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Article ; Online: Letter: Research Productivity of Physicians in the Pandemic and Post-pandemic Era: A "Productive Outbreak'".

Alawieh, Ali M / Saad, Hassan / Dimisko, Laurie / Barrow, Daniel L / Chern, Joshua J

2023 Volume 92, Issue 3, Page(s) e77–e79

MeSH term(s)	Humans ; Pandemics ; Disease Outbreaks/prevention & control ; Physicians ; Efficiency
Language	English
Publishing date	2023-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002343
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Zs.MO 539: Show issues

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Article ; Online: Pediatric infectious aneurysms: individual patient pooled analysis on presentation, management and outcomes.

Alawieh, Ali / Zohdy, Youssef M / El Annan, Rim / Assi, Jad H / Dimisko, Laurie / Grossberg, Jonathan A / Cawley, C Michael / Chandler, Katherine / Chern, Joshua J / Sawvel, Michael S / Brahma, Barunashish / Garzon-Muvdi, Tomas / Pradilla, Gustavo / Barrow, Daniel / Reisner, Andrew / Howard, Brian M

Journal of neurointerventional surgery

2024

Abstract: Background: Infectious intracranial aneurysms (IIAs) are a rare sequel of systemic infection and occur most commonly in patients with infective endocarditis (IE). Despite the increasing use of non-invasive screening angiography in patients with IE, the ... ...

Abstract	Background: Infectious intracranial aneurysms (IIAs) are a rare sequel of systemic infection and occur most commonly in patients with infective endocarditis (IE). Despite the increasing use of non-invasive screening angiography in patients with IE, the incidence remains low, yielding limited data on the management of IIAs in pediatric populations. We performed a pooled analysis of all published series of pediatric patients with IIAs to study the disease landscape including presentation, management, and outcomes. Methods: Data included in this study were pooled from published literature on IIAs between 1960 and 2023. Abstracts were selected for full review to include only manuscripts reporting at least one case of pediatric IIA (age 0-18 years). Results: A total of 145 pediatric patients with 178 IIAs were included. Patients presented with rupture in 68% of cases, of which 36% had intraparenchymal hemorrhage and 39% had subarachnoid hemorrhage. Using multivariate logistic regression, independent predictors of rupture were posterior location (aOR 10, P=0.041) and history of IE (aOR 7.2, P=0.001). Primary medical management was successful in 82% of cases with unruptured aneurysms while, in those with ruptured IIAs, medical management was successful in 26% of cases. The 90-day mortality rate was 28%. Using multivariate logistic regression, ruptured IIAs (aOR 5.4, P<0.01) and failure of medical management (aOR 11.1, P<0.05) were independent predictors of 90-day mortality. Conclusion: Pediatric IIAs remain a rare complication of systemic or localized CNS infection in the pediatric population. Medical management of unruptured aneurysms is highly successful, while ruptured aneurysms have a remarkably high rate of failure of medical management and should be treated by early surgical or endovascular intervention when feasible.
Language	English
Publishing date	2024-01-03
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/jnis-2023-021195
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Article ; Online: Management and Long-Term Outcomes of Patients With Infectious Intracranial Aneurysms.

Alawieh, Ali M / Dimisko, Laurie / Newman, Sarah / Grossberg, Jonathan A / Cawley, C Michael / Pradilla, Gustavo / Samuels, Owen / Barrow, Daniel L / Howard, Brian M

Neurosurgery

2022 Volume 92, Issue 3, Page(s) 515–523

Abstract: Background: Infectious intracranial aneurysms (IIAs) are rare complications of infective endocarditis (IE). Data on management and long-term outcomes remain limited.: Objective: To retrospectively study long-term outcomes of IIAs in patients treated ... ...

Abstract	Background: Infectious intracranial aneurysms (IIAs) are rare complications of infective endocarditis (IE). Data on management and long-term outcomes remain limited. Objective: To retrospectively study long-term outcomes of IIAs in patients treated medically or surgically. Methods: Adult cases of IE and/or IIAs admitted to Emory or Grady Healthcare Systems between May 2015 and May 2020 were reviewed for demographic, clinical, and radiographic variables for up to 2 years. Primary outcome measure was 2-year survival. Results: Among 1714 cases of IE, intracerebral hemorrhage occurred in 322 patients and IIAs in 17 patients. The presence of IIAs in IE was associated with higher odds of disposition to hospice/death (odds ratio = 6.9). Including non-IE patients, 24 patients had 38 IIAs mainly involving the distal middle cerebral artery and 16 were ruptured on admission. IIAs were predominantly treated with antibiotics as the primary approach. Open microsurgery was the primary approach for 5 aneurysms and was used as salvage in 7 IIAs. Endovascular management was the primary approach for 2 IIAs and used as salvage for 5 IIAs with antibiotic failure. Medical management had high rate of treatment failure (15/31) which predominantly occurred within 2 weeks of onset. The 2-year survival in this cohort was 70% (17/24). Conclusion: IIAs are rare complications of IE with a poor prognosis. Patients treated with antibiotics have higher risk of treatment failure requiring salvage surgical or endovascular intervention. Medical treatment failure occurred mostly within 2 weeks of onset and had a negative prognostic value emphasizing the need for close follow-up and early surgical or endovascular management.
MeSH term(s)	Adult ; Humans ; Intracranial Aneurysm/surgery ; Intracranial Aneurysm/complications ; Retrospective Studies ; Aneurysm, Infected/drug therapy ; Aneurysm, Infected/etiology ; Endovascular Procedures/adverse effects ; Anti-Bacterial Agents/therapeutic use ; Treatment Outcome ; Aneurysm, Ruptured/surgery ; Aneurysm, Ruptured/complications
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-11-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002235
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Article ; Online: Repeat thrombectomy after large vessel re-occlusion: a propensity score matched analysis of technical and clinical outcomes.

Zohdy, Youssef M / Saad, Hassan / Howard, Brian M / Cawley, C Michael / Pabaney, Aqueel / Akbik, Feras / Dimisko, Laurie / Maier, Ilko / Spiotta, Alejandro M / Jabbour, Pascal / Wolfe, Stacey Q / Rai, Ansaar / Kim, Joon-Tae / Mascitelli, Justin / Starke, Robert M / Shaban, Amir / Yoshimura, Shinichi / De Leacy, Reade / Kan, Peter /

Fragata, Isabel / Polifka, Adam J / Arthur, Adam S / Park, Min S / Matouk, Charles / Levitt, Michael R / Tjoumakaris, Stavropoula I / Liman, Jan / Waiters, Vanesha / Pradilla, Gustavo / Fargen, Kyle M / Alawieh, Ali / Grossberg, Jonathan A

Journal of neurointerventional surgery

2024

Abstract: Background: Endovascular thrombectomy (EVT) remains the standard of care for acute large vessel occlusion (LVO) stroke. However, the safety and efficacy of repeat thrombectomy (rEVT) in recurrent LVO remains unclear. This study uses a large real-world ... ...

Abstract	Background: Endovascular thrombectomy (EVT) remains the standard of care for acute large vessel occlusion (LVO) stroke. However, the safety and efficacy of repeat thrombectomy (rEVT) in recurrent LVO remains unclear. This study uses a large real-world patient cohort to study technical and clinical outcomes after rEVT. Methods: This is a retrospective cohort study including patients who underwent thrombectomy between January 2013 and December 2022. Data were included from 21 comprehensive stroke centers globally through the Stroke Thrombectomy and Aneurysm Registry (STAR). Patients undergoing single EVT or rEVT within 30 days of LVO stroke were included in the study. Propensity score matching was used to compare patients undergoing single EVT versus rEVT. Results: Out of a total of 7387 patients who underwent thrombectomy for LVO stroke, 90 (1.2%) patients underwent rEVT for the same vascular territory within 30 days. The median (IQR) time to re-occlusion was 2 (1-7) days. Compared with a matched cohort of patients undergoing a single EVT procedure, patients undergoing rEVT had a comparable rate of good functional outcome and mortality rate, but a higher rate of symptomatic intracranial hemorrhage (sICH). There was a significant reduction in the National Institutes of Health Stroke Scale (NIHSS) score of patients who underwent rEVT at discharge compared with baseline (-4.8±11.4; P=0.006). The rate of successful recanalization was similar in the single thrombectomy and rEVT groups (78% vs 80%, P=0.171) and between index and rEVT performed on the same patient (79% vs 80%; P=0.593). Conclusion: Short-interval rEVT is associated with an improvement in the NIHSS score following large vessel re-occlusion. Compared with single thrombectomy, there was a higher rate of sICH with rEVT, but without a significant impact on rates of functional independence or mortality.
Language	English
Publishing date	2024-01-17
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/jnis-2023-021197
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Article ; Online: Gabapentin Improves Symptoms of Functional Dyspepsia in a Retrospective, Open-label Cohort Study.

Staller, Kyle / Thurler, Andrea H / Reynolds, Justin S / Dimisko, Laurie R / McGovern, Ryan / Skarbinski, Kristina F / Kuo, Braden

Journal of clinical gastroenterology

2018 Volume 53, Issue 5, Page(s) 379–384

Abstract: Goals: We sought to determine the efficacy of gabapentin in the treatment of functional dyspepsia among an observational cohort of patients.: Background: Gabapentin has an established role in the treatment of neuropathic pain, with evidence ... ...

Abstract	Goals: We sought to determine the efficacy of gabapentin in the treatment of functional dyspepsia among an observational cohort of patients. Background: Gabapentin has an established role in the treatment of neuropathic pain, with evidence supporting a benefit in visceral hypersensitivity. There is currently no data on the use of gabapentin for the treatment of functional dyspepsia. Study: Consecutive patients presenting to a tertiary motility clinic for the evaluation of functional dyspepsia without concurrent gastric emptying delay completed a baseline Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) before evaluation and were started on gabapentin for functional dyspepsia by their providers. The primary endpoint was change in total PAGI-SYM score between initial and subsequent visits. Results: Of 110 patients enrolled, 62 patients with functional dyspepsia completed pregabapentin and postgabapentin surveys. Subjects' mean PAGI-SYM score decreased by 0.44 (P<0.0001) with significant changes in all subscales (including upper abdominal pain, lower abdominal pain, postprandial fullness) except for bloating. Multivariable analysis showed that worsening pretreatment symptom severity was independently associated with improvement. Seven (11.3%) patients discontinued gabapentin with 5 (71.4%) discontinuing due to side effects. Using the minimum significant PAGI-SYM score change threshold, ≥50% of the cohort had significant improvement in their overall, postprandial fullness, and upper abdominal pain subscores. Conclusions: In a retrospective, open-label cohort of patients treated with gabapentin for functional dyspepsia, there were significant improvements in dyspeptic symptoms interpreted within the limitations of an open-label study design. Further studies are needed to place gabapentin in the functional dyspepsia treatment algorithm.
MeSH term(s)	Analgesics/administration & dosage ; Analgesics/therapeutic use ; Cohort Studies ; Dyspepsia/drug therapy ; Female ; Gabapentin/administration & dosage ; Gabapentin/therapeutic use ; Gastric Emptying ; Humans ; Male ; Middle Aged ; Postprandial Period ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome
Chemical Substances	Analgesics ; Gabapentin (6CW7F3G59X)
Language	English
Publishing date	2018-04-13
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	448460-5
ISSN	1539-2031 ; 0192-0790
ISSN (online)	1539-2031
ISSN	0192-0790
DOI	10.1097/MCG.0000000000001034
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Article: Microfluidic platform for measuring neutrophil chemotaxis from unprocessed whole blood

Jones, Caroline N / Hoang, Anh N / Dimisko, Laurie / Hamza, Bashar / Martel, Joseph / Irimia, Daniel

Journal of visualized experiments. 2014 June 03, , no. 88

2014

Abstract: Neutrophils play an essential role in protection against infections and their numbers in the blood are frequently measured in the clinic. Higher neutrophil counts in the blood are usually an indicator of ongoing infections, while low neutrophil counts ... ...

Abstract	Neutrophils play an essential role in protection against infections and their numbers in the blood are frequently measured in the clinic. Higher neutrophil counts in the blood are usually an indicator of ongoing infections, while low neutrophil counts are a warning sign for higher risks for infections. To accomplish their functions, neutrophils also have to be able to move effectively from the blood where they spend most of their life, into tissues, where infections occur. Consequently, any defects in the ability of neutrophils to migrate can increase the risks for infections, even when neutrophils are present in appropriate numbers in the blood. However, measuring neutrophil migration ability in the clinic is a challenging task, which is time consuming, requires large volume of blood, and expert knowledge. To address these limitations, we designed a robust microfluidic assays for neutrophil migration, which requires a single droplet of unprocessed blood, circumvents the need for neutrophil separation, and is easy to quantify on a simple microscope. In this assay, neutrophils migrate directly from the blood droplet, through small channels, towards the source of chemoattractant. To prevent the granular flow of red blood cells through the same channels, we implemented mechanical filters with right angle turns that selectively block the advance of red blood cells. We validated the assay by comparing neutrophil migration from blood droplets collected from finger prick and venous blood. We also compared these whole blood (WB) sources with neutrophil migration from samples of purified neutrophils and found consistent speed and directionality between the three sources. This microfluidic platform will enable the study of human neutrophil migration in the clinic and the research setting to help advance our understanding of neutrophil functions in health and disease.
Keywords	chemoattractants ; chemotaxis ; droplets ; erythrocytes ; expert opinion ; filters ; neutrophils ; risk ; tissues
Language	English
Dates of publication	2014-0603
Size	p. e51215.
Publishing place	Journal of Visualized Experiments
Document type	Article
ZDB-ID	2259946-0
ISSN	1940-087X
ISSN	1940-087X
DOI	10.3791/51215
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Influence of the patient-practitioner interaction context on acupuncture outcomes in functional dyspepsia: study protocol for a multicenter randomized controlled trial

Ko, Seok-Jae / Park, Jae Woo / Leem, Jungtae / Kaptchuk, Ted J. / Napadow, Vitaly / Kuo, Braden / Gerber, Jessica / Dimisko, Laurie / Yeo, Inkwon / Lee, Junhee / Kim, Jinsung

BMC Complement Altern Med. 2017 Dec., v. 17, no. 1 p.363-363

2017

Abstract: BACKGROUND: In the treatment of functional dyspepsia, the placebo effect has been reported to be high, and the influence of the patient-practitioner relationship may be a major component of this effect. The specific and non-specific effects of ... ...

Abstract	BACKGROUND: In the treatment of functional dyspepsia, the placebo effect has been reported to be high, and the influence of the patient-practitioner relationship may be a major component of this effect. The specific and non-specific effects of acupuncture cannot be easily distinguished, and the patient-practitioner relationship may influence the total therapeutic effect in clinical practice. There have been no studies that investigate the influence of patient-practitioner relationship on acupuncture treatment for patients with functional dyspepsia. METHODS: Patients with postprandial distress syndrome, a functional dyspepsia subtype, will be recruited at three hospitals (two in Korea and one in USA) for an international, multi-center, randomized, patient/assessor-blinded, clinical trial. The total anticipated sample size is 88. The participants will be randomly allocated into two groups: an augmented interaction group and a limited interaction group. Acupuncture, with total 12 acupoints, will be performed twice weekly for 4 weeks in both groups. Trained practitioners will provide an “augmented” or “limited” interaction context, as determined by random allocation. The primary outcome measure is the proportion of responders, the proportion of participants who answer “yes” to more than half of the adequate relief questions during the study. Secondary outcome measures include questionnaires for quality of life and symptoms of dyspepsia, and maximum tolerable volume of nutrient drink test. Data will be collected at baseline and following 4 weeks of acupuncture. DISCUSSION: This study will evaluate the influence of the patient-practitioner interaction on clinical effects of acupuncture in patients with functional dyspepsia. TRIAL REGISTRATION: CRIS Identifier: (KCT0002229).
Keywords	acupuncture ; complement ; distress ; indigestion ; placebos ; quality of life ; randomized clinical trials ; sample size ; Korean Peninsula
Language	English
Dates of publication	2017-12
Size	p. 363.
Publishing place	BioMed Central
Document type	Article ; Online
Note	Resource is Open Access
ZDB-ID	2050429-9
ISSN	1472-6882
ISSN	1472-6882
DOI	10.1186/s12906-017-1869-y
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Microfluidic platform for measuring neutrophil chemotaxis from unprocessed whole blood.

Jones, Caroline N / Hoang, Anh N / Dimisko, Laurie / Hamza, Bashar / Martel, Joseph / Irimia, Daniel

Journal of visualized experiments : JoVE

2014 , Issue 88

Abstract	Neutrophils play an essential role in protection against infections and their numbers in the blood are frequently measured in the clinic. Higher neutrophil counts in the blood are usually an indicator of ongoing infections, while low neutrophil counts are a warning sign for higher risks for infections. To accomplish their functions, neutrophils also have to be able to move effectively from the blood where they spend most of their life, into tissues, where infections occur. Consequently, any defects in the ability of neutrophils to migrate can increase the risks for infections, even when neutrophils are present in appropriate numbers in the blood. However, measuring neutrophil migration ability in the clinic is a challenging task, which is time consuming, requires large volume of blood, and expert knowledge. To address these limitations, we designed a robust microfluidic assays for neutrophil migration, which requires a single droplet of unprocessed blood, circumvents the need for neutrophil separation, and is easy to quantify on a simple microscope. In this assay, neutrophils migrate directly from the blood droplet, through small channels, towards the source of chemoattractant. To prevent the granular flow of red blood cells through the same channels, we implemented mechanical filters with right angle turns that selectively block the advance of red blood cells. We validated the assay by comparing neutrophil migration from blood droplets collected from finger prick and venous blood. We also compared these whole blood (WB) sources with neutrophil migration from samples of purified neutrophils and found consistent speed and directionality between the three sources. This microfluidic platform will enable the study of human neutrophil migration in the clinic and the research setting to help advance our understanding of neutrophil functions in health and disease.
MeSH term(s)	Chemotaxis, Leukocyte/physiology ; Humans ; Microfluidic Analytical Techniques/instrumentation ; Microfluidic Analytical Techniques/methods ; Neutrophils/cytology
Language	English
Publishing date	2014-06-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Video-Audio Media
ZDB-ID	2259946-0
ISSN	1940-087X ; 1940-087X
ISSN (online)	1940-087X
ISSN	1940-087X
DOI	10.3791/51215
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Article ; Online: Multicenter investigation of technical and clinical outcomes after thrombectomy for Proximal Medium Vessel Occlusion (pMeVO) by frontline technique.

Grossberg, Jonathan A / Chalhoub, Reda M / Al Kasab, Sami / Pullmann, Dominika / Jabbour, Pascal / Psychogios, Marios / Starke, Robert M / Arthur, Adam S / Fargen, Kyle M / De Leacy, Reade / Kan, Peter / Dumont, Travis / Rai, Ansaar / Crosa, Roberto J / Naamani, Kareem E / Maier, Ilko / Goyal, Nitin / Wolfe, Stacey Quintero / Michael Cawley, C /

Mocco, J / Hafeez, Muhammad / Howard, Brian M / Dimisko, Laurie / Saad, Hassan / Ogilvy, Christopher S / Webster Crowley, R / Mascitelli, Justin / Fragata, Isabel / Levitt, Michael / Spiotta, Alejandro M / Alawieh, Ali M

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

2022 , Page(s) 15910199221138139

Abstract: Background: Endovascular thrombectomy(EVT) is the standard of care for large vessel occlusion(LVO) stroke. Data on technical and clinical outcome in proximal medium vessel occlusions(pMeVOs) comparing frontline techniques remain limited.: Methods: We ...

Abstract	Background: Endovascular thrombectomy(EVT) is the standard of care for large vessel occlusion(LVO) stroke. Data on technical and clinical outcome in proximal medium vessel occlusions(pMeVOs) comparing frontline techniques remain limited. Methods: We report an international multicenter retrospective study of patients undergoing EVT for stroke at 32 centers between 2015-2021. Patients were divided into LVOs(ICA/M1/Vertebrobasilar) or pMeVOs(M2/A1/P1) and categorized by thrombectomy technique. Primary outcome was 90-day good functional outcome(mRS ≤ 2). Multivariate logistic regressions were used to evaluate the impact of technical variables on clinical outcomes. Propensity score matching was used to compare outcome in patients with pMeVO treated with aspiration versus stent-retriever. Results: In the cohort of 5977 LVO and 1287 pMeVO patients, pMeVO did not independently predict good-outcome(p = 0.55). In pMeVO patients, successful recanalization irrespective of frontline technique(aOR = 3.2,p < 0.05), procedure time ≤ 1-h(aOR = 2.2,p < 0.05), and thrombectomy attempts ≤ 4(aOR = 2.8,p < 0.05) were independent predictors of good-outcomes.In a propensity-matched cohort of aspiration versus stent-retriever pMeVO patients, there was no difference in good-outcomes. The rates of hemorrhage were higher(9%vs.4%,p < 0.01) and procedure time longer(51-min vs. 33-min,p < 0.01) with stent-retriever, while the number of attempts was higher with aspiration(2.5vs.2,p < 0.01). Rates of hemorrhage and good-outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group compared to attempts in the stent-retriever group. Conclusions: Clinical outcomes following EVT for pMeVO are comparable to those in LVOs. The golden hour or 3-pass rules in LVO thrombectomy still apply to pMeVO thrombectomy. Different techniques may exhibit different futility metrics; SR thrombectomy was more influenced by attempts whereas aspiration was more dependent on procedure time.
Language	English
Publishing date	2022-11-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	1354913-3
ISSN	2385-2011 ; 1591-0199 ; 1123-9344
ISSN (online)	2385-2011
ISSN	1591-0199 ; 1123-9344
DOI	10.1177/15910199221138139
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Article ; Online: Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique.

Alawieh, Ali M / Chalhoub, Reda M / Al Kasab, Sami / Jabbour, Pascal / Psychogios, Marios-Nikos / Starke, Robert M / Arthur, Adam S / Fargen, Kyle M / De Leacy, Reade / Kan, Peter / Dumont, Travis M / Rai, Ansaar / Crosa, Roberto Javier / Maier, Ilko / Goyal, Nitin / Wolfe, Stacey Q / Cawley, C Michael / Mocco, J / Tjoumakaris, Stavropoula I /

Howard, Brian M / Dimisko, Laurie / Saad, Hassan / Ogilvy, Christopher S / Crowley, R Webster / Mascitelli, Justin R / Fragata, Isabel / Levitt, Michael R / Kim, Joon-Tae / Park, Min S / Gory, Benjamin / Polifka, Adam J / Matouk, Charles / Grossberg, Jonathan A / Spiotta, Alejandro M

Journal of neurointerventional surgery

2022 Volume 15, Issue e1, Page(s) e93–e101

Abstract: Background: Endovascular thrombectomy (EVT) is the standard-of-care for proximal large vessel occlusion (LVO) stroke. Data on technical and clinical outcomes in distal vessel occlusions (DVOs) remain limited.: Methods: This was a retrospective study ... ...

Abstract	Background: Endovascular thrombectomy (EVT) is the standard-of-care for proximal large vessel occlusion (LVO) stroke. Data on technical and clinical outcomes in distal vessel occlusions (DVOs) remain limited. Methods: This was a retrospective study of patients undergoing EVT for stroke at 32 international centers. Patients were divided into LVOs (internal carotid artery/M1/vertebrobasilar), medium vessel occlusions (M2/A1/P1) and isolated DVOs (M3/M4/A2/A3/P2/P3) and categorized by thrombectomy technique. Primary outcome was a good functional outcome (modified Rankin Scale ≤2) at 90 days. Secondary outcomes included recanalization, procedure-time, thrombectomy attempts, hemorrhage, and mortality. Multivariate logistic regressions were used to evaluate the impact of technical variables. Propensity score matching was used to compare outcome in patients with DVO treated with aspiration versus stent retriever RESULTS: We included 7477 patients including 213 DVOs. Distal location did not independently predict good functional outcome at 90 days compared with proximal (p=0.467). In distal occlusions, successful recanalization was an independent predictor of good outcome (adjusted odds ratio (aOR) 5.11, p<0.05) irrespective of technique. Younger age, bridging therapy, and lower admission National Institutes of Health Stroke Scale (NIHSS) were also predictors of good outcome. Procedure time ≤1 hour or ≤3 thrombectomy attempts were independent predictors of good outcomes in DVOs irrespective of technique (aOR 4.5 and 2.3, respectively, p<0.05). There were no differences in outcomes in a DVO matched cohort of aspiration versus stent retriever. Rates of hemorrhage and good outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group and attempts in the stent retriever group. Conclusions: Outcomes following EVT for DVO are comparable to LVO with similar results between techniques. Techniques may exhibit different futility metrics; stent retriever thrombectomy was influenced by attempts whereas aspiration was more dependent on procedure time.
MeSH term(s)	Humans ; Retrospective Studies ; Treatment Outcome ; Stroke/diagnostic imaging ; Stroke/surgery ; Stroke/etiology ; Thrombectomy/methods ; Carotid Artery, Internal ; Arterial Occlusive Diseases/etiology ; Ischemic Stroke/etiology ; Endovascular Procedures/methods ; Stents/adverse effects
Language	English
Publishing date	2022-08-02
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/jnis-2022-019023
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