Stroke (Hoboken, N.J.)最新文献

{"title":"Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: Systematic Review and Meta‐analysis","authors":"A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Galecio-Castillo, J. Sequeiros, Cynthia B. Zevallos, M. Farooqui, F. Siddiqui, S. Ortega‐Gutierrez","doi":"10.1161/svin.123.000881","DOIUrl":"https://doi.org/10.1161/svin.123.000881","url":null,"abstract":"\u0000 \u0000 When mechanical thrombectomy (MT) fails to achieve successful reperfusion, rescue stenting (RS) has proven to be a feasible rescue therapy. However, the available evidence remains underpowered to assess clinical outcomes. We aimed to compare the safety and efficacy of RS versus routine medical management in patients with failed MT using an aggregated meta‐analysis.\u0000 \u0000 \u0000 \u0000 A systematic review was performed from inception to July 2022 of all studies using RS after failed MT. Outcomes of interest included a modified Rankin scale score of 0–2 at 90 days, successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3) after RS and symptomatic intracranial hemorrhage. A random‐effects meta‐analysis between the RS and medical treatment arms was performed to calculate pooled odds ratios (OR) for each outcome. We assessed the certainty of evidence using the Grading of Recommendation, Assessment, Development, and Evaluation approach. Statistical heterogeneity across studies was assessed with I2 statistics.\u0000 \u0000 \u0000 \u0000 A total of 12 studies included 1855 participants, 729 in the RS arm and 1126 in the medical treatment arm. The pooled results indicated that RS was associated with a significantly higher proportion of patients with a modified Rankin scale score of 0–2 at 90 days (RS: 41% versus 21%; OR,3.27; [95% CI 2.08–5.16]; I2=64%; moderate‐certainty evidence) and a decreased risk of mortality at 90 days (RS: 22.5% versus 33.8%; OR, 0.47; [95% CI 0.32–0.69]; I2=45%; low‐certainty evidence), compared with medical treatment after failed MT. The pooled rate of successful reperfusion after RS was 87% (95% CI 82–91; I2=57%; low‐certainty evidence). The rate of symptomatic intracranial hemorrhage did not differ between groups (RS: 8.5% versus 11.7%; OR, 0.85; [95% CI 0.59–1.20]; I2=7%; low‐certainty evidence).\u0000 \u0000 \u0000 \u0000 RS is a promising strategy for maximizing recovery in acute stroke patients after first line MT fails to achieve meaningful reperfusion. However, randomized trials using a standardized approach/technique and MT failure definition are warranted to confirm these results.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47578802","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":"Long term stability of patients undergoing endovascular parent artery occlusion of their intracranial artery","authors":"Satoshi Koizumi, M. Shojima, T. Ota, Shogo Dofuku, S. Miyawaki, S. Kiyofuji, K. Maeda, Takashi Ochi, Akihiro Ito, Yukihiro Hidaka, S. Oya, Akira Saito, Gakushi Yoshikawa, Kei Yanai, Tomohiro Inoue, Sho Tsunoda, K. Hoya, Nobuhito Saito","doi":"10.1101/2023.05.06.23289239","DOIUrl":"https://doi.org/10.1101/2023.05.06.23289239","url":null,"abstract":"Background: Although endovascular parent artery occlusion (PAO) of the intracranial artery is a well-established treatment option, the long-term stability of cerebral blood flow remains a concern. This study aimed to evaluate the long-term clinical and radiological outcomes of patients who underwent PAO. Methods: The patients who underwent endovascular PAO of their internal carotid or vertebral artery (VA) between April 2011 and March 2022 were included in this observational study. Information about patient characteristics, details of the endovascular treatment, and clinical and radiological follow-up were collected. Results: The study included a total of 104 cases (average age 52.9{+/-}12.6 years old, male 73 (70.2%) cases, 95 (91.3%) VA PAO cases) from eight centers. Most cases were performed in an emergency condition, such as ruptured vertebral artery dissecting aneurysm (73 cases [70.2%]). PAO was successful in all cases. Early stroke (within 30 days) occurred in 33 (31.7%) cases (31 cases in VA PAO and two cases in internal carotid PAO) with ischemic stroke (29 cases) comprising the largest group. Clinical follow-up over 12 months was available in 78 cases. During an average follow-up period of 49.5 {+/-} 24.3 months, one case in VA PAO experienced a stroke without functional deterioration. Imaging follow-up was performed in 73 cases. Recanalization of the occluded VA was observed in two cases. The remaining image change was contralateral VA stenosis after VA PAO. The incidence of clinical and radiological events was 0.95 and 1.1% per patient-year, respectively. Conclusions: Once the patients surpass the acute phase after PAO, their mid-to-long term course was stable. The risk of late stroke or de novo aneurysm formation was lower than expected in the literature, and the direct comparison to novel reconstructive techniques is warranted in future studies. Registration: https://www.umin.ac.jp/ctr/index.html, trial ID: UMIN000045160","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46992371","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":"In Situ Measurement of Vascular Resistance to Evaluate Cerebral Microcirculation","authors":"Y. Chau, E. Lammens, S. Lachaud, J. Sédat","doi":"10.1161/svin.123.000870","DOIUrl":"https://doi.org/10.1161/svin.123.000870","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48876467","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":"Two‐Piece Craniotomy Is Associated With Improved Postoperative Outcomes of Combined Revascularization in Patients With Moyamoya Disease","authors":"Fumiaki Kanamori, Syuntaro Takasu, N. Hatano, Yoshio Araki, Y. Seki, R. Saito","doi":"10.1161/svin.122.000759","DOIUrl":"https://doi.org/10.1161/svin.122.000759","url":null,"abstract":"\u0000 \u0000 Revascularization for both anterior cerebral artery (ACA) and middle cerebral artery (MCA) territories in patients with moyamoya disease is often performed in a single operation. The influence of craniotomy type on postoperative outcomes has not been investigated. This study aimed to clarify the effects of craniotomy type on acute postoperative outcomes after combined revascularization by comparing 2‐piece, and large 1‐piece craniotomy approaches.\u0000 \u0000 \u0000 \u0000 This retrospective study included 337 consecutive combined revascularizations of the ACA and MCA territories in patients with moyamoya disease. Surgeries were classified into 2‐piece and large 1‐piece craniotomy groups. For indirect bypass, the following methods were used: (1) large 1‐piece craniotomy and encephalo‐myo‐galeo‐periosteal‐synangiosis for the MCA and ACA territories; (2) 2‐piece craniotomy and encephalo‐myo‐synangiosis for the MCA territory and encephalo‐periosteal‐synangiosis for the ACA territory. Acute postoperative outcomes were compared between the groups.\u0000 \u0000 \u0000 \u0000 \u0000 Two‐piece and large 1‐piece craniotomies were performed in 230 and 107 patients, respectively. The incidence of radiological and symptomatic infarction tended to be lower in the 2‐piece craniotomy group than that in the large 1‐piece craniotomy group (3.9% versus 11.2%;\u0000 P\u0000 =0.014, and 2.6% versus 6.5%;\u0000 P\u0000 =0.12, respectively). Logistic regression adjusted for potential confounders further explained the relationship between craniotomy type and radiological infarction (large 1‐piece/2‐piece craniotomy: odds ratio, 3.1; 95% CI, 1.2–7.6;\u0000 P\u0000 =0.015).\u0000 \u0000 \u0000 \u0000 \u0000 In combined revascularization of the ACA and MCA territories in moyamoya disease, 2‐piece craniotomy may reduce the risk of postoperative cerebral infarction.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46822693","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":"Intraarterial Transplantation of Mitochondria After Ischemic Stroke Reduces Cerebral Infarction.","authors":"Pedro Norat, Jennifer D Sokolowski, Catherine M Gorick, Sauson Soldozy, Jeyan S Kumar, Youngrok Chae, Kaan Yagmurlu, Joelle Nilak, Khadijeh A Sharifi, Melanie Walker, Michael R Levitt, Alexander L Klibanov, Zhen Yan, Richard J Price, Petr Tvrdik, M Yashar S Kalani","doi":"10.1161/svin.122.000644","DOIUrl":"10.1161/svin.122.000644","url":null,"abstract":"<p><strong>Background-: </strong>Transplantation of autologous mitochondria into ischemic tissue may mitigate injury caused by ischemia and reperfusion.</p><p><strong>Methods-: </strong>Using murine stroke models of middle cerebral artery occlusion, we sought to evaluate feasibility of delivery of viable mitochondria to ischemic brain parenchyma. We evaluated the effects of concurrent focused ultrasound activation of microbubbles, which serves to open the blood-brain barrier, on efficacy of delivery of mitochondria.</p><p><strong>Results-: </strong>Following intra-arterial delivery, mitochondria distribute through the stroked hemisphere and integrate into neural and glial cells in the brain parenchyma. Consistent with functional integration in the ischemic tissue, the transplanted mitochondria elevate concentration of adenosine triphosphate in the stroked hemisphere, reduce infarct volume and increase cell viability. Additional of focused ultrasound leads to improved blood brain barrier opening without hemorrhagic complications.</p><p><strong>Conclusions-: </strong>Our results have implications for the development of interventional strategies after ischemic stroke and suggest a novel potential modality of therapy after mechanical thrombectomy.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"3 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9950485","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":"Man vs Machine: Predicting First‐Pass Recanalization After Endovascular Thrombectomy","authors":"A. Garg, E. Samaniego","doi":"10.1161/svin.123.000836","DOIUrl":"https://doi.org/10.1161/svin.123.000836","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43151670","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":"Thrombectomy in Patients With Active Malignancy","authors":"J. Siegler, Thanh N. Nguyen","doi":"10.1161/svin.123.000835","DOIUrl":"https://doi.org/10.1161/svin.123.000835","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44464838","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":"Dissection Dilemma: Risk Stratification and Antithrombotic Selection","authors":"Mary Penckofer, J. Siegler","doi":"10.1161/svin.123.000841","DOIUrl":"https://doi.org/10.1161/svin.123.000841","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48150194","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":"On the Cover Submission","authors":"S. Sanchez","doi":"10.1161/svin.122.000691","DOIUrl":"https://doi.org/10.1161/svin.122.000691","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64515641","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":"Prediction of 90‐Day Home Time Among Patients With Medium‐Vessel Occlusion Undergoing Endovascular Thrombectomy","authors":"N. Singh, F. Bala, N. Kashani, M. Horn, J. Stang, A. Demchuk, Michael D. Hill, M. Almekhlafi, J. Holodinsky","doi":"10.1161/svin.122.000748","DOIUrl":"https://doi.org/10.1161/svin.122.000748","url":null,"abstract":"\u0000 \u0000 The benefit of endovascular thrombectomy for medium‐vessel occlusion (MeVO) strokes is unclear. We used 90‐day home time to explore outcomes in patients with MeVO versus large‐vessel occlusions treated with endovascular thrombectomy.\u0000 \u0000 \u0000 \u0000 Data are from the QuICR (Quality Improvement and Clinical Research) provincial stroke registry and linked administrative data to identify patients who underwent endovascular thrombectomy in our center from January 2015 to December 2020. Imaging data were scored by 2‐physician consensus. We defined MeVO as occlusion beyond and including M2–middle cerebral artery, A2–anterior cerebral artery, or P2–posterior cerebral artery segments. Successful reperfusion was defined as Thrombolysis in Cerebral ischemia grades (≥2b/3). The primary outcome was patient home time (the number of nights a patient is back at their premorbid living situation without an increase in level of care within 90 days of the stroke) using random forest regression. Covariate contribution to home time was determined using partial dependence plots.\u0000 \u0000 \u0000 \u0000 Among 663 patients who underwent endovascular thrombectomy, 139 (20.9%) had MeVO (median age, 71 years; 50.4% women; median National Institutes of Health Stroke Scale, 16). The majority (82%) had good pial collaterals, 10.4% had a tandem extracranial carotid occlusion or stenosis, and 41.7% received intravenous thrombolysis. The most common site of occlusion was M2–middle cerebral artery (58.3%). One hundred eighteen (86.7%) patients achieved successful reperfusion (Thrombolysis in Cerebral Ischemia grades ≥2b/3). Using partial dependence plots, the mean predicted home times were similar in patients with MeVO (45.5 days) versus large‐vessel occlusions (44.6 days). Factors predicting lower 90‐day home time in patients with MeVOs were diabetes (−8.7 days), hypertension (−6.5 days), and atrial fibrillation (−3.5 days). There was no meaningful difference in predicted 90‐day home‐time by sex, baseline National Institutes of Health Stroke Scale, collateral grade, or thrombolysis.\u0000 \u0000 \u0000 \u0000 Patients with MeVO who are selected for endovascular therapy with similar demographic and clinical profiles to large‐vessel occlusions can achieve similar 90‐day home time outcomes to large‐vessel occlusions.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47739786","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}