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Article ; Online: Mechanical thrombectomy in stroke patients of working age: Real-world outcomes in Sweden.

Roland, Mihae / Markaki, Ioanna / Andersson, Tommy / Arnberg, Fabian / Sjöstrand, Christina

2022 Volume 7, Issue 1, Page(s) 41–47

Abstract: Introduction: Outcomes after mechanical thrombectomy (MT) in young stroke patients remain elusive due to small patient cohorts. We sought to determine outcomes after MT in stroke patients between ages 18 and 64 years and compare with outcomes in older ... ...

Abstract	Introduction: Outcomes after mechanical thrombectomy (MT) in young stroke patients remain elusive due to small patient cohorts. We sought to determine outcomes after MT in stroke patients between ages 18 and 64 years and compare with outcomes in older patients in a large national stroke cohort. Patients and methods: We used the Swedish National Stroke Registry and the Swedish National Endovascular Thrombectomy Registry to identify all patients treated with MT for anterior circulation occlusions. We examined outcome measures in terms of functional independence at 90 days (modified Rankin Scale score of 0-2), symptomatic intracerebral hemorrhage (sICH), and mortality at 90 days with multivariable logistic regression analysis. Results: Of 2143 patients, 565 were between 18 and 64 years (26.4%) and 1179 (55.0%) were males. Analysis showed that patient aged 18-64 achieved higher rate of functional independence at 90 days (46.2% vs 28.4%, Conclusion: Patients aged 18-64 years demonstrated better outcome after thrombectomy regarding functional independence, sICH, and mortality at 90 days when compared to older ages.
Language	English
Publishing date	2022-02-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2851287-X
ISSN	2396-9881 ; 2396-9873
ISSN (online)	2396-9881
ISSN	2396-9873
DOI	10.1177/23969873211067883
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Article ; Online: Survival and functional outcome following endovascular thrombectomy for anterior circulation acute ischemic stroke caused by large vessel occlusion in Sweden 2017-2019-a nationwide, prospective, observational study.

Ullberg, Teresa / von Euler, Mia / Wassélius, Johan / Wester, Per / Arnberg, Fabian

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences

2022 Volume 29, Issue 1, Page(s) 94–101

Abstract: Background: Endovascular thrombectomy (EVT) is standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), but data on nationwide performance in routine healthcare are sparse. The study aims were to ... ...

Abstract	Background: Endovascular thrombectomy (EVT) is standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), but data on nationwide performance in routine healthcare are sparse. The study aims were to describe EVT patients with LVO AIS, analyze mortality and functional outcome, and compare results with randomized controlled trials (RCTs). Methods: Data from the Riksstroke and the Swedish Endovascular Treatment of Acute Stroke Registry (RSEVAS) on pre-stroke independent patients, with LVO AIS in 2017-2019, defined as occlusion of the intracranial internal carotid artery, or the M1 or M2 segments of the middle cerebral artery, and groin puncture <6 h of onset, were compared to aggregated HERMES collaboration RCT data. We assessed 90-day survival and function, defined by the modified Rankin Scale. Specific analyzes were stratified by occlusion location. Results: In all, 1011/2560 of RSEVAS patients matched RCT inclusion criteria. Compared with RCT data, patients were older (73 vs. 68), fewer received intravenous thrombolysis (63.1% vs. 83%), and M2 occlusions were more common (24.5% vs. 8%). 90-day survival in RSEVAS was 85.3%, 42.8% achieved good outcome and 5% had symptomatic intracerebral hemorrhage (sICH). Corresponding outcomes in RCT data were 84.7% survival, 46% good outcome, and 4.4% sICH. Functional outcome was most favorable following M2 occlusions. Conclusions: EVT patients from our large real-world national dataset differed from RCT patients in several baseline factors including distribution of vascular occlusion site. However, the overall outcome of EVT in our Swedish cohort appeared to well match the pivotal trial findings.
MeSH term(s)	Humans ; Sweden ; Endovascular Procedures/methods ; Stroke/surgery ; Thrombectomy/methods ; Ischemic Stroke ; Cerebral Hemorrhage ; Treatment Outcome ; Brain Ischemia/therapy
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1354913-3
ISSN	2385-2011 ; 1591-0199 ; 1123-9344
ISSN (online)	2385-2011
ISSN	1591-0199 ; 1123-9344
DOI	10.1177/15910199211073019
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Article ; Online: Endovascular thrombectomy for acute ischemic stroke.

Wassélius, Johan / Arnberg, Fabian / von Euler, Mia / Wester, Per / Ullberg, Teresa

Journal of internal medicine

2022 Volume 291, Issue 3, Page(s) 303–316

Abstract: This review describes the evolution of endovascular treatment for acute ischemic stroke, current state of the art, and the challenges for the next decade. The rapid development of endovascular thrombectomy (EVT), from the first attempts into standard of ... ...

Abstract	This review describes the evolution of endovascular treatment for acute ischemic stroke, current state of the art, and the challenges for the next decade. The rapid development of endovascular thrombectomy (EVT), from the first attempts into standard of care on a global scale, is one of the major achievements in modern medicine. It was possible thanks to the establishment of a scientific framework for patient selection, assessment of stroke severity and outcome, technical development by dedicated physicians and the MedTech industry, including noninvasive imaging for patient selection, and radiological outcome evaluation. A series of randomized controlled trials on EVT in addition to intravenous thrombolytics, with overwhelmingly positive results for anterior circulation stroke within 6 h of onset regardless of patient characteristics with a number needed to treat of less than 3 for any positive shift in outcome, paved the way for a rapid introduction of EVT into clinical practice. Within the "extended" time window of 6-24 h, the effect has been even greater for patients with salvageable brain tissue according to perfusion imaging with a number needed to treat below 2. Even so, EVT is only available for a small portion of stroke patients, and successfully recanalized EVT patients do not always achieve excellent functional outcome. The major challenges in the years to come include rapid prehospital detection of stroke symptoms, adequate clinical and radiological diagnosis of severe ischemic stroke cases, enabling effective recanalization by EVT in dedicated angiosuites, followed by personalized post-EVT stroke care.
MeSH term(s)	Brain Ischemia/diagnostic imaging ; Brain Ischemia/surgery ; Endovascular Procedures/methods ; Humans ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/surgery ; Stroke/diagnostic imaging ; Stroke/surgery ; Thrombectomy/methods ; Treatment Outcome
Language	English
Publishing date	2022-02-16
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13425
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Article ; Online: The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study.

El-Hajj, Victor Gabriel / Daller, Cornelia / Fletcher-Sandersjöö, Alexander / Gharios, Maria / Bydon, Mohamad / Söderman, Michael / Jabbour, Pascal / Edström, Erik / Elmi-Terander, Adrian / Arnberg, Fabian

Neurosurgical focus

2024 Volume 56, Issue 3, Page(s) E14

Abstract: Objective: Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object ... ...

Abstract	Objective: Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs. Methods: In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study. Results: Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03-1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18-12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00-1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0-306.7, p < 0.001). Conclusions: Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.
MeSH term(s)	Humans ; Male ; Aged ; Female ; Cohort Studies ; Longitudinal Studies ; Retrospective Studies ; Treatment Delay ; Central Nervous System Vascular Malformations/complications ; Central Nervous System Vascular Malformations/surgery
Language	English
Publishing date	2024-02-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2023.12.FOCUS23703
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Article ; Online: The Role of Carbon Dioxide in the Rat Acute Stroke Penumbra.

Yeo, Leonard L / Arnberg, Fabian / Chireh, Arvin / Sharma, Vijay / Tan, Benjamin / Gontu, Vamsi / Little, Philip / Holmin, Staffan

Frontiers in digital health

2022 Volume 3, Page(s) 824334

Abstract: Purpose: The vasodilatory response to inhaled CO: Methods: Twenty-two Sprague-Dawley rats were subjected to 90-min occlusion of the M2 segment of the middle cerebral artery (M2CAO) by endovascular technique. The animals were administered different ... ...

Abstract	Purpose: The vasodilatory response to inhaled CO Methods: Twenty-two Sprague-Dawley rats were subjected to 90-min occlusion of the M2 segment of the middle cerebral artery (M2CAO) by endovascular technique. The animals were administered different C02 concentrations and scanned serially with 9.4 T MRI. Infarct tissue was determined by diffusion-weighted imaging (DWI) and hypoperfused tissue was determined by arterial spin labeling (PWI). Results: 4 animals were administered room air (RA)+ 6% CO Conclusion: Inhaled CO
Language	English
Publishing date	2022-02-04
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-253X
ISSN (online)	2673-253X
DOI	10.3389/fdgth.2021.824334
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Article ; Online: Endovascular thrombectomy for anterior circulation stroke beyond 6 hours of onset in Sweden 2015 to 2020: rates and outcomes in a nationwide register-based study.

Ullberg, Teresa / von Euler, Mia / Wester, Per / Arnberg, Fabian / Norrving, Bo / Andersson, Tommy / Wassélius, Johan

Journal of neurointerventional surgery

2022 Volume 15, Issue 4, Page(s) 330–335

Abstract: Background: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden.: Methods: We included all ... ...

Abstract	Background: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden. Methods: We included all cases of anterior circulation IS caused by occlusion of the intracranial carotid artery, and the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015-2020. Three groups were defined from onset-to-groin-puncture (OTG) time: early window (<6 hours), late window (6-24 hours) known onset, late window last seen well (LSW). Favorable outcome (modified Rankin Scale (mRS) 0-2) and all-cause mortality at 90 days were the main outcomes, and symptomatic intracerebral hemorrhage (sICH) was the safety outcome. Results: Late window EVT increased from 0.3% of all IS in 2015 to 1.8% in 2020, and from 17.4% of all anterior circulation EVTs in 2015 to 32.9% in 2020. Of 2199 patients, 76.9% (n=1690) were early window EVTs and 23.1% late window EVTs (n=509; 141 known onset, 368 LSW). Median age was 73 years, and 46.2% were female, with no differences between groups. Favorable outcome did not differ between groups (early window 42.4%, late window known onset 38.9%, late window LSW 37.3% (p=0.737)) and remained similar when adjusted for baseline differences. sICH rates did not differ (early window 4.0%, late window known onset 2.1%, late window LSW 4.9% (p=0.413)). Conclusion: Late window EVTs have increased substantially over time, and currently account for one third of anterior circulation treatments. Early and late window patients had similar outcomes.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Sweden/epidemiology ; Treatment Outcome ; Stroke/epidemiology ; Stroke/surgery ; Thrombectomy/adverse effects ; Middle Cerebral Artery ; Ischemic Stroke/etiology ; Cerebral Hemorrhage/etiology
Language	English
Publishing date	2022-03-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/neurintsurg-2022-018670
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Zs.A 6845: Show issues

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Article ; Online: Micro-biopsy for detection of gene expression changes in ischemic swine myocardium: A pilot study.

Chireh, Arvin / Grankvist, Rikard / Sandell, Mikael / Mukarram, Abdul Kadir / Arnberg, Fabian / Lundberg, Johan / Daub, Carsten O / Holmin, Staffan

PloS one

2021 Volume 16, Issue 4, Page(s) e0250582

Abstract: Micro-endomyocardial biopsy (micro-EMB) is a novel catheter-based biopsy technique, aiming to increase flexibility and safety compared to conventional EMB. The technique was developed and evaluated in healthy swine. Therefore, the ability to detect ... ...

Abstract	Micro-endomyocardial biopsy (micro-EMB) is a novel catheter-based biopsy technique, aiming to increase flexibility and safety compared to conventional EMB. The technique was developed and evaluated in healthy swine. Therefore, the ability to detect disease related tissue changes could not be evaluated. The aim of the present pilot study was to investigate the ability to detect disease related gene expression changes using micro-EMB. Myocardial infarction was induced in three swine by coronary artery balloon occlusion. Micro-EMB samples (n = 164) were collected before, during, and after occlusion. RNA-sequencing was performed on 85 samples, and 53 of these were selected for bioinformatic analysis. A large number of responding genes was detected from the infarcted area (n = 1911). The early responding genes (n = 1268) were mostly related to apoptosis and inflammation. There were fewer responding genes two days after infarction (n = 6), which were related to extra-cellular matrix changes, and none after 14 days. In contrast to the infarcted area, samples harvested from a non-infarcted myocardial region showed considerably fewer regulated genes (n = 33). Deconvolution analysis, to estimate the proportion of different cell types, revealed a higher proportion of fibroblasts and a reduced proportion of cardiomyocytes two days after occlusion compared to baseline (p < 0.02 and p < 0.01, respectively. S5 File). In conclusion, this pilot study demonstrates the capabilities of micro-EMB to detect local gene expression responses at an early stage after ischemia, but not at later timepoints.
MeSH term(s)	Animals ; Apoptosis/genetics ; Biopsy ; Cardiac Catheterization ; Disease Models, Animal ; Gene Expression Regulation/genetics ; Humans ; Inflammation/diagnosis ; Inflammation/genetics ; Inflammation/pathology ; Myocardial Infarction/diagnosis ; Myocardial Infarction/genetics ; Myocardial Infarction/pathology ; Myocardium/metabolism ; Myocardium/pathology ; Myocytes, Cardiac/metabolism ; Myocytes, Cardiac/pathology ; Pilot Projects ; Swine
Language	English
Publishing date	2021-04-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0250582
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Article ; Online: Safety evaluation of high-risk myocardial micro-biopsy in a swine model.

Chireh, Arvin / Sandell, Mikael / Grankvist, Rikard / Lövljung, Victoria / Al-Saadi, Jonathan / Arnberg, Fabian / Lundberg, Johan / Settergren, Magnus / Holmin, Staffan

Heart and vessels

2021 Volume 37, Issue 4, Page(s) 697–704

Abstract: The objective of the study was to investigate the safety profile of high-risk micro-endomyocardial biopsy (micro-EMB) compared to conventional EMB in a large animal model. Twenty pigs were subjected to a maximum of 30 consecutive biopsies, including ... ...

Abstract	The objective of the study was to investigate the safety profile of high-risk micro-endomyocardial biopsy (micro-EMB) compared to conventional EMB in a large animal model. Twenty pigs were subjected to a maximum of 30 consecutive biopsies, including sampling from the free ventricular wall, with either micro-EMB (n = 10) or conventional EMB (n = 10). There were no major complications in the micro-EMB group (0/10), compared to six major complications in the EMB group (6/10; p = 0.003). Survival analysis further highlighted these differences (p = 0.004). There were significantly higher volumes of pericardial effusion in the EMB group (p = 0.01). The study shows a safety advantage of micro-EMB compared to standard EMB in the experimental high-risk circumstances investigated in this animal study. These results indicate enhanced possibilities to collect samples from sensitive areas by using the micro-EMB technique instead of standard EMB.
MeSH term(s)	Animals ; Biopsy/adverse effects ; Biopsy/methods ; Cardiac Catheterization ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/pathology ; Humans ; Myocardium/pathology ; Pericardial Effusion ; Swine
Language	English
Publishing date	2021-11-23
Publishing country	Japan
Document type	Journal Article
ZDB-ID	89678-0
ISSN	1615-2573 ; 0910-8327 ; 0935-736X
ISSN (online)	1615-2573
ISSN	0910-8327 ; 0935-736X
DOI	10.1007/s00380-021-01995-9
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Zs.A 2049: Show issues

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Article: Unusual Histopathological Findings in Mechanically Removed Stroke Thrombi - A Multicenter Experience.

Aspegren, Oskar / Staessens, Senna / Vandelanotte, Sarah / Desender, Linda / Cordonnier, Charlotte / Puy, Laurent / Bricout, Nicolas / De Meyer, Simon F / Andersson, Tommy / Arnberg, Fabian

Frontiers in neurology

2022 Volume 13, Page(s) 846293

Abstract: Background: Several studies have investigated the histopathology of mechanically retrieved thrombi from stroke patients. Thrombi with unusual components constitute about 1-2% of all stroke thrombi in clinical practice. Knowledge about these rare ... ...

Abstract	Background: Several studies have investigated the histopathology of mechanically retrieved thrombi from stroke patients. Thrombi with unusual components constitute about 1-2% of all stroke thrombi in clinical practice. Knowledge about these rare components is limited. Objectives: To characterize the histopathology of unusual stroke thrombi from a real-world setting with relation to clinical presentation, patient characteristics and procedural aspects of mechanical thrombectomy. Methods: One-thousand and eight thrombi retrieved from stroke patients with mechanical thrombectomy at three different hospitals were retrospectively reviewed for unusual histological components. Fifteen thrombi were included in the study for further histopathological analysis. Clinical data and data on procedural aspects were collected. Results: We identified six cases with large amounts of extracellular DNA, of which three were calcified. All six cases except one received anticoagulant therapy. We describe two types of calcifications that differ with respect to general calcification morphology, von Kossa staining pattern, macrophage immunophenotype and presence of multinucleated giant cells. Cholesterol-rich ( Conclusion: In our retrospective multicenter study, we characterized stroke thrombi histopathologically and found subgroups of thrombi defined by presence of rarely seen components. These defined subgroups showed relation to underlying cardiovascular disease, patient characteristics, and mechanical thrombectomy technique. Knowledge about these components may increase our understanding of stroke pathophysiology and influence interventional procedures.
Language	English
Publishing date	2022-05-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2022.846293
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Article: Clot composition characterization using diffuse reflectance spectroscopy in acute ischemic stroke.

Skyrman, Simon / Burström, Gustav / Aspegren, Oskar / Babic, Drazenko / Lucassen, Gerald / Edström, Erik / Arnberg, Fabian / Ohlsson, Marcus / Mueller, Manfred / Elmi-Terander, Adrian / Andersson, Tommy

Biomedical optics express

2022 Volume 13, Issue 6, Page(s) 3311–3323

Abstract: Acute ischemic stroke caused by large vessel occlusion is treated with endovascular thrombectomy, but treatment failure may occur when clot composition and thrombectomy technique mismatch. In this proof-of-concept study, diffuse reflectance spectroscopy ( ...

Abstract	Acute ischemic stroke caused by large vessel occlusion is treated with endovascular thrombectomy, but treatment failure may occur when clot composition and thrombectomy technique mismatch. In this proof-of-concept study, diffuse reflectance spectroscopy (DRS) is evaluated for identification of clot composition ex vivo. DRS spectra and histology were acquired from 45 clot units retrieved from 29 stroke patients. DRS spectra correlated to clot RBC content, R= 81, p < .001, and could discriminate between RBC-rich and fibrin-rich clots, p < 0.001. Sensitivity and specificity for detection of RBC-rich clots were 0.722 and 0.846 respectively. Applied in an intravascular device, DRS could potentially provide intraprocedural information on clot composition that could increase endovascular thrombectomy efficiency.
Language	English
Publishing date	2022-05-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2572216-5
ISSN	2156-7085
ISSN	2156-7085
DOI	10.1364/BOE.458445
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