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Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfusion.Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes.Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048).In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.

Background To compare efficacy and safety of mechanical thrombectomy (MT) depending on mono versus biplane angioroom (AR), radiation exposure, contrast dose, procedure duration for acute ischemic stroke with large vessel occlusion (AISLVO) according to procedural factors. To realize a systematic literature review on the single/biplane comparison. Materials and methods Between January 2014 and May 2017, 906 consecutive patients from 3 countries with all available data underwent a MT in four centers: – 330 on a single-plane (SP); – 576 on a biplane; – data were retrospectively analyzed. Efficacy and safety characteristics, radiation dose, contrast load and fluoroscopy duration were analyzed and compared depending on clinical and procedural factors of the AR. Results After multivariate analysis, only contrast load (50% lower) and scopy duration (19% lower) remained significantly lower on biplane versus monoplane. There was no difference concerning procedure duration, radiation doses, rate of successful recanalization, outcome and complication between MP and biplane, Philips and Siemens after multivariate analyses. Among other factors, general anaesthesia was associated with higher DAP, Kerma, contrast load. Performing an angiogram before MT was associated with increased procedure duration (15% increase), DAP (33% increase), contrast load (125% increase) on univariate analyses. Conclusion Both AR seem to be equivalent in terms of safety and effectiveness for MT. Biplane equipment drastically reduces contrast load. The decision to realize an angiogram before a MT should be clinically motivated because of increased radiation, contrast doses and procedure duration.

Introduction Les patients anticoagules (PAs) sont exclus de la prise en charge par thrombolyse intraveineuse (TIV) en cas d’infarctus cerebral (IC). Or, la thrombectomie mecanique (TM) pourrait etre un traitement de choix chez ce type de patient. Devant le peu de donnee, nous avons etudie la securite et l’efficacite de la TM chez les PAs. Methode Nous avons analyse 3 groupes provenant de deux registres prospectifs : les PAs, les patients non anticoagules (PNAs) beneficiant d’un TM seule et ceux ayant une TIV et TM (TIVTM). Une analyse univariee et multivariee etaient utilisees pour evaluer l’efficacite du traitement caracterisee par un score de Rankin modifie ≤ 2 et la securite avec le taux de deces a 3 mois, ainsi que le taux de transformation hemorragique. Resultats Trois cent trente-trois patients furent inclus : 40 PAs (12 %), 105 PNAs (31 %) et 188 (57 %) TIVTM. L’analyse univariee a montre que le groupe PA etait plus âge (p Conclusion Au regard de ces resultats, la TM semble aussi efficace et sure chez les PAs et les PNAs. Malgre tout, le groupe PAs par rapport aux TIVMT semble presenter un risque accru de deces, probablement du aux comorbidites et a l’âge des patients. La thrombectomie mecanique devrait etre systematiquement proposee aux PAs.

Background and purpose Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. There is no proven effectiveness of MT in the subgroup of minor stroke with LVO in the anterior circulation and data about mechanical thrombectomy (MT) in this subgroup of patients are sparse, with optimal management of these patients being yet not definitely addressed. The purpose of this case-control study was to evaluate MT in patients suffering from acute ischemic stroke (AIS) and LVO in the anterior circulation, presenting with minor to mild stroke symptoms (NIHSS Material and methods Case-control study involving 4 comprehensive stroke centers, having two approaches regarding management of minor and mild AIS patients harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0–1 at 3 months. Results In total, 301 patients were included, 170 with MT associated to best medical management (BMM, case group) and 131 with BMM alone as first line treatment (control group). Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.3%) belonging to the medical group had rescue MT due to neurologic worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the two groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. Conclusion Patients having underwent MT or BMM achieve excellent and favorable functional outcome at 3 months in similar proportions. However, baseline characteristics were different between the 2 groups, highlighting the urgent need for randomized clinical trials in this subset of patients.