C-reactive Protein is A Predictor of Deterioration of Acute Internal Carotid Artery M1 Qcclusion Following Recanalization.

INTRODUCTION: Administration of intravenous recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) have become standard therapeutic approaches for acute internal carotid artery and middle cerebral artery M1 segment occlusion (ICA/M1O). However, clinical deterioration of the condition is still observed in some cases. OBJECTIVE: We aimed to identify patients' factors associated with exacerbation. This was a single-center, retrospective study of 35 consecutive patients with acute ICA/M1O who underwent rt-PA/rt-PA and MT at our hospital between January 2016 and September 2019. We divided patients into two groups based on the total NIHSS score at discharge: the "improvement" and "exacerbation" groups. Clinical characteristics, laboratory data, and imaging findings were compared between the groups. RESULTS: The improvement group (13 patients [37%]) had a lower mean age (70 vs. 81 years, p = 0.02), National Institutes of Health Stroke Scale score (NIHSS, 13 vs. 19, p = 0.02), and C-reactive protein (CRP) levels (0.24 vs. 0.92 mg/dl, p < 0.01) than the exacerbation group (22 patients [63%]). Receiver operating characteristic curve analysis revealed the cut-off age to be 79 (sensitivity 76.9%, specificity 72.7%), NIHSS score to be 20 (sensitivity 92.3%, specificity 63.6%), and CRP to be 0.14 mg/dl (sensitivity 69.2%, specificity 81.8%). Multivariate analysis confirmed a CRP level of >0.14 mg/dl (odds ratio, 10.16; 95% confidence interval 1.38-75.13; p = 0.01) to be independently associated with clinical deterioration at discharge. CONCLUSIONS: A CRP level of >0.14 mg/dl is a strong predictor of clinical deterioration at discharge in patients with acute ICA/M1O undergoing recanalization therapy.

One-year single-center experience with the Aperio thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome.

BACKGROUND AND PURPOSE: The Aperio thrombectomy device (Aperio) is a stent retriever designed to achieve rapid and substantial flow restoration in acute ischemic stroke due to large-vessel occlusions (LVOs). We evaluated the safety and efficacy of the Aperio device and compared it with published data of established stent retrievers. METHODS: We retrospectively analyzed institutional data of consecutive stroke procedures in patients with LVO in the anterior circulation that were treated between January 2017 and December 2017 with the Aperio. Reperfusion rate regarding to the extended thrombolysis in cerebral infarction scale (eTICI), procedural times, early clinical outcome, and complications were documented. RESULTS: Eighty-two patients were treated by using the Aperio in LVO in the anterior circulation. Median age was 77 (± 12) years (w = 59.8%). Median Baseline National Institutes of Health Stroke Scale (NIHSS) score was 14. Fifty-three (64.6%) patients received intravenous thrombolysis. Successful recanalization (eTICI≥2b) was achieved in 85.3%. Mean time from groin puncture to final recanalization was 52.3 ± 34.8 min. Embolization to new territories occurred in one case. Symptomatic intracranial hemorrhage within 24 h was observed in six patients (7.3%). Twenty-eight (41.2%) out of 68 patients available for assessment of functional outcome at 3 months achieved favorable outcome (mRS 0-2). CONCLUSION: The Aperio stent retriever mechanical thrombectomy device demonstrated high rates of successful reperfusion and a good safety profile in patients with acute ischemic stroke due to LVO in the anterior circulation.

Mechanical thrombectomy in MCA-mainstem occlusion in patients with low NIHSS scores.

Introduction While effectiveness of mechanical thrombectomy (MTE) in M1 segment occlusion is approved for patients with severe impairment, there is a lack of evidence for a potential benefit of MTE in patients with minor to moderate symptoms. The purpose of this study was to evaluate neurological outcome and occurrence of periprocedural complications after MTE in patients with low National Institutes of Health Stroke Scale (NIHSS) scores. Materials and methods A retrospective analysis of 1081 consecutive patients with anterior circulation ischemic stroke due to M1 occlusion detected by computed tomography angiography and treated with MTE at our hospital between February 2012 and November 2017 was performed. NIHSS, Barthel Index (BI) and modified Rankin Scale (mRS) scores between admission and discharge were compared with paired Mann-Whitney test, and recanalization rate and complications were assessed in patients with NIHSS ≤ 5 at admission. Results Thirty patients were included with a median NIHSS score of 4. NIHSS score (median: 4 vs. 1; p < 0.001), BI (median: 43 vs. 80; p < 0.001) and mRS (2 vs. 1; p < 0.001) showed significant improvement from admission to discharge after MTE. Recanalization rate was Thrombolysis in Cerebral Infarction (TICI) 2b to 3 in 29 of 30 patients (96.7%). One case of an intracerebral reperfusion hematoma (ECASS: PH2) required surgical treatment. Conclusion MTE might lead to a significantly improved clinical outcome also for patients with low NIHSS score due to M1 segment occlusion. Periprocedural complications appeared infrequently. These results encourage further evaluation of the benefit-risk profile of MTE compared to standard treatment in patients with low NIHSS scores in future randomized trials.