Stroke: Vascular and Interventional Neurology最新文献

{"title":"Prognostication Following Aneurysmal Subarachnoid Hemorrhage: The Modified Hunt and Hess Grading Scale","authors":"F. Al‐Mufti, A. Dicpinigaitis, Christian A Bowers, Jan Claassen, Soojin Park, Sachin Agarwal, Priyank Khandelwal, Adnan I. Qureshi, S. Majidi, Johanna T. Fifi, Seon‐Kyu Lee, A. Jadhav, S. Yaghi, E. Raz, Sudhakar Satti, Hooman Kamel, A. Merkler, N. Dangayach, Adnan Siddiqui, Saef Izzy, Lucas Elijovich, D. Yavagal, E. S. Connolly, Chirag D. Gandhi, R. L. Macdonald, Stephan Mayer","doi":"10.1161/svin.124.001349","DOIUrl":"https://doi.org/10.1161/svin.124.001349","url":null,"abstract":"\u0000 \u0000 This study proposes a modification to the traditional Hunt and Hess (tHH) grading scale for prognostication in aneurysmal subarachnoid hemorrhage (aSAH), which differentiates the most severe‐grade patients based on the presence or absence of brainstem dysfunction [determined by Glasgow Coma Scale (GCS) scores 3‐5].\u0000 \u0000 \u0000 \u0000 Weighted aSAH hospitalizations were retrospectively identified in the National Inpatient Sample from 2015 to 2019 and were stratified by tHH and modified HH (mHH) grades. mHH grade 5 was defined as tHH grade 5 with GCS score 3–5, while mHH grade 4 comprised tHH grade 5 with GCS score 6–8 and tHH grade 4. HH grades 1–3 do not differ between the traditional and modified scales. Measures of diagnostic performance were compared for the primary study end point [poor outcome as determined by the previously validated NIS‐SAH Outcome Measure (NIS‐SOM), shown to have high concordance with modified Rankin Scale scores > 2]. External validation of the mHH was performed using data from a prospectively maintained aSAH registry.\u0000 \u0000 \u0000 \u0000 Among 6130 aSAH hospitalizations, 2245 (36%) were tHH grade 5. Seven hundred and eighty‐five (35%) of these had a GCS 3–5 and were designated as mHH grade 5. Poor outcomes were identified in 78% and 77% of grade 4 tHH and mHH, respectively, and in 83% and 95% of grade 5 tHH and mHH, respectively. In comparison with the tHH, the mHH achieved superior discrimination [c‐statistic 0.793 (95% CI 0.768, 0.818) versus 0.780 (95% CI 0.750, 0.807); DeLong p < 0.001] for poor outcome, as well as improved specificity (0.929 versus 0.304) and positive predictive value (PPV) (0.949 versus 0.827). External registry validation of the mHH demonstrated excellent discrimination [c‐statistic 0.835 (95% CI 0.801, 0.870)], with a specificity of 0.950 and PPV of 0.905.\u0000 \u0000 \u0000 \u0000 The mHH achieved a favorable diagnostic performance profile using retrospective data and may aid in the prognostication of high‐severity patients with aSAH.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"32 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141925644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra‐arterial Selective Bevacizumab Administration in the Middle Meningeal Artery for Chronic Subdural Hematoma: An Early Experience in 12 Hemispheres","authors":"Jane Khalife, Manisha Koneru, D. Tonetti, Hamza Shaikh, T. Jovin, Pratit D. Patel, Ajith J. Thomas","doi":"10.1161/svin.124.001409","DOIUrl":"https://doi.org/10.1161/svin.124.001409","url":null,"abstract":"\u0000 \u0000 Chronic subdural hematoma (cSDH) has a rising incidence associated with an increasing burden of disability and mortality worldwide. Vascular endothelial growth factor plays an integral role in the inflammation and formation of subdural membranes responsible for the origin and propagation of cSDH. We report an early experience of intra‐arterial bevacizumab, a vascular endothelial growth factor receptor antagonist, to the middle meningeal artery of 12 hemispheres in 8 patients with cSDH.\u0000 \u0000 \u0000 \u0000 Eight patients with either unilateral or bilateral cSDH received intra‐arterial infusion of 2 mg/kg bevacizumab into the middle meningeal artery of each treated hemisphere. The primary outcome was hematoma recurrence or reaccumulation requiring surgical drainage or middle meningeal artery embolization within 3 months posttreatment.\u0000 \u0000 \u0000 \u0000 Of 12 hemispheres treated, no treatment‐related complications were reported. Median duration of follow‐up was 5 months (interquartile range 3–7.5). By 3 months posttreatment, no patients experienced hematoma recurrence or reaccumulation. One patient required concurrent evacuation at the time of bevacizumab administration. There were no major strokes or mortality within 3 months. Four hemispheres (33.3%) demonstrated complete radiographic hematoma resolution by 3 months. All hemispheres achieved 50% reduction in hematoma size by 3 months.\u0000 \u0000 \u0000 \u0000 For all hemispheres treated, there was no hematoma recurrence or progression requiring surgical drainage or middle meningeal artery embolization within 3 months except 1 who required concurrent evacuation 24 hours after treatment. Our initial experience supports bevacizumab as a novel, potentially viable agent for cSDH treatment in select patients. Future studies in larger cohorts are necessary to confirm efficacy and safety and appropriate dosing.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion","authors":"A. Flores, Marcos Elizalde, L. Seró, X. Ustrell, Ylenia Avivar, A. Pellisé, P. Rodriguez, Angela Monterde, Lidia Lara, Jose Maria Gonzalez‐de‐Echavarri, Victor Cuba, Marc Rodrigo Gisbert, M. Requena, Carlos A. Molina, Angel Chamorro, N. Pérez de la Ossa, P. Cardona, D. Cánovas, F. Purroy, Yolanda Silva, Ana Camzpello, J. Martí-Fábregas, S. Abilleira, Marc Ribó","doi":"10.1161/svin.124.001371","DOIUrl":"https://doi.org/10.1161/svin.124.001371","url":null,"abstract":"\u0000 \u0000 Among patients with stroke eligible for endovascular treatment, preprocedure identification of those with low chances of successful recanalization with conventional devices (stent‐retrievers and/or direct aspiration) may allow anticipating procedural rescue strategies. We aimed to develop a preprocedural algorithm able to predict recanalization failure with conventional devices (RFCD).\u0000 \u0000 \u0000 \u0000 Observational study. Data from consecutive patients with stroke who received endovascular treatment between 2019 and 2022 in 10 centers were collected from the Catalan Stroke Registry (Codi Ictus Catalunya Registry, CICAT). RFCD was defined as final thrombolysis in cerebral infarction ≤2a or the use of rescue therapy defined as balloon angioplasty±stent deployment. Univariate and multivariate analysis to identify variables associated with RFCD were performed. A gradient boosted decision tree machine learning model to predict RFCD was developed utilizing preprocedure variables previously selected. Clinical improvement at 24 hours was defined as a drop of ≥4 points from baseline National Institutes of Health Stroke Scale score or 0–1 at 24 hours.\u0000 \u0000 \u0000 \u0000 \u0000 In total, 984 patients were included; RFCD was observed in 14.3% (n:141) of the cases. Of these, 47.5% (n = 67) received balloon angioplasty±stent deployment as rescue therapy. Among patients receiving balloon angioplasty±stent deployment, clinical improvement was associated with lower number of attempts with conventional devices (median number of passes 2 versus 3;\u0000 P\u0000 = 0.045). In logistic regression, the absence of atrial fibrillation (odds ratio [OR]: 2.730, 95%CI: 1.541–4.836;\u0000 P\u0000 = 0.007) and no‐thrombolytic treatment (OR: 1.826, 95%CI: 1.230–2.711;\u0000 P\u0000 = 0.003) emerged as independent predictors of RFCD. A predictive model for RFCD, based on age, sex, hypertension, wake‐up stroke, baseline National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT [Computed Tomography] Score, occlusion site, thrombolysis, and atrial fibrillation showed an acceptable discrimination (area under the curve: 0.72±0.024 SD) and accuracy (0.75±0.015 SD). Overall performance was moderate (weighted F1‐score: 0.77±0.041 SD).\u0000 \u0000 \u0000 \u0000 \u0000 In RFCD patients, early balloon angioplasty±stent deployment rescue was associated with improved outcomes. A predictive model using affordable preprocedure clinical variables could be useful to identify these patients before intervention.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Disparities in Mortality After Endovascular Therapy in Large Core Infarcts","authors":"N. M. Le, Camille Neal‐Harris, Emmanuel C. Ebirim, Ananya S Iyyangar, Hussain M Azeem, A. Ballekere, Saagar Dhanjani, Eunyoung Lee, Sunil A. Sheth","doi":"10.1161/svin.124.001366","DOIUrl":"https://doi.org/10.1161/svin.124.001366","url":null,"abstract":"\u0000 \u0000 In recent large core endovascular therapy (EVT) trials of large vessel occlusion acute ischemic stroke (AIS), treatment was associated with reduced rates of mortality. Because post‐AIS mortality can be influenced by societal and biological factors that differ between women and men, we investigate sex‐based differences in mortality outcomes following EVT in large core AIS.\u0000 \u0000 \u0000 \u0000 From our prospectively collected multicenter registry across 4 comprehensive stroke centers in the Greater Houston area, we identified patients from 2017 to 2022 with large vessel occlusion AIS and large infarct core. Large infarct core was defined by computed tomography perfusion exceeding 70 mL (by regional cerebral blood flow measurements using automated postprocessing) or computed tomography Alberta Stroke Program Early CT [Computed Tomography] Score<6. The primary outcome of this study was the likelihood of mortality at 90 days, determined through multivariable logistic regression adjusted for EVT, sex, and EVT/sex interaction term. Secondary outcomes included 90‐day disability outcomes and intracerebral hemorrhage.\u0000 \u0000 \u0000 \u0000 \u0000 Among 190 patients who met inclusion criteria, 50% were female and 45.3% received EVT. Demographic differences between the sexes were largely balanced apart from the older age of presentation for women compared with men (75 versus 67, women versus men;\u0000 P\u0000 <0.01). In univariable analysis, women who did not receive EVT had greater mortality (27.4% difference;\u0000 P\u0000 <0.001) compared with men, with comparable rates in EVT‐treated cohorts. In multivariable analysis, non‐EVT management was strongly associated with mortality in women compared with men at discharge (odds ratio [OR] 5.81, 95% CI [1.96–17.23]) and 90‐days (OR 6.77, 95% CI [2.09–21.94]). In the secondary analysis, which additionally adjusted the model for age and National Institutes of Health Stroke Scale score, these findings were unchanged. The sex/EVT interaction term showed significant interaction for mortality both at discharge and 90 days (\u0000 P\u0000 <0.01).\u0000 \u0000 \u0000 \u0000 \u0000 EVT in large core AIS populations may disparately reduce mortality in women compared to men.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"119 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141820732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelet Therapy and Platelet Activity Testing for Neurointerventional Procedures","authors":"Keiko A. Fukuda, C. Beaman, V. Szeder","doi":"10.1161/svin.124.001376","DOIUrl":"https://doi.org/10.1161/svin.124.001376","url":null,"abstract":"\u0000 The management of antiplatelet medications in neurointerventional procedures remains a subject of considerable variability and debate. This review article explores the diverse clinical practices and the impact of different antiplatelet regimens and platelet activity testing on patient outcomes in neurointerventional treatments. While much of the evidence around antiplatelet therapies largely stems from randomized trials in cardiac and peripheral vascular diseases, their application in neurointerventional settings requires nuanced consideration. Various assays exist to assess individual platelet function, yet the optimal assay, thresholds, and agents remain uncertain due to interpatient variability in medication responsiveness. Expert consensus groups have attempted to standardize antiplatelet management, which is summarized for elective and emergent neurointerventional procedures. Clopidogrel, a commonly used antiplatelet, faces challenges such as genetic variability in metabolism and drug–drug interactions, impacting its effectiveness. Other agents, such as ticagrelor and prasugrel, offer alternatives with different mechanisms of action and potential advantages. Additionally, short‐acting intravenous P2Y\u0000 12\u0000 inhibitors, such as cangrelor, and glycoprotein IIb/IIIa inhibitors provide options for acute bridging therapy in neurointerventional cases. Despite advancements, significant gaps persist in understanding the optimal antiplatelet management for neurovascular procedures. While platelet function testing is commonly used, its clinical utility and standardization remain an area of investigation. This review underscores the need for further multicenter studies to delineate best practices and optimize patient outcomes in neurointerventional settings.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"38 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Brain Arteriovenous Malformations From the Surgical Battlefield","authors":"Redi Rahmani, L. Scherschinski, Khashayar Mozaffari, Adam T. Eberle, J. Catapano, E. Winkler, A. Benet, Michael T. Lawton","doi":"10.1161/svin.124.001054","DOIUrl":"https://doi.org/10.1161/svin.124.001054","url":null,"abstract":"","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"50 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Direct Oral Anticoagulant Levels on Functional Independence Following Endovascular Thrombectomy in Patients With Atrial Fibrillation","authors":"Shin-Yi Lin, Yen-Heng Lin, Chih-Hao Chen, Chung-Wei Lee, Yuan‐Chang Chao, Yu-Fong Peng, Ching-Hua Kuo, Chih-Fen Huang, Sung-Chun Tang, J. Jeng","doi":"10.1161/svin.124.001410","DOIUrl":"https://doi.org/10.1161/svin.124.001410","url":null,"abstract":"\u0000 \u0000 In direct oral anticoagulant (DOAC) users with stroke due to large artery occlusion, endovascular thrombectomy is an effective treatment when intravenous thrombolytic therapy is unsuitable. The purpose of this study is to investigate the association between emergent DOAC levels and endovascular thrombectomy outcomes.\u0000 \u0000 \u0000 \u0000 Participants with atrial fibrillation, who had a premorbid modified Rankin Scale score of ≤3 and had undergone endovascular thrombectomy for acute stroke, were enrolled. Drug levels upon hospital arrival were measured in the prestroke DOAC users. Head noncontrast computed tomography and computed tomographic angiography images were used to quantify thrombus permeability. The primary outcome was functional independence at 3 months (modified Rankin Scale 0–2 or a return to premorbid status for patients with a premorbid modified Rankin Scale of 3).\u0000 \u0000 \u0000 \u0000 The study included 250 patients (antithrombotic agent nonusers, 42.0%; oral anticoagulant users, 34.0%; and antiplatelet users, 24.0%). The primary outcomes did not differ among the 3 groups. Among oral anticoagulant users, 78.8% were DOAC users. Of the 59 DOAC users with available drug level measurements, 62.7% had low levels (<50 ng/mL). Low‐level patients were less likely to achieve functional independence than high‐level patients (adjusted odds ratio, 0.26 [0.08–0.87]). Compared with antithrombotic nonusers, oral anticoagulant users with therapeutic anticoagulation were more likely to achieve functional independence (adjusted odds ratio, 2.83 [1.18–6.78]), whereas those with inadequate anticoagulation did not. Symptomatic intracerebral hemorrhage occurred in 3 DOAC users in the low‐level group (8.1%), 1 DOAC user in the high‐level group (4.5%), and 4 antithrombotic nonusers (3.8%). Thrombus permeability was similar between antithrombotic nonusers and low‐ or high‐level DOAC users.\u0000 \u0000 \u0000 \u0000 Among patients who underwent DOAC therapy and endovascular thrombectomy, those with low DOAC levels were less likely to achieve functional independence. Furthermore, oral anticoagulant users with therapeutic anticoagulation displayed better functional outcomes than antithrombotic nonusers.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"40 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141660350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Therapy for Isolated Cervical Internal Carotid Artery Occlusion","authors":"Katrine Falkesgaard, J. N. Hedegaard, Jonas Jensen, T. Leslie-Mazwi, R. Blauenfeldt, Claus Z. Simonsen","doi":"10.1161/svin.124.001382","DOIUrl":"https://doi.org/10.1161/svin.124.001382","url":null,"abstract":"\u0000 \u0000 Guidelines on endovascular therapy for acute ischemic stroke do not include isolated cervical internal carotid artery (cICA) occlusions. The effect of treating these lesions remains unclear. This study aimed to compare the baseline characteristics and treatment outcomes between patients with isolated cICA occlusions to patients who underwent endovascular therapy due to a level of occlusion supported by guidelines.\u0000 \u0000 \u0000 \u0000 A retrospective cohort study was conducted on 1162 patients who underwent endovascular therapy. Of these, 115 had an isolated cICA occlusion. Univariate analysis of baseline characteristics and outcome measured by the modified Rankin scale 90 days after endovascular therapy were compared between patients with isolated cICA occlusion, those with tandem occlusions, and those with occlusions of the middle cerebral artery/top of the internal carotid artery (first segment of the middle cerebral artery/intracranial internal carotid artery). To adjust for confounders, an inverse probability of treatment weighting was performed.\u0000 \u0000 \u0000 \u0000 \u0000 Patients with isolated cICA occlusions were more likely men (67.8% versus 50.9%;\u0000 P\u0000 <0.001) and active smokers (42.2% versus 26.4%;\u0000 P\u0000 = 0.002) compared with patients with first segment of the middle cerebral artery/intracranial internal carotid artery occlusions where atrial fibrillation was more common (35.5% versus 23.5%;\u0000 P\u0000 = 0.02). Patients with an isolated cICA had a lower chance of achieving a modified Rankin scale score of 0 to 2 at 90 days (adjusted relative risk, 0.71 [95% CI, 0.54–0.92]) and a higher mortality rate (adjusted relative risk, 1.97 [95% CI, 1.36–2.87]) compared with patients with first segment of the middle cerebral artery/intracranial internal carotid artery occlusions.\u0000 \u0000 \u0000 \u0000 \u0000 Patients with isolated cICA occlusions and first segment of the middle cerebral artery/intracranial internal carotid artery occlusions differ in sex, smoking status, and rate of atrial fibrillation. Patients with isolated cICA occlusions have lower reperfusion rates, worse outcome, and a higher mortality rate.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141668515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Thrombectomy Versus Intravenous Alteplase For Distal Medium Vessel Occlusions: A Propensity Score‐Matched Analysis","authors":"T. Yoshie, T. Ueda, Y. Hasegawa, M. Takeuchi, M. Morimoto, Y. Tsuboi, R. Yamamoto, S. Kaku, J. Ayabe, T. Akiyama, D. Yamamoto, K. Mori, H. Kagami, H. Ito, Hidetaka Onodera, Y. Kaga, H. Ohtsubo, K. Tatsuno, N. Usuki, S. Takaishi, Y. Yamano","doi":"10.1161/svin.123.001346","DOIUrl":"https://doi.org/10.1161/svin.123.001346","url":null,"abstract":"\u0000 \u0000 The benefits of endovascular thrombectomy (EVT) for distal medium vessel occlusions (DMVOs) are not well established. This study aimed to determine the superiority of EVT over intravenous tissue‐type plasminogen activator (IV tPA) in the treatment of DMVOs.\u0000 \u0000 \u0000 \u0000 This study analyzed data from the Kanagawa Intravenous and Endovascular Treatment of Acute Ischemic Stroke Registry, a prospective, multicenter, observational registry of acute ischemic stroke patients treated with EVT or IV tPA. The study evaluated patients with acute DMVOs who were treated with EVT and/or IV tPA. DMVOs was defined as occlusions in M2–M3 segment of the middle cerebral artery, anterior cerebral artery, or posterior cerebral artery. The analysis included primary DMVOs and excluded secondary DMVOs, such as distal embolism after recanalization of proximal vessel occlusion. Propensity score‐matched analysis was conducted to compare the outcomes between EVT and IV tPA alone. A good outcome was defined as a modified Rankin Scale score 0–2 or no worsening at 90 days. An excellent outcome was defined as an modified Rankin Scale score 0–1.\u0000 \u0000 \u0000 \u0000 \u0000 The study included 1148 patients with DMVOs, of whom 816 were treated with EVT and 332 were IV tPA alone. Before propensity score matching, the incidence of good and excellent outcomes was significantly lower in EVT group (good outcomes: EVT 50.3% versus IV tPA 68.0%;\u0000 P\u0000  < 0.01; excellent outcomes: 39.8% versus 59.8%;\u0000 P\u0000  < 0.001). After propensity score matching, there were no significant differences between EVT and IV tPA groups in good outcomes (EVT 57.8% versus IV tPA 61.3%;\u0000 P\u0000  = 0.51), excellent outcomes (46.6% versus 55.0%;\u0000 P\u0000  = 0.17), all cerebral hemorrhage (11.6% versus 12.7%;\u0000 P\u0000  = 0.74), and symptomatic hemorrhage (2.9% versus 0.6%;\u0000 P\u0000  = 0.13). Subarachnoid hemorrhage was more frequent in EVT group (14.5% versus IV tPA 0%).\u0000 \u0000 \u0000 \u0000 \u0000 The benefits of EVT for acute DMVOs were similar to IV tPA alone. Randomized multicenter trials are warranted to establish the superiority of EVT over IV tPA alone for DMVOs.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141671568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MINT Registry: Rationale and Study Design","authors":"K. Limaye, S. A. Kasab, Jaydevsinh Dolia, M. Ezzeldin, Daniel Vela Duarte, Vinodh Doss, S. Lahoti, David Hasan, A. Spiotta, Khaled Asi, Vasu Saini, Tapan Mehta, Ameer Hassan, Diogo C. Haussen, Dileep R. Yavagal, Jesse Jones, O. Tanweer, Waleed Brinjikji","doi":"10.1161/svin.124.001384","DOIUrl":"https://doi.org/10.1161/svin.124.001384","url":null,"abstract":"\u0000 \u0000 Mechanical thrombectomy has become the standard of care for treatment of acute ischemic stroke secondary to large‐vessel occlusion up to 24 hours from last known normal time. Multiple different techniques for mechanical thrombectomy have been described, including a direct aspiration first‐pass technique and stent retriever thrombectomy. With a direct aspiration first‐pass technique, classically, a large‐bore aspiration catheter is delivered over a microcatheter and microwire to the clot. Recently, a novel macrowire has been introduced as a potential alternative to the use of microwire–microcatheter to allow the delivery of the aspiration catheter. The aim of this study is to develop a multicenter registry comparing delivery of an aspiration catheter for intracranial thrombectomy for acute ischemic stroke secondary to emergent large‐vessel occlusion over a macrowire in comparison with traditional use of microcatheter and microwire.\u0000 \u0000 \u0000 \u0000 MINT (Macrowire for Intracranial Thrombectomy) is a multicenter, observational study currently enrolling patients with large‐vessel occlusion who underwent mechanical thrombectomy using a macrowire to deliver the aspiration catheter to the intracranial occlusion. All the participating sites will screen and report cases on a monthly basis. The decision to use the macrowire and various aspiration catheters is at the discretion of the interventionalist.\u0000 \u0000 \u0000 \u0000 We will collect patient's clinical, demographic, and radiographic data. In addition, we plan to collect procedure variables and postprocedure clinical and imaging data. Outcomes include successful delivery of the reperfusion catheter to the clot interface, time taken from groin access to first pass, and a bailout strategy for thrombectomy in cases where this is not feasible.\u0000 \u0000 \u0000 \u0000 The MINT registry will add to our understanding of safety and efficacy of this novel macrowire in intracranial thrombectomy. This registry will also highlight and allow for understanding in workflow improvements from simplifying setup and possibly cost effectiveness of this technique.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141670272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}