eTICI reperfusion: defining success in endovascular stroke therapy
David S Liebeskind,Serge Bracard,Serge Bracard,Francis Guillemin,Francis Guillemin,Reza Jahan,Tudor G Jovin,Charles B. L. M. Majoie,Peter Mitchell,Aad van der Lugt,Bijoy K Menon,Luis San Roman,Bruce C.V. Campbell,Keith W. Muir,Michael D. Hill,Diederik W.J. Dippel,Jeffrey L. Saver,Andrew M. Demchuk,Antoni Dávalos,Philip White,Scott Brown,Mayank Goyal +21 more
TLDR
The benefit of endovascular therapy in HERMES was strongly associated with increasing degrees of reperfusion defined by eTICI, which identified meaningful distinctions in clinical outcomes and may be used in future studies and routine practice.Abstract:
Background: Revascularization after endovascular therapy for acute ischemic stroke is measured by the Thrombolysis In Cerebral Infarction (TICI) scale, yet variability exists in scale definitions We examined the degree of reperfusion with the expanded TICI (eTICI) scale and association with outcomes in the HERMES collaboration of recent endovascular trials Methods: The HERMES Imaging Core, blind to all other data, evaluated angiography after endovascular therapy in HERMES A battery of TICI scores (mTICI, TICI, TICI2C) was used to define reperfusion of the initial target occlusion defined by non-invasive imaging and conventional angiography Results: Angiography of 801 subjects was available, including 797 defined by non-invasive imaging (154 internal carotid artery (ICA), 583 M1, 60 M2) and 748 by conventional angiography (195 ICA, 459 M1, 94 M2) Among 729 subjects in whom the reperfusion grade could be established, using eTICI (3=100%, 2C=90-99%, 2b67=67-89%, 2b50=50-66%) of the conventional angiography target occlusion, there were 63 eTICI 3 (9%), 166 eTICI 2c (23%), 218 eTICI 2b67 (30%), 103 eTICI 2b50 (14%), 100 eTICI 2a (14%), 19 eTICI 1 (3%), and 60 eTICI 0 (8%) Modified Rankin Scale shift analyses from baseline to 90 days showed that increasing TICI grades were linked with better outcomes, with significant distinctions between TICI 0/1 versus 2a (p=0028), 2a versus 2b50 (p=0017), and 2b50 versus 2b67 (p=0014) Conclusions: The benefit of endovascular therapy in HERMES was strongly associated with increasing degrees of reperfusion defined by eTICI The eTICI metric identified meaningful distinctions in clinical outcomes and may be used in future studies and routine practiceread more
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European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke.
Eivind Berge,William Whiteley,Heinrich J. Audebert,Gian Marco De Marchis,Ana Catarina Fonseca,Chiara Padiglioni,Natalia Pérez de la Ossa,Daniel Strbian,Georgios Tsivgoulis,Georgios Tsivgoulis,Guillaume Turc,Guillaume Turc +11 more
TL;DR: The European Stroke Organisation (ESO) guidelines provide evidence-based recurrence guidelines for patients with acute ischaemic stroke as mentioned in this paper, where intrvenous thrombolysis is the only approved systemic reperfusion treatment.
Journal ArticleDOI
Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial.
Michael D. Hill,Mayank Goyal,Bijoy K Menon,Raul G. Nogueira,Ryan A McTaggart,Andrew M. Demchuk,Alexandre Y Poppe,Brian H Buck,Thalia S Field,Dar Dowlatshahi,Brian van Adel,Richard H. Swartz,Ruchir Shah,Eric Sauvageau,Charlotte Zerna,Johanna M. Ospel,Manish Joshi,Mohammed A. Almekhlafi,Karla J Ryckborst,M.W. Lowerison,Kathy Heard,David Garman,Diogo C Haussen,Shawna Cutting,Shelagh B. Coutts,Daniel Roy,Jeremy L Rempel,A. Rohr,Daniela Iancu,Daniela Iancu,Demetrios J Sahlas,Amy Y.X. Yu,Thomas Devlin,Ricardo A. Hanel,Volker Puetz,F L Silver,Bruce C.V. Campbell,René Chapot,Jeanne Teitelbaum,Jennifer L Mandzia,Timothy Kleinig,David Turkel-Parrella,Donald V. Heck,Michael E Kelly,Aditya Bharatha,Oh Young Bang,Ashutosh P Jadhav,Rishi Gupta,Donald Frei,Jason W Tarpley,Cameron G. 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TL;DR: Nerinetide did not improve the proportion of patients achieving good clinical outcomes after endovascular thrombectomy compared with patients receiving placebo, and this trial is registered with ClinicalTrials.gov, NCT02930018.
Journal ArticleDOI
European Stroke Organisation (ESO)- European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke
Guillaume Turc,Pervinder Bhogal,Urs Fischer,Pooja Khatri,Kyriakos Lobotesis,Mikael Mazighi,Peter D. Schellinger,Danilo Toni,Joost de Vries,Philip White,Jens Fiehler +10 more
TL;DR: High quality evidence is found to recommend Mechanical thrombectomy plus best medical management (BMM) to improve functional outcome in patients with LVO related acute ischemic stroke within 6 hours after symptom onset.
Journal ArticleDOI
Effect of intravenous tenecteplase dose on cerebral reperfusion before thrombectomy in patients with large vessel occlusion ischemic stroke: the EXTEND-IA TNK Part 2 randomized clinical trial
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TL;DR: Among patients with large vessel occlusion ischemic stroke, a dose of 0.40 mg/kg of tenecteplase did not significantly improve cerebral reperfusion prior to endovascular thrombectomy, and the findings suggest that the0.40-mg/kg dose ofTenecte Plase does not confer an advantage over the 0.25-mg-kg dose.
Journal ArticleDOI
Thrombectomy for Distal, Medium Vessel Occlusions: A Consensus Statement on Present Knowledge and Promising Directions.
Jeffrey L. Saver,René Chapot,Ronit Agid,Ameer E Hassan,Ashutosh P Jadhav,David S Liebeskind,Kyriakos Lobotesis,Dan Meila,Lukas Meyer,Guy Raphaeli,Rishi Gupta +10 more
TL;DR: This research presents a novel probabilistic approach that allows us to assess the importance of knowing the carrier and removal status of canine coronavirus as a source of infection for other animals.
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Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials
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Journal ArticleDOI
Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial
Serge Bracard,Xavier Ducrocq,Jean-Louis Mas,Marc Soudant,Catherine Oppenheim,Thierry Moulin,Francis Guillemin +6 more
TL;DR: Mechanical thrombectomy combined with standard intravenous thrombolysis improves functional independence in patients with acute cerebral ischaemia, with no evidence of increased mortality.
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