Daniel Behme1, Christoph Kabbasch2, Annika Kowoll3, Franziska Dorn2, Thomas Liebig2, Werner Weber3, Anastasios Mpotsaris4. 1. Department of Neuroradiology, University Medical Center, Georg-August-University Göttingen, Göttingen, Germany. Electronic address: daniel.behme@med.uni-goettingen.de. 2. Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany. 3. Department of Radiology and Neuroradiology, Ruhr University Bochum, Bochum, Germany. 4. Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany. Electronic address: anastasios.mpotsaris@uk-koeln.de.
Abstract
AIM: Several factors influence the outcome after acute ischemic stroke secondary to proximal occlusions of cerebral vessels. Among others, noneligibility for intravenous thrombolysis (IVT) and incomplete revascularization have been identified as predictors of unfavorable outcome. The aim of this study was to investigate whether concomitant IVT influences the revascularization efficacy in mechanical thrombectomy (MT). METHODS: This study conducted a retrospective analysis of all consecutive patients presenting with an anterior circulation stroke due to large-artery occlusion with imaging evidence who were treated with MT between July 2012 and December 2013 at 2 high-volume stroke centers. Imaging data were regraded and re-evaluated according to the modified Treatment in Cerebral Ischemia scale and its respective vessel occlusion site definitions. Clinical end points included National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale; imaging and procedural measures were technical end points. RESULTS: We identified 93 patients who presented with an occlusion of the middle cerebral artery (MCA): of these patients, 66 (71%) received IVT. We did not find statistically significant differences in the baseline NIHSS score, time from symptom onset to groin puncture, and age when comparing the IVT group with the non-IVT group. The rate of successful recanalizations (modified Treatment in Cerebral Ischemia score ≥ 2b) was significantly higher in patients with MCA occlusion and concomitant IVT (P = .01). Stepwise logistic regression identified IVT and thrombus length as predictive factors for successful mechanical recanalization (P = .004, P = .002). CONCLUSION: IVT and thrombus length are predictive factors for a successful recanalization in MT for acute ischemic stroke with underlying MCA occlusion.
AIM: Several factors influence the outcome after acute ischemic stroke secondary to proximal occlusions of cerebral vessels. Among others, noneligibility for intravenous thrombolysis (IVT) and incomplete revascularization have been identified as predictors of unfavorable outcome. The aim of this study was to investigate whether concomitant IVT influences the revascularization efficacy in mechanical thrombectomy (MT). METHODS: This study conducted a retrospective analysis of all consecutive patients presenting with an anterior circulation stroke due to large-artery occlusion with imaging evidence who were treated with MT between July 2012 and December 2013 at 2 high-volume stroke centers. Imaging data were regraded and re-evaluated according to the modified Treatment in Cerebral Ischemia scale and its respective vessel occlusion site definitions. Clinical end points included National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale; imaging and procedural measures were technical end points. RESULTS: We identified 93 patients who presented with an occlusion of the middle cerebral artery (MCA): of these patients, 66 (71%) received IVT. We did not find statistically significant differences in the baseline NIHSS score, time from symptom onset to groin puncture, and age when comparing the IVT group with the non-IVT group. The rate of successful recanalizations (modified Treatment in Cerebral Ischemia score ≥ 2b) was significantly higher in patients with MCA occlusion and concomitant IVT (P = .01). Stepwise logistic regression identified IVT and thrombus length as predictive factors for successful mechanical recanalization (P = .004, P = .002). CONCLUSION: IVT and thrombus length are predictive factors for a successful recanalization in MT for acute ischemic stroke with underlying MCA occlusion.
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Authors: Romain Bourcier; Mayank Goyal; David S Liebeskind; Keith W Muir; Hubert Desal; Adnan H Siddiqui; Diederik W J Dippel; Charles B Majoie; Wim H van Zwam; Tudor G Jovin; Elad I Levy; Peter J Mitchell; Olvert A Berkhemer; Stephen M Davis; Imad Derraz; Geoffrey A Donnan; Andrew M Demchuk; Robert J van Oostenbrugge; Michael Kelly; Yvo B Roos; Reza Jahan; Aad van der Lugt; Marieke Sprengers; Stephane Velasco; Geert J Lycklama À Nijeholt; Wagih Ben Hassen; Paul Burns; Scott Brown; Emmanuel Chabert; Timo Krings; Hana Choe; Christian Weimar; Bruce C V Campbell; Gary A Ford; Marc Ribo; Phil White; Geoffrey C Cloud; Luis San Roman; Antoni Davalos; Olivier Naggara; Michael D Hill; Serge Bracard Journal: JAMA Neurol Date: 2019-04-01 Impact factor: 18.302
Authors: Ilko L Maier; Andreas Leha; Mostafa Badr; Ibrahim Allam; Mathias Bähr; Ala Jamous; Amelie Hesse; Marios-Nikos Psychogios; Daniel Behme; Jan Liman Journal: Front Neurol Date: 2021-06-10 Impact factor: 4.003