scholarly journals Identification of embolic stroke in patients with large vessel occlusion: The Chinese embolic stroke score, CHESS

2021 ◽  
Author(s):  
Lan Hong ◽  
Longting Lin ◽  
Gang Li ◽  
Jianhong Yang ◽  
Yu Geng ◽  
...  
Keyword(s):  
Embolic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Abstract P558: Identification of Embolic Stroke in Patients With Large Vessel Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lan Hong ◽  
Longting Lin ◽  
Gang Li ◽  
Jianhong Yang ◽  
Geng Yu ◽  
...  
Keyword(s):  
Perfusion Imaging ◽  
Delay Time ◽  
Validation Cohort ◽  
Embolic Stroke ◽  
Large Vessel ◽  
Smoking History ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Derivation Cohort ◽  
History Of

Objective: To develop a simple and objective score using clinical variables and quantified perfusion measures to identify embolic stroke with large vessel occlusions. Methods: Eligible patients from the Chinese centers participating in the International Stroke Perfusion Imaging Registry were included in this study. Patients were split into a derivation cohort (n=213) and a validation cohort (n=116). A score was developed according to the coefficients of independent predictors of embolic stroke from stepwise logistic regression model in the derivation cohort. The performance of the score was validated by assessing its discrimination and calibration. Additionally, a comparison between the area under curve (AUC) of history of atrial fibrillation (AF) alone and history of AF plus the score was also conducted. Results: The independent predictors of embolic stroke made up the Chinese Embolic Stroke Score (CHESS). There were: age (≥64 years, 1 point), non-smoking history (1 point), non-hypertension history (1 point) , baseline NIH Stroke Scale (≥14, 1 point) and delay time>6s volume/delay time>3s volume on perfusion imaging (≥0.23, 2 points). The AUC of CHESS in the derivation cohort and validation cohort were 0.80 and 0.72 respectively. Calibration tests indicated high agreement between predicted and observed probabilities. The AUC of AF-plus-CHESS compared to history of AF alone was significant (derivation cohort P<0.001; validation cohort P=0.01). Conclusions: In a Chinese population, CHESS reliably and independently identified embolic stroke as the cause of large vessel occlusion.

scholarly journals Thrombectomy for Treatment of Acute Stroke in the COVID-19 Pandemic

2020 ◽  
pp. 1-6
Author(s):  
Panagiotis Papanagiotou ◽  
Guillermo Parrilla ◽  
L. Creed Pettigrew
Keyword(s):  
Acute Stroke ◽  
Embolic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Novel Coronavirus

This commentary will focus on the role of thrombectomy for the treatment of embolic stroke during the 2019 novel coronavirus disease (COVID-19). We will begin with review of recently promulgated guidelines for use of thrombectomy in COVID-19-associated stroke. We will then survey the reported experience of thrombectomy applied to treatment of large-vessel occlusion (LVO) stroke in COVID-19. We will conclude by discussing unusual challenges confronted by neuro-interventionalists seeking to perform thrombectomy in COVID-19 patients with acute LVO stroke.

Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration

2020 ◽  
Vol 132 (4) ◽  
pp. 1202-1208 ◽  
Author(s):  
Dong-Hun Kang ◽  
Woong Yoon ◽  
Byung Hyun Baek ◽  
Seul Kee Kim ◽  
Yun Young Lee ◽  
...  
Keyword(s):  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Large Vessel ◽  
Binary Logistic Regression Analysis ◽  
Large Vessel Occlusion ◽  
Front Line ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Atherosclerotic Stenosis ◽  
Antegrade Flow

OBJECTIVEThe optimal front-line thrombectomy choice for primary recanalization of a target artery remains unknown for patients with acute large-vessel occlusion (LVO) and an underlying intracranial atherosclerotic stenosis (ICAS). The authors aimed to compare procedural characteristics and outcomes between patients who received a stent-retriever thrombectomy (SRT) and patients who received a contact aspiration thrombectomy (CAT), as the front-line approach for treating LVO due to severe underlying ICAS.METHODSOne hundred thirty patients who presented with acute LVO and underlying severe ICAS at the occlusion site were included. Procedural characteristics and treatment outcomes were compared between patients treated with front-line SRT (n = 70) and those treated with front-line CAT (n = 60). The primary outcomes were the rate of switching to an alternative thrombectomy technique, time from groin puncture to initial reperfusion, and duration of the procedure. Initial reperfusion was defined as revealing the underlying culprit stenosis with an antegrade flow after thrombectomy.RESULTSThe rate of switching to an alternative thrombectomy after failure of the front-line technique was significantly higher in the CAT group than in the SRT group (40% vs 4.3%; OR 2.543, 95% CI 1.893–3.417, p < 0.001). The median time from puncture to initial reperfusion (17 vs 31 minutes, p < 0.001) and procedure duration (39 vs 75.5 minutes, p < 0.001) were significantly shorter in the SRT group than in the CAT group. In the binary logistic regression analysis, a longer time from puncture to initial reperfusion was an independent predictor of a 90-day poor (modified Rankin Scale score 3–6) functional outcome (per 1-minute increase; OR 1.029, 95% CI 1.008–1.050, p = 0.006).CONCLUSIONSThe authors’ results suggest that SRT may be more effective than CAT for identifying underlying culprit stenosis and therefore considered the optimal front-line thrombectomy technique in acute stroke patients with LVO and severe underlying ICAS.

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