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1. 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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3. Anticoagulation Use and Endovascular Thrombectomy in Patients with Large Core Stroke: A Secondary Analysis of the SELECT2 Trial.

Author

Pujara, Deep K., Hussain, M. Shazam, Abraham, Michael G., Ortega‐Gutierrez, Santiago, Chen, Michael, Kasner, Scott E., Churilov, Leonid, Sitton, Clark W., Blackburn, Spiros, Sundararajan, Sophia, Hu, Yin C., Herial, Nabeel A., Budzik, Ronald F., Hicks, William J., Arenillas, Juan F., Tsai, Jenny P., Kozak, Osman, Cordato, Dennis J., Manning, Nathan W., and Hanel, Ricardo A.

Subjects
INTRACRANIAL hemorrhage, ENDOVASCULAR surgery, ANTICOAGULANTS, CONGESTIVE heart failure, ORAL medication
Abstract

Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4–6] vs MM 5 [4–6], adjusted generalized odds ratio 0.89 [0.53–1.50]), but demonstrated significantly better outcomes in patients without OAC (EVT 4 [3–6] vs MM 5 [4–6], adjusted generalized odds ratio 1.87 [1.45–2.40], p = 0.02). The OAC group had higher comorbidities, including atrial fibrillation (70% vs 17%), congestive heart failure (28% vs 10%), and hypertension (87% vs 72%), suggesting increased frailty. However, the results were consistent after adjustment for these comorbidities, and was similar regardless of the type of OACs used. Whereas any hemorrhage rates were higher in the OAC group receiving EVT (86% in OAC vs 70% in no OAC), no parenchymal hemorrhage or symptomatic intracranial hemorrhage were observed with OAC use in both the EVT and MM arms. Although we did not find evidence that the effect was due to excess hemorrhage or confounded by underlying cardiac disease or older age, OAC use alone should not exclude patients from receiving EVT. Baseline comorbidities and ischemic injury extent should be considered while making individualized treatment decisions. ANN NEUROL 2024;96:887–894 [ABSTRACT FROM AUTHOR]

Published
2024
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5. Surface modification of neurovascular stents: from bench to patient.

Author

Zoppo, Christopher T., Mocco, J., Manning, Nathan W., Bogdanov Jr, Alexei A., and Gounis, Matthew J.

Subjects
INTRACRANIAL aneurysm surgery, POLYMERS, CELL membranes, SURFACE properties, ENDOTHELIAL growth factors, HEPARIN, CELL proliferation, SURGICAL stents, FIBRINOLYTIC agents, CHOLINE, POLYSACCHARIDES, BIOMEDICAL materials, SCANNING electron microscopy, THROMBOEMBOLISM, HEMATOPOIETIC stem cells, DISEASE complications
Abstract

Flow-diverting stents (FDs) for the treatment of cerebrovascular aneurysms are revolutionary. However, these devices require systemic dual antiplatelet therapy (DAPT) to reduce thromboembolic complications. Given the risk of ischemic complications as well as morbidity and contraindications associated with DAPT, demonstrating safety and efficacy for FDs either without DAPT or reducing the duration of DAPT is a priority. The former may be achieved by surface modifications that decrease device thrombogenicity, and the latter by using coatings that expedite endothelial growth. Biomimetics, commonly achieved by grafting hydrophilic and non-interacting polymers to surfaces, can mask the device surface with nature-derived coatings from circulating factors that normally activate coagulation and inflammation. One strategy is to mimic the surfaces of innocuous circulatory system components. Phosphorylcholine and glycan coatings are naturally inspired and present on the surface of all eukaryotic cell membranes. Another strategy involves linking synthetic biocompatible polymer brushes to the surface of a device that disrupts normal interaction with circulating proteins and cells. Finally, drug immobilization can also impart antithrombotic effects that counteract normal foreign body reactions in the circulatory system without systemic effects. Heparin coatings have been explored since the 1960s and used on a variety of blood contacting surfaces. This concept is now being explored for neurovascular devices. Coatings that improve endothelialization are not as clinically mature as anti-thrombogenic coatings. Coronary stents have used an anti-CD34 antibody coating to capture circulating endothelial progenitor cells on the surface, potentially accelerating endothelial integration. Similarly, coatings with CD31 analogs are being explored for neurovascular implants. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial

Author

Chen, Michael, primary, Joshi, Krishna C, additional, Kolb, Bradley, additional, Sitton, Clark W, additional, Pujara, Deep Kiritbhai, additional, Abraham, Michael G, additional, Ortega-Gutierrez, Santiago, additional, Kasner, Scott E, additional, Hussain, Shazam M, additional, Churilov, Leonid, additional, Blackburn, Spiros, additional, Sundararajan, Sophia, additional, Hu, Yin C, additional, Herial, Nabeel, additional, Arenillas, Juan F, additional, Tsai, Jenny P, additional, Budzik, Ronald F, additional, Hicks, William, additional, Kozak, Osman, additional, Yan, Bernard, additional, Cordato, Dennis, additional, Manning, Nathan W, additional, Parsons, Mark, additional, Hanel, Ricardo A, additional, Aghaebrahim, Amin, additional, Wu, Teddy, additional, Cardona Portela, Pere, additional, Gandhi, Chirag D, additional, Al-Mufti, Fawaz, additional, Perez de la Ossa, Natalia, additional, Schaafsma, Joanna, additional, Blasco, Jordi, additional, Sangha, Navdeep, additional, Warach, Steven, additional, Kleinig, Timothy J, additional, Johns, Hannah, additional, Shaker, Faris, additional, Abdulrazzak, Mohammad A, additional, Ray, Abhishek, additional, Sunshine, Jeffery, additional, Opaskar, Amanda, additional, Duncan, Kelsey R, additional, Xiong, Wei, additional, Al-Shaibi, Faisal K, additional, Samaniego, Edgar A, additional, Nguyen, Thanh N, additional, Fifi, Johanna T, additional, Tjoumakaris, Stavropoula I, additional, Jabbour, Pascal, additional, Mendes Pereira, Vitor, additional, Lansberg, Maarten G, additional, Sila, Cathy, additional, Bambakidis, Nicholas C, additional, Davis, Stephen, additional, Wechsler, Lawrence, additional, Albers, Gregory W, additional, Grotta, James C, additional, Ribo, Marc, additional, Hassan, Ameer E, additional, Campbell, Bruce, additional, Hill, Michael D, additional, and Sarraj, Amrou, additional

Published
2024
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11. 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, Cordato, Dennis J., Hanel, Ricardo A., Wu, Teddy Y., Portela, Pere Cardona, Gandhi, Chirag D., Al-Mufti, Fawaz, Maali, Laith, Gibson, Daniel, Pérez de la Ossa, Natalia, Schaafsma, Joanna D., Blasco, Jordi, Sangha, Navdeep, Warach, Steven, Kleinig, Timothy J., Shaker, Faris, Sitton, Clark W., Nguyen, Thanh, Fifi, Johanna T., Jabbour, Pascal, Furlan, Anthony, Lansberg, Maarten G., Tsivgoulis, Georgios, Sila, Cathy, Bambakidis, Nicholas, Davis, Stephen, Wechsler, Lawrence, Albers, Greg W., Grotta, James C., Ribo, Marc, Campbell, Bruce C., Hassan, Ameer E., Vora, Nirav, Manning, Nathan W., Cheung, Andrew, Aghaebrahim, Amin N., Paipa Merchán, Andres J., Sahlein, Daniel, Requena Ruiz, Manuel, Elijovich, Lucas, Arthur, Adam, Al-Shaibi, Faisal, Samaniego, Edgar A., Duncan, Kelsey R., Opaskar, Amanda, Ray, Abhishek, Xiong, Wei, Sunshine, Jeffery, DeGeorgia, Michael, Tjoumakaris, Stavropoula, and Mendes Pereira, Vitor

Abstract

IMPORTANCE: Patients with large ischemic core stroke have poor clinical outcomes and are frequently not considered for interfacility transfer for endovascular thrombectomy (EVT). OBJECTIVE: To assess EVT treatment effects in transferred vs directly presenting patients and to evaluate the association between transfer times and neuroimaging changes with EVT clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: This prespecified secondary analysis of the SELECT2 trial, which evaluated EVT vs medical management (MM) in patients with large ischemic stroke, evaluated adults aged 18 to 85 years with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) as well as an Alberta Stroke Program Early CT Score (ASPECTS) of 3 to 5, core of 50 mL or greater on imaging, or both. Patients were enrolled between October 2019 and September 2022 from 31 EVT-capable centers in the US, Canada, Europe, Australia, and New Zealand. Data were analyzed from August 2023 to January 2024. INTERVENTIONS: EVT vs MM. MAIN OUTCOMES AND MEASURES: Functional outcome, defined as modified Rankin Scale (mRS) score at 90 days with blinded adjudication. RESULTS: A total of 958 patients were screened and 606 patients were excluded. Of 352 enrolled patients, 145 (41.2%) were female, and the median (IQR) age was 66.5 (58-75) years. A total of 211 patients (59.9%) were transfers, while 141 (40.1%) presented directly. The median (IQR) transfer time was 178 (136-230) minutes. The median (IQR) ASPECTS decreased from the referring hospital (5 [4-7]) to an EVT-capable center (4 [3-5]). Thrombectomy treatment effect was observed in both directly presenting patients (adjusted generalized odds ratio [OR], 2.01; 95% CI, 1.42-2.86) and transferred patients (adjusted generalized OR, 1.50; 95% CI, 1.11-2.03) without heterogeneity (P for interaction = .14). Treatment effect point estimates favored EVT among 82 transferred patients with a referral hospital ASPECTS of 5 or less (44 received EVT; adjusted generalized OR, 1.52; 95% CI, 0.89-2.58). ASPECTS loss was associated with numerically worse EVT outcomes (adjusted generalized OR per 1-ASPECTS point loss, 0.89; 95% CI, 0.77-1.02). EVT treatment effect estimates were lower in patients with transfer times of 3 hours or more (adjusted generalized OR, 1.15; 95% CI, 0.73-1.80). CONCLUSIONS AND RELEVANCE: Both directly presenting and transferred patients with large ischemic stroke in the SELECT2 trial benefited from EVT, including those with low ASPECTS at referring hospitals. However, the association of EVT with better functional outcomes was numerically better in patients presenting directly to EVT-capable centers. Prolonged transfer times and evolution of ischemic change were associated with worse EVT outcomes. These findings emphasize the need for rapid identification of patients suitable for transfer and expedited transport. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03876457

Published
2024
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12. Trial of Endovascular Thrombectomy for Large Ischemic Strokes

Author

Sarraj, Amrou, primary, Hassan, Ameer E., additional, Abraham, Michael G., additional, Ortega-Gutierrez, Santiago, additional, Kasner, Scott E., additional, Hussain, M. Shazam, additional, Chen, Michael, additional, Blackburn, Spiros, additional, Sitton, Clark W., additional, Churilov, Leonid, additional, Sundararajan, Sophia, additional, Hu, Yin C., additional, Herial, Nabeel A., additional, Jabbour, Pascal, additional, Gibson, Daniel, additional, Wallace, Adam N., additional, Arenillas, Juan F., additional, Tsai, Jenny P., additional, Budzik, Ronald F., additional, Hicks, William J., additional, Kozak, Osman, additional, Yan, Bernard, additional, Cordato, Dennis J., additional, Manning, Nathan W., additional, Parsons, Mark W., additional, Hanel, Ricardo A., additional, Aghaebrahim, Amin N., additional, Wu, Teddy Y., additional, Cardona-Portela, Pere, additional, Pérez de la Ossa, Natalia, additional, Schaafsma, Joanna D., additional, Blasco, Jordi, additional, Sangha, Navdeep, additional, Warach, Steven, additional, Gandhi, Chirag D., additional, Kleinig, Timothy J., additional, Sahlein, Daniel, additional, Elijovich, Lucas, additional, Tekle, Wondwossen, additional, Samaniego, Edgar A., additional, Maali, Laith, additional, Abdulrazzak, M. Ammar, additional, Psychogios, Marios N., additional, Shuaib, Ashfaq, additional, Pujara, Deep K., additional, Shaker, Faris, additional, Johns, Hannah, additional, Sharma, Gagan, additional, Yogendrakumar, Vignan, additional, Ng, Felix C., additional, Rahbar, Mohammad H., additional, Cai, Chunyan, additional, Lavori, Philip, additional, Hamilton, Scott, additional, Nguyen, Thanh, additional, Fifi, Johanna T., additional, Davis, Stephen, additional, Wechsler, Lawrence, additional, Pereira, Vitor M., additional, Lansberg, Maarten G., additional, Hill, Michael D., additional, Grotta, James C., additional, Ribo, Marc, additional, Campbell, Bruce C., additional, and Albers, Gregory W., additional

Published
2023
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13. Prior anticoagulation and bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke.

Author

Longting Lin, Blair, Christopher, Fu, James, Cordato, Dennis, Cappelen-Smith, Cecilia, Cheung, Andrew, Manning, Nathan W., Wenderoth, Jason, Chushuang Chen, Bivard, Andrew, Butcher, Kenneth, Kleinig, Timothy J., Choi, Philip, Levi, Christopher R., and Parsons, Mark

Subjects
MORTALITY prevention, CONFIDENCE intervals, FUNCTIONAL status, ANTICOAGULANTS, ATRIAL fibrillation, THROMBOLYTIC therapy, RETROSPECTIVE studies, ACQUISITION of data, TREATMENT effectiveness, STROKE patients, THROMBECTOMY, MEDICAL records, DESCRIPTIVE statistics, ENDOVASCULAR surgery, ODDS ratio
Abstract

Background Where stroke occurs with pre-existing atrial fibrillation (AF)studies validating the safety and efficacy of bridging thrombolysis, and the use of endovascular thrombectomy (EVT) in the setting of prior anticoagulation, are limited to single-center reports. Methods In a retrospective analysis, AF patients undergoing EVT for anterior circulation large vessel occlusion stroke enrolled in a prospectively-maintained, international multicenter database (International Stroke Perfusion Imaging Registry (INSPIRE)) between 2016 and 2019 were studied. Patients were categorized by anticoagulation status: anticoagulated (warfarin/non-vitamin K oral anticoagulants) versus not anticoagulated. Patients not anticoagulated were further divided into intravenous thrombolysis versus no thrombolysis. Outcomes compared between groups included 90-day modified Rankin Scale, 90-day mortality, rates of symptomatic intracerebral hemorrhage (sICH), and good reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3). Results Of 563 AF patients, 118 (21%) were on anticoagulation. AF patients on anticoagulation showed improved 90-day functional outcomes (adjusted odds ratio (aOR) 1.68, 95% confidence interval (95% CI) 1.00 to 2.82). Mortality (26.3% vs 23.8%), sICH (4.5% vs 3.9%), and rates of good reperfusion (91.3% vs 88.0%) were similar between those anticoagulated and those not anticoagulated. Thrombolysis before EVT in AF patients was independently associated with improved 90-day functional outcomes (aOR 1.81, 95% CI 1.18 to 2.79) and reduced mortality (aOR 0.51, 95% CI 0.31 to 0.84), with similar sICH rates (3.4% vs 4.5%). Conclusions Anticoagulated patients with AF who underwent EVT had improved 90-day functional outcomes and similar sICH rates. Thrombolysis before EVT in AF patients was associated with improved 90-day functional outcomes and reduced mortality. [ABSTRACT FROM AUTHOR]

Published
2023
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14. Prior anticoagulation and bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke

Author

Lin, Longting, primary, Blair, Christopher, additional, Fu, James, additional, Cordato, Dennis, additional, Cappelen-Smith, Cecilia, additional, Cheung, Andrew, additional, Manning, Nathan W, additional, Wenderoth, Jason, additional, Chen, Chushuang, additional, Bivard, Andrew, additional, Butcher, Kenneth, additional, Kleinig, Timothy J, additional, Choi, Philip, additional, Levi, Christopher R, additional, and Parsons, Mark, additional

Published
2023
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15. sj-docx-1-ine-10.1177_15910199231185632 - Supplemental material for Balloon assisted Woven endobridge deployment (BAWD): A safety and efficacy study

Author

Trimboli, Anthony, Wenderoth, Jason D, Cheung, Andrew K, Whitley, Justin, McQuinn, Alex, Williams, Cameron, Phillips, Timothy J, Fairhall, Jacob, Sheridan, Mark, and Manning, Nathan W

Subjects
Neurology and Neuromuscular Diseases, FOS: Clinical medicine, Neuroscience
Abstract

Supplemental material, sj-docx-1-ine-10.1177_15910199231185632 for Balloon assisted Woven endobridge deployment (BAWD): A safety and efficacy study by Anthony Trimboli, Jason D Wenderoth, Andrew K Cheung, Justin Whitley, Alex McQuinn, Cameron Williams, Timothy J Phillips, Jacob Fairhall, Mark Sheridan and Nathan W Manning in Interventional Neuroradiology

Published
2023
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16. Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well

Author

Sarraj, Amrou, primary, Kleinig, Timothy J., additional, Hassan, Ameer E., additional, Portela, Pere Cardona, additional, Ortega-Gutierrez, Santiago, additional, Abraham, Michael G., additional, Manning, Nathan W., additional, Siegler, James E., additional, Goyal, Nitin, additional, Maali, Laith, additional, Blackburn, Spiros, additional, Wu, Teddy Y., additional, Blasco, Jordi, additional, Renú, Arturu, additional, Sangha, Navdeep S., additional, Arenillas, Juan F., additional, McCullough-Hicks, Margy E., additional, Wallace, Adam, additional, Gibson, Daniel, additional, Pujara, Deep K., additional, Shaker, Faris, additional, de Lera Alfonso, Mercedes, additional, Olivé-Gadea, Marta, additional, Farooqui, Mudassir, additional, Vivanco Suarez, Juan S., additional, Iezzi, Zachary, additional, Khalife, Jane, additional, Lechtenberg, Colleen G., additional, Qadri, Syed K., additional, Moussa, Rami B., additional, Abdulrazzak, Mohammad A., additional, Almaghrabi, Tareq S., additional, Mir, Osman, additional, Beharry, James, additional, Krishnaiah, Balaji, additional, Miller, Megan, additional, Khalil, Najwa, additional, Sharma, Gagan J., additional, Katsanos, Aristeidis H., additional, Fadhil, Ali, additional, Duncan, Kelsey R., additional, Hu, Yin, additional, Martin-Schild, Sheryl B., additional, Tsivgoulis, Georgios K., additional, Cordato, Dennis, additional, Furlan, Anthony, additional, Churilov, Leonid, additional, Mitchell, Peter J., additional, Arthur, Adam S., additional, Parsons, Mark W., additional, Grotta, James C., additional, Sitton, Clark W., additional, Ribo, Marc, additional, Albers, Gregory W., additional, and Campbell, Bruce C. V., additional

Published
2022
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18. Safety and Clinical Effectiveness of Pipeline Shield Device for Intracranial Aneurysms in an Australian Cohort (SCOPE‐AUS)

Author

Chia, Ghim Song, primary, de Villiers, Laetitia, additional, Carraro do Nascimento, Vinicius, additional, Rapier, Cheryl Lee, additional, Owusu, Maame Amma, additional, Lau, Fiona S., additional, McQuinn, Alexander, additional, Williams, Cameron, additional, Whitley, Justin, additional, Cheung, Andrew, additional, Manning, Nathan W., additional, and Rice, Hal, additional

Published
2022
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20. Abstract 36: Endovascular Thrombectomy Beyond 24 Hours From Last Known Well: A Pooled Multicenter International Cohort

Author

Sarraj, Amrou, primary, Hassan, Ameer E, additional, Abraham, Michael G, additional, Cardona Portela, Pere, additional, Manning, Nathan W, additional, Cordato, Dennis, additional, Kleinig, Timothy J, additional, Goyal, Nitin, additional, Blackburn, Spiros, additional, McCullough-Hicks, Margy E, additional, Ribo, Marc, additional, Wu, Teddy Y, additional, Blasco, Jordi, additional, Sangha, Navdeep, additional, Arenillas, Juan F, additional, Wallace, Adam, additional, Pujara, Deep K, additional, Shaker, Faris, additional, de Lera Alfonso, Mercedes, additional, Renu, Arturo, additional, Olivé Gadea, Marta, additional, Gibson, Daniel, additional, Lechtenberg, Colleen G, additional, Maali, Laith N, additional, Abdulrazzak, Mohammad A, additional, Almaghrabi, Tareq S, additional, Beharry, James, additional, Krishnaiah, Balaji, additional, Miller, Megan, additional, Khalil, Najwa, additional, Sharma, Gagan J, additional, Katsanos, Aristeidis H, additional, Fadhil, Ali, additional, Duncan, Kelsey R, additional, Hu, Yin, additional, sitton, clark W, additional, Martin-schild, Sheryl B, additional, Tsivgoulis, Georgios K, additional, Mitchell, Peter J, additional, Arthur, Adam S, additional, Parsons, Mark, additional, Grotta, James C, additional, Campbell, Bruce C, additional, and Albers, Gregory W, additional

Published
2022
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21. Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well: The SELECT Late Study.

Author

Sarraj, Amrou, Kleinig, Timothy J., Hassan, Ameer E., Portela, Pere Cardona, Ortega-Gutierrez, Santiago, Abraham, Michael G., Manning, Nathan W., Siegler, James E., Goyal, Nitin, Maali, Laith, Blackburn, Spiros, Wu, Teddy Y., Blasco, Jordi, Renú, Arturu, Sangha, Navdeep S., Arenillas, Juan F., McCullough-Hicks, Margy E., Wallace, Adam, Gibson, Daniel, and Pujara, Deep K.

Published
2023
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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

24. SELECTion criteria for large core trials: dogma or data?

Author

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

Published
2021
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27. Abstract TP32: Efficacy and Safety of Hyper-acute Stenting for Symptomatic Intracranial Atherosclerotic Disease

Author

McQuinn, Alexander, primary, Cheung, Andrew, additional, Wenderoth, Jason, additional, Mitchelle, Amer, additional, Blair, Christopher, additional, Cappelen-Smith, Cecilia, additional, Cordato, Dennis, additional, Hodgkinson, Suzanne, additional, McDougall, Alan, additional, Zagami, Alessandro S, additional, and Manning, Nathan W, additional

Published
2020
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28. Abstract WP57: Acute Carotid Stenting Following Intracranial Thrombectomy Has Comparable Safety and Efficacy in Early versus Late Time Window Stroke

Author

Mitchelle, Amer, primary, Lau, Fiona S, additional, Cheung, Andrew, additional, Wenderoth, Jason, additional, McQuinn, Alexander, additional, Cappelen-Smith, Cecilia, additional, Cordato, Dennis, additional, Hodgkinson, Suzanne, additional, Blair, Christopher, additional, McDougall, Alan, additional, Zagami, Alessandro S, additional, and Manning, Nathan W, additional

Published
2020
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29. Abstract TMP9: Use of Immediate Dual Antiplatelet Therapy in Carotid Stenting for Tandem Occlusion Stroke is Associated With Acceptable Symptomatic Intracranial Haemorrhage Rates

Author

Lau, Fiona S, primary, Mitchelle, Amer, additional, Cheung, Andrew, additional, Wenderoth, Jason, additional, Cappelen-Smith, Cecilia, additional, Cordato, Dennis, additional, Hodgkinson, Suzanne, additional, McDougall, Alan, additional, Zagami, Alessandro S, additional, and Manning, Nathan W, additional

Published
2020
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31. Abstract 154: Non-Contrast Computed Tomography Based Patient Selection Achieves Similar Outcomes to Advanced Neuroimaging in Late Time Window Endovascular Thrombectomy

Author

Desai, Mihir, primary, Alsahli, Khalid, additional, Cheung, Andrew, additional, Wenderoth, Jason, additional, Kohli, Akshay, additional, Cappelen-Smith, Cecilia, additional, Cordato, Dennis, additional, Tay, Kevin, additional, Hodgkinson, Suzanne, additional, McDougall, Alan, additional, Zagami, Alessandro S, additional, and Manning, Nathan W, additional

Published
2019
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32. Isolated Striatocapsular Infarcts after Endovascular Treatment of Acute Proximal Middle Cerebral Artery Occlusions

Author

Kaesmacher, Johannes, Huber, Thomas, Lehm, Manuel, Zimmer, Claus, Bernkopf, Kathleen, Wunderlich, Silke, Boeckh-Behrens, Tobias, Manning, Nathan W., and Kleine, Justus F.

Subjects
animal structures, thrombectomy, striatocapsular infarcts, basal ganglia, prevalence, endovascular, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit, stroke, Neuroscience, Original Research
Abstract

Background: Striatocapsular infarcts (SCIs) are defined as large subcortical infarcts involving the territory of more than one lenticulostriate artery. SCI without concomitant ischemia in the more distal middle cerebral artery (MCA) territory [isolated SCI (iSCI)] has been described as a rare infarct pattern. The purpose of this study was to assess the prevalence of iSCI in patients treated with endovascular thrombectomy (ET), to evaluate baseline and procedural parameters associated with this condition, and to describe the clinical course of iSCI patients. Methods: A retrospective analysis of 206 consecutive patients with an isolated MCA occlusion involving the lenticulostriate arteries and treated with ET was performed. Baseline patient and procedural characteristics and ischemic involvement of the striatocapsular and distal MCA territory [iSCI, as opposed to non-isolated SCI (niSCI)] were analyzed using multivariate logistic regression models. Prevalence of iSCI was assessed, and clinical course was determined with the rates of substantial neurological improvement and good functional short- and mid-term outcome (discharge/day 90 Modified Rankin Scale ≤2). Results: iSCI was detected in 53 patients (25.7%), and niSCI was detected in 153 patients (74.3%). Successful reperfusion [thrombolysis in cerebral infarction (TICI) 2b/3] [adjusted odds ration (aOR) 8.730, 95% confidence interval (95% CI) 1.069–71.308] and good collaterals (aOR 2.100, 95% CI 1.119–3.944) were associated with iSCI. In successfully reperfused patients, TICI 3 was found to be an additional factor associated with iSCI (aOR 5.282, 1.759–15.859). Patients with iSCI had higher rates of substantial neurological improvement (71.7 vs. 37.9%, p < 0.001) and higher rates of good functional short- and mid-term outcome (58.3 vs. 23.7%, p < 0.001 and 71.4 vs. 41.7%, p < 0.001). However, while iSCI patients, in general, had a more favorable outcome, considerable heterogeneity in outcome was observed. Conclusion: High rates of successful reperfusion (TICI 2b/3) and in particular, complete reperfusion (TICI 3) are associated with iSCIs. The high prevalence of iSCI in successfully reperfused patients with good collaterals corroborates previous concepts of iSCI pathogenesis. iSCI, once considered a rare pattern of cerebral ischemia, is likely to become more prevalent with increases in endovascular stroke therapy. This may have implications for patient rehabilitation and pathophysiological analyses of ischemic damage confined to subcortical regions of the MCA territory.

Published
2017
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37. Clinical outcome prediction after thrombectomy of proximal middle cerebral artery occlusions by the appearance of lenticulostriate arteries on magnetic resonance angiography: A retrospective analysis

Author

Kaesmacher, Johannes, primary, Kreiser, Kornelia, additional, Manning, Nathan W, additional, Gersing, Alexandra S, additional, Wunderlich, Silke, additional, Zimmer, Claus, additional, Kleine, Justus F, additional, Wiestler, Benedikt, additional, and Boeckh-Behrens, Tobias, additional

Published
2017
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40. Pipeline shield with single antiplatelet therapy in aneurysmal subarachnoid haemorrhage: multicentre experience.

Author

Manning, Nathan W., Cheung, Andrew, Phillips, Timothy J., and Wenderoth, Jason D.

Subjects
CEREBRAL ischemia, PLATELET aggregation inhibitors, CEREBRAL circulation, DISEASES, HEPARIN, INTRACRANIAL aneurysms, LONGITUDINAL method, MEDICAL cooperation, MEDICAL records, PATIENT safety, POSTOPERATIVE period, RESEARCH, SUBARACHNOID hemorrhage, THERAPEUTIC embolization, SYMPTOMS, DISCHARGE planning, TREATMENT effectiveness, OFF-label use (Drugs), RETROSPECTIVE studies, TREATMENT duration, ACQUISITION of data methodology, THERAPEUTICS, DISEASE risk factors
Abstract

Background The Pipeline embolisation Device with shield technology (PED-Shield) is suggested to have reduced thrombogenicity. This reduced thrombogenicity may make it possible to use safely in the acute treatment of aneurysmal subarachnoid haemorrhage (ASAH) on single antiplatelet therapy (SAPT). Objective To evaluate the safety and efficacy of the off-label use of PED-shield with SAPT for the acute treatment of ASAH. Methods Patients who underwent acute treatment of ruptured intracranial aneurysms with the PEDShield with SAPT were retrospectively identified from prospectively maintained databases at three australian neurointerventional centres. Patient demographics, aneurysm characteristics, clinical and imaging outcomes were reviewed. Results Fourteen patients were identified (12 women), median age 64 (IQr 21.5) years. Aneurysm morphology was saccular in seven, fusiform in five, and blister in two. Aneurysms arose from the anterior circulation in eight patients (57.1%). six (42.9%) patients were poor grade (World Federation of neurological societies grade ≥IV) SAH. Median time to treatment was 1 IQr 0.5) day. complete or near complete aneurysm occlusion (Raymond-Roy <3) was achieved in 12 (85.7%) patients at the end of early-acute follow-up (median day 7 after SAH). Permanent, treatment-related morbidity occurred in one (7.1%) patient and one (7.1%) treatment-related death occurred. The use of a postoperative heparin infusion (n=5) was associated with a higher rate of all complications (80.0% vs 11.1%, p=0.023) and symptomatic complications (60% vs 0.0%, p=0.028). No symptomatic ischaemic or haemorrhagic complications were observed in the patients who did not receive a post-operative heparin infusion. nine (64.3%) patients were functionally independent on discharge from the treatment centre. Conclusion The PED-Shield may be safe to use in the acute treatment of ruptured intracranial aneurysms with SAPT. Further investigation with a formal treatment registry is needed. [ABSTRACT FROM AUTHOR]

Published
2019
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41. Balloon assisted Woven endobridge deployment (BAWD): A safety and efficacy study

Author

Trimboli, Anthony, Wenderoth, Jason D, Cheung, Andrew K, Whitley, Justin, McQuinn, Alex, Williams, Cameron, Phillips, Timothy J, Fairhall, Jacob, Sheridan, Mark, and Manning, Nathan W

Abstract

Background Balloon-assisted deployment/remodelling is a proven adjunctive technique for coil embolization of intracranial aneurysms, and it may be a helpful adjunct in delivering the Woven EndoBridge (WEB) device.Objective To evaluate the safety, efficacy and feasibility of balloon-assisted WEB deployment in both ruptured and unruptured intracranial aneurysms in both typical and atypical locations.Methods Patients who underwent treatment of ruptured and unruptured intracranial aneurysms with the BAWD technique were retrospectively identified from a prospectively maintained database at two neurointerventional centres. Patient demographics, aneurysm characteristics, technical procedure details, clinical and imaging outcomes were reviewed.Results Thirty-three aneurysms (23 women) were identified with a median age of 58 years. There were 15 (45.5%) ruptured aneurysms, 25 (64.3%) in the anterior circulation and 12 (36.4%) aneurysms having an atypical location for WEB treatment. The average aneurysm size was 6.8 mm (greatest dimension), 4.6 mm (height) and 4.5 mm (width), and 25 (75.8%) aneurysms had a wide neck morphology. One patient died (3.0%) secondary to a procedure-related complication, and there was no procedure-related permanent morbidity. Complete and adequate aneurysm occlusion on mid-term follow-up DSA was 85.2% and 92%, respectively.Conclusion Balloon-assisted WEB deployment appears to be a safe and effective technique that may increase the utility of the WEB device. Further prospective studies on BAWD should be considered.

Published
2024
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43. Acute Ischemic Stroke

Author

Manning, Nathan W., primary, Campbell, Bruce C.V., additional, Oxley, Thomas J., additional, and Chapot, René, additional

Published
2014
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44. Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub‐Analysis from the SELECT2 Trial.

Author

Hassan, Ameer E., Abraham, Michael G., Blackburn, Spiros, Hussain, Muhammad S., Ortega‐Gutierrez, Santiago, Chen, Michael, Hu, Yin C., Pujara, Deep K., Herial, Nabeel A., Tsai, Jenny P., Budzik, Ronald F., Manning, Nathan W., Kozak, Osman, Hanel, Ricardo A., Aghaebrahim, Amin N., Gandhi, Chirag D., Al‐Mufti, Fawaz, Cheung, Andrew, Yan, Bernard, and Mitchell, Peter

Subjects
*ENDOVASCULAR surgery, *CEREBRAL infarction, *RANDOMIZED controlled trials, *STROKE, *REPERFUSION
Abstract

Methods Results Interpretation Endovascular thrombectomy (EVT) was shown to be safe and efficacious in patients with large core stroke in multiple randomized controlled trials. However, the impact of reperfusion and other procedural metrics on EVT outcomes in this population has not been well‐characterized.From the SELECT2 trial, we evaluated the association between reperfusion status, first‐pass effect (near‐complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c‐3] in 1 pass), procedure time and primary technique (aspiration vs stent‐retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml).Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b‐3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01–2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near‐complete reperfusion (eTICI 2c‐3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33–2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first‐pass‐effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96–2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87–0.96, p‐value = 0.001 for 10 minutes increment). Aspiration‐first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50–1.10) as compared with stent‐retriever first.Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2024 [ABSTRACT FROM AUTHOR]

Published
2024
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45. Critical Care Decisions After Large Core Cerebral Infarctions: A Secondary Analysis From the SELECT2 Trial.

Author

Kasner SE, Mullen MT, DeGeorgia M, Blackburn S, George DK, Kumar M, Messe S, Abraham MG, Chen M, Ortega-Gutierrez S, Sitton CW, Burkhardt JK, Hussain MS, Churilov L, Sundararajan S, Hu YC, Herial NA, Jabbour P, Gibson D, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Hanel RA, Aghaebrahim AN, Wu TY, Portela PC, de la Ossa NP, Schaafsma JD, Blasco J, Sangha N, Warach S, Gandhi CD, Kleinig TJ, Sahlein D, Samaniego EA, Maali L, Abdulrazzak MA, Amuluru K, Pujara DK, Shaker F, Johns H, Moussa R, Al-Shaibi F, Duncan KR, Tjoumakaris S, Opaskar A, Xiong W, Ray A, Amin-Hanjani S, Nguyen TN, Fifi JT, Davis S, Wechsler L, Furlan A, Sila C, Bambakidis N, Hill MD, Mendes Pereira V, Lansberg MG, Grotta JC, Ribo M, Albers GW, Campbell BC, Hassan AE, and Sarraj A

Abstract

Objective: Among patients with large vessel occlusion (LVO) and large ischemic cores, critical decisions often need to be made about decompressive hemicraniectomy (DHC) or early withdrawal of life-sustaining therapy (WLST). In this study, we aimed to evaluate utilization of DHC and early WLST and factors associated with them in patients with large strokes from the SELECT2 trial., Methods: We analyzed the entire SELECT2 trial population, which randomized 352 patients with stroke due to LVO and large ischemic cores to endovascular thrombectomy (EVT) or medical management. We used the as-treated principle to compare the use of DHC and early WLST within 7 days after randomization. We further assessed functional outcomes (modified Rankin Score) after these decisions., Results: Of 352 patients enrolled in this study, 55 received DHC and 81 transitioned to early WLST. Patients treated with EVT were as likely to undergo DHC (16% vs 15%, adjusted relative risk [aRR] = 1.19, 95% CI:0.75-1.88, p = 0.46) or WLST (22% vs 24%, aRR = 0.94, 95% CI: 0.66-1.34, p = 0.72) as those given medical management. DHC was used more frequently in younger patients and WLST more in older patients. EVT efficacy was maintained after adjusting for DHC (adjusted generalized odds ratio [aGenOR] = 1.68, 95% CI: 1.24-2.11, p < 0.001), with no interaction between DHC and treatment (p-interaction = 0.93). At 1 year, 21% of DHC-treated patients were ambulatory; the outcomes were universally poor after early WLST., Interpretation: In the SELECT2 trial of patients with large ischemic core, DHC was performed in ~1 of 6 patients and early WLST in ~1 of 5 patients, without differences based on treatment with EVT or medical management, nor successful reperfusion. DHC or WLST did not detract from thrombectomy treatment benefit. Additionally, ~20% of patients achieved independent ambulation despite receiving DHC by the 1-year follow-up. The similar distribution of these critical care decisions provides reassurance that the overall trial outcomes were not biased by open-label treatment allocation. ANN NEUROL 2024., (© 2024 American Neurological Association.)

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

Author

Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Churilov L, Johns H, Sitton CW, Yogendrakumar V, Ng FC, Pujara DK, Blackburn S, Sundararajan S, Hu YC, Herial NA, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Cheung A, Hanel RA, Aghaebrahim AN, Wu TY, Portela PC, Gandhi CD, Al-Mufti F, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Kleinig TJ, Shaker F, Al Shaibi F, Toth G, Abdulrazzak MA, Sharma G, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Samaniego EA, Maali L, Lechtenberg CG, Renú A, Vora N, Nguyen T, Fifi JT, Tjoumakaris SI, Jabbour P, Tsivgoulis G, Pereira VM, Lansberg MG, DeGeorgia M, Sila CA, Bambakidis N, Hill MD, Davis SM, Wechsler L, Grotta JC, Ribo M, Albers GW, and Campbell BC

Subjects
Adult, Humans, Female, Aged, Male, Thrombectomy adverse effects, Thrombectomy methods, Brain diagnostic imaging, Stroke diagnostic imaging, Stroke surgery, Ischemic Stroke diagnostic imaging, Ischemic Stroke surgery, Brain Ischemia diagnostic imaging, Brain Ischemia surgery
Abstract

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.

Published
2024
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