Eimad Shotar

Mechanical Thrombectomy in Perioperative Strokes: A Case–Control Study

Background and Purpose— Perioperative strokes (POS) are rare but serious complications for which mechanical thrombectomy could be beneficial. We aimed to compare the technical results and patients outcomes in a population of POS versus non-POS (nPOS) treated by mechanical thrombectomy. Methods— From 2010 to 2017, 25 patients with POS (ie, acute ischemic stroke occurring during or within 30 days after a procedure) who underwent mechanical thrombectomy (POS group) were enrolled and paired with 50 consecutive patients with nPOS (control group), based on the occlusion’s site, National Institute of Health Stroke Scale, and age. Results— Respectively, mean age was 68.3±16.6 versus 67.2±16.6 years (P=0.70), and median National Institute of Health Stroke Scale score at admission was 20 (interquartile range, 15–25) versus 19 (interquartile range, 17–25; P=0.79). Good clinical outcome (modified Rankin Scale score of 0–2 at 3 months) was achieved by 33.3% (POS) versus 56.5% (nPOS) of patients (P=0.055). Successful reperfusion (modified Thrombolysis In Cerebral Infarction score of ≥2b) was obtained in 76% (POS) versus 86% (nPOS) of cases (P=0.22). Mortality at 3 months was 33.3% in the POS group versus 4.2% (nPOS) (P=0.002). The rate of major procedural complications was 4% (POS) versus 6% (nPOS); none were lethal. Average time from symptoms’ onset to reperfusion was 4.9 hours (±2.0) in POS versus 5.2 hours (±2.6). Conclusions— Successful reperfusion seems accessible in POS within a reasonable amount of time and with a good level of safety. However, favorable outcome was achieved with a lower rate than in nPOS, owing to a higher mortality rate.

Early Rebleeding after Brain Arteriovenous Malformation Rupture, Clinical Impact and Predictive Factors: A Monocentric Retrospective Cohort Study

Background: Brain arteriovenous malformations (BAVMs) are a leading cause of intracranial hemorrhage in young adults. This study aimed to identify individual predictive factors of early rebleeding after BAVM rupture and determine its impact on prognosis. Methods: Early rebleeding was defined as a spontaneous intracranial hemorrhage within 30 days of BAVM rupture in patients with nonobliterated BAVMs. One hundred fifty one patients with 158 BAVM hemorrhagic events admitted to a tertiary care center during 14 years were included. Univariate followed by multivariate logistic regression was performed to assess the impact of early rebleeding on in-hospital mortality and modified Rankin Scale (mRS) score beyond 3 months and to identify independent predictors of early rebleeding. Results: Eight early rebleeding events were observed, 6 of which occurred during the first 7 days. Early rebleeding was independently and significantly associated with poor outcome (mRS ≥3 beyond 3 months, p = 0.004) but not with in-hospital mortality (p = 0.9). Distal flow-related aneurysms (p = 0.009) and altered consciousness with a Glasgow coma scale score of 3 (p = 0.01) were independently associated with early rebleeding. Conclusions: Early rebleeding is a severe complication that can occur after BAVM-related hemorrhage. Distal flow-related aneurysms and initial altered consciousness are associated with early rebleeding.

Caution; Confusion Ahead…

We read with great interest the article entitled “Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes” by Tomsick et al.[1][1] This study is a post hoc subgroup analysis of the patients randomized in the

Triage in the Angiography Suite for Mechanical Thrombectomy in Acute Ischemic Stroke: Not Such a Good Idea

The recent evidence on the effectiveness of mechanical thrombectomy (MT) for the treatment of acute ischemic stroke (AIS) with large-vessel occlusion[1][1] has led to rethinking of the patient workflow. Indeed, the need to rapidly bring the patients eligible for MT into the angiography suite has

P-020 Non-Ischemic Cerebral Enhancing (NICE) Lesions Secondary to Endovascular Aneurysm Therapy: Nickel Allergy or Foreign Body Reaction? Reports of Two Cases and Review of the Literature

Delayed onset of non-ischemic cerebral enhancing lesions is a rare complication of intracranial aneurysms’ endovascular therapy (EVT). This complication has been attributed either to foreign body emboli and subsequent granulomatous reaction or cerebral hypersensitivity and nickel allergy. After retrospective review of all patients managed by EVT at our Institution from January 1st 2012 to December 31st 2014, 2 out of 374 patients (0.5%) with such a complication were identified. Patient # 1 developed non-ischemic cerebral enhancing (NICE) lesions 1 month after balloon assisted coiling of a ruptured anterior communicating artery aneurysm. Patient # 2 developed NICE lesions 12 months (the longest delay reported to date for such complication) after the treatment of a right carotidophthalmic aneurysm by loose coiling and flow diversion. Skin patch testing was performed with all endovascular devices used in the 2 patients and with the European baseline series, including nickel. Patient # 2 demonstrated nickel skin reactivity but none of the 2 patients presented allergic reaction to the devices used during interventions. Based on our observations and review of the literature, we hypothesize that delayed non-ischemic cerebral enhancing lesions after EVT are more likely related to foreign body emboli rather than nickel allergy. Disclosures E. Shotar: None. B. Law-Ye: None. F. Di Maria: None. F. Baronnet-Chauvet: None. S. Zeidan: None. D. Psimaras: None. F. Bielle: None. C. Pecquet: None. S. Navarro: None. C. Rosso: None. F. Cohen: None. J. Chiras: None. N. Sourour: 2; C; Covidien. F. Clarençon: 2; C; Covidien, Codman.