Stroke (Hoboken, N.J.)最新文献

{"title":"Comparison of HEmorrhage on CT versus MRI After ThrombEctomy: The HECATE study.","authors":"Amie W Hsia, Lawrence L Latour, Sana Somani, Carolyn A Lomahan, Yongwoo Kim, John K Lynch, Marie Luby","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The characterization of hemorrhage following acute stroke intervention has largely been CT-based. We sought to compare MRI- and CT-based scoring of hemorrhage after acute endovascular therapy (EVT) applying the Heidelberg Bleeding Classification (HBC) to assess inter-modal agreement and quantify inter-rater agreement.</p><p><strong>Methods: </strong>Consecutive acute stroke patients were included in this retrospective study if they: i) had MRI and CT ≤12 hours of each other OR ii) had CT bracketed by MRI pre- and post-CT [i.e. MRI-CT-MRI] ≤7 days post-EVT. The concordance of the HBC ratings by consensus panel were compared between CT and T2*GRE MRI.</p><p><strong>Results: </strong>For the 87 EVT-treated patients included, median age was 68 years [60-74], admit NIHSS 18 [13-23], 47% were treated with IV/IA thrombolytics, and 93% were successfully recanalized (mTICI 2b/3). Hemorrhage was detected on at least one modality in 60% (52/87) of patients. We found a 68% (59/87, 95% CI [57-77%]) agreement overall between CT and MRI for hemorrhage classification post-EVT. MRI had the best inter-rater agreement for HBC 0 (no hemorrhage) with excellent concordance (κ=0.882), compared to CT (κ=0.683). T2*GRE MRI tended to have increased sensitivity to scattered petechial hemorrhage (HBC 1a) as compared to CT with 17% (2/12) inter-modal agreement. The inter-rater agreement of HBC class 2 (i.e. PH-2) was substantial for MRI (κ=0.781) and excellent in CT (κ=0.951), with 67% (8 /12) inter-modal agreement. SAH was detected in 24% (21/87) of patients on CT and/or MRI with 29% (6/21) inter-modal agreement.</p><p><strong>Conclusions: </strong>With the exception of SAH and minor petechial hemorrhagic transformation, we found that MRI and CT are overall interchangeable for detecting and classifying hemorrhage after endovascular therapy, reassuring findings for both clinical-decision making and research application. Given the complexity of hemorrhage subtypes post-EVT, work to further refine a post-EVT hemorrhage classification scale with clinical correlation would be beneficial.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"4 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review and Meta-Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms.","authors":"Sergio A Pineda-Castillo, Evan R Jones, Keely A Laurence, Lauren R Thoendel, Tanner L Cabaniss, Yan D Zhao, Bradley N Bohnstedt, Chung-Hao Lee","doi":"10.1161/SVIN.123.001118","DOIUrl":"10.1161/SVIN.123.001118","url":null,"abstract":"<p><strong>Background: </strong>Currently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported Raymond-Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow-up occlusion effectiveness for the treatment of unruptured saccular ICAs.</p><p><strong>Methods: </strong>A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and follow-up RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates.</p><p><strong>Results: </strong>A total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The complete occlusion probability (RROC-I) was analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The RROC-I rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The follow-up RROC-I probability was homogenous in all analyzed devices.</p><p><strong>Conclusions: </strong>We observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon-assisted coils. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of follow-up complete occlusion (~18 months). Overall, the GDCs remain the <i>gold standard</i> for endovascular treatment of unruptured saccular aneurysms.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large, Wide-Neck, Side-Wall Aneurysm Treatment in Canines Using NeuroCURE: A Novel Liquid Embolic.","authors":"William C Merritt,&nbsp;Nicholas Norris,&nbsp;Sophia Robertson,&nbsp;Mark C Preul,&nbsp;Andrew F Ducruet,&nbsp;Timothy A Becker","doi":"10.1161/svin.123.000857","DOIUrl":"https://doi.org/10.1161/svin.123.000857","url":null,"abstract":"<p><strong>Background: </strong>Untreated intracranial aneurysms can rupture and result in high rates of morbidity and mortality. Although there are numerous approved endovascular aneurysm treatment devices, most require dual anti-platelet therapy, are minimally biocompatible, or are prone to recanalization. Neurovascular Controlled Uniform Rapid Embolic (NeuroCURE) is an innovative polymer gel material with long-term stability, biocompatibility, and hemocompatibility developed for the treatment of large, wide-neck aneurysms.</p><p><strong>Methods: </strong>Sidewall aneurysms were surgically created in 10 canines and NeuroCURE was injected through a 0.025 microcatheter under a single balloon inflation period. Aneurysm treatment was angiographically assessed post-embolization and pre-term with Raymond-Roy occlusion classification and a qualitative flow grade scale. Aneurysm neck stability and biocompatibility was histologically assessed to grade platelet/fibrin thrombus, percent endothelialization, and neointimal formation. Aneurysm sac stability was assessed by NeuroCURE sac content, inflammation, and neo-angiogenesis scales.</p><p><strong>Results: </strong>Explanted aneurysms exhibited a smooth surface at the aneurysm neck with nearly complete neointimal coverage at 3-months. By 6-months, neck endothelialization was 100% in all animals (average Raymond-Roy occlusion classification of 1.2), with no instances of aneurysm recanalization or parent vessel flow compromise. Biocompatibility assessments verified a lack of inflammatory response, neo-angiogenesis, and platelet/fibrin thrombus formation.</p><p><strong>Conclusion: </strong>The NeuroCURE material promotes progressive occlusion of wide-necked side wall aneurysms over time without the need for dual antiplatelet agents. NeuroCURE also promotes neointimal tissue infill without dependence on thrombus formation and thus resists aneurysm recanalization. NeuroCURE remains a compelling investigational device for the treatment of intracranial aneurysms.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"3 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/69/nihms-1924898.PMC10500583.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Tree","authors":"Batool Rizvi","doi":"10.1161/svin.123.000961","DOIUrl":"https://doi.org/10.1161/svin.123.000961","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49083536","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":"Catching Up With Time: Endovascular Treatment Beyond 24 Hours","authors":"M. Kappelhof, J. Kaesmacher","doi":"10.1161/svin.123.000943","DOIUrl":"https://doi.org/10.1161/svin.123.000943","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45099596","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":"Can Aneurysm Wall Radiomics Help Predict Rupture Risk?","authors":"R. Regenhardt, E. Raz","doi":"10.1161/svin.123.001071","DOIUrl":"https://doi.org/10.1161/svin.123.001071","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47548614","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":"Proceedings of the Seventh Annual CLOTS Meeting: CLOTS 7.0, Madrid, Spain","authors":"Ray McCarthy, F. Clarençon, R. Bourcier, Patrick A. Brouwer, A. Consoli, Karen Doyle, Matthew J. Gounis, W. Hacke, Z. Kulcsár, T. Jovin, Mahmood Mirza, M. Mokin, A. Narata, J. Ospel, A. Rai, Marc Ribó, Nobuyuki Sakai, A. Siddiqui, Teresa Ullberg, Osama O. Zaidat, J. Fiehler, D. Liebeskind","doi":"10.1161/svin.123.000936","DOIUrl":"https://doi.org/10.1161/svin.123.000936","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41598287","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":"Clinical Scales in Aneurysm Rupture Prediction","authors":"S. Sanchez, Jacob M. Miller, E. Samaniego","doi":"10.1161/svin.123.000625","DOIUrl":"https://doi.org/10.1161/svin.123.000625","url":null,"abstract":"The rate of incidentally discovered unruptured intracranial aneurysms has increased with the broad availability of neuroimaging. The determination of the risk of rupture of brain aneurysms is challenging. Several clinical scales for aneurysm rupture prediction have been developed. The most common scales are PHASES, ELAPSS, and UIATS. These scales are not routinely used in clinical practice due to inherent shortcomings. In this review, we analyze the risk factors used in generating these scales and the performance of these scales in clinical studies. We also discuss new potential biomarkers and tools to predict aneurysm rupture.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49072070","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":"Anterior Circulation Thrombectomy in Patients With Low National Institutes of Health Stroke Scale Score: Analysis of the National Inpatient Sample","authors":"Karan Patel, Kamil Taneja, Liqi Shu, Linda Zhang, Yunting Yu, M. Abdalkader, Matthew B. Obusan, S. Yaghi, Thanh N. Nguyen, N. Asdaghi, S. Oak, D. Tonetti, J. Siegler","doi":"10.1161/svin.123.000998","DOIUrl":"https://doi.org/10.1161/svin.123.000998","url":null,"abstract":"\u0000 \u0000 Prior studies have shown benefit for endovascular therapy (EVT) in patients with large‐vessel occlusion and severe deficits, as captured by the National Institutes of Health Stroke Scale. However the benefit of EVT in patients with National Institutes of Health Stroke Scale score <6 is unclear.\u0000 \u0000 \u0000 \u0000 We queried the National Inpatient Sample (2018–2020) for patients with a large‐vessel occlusion of the internal carotid or middle cerebral artery with a National Institutes of Health Stroke Scale score <6, and compared outcomes between patients treated with EVT versus best medical management, using propensity score matching. The primary outcome was routine discharge (home or self‐care). Secondary outcomes were in‐hospital mortality, intracerebral hemorrhage, and length of stay. Primary and secondary outcomes were evaluated using multivariable regression adjusted for baseline characteristics, stroke severity, and treatment with thrombolysis.\u0000 \u0000 \u0000 \u0000 \u0000 Of the 212 515 patients with an internal carotid artery/middle cerebral artery stroke, 49 115 met the inclusion criteria for our study. A total of 8035 patients were treated with EVT, and 41 080 were treated with best medical management. Patients treated with EVT had increased odds of routine discharge (adjusted odds ratio [OR], 1.78 [95% CI, 1.57–2.01];\u0000 P\u0000 <0.001), shorter length of hospital stays (adjusted β, −0.41 [95% CI, −0.63 to −0.19];\u0000 P\u0000 <0.001), and similar rates of death (adjusted OR, 0.70 [95% CI, 0.39–1.24];\u0000 P\u0000 =0.22), compared with patients treated with best medical management. These relationships persisted in the propensity‐matched cohort.\u0000 \u0000 \u0000 \u0000 \u0000 Patients treated with EVT compared with best medical management had greater odds of routine discharge, reduced length of stay, and no differences in intracerebral hemorrhage or early mortality. Our findings suggest potential real‐world benefit for EVT in patients with low National Institutes of Health Stroke Scale scores.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44687817","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":"Time to Reperfusion Is Not Associated With Functional Outcomes in First‐Pass Reperfusion: Analysis of the STRATIS Registry","authors":"N. Manning, A. Hassan, D. Liebeskind, N. Mueller-Kronast, A. Jadhav, R. Nogueira, D. Yavagal, A. Cheung, J. Wenderoth, O. Zaidat","doi":"10.1161/svin.122.000635","DOIUrl":"https://doi.org/10.1161/svin.122.000635","url":null,"abstract":"\u0000 \u0000 Time is considered a fundamental driver of treatment success in ischemic stroke reperfusion therapy. First‐pass reperfusion (FPR) is associated with improved outcomes. We explored the association between time to reperfusion, FPR, and functional outcomes in an analysis of the STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) registry data.\u0000 \u0000 \u0000 \u0000 Registry patients with anterior circulation stroke, treated with endovascular thrombectomy and achieving complete or near‐complete expanded Thrombolysis in Cerebral Infarction scale (eTICI) 2c/3 reperfusion per core laboratory assessment were included. FPR was considered eTICI 2c/3 reperfusion in a single device pass. Patients undergoing multipass reperfusion required ≥2 device passes to achieve the same, total, or near‐total reperfusion (eTICI 2c/3). Logistic regression was used to model functional independence, defined as a modified Rankin scale score of 0 to 2 at 3 months, as a function of time to reperfusion, comparing FPR and multipass reperfusion patient populations.\u0000 \u0000 \u0000 \u0000 \u0000 Of the 984 patients in the STRATIS registry, 563 patients achieved eTICI 2c/3 reperfusion of anterior circulation large‐vessel occlusions and were eligible for inclusion in the analysis. In patients undergoing multipass reperfusion (n=186), increased time to treatment was associated with a decreased likelihood of a good clinical outcome. Odds ratio for every 60‐minute delay to treatment: 0.71 (95% CI, 0.55–0.90;\u0000 P\u0000 =0.005). However, in patients undergoing FPR (n=377), no association between increased time to treatment and good clinical outcomes was observed (odds ratio for every 60‐minute delay to treatment, 0.93 [95% CI, 0.79–1.09];\u0000 P\u0000 =0.347).\u0000 \u0000 \u0000 \u0000 \u0000 First‐pass reperfusion may compensate for the effects of delays to reperfusion on functional outcomes in ischemic stroke.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45940067","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}