Efficacy and Safety of Rivaroxaban Versus Aspirin in Embolic Stroke of Undetermined Source and Carotid Atherosclerosis

George Ntaios, Balakumar Swaminathan, Scott D. Berkowitz, Rubens José Gagliardi, Wilfried Lang, James E. Siegler, Pablo Lavados, Hardi Mundl, Natan Bornstein, Elena Meseguer, Pierre Amarenco, Brett Cucchiara, Pol Camps-Renom, Konstantinos Makaritsis, Eleni Korompoki, Vasileios Papavasileiou, Joan Marti-Fabregas, Haralampos Milionis, Konstantinos Vemmos, Stuart J. Connolly, Robert G. Hart and on behalf of the NAVIGATE ESUS Investigators

Abstract Background and Purpose— The sources of emboli in patients with embolic stroke of undetermined source (ESUS) are multiple and may not respond uniformly to anticoagulation. In this exploratory subgroup analysis of patients with carotid atherosclerosis in the NAVIGATE (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism)-ESUS trial, we assessed whether the treatment effect in this subgroup is consistent with the overall trial population and investigated the association of carotid atherosclerosis with recurrent ischemic stroke.

Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry

Raul G. Nogueira, Diogo C. Haussen, Alicia Castonguay, Leticia C. Rebello, Michael Abraham, Ajit Puri, Amer Alshekhlee, Aniel Majjhoo, Hamed Farid, Ira Finch, Joey English, Maxim Mokin, Michael T. Froehler, Mo Kabbani, Muhammad A. Taqi, Nirav Vora, Ramy El Khoury, Randall C. Edgell, Roberta Novakovic, Thanh Nguyen, Vallabh Janardhan, Enrol Veznedaroglu, Shyam Prabhakaran, Ron Budzik, Michael R. Frankel, Brittany L. Nordhaus and Osama O. Zaidat

Abstract Background and Purpose— It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry.

Blood Pressure and Outcome After Mechanical Thrombectomy With Successful Revascularization

Mohammad Anadani, Mohamad Y. Orabi, Ali Alawieh, Nitin Goyal, Andrei V. Alexandrov, Nils Petersen, Sreeja Kodali, Ilko L. Maier, Marios-Nikos Psychogios, Christa B. Swisher, Ovais Inamullah, Akash P. Kansagra, James A. Giles, Stacey Q. Wolfe, Jasmeet Singh, Benjamin Gory, Pierre De Marini, Peter Kan, Fábio A. Nascimento, Luis Idrovo Freire, Abhi Pandhi, Hunter Mitchell, Joon-Tae Kim, Kyle M. Fargen, Sami Al Kasab, Jan Liman, Shareena Rahman, Michelle Allen, Sébastien Richard and Alejandro M. Spiotta

Abstract Background and Purpose— Successful reperfusion can be achieved in more than two-thirds of patients treated with mechanical thrombectomy. Therefore, it is important to understand the effect of blood pressure (BP) on clinical outcomes after successful reperfusion. In this study, we investigated the relationship between BP on admission and during the first 24 hours after successful reperfusion with clinical outcomes.

Factors Associated With the Decision-Making on Endovascular Thrombectomy for the Management of Acute Ischemic Stroke

Gustavo Saposnik, Bijoy K. Menon, Nima Kashani, Alexis T. Wilson, Shinichi Yoshimura, Bruce C.V. Campbell, Blaise Baxter, Alejandro Rabinstein, Francis Turjman, Urs Fischer, Johanna M. Ospel, Peter J. Mitchell, Pillai N. Sylaja, Mathew Cherian, Byungmoon Kim, Ji-Hoe Heo, Anna Podlasek, Mohammed Almekhlafi, Mona M. Foss, Andrew M. Demchuk, Michael D. Hill and Mayank Goyal

Abstract Background and Purpose— Little is known about the real-life factors that clinicians use in selection of patients that would receive endovascular treatment (EVT) in the real world. We sought to determine patient, practitioner, and health system factors associated with therapeutic decisions around endovascular treatment.

Magnitude of Benefit of Combined Endovascular Thrombectomy and Intravenous Fibrinolysis in Large Vessel Occlusion Ischemic Stroke

Dashiell F. Young-Saver, Jeffrey Gornbein, Sidney Starkman and Jeffrey L. Saver

Abstract Background and Purpose— Quantifying the benefit magnitude of combined endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) versus nonreperfusion care in patients with acute ischemic stroke caused by large vessel occlusion would aid organization of regional stroke care systems

Racial and Ethnic Disparities in the Utilization of Thrombectomy for Acute Stroke

Lorenzo Rinaldo, Alejandro A. Rabinstein, Harry Cloft, John M. Knudsen, Leonardo Rangel Castilla and Waleed Brinjikji

Abstract Background and Purpose— Racial and ethnic disparities in the access to mechanical thrombectomy (MT) for treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion have been previously described. The effect of recent randomized trials validating MT as an effective therapy for AIS secondary to large vessel occlusion on such disparities has not been investigated.

Sex Differences in Outcome After Endovascular Stroke Therapy for Acute Ischemic Stroke

Sunil A. Sheth, Songmi Lee, Steven J. Warach, Jan Gralla, Reza Jahan, Mayank Goyal, Raul G. Nogueira, Osama O. Zaidat, Vitor M. Pereira, Adnan Siddiqui, Helmi Lutsep, David S. Liebeskind, Louise D. McCullough and Jeffrey L. Saver

Abstract Background and Purpose— We determined the effect of sex on outcome after endovascular stroke thrombectomy in acute ischemic stroke, including lifelong disability outcomes.

Does Sex Modify the Effect of Endovascular Treatment for Ischemic Stroke?

Vicky Chalos, Inger R. de Ridder, Hester F. Lingsma, Scott Brown, Robert J. van Oostenbrugge, Mayank Goyal, Bruce C.V. Campbell, Keith W. Muir, Francis Guillemin, Serge Bracard, Philip White, Antoni Dávalos, Tudor G. Jovin, Michael D. Hill, Peter J. Mitchell, Andrew M. Demchuk, Jeffrey L. Saver, Wim H. van Zwam, Diederik W.J. Dippel and on behalf of the HERMES Collaborators

Abstract Background and Purpose— Previous studies have reported less favorable outcome and less effect of endovascular treatment (EVT) after ischemic stroke in women than in men. Our aim was to study the influence of sex on outcome and on the effect of EVT for ischemic stroke in recent randomized trials on EVT.

Exploring Reperfusion Following Endovascular Thrombectomy

Jayme C. Kosior, Brian Buck, Robert Wannamaker, Mahesh Kate, Natalia A. Liapounova, Jeremy L. Rempel and Kenneth Butcher

Abstract Background and Purpose— Cerebral perfusion in acute ischemic stroke patients is often assessed before endovascular thrombectomy (EVT), but rarely after. Perfusion data obtained following EVT may provide additional prognostic information. We developed a tool to quantitatively derive perfusion measurements from digital subtraction angiography (DSA) data and examined perfusion in patients following EVT.

Predicting Clinical Outcomes of Large Vessel Occlusion Before Mechanical Thrombectomy Using Machine Learning

Hidehisa Nishi, Naoya Oishi, Akira Ishii, Isao Ono, Takenori Ogura, Tadashi Sunohara, Hideo Chihara, Ryu Fukumitsu, Masakazu Okawa, Norikazu Yamana, Hirotoshi Imamura, Nobutake Sadamasa, Taketo Hatano, Ichiro Nakahara, Nobuyuki Sakai and Susumu Miyamoto

Abstract Background and Purpose— The clinical course of acute ischemic stroke with large vessel occlusion (LVO) is a multifactorial process with various prognostic factors. We aimed to model this process with machine learning and predict the long-term clinical outcome of LVO before endovascular treatment and to compare our method with previously developed pretreatment scoring methods.

Predictors of Parenchymal Hematoma After Mechanical Thrombectomy

William Boisseau, Robert Fahed, Bertrand Lapergue, Jean-Philippe Desilles, Kevin Zuber, Naim Khoury, Jeanne Garcia, Benjamin Maïer, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Simon Escalard, Guillaume Taylor, Mikael Mazighi, Michel Piotin, Benjamin Gory, Raphaël Blanc and on behalf of ETIS Investigators

Abstract Background and Purpose— Parenchymal hematoma (PH) is a rare but dreadful complication of acute ischemic stroke with unclear underlying mechanisms. We aimed to study the incidence and predictors of PH after mechanical thrombectomy.

Derivo Embolization Device for the Treatment of Intracranial Aneurysms

Felipe Padovani Trivelato, Daniel Giansante Abud, Alexandre Cordeiro Ulhôa, Eduardo Siqueira Waihrich, Thiago Giansante Abud, Luis Henrique Castro Afonso, Guilherme Seizem Nakiri, Guilherme Duarte de Castro, Bruno de Sousa Mendes Parente, Rodrigo dos Santos Silva, Luciano Bambini Manzato, Lucas Eduardo Bonadio, Dinark Conceição Viana, José Ricardo Vanzin, Carlos Eduardo Baccin and Marco Túlio Salles Rezende

Abstract Background and Purpose— Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms.

Biomaterials for Stroke Therapy

Christopher J. Love, Magdy Selim, Myron Spector and Eng H. Lo

The goal of stroke treatment is to minimize the amount of brain damage resulting from ischemia or hemorrhage in the cerebrovascular network. Some standard acute-phase interventions—tPA (tissue-type plasminogen activator) and mechanical thrombectomy—exist for ischemic stroke with dramatically improved outcomes.1,2 For hemorrhagic stroke, the interventions3 focus on stabilizing temperature and blood pressure and aggressively managing and preventing complications, including rising intracranial pressure and cerebral edema. Ongoing clinical trials4 are investigating pharmacological agents and early removal of the hematoma.

Reversible Cerebral Vasoconstriction Syndrome

Tina M. Burton and Cheryl D. Bushnell

Reversible cerebral vasoconstriction syndrome (RCVS) is used to describe a multitude of pathologies encompassing the clinical terms Call-Fleming syndrome, thunderclap headache (TCH) with reversible vasospasm, benign angiopathy of the central nervous system, postpartum angiopathy, migrainous vasospasm or migraine angiitis, drug-induced cerebral arteritis or angiopathy, and sexual headache.

Emergent Carotid Stenting Plus Thrombectomy After Thrombolysis in Tandem Strokes

Mohammad Anadani, Alejandro M. Spiotta, Ali Alawieh, Francis Turjman, Michel Piotin, Diogo C. Haussen, Raul G. Nogueira, Panagiotis Papanagiotou, Adnan H. Siddiqui, Bertrand Lapergue, Franziska Dorn, Christophe Cognard, Marc Ribo, Marios N. Psychogios, Marc Antoine Labeyrie, Mikael Mazighi, Alessandra Biondi, René Anxionnat, Serge Bracard, Sébastien Richard and Benjamin Gory

Abstract Background and Purpose— Emergent carotid artery stenting plus mechanical thrombectomy is an effective treatment for acute ischemic stroke patients with tandem occlusion of the anterior circulation. However, there is limited data supporting the safety of this approach in patients treated with prior intravenous thrombolysis (IVT). We aimed to investigate the safety of emergent carotid artery stenting-mechanical thrombectomy approach in stroke patient population treated with prior IVT.