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Browsing by Author "Tsivgoulis, G"

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  • Basilar Artery Occlusion Management: Specialist Perspectives From an International Survey
    Publication . Edwards, C; Drumm, B; Siegler, J; Schonewille, W; Klein, P; Huo, X; Chen, Y; Abdalkader, M; Qureshi, M; Strbian, D; Liu, X; Hu, W; Ji, X; Li, C; Fischer, U; Nagel, S; Puetz, V; Michel, P; Alemseged, F; Sacco, S; Yamagami, H; Yaghi, S; Strambo, D; Kristoffersen, E; Sandset, E; Mikulik, R; Tsivgoulis, G; Masoud, H; Aguiar de Sousa, D; Marto, JP; Lobotesis, K; Roi, D; Berberich, A; Demeestere, J; Meinel, T; Rivera, R; Poli, S; Ton, M; Zhu, Y; Li, F; Sang, H; Thomalla, G; Parsons, M; Campbell, B; Zaidat, O; Chen, HS; Field, T; Raymond, J; Kaesmacher, J; Nogueira, R; Jovin, T; Sun, D; Liu, R; Qureshi, A; Qiu, Z; Miao, Z; Banerjee, S; Nguyen, T
    Background and purpose: Two early basilar artery occlusion (BAO) randomized controlled trials did not establish the superiority of endovascular thrombectomy (EVT) over medical management. While many providers continue to recommend EVT for acute BAO, perceptions of equipoise in randomizing patients with BAO to EVT versus medical management may differ between clinician specialties. Methods: We conducted an international survey (January 18, 2022 to March 31, 2022) regarding management strategies in acute BAO prior to the announcement of two trials indicating the superiority of EVT, and compared responses between interventionalists (INTs) and non-interventionalists (nINTs). Selection practices for routine EVT and perceptions of equipoise regarding randomizing to medical management based on neuroimaging and clinical features were compared between the two groups using descriptive statistics. Results: Among the 1245 respondents (nINTs = 702), INTs more commonly believed that EVT was superior to medical management in acute BAO (98.5% vs. 95.1%, p < .01). A similar proportion of INTs and nINTs responded that they would not randomize a patient with BAO to EVT (29.4% vs. 26.7%), or that they would only under specific clinical circumstances (p = .45). Among respondents who would recommend EVT for BAO, there was no difference in the maximum prestroke disability, minimum stroke severity, or infarct burden on computed tomography between the two groups (p > .05), although nINTs more commonly preferred perfusion imaging (24.2% vs. 19.7%, p = .04). Among respondents who indicated they would randomize to medical management, INTs were more likely to randomize when the National Institutes of Health Stroke Scale was ≥10 (15.9% vs. 6.9%, p < .01). Conclusions: Following the publication of two neutral clinical trials in BAO EVT, most stroke providers believed EVT to be superior to medical management in carefully selected patients, with most indicating they would not randomize a BAO patient to medical treatment. There were small differences in preference for advanced neuroimaging for patient selection, although these preferences were unsupported by clinical trial data at the time of the survey.
    2023Journal article Open access Show more
  • Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine–Induced Immune Thrombotic Thrombocytopenia
    Publication . Sánchez van Kammen, M; Aguiar de Sousa, D; Poli, S; Cordonnier, C; Heldner, M; van de Munckhof, A; Krzywicka, K; van Haaps, T; Ciccone, A; Middeldorp, S; Levi, M; Kremer Hovinga, J; Silvis, S; Hiltunen, S; Mansour, M; Arauz, A; Barboza, M; Field, T; Tsivgoulis, G; Nagel, S; Lindgren, E; Tatlisumak, T; Jood, K; Putaala, J; Ferro, J; Arnold, M; Coutinho, J; Sharma, A; Elkady, A; Negro, A; Günther, A; Gutschalk, A; Schönenberger, S; Buture, A; Murphy, S; Paiva Nunes, A; Tiede, A; Puthuppallil Philip, A; Mengel, A; Medina, A; Hellström Vogel, Å; Tawa, A; Aujayeb, A; Casolla, B; Buck, B; Zanferrari, C; Garcia-Esperon, C; Vayne, C; Legault, C; Pfrepper, C; Tracol, C; Soriano, C; Guisado-Alonso, D; Bougon, D; Zimatore, D; Michalski, D; Blacquiere, D; Johansson, E; Cuadrado-Godia, E; De Maistre, E; Carrera, E; Vuillier, F; Bonneville, F; Giammello, F; Bode, F; Zimmerman, J; d’Onofrio, F; Grillo, F; Cotton, F; Caparros, F; Puy, L; Maier, F; Gulli, G; Frisullo, G; Polkinghorne, G; Franchineau, G; Cangür, H; Katzberg, H; Sibon, I; Baharoglu, I; Brar, J; Payen, JF; Burrow, J; Fernandes, J; Schouten, J; Althaus, K; Garambois, K; Derex, L; Humbertjean, L; Lebrato Hernandez, L; Kellermair, L; Morin Martin, M; Petruzzellis, M; Cotelli, M; Dubois, MC; Carvalho, M; Wittstock, M; Miranda, M; Skjelland, M; Bandettini di Poggio, M; Scholz, M; Raposo, N; Kahnis, R; Kruyt, N; Huet, O; Sharma, P; Candelaresi, P; Reiner, P; Vieira, R; Acampora, R; Kern, R; Leker, R; Coutts, S; Bal, S; Sharma, S; Susen, S; Cox, T; Geeraerts, T; Gattringer, T; Bartsch, T; Kleinig, T; Dizonno, V; Arslan, Y
    Importance: Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). Objective: To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. Design, setting, and participants: This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. Exposures: Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. Main outcomes and measures: Clinical characteristics and mortality rate. Results: Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. Conclusions and relevance: In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.
    2021-11Journal article Open access Show more
  • Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis
    Publication . Palaiodimou, L; Stefanou, MI; Katsanos, AH; Paciaroni, M; Sacco, S; De Marchis, GM; Shoamanesh, A; Malhotra, K; Aguiar de Sousa, D; Lambadiari, V; Kantzanou, M; Vassilopoulou, S; Toutouzas, K; Filippou, DK; Seiffge, DJ; Tsivgoulis, G
    Introduction: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF). Methods: We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral haemorrhage (sICH) and any ICH. Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p = 0.1677; p = 0.8941; and p = 0.7786, respectively). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality. Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs.
    2022Journal article Open access Show more
  • Endovascular Treatment for Anterior Circulation Large-Vessel Occlusion Ischemic Stroke with Low ASPECTS: a Systematic Review and Meta-Analysis
    Publication . Safouris, A; Palaiodimou, L; Szikora, I; Kargiotis, O; Magoufis, G; Psychogios, K; Paraskevas, G; Spiliopoulos, S; Brountzos, E; Nardai, S; Goyal, N; Aguiar de Sousa, D; Strbian, D; Caso, V; Alexandrov, A; Tsivgoulis, G
    Background: Endovascular treatment (EVT) for acute ischemic stroke (AIS) patients presenting with Alberta Stroke Program Early CT Score (ASPECTS) 0-5 has not yet proven safe and effective by clinical trials. Objectives: The aim of the study was to assess whether EVT in AIS patients presenting with low ASPECTS is beneficial. Design: Systematic review and meta-analysis of available studies in accordance with the PRISMA statement. Data sources and methods: We have searched MEDLINE, the Cochrane Central Register of Controlled Trials, and reference lists of articles published until 28 May 2022 with the aim to calculate (1) modified Rankin scale (mRS) score 0-3 at 3 months, (2) mRS score 0-2 at 3 months, (3) symptomatic intracranial hemorrhage (sICH), and (3) mortality at 3 months. Results: Overall, 24 eligible studies were included in the meta-analysis, comprising a total of 2539 AIS patients with ASPECTS 0-5 treated with EVT. The pooled proportion of EVT-treated patients achieving mRS 0-3 at 3 months was calculated at 38.4%. The pooled proportion of EVT-treated patients achieving mRS 0-2 at 3 months was 25.7%. Regarding safety outcomes, sICH occurred in 12.8% of patients. The 3-month pooled mortality was 30%. In pairwise meta-analysis, patients treated with EVT had a higher likelihood of achieving mRS 0-3 at 3 months compared with patients treated with best medical therapy (BMT, OR: 2.41). sICH occurred more frequently in EVT-treated patients compared with the BMT-treated patients (OR: 2.30). Mortality at 3 months was not different between the two treatment groups (OR: 0.71). Conclusion: EVT may be beneficial for AIS patients with low baseline ASPECTS despite an increased risk for sICH. Further data from randomized-controlled clinical trials are needed to elucidate the role of EVT in this subgroup of AIS patients. Registration: The protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO; Registration Number: CRD42022334417.
    2022-11Journal article Open access Show more
  • Global Impact of COVID-19 on Stroke Care and IV Thrombolysis
    Publication . Nogueira, RG; Qureshi, MM; Abdalkader, M; Martins, SO; Yamagami, H; Qiu, Z; Mansour, OY; Sathya, A; Czlonkowska, A; Tsivgoulis, G; Aguiar de Sousa, D; Demeestere, J; Mikulik, R; Vanacker, P; Siegler, JE; Kõrv, J; Biller, J; Liang, CW; Sangha, NS; Zha, AM.; Czap, AL; Holmstedt, CA; Turan, TN; Ntaios, G; Malhotra, K; Tayal, A; Loochtan, A; Ranta, A; Mistry, EA; Alexandrov, AW; Huang, DY; Yaghi, S; Raz, E; Sheth, SA; Mohammaden, MH; Frankel, M; Bila Lamou, EG; Aref, HM; Elbassiouny, A; Hassan, F; Menecie, T; Mustafa, W; Shokri, HM; Roushdy, T; Sarfo, FS; Alabi, TO; Arabambi, B; Nwazor, EO; Sunmonu, TA; Wahab, K; Yaria, J; Mohammed, HH; Adebayo, PB; Riahi, AD; Sassi, SB; Gwaunza, L; Ngwende, GW; Sahakyan, D; Rahman, A; Ai, Z; Bai, F; Duan, Z; Hao, Y; Huang, W; Li, G; Li, W; Liu, G; Luo, J; Shang, X; Sui, Y; Tian, L; Wen, H; Wu, B; Yan, Y; Yuan, Z; Zhang, H; Zhang, J; Zhao, W; Zi, W; Leung, TW; Chugh, C; Huded, V; Menon, B; Pandian, JD; Sylaja, PN; Usman, FS; Farhoudi, M; Hokmabadi, ES; Horev, A; Reznik, A; Sivan Hoffmann, R; Ohara, N; Sakai, N; Watanabe, D; Yamamoto, R; Doijiri, R; Tokuda, N; Yamada, T; Terasaki, T; Yazawa, Y; Uwatoko, T; Dembo, T; Shimizu, H; Sugiura, Y; Miyashita, F; Fukuda, H; Miyake, K; Shimbo, J; Sugimura, Y; Yagita, Y; Takenobu, Y; Matsumaru, Y; Yamada, S; Kono, R; Kanamaru, T; Yamazaki, H; Sakaguchi, M; Todo, K; Yamamoto, N; Sonoda, K; Yoshida, T; Hashimoto, H; Nakahara, I; Kondybayeva, A; Faizullina, K; Kamenova, S; Zhanuzakov, M; Baek, JH; Hwang, Y; Lee, JS; Lee, SB; Moon, J; Park, H; Seo, JH; Seo, KD; Sohn, SI; Young, CJ; Ahdab, R; Wan Zaidi, WA; Aziz, ZA; Basri, HB; Chung, LW; Ibrahim, AB; Ibrahim, KA; Looi, I; Tan, WY; Yahya, NW; Groppa, S; Leahu, P; Al Hashmi, AM; Imam, YZ; Akhtar, N; Pineda-Franks, MC; Co, CO; Kandyba, D; Alhazzani, A; Al-Jehani, H; Tham, CH; Mamauag, MJ; Venketasubramanian, N; Chen, CH; Tang, SC; Churojana, A; Akil, E; aykaç, O; Ozdemir, AO; Giray, S; Hussain, SI; John, S; Le Vu, H; Tran, AD; Nguyen, HH; Nhu Pham, T; Nguyen, TH; Nguyen, TQ; Gattringer, T; Enzinger, C; Killer-Oberpfalzer, M; Bellante, F; De Blauwe, S; Vanhooren, G; De Raedt, S; Dusart, A; Lemmens, R; Ligot, N; Pierre Rutgers, M; Yperzeele, L; Alexiev, F; Sakelarova, T; Bedeković, MR; Budincevic, H; Cindric, I; Hucika, Z; Ozretic, D; Saric, MS; Pfeifer, F; Karpowic, I; Cernik, D; Sramek, M; Skoda, M; Hlavacova, H; Klecka, L; Koutny, M; Vaclavik, D; Skoda, O; Fiksa, J; Hanelova, K; Nevsimalova, M; Rezek, R; Prochazka, P; Krejstova, G; Neumann, J; Vachova, M; Brzezanski, H; Hlinovsky, D; Tenora, D; Jura, R; Jurák, L; Novak, J; Novak, A; Topinka, Z; Fibrich, P; Sobolova, H; Volny, O; Krarup Christensen, H; Drenck, N; Klingenberg Iversen, H; Simonsen, CZ; Truelsen, TC; Wienecke, T; Vibo, R; Gross-Paju, K; Toomsoo, T; Antsov, K; Caparros, F; Cordonnier, C; Dan, M; Faucheux, JM; Mechtouff, L; Eker, O; Lesaine, E; Ondze, B; Peres, R; Pico, F; Piotin, M; Pop, R; Rouanet, F; Gubeladze, T; Khinikadze, M; Lobjanidze, N; Tsiskaridze, A; Nagel, S; Ringleb, PA; Rosenkranz, M; Schmidt, H; Sedghi, A; Siepmann, T; Szabo, K; Thomalla, G; Palaiodimou, L; Sagris, D; Kargiotis, O; Klivenyi, P; Szapary, L; Tarkanyi, G; Adami, A; Bandini, P; Calabresi, P; Frisullo, G; Renieri, L; Sangalli, D; Pirson, A; Uyttenboogaart, M; van den Wijngaard, I; Kristoffersen, ES; Brola, W; Fudala, M; Horoch-Lyszczarek, E; Karlinski, M; Kazmierski, R; Kram, P; Rogoziewicz, M; Kaczorowski, R; Luchowski, P; Sienkiewicz-Jarosz, H; Sobolewski, P; Fryze, W; Wisniewska, A; Wiszniewska, M; Ferreira, P; Ferreira, P; Fonseca, L; Marto, JP; Pinho e Melo, T; Nunes, AP; Rodrigues, M; Tedim Cruz, V; Falup-Pecurariu, C; Krastev, G; Mako, M; de Leciñana, MA; Arenillas, JF; Ayo-Martin, O; Cruz Culebras, A; Tejedor, ED; Montaner, J; Pérez-Sánchez, S; Tola Arribas, MA; Rodriguez Vasquez, A; Mayza, M; Bernava, G; Brehm, A; Machi, P; Fischer, U; Gralla, J; Michel, PL; Psychogios, MN; Strambo, D; Banerjee, S; Krishnan, K; Kwan, J; Butt, A; Catanese, L; Demchuk, AM; Field, T; Haynes, J; Hill, MD.; Khosravani, H; Mackey, A; Pikula, A; Saposnik, G; Scott, CA; Shoamanesh, A; Shuaib, A; Yip, S; Barboza, MA; Barrientos, JD; Portillo Rivera, LI; Gongora-Rivera, F; Novarro-Escudero, N; Blanco, A; Abraham, M; Alsbrook, D; Altschul, D; Alvarado-Ortiz, AJ; Bach, I; Badruddin, A; Barazangi, N; Brereton, C; Castonguay, A; Chaturvedi, S; Chaudry, SA; Choe, H; Choi, JA; Dharmadhikari, S; Desai, K; Devlin, TG; Doss, VT; Edgell, R; Etherton, M; Farooqui, M; Frei, D; Gandhi, D; Grigoryan, M; Gupta, R; Hassan, AE; Helenius, J; Kaliaev, A; Kaushal, R; Khandelwal, P; Khawaja, AM; Khoury, NN; Kim, BS; Kleindorfer, DO; Koyfman, F; Lee, VH; Leung, LY; Linares, G; Linfante, I; Lutsep, HL; Macdougall, L; Male, S; Malik, AM; Masoud, H; McDermott, M; Mehta, BP; Min, J; Mittal, M; Morris, JG; Multani, SS; Nahab, F; Nalleballe, K; Nguyen, CB; Novakovic-White, R; Ortega-Gutierrez, S; Rahangdale, RH; Ramakrishnan, P; Romero, JR; Rost, N; Rothstein, A; Ruland, S; Shah, R; Sharma, M; Silver, B; Simmons, M; Singh, A; Starosciak, AK; Strasser, SL; Szeder, V; Teleb, M; Tsai, JP; Voetsch, B; Balaguera, O; Pujol Lereis, VA; Luraschi, A; Almeida, MS; Cardoso, FB; Conforto, A; De Deus Silva, L; Varrone Giacomini, L; Oliveira Lima, F; Longo, AL; Magalhães, PSC; Martins, RT; Mont'alverne, F; Mora Cuervo, DL; Costa Rebello, L; Valler, L; Zetola, VF; Lavados, PM; Navia, V; Olavarría, VV; Almeida Toro, JM; Amaya, PFR; Bayona, H; Corredor, A; Rivera Ordonez, CE; Mantilla Barbosa, DK; Lara, O; Patiño, MR; Diaz Escobar, LF; Dejesus Melgarejo Fariña, DE; Cardozo Villamayor, A; Zelaya Zarza, AJ; Barrientos Iman, DM; Rodriguez Kadota, L; Campbell, B; Hankey, GJ.; Hair, C; Kleinig, T; Ma, A; Tomazini Martins, R; Sahathevan, R; Thijs, V; Salazar, D; Yuan-Hao Wu, T; Haussen, DC; Liebeskind, D; Yavagal, DR; Jovin, TG; Zaidat, OO; Nguyen, TN
    Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
    2021Journal article Open access Show more
  • Magnitude of Blood Pressure Change and Clinical Outcomes after Thrombectomy in SAtroke Caused by Large Artery Occlusion
    Publication . Anadani, M; Matusevicius, M; Tsivgoulis, G; Peeters, A; Nunes, AP; Mancuso, M; Roffe, C; Havenon, A; Ahmed, N
    Background: Extremes of both high and low systolic blood pressure (SBP) after mechanical thrombectomy (MT) in large artery occlusion stroke are known predictors of unfavorable outcome. However, the effect of SBP change (∆SBP) during the first 24 h on thrombectomy outcomes remains unclear. We aimed to investigate the association between ∆SBP at different time intervals and thrombectomy outcomes. Methods: We analyzed MT-treated patients registered in the SITS International Stroke Thrombectomy Registry from January 1, 2014 to September 3, 2019. Primary outcome was 3-month unfavorable outcome (modified Rankin scale scores 3-6). We defined ∆SBP as the mean SBP of a given time interval after MT (0-2, 2-4, 4-12, 12-24 h) minus admission SBP. Multivariable mixed logistic regression models were used to adjust for known confounders and center as random effect. Subgroup analyses were included to contrast specific subpopulations. Restricted cubic splines were used to model the associations. Results: The study population consisted of 5835 patients (mean age 70 years, 51% male, median NIHSS 16). Mean ∆SBP was -12.3, -15.7, -17.2, and -16.9 mmHg for the time intervals 0-2, 2-4, 4-12 h, and 12-24 h, respectively. Higher ∆SBP was associated with unfavorable outcome at 0-2 h (odds ratio 1.065, 95% confidence interval 1.014-1.118), 2-4 h (1.140, 1.081-1.203), 4-12 h (1.145, 1.087-1.203), and 12-24 h (1.145, 1.089-1.203), for every increase of 10 mmHg. Restricted cubic spline models suggested that increasing ∆SBP was associated with unfavorable outcome, with higher values showing increased risk of unfavorable outcome. Conclusion: SBP increase after thrombectomy in large artery occlusion stroke is associated with poor functional outcome.
    2021Journal article Open access Show more
  • Safety and Outcomes of Routine Endovascular Thrombectomy in Large Artery Occlusion Recorded in the SITS Register: An Observational Study
    Publication . Ahmed, N.; Mazya, M.; Paiva Nunes, A; Moreira, T; Ollikainen, JP; Escudero‐Martinez, I; Bigliardi, G; Dorado, L; Dávalos, A; Egido, JA; Tassi, R; Strbian, D; Zini, A; Nichelli, P; Herzig, R; Jurák, L; Hurtikova, E; Tsivgoulis, G; Peeters, A; Nevšímalová, M; Brozman, M; Cavallo, R; Lees, KR; Mikulik, R; Toni, D; Holmin, S
    Background and objective: We aimed to evaluate the safety and outcomes of thrombectomy in anterior circulation acute ischaemic stroke recorded in the SITS-International Stroke Thrombectomy Register (SITS-ISTR) and compare them with pooled randomized controlled trials (RCTs) and two national registry studies. Methods: We identified centres recording ≥10 consecutive patients in the SITS-ISTR with at least 70% of available modified Rankin Scale (mRS) at 3 months during 2014-2019. We defined large artery occlusion as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Outcome measures were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial haemorrhage (SICH) per modified SITS-MOST. Results: Results are presented in the following order: SITS-ISTR, RCTs, MR CLEAN Registry and German Stroke Registry (GSR). Median age was 73, 68, 71 and 75 years; baseline NIHSS score was 16, 17, 16 and 15; prior intravenous thrombolysis was 62%, 83%, 78% and 56%; onset to reperfusion time was 289, 285, 267 and 249 min; successful recanalization (mTICI score 2b or 3) was 86%, 71%, 59% and 83%; functional independence at 3 months was 45.5% (95% CI: 44-47), 46.0% (42-50), 38% (35-41) and 37% (35-41), respectively; death was 19.2% (19-21), 15.3% (12.7-18.4), 29.2% (27-32) and 28.6% (27-31); and SICH was 3.6% (3-4), 4.4% (3.0-6.4), 5.8% (4.7-7.1) and not available. Conclusion: Thrombectomy in routine clinical use registered in the SITS-ISTR showed safety and outcomes comparable to RCTs, and better functional outcomes and lower mortality than previous national registry studies.
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