Publications by authors named "Sergio Salazar-Marioni"
Article Synopsis
- A study evaluated the safety and efficacy of endovascular thrombectomy in patients with acute large-vessel occlusion and tandem lesions, focusing on those with low (0-5) and high (6-10) Alberta Stroke Program Early Computed Tomography Scores (ASPECTS).
- The analysis included 691 patients, revealing that those with low ASPECTS had significantly lower odds of achieving a favorable functional outcome (mRS 0-2) and higher odds of suffering symptomatic intracranial hemorrhage compared to those with high ASPECTS.
- The researchers concluded that endovascular thrombectomy may lead to poorer functional recovery in patients with tandem lesions and low ASPECTS, particularly in the
Hyperglycemia Is Associated With Computed Tomography Perfusion Core Volume Underestimation in Patients With Acute Ischemic Stroke With Large-Vessel Occlusion.
Stroke Vasc Interv Neurol
July 2024
Background: CT Perfusion (CTP) predictions of infarct core play an important role in the determination of treatment eligibility in large vessel occlusion (LVO) acute ischemic stroke (AIS). Prior studies have demonstrated that blood glucose can affect cerebral blood flow (CBF). Here we examine the influence of acute and chronic hyperglycemia on CTP estimations of infarct core.
View Article and Find Full Text PDFArticle Synopsis
- The study looked at whether a medical procedure called thrombectomy helps patients who have a large stroke as seen on a specific type of scan called a noncontrast CT within 24 hours of having the stroke.
- It involved 300 patients from different hospitals who were split into two groups; one group received the thrombectomy treatment, while the other only received regular care.
- The main goal was to see if those who had thrombectomy had better recovery after 90 days compared to those who didn’t, along with checking if there were any serious side effects.
Article Synopsis
- The study examines how adding endovascular stroke therapy (EST) capabilities in community hospitals affects acute ischemic stroke (AIS) admissions in a large hospital system over a period from 2014 to 2022.! -
- Data gathered from 10 hospitals showed that community hospitals transitioning to EST-performing hospitals (EPHs) experienced a 1.9% monthly increase in AIS admissions, particularly for non-large vessel occlusion strokes, while an established EPH saw a decline in admissions and treatment rates.! -
- The findings suggest that enhancing EST availability in community settings can lead to increased AIS admissions, highlighting a shift in patient care dynamics when hospitals gain EST capabilities.!
Article Synopsis
- * Data from 670 patients revealed that while IVT may improve some outcomes, such as higher chances of achieving a modified Rankin Scale score of 0-2 in univariable analysis, this benefit was not consistently observed in more rigorous multivariable analyses.
- * Overall, the findings suggest that adjunctive IVT may not significantly enhance clinical outcomes or safety compared to MT alone for this patient population.
CLEAR Thrombectomy Score: An Index to Estimate the Probability of Good Functional Outcome With or Without Endovascular Treatment in the Late Window for Anterior Circulation Occlusion.
J Am Heart Assoc
July 2024
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
- Mechanical thrombectomy is the standard treatment for large vessel occlusions, but there's limited evidence for its effectiveness in treating distal and medium vessel occlusions, particularly for patients with low stroke scale scores (≤6).
- A study analyzed data from 41 academic centers, comparing outcomes of low versus higher stroke scale score patients who underwent thrombectomy, revealing high successful reperfusion rates in both groups.
- Results showed that patients with lower stroke scale scores experienced better functional outcomes and lower mortality rates, but the treatment's effectiveness compared to intravenous thrombolysis (IVT) is still uncertain.
Article Synopsis
- Tandem lesions involve stenosis or occlusion of the cervical internal carotid artery, often due to atherosclerosis or dissection, combined with a large vessel occlusion; this study compares patient outcomes based on the cause of ICA lesions.
- The study analyzed data from 526 patients treated endovascularly between 2015 and 2020, focusing on 90-day functional independence and various secondary outcomes, using matching methods for analysis.
- Results showed no differences in 90-day independence, but patients with dissection had lower successful recanalization rates and higher distal emboli incidents compared to those with atherosclerosis.
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.
Background And Purpose: We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability.
Methods: In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0-4 and LVO who underwent EVT 6-24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0-2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days.
Background: Early identification of intracranial atherosclerotic disease (ICAD) may impact the management of patients undergoing mechanical thrombectomy (MT). We sought to develop and validate a scoring system for pre-thrombectomy diagnosis of ICAD in anterior circulation large vessel/distal medium vessel occlusion strokes (LVOs/DMVOs).
Methods: Retrospective analysis of two prospectively maintained comprehensive stroke center databases including patients with anterior circulation occlusions spanning 2010-22 (development cohort) and 2018-22 (validation cohort).
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.
Rescue Therapy for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Pooled Analysis of the Society of Vascular and Interventional Neurology Registry.
Ann Neurol
August 2024
Article Synopsis
- This study aimed to compare the effectiveness of rescue therapy (RT) versus medical management (MM) in improving functional outcomes for patients who experienced a failed mechanical thrombectomy (MT).
- Analyzing data from 2011 to 2021, the research focused on patients with large vessel occlusions (LVOs) and assessed disability at 90 days using the modified Rankin Scale (mRS).
- Results showed that RT led to better functional independence, lower rates of symptomatic intracranial hemorrhage, and decreased 90-day mortality compared to MM, suggesting that RT might be a more effective treatment strategy for these patients.
Background: Studies comparing bridging intravenous thrombolysis (IVT) with direct endovascular therapy (EVT) in patients with acute ischemic stroke who present late are limited. We aimed to compare the clinical outcomes and safety of bridging IVT in patients with acute ischemic stroke due to anterior circulation large vessel occlusion who underwent EVT 6 to 24 hours after time last known well.
Methods: We enrolled patients with anterior circulation large vessel occlusion stroke and a National Institutes of Health Stroke Scale score of ≥6 from 20 centers across 10 countries in the multicenter retrospective CLEAR study (CT for Late Endovascular Reperfusion) between January 2014 and May 2022.
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.
Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study.
Clin Neuroradiol
December 2024
Background: Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients.
Methods: We conducted an international retrospective study of MeVO cases.
Article Synopsis
- Early changes in endovascular therapy (EVT) techniques for ischemic stroke can impact reperfusion outcomes, particularly after initial failed attempts.
- Switching from stent retriever (SR) to combined technique (CT) after two unsuccessful passes significantly improves chances of achieving complete/near-complete reperfusion (eTICI 2c-3).
- Adjusting strategy from contact aspiration (CA) to CT also shows improved outcomes, while changing from CA to SR had no significant benefits, highlighting the importance of flexible approaches in EVT.
Background: Endovascular therapy (EVT) stands as an established and effective intervention for acute ischemic stroke in patients harboring tandem lesions (TLs). However, the optimal anesthetic strategy for EVT in TL patients remains unclear. This study aims to evaluate the impact of distinct anesthetic techniques on outcomes in acute ischemic stroke patients presenting with TLs.
View Article and Find Full Text PDFBackground: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO.
Methods: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021.
Article Synopsis
- The study aimed to evaluate the effectiveness and safety of the pRESET LITE stent retriever for treating medium vessel occlusions in acute ischemic stroke patients.
- A retrospective analysis included 227 patients from 37 institutions, distinguishing between proximal and distal occlusions, revealing successful reperfusion rates of 85% and 97%, respectively.
- Despite a 7% complication rate and a significant percentage of patients experiencing hemorrhagic transformations, the procedure showed a favorable outcome in 58% of cases after three months.
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.
Objective: The optimal technique for treating tandem lesions (TLs) with endovascular therapy is debatable. The authors evaluated the functional, safety, and procedural outcomes of different approaches in a multicenter study.
Methods: Anterior circulation TL patients treated from January 2015 to December 2020 were divided on the basis of antegrade versus retrograde approach and included.