1.Mechanical Thrombectomy in Patients with a Large Ischemic Volume at Presentation: Systematic Review and Meta-Analysis
Basile KERLEROUX ; Kevin JANOT ; Jean François HAK ; Johannes KAESMACHER ; Wagih Ben HASSEN ; Joseph BENZAKOUN ; Catherine OPPENHEIM ; Denis HERBRETEAU ; Heloise IFERGAN ; Nicolas BRICOUT ; Hilde HENON ; Takeshi YOSHIMOTO ; Manabu INOUE ; Arturo CONSOLI ; Vincent COSTALAT ; Olivier NAGGARA ; Bertrand LAPERGUE ; Federico CAGNAZZO ; Grégoire BOULOUIS
Journal of Stroke 2021;23(3):358-366
The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.
2.Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.
Romain BOURCIER ; Mickael MAZIGHI ; Julien LABREUCHE ; Robert FAHED ; Raphael BLANC ; Benjamin GORY ; Alain DUHAMEL ; Gaultier MARNAT ; Suzana SALEME ; Vincent COSTALAT ; Serge BRACARD ; Hubert DESAL ; Arturo CONSOLI ; Michel PIOTIN ; Bertrand LAPERGUE
Journal of Stroke 2018;20(2):268-276
BACKGROUND AND PURPOSE: In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) was studied to determine its influence on trial results. METHODS: We included patients having undergone CA or SR for M1 or M2 occlusions, who were screened by MRI with T2* gradient recalled echo. Occlusions were classified as SVS (+) or SVS (–) in each randomization arm. Modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3 revascularization rates were recorded and clinical outcomes assessed by the overall distribution of modified Rankin scale (mRS) at 90 days. RESULTS: Among the 202 patients included, 143 patients were SVS (+) (70.8%; 95% confidence interval [CI], 64.5% to 77.1%). Overall, there was no difference in angiographic and clinical outcomes according to SVS status. However, compared to SR, CA achieved a lower mTICI 2c/3 rate in SVS (+) patients (risk ratio [RR] for CA vs. SR, 0.60; 95% CI, 0.51 to 0.71) but not in SVS (–) (RR, 1.11; 95% CI, 0.69 to 1.77; P for interaction=0.018). A significant heterogeneity in favor of superiority of first-line SR strategy in SVS (+) patients was also found regarding the overall mRS distribution (common odds ratio for CA vs. SR, 0.40 vs. 1.32; 95% CI, 0.21 to 0.74 in SVS (+) vs. 95% CI, 0.51 to 3.35 in SVS (–); P for interaction=0.038). CONCLUSIONS: As a first line strategy, SR achieved higher recanalization rates and a more favourable clinical outcome at 3 months compared to CA when MRI shows SVS within the thrombus.
Arm
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Cerebral Infarction
;
Humans
;
Magnetic Resonance Imaging
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Odds Ratio
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Population Characteristics
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Random Allocation
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Stents*
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Thrombectomy
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Thrombosis
3.Erratum: Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.
Romain BOURCIER ; Mickael MAZIGHI ; Julien LABREUCHE ; Robert FAHED ; Raphael BLANC ; Benjamin GORY ; Alain DUHAMEL ; Gaultier MARNAT ; Suzana SALEME ; Vincent COSTALAT ; Serge BRACARD ; Hubert DESAL ; Arturo CONSOLI ; Michel PIOTIN ; Bertrand LAPERGUE
Journal of Stroke 2018;20(3):416-416
On page 271, in Table 1, the value ‘1115 (65??51)’ of subgroup ‘Imaging to groin puncture’ and column heading ‘SVS (??’ was input incorrectly. The correct value is ‘115 (65??51).’
4.Mechanical Thrombectomy in Patients with a Large Ischemic Volume at Presentation: Systematic Review and Meta-Analysis
Basile KERLEROUX ; Kevin JANOT ; Jean François HAK ; Johannes KAESMACHER ; Wagih Ben HASSEN ; Joseph BENZAKOUN ; Catherine OPPENHEIM ; Denis HERBRETEAU ; Heloise IFERGAN ; Nicolas BRICOUT ; Hilde HENON ; Takeshi YOSHIMOTO ; Manabu INOUE ; Arturo CONSOLI ; Vincent COSTALAT ; Olivier NAGGARA ; Bertrand LAPERGUE ; Federico CAGNAZZO ; Grégoire BOULOUIS
Journal of Stroke 2021;23(3):358-366
The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.
5.Recanalization before Thrombectomy in Tenecteplase vs. Alteplase-Treated Drip-and-Ship Patients
Pierre SENERS ; Jildaz CAROFF ; Nicolas CHAUSSON ; Guillaume TURC ; Christian DENIER ; Michel PIOTIN ; Manvel AGHASARYAN ; Cosmin ALECU ; Olivier CHASSIN ; Bertrand LAPERGUE ; Olivier NAGGARA ; Marc FERRIGNO ; Caroline ARQUIZAN ; Tae Hee CHO ; Ana Paula NARATA ; Sébastien RICHARD ; Nicolas BRICOUT ; Mikaël MAZIGHI ; Vincent COSTALAT ; Benjamin GORY ; Séverine DEBIAIS ; Arturo CONSOLI ; Serge BRACARD ; Catherine OPPENHEIM ; Jean Louis MAS ; Didier SMADJA ; Laurent SPELLE ; Jean Claude BARON
Journal of Stroke 2019;21(1):105-107
No abstract available.
Humans
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Thrombectomy