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  1. Article ; Online: Longitudinal Morphometric Changes in the Corticospinal Tract Shape After Hemorrhagic Stroke.

    Boren, Seth B / Savitz, Sean I / Gonzales, Nicole / Hasan, Khader / Becerril-Gaitan, Andrea / Maroufy, Vahed / Li, Yuan / Grotta, James / Steven, Emily A / Chen, Ching-Jen / Sitton, Clark W / Aronowski, Jaroslaw / Haque, Muhammad E

    Translational stroke research

    2023  

    Abstract: Deep intracerebral hemorrhage (ICH) exerts a direct force on corticospinal tracts (CST) causing shape deformation. Using serial MRI, Generalized Procrustes Analysis (GPA), and Principal Components Analysis (PCA), we temporally evaluated the change in CST ...

    Abstract Deep intracerebral hemorrhage (ICH) exerts a direct force on corticospinal tracts (CST) causing shape deformation. Using serial MRI, Generalized Procrustes Analysis (GPA), and Principal Components Analysis (PCA), we temporally evaluated the change in CST shape. Thirty-five deep ICH patients with ipsilesional-CST deformation were serially imaged on a 3T-MRI with a median imaging time of day-2 and 84 of onset. Anatomical and diffusion tensor images (DTI) were acquired. Using DTI color-coded maps, 15 landmarks were drawn on each CST and the centroids were computed in 3 dimensions. The contralesional-CST landmarks were used as a reference. The GPA outlined the shape coordinates and we superimposed the ipsilesional-CST shape at the two-time points. A multivariate PCA was applied to identify eigenvectors associated with the highest percentile of change. The first three principal components representing CST deformation along the left-right (PC1), anterior-posterior (PC2), and superior-inferior (PC3) respectively were responsible for 57.9% of shape variance. The PC1 (36.1%, p < 0.0001) and PC3 (9.58%, p < 0.01) showed a significant deformation between the two-time points. Compared to the contralesional-CST, the ipsilesional PC scores were significantly (p < 0.0001) different only at the first-timepoint. A significant positive association between the ipsilesional-CST deformation and hematoma volume was observed. We present a novel method to quantify CST deformation caused by ICH. Deformation most often occurs in left-right axis (PC1) and superior-inferior (PC3) directions. As compared to the reference, the significant temporal difference at the first time point suggests CST restoration over time.
    Language English
    Publishing date 2023-06-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2541897-X
    ISSN 1868-601X ; 1868-4483
    ISSN (online) 1868-601X
    ISSN 1868-4483
    DOI 10.1007/s12975-023-01168-y
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  2. Article ; Online: Accuracy of CT Perfusion-Based Core Estimation of Follow-up Infarction: Effects of Time Since Last Known Well.

    Sarraj, Amrou / Campbell, Bruce C V / Christensen, Soren / Sitton, Clark W / Khanpara, Shekhar / Riascos, Roy F / Pujara, Deep / Shaker, Faris / Sharma, Gagan / Lansberg, Maarten G / Albers, Gregory W

    Neurology

    2022  Volume 98, Issue 21, Page(s) e2084–e2096

    Abstract: Background and objectives: To assess the accuracy of baseline CT perfusion (CTP) ischemic core estimates.: Methods: From SELECT (Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke), a prospective multicenter cohort study ...

    Abstract Background and objectives: To assess the accuracy of baseline CT perfusion (CTP) ischemic core estimates.
    Methods: From SELECT (Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke), a prospective multicenter cohort study of imaging selection, patients undergoing endovascular thrombectomy who achieved complete reperfusion (modified Thrombolysis In Cerebral Ischemia score 3) and had follow-up diffusion-weighted imaging (DWI) available were evaluated. Follow-up DWI lesions were coregistered to baseline CTP. The difference between baseline CTP core (relative cerebral blood flow [rCBF] <30%) volume and follow-up infarct volume was classified as overestimation (core ≥10 mL larger than infarct), adequate, or underestimation (core ≥25 mL smaller than infarct) and spatial overlap was evaluated.
    Results: Of 101 included patients, median time from last known well (LKW) to imaging acquisition was 138 (82-244) minutes. The median baseline ischemic core estimate was 9 (0-31.9) mL and median follow-up infarct volume was 18.4 (5.3-68.7) mL. All 6/101 (6%) patients with overestimation of the subsequent infarct volume were imaged within 90 minutes of LKW and achieved rapid reperfusion (within 120 minutes of CTP). Using rCBF <20% threshold to estimate ischemic core in patients presenting within 90 minutes eliminated overestimation. Volumetric correlation between the ischemic core estimate and follow-up imaging improved as LKW time to imaging acquisition increased: Spearman ρ <90 minutes 0.33 (
    Discussion: Significant overestimation of irreversibly injured ischemic core volume was rare, was only observed in patients who presented within 90 minutes of LKW and achieved reperfusion within 120 minutes of CTP acquisition, and occurred primarily in white matter. Use of a more conservative (rCBF <20%) threshold for estimating ischemic core in patients presenting within 90 minutes eliminated all significant overestimation cases.
    Trial registration information: ClinicalTrials.gov: NCT03876457.
    MeSH term(s) Brain Ischemia/diagnostic imaging ; Brain Ischemia/therapy ; Cerebral Infarction ; Cerebrovascular Circulation/physiology ; Cohort Studies ; Cytidine Triphosphate ; Follow-Up Studies ; Humans ; Ischemic Stroke ; Perfusion Imaging/methods ; Prospective Studies ; Reperfusion ; Stroke/therapy ; Tomography, X-Ray Computed/methods
    Chemical Substances Cytidine Triphosphate (65-47-4)
    Language English
    Publishing date 2022-04-21
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000200269
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  3. Article ; Online: Introducing the "Temporal Thumb Sign" in Pediatric Patients With New-Onset Idiopathic Seizures With and Without Elevated Cerebrospinal Fluid Opening Pressure.

    Kamali, Arash / Park, Evelyn S / Lee, Seung A / Nunez, Luis C / Butler, Ian J / Sitton, Clark W / Riascos, Roy F / Shah, Manish N / Zhang, Xu / Huisman, Thierry A G M

    Pediatric neurology

    2022  Volume 140, Page(s) 52–58

    Abstract: Background: Temporal lobe changes, such as anterior temporal lobe meningoceles or encephaloceles, have been documented as possible epileptogenic foci in a subset of pediatric patients with seizures. In our study, we aim to analyze a different structural ...

    Abstract Background: Temporal lobe changes, such as anterior temporal lobe meningoceles or encephaloceles, have been documented as possible epileptogenic foci in a subset of pediatric patients with seizures. In our study, we aim to analyze a different structural change in the temporal lobe, remodeling of the posterior temporal skull base by the inferior temporal gyrus called the "temporal thumb sign" (TTS), in pediatric patients presenting with new-onset seizures with or without elevated opening pressure (OP), patients presenting with confirmed diagnosis of idiopathic intracranial hypertension (IIH) without seizure presentation, and healthy controls.
    Methods: Magnetic resonance imaging scans of 163 pediatric patients were studied retrospectively for the presence of TTS. We analyzed the scans of 43 patients with elevated OP and confirmed IIH, 40 patients with elevated OP and new-onset idiopathic seizures, 40 patients with normal OP and new-onset idiopathic seizures, and 40 age- and sex-matched healthy controls.
    Results: The TTS was detected most frequently in patients with elevated OP and seizures at 72.5% compared with patients with IIH with no seizures and patients with normal OP and seizures (32.6% and 27.5%, respectively). The TTS had a frequency of 12.5% in the control group. The TTS had the highest combination of specificity and sensitivity (72.5% and 72.5%) in patients with seizures and elevated OP compared with patients with seizures and normal OP (P value < 0.001).
    Conclusions: Our results suggest the Kamali "temporal thumb sign" is a novel imaging feature that may be used as a sensitive and specific imaging finding associated with seizures and elevated OP in the pediatric population.
    MeSH term(s) Humans ; Child ; Retrospective Studies ; Pseudotumor Cerebri/diagnosis ; Cerebrospinal Fluid Pressure ; Encephalocele/complications ; Temporal Lobe ; Magnetic Resonance Imaging/methods
    Language English
    Publishing date 2022-12-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639164-3
    ISSN 1873-5150 ; 0887-8994
    ISSN (online) 1873-5150
    ISSN 0887-8994
    DOI 10.1016/j.pediatrneurol.2022.12.010
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  4. Article ; Online: Ischemic Infarction in Young Adults: A Review for Radiologists.

    McCarty, Jennifer L / Leung, Lester Y / Peterson, Ryan B / Sitton, Clark W / Sarraj, Amrou / Riascos, Roy F / Brinjikji, Waleed

    Radiographics : a review publication of the Radiological Society of North America, Inc

    2019  Volume 39, Issue 6, Page(s) 1629–1648

    Abstract: Ischemic strokes in young adults are devastatingly debilitating and increasingly frequent. Stroke remains the leading cause of serious disability in the United States. The consequences of this familiar disease in this atypical age group are especially ... ...

    Abstract Ischemic strokes in young adults are devastatingly debilitating and increasingly frequent. Stroke remains the leading cause of serious disability in the United States. The consequences of this familiar disease in this atypical age group are especially detrimental and long lasting. Ischemic stroke in young adults is now emerging as a public health issue, one in which radiologists can play a key role. The incidence of ischemic infarction in young adults has risen over the past couple of decades. Increased public awareness, increased use of MRI and angiography, and more accurate diagnosis may in part explain the increased detection of stroke in young adults. The increased prevalence of stroke risk factors in young adults (especially sedentary lifestyle and hypertension) may also contribute. However, compared with older adults, young adults have fewer ischemic infarcts related to the standard cardiovascular risk factors and large- or small-vessel disease. Instead, their infarcts most commonly result from cardioembolic disease and other demonstrated causes (ie, dissection). Thus, radiologists must expand their differential diagnoses to appropriately diagnose ischemic strokes and identify their causes in the young adult population. From the more frequent cardioembolism and dissection to the less common vasculitis, drug-related, CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), moyamoya, and hypercoagulable state-related infarcts, this article covers a wide breadth of causes and imaging findings of ischemic stroke in young adults.
    MeSH term(s) Adolescent ; Adult ; Angiography ; Brain Infarction/diagnostic imaging ; Brain Infarction/etiology ; Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neuroimaging/methods ; Tomography, X-Ray Computed
    Language English
    Publishing date 2019-10-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603172-9
    ISSN 1527-1323 ; 0271-5333
    ISSN (online) 1527-1323
    ISSN 0271-5333
    DOI 10.1148/rg.2019190033
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  5. Article: Serial Cerebral Metabolic Changes in Patients With Ischemic Stroke Treated With Autologous Bone Marrow Derived Mononuclear Cells.

    Haque, Muhammad E / Gabr, Refaat E / George, Sarah D / Boren, Seth B / Vahidy, Farhaan S / Zhang, Xu / Arevalo, Octavio D / Alderman, Susan / Narayana, Ponnada A / Hasan, Khader M / Friedman, Elliott R / Sitton, Clark W / Savitz, Sean I

    Frontiers in neurology

    2019  Volume 10, Page(s) 141

    Abstract: Purpose: ...

    Abstract Purpose:
    Language English
    Publishing date 2019-02-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2019.00141
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  6. Article: Ongoing Secondary Degeneration of the Limbic System in Patients With Ischemic Stroke: A Longitudinal MRI Study.

    Haque, Muhammad E / Gabr, Refaat E / Hasan, Khader M / George, Sarah / Arevalo, Octavio D / Zha, Alicia / Alderman, Susan / Jeevarajan, Jerome / Mas, Manual F / Zhang, Xu / Satani, Nikunj / Friedman, Elliott R / Sitton, Clark W / Savitz, Sean

    Frontiers in neurology

    2019  Volume 10, Page(s) 154

    Abstract: Purpose: ...

    Abstract Purpose:
    Language English
    Publishing date 2019-03-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2019.00154
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  7. Article ; Online: Endovascular Thrombectomy Versus Medical Management in Isolated M2 Occlusions: Pooled Patient-Level Analysis from the EXTEND-IA Trials, INSPIRE, and SELECT Studies.

    Sarraj, Amrou / Parsons, Mark / Bivard, Andrew / Hassan, Ameer E / Abraham, Michael G / Wu, Teddy / Kleinig, Timothy / Lin, Longting / Chen, Chushuang / Levi, Christopher / Dong, Qiang / Cheng, Xin / Butcher, Ken S / Choi, Philip / Yassi, Nawaf / Shah, Darshan / Sharma, Gagan / Pujara, Deep / Shaker, Faris /
    Blackburn, Spiros / Dewey, Helen / Thijs, Vincent / Sitton, Clark W / Donnan, Geoffrey A / Mitchell, Peter J / Yan, Bernard / Grotta, James G / Albers, Gregory W / Davis, Stephen M / Campbell, Bruce

    Annals of neurology

    2022  Volume 91, Issue 5, Page(s) 629–639

    Abstract: Objective: The objective of this study was to evaluate functional and safety outcomes of endovascular thrombectomy (EVT) versus medical management (MM) in patients with M2 occlusion and examine their association with perfusion imaging mismatch and ... ...

    Abstract Objective: The objective of this study was to evaluate functional and safety outcomes of endovascular thrombectomy (EVT) versus medical management (MM) in patients with M2 occlusion and examine their association with perfusion imaging mismatch and stroke severity.
    Methods: In a pooled, patient-level analysis of 3 randomized controlled trials (EXTEND-IA, EXTEND-and IA-TNK parts 1 and 2) and 2 prospective nonrandomized studies (INSPIRE and SELECT), we evaluated EVT association with 90-day functional independence (modified Rankin Scale [mRS] = 0-2) in isolated M2 occlusions as compared to medical management overall and in subgroups by mismatch profile status and stroke severity.
    Results: We included 517 patients (EVT = 195 and MM = 322), baseline median (interquartile range [IQR]) National Institutes of Health Stroke Scale (NIHSS) was 13 (8-19) in EVT versus 10 (6-15) in MM, p < 0.001. Pretreatment ischemic core did not differ (EVT = 10 [0-24] ml vs MM = 9 [3-21] ml, p = 0.59). Compared to MM, EVT was more frequently associated with functional independence (68.3 vs 61.6%, adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] = 1.25-4.67, p = 0.008, inverse probability of treatment weights [IPTW]-OR = 1.75, 95% CI = 1.00-3.75, p = 0.05) with a shift toward better mRS outcomes (adjusted cOR = 2.02, 95% CI:1.23-3.29, p = 0.005), and lower mortality (5 vs 10%, aOR = 0.32, 95% CI = 0.12-0.87, p = 0.025). EVT was associated with higher functional independence in patients with a perfusion mismatch profile (EVT = 70.7% vs MM = 61.3%, aOR = 2.29, 95% CI = 1.09-4.79, p = 0.029, IPTW-OR = 2.02, 1.08-3.78, p = 0.029), whereas no difference was found in those without mismatch (EVT = 43.8% vs MM = 62.7%, p = 0.17, IPTW-OR: 0.71, 95% CI = 0.18-2.78, p = 0.62). Functional independence was more frequent with EVT in patients with moderate or severe strokes, as defined by baseline NIHSS above any thresholds from 6 to 10, whereas there was no difference between groups with milder strokes below these thresholds.
    Interpretation: In patients with M2 occlusion, EVT was associated with improved clinical outcomes when compared to MM. This association was primarily observed in patients with a mismatch profile and those with higher stroke severity. ANN NEUROL 2022;91:629-639.
    MeSH term(s) Brain Ischemia/diagnostic imaging ; Brain Ischemia/surgery ; Endovascular Procedures/methods ; Humans ; Perfusion Imaging ; Prospective Studies ; Stroke/surgery ; Thrombectomy/methods ; Treatment Outcome
    Language English
    Publishing date 2022-03-17
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80362-5
    ISSN 1531-8249 ; 0364-5134
    ISSN (online) 1531-8249
    ISSN 0364-5134
    DOI 10.1002/ana.26331
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  8. Article ; Online: Endovascular Thrombectomy Treatment Effect in Direct vs Transferred Patients With Large Ischemic Strokes: A Prespecified Analysis of the SELECT2 Trial.

    Sarraj, Amrou / Hill, Michael D / Hussain, M Shazam / Abraham, Michael G / Ortega-Gutierrez, Santiago / Chen, Michael / Kasner, Scott E / Churilov, Leonid / Pujara, Deep K / Johns, Hannah / Blackburn, Spiros / Sundararajan, Sophia / Hu, Yin C / Herial, Nabeel A / Budzik, Ronald F / Hicks, William J / Arenillas, Juan F / Tsai, Jenny P / Kozak, Osman /
    Cordato, Dennis J / Hanel, Ricardo A / Wu, Teddy Y / Portela, Pere Cardona / Gandhi, Chirag D / Al-Mufti, Fawaz / Maali, Laith / Gibson, Daniel / Pérez de la Ossa, Natalia / Schaafsma, Joanna D / Blasco, Jordi / Sangha, Navdeep / Warach, Steven / Kleinig, Timothy J / Shaker, Faris / Sitton, Clark W / Nguyen, Thanh / Fifi, Johanna T / Jabbour, Pascal / Furlan, Anthony / Lansberg, Maarten G / Tsivgoulis, Georgios / Sila, Cathy / Bambakidis, Nicholas / Davis, Stephen / Wechsler, Lawrence / Albers, Greg W / Grotta, James C / Ribo, Marc / Campbell, Bruce C / Hassan, Ameer E / Vora, Nirav / Manning, Nathan W / Cheung, Andrew / Aghaebrahim, Amin N / Paipa Merchán, Andres J / Sahlein, Daniel / Requena Ruiz, Manuel / Elijovich, Lucas / Arthur, Adam / Al-Shaibi, Faisal / Samaniego, Edgar A / Duncan, Kelsey R / Opaskar, Amanda / Ray, Abhishek / Xiong, Wei / Sunshine, Jeffery / DeGeorgia, Michael / Tjoumakaris, Stavropoula / Mendes Pereira, Vitor

    JAMA neurology

    2024  

    Abstract: Importance: Patients with large ischemic core stroke have poor clinical outcomes and are frequently not considered for interfacility transfer for endovascular thrombectomy (EVT).: Objective: To assess EVT treatment effects in transferred vs directly ... ...

    Abstract Importance: Patients with large ischemic core stroke have poor clinical outcomes and are frequently not considered for interfacility transfer for endovascular thrombectomy (EVT).
    Objective: To assess EVT treatment effects in transferred vs directly presenting patients and to evaluate the association between transfer times and neuroimaging changes with EVT clinical outcomes.
    Design, setting, and participants: This prespecified secondary analysis of the SELECT2 trial, which evaluated EVT vs medical management (MM) in patients with large ischemic stroke, evaluated adults aged 18 to 85 years with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) as well as an Alberta Stroke Program Early CT Score (ASPECTS) of 3 to 5, core of 50 mL or greater on imaging, or both. Patients were enrolled between October 2019 and September 2022 from 31 EVT-capable centers in the US, Canada, Europe, Australia, and New Zealand. Data were analyzed from August 2023 to January 2024.
    Interventions: EVT vs MM.
    Main outcomes and measures: Functional outcome, defined as modified Rankin Scale (mRS) score at 90 days with blinded adjudication.
    Results: A total of 958 patients were screened and 606 patients were excluded. Of 352 enrolled patients, 145 (41.2%) were female, and the median (IQR) age was 66.5 (58-75) years. A total of 211 patients (59.9%) were transfers, while 141 (40.1%) presented directly. The median (IQR) transfer time was 178 (136-230) minutes. The median (IQR) ASPECTS decreased from the referring hospital (5 [4-7]) to an EVT-capable center (4 [3-5]). Thrombectomy treatment effect was observed in both directly presenting patients (adjusted generalized odds ratio [OR], 2.01; 95% CI, 1.42-2.86) and transferred patients (adjusted generalized OR, 1.50; 95% CI, 1.11-2.03) without heterogeneity (P for interaction = .14). Treatment effect point estimates favored EVT among 82 transferred patients with a referral hospital ASPECTS of 5 or less (44 received EVT; adjusted generalized OR, 1.52; 95% CI, 0.89-2.58). ASPECTS loss was associated with numerically worse EVT outcomes (adjusted generalized OR per 1-ASPECTS point loss, 0.89; 95% CI, 0.77-1.02). EVT treatment effect estimates were lower in patients with transfer times of 3 hours or more (adjusted generalized OR, 1.15; 95% CI, 0.73-1.80).
    Conclusions and relevance: Both directly presenting and transferred patients with large ischemic stroke in the SELECT2 trial benefited from EVT, including those with low ASPECTS at referring hospitals. However, the association of EVT with better functional outcomes was numerically better in patients presenting directly to EVT-capable centers. Prolonged transfer times and evolution of ischemic change were associated with worse EVT outcomes. These findings emphasize the need for rapid identification of patients suitable for transfer and expedited transport.
    Trial registration: ClinicalTrials.gov Identifier: NCT03876457.
    Language English
    Publishing date 2024-02-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2702023-X
    ISSN 2168-6157 ; 2168-6149
    ISSN (online) 2168-6157
    ISSN 2168-6149
    DOI 10.1001/jamaneurol.2024.0206
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  9. Article ; Online: Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial.

    Chen, Michael / Joshi, Krishna C / Kolb, Bradley / Sitton, Clark W / Pujara, Deep Kiritbhai / Abraham, Michael G / Ortega-Gutierrez, Santiago / Kasner, Scott E / Hussain, Shazam M / Churilov, Leonid / Blackburn, Spiros / Sundararajan, Sophia / Hu, Yin C / Herial, Nabeel / Arenillas, Juan F / Tsai, Jenny P / Budzik, Ronald F / Hicks, William / Kozak, Osman /
    Yan, Bernard / Cordato, Dennis / Manning, Nathan W / Parsons, Mark / Hanel, Ricardo A / Aghaebrahim, Amin / Wu, Teddy / Cardona Portela, Pere / Gandhi, Chirag D / Al-Mufti, Fawaz / Perez de la Ossa, Natalia / Schaafsma, Joanna / Blasco, Jordi / Sangha, Navdeep / Warach, Steven / Kleinig, Timothy J / Johns, Hannah / Shaker, Faris / Abdulrazzak, Mohammad A / Ray, Abhishek / Sunshine, Jeffery / Opaskar, Amanda / Duncan, Kelsey R / Xiong, Wei / Al-Shaibi, Faisal K / Samaniego, Edgar A / Nguyen, Thanh N / Fifi, Johanna T / Tjoumakaris, Stavropoula I / Jabbour, Pascal / Mendes Pereira, Vitor / Lansberg, Maarten G / Sila, Cathy / Bambakidis, Nicholas C / Davis, Stephen / Wechsler, Lawrence / Albers, Gregory W / Grotta, James C / Ribo, Marc / Hassan, Ameer E / Campbell, Bruce / Hill, Michael D / Sarraj, Amrou

    Journal of neurointerventional surgery

    2024  

    Abstract: Background: The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized.: Methods: SELECT2 trial follow-up imaging was ... ...

    Abstract Background: The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized.
    Methods: SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined.
    Results: Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (P
    Conclusions: ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.
    Language English
    Publishing date 2024-03-12
    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-2023-021219
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Endovascular thrombectomy plus medical care versus medical care alone for large ischaemic stroke: 1-year outcomes of the SELECT2 trial.

    Sarraj, Amrou / Abraham, Michael G / Hassan, Ameer E / Blackburn, Spiros / Kasner, Scott E / Ortega-Gutierrez, Santiago / Hussain, Muhammad Shazam / Chen, Michael / Johns, Hannah / Churilov, Leonid / Pujara, Deep K / Shaker, Faris / Maali, Laith / Cardona Portela, Pere / Herial, Nabeel A / Gibson, Daniel / Kozak, Osman / Arenillas, Juan F / Yan, Bernard /
    Pérez de la Ossa, Natalia / Sundararajan, Sophia / Hu, Yin C / Cordato, Dennis J / Manning, Nathan W / Hanel, Ricardo A / Aghaebrahim, Amin N / Budzik, Ronald F / Hicks, William J / Blasco, Jordi / Wu, Teddy Y / Tsai, Jenny P / Schaafsma, Joanna D / Gandhi, Chirag D / Al-Mufti, Fawaz / Sangha, Navdeep / Warach, Steven / Kleinig, Timothy J / Yogendrakumar, Vignan / Ng, Felix / Samaniego, Edgar A / Abdulrazzak, Mohammad A / Parsons, Mark W / Rahbar, Mohammad H / Nguyen, Thanh N / Fifi, Johanna T / Mendes Pereira, Vitor / Lansberg, Maarten G / Albers, Greg W / Furlan, Anthony J / Jabbour, Pascal / Sitton, Clark W / Sila, Cathy / Bambakidis, Nicholas / Davis, Stephen M / Wechsler, Lawrence / Hill, Michael D / Grotta, James C / Ribo, Marc / Campbell, Bruce C V

    Lancet (London, England)

    2024  Volume 403, Issue 10428, Page(s) 731–740

    Abstract: Background: Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these ... ...

    Abstract Background: Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these patients.
    Methods: SELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand. Patients aged 18-85 years with ischaemic stroke due to proximal occlusion of the internal carotid artery or of the first segment of the middle cerebral artery, showing large ischaemic core on non-contrast CT (Alberta Stroke Program Early Computed Tomographic Score of 3-5 [range 0-10, with lower values indicating larger infarctions]) or measuring 50 mL or more on CT perfusion and MRI, were randomly assigned, within 24 h of ischaemic stroke onset, to thrombectomy plus medical care or to medical care alone. The primary outcome for this analysis was the ordinal modified Rankin Scale (range 0-6, with higher scores indicating greater disability) at 1-year follow-up in an intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT03876457) and is completed.
    Findings: The trial was terminated early for efficacy at the 90-day follow-up after 352 patients had been randomly assigned (178 to thrombectomy and 174 to medical care only) between Oct 11, 2019, and Sept 9, 2022. Thrombectomy significantly improved the 1-year modified Rankin Scale score distribution versus medical care alone (Wilcoxon-Mann-Whitney probability of superiority 0·59 [95% CI 0·53-0·64]; p=0·0019; generalised odds ratio 1·43 [95% CI 1·14-1·78]). At the 1-year follow-up, 77 (45%) of 170 patients receiving thrombectomy had died, compared with 83 (52%) of 159 patients receiving medical care only (1-year mortality relative risk 0·89 [95% CI 0·71-1·11]).
    Interpretation: In patients with ischaemic stroke due to a proximal occlusion and large core, thrombectomy plus medical care provided a significant functional outcome benefit compared with medical care alone at 1-year follow-up.
    Funding: Stryker Neurovascular.
    MeSH term(s) Humans ; Stroke/diagnostic imaging ; Stroke/surgery ; Brain Ischemia/therapy ; Brain Ischemia/drug therapy ; Treatment Outcome ; Endovascular Procedures/methods ; Thrombectomy/methods ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/surgery ; Alberta ; Fibrinolytic Agents/therapeutic use
    Chemical Substances Fibrinolytic Agents
    Language English
    Publishing date 2024-02-09
    Publishing country England
    Document type Randomized Controlled Trial ; Clinical Trial, Phase III ; Journal Article
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(24)00050-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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