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2. Safety Outcomes of Antiplatelet Therapy During Endovascular Treatment of Tandem Lesions in Acute Ischemic Stroke Patients

Author

Farooqui, Mudassir, Divani, Afshin A., Galecio-Castillo, Milagros, Hassan, Ameer E., Jumaa, Mouhammad A., Ribo, Marc, Abraham, Michael, Petersen, Nils, Fifi, Johanna, Guerrero, Waldo R., Malik, Amer M., Siegler, James E., Nguyen, Thanh N., Sheth, Sunil A., Yoo, Albert J., Linares, Guillermo, Janjua, Nazli, Quispe-Orozco, Darko, Ikram, Asad, Tekle, Wondewossen G., Zaidi, Syed F., Zevallos, Cynthia B., Rizzo, Federica, Barkley, Tiffany, De Leacy, Reade, Khalife, Jane, Abdalkader, Mohamad, Salazar-Marioni, Sergio, Soomro, Jazba, Gordon, Weston, Rodriguez-Calienes, Aaron, Vivanco-Suarez, Juan, Turabova, Charoskhon, Mokin, Maxim, Yavagal, Dileep R., and Ortega-Gutierrez, Santiago

Published
2023
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4. Endovascular thrombectomy plus medical care versus medical care alone for large ischaemic stroke: 1-year outcomes of the SELECT2 trial

Author

Sarraj, Amrou, Abraham, Michael G, Hassan, Ameer E, Blackburn, Spiros, Kasner, Scott E, Ortega-Gutierrez, Santiago, Hussain, Muhammad Shazam, Chen, Michael, Johns, Hannah, Churilov, Leonid, Pujara, Deep K, Shaker, Faris, Maali, Laith, Cardona Portela, Pere, Herial, Nabeel A, Gibson, Daniel, Kozak, Osman, Arenillas, Juan F, Yan, Bernard, Pérez de la Ossa, Natalia, Sundararajan, Sophia, Hu, Yin C, Cordato, Dennis J, Manning, Nathan W, Hanel, Ricardo A, Aghaebrahim, Amin N, Budzik, Ronald F, Hicks, William J, Blasco, Jordi, Wu, Teddy Y, Tsai, Jenny P, Schaafsma, Joanna D, Gandhi, Chirag D, Al-Mufti, Fawaz, Sangha, Navdeep, Warach, Steven, Kleinig, Timothy J, Yogendrakumar, Vignan, Ng, Felix, Samaniego, Edgar A, Abdulrazzak, Mohammad A, Parsons, Mark W, Rahbar, Mohammad H, Nguyen, Thanh N, Fifi, Johanna T, Mendes Pereira, Vitor, Lansberg, Maarten G, Albers, Greg W, Furlan, Anthony J, Jabbour, Pascal, Sitton, Clark W, Sila, Cathy, Bambakidis, Nicholas, Davis, Stephen M, Wechsler, Lawrence, Hill, Michael D, Grotta, James C, Ribo, Marc, and Campbell, Bruce C V

Published
2024
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5. Sex Differences in Outcomes of Late-Window Endovascular Stroke Therapy

Author

Abdalkader, Mohamad, Ning, Shen, Qureshi, Muhammad M., Haussen, Diogo C., Strbian, Daniel, Nagel, Simon, Demeestere, Jelle, Puetz, Volker, Mohammaden, Mahmoud H., Olive Gadea, Marta, Winzer, Simon, Yamagami, Hiroshi, Tanaka, Kanta, Marto, João Pedro, Tomppo, Liisa, Henon, Hilde, Sheth, Sunil A., Ortega-Gutierrez, Santiago, Martinez-Majander, Nicolas, Caparros, Francois, Lemmens, Robin, Dusart, Anne, Bellante, Flavio, Zaidi, Syed F., Siegler, James E., Nannoni, Stefania, Kaesmacher, Johannes, Dobrocky, Tomas, Farooqui, Mudassir, Salazar-Marioni, Sergio, Virtanen, Pekka, Vandewalle, Lieselotte, Wouters, Anke, Jesser, Jessica, Ventura, Rita, Castonguay, Alicia C., Uchida, Kazutaka, Puri, Ajit S., Masoud, Hesham E., Klein, Piers, Mansoor, Zain, Bui, Jenny, Kang, Matthew, Mujanovic, Adnan, Rizzo, Federica, Kokkonen, Tatu, Ramos, João Nuno, Strambo, Davide, Michel, Patrik, Möhlenbruch, Markus A., Lin, Eugene, Kaiser, Daniel P.O., Yoshimura, Shinichi, Sakai, Nobuyuki, Cordonnier, Charlotte, Ringleb, Peter A., Roy, Daniel, Zaidat, Osama O., Fischer, Urs, Ribo, Marc, Raymond, Jean, Nogueira, Raul G., and Nguyen, Thanh N.

Published
2024
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10. Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry.

Author

Mierzwa, Adam T, Nelson, Ashley, Kasab, Sami Al, Ortega Gutierrez, Santiago, Vivanco-Suarez, Juan, Farooqui, Mudassir, Jadhav, Ashutosh P, Desai, Shashvat, Toth, Gabor, Alrohimi, Anas, Nguyen, Thanh N, Klein, Piers, Abdalkader, Mohamad, Salahuddin, Hisham, Pandey, Aditya, Wilseck, Zachary, Koduri, Sravanthi, Vora, Niraj, Aladamat, Nameer, and Gharaibeh, Khaled

Published
2024
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11. Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis

Author

Jovin, Tudor G, Nogueira, Raul G, Lansberg, Maarten G, Demchuk, Andrew M, Martins, Sheila O, Mocco, J, Ribo, Marc, Jadhav, Ashutosh P, Ortega-Gutierrez, Santiago, Hill, Michael D, Lima, Fabricio O, Haussen, Diogo C, Brown, Scott, Goyal, Mayank, Siddiqui, Adnan H, Heit, Jeremy J, Menon, Bijoy K, Kemp, Stephanie, Budzik, Ron, Urra, Xabier, Marks, Michael P, Costalat, Vincent, Liebeskind, David S, and Albers, Gregory W

Published
2022
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21. Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration

Author

Ortega-Gutierrez, Santiago, Farooqui, Mudassir, Zha, Alicia, Czap, Alexandra, Sebaugh, Jacob, Desai, Shashvat, Jadhav, Ashutosh, Vora, Nirav, Rai, Vivek, Jovin, Tudor G., Thon, Jesse M., Heslin, Mark, Thau, Lauren, Zevallos, Cynthia, Quispe-Orozco, Darko, Jillella, Dinesh V., Nahab, Fadi, Mohammaden, Mahmoud H., Nogueira, Raul G., Haussen, Diogo C., Nguyen, Thanh N., Romero, Jose Rafael, Aparicio, Hugo J., Osman, Mohamed, Haq, Israr Ul, Liebeskind, David, Hassan, Ameer E., Zaidat, Osama, and Siegler, James E.

Published
2021
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26. Endovascular thrombectomy beyond 24 hours from last known well: a systematic review with meta-analysis.

Author

Rodriguez-Calienes, Aaron, Galecio-Castillo, Milagros, Vivanco-Suarez, Juan, Mohamed, Ghada A., Toth, Gabor, Sarraj, Amrou, Pujara, Deep, Chowdhury, AJ A., Farooqui, Mudassir, Ghannam, Malik, Samaniego, Edgar A., Jovin, Tudor G., and Ortega-Gutierrez, Santiago

Subjects
MEDICAL information storage & retrieval systems, INTRACRANIAL hemorrhage, PATIENT safety, ENDOVASCULAR surgery, TREATMENT effectiveness, META-analysis, FUNCTIONAL status, DESCRIPTIVE statistics, INFORMATION resources, SYSTEMATIC reviews, MEDLINE, ODDS ratio, ISCHEMIC stroke, MATHEMATICAL models, THROMBECTOMY, CONFIDENCE intervals, REPERFUSION, THEORY, COMORBIDITY, EVALUATION
Abstract

Background Different studies have demonstrated the benefit of endovascular treatment (EVT) up to 24 hours after acute ischemic stroke (AIS) onset. Recent cohort observational studies suggest that patients with large vessel occlusion AIS may benefit from EVT beyond 24 hours from the last known well (LKW) when adequately selected. We aimed to examine the safety and efficacy of EVT beyond 24 hours from LKW using a meta-analysis of all the literature available. Methods A systematic search from inception to April 2023 was conducted for studies including AIS patients with EVT beyond 24 hours from LKW in Medline, Embase, Scopus, and Web of Science. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0-2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90- day mortality. Data were pooled using a random-effects model. Results Twelve studies with 894 patients were included. The rate of favorable functional outcome was 40% (95% CI 31% to 49%; I²=76%). The rate of successful reperfusion was 83% (95% CI 80% to 85%; I²=0%). The sICH rate was 7% (95% CI 5% to 9%; I²=0%) and the 90-day mortality rate was 28% (95% CI 24% to 33%; I²=0%). There was no significant difference in favorable outcomes (OR=0.69; 95% CI 0.41 to 1.14) and 90-day mortality (OR=1.35; 95% CI 0.90 to 2.00) among patients who underwent EVT <24 hours versus >24 hours. Conclusions EVT beyond 24 hours from LKW may achieve favorable clinical outcomes and high reperfusion rates, with acceptable intracranial hemorrhage rates in selected patients. Considering the current certainty of the evidence and heterogenous individual study results, larger prospective trials are warranted. [ABSTRACT FROM AUTHOR]

Published
2024
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28. Off-Label Use of the WEB Device

Author

Zanaty, Mario, Roa, Jorge A., Tjoumakaris, Stavropoula I., Jabbour, Pascal, Mouchtouris, Nikolaos, Sweid, Ahmad, Ortega-Gutierrez, Santiago, Ishii, Daizo, Limaye, Kaustubh, Asi, Khaled, Samaniego, Edgar A., and Hasan, David M.

Published
2020
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29. Transcirculation Approach for Endovascular Embolization of Intracranial Aneurysms, Arteriovenous Malformations, and Dural Fistulas: A Multicenter Study

Author

Roa, Jorge A., Ortega-Gutierrez, Santiago, Martinez-Galdamez, Mario, Maud, Alberto, Dabus, Guilherme, Pazour, Avery, Dandapat, Sudeepta, Arteaga, Miguel Schüller, Fernandez, Jorge Galvan, Paez-Granda, Diego, Kalousek, Vladimir, Pons, Roger Barranco, Mowla, Ashkan, Duckwiler, Gary, Szeder, Viktor, Jabbour, Pascal, Hasan, David M., and Samaniego, Edgar A.

Published
2020
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37. Endovascular Thrombectomy Treatment Effect in Direct vs Transferred Patients With Large Ischemic Strokes: A Prespecified Analysis of the SELECT2 Trial.

Author

Sarraj, Amrou, Hill, Michael D., Hussain, M. Shazam, Abraham, Michael G., Ortega-Gutierrez, Santiago, Chen, Michael, Kasner, Scott E., Churilov, Leonid, Pujara, Deep K., Johns, Hannah, Blackburn, Spiros, Sundararajan, Sophia, Hu, Yin C., Herial, Nabeel A., Budzik, Ronald F., Hicks, William J., Arenillas, Juan F., Tsai, Jenny P., Kozak, Osman, and Cordato, Dennis J.

Published
2024
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38. Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles.

Author

Sarraj, Amrou, Hassan, Ameer E., Abraham, Michael G., Ortega-Gutierrez, Santiago, Kasner, Scott E., Hussain, Muhammad Shazam, Chen, Michael, Churilov, Leonid, Johns, Hannah, Sitton, Clark W., Yogendrakumar, Vignan, Ng, Felix C., Pujara, Deep K., Blackburn, Spiros, Sundararajan, Sophia, Hu, Yin C., Herial, Nabeel A., Arenillas, Juan F., Tsai, Jenny P., and Budzik, Ronald F.

Subjects
ENDOVASCULAR surgery, ISCHEMIC stroke, STROKE patients, TREATMENT effect heterogeneity, DIFFUSION magnetic resonance imaging, REPERFUSION injury, LACUNAR stroke
Abstract

Key Points: Question: Does the benefit from endovascular thrombectomy for patients with large ischemic strokes caused by large vessel occlusion vary by the extent of presenting ischemic injury? Findings: In an exploratory analysis of a randomized clinical trial that included 336 participants, while functional outcomes worsened as baseline ischemic core volumes increased, endovascular thrombectomy was associated with better clinical outcomes across a wide spectrum of ischemic changes and penumbra profiles on various imaging modalities compared with medical management. Meaning: Endovascular thrombectomy, compared with medical management, improved clinical outcomes across a wide spectrum of ischemic core volumes and penumbral profiles; however, large ischemic core volume is an important prognostic factor to consider when individualizing treatment decisions. Importance: Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain. Objective: To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect. Design, Setting, and Participants: An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022. Intervention: EVT vs MM. Main Outcomes and Measures: Primary outcome was functional outcome—90-day mRS score (0, no symptoms, to 6, death) assessed by adjusted generalized OR (aGenOR; values >1 represent more favorable outcomes). Benefit of EVT vs MM was assessed across levels of ischemic injury defined by noncontrast CT using ASPECTS score and by the volume of brain with severely reduced blood flow on CT perfusion or restricted diffusion on MRI. Results: Among 352 patients randomized, 336 were analyzed (median age, 67 years; 139 [41.4%] female); of these, 168 (50%) were randomized to EVT, and 2 additional crossover MM patients received EVT. In an ordinal analysis of mRS at 90 days, EVT improved functional outcomes compared with MM within ASPECTS categories of 3 (aGenOR, 1.71 [95% CI, 1.04-2.81]), 4 (aGenOR, 2.01 [95% CI, 1.19-3.40]), and 5 (aGenOR, 1.85 [95% CI, 1.22-2.79]). Across strata for CT perfusion/MRI ischemic core volumes, aGenOR for EVT vs MM was 1.63 (95% CI, 1.23-2.16) for volumes ≥70 mL, 1.41 (95% CI, 0.99-2.02) for ≥100 mL, and 1.47 (95% CI, 0.84-2.56) for ≥150 mL. In the EVT group, outcomes worsened as ASPECTS decreased (aGenOR, 0.91 [95% CI, 0.82-1.00] per 1-point decrease) and as CT perfusion/MRI ischemic core volume increased (aGenOR, 0.92 [95% CI, 0.89-0.95] per 10-mL increase). No heterogeneity of EVT treatment effect was observed with or without mismatch, although few patients without mismatch were enrolled. Conclusion and Relevance: In this exploratory analysis of a randomized clinical trial of patients with extensive ischemic stroke, EVT improved clinical outcomes across a wide spectrum of infarct volumes, although enrollment of patients with minimal penumbra volume was low. In EVT-treated patients, clinical outcomes worsened as presenting ischemic injury estimates increased. Trial Registration: ClinicalTrials.gov Identifier: NCT03876457 This exploratory analysis of the SELECT2 trial assesses the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and the association of mismatch with clinical outcomes and endovascular treatment effect in adult patients with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery and large ischemic core in 31 global centers between October 2019 and September 2022. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Early and late basilar artery thrombectomy time window outcomes.

Author

Mierzwa, Adam T., Rao, Rahul, Al Kasab, Sami, Nelson, Ashley, Ortega-Gutierrez, Santiago, Vivanco-Suarez, Juan, Farooqui, Mudassir, Jadhav, Ashutosh P., Desai, Shashvat, Toth, Gabor, Alrohimi, Anas, Nguyen, Thanh N., Klein, Piers, Abdalkader, Mohamad, Salahuddin, Hisham, Pandey, Aditya, Wilseck, Zachary, Koduri, Sravanthi, Vora, Nirav, and Aladamat, Nameer

Subjects
BASILAR artery, THROMBECTOMY, MULTIPLE regression analysis, LOGISTIC regression analysis, ISCHEMIC stroke
Abstract

Importance: Stroke-to-recanalization time is a strong predictor of outcomes in anterior circulation large-vessel occlusion (LVO). The authors aimed to evaluate functional outcomes in early (<6 h) vs. late (6-24 h) time windows for thrombectomy-treated basilar artery occlusions. Methods: Patients were derived from the Posterior Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intra-procedural Predictors of Mechanical Thrombectomy (PC-SEARCH) Registry and retrospectively analyzed early and late basilar artery thrombectomy time windows cohorts. Patients were dichotomized based on the last known well and correlated to 90-day functional outcomes (mRS 0-3). A multiple logistic regression analysis was performed. Results: A total of 405 patients were included in this study: 216 and 189 patients in the early and late time windows, respectively. Baseline demographic, stroke, radiographic, and intraprocedural characteristics were similar between the groups. A total of 99 (46%) and 79 (42%) patients in the early and late time windows, respectively, achieved favorable functional outcomes at 90 days (p = 0.41), and multiple logistic regression analysis did not reveal differences between cohorts (OR: 0.74; 95% CI: 0.46-1.19; p = 0.22). Symptomatic hemorrhage (7% vs. 5%; p = 0.69) and neurological complications (8% vs. 9%; p = 0.83) were similar between the groups; however, hospital complications were more common in the early time window cohort (22% vs. 13%; p = 0.01). Conclusion: The early and late thrombectomy time windows can achieve similar rates of 90-day favorable functional outcomes. However, timely thrombectomy influences the likelihood of achieving excellent functional outcomes (mRS = 2) within the early time window. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Thrombectomy With the pRESET vs Solitaire Stent Retrievers as First-Line Large Vessel Occlusion Stroke Treatment: A Randomized Clinical Trial.

Author

Nogueira, Raul G., Lobsien, Donald, Klisch, Joachim, Pielenz, Daniel, Lobsien, Elmar, Sauvageau, Eric, Aghaebrahim, Nima, Möhlenbruch, Markus, Vollherbst, Dominik, Ulfert, Christian, Bozorgchami, Hormozd, Clark, Wayne, Priest, Ryan, Samaniego, Edgar A., Ortega-Gutierrez, Santiago, Ghannam, Malik, Lopes, Demetrius, Billingsley, Joshua, Keigher, Kiffon, and Haussen, Diogo C.

Published
2024
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43. Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Recent Direct Oral Anticoagulant Use: A Systematic Review and Meta-Analysis.

Author

Ghannam, Malik, AlMajali, Mohammad, Galecio-Castillo, Milagros, Al Qudah, Abdullah, Khasiyev, Farid, Dibas, Mahmoud, Ghazaleh, Dana, Vivanco-Suarez, Juan, Morán-Mariños, Cristian, Farooqui, Mudassir, Rodriguez-Calienes, Aaron, Koul, Prateeka, Roeder, Hannah, Shim, HyungSub, Samaniego, Edgar, Leira, Enrique C., Adams Jr, Harold P., and Ortega-Gutierrez, Santiago

Published
2023
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44. Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke: systematic review and meta-analysis.

Author

Rodriguez-Calienes, Aaron, Vivanco-Suarez, Juan, Sequeiros, Joel M., Galecio-Castillo, Milagros, Zevallos, Cynthia B., Farooqui, Mudassir, and Ortega-Gutierrez, Santiago

Subjects
MEDICAL databases, META-analysis, CEREBRAL hemorrhage, MEDICAL information storage & retrieval systems, ISCHEMIC stroke, SYSTEMATIC reviews, FUNCTIONAL status, TREATMENT effectiveness, THROMBECTOMY, MEDLINE, PATIENT safety
Abstract

Background There is limited evidence on the indication and role of mechanical thrombectomy (MT) in patients with distal medium-vessel occlusions (DMVOs). The aim of this systematic review and meta-analysis was to evaluate all the evidence available on the efficacy and safety of MT techniques (stent retriever, aspiration) in primary and secondary DMVOs. Methods Five databases were searched from inception to January 2023 for studies of MT in primary and secondary DMVOs. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0-2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Prespecified subgroup meta-analyses according to the specific MT technique and to the vascular territory (distal M2-M5, A2-A5, P2-P5) were also performed. results A total of 29 studies with 1262 patients were included. For primary DMVOs (n=971 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 84% (95% confidence interval (CI) 76 to 90%), 64% (95% CI 54 to 72%), 12% (95% CI 8 to 18%), and 6% (95% CI 4 to 10%), respectively. For secondary DMVOs (n=291 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 82% (95% CI 73 to 88%), 54% (95% CI 39 to 69%), 11% (95% CI 5 to 20%), and 3% (95% CI 1 to 9%), respectively. Subgroup analyses by MT technique and by vascular territory showed no differences in primary and secondary DMVOs. Conclusion Our findings suggest that MT using aspiration or stent retriever techniques appears to be effective and safe in primary and secondary DMVOs. However, given the level of evidence of our results, further confirmation in well-designed randomized controlled trials is needed. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion.

Author

Seker, Fatih, Qureshi, Muhammad M., Möhlenbruch, Markus A., Nogueira, Raul G., Abdalkader, Mohamad, Ribo, Marc, Caparros, Francois, Haussen, Diogo C., Mohammaden, Mahmoud H., Sheth, Sunil A., Ortega-Gutierrez, Santiago, Siegler, James E., Zaidi, Syed F., Olive-Gadea, Marta, Henon, Hilde, Castonguay, Alicia C., Nannoni, Stefania, Kaesmacher, Johannes, Puri, Ajit S., and Farooqui, Mudassir

Published
2023
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46. Reducing the incidence and mortality of traumatic brain injury in Latin America.

Author

Rivera-Lara, Lucia, Videtta, Walter, Calvillo, Eusebia, Mejia-Mantilla, Jorge, March, Karen, Ortega-Gutierrez, Santiago, Obrego, Guadalupe Castillo, Paranhos, Jorge E., and Suarez, Jose I.

Subjects
TRAFFIC safety, SAFETY, ONLINE information services, MEDICAL databases, MEDICAL information storage & retrieval systems, SYSTEMATIC reviews, DISEASE incidence, BRAIN injuries, MEDLINE
Abstract

Traumatic brain injury (TBI) represents a considerable portion of the global injury burden. The incidence of TBI will continue to increase in view of an increase in population density, an aging population, and the increased use of motor vehicles, motorcycles, and bicycles. The most common causes of TBI are falls and road traffic injuries. Deaths related to road traffic injury are three times higher in low-and middle-income countries (LMIC) than in high-income countries (HIC). The Latin American Caribbean region has the highest incidence of TBI worldwide, primarily caused by road traffic injuries. Data from HIC indicates that road traffic injuries can be successfully prevented through concerted efforts at the national level, with coordinated and multisector responses to the problem. Such actions require implementation of proven measures to address the safety of road users and the vehicles themselves, road infrastructure, and post-crash care. In this review, we focus on the epidemiology of TBI in Latin America and the implementation of solutions and preventive measures to decrease mortality and long-term disability. [ABSTRACT FROM AUTHOR]

Published
2023
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47. General anesthesia vs procedural sedation for failed NeuroThrombectomy undergoing rescue stenting: intention to treat analysis.

Author

Mohammaden, Mahmoud H., Haussen, Diogo C., Al-Bayati, Alhamza R., Hassan, Ameer E., Tekle, Wondwossen, Fifi, Johanna T., Matsoukas, Stavros, Kuybu, Okkes, Gross, Bradley A., Lang, Michael, Narayanan, Sandra, Cortez, Gustavo M., Hanel, Ricardo A., Aghaebrahim, Amin, Sauvageau, Eric, Farooqui, Mudassir, Ortega-Gutierrez, Santiago, Zevallos, Cynthia B., Galecio-Castillo, Milagros, and Sheth, Sunil A.

Subjects
SKULL surgery, GENERAL anesthesia, ANESTHESIA, NEUROSURGERY, INTRACRANIAL hemorrhage, MORTALITY, SURGICAL stents, SURGERY, PATIENTS, TREATMENT failure, TREATMENT effectiveness, FUNCTIONAL assessment, THROMBECTOMY, REPERFUSION, PATIENT safety, CEREBRAL arteriosclerosis, ANGIOPLASTY, PROBABILITY theory, EVALUATION
Abstract

Background There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA). Methods We searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study. In our review we included patients if they had anterior circulation large vessel occlusion strokes due to intracranial internal carotid artery (ICA) or middle cerebral artery (MCA-M1/M2) segments, failed MT, and underwent rescue ICAS. The cohort was divided into two groups: GA and non-GA. We used propensity score matching to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included functional independence (90-day mRS0-2) and successful reperfusion defined as mTICI2B-3. Safety measures included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Results Among 253 patients who underwent rescue ICAS, 156 qualified for the matching analysis at a 1:1 ratio. Baseline demographic and clinical characteristics were balanced between both groups. Non-GA patients had comparable outcomes to GA patients both in terms of the overall degree of disability (mRS ordinal shift; adjusted common odds ratio 1.29, 95% CI [0.69 to 2.43], P=0.43) and rates of functional independence (33.3% vs 28.6%, adjusted odds ratio 1.32, 95% CI [0.51 to 3.41], P=0.56) at 90 days. Likewise, there were no significant differences in rates of successful reperfusion, sICH, procedural complications or 90-day mortality among both groups. Conclusions Non- GA seems to be a safe and effective anesthesia strategy for patients undergoing rescue ICAS after failed MT. Larger prospective studies are warranted for more concrete evidence. [ABSTRACT FROM AUTHOR]

Published
2023
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49. Comparing Functional Outcomes and Safety Profiles of First-Line Aspiration Thrombectomy Versus Stentriever for Acute Basilar Artery Occlusion: Propensity Analysis of the PC-SEARCH Thrombectomy Registry.

Author

Mierzwa, Adam T., Al Kasab, Sami, Nelson, Ashley, Ortega Gutierrez, Santiago, Vivanco-Suarez, Juan, Farooqui, Mudassir, Jadhav, Ashutosh P., Desai, Shashvat, Toth, Gabor, Alrohimi, Anas, Thanh N. Nguyen, Klein, Piers, Abdalkader, Mohamad, Salahuddin, Hisham, Pandey, Aditya, Koduri, Sravanthi, Vora, Niraj, Aladamat, Nameer, Gharaibeh, Khaled, and Afreen, Ehad

Published
2023
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50. Stroke imaging modality for endovascular therapy in the extended window: systematic review and meta-analysis.

Author

Sequeiros, Joel M., Rodriguez-Calienes, Aaron, Chavez-Malpartida, Sandra S., Morán-Mariños, Cristian, Alvarado-Gamarra, Giancarlo, Malaga, Marco, Quincho-Lopez, Alvaro, Hernadez-Fernandez, Wendy, Pacheco-Barrios, Kevin, Ortega-Gutierrez, Santiago, Hoit, Daniel, Arthur, Adam S., Alexandrov, Andrei V., Alva-Diaz, Carlos, and Elijovich, Lucas

Subjects
STROKE diagnosis, ONLINE information services, MEDICAL databases, META-analysis, CONFIDENCE intervals, MEDICAL information storage & retrieval systems, SYSTEMATIC reviews, INTRACRANIAL hemorrhage, DIAGNOSTIC imaging, DESCRIPTIVE statistics, ENDOVASCULAR surgery, MEDLINE
Abstract

Background In anterior circulation large vessel occlusion (LVO) in the extended time window, the guidelines recommend advanced imaging (ADVI) to select patients for endovascular therapy (EVT). However, questions remain regarding its availability and applicability in the real world. It is unclear whether an approach to the extended window EVT that does not use ADVI would be equivalent. Methods In April 2022, a literature search was performed to identified randomized controlled trials (RCT) and observational studies describing 90-day outcomes. We performed a meta-analysis of the proportion of aggregate using a random effect to estimate rates of functional independence, defined as modified Rankin Scale (mRS) score ≤2 at 90 days, mean mRS, mortality and symptomatic intracranial hemorrhage (sICH) stratified by imaging modality. Results Four RCTs and 28 observational studies were included. The pooled proportion of functional independence among patients selected by ADVI was 44% (95% CI 39% to 48%; I²=80%) and 48% (95% CI 41% to 55%; I ²=75%) with non-contrast CT/CT angiography (NCCT/CTA) (p=0.36). Mean mRS with ADVI was 2.88 (95% CI 2.36 to 3.41; I #178;=0.0%) and 2.79 (95% CI 2.31 to 3.27; I²=0.0%) with NCCT (p=0.79). Mortality in patients selected by ADVI was 13% (95% CI 10% to 17%; I²=81%) and 16% (95% CI 12% to 22%; I²=69%) with NCCT (p=0.29). sICH with ADVI was 4% (95% CI 3% to 7%; I²=73%) and 6% with NCCT/CTA (95% CI 4% to 8%; I #178;=6%, p=0.27). Conclusions Our study suggests that, in anterior circulation LVO, the rates of functional independence may be similar when patients are selected using ADVI or NCCT for EVT in the extended time window. A simplified triage protocol does not seem to increase mortality or sICH. Protocol registration number (PROSPERO ID: CRD42021236092). [ABSTRACT FROM AUTHOR]

Published
2023
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