IntroductionAcute stroke treatment with intracranial thrombectomy and stent-PTA of ipsilateral carotid artery stenosis/occlusion (“tandem lesion’ TL) in one session is considered safe. However, the ...risk of stent restenosis after TL treatment is high. Antiplatelet (AP) therapy to prevent restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the procedural safety and 90 days outcome of patients receiving TL treatment under triple-AP with a focus on stent-patency and possible disadvantageous comorbidities.Aim of StudyTo ensure stent patency after TL treatment without putting the patient at risk of recurrent stroke or intracranial hemorrhage.MethodsPatients receiving TL treatment at our institution in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All treatments were with i.v. administration of eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Follow-up was done with duplex imaging at discharge and 90 days, with digital subtraction angiography upon suspected restenosis.Results176 patients were included. No periprocedural death occurred, periprocedural complications rate was 2.3%, in-hospital death rate 13.6%. 92.61% of patients maintained or improved the discharge mRS score at 90 days follow-up. 4.54% had an instent-restenosis within 90 days, no recorded comorbidity rendered significantly disadvantageous for stent patency.ConclusionTL treatment under triple AP was safe in our experience, resulting in a low rate of restenosis and with favorable outcome in 92%. The influence of comorbidities on restenosis could be negligible within the described follow-up period.Disclosure of InterestPhilipp von Gottberg: Nothing to disclose.Ali Khanafer: Nothing to discloseVictoria Hellstern: Proctering for phenox GmbH.Alexandru Cimpocca: Nothing to disclose.Hans Henkes: Proctoring for phenox GmbH, Co-Founder and Co-Owner of CONTARA GmbH
IntroductionIn the treatment of acute stroke, there are key points to optimize time. In 2022, in our centre some elements were modified to create a new circuit, in order to reduce the time from the ...detection of the stroke, to the moment of the start of treatment.Aim of StudyThere will be better results if we make an early diagnosis and treatment.MethodsOnce the stroke is confirmed, the next step is the election of the optimal treatment. Endovascular treatment is one of the possibilities in which the nursing team plays an important role.In our centre, at the angiosuite, nursing is organized into two roles: a surgical nurse and an assistant nurse. The surgical nurse is who assists in the surgical field during sterile techniques. The assistant nurse has to take care of the patient, to assist the instrumentalist nurse and to communicate with the rest of the hospital units.ResultsHospital Parc Taulí is the referent institution for around 450.000 citizens. It has a neurointerventional radiology team, who attends the acute stroke that requires endovascular treatment. During 2022, the institution has attended 66 patients who required thrombectomy. With the ongoing update of the guidelines, the hospital has reduced the detection-treatment time from 85 to 71 minutes.ConclusionIn order to provide the best attention during an acute stroke, time is the key factor. Nurses have an important role throughout the process, which means that they need to be trained adequately to achieve those required functions.Disclosure of InterestNothing to disclose
IntroductionThrombectomy is the standard treatment for acute ischemic stroke. No treatment for failed Thrombectomy has been so far established. As a rescue method, a double stent-retriever(SR) seems ...to be effective and associated with a low complication rate.Aim of StudyTo prove the efficacy and saftey of Double Stentreiver as a rescue method after failed Thrombectomy.MethodsIn a retrospective analysis, all patients having received mechanical Thrombectomy with double-SR as rescue therapy following failed single-SR thrombectomy between 2010–2022 were studied. The efficacy and safety of double-SR rescue therapy were evaluated using modified thrombolysis in cerebral infarction (TICI 2b/3), European Cooperation Acute Stroke Study( ECASS) II classification, and the National Institutes of Health Stroke Scale Score (NIHSS) at discharge.ResultsOf 120 enrolled patients, 74 presented with MCA- (M1= 66, M2= 8), 14 with TICA, and 14 with basilar artery -occlusion. The mean intervention duration before changing the method was 34.51 minutes, and the mean number of failed- passes was 1.98. Fist-pass Effect was achieved in 81 (67%) patients after using Double-SR. The mean time of rescue-thrombectomy was 26.12 (10–150 minutes). Symptomatic intracerebral hemorrhage was observed in 6 patients (5%).ConclusionRescue Mechanical thrombectomy using double-SR is associated with a higher rate of successful recanalization, first-pass effect, and relatively low rate of hemorrhagic complications. Further randomized control trials are needed to confirm results and long-term outcomes.Disclosure of InterestNothing to disclose.
IntroductionFor large vessel occlusions, 24h NIHSS was described as most accurate early clinical predictor of functional outcome in acute stroke patients. M2 occlusions are characterized by more ...distal and smaller infarct cores, early clinical surrogates of functional outcome might differ.Aim of StudyTo investigate early clinical surrogates for long-term independency of patients treated with mechanical thrombectomy for M2 occlusion stroke in comparison to patients with M1 occlusion stroke.MethodsAll patients enrolled in the German Stroke Registry-Endovascular Treatment (05/2015–12/2021; N=13082) were screened for anterior circulation stroke. Receiver-operating-characteristics(ROC)-curve analyses and area-under-the-curve(AUC) were used to evaluate the performance of admission NIHSS, 24h NIHSS and NIHSS percentage and absolute change to predict functional outcome at 90d. Excellent and good outcome were defined as modified Rankin Scale(mRS) 0–1 and 0–2, respectively.Results1268 patients with M2 and 2749 patients with M1 occlusion were included. For both cohorts, 24h NIHSS had the highest discriminative ability to predict excellent functional outcome with AUC=0.86(95%CI=0.84–0.88) for M2 and AUC=0.86(0.84–0.88) for M1 occlusions. Optimal cutoffs were NIHSS≤7 and NIHSS≤8, respectively. Good long-term functional outcome was predicted with AUC=0.86(0.85–0.88) for M2 and AUC=0.86(0.85–0.88) for M1 occlusions with optimal cut-offs NIHSS≤8 and NIHSS≤9, respectively.Conclusion24h NIHSS was identified as best surrogate for long-term functional outcome after thrombectomy for patients with M1 and M2 occlusion, while optimal cut-offs to predict good and excellent outcome were 1 NIHSS-point higher in M2 occlusions compared to M1 occlusions.Disclosure of InterestHK has financial interest in Eppdata GmbH.GT received fees as consultant and lecturer from Acandis, Alexion, Amarin, Boehringer Ingelheim, Bayer, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO.JF is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche, Stryker and Tonbridge. He is stock holder of Tegus Medical, Eppdata and Vastrax. He serves as Associate Editor at JNIS.All other authors have nothing to disclose.
2WIM, Warsaw, PolandIntroductionTigertriever stent-retriever (Rapid Medical, Israel) is a device designed using a different approach compared to classical stent-retrievers (i.e. Solitare or pRESET). ...The Tigetriever is an adjustable device that provides manual control of its diameter and curvature during stroke endovascular treatment.Aim of StudyTo compare the efficacy and safety of Tigertriever (adjustable stent-retriever) to stent-like stent-retrievers (SolitaireX and pRESET) in a retrospective single-center study using propensity score analysis.MethodsPatients treated in a comprehensive stroke center due to large vessel occlusion acute ischemic stroke between January 2016 and August 2021 were evaluated. Baseline characteristics and treatment results were compared between these groups before and after pair matching. There were 140 patients (60 in Tigertriever group and 80 in the stent-like stent-retriever group). In propensity score analysis, 52 matched pairs were selected in Tigertriever and stent-like stent-retriever groups.ResultsThe Tigertriever group had a higher successful first pass revascularization rate 46 vs. 23%, OR (95% CI): 1.7 (1.1–2.9), p = 0.013 and 14-min shorter groin-to-revascularization time (51 vs. 65 min. p = 0.017). There were no significant differences between Tigertriever and stent-like stent-retriever groups in the following: favorable mRS at 3 months, favorable recanalization rate, and symptomatic intracranial hemorrhages. There were no observed periprocedural adverse events related to Tigertriever, SolitaireX, or pRESET.ConclusionTigertriever had a significantly higher successful first pass revascularization rate and shorter groin-to-revascularization time in the analysis done before and after propensity score matching with stent-like stent-retrievers.Disclosure of InterestNothing to disclose
In this trial in patients with stroke who had a mismatch between sizes of early infarction and a hypoperfused brain region, endovascular thrombectomy at 6 to 16 hours after stroke onset was ...associated with a favorable shift in the distribution of disability scores at 90 days.
Stroke, a complex and heterogeneous disease, is a leading cause of morbidity and mortality worldwide. The timely therapeutic intervention significantly impacts patient outcomes, but early stroke ...diagnosis is challenging due to the lack of specific diagnostic biomarkers. This review critically examines the literature for potential biomarkers that may aid in early diagnosis, differentiation between ischemic and hemorrhagic stroke, and prediction of hemorrhagic transformation in ischemic stroke. After a thorough analysis, four promising biomarkers were identified: Antithrombin III (ATIII), fibrinogen, and ischemia-modified albumin (IMA) for diagnostic purposes; glial fibrillary acidic protein (GFAP), micro RNA 124-3p, and a panel of 11 metabolites for distinguishing between ischemic and hemorrhagic stroke; and matrix metalloproteinase-9 (MMP-9), s100b, and interleukin 33 for predicting hemorrhagic transformation. We propose a biomarker panel integrating these markers, each reflecting different pathophysiological stages of stroke, that could significantly improve stroke patients' early detection and treatment. Despite promising results, further research and validation are needed to demonstrate the clinical utility of this proposed panel for routine stroke treatment.
In the 2014 Palestinian annual health report, cerebrovascular accident was ranked as the third leading cause of death in the occupied Palestinian territory. Cerebrovascular accident is also one the ...most common causes of disability worldwide. Good management decreases mortality and morbidity. The aim of this study was to assess the current management of patients with ischaemic stroke at the Al-Shifa Hospital and to compare this with international guidelines.
For this clinical audit, we used simple random sampling to select files of patients admitted with the diagnosis of ischaemic stroke to the Al-Shifa Hospital. Data collection sheets were completed, and clinical practice was compared with the 2013 American Stroke Association guidelines.
Between January and June, 2016, 254 patients were admitted with ischaemic stroke, haemorrhagic stroke, or transient ischaemic attack. We selected 55 patient files. The International Classification of Diseases coding for cerebral infarction in patient files was relatively good, with 92% of files correctly coded. However, we found a substantial weakness in the documentation of duration, progression of symptoms (documented in 20% of files only), and physiotherapy assessment. Most essential acute investigations were done on time (for all 100% patients needing blood count, renal function tests, and CT scan and for 42 76% patients needing ECG). However, thrombolytic drugs were not used because they were not available. Long-term antiplatelet therapy was provided properly to 51 (92%) patients discharged from hospital. However, the initial doses of antiplatelet therapy were generally lower than the international recommendations. Findings also showed a marked inconformity of blood pressure management, especially with respect to the treatment decision and the choice of antihypertensive drug.
No local guidelines exist. Furthermore, the lack of availability of thrombolysis medication and the poor deviation in blood pressure management show a lack of evidence-based practice. These findings point to the urgent need for the development of local, evidence-based guidelines.
None.
BACKGROUND AND PURPOSE:The purpose was to assess quantitatively and qualitatively the composition and structure of cerebral thrombi and correlate them with the signs of intravital clot contraction ...(retraction), as well as with etiology, severity, duration, and outcomes of acute ischemic stroke.
METHODS:We quantified high-resolution scanning electron micrographs of 41 cerebral thrombi for their detailed cellular and noncellular composition and analyzed histological images for the overall structure with the emphasis on red blood cell compression, fibrin age, and the signs of inflammation.
RESULTS:Cerebral thrombi were quite compact and had extremely low porosity. The prevailing cell type was polyhedral compressed erythrocytes (polyhedrocytes) in the core, and fibrin-platelet aggregates were concentrated at the periphery; both findings are indicative of intravital contraction of the thrombi. The content of polyhedrocytes directly correlated with the stroke severity. The prevalence of fibrin bundles was typical for more severe cases, while the content of fibrin sponge prevailed in cases with a more favorable course. The overall platelet content in cerebral thrombi was surprisingly small, while the higher content of platelet aggregates was a marker of stroke severity. Fibrillar types of fibrin prevailed in atherothrombogenic thrombi. Older fibrin prevailed in thrombi from the patients who received thrombolytics, and younger fibrin dominated in cardioembolic thrombi. Alternating layers of erythrocytes and fibrin mixed with platelets were common for thrombi from the patients with more favorable outcomes. Thrombi with a higher number of leukocytes were associated with fatal cases.
CONCLUSIONS:Most cerebral thrombi undergo intravital clot contraction (retraction) that may be of underestimated clinical importance. Despite the high variability of the composition and structure of cerebral thrombi, the content of certain types of blood cells and fibrin structures combined with the morphological signs of intravital contraction correlate with the clinical course and outcomes of acute ischemic stroke.
Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department ...of Nasser Hospital, Gaza Strip.
For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health.
Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54%) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91%) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92%) patients, electrocardiography for 85 (89%) patients, carotid duplex ultrasound for 32 (34%) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74%) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85%) patients received venous thromboembolism prophylaxis. 41 (43%) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43%) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48%) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57%) patients.
No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further.
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