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Treatment practice of vasospasm during endovascular thrombectomy: an international survey
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作者 Jessica Jesser Thanh Nguyen +16 位作者 Adam A Dmytriw Hiroshi Yamagami Zhongrong Miao Louisa Johanna Sommer Andrea Stockero Johannes Alex Rolf Pfaff Johanna Ospel mayank goyal Aman B Patel Vitor Mendes Pereira Uta Hanning Lukas Meyer Wim H van Zwam Martin Bendszus Martin Wiesmann Markus Möhlenbruch Charlotte Sabine Weyland 《Stroke & Vascular Neurology》 SCIE CSCD 2024年第5期490-496,共7页
Background and aim The clinical importance and management of vasospasm as a complication during endovascular stroke treatment(EVT)has not been well studied.We sought to investigate current expert opinions in neurointe... Background and aim The clinical importance and management of vasospasm as a complication during endovascular stroke treatment(EVT)has not been well studied.We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT.Methods We conducted an anonymous international online survey(4 April 2023 to 15 May 2023)addressing treatment standards of neurointerventionalists(NIs)practising EVT.Several illustrative cases of patients with vasospasm during EVT were shown.Two study groups were compared according to the NI’s opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis.Results In total,534 NI from 56 countries responded,of whom 51.5%had performed>200 EVT.Vasospasm was considered a complication potentially influencing the patient’s outcome by 52.6%(group 1)whereas 47.4%did not(group 2).Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely(43.7%vs 33.9%,p=0.033)and more often treated severe large-vessel vasospasm with vasodilators(75.3%vs 55.9%;p<0.001),as well as extracranial vasospasm(61.4%vs 36.5%,p<0.001)and intracranial medium-vessel vasospasm(27.1%vs 11.2%,p<0.001),compared with group 2.In case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT,the study groups showed different treatment strategies.Group 2 continued the EVT immediately more often,without initiating therapy to treat the vasospasm first(9.6%vs 21.1%,p<0.001).Conclusion There is disagreement among NIs about the clinical relevance of vasospasm during EVT and its management.There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm. 展开更多
关键词 SURVEY continued ROUTINE
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Lesion-symptom mapping with NIHSS sub-scores in ischemic stroke patients 被引量:12
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作者 Deepthi Rajashekar Matthias Wilms +6 位作者 M Ethan MacDonald Serena Schimert Michael D Hill Andrew Demchuk mayank goyal Sean P Dukelow Nils Daniel Forkert 《Stroke & Vascular Neurology》 SCIE CSCD 2022年第2期124-131,共8页
Background Lesion-symptom mapping(LSM)is a statistical technique to investigate the population-specific relationship between structural integrity and post-stroke clinical outcome.In clinical practice,patients are comm... Background Lesion-symptom mapping(LSM)is a statistical technique to investigate the population-specific relationship between structural integrity and post-stroke clinical outcome.In clinical practice,patients are commonly evaluated using the National Institutes of Health Stroke Scale(NIHSS),an 11-domain clinical score to quantitate neurological deficits due to stroke.So far,LSM studies have mostly used the total NIHSS score for analysis,which might not uncover subtle structure–function relationships associated with the specific sub-domains of the NIHSS evaluation.Thus,the aim of this work was to investigate the feasibility to perform LSM analyses with sub-score information to reveal category-specific structure–function relationships that a total score may not reveal.Methods Employing a multivariate technique,LSM analyses were conducted using a sample of 180 patients with NIHSS assessment at 48-hour post-stroke from the ESCAPE trial.The NIHSS domains were grouped into six categories using two schemes.LSM was conducted for each category of the two groupings and the total NIHSS score.Results Sub-score LSMs not only identify most of the brain regions that are identified as critical by the total NIHSS score but also reveal additional brain regions critical to each function category of the NIHSS assessment without requiring extensive,specialised assessments.Conclusion These findings show that widely available sub-scores of clinical outcome assessments can be used to investigate more specific structure–function relationships,which may improve predictive modelling of stroke outcomes in the context of modern clinical stroke assessments and neuroimaging. 展开更多
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