BackgroundDespite successful endovascular thrombectomy for acute ischemic stroke, a significant proportion of patients still fail to demonstrate functional independence at 90 days and show fast and ...early progression of infarct volume after thrombectomy. Several factors have been proposed to influence the fast progression of infarct volume after successful recanalization including collateral score and post-procedural hemorrhage. In this work, we compare clinical and technical outcomes in patients with ICA LVO to those with concurrent MCA and ACA occlusion.MethodsWe analyzed vessel-specific outcomes from the prospectively maintained Stroke Thrombectomy and Aneurysm Registry (STAR). We included adult patients undergoing endovascular thrombectomy for acute ischemic stroke from 32 centers in the US and globally between January 2015 and May 2021. Patients were included if the location of thrombus involved the ICA, ICA+MCA, ICA+ACA, or MCA+ACA. Patient demographics, baseline deficits, admission variables, technical and clinical outcomes were reviewed and compared between the ICA group (including ICA+MCA, ICA+ACA) and the MCA+ACA group. Patients with tandem occlusions were not included. The primary outcome measure was modified Rankin Score (mRS) at 90 days dichotomized into good outcome (mRS 0–2) and poor outcome (mRS 3–6). Secondary outcomes included successful recanalization, procedure time, and rates of post-procedural hemorrhage.ResultsA total of 2067 patients were included in the study of which 83 patients (4%) had concurrent MCA and ACA thrombus. When comparing admission variables, there were no differences in age, admission NIHSS, comorbidities, onset to groin time, ASPECT scores, or use of IV-tPA between the ICA group and MCA+ACA group (P > 0,05). On univariate analysis, the median 90-day mRS was significantly higher in the MCA+ACA group compared to ICA group (5 vs. 4, p < 0.05). There was no difference in rate of symptomatic hemorrhage, successful recanalization rate, or procedure time between the two groups (P > 0.05). On multivariate regression baseline covariates, admission deficits, and procedure time, MCA+ACA location was an independent predictor of lower odds of good outcome compared to the ICA group in the full cohort (aOR=0.46, p= 0.018) and in successfully recanalized patients (aOR = 0.47, p = 0.041). On multivariate linear regression, MCA+ACA location was not an independent predictor of longer procedure time compared to the ICA group. Mortality rate was 56% in the MCA+ACA group compared to 31% in the ICA group (P<0.05).ConclusionsDespite similar vascular territories, concurrent occlusion of the MCA and ACA segments results in worse clinical outcomes compared to more proximal ICA occlusion. The likely explanation for fast progression of infarct in the MCA+ACA group is the higher likelihood of end-artery involvement and lower contribution of collateral flow. Reperfusion of both territories; however, does add to the risk of symptomatic post-procedural hemorrhage.Disclosures S. Eshraghi: None. S. Saperian: None. A. Alawieh: None. B. Howard: None. J. Grossberg: None. F. Tong: None. P. Jabbour: None. I. Maier: None. S. Wolfe: None. A. Rai: None. R. Starke: None. B. Gory: None. M. Psychogios: None. A. Shaaban: None. A. Arthur: None. J. Kim: None. S. Yoshimura: None. P. Kan: None. R. DeLeacy: None. I. Fragata: None. A. Polifka: None. J. Osbun: None. T. Dumont: None. R. Williamson: None. R. Crosa: None. M. Levitt: None. M. Moss: None. W. Casagrande: None. S. Chowdhry: None. C. Cawley: None.
IntroductionGiven the mixed results of recent clinical trials, the role of bridging therapy with intravenous thrombolysis (IVT) in patients undergoing mechanical thrombectomy (MT) remains contested. ...These results highlight the need to identify subgroup specific strategies to optimize patient selection. Patients undergoing MT for intracranial atherosclerotic disease (ICAD) are more likely to require rescue intracranial stenting and an attendant load of dual antiplatelet drugs. Whether bridging thrombolysis increases hemorrhagic complications in patients requiring rescue intracranial stenting is unclear and may affect frontline thrombolysis decisions in patients with suspected ICAD related large vessel occlusions (LVOs). Here we determine whether bridging therapy modifies procedural and clinical outcomes in patients requiring rescue intracranial stenting after a failed MT.MethodsWe performed a retrospective cohort study of the Stroke and Aneurysm Registry (STAR) from January 2015 to December 2021 and identified 8,988 patients who underwent MT, 108 (1.2%) of underwent rescue intracranial stenting after failed MT for anterior circulation LVOs. Prospectively defined baseline characteristics and clinical outcomes were compared.Results108 patients underwent rescue stenting, 32 (29.6%) who received IVT and 76 (70.4%) did not. Patients receiving IVT presented significantly earlier (700 312–1178 vs 242 179–333 min, p<0.001), but were otherwise comparable in baseline demographics. A similar number of mechanical thrombectomy passes were employed in both cohorts (3 2–5 vs 3 2–5, not significant) with comparable procedural times. Any post-procedural hemorrhage within the first 36 hours was similarly common between both groups (24.6% vs. 31.3%). Symptomatic hemorrhage or type-2 parenchymal hematomas were rare in both groups, with a non-significant trend towards increased events with IVT (2 vs. 4 events, 2.9% vs 12.5%, p=.078). Good functional outcomes, defined as a modified Rankin score of 0–2 measured 90 days post discharge, were comparable between groups (23.7% vs. 37.0%, p=0.209). IVT use did not associate with hemorrhagic complications or good functional outcomes at 90 days in multivariable binary logistic regression analyses.ConclusionsIn this international, retrospective cohort study of likely highly-selected patients, IVT exposure did not modify hemorrhagic complications or outcomes in patients requiring intracranial rescue stenting after failed MT. These results are consistent with several randomized clinical trials which did not demonstrate increased hemorrhagic complications in unselected patients undergoing bridging thrombolysis. These data suggest that acute intracranial stenting (with attendant dual antiplatelet loading) may be safe in selected patients exposed to IVT and argue against withholding IVT for patients at higher risk of needing rescue stenting.Abstract O-018 Figure 1Disclosures F. Akbik: None. A. Alawieh: None. J. Grossberg: None. C. Cawley: None. J. Kinariwala: None. P. Jabbour: None. I. Maier: None. S. Wolfe: None. A. Rai: None. R. Starke: None. B. Gory: None. M. Psychogios: None. A. Shaban: None. A. Arthur: None. J. Kim: None. S. Yoshimura: None. P. Kan: None. R. DeLeacy: None. I. Fragata: None. A. Polifka: None. J. Osbun: None. T. Dumont: None. R. Williamson: None. R. Crosa: None. M. Levitt: None. M. Moss: None. M. Park: None. W. Casagrande: None. S. Chowdhry: None. A. Spiotta: None. A. Spiotta: None. B. Howard: None.
BackgroundFemale gender has been associated with worse clinical outcomes after ischemic stroke and account for the majority of stroke mortality. Females were more likely to receive intra-arterial ...therapy for ischemic stroke but had worse clinical outcomes then their male counterparts. Data on gender differences in endovascular thrombectomy remains limited.MethodsWe analyzed gender-specific outcomes from the prospectively maintained Stroke Thrombectomy and Aneurysm Registry (STAR). We included adult patients undergoing endovascular thrombectomy for acute ischemic stroke from 32 centers in the US and globally between January 2015 and May 2021. Patient demographics, baseline deficits, admission variables, technical and clinical outcomes were reviewed and compared between the males and females. The primary outcome measure was modified Rankin Score (mRS) at 90 days dichotomized into good outcome (mRS 0–2) and poor outcome (mRS 3–6).ResultsA total of 7477 patients were included in the study of which 50% were females. On average, female patients were older (70 vs. 67, p< 0.01), more likely to have comorbid atrial fibrillation (39% vs. 34%, p< 0.01), and more likely to have mRS > 2 on presentation (11% vs. 8%, p<0.01). However, there was no difference in admission NIHSS, admission ASPECT scores, onset-to-groin time, and use of bridging thrombolysis between the two groups. On univariate analysis, females had significantly higher mRS score at 90-days compared to males (p<0.01) and demonstrated lower rates of functional independence (mRS 0–2, 34% vs. 40%, p<0.01). Using propensity score matching, when controlling for baseline covariates, there was no significant difference in 90-day mRS scores between males and females. Similarly, when baseline covariates were controlled for on univariate analysis, there was no significant gender differences in 90-mRS scores or procedural complications. Predictors of good functional outcome at 90 days were similar in males and females.ConclusionsOlder females with higher baseline disability are more likely to undergo mechanical thrombectomy compared to males. Biological sex is not an independent predictor of thrombectomy outcomes in acute stroke when controlling for baseline and comorbid variables. Future studies will explore the determinants underlying differences in presentations and outcomes betweenDisclosures L. Dimisko: 1; C; T32NR012715. V. Hertzberg: None. J. Grossberg: None. B. Howard: None. C. Cawley: None. F. Tong: None. P. Jabbour: 2; C; Medtronic, MicroVention, Cerus Endovascular, and Balt. I. Maier: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; Medtronic, NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by National Institute of Health(R01NS111119–01A1) and(UL1TR002736, KL2TR002737) through the Miami Clinical and Translational. 2; C; xPenumbra, Abbott, Medtronic, InNeuroCo and Cerenovus. B. Gory: None. M. Psychogios: 1; C; Phenox, Stryker, and Siemen.. A. Shaban: None. A. Arthur: 1; C; Cerenovus, MicroVention, Penumbra, and Siemens. 2; C; Balt, Johnson and Johnson, Leica, Medtronic, MicroVention,Penumbra, Scientia, Siemens, and Stryker. 4; C; Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity,Synchron, Triad Medical, and Vascular Simulations. J. Kim: None. S. Yoshimura: None. P. Kan: 2; C; Stryker and Cerenovus. R. De Leacy: None. I. Fragata: None. A. Polifka: None. J. Osbun: None. T. Dumont: None. R. Williamson: None. R. Crosa: None. M. Levitt: None. M. Moss: None. M. Park: None. W. Casagrande: None. S. Chowdhry: None. A. Spiotta: 1; C; Penumbra, Pulsar Vascular, MicroVention, and Stryker. 2; C; Penumbra, MicroVention, and PulsarVascular;. A. Alawieh: None.
IntroductionLimited data is available about the outcomes of mechanical thrombectomy (MT) in stroke patients presenting with a large core infarct. We aim to investigate the safety and efficacy of MT ...in patients with large vessel occlusion and Alberta Stroke Program Early CT Score (ASPECTS) of 2-5.MethodsData from Stroke Thrombectomy and Aneurysm Registry (STAR), which combined the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia, was interrogated. We identified thrombectomy patients presenting with an occlusion in the Internal carotid artery (ICA) or M1 segment of the middle cerebral artery (MCA). Multivariable regression analysis was performed to assess factors associated with favorable 90-day outcome (modified Rankin scale 0-3), including interaction terms between ASPECTS 2-5 and receiving MT in the extended window (≥ 6 hours from symptom-onset).ResultsAmong MT patients who presented with ICA or M1 occlusion, 2132 had ASPECTS≥6 and 213 patients had ASPECTS 2-5. Patients in the low ASPECTS group were younger (70 vs. 72 years old, P=0.003) and more likely to present with an ICA occlusion (47.9% vs. 28.8%, P<0.001) compared to patients with ASPECTS≥6. At 90 days, mRS 0-3 was observed in 36.6% of the patients who presented with ASPECTS 2-5 (42% in patients who had successful recanalization and 10.8% in patients who had failed recanalization, P=0.001) (figure 1). Lower ASPECTS and presenting in the extended window were both associated with worse 90- day outcomes after controlling for potential confounders, without significant interaction between these two factors.ConclusionMore than one in three patients presenting with ASPECTS (2-5) may achieve favorable 90-day functional outcome following MT. Favorable outcome was 4 times higher in low ASPECTS patients who had successful recanalization. The effect of low ASPECTS on 90-day outcome did not differ in patients presenting in the early versus extended MT window.Abstract O-011 Figure 1Disclosures E. Almallouhi: None. S. Al Kasab: None. Z. Hubbard: None. G. Porto: None. A. Alawieh: None. R. Chalhoub: None. E. Bass: None. P. Jabbour: None. R. Starke: None. S. Wolfe: None. A. Arthur: None. I. Maier: None. J. Grossberg: None. A. Rai: None. M. Park: None. J. Mascitelli: None. M. Psychogios: None. R. De Leacy: None. D. Raper: None. T. Dumont: None. M. Levitt: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. J. Kim: None. W. Casagrande: None. M. Mokin: None. C. Matouk: None. A. Shaban: None. I. Fragata: None. A. Yoo: None. A. Spiotta: 1; C; Stryker, Penumbra, and Medtronic. 2; C; Penumbra, Stryker, Cerenovus, Terumo.
BackgroundMechanical thrombectomy (MT) indications for acute stroke treatment have expanded in the last few years to include medium vessel occlusions. However, limited data is available about the ...safety and efficacy of MT in the distal anterior cerebral artery (ACA) segments (A2/A3). This study aims to assess the feasibility and outcomes of MT in stroke patients presenting with acute A2 and A3 occlusions in a large multicenter registry.MethodsThis is a retrospective analysis from the Stroke Thrombectomy and Aneurysm registry (STAR) which maintains data from 40 stroke centers in the United States, Europe, Asia, and South America. We included patients who presented with A2/A3 occlusions and were treated with MT using second generation thrombectomy devices between January 1, 2014, and December 31, 2020. Primary outcome of this analysis was the final modified treatment in cerebral infarction (mTICI) score. Other endpoints included the modified Rankin Scale (mRS) score at 90 days and the rate of symptomatic intracranial hemorrhage (sICH).ResultsWe identified 27 patients who met the inclusion criteria. Median age was 61 (IQR 53-81) years, 15 (55.6%) were female, and 14 (51.9%) were white. A2 segment occlusion was seen in 20 (74.1%) patients and A3 segment in 7 (25.9%) patients. Fourteen (51.9%) in patients received intravenous tissue plasminogen activator (tPA) prior to MT. Regarding MT technique used, contact aspiration first line (ADAPT) was used in 14 (51.9%) patients, stent retriever first-line was used in 4 (14.8%) patients, and a combination of both techniques was used in 9 (33.3%). Intraarterial tPA was used in 6 (22.2%) patients. Final mTICI ≥ 2B was recorded in 20 (74.1%) patients (13 48.1% had mTICI of 2C or 3). Periprocedural complications were seen in 4 (14.8%) patients and sICH occurred in 1 (3.7%) patient. At 90 days, 17 (63%) patients achieved functional independence (mRS 0-2).ConclusionIn this multicenter study, MT for distal ACA occlusions in the A2/A3 segments seem to be feasible and associated with low complication and symptomatic hemorrhage rates. Future studies are needed to compare the functional outcome of MT versus medical management for stroke patients presenting with A2/A3 occlusions.Disclosures D. Pullmann: None. E. Almallouhi: None. S. Al Kasab: None. A. Alawieh: None. R. Chalhoub: None. R. Starke: None. R. De Leacy: None. D. Raper: None. A. Rai: None. T. Dumont: None. S. Wolfe: None. P. Jabbour: None. C. Ogilvy: None. M. Park: None. M. Levitt: None. A. Polifka: None. R. Crowley: None. A. Arthur: None. J. Osbun: None. R. Crosa: None. I. Maier: None. J. Kim: None. W. Casagrande: None. A. Shaban: None. J. Grossberg: None. S. Chowdhry: None. M. Mokin: None. C. Matouk: None. I. Fragata: None. S. Webb: None. A. Yoo: None. J. Mascitelli: None. M. Psychogios: None. M. Azab: None. A. Spiotta: None.
Poor oral health status may have an impact on the health status of patients with chronic renal failure.
To describe the oral health status of a group of Brazilian patients with chronic renal failure.
...Retrospective review of the medical records of patients with chronic renal failure, of whom 13 (4.5%) were in a predialysis stage, 158 (55%) were on hemodialysis, 23 (8.4%) were on peritoneal dialysis and 92 (32.1%) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) index.
The sample was composed of 152 men (53%) and 134 women (47%), aged 42+/-13 years. Oral health status was considered defective in most patients (83%). Eighty-seven percent had dental calculus and 55% had halitosis. Transplant patients reported significantly less halitosis (40.2%) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age.
This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.
We describe a 40-year-old man with limited scleroderma who presented with acute heart failure following a flu-like illness. He was known to have incomplete left anterior bundle branch block, initial ...isolated pulmonary hypertension with enlarged right atrium, and no pulmonary fibrosis. He received therapy for acute heart failure and was transferred to a scleroderma centre for specific treatment of scleroderma cardiomyopathy. Investigations showed raised inflammatory markers and diffuse hyperechogenic thickening of the myocardium on echocardiography. Contrast-enhanced (Gd-DOTA) cardiovascular magnetic resonance imaging (CV-MRI) showed multiple areas of non-homogeneous delayed hyperenhancement in the left ventricle, suggestive of myocarditis. Antiadenovirus IgM antibodies were detected with a titer consistent with recent infection. Six weeks later a repeat Gd-DOTA CV-MRI showed an almost complete resolution of the areas of hyperenhancement and there was a significant reduction in the adenovirus antibody titer with serological conversion to IgG. To our knowledge this is the first report of viral myocarditis in scleroderma. Infections are important causes of morbidity and mortality in this disease and should always be included in the differential diagnosis of cardiac symptoms. We propose that contrast-enhanced CV-MRI is valuable in a non-invasive diagnosis of heart disease in patients with scleroderma.
PDF
