumont, Travis M, additional, Cuellar-Saenz, Hugo H, additional, Williamson, Richard, additional, Romano, Daniele G, additional, Crosa, Roberto Javier, additional, Gory, Benjamin, additional, Mokin, Maxim, additional, Moss, Mark, additional, Limaye, Kaustubh, additional, Kan, Peter, additional, Spiotta, Alejandro M, additional, and Park, Min S, additional

Published
2023
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35. Technical and clinical outcomes in concurrent multivessel occlusions treated with mechanical thrombectomy: insights from the STAR collaboration

Author

Saad, Hassan, primary, Eshraghi, Sheila, additional, Alawieh, Ali M, additional, Akbik, Feras, additional, Cawley, C Michael, additional, Howard, Brian M, additional, Ash, Makenna, additional, Hsu, Alice, additional, Pabaney, Aqueel, additional, Maier, Ilko, additional, Al Kasab, Sami, additional, El Naamani, Kareem, additional, Jabbour, Pascal, additional, Kim, Joon-tae, additional, Wolfe, Stacey Q, additional, Rai, Ansaar, additional, Starke, Robert M, additional, Psychogios, Marios-Nikos, additional, Shaban, Amir, additional, Arthur, Adam S, additional, Yoshimura, Shinichi, additional, Fragata, Isabel, additional, Cuellar-Saenz, Hugo H, additional, Polifka, Adam J, additional, Mascitelli, Justin, additional, Osbun, Joshua W, additional, Matouk, Charles, additional, Park, Min S, additional, Levitt, Michael R, additional, Dumont, Travis M, additional, Williamson, Richard, additional, Spiotta, Alejandro M, additional, and Grossberg, Jonathan A, additional

Published
2022
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37. Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique

Author

Alawieh, Ali M, primary, Chalhoub, Reda M, additional, Al Kasab, Sami, additional, Jabbour, Pascal, additional, Psychogios, Marios-Nikos, additional, Starke, Robert M, additional, Arthur, Adam S, additional, Fargen, Kyle M, additional, De Leacy, Reade, additional, Kan, Peter, additional, Dumont, Travis M, additional, Rai, Ansaar, additional, Crosa, Roberto Javier, additional, Maier, Ilko, additional, Goyal, Nitin, additional, Wolfe, Stacey Q, additional, Cawley, C Michael, additional, Mocco, J, additional, Tjoumakaris, Stavropoula I, additional, Howard, Brian M, additional, Dimisko, Laurie, additional, Saad, Hassan, additional, Ogilvy, Christopher S, additional, Crowley, R Webster, additional, Mascitelli, Justin R, additional, Fragata, Isabel, additional, Levitt, Michael R, additional, Kim, Joon-tae, additional, Park, Min S, additional, Gory, Benjamin, additional, Polifka, Adam J, additional, Matouk, Charles, additional, Grossberg, Jonathan A, additional, and Spiotta, Alejandro M, additional

Published
2022
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38. Bridging thrombolysis in atrial fibrillation stroke is associated with increased hemorrhagic complications without improved outcomes

Author

Akbik, Feras, Alawieh, Ali, Dimisko, Laurie, Howard, Brian M., Cawley, C Michael, Tong, Frank C., Nahab, Fadi, Samuels, Owen B., Maier, Ilko, Feng, Wuwei, Goyal, Nitin, Starke, Robert M., Rai, Ansaar, Fargen, Kyle M., Psychogios, Marios N., Jabbour, Pascal, De Leacy, Reade, Keyrouz, Saleh G., Dumont, Travis M., Kan, Peter, Liman, Jan, Arthur, Adam S., Wolfe, Stacey Q., Mocco, J., Crosa, Roberto Javier, Fox, W Christopher, Gory, Benjamin, Spiotta, Alejandro M., Grossberg, Jonathan A., Akbik, Feras, Alawieh, Ali, Dimisko, Laurie, Howard, Brian M., Cawley, C Michael, Tong, Frank C., Nahab, Fadi, Samuels, Owen B., Maier, Ilko, Feng, Wuwei, Goyal, Nitin, Starke, Robert M., Rai, Ansaar, Fargen, Kyle M., Psychogios, Marios N., Jabbour, Pascal, De Leacy, Reade, Keyrouz, Saleh G., Dumont, Travis M., Kan, Peter, Liman, Jan, Arthur, Adam S., Wolfe, Stacey Q., Mocco, J., Crosa, Roberto Javier, Fox, W Christopher, Gory, Benjamin, Spiotta, Alejandro M., and Grossberg, Jonathan A.

Abstract

BACKGROUND: Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT. METHODS: This international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into four groups based on comorbid AF and IVT exposure. Baseline patient characteristics, complications, and outcomes were reported and compared. RESULTS: 6461 patients underwent MT for LVO. 2311 (35.8%) patients had comorbid AF. In non-AF patients, bridging therapy improved the odds of good 90 day functional outcomes (adjusted OR (aOR) 1.29, 95% CI 1.03 to 1.60, p=0.025) and did not increase hemorrhagic complications. In AF patients, bridging therapy led to significant increases in symptomatic intracranial hemorrhage and parenchymal hematoma type 2 (aOR 1.66, 1.07 to 2.57, p=0.024) without any benefit in 90 day functional outcomes. Similar findings were noted in a separate propensity score analysis. CONCLUSION: In this large thrombectomy registry, AF patients exposed to IVT before MT had increased hemorrhagic complications without improved functional outcomes, in contrast with non-AF patients. Prospective trials are warranted to assess whether AF patients represent a subgroup of LVO patients who may benefit from a direct to thrombectomy approach at thrombectomy capable centers.

Published
2022

40. Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry

Author

Mueller-Kronast, Nils H., Zaidat, Osama O., Froehler, Michael T., Jahan, Reza, Aziz-Sultan, Mohammad Ali, Klucznik, Richard P., Saver, Jeffrey L., Hellinger, Frank R., Jr, Yavagal, Dileep R., Yao, Tom L., Liebeskind, David S., Jadhav, Ashutosh P., Gupta, Rishi, Hassan, Ameer E., Martin, Coleman O., Bozorgchami, Hormozd, Kaushal, Ritesh, Nogueira, Raul G., Gandhi, Ravi H., Peterson, Eric C., Dashti, Shervin R., Given, Curtis A., II, Mehta, Brijesh P., Deshmukh, Vivek, Starkman, Sidney, Linfante, Italo, McPherson, Scott H., Kvamme, Peter, Grobelny, Thomas J., Hussain, Muhammad S., Thacker, Ike, Vora, Nirav, Chen, Peng Roc, Monteith, Stephen J., Ecker, Robert D., Schirmer, Clemens M., Sauvageau, Eric, Abou-Chebl, Alex, Derdeyn, Colin P., Maidan, Lucian, Badruddin, Aamir, Siddiqui, Adnan H., Dumont, Travis M., Alhajeri, Abdulnasser, Taqi, M. Asif, Asi, Khaled, Carpenter, Jeffrey, Boulos, Alan, Jindal, Gaurav, Puri, Ajit S., Chitale, Rohan, Deshaies, Eric M., Robinson, David H., Kallmes, David F., Baxter, Blaise W., Jumaa, Mouhammad A., Sunenshine, Peter, Majjhoo, Aniel, English, Joey D., Suzuki, Shuichi, Fessler, Richard D., Delgado Almandoz, Josser E., Martin, Jerry C., and Haussen, Diogo C.

Published
2017
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48. Bridging thrombolysis in atrial fibrillation stroke is associated with increased hemorrhagic complications without improved outcomes

Author

Akbik, Feras, primary, Alawieh, Ali, additional, Dimisko, Laurie, additional, Howard, Brian M, additional, Cawley, C Michael, additional, Tong, Frank C, additional, Nahab, Fadi, additional, Samuels, Owen B, additional, Maier, Ilko, additional, Feng, Wuwei, additional, Goyal, Nitin, additional, Starke, Robert M, additional, Rai, Ansaar, additional, Fargen, Kyle M, additional, Psychogios, Marios N, additional, Jabbour, Pascal, additional, De Leacy, Reade, additional, Keyrouz, Saleh G, additional, Dumont, Travis M, additional, Kan, Peter, additional, Liman, Jan, additional, Arthur, Adam S, additional, Wolfe, Stacey Q, additional, Mocco, J, additional, Crosa, Roberto Javier, additional, Fox, W Christopher, additional, Gory, Benjamin, additional, Spiotta, Alejandro M, additional, and Grossberg, Jonathan A, additional

Published
2021
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50. Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke—Insights from the STAR Collaboration

Author

Alawieh, Ali M, primary, Eid, Maya, additional, Anadani, Mohammad, additional, Sattur, Mithun, additional, Maier, Ilko L, additional, Feng, Wuwei, additional, Goyal, Nitin, additional, Starke, Robert M, additional, Rai, Ansaar, additional, Fargen, Kyle M, additional, Psychogios, Marios-Nikos, additional, De Leacy, Reade, additional, Grossberg, Jonathan A, additional, Keyrouz, Salah G, additional, Dumont, Travis M, additional, Kan, Peter, additional, Lena, Jonathan, additional, Liman, Jan, additional, Arthur, Adam S, additional, Elijovich, Lucas, additional, Mccarthy, David J, additional, Saini, Vasu, additional, Wolfe, Stacey Q, additional, Mocco, J, additional, Fifi, Johanna T, additional, Nascimento, Fábio A, additional, Giles, James A, additional, Allen, Michelle, additional, Crosa, Roberto, additional, Fox, W Christopher, additional, Gory, Benjamin, additional, and Spiotta, Alejandro M, additional

Published
2021
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