Displaying One Session

Rapid Communications
Session Type
Rapid Communications
Room
Hall L2
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:00 PM

ENDOVASCULAR TREATMENT OF PEDIATRIC STROKE – DOES DEVICE SELECTION IMPACT RECANALIZATION RATE AND NEUROLOGICAL OUTCOME?

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:00 PM
Room
Hall L2
Lecture Time
03:20 PM - 03:25 PM

Abstract

Group Name

SaveChildS Investigators

Background And Aims

The recent Save ChildS study provides multicenter evidence for the use of mechanical thrombectomy in children with large vessel occlusion arterial ischemic stroke. However, device selection for thrombectomy may influence rates of recanalization, complications and neurological outcomes in pediatric patients of different ages.

Methods

The Save ChildS cohort study (01/2000–12/2018) analyzed data from 27 European and United States stroke centers and included all pediatric patients (<18 years), diagnosed with AIS who underwent endovascular recanalization. Patients were grouped into first-line contact aspiration (ADAPT) and non-ADAPT groups as well as different stent retriever size groups. Associations with baseline characteristics, recanalization rates (mTICI), complication rates and neurological outcome parameters (PedNIHSS after 24 hours and 7 days; mRS and PSOM at discharge, after 6 and 24 months) were investigated.

Results

73 patients with a median age of 11.3 years were included. Currently available stent retrievers were used in 59 patients (80.8%) of which 4 x 20 mm (width x length) was the most frequently chosen size (36 patients = 61%). A first-line ADAPT approach was used in 7 patients (9.6%) and 7 patients (9.6%) were treated with first-generation thrombectomy devices. In this study, a first-line ADAPT approach was neither associated with the rate of successful recanalization (ADAPT 85.7% versus 87.5% No ADAPT), nor with the complication rate or the neurological outcome.

Conclusions

Our study suggests that neurological outcomes are generally good regardless of any specific device selection and suggests that it is important to offer thrombectomy in eligible children regardless of technique or device selection.

Trial Registration Number

German Clinical Trials Register (DRKS00016528).

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SAFETY AND EFFICACY OF LOW-DOSE TIROFIBAN AFTER FAILED OR INCOMPLETE MECHANICAL THROMBECTOMY FOR PATIENTS WITH IN SITU THROMBO-OCCLUSIVE STROKE.

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:00 PM
Room
Hall L2
Lecture Time
03:25 PM - 03:30 PM
Presenter

Abstract

Group Name

the ANGEL Investigators

Background And Aims

In situ thrombo-occlusion (IST), as one major stroke mechanism of large vessel occlusion (LVO), has been confirmed to contribute to mechanical thrombectomy (MT) failures. Based on the specific inhibition effect on platelet aggregation, tirofiban may be particularly effective for MT patients with IST. We aim to evaluate the safety and efficacy of low-dose tirofiban during and after MT in patients with IST.

Methods

We derived data from the ANGEL, a multi-centric, prospective registry study, which included MT patients from June 2015 to December 2017. IST was defined as underlying intracranial atherosclerosis accounting for artery occlusion by follow-up imaging. Patients were dichotomized into tirofiban and non-tirofiban group according to whether tirofiban was administrated. Safety outcomes (symptomatic intracerebral hemorrhage [sICH], ICH, and distal embolization) and efficacy outcomes (artery recanalization and functional outcomes at 3-month follow-up) were compared between groups.

Results

Of the 369 patients (151 with tirofiban and 218 without non-tirofiban) with IST from the registry, 26 (7.1%) patients suffered sICH, 174 (47.2%) achieved functional independence, and 65 (17.6%) died after three-month follow-up. After adjusting for potential confounders, no significant differences in sICH, ICH, and distal embolization were found between two groups. Low-dose tirofiban was associated with improved functional independence (adjusted HR 1.74 [1.08-2.80], p=0.02) and mortality reduction (adjusted HR 0.38 [0.19-0.74], p<0.01)

Conclusions

IST was one of the primary mechanisms contributing to acute LVO. Adjunctive treatment with low-dose tirofiban during and after MT was safe and improved functional outcomes at three months for acute LVO secondary to IST. More prospective randomized trials are needed.

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Trial Registration Number

Not applicable

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EFFECT OF WHITE BLOOD CELL COUNT ON OUTCOMES IN IVT-TREATED STROKE PATIENTS

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:00 PM
Room
Hall L2
Lecture Time
03:30 PM - 03:35 PM

Abstract

Group Name

for the Thrombolysis in Stroke Patients (TRISP) collaborators

Background And Aims

To investigate the effect of white blood cell count (WBC) on functional outcome, mortality and bleeding risk in stroke patients treated with IV-thrombolysis (IVT).

Methods

In this prospective multicenter study from the TRISP-registry, we investigated the association between WBC count on admission and 3-month poor outcome (modified Rankin Scale 3-6), mortality and symptomatic intracranial hemorrhage (sICH; ECASS-II-criteria) in IVT-treated stroke patients. WBC was used as continuous and categorical variable distinguishing leukocytosis (WBC>10x109/l) and leukocytopenia (WBC<4x109/l). Unadjusted and adjusted odds ratios with 95% confidence intervals (OR[95%-CI]) from the logistic regression models were calculated. In a subgroup, we analyzed the association of WBC and C-reactive protein (normal range CRP<10mg/l) on outcomes.

Results

Among 10813 IVT-treated stroke patients, 2521 (23.3%) had leukocytosis and 112 (1.0%) leukocytopenia. Data completeness rate was high (missing information on WBC: 415,3.6%; mRS: 357,3.2%). Increasing WBC (by 1x109/l) independently predicted poor outcome (ORadjusted 1.03[1.02-1.05]) but not mortality (ORadjusted 1.00[0.99-1.01]) or sICH (ORundjusted 1.00[0.99-1.01]). Leukocytosis at baseline was associated with poor outcome (ORadjusted 1.38[1.21-1.58]) and mortality (ORadjusted 1.49[1.25-1.79]) but not with sICH (ORadjusted 1.25[0.99-1.56]). Leukocytopenia was not associated with any outcome. In a subgroup analysis, patients with leukocytosis and elevated CRP (n=502) had the highest risk for poor outcome (ORadjusted 2.30[1.50-3.51]) and mortality (ORadjusted 2.13[1.34-3.37]) when compared to patients with normal WBC and CRP (n=3489).

Conclusions

In IVT-treated stroke patients, leukocytosis on admission, especially in combination with elevated CRP, independently increased the risk for poor outcome and mortality but not for sICH. Leukocytopenia was not associated with any outcome.

Trial Registration Number

Not applicable

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HIGH ADMISSION SERUM GLUCOSE IS ASSOCIATED WITH POOR OUTCOMES AFTER ENDOVASCULAR TREATMENT FOR ISCHEMIC STROKE

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:00 PM
Room
Hall L2
Lecture Time
03:35 PM - 03:40 PM

Abstract

Group Name

on behalf of the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry Investigators.

Background And Aims

High serum glucose on admission is a predictor of poor outcome after stroke. We assessed the association between glucose concentrations and clinical outcomes in patients who underwent endovascular treatment (EVT).

Methods

From the MR CLEAN Registry, we selected consecutive adult patients with a large vessel occlusion of the anterior circulation who underwent EVT and for whom admission serum glucose levels were available. We assessed the association between serum glucose on admission and the modified Rankin Scale (mRS) score at 90 days, symptomatic intracranial hemorrhage (sICH) and successful reperfusion rates. We evaluated the association between glucose and mRS using multivariable ordinal logistic regression, and assessed whether successful reperfusion (TICI 2b-3) modified this association. Hyperglycemia was defined as serum glucose ≥7.8mmol/L.

Results

Of 3637 patients in the Registry, 2908 were included. 882 (30.3%) had hyperglycemia on admission. Hyperglycemia was associated with a shift towards worse functional outcome (median mRS 3 vs 4; acOR 1.69; 95%CI 1.44-1.99), increased mortality (23.2% vs 40.3%; aOR 1.95; 95%CI 1.60-2.38) and an increased risk of sICH (4.5% vs 9.3%; aOR 1.94; 95%CI 1.41-2.66). The association between glucose and poor outcome (mRS 3-6) was J-shaped (figure 1). Hyperglycemia was not associated with a different rate of successful reperfusion and successful reperfusion did not modify the association between glucose and functional outcome.schermafbeelding 2020-01-02 om 20.11.06.png

Conclusions

Increased serum glucose on admission is associated with poor functional outcome and an increased risk of sICH after EVT.

Trial Registration Number

Not applicable

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ACUTE ISCHEMIC STROKE ETIOLOGY AND ITS EFFECTS ON ENDOVASCULAR THROMBECTOMY OUTCOMES: AN OBSERVATIONAL STUDY BASED ON THE SAFE IMPLEMENTATION OF TREATMENT IN STROKE THROMBECTOMY REGISTRY.

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:00 PM
Room
Hall L2
Lecture Time
03:40 PM - 03:45 PM

Abstract

Background And Aims

Acute ischemic stroke etiology and how it affects endovascular thrombectomy outcomes is not well understood. We aimed to investigate whether stroke etiology influences outcomes in large artery occlusion treated by endovascular thrombectomy.

Methods

We included acute ischemic stroke patients treated with endovascular thrombectomy from 2014-01-01 to 2019-09-03 in centers with at least 10 registered patients and 70% completeness of 3-month follow-up data in the Safe Implementation of Treatment in Stroke Thrombectomy registry. We compared the effects of the ischemic stroke etiologies Large artery atherosclerosis (LAA) and Cardiac embolism (CE). Primary outcome was successful recanalization (modified Treatment in Cerebral Infarction score 2b-3). Secondary outcomes were 3-month modified Rankin Scale score 0-2 and death, and SICH. Multivariable logistic regression models were used for the outcomes to compare etiologies.

Results

Of 8678 patients, 3818 (44.0%) had CE, 2359 (27.2%) LAA, and 2112 (24.3%) unknown or multiple etiologies. Patients with LAA were younger (74.2 vs 80.6, p<0.001), had lower NIHSS score at baseline (15 vs 16, p<0.001), and had similar successful recanalization (83.8% vs 85.8%, p=0.081), compared to patients with CE. In the multivariable analyses, patients with LAA had a lower chance of successful recanalization (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.70-0.91) and modified Rankin Scale score 0-2 (OR 0.71, CI 0.61-0.82), higher risk of death (OR 1.42, CI 1.21-1.67), but no difference in SICH (OR 1.02, CI 0.73-1.43).

Conclusions

The etiology of acute ischemic stroke may affect endovascular thrombectomy outcomes, with LAA occlusions showing worse outcomes despite presenting with fewer risk-factors at baseline.

Trial Registration Number

Not applicable

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ARE PATIENTS WITH ACUTE STROKE TAKING LONGER TO GET TO HOSPITAL IN THE UK? DATA FROM THE NATIONAL STROKE REGISTRY

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:00 PM
Room
Hall L2
Lecture Time
03:45 PM - 03:50 PM

Abstract

Group Name

on behalf of the SSNAP Collaboration

Background And Aims

Patients arriving to hospital sooner after stroke onset are more likely to be eligible to receive hyper-acute interventions such as thrombolysis, thrombectomy, and blood pressure-lowering treatment.

Methods

Data from April 2014-March 2019 were extracted from the Sentinel Stroke National Audit Programme (SSNAP). For patients with reported onset times (precise or best estimate), the median annual onset-to-arrival times were analysed and changes in the proportion of patients arriving to hospital across 1.5 hour periods were compared.

Results

Of 427,770 patients admitted to 344 stroke units over 5 years, 63% had a known onset time. 94% arrived by ambulance. The median onset-to-arrival time has increased by 36 minutes from 150 minutes [IQR 80-451] in 2014/15 to 186 minutes [IQR 95-573] in 2018/19, [p<0.001]. The proportion of patients arriving to hospital within 1.5 hours decreased from 31% to 23%, [p<0.001], while the proportion arriving beyond 4.5 hours increased from 35% to 40%, [p<0.001].

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Conclusions

Data shows that over time there has been an increase in onset-to-arrival time. For patients eligible for thrombolysis (arriving within 4.5 hours) this increase cancels out the modest 7-minute reduction in the median door-to-needle time over the same period, leading to a reduced population benefit from reperfusion. This increase may be attributable to regional reconfigurations of stroke services, but more likely to increasing pressure on pre-hospital services leading to delays in response times. These data require further exploration on response times for stroke now being collected from ambulance services in England.

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