Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers

Background and Purpose. Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. Methods. A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We evaluated the influence of risk factors for stroke, baseline NIHSS score, Alberta Stroke Program Early CT (ASPECT) score, recanalization rate, onset-to-recanalization and onset-to-groin puncture time, and glucose levels at admission on good outcomes. The number of stent passes during procedure and symptomatic hemorrhage rate were also recorded. A modified Rankin Scale (mRS) score of 0–2 at 90 days was considered as a good outcome. Results. From January 2011 to 2014, 70 consecutive patients with an acute ischemic stroke underwent EVT with stent retrievers. The absence of a medical history of diabetes was associated with good outcomes. Apart from diabetes, the baseline demographic and clinical characteristics of patients were similar between subjects with poor outcome versus those with good outcomes. Median time from onset to recanalization was significantly shorter in patients with good outcomes 245 (IQR: 216–313 min) compared with poor outcome patients (315 (IQR: 240–360 min); P=0.023). Symptomatic intracranial hemorrhage was observed in eight (21.6%) of 37 patients with poor outcomes and no symptomatic hemorrhage was seen in patients with good outcomes (P=0.006). In multivariate stepwise logistic regression analysis, a favorable ASPECT score (ASPECT > 7) and successful recanalization after EVT were predictors of good outcomes. Every 10-year increase was associated with a 3.60-fold decrease in the probability of a good outcome at 3 months. The probability of a good outcome decreases by 1.43-fold for each 20 mg/dL increase in the blood glucose at admission. Conclusion. To achieve a good outcome after EVT with stent retrievers, quick and complete recanalization and better strategies for patient selection are warranted. We need randomized trials to identify the significance of tight blood glucose control in clinical outcome during or after EVT

İNME KLİNİK PRATİĞİNDE NOAK KULLANIMI: TÜRK BEYİN DAMAR HASTALIKLARI DERNEĞİ UZMAN GÖRÜŞÜ

Non-vitamin K oral antikoagülanların (NOAK) atrial fibrilasyonda inmenin önlenmesi amacıyla on yılı aşan bir süredir başarı ile kullanıldığı açıktır. Varfarine göre belirgin derecede az kanamaya yol açmaları ve inmeyi de eşit veya daha fazla oranda önleyebilmeleri yanı sıra kolay kullanım özellikleri primer proflakside atrial fibrilasyona bağlı inmeyi azaltma konusunda öne çıkmaktadır. Bunlar aynı zamanda genel inme prevalansının azalması anlamına gelmektedir. Yani AF nedenli inmenin engellenmesi toplum sağlığı için çağdaş bir gereklilik olarak algılanmalıdır. İnme klinik pratiğinde kardiyoloji uzmanları ile birlikte bu bağlamda çaba sarf eden nöroloji uzmanları için Türk Beyin Damar Hastalıkları Derneği bu uzman görüşünü hazırladı. Görüşler NOAK grubu ilaçların kullanımında sıkça karşılaşılan sorunlar ve bu problemler için güncel çözüm önerilerini içermektedir

Mechanical thrombectomy in acute stroke patients during covid-19; comparison of pre-pandemic and pandemic data

Aim: To evaluate the reflection of the pandemic, on the mechanical thrombectomy (MT) management of acutestrokeMethod: We retrospectively evaluated 100 acute ischemic stroke patients between March 1, 2019- Februray 29,2020, and between March 1, 2020 - March 1, 2021, who underwent MT at our institute. Patients were divided intotwo groups as those who underwent MT before the Covid 19 pandemic (group 1) and those who underwent MTduring the period of Covid 19 pandemic (group 2). All the diagnosis of stroke patients was confirmed by MRI and CT.Demographics, clinical and laboratory data were recorded. National Institutes of Health Stroke Scale (NIHSS) scoreon pre-hospitalization and at discharge, ASPECT score, occluded vessel location, use of preprocedural lyticmedication, modified Rankin scores (mRS), procedure times (onset to groin puncture, door to needle, groin punctureto recanalization), device pass counts until successful recanalization or last angiogram if recanalization failed,Thrombolysis in Cerebral İnfarction (TICI) scales, early neurological improvements, post-procedure hemorrhage,decompression surgery, type of anesthesia during procedure and periprocedural complications were analyzedbetween groups. TOAST classification was used for stroke etiology.MT findings; symptom onset to groin puncture and recanalization times, first pass effect defined with single devicepass with TICI 2b/3 recanalization and final recanalization, admission and NIHHS scores and 3rd month mRS scores,postprocedural hemorrage rates were compared between groups.The SPSS version 26.0 was used for statistical analysis. The distribution of variables was assessed by theKolmogorov- Smirnov test. Categorical variable was evaluated using Chi-square test or Fisher’s exact test. Mann-Whitney U test or independent t-test was used for comparing continuous variables.Result: A total of 100 patients, 50 before and 50 after the pandemic, were included in the study. No statisticallysignificant difference was observed between the groups in terms of demographic data and risk factors. The timefrom symptom onset to groin puncture wassignificantly longer during the pandemic period than before (p=0.001). No significant difference was observed in thetime from groin puncture to recanalization (p=0.251), recanalization rates (p=0.806) and the number of passes(p=0.889). There was no difference between the pre-pandemic and post-pandemic groups in terms of the frequencyof intracranial hemorrhage (p=0.501), complication (p=0.153) and decompression (p=0.538) after MT. The mRSscores at 3 months were similar (p=0.316).Conclusion: As a result, the time from symptom to procedure is prolonged in acute ischemic stroke patients whounderwent MT in our center during the pandemic period.İn the respect of procedural findings and outcomes of MTbefore and during pandemic, there had been no significant change at our center.</div