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Front Neurol 2019 2;10:308. Epub 2019 Apr 2.

Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Endovascular treatment (EVT) has become a standard treatment for acute ischemic stroke due to large vessel occlusion (LVO) in the anterior circulation. However, whether EVT tools used for intracranial atherosclerotic stenosis (ICAS)-related LVO are as safe and effective as for use in embolic LVO remains unclear. There have been only a few studies about EVT for ICAS-related LVO, and these studies revealed that mechanical thrombectomy with a stent retriever or contact aspiration was less effective and more time consuming in ICAS-related LVO than in embolic LVO. Read More

BMC Neurol 2019 Apr 15;19(1):65. Epub 2019 Apr 15.

Department of Neuroradiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.

Background: Embolectomy is the standard of care in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Aim of this study was to compare two techniques: A Direct Aspiration First Pass Technique (ADAPT) and Stent-retriever Assisted Vacuum-locked Extraction (SAVE) stratified by the occluded vessel.

Methods: One hundred seventy-one patients (71 male) treated between January 2014 and September 2017 with AIS due to LVO of the anterior circulation (55 carotid T, 94 M1, 22 M2) were included. Read More

Anat Cell Biol 2019 Mar 29;52(1):43-47. Epub 2019 Mar 29.

Department of Neurology, Narayana Medical College, Nellore, India.

Pre-communicating or A1 segment of anterior cerebral artery (A1ACA) hypoplasia can negotiate the anterior cerebral circulation. Not many studies have been examined the association of hypoplastic A1ACA and cerebral ischemic stroke (CIS). In this study the authors' want to accomplish the relationship between hypoplastic A1ACA and outcomes among the patients with CIS in Andhra Pradesh population of India. Read More

J Neuroradiol 2019 Apr 11. Epub 2019 Apr 11.

Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address:

Background And Purposes: Stroke secondary to emergent large vessel occlusions (ELVO) involving the anterior circulation can be treated with intravenous tissue plasminogen activator (IV-tPA) or thrombectomy. Data regarding the influence of the number of stentriever passes needed for vessel recanalization on outcome is lacking.

Patients And Methods: We prospectively accrued data on consecutive patients with ELVO that were treated with thrombectomy. Read More

J Stroke Cerebrovasc Dis 2019 Apr 10. Epub 2019 Apr 10.

Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China. Electronic address:

Objective: We aim to use 4D CTA with a comprehensive and objective scoring system to assess collateral circulation, and explore the value of prognosis prediction in endovascular treated patients.

Methods: Thirty-four patients with unilateral anterior circulation large vessels occlusion were reviewed in this study retrospectively. Single-phase CTA (sCTA) and 4D CTA acquired by CT perfusion scanning were analyzed for collateral circulation assessment. Read More

World Neurosurg 2019 Apr 10. Epub 2019 Apr 10.

University of Pittsburgh Medical Center, Departments of Neurology, Pittsburgh PA; Neurosurgery, Pittsburgh PA. Electronic address:

Background: Intracranial hemorrhage (ICH) can be a devastating complication of endovascular thrombectomy (ET) following acute ischemic stroke increasing disability and mortality. Patients with low platelet count were excluded from major ET trials. This study explores the association between platelet count and ICH after ET. Read More

Transl Stroke Res 2019 Apr 12. Epub 2019 Apr 12.

Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA.

The chance for a favorable outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke decreases with the symptom onset-to-reperfusion time (OTR). Patients with severe leukoaraiosis are at increased risk for a poor outcome after MT. However, whether leukoaraiosis modulates to the association between OTR and 90-day functional outcome is uncertain. Read More

J Neurointerv Surg 2019 Apr 11. Epub 2019 Apr 11.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA.

Background: Thrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to 'real-world' practice.

Objective: To compare revascularization rates and outcomes for direct aspiration (ADAPT) and stent retriever thrombectomy following anterior acute ischemic stroke (AIS) in a real-life setting. Read More

J Neurointerv Surg 2019 Apr 6. Epub 2019 Apr 6.

Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland.

Background: Mechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access. Read More

J Neuroimaging 2019 Apr 4. Epub 2019 Apr 4.

Department of Neuroradiology, Hospices Civils de Lyon, Bron, France.

Background And Purpose: Hemodynamic and metabolic impairment in intracranial atherosclerotic stenosis (ICAS) may promote stroke vulnerability particularly in borderzone areas. Perfusion and oxygen mapping magnetic resonance imaging (MRI) may provide useful information in this setting.

Methods: In this pilot study, patients with symptomatic atherosclerotic anterior circulation stenosis ≥60%, without other sources of ischemic stroke, were included. Read More

Neurol Sci 2019 Apr 4. Epub 2019 Apr 4.

Medical Faculty, Department of Diagnostic and Interventional Radiology, University Duesseldorf, Moorenstr.5, 40225, Duesseldorf, Germany.

Background And Purpose: The Aperio thrombectomy device (Aperio) is a stent retriever designed to achieve rapid and substantial flow restoration in acute ischemic stroke due to large-vessel occlusions (LVOs). We evaluated the safety and efficacy of the Aperio device and compared it with published data of established stent retrievers.

Methods: We retrospectively analyzed institutional data of consecutive stroke procedures in patients with LVO in the anterior circulation that were treated between January 2017 and December 2017 with the Aperio. Read More

Front Neurol 2019 20;10:254. Epub 2019 Mar 20.

Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia.

Elderly patients account for 30% of acute ischemic stroke (AIS) but are under-represented in randomized controlled trials of endovascular thrombectomy (EVT). Meta-analysis of "real world" studies evaluating 90-day outcomes in elderly patients ≥80 years have been limited to small numbers undergoing EVT with older generation devices. A retrospective analysis of 181 prospectively collected patients who received EVT for anterior circulation AIS at an Australian center over 2. Read More

AJNR Am J Neuroradiol 2019 Apr 4. Epub 2019 Apr 4.

From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea

Background And Purpose: Mechanical thrombectomy with proximal flow control and forced aspiration may improve the outcome of endovascular revascularization therapy for patients with acute stroke. The purpose of this study was to compare the impact of balloon-guiding catheter locations in patients treated for anterior circulation acute ischemic stroke using mechanical thrombectomy.

Materials And Methods: The influence of the balloon-guiding catheter location (proximal, balloon-guiding catheter tip proximal to C1 vertebral body; distal, between the skull base and the C1 vertebral body) was analyzed in patients with acute anterior circulation stroke treated with stent-retriever thrombectomy. Read More

Ther Adv Neurol Disord 2019 27;12:1756286419835708. Epub 2019 Mar 27.

Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, CH-3010, Switzerland.

Background And Purpose: In acute ischaemic stroke (AIS) of the anterior circulation (AC) treated with mechanical thrombectomy (MT), data point to a decline of treatment effect with increasing time from symptom onset to treatment. However, the magnitude of the decline will depend on the clinical setting and imaging selection used. The aims of this study were (1) to evaluate the clinical effect of time to reperfusion (TTR); and (2) to assess the safety and technical efficacy of MT according to strata of TTR. Read More

Stroke 2019 Apr 4:STROKEAHA119024986. Epub 2019 Apr 4.

Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea (J.H.H., H.S.N., Y.D.K.).

Background and Purpose- The effect of endovascular thrombectomy (EVT) cumulative case volume (EVT-CCV) on outcomes of acute stroke patients has not been studied. This study investigated whether EVT-CCV was associated with outcomes. Methods- We identified all patients who underwent EVT for anterior circulation large vessel occlusion. Read More

J Clin Neurosci 2019 Mar 28. Epub 2019 Mar 28.

Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address:

Our objective was to assess the impact of hs-cTnT elevation on functional outcome and mortality in AIS patients with large vessel occlusion (LVO) in the anterior circulation 3 months after ET and explore factors affecting hs-cTnT elevation. A total of 143 consecutive AIS patients with large vessel occlusion (LVO) in the anterior circulation following ET in a single stroke center were enrolled between January 2015 and November 2017. Hs-cTnT was quantitated on admission. Read More

Emerg Radiol 2019 Mar 31. Epub 2019 Mar 31.

Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, Room 377, Providence, RI, 02903, USA.

Purpose: Patients with large vessel occlusion and target mismatch on imaging may be thrombectomy candidates in the extended time window. However, the ability of imaging modalities including non-contrast CT Alberta Stroke Program Early Computed Tomographic Scoring (CT ASPECTS), CT angiography collateral score (CTA-CS), diffusion-weighted MRI ASPECTS (DWI ASPECTS), DWI lesion volume, and DWI volume with clinical deficit (DWI + NIHSS), to identify mismatch is unknown.

Methods: We defined target mismatch as core infarct (DWI volume) of < 70 mL, mismatch volume (tissue with TMax > 6 s) of ≥ 15 mL, and mismatch ratio of ≥ 1. Read More

J Stroke Cerebrovasc Dis 2019 Mar 28. Epub 2019 Mar 28.

Evidence-Based Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, China.

Background: Complex aortic plaque is a potential cause of acute ischemic cerebrovascular disease, which needs timely identification. Also as a marker for systemic atherosclerosis, complex aortic plaque may be indicated by significant (≥50%) cervicocephalic atherosclerotic stenosis. We aimed at examining whether age ranges would influence their association to more accurately estimate the risk of having complex aortic plaque in acute ischemic cerebrovascular disease. Read More

J Neurointerv Surg 2019 Mar 29. Epub 2019 Mar 29.

Neurology, Aarhus University Hospital, Aarhus, Denmark.

Background: The "General or Local Anesthesia in Intra-Arterial Therapy" (GOLIATH) trial compared infarct growth and outcome in patients undergoing endovascular therapy (EVT) under either general anesthesia (GA) or conscious sedation (CS). The results were the same for the primary outcome (infarct growth) but successful reperfusion was higher in the GA arm.

Objective: To further examine differences in the quality and safety of EVT with the two anesthetic regimens in a post hoc analysis of GOLIATH. Read More

J Stroke Cerebrovasc Dis 2019 Mar 26. Epub 2019 Mar 26.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address:

Background: Asymptomatic intracerebral hemorrhage (AICH) is a common phenomenon in patients with acute ischemic stroke (AIS) who were treated with endovascular thrombectomy (ET). This study aimed to evaluate the clinical effects of AICH and its risk factors in this patient population.

Methods: This observational study was based on a prospective registry study. Read More

Int J Stroke 2019 Mar 29:1747493019840932. Epub 2019 Mar 29.

11 Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.

Rationale: Bridging therapy with endovascular therapy (EVT) and intravenous thrombolysis (IVT) has been reported to improve outcomes for acute stroke patients with large-vessel occlusion in the anterior circulation. While the IVT may increase the reperfusion rate, the risk of hemorrhagic complications increases. Whether EVT without IVT (direct EVT) is equally effective as bridging therapy in acute stroke remains unclear. Read More

Int J Stroke 2019 Mar 27:1747493019840933. Epub 2019 Mar 27.

7 Departments of Clinical Neurosciences, Community Health Sciences, Medicine, and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background And Purpose: The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial interobserver variability impairs outcome assessment as well as reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health, we developed a comprehensive, hierarchical assessment tool (miFUNCTION) to address the shortcomings of the modified Rankin Scale and deliver a more thorough understanding of disability following stroke. Read More

J Neurol 2019 Mar 26. Epub 2019 Mar 26.

Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Objectives: To explore risk factors contributing to 30-day and long-term survival in children with a first episode of arterial ischemic stroke (AIS).

Study Design: Single center prospective observational study including 119 children aged between 30 days and 18 years, with a first episode of AIS between 2003 and 2015. Diagnosis was confirmed with magnetic resonance images. Read More

J Clin Neurosci 2019 Mar 20. Epub 2019 Mar 20.

Department of Neurosurgery, Hokuto Hospital, Obihiro, Japan. Electronic address:

Objective: Mechanical thrombectomy using a stent retriever for acute large vessel occlusion is indispensable in stroke treatment, however, vasospasm may occur. The objective of this retrospective study was to investigate which cases are more likely to experience vasospasm after thrombectomy with stent retrievers.

Methods: We included 29 patients diagnosed with acute cardiogenic cerebral embolism who were treated with stent retrievers at our facility from December 2014 to December 2017. Read More

Eur Neurol 2018 21;80(5-6):313-320. Epub 2019 Mar 21.

Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Tokyo, Japan.

Background: The functional independence measure (FIM) is a standard tool to provide a detailed evaluation of ADL of patients with disabilities. This study aimed to show the differences in FIM scores as an outcome predictor between patients with anterior circulation (AC) and posterior circulation (PC) strokes.

Methods: Consecutive patients with acute ischemic stroke hospitalized within 7 days after onset were investigated. Read More

J Chin Med Assoc 2019 Mar 11. Epub 2019 Mar 11.

School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC.

Background: Quantitative digital subtraction angiography (DSA) facilitates in-room assessment of flow changes in various cerebrovascular diseases, and improves patient safety. The purpose of this study was to compare the diagnostic accuracy of quantitative fluoroscopic angiography (FA) and DSA.

Methods: Twenty-two patients with more than 70% carotid stenosis according to NASCET criteria were prospectively included. Read More

J Stroke Cerebrovasc Dis 2019 Mar 16. Epub 2019 Mar 16.

Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, China; Department of Neurology, Zhongshan Hospital, The Union Clinical Medical school of Fujian medical university, Xiamen, China. Electronic address:

Objective: The present study aimed to evaluate the association between stress hyperglycemia ratio (SHR) and outcome at 3 months after mechanical thrombectomy (MT) for acute occlusion in the anterior circulation.

Methods: Data from 160 consecutive patients with large vessel occlusion in the anterior circulation who underwent MT from May 2013 to March 2018 were retrospectively reviewed. SHR was calculated as the fasting glucose concentration divided by the estimated average glucose concentration (derived from the glycosylated hemoglobin level). Read More

Stroke 2019 Mar 20:STROKEAHA118023758. Epub 2019 Mar 20.

Department of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada (G.J., A.Y.P., M.L., N.D., Y.D., L.C.G., C.O., C.S.).

Background and Purpose- In patients with acute stroke caused by tandem occlusion, the benefit of immediate revascularization (stenting) of the cervical internal carotid artery lesion during endovascular thrombectomy is uncertain. We sought to determine current practice patterns and whether consensus existed among physicians with stroke expertise. Methods- We distributed an online survey to stroke experts affiliated with the Canadian Stroke Consortium, the Canadian Interventional Neuro Group, the Society of Vascular and Interventional Neurology, and international ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) collaborators. Read More

Stroke 2019 Mar 20:STROKEAHA118024760. Epub 2019 Mar 20.

Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Eur Radiol 2019 Mar 18. Epub 2019 Mar 18.

Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.

Objectives: In patients with acute ischemic stroke, we aimed to investigate whether microvascular changes, as indexed by capillary transit time heterogeneity (CTH), contribute to the decline of the chance for favorable outcome over time and whether they are a predictor of an intracranial hemorrhage (ICH).

Methods: We retrospectively calculated CTH maps for 131 consecutive patients with acute ischemic stroke due to large vessel occlusion of the anterior circulation who had a relevant MRI PWI-DWI mismatch and were treated with endovascular thrombectomy (ET). Multivariable logistic regressions were conducted with favorable outcome (mRS ≤ 2 after 3 months) and occurrence of an ICH as dependent variables and the volume of mildly elevated CTH as independent variable adjusted for age, successful recanalization, hypertension, diabetes, atrial fibrillation, NIHSS score on admission, DWI lesion volume, and symptom-onset-to-treatment time (OTT). Read More

Anesth Analg 2019 Apr;128(4):706-717

From the Department of Anesthesia, The University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.

The 2018 American Heart Association stroke care guidelines consider endovascular thrombectomy to be the standard of care for patients who have acute ischemic stroke in the anterior circulation when arterial puncture can be made: (1) within 6 h of symptom onset; or (2) within 6-24 h of symptom onset when specific eligibility criteria are satisfied. The aim of this 2-part review is to provide practical perspective on the clinical literature regarding anesthesia care of endovascular thrombectomy patients. In the preceding companion article (part 1), the rationale for rapid workflow and maintenance of blood pressure before reperfusion were reviewed. Read More

Anesth Analg 2019 Apr;128(4):695-705

From the Department of Anesthesia, The University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.

In the United States, stroke ranks fifth among all causes of death and is the leading cause of serious long-term disability. The 2018 American Heart Association stroke care guidelines consider endovascular thrombectomy to be the standard of care for patients who have acute ischemic stroke in the anterior circulation when arterial puncture can be made within 6 hours of symptom onset or within 6-24 hours of symptom onset when specific eligibility criteria are satisfied. The aim of this 2-part review is to provide practical perspective on the clinical literature regarding anesthesia care of patients treated with endovascular thrombectomy. Read More

World Neurosurg 2019 Mar 15. Epub 2019 Mar 15.

Research Fellow, National Medical Research Center, Burdenko Neurosurgical Institute, Moscow, Russia.

Background: Surgeries for deep and eloquent cerebral lesions require a detailed knowledge of normal brain anatomy and accurate planning. Important parts of brain anatomy are the cerebral blood supply and collateral circulation system. In addition to well-known cortical and basal (circle of Willis) anastomoses, there is also a deep interarterial anastomotic circle that is not described in the literature. Read More

J Stroke Cerebrovasc Dis 2019 Mar 13. Epub 2019 Mar 13.

Department of Neurosurgery, State University of New York Upstate, Syracuse, New York.

Introduction: There is continued interest in identifying factors that predict a favorable outcome after endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion (ACLVO). We compared the predictive values of 2 different scoring systems for evaluating venous collateral circulation.

Methods: A retrospective review of patients who underwent EVT for ACLVO at a single institution was performed. Read More

Neurol Sci 2019 Mar 14. Epub 2019 Mar 14.

NEUROFARBA Department, University of Florence, Florence, Italy.

Background: Pre-existing small vessel disease (SVD) has been associated with poor functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis; however, there are scarce data in patients treated with endovascular therapy. We aimed to investigate the associations between SVD and clinical outcomes in patients treated with endovascular therapy.

Methods: We retrospectivel y evaluated patients with acute ischemic stroke in the anterior circulation receiving endovascular treatment. Read More

Front Neurol 2019 27;10:127. Epub 2019 Feb 27.

Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany.

A tandem occlusion of the intracranial circulation and the extracranial carotid artery (ICA) occurs in 10-20% of all strokes based on large vessel occlusion (LVO). The optimal treatment strategy for those patients is unknown. We report our management strategy and the outcome in these patients in a large single-center cohort. Read More

Pract Neurol 2019 Mar 14. Epub 2019 Mar 14.

Department of Neurology, St. George's University Hospitals NHS Foundation Trust, London, UK.

Current national guidelines advocate intravenous thrombolysis to treat patients with acute ischaemic stroke presenting within 4.5 hours from symptom onset, and thrombectomy for patients with anterior circulation ischaemic stroke from large vessel occlusion presenting within 6 hours from onset. However, a substantial group of patients presents with acute ischaemic stroke beyond these time windows or has an unknown time of onset. Read More

Stroke 2019 Apr;50(4):1017-1020

Department of Clinical Neurosciences and Community Health Sciences (M.D.H.), University of Calgary, Canada.

Background and Purpose- The ESCAPE trial (The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) was a multicentre, randomized controlled trial of endovascular thrombectomy versus standard care for patients with acute ischemic stroke that allowed patients to be enrolled with deferred consent. We investigated the knowledge and opinions of these patients or their authorized third parties about the consent process. Methods- All patients (or their authorized third parties) enrolled with deferral of consent in ESCAPE were invited to complete a 12-question survey within the first 4 days of enrollment and again at 90 days. Read More

Eur J Neurol 2019 Mar 13. Epub 2019 Mar 13.

Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.

Background: High blood pressure (BP) at presentation is associated with poor outcomes in acute ischemic stroke (AIS), but serial BP measurements may better delineate the clinical implications of BP. We aimed to investigate the association between various BP parameters and functional outcomes in AIS patients treated with endovascular thrombectomy (EVT).

Methods: This study reports a retrospective analysis of a prospective registry of a comprehensive stroke center. Read More

Interv Neuroradiol 2019 Feb 4:1591019918821074. Epub 2019 Feb 4.

4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.

Background: In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another.

Purpose: The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion.

Methods: We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. Read More

Stroke 2019 Apr;50(4):923-930

Department of Neurology (E.V., V.C., M.J.H.L.M., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam.

Background and Purpose- To assess the effect of inter-hospital transfer on time to treatment and functional outcome after endovascular treatment (EVT) for acute ischemic stroke, we compared patients transferred from a primary stroke center to patients directly admitted to an intervention center in a large nationwide registry. Methods- MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry is an ongoing, prospective, observational study in all centers that perform EVT in the Netherlands. We included adult patients with an acute anterior circulation stroke who received EVT between March 2014 to June 2016. Read More

Acta Radiol 2019 Mar 12:284185119836220. Epub 2019 Mar 12.

1 Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany.

Background: Flat detector computed tomography angiography (FDCTA) can be reconstructed from volume perfusion flat detector computed tomography (VP-FDCT). Thus, CTA equivalent stroke imaging might be feasible within the angio suite.

Purpose: To evaluate the diagnostic accuracy of FDCTA in detecting large vessel occlusion (LVO) and collateral supply in acute stroke patients. Read More

Lancet 2019 Mar;393(10175):998-1008

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Stent retriever thrombectomy of large-vessel occlusion results in better outcomes than medical therapy alone. Alternative thrombectomy strategies, particularly a direct aspiration as first pass technique, while promising, have not been rigorously assessed for clinical efficacy in randomised trials. We designed COMPASS to assess whether patients treated with aspiration as first pass have non-inferior functional outcomes to those treated with a stent retriever as first line. Read More

Cardiovasc Intervent Radiol 2019 Mar 11. Epub 2019 Mar 11.

University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 8, 3010, Bern, Switzerland.

Background And Purpose: Data on the management of large vessel occlusion in patients with anterior circulation acute ischemic stroke (AIS) due to underlying intracranial stenosis are scarce. The aim of this retrospective study was to compare endovascular treatment and outcome in AIS patients with and without underlying stenosis of the M1 segment.

Materials And Methods: A total of 533 acute stroke patients with an isolated M1 occlusion who underwent mechanical thrombectomy between 02/2010 and 08/2017 were included. Read More

Brain 2019 Mar 11. Epub 2019 Mar 11.

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

The impact of endovascular vessel recanalization on patients with a low initial Alberta Stroke Program Early Computer Tomography Score (ASPECTS) is still uncertain. We hypothesized that vessel recanalization leads to an improvement in mortality and degree of disability by reducing brain oedema and malignant mass effect. In this multicentre observational study, patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and an ASPECTS of ≤ 5 were analysed. Read More

J Neurointerv Surg 2019 Mar 6. Epub 2019 Mar 6.

Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.

Backgroud: The need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT.

Methods: We identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Read More

J Neurointerv Surg 2019 Mar 6. Epub 2019 Mar 6.

Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France.

Introduction: Endovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT. Read More

Stroke 2019 Apr;50(4):917-922

From the Department of Radiology, Neuroimaging and Neurointervention Section, Stanford Medical Center, CA (A.G., D.G.M., B.W.M, M.P.M., M.W., J.J.H.).

Background and Purpose- Hypoperfusion intensity ratio (HIR) is associated with collateral status in acute ischemic stroke patients with anterior circulation large vessel occlusion. We assessed whether HIR was correlated to patient eligibility for mechanical thrombectomy (MT). Methods- We performed a retrospective cohort study of consecutive acute ischemic stroke patients with a proximal middle cerebral artery or internal carotid artery occlusion who underwent MT triage with computed tomography or magnetic resonance perfusion imaging. Read More

J Korean Neurosurg Soc 2019 Mar 27;62(2):193-200. Epub 2019 Feb 27.

Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon, Korea.

Objective: Endovascular treatment (EVT) outcomes for acute M2 segment of middle cerebral artery occlusion remains unclear because most results are obtained from patients with large artery occlusion in the anterior circulation. The objective of this study was to assess procedural outcomes for acute M2 occlusion and compare outcomes according to thrombus location (M1 vs. M2). Read More

Front Neurol 2019 19;10:71. Epub 2019 Feb 19.

Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Sporadic data showed hyperglycemia at presentation is associated with poor outcomes in patients with acute ischemic stroke (AIS) under mechanical thrombectomy (MT) treatment. This study aims to evaluate the relationship of admission hyperglycemia and outcomes in patients treated with solitaire stent thrombectomy. This multicenter prospective study registered patients with AIS due to anterior circulation large vessel occlusion (LVO) suitable for MT with Solitaire stent retriever. Read More