Publications by authors named "Adnan Mujanovic"
Background: There are limited therapeutic options in cases of failed reperfusion (modified thrombolysis in cerebral infarction [mTICI] score < 2b) after stent-retriever and/or aspiration based endovascular treatment (EVT) for acute ischemic stroke. Despite the absence of data supporting its use, rescue therapy (balloon angioplasty and/or stent implantation) is often utilized in such cases. Studies are limited to large vessel occlusions, while the outcomes and complications after rescue therapy in medium/distal vessel occlusions (MDVOs) have not been reported.
View Article and Find Full Text PDFBackground: A third of endovascularly treated stroke patients experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, eTICI<3) and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy.
Methods: A systematic review of MEDLINE, Embase and PubMed up until March 1, 2024 using a predefined strategy.
Background: Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction,
Methods: Retrospective registry analysis of patients undergoing endovascular therapy between July 2020 and December 2022, with available immediate post-interventional FPDCT and 24 hours follow-up perfusion imaging.
Article Synopsis
- The no-reflow phenomenon may lead to poor patient outcomes after thrombectomy, with various imaging definitions leading to inconsistent prevalence rates.
- An analysis of 131 patients showed significant variability in no-reflow prevalence (0.8-22.1%) and poor agreement between different imaging definitions regarding patient outcomes.
- The definition based on >15% cerebral blood volume or flow asymmetry was most effective in predicting poor clinical outcomes 90 days post-treatment.
Background: Perfusion abnormalities in the infarct and salvaged penumbra have been proposed as a potential reason for poor clinical outcome (modified Rankin Scale score >2) despite complete angiographic reperfusion (Thrombolysis in Cerebral Infarction [TICI3]). In this study, we aimed to identify different microvascular perfusion patterns and their association with clinical outcomes among TICI3 patients.
Methods: University Hospital Bern's stroke registry of all patients between February 2015 and December 2021.
Background: The superiority of endovascular thrombectomy (EVT) over medical management was not established in two early basilar artery occlusion (BAO) randomized controlled trials. Despite this, many clinicians recommended EVT for acute BAO under certain circumstances. This paper aims to compare physicians' diagnostic and management strategies of BAO according to gender.
View Article and Find Full Text PDFArticle Synopsis
- Early diagnosis of occult cancer in acute ischemic stroke (AIS) patients might lead to quicker treatment and better outcomes, prompting this study to compare mortality rates based on when cancers were diagnosed.
- The research analyzed data from AIS patients treated between 2015 and 2020, finding that out of 3894 patients, 1.5% were diagnosed with new cancer within a year, with a nearly even split between those diagnosed during hospitalization and after discharge.
- Results indicated no significant difference in long-term mortality between the two groups, suggesting that the timing of cancer diagnosis does not impact survival rates, highlighting the need for larger studies to verify these findings.
Article Synopsis
- Researchers developed a 9-point score to predict positive outcomes for patients undergoing endovascular therapy (EVT) in late-presenting strokes (6-24 hours after last known well), based on a multinational study involving over 3,200 patients.
- The score takes into account factors like age, early CT changes, and stroke severity, with higher scores indicating a better chance of functional recovery at 90 days compared to those receiving only medical management.
- Validation of the score showed it is a useful tool for estimating EVT outcomes, particularly benefiting patients with lower to midrange scores in terms of good functional results and independence.
Article Synopsis
- The study aimed to understand how time from symptom onset affects D-dimer levels in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA), as this knowledge may help identify other thrombotic conditions.
- A total of 2467 AIS patients and 708 TIA patients were analyzed, finding that D-dimer levels were higher in AIS patients compared to TIA patients, with distinct fluctuations in D-dimer levels over time in AIS patients.
- The research concluded that while D-dimer levels in AIS patients change significantly after symptoms begin, TIA patients do not show these time-dependent variations, indicating the need for further studies to better utilize D-dimer as a biomarker in acute stroke cases.
Article Synopsis
- The PROCEED model was developed to predict persistent perfusion deficit (PPD) in patients after thrombectomy who have incomplete blood flow restoration, and this study aimed to validate its effectiveness using data from multiple centers.
- Researchers used data from two clinical trials and a cohort from the Medical University of Graz to assess how well the model can predict PPD, analyzing metrics like discrimination and calibration accuracy.
- Results showed the model performed well, accurately identifying PPD in 38% of 371 patients, and offering the potential to reduce unnecessary medical interventions while maintaining the identification of patients with PPD.
Article Synopsis
- The study investigates the effectiveness of two anesthesia methods—general anesthesia (GA) and conscious sedation (non-GA)—for patients undergoing endovascular treatment for isolated posterior cerebral artery (PCA) occlusion stroke.
- Researchers analyzed data from the PLATO study focusing on patient outcomes such as the modified Rankin Scale scores after 90 days, as well as successful reperfusion rates and safety measures like intracranial hemorrhage.
- Results show that while both anesthesia methods had similar functional outcomes and safety profiles, GA was associated with significantly higher rates of successful reperfusion during treatment.
Article Synopsis
- Posterior cerebral artery occlusion (PCAo) can lead to long-term disabilities, and this study compares the effectiveness of endovascular thrombectomy (EVT), both with and without intravenous thrombolysis (IVT), against IVT alone for treating PCAo.
- The study analyzed data from 724 patients treated within 24 hours of PCAo onset, measuring outcomes like functional independence and early neurological improvement over a three-month period.
- Results indicated that EVT did not improve overall functional outcomes compared to IVT alone; however, it increased the likelihood of early improvement, but also raised risks of symptomatic intracranial hemorrhage and mortality.
Article Synopsis
- Cancer patients have a higher risk of acute ischemic stroke (AIS) and may have a cardiac right-to-left shunt (RLS), but the relationship between RLS and cancer in AIS is unclear.
- In a study of 2,236 AIS patients, only 4.6% had active cancer, and RLS was found less frequently in these patients compared to those without cancer.
- The findings suggest that arterial causes could be more significant than paradoxical embolism in cancer-related strokes, indicating a need for further research on treatment options like patent foramen ovale (PFO) closure for these patients.
Introduction: The benefit of endovascular therapy (EVT) among stroke patients with large ischemic core (ASPECTS 0-5) in the extended time window outside of trial settings remains unclear. We analyzed the effect of EVT among these stroke patients in real-world settings.
Patients And Methods: The CT for Late Endovascular Reperfusion (CLEAR) study recruited patients from 66 centers in 10 countries between 01/2014 and 05/2022.
Article Synopsis
- The study investigates the effectiveness of endovascular treatment (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion (iPCAO) during acute ischemic strokes, lacking prior randomized trial evidence.
- Results show that EVT leads to better functional outcomes for patients with more severe stroke symptoms (NIHSS >6), but not for those with milder symptoms (NIHSS ≤6).
- Additionally, while EVT improves outcomes, it is also linked to a higher occurrence of symptomatic intracranial hemorrhages, regardless of initial stroke severity.
Background And Objectives: There is uncertainty whether patients with large vessel occlusion (LVO) presenting in the late 6-hour to 24-hour time window can be selected for endovascular therapy (EVT) by noncontrast CT (NCCT) and CT angiography (CTA) for LVO detection. We evaluated the clinical outcomes of patients selected for EVT by NCCT compared with those medically managed in the extended time window.
Methods: This multinational cohort study was conducted at 66 sites across 10 countries.
Background And Purpose: Contrast staining is a common finding after endovascular treatment of acute ischemic stroke. It typically occurs in infarcted tissue and is considered an indicator of irreversible brain damage. Contrast staining in noninfarcted tissue has not been systematically investigated.
View Article and Find Full Text PDFBackground And Purpose: Flat-panel detector CT immediately after mechanical thrombectomy can detect complications, including early hemorrhagic transformation and subarachnoid hyperdensities. The clinical significance of subarachnoid hyperdensities in patients undergoing mechanical thrombectomy remains unclear.
Materials And Methods: We studied 223 patients who underwent mechanical thrombectomy for anterior circulation stroke who had flat-panel detector CT performed immediately after the procedure and had follow-up imaging within 24 hours.
Article Synopsis
- - The study compared flat-panel detector computed tomography perfusion (FDCTP) with conventional multidetector computed tomography perfusion (MDCTP) in analyzing patients with acute ischemic stroke, specifically those who underwent mechanical thrombectomy.
- - Results indicated strong correlations between FDCTP and MDCTP for manually segmented hypoperfused tissue volumes, yet showed lower correlations for direct quantitative comparisons, implying FDCTP may underestimate some values compared to MDCTP.
- - Overall, while FDCTP and MDCTP offered comparable qualitative results in measuring perfusion maps, the direct quantitative assessment had limitations, suggesting the need for improved normalization techniques for accurate evaluations.
Background: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) may cause ischaemic stroke and intracranial haemorrhage. The aim of our study was to assess the frequency of the afore-mentioned outcomes.
Methods: We performed a PROSPERO-registered (CRD42022355704) systematic review and meta-analysis accessing PubMed until 7 November 2022.
Background And Purpose: The value of intravenous thrombolysis (IVT) in eligible tandem lesion patients undergoing endovascular treatment (EVT) is unknown. We investigated treatment effect heterogeneity of EVT + IVT versus EVT-only in tandem lesion patients. Additional analyses were performed for patients undergoing emergent internal carotid artery (ICA) stenting.
View Article and Find Full Text PDFIntroduction: Covert brain infarcts (CBI) are frequent incidental findings on MRI and associated with future stroke risk in patients without a history of clinically evident cerebrovascular events. However, the prognostic value of CBI in first-ever ischemic stroke patients is unclear and previous studies did not report on different etiological stroke subtypes. We aimed to test CBI phenotypes and their association with stroke recurrence in first-ever ischemic stroke patients according to stroke etiology.
View Article and Find Full Text PDFBackground: Immediate non-contrast post-interventional flat-panel detector CT (FPDCT) has been suggested as an imaging tool to assess complications after endovascular therapy (EVT). We systematically investigated a new imaging finding of focal hyperdensities correlating with remaining distal vessel occlusion after EVT.
Methods: A single-center retrospective analysis was conducted for all acute ischemic stroke patients admitted between July 2020 and December 2022 who underwent EVT and immediate post-interventional FPDCT.
Background: The association between sex and outcome after endovascular thrombectomy of acute ischemic stroke is unclear. The aim of this study was to compare the clinical and safety outcomes between men and women treated with endovascular thrombectomy in the late 6-to-24-hour window period.
Methods: This multicenter, retrospective observational cohort study included consecutive patients who underwent endovascular thrombectomy of anterior circulation stroke in the late window from 66 clinical sites in 10 countries from January 2014 to May 2022.