Internal carotid artery patency after mechanical thrombectomy for stroke due to occlusive dissection: Impact on outcome.

Introduction: Internal carotid artery dissection (ICAD) is a rare cause of acute ischemic stroke with large vessel occlusion (AIS-LVO). We aimed investigating the impact on outcome of internal carotid artery (ICA) patency after mechanical thrombectomy (MT) for AIS-LVO due to occlusive ICAD. Patients and methods: We included consecutive patients with AIS-LVO due to occlusive ICAD treated with MT from January 2015 to December 2020 in three European stroke centers. We excluded patients with unsuccessful intracranial reperfusion after MT (modified Thrombolysis in Cerebral Infarction (mTICI) score < 2b). We compared 3-month favorable clinical outcome rate, defined as a modified Rankin scale (mRS) score ⩽2, according to ICA status (patency vs occlusion) at the end of MT and at 24-h follow-up imaging, using univariate and multivariable models. Results: Among 70 included patients, ICA was patent in 54/70 (77%) at the end of MT, and in 36/66 (54.5%) patients with 24-h follow-up imaging. Among patients with ICA patency at the end of MT, 32% presented ICA occlusion at 24-h control imaging. Favorable 3-month outcome occurred in 41/54 (76%) patients with ICA patency post-MT and in 9/16 (56%) patients with occluded ICA post-MT (p = 0.21). Rates of favorable outcome were significantly higher in patients with 24-h ICA patency compared to patients with 24-h ICA occlusion (32/36 [89%] vs 15/30 [50%]), with an adjusted odds ratio of 4.67 (95% CI: 1.26-17.25). Discussion and conclusion: Obtaining sustained (24-h) ICA patency after MT could be a therapeutic target for improving functional outcome in patients with AIS-LVO due to ICAD.

Myeloneuropathy induced by recreational nitrous oxide use with variable exposure levels.

BACKGROUND AND PURPOSE: Although several case series have described nitrous-oxide-associated neurological disorders, a comprehensive assessment of exposure characteristics (e.g., time to onset, level of exposure) in substance abusers has not been performed. The aim of this study was to describe the onset patterns of recreational use of nitrous-oxide-induced neurological disorders. METHODS: All cases of neurological disorders related to nitrous oxide recreational use reported to the Hauts-de-France addictovigilance center between January 2019 and August 2020 were selected. Only cases requiring hospitalization with informative data to perform the nitrous oxide causality assessment were included. RESULTS: A total of 20 cases from five hospitals were included. The male-to-female ratio was 6:1 and the median age was 19 years (range 16-34). The neurological presentation (myeloneuropathy 64%, 7/11; sensorimotor neuropathy 36%, 4/11) included for all patients gait disorders due to proprioceptive ataxia and limb hypoesthesia. The median dose used per occasion was 100 cartridges (range 5-960; n = 19). The median time from the start of nitrous oxide use to the onset of neurological symptoms was 6 months (range 0.7-54; n = 16). The cumulative dose was significantly higher in patients with damage to all four limbs than in patients with lower limb symptoms only (p = 0.042). CONCLUSIONS: A low intermittent exposure may be sufficient to cause neurological damage in some subjects, suggesting that, at the population level, there is no safe exposure to nitrous oxide in recreational settings. The severity of neurological impairment could increase once used at high doses and for prolonged durations of nitrous oxide.

Thrombectomy Using the EmboTrap II Device in Late Treatment Patients in the Real-World Setting.

OBJECTIVE: We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) using the EmboTrap Revascularization Device (EmboTrap) in patients with ischemic stroke treated >6-24 hours after stroke onset. METHODS: We performed a retrospective analysis of data from a prospective registry of consecutive patients with stroke with anterior circulation large vessel occlusion treated by stent-retriever thrombectomy with EmboTrap II in a single stroke center in France from 2016 to 2017. Patients were divided into late treatment window (>6-24 hours after stroke onset) or early treatment window (≤6 hours) groups. Baseline clinical and imaging characteristics, rates of successful recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), complications, 3 months good functional outcome (modified Rankin Scale score 0-2), and mortality were analyzed. RESULTS: Of the 225 patients (mean age, 71.5 ± 14.5 years; 55.6% [125/225] female) included in the study, 54 were treated in the late treatment window, with a mean time from last known well to treatment of 651 ± 223 minutes. Compared with the early treatment window group, there were no significant differences in baseline characteristics, successful recanalization (83.3% [45/54] vs. 81.3% [139/171]; P = 0.734), 3 months good functional outcome (37.0% [20/54] vs. 37.4% [64/171]; P = 0.959), or mortality (24.1% [13/54] vs. 27.5% [47/171]; P = 0.621). CONCLUSIONS: This real-world study provides evidence that EVT using EmboTrap is safe and effective in the late treatment window in patients with large vessel occlusion.