7 research outputs found
Abstract 1122â000122: The Role of the Venous System in Infarct Burden in Patients with Acute Ischemic Stroke
Introduction: Acute ischemic stroke (AIS) is a leading cause of disability internationally. Most therapies focus on intraâarterial treatment to improve postâstroke deficits and neurologic status. However, if a relationship between venous anatomy and postâstroke deficits or infarct size can be shown, then venous augmentation strategies represent a possibility for future interventions as an adjunct to intraâarterial treatment. Methods: We retrospectively reviewed all ischemic infarcts at our institution that underwent thrombectomy from January 2018 â October 2020. From these, we selected cases that were demonstrated as M1 occlusions on intraâprocedural angiogram and those who had a CT Head obtained within six hours of the patientâs last known normal (LKN). Patients without a CT Head or CT Angiogram of their head were excluded. Using axial and sagittal reconstructed views of 0.9mm slices, crossâsectional area measurements were taken of the superior sagittal sinus 1cm above the Torcula, in three locations of the ipsilateral and contralateral transverse sinus, in three locations of the ipsilateral and contralateral sigmoid sinus, and of the ipsilateral and contralateral internal jugular vein (IJV) at the external surface of the skull. For the transverse and sigmoid sinuses, the three measurements were averaged together. These measurements were then compared against patientâs Alberta Stroke Program Early CT Score (ASPECTS). Results: 77 patients were identified in the study period. Average ASPECTS was 8.9, ranging from 5â10. There were three patients included with ASPECTS < 6. Average ipsilateral transverse sinus area was 34.4mm ± 3.34, average ipsilateral sigmoid sinus area was 32.8mm ± 2.74, average ipsilateral IJV area was 46.9 mm ± 5.00. Correlation tests to identify relationships between venous sinus area and ASPECTS was unremarkable (ipsilateral transverse sinus p = 0.574, ipsilateral sigmoid sinus p = 0.548, ipsilateral IJV p = 0.798). When assessed as a ratio of ipsilateral venous sinus area to contralateral sinus area to assess correlation with ASPECTS, results were unremarkable (transverse sinus p = 0.891, sigmoid sinus p = 0.292, IJV p = 0.499). Conclusions: Venous sinus size was not found to be predictive or associated with predominantly favorable ASPECTS for strokes found within six hours. We believe this may be due to our cohort lacking significant numbers of patients with low ASPECTS, yielding a false negative result. We are currently expanding this project to include a comparable number of patients with ASPECTS < 6 to determine the role of venous collateral system in infarct progression
Off-label use of Woven EndoBridge device in vertebro-basilar junction aneurysm and a review of the literature
An intrasaccular flow diverter, the Woven EndoBridge device has emerged as an alternate intervention for complex aneurysms of the ACA, MCA, ICA, and basilar artery. However, few studies report the use of the WEB device in off-label locations. This case report aims to contribute to this limited collection of data. We present a case of a 53-year-old male presenting with occipital headaches, found to have vertebrobasilar junction aneurysm. The WEB device was successfully used to embolize a large aneurysm of the vertebrobasilar junction, a current off-label location. This represents a new use of the WEB device, as well as an approach that addresses the limitations of other techniques used for vertebrobasilar junction aneurysms
Apparent Reversal of Early Ischemic Changes on NonâContrast Computed Tomography Following Successful Endovascular Reperfusion
Early ischemic changes seen on nonâcontrast computed tomography secondary to cerebral edema is believed to indicate irreversible cellular injury. Computed tomography perfusion may overpredict the infarct core in patients with large vessel occlusion presenting in acute phase as these changes are potentially reversible if successful endovascular reperfusion is performed in a timely manner. This has led to the concept of âghost infarct coreâ which is the mismatch in the infarct core as seen on followâup imaging. We present a case which potentially supports the concept of âghost infarct coreâ evaluated not only by computed tomography perfusion but also nonâcontrast computed tomography in a patient with large vessel occlusion following successful thrombectomy
A Case Report of Recurrent Takotsubo Cardiomyopathy in a Patient during Myasthenia Crisis
Introduction. Patients with myasthenia crisis can develop Takotsubo stress cardiomyopathy (SC) due to emotional or physical stress and high level of circulating catecholamines. We report a patient who developed recurrent Takotsubo cardiomyopathy during myasthenia crisis. Coexisting autoimmune disorders known to precipitate stress cardiomyopathy like Graveâs disease need to be evaluated. Case Report. A 69-year-old female with seropositive myasthenia gravis (MG), Graveâs disease, and coronary artery disease on monthly infusion of intravenous immunoglobulin (IVIG), prednisone, pyridostigmine, and methimazole presented with shortness of breath and chest pain. Electrocardiogram (ECG) showed ST elevation in anterolateral leads with troponemia. Coronary angiogram was unremarkable for occlusive coronary disease with left ventriculogram showing reduced wall motion with apical and mid left ventricle (LV) hypokinesis suggestive of Takotsubo stress cardiomyopathy. Her symptoms were attributed to MG crisis. Her symptoms, ECG, and echocardiographic findings resolved after five cycles of plasma exchange (PLEX). She had another similar episode one year later during myasthenia crisis with subsequent resolution in 10 days after PLEX. Conclusion. Takotsubo cardiomyopathy can be one of the manifestations of myasthenia crisis with or without coexisting Graveâs disease. These patients might benefit from meticulous fluid status and cardiac monitoring while administering rescue treatments like IVIG and PLEX
sj-docx-1-ine-10.1177_15910199241227262 - Supplemental material for Patientsâ perceptions on outcomes after mechanical thrombectomy in acute ischemic stroke
Supplemental material, sj-docx-1-ine-10.1177_15910199241227262 for Patientsâ perceptions on outcomes after mechanical thrombectomy in acute ischemic stroke by Shail Thanki, Elliot Pressman, Kassandra M Jones, Ruby Skanes, Ahmad Armouti, Waldo R Guerrero, Kunal Vakharia, Ashwin B Parthasarathy, Kyle Fargen, Eva A Mistry, Shahid M Nimjee, Ameer E Hassan and Maxim Mokin in Interventional Neuroradiology</p
Endovascular versus medical therapy in posterior cerebral artery stroke: role of baseline NIHSS and occlusion site.
Background: Acute ischemic stroke (AIS) with isolated posterior cerebral artery occlusion (iPCAO) lacks management evidence from randomized trials. We aimed to evaluate whether the association between endovascular treatment (EVT) and outcomes in iPCAO-AIS is modified by initial stroke severity (baseline NIHSS) and arterial occlusion site. Methods: Based on the multicenter, retrospective, case-control study of consecutive iPCAO-AIS patients (PLATO study), we assessed the heterogeneity of EVT outcomes compared to medical management (MM) for iPCAO, according to baseline NIHSS (â€6 vs. >6) and occlusion site (P1 vs. P2), using multivariable regression modelling with interaction terms. The primary outcome was the favorable shift of 3-month mRS. Secondary outcomes included excellent outcome (mRS 0-1), functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH) and mortality. Results: From 1344 patients assessed for eligibility, 1,059 were included (median age 74 years, 43.7% women, 41.3% had intravenous thrombolysis), 364 receiving EVT and 695 MM. Baseline stroke severity did not modify the association of EVT with 3-month mRS distribution (pint=0.312), but did with functional independence (pint=0.010), with a similar trend on excellent outcome (pint=0.069). EVT was associated with more favorable outcomes than MM in patients with baseline NIHSS>6 (mRS 0-1: 30.6% vs. 17.7%, aOR=2.01, 95%CI=1.22-3.31; mRS 0-2: 46.1% vs. 31.9%, aOR=1.64, 95%CI=1.08-2.51), but not in those with NIHSSâ€6 (mRS 0-1: 43.8% vs. 46.3%, aOR=0.90, 95%CI=0.49-1.64; mRS 0-2: 65.3% vs. 74.3%, aOR=0.55, 95%CI=0.30-1.0). EVT was associated with more sICH regardless of baseline NIHSS (pint=0.467), while the mortality increase was more pronounced in patients with NIHSSâ€6 (pint=0.044, NIHSSâ€6: aOR=7.95,95%CI=3.11-20.28, NIHSS>6: aOR=1.98,95%CI=1.08-3.65). Arterial occlusion site did not modify the association of EVT with outcomes compared to MM. Conclusion: Baseline clinical stroke severity, rather than the occlusion site, may be an important modifier of the association between EVT and outcomes in iPCAO. Only severely affected patients with iPCAO (NIHSS>6) had more favorable disability outcomes with EVT than MM, despite increased mortality and sICH
Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study.
BACKGROUND
The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion.
METHODS
This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and â„2-point decrease in the National Institutes of Health Stroke Scale.
RESULTS
Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by â„2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002).
CONCLUSIONS
In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted