The Experts below are selected from a list of 13239 Experts worldwide ranked by ideXlab platform
Gilberto R Gonzalez - One of the best experts on this subject based on the ideXlab platform.
-
mri based selection for intra arterial stroke therapy value of pretreatment diffusion weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early Recanalization
Stroke, 2009Co-Authors: Albert J Yoo, Luis A Verduzco, Pamela W Schaefer, Joshua A Hirsch, James D Rabinov, Gilberto R GonzalezAbstract:Background and Purpose— Recent studies demonstrate that an acute diffusion-weighted imaging lesion volume >70 cm3 predicts poor outcome in patients with stroke. We sought to determine if this threshold could identify patients treated with intra-arterial therapy who would do poorly despite reperfusion. In patients with initial infarcts <70 cm3, we sought to determine what effect Recanalization and time to Recanalization had on infarct growth and functional outcome. Methods— We retrospectively studied 34 consecutive patients with anterior circulation stroke who underwent pretreatment diffusion-weighted imaging and perfusion-weighted imaging and subsequent intra-arterial therapy. Recanalization success and time to Recanalization were recorded. Initial diffusion-weighted imaging and mean transit time lesion and final infarct volumes were determined. Patients were stratified based on initial infarct volume, Recanalization status, and time to Recanalization. Statistical tests were performed to assess difference...
-
mri based selection for intra arterial stroke therapy value of pretreatment diffusion weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early Recanalization
Stroke, 2009Co-Authors: Albert J Yoo, Luis A Verduzco, Pamela W Schaefer, Joshua A Hirsch, James D Rabinov, Gilberto R GonzalezAbstract:Background and Purpose— Recent studies demonstrate that an acute diffusion-weighted imaging lesion volume >70 cm 3 predicts poor outcome in patients with stroke. We sought to determine if this threshold could identify patients treated with intra-arterial therapy who would do poorly despite reperfusion. In patients with initial infarcts 3 , we sought to determine what effect Recanalization and time to Recanalization had on infarct growth and functional outcome. Methods— We retrospectively studied 34 consecutive patients with anterior circulation stroke who underwent pretreatment diffusion-weighted imaging and perfusion-weighted imaging and subsequent intra-arterial therapy. Recanalization success and time to Recanalization were recorded. Initial diffusion-weighted imaging and mean transit time lesion and final infarct volumes were determined. Patients were stratified based on initial infarct volume, Recanalization status, and time to Recanalization. Statistical tests were performed to assess differences in clinical and imaging outcomes. Good clinical outcome was defined as a 3-month modified Rankin Scale score ≤2. Results— Among patients with initial infarcts >70 cm 3 , all had poor outcomes despite a 50% Recanalization rate with mean infarct growth of 114 cm 3 . These patients also had the largest mean transit time volumes ( P 3 who recanalized early had the best clinical outcomes ( P P 3 . Conclusion— This study supports the use of an acute diffusion-weighted imaging lesion volume threshold as an imaging selection criterion for intra-arterial therapy. It also confirms the importance of early reperfusion in selected patients.
Andrew M Demchuk - One of the best experts on this subject based on the ideXlab platform.
-
a meta analysis of observational intra arterial stroke therapy studies using the merci device penumbra system and retrievable stents
American Journal of Neuroradiology, 2013Co-Authors: Mohammed A Almekhlafi, Andrew M Demchuk, B K Menon, E A Freiheit, Mayank GoyalAbstract:BACKGROUND AND PURPOSE: The time from arterial puncture to successful Recanalization is an important milestone toward timely Recanalization. With the significant improvement in Recanalization rates by using thrombectomy devices, procedural time to Recanalization is becoming a determinant factor in choosing among available devices. We aimed to assess the impact of time to Recanalization on the outcome of intra-arterial stroke therapies. MATERIALS AND METHODS: We conducted a meta-analysis of studies reporting procedural times in patients with stroke treated with the MD, PS, and RS. RESULTS: We identified 16 eligible studies: 4 on the MD ( n = 357), 8 on the PS ( n = 455), and 4 on RS ( n = 113). Merci device studies described total procedural duration, while PS and RS studies described puncture-to-Recanalization times. With a random-effects model, mean procedural duration for the MD was 120 minutes (95% CI, 105.7–134.2 minutes). Mean puncture to Recanalization time for the PS was 64.6 minutes (95% CI, 44.4–84.8 minutes) and 54.7 minutes for RS (95% CI, 47.3–62.2 minutes). Successful Recanalization was achieved in 211 of 357 patients (59.1%) in the MD studies (95% CI, 49.3–77.7), 394 of 455 (86.6%) in the PS studies (95% CI, 84.1–93.8), and 105 of 113 (92.9%) in the RS studies (95% CI, 90.9–99.9). Functional independence (mRS ≤2) was achieved in 31.5% of patients in the MD studies, 36.6% in the PS studies, and 46.9% in the RS studies. CONCLUSIONS: The use of the PS and RS was associated with comparable procedural time to Recanalization. Available data did not allow this parameter to be determined for trials using the MD. Retrievable stents achieved the highest rate of successful Recanalization and functional outcome and the lowest mortality.
-
quantification of thrombus hounsfield units on noncontrast ct predicts stroke subtype and early Recanalization after intravenous recombinant tissue plasminogen activator
American Journal of Neuroradiology, 2012Co-Authors: J Puig, Andrew M Demchuk, Salvador Pedraza, Josep Daunisiestadella, H Termes, Gerard Blasco, Guadalupe Soria, Imma Boada, Sebastian Remollo, J BanosAbstract:BACKGROUND AND PURPOSE: Little is known about the factors that determine Recanalization after intravenous thrombolysis. We assessed the value of thrombus Hounsfield unit quantification as a predictive marker of stroke subtype and MCA Recanalization after intravenous rtPA treatment. MATERIALS AND METHODS: NCCT scans and CTA were performed on patients with MCA acute stroke within 4.5 hours of symptom onset. Demographics, stroke severity, vessel hyperattenuation, occlusion site, thrombus length, and time to thrombolysis were recorded. Stroke origin was categorized as LAA, cardioembolic, or indeterminate according to TOAST criteria. Two blinded neuroradiologists calculated the Hounsfield unit values for the thrombus and contralateral MCA segment. We used ROC curves to determine the rHU cutoff point to discriminate patients with successful Recanalization from those without. We assessed the accuracy (sensitivity, specificity, and positive and negative predictive values) of rHU in the prediction of Recanalization. RESULTS: Of 87 consecutive patients, 45 received intravenous rtPA and only 15 (33.3%) patients had acute Recanalization. rHU values and stroke mechanism were the highest predictive factors of Recanalization. The Matthews correlation coefficient was highest for rHU (0.901). The sensitivity, specificity, and positive and negative predictive values for lack of Recanalization after intravenous rtPA for rHU ≤ 1.382 were 100%, 86.67%, 93.75%, and 100%, respectively. LAA thrombi had lower rHU than cardioembolic and indeterminate stroke thrombi (P = .004). CONCLUSIONS: The Hounsfield unit thrombus measurement ratio can predict Recanalization with intravenous rtPA and may have clinical utility for endovascular treatment decision making.
-
quantification of thrombus hounsfield units on noncontrast ct predicts stroke subtype and early Recanalization after intravenous recombinant tissue plasminogen activator
American Journal of Neuroradiology, 2012Co-Authors: J Puig, Andrew M Demchuk, Salvador Pedraza, Josep Daunisiestadella, H Termes, Gerard Blasco, Guadalupe Soria, Imma Boada, Sebastian Remollo, J BanosAbstract:RESULTS: Of 87 consecutive patients, 45 received intravenous rtPA and only 15 (33.3%) patients had acute Recanalization. rHU values and stroke mechanism were the highest predictive factors of Recanalization. The Matthews correlation coefficient was highest for rHU (0.901). The sensitivity, specificity, and positive and negative predictive values for lack of Recanalization after intravenous rtPA for rHU 1.382 were 100%, 86.67%, 93.75%, and 100%, respectively. LAA thrombi had lower rHU than cardioembolic and indeterminate stroke thrombi (P .004). CONCLUSIONS: The Hounsfield unit thrombus measurement ratio can predict Recanalization with intravenous rtPA and may have clinical utility for endovascular treatment decision making.
-
effect of baseline ct scan appearance and time to Recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes
Stroke, 2011Co-Authors: Mayank Goyal, Michael D Hill, Bijoy K Menon, Shelagh B Coutts, Andrew M DemchukAbstract:Background and Purpose—The Penumbra Pivotal Stroke Trial reported a 25% good outcome (modified Rankin scale score ≤2) despite an 81% Recanalization rate. We evaluated the association of a favorable initial noncontrast CT and a short time to Recanalization in predicting good outcome. Methods—Data were from the Penumbra Pivotal Stroke Trial. Baseline scans were evaluated by 2 experienced readers blinded to outcomes using ASPECTS. ASPECTS scores were dichotomized into >7 and ≤7 for primary analysis. Data on degree of Recanalization based on thrombolysis in myocardial infarction scores, stroke onset to Recanalization, and CT to Recanalization times were obtained. Primary outcome was modified Rankin scale score ≤2 at 3 months. Results—Median baseline NIHSS was 18 (range, 8–34) and median baseline ASPECTS score was 6 (range, 0–10); 81.2% achieved Recanalization (thrombolysis in myocardial infarction, 2–3) and (27.7%) achieved good outcome. Good outcome was significantly higher in the ASPECTS score >7 group when...
-
low rates of acute Recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke real world experience and a call for action
Stroke, 2010Co-Authors: Rohit Bhatia, Michael D Hill, Mayank Goyal, Nandavar Shobha, Bijoy K Menon, Puneet Kochar, Timothy Watson, Andrew M DemchukAbstract:Background and Purpose— Acute rates of Recanalization after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) in proximal vessel occlusion have been estimated sparingly, typically using transcranial Doppler (TCD). We aimed to study acute Recanalization rates of IV rt-PA in CT angiogram-proven proximal (internal carotid artery [ICA], M1 middle cerebral artery [MCA], M2-MCA, and basilar artery) occlusions and their effects on outcome. Materials and Methods— The CT angiogram database of the Calgary stroke program was reviewed for the period 2002 to 2009. All patients with proximal vessel occlusions receiving IV rt-PA who were assessed for Recanalization by TCD or angiogram (for acute endovascular treatment) were included for analysis. Rates of acute Recanalization as observed on TCD/first run of angiogram and postendovascular therapy Recanalization rates were noted. Modified Rankin Scale score ≤2 at 3 months was used as a good outcome. Results— Among 1341 patients in the CT angiogram database, 388 patients with proximal occlusion were identified. Of these, 216 patients had received IV rt-PA; 127 patients underwent further imaging to assess Recanalization. Among the patients undergoing TCD (n=46) and cerebral angiogram (n=103), only 27 (21.25%) patients had acute Recanalization. By occlusion subtype, the rates of Recanalization were: distal ICA (with or without ICA neck occlusion or stenotic disease) 1 of 24 (4.4%); M1-MCA (with or without ICA neck occlusion or stenotic disease) 21 of 65 (32.3%); M2-MCA 4 of 13 (30.8%); and basilar artery 1 of 25 (4%). Onset to rt-PA time was comparable in patients with and without Recanalization. Recanalization ( P Conclusions— A low rate of acute Recanalization was observed with IV rt-PA in proximal vessel occlusions identified by baseline CT angiogram. Recanalization was the strongest predictor of good outcome.
Albert J Yoo - One of the best experts on this subject based on the ideXlab platform.
-
mri based selection for intra arterial stroke therapy value of pretreatment diffusion weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early Recanalization
Stroke, 2009Co-Authors: Albert J Yoo, Luis A Verduzco, Pamela W Schaefer, Joshua A Hirsch, James D Rabinov, Gilberto R GonzalezAbstract:Background and Purpose— Recent studies demonstrate that an acute diffusion-weighted imaging lesion volume >70 cm3 predicts poor outcome in patients with stroke. We sought to determine if this threshold could identify patients treated with intra-arterial therapy who would do poorly despite reperfusion. In patients with initial infarcts <70 cm3, we sought to determine what effect Recanalization and time to Recanalization had on infarct growth and functional outcome. Methods— We retrospectively studied 34 consecutive patients with anterior circulation stroke who underwent pretreatment diffusion-weighted imaging and perfusion-weighted imaging and subsequent intra-arterial therapy. Recanalization success and time to Recanalization were recorded. Initial diffusion-weighted imaging and mean transit time lesion and final infarct volumes were determined. Patients were stratified based on initial infarct volume, Recanalization status, and time to Recanalization. Statistical tests were performed to assess difference...
-
mri based selection for intra arterial stroke therapy value of pretreatment diffusion weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early Recanalization
Stroke, 2009Co-Authors: Albert J Yoo, Luis A Verduzco, Pamela W Schaefer, Joshua A Hirsch, James D Rabinov, Gilberto R GonzalezAbstract:Background and Purpose— Recent studies demonstrate that an acute diffusion-weighted imaging lesion volume >70 cm 3 predicts poor outcome in patients with stroke. We sought to determine if this threshold could identify patients treated with intra-arterial therapy who would do poorly despite reperfusion. In patients with initial infarcts 3 , we sought to determine what effect Recanalization and time to Recanalization had on infarct growth and functional outcome. Methods— We retrospectively studied 34 consecutive patients with anterior circulation stroke who underwent pretreatment diffusion-weighted imaging and perfusion-weighted imaging and subsequent intra-arterial therapy. Recanalization success and time to Recanalization were recorded. Initial diffusion-weighted imaging and mean transit time lesion and final infarct volumes were determined. Patients were stratified based on initial infarct volume, Recanalization status, and time to Recanalization. Statistical tests were performed to assess differences in clinical and imaging outcomes. Good clinical outcome was defined as a 3-month modified Rankin Scale score ≤2. Results— Among patients with initial infarcts >70 cm 3 , all had poor outcomes despite a 50% Recanalization rate with mean infarct growth of 114 cm 3 . These patients also had the largest mean transit time volumes ( P 3 who recanalized early had the best clinical outcomes ( P P 3 . Conclusion— This study supports the use of an acute diffusion-weighted imaging lesion volume threshold as an imaging selection criterion for intra-arterial therapy. It also confirms the importance of early reperfusion in selected patients.
Andrei V Alexandrov - One of the best experts on this subject based on the ideXlab platform.
-
association of pretreatment blood pressure with tissue plasminogen activator induced arterial Recanalization in acute ischemic stroke
Stroke, 2007Co-Authors: Georgios Tsivgoulis, Michael D Hill, Maher Saqqur, Vijay K Sharma, Andrei V AlexandrovAbstract:Background and Purpose— Elevated systolic blood pressure (SBP) and lack of early vessel Recanalization are predictors of poor outcome among patients with stroke treated with systemic tissue plasminogen activator (tPA). We aimed to evaluate the potential relationship between pretreatment SBP and tPA-induced Recanalization. Methods— Consecutive patients with acute ischemic stroke resulting from intracranial artery occlusion were treated with standard intravenous tPA and assessed with 2-MHz transcranial Doppler for arterial Recanalization. Early arterial Recanalization was determined with previously validated Thrombolysis in Brain Ischemia flow grading system at 120 minutes after tPA bolus. Functional outcome at 3 months was evaluated using the modified Rankin Scale. Results— A total of 351 patients received intravenous tPA (mean age: 68.7±13.4 years, median National Institutes of Health Stroke Scale score 16.5). Patients with complete Recanalization (n=94) had lower mean pretreatment SBP values (152±23 mm H...
-
arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator
Neurology, 2002Co-Authors: Andrei V Alexandrov, James C GrottaAbstract:Background: Arterial reocclusion has not been systematically studied despite the fact that 13% of patients in the National Institute of Neurological Diseases and Stroke rt-PA Trial deteriorated following initial improvement, suggesting that reocclusion might be responsible for poor clinical outcome in some of these patients. Methods: Consecutive stroke patients treated with IV tissue plasminogen activator (TPA) within 3 hours and an M1 or M2 middle cerebral artery (MCA) occlusion on pre-TPA transcranial Doppler (TCD) were monitored up to 2 hours after TPA bolus. Reocclusion was defined as the Thrombolysis in Brain Ischemia flow decrease by ≥1 grades and no hemorrhage on repeat CT. The NIH Stroke Scale (NIHSS) and modified Rankin Scores (mRS) were obtained by a neurologist independently of TCD. Results: Sixty patients with median prebolus NIHSS score of 16 (range 6 to 28, 90% with ≥10 points) had TPA bolus at 130 ± 32 minutes (median 120 minutes, 58% within the first 2 hours). Recanalization was complete in 18 (30%), partial in 29 (48%), and none in 13 (22%) patients. Reocclusion occurred in 34% of patients with any initial Recanalization (16/47): in 4 of 16 patients with complete Recanalization (22%), and in 12 of 29 patients with partial Recanalization (41%). Reocclusion was detected in four patients (25%) before TPA bolus, in three (19%) by 30 minutes after bolus, in three (19%) by the end of infusion, and in six (37%) by 60 to 120 minutes. Before reocclusion, those patients had earlier median timing of Recanalization: 130 versus 180 minutes after stroke onset compared with those who recanalized without reocclusion ( p = 0.01). Median prebolus NIHSS score in the reocclusion group was 13.5 versus 17 (rest, NS), whereas at 2 and 24 hours, their NIHSS scores were higher: 14 versus 9 and 16 versus 6 points ( p ≤ 0.04). Deterioration followed by improvement by ≥4 NIHSS points occurred in 8 of 16 (50%) patients with reocclusion versus 10% (rest) ( p p p ≤ 0.05), and mortality was 42% with no early Recanalization, 33% after reocclusion, and 8% in patients with stable Recanalization ( p ≤ 0.05). Conclusions: Early reocclusion occurs in 34% of TPA-treated patients with any initial Recanalization, accounting for two-thirds of deteriorations following improvement. Reocclusion occurs more often in patients with earlier and partial Recanalization, leading to neurologic deterioration and higher in-hospital mortality. However, patients with reocclusion have better long-term outcomes than patients without any early Recanalization.
-
speed of intracranial clot lysis with intravenous tissue plasminogen activator therapy sonographic classification and short term improvement
Circulation, 2001Co-Authors: Andrei V Alexandrov, Andrew M Demchuk, Scott W Burgin, Ashraf Elmitwalli, James C GrottaAbstract:Background—Arterial Recanalization precedes clinical improvement or may lead to hemorrhage or reperfusion injury. Speed of clot lysis was not previously measured in human stroke. Methods and Results—Transcranial Doppler (TCD) and the National Institutes of Health Stroke Scale (NIHSS) were used to monitor consecutive patients receiving intravenous tissue plasminogen activator (tPA), before tPA bolus and at 24 hours. Patients with complete or partial Recanalization of the middle cerebral or basilar artery on TCD were studied. Recanalization was classified a priori as sudden (abrupt appearance of a normal or stenotic low-resistance signal), stepwise (flow improvement over 1 to 29 minutes), or slow (≥30 minutes). Recanalization was documented in 43 tPA-treated patients (age 68±17 years; NIHSS score 16.8±6, median 15 points). tPA bolus was given at a mean of 135±61 minutes after symptom onset. Recanalization began at a median of 17 minutes and was completed at 35 minutes after tPA bolus, with mean duration of ...
Ji Hoe Heo - One of the best experts on this subject based on the ideXlab platform.
-
effect of balloon guide catheter utilization on contact aspiration thrombectomy
Journal of Neurosurgery, 2019Co-Authors: Donghun Kang, Young Dae Kim, Hyo Suk Nam, Byung Moon Kim, Dong Joon Kim, Ji Hoe Heo, Yangha Hwang, Yong Won Kim, Y S Kim, Hyo Sung KwakAbstract:OBJECTIVEThe role of the balloon guide catheter (BGC) has not been evaluated in contact aspiration thrombectomy (CAT) for acute stroke. Here, the authors aimed to test whether the BGC was associated with Recanalization success and good functional outcome in CAT.METHODSAll patients who had undergone CAT as the first-line treatment for anterior circulation intracranial large vessel occlusion were retrospectively identified from prospectively maintained registries for six stroke centers. The patients were dichotomized into BGC utilization and nonutilization groups. Clinical findings, procedural details, and Recanalization success rates were compared between the two groups. Whether the BGC was associated with Recanalization success and functional outcome was assessed.RESULTSA total of 429 patients (mean age 68.4 ± 11.4 years; M/F ratio 215:214) fulfilled the inclusion criteria. A BGC was used in 45.2% of patients. The overall Recanalization and good outcome rates were 80.2% and 52.0%, respectively. Compared to the non-BGC group, the BGC group had a significantly reduced number of CAT passes (2.6 ± 1.6 vs 3.4 ± 1.5), shorter puncture-to-Recanalization time (56 ± 27 vs 64 ± 35 minutes), lower need for the additional use of thrombolytics (1.0% vs 8.1%), and less embolization to a distal or different site (0.5% vs 3.4%). The BGC group showed significantly higher final (89.2% vs 72.8%) and first-pass (24.2% vs 8.1%) Recanalization success rates. After adjustment for potentially associated factors, BGC utilization remained independently associated with Recanalization (OR 4.171, 95% CI 1.523-11.420) and good functional outcome (OR 2.103, 95% CI 1.225-3.612).CONCLUSIONSBGC utilization significantly increased the final and first-pass Recanalization rates and remained independently associated with Recanalization success and good functional outcome.
-
need for rescue treatment and its implication stent retriever versus contact aspiration thrombectomy
Journal of NeuroInterventional Surgery, 2019Co-Authors: Donghun Kang, Jang Hyun Baek, Young Dae Kim, Hyo Suk Nam, Byung Moon Kim, Ji Hoe Heo, Yangha Hwang, Yong Won Kim, Jin Woo Kim, Joonsang YooAbstract:Backgroud The need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT. Methods We identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final Recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome. Results A total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final Recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, Recanalization with the first-line modality alone and first-pass Recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-Recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870). Conclusion CA was associated with requiring RT, while Recanalization with first-line modality alone and first-pass Recanalization rates were higher with SR. RT was negatively associated with good outcome.
-
number of stent retriever passes associated with futile Recanalization in acute stroke
Stroke, 2018Co-Authors: Jang Hyun Baek, Joonsang Yoo, Young Dae Kim, Hyo Suk Nam, Byung Moon Kim, Dong Joon Kim, Ji Hoe Heo, Hyungjong Park, Oh Young Bang, Pyoung JeonAbstract:Background and Purpose- Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile Recanalization can be determined. Methods- Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The Recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results- A total of 467 patients were included. Successful Recanalization by SR alone was achieved in 82.2% of patients. Recanalization rates got sequentially lower as the number of passes increased, and the Recanalization rate achievable by ≥5 passes of the SR was 5.5%. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without Recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without Recanalization (OR 1.70 with 95% CI, 0.42-6.90 for 5 passes, P=0.455; OR 0.33 with 0.02-5.70, P=0.445 for ≥6 passes). Conclusions- The likelihood of successful Recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the Recanalization rate and functional outcomes.
-
predictive value of thrombus volume for Recanalization in stent retriever thrombectomy
Scientific Reports, 2017Co-Authors: Jang Hyun Baek, Joonsang Yoo, Dongbeom Song, Young Dae Kim, Hyo Suk Nam, Byung Moon Kim, Dong Joon Kim, Hye Sun Lee, Ji Hoe HeoAbstract:This retrospective study investigated whether the volume or density of the thrombus is predictive of Recanalization in stent retriever (SR) treatment. Consecutive patients treated with SR thrombectomy as the first endovascular modality were enrolled. The thrombus volume and density were measured on thin-section noncontrast computed tomography using 3-dimensional software. The patients were grouped by Recanalization status and the number of SR passes. Among 165 patients, Recanalization was achieved with the first pass in 68 (50.0%), 2-3 passes in 43 (31.6%), and ≥4 passes in 25 (18.4%) patients. The thrombus volume was smaller in patients with (107.5 mm3) than without (173.7 mm3, p = 0.025) Recanalization, and tended to be larger with increasing number of passes (p for trend = 0.001). The thrombus volume was an independent predictor of first-pass Recanalization (odds ratio 0.93 per 10 mm3, 95% confidence interval 0.89-0.97). However, the thrombus density was not associated with Recanalization success. Recanalization within 3 passes was associated with a favorable outcome. In conclusion, the thrombus volume was significantly related to Recanalization in SR thrombectomy. Measuring the thrombus volume was particularly predictive of first-pass Recanalization, which was associated with a higher likelihood of a favorable outcome.
