Welcome to the WSC 2022 Interactive Program
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*Please note that all sessions in halls Summit 1, Summit 2 & Hall 406 will be live streamed in addition to the onsite presentation
ASK THE SPEAKER
Sessions in Halls 406, Summit 1 and Summit 2 have a Q&A component, through the congress App called “Ask the Speaker”
IMPACT OF ATRIAL FIBRILLATION ON THE TREATMENT EFFECT OF BRIDGING THROMBOLYSIS IN ISCHEMIC STROKE PATIENTS UNDERGOING ENDOVASCULAR THROMBECTOMY
Abstract
Background and Aims
Recent evidence has demonstrated the noninferiority of endovascular thrombectomy (EVT) alone compared to bridging intravenous thrombolysis (IVT) plus EVT in the treatment of anterior circulation acute ischaemic stroke (AIS). We hypothesize that atrial fibrillation (AF) associated strokes are associated with reduced treatment effect from IVT. This study compares the effect of bridging IVT in AF and non-AF patients.
Methods
This multicentre retrospective cohort study comprises anterior circulation large vessel occlusion AIS patients who received EVT alone or combined bridging IVT plus EVT within 6 hours of symptom onset. Primary outcome measure was functional independence defined as modified Rankin scale (mRS) 0-2 measured at 3 months. Secondary outcomes were symptomatic intracranial haemorrhage (sICH) and in-hospital mortality.
Results
We included 724 patients, 325 (44.9%) with AF and 399 (55.1%) without AF. The mean age was 68.7 years, 54.3% were male and median NIHSS was 17.3. For AF patients, the rate of functional independence, sICH and mortality were similar between the bridging IVT and EVT groups. For non-AF patients, the rate of functional independence was higher in the bridging IVT group than EVT group (45.1% vs 23.3%; p<0.001), although there was no difference in sICH and mortality (Table 1). On multivariable analyses, bridging IVT was an independent predictor of functional independence in the non-AF group only (OR=2.48, 95% CI 1.15 – 5.35; p=0.021).
Conclusions
Bridging IVT appears to confer benefit over EVT alone in non-AF patients. There is a need for careful patient selection for those who might benefit from bridging IVT in a thrombectomy-capable centre.
EXTRACRANIAL INTERNAL CAROTID ARTERY NON-OPACIFICATION AT PREOPERATORY CTA: CORRELATION WITH CLINICAL OUTCOME IN PATIENTS WHO UNDERGO MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE
Abstract
Background and Aims
To evaluate the impact of extracranial carotid artery (ICA) non-opacification at preoperatory CTA in patients with acute ischemic stroke due to intracranial large vessel occlusion who underwent mechanical thrombectomy.
Methods
IRB-approved retrospective study, need for informed consent was waived. We included 90 consecutive patients with anterior circulation acute ischemic stroke secondary to intracranial large vessel occlusion and extracranial ICA non-opacification at preoperatory CTA. ASPECTS and collateral score (Tan score) were assessed on preoperative CT/CTA. 90 days mRS was retrieved from institutional database. DSA was used as gold standard for characterizing ICA involvement.
Results
Clinical outcome was good (90 days mRS 0-2) in 28/90 (31.1%) patients. At DSA, lack of opacification of the extracranial ICA was due to true proximal ICA occlusion, secondary to thrombosis or dissection, in 49/90 (54.4%) patients and to pseudo-occlusion secondary to carotid apex occlusion in 41/90 (45.6%). While technical success rate was similar in the two groups (p>0.05), a significantly higher rate of favorable clinical outcome (mRS 0-2) was found in patients with true ICA occlusion in comparison to those with pseudo-occlusion (22/49, 45% vs 6/41, 14,6%; p=0.0027, Fisher’s exact test); good collaterals were also significantly more frequent in patients with true occlusion (33/49, 67% vs 12/41, 29%; p=0,0006, Fisher’s exact test). Collateral score did significantly correlate with clinical outcome (p=0.0155, Chi-square test).
Conclusions
Patients with true extracranial ICA occlusion (i.e. tandem occlusion) showed significantly better clinical outcome in comparison to patients with pseudo-occlusion (i.e. carotid apex occlusion), probably because of the presence of better collaterals.
BEST REVASCULARISATION APPROACH FOR POSTERIOR CIRCULATION STROKES WITH ISOLATED VERTEBRAL ARTERY OCCLUSIONS: SINGLE-CENTER RESULTS FROM THE “BRAVO” STUDY
Abstract
Background and Aims
Isolated vertebral artery occlusions (iVAO) represent approximately one third of posterior circulation occlusions. Since effects of acute revascularization treatments have not yet been systematically studied, BRAVO will retrospectively investigate the impact of acute recanalization treatments in acute ischemic stroke (AIS) with iVAO. Analysis will first be performed in a single center stroke registry, then extended to a multicenter international collaboration.
Methods
In the Acute-Stroke-Registry-and-Analysis-of-Lausanne (ASTRAL), we identified all patients with posterior circulation AIS and documented iVAO (intra and/or extracranial). The primary outcome was the 3-month favorable shift on the modified Rankin scale (mRS). Comparisons were made between the A) intravenous thrombolysis (IVT) versus conservative treatment (CT); and B) endovascular treatment (EVT) ±IVT versus IVT alone. Multivariate analysis was corrected for age, admission NIHSS, revascularization treatment and intracranial recanalization. The study is registered on Clinicaltrials.gov.
Results
In 147 consecutive iVAO patients (median age 67 [54-78], 25% female), n=25 (17%) had IVT and n=14 (10%) EVT±IVT (table 1). Favorable 3-months-mRS shift was significantly associated with lower admission NIHSS. Revascularization treatment showed a trend towards unfavorable outcome, and subacute intracranial recanalization on control imaging a trend towards better outcome (table 2).
Conclusions
BRAVO is the first attempt to specifically address revascularization outcomes in stroke with iVAO. Preliminary results do not seem to indicate benefits from acute revascularization treatments. The ongoing retrospective multicenter data collection will increase the statistical power and allow to create hypotheses for the design of future prospective clinical trials.