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1. New Class of Radially Adjustable Stentrievers for Acute Ischemic Stroke: Primary Results of the Multicenter TIGER Trial.

Author

Gupta, Rishi, Saver, Jeffrey L, Levy, Elad, Zaidat, Osama O, Yavagal, Dileep, Liebeskind, David S, Khaldi, Ahmad, Gross, Bradley, Lang, Michael, Narayanan, Sandra, Jankowitz, Brian, Snyder, Kenneth, Siddiqui, Adnan, Davies, Jason, Lin, Eugene, Hassan, Ameer, Hanel, Ricardo, Aghaebrahim, Amin, Kaushal, Ritesh, Malek, Ali, Mueller-Kronast, Nils, Starke, Robert, Bozorgchami, Hormozd, Nesbit, Gary, Horikawa, Masahiro, Priest, Ryan, Liu, Jesse, Budzik, Ronald F, Pema, Peter, Vora, Nirav, Taqi, M Asif, Samaniego, Edgar, Wang, Qingliang Tony, Nossek, Erez, Dabus, Guilherme, Linfante, Italo, Puri, Ajit, Abergel, Eitan, Starkman, Sidney, Tateshima, Satoshi, Jadhav, Ashutosh P, and TIGER Trial Investigators

Subjects
TIGER Trial Investigators, Humans, Thrombectomy, Aged, Middle Aged, Female, Male, Endovascular Procedures, Ischemic Stroke, goal, intracranial hemorrhage, laboratories, reperfusion, stent, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurosciences, Neurology & Neurosurgery
Abstract

[Figure: see text].

Published
2021

2. Rapid learning curve for Solitaire FR stent retriever therapy: evidence from roll-in and randomised patients in the SWIFT trial

Author

Sheth, Sunil A, Jahan, Reza, Levy, Elad I, Jovin, Tudor G, Baxter, Blaise, Nogueira, Raul G, Clark, Wayne, Budzik, Ronald, Zaidat, Osama O, and Saver, Jeffrey L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Bioengineering, Clinical Trials and Supportive Activities, Stroke, Neurosciences, Brain Disorders, Clinical Research, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Aged, Aged, 80 and over, Brain Ischemia, Female, Humans, Learning Curve, Male, Middle Aged, Prospective Studies, Stents, Survival Rate, Thrombectomy, SWIFT Trialists, Angiography, Intervention, Technique, Clinical sciences
Abstract

BackgroundIn light of recent positive trial data for endovascular therapy in acute ischemic stroke (AIS), stent retriever use by practitioners without prior experience with these devices may become more common.ObjectiveTo assess the safety and efficacy of thrombectomy for AIS using Solitaire for patients treated in the roll-in period of the Solitaire With the Intention For Thrombectomy (SWIFT) trial, which represented the first clinical use of the device for these interventionalists.MethodsProspectively collected demographic, clinical, and angiographic data on patients treated in the initial roll-in and subsequent randomized phases of the SWIFT study were collected and analyzed. Key statistical analyses were validated by an independent external statistician.ResultsPatients in the roll-in period achieved equivalently high rates of reperfusion (55%) compared with those treated with the device in the randomized phase (61%). Rates of adverse events were comparable (13% vs. 9%). Rates of good neurological outcome were equivalent between the roll-in and randomized patients treated with Solitaire (63% vs. 58%). Including the roll-in patients strengthened the conclusions of the study, that reperfusion rates without symptomatic hemorrhage with Solitaire were greater than with Merci (59% vs. 24%, p

Published
2016

4. Carotid I's, L's and T's: collaterals shape the outcome of intracranial carotid occlusion in acute ischemic stroke

Author

Liebeskind, David S, Flint, Alexander C, Budzik, Ronald F, Xiang, Bin, Smith, Wade S, Duckwiler, Gary R, and Nogueira, Raul G

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Brain Disorders, Neurosciences, Stroke, Adult, Aged, Aged, 80 and over, Brain Ischemia, Carotid Artery, Internal, Cerebral Arterial Diseases, Cerebrovascular Circulation, Clinical Trials as Topic, Collateral Circulation, Female, Humans, Male, Mechanical Thrombolysis, Middle Aged, Outcome Assessment, Health Care, Radiography, Thrombosis, Angiography, Blood Flow, Thrombectomy, MERCI and Multi-MERCI Investigators, Clinical sciences
Abstract

BackgroundCollaterals may affect revascularization, ischemic severity, and clinical outcomes in acute stroke owing to internal carotid artery (ICA) occlusion.ObjectiveTo examine the hypothesis that morphology of occlusive thrombus and collateral flow patterns may influence the outcome of ICA occlusions after mechanical thrombectomy.MethodsPooled analyses of ICA occlusions in the MERCI and Multi-MERCI trials employed central angiography review readings to categorize lesions as I, L, or T clots and functional lesions based on collateral flow patterns. Demographic variables, procedural details, and clinical outcomes were compared across ICA lesion types.ResultsA total of 72 subjects (mean age 67 years (SD 16), 51% female, median National Institutes of Health Stroke Scale 20 (range 8-35)) were included, with 90-day modified Rankin score ≤2 in 28% and 51% mortality. Clots were categorized as an I lesion in 9/72 (12.5%), L lesion in 12/72 (16.7%), and T lesion in 51/72 (70.8%). Based on collateral flow patterns, cases were categorized as having a functional I lesion in 7/72 (9.7%), functional L in 38/72 (52.8%), and functional T in only 27/72 (37.5%). Multivariate analyses showed that a functional T lesion, with insufficient collateral flow to ipsilateral anterior cerebral arteries via the contralateral ICA, was a strong predictor of both revascularization success and subsequent clinical outcomes.ConclusionsCollateral flow patterns distinguish the nature and impact of ICA occlusions on expected revascularization and subsequent clinical outcomes in acute ischemic stroke. The nomenclature of terminal ICA occlusions introduced here (carotid I's, L's, and T's) may enhance future endovascular trials targeting such proximal occlusions.Trial registration numberNCT00318071 (http://clinicaltrials.gov). MERCI was not registered because enrollment began before July 1, 2005.

Published
2015

5. Predictors of Functional Dependence Despite Successful Revascularization in Large-Vessel Occlusion Strokes

Author

Shi, Zhong-Song, Liebeskind, David S, Xiang, Bin, Ge, Sijian Grace, Feng, Lei, Albers, Gregory W, Budzik, Ronald, Devlin, Thomas, Gupta, Rishi, Jansen, Olav, Jovin, Tudor G, Killer-Oberpfalzer, Monika, Lutsep, Helmi L, Macho, Juan, Nogueira, Raul G, Rymer, Marilyn, Smith, Wade S, Wahlgren, Nils, and Duckwiler, Gary R

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Clinical Trials and Supportive Activities, Stroke, Clinical Research, Brain Disorders, Aged, Aged, 80 and over, Brain Infarction, Brain Ischemia, Cerebral Revascularization, Clinical Trials as Topic, Female, Humans, Male, Middle Aged, Multicenter Studies as Topic, Predictive Value of Tests, Recovery of Function, Severity of Illness Index, Thrombectomy, Thrombolytic Therapy, stroke, Multi MERCI, TREVO, and TREVO 2 Investigators, Cardiorespiratory Medicine and Haematology, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

Background and purposeHigh revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy.MethodsWe analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization.ResultsTwo hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02-1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02-1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01-1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence.ConclusionsOne half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes.Clinical trial registration urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00318071, NCT01088672, and NCT01270867.

Published
2014

6. Serial ASPECTS in the DAWN Trial: Infarct Evolution and Clinical Impact

Author

Liebeskind, David S., Saber, Hamidreza, Bhuva, Parita, Xiang, Bin, Yoo, Albert J., Jadhav, Ashutosh P., Haussen, Diogo C., Budzik, Ronald F., Bonafe, Alain, Yavagal, Dileep R., Hanel, Ricardo A., Ribo, Marc, Cognard, Christophe, Sila, Cathy, Hassan, Ameer E., Smith, Wade S., Saver, Jeffrey L., Nogueira, Raul G., and Jovin, Tudor G.

Published
2021
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7. Early Infarct Growth Rate Correlation With Endovascular Thrombectomy Clinical Outcomes: Analysis From the SELECT Study

Author

Sarraj, Amrou, Hassan, Ameer E., Grotta, James, Blackburn, Spiros, Day, Arthur, Abraham, Michael, Sitton, Clark, Dannenbaum, Mark, Cai, Chunyan, Pujara, Deep, Hicks, William, Vora, Nirav, Budzik, Ronald, Shaker, Faris, Arora, Ashish, Riascos, Roy F., Kamal, Haris, Martin-Schild, Sheryl, Lansberg, Maarten, Gupta, Rishi, and Albers, Gregory W.

Published
2021
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8. Thrombectomy Outcomes With General vs Nongeneral Anesthesia

Author

Sarraj, Amrou, Albers, Gregory W., Mitchell, Peter J., Hassan, Ameer E., Abraham, Michael G., Blackburn, Spiros, Sharma, Gagan, Yassi, Nawaf, Kleinig, Timothy J., Shah, Darshan G., Wu, Teddy Y., Hussain, Muhammad Shazam, Tekle, Wondwoseen G., Gutierrez, Santiago Ortega, Aghaebrahim, Amin Nima, Haussen, Diogo C., Toth, Gabor, Pujara, Deep, Budzik, Ronald F., Hicks, William, Vora, Nirav, Edgell, Randall C., Slavin, Sabreena, Lechtenberg, Colleen G., Maali, Laith, Qureshi, Abid, Rosterman, Lee, Abdulrazzak, Mohammad Ammar, AlMaghrabi, Tareq, Shaker, Faris, Mir, Osman, Arora, Ashish, Martin-Schild, Sheryl, Sitton, Clark W., Churilov, Leonid, Gupta, Rishi, Lansberg, Maarten G., Nogueira, Raul G., Grotta, James C., Donnan, Geoffrey Alan, Davis, Stephen M., and Campbell, Bruce C. V.

Subjects
Neurology (clinical), Research Article
Abstract

Background and ObjectivesThe effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice.MethodsIn a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) – Tmax > 10 seconds/Tmax > 6 seconds (good collaterals – HIR < 0.4, poor collaterals – HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes.ResultsOf 725 treated with EVT, 299 (41%) received GA and 426 (59%) non-GA. The baseline characteristics differed in presentation National Institutes of Health Stroke Scale score (median [interquartile range] GA: 18 [13–22], non-GA: 16 [11–20],p< 0.001) and ischemic core volume (GA: 15.0 mL [3.2–38.0] vs non-GA: 9.0 mL [0.0–31.0],p< 0.001). In addition, GA was associated with longer last known well to arterial access (203 minutes [157–267] vs 186 minutes [138–252],p= 0.002), but similar procedural time (35.5 minutes [23–59] vs 34 minutes [22–54],p= 0.51). Of 182 matched pairs using propensity scores, baseline characteristics were similar. In the propensity score–matched pairs, GA was independently associated with worse functional outcomes (adjusted common odds ratio [adj. cOR]: 0.64, 95% CI: 0.44–0.93,p= 0.021) and higher neurologic worsening (GA: 14.9% vs non-GA: 8.9%, aOR: 2.10, 95% CI: 1.02–4.33,p= 0.045). Patients with poor collaterals had worse functional outcomes with GA (adj. cOR: 0.47, 95% CI: 0.29–0.76,p= 0.002), whereas no difference was observed in those with good collaterals (adj. cOR: 0.93, 95% CI: 0.50–1.74,p= 0.82),pinteraction: 0.07. No difference was observed in infarct growth overall and in patients with good collaterals, whereas patients with poor collaterals demonstrated larger infarct growth with GA with a significant interaction between collaterals and anesthesia type on infarct growth rate (pinteraction: 0.020).DiscussionGA was associated with worse functional outcomes after EVT, particularly in patients with poor collaterals in a propensity score–matched analysis from a pooled patient-level cohort from 3 randomized trials and 1 prospective cohort study. The confounding by indication may persist despite the doubly robust nature of the analysis. These findings have implications for randomized trials of GA vs non-GA and may be of utility for clinicians when making anesthesia type choice.Classification of EvidenceThis study provides Class III evidence that use of GA is associated with worse functional outcome in patients undergoing EVT.Trial Registration InformationEXTEND-IA: ClinicalTrials.gov (NCT01492725); EXTEND-IA TNK: ClinicalTrials.gov (NCT02388061); EXTEND-IA TNK part II: ClinicalTrials.gov (NCT03340493); and SELECT: ClinicalTrials.gov (NCT02446587).

Published
2022

10. Noncontrast Computed Tomography Alberta Stroke Program Early CT Score May Modify Intra-Arterial Treatment Effect in DAWN

Author

Bhuva, Parita, Yoo, Albert J., Jadhav, Ashutosh P., Jovin, Tudor G., Haussen, Diogo C., Bonafe, Alain, Budzik, Ronald J., Yavagal, Dileep R., Hanel, Ricardo A., Hassan, Ameer E., Ribo, Marc, Cognard, Christophe, Sila, Cathy A., Morgan, Patricia M., Zhang, Yanchang, Shields, Ryan, Smith, Wade, Saver, Jeffrey L., Liebeskind, David S., and Nogueira, Raul G.

Published
2019
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11. Abstract Number ‐ 7: Final Angiographic, Clinical and Thrombus Composition Results of 1000 Patients in the EXCELLENT Registry

Author

Nogueira, Raul G, primary, Andersson, Tommy, additional, Yoo, Albert J, additional, Hanel, Ricardo A, additional, Zaidat, Osama O, additional, Hacke, Werner, additional, Jovin, Tudor, additional, Fiehler, Jens, additional, De Meyer, Simon F, additional, Brinjikji, Waleed, additional, Doyle, Karen, additional, Liebeskind, David S, additional, Haussen, Diogo, additional, Inoa, Violiza, additional, Humphries, William, additional, Woodward, Keith B, additional, Jabbour, Pascal M, additional, Francois, Olivier, additional, Bozorgchami, Hormozd, additional, Levy, Elad I, additional, Boor, Stephan, additional, Cohen, Jose, additional, Dashti, Shervin R, additional, Taqi, Muhammad A, additional, Budzik, Ronald F, additional, Schirmer, Clemens M, additional, Hussain, Shazam, additional, Estrade, Laurent, additional, De Leacy, Reade A, additional, Puri, Ajit S, additional, Chitale, Rohan V, additional, Brekenfeld, Caspar, additional, and Siddiqui, Adnan H, additional

Published
2023
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12. Abstract WP7: Mstu Validation Of A Pre-reperfusion Map For Better Thrombectomy Outcomes

Author

Hake, Joshua, primary, Willis, Corbin, additional, Killedar, Amogh, additional, Shah, Sarthak, additional, Fuchs, Vadeem, additional, Hicks, William J, additional, Katz, Brian S, additional, Rai, Vivek, additional, Jennings, Nate, additional, Hill, Michelle, additional, Loochtan, Aaron, additional, Budzik, Ronald, additional, Pema, Peter J, additional, Alhajeri, Abdulnasser, additional, and Vora, Nirav, additional

Published
2023
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13. Abstract 28: First Pass Outcomes And Associated Clot Characteristics: Secondary Analysis Of The Excellent Registry

Author

Andersson, Tommy, primary, Nogueira, Raul G, additional, Yoo, Albert J, additional, Hanel, Ricardo, additional, Zaidat, Osama O, additional, Hacke, Werner, additional, Jovin, Tudor, additional, Fiehler, Jens, additional, De Meyer, Simon F, additional, Brinjikji, Waleed, additional, Doyle, Karen, additional, Liebeskind, David S, additional, Haussen, Diogo C, additional, Inoa, Violiza, additional, Humphries, William E, additional, Woodward, Keith B, additional, Jabbour, Pascal M, additional, Francois, Olivier, additional, Bozorgchami, Hormozd, additional, Levy, Elad I, additional, Boor, Stephan, additional, Cohen, Jose, additional, Dashti, Shervin R, additional, Taqi, Muhammad A, additional, Budzik, Ronald F, additional, Schirmer, Clemens M, additional, Hussain, M. Shazam, additional, Estrade, Laurent, additional, De Leacy, Reade A, additional, Puri, Ajit S, additional, Chitale, Rohan V, additional, Brekenfeld, Caspar, additional, and Siddiqui, Adnan H, additional

Published
2023
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14. Abstract 24: Primary Results Of The Preset For Occlusive Stroke Treatment (prost) Randomized Clinical Trial

Author

Nogueira, Raul G, primary, Hanel, Ricardo, additional, Klisch, Joachim, additional, Moehlenbruch, Markus, additional, Bozorgchami, Hormozd, additional, Samaniego, Edgar A, additional, Liebeskind, David S, additional, Lobsien, Donald, additional, Pielenz, Daniel, additional, Sauvageau, Eric, additional, Aghaebrahim, Amin N, additional, Clark, Wayne M, additional, Priest, Ryan, additional, Ortega-Gutierrez, Santiago, additional, Lopes, Demetrius, additional, Billingsley, Joshua, additional, Haussen, Diogo C, additional, Al-Bayati, Alhamza R, additional, Siddiqui, Adnan H, additional, Chen, Michael, additional, Schramm, Peter, additional, Narayanan, Sandra, additional, Roth, Christian, additional, Boeckh-Behrens, Tobias, additional, Hassan, Ameer E, additional, Fifi, Johanna T, additional, Budzik, Ronald, additional, Tarpley, Jason W, additional, Starke, Robert, additional, and Raz, Eytan, additional

Published
2023
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15. Outcome in Direct Versus Transfer Patients in the DAWN Controlled Trial

Author

Aghaebrahim, Amin, Jadhav, Ashutosh P., Hanel, Ricardo, Sauvageau, Eric, Granja, Manuel F., Zhang, Yanchang, Haussen, Diogo C., Budzik, Ronald F., Bonafe, Alain, Bhuva, Parita, Ribo, Marc, Cognard, Christophe, Sila, Cathy, Yavagal, Dileep, Hassan, Ameer E., Smith, Wade S., Saver, Jeffrey, Liebeskind, David S., Nogueira, Raul G., and Jovin, Tudor G.

Published
2019
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17. A Decade of Improvement in Door‐to‐Puncture Times for Mechanical Thrombectomy But Ongoing Stagnation in Prehospital Care

Author

Sun, Chung‐Huan, primary, Zaidat, Osama O., additional, Castonguay, Alicia C., additional, Veznedaroglu, Erol, additional, Budzik, Ronald F., additional, English, Joey, additional, Baxter, Blaise, additional, Nogueira, Raul G., additional, Krajina, Antonín, additional, Bartolini, Bruno, additional, Liebeskind, David S., additional, Smith, Wade, additional, Koenig, Matt, additional, Jenkins, Paul, additional, and Gupta, Rishi, additional

Published
2023
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19. Abstract 42: The Effect Of Anesthesia On Thrombectomy Outcomes Is Modified By Collateral Flow: Pooled Patient Level Analysis From EXTEND-IA, EXTEND-IA TNK Part I And II, And SELECT

Author

Sarraj, Amrou, primary, Albers, Gregory, additional, Hassan, Ameer, additional, Abraham, Michael G, additional, Blackburn, Spiros, additional, Hussain, Muhammad, additional, Tekle, Wondwossen, additional, Ortega-Gutierrez, Santiago, additional, Aghaebrahim, Amin N, additional, Haussen, Diogo C, additional, Toth, Gabor, additional, Budzik, Ronald, additional, Pujara, Deep K, additional, Hicks, William J, additional, Vora, Nirav, additional, Edgell, Randall C, additional, Slavin, Sabreena, additional, Lechtenberg, Colleen G, additional, Maali, Laith N, additional, Qureshi, Abid Y, additional, Rosterman, Lee, additional, Aertker, Benjamin, additional, Abdulrazzak, Mohammad A, additional, Mir, Osman, additional, Parsha, Kaushik N, additional, Reddy, Sujan S, additional, Alenzi, Bader, additional, Cai, Chunyan, additional, Almaghrabi, Tareq S, additional, Shaker, Faris, additional, Kamal, Haris, additional, Arora, Ashish, additional, Yassi, Nawaf, additional, Sharma, Gagan J, additional, Kleinig, Timothy J, additional, Shah, Darshan, additional, Wu, Teddy Y, additional, Martin-schild, Sheryl B, additional, Day, Arthur L, additional, sitton, clark W, additional, Mitchell, Peter J, additional, Gupta, Rishi, additional, Lansberg, Maarten G, additional, Nogueira, Raul G, additional, Donnan, Geoffrey A, additional, Davis, Stephen, additional, Grotta, James C, additional, and Campbell, Bruce C, additional

Published
2022
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20. Abstract 1122‐000176: Incidence and Predictors of Delayed Functional Independence in the TREVO Retriever Registry

Author

Desai, Shashvat M, primary, Jadhav, Ashutosh P, additional, Gupta, Rishi, additional, Baxter, Blaise W, additional, Bartolini, Bruno, additional, Krajina, Antonin, additional, English, Joey, additional, Nogueira, Raul G, additional, Liebeskind, David S, additional, Veznedaroglu, Erol, additional, and Budzik, Ronald F, additional

Published
2021
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21. Abstract 1122‐000075: Optimization of Transport Protocols to Increase the Odds of Thrombectomy

Author

Killedar, Amogh, primary, Hill, Michelle, additional, Pema, Peter, additional, Budzik, Ronald, additional, Alhajeri, Abdulnasser, additional, Koss, Adam, additional, Dedhia, Nikita, additional, Loochtan, Aaron, additional, Rai, Vivek, additional, Katz, Brian, additional, Hicks, William, additional, Vora, Nirav, additional, and Raetzke, Brad, additional

Published
2021
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22. SELECTion criteria for large core trials: dogma or data?

Author

Sarraj, Amrou Campbell, Bruce Ribo, Marc Hussain, Muhammad Shazam Chen, Michael Abraham, Michael G. Lansberg, Maarten G. Mendes Pereira, Vitor Blackburn, Spiros Sitton, Clark W. and Budzik, Ronald F. Perez de la Ossa, Natalia Arenillas, Juan F. Wu, Teddy Blasco, Jordi Mullen, Michael Schaafsma, Joanna Tsai, Jenny P. Sangha, Navdeep Kozak, Osman and Gibson, Daniel Warach, Steven Cordato, Dennis Manning, Nathan W. Kleinig, Timothy J. Olivot, Jean-Marc Elijovich, Lucas Tsivgoulis, Georgios Alexandrov, Andrei Jabbour, Pascal Yan, Bernard Kasner, Scott E. Arthur, Adam S. and Parsons, Mark Grotta, James C. Hassan, Ameer E. Albers, Gregory W. SELECT2 Investigators SELECT2 Steering Comm

Published
2021

23. Clinical and Neuroimaging Outcomes of Direct Thrombectomy vs Bridging Therapy in Large Vessel Occlusion Analysis of the SELECT Cohort Study

Author

Sarraj, Amrou Grotta, James Albers, Gregory W. Hassan, Ameer E. Blackburn, Spiros Day, Arthur Sitton, Clark Abraham, Michael Cai, Chunyan Dannenbaum, Mark Pujara, Deep and Hicks, William Budzik, Ronald Vora, Nirav Arora, Ashish and Alenzi, Bader Tekle, Wondwossen G. Kamal, Haris Mir, Osman and Barreto, Andrew D. Lansberg, Maarten Gupta, Rishi and Martin-Schild, Sheryl Savitz, Sean Tsivgoulis, Georgios and SELECT Investigators

Abstract

Objective To evaluate the comparative safety and efficacy of direct endovascular thrombectomy (dEVT) compared to bridging therapy (BT; IV tissue plasminogen activator + EVT) and to assess whether BT potential benefit relates to stroke severity, size, and initial presentation to EVT vs non-EVT center. Methods In a prospective multicenter cohort study of imaging selection for endovascular thrombectomy (Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke [SELECT]), patients with anterior circulation large vessel occlusion (LVO) presenting to EVT-capable centers within 4.5 hours from last known well were stratified into BT vs dEVT. The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] score 0-2). Secondary outcomes included a shift across 90-day mRS grades, mortality, and symptomatic intracranial hemorrhage. We also performed subgroup analyses according to initial presentation to EVT-capable center (direct vs transfer), stroke severity, and baseline infarct core volume. Results We identified 226 LVOs (54% men, mean age 65.6 +/- 14.6 years, median NIH Stroke Scale [NIHSS] score 17, 28% received dEVT). Median time from arrival to groin puncture did not differ in patients with BT when presenting directly (dEVT 1.43 [interquartile range (IQR) 1.13-1.90] hours vs BT 1.58 [IQR 1.27-2.02] hours, p = 0.40) or transferred to EVT-capable centers (dEVT 1.17 [IQR 0.90-1.48] hours vs BT 1.27 [IQR 0.97-1.87] hours, p = 0.24). BT was associated with higher odds of 90-day functional independence (57% vs 44%, adjusted odds ratio [aOR] 2.02, 95% confidence interval [CI] 1.01-4.03, p = 0.046) and functional improvement (adjusted common OR 2.06, 95% CI 1.18-3.60, p = 0.011) and lower likelihood of 90-day mortality (11% vs 23%, aOR 0.20, 95% CI 0.07-0.58, p = 0.003). No differences in any other outcomes were detected. In subgroup analyses, patients with BT with baseline NIHSS scores = 15 (aOR 1.05, 95% CI 0.40-2.74, p = 0.92). Similarly, functional outcomes improvements with BT were detected in patients with core volume strata (ischemic core = 50 cm(3): aOR 0.41, 95% CI 0.01-16.02, p = 0.64) and transfer status (transferred: aOR 2.21, 95% CI 0.93-9.65, p = 0.29 vs direct to EVT center: aOR 1.84, 95% CI 0.80-4.23, p = 0.15). Conclusions BT appears to be associated with better clinical outcomes, especially with milder NIHSS scores, smaller presentation core volumes, and those who were “dripped and shipped.” We did not observe any potential benefit of BT in patients with more severe strokes.

Published
2021

24. Abstract P548: Multiple Attempts Complete Reperfusion versus Single Pass Successful Reperfusion: A Sub-Analysis From the Select Study

Author

Hassan, Ameer E, primary, Blackburn, Spiros, additional, Abraham, Michael G, additional, G Tekle, Wondwossen, additional, Vora, Nirav, additional, Dannenbaum, Mark, additional, Day, Arthur, additional, Dibas, Mahmoud, additional, Pujara, Deep, additional, Shaker, Faris, additional, Hellinger, Kevin, additional, Edgell, Randi, additional, Budzik, Ronald, additional, Gupta, Rishi, additional, and Sarraj, Amrou, additional

Published
2021
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25. Abstract P14: Per Pass Clot Retrieval Technique: Interim Analysis of the Excellent Registry

Author

Siddiqui, Adnan H, primary, Waqas, Muhammad, additional, Andersson, Tommy, additional, De Meyers, Simon F, additional, Fiehler, Jens, additional, Hacke, Werner, additional, Hanel, Ricardo, additional, Jovin, Tudor, additional, Liebeskind, David S, additional, Yoo, Albert J, additional, Zaidat, Osama O, additional, Haussen, Diogo C, additional, Inoa, Violiza, additional, Woodward, Keith, additional, Humphries, William E, additional, Jabbour, Pascal M, additional, Francois, Olivier, additional, Dashti, Shervin R, additional, Bozorgchami, Hormozd, additional, Levy, Elad, additional, Budzik, Ronald, additional, Schirmer, Clemens, additional, Taqi, Muhammad A, additional, Estrade, Laurent, additional, De Leacy, Reade A, additional, Boor, Stephan, additional, Hussain, Shazam, additional, Puri, Ajit S, additional, and Nogueira, Raul G, additional

Published
2021
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26. Abstract P137: Large Vessel Occlusion Prediction Scale Thresholds That Are Sensitive for DAWN Trial Participants

Author

Keenan, Kevin J, primary, Smith, Wade S, additional, Jadhav, Ashutosh P, additional, Haussen, Diogo C, additional, Budzik, Ronald F, additional, Bonafe, Alain, additional, Bhuva, Parita, additional, Yavagal, Dileep R, additional, Ribo, Marc, additional, Cognard, Christophe, additional, Hanel, Ricardo A, additional, Hassan, Ameer E, additional, Sila, Cathy A, additional, Saver, Jeffrey L, additional, Liebeskind, David S, additional, Jovin, Tudor G, additional, and Nogueira, Raul G, additional

Published
2021
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32. Trevo 2000: Results of a Large Real‐World Registry for Stent Retriever for Acute Ischemic Stroke

Author

Binning, Mandy J., primary, Bartolini, Bruno, additional, Baxter, Blaise, additional, Budzik, Ronald, additional, English, Joey, additional, Gupta, Rishi, additional, Hedayat, Hirad, additional, Krajina, Antonin, additional, Liebeskind, David, additional, Nogueira, Raul G., additional, Shields, Ryan, additional, and Veznedaroglu, Erol, additional

Published
2018
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34. Impact of Periprocedural and Technical Factors and Patient Characteristics on Revascularization and Outcome in the DAWN Trial.

Author

Tekle, Wondwossen G., Hassan, Ameer E., Jadhav, Ashutosh P., Haussen, Diogo C., Budzik, Ronald F., Bonafe, Alain, Bhuva, Parita, Yavagal, Dileep R., Hanel, Ricardo A., Ribo, Marc, Cognard, Christophe, Sila, Cathy A., Smith, Wade S., Saver, Jeffrey L., Liebeskind, David S., Shields, Ryan, Nogueira, Raul G., Jovin, Tudor G., and DAWN Trial Investigators

Published
2020
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37. Abstract TP20: Uncertainties of Endovascular Therapy Outside the AHA Guidelines

Author

Sarraj, Amrou, primary, Budzik, Ronald F, additional, Veznedaroglu, Erol, additional, English, Joey D, additional, Baxter, Blaise W, additional, Bartolini, Bruno M, additional, Liebeskind, David S, additional, Krajina, Antonin, additional, Shields, Ryan D, additional, Jin, Nancy, additional, Nogueira, Raul G, additional, Gupta, Rishi, additional, Chen, Peng R, additional, Farrell, Christine M, additional, Savitz, Sean I, additional, and McCullough, Louise D, additional

Published
2017
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38. Abstract WMP9: Endovascular Thrombectomy Impact in the First Three “Golden” Hours

Author

Sarraj, Amrou, primary, Veznedaroglu, Erol, additional, Budzik, Ronald F, additional, English, Joey D, additional, Baxter, Blaise W, additional, Bartolini, Bruno M, additional, Krajina, Antonin, additional, Shields, Ryan D, additional, Nogueira, Raul G, additional, Gupta, Rishi, additional, Spiegel, Gary R, additional, Savitz, Sean I, additional, McCullough, Louise D, additional, Farrell, Christine M, additional, and Liebeskind, David S, additional

Published
2017
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39. Abstract WP4: Transfer Patients and Patients Presenting Directly to Endovascular Capable Centers Achieve Similar Good Outcome Rates with Endovascular Therapy

Author

Sarraj, Amrou, primary, Veznedaroglu, Erol, additional, Budzik, Ronald F, additional, English, Joey D, additional, Baxter, Blaise W, additional, Bartolini, Bruno, additional, Liebeskind, David S, additional, Krajina, Antonin, additional, Shields, Ryan D, additional, Xiang, Bin, additional, Nogueira, Raul G, additional, Blackburn, Spiros, additional, Farrell, Christine M, additional, Savitz, Sean I, additional, McCullough, Louise D, additional, and Gupta, Rishi, additional

Published
2017
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40. Abstract WMP11: Joint Commission Certified Stroke Centers Treat More Severe Strokes with Faster Procedure Times Compared to Non-joint Commission Certified Stroke Centers in the Trevo Registry

Author

Gupta, Rishi, primary, Veznedaroglu, Erol, additional, Budzik, Ronald F, additional, English, Joey D, additional, Baxter, Blaise W, additional, Bartolini, Bruno M, additional, Krajina, Antonin, additional, Sarraj, Amrou, additional, Liebeskind, David S, additional, Shields, Ryan D, additional, and Xiang, Bin, additional

Published
2017
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41. Abstract WP5: The Transfer Score May Aid Decisions Whether to Transfer Patients with Large Vessel Occlusions for Endovascular Therapy

Author

Sarraj, Amrou, primary, Veznedaroglu, Erol, additional, Budzik, Ronald F, additional, English, Joey D, additional, Baxter, Blaise W, additional, Bartolini, Bruno M, additional, Liebeskind, David S, additional, Krajina, Antonin, additional, Shields, Ryan D, additional, Xiang, Bin, additional, Nogueira, Raul G, additional, Gupta, Rishi, additional, Dannenbaum, Mark, additional, Farrell, Christine M, additional, McCullough, Louise D, additional, and Savitz, Sean I, additional

Published
2017
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42. Rheolytic Thrombectomy of the Occluded Internal Carotid Artery in the Setting of Acute Ischemic Stroke

Author

Bellon, Richard J., Putman, Christopher M., Budzik, Ronald F., Pergolizzi, Richard S., Reinking, Gregory F., and Norbash, Alexander M.

Subjects
Aged, 80 and over, Carotid Artery Diseases, Male, Interventional, Constriction, Pathologic, Middle Aged, Brain Ischemia, Catheterization, Cerebral Angiography, Stroke, cardiovascular system, Humans, Female, cardiovascular diseases, Intracranial Thrombosis, Carotid Artery, Internal, Aged, Retrospective Studies, Thrombectomy
Abstract

BACKGROUND AND PURPOSE: Acute thromboembolic stroke complicated by ipsilateral carotid occlusion may present both mechanical and inflow-related barriers to effective intracranial thrombolysis. We sought to review our experience with a novel method of mechanical thrombectomy, in such cases, using the Possis AngioJet system, a rheolytic thrombectomy device. METHODS: A review of our interventional neuroradiology database revealed three patients in whom an occluded cervical internal carotid artery was encountered during endovascular treatment for acute stroke and in whom thrombectomy was attempted, using the 5F Possis AngioJet thrombectomy catheter. The medical records and radiographic studies of these patients were reviewed. RESULTS: Three patients were identified (ages, 52–84 years). Two patients had isolated occlusion of the internal carotid artery; in one patient, thrombus extended down into the common carotid artery. Treatment was initiated within 190 to 360 minutes of stroke onset. Thrombectomy of the carotid artery was deemed necessary because of poor collateral flow to the affected hemisphere (chronic contralateral internal carotid artery occlusion [one patient] and thrombus extending to the carotid “T” [one patient]) or inability to pass a microcatheter through the occluded vessel (one patient). Adjunctive therapy included pharmacologic thrombolysis with tissue plasminogen activator (all patients), carotid angioplasty and stenting (two patients), and middle cerebral artery angioplasty (one patient). Patency of the carotid artery was reestablished in two patients, with some residual thrombus burden. In the third patient, the device was able to create a channel through the column of thrombus, allowing intracranial access. CONCLUSION: Rheolytic thrombectomy shows potential for rapid, large-burden thrombus removal in cases of internal carotid artery thrombosis, allowing expedient access to the intracranial circulation for additional thrombolytic therapy.

Published
2001

44. CT Perfusion Imaging versus MR Diffusion Weighted Imaging: Prediction of Final Infarct Size in Hyperacute Stroke

Author

Berzin, Tyler M, primary, Lev, Michael H, additional, Goodman, Daniel, additional, Koroshetz, Walter J, additional, Hunter, George J, additional, Hamberg, Leena, additional, Buonanno, Ferdinand, additional, Putman, Christopher, additional, Budzik, Ronald, additional, Eskey, Clifford, additional, Schwamm, Lee H, additional, and Gonzalez, Ramon G, additional

Published
2001
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49. Abstract 2187.

Author

Lutsep, Helmi, Jovin, Tudor, Devlin, Thomas, Budzik, Ronald, Smith, Wade, Walker, Gary, and Rymer, Marilyn

Published
2012

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