Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke

Autor: Nerea, Arrarte Terreros, Agnetha A E, Bruggeman, Henk, van Voorst, Praneeta R, Konduri, Ivo G H, Jansen, Manon, Kappelhof, Manon L, Tolhuisen, Nikki, Boodt, Diederik W J, Dippel, Aad, van der Lugt, Wim H, van Zwam, Robert J, van Oostenbrugge, H Bart, van der Worp, Bart J, Emmer, Frederick J A, Meijer, Yvo B W E M, Roos, Ed, van Bavel, Henk A, Marquering, Charles B L M, Majoie, Lucas A, Ramos
Přispěvatelé: Internal medicine, Radiology and nuclear medicine, Neurology, Radiology & Nuclear Medicine, Biomedical Engineering and Physics, Graduate School, Radiology and Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ANS - Brain Imaging, ANS - Neurovascular Disorders, ANS - Cellular & Molecular Mechanisms, ANS - Compulsivity, Impulsivity & Attention, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, RS: Carim - B06 Imaging, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Klinische Neurowetenschappen, MUMC+: MA Neurologie (3), MUMC+: Hersen en Zenuw Centrum (3), ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE)
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: journal of NeuroInterventional Surgery
Journal of NeuroInterventional Surgery. BMJ PUBLISHING GROUP
Journal of NeuroInterventional Surgery
Arrarte Terreros, N, Bruggeman, A A E, van Voorst, H, Konduri, P R, Jansen, I G H, Kappelhof, M, Tolhuisen, M L, Boodt, N, Dippel, D W J, van der Lugt, A, van Zwam, W H, van Oostenbrugge, R J, van der Worp, H B, Emmer, B J, Meijer, F J A, Roos, Y B W E M, van Bavel, E, Marquering, H A & Majoie, C B L M 2022, ' Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke ', Journal of neurointerventional surgery . https://doi.org/10.1136/neurintsurg-2021-018560
Amsterdam UMC (VU Amsterdam)-Institutional Repository
NARCIS
ORCID
Journal of neurointerventional surgery. BMJ Publishing Group
Journal of NeuroInterventional Surgery, 15, 355-362
Journal of NeuroInterventional Surgery, 15(4), 355-362. BMJ Publishing Group
Journal of Neurointerventional Surgery, 15(4), 355-362. BMJ Publishing Group
Journal of NeuroInterventional Surgery, 15, 4, pp. 355-362
Journal of Neurointerventional Surgery, 15, 355-362. BMJ PUBLISHING GROUP
ISSN: 1759-8478
Popis: BackgroundA thrombus in the M1 segment of the middle cerebral artery (MCA) can occlude this main stem only or extend into the M1-M2 bifurcation. The occlusion pattern may affect endovascular treatment (EVT) success, as a bifurcated thrombus may be more prone to fragmentation during retrieval.ObjectiveTo investigate whether bifurcated thrombus patterns are associated with EVT procedural and clinical outcomes.MethodsOcclusion patterns of MCA thrombi on CT angiography from MR CLEAN Registry patients were classified into three groups: main stem occlusion, bifurcation occlusion extending into one M2 branch, and bifurcation occlusion extending into both M2 branches. Procedural parameters, procedural outcomes (reperfusion grade and embolization to new territory), and clinical outcomes (24-48 hour National Institutes of Health Stroke Scale [NIHSSFU] score, change in NIHSS scores between 24 and 48 hours and baseline ∆[NIHSS], and 90-day modified Rankin Scale [mRS] scores) were compared between occlusion patterns.ResultsWe identified 1023 patients with an MCA occlusion of whom 370 (36%) had a main stem occlusion, 151 (15%) a single branch, and 502 (49%) a double branch bifurcation occlusion. There were no statistically significant differences in retrieval method, procedure time, number of retrieval attempts, reperfusion grade, and embolization to new territory between occlusion patterns. Patients with main stem occlusions had lower NIHSSFU scores than patients with single (7 vs 11, p=0.01) or double branch occlusions (7 vs 9, p=0.04). However, there were no statistically significant differences in ∆NIHSS or in 90-day mRS scores.ConclusionsIn our population, EVT procedural and long-term clinical outcomes were similar for MCA bifurcation occlusions and MCA main stem occlusions.
Databáze: OpenAIRE
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