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Predictors and outcome of early neurological deterioration after endovascular thrombectomy: a secondary analysis of the DIRECT-MT trial
Conclusions Postoperative END is associated with adverse functional outcome. Several non-modifiable and modifiable factors can predict END and support future treatment decision-making to improve the potential utility of endovascular thrombectomy. Trial registration number DIRECT-MT ClinicalTrials.gov NCT03469206.
Source: Journal of NeuroInterventional Surgery - August 29, 2023 Category: Neurosurgery Authors: Zhang, M., Xing, P., Tang, J., Shi, L., Yang, P., Zhang, Y., Zhang, L., Peng, Y., Liu, S., Zhang, L., Fu, J., Liu, J., On behalf of the DIRECT-MT Investigators, Liu, Deng, Hong, Ke, Lou, Yin, Wang, Chen, Xu, Li, Wei, Li, Zhu, Sun, Liang, Wang, Wang, Peng, Tags: Ischemic stroke Source Type: research

P158/212 The first pass effect: the initial real-life experience of the University Clinical centre of Serbia
ConclusionDespite shorter time intervals and higher frequency of recanalization rate of the FPE group, no difference was observed in relation to clinical and safety outcomes after 90 days of AIS. In order to better understand the FPE and its predictors, further studies are needed in form of randomized controlled clinical studies.Disclosure of InterestNothing to disclose
Source: Journal of NeuroInterventional Surgery - August 21, 2023 Category: Neurosurgery Authors: Mircic, U., Vukasinovic, I., Nedeljkovic, Z., Pirkovic, I., Nestorovic, D., Cvetic, V., Ercegovac, M., Jovanovic, D., Berisavac, I., Stanarcevic, P. Tags: 2.3 ISCHEMIC - Treatment Source Type: research

O35/335 Factors associated with successful recanalization in patients with acute ischemic stroke treated with endovascular thrombectomy - a nationwide register-based observational study
ConclusionThis study explore procedural factors associated with technically successful EVT on nationwide scale.Disclosure of InterestJW received funding from the Crafoord Foundation (#20200548) The Swedish Government (YF-ALF #43435), Region of Skåne research grant (#47455), Skåne university Hospital research grants (#96437 and #96438), VINNOVA (#2020–04841) and AIDA (#2024). JW is a founder and shareholder in Uman Sense AB.
Source: Journal of NeuroInterventional Surgery - August 21, 2023 Category: Neurosurgery Authors: Wasselius, J., Hall, E., Ramgren, B., Andersson, T., Ullberg, T. Tags: 2.3 ISCHEMIC - Treatment Source Type: research

E-107 Carotid artery stenting in patients with symptomatic non-stenotic carotid artery disease - a case series
ConclusionsIn this case series performed over a 10-year period at a high-volume stroke center we show that CAS is safe and efficient in patients with SyNC. Previous studies have established safety and effectiveness of CES in patients presenting with SyNC, however there is a paucity of reports in the literature regarding the effect of CAS in this patient population. Recent guidelines have brought specific attention to high-risk plaque characteristics which suggest that plaque instability plays a major role in the onset of ischemic events, regardless of lumen narrowing. Advanced imaging techniques, such as Optical Coherence ...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Nedelcu, S., Kuhn, A., Singh, J., Puri, A. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

E-115 Trans-radial versus trans-femoral access routes for diagnostic cerebral angiograms: a large single-center comparative cost-analysis study
ConclusionOverall, our study shows that the TR approach can be less a less expensive option for patients undergoing diagnostic cerebral angiograms, especially if complications occur. Future studies can corroborate our findings and potentially lead to the adoption of TR as a low-cost, efficient, gold-standard technique for cerebral angiography.Costs (dollars) Associated with Trans-Radial Versus Trans-Femoral AccessAbstract E-115 Table 1 Variable Trans-Femoral (n=314) Trans-Radial(n=612) P-value Total Cost, mean (SD) 12591.8 (19128) 12789.5 (18424) .88 Catheters, median (range) 12.4 (12.4-1900) 55.2 (12.4-369) .03 Closure d...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: El Naamani, K., Atallah, E., Momin, A., Jain, P., Hunt, A., Sambangi, A., Carreras, A., El Fadel, O., Gooch, M., Tjoumakaris, S., Zarzour, H., Schmidt, R., Herial, N., Rosenwasser, R., Jabbour, P. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

O-021 Concurrent middle meningeal artery embolization for treatment of chronic subdural hematomas
This study provides evidence from a multi-institutional cohort that performing concurrent MMAe in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce surgical recurrence in patients with NASHs.Abstract O-021 Table 1Procedural details of 145 patients (149 NASHs) who underwent concurrent MMAe Characteristic Value (range or%) Antiplatelet/anticoagulation use Antiplatelet 46/147* (31) Anticoagulant 29/148* (20) Both 9/148* (6) Prior SDH evacuation 38/149* (26) Perioperative platelet count < 100K 8/148* (5) Procedure details Anesthesia General 63/149* (42) MAC 57/149* (38) C...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Salah, W., Baker, C., Scoville, J., Hunsaker, J., Ogilvy, C., Moore, J., Riina, H., Levy, E., Spiotta, A., Jankowitz, B., Cawley, C., Khalessi, A., Tanweer, O., Hanel, R., Gross, B., Kuybu, O., Nguyen Hoang, A., Baig, A., Khorasanizadeh, M., Mendez, A., C Tags: SNIS 20th annual meeting oral abstracts Source Type: research

P-013 The need for speed: reducing endovascular treatment times in ischemic stroke
ConclusionsImproving awareness of process expectations by meeting with stakeholders resulted in a substantial and sustainable decreases in median door to groin puncture and door to first pass times. Implementation of hospital-based PI multidisciplinary team initiatives helped improve our sites work flow and continued to improve our door to 1st pass times.Disclosures H. Shownkeen: None. A. Doerr: None. B. Fill: None. A. Mazumdar: None. D. Pandya: None. K. Buffo: None. A. Stacey: None. T. Iacob: None. L. Stanek: None. J. Carlson: None. L. Spellman: None.
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Shownkeen, H., Doerr, A., Fill, B., Mazumdar, A., Pandya, D., Buffo, K., Stacey, A., Iacob, T., Stanek, L., Carlson, J., Spellman, L. Tags: SNIS 20th annual meeting oral poster abstracts Source Type: research

E-248 Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from saint study
ConclusionIn patients with posterior circulation occlusion stokes who failed mechanical thrombectomy, our study suggests that RS has better outcomes with comparable safety profile. Randomized controlled studies are warranted for more concrete evidence.Abstract E-248 Table 1Baseline demographic, clinical and procedural characteristics among rescue stenting and failed reperfusion groups Rescue stentingN=84 Failed ReperfusionN=68 P value Age 63.6±12.6 69.7±13.5 0.005 Female 18 (21.4%) 35 (51.5%) <0.001 Ethnic BackgroundWhiteAAHispanicAsianOthers 33 (39.3%)20 (23.8%)22 (26.2%)4 (4.8%)5 (6%) 34 (50%)22 (32.4%)...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Mohammaden, M., Tarek, M., Haussen, D., Fifi, J., Matsoukas, S., Farooqui, M., Ortega-Gutierrez, S., Zevallos, C., Galecio-Castillo, M., Hassan, A., Tekle, W., Al-Bayati, A., Salem, M., Burkhardt, J., Pukenas, B., Cortez, G., Hanel, R., Aghaebrahim, A., S Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

Betwixt and between: an idiomatic understanding of anesthesia in stroke intervention
After years of investigation, including substantial studies, opinions continue to shift regarding conscious sedation (CS) versus general anesthesia (GA) utilization in mechanical thrombectomy for emergent large vessel occlusion (ELVO) stroke. Early retrospective studies demonstrated that CS was superior,1 but subsequent randomized controlled trials failed to show the superiority of one method.2–4 Current research continues to explore the best use of anesthesia in acute ischemic stroke therapy.5–8 While consensus does not exist on whether CS or GA is safer and/or more beneficial for stroke interventions, there a...
Source: Journal of NeuroInterventional Surgery - April 13, 2023 Category: Neurosurgery Authors: Milburn, J. M., Fiorella, D., Hirsch, J. A. Tags: Editor ' s column Source Type: research

Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window
Conclusion LA without sedation during EVT was associated with improved functional outcomes compared with GA, but not CS, within and beyond 6 hours from stroke onset. Prospective studies assessing anesthesia-related outcomes in the extended time window are warranted.
Source: Journal of NeuroInterventional Surgery - April 13, 2023 Category: Neurosurgery Authors: Dhillon, P. S., Butt, W., Podlasek, A., McConachie, N., Lenthall, R., Nair, S., Malik, L., Hewson, D. W., Bhogal, P., Makalanda, H. L. D., James, M. A., Dineen, R. A., England, T. J. Tags: Vascular neurology Source Type: research

Impact of anesthetic strategy on outcomes for patients with acute basilar artery occlusion undergoing mechanical thrombectomy
Conclusions The choice of anesthetic strategy, GA, LA, or CS, did not affect the clinical outcomes of patients with acute BAO treated with MT in the BASILAR registry.
Source: Journal of NeuroInterventional Surgery - October 14, 2022 Category: Neurosurgery Authors: Li, F., Wan, J., Song, J., Yuan, J., Kong, W., Huang, J., Luo, W., Wu, D., Li, L., Chen, L., Zhao, C., Chen, J., Tao, H., Sang, H., Qiu, Z., Zi, W., Yang, Q., Chen, X., Li, H., Peng, F. Tags: Ischemic stroke Source Type: research

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry
Conclusions ENDunexplained associated with poor 90day outcomes occurred in 4.3% of patients with acute LVO undergoing EVT. Several independent predictors of ENDunexplained were identified in this study, which should be considered in daily practice to improve acute LVO management. Clinical trial Registration http://wwwclinicaltrialsgov NCT03370939.
Source: Journal of NeuroInterventional Surgery - August 12, 2022 Category: Neurosurgery Authors: Sun, D., Tong, X., Huo, X., Jia, B., Raynald, , Wang, A., Ma, G., Ma, N., Gao, F., Mo, D., Song, L., Sun, X., Liu, L., Deng, Y., Li, X., Wang, B., Luo, G., Wang, Y., Miao, Z., On behalf of the ANGEL-ACT study group Tags: Ischemic stroke Source Type: research

General anesthesia during endovascular therapy for acute ischemic stroke: benefits beyond better reperfusion?
Conclusion The better outcome after EVT in the GA arm was mainly a direct effect—that is, an effect that was not explained by better reperfusion. We also found a better outcome in the GA arm when reperfusion was not achieved. Whether this is an effect of the stable condition and blood pressure under GA or a neuroprotective effect will need to be investigated in future research.
Source: Journal of NeuroInterventional Surgery - July 14, 2022 Category: Neurosurgery Authors: Simonsen, C. Z., Rasmussen, M., Schönenberger, S., Henden, P. L., Bösel, J., Valentin, J. B. Tags: Ischemic stroke Source Type: research

Local anesthesia as a distinct comparator versus conscious sedation and general anesthesia in endovascular stroke treatment: a systematic review and meta-analysis
Conclusion LA without sedation was not significantly superior to CS or GA in improving outcomes when performing EVT for AIS. However, the quality of the included studies impaired interpretation, and inclusion of an LA arm in future well designed multicenter, randomized controlled trials is warranted.
Source: Journal of NeuroInterventional Surgery - February 16, 2022 Category: Neurosurgery Authors: Butt, W., Dhillon, P. S., Podlasek, A., Malik, L., Nair, S., Hewson, D., England, T. J., Lenthall, R., McConachie, N. Tags: Ischemic stroke Source Type: research

Monitored anesthesia care during mechanical thrombectomy for stroke: need for data-driven and individualized decisions
Conclusions Our study showed that the overall rate of conversion from MAC to GA during MT was low (1.6%) and, while higher in posterior circulation strokes, it was not predicted by either hemispheric dominance or stroke severity. Caution should be given before changing clinical practice during moments of crisis.
Source: Journal of NeuroInterventional Surgery - November 18, 2021 Category: Neurosurgery Authors: Nogueira, R. G., Mohammaden, M. H., Moran, T. P., Whalin, M. K., Gershon, R. Y., Al-Bayati, A. R. R., Ratcliff, J., Pisani, L., Liberato, B., Bhatt, N., Frankel, M. R., Haussen, D. C. Tags: Ischemic stroke, COVID-19 Source Type: research

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