Journal of NeuroInterventional Surgery最新文献

{"title":"Comparative analysis of single plane and biplane angiography systems for mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis.","authors":"Atakan Orscelik, Cem Bilgin, Jonathan Cortese, Joshua J Cayme, Sara Zandpazandi, Yigit Can Senol, Basel Musmar, Sherief Ghozy, Esref Alperen Bayraktar, Zahra Beizavi, Waleed Brinjikji, David F Kallmes","doi":"10.1136/jnis-2024-022381","DOIUrl":"https://doi.org/10.1136/jnis-2024-022381","url":null,"abstract":"<p><strong>Background: </strong>The choice of angiography system could influence the outcomes of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS), but its impact is not yet well understood. This study aims to compare the clinical and technical outcomes of MT performed with single plane versus biplane angiography systems.</p><p><strong>Method: </strong>We conducted a systematic review and meta-analysis, following PRISMA guidelines, by searching PubMed, Embase, Web of Science, and Scopus to include studies on patients with AIS who underwent MT with either single plane or biplane angiography up to May 4, 2024. The primary outcome was a favorable outcome defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days after the procedure. Data were analyzed using a random-effects model and heterogeneity was assessed using the I² test and Q statistics.</p><p><strong>Results: </strong>Five studies with a total of 1562 patients were analyzed. Of these, 68.4% were treated with biplane systems and 31.6% with single plane systems. Single plane angiography was associated with a significantly higher rate of favorable outcomes (OR 1.43; 95% CI 1.13 to 1.80; P<0.01). There were no significant differences in successful recanalization, periprocedural complications, procedure time, total fluoroscopy time, or contrast volume between the two systems.</p><p><strong>Conclusion: </strong>While single plane angiography systems may offer slightly better outcomes in MT for AIS, both systems appear equally effective in most clinical and technical perspectives, suggesting that system selection may be more dependent on availability and procedural requirements rather than inherent superiority. Our findings may encourage clinicians to use single-plane angiography in settings where the biplane angiography suite availability is limited, but it should be noted that this observation may have been influenced by selection bias, particularly since the larger studies included in our meta-analysis did not observe this effect in adjusted analyses for potential confounder factors.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-high resolution CT angiography for the assessment of intracranial stents and flow diverters using photon counting detector CT.","authors":"Riccardo Ludovichetti, Dunja Gorup, Mikos Krepuska, Sebastian Winklhofer, Patrick Thurner, Jawid Madjidyar, Thomas Flohr, Marco Piccirelli, Lars Michels, Hatem Alkadhi, Victor Mergen, Zsolt Kulcsar, Tilman Schubert","doi":"10.1136/jnis-2024-022041","DOIUrl":"https://doi.org/10.1136/jnis-2024-022041","url":null,"abstract":"<p><strong>Background: </strong>The patency of intracranial stents may not be reliably assessed with either CT angiography or MR angiography due to imaging artifacts. We investigated the potential of ultra-high resolution CT angiography using a photon counting detector (PCD) CT to address this limitation by optimizing scanning and reconstruction parameters.</p><p><strong>Methods: </strong>A phantom with different flow diverters was used to optimize PCD-CT reconstruction parameters, followed by imaging of 14 patients with intracranial stents using PCD-CT. Images were reconstructed using three kernels based on the phantom results (Hv56, Hv64, and Hv72; Hv=head vascular) and one kernel to virtually match the resolution of standard CT angiography (Hv40). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements were calculated. Subjective image quality and diagnostic confidence (DC) were assessed using a five point visual grading scale (5=best, 1=worst) and a three point grading scale (1=best, 3=worst), respectively, by two independent neuroradiologists.</p><p><strong>Results: </strong>Phantom images demonstrated the highest image quality across dose levels for 0.2 mm reconstructions with Hv56 (4.5), Hv64 (5), and Hv72 (5). In patient images, SNR and CNR decreased significantly with increasing kernel sharpness compared with control parameters. All reconstructions showed significantly higher image quality and DC compared with the control reconstruction with Hv40 kernel (P<0.001), with both image quality and DC being highest with Hv64 (0.2 mm) and Hv72 (0.2 mm) reconstructions.</p><p><strong>Conclusion: </strong>Ultra-high resolution PDC-CT angiography provides excellent visualization of intracranial stents, with optimal reconstructions using the Hv64 and the Hv72 kernels at 0.2 mm.</p><p><strong>Registration: </strong>BASEC 2021-00343.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transumbilical access for neonatal vein of Galen malformation and pial arteriovenous fistula embolization.","authors":"Maximilian Jeremy Bazil, Johanna T Fifi, Alejandro Berenstein, Tomoyoshi Shigematsu","doi":"10.1136/jnis-2024-021921","DOIUrl":"https://doi.org/10.1136/jnis-2024-021921","url":null,"abstract":"<p><strong>Background: </strong>In the neonatal period, transfemoral access may be complicated by sheath size needed for embolization, especially if retreatment is required. A viable alternative is access through an umbilical artery (UA) which allows for preservation of the femoral artery for access in future intervention.</p><p><strong>Methods: </strong>We conducted a retrospective study from January 2014 to March 2023, focusing on 19 vein of Galen malformation, dural arteriovenous (AV) fistula, and pial AV fistula cases treated via transumbilical (TU) access for endovascular embolization in neonates.</p><p><strong>Results: </strong>TU access was achieved successfully in 20 out of 21 intended cases, with a 4 French sheath placed intraprocedurally in all instances. We observed a median retreatment time of 7 months for patients requiring subsequent femoral artery access, highlighting the importance of preserving femoral access for future interventions. There were no complications associated with TU access or sheath retention and no procedural mortality attributed to this approach. Despite intraprocedural and periprocedural complications of other etiologies (including post-procedural hemorrhages and fever requiring antibiotic treatment), the TU approach demonstrated overall safety and efficacy.</p><p><strong>Conclusions: </strong>Our findings align with previous reports of TU access in vascular malformations, emphasizing its role as a vital technique in neonatal neurointervention. The TU approach offers advantages such as sparing femoral arteries for future treatments and potential applicability to other high-flow brain fistulas. Our study contributes to the growing body of evidence supporting the use of TU access in neonatal neuroendovascular interventions, underscoring its importance in managing complex vascular malformations in this vulnerable population.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial doppler (TCD) in predicting outcomes following successful mechanical thrombectomy of large vessel occlusions in anterior circulation: a systematic review and meta-analysis.","authors":"Seyed Behnam Jazayeri, Behnam Sabayan, Yasaman Pirahanchi, Vikas Ravi, Julián Carrión-Penagos, Jeffrey Bowers, Royya Modir, Kunal Agrawal, Thomas Hemmen, Brett C Meyer, Dawn Meyer, Reza Bavarsad Shahripour","doi":"10.1136/jnis-2024-022457","DOIUrl":"https://doi.org/10.1136/jnis-2024-022457","url":null,"abstract":"<p><strong>Background: </strong>Transcranial Doppler (TCD) is a non-invasive, bedside tool that allows for real-time monitoring of the patient's hemodynamic status following mechanical thrombectomy (MT). This systematic review and meta-analysis aims to evaluate the predictive value of TCD parameters following successful MT (Thrombolysis in Cerebral Infarction 2b-3).</p><p><strong>Methods: </strong>In July 2024, we searched PubMed, Embase, and Scopus, to identify observational studies in which TCD parameters were measured within 48 hours of MT. Using random-effects models, we compared four TCD parameters (mean flow velocity (MFV), MFV index, pulsatility index (PI), and peak systolic velocity (PSV) among groups with vs without hemorrhagic transformation (HT) and favorable vs poor functional recovery (modified Rankin Scale 0-2 vs 3-6).</p><p><strong>Results: </strong>Eleven studies comprising 1432 patients (59% male; mean age range: 63-73 years) were included. The MFV and MFV index were higher in patients with HT (Hedges' g=0.42 and 0.54, P=0.015 and 0.005, respectively). Patients with MFV index ≥1.3 showed a higher risk of all HT (RR 1.97; 95% confidence interval (CI) 1.28 to 3.03, P=0.002), symptomatic HT (RR 4.68; 95% CI 1.49 to 14.65, P=0.008), and poor functional status at 90 days (RR 1.65; 95% CI 1.27 to 2.14, P=0.029), respectively. There was no difference in mean PSV (P=0.1) and PI (P=0.3) among groups with and without HT.</p><p><strong>Conclusion: </strong>This study underscores the prognostic value of the MFV index in predicting HT, symptomatic HT, and poor functional recovery after successful MT in the anterior circulation. Large-scale, multi-center studies are necessary to confirm these findings and to validate the MFV index as a reliable predictor for improving post-thrombectomy care.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National trends in catheter angiography and cerebrovascular imaging in a group of privately insured patients in the US.","authors":"Francis Jareczek, Kyle Tuohy, Edeanya Agbese, Ephraim Church, Kevin Cockroft, Scott Simon, Douglas L Leslie, D Andrew Wilkinson","doi":"10.1136/jnis-2024-022296","DOIUrl":"https://doi.org/10.1136/jnis-2024-022296","url":null,"abstract":"<p><strong>Background: </strong>Despite the increasing use of non-invasive imaging, DSA remains the gold standard for cerebrovascular imaging. However, trends in DSA utilization are poorly understood. The goal of this study was to describe DSA utilization in a large claims database in the US over a 13 year period.</p><p><strong>Methods: </strong>This retrospective cohort study assessed a nationwide database of privately insured individuals from 2005 to 2018 for patients undergoing cranial CT angiography (CTA), MR angiography (MRA), and DSA. We assessed trends in the overall use of and indications for each modality. For DSA, we examined the types of performing proceduralists.</p><p><strong>Results: </strong>Among patients undergoing DSA in 2018, median age was 52 years, and 60% were women. MRA and DSA use decreased, from 289 to 275 claims, and from 38 to 29 claims per 100 000 enrollees, respectively, while CTA use increased from 31 to 286 claims per 100 000 enrollees. These trends differed by geographic region and indication. Nearly half of DSA procedures but <25% of non-invasive imaging were inpatient studies. DSA performed by neurosurgeons increased from 0.5 to 4.1 while those performed by radiologists decreased from 7.2 to 4.0 studies per 100 000 enrollees.</p><p><strong>Conclusions: </strong>DSA use decreased slightly while CTA use increased by ninefold. The reasons for this change are likely complex and may reflect more aggressive imaging for stroke, increased detection of incidental findings, and increased quality of non-invasive imaging. Over time, the proportion of DSA procedures performed by neurosurgeons overtook that performed by radiologists.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral emboli detection and autonomous neuromonitoring using robotic transcranial Doppler with artificial intelligence for transcatheter aortic valve replacement with and without embolic protection devices: a pilot study.","authors":"Ammad A Baig, Christopher Manion, Wasiq I Khawar, Brianna M Donnelly, Kunal Raygor, Ryan Turner, David R Holmes, Vijay S Iyer, L Nelson Hopkins, Jason M Davies, Elad I Levy, Adnan H Siddiqui","doi":"10.1136/jnis-2023-020812","DOIUrl":"10.1136/jnis-2023-020812","url":null,"abstract":"<p><strong>Background: </strong>Periprocedural ischemic stroke remains a serious complication in patients undergoing transcatheter aortic valve replacement (TAVR). We used a novel robotic transcranial Doppler (TCD) system equipped with artificial intelligence (AI) for real-time continuous intraoperative neuromonitoring during TAVR to establish the safety and potential validity of this tool in detecting cerebral emboli, report the quantity and distribution of high intensity transient signals (HITS) with and without cerebral protection, and correlate HITS occurrence with various procedural steps.</p><p><strong>Methods: </strong>Consecutive patients undergoing TAVR procedures during which the robotic system was used between October 2021 and May 2022 were prospectively enrolled in this pilot study. The robotic TCD system included autonomous adjustment of the TCD probes and AI-assisted post-processing of HITS and other cerebral flow parameters. Basic demographics and procedural details were recorded. Continuous variables were analyzed by a two-sample Mann-Whitney t-test and categorical variables by a χ² or Fisher test.</p><p><strong>Results: </strong>Thirty-one patients were prospectively enrolled (mean age 79.9±7.6 years; 16 men (51.6%)). Mean aortic valve stenotic area was 0.7 cm² and mean aortic-ventricular gradient was 43 mmHg (IQR 31.5-50 mmHg). Cerebral protection was used in 16 cases (51.6%). Significantly fewer emboli were observed in the protection group than in the non-protection group (mean 470.38 vs 693.33; p=0.01). Emboli counts during valve positioning and implantation were significantly different in the protection and non-protection groups (mean 249.92 and 387.5, respectively; p=0.01). One (4%) transient ischemic attack occurred post-procedurally in the non-protection group.</p><p><strong>Conclusion: </strong>We describe a novel real-time intraoperative neuromonitoring tool used in patients undergoing TAVR. Significantly fewer HITS were detected with protection. Valve positioning-implantation was the most significant stage for intraprocedural HITS.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1167-1173"},"PeriodicalIF":4.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of long term effectiveness of Neuroform Atlas stent versus low profile visualized intraluminal stent/Woven EndoBridge devices in treatment of wide necked intracranial aneurysms.","authors":"Mohamed M Salem, Brian T Jankowitz, Jan-Karl Burkhardt, Lori Lyn Price, Osama O Zaidat","doi":"10.1136/jnis-2023-020716","DOIUrl":"10.1136/jnis-2023-020716","url":null,"abstract":"<p><strong>Background: </strong>We compared the outcomes of wide necked aneurysms (WNA) treated with the Neuroform Atlas with those treated with the low profile visualized intraluminal stent (LVIS) or the Woven EndoBridge (WEB).</p><p><strong>Methods: </strong>Objective, prospectively collected, core laboratory adjudicated data from published trials for the Neuroform Atlas, LVIS, and WEB devices were reviewed. ATLAS (Safety and Effectiveness of the Treatment of Wide Neck, Saccular Intracranial Aneurysms With the Neuroform Atlas Stent System) study patients were included if they met other studies' inclusion criteria. Outcomes included (1) primary effectiveness (complete aneurysmal occlusion without retreatment/>50% parent vessel stenosis), (2) primary safety, (3) complete aneurysmal occlusion, and (4) retreatment rates (outcomes evaluated at the 12 month follow-up). Matching adjusted indirect comparison analysis was used to compare outcomes.</p><p><strong>Results: </strong>Analytical samples included 141 ATLAS subjects meeting WEB-IT (Woven EndoBridge Intrasaccular Therapy Study) criteria (ATLAS/WEB-IT) and 241 meeting LVIS (Pivotal Study of the Low Profile Visualized Intraluminal Support) criteria (ATLAS/LVIS). ATLAS/WEB-IT exhibited significantly higher rates of primary effectiveness and complete occlusion versus WEB (86.6% vs 53.9 %, P<0.0001, and 90.3% vs 53.9%, P<0.0001, respectively). For LVIS, there was no significant differences in primary effectiveness rates between ATLAS and LVIS (84.2% vs 77.7%, respectively, P=0.12). However, ATLAS/LVIS had a significantly higher proportion of patients achieving complete occlusion than LVIS (88.1 vs 79.1, P=0.03). Retreatment rates and primary safety outcomes were not significantly different (P>0.05) for the Atlas versus other devices except for a lower retreatment rate for ATLAS/WEB-IT versus WEB-IT (2.4% vs 9.8%, P=0.01).</p><p><strong>Conclusion: </strong>The Neuroform Atlas provided higher occlusion rates and similar retreatment rates in comparable datasets compared with LVIS and WEB devices when treating WNA.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1115-1118"},"PeriodicalIF":4.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41128197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low body mass index patients have worse outcomes after mechanical thrombectomy.","authors":"Adeline L Fecker, Maryam N Shahin, Samantha Sheffels, Joseph Girard Nugent, Daniel Munger, Parker Miller, Ryan Priest, Aclan Dogan, Wayne Clark, James Wright, Jesse L Liu","doi":"10.1136/jnis-2023-020628","DOIUrl":"10.1136/jnis-2023-020628","url":null,"abstract":"<p><strong>Background: </strong>There is evidence that frailty is an independent predictor of worse outcomes after stroke. Similarly, although obesity is associated with a higher risk for stroke, there are multiple reports describing improved mortality and functional outcomes in higher body mass index (BMI) patients in a phenomenon known as the obesity paradox. We investigated the effect of low BMI on outcomes after mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 231 stroke patients who underwent MT at an academic medical center between 2020-2022. The patients' BMI data were collected from admission records and coded based on the Centers for Disease Control and Prevention (CDC) obesity guidelines. Recursive partitioning analysis (RPA) in R software was employed to automatically detect a BMI threshold associated with a significant survival benefit. Frailty was quantified using the Modified Frailty Index 5 and 11.</p><p><strong>Results: </strong>In our dataset, by CDC classification, 2.6% of patients were underweight, 27.3% were normal BMI, 30.7% were overweight, 19.9% were class I obese, 9.5% were class II obese, and 10% were class III obese. There were no significant differences between these groups. RPA identified a clinically significant BMI threshold of 23.62 kg/m². Independent of frailty, patients with a BMI ≤23.62 kg/m² had significantly worse overall survival (P<0.001) and 90-day modified Rankin Scale (P=0.027) than patients above the threshold.</p><p><strong>Conclusions: </strong>Underweight patients had worse survival and functional outcomes after MT. Further research should focus on the pathophysiology underlying poor prognosis in underweight MT patients, and whether optimizing nutritional status confers any neuroprotective benefit.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1194-1199"},"PeriodicalIF":4.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41133529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive analysis of the impact of procedure time and the 'golden hour' in subpopulations of stroke thrombectomy patients.","authors":"Makenna Ash, Laurie Dimisko, Reda M Chalhoub, Brian M Howard, C Michael Cawley, Charles Matouk, Aqueel Pabaney, Alejandro M Spiotta, Pascal Jabbour, Ilko Maier, Stacey Q Wolfe, Ansaar T Rai, Joon-Tae Kim, Marios-Nikos Psychogios, Justin R Mascitelli, Robert M Starke, Amir Shaban, Shinichi Yoshimura, Reade De Leacy, Peter Kan, Isabel Fragata, Adam J Polifka, Adam S Arthur, Min S Park, Roberto Javier Crosa, Richard Williamson, Travis M Dumont, Michael R Levitt, Sami Al Kasab, Stavropoula I Tjoumakaris, Jan Liman, Hassan Saad, Edgar A Samaniego, Kyle M Fargen, Jonathan A Grossberg, Ali Alawieh","doi":"10.1136/jnis-2023-020792","DOIUrl":"10.1136/jnis-2023-020792","url":null,"abstract":"<p><strong>Objective: </strong>To 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.</p><p><strong>Methods: </strong>This 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.</p><p><strong>Results: </strong>Among 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.</p><p><strong>Conclusions: </strong>In 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.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1069-1075"},"PeriodicalIF":4.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous alteplase before endovascular therapy for acute large vessel occlusion with large ischemic core: subanalysis of a randomized clinical trial.","authors":"Seigo Shindo, Kazutaka Uchida, Shinichi Yoshimura, Nobuyuki Sakai, Hiroshi Yamagami, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kazumi Kimura, Reiichi Ishikura, Manabu Inoue, Fumihiro Sakakibara, Makoto Nakajima, Mitsuharu Ueda, Takeshi Morimoto","doi":"10.1136/jnis-2023-020846","DOIUrl":"10.1136/jnis-2023-020846","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of endovascular therapy (EVT) in patients with large ischemic core has been reported, but it remains unclear whether IV alteplase (IVT) has beneficial effects in addition to EVT in such patients. We evaluated the efficacy and safety of EVT with or without IVT.</p><p><strong>Methods: </strong>The RESCUE-Japan LIMIT was an open-label, prospective, multicenter, randomized clinical trial to evaluate the efficacy and safety of EVT in stroke patients with large ischemic core, defined as Alberta Stroke Program Early CT Score (ASPECTS) 3-5. This subanalysis evaluated the differences in the effects of EVT with medical care (EVT group) compared with medical care alone (No-EVT group) between those who received IVT (IVT stratum) and those who did not (No-IVT stratum) before EVT.</p><p><strong>Results: </strong>Among 202 enrolled patients, 147 (73%) did not receive IVT. In the No-IVT stratum, the modified Rankin Scale (mRS) score of 0-3 at 90 days was significantly higher in the EVT group than in the No-EVT group (31.1% vs 12.3%, OR 3.21 (95% CI 1.37 to 7.53)). In the IVT stratum, the mRS score of 0-3 was 30.8% in the EVT group and 13.8% in the No-EVT group (OR 2.78 (95% CI 0.72 to 10.7)) (interaction p=0.77). The incidence of symptomatic intracranial hemorrhage was not different between the two groups in the No-IVT stratum (OR 1.20 (95% CI 0.35 to 4.12)), but it was significantly higher in the EVT group than in the No-EVT group in the IVT stratum (11.5% vs 0%, p=0.03).</p><p><strong>Conclusions: </strong>There was no difference in efficacy of EVT with or without IVT, while IVT before EVT might increase symptomatic intracranial hemorrhage in patients with large ischemic core.</p><p><strong>Trial registration information: </strong>NCT03702413.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1094-1100"},"PeriodicalIF":4.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61563193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}