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1. Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study.

Author

Dmytriw, Adam, Musmar, Basel, Salim, Hamza, Ghozy, Sherief, Siegler, James, Kobeissi, Hassan, Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh, Heit, Jeremy, Regenhardt, Robert, Cancelliere, Nicole, Bernstock, Joshua, Naamani, Kareem, Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Kühn, Anna, Puri, Ajit, Dyzmann, Christian, Kan, Peter, Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Marotta, Thomas, Stapleton, Christopher, Rabinov, James, Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard, Tan, Benjamin, Gopinathan, Anil, Martinez-Gutierrez, Juan, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Chervak, Lina, Vagal, Achala, Adeeb, Nimer, Cuellar-Saenz, Hugo, Tjoumakaris, Stavropoula, Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Filipe, João, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor, Möhlenbruch, Markus, Jesser, Jessica, Costalat, Vincent, Ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Aziz, Yasmin, Gory, Benjamin, Stracke, Christian, Hecker, Constantin, Kadirvel, Ramanathan, Killer-Oberpfalzer, Monika, Griessenauer, Christoph, Thomas, Ajith, Hsieh, Cheng-Yang, Liebeskind, David, Alexandru Radu, Răzvan, Alexandre, Andrea, Tancredi, Illario, Faizy, Tobias, Fahed, Robert, Weyland, Charlotte, Lubicz, Boris, Patel, Aman, Pereira, Vitor, and Guenego, Adrien

Subjects
AIS, MT, MeVo, Stroke, mechanical thrombectomy, perforation, Humans, Ischemic Stroke, Male, Retrospective Studies, Female, Aged, Middle Aged, Incidence, Thrombectomy, Treatment Outcome, Aged, 80 and over
Abstract

BACKGROUND: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. METHODS: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p

Published
2024

2. Multicenter evaluation of mechanical thrombectomy for distal medium vessel occlusions with National Institute of Health Stroke Scale Scores ≥ 6 and ≤ 6

Author

Kühn, Anna Luisa, Puri, Ajit S., Salim, Hamza Adel, Musmar, Basel, Ghozy, Sherief, Siegler, James, Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh N., Heit, Jeremy J., Regenhardt, Robert W., Diestro, Jose Danilo Bengzon, Cancelliere, Nicole M., Sweid, Ahmad, Naamani, Kareem El, Hasan, Zuha, Gopinathan, Anil, Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Dyzmann, Christian, Kan, Peter T., Singh, Jasmeet, Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Marotta, Thomas R., Stapleton, Christopher J., Rabinov, James D., Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard LL., Tan, Benjamin Y. Q., Martinez-Gutierrez, Juan Carlos, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Filipe, João Pedro, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor R., Möhlenbruch, Markus A., Jesser, Jessica, Costalat, Vincent, ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Chervak, Lina, Aziz, Yasmin, Gory, Benjamin, Stracke, Christian Paul, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph J., Thomas, Ajith, Hsieh, Cheng-Yang, Liebeskind, David S., Radu, Răzvan Alexandru, Alexandre, Andrea M., Fahed, Robert, Tancredi, Illario, Faizy, Tobias D., Weyland, Charlotte, Lubicz, Boris, Patel, Aman B., Pereira, Vitor Mendes, Guenego, Adrien, and Dmytriw, Adam A.

Published
2024
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4. First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study.

Author

Radu, Răzvan, Costalat, Vincent, Fahed, Robert, Ghozy, Sherief, Siegler, James, Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh, Heit, Jeremy, Sweid, Ahmad, El Naamani, Kareem, Regenhardt, Robert, Diestro, Jose, Cancelliere, Nicole, Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Kühn, Anna, Puri, Ajit, Dyzmann, Christian, Kan, Peter, Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Kyheng, Maéva, Marotta, Thomas, Stapleton, Christopher, Rabinov, James, Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard, Tan, Benjamin, Martinez-Gutierrez, Juan, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Tjoumakaris, Stavropoula, Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Pedro Filipe, João, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor, Möhlenbruch, Markus, Jesser, Jessica, Tancredi, Illario, Ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Chervak, Lina, Aziz, Yasmin, Gory, Benjamin, Paul Stracke, Christian, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph, Thomas, Ajith, Hsieh, Cheng-Yang, Liebeskind, David, Alexandre, Andrea, Faizy, Tobias, Weyland, Charlotte, Patel, Aman, Pereira, Vitor, Lubicz, Boris, Dmytriw, Adam, and Guenego, Adrien

Subjects
MeVO, Stroke, outcomes research, reperfusion, thrombectomy, Humans, Stroke, Brain Ischemia, Retrospective Studies, Thrombectomy, Treatment Outcome, Intracranial Hemorrhages
Abstract

INTRODUCTION: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. PATIENTS AND METHODS: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0-2 at 3 months. RESULTS: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10-2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93-0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59-3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25-0.72) and 0.55 (95% CI, 0.39-0.77), respectively. CONCLUSION: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

Published
2024

5. Follow-up infarct volume on fluid attenuated inversion recovery (FLAIR) imaging in distal medium vessel occlusions: the role of cerebral blood volume index

Author

Salim, Hamza, Lakhani, Dhairya A., Balar, Aneri, Musmar, Basel, Adeeb, Nimer, Hoseinyazdi, Meisam, Luna, Licia, Deng, Francis, Hyson, Nathan Z., Mei, Janet, Dmytriw, Adam A., Guenego, Adrien, Faizy, Tobias D., Heit, Jeremy J., Albers, Gregory W., Urrutia, Victor C., Llinas, Raf, Marsh, Elisabeth B., Hillis, Argye E., Nael, Kambiz, and Yedavalli, Vivek

Published
2024
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7. Pretreatment CTP Collateral Parameters Predict Good Outcomes in Successfully Recanalized Middle Cerebral Artery Distal Medium Vessel Occlusions

Author

Yedavalli, Vivek, Koneru, Manisha, Hamam, Omar, Hoseinyazdi, Meisam, Marsh, Elisabeth Breese, Llinas, Raf, Urrutia, Victor, Leigh, Richard, Gonzalez, Fernando, Xu, Risheng, Caplan, Justin, Huang, Judy, Lu, Hanzhang, Wintermark, Max, Heit, Jeremy, Guenego, Adrien, Albers, Greg, Nael, Kambiz, and Hillis, Argye

Published
2024
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8. Long-Term Follow-Up of Cerebral Aneurysms Completely Occluded at 6 Months After Intervention with the Woven EndoBridge (WEB) Device: a Retrospective Multicenter Observational Study

Author

El Naamani, Kareem, Mastorakos, Panagiotis, Adeeb, Nimer, Lan, Mathews, Castiglione, James, Khanna, Omaditya, Diestro, Jose Danilo Bengzon, McLellan, Rachel M., Dibas, Mahmoud, Vranic, Justin E., Aslan, Assala, Cuellar-Saenz, Hugo H., Guenego, Adrien, Carnevale, Joseph, Saliou, Guillaume, Ulfert, Christian, Möhlenbruch, Markus, Foreman, Paul M., Vachhani, Jay A., Hafeez, Muhammad U., Waqas, Muhammad, Tutino, Vincent M., Rabinov, James D., Ren, Yifan, Michelozzi, Caterina, Spears, Julian, Panni, Pietro, Griessenauer, Christoph J., Asadi, Hamed, Regenhardt, Robert W., Stapleton, Christopher J., Ghozy, Sherief, Siddiqui, Adnan, Patel, Nirav J., Kan, Peter, Boddu, Srikanth, Knopman, Jared, Aziz-Sultan, Mohammad A., Zanaty, Mario, Ghosh, Ritam, Abbas, Rawad, Amllay, Abdelaziz, Tjoumakaris, Stavropoula I., Gooch, Michael R., Cancelliere, Nicole M., Herial, Nabeel A., Rosenwasser, Robert H., Zarzour, Hekmat, Schmidt, Richard F., Pereira, Vitor Mendes, Patel, Aman B., Jabbour, Pascal, and Dmytriw, Adam A.

Published
2024
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9. Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study

Author

Hamza Adel Salim, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Muhammed Amir Essibayi, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin Y.Q. Tan, Benjamin Pulli, Jeremy J. Heit, Robert W. Regenhardt, Nicole M. Cancelliere, Joshua D. Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S. Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Razvan Alexandru Radu, Thomas R. Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E. Siegler, Thanh N. Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R. Gonzalez, Markus A. Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S. Liebeskind, Alessandro Pedicelli, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Erwah Kalsoum, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Adrien Guenego, and Adam A. Dmytriw

Subjects
stroke, mechanical thrombectomy, distal medium vessel occlusions, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background and Purpose The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone. Methods This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage. Results The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0–1 and 0–2), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; P=0.35) and 1.00 (95% CI 0.66 to 1.51; P>0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; P=0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; P

Published
2024
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10. The Compensation Index Is Better Associated with DSA ASITN Collateral Score Compared to the Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio.

Author

Lakhani, Dhairya, Balar, Aneri, Koneru, Manisha, Wen, Sijin, Hoseinyazdi, Meisam, Greene, Cynthia, Xu, Risheng, Luna, Licia, Caplan, Justin, Dmytriw, Adam, Guenego, Adrien, Wintermark, Max, Gonzalez, Fernando, Urrutia, Victor, Huang, Judy, Rai, Ansaar, Albers, Gregory, Heit, Jeremy, Yedavalli, Vivek, and Nael, Kambiz

Subjects
CBV index, HIR, acute ischemic stroke, collateral status, compensation index, hypoperfusion intensity ratio
Abstract

BACKGROUND: Pretreatment CT Perfusion (CTP) parameters serve as reliable surrogates of collateral status (CS). In this study, we aim to assess the relationship between the novel compensation index (CI, Tmax > 4 s/Tmax > 6 s) and already established CTP collateral markers, namely cerebral blood volume (CBV) index and Hypoperfusion Intensity Ratio (HIR), with the reference standard American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score (CS) on DSA. METHODS: In this retrospective study, inclusion criteria were the following: (a) CT angiography confirmed anterior circulation large vessel occlusion from 9 January 2017 to 10 January 2023; (b) diagnostic CT perfusion; and (c) underwent mechanical thrombectomy with documented DSA-CS. Student t-test, Mann-Whitney-U-test and Chi-square test were used to assess differences. Spearmans rank correlation and logistic regression analysis were used to assess associations. p ≤ 0.05 was considered significant. RESULTS: In total, 223 patients (mean age: 67.8 ± 15.8, 56% female) met our inclusion criteria. The CI (ρ = 0.37, p < 0.001) and HIR (ρ = -0.29, p < 0.001) significantly correlated with DSA-CS. Whereas the CBV Index (ρ = 0.1, p > 0.05) did not correlate with DSA-CS. On multivariate logistic regression analysis taking into account age, sex, ASPECTS, tPA, premorbid mRS, NIH stroke scale, prior history of TIA, stroke, atrial fibrillation, diabetes mellitus, hyperlipidemia, heart disease and hypertension, only CI was not found to be independently associated with DSA-CS (adjusted OR = 1.387, 95% CI: 1.09-1.77, p < 0.01). CONCLUSION: CI demonstrates a stronger correlation with DSA-CS compared to both the HIR and CBV Index where it may show promise as an additional quantitative pretreatment CS biomarker.

Published
2023

11. Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study

Author

Radu, Răzvan Alexandru, Costalat, Vincent, Romoli, Michele, Musmar, Basel, Siegler, James E., Ghozy, Sherief, Khalife, Jane, Salim, Hamza, Shaikh, Hamza, Adeeb, Nimer, Cuellar-Saenz, Hugo H., Thomas, Ajith J., Kadirvel, Ramanathan, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh N., Heit, Jeremy J., Regenhardt, Robert W., Bernstock, Joshua D., Patel, Aman B., Rabinov, James D., Stapleton, Christopher J., Cancelliere, Nicole M., Marotta, Thomas R., Mendes Pereira, Vitor, El Naamani, Kareem, Amllay, Abdelaziz, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Meyer, Lukas, Fiehler, Jens, Faizy, Tobias D., Guerreiro, Helena, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Mounayer, Charbel, Kühn, Anna Luisa, Puri, Ajit S., Dyzmann, Christian, Kan, Peter T., Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard L. L., Tan, Benjamin YQ, Gopinathan, Anil, Martinez-Gutierrez, Juan Carlos, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Chervak, Lina M., Vagal, Achala, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Alexandre, Andrea M., Filipe, João Pedro, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor R., YMD, Markus A., Jesser, Jessica, Weyland, Charlotte, ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Aziz, Yasmin, Gory, Benjamin, Paul Stracke, Christian, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph J., Hsieh, Cheng-Yang, Liebeskind, David S., Tancredi, Illario, Fahed, Robert, Lubicz, Boris, Essibayi, Muhammed Amir, Baker, Amanda, Altschul, David, Scarcia, Luca, Kalsoum, Erwah, Dmytriw, Adam A., and Guenego, Adrien

Published
2024
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12. Use of the pRESET LITE thrombectomy device in combined approach for medium vessel occlusions: A multicenter evaluation

Author

Wang, Maud, Henkes, Hans, Ghozy, Sherief, Siegler, James E., Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh N., Heit, Jeremy J., Sweid, Ahmad, Naamani, Kareem El, Regenhardt, Robert W., Diestro, Jose Danilo Bengzon, Cancelliere, Nicole M., Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Kühn, Anna Luisa, Puri, Ajit S., Dyzmann, Christian, Kan, Peter T., Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Weyland, Charlotte, Marotta, Thomas R., Stapleton, Christopher J., Rabinov, James D., Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard LL., Tan, Benjamin Y. Q., Martinez-Gutierrez, Juan Carlos, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Filipe, João Pedro, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor R., Möhlenbruch, Markus A., Jesser, Jessica, Costalat, Vincent, ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Chervak, Lina M., Aziz, Yasmin, Gory, Benjamin, Stracke, Christian Paul, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph J., Thomas, Ajith J., Hsieh, Cheng-Yang, Liebeskind, David S., Radu, Răzvan Alexandru, Alexandre, Andrea M., Tancredi, Illario, Faizy, Tobias D., Patel, Aman B., Pereira, Vitor Mendes, Fahed, Robert, Lubicz, Boris, Dmytriw, Adam A., and Guenego, Adrien

Published
2024
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13. Pretreatment parameters associated with hemorrhagic transformation among successfully recanalized medium vessel occlusions

Author

Koneru, Manisha, Hoseinyazdi, Meisam, Wang, Richard, Ozkara, Burak Berksu, Hyson, Nathan Z., Marsh, Elisabeth Breese, Llinas, Rafael H., Urrutia, Victor C., Leigh, Richard, Gonzalez, Luis Fernando, Xu, Risheng, Caplan, Justin M., Huang, Judy, Lu, Hanzhang, Luna, Licia, Wintermark, Max, Dmytriw, Adam A., Guenego, Adrien, Albers, Gregory W., Heit, Jeremy J., Nael, Kambiz, Hillis, Argye E., and Yedavalli, Vivek S.

Published
2024
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14. Predictors and Outcomes of Excellent Recanalization Versus Successful Recanalization After Thrombectomy in Proximal and Distal Medium Vessel Occlusion Strokes: A Multinational Study

Author

Vivek Yedavalli, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin Y. Q. Tan, Jeremy J. Heit, Robert W. Regenhardt, Nicole M. Cancelliere, Joshua D. Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Muhammed Amir Essibayi, Ajit S. Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R. Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E. Siegler, Thanh N. Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R. Gonzalez, Markus A. Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz‐Sultan, Constantin Hecker, Hamza Shaikh, David S. Liebeskind, Alessandro Pedicelli, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Erwah Kalsoum, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Adrien Guenego, and Adam A. Dmytriw

Subjects
acute ischemic stroke, mechanical thrombectomy, medium vessel occlusions, mTICI score, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Acute ischemic stroke arising from medium vessel occlusions (MeVO) poses substantial challenges in treatment and management. This study aims to elucidate the outcomes and factors contributing to achieving excellent recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2c–3) versus successful recanalization (mTICI 2b) in patients with MeVO stroke undergoing mechanical thrombectomy (MT). Methods We conducted a multinational study analyzing data from the MAD‐MT (Multicenter Analysis of Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy) registry, encompassing 37 centers across North America, Asia, and Europe, collected between September 2017 and July 2023. The study included acute ischemic stroke patients with MeVO treated with MT, with or without intravenous thrombolysis, who achieved mTICI 2b–3 post‐MT. Results Among 1463 patients with successful recanalization (mTICI 2b–3), 523 achieved mTICI 2b recanalization, and 940 achieved mTICI 2c–3. Distal occlusions exhibited higher odds of excellent recanalization compared with proximal MeVO vessel occlusions (odds ratio, 1.58; 95% CI, 1.17–2.15; P = 0.003). Cardioembolic stroke pathogenesis was associated with a higher likelihood of excellent recanalization (1.67; 95% CI, 1.07–2.59; P = 0.018). Patients achieving mTICI 2c–3 recanalization demonstrated lower initial National Institutes of Health Stroke Scale scores, significant improvements in postprocedural National Institutes of Health Stroke Scale shift, and a higher percentage of favorable 90‐day outcomes compared with those with mTICI 2b. However, no significant difference in 90‐day mortality rates was observed. Conclusion This study underscores that among patients with MeVO stroke with successful recanalization (mTICI 2b–3) there is higher likelihood of achieving excellent recanalization (mTICI 2c–3) in distal occlusions and cardioembolic pathogenesis. mTICI 2c–3 scores post‐MT correlate with improved clinical outcomes compared with mTICI 2b, affirming the superiority of excellent recanalization over successful recanalization in patients with MeVO stroke. Further prospective studies and randomized controlled trials are warranted for validation.

Published
2024
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15. CT perfusion imaging in aneurysmal subarachnoid hemorrhage. State of the art

Author

Valentina Elisabetta Lolli, Adrien Guenego, Niloufar Sadeghi, Lise Jodaitis, Boris Lubicz, Fabio Silvio Taccone, and Elisa Gouvea Bogossian

Subjects
delayed cerebral ischemia, aneurysmal subarachnoid hemorrhage, cerebral vasospasm, hypoperfusion, computed tomography perfusion, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

CT perfusion (CTP) images can be easily and rapidly obtained on all modern CT scanners and have become part of the routine imaging protocol of patients with aneurysmal subarachnoid haemorrhage (aSAH). There is a growing body of evidence supporting the use of CTP imaging in these patients, however, there are significant differences in the software packages and methods of analysing CTP. In. addition, no quantitative threshold values for tissue at risk (TAR) have been validated in this patients’ population. Here we discuss the contribution of the technique in the identification of patients at risk of aSAH-related delayed cerebral ischemia (DCI) and in the assessment of the response to endovascular rescue therapy (ERT). We also address the limitations and pitfalls of automated CTP postprocessing that are specific to aSAH patients as compared to acute ischemic stroke (AIS).

Published
2024
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16. Prolonged Venous Transit Is Associated With Lower Likelihood of Favorable Clinical Recovery in Reperfused Anterior Circulation Large‐Vessel Occlusion Stroke

Author

Vivek S. Yedavalli, Manisha Koneru, Aneri B. Balar, Dhairya A. Lakhani, Andrew Cho, Sijin Wen, Yanqing Mei, Meisam Hoseinyazdi, Cynthia Greene, Risheng Xu, Licia P Luna, Justin M. Caplan, Adam A. Dmytriw, Adrien Guenego, Jeremy J Heit, Gregory W. Albers, Max Wintermark, Luis Fernando Gonzalez, Victor C. Urrutia, Judy Huang, Kambiz Nael, Tobias D. Faizy, Richard Leigh, Elisabeth B. Marsh, Argye E. Hillis, and Rafael H. Llinas

Subjects
acute ischemic stroke, cerebral blood flow, large‐vessel occlusion, prolonged venous transit, venous outflow, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Unfavorable clinical outcomes in patients with acute ischemic stroke caused by large‐vessel occlusions despite successful reperfusion have been associated with poor venous outflow. The objective of this study is to assess the relationship between prolonged venous transit (PVT), a novel perfusion imaging surrogate for poor venous outflow, and likelihood of favorable clinical recovery. Methods In this retrospective review of prospectively collected data of consecutive patients (2017–2022) with successfully reperfused, anterior circulation acute ischemic stroke caused by large‐vessel occlusions, we assessed the association between PVT+, defined as time to maximum ≧10‐second timing delays within either the posterior superior sagittal sinus, torcula, or both regions on pretreatment perfusion imaging, and favorable clinical outcomes defined as 90‐day modified Rankin Scale score of 0 to 2. Patients were dichotomized into PVT+ and PVT− for analysis. Multivariable logistic regression analyses for favorable recovery were performed with demographic variables and stroke characteristics. Results A total of 127 consecutive patients (median age, 71 [interquartile range 61—77] years; 59.1% women) were included, and 40 of 127 (31.5%) were PVT+. PVT+ (adjusted odds ratio [aOR], 0.23 [95% CI, 0.07–0.81]; P = 0.02) and advanced age (aOR, 0.92 [95% CI, 0.88–0.97]; P = 0.01) were significantly associated with the primary outcome. Conclusion PVT+ was associated with a lower likelihood of achieving favorable clinical recovery in successfully reperfused patients with acute ischemic stroke caused by large vessel occlusion. PVT may serve as a clinically useful adjunctive imaging parameter.

Published
2024
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17. Off-Label use of Woven EndoBridge device for intracranial brain aneurysm treatment: Modeling of occlusion outcome

Author

Dibas, Mahmoud, Spears, Julian, Sundararajan, Sri Hari, Al Balush, Ali, Vranic, Justin E., Inoue, Yasuaki, Mirshahi, Shervin, Alotaibi, Naif M., Harker, Pablo, Tutino, Vincent M., Sporns, Peter, Brehm, Alex, Essibayi, Muhammed Amir, Jabal, Mohamed Sobhi, Musmar, Basel, Adeeb, Nimer, Salim, Hamza, Aslan, Assala, Cancelliere, Nicole M., McLellan, Rachel M., Algin, Oktay, Ghozy, Sherief, Lay, Sovann V., Guenego, Adrien, Renieri, Leonardo, Carnevale, Joseph, Saliou, Guillaume, Mastorakos, Panagiotis, Naamani, Kareem El, Shotar, Eimad, Premat, Kevin, Möhlenbruch, Markus, Kral, Michael, Doron, Omer, Chung, Charlotte, Salem, Mohamed M, Lylyk, Ivan, Foreman, Paul M., Vachhani, Jay A., Shaikh, Hamza, Župančić, Vedran, Hafeez, Muhammad U., Catapano, Joshua, Waqas, Muhammad, Yavuz, Kivilcim, Gunes, Yasin Celal, Rabinov, James D., Ren, Yifan, Schirmer, Clemens M., Piano, Mariangela, Kühn, Anna L., Michelozzi, Caterina, Starke, Robert M., Hassan, Ameer, Ogilvie, Mark, Nguyen, Anh, Jones, Jesse, Brinjikji, Waleed, Nawka, Marie T., Psychogios, Marios, Ulfert, Christian, Diestro, Jose Danilo Bengzon, Pukenas, Bryan, Burkhardt, Jan-Karl, Huynh, Thien, Gutierrez, Juan Carlos Martinez, Sheth, Sunil A., Spiegel, Gary, Tawk, Rabih, Lubicz, Boris, Panni, Pietro, Puri, Ajit S., Pero, Guglielmo, Nossek, Erez, Raz, Eytan, Killer-Oberfalzer, Monika, Griessenauer, Christoph J., Asadi, Hamed, Siddiqui, Adnan, Brook, Allan L., Haranhalli, Neil, Ducruet, Andrew F., Albuquerque, Felipe C., Regenhardt, Robert W., Stapleton, Christopher J., Kan, Peter, Kalousek, Vladimir, Lylyk, Pedro, Boddu, Srikanth, Knopman, Jared, Aziz-Sultan, Mohammad A., Tjoumakaris, Stavropoula I., Clarençon, Frédéric, Limbucci, Nicola, Cuellar-Saenz, Hugo H., Jabbour, Pascal M, Pereira, Vitor Mendes, Patel, Aman B., Altschul, David, and Dmytriw, Adam A.

Published
2024
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20. Actualisation de la prise de position des experts français sur l’insulinothérapie automatisée en boucle fermée

Author

Renard, Éric, Tubiana-Rufi, Nadia, Chaillous, Lucy, Bonnemaison, Élisabeth, Hanaire, Hélène, Bismuth, Élise, Joubert, Michael, Coutant, Régis, Schaepelynck, Pauline, Beltrand, Jacques, Reznik, Yves, Authier, Florence, Borot, Sophie, Brunot, Sophie, Calvez, Claire, Charpentier, Guillaume, Dalla-Vale, Fabienne, Delawoevre, Anne, Delemer, Brigitte, Desserprix, Agnès, Durain, Danielle, Fendri, Salha, Franc, Sylvia, Godot, Cécile, Gouet, Didier, Guenego, Agathe, Guerci, Bruno, Guilhem, Isabelle, Jeandidier, Nathalie, Lablanche, Sandrine, Le Tallec, Claire, Malwe, Mathilde, Meyer, Laurent, Morin, Carole, Penfornis, Alfred, Picard, Sylvie, Riveline, Jean-Pierre, Rossignol, Valérie, Smati, Sarra, Sola-Gazagnes, Agnès, Thivolet, Charles, Villard, Orianne, and Benhamou, Pierre Yves

Published
2024
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21. Nonaneurysmal perimesencephalic subarachnoid hemorrhage on noncontrast head CT: An accuracy, inter-rater, and intra-rater reliability study

Author

Benomar, Anass, Diestro, Jose Danilo B., Darabid, Houssam, Saydy, Karim, Tzaneva, Lora, Li, Jimmy, Zarour, Eleyine, Tanguay, William, El Sayed, Nohad, Padilha, Igor Gomes, Létourneau-Guillon, Laurent, Bard, Céline, Nelson, Kristoff, Weill, Alain, Roy, Daniel, Eneling, Johanna, Boisseau, William, Nguyen, Thanh N., Abdalkader, Mohamad, Najjar, Ahmed A., Nehme, Ahmad, Lemoine, Émile, Jacquin, Gregory, Bergeron, David, Brunette-Clément, Tristan, Chaalala, Chiraz, Bojanowski, Michel W., Labidi, Moujahed, Jabre, Roland, Ignacio, Katrina H.D., Omar, Abdelsimar T., II, Volders, David, Dmytriw, Adam A., Hak, Jean-François, Forestier, Géraud, Holay, Quentin, Olatunji, Richard, Alhabli, Ibrahim, Nico, Lorena, Shankar, Jai J.S., Guenego, Adrien, Pascual, Jose L.R., Marotta, Thomas R., Errázuriz, Juan I., Lin, Amy W., Alves, Aderaldo Costa, Jr, Fahed, Robert, Hawkes, Christine, Lee, Hubert, Magro, Elsa, Sheikhi, Lila, Darsaut, Tim E., and Raymond, Jean

Published
2024
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22. Low Cerebral Blood Volume Index, Thrombectomy, and Prior Stroke Are Independently Associated With Hemorrhagic Transformation in Medium‐Vessel Occlusion Ischemic Stroke

Author

Vivek S. Yedavalli, Manisha Koneru, Meisam Hoseinyazdi, Elisabeth B. Marsh, Rafael H. Llinas, Victor Urrutia, Richard Leigh, Luis Fernando Gonzalez, Risheng Xu, Justin Caplan, Judy Huang, Hanzhang Lu, Max Wintermark, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers, Licia Luna, Jeremy J. Heit, Kambiz Nael, and Argye E. Hillis

Subjects
acute ischemic stroke, cerebral blood flow, distal medium‐vessel occlusion, large‐vessel occlusion, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Hemorrhagic transformation (HT) is a major complication in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy. However, HT in patients with AIS due to medium‐vessel occlusions has still not been well researched. In large‐vessel occlusions, collateral status is an important determinant of postprocedural HT, and the cerebral blood volume (CBV) index is a reliable surrogate of collateral status. The aim of our study is to identify an optimal CBV index threshold associated with HT in patients with AIS due to medium‐vessel occlusion and evaluate additional parameters that are independently associated with HT in this group. Methods This retrospective analysis of our prospectively collected database from 2 comprehensive stroke centers consisted of patients presenting with AIS due to medium‐vessel occlusion from 2019 to 2023. The primary outcome was the presence of HT on follow‐up imaging. Optimal CBV index cutoff for HT was derived from a univariate logistic regression analysis. Multivariable logistic regression analysis for HT was derived from the dichotomized CBV index and other covariates. The receiver operator characteristic curve yielded area under the curve. Statistical significance was P≤$ \le $0.05. Results Of 111 patients (median age, 70 years; 43.2% women) included, 26 (23.4%) patients had HT. The optimal CBV index cutoff was 0.7. From multivariable regression analysis, significant variables included prior stroke (adjusted odds ratio [aOR], 7.18 [95% CI, 1.60–32.16]; P = 0.01), endovascular thrombectomy attempt (aOR, 7.86 [95% CI, 1.78–34.68]; P = 0.01), and CBV index (≤$ \le $ 0.7; aOR, 4.23 [95% CI, 1.02–17.59]; P = 0.04). The area under the curve was 0.82 (95% CI, 0.69–0.91). Conclusion A CBV index ≤$ \le $ 0.7 was independently associated with HT in patients with AIS due to medium‐vessel occlusion. Endovascular thrombectomy attempt and prior stroke history were also independently associated with HT in this population.

Published
2024
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23. The Woven EndoBridge (WEB) Device for the Treatment of Intracranial Aneurysms: Ten Years of Lessons Learned and Adjustments in Practice from the WorldWideWEB Consortium

Author

Dmytriw, Adam A., Dibas, Mahmoud, Ghozy, Sherief, Adeeb, Nimer, Diestro, Jose Danilo Bengzon, Phan, Kevin, Cuellar-Saenz, Hugo H., Sweid, Ahmad, Lay, Sovann V., Guenego, Adrien, Renieri, Leonardo, Al Balushi, Ali, Saliou, Guillaume, Möhlenbruch, Markus, Regenhardt, Robert W., Vranic, Justin E., Lylyk, Ivan, Foreman, Paul M., Vachhani, Jay A., Župančić, Vedran, Hafeez, Muhammad U., Rutledge, Caleb, Waqas, Muhammad, Tutino, Vincent M., Rabinov, James D., Ren, Yifan, Schirmer, Clemens M., Piano, Mariangela, Kühn, Anna L., Michelozzi, Caterina, Elens, Stéphanie, Starke, Robert M., Hassan, Ameer, Salehani, Arsalaan, Sporns, Peter, Jones, Jesse, Psychogios, Marios, Spears, Julian, Lubicz, Boris, Panni, Pietro, Puri, Ajit S., Pero, Guglielmo, Griessenauer, Christoph J., Asadi, Hamed, Stapleton, Christopher J., Siddiqui, Adnan, Ducruet, Andrew F., Albuquerque, Felipe C., Du, Rose, Kan, Peter, Kalousek, Vladimir, Lylyk, Pedro, Boddu, Srikanth, Tjoumakaris, Stavropoula, Knopman, Jared, Aziz-Sultan, Mohammad A., Limbucci, Nicola, Jabbour, Pascal, Cognard, Christophe, and Patel, Aman B.

Published
2023
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25. Correction to: The Woven EndoBridge (WEB) Device for the Treatment of Intracranial Aneurysms: Ten Years of Lessons Learned and Adjustments in Practice from the WorldWideWEB Consortium

Author

Dmytriw, Adam A., Dibas, Mahmoud, Ghozy, Sherief, Adeeb, Nimer, Diestro, Jose Danilo Bengzon, Phan, Kevin, Cuellar-Saenz, Hugo H., Sweid, Ahmad, Lay, Sovann V., Guenego, Adrien, Renieri, Leonardo, Al Balushi, Ali, Saliou, Guillaume, Möhlenbruch, Markus, Regenhardt, Robert W., Vranic, Justin E., Lylyk, Ivan, Foreman, Paul M., Vachhani, Jay A., Župančić, Vedran, Hafeez, Muhammad U., Rutledge, Caleb, Waqas, Muhammad, Tutino, Vincent M., Rabinov, James D., Ren, Yifan, Schirmer, Clemens M., Piano, Mariangela, Kühn, Anna L., Michelozzi, Caterina, Elens, Stéphanie, Starke, Robert M., Hassan, Ameer, Salehani, Arsalaan, Sporns, Peter, Jones, Jesse, Psychogios, Marios, Spears, Julian, Lubicz, Boris, Panni, Pietro, Puri, Ajit S., Pero, Guglielmo, Griessenauer, Christoph J., Asadi, Hamed, Stapleton, Christopher J., Siddiqui, Adnan, Ducruet, Andrew F., Albuquerque, Felipe C., Du, Rose, Kan, Peter, Kalousek, Vladimir, Lylyk, Pedro, Boddu, Srikanth, Tjoumakaris, Stavropoula, Jared Knopman, Aziz-Sultan, Mohammad A., Limbucci, Nicola, Jabbour, Pascal, Cognard, Christophe, and Patel, Aman B.

Published
2023
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26. Robust Collaterals Are Independently Associated With Excellent Recanalization in Patients With Large Vessel Occlusion Causing Acute Ischemic Stroke

Author

Vivek Yedavalli, Manisha Koneru, Meisam Hoseinyazdi, Cynthia Greene, Karen Copeland, Risheng Xu, Licia Luna, Justin Caplan, Adam A. Dmytriw, Adrien Guenego, Jeremy Heit, Gregory Albers, Max Wintermark, Luis Fernando Gonzalez, Victor Urrutia, Judy Huang, Richard Leigh, Elisabeth Marsh, Rafael Llinas, Argye Hillis, and Kambiz Nael

Subjects
Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background In patients with acute ischemic stroke secondary to large vessel occlusion, achieving modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 (excellent recanalization) over mTICI 2b is associated with improved functional outcomes. We aimed to determine pretreatment and interventional parameters that are independently associated with mTICI 2c/3 over 2b reperfusion in patients who underwent technically successful mechanical thrombectomy. Methods In this retrospective study, consecutive patients with acute ischemic stroke with anterior circulation large vessel occlusion achieving mTICI 2b/2c/3 recanalization after mechanical thrombectomy were included. We evaluated the association between pretreatment clinical, imaging, and interventional parameters in patients who achieved mTICI 2c/3 versus 2b using multivariate logistic regressions. Results From May 11, 2019 to October 9, 2022, 149 consecutive patients met our inclusion criteria (median 70 years old [interquartile range 65–78.5], 57.7% female). Adjusted multivariate regression analyses showed that patients with excellent recanalization had lower admission National Institutes of Health Stroke Scale scores (adjusted odds ratio [aOR], 0.93; P=0.036), were less likely to have a history of diabetes (aOR, 0.42; P=0.050) and prior stroke (aOR, 0.27; P=0.007), had a cerebral blood volume index ≥0.7 (aOR, 3.75; P=0.007), and were more likely to achieve excellent recanalization with aspiration alone (aOR, 2.89; P=0.012). A multivariate logistic regression model comprising these independent factors predicted mTICI 2c/3 with an area under the curve 0.79 (95% CI, 0.68–0.86; P

Published
2024
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27. Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion

Author

Vivek Yedavalli, MD, MS, Manisha Koneru, MS, Meisam Hoseinyazdi, MD, Karen Copeland, PhD, Risheng Xu, MD, PhD, Licia Luna, MD, PhD, Justin Caplan, MD, Adam Dmytriw, MD, MPH, MSc, Adrien Guenego, MD, PhD, Jeremy Heit, MD, PhD, Gregory Albers, MD, Max Wintermark, MD, MS, MBA, Fernando Gonzalez, MD, Victor Urrutia, MD, Judy Huang, MD, Richard Leigh, MD, Elisabeth Marsh, MD, Rafael Llinas, MD, Marlis Gonzalez Hernandez, MD, PhD, and Argye Hillis, MD

Subjects
Acute ischemic stroke, perfusion imaging, CT, AMPAC, Rehabilitation, Medicine (General), R5-920
Abstract

Objective: To assess pretreatment and interventional parameters as predictors of favorable Activity Measure for Post-Acute Care (AM-PAC) scores for optimal discharge planning. Design: In this prospectively collected, retrospectively reviewed multicenter study from 9/1/2017 to 9/22/2022, patients were dichotomized into favorable and unfavorable AM-PAC. Multivariate logistic regression and receiver operator characteristics analyses were performed for the identified significant variables. A P value of ≤.05 was significant. Setting: Hospitalized care. Participants: In total, 229 patients (mean ±SD 70.65 ±15.2 [55.9% women]) met our inclusion criteria. Inclusion criteria were (a) computed tomography (CT) angiography confirmed LVO from 9/1/2017 to 9/22/2022; (b) diagnostic CT perfusion; and (c) available AM-PAC scores. Interventions: None. Main Outcome Measures: Favorable AM-PAC, defined as a daily activity score ≥19 and basic mobility score of ≥17. Results: Patients with favorable AM-PAC were younger (61.3 vs 70.7, P

Published
2023
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28. Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion

Author

Yedavalli, Vivek, Koneru, Manisha, Hoseinyazdi, Meisam, Copeland, Karen, Xu, Risheng, Luna, Licia, Caplan, Justin, Dmytriw, Adam, Guenego, Adrien, Heit, Jeremy, Albers, Gregory, Wintermark, Max, Gonzalez, Fernando, Urrutia, Victor, Huang, Judy, Leigh, Richard, Marsh, Elisabeth, Llinas, Rafael, Hernandez, Marlis Gonzalez, and Hillis, Argye

Published
2023
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29. Aspiration Versus Stent‐Retriever as First‐Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity‐Score Matched Multicenter Analysis

Author

James E. Siegler, Hamza Shaikh, Jane Khalife, Solomon Oak, Linda Zhang, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Tareq Kass‐Hout, Rami Z. Morsi, Jeremy J. Heit, Robert W. Regenhardt, Jose Danilo Bengzon Diestro, Nicole M. Cancelliere, Sherief Ghozy, Ahmad Sweid, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kühn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R. Marotta, Alvin S. Das, Christopher J. Stapleton, James D. Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L.L. Yeo, Benjamin Y.Q. Tan, Juan Carlos Martinez‐Gutierrez, Sergio Salazar‐Marioni, Sunil A. Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Stavropoula I. Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, João Pedro Filipe, Ricardo Varela, Miguel Quintero‐Consuegra, Nestor R. Gonzalez, Markus A. Möhlenbruch, Jessica Jesser, Vincent Costalat, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Lina M. Chervak, Yasmin Aziz, Maria Bres Bullrich, Luciano Sposato, Benjamin Gory, Constantin Hecker, Monika Killer‐Oberpfalzer, Christoph J. Griessenauer, Ajith J. Thomas, Cheng‐Yang Hsieh, David S. Liebeskind, Răzvan Alexandru Radu, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Robert Fahed, Charlotte Weyland, Aman B. Patel, Vitor Mendes Pereira, Boris Lubicz, Adrien Guenego, and Adam A. Dmytriw

Subjects
outcomes research, stroke, thrombectomy, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry. Methods Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups. Results Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P

Published
2023
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31. Venous Outflow Profiles Are Linked to Clinical Outcomes in Ischemic Stroke Patients with Extensive Baseline Infarct

Author

Laurens Winkelmeier, Gabriel Broocks, Helge Kniep, Vincent Geest, Jonathan Reinwald, Lukas Meyer, Noel van Horn, Adrien Guenego, Kamil Zeleňák, Gregory W. Albers, Maarten Lansberg, Peter Sporns, Max Wintermark, Jens Fiehler, Jeremy J. Heit, and Tobias D. Faizy

Subjects
ischemic stroke, cerebral edema, cerebrovascular circulation, thrombectomy, neuroimaging, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background and Purpose The benefit of endovascular thrombectomy (EVT) treatment is still unclear in stroke patients presenting with extensive baseline infarct. The use of additional imaging biomarkers could improve clinical outcome prediction and individualized EVT selection in this vulnerable cohort. We hypothesized that cerebral venous outflow (VO) may be associated with functional outcomes in patients with low Alberta Stroke Program Early CT Score (ASPECTS). Methods We conducted a retrospective multicenter cohort study of patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Extensive baseline infarct was defined by an ASPECTS of ≤5 on admission computed tomography (CT). VO profiles were assessed on admission CT angiography using the Cortical Vein Opacification Score (COVES). Favorable VO was defined as COVES ≥3. Multivariable logistic regression was used to determine the association between cerebral VO and good clinical outcomes (90-day modified Rankin Scale score of ≤3). Results A total of 98 patients met the inclusion criteria. Patients with extensive baseline infarct and favorable VO achieved significantly more often good clinical outcomes compared to patients with unfavorable VO (45.5% vs. 10.5%, P

Published
2022
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34. Association of preprocedural antiplatelet use with decreased thromboembolic complications for intracranial aneurysms undergoing intrasaccular flow disruption.

Author

Bengzon Diestro, Jose Danilo, Adeeb, Nimer, Musmar, Basel, Salim, Hamza, Aslan, Assala, Cancelliere, Nicole M., McLellan, Rachel M., Algin, Oktay, Ghozy, Sherief, Lay, Sovann V., Guenego, Adrien, Renieri, Leonardo, Carnevale, Joseph, Saliou, Guillaume, Mastorakos, Panagiotis, El Naamani, Kareem, Shotar, Eimad, Premat, Kevin, Möhlenbruch, Markus, and Kral, Michael

Published
2024
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35. Severely Hypoperfused Brain Tissue Correlates with Final Infarct Volume Despite Recanalization in DMVO Stroke

Author

Maud Wang, Yousra Farouki, Franny Hulscher, Benjamin Mine, Thomas Bonnet, Stephanie Elens, Juan Vazquez Suarez, Lise Jodaitis, Noemie Ligot, Gilles Naeije, Boris Lubicz, and Adrien Guenego

Subjects
acute ischemic stroke, endovascular recanalization, distal thrombectomy, perfusion imaging, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Objectives: We sought to assess whether there were any parameter(s) on baseline computed-tomography-perfusion (CTP) strongly correlating with final-infarct-volume, and infarct volume progression after endovascular recanalization of acute ischemic stroke (AIS) with primary distal, medium vessel occlusion (DMVO). Materials and Methods: We performed a retrospective analysis of consecutive AIS patients who were successfully recanalized by thrombectomy for DMVO. By comparing baseline CTP and follow-up MRI, we evaluated the correlation between baseline infarct and hypoperfusion volumes, and final infarct volume and infarct volume progression. We also examined their effect on good clinical outcome at 3 months (defined as an mRS score of 0 to 2). Results: Between January 2018 and January 2021, 38 patients met the inclusion criteria (76% [29/38] female, median age 75 [66–86] years). Median final infarct volume and infarct volume progression were 8.4 mL [IQR: 5.2–44.4] and 7.2 mL [IQR: 4.3–29.1] respectively. TMax>10 sec volume was strongly correlated with both (r=0.831 and r=0.771 respectively, p10 sec volume increased the probability of a higher final-infarct-volume (r2=0.690, coefficient = 0.83 [0.64–1.00], p10 sec volume on baseline CTP correlates strongly with final infarct volume as well as with clinical outcome after mechanical thrombectomy for an AIS with DMVO.

Published
2023
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36. Thrombectomy for Comatose Patients with Basilar Artery Occlusion: A Multicenter Study

Author

Guenego, Adrien, Lucas, Ludovic, Gory, Benjamin, Richard, Sébastien, Aubertin, Mathilde, Weisenburger-Lile, David, Labreuche, Julien, Dargazanli, Cyril, Benali, Amel, Bourcier, Romain, Detraz, Lili, Vannier, Stéphane, Guillen, Maud, Eugene, François, Walker, Gregory, Lun, Ronda, Wormsbecker, Andrew, Ducroux, Célina, Piotin, Michel, Blanc, Raphael, Consoli, Arturo, Lapergue, Bertrand, and Fahed, Robert

Published
2021
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38. Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke

Author

Mei, Janet, primary, Salim, Hamza A., additional, Lakhani, Dhairya A., additional, Balar, Aneri, additional, Musmar, Basel, additional, Adeeb, Nimer, additional, Hoseinyazdi, Meisam, additional, Luna, Licia, additional, Deng, Francis, additional, Hyson, Nathan Z., additional, Dmytriw, Adam A., additional, Guenego, Adrien, additional, Faizy, Tobias D., additional, Heit, Jeremy J., additional, Albers, Gregory W., additional, Urrutia, Victor C., additional, Llinas, Raf, additional, Marsh, Elisabeth B., additional, Hillis, Argye E., additional, Nael, Kambiz, additional, and Yedavalli, Vivek S., additional

Published
2024
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39. Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke

Author

Salim, Hamza, primary, Musmar, Basel, additional, Adeeb, Nimer, additional, Yedavalli, Vivek, additional, Lakhani, Dhairya, additional, Grewal, Sahibjot Singh, additional, El Naamani, Kareem, additional, Henninger, Nils, additional, Sundararajan, Sri Hari, additional, Kühn, Anna Luisa, additional, Khalife, Jane, additional, Ghozy, Sherief, additional, Scarcia, Luca, additional, Tan, Benjamin YQ, additional, Regenhardt, Robert W, additional, Heit, Jeremy J, additional, Cancelliere, Nicole M, additional, Bernstock, Joshua D, additional, Rouchaud, Aymeric, additional, Fiehler, Jens, additional, Sheth, Sunil, additional, Puri, Ajit S, additional, Dyzmann, Christian, additional, Colasurdo, Marco, additional, Barreau, Xavier, additional, Renieri, Leonardo, additional, Filipe, João Pedro, additional, Harker, Pablo, additional, Radu, Răzvan Alexandru, additional, Abdalkader, Mohamad, additional, Klein, Piers, additional, Marotta, Thomas R, additional, Spears, Julian, additional, Ota, Takahiro, additional, Mowla, Ashkan, additional, Jabbour, Pascal, additional, Biswas, Arundhati, additional, Clarençon, Frédéric, additional, Siegler, James E, additional, Nguyen, Thanh N, additional, Varela, Ricardo, additional, Baker, Amanda, additional, Essibayi, Muhammed Amir, additional, Altschul, David, additional, Gonzalez, Nestor R, additional, Möhlenbruch, Markus A, additional, Costalat, Vincent, additional, Gory, Benjamin, additional, Stracke, Christian Paul, additional, Aziz-Sultan, Mohammad Ali, additional, Hecker, Constantin, additional, Shaikh, Hamza, additional, Liebeskind, David S, additional, Pedicelli, Alessandro, additional, Alexandre, Andrea M, additional, Tancredi, Illario, additional, Faizy, Tobias D, additional, Kalsoum, Erwah, additional, Lubicz, Boris, additional, Patel, Aman B, additional, Pereira, Vitor Mendes, additional, Guenego, Adrien, additional, Dmytriw, Adam A, additional, Amllay, Abdelaziz, additional, Vagal, Achala, additional, ter Schiphorst, Adrien, additional, Thomas, Ajith J., additional, Gopinathan, Anil, additional, Dusart, Anne, additional, Capirossi, Carolina, additional, Mounayer, Charbel, additional, Weyland, Charlotte, additional, Hsieh, Cheng-Yang, additional, Griessenauer, Christoph J., additional, Stapleton, Christopher J., additional, Bellante, Flavio, additional, Marnat, Gaultier, additional, Forestier, Géraud, additional, Cuellar-Saenz, Hugo H., additional, Valente, Iacopo, additional, Sibon, Igor, additional, Rabinov, James D., additional, Berge, Jérôme, additional, Jesser, Jessica, additional, Carlos Martinez-Gutierrez, Juan, additional, Premat, Kevin, additional, Yeo, Leonard LL., additional, Chervak, Lina, additional, Meyer, Lukas, additional, Elhorany, Mahmoud, additional, and Quintero-Consuegra, Miguel, additional

Published
2024
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42. Dual Layer vs Single Layer Woven EndoBridge Device in the Treatment of Intracranial Aneurysms: A Propensity Score-Matched Analysis

Author

Dmytriw, Adam A., primary, Salim, Hamza, additional, Musmar, Basel, additional, Aslan, Assala, additional, Cancelliere, Nicole M., additional, McLellan, Rachel M., additional, Algin, Oktay, additional, Ghozy, Sherief, additional, Dibas, Mahmoud, additional, Lay, Sovann V., additional, Guenego, Adrien, additional, Renieri, Leonardo, additional, Carnevale, Joseph, additional, Saliou, Guillaume, additional, Mastorakos, Panagiotis, additional, Naamani, Kareem El, additional, Shotar, Eimad, additional, Premat, Kevin, additional, Möhlenbruch, Markus, additional, Kral, Michael, additional, Doron, Omer, additional, Chung, Charlotte, additional, Salem, Mohamed M., additional, Lylyk, Ivan, additional, Foreman, Paul M., additional, Vachhani, Jay A., additional, Shaikh, Hamza, additional, Župančić, Vedran, additional, Hafeez, Muhammad U., additional, Catapano, Joshua, additional, Waqas, Muhammad, additional, Tutino, Vincent M., additional, Ibrahim, Mohamed K., additional, Mohammed, Marwa A., additional, Imamoglu, Cetin, additional, Bayrak, Ahmet, additional, Rabinov, James D., additional, Ren, Yifan, additional, Schirmer, Clemens M., additional, Piano, Mariangela, additional, Kühn, Anna L., additional, Michelozzi, Caterina, additional, Elens, Stéphanie, additional, Starke, Robert M., additional, Hassan, Ameer E., additional, Ogilvie, Mark, additional, Sporns, Peter, additional, Jones, Jesse, additional, Brinjikji, Waleed, additional, Nawka, Marie T., additional, Psychogios, Marios, additional, Ulfert, Christian, additional, Diestro, Jose Danilo Bengzon, additional, Pukenas, Bryan, additional, Burkhardt, Jan-Karl, additional, Huynh, Thien, additional, Martinez-Gutierrez, Juan Carlos, additional, Essibayi, Muhammed Amir, additional, Sheth, Sunil A., additional, Spiegel, Gary, additional, Tawk, Rabih, additional, Lubicz, Boris, additional, Panni, Pietro, additional, Puri, Ajit S., additional, Pero, Guglielmo, additional, Nossek, Erez, additional, Raz, Eytan, additional, Killer-Oberfalzer, Monika, additional, Griessenauer, Christoph J., additional, Asadi, Hamed, additional, Siddiqui, Adnan, additional, Brook, Allan L., additional, Altschul, David, additional, Ducruet, Andrew F., additional, Albuquerque, Felipe C., additional, Regenhardt, Robert W., additional, Stapleton, Christopher J., additional, Kan, Peter, additional, Kalousek, Vladimir, additional, Lylyk, Pedro, additional, Boddu, Srikanth, additional, Knopman, Jared, additional, Aziz-Sultan, Mohammad A., additional, Tjoumakaris, Stavropoula I., additional, Clarençon, Frédéric, additional, Limbucci, Nicola, additional, Cuellar-Saenz, Hugo H., additional, Jabbour, Pascal M., additional, Pereira, Vitor Mendes, additional, Patel, Aman B., additional, and Adeeb, Nimer, additional

Published
2024
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43. Prolonged venous transit on perfusion imaging is associated with higher odds of mortality in successfully reperfused patients with large vessel occlusion stroke

Author

Yedavalli, Vivek S, primary, Koneru, Manisha, additional, Hoseinyazdi, Meisam, additional, Greene, Cynthia, additional, Lakhani, Dhairya A, additional, Xu, Risheng, additional, Luna, Licia P, additional, Caplan, Justin M, additional, Dmytriw, Adam A, additional, Guenego, Adrien, additional, Heit, Jeremy J, additional, Albers, Gregory W, additional, Wintermark, Max, additional, Gonzalez, L Fernando, additional, Urrutia, Victor C, additional, Huang, Judy, additional, Nael, Kambiz, additional, Leigh, Richard, additional, Marsh, Elisabeth B, additional, Hillis, Argye E, additional, and Llinas, Rafael H, additional

Published
2024
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45. Thrombectomy for Basilar Artery Occlusion with Mild Symptoms

Author

Piotin, Michel, Blanc, Raphael, Redjem, Hocine, Escalard, Simon, Desilles, Jean-Philippe, Ciccio, Gabriele, Smajda, Stanislas, Maier, Benjamin, Hebert, Solene, Delvoye, François, Mazighi, Mikael, Obadia, Mikael, Sabben, Candice, Peres, Roxanne, Corabianu, Ovide, de Broucker, Thomas, Smadja, Didier, Alamowitch, Sonia, Ille, Olivier, Manchon, Eric, Garcia, Pierre-Yves, Taylor, Guillaume, Ben Maacha, Malek, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Ajili, Nadia, Lapergue, Bertrand, Weisenburger, David, Gorza, Lucas, Buard, Géraldine, Coskun, Oguzhan, Consoli, Arturo, Di Maria, Federico, Rodesh, Georges, Zimatore, Sergio, Leguen, Morgan, Gratieux, Julie, Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Marinier, Sylvie, Marnat, Gaultier, Gariel, Florent, Barreau, Xavier, Berge, Jérôme, Veunac, Louis, Menegon, Patrice, Sibon, Igor, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Bourcier, Romain, Detraz, Lili, Daumas-Duport, Benjamin, Alexandre, Pierre-Louis, Roy, Monica, Lenoble, Cédric, L'allinec, Vincent, Girot, Jean-Baptiste, Desal, Hubert, Gory, Benjamin, Bracard, Serge, Anxionnat, René, Braun, Marc, Derelle, Anne-Laure, Tonnelet, Romain, Liao, Liang, Zhu, François, Schmitt, Emmanuelle, Planel, Sophie, Richard, Sébastien, Humbertjean, Lisa, Mione, Gioia, Lacour, Jean-Christophe, Bonnerot, Mathieu, Riou-Comte, Nolwenn, Costalat, Vincent, Arquizan, Caroline, Dargazanli, Cyril, Gascou, Grégory, Lefèvre, Pierre-Henri, Derraz, Imad, Riquelme, Carlos, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, François, Eugene, Vannier, Stéphane, Ferre, Jean-Christophe, Raoult, Helene, Ronziere, Thomas, Lassale, Maria, Paya, Christophe, Gauvrit, Jean-Yves, Tracol, Clément, Langnier-Lemercier, Sophie, Guenego, Adrien, Weisenburger-Lile, David, Ducroux, Célina, Labreuche, Julien, Aubertin, Mathilde, Benali, Amel, Guillen, Maud, Eugene, François, Walker, Gregory, Lun, Ronda, and Fahed, Robert

Published
2021
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46. Treatment of Large Intracranial Aneurysms Using the Woven EndoBridge (WEB): A Propensity Score-Matched Analysis

Author

Musmar, Basel, Salim, Hamza, Adeeb, Nimer, Aslan, Assala, Aljeradat, Bahaa, Diestro, Jose, McLellan, Rachel, Algin, Oktay, Ghozy, Sherief, Dibas, Mahmoud, Lay, Sovann, Guenego, Adrien, Renieri, Leonardo, Cancelliere, Nicole, Carnevale, Joseph, Saliou, Guillaume, Mastorakos, Panagiotis, El Naamani, Kareem, Shotar, Eimad, Premat, Kevin, Möhlenbruch, Markus, Kral, Michael, Vranic, Justin, Chung, Charlotte, Salem, Mohamed, Lylyk, Ivan, Foreman, Paul, Vachhani, Jay, Shaikh, Hamza, Župančić, Vedran, Hafeez, Muhammad, Catapano, Joshua, Waqas, Muhammad, Tutino, Vincent, Ibrahim, Mohamed, Mohammed, Marwa, Ozates, M. Ozgur, Ayberk, Giyas, Rabinov, James, Ren, Yifan, Schirmer, Clemens, Piano, Mariangela, Kühn, Anna, Michelozzi, Caterina, Elens, Stéphanie, Starke, Robert, Hassan, Ameer, Ogilvie, Mark, Nguyen, Anh, Jones, Jesse, Brinjikji, Waleed, Nawka, Marie, Psychogios, Marios, Ulfert, Christian, Spears, Julian, Jankowitz, Brian, Burkhardt, Jan-Karl, Domingo, Ricardo, Huynh, Thien, Martinez-Gutierrez, Juan Carlos, Essibayi, Muhammed, Sheth, Sunil, Spiegel, Gary, Tawk, Rabih, Lubicz, Boris, Panni, Pietro, Puri, Ajit, Pero, Guglielmo, Nossek, Erez, Raz, Eytan, Killer-Oberfalzer, Monika, Griessenauer, Christoph, Asadi, Hamed, Siddiqui, Adnan, Brook, Allan, Altschul, David, Ducruet, Andrew, Albuquerque, Felipe, Regenhardt, Robert, Stapleton, Christopher, Kan, Peter, Kalousek, Vladimir, Lylyk, Pedro, Boddu, Srikanth, Knopman, Jared, Aziz-Sultan, Mohammad A, Tjoumakaris, Stavropoula, Clarençon, Frédéric, Limbucci, Nicola, Cuellar-Saenz, Hugo, Jabbour, Pascal, Pereira, Vitor, Patel, Aman, Dmytriw, Adam, Musmar, Basel, Salim, Hamza, Adeeb, Nimer, Aslan, Assala, Aljeradat, Bahaa, Diestro, Jose, McLellan, Rachel, Algin, Oktay, Ghozy, Sherief, Dibas, Mahmoud, Lay, Sovann, Guenego, Adrien, Renieri, Leonardo, Cancelliere, Nicole, Carnevale, Joseph, Saliou, Guillaume, Mastorakos, Panagiotis, El Naamani, Kareem, Shotar, Eimad, Premat, Kevin, Möhlenbruch, Markus, Kral, Michael, Vranic, Justin, Chung, Charlotte, Salem, Mohamed, Lylyk, Ivan, Foreman, Paul, Vachhani, Jay, Shaikh, Hamza, Župančić, Vedran, Hafeez, Muhammad, Catapano, Joshua, Waqas, Muhammad, Tutino, Vincent, Ibrahim, Mohamed, Mohammed, Marwa, Ozates, M. Ozgur, Ayberk, Giyas, Rabinov, James, Ren, Yifan, Schirmer, Clemens, Piano, Mariangela, Kühn, Anna, Michelozzi, Caterina, Elens, Stéphanie, Starke, Robert, Hassan, Ameer, Ogilvie, Mark, Nguyen, Anh, Jones, Jesse, Brinjikji, Waleed, Nawka, Marie, Psychogios, Marios, Ulfert, Christian, Spears, Julian, Jankowitz, Brian, Burkhardt, Jan-Karl, Domingo, Ricardo, Huynh, Thien, Martinez-Gutierrez, Juan Carlos, Essibayi, Muhammed, Sheth, Sunil, Spiegel, Gary, Tawk, Rabih, Lubicz, Boris, Panni, Pietro, Puri, Ajit, Pero, Guglielmo, Nossek, Erez, Raz, Eytan, Killer-Oberfalzer, Monika, Griessenauer, Christoph, Asadi, Hamed, Siddiqui, Adnan, Brook, Allan, Altschul, David, Ducruet, Andrew, Albuquerque, Felipe, Regenhardt, Robert, Stapleton, Christopher, Kan, Peter, Kalousek, Vladimir, Lylyk, Pedro, Boddu, Srikanth, Knopman, Jared, Aziz-Sultan, Mohammad A, Tjoumakaris, Stavropoula, Clarençon, Frédéric, Limbucci, Nicola, Cuellar-Saenz, Hugo, Jabbour, Pascal, Pereira, Vitor, Patel, Aman, and Dmytriw, Adam

Abstract

The Woven EndoBridge (WEB) device is primarily used for treating wide-neck intracranial bifurcation aneurysms under 10 mm. Limited data exists on its efficacy for large aneurysms. We aim to assess angiographic and clinical outcomes of the WEB device in treating large versus small aneurysms. We conducted a retrospective review of the WorldWide WEB Consortium database, from 2011 to 2022, across 30 academic institutions globally. Propensity score matching (PSM) was employed to compare small and large aneurysms on baseline characteristics. A total of 898 patients were included. There was no significant difference observed in clinical presentations, smoking status, pretreatment mRS, presence of multiple aneurysms, bifurcation location, or prior treatment between the two groups. After PSM, 302 matched pairs showed significantly lower last follow-up adequate occlusion rates (81% vs 90%, p = 0.006) and higher retreatment rates (12% vs 3.6%, p < 0.001) in the large aneurysm group. These findings may inform treatment decisions and patient counseling. Future studies are needed to further explore this area.

Published
2024

47. The Anch'Or Harpoon Technique With a Manually Expandable Stentretriever (Tigertriever 13), a Technical Note

Author

Maud Wang, Stephanie Elens, Thomas Bonnet, Marin Halut, Juan Vazquez Suarez, Benjamin Mine, Boris Lubicz, and Adrien Guenego

Subjects
distal thrombectomy, stroke, anchor technique, Harpoon technique, endovascular recanalization, Neurology. Diseases of the nervous system, RC346-429
Abstract

Background and purposeStent and balloon anchor techniques have been described to obtain distal support and straighten catheter loops, stabilize microcatheters in giant aneurysms, or access distal tortuous anatomy during thrombectomy. These techniques require catheterization of distal arteries with a microcatheter but tortuosity and length issues may render it challenging, precluding the distal unsheathing of a classical auto-expandable stentretriever with the anchor technique.MethodsTherefore, we developed the so-called Anch'Or Harpoon Technique using a manually expandable stent retriever, the Tigertriever 13 (Rapid Medical, Yoqneam, Israel). Here, the stent retriever is not unsheathed but pushed out of a microcatheter, and then advanced as far as possible before manual opening.Results and conclusionThis technique may be used in 2 different situations. First, in the case of vessel tortuosity if the microcatheter can't be advanced as far as the physician wants: the Tigertriever 13 could be delivered through the microcatheter without having to unsheathe it, and be advanced and opened distally to its microcatheter to establish a stable anchor prior to advancing the guiding, intermediate, and micro-catheters (Anchor technique). The second situation is when distal occlusions lead to length issues; the microcatheter may be too short to cross a distal clot: the Tigertriever 13 could then be pushed out of the microcatheter, and be used to cross a sub-occlusive clot as it has a soft shaped distal tip and the physician has a visual on the artery beyond the sub-occlusion. Then, the Tigertriever would be manually expanded through the clot and retrieved (Harpoon technique) to obtain a recanalization.

Published
2022
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48. Association between occlusion location, net water uptake and ischemic lesion growth in large vessel anterior circulation strokes.

Author

Winkelmeier, Laurens, Heit, Jeremy J, Broocks, Gabriel, Prüter, Julia, Heitkamp, Christian, Schell, Maximilian, Albers, Gregory W, Lansberg, Maarten G, Wintermark, Max, Kemmling, André, Stracke, Christian Paul, Guenego, Adrien, Paech, Daniel, Fiehler, Jens, and Faizy, Tobias D

Abstract

Ischemic lesion net water uptake (NWU) represents a quantitative imaging biomarker for cerebral edema in acute ischemic stroke. Data on NWU for distinct occlusion locations remain scarce, but might help to improve the prognostic value of NWU. In this retrospective multicenter cohort study, we compared NWU between patients with proximal large vessel occlusion (pLVO; ICA or proximal M1) and distal large vessel occlusion (dLVO; distal M1 or M2). NWU was quantified by densitometric measurements of the early ischemic region. Arterial collateral status was assessed using the Maas scale. Regression analysis was used to investigate the relationship between occlusion location, NWU and ischemic lesion growth. A total of 685 patients met inclusion criteria. Early ischemic lesion NWU was higher in patients with pLVO compared with dLVO (7.7% vs 3.9%, P <.001). The relationship between occlusion location and NWU was partially mediated by arterial collateral status. NWU was associated with absolute ischemic lesion growth between admission and follow-up imaging (β estimate, 5.50, 95% CI, 3.81–7.19, P <.001). This study establishes a framework for the relationship between occlusion location, arterial collateral status, early ischemic lesion NWU and ischemic lesion growth. Future prognostic thresholds for NWU might be optimized by adjusting for the occlusion location. [ABSTRACT FROM AUTHOR]

Published
2024
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49. Diagnosis and endovascular management of vasospasm after aneurysmal subarachnoid hemorrhage -- survey of real-life practices.

Author

Guenego, Adrien, Fahed, Robert, Rouchaud, Aymeric, Walker, Gregory, Faizy, Tobias D., Sporns, Peter B., Aggour, Mohamed, Jabbour, Pascal, Alexandre, Andrea M., Mosimann, Pascal John, Dmytriw, Adam A., Ligot, Noémie, Sadeghi, Niloufar, Chengbo Dai, Hassan, Ameer E., Pereira, Vitor M., Singer, Justin, Heit, Jeremy J., Taccone, Fabio Silvio, and Chen, Michael

Subjects
INTRACRANIAL aneurysms, NIMODIPINE, CEREBRAL vasospasm, NEUROLOGISTS, SUBARACHNOID hemorrhage, QUESTIONNAIRES, ANGIOPLASTY, ENDOVASCULAR surgery, DESCRIPTIVE statistics, TRANSCRANIAL Doppler ultrasonography, PHYSICIAN practice patterns, DISEASE complications
Abstract

Background Vasospasm and delayed cerebral ischemia (DCI) are the leading causes of morbidity and mortality after intracranial aneurysmal subarachnoid hemorrhage (aSAH). Vasospasm detection, prevention and management, especially endovascular management varies from center to center and lacks standardization. We aimed to evaluate this variability via an international survey of how neurointerventionalists approach vasospasm diagnosis and endovascular management. Methods We designed an anonymous online survey with 100 questions to evaluate practice patterns between December 2021 and September 2022. We contacted endovascular neurosurgeons, neuroradiologists and neurologists via email and via two professional societies -- the Society of NeuroInterventional Surgery (SNIS) and the European Society of Minimally Invasive Neurological Therapy (ESMINT). We recorded the physicians' responses to the survey questions. Results A total of 201 physicians (25% [50/201] USA and 75% non-USA) completed the survey over 10 months, 42% had >7 years of experience, 92% were male, median age was 40 (IQR 35-46). Both high-volume and low- volume centers were represented. Daily transcranial Doppler was the most common screening method (75%) for vasospasm. In cases of symptomatic vasospasm despite optimal medical management, endovascular treatment was directly considered by 58% of physicians. The most common reason to initiate endovascular treatment was clinical deficits associated with proven vasospasm/DCI in 89%. The choice of endovascular treatment and its efficacy was highly variable. Nimodipine was the most common first- line intra-arterial therapy (40%). Mechanical angioplasty was considered the most effective endovascular treatment by 65% of neurointerventionalists. Conclusion Our study highlights the considerable heterogeneity among the neurointerventional community regarding vasospasm diagnosis and endovascular management. Randomized trials and guidelines are needed to improve standard of care, determine optimal management approaches and track outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Predictors of Aneurysm Obliteration in Patients Treated with the WEB Device: Results of a Multicenter Retrospective Study.

Author

Mastorakos, Panagiotis, El Naamani, Kareem, Adeeb, Nimer, Lan, Mathews, Castiglione, James, Khanna, Omaditya, Ghosh, Ritam, Bengzon Diestro, Jose Danilo, Dibas, Mahmoud, McLellan, Rachel M., Algin, Oktay, Ghozy, Sherief, Cancelliere, Nicole M., Aslan, Assala, Cuellar-Saenz, Hugo H., Lay, Sovann V., Guenego, Adrien, Renieri, Leonardo, Carnevale, Joseph, and Saliou, Guillaume

Published
2024
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