Endovascular therapy of acute ischaemic stroke by interventional cardiologists: single-centre experience from Turkey

2014 ◽  
Vol 10 (7) ◽  
pp. 876-883 ◽  
Author(s):  
Omer Goktekin ◽  
Abdurrahman Tasal ◽  
Huseyin Uyarel ◽  
Mehmet Akif Vatankulu ◽  
Osman Sonmez ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Therapy ◽  
Acute Ischaemic Stroke ◽  
Single Centre ◽  
Single Centre Experience

scholarly journals Contrast extravasation and outcome of endovascular therapy in acute ischaemic stroke: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044917
Author(s):  
Tao Xu ◽  
You Wang ◽  
Jinxian Yuan ◽  
Yangmei Chen ◽  
Haiyan Luo
Keyword(s):  
Systematic Review ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Acute Ischaemic Stroke ◽  
Data Extraction ◽  
Meta Analysis ◽  
Poor Functional Outcome ◽  
Eligibility Criteria ◽  
Contrast Extravasation

ObjectiveContrast extravasation (CE) after endovascular therapy (EVT) is commonly present in acute ischaemic stroke (AIS) patients. Substantial uncertainties remain about the relationship between CE and the outcomes of EVT in patients with AIS. Therefore, we aimed to evaluate this association.DesignA systematic review and meta-analysis of published studies were performed.Data sourceWe systematically searched the Medline and Embase databases for relevant clinical studies. The last literature search in databases was performed in June 2020.Eligibility criteria for study selectionWe included studies exploring the associations between CE and the outcomes of EVT in patients with AIS undergoing EVT.Data extraction and synthesisTwo reviewers extracted relevant information and data from each article independently. We pooled ORs with CIs using a random-effects meta-analysis to calculate the associations between CE and outcomes of EVT. The magnitude of heterogeneity between estimates was quantified with the I2 statistic with 95% CIs.ResultsFifteen observational studies that enrolled 1897 patients were included. Patients with CE had higher risks of poor functional outcome at discharge (2.38, 95% CI 1.45 to 3.89 p=0.001; n=545) and poor functional outcome at 90 days (OR 2.16, 95% CI 1.20 to 3.90; n=1194). We found no association between CE and in-hospital mortality (OR 0.95, 95% CI 0.27 to 3.30; n=376) or 90-day mortality (OR 1.38, 95% CI 0.81 to 2.36; n=697) after EVT. Moreover, CE was associated with higher risks of post-EVT intracranial haemorrhage (ICH) (OR 6.68, 95% CI 3.51 to 12.70; n=1721) and symptomatic ICH (OR 3.26, 95% CI 1.97 to 5.40; n=1092).ConclusionsThis systematic review and meta-analysis indicates that in patients with AIS undergoing EVT, CE is associated with higher risks of unfavourable functional outcomes and ICH. Thus, we should pay more attention to CE in patients with AIS undergoing EVT.

scholarly journals Endovascular therapy after acute ischaemic stroke—Experiences and needs of relatives

2018 ◽  
Vol 28 (5-6) ◽  
pp. 792-800 ◽  
Author(s):  
Kristina Eiskjær Sørensen ◽  
Pia Dreyer ◽  
Mads Rasmussen ◽  
Claus Z. Simonsen ◽  
Grethe Andersen
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Therapy ◽  
Acute Ischaemic Stroke

scholarly journals Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients

2019 ◽  
Vol 32 (4) ◽  
pp. 303-308 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Norio Nakajima ◽  
Hidenori Miyake ◽  
Shunichi Fukuda ◽  
Tetsuya Tsukahara
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Favourable Outcome ◽  
Modified Rankin Scale ◽  
Very Elderly ◽  
Younger Patients

Purpose: Endovascular therapy for emergent large vessel occlusion has been established as the standard approach for acute ischaemic stroke. However, the effectiveness and safety of endovascular therapy in the very elderly population has not been proved. Objective: To determine the safety and effectiveness of endovascular therapy in octogenarians and nonagenarians. Methods: We retrospectively reviewed all patients who underwent endovascular therapy at two stroke centres between April 2012 and July 2018. Functional outcome was assessed using the modified Rankin scale at 90 days after stroke or at discharge. A favourable outcome was defined as a modified Rankin scale score of 0–2 or not worsening of the modified Rankin scale score before stroke. Outcome was compared between younger patients (aged 46–79 years, n = 40) and octogenarians and nonagenarians (aged 80–97 years, n = 19). Results: Octogenarian and nonagenarian patients had pre-stroke functional deficit (modified Rankin scale score >1) more frequently than younger patients (57.9% vs. 20.0%, respectively, P = 0.0059). No difference was observed between very elderly and younger patients in the rate of successful reperfusion (89.5% vs. 67.5%, respectively, P = 0.11), favourable functional outcome (47.4% vs. 45.0%, respectively, P = 1.00) and mortality (21.1% vs. 27.5%, respectively, P = 1.00). On multiple regression analysis, successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were independent predictors of favourable outcome ( P = 0.0003, 0.015 and 0.028, respectively). Conclusions: Successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were clinical predictors of favourable outcome. However, we did not observe an age-dependent effect of clinical outcome after endovascular therapy.

scholarly journals Bolus-Infusion Delays of Alteplase during Thrombolysis in Acute Ischaemic Stroke and Functional Outcome at 3 Months

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Paul Acheampong ◽  
Margaret T. May ◽  
Gary A. Ford ◽  
Anand K. Dixit
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Medical Records ◽  
Functional Independence ◽  
Time Dependent ◽  
Single Centre ◽  
Bolus Infusion ◽  
Baseline Characteristics ◽  
The Impact ◽  
The Relationship

Background. The efficacy of alteplase in acute ischaemic stroke (AIS) is highly time dependent. Hence, alteplase is administered as soon as possible with a bolus followed by an infusion. Delays between bolus and infusion may occur, but the extent of these delays and the impact on outcome are unclear.Aims. We investigated the extent of bolus-infusion delays and the relationship between delays and stroke outcome.Method. We reviewed medical records of 276 patients who received alteplase for AIS at our centre between April, 2008, and June, 2013. Complete demographic and clinical data including 3-month modified Rankin Score (mRS) from 229 patients were analysed comparing delays of 0–8 and >8 minutes.Results. Overall mean (SD) bolus-infusion delay was 9 (7) minutes. Baseline characteristics were similar apart from more severe strokes in delays >8 minutes. Three-month outcomes were not significantly different although delays >8 minutes had lower functional independence rate (mRS 0-1: 23.1% versus 28.1%; adjusted OR 1.2 (95% CI 0.6 to 2.4,P=0.68)) and higher mortality rate (18% versus 11%, OR 1.0, 95% CI 0.6 to 1.7,P=0.95).Conclusions. In this single centre series, bolus-infusion delays of alteplase in AIS were common and no effect of bolus-infusion delays on independence and mortality was found.

scholarly journals Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027561 ◽  
Author(s):  
Russell Chabanne ◽  
Charlotte Fernandez-Canal ◽  
Vincent Degos ◽  
Anne-Claire Lukaszewicz ◽  
Lionel Velly ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
General Anaesthesia ◽  
Endovascular Therapy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Acute Pulmonary Oedema ◽  
Anterior Circulation ◽  
Randomised Controlled

IntroductionEndovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS.Methods and analysisAnesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (≤15 or >15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0–2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7.Ethics and disseminationThe AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal.Trial registration numberNCT03229148.

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