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Background: Faster time to recanalization leads to better clinical outcomes in patients treated with endovascular thrombectomy. Whether the association between time to recanalization and clinical outcomes depends on cerebral blood volume (CBV) obtained from pretreatment computed tomography (CT) perfusion (CTP) imaging was investigated.
Methods: In consecutive patients with acute ischemic stroke who achieved recanalization by endovascular thrombectomy for intracranial internal carotid artery or M1 occlusion, the effects on clinical outcome of time to recanalization and the relative CBV value (rCBV) assessed by pretreatment CTP were evaluated. The patient population was divided into 2 groups according to rCBV: normal rCBV group (rCBV ≥ .9) and low rCBV group (rCBV < .9). In each group, time to recanalization was compared between the good and the poor clinical outcome groups.
Results: Sixty-four patients were eligible for this study. Twenty-six patients (40.6%) achieved good clinical outcomes. In the normal rCBV group, no association was found between clinical outcome and time to recanalization. In the low rCBV group, time to recanalization from CTP (101 minutes versus 136 minutes, P = .040) was significantly shorter in the good clinical outcome group. On binary logistic regression modeling, CTP to recanalization time (odds ratio 1.035 [1.004-1.067], P = .025) was an independent predictor of good clinical outcome only in the low rCBV group.
Conclusions: The association between time to recanalization and clinical outcomes depends on rCBV obtained from pretreatment CTP. Time to recanalization is more important for good clinical outcomes in patients with low rCBV than in patients with normal rCBV.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.009 | DOI Listing |
Front Cardiovasc Med
December 2024
Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Background: The number of people undergoing maintenance hemodialysis is increasing rapidly worldwide. Central vein stenosis (CVS) is a common vascular complication in undergoing hemodialysis, especially those with a history of catheterization. This study aimed to investigate the characteristics of CVS and the clinical effectiveness of percutaneous transluminal angioplasty (PTA) alone and sequential percutaneous transluminal stenting (PTS) in hemodialysis patients with CVS.
View Article and Find Full Text PDFJ Neurointerv Surg
December 2024
Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
Background: Despite successful recanalization via mechanical thrombectomy (MT), only half of acute ischemic stroke (AIS) patients achieve functional independence. Post-MT hemodynamic features are insufficiently investigated, and the lack of bilateral comparisons limits individual assessment. Therefore, we aimed to explore how individualized hemodynamic features affect functional outcomes using quantitative digital subtraction angiography (Q-DSA).
View Article and Find Full Text PDFFront Neurol
December 2024
Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China.
Background: Clinically ineffective reperfusion (CIR) refers to the discrepancy between successful reperfusion and a favorable functional outcome in patients with large vessel occlusion (LVO) stroke after endovascular treatment (EVT). The Improving Neuroprotective Strategy for Ischemic Stroke with Sufficient Recanalization after Thrombectomy by Intra-arterial Cocktail Therapy (INSIST-CT) trial aimed to explore the safety, feasibility, and efficacy of intra-arterial cocktail therapy using argatroban, dexamethasone, and edaravone in patients who achieved sufficient reperfusion after EVT.
Methods: In this prospective, single-arm, pilot study, eligible patients with anterior circulation LVO who achieved sufficient reperfusion after EVT were enrolled in the INSIST-CT trial.
Introduction Parenteral heparin is widely used as bridging therapy while optimising oral anticoagulation(OAC). Newer Direct-Acting OACs(DOACs) attain therapeutic effect very quickly. We report the use of dabigatran as bridging therapy during warfarin optimization for cardioembolic stroke in two patients who opted to receive warfarin for long-term anticoagulation for secondary stroke prevention.
View Article and Find Full Text PDFJ Neurosurg
December 2024
Departments of1Neurological Surgery.
Objective: Endovascular intracranial aneurysm (IA) management has significantly evolved over the last 2 decades. Despite these advancements, the aneurysm recanalization rate after coil embolization remains a concern. Statins have been found to affect vascular repair and remodeling; therefore, the authors hypothesized that patients receiving statin therapy at the time of coil embolization would have lower aneurysm recurrence and retreatment rates compared with patients not receiving statin therapy.
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