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Possible Empirical Evidence of Glymphatic System on CT after Endovascular Perforations

Raz, Eytan; Dehkharghani, Seena; Shapiro, Maksim; Nossek, Erez; Jain, Rajan; Zhang, Cen; Ishida, Koto; Tanweer, Omar; Peschillo, Simone; Nelson, Peter Kim
INTRODUCTION/BACKGROUND:The glial-lymphatic pathway is a fluid-clearance pathway consisting of a para-arterial route for the flow of cerebrospinal fluid along perivascular spaces and subsequently toward the brain interstitium. In this case series we aim to investigate an empirical demonstration of glymphatic clearance of extravasated iodine following perforation incurred during endovascular therapy on serial CT. METHODS AND RESULTS/RESULTS:Six consecutive cases of endovascular perforation during thrombectomy performed between 2005 and 2018 were retrospectively collected by searching our internal database of total 446 thrombectomies. Two cases were excluded because care was withdrawn shortly following the procedure and no follow-up imaging was available. One case was excluded because a ventricular drain was placed. Three cases were hence included in this analysis. All three cases demonstrated progressive absorption of contrast by the brain parenchyma with eventual contrast disappearance. CONCLUSION/CONCLUSIONS:We described a likely in vivo CT correlate of the glymphatic system in a cohort of patients who sustained intraprocedural extravasation during thrombectomy for acute ischemic stroke.
PMID: 31655242
ISSN: 1878-8769
CID: 4161962

Identifying Predictors for Final Diagnosis of Ischemic Events in an Emergency Department Observation Unit [Meeting Abstract]

Kumar, Arooshi; Zhang, Cen; Liberman, Ava; Ishida, Koto; Torres, Jose; Rostanski, Sara
ISI:000536058008219
ISSN: 0028-3878
CID: 4561822

Association Between Functional Outcomes of Stroke Patients Receiving Mechanical Thrombectomy and CT Perfusion Imaging Acquisition [Meeting Abstract]

Agarwal, Shashank; Mistry, Eva; Scher, Erica; Kim, Sun; Sanger, Matthew; Humbert, Kelley; Ishida, Koto; Torres, Jose; Rostanski, Sara; Zhang, Cen; Arcot, Karthikeyan; Turkel-Parrella, David; Farkas, Jeffrey; Raz, Eytan; Gordon, David; Riina, Howard; Shapiro, Maksim; Tanweer, Omar; Nossek, Erez; Nelson, Peter; Lord, Aaron; Frontera, Jennifer; Yaghi, Shadi
ISI:000536058002105
ISSN: 0028-3878
CID: 4561212

Diagnostic Evaluation of Patients Admitted to Emergency Department Observation Unit for Suspected TIA [Meeting Abstract]

Kumar, Arooshi; Ishida, Koto; Liberman, Ava; Zhang, Cen; Yaghi, Shadi; Torres, Jose; Rostanski, Sara
ISI:000536058006081
ISSN: 0028-3878
CID: 4561622

Border-zone Infarcts Predict Early Recurrence in Patients with Large Artery Atherosclerotic Subtype Despite Medical Treatment [Meeting Abstract]

Kvernland, Alexandra; Prabhakaran, Shyam; Khatri, Pooja; de Havenon, Adam; Yeatts, Sharon; Scher, Erica; Torres, Jose; Ishida, Koto; Frontera, Jennifer; Lord, Aaron; Liebeskind, David; Yaghi, Shadi
ISI:000536058005253
ISSN: 0028-3878
CID: 4561552

Predicting Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy: The TAG Score [Meeting Abstract]

Montalvo, Mayra; Mistry, Eva; Chang, Andrew; Yakhkind, Aleksandra; Dakay, Katarina; Azher, Idrees; Mistry, Akshitkumar; Chitale, Rohan; Cutting, Shawna; Burton, Tina; Mac Grory, Brian; Reznik, Michael; Mahta, Ali; Thompson, Bradford; Ishida, Koto; Frontera, Jennifer; Riina, Howard; Gordon, David; Turkel-Parrella, David; Scher, Erica; Farkas, Jeffrey; McTaggart, Ryan A.; Khatri, Pooja; Furie, Karen; Jayaraman, Mahesh; Yaghi, Shadi
ISI:000536058001210
ISSN: 0028-3878
CID: 4561172

Poor Risk Factor Control And Lower Levels Of Physical Activity Predict Incident Major Cardiovascular Events In Patients With Symptomatic Vertebrobasilar Disease: A Post-hoc Analysis Of The SAMMPRIS Trial [Meeting Abstract]

Croll, Leah; Chang, Andrew; Scher, Erica; Ishida, Koto; Torres, Jose; Riina, Howard; Frontera, Jennifer; Lord, Aaron; Yaghi, Shadi
ISI:000536058001201
ISSN: 0028-3878
CID: 4561162

TIME IS BRAIN in mechanical thrombectomy Particularly in Those Arriving within 6 hours and have good ASPECTS score [Meeting Abstract]

Snyder, Thomas; Agarwal, Shashank; Flusty, Brent; Kim, Sun; Frontera, Jennifer; Lord, Aaron; Favate, Albert; Humbert, Kelley; Torres, Jose; Sanger, Matthew; Zhang, Cen; Ishida, Koto; Rostanski, Sara; Yaghi, Shadi
ISI:000536058003240
ISSN: 0028-3878
CID: 4561342

Redefining Early Neurological Improvement After Reperfusion Therapy in Stroke

Agarwal, Shashank; Cutting, Shawna; Grory, Brian Mac; Burton, Tina; Jayaraman, Mahesh; McTaggart, Ryan; Reznik, Michael; Scher, Erica; Chang, Andrew D; Frontera, Jennifer; Lord, Aaron; Rostanski, Sara; Ishida, Koto; Torres, Jose; Furie, Karen; Yaghi, Shadi
BACKGROUND AND PURPOSE/OBJECTIVE:Early neurologic improvement (ENI) in patients treated with alteplase has been shown to correlate with functional outcome. However, the definition of ENI remains controversial and has varied across studies. We hypothesized that ENI defined as a percentage change in the National Institute of Health Stroke Scale (NIHSS) score (percent change NIHSS score) at 24-hours would better correlate with favorable outcomes at 3 months than ENI defined as the change in NIHSS score (delta NIHSS score) at 24 hours. METHODS:Retrospective analysis of prospectively collected single-center quality improvement data was performed of all acute ischemic stroke (AIS) patients treated with alteplase. We examined delta NIHSS score and percent change NIHSS score in unadjusted and adjusted logistic regression models as predictors of a favorable outcome at 3 months (defined as mRS 0-1). RESULTS:Among 586 patients who met the inclusion criteria, 194 (33.1%) had a favorable outcome at 3 months. In fully adjusted models, both delta NIHSS score (OR per point decrease 1.27; 95% confidence interval [CI] 1.19-1.36) and percent change NIHSS score (OR per 10 percent decrease 1.17; 95% CI 1.12-1.22) were associated with favorable functional outcome at 3 months. Receiver operating characteristic (ROC) curve comparison showed that the area under the ROC curve for percent change NIHSS score (.755) was greater than delta NIHSS score (.613) or admission NIHSS (.694). CONCLUSIONS:Percentage change in NIHSS score may be a better surrogate marker of ENI and functional outcome in AIS patients after receiving acute thrombolytic therapy. More studies are needed to confirm our findings.
PMID: 31836356
ISSN: 1532-8511
CID: 4241792

Predicting symptomatic intracranial haemorrhage after mechanical thrombectomy: the TAG score

Montalvo, Mayra; Mistry, Eva; Chang, Andrew Davey; Yakhkind, Aleksandra; Dakay, Katarina; Azher, Idrees; Kaushal, Ashutosh; Mistry, Akshitkumar; Chitale, Rohan; Cutting, Shawna; Burton, Tina; Mac Grory, Brian; Reznik, Michael; Mahta, Ali; Thompson, Bradford B; Ishida, Koto; Frontera, Jennifer; Riina, Howard A; Gordon, David; Parella, David; Scher, Erica; Farkas, Jeffrey; McTaggart, Ryan; Khatri, Pooja; Furie, Karen L; Jayaraman, Mahesh; Yaghi, Shadi
BACKGROUND:There is limited data on predictors of symptomatic intracranial haemorrhage (sICH) in patients who underwent mechanical thrombectomy. In this study, we aim to determine those predictors with external validation. METHODS:and t tests to identify independent predictors of sICH with p<0.1. Significant variables were then combined in a multivariate logistic regression model to derive an sICH prediction score. This score was then validated using data from the Blood Pressure After Endovascular Treatment multicentre prospective registry. RESULTS:We identified 578 patients with acute ischaemic stroke who received thrombectomy, 19 had sICH (3.3%). Predictive factors of sICH were: thrombolysis in cerebral ischaemia (TICI) score, Alberta stroke program early CT score (ASPECTS), and glucose level, and from these predictors, we derived the weighted TICI-ASPECTS-glucose (TAG) score, which was associated with sICH in the derivation (OR per unit increase 1.98, 95% CI 1.48 to 2.66, p<0.001, area under curve ((AUC)=0.79) and validation (OR per unit increase 1.48, 95% CI 1.22 to 1.79, p<0.001, AUC=0.69) cohorts. CONCLUSION/CONCLUSIONS:High TAG scores are associated with sICH in patients receiving mechanical thrombectomy. Larger studies are needed to validate this scoring system and test strategies to reduce sICH risk and make thrombectomy safer in patients with elevated TAG scores.
PMID: 31427365
ISSN: 1468-330x
CID: 4046642