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3. Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS): protocol of a prospective, multicentre, randomised, controlled trial.

Author

Wang, Yongjun, Wang, Yilong, Miao, Zhongrong, Sun, Xuan, Yang, Ming, Sun, Dapeng, Peng, Guangge, Deng, Yiming, Zhao, Xingquan, Liu, Liping, Ma, Ning, Gao, Feng, Mo, Dapeng, and Yu, Wengui

Subjects
Angiography, Angioplasty, Atherosclerosis, Humans, Adult, Middle Aged, Aged, Aged, 80 and over, Constriction, Pathologic, Stents, Angioplasty, Balloon, Arteries, Ischemic Stroke, Randomized Controlled Trials as Topic, Multicenter Studies as Topic
Abstract

BACKGROUND: The superiority of balloon angioplasty plus aggressive medical management (AMM) to AMM alone for symptomatic intracranial artery stenosis (sICAS) on efficacy and safety profiles still lacks evidence from randomised controlled trials (RCTs). AIM: To demonstrate the design of an RCT on balloon angioplasty plus AMM for sICAS. DESIGN: Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS) trial is a multicentre, prospective, randomised, open-label, blinded end-point trial to investigate whether balloon angioplasty plus AMM could improve clinical outcome compared with AMM alone in patients with sICAS. Patients eligible in BASIS were 35-80 years old, with a recent transient ischaemic attack within the past 90 days or ischaemic stroke between 14 days and 90 days prior to enrolment due to severe atherosclerotic stenosis (70%-99%) of a major intracranial artery. The eligible patients were randomly assigned to receive balloon angioplasty plus AMM or AMM alone at a 1:1 ratio. Both groups will receive identical AMM, including standard dual antiplatelet therapy for 90 days followed by long-term single antiplatelet therapy, intensive risk factor management and life-style modification. All participants will be followed up for 3 years. STUDY OUTCOMES: Stroke or death in the next 30 days after enrolment or after balloon angioplasty procedure of the qualifying lesion during follow-up, or any ischaemic stroke or revascularisation from the qualifying artery after 30 days but before 12 months of enrolment, is the primary outcome. DISCUSSION: BASIS trail is the first RCT to compare the efficacy and safety of balloon angioplasty plus AMM to AMM alone in sICAS patients, which may provide an alternative perspective for treating sICAS. TRIAL REGISTRATION NUMBER: NCT03703635; https://www. CLINICALTRIALS: gov.

Published
2024

7. Perceived acceptable uncertainty regarding comparability of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment

Author

Kaesmacher, Johannes, Mujanovic, Adnan, Treurniet, Kilian, Kappelhof, Manon, Meinel, Thomas R, Yang, Pengfei, Liu, Jianmin, Zhang, Yongwei, Zi, Wenjie, Yang, Qingwu, Nogueira, Raul G, Kimura, Kazumi, Matsumaru, Yuji, Suzuki, Kentaro, Yan, Bernard, Mitchell, Peter J, Miao, Zhongrong, Roos, Yvo BWEM, Majoie, Charles BLM, Gralla, Jan, Saver, Jeffrey L, and Fischer, Urs

Subjects
Clinical Trials and Supportive Activities, Clinical Research, Humans, Brain Ischemia, Endovascular Procedures, Fibrinolytic Agents, Stroke, Thrombectomy, Thrombolytic Therapy, Treatment Outcome, Uncertainty, thrombectomy, thrombolysis, stroke
Abstract

BackgroundMost trials comparing endovascular treatment (EVT) alone versus intravenous thrombolysis with alteplase (IVT) + EVT in directly admitted patients with a stroke are non-inferiority trials. However, the margin based on the level of uncertainty regarding non-inferiority of the experimental treatment that clinicians are willing to accept to incorporate EVT alone into clinical practice remains unknown.ObjectiveTo characterize what experienced stroke clinicians would consider an acceptable level of uncertainty for hypothetical decisions on whether to administer IVT or not before EVT in patients admitted directly to EVT-capable centers.MethodsA web-based, structured survey was distributed to a cross-section of 600 academic neurologists/neurointerventionalists. For this purpose, a response framework for a hypothetical trial comparing IVT+EVT (standard of care) with EVT alone (experimental arm) was designed. In this trial, a similar proportion of patients in each arm achieved functional independence at 90 days. Invited physicians were asked at what level of certainty they would feel comfortable skipping IVT in clinical practice, considering these hypothetical trial results.ResultsThere were 180 respondents (response rate: 30%) and 165 with complete answers. The median chosen acceptable uncertainty suggesting reasonable comparability between both treatments was an absolute difference in the rate of day 90 functional independence of 3% (mode 5%, IQR 1-5%), with higher chosen margins observed in interventionalists (aOR 2.20, 95% CI 1.06 to 4.67).ConclusionPhysicians would generally feel comfortable skipping IVT before EVT at different certainty thresholds. Most physicians would treat with EVT alone if randomized trial data suggested that the number of patients achieving functional independence at 90 days was similar between the two groups, and one could be sufficiently sure that no more than 3 out of 100 patients would not achieve functional independence at 90 days due to skipping IVT.

Published
2023

9. Bailout intracranial angioplasty or stenting following thrombectomy for acute large vessel occlusion in China (ANGEL-REBOOT): a multicentre, open-label, blinded-endpoint, randomised controlled trial

Author

Gao, Feng, Tong, Xu, Jia, Baixue, Wei, Ming, Pan, Yuesong, Yang, Ming, Sun, Dapeng, Nguyen, Thanh N, Ren, Zeguang, Demiraj, Francis, Yao, Xiaoxi, Xu, Chenghua, Yuan, Guangxiong, Wan, Yue, Tang, Jianjun, Wang, Jing, Jiang, Yuanfei, Wang, Chaobin, Luo, Xiang, Yang, Haihua, Shen, Ruile, Wu, Zhilin, Yuan, Zhengzhou, Wan, Dongjun, Hu, Wei, Liu, Yan, Jing, Ping, Wei, Liping, Zheng, Tuanyuan, Wu, Yingchun, Yang, Xinguang, Sun, Yaxuan, Wen, Changming, Chang, Mingze, Yin, Bo, Li, Di, Duan, Jixin, Sun, Dianjing, Guo, Zaiyu, Xu, Guodong, Wang, Guoqing, Wang, Liyu, Wang, Yang, Jia, Weihua, Ma, Gaoting, Huo, Xiaochuan, Mo, Dapeng, Ma, Ning, Liu, Liping, Zhao, Xingquan, Wang, Yilong, Fiehler, Jens, Wang, Yongjun, and Miao, Zhongrong

Published
2024
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10. Specialist Perspectives on the Imaging Selection of Large Vessel Occlusion in the Late Window

Author

Klein, Piers, Huo, Xiaochuan, Chen, Yimin, Abdalkader, Mohamad, Qiu, Zhongming, Nagel, Simon, Raymond, Jean, Liu, Liping, Siegler, James E., Strbian, Daniel, Field, Thalia S., Yaghi, Shadi, Qureshi, Muhammad M., Demeestere, Jelle, Puetz, Volker, Berberich, Anne, Michel, Patrik, Fischer, Urs, Kaesmacher, Johannes, Yamagami, Hiroshi, Alemseged, Fana, Tsivgoulis, Georgios, Schonewille, Wouter J., Hu, Wei, Liu, Xinfeng, Li, Chuanhui, Ji, Xunming, Drumm, Brian, Banerjee, Soma, Sacco, Simona, Sandset, Else C., Kristoffersen, Espen Saxhaug, Slade, Peter, Mikulik, Robert, Romoli, Michele, Diana, Francesco, Krishnan, Kailash, Dhillon, Permesh, Lee, Jin Soo, Kasper, Ekkehard, Dasenbrock, Hormuzdiyar, Ton, Mai Duy, Masiliūnas, Rytis, Arsovska, Anita Ante, Marto, João Pedro, Dmytriw, Adam A., Regenhardt, Robert W., Silva, Gisele Sampaio, Siepmann, Timo, Sun, Dapeng, Sang, Hongfei, Diestro, Jose Danilo, Yang, Pengfei, Mohammaden, Mahmoud H., Li, Fengli, Masoud, Hesham E., Ma, Alice, Raynald, Ganesh, Aravind, Liu, Jianmin, Meyer, Lukas, Dippel, Diederik W. J., Thomalla, Götz, Parsons, Mark, Qureshi, Adnan I., Goyal, Mayank, Yoo, Albert J., Lapergue, Bertrand, Zaidat, Osama O., Chen, Hui-Sheng, Campbell, Bruce C. V., Jovin, Tudor G., Nogueira, Raul G., Miao, Zhongrong, Saposnik, Gustavo, and Nguyen, Thanh N.

Published
2023
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11. Endovascular therapy in acute ischaemic stroke with large infarction with matched or mismatched clinical-radiological severities: a post-hoc analysis of the ANGEL-ASPECT trial

Author

Wang, Yongjun, Wang, Yilong, Liu, Liping, Liebeskind, David S., Miao, Zhongrong, Ren, Zeguang, Pereira, Vitor Mendes, Ji, Xunming, Dong, Qiang, Xu, Anding, Liu, Xinfeng, Yang, Qingwu, Jing (Chair), Jing, Zhang, Zhe, Zhang, Yingkui, Wu, Wei, Sun, Dapeng, Qi, Zhongqi, Li, Shuo, Liu, Zhenqiang, Yu, Zequan, Zhang, Jingyu, Chen, Fangguang, Li, Kangyue, Zhang, Kai, Hu, Mingkai, Liu (Chair), Jianmin, Yao, Chen, Chen, Kangning, Fang (Chair), Kun, Song, Bo, Dong, Yi, Huo, Xiaochuan, Ma, Gaoting, Yuan, Guangxiong, Han, Hongxing, Chen, Wenhuo, Wei, Ming, Zhang, Jiangang, Zhou, Zhiming, Yao, Xiaoxi, Wang, Guoqing, Song, Weigen, Cai, Xueli, Nan, Guangxian, Li, Di, Wang, Yizhou, Ling, Wentong, Cai, Chuwei, Wen, Changming, Wang, En, Zhang, Liyong, Jiang, Changchun, Liu, Yajie, Liao, Geng, Chen, Xiaohui, Li, Tianxiao, Liu, Shudong, Li, Jinglun, Sun, Yaxuan, Xu, Na, Gao, Zong’en, Ju, Dongsheng, Song, Cunfeng, Xuan, Jinggang, Zhou, Feng, Shi, Qing, Luo, Jun, Liu, Yan, Guo, Zaiyu, Li, Tong, Zheng, Hongbo, Dai, Linzhi, Zhao, Junfeng, Gui, Liqiang, Geng, Xiaokun, Tang, Yufeng, Yin, Congguo, Yang, Hua, An, Ruiyang, Sun, Yuying, Wu, Yanan, Yu, Chunlai, Zheng, Shuangcheng, Pan, Yuesong, Jin, Aoming, Xiang, Xianglong, Wang, Mengxing, Yan, Hongyi, He, Yuanling, Li, Chunyang, Kong, Weixia, Chen, Yuhuan, Guo, Chenhao, Ji, Fengjie, Ji, Pengshan, Liu, Lei, Lu, Xinghua, Luo, Guangkuo, Wang, Nanjing, Zhang, Yu, Liu, Bo, Yang, Jian, Deng, Jingjing, Wang, Juan, Wang, Wanru, Yu, Hang, Cui, Le, Liu, Wenwen, Wang, Ziyong, Zhao, Xia, Zhou, Zhou, Yi-Chou Wang, Alvin, Zheng, Lina, Nie, Ximing, Liu, Xin, Duan, Wanying, Liu, Jingyi, Wei, Yufei, Wen, Miao, Yang, Zhonghua, Leung, Thomas W., Nguyen, Thanh N., and Leng, Xinyi

Published
2024
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13. Thrombus magnetic susceptibility is associated with recanalization and clinical outcome in patients with ischemic stroke

Author

Chen, Jie, Zhang, Zhe, Nie, Ximing, Xu, Yuyuan, Liu, Chunlei, Zhao, Xingquan, Miao, Zhongrong, Wang, Yongjun, and Liu, Liping

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Stroke, Clinical Research, Neurosciences, Brain Disorders, Biomedical Imaging, Hematology, Cardiovascular, Humans, Ischemic Stroke, Treatment Outcome, Thrombectomy, Thrombosis, Brain Ischemia, Retrospective Studies, Quantitative susceptibility mapping, Endovascular treatment, Thrombus, Susceptibility vessel sign, Biological psychology, Clinical and health psychology
Abstract

In acute ischemic stroke patients with large vessel occlusion, the characteristics of the occluding thrombus on neuroimaging may be associated with recanalization after endovascular thrombectomy (EVT); however, the relationship between magnetic susceptibility of thrombus and clinical outcome remains unclear. We utilized quantitative susceptibility mapping (QSM) MRI to assess the magnetic susceptibility of thrombus in acute ischemic stroke patients undergoing EVT, and to evaluate its relationship with recanalization and functional outcomes. Patients with documented intracranial artery occlusion were consecutively recruited from one research center of the RESCUE-RE study (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization). All the recruited patients underwent a 3D multi-echo MRI scan on a 3.0 T scanner for both susceptibility-weighted imaging (SWI) and QSM quantification of the thrombus. Among 61 patients included in the analyses, 51 (75.0 %) patients achieved thrombolysis in cerebral infarction (TICI) 2b/3 and 22 (36.1 %) patients had favorable functional outcomes. Successful recanalization was significantly associated with a higher thrombus magnetic susceptibility mean value (0.27 ± 0.09 vs 0.20 ± 0.09 ppm, p = 0.020) and lower coefficient of variation (0.42 ± 0.12 vs 0.52 ± 0.19, p = 0.024). ROC curve analysis showed the optimal cutoff value for thrombus susceptibility for predicting good clinical outcomes was 0.25 ppm (sensitivity 86.4 %, specificity 69.2 %). In multivariable logistic regression analyses, increased thrombus magnetic susceptibility was independently and significantly associated with good functional outcomes (adjusted odds ratio 15.11 [95 % confidence interval 2.64-86.46], p = 0.002). This study demonstrated that the increased thrombus magnetic susceptibility is associated with successful recanalization and favorable functional outcomes for intracranial artery occluded stroke patients.

Published
2022

20. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials

Author

Zi, Wenjie, Nogueira, Raul, Yang, Qingwu, Liu, Jianmin, Yang, Pengfei, Zhang, Yongwei, Yan, Bernard, Mitchell, Peter, Miao, Zhong Rong, Majoie, Charles B., Roos, Yvo B., Suzuki, Kentaro, Kimura, Kazumi, Matsumaru, Yuji, Fischer, Urs, Gralla, Jan, Cavalcante, Fabiano W., Kappelhof, Manon, Treurniet, Kilian M., Kaesmacher, Johannes, Zhang, Lei, Bush, Steven, Nieboer, Daan, Lingsma, Hester F., Rothwell, Peter, Saver, Jeffrey, Fiehler, Jens, Li, Fengli, Huang, Jiacheng, Song, Jiaxing, Hong, Bo, Chen, Wenhuo, Peng, Ya, Han, Hongxing, Zhang, Liyong, Li, Zifu, Xing, Pengfei, Shen, Hongjian, Zhang, Ping, Zhang, Xiaoxi, Davis, Stephen, Nguyen, Huy-Thang, Donnan, Geoffrey, Huo, Xiaochuan, Nan, Guangxian, Bivard, Andrew, Ma, Henry, Vu, Dang Lu, Campbell, Bruce, Rinkel, Leon A., Emmer, Bart J., Coutinho, Jonathan M., LeCouffe, Natalie E., Dippel, Diederik W., van der Lugt, Aad, van Zwam, Wim H., van Oostenbrugge, Robert J., Uyttenboogaart, Maarten, Costalat, Vincent, Lycklama, Geert, Hofmeijer, Jeannette, van Norden, Anouk, Otsuka, Toshiaki, Takeuchi, Masataka, Morimoto, Masafumi, Kanazawa, Ryuzaburo, Takayama, Yohei, Kamiya, Yuki, Shigeta, Keigo, Okubo, Seiji, Hayakawa, Mikito, Strbian, Daniel, Eker, Omer, Cognard, Christophe, Meinel, Thomas, Dobrocky, Tomas, Jung, Simon, Piechowiak, Eike, Marnat, Gaultier, Sibon, Igor, Bourcier, Romain, de Gaalon, Solene, Papagiannaki, Chrysanthi, Lefebvre, Margaux, Majoie, Charles B, Cavalcante, Fabiano, Treurniet, Kilian M, Miao, Zhongrong, Rinkel, Leon A, Wang, Shouchun, Coutinho, Jonathan M, Emmer, Bart J, LeCouffe, Natalie E, Lingsma, Hester F, Nogueira, Raul G, and Roos, Yvo B

Published
2023
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26. Choice of ANesthesia for EndoVAScular Treatment of Acute Ischemic Stroke (CANVAS): Results of the CANVAS Pilot Randomized Controlled Trial

Author

Sun, Jian, Liang, Fa, Wu, Youxuan, Zhao, Yan, Miao, Zhongrong, Zhang, Li, Gelb, Adrian W, Chan, Matthew TV, Peng, Yuming, and Han, Ruquan

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Clinical Trials and Supportive Activities, Rehabilitation, Stroke, Clinical Research, Brain Disorders, Aged, Anesthesia, Anesthesia, General, Brain Ischemia, Conscious Sedation, Endovascular Procedures, Female, Humans, Male, Middle Aged, Pilot Projects, Recovery of Function, Reperfusion, Treatment Outcome, anesthesia, acute ischemic stroke, endovascular treatment, CANVAS Pilot Trial Investigators, Psychology, Anesthesiology, Clinical sciences
Abstract

BackgroundThe effect of choice of anesthesia on clinical outcome for endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) remains unclear.MethodsWe conducted a pilot trial of 43 patients with acute anterior circulation ischemic stroke having EVT. Patients were randomly allocated to receive general anesthesia or conscious sedation. We documented the rate of recruitment and rate of conversion from conscious sedation to general anesthesia. In addition, we recorded the change in National Institute of Health stroke scale (NIHSS) on day 7, the rate of successful reperfusion and measured neurological function by certified researchers using modified Rankin Score (mRS 0 to 2) at 90 days.ResultsThe recruitment rate was 31.4% and majority of patients were excluded because of delay in hospital presentation and posterior circulation stroke. The rate of conversion from conscious sedation to general anesthesia was 18.2%. This was primarily related to excessive sedation and uncontrolled movement. Change in NIHSS score, rate of successful reperfusion and functional recovery were similar between groups.ConclusionsIt was feasible to randomize AIS patients receiving either general anesthesia or conscious sedation for EVT.

Published
2020

31. Semi-automatic computed tomography angiography quantification assessment is an alternative method to digital subtraction angiography in intracranial stenosis: a multicenter study

Author

Yan, Long, primary, Yu, Ying, additional, Yang, Bo, additional, Fu, Weilun, additional, Zhang, Zhe, additional, Jia, Baixue, additional, Lyu, Jinhao, additional, Hou, Zhikai, additional, Jiang, Changchun, additional, Xu, Ziqi, additional, Sun, Dong, additional, Xu, Peng, additional, Li, Yingyi, additional, Gu, Weibin, additional, Ma, Guofeng, additional, Wang, Yongjun, additional, Miao, Zhongrong, additional, Lou, Xin, additional, and Ma, Ning, additional

Published
2024
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32. Endovascular therapy in acute ischaemic stroke with large infarction with matched or mismatched clinical-radiological severities: a post-hoc analysis of the ANGEL-ASPECT trial

Author

Zheng, Lina, primary, Nie, Ximing, additional, Wang, Mengxing, additional, Liu, Xin, additional, Duan, Wanying, additional, Zhang, Zhe, additional, Liu, Jingyi, additional, Wei, Yufei, additional, Wen, Miao, additional, Yang, Zhonghua, additional, Leung, Thomas W., additional, Ma, Gaoting, additional, Huo, Xiaochuan, additional, Pan, Yuesong, additional, Nguyen, Thanh N., additional, Leng, Xinyi, additional, Miao, Zhongrong, additional, Liu, Liping, additional, Wang, Yongjun, additional, Wang, Yilong, additional, Liebeskind, David S., additional, Ren, Zeguang, additional, Pereira, Vitor Mendes, additional, Ji, Xunming, additional, Dong, Qiang, additional, Xu, Anding, additional, Liu, Xinfeng, additional, Yang, Qingwu, additional, Jing (Chair), Jing, additional, Zhang, Yingkui, additional, Wu, Wei, additional, Sun, Dapeng, additional, Qi, Zhongqi, additional, Li, Shuo, additional, Liu, Zhenqiang, additional, Yu, Zequan, additional, Zhang, Jingyu, additional, Chen, Fangguang, additional, Li, Kangyue, additional, Zhang, Kai, additional, Hu, Mingkai, additional, Liu (Chair), Jianmin, additional, Yao, Chen, additional, Chen, Kangning, additional, Fang (Chair), Kun, additional, Song, Bo, additional, Dong, Yi, additional, Yuan, Guangxiong, additional, Han, Hongxing, additional, Chen, Wenhuo, additional, Wei, Ming, additional, Zhang, Jiangang, additional, Zhou, Zhiming, additional, Yao, Xiaoxi, additional, Wang, Guoqing, additional, Song, Weigen, additional, Cai, Xueli, additional, Nan, Guangxian, additional, Li, Di, additional, Wang, Yizhou, additional, Ling, Wentong, additional, Cai, Chuwei, additional, Wen, Changming, additional, Wang, En, additional, Zhang, Liyong, additional, Jiang, Changchun, additional, Liu, Yajie, additional, Liao, Geng, additional, Chen, Xiaohui, additional, Li, Tianxiao, additional, Liu, Shudong, additional, Li, Jinglun, additional, Sun, Yaxuan, additional, Xu, Na, additional, Gao, Zong’en, additional, Ju, Dongsheng, additional, Song, Cunfeng, additional, Xuan, Jinggang, additional, Zhou, Feng, additional, Shi, Qing, additional, Luo, Jun, additional, Liu, Yan, additional, Guo, Zaiyu, additional, Li, Tong, additional, Zheng, Hongbo, additional, Dai, Linzhi, additional, Zhao, Junfeng, additional, Gui, Liqiang, additional, Geng, Xiaokun, additional, Tang, Yufeng, additional, Yin, Congguo, additional, Yang, Hua, additional, An, Ruiyang, additional, Sun, Yuying, additional, Wu, Yanan, additional, Yu, Chunlai, additional, Zheng, Shuangcheng, additional, Jin, Aoming, additional, Xiang, Xianglong, additional, Yan, Hongyi, additional, He, Yuanling, additional, Li, Chunyang, additional, Kong, Weixia, additional, Chen, Yuhuan, additional, Guo, Chenhao, additional, Ji, Fengjie, additional, Ji, Pengshan, additional, Liu, Lei, additional, Lu, Xinghua, additional, Luo, Guangkuo, additional, Wang, Nanjing, additional, Zhang, Yu, additional, Liu, Bo, additional, Yang, Jian, additional, Deng, Jingjing, additional, Wang, Juan, additional, Wang, Wanru, additional, Yu, Hang, additional, Cui, Le, additional, Liu, Wenwen, additional, Wang, Ziyong, additional, Zhao, Xia, additional, Zhou, Zhou, additional, and Yi-Chou Wang, Alvin, additional

Published
2024
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33. Effectiveness and safety of bridging therapy and endovascular therapy in patients with large cerebral infarctions: from ANGEL-ASPECT

Author

Yuan, Guangxiong, primary, Zhang, Jun, additional, Ye, Zekang, additional, Sun, Jingping, additional, Huo, Xiaochuan, additional, Pan, Yuesong, additional, Wang, Mengxing, additional, Peng, Xiao, additional, Zheng, Chanjuan, additional, Lei, Xueyao, additional, Miao, Zhongrong, additional, and Cai, Xueli, additional

Published
2024
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34. Perceptions on basilar artery occlusion management in China versus other countries: Analysis of the after the BEST of BASICS (ABBA) survey

Author

Huo, Xiaochuan, Klein, Piers, Raynald, Drumm, Brian, Chen, Yimin, Qureshi, Muhammad M., Schonewille, Wouter J., Liu, Xinfeng, Hu, Wei, Ji, Xunming, Li, Chuanhui, Zhu, Yuyou, Abdalkader, Mohamad, Strbian, Daniel, Fischer, Urs, Puetz, Volker, Alemseged, Fana, Yamagami, Hiroshi, Sacco, Simona, Saposnik, Gustavo, Michel, Patrik, Kristoffersen, Espen Saxhaug, Sedova, Petra, Mikulik, Robert, Siegler, James E., Lobotesis, Kyriakos, Roi, Dylan, Demeestere, Jelle, Han, Hongxin, Yuan, Guangxiong, Ton, Mai Duy, Chen, Hui-Sheng, Yang, Qingwu, Qiu, Zhongming, Martins, Sheila O., Tsivgoulis, Georgios, Thomalla, Götz, Nagel, Simon, Campbell, Bruce C.V., Jovin, Tudor G., Nogueira, Raul G., Raymond, Jean, Banerjee, Soma, Nguyen, Thanh N., and Miao, Zhongrong

Published
2022
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40. No-reflow phenomenon after revascularization in acute ischemic stroke: Achilles' heel of the neurointerventionalist?

Author

CHEN Kangning and MIAO Zhongrong

Subjects
ischemic stroke, endovascular reperfusion therapies, no-reflow phenomenon, neurological function, prognosis, Medicine (General), R5-920
Abstract

In 2015, several clinical trials demonstrated the efficacy of endovascular reperfusion therapies (EVT) in stroke patients with large vessel occlusion, which had changed stroke treatment guidelines and clinical practice all over the world. However, despite substantial recanalization, about half of the patients obtain a poor functional outcome at 3 months after endovascular treatment. The difference between the high recanalization rate of cerebral vessels and the low recovery rate of good clinical function has become a pain for neurointerventionalists! Alberta stroke program early CT score (ASPECTS), direct arrival, previous thrombolysis, time from onset to recanalization < 6 h, and recanalization status, etc. are certainly the reasons for this outcome. But we may have overlooked an important issue, that recanalization of blood vessels does not mean reperfusion of tissues. The phenomenon of poor tissue perfusion after recanalization is called no-reflow phenomenon (NRP). Coronary NRP has become an important predictor of clinical prognosis for acute coronary occlusion after percutaneous coronary intervention (PCI). In the past nearly half century, interventional cardiologists have done a lot of researches on the pathogenesis, diagnosis and treatment of NRP, which effectively improve the clinical efficacy of coronary PCI. When neurointerventionalists are actively carrying out endovascular treatment for acute ischemic stroke, should they actively pay more attention to NRP?

Published
2022
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45. The impact of intraarterial, intravenous, and combined tirofiban on endovascular treatment for acute intracranial atherosclerotic occlusion

Author

Bu, Zhiping, primary, Sun, Dapeng, additional, Ma, Gaoting, additional, Jia, Baixue, additional, Tong, Xu, additional, Huo, Xiaochuan, additional, Wang, Anxin, additional, Ma, Ning, additional, Gao, Feng, additional, Mo, Dapeng, additional, Song, Ligang, additional, Sun, Xuan, additional, Deng, Yiming, additional, Li, Xiaoqing, additional, Wang, Bo, additional, Luo, Gang, additional, Su, Deguo, additional, and Miao, Zhongrong, additional

Published
2024
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50. Endovascular management of acute stroke

Author

Nguyen, Thanh N, Abdalkader, Mohamad, Fischer, Urs, Qiu, Zhongming, Nagel, Simon, Chen, Hui-Sheng, Miao, Zhongrong, and Khatri, Pooja

Abstract

Stroke related to large vessel occlusion is a leading cause of disability and death worldwide. Advances in endovascular therapy to reopen occluded arteries have been shown to reduce patient disability and mortality. Expanded indications to treat patients with large vessel occlusion in the late window (>6 h from symptom onset), with basilar artery occlusion, and with large ischaemic core at presentation have enabled treatment of more patients with simplified imaging methods. Ongoing knowledge gaps include an understanding of which patients with large ischaemic infarct are more likely to benefit from endovascular therapy, the role of endovascular therapy in patients who present with low National Institutes of Health Stroke Scale scores or medium or distal vessel occlusion, and optimal management of patients with underlying intracranial atherosclerotic disease. As reperfusion can now be facilitated by intravenous thrombolysis, mechanical thrombectomy, or both, the development of cytoprotective or adjunctive drugs to slow infarct growth, enhance reperfusion, or decrease haemorrhagic risk has gained renewed interest with the hope to improve patient outcomes.

Published
2024
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