Stroke (Hoboken, N.J.)最新文献

{"title":"Number Needing Review: A Novel Metric to Assess Triage Efficiency of Large Vessel Occlusion Detection Systems","authors":"J. Catapano, Katriel E. Lee, S. Desai, India C. Rangel, H. Stonnington, K. Rumalla, C. Rutledge, V. Srinivasan, J. Baranoski, T. Cole, E. Winkler, A. Ducruet, F. Albuquerque, A. Jadhav","doi":"10.1161/svin.122.000527","DOIUrl":"https://doi.org/10.1161/svin.122.000527","url":null,"abstract":"\u0000 \u0000 Endovascular thrombectomy is the gold‐standard treatment for large vessel occlusions (LVOs). A novel metric is introduced: the number needing review (NNR) to assess the triage efficiency of LVO detection systems.\u0000 \u0000 \u0000 \u0000 Patients with suspected ischemic stroke and images processed by RapidAI LVO detection software over 6 months were reviewed. Only patients with LVOs of the M1 segment were included. The NNR was calculated for an M1 occlusion.\u0000 \u0000 \u0000 \u0000 \u0000 Of 559 patients, M1 occlusion was detected in 42 patients (7.5%). RapidAI LVO had a sensitivity of 71%, specificity of 94%, positive predictive value of 49%, and negative predictive value of 92% for M1 occlusion. When gaze deviation and hyperdense sign were combined with RapidAI LVO, the specificity and positive predictive value increased to 100% for an M1 occlusion. A negative RapidAI LVO result combined with a low (<15 mL, T\u0000 max\u0000 >6 seconds) or high (<50 mL, T\u0000 max\u0000 >6 seconds) T\u0000 max\u0000 threshold was found to have a specificity and positive predictive value of 100% for no occlusion. The combination of gaze deviation, hyperdense sign, positive RapidAI LVO, and negative RapidAI LVO with low T\u0000 max\u0000 threshold yielded an NNR of 24 per 100 cases. When combined with a negative RapidAI LVO and a high T\u0000 max\u0000 threshold, the NNR was 16 per 100 cases. Adding National Institutes of Health Stroke Scale score <7 decreased the NNR to 9 per 100 cases.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Adding gaze deviation and hyperdense sign to the RapidAI LVO increases the specificity and positive predictive value for an M1 occlusion. When combined with a negative RapidAI LVO detection and either a low or high T\u0000 max\u0000 >6 seconds threshold, the NNR is significantly reduced.\u0000 \u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48981893","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":"Transferring Patients From a Primary Stroke Center to Higher Levels of Care: A Qualitative Study of Stroke Coordinators’ Experiences","authors":"Jennifer L. Patterson, Wendy Dusenbury, A. Stanfill, B. Brewer, A. Alexandrov, A. Alexandrov","doi":"10.1161/svin.122.000678","DOIUrl":"https://doi.org/10.1161/svin.122.000678","url":null,"abstract":"\u0000 \u0000 Transfer times from primary stroke centers and acute stroke–ready hospitals to higher levels of care are often excessive, prompting some to suggest ambulance bypass regulations. Since barriers to rapid transfer have never been fully explored, we sought to understand stroke coordinators’ experiences with transfer of patients with hyperacute stroke from lower to higher levels of stroke centers.\u0000 \u0000 \u0000 \u0000 We conducted a national focus group study with primary stroke center stroke coordinators who had recent experience overseeing transfer of a patient with hyperacute stroke to a higher‐level stroke center. Interviews were conducted using prescripted open‐ended questions; information was recorded and data were transcribed for theme identification.\u0000 \u0000 \u0000 \u0000 A total of 23 stroke coordinators participated representing the Northeast, Mid‐Atlantic, Southeast, Midwest, and Western United States. Findings were grouped into 3 main categories: Internal Primary Stroke Center Factors, Transport Factors, and External Comprehensive Stroke Center Factors. Within the primary stroke center group, themes slowing transfer were exclusively physician based, whereas themes emerging from the transport category were associated with poor transport company processes. Within the comprehensive stroke center category, themes were all associated with complex hospital processes and communication.\u0000 \u0000 \u0000 \u0000 Important contributors to efficient transfer of patients with hyperacute stroke are beyond the control of stroke coordinators, requiring cross‐system collaboration and improved administrative management to resolve. Quantification of these factors is warranted to support transfer system redesign for rapid access to care for patients with stroke.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48843227","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":"Association of White Matter Disease With Functional Recovery and 90‐Day Outcome After EVT: Beyond Chronological Age","authors":"F. Benali, J. Fladt, T. Jaroenngarmsamer, F. Bala, N. Singh, I. Alhabli, J. Ospel, M. Tymianski, Michael D. Hill, M. Goyal, A. Ganesh","doi":"10.1161/svin.122.000734","DOIUrl":"https://doi.org/10.1161/svin.122.000734","url":null,"abstract":"\u0000 \u0000 Patients with white matter disease (WMD) – a key marker of cerebral small vessel disease – may have less brain reserve to cope with ischemic injury. The relationship of WMD to functional recovery after endovascular thrombectomy is uncertain. We aim to explore the association between WMD and functional outcome, assessed at multiple time‐points postendovascular thrombectomy.\u0000 \u0000 \u0000 \u0000 In this post hoc analysis, we analyzed noncontrast computed tomography‐imaging from the ESCAPE‐NA1 (Safety and Efficacy of Nerinetide [NA‐1] in Subjects Undergoing Endovascular Thrombectomy for Stroke) trial and assessed WMD by using the total Fazekas‐score (score range: 0–6). The primary outcome was repeated measurements of the modified Rankin scale (mRS) scores (i.e., day‐5/discharge, day‐30, and day‐90). Secondary outcome measures were the ordinal‐mRS at 90‐days, 90‐day‐mRS0–2, and 90‐day‐mortality. Mixed‐linear and binary/ordinal logistic regressions were performed, adjusting for age, sex, baseline National Institutes of Health Stroke Scale, cortical atrophy, chronic infarctions, stroke laterality, follow‐up infarct volume, and alteplase–nerinetide interaction. Sensitivity analyses were done including only those patients for whom magnetic resonance imaging was available.\u0000 \u0000 \u0000 \u0000 \u0000 We included 1102 patients with noncontrast computed tomography (median age 71, interquartile range: 61–80; median National Institutes of Health Stroke Scale 17, interquartile range: 12–21). The median total Fazekas‐score was 1(interquartile range: 0–2). Out of 1202 patients, 566 had follow‐up magnetic resonance imaging. We observed heterogeneity in functional recovery with varying degrees of WMD‐burden (\u0000 P\u0000 <0.001). Patients with Fazekas=3–6 fared worse at every time‐point after endovascular thrombectomy, compared with patients with Fazekas=0–1. At 30‐days, the adjusted difference of the mean mRS=0.47; 95% CI, 0.22–0.72 and at 90‐days: adjusted difference=0.60 (95% CI, 0.36–0.85). Higher WMD‐burdens were also associated with worse 90‐day mRS (adjusted common odds ratio for Fazekas=3–6 versus 0–1: 1.42; 95% CI, 1.03–1.96). Similar results were found in magnetic resonance imaging‐only sensitivity analyses.\u0000 \u0000 \u0000 \u0000 \u0000 Patients with more WMD showed worse functional recovery after endovascular thrombectomy, compared with patients without WMD, even after adjusting for age and chronic disease markers like atrophy and chronic infarctions. These data may further help inform treatment expectations and recovery‐related planning, by using simple visual ratings on routinely acquired noncontrast computed tomography.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45587396","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":"Four‐Year Follow‐Up on the First‐in‐Human Experience With Nautilus Intrasaccular System Assisted Coiling for Unruptured Intracranial Aneurysms","authors":"N. Sakai, Shuhei Kawabata, Takayuki Funatsu, Tomohiro Okuda, R. Akiyama, Mikiya Beppu, Y. Matsui, Hiromasa Adachi, K. Horiuchi, H. Imamura, C. Sakai, S. Tani, H. Adachi, N. Sasaki, Soji Tokunaga, R. Fukumitsu, T. Shigematsu","doi":"10.1161/svin.122.000770","DOIUrl":"https://doi.org/10.1161/svin.122.000770","url":null,"abstract":"\u0000 \u0000 The authors present the long‐term (4 year) results of a first‐in‐man, single‐center case series with the Nautilus Intrasaccular System for the embolization of wide‐neck intracranial aneurysms.\u0000 \u0000 \u0000 \u0000 From February 2018 to July 2018, the authors enrolled 5 patients into a first‐in‐human study of the Nautilus device. After treatment, patients underwent 6 months with digital subtraction angiography and 3 years with magnetic resonance angiography according to institutional standard of care. Occlusion rates were core‐laboratory adjudicated for the digital subtraction angiography and independently assessed by a neurointerventionalist not part of the care team for the magnetic resonance angiography. Neurological outcome (modified Ranking scale score) was evaluated at 24 hours, 7 days, 6 months, and 1, 2, 3, and 4 years, and adverse events were collected during the first 6 months post treatment.\u0000 \u0000 \u0000 \u0000 Five patients with unruptured, wide‐necked aneurysms were treated and followed up for 4 years. Aneurysm locations included basilar bifurcation (2 of 5), internal carotid artery terminus (1 of 5), superior cerebellar artery (1 of 5), and the anterior communicating artery (1 of 5). The average aneurysm size was 7.6 mm and the average neck diameter was 5.2 mm. Immediate complete and near‐complete occlusion (Raymond–Roy classification class I and II) was achieved in 80% (4 of 5) of the aneurysms. Occlusion results improved at 6 months and remained stable at 3 years, without retreatment (Raymond–Roy classification class I 80%, class I and II 100%). All patients maintained good neurological outcome at all follow‐ups (modified Ranking scale 0).\u0000 \u0000 \u0000 \u0000 This initial clinical experience provides early evidence of the long‐term safety and effectiveness of the new intrasaccular neck bridging device, Nautilus. The Nautilus appears to add a simple, safe, and effective option and solution to the coil embolization of the wide‐neck aneurysm.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42134919","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":"Association of Time Course of Thrombectomy and Outcomes for Large Acute Ischemic Region: RESCUE-Japan LIMIT Sub-Analysis","authors":"H. Ishihara, Takuma Nishimoto, M. Shimokawa, F. Oka, N. Sakai, H. Yamagami, K. Toyoda, Y. Matsumaru, Y. Matsumoto, K. Kimura, R. Ishikura, M. Inoue, K. Uchida, Fumihiro Sakakibara, T. Morimoto, S. Yoshimura","doi":"10.1101/2023.03.15.23287338","DOIUrl":"https://doi.org/10.1101/2023.03.15.23287338","url":null,"abstract":"Background: The effectiveness of endovascular thrombectomy (EVT) has been proven even in patients with large cerebral infarction in early time window. However, the association of the time course with the treatment effect is unknown. The aim of this analysis was to evaluate the influence of the time course from stroke onset to reperfusion on the therapeutic effect of EVT.Methods: The subjects were patients with occlusion of large vessels and sizable strokes on imaging (ASPECTS 3 to 5) in RESCUE-Japan LIMIT (a multicenter, randomized clinical open-label trial of EVT vs. medical care alone). In the current analysis, the clinical and time course characteristics associated with a favorable outcome (modified Rankin Scale (mRS) 0-2 and 0-3 at 90 days) were examined in patients treated with EVT. Results: The analysis included 71 patients (median age, 77 years; median NIHSS score on admission, 21). Occlusion sites were the internal carotid artery (48%), M1 segment of the middle cerebral artery (72%) and tandem lesions (20%). Of these patients, 23 (32%) had mRS 0-3 and 12 (17%) had mRS 0-2 at 90 days. In multivariate analysis, there were independent associations of onset to reperfusion time (OR, 0.991; 95% CI, 0.984-0.999, P = 0.01) and puncture to reperfusion time (OR, 0.952; 95% CI, 0.917-0.988, P < 0.001) with mRS 0-3 at 90 days, and of puncture to reperfusion time (OR, 0.930; 95% CI, 0.872-0.991, P = 0.004) with mRS 0-2 at 90 days. Conclusions: Earlier reperfusion was related to a favorable outcome in patients with acute large vessel occlusion with a large ischemic region. Onset to reperfusion time and especially puncture to reperfusion time were independently associated with a favorable outcome. These results suggest the importance of timing and uninterrupted EVT in this patient population.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47623583","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":"Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry","authors":"K. Limaye, Andrew B. Koo, A. Havenon, S. A. Kasab, B. Bohnstedt, I. Maier, M. Psychogios, S. Wolfe, A. Arthur, Peter T Kan, Joon-Tae Kim, R. Leacy, J. Osbun, A. Rai, P. Jabbour, M. Park, R. Crosa, J. Mascitelli, M. Levitt, A. Polifka, W. Casagrande, S. Yoshimura, R. Williamson, B. Gory, M. Mokin, Isabel Fragata, D. Romano, S. Chowdry, A. Shaban, M. Moss, D. Behme, A. Spiotta, C. Matouk","doi":"10.1161/svin.122.000664","DOIUrl":"https://doi.org/10.1161/svin.122.000664","url":null,"abstract":"\u0000 \u0000 Mechanical thrombectomy of middle cerebral artery M2 segment occlusion of the middle cerebral artery has reported safety and efficacy in recent post‐hoc and observational studies. However, there is no known benefit of mechanical thrombectomy for patients with M2 segment occlusions in the delayed time window (>6 hours).\u0000 \u0000 \u0000 \u0000 The Stroke Thrombectomy and Aneurysm Registry (STAR) is a prospective, multicenter, nonrandomized observational study registry for acute ischemic stroke thrombectomy and aneurysm treatment. We analyzed all patients who underwent mechanical thrombectomy within the late time window (>6 hours from symptom onset) involving isolated M2 occlusions. We used propensity score matching to select a comparison group of patients who underwent mechanical thrombectomy for M1 occlusion in the same time window.\u0000 \u0000 \u0000 \u0000 \u0000 Of 1083 consecutive patients analyzed, propensity matching yielded 180 well matched M1 and M2 pairs. Baseline demographics were well balanced between the groups (M1 and M2). Alberta stroke program early CT score (7.6±1.7 versus 8.3±1.5;\u0000 P\u0000 <0.001) was higher in the M2 group. There was a trend towards less complete recanalization (Thrombolysis in Cerebral Infarction 3) 46.1% versus 39.9% (\u0000 P\u0000 =0.053) in the middle cerebral artery M2 segment cohort. However, successful recanalization (Thrombolysis in Cerebral Infarction 2b‐3) was better in middle cerebral artery M2 segment cohort (85% versus 90.5%;\u0000 P\u0000 =0.053). Postprocedural asymptomatic hemorrhage rates were similar (29.4% versus 27.8%;\u0000 P\u0000 =0.816), but symptomatic hemorrhage rates were higher in the M1 group (7.2% versus 2.2%;\u0000 P\u0000 =0.047). Rates of good clinical outcome (modified Rankin scale 0–2) were similar at final follow‐up (43.9% versus 46.7%;\u0000 P\u0000 =0.672). The overall mortality was also similar between the cohorts (12.8% versus 13.9%;\u0000 P\u0000 =0.877).\u0000 \u0000 \u0000 \u0000 \u0000 In our analysis of the Stroke Thrombectomy and Aneurysm Registry, M2 occlusions not only achieved similar rates of recanalization and good functional outcome compared with M1 occlusions in a delayed time window (6–24 hours from last normal) but also had less symptomatic intracranial hemorrhage.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64515560","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":"Computational Fluid Dynamics in Intracranial Atherosclerotic Disease","authors":"A. Ballout, Grace Prochilo, N. Kaneko, Chuanlong Li, Ryan Apfel, J. Hinman, D. Liebeskind","doi":"10.1161/svin.122.000792","DOIUrl":"https://doi.org/10.1161/svin.122.000792","url":null,"abstract":"Recurrent stroke risk in intracranial atherosclerotic disease remains high despite aggressive medical therapy. While hemodynamic insufficiency appears to be a strong marker of stroke recurrence, natural history studies using various unimodal imaging modalities have shown mixed results, as they likely do not adequately capture the complex local hemodynamic environment generated by a focal stenosis. Computational fluid dynamics, a multimodal tool used to simulate fluid flow and the interactions between fluids and surfaces, has recently been used to illustrate the complex hemodynamic environment surrounding intracranial atherosclerotic lesions and to risk‐stratify patients on the basis of simulated outputs. We aimed to summarize the literature pertaining to computational fluid dynamics use in intracranial atherosclerotic disease and to describe its future potential use in generating more targeted therapies.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46603445","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":"Imaging Cerebral Arteries Tortuosity and Velocities by Transcranial Doppler Ultrasound Is a Reliable Assessment of Brain Aneurysm in Mouse Models.","authors":"Héloïse Lebas,&nbsp;Alexandre Boutigny,&nbsp;Clémence Maupu,&nbsp;Jonas Salfati,&nbsp;Cyrille Orset,&nbsp;Mikael Mazighi,&nbsp;Philippe Bonnin,&nbsp;Yacine Boulaftali","doi":"10.1161/SVIN.122.000476","DOIUrl":"https://doi.org/10.1161/SVIN.122.000476","url":null,"abstract":"<p><strong>Background: </strong>During the past few decades, several pathophysiological processes contributing to intracranial aneurysm (IA) rupture have been identified, including irregular IA shape, altered hemodynamic stress within the IA, and vessel wall inflammation. The use of preclinical models of IA and imaging tools is paramount to better understand the underlying disease mechanisms.</p><p><strong>Methods: </strong>We used 2 established mouse models of IA, and we analyzed the progression of the IA by magnetic resonance imaging, transcranial Doppler, and histology.</p><p><strong>Results: </strong>In both models of IA, we observed, by transcranial Doppler, a significant decrease of the blood velocities and wall shear stress of the internal carotid arteries. We also observed the formation of tortuous arteries in both models that were correlated with the presence of an aneurysm as confirmed by magnetic resonance imaging and histology. A high grade of tortuosity is associated with a significant decrease of the mean blood flow velocities and a greater artery dilation.</p><p><strong>Conclusions: </strong>Transcranial Doppler is a robust and convenient imaging method to evaluate the progression of IA. Detection of decreased blood flow velocities and increased tortuosity can be used as reliable indicators of IA.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"3 2","pages":"e000476"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/a8/SVI2-3-e000476.PMC10368188.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9879707","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":"Abstract Number ‐ 156: Transradial versus Transfemoral Access for Mechanical Thrombectomy: A Meta‐Analysis of Nine Studies (2,161 Patients)","authors":"Mohamed Elfil, M. F. Doheim, Hazem S. Ghaith, M. Salem, P. Aboutaleb, M. Aladawi, F. Al‐Mufti, R. Nogueira","doi":"10.1161/svin.03.suppl_1.156","DOIUrl":"https://doi.org/10.1161/svin.03.suppl_1.156","url":null,"abstract":"\u0000 \u0000 Previous studies have compared the transradial access (TRA) with the transfemoral access (TFA) in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We conducted this meta‐analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of the TRA versus the TFA in AIS patients undergoing MT.\u0000 \u0000 \u0000 \u0000 We performed a comprehensive literature search of four electronic databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL) from inception until 1 May 2022. All duplicates were removed, and all references of the included studies were screened manually for any eligible studies. The full‐text articles of eligible abstracts were retrieved and screened for continued eligibility. Relevant data were extracted and then analyzed. For outcomes that constitute continuous data, the mean difference (MD) between the two groups and its standard deviation (SD) were pooled. For outcomes that constitute dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the two groups.\u0000 \u0000 \u0000 \u0000 Nine studies were included in this meta‐analysis, all of which were observational studies. The population of the studies was homogenous comprising a total of 2,161 patients who underwent MT, including 446 in the TRA group and 1,715 in the TFA group. There were no significant differences across the two groups in terms of successful recanalization (Thrombolysis in cerebral Infarction [TICI] score of 2b‐3: OR 0.83, 95% CI [0.55 to 1.25], P = 0.36) (Figure 1, A), complete recanalization (TICI 3: OR 1.16, 95% CI [0.50 to 2.68], P = 0.73), favorable functional outcome (90‐day modified Rankin scale [mRS] score of 0–2 (OR 0.86, 95% CI [0.53 to 1.41], P = 0.56), first‐pass reperfusion (OR 0.88, 95% CI [0.64 to 1.19], P = 0.41), number of passes (MD 0.12, 95% CI [‐0.18 to 0.42], P = 0.43) (Figure 1, B), access‐to‐reperfusion time (MD ‐3.92 minutes, 95% CI [‐9.49 to 1.65], P = 0.17), the amount of contrast used (MD 5.03 mL, 95% CI [‐20.27 to 30.33], P = 0.70), or symptomatic intracranial hemorrhage (OR 0.86, 95% CI [0.47 to 1.57], P = 0.62). However, access‐site complications were significantly less frequent in the TRA group as compared to the TFA group (OR 0.18, 95% CI [0.06 to 0.51], P = 0.001) (Finger 1, C).\u0000 \u0000 \u0000 \u0000 In patients undergoing MT for AIS, the collective evidence suggests that the TRA seems to result in lower rates of access‐site complications than the TFA without any significant compromise in other clinical or procedural metrics. Large prospective studies are warranted.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42546973","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":"Abstract Number ‐ 53: Endovascular therapy versus medical management for mild strokes due to medium and distal vessel occlusions","authors":"S. Nedelcu, N. Henninger","doi":"10.1161/svin.03.suppl_1.053","DOIUrl":"https://doi.org/10.1161/svin.03.suppl_1.053","url":null,"abstract":"\u0000 \u0000 Distal and medium vessel occlusion (DMVO) strokes account for 25–40% of all acute ischemic strokes1 and are associated with long‐term disability in as many as 77% of patients2. Approximately one third of DMVO stroke patients have a low National Institute of Stroke Scale (NIHSS) (≤6)3. Multiple randomized controlled trials showed superiority of endovascular therapy (EVT) over best medical management (BMT) in patients presenting with proximal LVO involving the anterior circulation and NIHSS of &gt;64. The efficacy and safety of EVT for DMVO patients is uncertain, especially in patients with low NIHSS. A better understanding of this issue is important because many patients with DMVO and low NIHSS scores suffer disabling deficits while procedural risk are increased due to the target vessels’ small caliber, tortuosity, and thinner walls. We conducted a retrospective single center study to compare clinical and safety outcomes of DMVO patients with NIHSS ≤ 6 that were treated with EVT versus BMT.\u0000 \u0000 \u0000 \u0000 We retrospectively analyzed consecutive patients with acute mild (NIHSS ≤ 6) DMVO stroke that presented between January 2018 and December 2021. We defined DMVO stroke as stroke caused by an occlusion of the M2‐4 segments of the MCA, A2‐3 segments of the ACA, P1‐2 segments of the PCA. Outcomes of interest were the NIHSS at day one and at discharge, the change in NIHSS from admission to discharge (ΔNIHSS) and the mRS at 90‐days. Safety outcomes were clinical deterioration, defined as an increase in the NIHSS by 4 or more points and the occurrence of symptomatic intracranial hemorrhage (sICH), defined as any type of ICH causing an increase in the NIHSS by 4 or more points.\u0000 \u0000 \u0000 \u0000 Overall, we included 80 subjects that fulfilled our study criteria. Of these, 41 were treated with BMT and 39 were selected to undergo EVT. Clinical characteristics of subjects selected for BMT versus EVT were overall similar except for more frequent diabetes (p = 0.035) and antiplatelet use (p = 0.045) as well as less frequent anticoagulation (p = 0.019) in the BMT group. Moreover, subjects selected for EVT had a lower pre‐stroke mRS (p = 0.025) and a lower ASPECT score on the admission head CT (p = 0.044). Overall, there was no statistical difference between NIHSS at day 1 (p = 0.654), NIHSS at discharge (p = 0.244), and ΔNIHSS from Day 0 to Day 1 (p = 0.08). There was further no difference in the discharge (p = 0.895) and 3‐month (p = 0.957) mRS between groups. Regarding safety outcomes, there was no difference in the number of all types of ICHs combined between the two groups (p = 0.229) and there was no difference in the number of patients who had clinical deterioration (p = 0.258).\u0000 \u0000 \u0000 \u0000 Our analysis shows that in patients who present with mild DMVO strokes, early and 3‐month clinical outcomes were comparable between EVT and BMT groups. Moreover, risk of intracranial hemorrhage, clinical deterioration, and death were similar between groups. Nevertheless, given the low numbe","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42665264","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}