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3. The effect of occlusion location and technique in mechanical thrombectomy for minor stroke

Author

Abecassis, Isaac Josh, primary, Almallouhi, Eyad, additional, Chalhoub, Reda M., additional, Helal, Ahmed, additional, Naidugari, Janki R., additional, Kasab, Sami Al, additional, Bass, Eric, additional, Ding, Dale, additional, Saini, Vasu, additional, Burks, Joshua D., additional, Maier, Ilko L., additional, Jabbour, Pascal, additional, Kim, Joon-Tae, additional, Wolfe, Stacey, additional, Rai, Ansaar, additional, Psychogios, Marios-Nikos, additional, Samaniego, Edgar, additional, Arthur, Adam S., additional, Yoshimura, Shinichi, additional, Howard, Brian, additional, Alawieh, Ali, additional, Fragata, Isabel, additional, Cuellar, Hugo, additional, Polifka, Adam, additional, Mascitelli, Justin, additional, Osbun, Joshua, additional, Crosa, Roberto, additional, Matouk, Charles, additional, Park, Min S., additional, Levitt, Michael R., additional, Dumont, Travis, additional, Williamson, Richard W., additional, Spiotta, Alejandro M., additional, and Starke, Robert M., additional

Published
2023
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6. Effect of Hispanic Status in Mechanical Thrombectomy Outcomes After Ischemic Stroke: Insights From STAR

Author

Burks, Joshua D., primary, Chen, Stephanie H., additional, Luther, Evan M., additional, Almallouhi, Eyad, additional, Al Kasab, Sami, additional, Jabbour, Pascal M., additional, Wolfe, Stacey Q., additional, Fargen, Kyle M., additional, Arthur, Adam S., additional, Goyal, Nitin, additional, Fragata, Isabel, additional, Maier, Ilko, additional, Matouk, Charles, additional, Grossberg, Jonathan, additional, Kan, Peter, additional, Schirmer, Clemens, additional, Crowley, R. Webster, additional, Ares, William, additional, Ogilvy, Christopher S., additional, Rai, Ansaar T., additional, Levitt, Michael R., additional, Mokin, Maxim, additional, Guerrero, Waldo, additional, Park, Min S., additional, Mascitelli, Justin, additional, Yoo, Albert, additional, Williamson, Richard W., additional, Grande, Andrew, additional, Crosa, Roberto, additional, Webb, Sharon, additional, Psychogios, Marios, additional, Peterson, Eric C., additional, Yavagal, Dileep R., additional, Spiotta, Alejandro M., additional, Starke, Robert M., additional, Raper, Daniel, additional, Brown, Patrick, additional, Gooch, M. Reid, additional, Herial, Nabeel, additional, Thomas, Ajith, additional, Moore, Justin, additional, Albuquerque, Felipe, additional, Kim, Louis, additional, Walker, Melanie, additional, Chen, Michael, additional, Munich, Stephan, additional, Hoit, Daniel, additional, Inoa-Acosta, Violiza, additional, Nickele, Christopher, additional, Elijovich, Lucas, additional, Rodriguez-Erazú, Fernanda, additional, Liman, Jan, additional, Cawley, Michael, additional, Pradilla, Gustavo, additional, Howard, Brian, additional, Walcott, Brian, additional, Ren, Zeguang, additional, Hebert, Ryan, additional, Reis, Joāo, additional, Pamplona, Jaime, additional, Carvalho, Rui, additional, Baptista, Mariana, additional, Nunes, Ana, additional, Cerejo, Russell, additional, Tayal, Ashis, additional, Bhuva, Parita, additional, Hansen, Paul, additional, Ajibove, Norman, additional, Brehm, Alex, additional, Lena, Jonathan, additional, and Kicielinski, Kimberly, additional

Published
2021
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7. Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in the Early and Extended Window

Author

Almallouhi, Eyad, Al Kasab, Sami, Hubbard, Zachary, Bass, Eric C, Porto, Guilherme, Alawieh, Ali, Chalhoub, Reda, Jabbour, Pascal, Starke, Robert M, Wolfe, Stacey Q, Arthur, Adam S, Samaniego, Edgar, Maier, Ilko, Howard, Brian M, Rai, Ansaar, Park, Min S, Mascitelli, Justin, Psychogios, Marios, De Leacy, Reade, Dumont, Travis, Levitt, Michael R, Polifka, Adam, Osbun, Joshua, Crosa, Roberto, Kim, Joon-Tae, Casagrande, Walter, Yoshimura, Shinichi, Matouk, Charles, Kan, Peter T, Williamson, Richard W, Gory, Benjamin, Mokin, Maxim, Fragata, Isabel, Zaidat, Osama, Yoo, Albert J, Spiotta, Alejandro M, Almallouhi, Eyad, Al Kasab, Sami, Hubbard, Zachary, Bass, Eric C, Porto, Guilherme, Alawieh, Ali, Chalhoub, Reda, Jabbour, Pascal, Starke, Robert M, Wolfe, Stacey Q, Arthur, Adam S, Samaniego, Edgar, Maier, Ilko, Howard, Brian M, Rai, Ansaar, Park, Min S, Mascitelli, Justin, Psychogios, Marios, De Leacy, Reade, Dumont, Travis, Levitt, Michael R, Polifka, Adam, Osbun, Joshua, Crosa, Roberto, Kim, Joon-Tae, Casagrande, Walter, Yoshimura, Shinichi, Matouk, Charles, Kan, Peter T, Williamson, Richard W, Gory, Benjamin, Mokin, Maxim, Fragata, Isabel, Zaidat, Osama, Yoo, Albert J, and Spiotta, Alejandro M

Abstract

Importance: Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct. Objective: To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5. Design, setting, and participants: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid artery or M1 segment of the middle cerebral artery from January 1, 2016, to December 31, 2020. Patients were followed up for 90 days after intervention. The ASPECTS is a 10-point scoring system based on the extent of early ischemic changes on the baseline noncontrasted computed tomography scan, with a score of 10 indicating normal and a score of 0 indicating ischemic changes in all of the regions included in the score. Exposure: All patients underwent MT in one of the included centers. Main outcomes and measures: A multivariable regression model was used to assess factors associated with a favorable 90-day outcome (modified Rankin Scale score of 0-2), including interaction terms between an ASPECTS of 2 to 5 and receiving MT in the extended window (6-24 hours from symptom onset). Results: A total of 2345 patients who underwent MT were included (1175 women [50.1%]; median age, 72 years [IQR, 60-80 years]; 2132 patients [90.9%] had an ASPECTS of ≥6, and 213 patients [9.1%] had an ASPECTS of 2-5). At 90 days, 47 of the 213 patients (22.1%) with an ASPECTS of 2 to 5 had a modified Rankin Scale score of 0 to 2 (25.6% [45 of 176] of patients who underwent successful recanalization [modified Thrombolysis in Cerebral Ischemia score ≥2B] vs 5.4% [2 of 37] of patients who underwent unsuccessful

Published
2021

10. The effect of occlusion location and technique in mechanical thrombectomy for minor stroke

Author

Abecassis, Isaac Josh, Almallouhi, Eyad, Chalhoub, Reda M., Helal, Ahmed, Naidugari, Janki R., Kasab, Sami Al, Bass, Eric, Ding, Dale, Saini, Vasu, Burks, Joshua D., Maier, Ilko L., Jabbour, Pascal, Kim, Joon-Tae, Wolfe, Stacey, Rai, Ansaar, Psychogios, Marios-Nikos, Samaniego, Edgar, Arthur, Adam S., Yoshimura, Shinichi, Howard, Brian, Alawieh, Ali, Fragata, Isabel, Cuellar, Hugo, Polifka, Adam, Mascitelli, Justin, Osbun, Joshua, Crosa, Roberto, Matouk, Charles, Park, Min S., Levitt, Michael R., Dumont, Travis, Williamson, Richard W., Spiotta, Alejandro M., and Starke, Robert M.

Abstract

Introduction Endovascular mechanical thrombectomy (MT) is an established treatment for large vessel occlusion strokes with a National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher. Data pertaining to minor strokes, medium, or distal vessel occlusions, and most effective MT technique is limited and controversial.Methods A multicenter retrospective study of all patients treated with MT presenting with NIHSS score of 5 or less at 29 comprehensive stroke centers. The cohort was dichotomized based on location of occlusion (proximal vs. distal) and divided based on MT technique (direct aspiration first-pass technique [ADAPT], stent retriever [SR], and primary combined [PC]). Outcomes at discharge and 90 days were compared between proximal and distal occlusion groups, and across MT techniques.Results The cohort included 759 patients, 34% presented with distal occlusion. Distal occlusions were more likely to present with atrial fibrillation (p = 0.008) and receive IV tPA (p = 0.001). Clinical outcomes at discharge and 90 days were comparable between proximal and distal groups. Compared to SR, patients managed with ADAPT were more likely to have a modified Rankin Scale of 0–2 at discharge and at 90 days (p = 0.024 and p = 0.013). Primary combined compared to ADAPT, prior stroke, multiple passes, older age, and longer procedure time were independently associated with worse clinical outcome, while successful recanalization was positively associated with good clinical outcomes.Conclusions Proximal and distal occlusions with low NIHSS have comparable outcomes and safety profiles. While all MT techniques have a similar safety profile, ADAPT was associated with better clinical outcomes at discharge and 90 days.

Published
2024
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11. Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in the Early and Extended Window.

Author

Almallouhi E, Al Kasab S, Hubbard Z, Bass EC, Porto G, Alawieh A, Chalhoub R, Jabbour PM, Starke RM, Wolfe SQ, Arthur AS, Samaniego E, Maier I, Howard BM, Rai A, Park MS, Mascitelli J, Psychogios M, De Leacy R, Dumont T, Levitt MR, Polifka A, Osbun J, Crosa R, Kim JT, Casagrande W, Yoshimura S, Matouk C, Kan PT, Williamson RW, Gory B, Mokin M, Fragata I, Zaidat O, Yoo AJ, and Spiotta AM

Subjects
Aged, Aged, 80 and over, Asia, Cohort Studies, Europe, Female, Humans, Male, Middle Aged, Retrospective Studies, Tomography, X-Ray Computed methods, Treatment Outcome, United States, Brain Ischemia diagnosis, Brain Ischemia surgery, Carotid Artery, Internal surgery, Risk Assessment methods, Stroke diagnosis, Stroke surgery, Thrombectomy methods
Abstract

Importance: Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct., Objective: To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5., Design, Setting, and Participants: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid artery or M1 segment of the middle cerebral artery from January 1, 2016, to December 31, 2020. Patients were followed up for 90 days after intervention. The ASPECTS is a 10-point scoring system based on the extent of early ischemic changes on the baseline noncontrasted computed tomography scan, with a score of 10 indicating normal and a score of 0 indicating ischemic changes in all of the regions included in the score., Exposure: All patients underwent MT in one of the included centers., Main Outcomes and Measures: A multivariable regression model was used to assess factors associated with a favorable 90-day outcome (modified Rankin Scale score of 0-2), including interaction terms between an ASPECTS of 2 to 5 and receiving MT in the extended window (6-24 hours from symptom onset)., Results: A total of 2345 patients who underwent MT were included (1175 women [50.1%]; median age, 72 years [IQR, 60-80 years]; 2132 patients [90.9%] had an ASPECTS of ≥6, and 213 patients [9.1%] had an ASPECTS of 2-5). At 90 days, 47 of the 213 patients (22.1%) with an ASPECTS of 2 to 5 had a modified Rankin Scale score of 0 to 2 (25.6% [45 of 176] of patients who underwent successful recanalization [modified Thrombolysis in Cerebral Ischemia score ≥2B] vs 5.4% [2 of 37] of patients who underwent unsuccessful recanalization; P = .007). Having a low ASPECTS (odds ratio, 0.60; 95% CI, 0.38-0.85; P = .002) and presenting in the extended window (odds ratio, 0.69; 95% CI, 0.55-0.88; P = .001) were associated with worse 90-day outcome after controlling for potential confounders, without significant interaction between these 2 factors (P = .64)., Conclusions and Relevance: In this cohort study, more than 1 in 5 patients presenting with an ASPECTS of 2 to 5 achieved 90-day functional independence after MT. A favorable outcome was nearly 5 times more likely for patients with low ASPECTS who had successful recanalization. The association of a low ASPECTS with 90-day outcomes did not differ for patients presenting in the early vs extended MT window.

Published
2021
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