Endovascular treatment of patients with stroke caused by anterior cerebral artery occlusions.

BACKGROUND: Occlusion of the anterior cerebral artery (ACA) is uncommon but may lead to significant disability. The benefit of endovascular treatment (EVT) for ACA occlusions remains uncertain. METHODS: We included patients treated with EVT and compared patients with ACA occlusions with patients who had internal carotid artery (ICA) or proximal (M1/M2) middle cerebral artery (MCA) occlusions from the MR CLEAN Registry. Primary outcome was the modified Rankin Scale score (mRS). Secondary outcomes were functional independence (mRS 0-2), National Institutes of Health Stroke Scale (NIHSS) score, delta-NIHSS (baseline minus NIHSS score at 24-48 h), and successful recanalization (expanded thrombolysis in cerebral infarction (eTICI) score 2b-3). Safety outcomes were symptomatic intracranial hemorrhage (sICH), periprocedural complications, and mortality. RESULTS: Of 5193 patients, 11 (0.2%) had primary ACA occlusions. Median NIHSS at baseline was lower in patients with ACA versus ICA/MCA occlusions (11, IQR 9-14; versus 15, IQR 11-19). Functional outcome did not differ from patients with ICA/MCA occlusions. Functional independence was 4/11 (36%) in patients with ACA versus 1949/4815 (41%) in ICA/MCA occlusions; median delta-NIHSS was - 1 (IQR - 7 to 2) and - 4 (IQR - 9 to 0), respectively. Successful recanalization was 4/9 (44%), versus 3083/4787 (64%) in ICA/MCA occlusions. Mortality was 3/11 (27%) versus 1263/4815 (26%). One patient with ACA occlusion had sICH; no other complications occurred. CONCLUSION: In this cohort ACA occlusions were uncommon. Functional outcome did not differ between patients with ACA occlusions and ICA/MCA occlusions. Prospective research is needed to determine feasibility, safety, and outcomes of EVT for ACA occlusions.

Subjective hearing impairment after subarachnoid haemorrhage: Prevalence and risk factors.

BACKGROUND: Sensorineural hearing impairment is a key symptom in patients with superficial siderosis of the central nervous system, a disease caused by chronic or intermittent haemorrhage into the subarachnoid space. We investigated the prevalence and risk factors of subjective hearing impairment after SAH. METHODS: We systematically interviewed all SAH patients admitted between June 2011 and December 2014, who were able to visit the SAH outpatient clinic six to eight weeks after hospital discharge. We calculated the proportion of patients with subjective hearing impairment noticed after SAH onset, and adjusted risk ratios (aRR) with 95% confidence intervals (CI) for potential risk factors with Poisson regression. RESULTS: We included 277 patients. Subjective hearing impairment was reported by 54/277 (19%) patients (aneurysmal SAH: 42/212 [20%;95%CI:15-26%]; perimesencephalic haemorrhage 8/36 [22%;95%CI:12-38%], non-aneurysmal non-perimesencephalic SAH: 4/29 [14%;95%CI:6-31%]). Hearing impairment was associated with a poor clinical condition on admission (defined as PAASH score 4-5) (aRR3.00;95%CI:1.43-6.28), aneurysm rupture at the middle cerebral artery (aRR2.72;95%CI:1.38-5.39), and moderate/severe disability 3months after ictus (aRR2.25;95%CI:1.28-3.97), but not with large amounts of extravasated blood (highest vs. lowest tertile of Hijdra score) (aRR0.77;95%CI:0.33-1.81) or endovascular treatment (aRR1.19;95%CI:0.61-2.33). CONCLUSION: Subjective hearing impairment occurs in 1 of every 5 SAH patients. It is related to the clinical condition on admission, aneurysm rupture at the middle cerebral artery, and functional outcome, but not to the amount of subarachnoid blood or the method of aneurysm occlusion. Audiometric tests, auditory cognitive assessments, and follow-up studies are needed to determine the cause and prognosis of hearing impairment after SAH.