Displaying One Session

Rapid Communications
Session Type
Rapid Communications
Room
Hall L2
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM

EFFECT OF BIFURCATED THROMBI ON ENDOVASCULAR TREATMENT OUTCOME

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
02:30 PM - 02:35 PM

Abstract

Background And Aims

A thrombus in the middle cerebral artery (MCA) can occlude the main stem only or the M1-M2 bifurcation. This difference in occlusion pattern may affect endovascular treatment (EVT) success, as a bifurcated thrombus may be prone to fragmentation during retrieval. This study investigates if bifurcated thrombi affect EVT procedural and clinical outcomes.

Methods

Occlusion patterns of MCA thrombi were classified using CT angiography. We identified 1023 patients from the MRCLEAN Registry that had an MCA main stem occlusion, a bifurcated thrombus with occlusion of only one M2 branch, or a bifurcated thrombus with occlusion of both M2 branches. Duration of EVT procedure, number of retrieval attempts, reperfusion grade (extended thrombolysis in cerebral infarction, eTICI), presence of thrombus in a new vascular territory (ENT), and functional outcome (modified Rankin scale, mRS) at 90 days were compared for different occlusion patterns. The Kruskall-Wallis (KW) test was used to compare non-normally distributed numerical data and the Chi-square (X2) test for categorical data.

Results

There was no statistically significant difference in procedural time (N=952, p=0.62), number of passes (N=1023, p=0.60), eTICI (N=1004, p=0.55), ENT (N=939, p=0.59), and mRS (N=955, p=0.58) for different occlusion patterns (Figure 1).

esowso_image.jpg

Figure 1: Descriptive statistics of procedural time [min], number of passes, eTICI, ENT, and mRS at 90 days, for the three occlusion patterns: MCA main stem only, single branch occlusion, and double branch occlusion.

Conclusions

MCA main stem vs bifurcation occlusion patterns did not affect procedural and clinical outcomes.

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SUCCESSFUL REPERFUSION AFTER EVT IN PATIENTS WITH LARGE DWI LESIONS PREVENTS OCCURRENCE OF MALIGNANT STROKE

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
02:35 PM - 02:40 PM

Abstract

Background And Aims

Background – Malignant MCA infarction is a severe complication of acute ischemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with malignant profile decreased occurrence of malignant MCA infarction (MMI).

Methods

Methods - Data were collected between January 2014 and July 2018 in a monocentric prospective AIS patients registry treated with EVT. Patients selected were under 65 years old, with severe anterior stroke with a National Institutes of Health Stroke Scale (NIHSS) score higher than 15 and a DWI lesion volume larger than 82ml within the 6 first hours of symptoms onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia (TICI) score ≥2b. Primary endpoint was the occurrence of MMI defined as AIS with a mass effect >50% of the affected MCA territory, with significant midline shift visualized on follow-up imaging and/or clinical signs of herniation.

Results

Results - Sixty-six EVT-treated patients were included in our study. MMI occurred in 27 (42%), and 22 (33%) had undergone craniectomy. MMI occurrence was significantly lower in patients with successful reperfusion compared to the non-reperfused group (31.8% vs 65.0%; p=0.015) and fewer craniectomies were performed (26.1% vs 50.0%; p=0.063) without significant difference of symptomatic intracranial hemorrhage or all-cause mortality rates.

Conclusions

Conclusions - Successful reperfusion performed in AIS patients with large DWI lesions was associated with decreased MMI occurrence and fewer craniectomy procedures. Reperfusion status should be considered in evaluating the need for craniectomy in patients with risk factors predictive of MMI.

Trial Registration Number

Not Applicable

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ENDOVASCULAR TREATMENT FOR ISOLATED POSTERIOR ARTERY OCCLUSIONS IN THE MR CLEAN REGISTRY – A CONSECUTIVE CASE SERIES

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
02:40 PM - 02:45 PM

Abstract

Group Name

MR CLEAN Registry Investigators

Background And Aims

Endovascular treatment (EVT) is standard-of-care for anterior circulation large vessel occlusions(LVO) and is under investigation in patients with basilar occlusions. However, data on EVT in patients with isolated posterior cerebral artery occlusions (PCA-O) are very scarce and so remains a clinical dilemma whether to treat these patients with EVT. We describe a consecutive case series of patients with isolated PCA-O, treated with EVT.

Methods

We used data (March 2014 – Nov 2017) from the MR CLEAN Registry, a nationwide, prospective cohort study of patients treated with EVT in the Netherlands. Indication for EVT was based on e.g. location of occlusion on CTA (core-lab assessed) and clinical manifestations. Outcomes included eTICI, change in NIHSS (ΔNIHSS), mRS 0-2 after 90 days, mortality, and complications.

Results

Of the 162 patients with posterior LVO, 20 (12%) had a PCA-O (15 P1 segment, 4 P2, 1 P3). Median age was 70 years; 65% were women. Median NIHSS at baseline was 13(IQR 5-18) and 6/20(30%) were comatose. Percheron artery was encountered in one patient (5%). Twelve patients were treated with IVT (60%). eTICI 2b-3 was reached in fifteen patients (71%). Median ΔNIHSS was -4 (IQR-11–+1). Four (20%) patients reached mRS 0-2; seven (35%) died. About 25% had a peri-procedural complication.

Conclusions

PCA-O can present with a wide variety of neurological deficits, including coma. EVT in PCA-O achieves comparable reperfusion rates as in anterior circulation stroke and appears to be feasible and safe. This case series provides insights into clinical presentation and potential treatment options in patients with PCA-O.

Trial Registration Number

Not applicable

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FEASIBILITY AND SAFETY OF DISTAL THROMBECTOMY FOR ISOLATED OCCLUSIONS OF THE POSTERIOR CEREBRAL ARTERY: A MULTICENTER EXPERIENCE AND SYSTEMATIC LITERATURE REVIEW

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
02:45 PM - 02:50 PM

Abstract

Background And Aims

Substantial clinical evidence supporting the benefit of mechanical thrombectomy (MT) for isolated posterior cerebral artery occlusion (IPCAOs) stroke is still missing. This study aims to investigate the procedural feasibility and safety of MT for IPCAOs.

Methods

We retrospectively reviewed patients from three tertiary stroke-centers with acute ischemic stroke due to IPCAOs (P1-P3 segments) that underwent MT between 01/2014-12/2019. Successful recanalization was assessed with the Thrombolysis in Cerebral Infarction Scale (TICI) defined as TICI≥2b. Procedural and safety assessment included the first-pass effects (TICI3), number of MT attempts, symptomatic intracranial hemorrhage (sICH), mortality, and intervention-related serious adverse events (SAE). Early functional outcome was evaluated with the modified Rankin scale (mRS) and National Institute of Health Stroke Scale (NIHSS) at discharge. A systematic literature review was conducted to identify previous reports on MT for IPACOs.

Results

42 Patients with IPCAOs located in the P1 (54.8%, 23/42), P2 (38.1%, 16/42) and P3 segment (7.1%, 3/42) were analyzed. The overall rate of TICI≥2b recanalization was 82.2% (37/42) including a first pass-effect of 47.6% (20/42) leading to TICI3. sICH occurred in 4.8% (2/42) and there were 3 cases with iatrogenic vessel perforation. Early favorable functional outcome was observed in 63.2% (24/38); NIHSS decreased significantly (p<0.001) from 7 (IQR 4-10) on admission to 2.5 (IQR 1-4) at discharge. The in-hospital mortality was 7.9% (3/38).

Conclusions

Our study suggests the technical feasibility and safety of distal thrombectomy for IPCAOs. Further studies are needed to investigate long-term functional outcomes with posterior circulation stroke adjusted scales.

Trial Registration Number

Not applicable

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FIRST PASS EFFECT OF THROMBECTOMY WITH THE PENUMBRA SYSTEM IN PATIENTS WITH LARGE VESSEL OCCLUSION ACUTE ISCHEMIC STROKE, AN ANALYSIS OF THE COMPLETE REGISTRY

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
02:50 PM - 02:55 PM

Abstract

Group Name

on behalf of the COMPLETE Study Investigators

Background And Aims

To minimize neuronal death associated with ischemic stroke, time to reperfusion should be minimized. Devices leading to higher first pass effect (FPE) may facilitate shorter procedure times. Outcome and FPE data from the COMPLETE registry is reported here.

Methods

COMPLETE was a global prospective multicenter registry that enrolled large vessel occlusion acute ischemic stroke patients treated per site routine practice with thrombectomy using the Penumbra System (PS) as the initial device. Endpoints include core-lab adjudicated angiographic revascularization by pass, 90-day functional outcome (mRS 0-2), and 90-day all-cause mortality.

Results

There were 650 patients enrolled at 42 sites across North America and Europe; 363 patients had core lab adjudicated revascularization data available for this analysis. Per core lab, occlusion locations were 19.1% ICA/carotid-T, 54.0% M1, 17.2% M2, 1.7% M3, and 8.0% posterior. FPE-TICI 3 was 31.7% (115/363), FPE-TICI2c-3 was 42.1% (153/363), and FPE-TICI2b-3 was 56.2% (204/363). At 90-days, mRS 0-2 rates were 61.0% (64/105), 60.3% (85/141), and 57.5% (107/186) for FPE defined as TICI3, TICI2c-3, and TICI2b-3 respectively. FPE-TICI 2c-3 compared to non-FPE-TICI 2c-3 resulted in significantly higher rates of 90-day mRS 0-2 (60.3% vs. 49.0% respectively, p=0.040). Data collection and core lab review are ongoing.

fpe_final table.png

Conclusions

Achieving revascularization to TICI 2c-3 with a single pass of the PS was associated with significantly higher rates of good clinical outcome.

Trial Registration Number

NCT03464565

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DEVICE PASS EFFECT ON CLINICAL OUTCOME AFTER ENDOVASCULAR THROMBECTOMY IN LARGE VESSEL OCCLUSION STROKE

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
02:55 PM - 03:00 PM

Abstract

Background And Aims

A higher degree of revascularization has been repeatedly reported as a predictor of improved clinical outcome. The number of passes performed in a thrombectomy procedure and its relationship to functional outcome is of ongoing study.

Methods

We performed a retrospective analysis of a prospectively maintained database on anterior cerebral circulation stroke thrombectomy cases from January 2016 to August 2019 at a single tertiary stroke center. Data compiled included baseline characteristics, radiographic findings, time metrics, procedural details and 90 day modified Rankin Scale (mRS) scores. Patients were categorised into three groups (1 vs 2-4 vs 5+ passes) according to the number of passes performed.

Results

results.jpg

677 patients were included. 266 required 1 pass, 303 required 2-4 passes, 108 required 5 or more passes. The three groups did not differ by average age (p=0.192), NIHSS score (p=0.16), baseline mRS (p=0.832) or rates of thrombolysis (p=0.1818). There was no significant difference between onset-to-thrombolysis (p=0.554) or onset-to-groin puncture (p=0.332). Successful revascularization (mTICI 2b-3) was achieved in 94.7% of the 1 pass group, 89.8% of the 2-4 passes group and 75% of the 5+ passes group.) (p=<0.001). Length of procedure was significantly longer in the 2-4 and 5+ groups (p=<0.001). There was no significant difference when comparing onset-to-reperfusion time amongst groups (p=0.243). When only considering patients who achieved successful revascularization, mean 90 day mRS score was progressively worse amongst the 3 groups (p=0.004).

Conclusions

Successful revascularization is less likely with increasing number of passes. In patients with successful revascularization and similar onset-to-reperfusion times, additional passes predict poorer functional outcome.

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IS “THE FIRST PASS EFFECT” SIMILAR IN LATE VERSUS EARLY TREATMENT WINDOW?

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
03:00 PM - 03:05 PM

Abstract

Group Name

NORDICTUS

Background And Aims

The “first pass effect”(FPE) is defined as a complete revascularization obtained after a single device pass and it has been associated with improved clinical outcome and decreased mortality. We aimed to evaluate possible differences in FPE in patients treated in late versus early windows in NORDICTUS registry.

Methods

Multicentre prospective registry of consecutive patients treated with mechanical thrombectomy in 14 centres of Northern Spain. FPE was defined as final TICI 3 after one single pass. Early/late treatment window was defined as onset-to-groin puncture</>6hours. We evaluated association of baseline characteristics, procedural complications, intrahospital mortality and good functional outcome (mRS≤2) at three months with FPE. Those associations were also studied separately in early and late treatment windows.

Results

FPE was achieved in 504 out of 1300 patients (38.8%), and this rate was higher in early (39.4%) than in late treatment window (35.3%). Age, gender, TOAST aetiology, ASPECTS and baseline NIHSS were similar between patients with FPE and those without. FPE was significantly associated with fewer procedural complications (intracranial dissection and distal embolization), lower intrahospital mortality, lower NIHSS at 24h and with good functional outcome at 3 months, both in the global cohort and also in the different treatment window groups. In multivariate analysis, FPE was an independent predictor of good functional outcome in both early and late windows(OR=2.3).

Conclusions

FPE was achieved more frequently in early treatment window and associated with better prognosis. We should continue to treat patients as early as possible and to investigate new devices and techniques that achieve prompt FPE.

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FUNCTIONAL OUTCOME AFTER MECHANICAL THROMBECTOMY OFFERED TO PATIENTS WITH IMPAIRED BASELINE STATUS

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Hall L2
Lecture Time
03:05 PM - 03:10 PM

Abstract

Background And Aims

Patients with pre-stroke disability are not being enrolled in clinical trials on effectiveness of endovascular treatment (EVT) for acute ischemic stroke. In reality, acute stroke patients frequently have pre-existing functional impairment. We aimed to assess whether patients with baseline disability still benefit from EVT.

Methods

In this retrospective single-center study on prospectively collected data, we included consecutive patients who were offered EVT for acute stroke between 2015-2019. We compared the change in modified Rankin score (mRS) before and after EVT, discharge destination, and intracranial hemorrhage rates for patients with baseline mRS≥2 versus mRS<2. We repeated the analysis for baseline mRS≥3 versus mRS<3.

Results

Among 333 included patients (44% male, median age 75), 92 had baseline mRS≥2. At 3 months post-EVT, 27/92 (29%) patients had reached their baseline mRS compared to 36/241 (15%) patients without premorbid disability (OR 2.4; 95%CI:1.3-4.2; chi-square p<0.05). The hemorrhage rate was not higher for patients with baseline mRS≥2 (11% versus 6%; OR 1.8; 95%CI:0.8-4.3). Fewer patients with baseline mRS≥2 were discharged home or to rehabilitation (45% versus 65%; OR 0.44; 95%CI:0.27-0.72).

Patients with baseline mRS≥3 (n=53) had similar outcomes: 32% returned to their premorbid status versus 16% of patients with baseline mRS<3 (OR 2.5; 95%CI:1.2-4.6; p<0.05). Their hemorrhage rate was not higher (OR 2.2; 95%CI:0.9-5.6) and fewer patients went home or to rehabilitation (OR 0.24; 95%CI:0.13-0.45).

Conclusions

In this selective cohort, patients with pre-existing disability were more likely to return to their baseline after EVT than patients without pre-stroke disability, suggesting that EVT should be considered for these individuals.

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