NeurologistPub Date : 2024-09-01DOI: 10.1097/NRL.0000000000000568
Shi-Chang Yang, Xing-Wen Zhang, Xi-Ting Nie, Ying-Lu Liu, Hui Su, Yan Wang, Ya Cao, Hui-Juan Yuan, Zhe Yu, Shan-Shan Kong, Sheng-Yuan Yu
{"title":"Stop Ischemic Event to the Brain: Screening Risk Factors of Cerebrovascular Stenosis in Coronary Artery Disease Patients.","authors":"Shi-Chang Yang, Xing-Wen Zhang, Xi-Ting Nie, Ying-Lu Liu, Hui Su, Yan Wang, Ya Cao, Hui-Juan Yuan, Zhe Yu, Shan-Shan Kong, Sheng-Yuan Yu","doi":"10.1097/NRL.0000000000000568","DOIUrl":"10.1097/NRL.0000000000000568","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we investigated the difference in risk factors between the 2 diseases, aiming to further clarify who needs to do ischemic cerebrovascular disease (ICVD)-related screening among coronary artery disease (CAD) patients.</p><p><strong>Methods: </strong>Clinical data of 326 patients with first-episode CAD from June 1, 2017, to July 31, 2020, in the Chinese PLA General Hospital were retrospectively reviewed. Outcomes, including clinical features and laboratory examination, were taken. Features related to ICVD including the extension of intracranial arterial (internal carotid artery intracranial segment, middle cerebral artery M1 segment, anterior cerebral A1 segment, vertebrobasilar artery intracranial segment, posterior cerebral artery P1 segment) and carotid arterial (internal carotid artery extracranial segment, common carotid artery, subclavian artery) stenosis were detected. Risk factors for the occurrence of ICVD in patients with CAD were analyzed.</p><p><strong>Results: </strong>Among patients with the onset of CAD, in comparison of the nonstenosis and stenosis of intracranial artery subgroups, there were statistical differences in the onset age, hypertension, and duration of hypertension as well as the biochemical indicators, including high-density lipoprotein and glycosylated hemoglobin. In addition, statistical differences were detected in the onset age as well as the biochemical indicators, including glycosylated hemoglobin and blood glucose serum protein, along with the difference in the degree of cardiovascular stenosis.</p><p><strong>Conclusions: </strong>The onset age of CAD was shown to serve as a vital risk factor for ICVD. The primary prevention of ICVD in patients with CAD should lay more emphasis on the management of hypertension and diabetes.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Relationship of Day-by-Day Blood Pressure Variability and Admission Stroke Severity in Acute Ischemic Stroke.","authors":"Yuan Zhu, Minghua Wu, Yawei Zheng, Xintong Wang, Jingyi Xiayang, Tianrui Zhang, Shana Wang, Zhuyuan Fang","doi":"10.1097/NRL.0000000000000556","DOIUrl":"10.1097/NRL.0000000000000556","url":null,"abstract":"<p><strong>Objectives: </strong>Research on the association between stroke severity and day-by-day blood pressure variability (BPV) in acute ischemic stroke (AIS) is rare as the majority focus on the blood pressure (BP) or the short-term BPV. Our study aims to explore the exact roles of daily BPV through the 7-day commencement on stroke severity in AIS.</p><p><strong>Methods: </strong>The study included 633 patients with AIS, defining AIS as the time from the beginning of symptom up to 7 days with recording BP twice a day as well as calculating the daily BPV, and then matching them to the stroke severity. The logistic regression models were used to evaluate associations between stroke severity and day-by-day BPV. We used the smooth curve fitting to identify whether there was a nonlinear association. In addition, the subgroup analyses were performed using the logistic regression.</p><p><strong>Results: </strong>According to the modified National Institutes of Health Stroke Scale score, 301 (47.5%) patients were allocated to the mild stroke group and 332 (52.5%) to the moderate-to-severe stroke group. In terms of stroke categories, we found no significant difference between BP at admission or mean BP. However, the moderate-to-severe stroke group exhibited higher daily BPV. The multiple logistic regression analysis indicated that day-by-day BPV was positively correlated to stroke severity [odds ratio (OR)=1.05, 95% CI:1.01-1.1, P =0.03 for SBP-SD; OR=1.08, 95% CI:1.01-1.15, P =0.03 for SBP-CV; OR=1.04, 95% CI:1.01-1.07, P =0.015 for SBP-SV).</p><p><strong>Conclusions: </strong>High day-by-day BPV in AIS was associated with more severe stroke independent of BP levels.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2024-09-01DOI: 10.1097/NRL.0000000000000573
Konstantinos Melanis, Athanasia Athanasaki, Eleni Bakola, Maria Chondrogianni, Andreas Lazaris, Alexandra Akrivaki, Alexandros Stavros Triantafyllou, Vasiliki Kotsali-Peteinelli, Anastasios Bonakis, George P Paraskevas, Georgios Tsivgoulis
{"title":"Symptomatic Unilateral Carotid Artery Disease: An Uncommon but Reversible Cause of Corticobasal Syndrome.","authors":"Konstantinos Melanis, Athanasia Athanasaki, Eleni Bakola, Maria Chondrogianni, Andreas Lazaris, Alexandra Akrivaki, Alexandros Stavros Triantafyllou, Vasiliki Kotsali-Peteinelli, Anastasios Bonakis, George P Paraskevas, Georgios Tsivgoulis","doi":"10.1097/NRL.0000000000000573","DOIUrl":"10.1097/NRL.0000000000000573","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic carotid artery disease (CAD) represents an uncommon but treatable cause of corticobasal syndrome.</p><p><strong>Case report: </strong>We present the clinical details and successful management of a previously healthy 77-year-old patient who presented with 1-year cognitive dysfunction, alien limb syndrome, limb kinetic apraxia, and ipsilateral cortical sensory deficit, fulfilling the criteria of the diagnosis of probable corticobasal syndrome. Imaging modalities, including magnetic resonance imaging and time-of-flight magnetic resonance angiography, revealed acute external borderzone infarcts of the right hemisphere due to symptomatic CAD causing near occlusion of the vessel. The patient underwent a right carotid endarterectomy, leading to a marked improvement in mobility and neuropsychological evaluation.</p><p><strong>Conclusion: </strong>This case highlights the importance of swift diagnosis of symptomatic CAD in patients with corticobasal syndrome. Moreover, it emphasizes the efficacy of carotid endarterectomy in achieving symptom improvement in such cases.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2024-07-01DOI: 10.1097/NRL.0000000000000549
Liang Hao, Mingming Gao, Wei Guo, Zhigang Yao
{"title":"Correlation Between Risk Factors, Degree of Vascular Restenosis, and Inflammatory Factors After Interventional Treatment for Stroke: A Two-Center Retrospective Study.","authors":"Liang Hao, Mingming Gao, Wei Guo, Zhigang Yao","doi":"10.1097/NRL.0000000000000549","DOIUrl":"10.1097/NRL.0000000000000549","url":null,"abstract":"<p><strong>Objective: </strong>To study the correlation between risk factors, degree of vascular restenosis, and inflammatory factors after interventional treatment for stroke.</p><p><strong>Methods: </strong>The clinical data of 96 stroke patients who received interventional therapy in our hospital from April 2020 to June 2021 were selected for retrospective study, and the postoperative follow-up was 1 year. Univariate and multivariate regression were used to analyze identified factors associated with interventional stroke efficacy. At the same time, the value of inflammatory factor levels in predicting vascular restenosis after interventional stroke was analyzed.</p><p><strong>Results: </strong>According to our findings, several risk factors, including body mass index ≥ 25.51 kg/m 2 , smoking, drinking, hypertension, and diabetes, were identified as contributors to poor postoperative efficacy following stroke intervention ( P <0.05). Furthermore, a notable association was observed between the severity of vascular stenosis ( P <0.001) and the levels of interleukin 6, interleukin 2, TNF-α, and C-reactive protein. The combined assessment of these serum inflammatory factors exhibited excellent predictive capability for postoperative vascular restenosis and stenosis severity, yielding a sensitivity of 84.30%, a specificity of 81.20%, and an area under the curve of 0.882.</p><p><strong>Conclusions: </strong>Obesity, smoking, alcohol consumption, hypertension, and diabetes have been found to be associated with suboptimal outcomes following interventional treatment for stroke. The assessment of preoperative levels of inflammatory factors holds promise in predicting the likelihood of postoperative restenosis to a certain degree.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2024-07-01DOI: 10.1097/NRL.0000000000000538
Tingting Yu, Zhengyang Wang
{"title":"Utility of the Systemic Inflammation Response Index as a Predictor of Pneumonia After Spontaneous Intracerebral Hemorrhage.","authors":"Tingting Yu, Zhengyang Wang","doi":"10.1097/NRL.0000000000000538","DOIUrl":"10.1097/NRL.0000000000000538","url":null,"abstract":"<p><strong>Objective: </strong>We sought to determine whether the initial Systemic Inflammatory Response Index (SIRI) was associated with pneumonia after spontaneous intracerebral hemorrhage (SICH) in hospitalized patients.</p><p><strong>Patients and methods: </strong>Patients with SICH admitted to Taizhou People's Hospital between January 2019 and December 2021 were retrospectively analyzed. Baseline variables were compared between stroke-associated pneumonia (SAP) and non-SAP groups. Multivariable logistic regression analyses were utilized to calculate the relationship between SIRI and SAP risk.</p><p><strong>Results: </strong>Of 495 patients included in this research, 192 (38.79%) developed SAP ultimately. The SIRI values exhibited the highest area under the curve value for SAP incidence (area under the curve = 0.736, 95% CI: 0.692-0.781), with respective sensitivity and specificity values of 0.646 and 0.749 at the optimal cutoff threshold of 2.53. In multivariate analysis, high SIRI (≥2.53) was a significant independent predictor of post-SICH SAP even after controlling for other possible confounding variables (odds ratio: 5.11, 95% CI: 2.89-9.04, P < 0.001). According to the restricted cubic splines model, SAP risk increases as SIRI increases.</p><p><strong>Conclusions: </strong>We observed that SIRI values may offer high diagnostic utility as a predictor of SAP risk among patients with SICH during the early stages of the disease.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2024-07-01DOI: 10.1097/NRL.0000000000000550
Haimei Liu, Denglu Liu, Peng Zuo
{"title":"Association Between Insulin Resistance Markers and Poor Prognosis in Patients With Acute Ischemic Stroke After Intravenous Thrombolysis.","authors":"Haimei Liu, Denglu Liu, Peng Zuo","doi":"10.1097/NRL.0000000000000550","DOIUrl":"10.1097/NRL.0000000000000550","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to investigate the significance of insulin resistance markers in predicting poor prognosis in acute ischemic stroke (AIS) patients after intravenous thrombolysis and to establish the corresponding nomogram.</p><p><strong>Methods: </strong>From January 2019 to March 2023, the data of 412 patients with AIS who received intravenous alteplase thrombolytic therapy in the Affiliated Taizhou People's Hospital of Nanjing Medical University were selected. Patients were randomly divided into training groups (70%, 288 cases) and validation groups (30%, 124 cases). In the training group, multivariate logistic regression analysis was used to establish the best nomogram prediction model. The predictive ability of the nomogram was further evaluated by the area under the receiver operating characteristic curve, calibration curve, decision curve analysis, and reclassification analysis. Furthermore, the model was further validated in the validation set.</p><p><strong>Results: </strong>Multivariate logistic regression analysis showed that systolic blood pressure, diabetes, National Institutes of Health Stroke Scale score, triglyceride-glucose index, triglyceride-glucose-body mass index, ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol were associated with poor prognosis in AIS patients after intravenous thrombolysis ( P <0.05). Compared with conventional factors, the nomogram showed stronger prognostic ability, area under receiver operating characteristic curves were 0.948 (95% CI: 0.920-0.976, P <0.001) and 0.798 (95% CI: 0.747-0.849, P <0.001), respectively.</p><p><strong>Conclusions: </strong>Triglyceride-glucose index, triglyceride-glucose-body mass index, and low-density lipoprotein cholesterol to high-density lipoprotein cholesterol levels upon admission can serve as markers for poor prognosis in AIS patients after intravenous thrombolysis. The nomogram enables a more accurate prediction of poor prognosis in AIS patients after intravenous thrombolysis.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2024-07-01DOI: 10.1097/NRL.0000000000000571
Maximilian von Bernstorff, Theresa Obermueller, Julia Blum, Erdi Hoxhallari, Veit M Hofmann, Annett Pudszuhn
{"title":"Accuracy of the Bedside Examination in Patients With Suspected Acute Unilateral Peripheral Vestibulopathy.","authors":"Maximilian von Bernstorff, Theresa Obermueller, Julia Blum, Erdi Hoxhallari, Veit M Hofmann, Annett Pudszuhn","doi":"10.1097/NRL.0000000000000571","DOIUrl":"10.1097/NRL.0000000000000571","url":null,"abstract":"<p><strong>Objective: </strong>Acute unilateral peripheral vestibulopathy (AUPVP) is a frequent form of peripheral vestibular vertigo characterized by unilateral vestibular organ dysfunction. Diagnostic challenges in anamnesis and bedside examination can lead to potential misdiagnoses. This study investigated the sensitivity of bedside examinations in diagnosing AUPVP.</p><p><strong>Methods: </strong>This retrospective analysis examined 136 AUPVP inpatients at a level 3 university hospital between 2017 and 2019. Demographic data and bedside test results were collected. Instrumental otoneurological tests included caloric testing and video head impulse test (HIT). The sensitivity of each bedside parameter was computed based on the instrumental diagnostics, and statistical analyses were performed.</p><p><strong>Results: </strong>The study included 76 men and 60 women, with a mean age of 59.2 years. Spontaneous nystagmus exhibited a sensitivity of 92%, whereas the absence of skew deviation was identified with a sensitivity of 98%. Abnormal bedside HIT showed a sensitivity of 87%. The combined HINTS (HIT, nystagmus, and test of skew) had a sensitivity of 83%. The Romberg test and Fukuda test demonstrated sensitivities of 26% and 48%, respectively.</p><p><strong>Conclusion: </strong>The sensitivity of bedside tests varied from 26% to 98%. This aligns with previous literature, highlighting the challenge of differentiating AUPVP from vestibular pseudoneuritis solely through bedside examination. Although the tests excel in excluding central causes, they are insufficient for diagnosing AUPVP with certainty. In addition, the bedside examination sensitivities vary widely, and early radiological imaging can be misleading. Therefore, this study underlines the necessity of prompt otoneurological testing for accurate exclusion of vestibular pseudoneuritis and thus improve patient outcomes.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2024-07-01DOI: 10.1097/NRL.0000000000000572
Lauren Singer, Jorie Singer, Craig Horbinski, Marta Penas-Prado, Rimas V Lukas
{"title":"Immunotherapy for Solitary Fibrous Tumor (Hemangiopericytoma): A Unique Treatment Approach for a Rare Central Nervous System Tumor.","authors":"Lauren Singer, Jorie Singer, Craig Horbinski, Marta Penas-Prado, Rimas V Lukas","doi":"10.1097/NRL.0000000000000572","DOIUrl":"10.1097/NRL.0000000000000572","url":null,"abstract":"<p><strong>Introduction: </strong>Solitary fibrous tumors (SFTs) of the central nervous system represent a unique entity with limited data on best treatment practices.</p><p><strong>Case report: </strong>Here, we present a case of multiply recurrent central nervous system SFT treated with radiation and immunotherapy. Immunotherapy was chosen based on mutations of genes encoding DNA repair enzymes detected through next-generation sequencing of the tumor, DNA polymerase epsilon catalytic subunit ( POLE ) and mutL homolog 1. The use of radiation and immunotherapy led to slight shrinkage and no recurrence of the tumor for over 2 years.</p><p><strong>Conclusion: </strong>The presence of somatic DNA repair enzyme gene mutations in SFT may suggest a benefit from a combination of radiotherapy and immunotherapy. This may serve as a biomarker for guiding management in patients with this rare tumor.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reverse Flow Thromboembolism From Distal Subclavian Artery Aneurysm Due to Arterial Thoracic Outlet Syndrome and Posterior Circulation Stroke-Role of Dynamic Doppler Imaging.","authors":"Adarsh Anil Kumar, Santhosh Kumar Kannath, Bejoy Thomas, Sylaja Pn, Shivanesan P, Manju Surendran","doi":"10.1097/NRL.0000000000000536","DOIUrl":"10.1097/NRL.0000000000000536","url":null,"abstract":"<p><strong>Introduction: </strong>Arterial thoracic outlet syndrome (aTOS) is the least common among the 3 subtypes of thoracic outlet syndrome and can be the cause of posterior circulation infarction due to thrombus from a secondary thrombosed subclavian-axillary artery aneurysm.</p><p><strong>Case report: </strong>Here, we report a case of a 51-year-old man who presented to our institute with sudden onset vertigo, dizziness, vomiting, gait imbalance, and visual field defects immediately after strenuous exercise. Computed tomography angiography revealed bilateral cervical ribs with aneurysmal dilatation of the left distal subclavian and proximal axillary arteries. The computed tomography also revealed subacute infarcts in the bilateral cerebellar hemispheres, as well as in the bilateral occipital lobes. Color Doppler evaluation of the subclavian artery after hyperabduction of the ipsilateral arm revealed a continuous reversal of flow in the subclavian artery, which reached the vertebral ostia. The left cervical rib was resected, aneurysm was repaired, and the patient remained asymptomatic on follow-up.</p><p><strong>Conclusion: </strong>Posterior circulation stroke caused by the ipsilateral thrombosed subclavian artery aneurysm in an adult patient with aTOS due to a complete cervical rib is rare. A high index of suspicion should be present for thoracic outlet syndrome in patients with stroke and upper-limb arterial claudication symptoms. Dynamic Doppler evaluation in such patients can be used to demonstrate the underlying pathomechanism, and definitive surgical treatment can prevent further ischemic episodes. Posterior circulation stroke caused by partially thrombosed distal subclavian and axillary artery aneurysms due to aTOS is rare.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2024-07-01DOI: 10.1097/NRL.0000000000000543
Beihai Ge, Limei Pan, Huihua Liu
{"title":"Feasibility and Clinical Outcome Predictors of Mechanical Thrombectomy in Distal Arterial Occlusion Causing Acute Ischemic Stroke: A Monocentric Retrospective Study.","authors":"Beihai Ge, Limei Pan, Huihua Liu","doi":"10.1097/NRL.0000000000000543","DOIUrl":"10.1097/NRL.0000000000000543","url":null,"abstract":"<p><strong>Background: </strong>The feasibility and clinical outcome predictors of mechanical thrombectomy (MT) for strokes caused by distal arterial occlusion (DAO) remain the subject of debate.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients with consecutive acute ischemic stroke treated using MT. Clinical and procedural-associated factors were studied to compare the efficacy, safety, and short-term and long-term outcomes of MT between the proximal arterial occlusion (PAO) and DAO groups. The predictors of a good functional outcome in the DAO group were also identified.</p><p><strong>Results: </strong>A total of 116 patients were included in this study, of whom 23 (19.8%) underwent MT for DAO. A higher complete recanalization rate was independently associated with PAO in adjusted models [adjusted odds ratio, 0.596; 95% CI, 0.377-0.941]. The measures of safety and clinical outcome showed no significant differences between the DAO and PAO groups. The National Institute of Health stroke scale (NIHSS) score on admission, hybrid technique use, and complete recanalization rate emerged as independent predictors of a good functional outcome in the DAO group.</p><p><strong>Conclusions: </strong>The efficacy, safety, and short-term and long-term outcomes of DAO thrombectomy were similar to those of PAO thrombectomy. The good functional outcome predictors of MT in DAO included NIHSS on admission, hybrid technique use, and complete recanalization. Overall, the findings lead us to propose that MT may be considered a feasible option for treating DAO after a careful risk-benefit analysis.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11219071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}