SVIN 2021 Annual Meeting Late‐Breaking Abstracts
2023; Wiley; Volume: 3; Issue: 3 Linguagem: Inglês
10.1161/svin.01.suppl_1.000254
ISSN2694-5746
Tópico(s)Optical Imaging and Spectroscopy Techniques
ResumoHomeStroke: Vascular and Interventional NeurologyAhead of PrintSVIN 2021 Annual Meeting Late‐Breaking Abstracts Open AccessAbstractPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessAbstractPDF/EPUBSVIN 2021 Annual Meeting Late‐Breaking Abstracts Originally published31 Jan 2023https://doi.org/10.1161/SVIN.01.suppl_1.000254Stroke: Vascular and Interventional Neurology. 2023;0:e000155Continuous Non‐Invasive Monitoring of Vasospasm in Subarachnoid Hemorrhage Using Next‐Generation Optical SpectroscopyTigran Khachatryan, MD, PhD1, Masih Rafi, MD1, Amit Chaudhari, MD, PhD1, Ariana Aini, BS1, Shirin M Dara, MD1, Tyler Irani, MS1, Kevin Wei, MS1, Megan Keys, MS1, Robert V Warren, PhD1, Yukio Ueda, MD2, Robert Wilson, PhD1, Yama Akbari, MD, PhD11University of California, irvine, Irvine, California, United States of America; 2Central Research Laboratory, Hamamatsu Photonics K. K., Hamamatsu City, JapanIntroductionDelayed Ischemic Neurological Deficit from cerebral vasospasm is responsible for 19.7% of mortality after aneurysmal subarachnoid hemorrhage (aSAH) and results in permanent disability in 25% of survivors1.2. Time‐Resolved Spectroscopy (TRS) is a promising method for early detection of vasospasm because it can provide continuous monitoring of tissue hemodynamics, as compared with Transcranial Doppler (TCD) ultrasound, which provides only a spot reading. TRS is a diffuse optical method that analyzes the temporal profile of detected photons to separately quantify tissue absorption (μa) and scattering (μs’) coefficients. This technique allows more rigorous characterization of hemodynamics (related to μa) and tissue morphology (related to μs’) than conventional Near Infrared Spectroscopy (NIRS). Ohmae et al.3 used TRS system to measure cerebral blood volume and oxygenation differences before and after administering acetazolamide to healthy subjects. Yokose et al.4 monitored hemodynamic changes in SAH using TRS. However, these previous studies used 3‐wavelength systems, whereas our study is, to our knowledge, the first to use a next‐generation 6‐wavelength TRS device to monitor cerebral water and lipid content along with hemodynamics in SAH. Here we validate 6‐wavelength TRS against TCD, heart rate, and blood pressure in SAH patients.MethodsThis is an IRB‐approved case series of aSAH patients in early stages of enrollment. Patients were treated by standard aSAH pathway and underwent TCD ultrasound from day one of admission until discharge from the intensive care unit. After obtaining written consent from a legal representative, the TRS device was applied to the forehead for 4 hours per day over a 1 week post‐SAH monitoring period.The TRS device enables measurements of oxyhemoglobin, deoxyhemoglobin, and total hemoglobin concentrations (ctHbO2, ctHb, ctHbTot), representative of cerebral perfusion. We compared TRS data with TCD ultrasound data and other parameters affecting cerebral perfusion (intracranial pressure, mean arterial pressure (MAP), heart rate, volume status).ResultsAs of this report, 2 patients (Hunt&Hess‐2, Fisher‐3) were enrolled. Patient#1 developed mild asymptomatic vasospasm with MCA velocities increased to 186 and 153 on the right and left hemispheres, MAPrespectively, by Day 12 post‐SAH. TCD data correlated negatively with ctHbO2, ctHb, and ctHbTot. During the same period, the patient maintained positive fluid balance and experienced a gradual increase in and heart rate, indicating that the cerebral perfusion changes were not related to lower cardiac output but to vasospasm (Figure 1). Patient#2 did not develop elevated MCA velocity and remained asymptomatic, with stable TRS‐measured hemodynamics, throughout the study period.ConclusionsPreliminary data suggest the promise of TRS for non‐invasively monitoring cortical microcirculation in aSAH. More patients are being enrolled to assess the validity and reproducibility of these presented results.Key Words: CBF Monitoring, Neuromonitoring, Subarachnoid Hemorrhage, TCD, VasospasmFinancial Disclosures: The authors had no disclosures.Grant Support: This study is funded by an investigator‐initiated sponsored contract (HP‐5568330; Co‐PIs Akbari and Wilson) with Hamamatsu Photonics.Establishing Last Electrically Well: Identification of Intra‐Operative Early Cerebral Ischemia through Neurophysiologic MonitoringKeiko A Fukuda, MD1, Ammar Bata, MD1, Alaina Giacobbe, MD1, Jacob Frenchman, BS2, Katherine Anetakis, MD1, Donald J Crammond, PhD1, Jeffrey Balzer, PhD1, Bradley Gross, MD1, Ashutosh Jadhav, MD, PhD3, Parthasarathy D Thirumala, MD11University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America; 2University of Pittsburgh, Pittsburgh, United States of America; 3Barrow Neurological Institute, Phoenix, Arizona, United States of AmericaIntroductionTimely detection of early cerebral ischemia is critical to favorable post‐procedural outcomes. However, no clear guidelines for the application of intra‐operative neurophysiological monitoring (IONM) in surgical cases exist. IONM can detect the onset of neurological dysfunction and define when the patient was last electrically well (LEW). Determining LEW is of particular interest to identify potential candidates for endovascular thrombectomy (EVT) as post‐operative patients are typically not eligible for thrombolytic therapy. In this case series, we aim to better establish LEW and its potential in triaging, optimizing management, and improving clinical outcomes following complications, such as intra‐operative stroke (IOS).MethodsWe performed a retrospective analysis of a prospectively maintained IONM database from September 2013‐December 2019. Patients were included if they met the following criteria: (a) underwent endovascular repair of both ruptured and unruptured cerebral aneurysms, arteriovenous malformations, or arteriovenous fistulas under general anesthesia with IONM including EEG and/or SSEP; (b) developed significant EEG changes defined as >50% decrease in amplitude of background activity and/or developed significant SSEP changes defined as either > 50% amplitude reduction from baseline and/or a 10% increase in latency prolongation of the upper extremity SSEP N20 complex or the lower extremity P40 complex and (c) had a large vessel occlusion, vasospasm, or vessel rupture on neuro‐imaging.ResultsForty‐four cases were identified. Such significant changes in IONM identified 20 patients with a large vessel occlusion (LVO) in the anterior circulation, prompting thrombectomy or intra‐arterial (IA) thrombolysis with resultant successful recanalization. Six patients had vasospasm prompting IA vasodilation. Four patients received combined IA thrombolysis and vasodilation. Eight had intraoperative vessel rupture prompting embolization. IA intervention was not pursued in 6 cases due to spontaneous recanalization or distal embolization with resolution of the associated neurophysiologic changes. LEW to IA treatment and closure time ranged from 8 to 167 minutes in these cases.ConclusionsPreviously reported case series showed LEW to OR treatment and closure time ranged from 43 to 174 minutes and last known well (LKW) to treatment and closure time ranged from 66 to 321 minutes.1 This study suggests that IONM can successfully identify and rapidly treat patients suffering from early cerebral ischemia. LEW may be an appropriate marker in OR workflows to identify patients suffering from early cerebral ischemia, including LVO, for highly effective treatment, such as EVT. Given the challenges of recognizing IOS, LEW may be an appropriate surrogate to quickly identify and triage such surgical patients.Key Words: Aneurysm Embolization, Avm Embolization, Embolization, Neuromonitoring, RecanalizationFinancial Disclosures: The authors had no disclosures.Grant Support: None.Global and Gender Diversity in Authorship of Cochrane Review of Stroke: A 2021 AnalysisAhmad Ozair, MBBS(c)1, Vivek Bhat, MBBS(c)2, Shreyas Bellur, MBBS2, Nishanth R Subash, MBBS(c)11King George's Medical University, India, Lucknow, India; 2St John's Medical College, Bangalore, IndiaIntroductionThe need for equitable representation of authors in research is being increasingly recognized in the field of neurology and neurointervention. Cochrane, a non‐profit collaborative group, publishes high‐quality systematic reviews and meta‐analyses. Because of their standardized methodology, Cochrane reviews are globally perceived to be amongst the highest kinds of evidence available with their conclusions frequently influencing health policy and clinical practice in several nations worldwide. Previously, certain countries have been reported to have a disproportionately higher representation of authors for Cochrane reviews in other specialties. However, it is unknown as to what is the current state of authorship diversity in Cochrane reviews of stroke. This study aimed to determine the country‐based and gender‐based authorship patterns, along with global author collaborations patterns, in Cochrane reviews of stroke.MethodsWe searched Cochrane Library (CL) on 1st September 2021 using the topic 'stroke’, and included published reviews, protocols of unpublished reviews, and publications withdrawn from CL for updation or non‐completion. We extracted details of authors and searched online to determine their gender, attempting to capture at least one webpage, such as an institutional profile, that demonstrated their gender. Authors whose gender could not be definitively ascertained were excluded from the gender‐based analysis. Author affiliations were captured and countries were divided into high‐income countries (HICs) and LMICs based on World Bank 2022 classification. The dataextracted were cross‐verified by a second author for accuracy.ResultsA total of 209 publications were included having been published by September 1, 2021, having 950 co‐authors cumulatively. These coauthors found a disproportionately high representation from high‐income countries (HICs), with the top‐5 nations being the United Kingdom (33.3%), China (16.7%), Australia (8.2%), Netherlands (8.2%), and Italy (6.74%). Extremely low representation from low and lower‐middle‐income countries (LMICs) was found (Fig.1). Women were found to be well represented amongst the total number of coauthors (48.5%), first authors (50.6%), and corresponding authors (50.3%).ConclusionsAuthors from high‐income countries continue to be the biggest contributors to the highest‐quality evidence in stroke, with the highest representation from the UK and China. Despite their high contribution to the global stroke literature, the US and Canada find surprisingly much lower representation in authorship of Cochrane stroke reviews. Capacity‐building efforts are warranted for equitable global representation and the involvement of neurointerventionalists in Cochrane.Key Words: Acute Stroke, Clinical Trial, Epidemiology, Ischemic And Hemorrhagic StrokeFinancial Disclosures: The authors had no disclosures.Grant Support: None.Global Disparities in Access to Mechanical Thrombectomy for Large Vessel Occlusion Stroke: An MT2020+ ReportKaiz S Asif, MD1, Fadar O Otite, MD2, Nabeel A Herial, MD3, Siddharth Galav, Associate Consultant4, Shashvat Desai, MD5, Adam Dmytriw, MD6, Priyank Khandelwal, MD7, Jennifer Potter‐Vig, PhD8, Ashutosh Jadhav, MD9, Santiago Ortega, MD10, Violiza Inoa, MD11, Fawaz Al‐Mufti, MD12, Viktor Szeder, MD13, Tanzila Kulman, MD14, Victor C Urrutia, MD15, Hesham Masoud, MD16, Gabor Toth, MD17, Kaustubh Limaye, MD18, Alicia C Castonguay, PhD19, Mehari Gebreyohanns, MD20, Carlos Molina, MD21, Thomas Leung, MD22, Ossama Y Mansour, MD23, Andrew Demchuk, MD24, Sheila Martins, MD25, P.N Sylaja, MD26, Zhongrong Miao, MD27, Dileep R Yavagal, MD28, Global Executive Committee MT 2020+, Members291AMITA Health and University of Illinois ‐ Chicago (UIC), naperville, United States of America; 2State University of New York Upstate Medical University, New York, New York, United States of America; 3Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America; 4Orbees Medical, Hyderabad, India; 5Barrow Neurological Institute, Phoenix, Arizona, United States of America; 6Brigham and Women's Hospital, Boston, Massachusetts, United States of America; 7Rutgers New Jersey Medical School, New Jersey, New Jersey, United States of America; 8MT2020+, Miami, United States of America; 9Barrow Neurological Institute, Phoenix, Arizona, United States of America; 10University of Iowa Hospitalsand Clinics, Iowa City, Iowa, United States of America; 11Semmes Murphey Clinic, Memphis, Tennessee, United States of America; 12Westchester Medical Center, New York, New York, United States of America; 13Ronald Reagan UCLA Medical Center, Los Angeles, California, United States of America; 14MidAtlantic Epilepsy and Sleep Center, Bethesda, Maryland, United States of America; 15The Johns Hopkins Hospital, Baltimore, Maryland, United States of America; 16SUNY Upstate Medical University, New York, New York, United States of America; 17Cleveland Clinic, Cleveland, Ohio, United States of America; 18Indiana University School of Medicine, Indianapolis, Indiana, United States of America; 19University of Toledo, Toledo, Ohio, United States of America; 20UT Southwestern Medical Center, Dallas, Texas, United States of America; 21Hospital Universitari Vall d'Hebron, Barcelona, Spain; 22The Chinese University of Hong Kong, Hong Kong, Hong Kong; 23Alexandria University Hospital, Alexandria, Egypt; 24Cumming School of Medicine, University of Calgary, Calgary, Canada; 25Medical School of Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 26Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India; 27Beijing Tiantan hospital, Beijing, China; 28University of Miami & Jackson Memorial Hospitals, Miami, Florida, United States of America; 29Worlwide, Worldwide, United States of AmericaIntroductionMechanical Thrombectomy (MT) is a highly effective treatment for large vessel occlusion (LVO) stroke. At a global level, the inequities in MT access amongst countries have not been studied. We conducted a survey of a global cohort of countries to study factors affecting MT access and to estimate the number of MT operators and centers needed country‐wise to meet the deficit.MethodsAn electronic survey was distributed to 75 MT2020+ Regional Committees between November 22, 2020, to February 28, 2021. MT access rate was defined as the proportion of estimated LVO patients receiving MT. Determinants of MT access rate were analyzed using regression analysis. We assumed each country's LVO incidence as 20% of the total incident ischemic strokes based on the global burden of disease (GBD) database. Also, based on an assumption of an optimal MT volume per operator of 50 and an optimal MT volume per center of 150, we defined the following indices: optimal MT operator index [(one MT operator/optimal number of LVO) x 100 = 1/50 × 100 = 2] and optimal MT center index [(one MT center/optimal number of LVO) × 100 = 1/150 × 100 = 0.67]. The current MT center and operator indices were then calculated for each country as [(Current number of MT operators or centers/Optimal number of LVO) ×100].ResultsA total of 887 survey responses from 67 countries were received with a response rate of 89% (67/75). Complete responses (702) from 59 countries were analyzed. The median MT access was 2.76% (interquartile range [IQR] 0.66–14.70). There were significant differences in MT access rate amongst countries grouped by their per capita gross national income (GNI) with high‐income countries (HICs) at 23.01% (IQR, 10.04–32.65), Upper middle‐income countries (UMICs) at 2.76% (IQR, 1.36–6.24) and low/lower‐middle‐income countries (LMICs) at 0.48% (IQR, 0.00–1.13). On multivariate regression models, MT access rate correlated with per capita GNI of the country (comparing HICs to LMICs ‐ β: ‐1.97; 95% CI, ‐2.70 to ‐1.24, P <0.001), reimbursement (β 0.69; CI 0.19 to 1.19, P = 0.008), MT operator index (β: 0.85%, CI 0.30 to 1.39, P = 0.003) and MT center index (β: 2.01, CI ‐ 0.96 to 3.06, P <0.001). MT access was <1.0% for 18 (70%) of the analyzed countries and it was zero for 7 (11%) of them. China and India had the largest absolute MT center and MT operator deficit.ConclusionsMT access rate is low worldwide with vast disparities amongst countries. The significant determinants of access are the country's per capita GNI, availability of reimbursement for MT, and their operator and center indices. Global health initiatives are critically needed to address these inequities and deficits.Key Words: Acute Ischemic Stroke Intervention, Acute Stroke, Endovascular Therapy, Ischemic Stroke, StrokeFinancial Disclosures: The authors had no disclosures.Grant Support: None.Identifying the More Appropriate Treatment For Cerebral Aneurysms in Elderly Patients: Clipping Versus CoilingAndrew Lekarczyk, Medical Student1, Arjun Adapa, Medical Student1, Sreehari Panicker, Medical Student11University of Michigan Medical School, Ann Arbor, Michigan, United States of AmericaIntroductionCerebral aneurysms are a major cause of morbidity and mortality in patients over 60 years of age. Currently, the 2 most common treatment modalities used for these aneurysms are neurosurgical clipping and endovascular coiling. While numerous studies have compared outcomes between these 2 modalities for ruptured and unruptured aneurysms, which of these is the more appropriate choice of treatment in the elderly population remains an understudied question. We hypothesize that clipping will result in higher rates of aneurysmal occlusion and a better clinical outcome compared with coiling.MethodsA meta‐analysis was conducted in accordance with PRISMA guidelines. Five hundred and fifty studies related to cerebral aneurysms were identified through a literature search, and assessed for their relevance. Of these, 337 were eliminated after title and abstract review. The remaining 213 studies were reviewed in full, and 13 were found to have data suitable for the meta‐analysis.ResultsPatients who underwent endovascular coiling had significantly decreased odds of complete aneurysmal occlusion compared with patients who underwent neurosurgical clipping (Odds ratio [OR] 0.37; 95% CI, 0.19–0.71). Patients who underwent coiling had decreased odds of a good clinical outcome (OR, 0.91; 95% CI, 0.24–3.43), defined as mRS (modified Rankin scale) 0–2, and death (OR, 1.26; 95% CI, 0.14–11.29), but these findings were not statistically significant. These results are shown in the included figures.ConclusionsNeurosurgical clipping is associated with a higher probability of aneurysmal occlusion in the elderly compared with endovascular coiling. However, no significant difference in clinical outcomes or mortality was seen between these 2 approaches. Consequently, the appropriate treatment should be determined by the clinician's expertise and patient preference, giving consideration to the size and location of the aneurysm.Key Words: Acute Stroke, Aneurysm, Clipping, Coiling, EndovascularFinancial Disclosures: The authors had no disclosures.Grant Support: None.Mechanical Thrombectomy In A Patient With Severe Pre‐Stroke Disability: A Case ReportPrateeka Koul, Neurology1, Prateeka Koul, Neurology1, Kevin Shah, Neurosurgery1, Timothy White, Neurosurgery1, Athos Patsalides, Neurosurgery1, Richard Libman, Vascular Neurology11Northwell Health, Manhasset, New York, United States of AmericaIntroductionSeveral mechanical thrombectomy trials for acute ischemic stroke since 2015 have been instrumental in expanding the time window and outlining appropriate patient selection for those with large vessel occlusions. However, there are no randomized clinical trials to date evaluating patients with high baseline mRS scores (i.e. with significant preexisting disability). Several observational studies exist that demonstrate patients with pre‐stroke mRS 3 (or moderate disability) did not have an increase in disability as compared with patients with pre‐stroke mRS 0–2 (none to mild disability). We present a patient with severe baseline disability who underwent mechanical thrombectomy.MethodsCase report and literature review.Results78‐year‐old man with history of Parkinson's disease, HTN, HLD, presented as transfer for stroke rescue for right hemiparesis and anisocoria. Upon examination patient had mild dysarthria, expressive aphasia, mild right nasolabial flattening, right arm and leg drift. Initial CT angiography head and neck from outside hospital demonstrated thrombus in basilar artery. He received tPA at the outside hospital, and his anisocoria resolved after its administration. His NIHSS was 8 upon arrival to our institution and after discussion with his nursing home, baseline mRS was found to be 5. Repeat CT head noncontrast demonstrated right occipital subacute infarct, CT angiography head and neck re‐demonstrated non‐occlusive distal basilar thrombus, CT perfusion demonstrated 0 cc core infarct and 119 cc penumbra. He was taken to the angiography suite and underwent mechanical thrombectomy with TICI 2B reperfusion. He demonstrated improvement in language fluency and with his right side moving well against gravity without drift. However, given the severity of his Parkinson's disease, he had significant pre‐stroke truncal instability, thus requiring significant assistance. His dysarthria fluctuated throughout his hospital course and his nasolabial flattening was unchanged. Patient was discharged with mRS 5 back to his nursing home with physical therapy services.ConclusionsExpanding the time window for mechanical thrombectomy has significantly increased the number of patients eligible for endovascular intervention for large vessel occlusions. Defining pre‐stroke disability, however, may be nuanced, and the benefit of mechanical thrombectomy to prevent progression of established disability is not well‐studied. Randomized clinical trials are warranted to evaluate this population and the potential for benefit from mechanical thrombectomy.Key Words: Acute Ischemic Stroke Intervention, Acute Stroke, Functional Recovery In Stroke, Ethics, Interventional NeuroradiologyFinancial Disclosures: The authors had no disclosures.Grant Support: None.Reduced Racial and Ethnic Disparities in Acute Stroke Care through TelestrokeMark McDonald , MD, MS1, Theresa Sevilis, DO1, Amanda Avila, MD1, Gregory Heath, DHSc, MPH2, Hsiong Chen, MD1, Michelle Boudreau, MD1, Mohammed Zaman, MD1, Thomas Devlin, MD, PhD31TeleSpecialists, LLC, Fort Myers, Florida, United States of America; 2University of Tennessee‐Chattanooga, Chattanooga, Tennessee, United States of America; 3University of Tennessee Health Science Center, Memphis, Tennessee, United States of AmericaIntroductionPrevious research suggests ethnic and racial differences in acute stroke care including thrombolytic treatment rates. There is conflicting evidence from statewide programs that telestroke may mitigate such disparities. This study evaluates ethnic or racial differences in acute stroke treatment within a multi‐state telestroke program.MethodsData from acute telestroke consultations seen in the emergency department in 203 facilities and 23 states between January 1, 2012 to April 30, 2021 were extracted. These cases were reviewed for age, race, ethnicity, sex, last known normal time, arrival time, treatment with thrombolytic therapy, door‐to‐needle (DTN) time, reasons for not treating with thrombolytic therapy, baseline NIH Stroke Scale score, and premorbid modified Rankin Score. Race was defined as Black, White, or Other. Ethnicity was defined as Hispanic or non‐Hispanic. Thrombolytic treatment rates were compared among race and ethnic groups.ResultsA total of 13 221 patients were included in the study. Among these, 2,048 patients were Black, 9,890 were White, and 1,283 patients were classified as Other. A total of 934 patients were Hispanic and 12,287 patients were non‐Hispanic. There was no significant difference in thrombolytic treatment rates between White (7.9%) versus non‐White patients (7.4%), p = 0.36, or Black (8.1%) versus non‐Black patients (7.8%), p = 0.59. DTN times did not significantly differ by race. The median LKN‐to‐arrival interval was greater for Black patients (194 minutes) as compared with non‐Black patients (166 minutes), p < 0.01. The arrival‐to‐notification median times were statistically longer for Black (9.4 minutes) as compared with non‐Black patients (9.0 minutes), p < 0.01. There was no statistically significant difference between treatment rates between Hispanic (6.3%) versus non‐Hispanic (7.9%) patients (odds ratio, 0.78; 95% CI, 0.59–1.02, p = 0.0719). DTN, LKN‐to‐arrival, and arrival‐to‐notification times did not significantly differ between Hispanic and non‐Hispanic patients.ConclusionsDespite racial differences of delay in arrival, acute stroke treatment rates and time to treatment did not differ among race in a multi‐state telestroke system. The difference in thrombolytic treatment rates associated with ethnicity did not reach statistical significance although the limited number of Hispanic patients included in the study potentially impacts its power. There was no difference in thrombolytic treatment times associated with ethnicity. Further research is needed to understand how telestroke reduces the racial and ethnic disparities associated with traditional acute stroke care delivery.Key Words: Acute Ischemic Stroke Intervention, Acute Stroke, Door To Needle, Thrombolytics, TreatmentFinancial Disclosures: The authors had no disclosures.Grant Support: Financial support for this study was provided by TeleSpecialists, LLC and the Neuroscience Innovation FoundationSafety and Effectiveness of Mechanical Thrombectomy for Acute Ischemic Stroke Using Single Plane AngiographyKrishna Amuluru, MD1, Jimmy Nguyen, MD, MS2, John Scott, MD1, Andrew Denardo, MD1, Daniel Sahlein, MD11Goodman Campbell Brain and Spine, Indianapolis, Indiana, United States of America; 2Indiana University School of Medicine, Indianapolis, United States of AmericaIntroductionThe pivotal trials studying thrombectomy for acute ischemic stroke, and nearly all clinical data are based on biplane (BP) fluoroscopy systems. However, thrombectomy may be performed on single‐plane (SP) systems due to limited resources and/or situations that necessitate triage of cases. We assessed whether thrombectomy performed on SP systems is as safe and effective as BP systems.MethodsWe performed a retrospective case control study on consecutive patients treated by thrombectomy between 7/2/20 and 7/29/21at a high‐volume practice, with patients dichotomized by SP versus BP system use. The primary outcome was follow‐up modified Rankin Score (mRS; 2–5 months), and was dichotomized (mRS ≤ 2; ‘good’ outcome). Secondary outcomes included total fluoroscopy time, contrast volume, groin‐puncture to reperfusion time, final TICI scores (‘successful’ defined as ≥TICI 2B), 24‐hour NIHSS, and procedural and peri‐procedural complications (including embolization, intra‐ and peri‐procedural hemorrhage, new/recurrent stroke, vessel injury). Mann‐Whitney U‐test was used for continuous variables. Fishers exact test was used for categorical data. Multiple logistic regression accounted for confounders including hypertension, atrial fibrillation, diabetes, hyperlipidemia, thrombectomy technique, prior stroke, IV thrombolysis, stroke onset‐to groin puncture time. Seven separate models were created, each evaluating a separate primary or secondary outcome.ResultsBaseline Characteristics: Of the 176 patients treated with emergent thrombectomy, and with complete follow‐up data, 67 (38%) and 109 (62%) were treated on SP and BP systems, respectively. Baseline characteristics did not differ significantly in regards to demographics, clinical or imaging presentations or procedural technique. Procedural Details: Procedure time (from initial groin puncture to reperfusion) did not differ significantly when comparing SP to BP systems (31 versus 32 minutes; p = 0.7 on uni‐ and multivariate analysis). However, total fluoroscopy times did differ significantly (15 versus 19 minutes; p = 0.09 and p < 0.05 on uni‐ and multivariate analysis, respectively). Patients treated on SP systems required significantly higher contrast volumes in both uni‐ and multivariate analysis (104 mL versus 65 mL; p < 0.01). Radiation dosage was significantly different (696 mGy versus 1000 mGy; p < 0.01) on univariate analysis, but was not significant in multivariate analysis. Technical and Clinical Outcomes: Successful recanalization (≥TICI 2B) did not differ significantly on univariate analysis (87% versus 88%; p = 1). Complication rate did not differ significantly on uni‐ or multivariate analysis (33% versus 41%; p = 0.3 and 0.23, respectively). Discharge NIHSS did not differ significantly (7 versus 8; p = 0.16 and p = 0.43 on uni‐ and multivariate analysis, respectively). There was no significant difference in follow‐up mRS in univariate analysis, however patients treated on SP systems had a slightly greater chance of ‘good outcome’ with multivariate analysis (p < 0.01).ConclusionsThe use of SP for thrombectomy is as safe and effective as BP systems, with similar TICI scores and complications. Patients treated on SP systems have similar, or improved functional outcome. BP angiography results in greater fluoroscopy times, although overall procedure time is similar. These results have important implications for the maximization of access to stroke care, both domestically and internationally.Key Words: Acute Ischemic Stroke Intervention, Acute Stroke, Clinical Investigations, Mechanical Thrombectomy, New TechniqueFinancial Disclosures: The authors had no disclosures.Grant Support: None.FootnotesSome meeting abstracts were removed due to the OA licensing requirements of this journal. Those abstracts are listed here: https://www.svin.org/files/Abstracts/SVIN_2021_Abstracts_Late_Breaking.pdf Previous Back to top Next FiguresReferencesRelatedDetails Article InformationMetrics © 2023 The Authors. Published on behalf of the American Heart Association, Inc., and the Society of Vascular and Interventional Neurology by Wiley Periodicals LLC.This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.https://doi.org/10.1161/SVIN.01.suppl_1.000254 Originally publishedJanuary 31, 2023 PDF download
Referência(s)