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Association Between Age and Endovascular Treatment Outcomes: Binational Registry of 9934 EVT Cases From Korea and Taiwan

Tue, 31 Dec 2024 15:00:00 GMT

Title: Association Between Age and Endovascular Treatment Outcomes: Binational Registry of 9934 EVT Cases From Korea and Taiwan Author(s): Beom Joon Kim; Sung-Chun Tang; Yi-Chen Hsieh; Chih-Hao Chen; Yong Soo Kim; Chun-Jen Lin; Jong-Moo Park; Pi-Shan Sung; Kyusik Kang; Yu-Wei Chen; Soo Joo Lee; Kuan-Hung Lin; Jae-Kwan Cha; Chih-Wei Tang; Tai Hwan Park; Hai-Jui Chu; Kyungbok Lee; Chuan-Hsiu Fu; Jun Lee; Chao-Liang Chou; Keun-Sik Hong; Ching-Huang Lin; Kyung-Ho Yu; Cheng-Yu Wei; Dong-Eog Kim; Shang-Yih Yen; Joon-Tae Kim; Po-Lin Chen; Jay Chol Choi; Lung Chan; Jee Hyun Kwon; Dong-Ick Shin; Sung-Il Sohn; Hung-Yi Chiou; Chulho Kim; Kwang-Yeol Park; Chi Kyung Kim; Li-Ming Lien; Sung Hyuk Heo; Jiunn-Tay Lee; Hee-Joon Bae; Jiann-Shing Jeng Abstract: BACKGROUND: As populations age, there is an increasing need to optimize endovascular treatment (EVT) and to understand country-specific differences in East Asia. We harmonized stroke registries from Korea and Taiwan to enable comparisons of patient characteristics and outcomes, with a particular focus on the impact of age. METHODS: Multicenter prospective stroke registries in Korea (CRCS-K [Clinical Research Collaboration for Stroke in Korea]) and Taiwan (TREAT-AIS [Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke]) were harmonized to form a unified data set of patients undergoing EVT. Outcomes included 3-month modified Rankin Scale, symptomatic intracranial hemorrhage, and successful recanalization. We assessed the association between age and outcomes in the overall population and those who were aged ≥80 years using logistic regression models, adjusting for relevant covariates. RESULTS: A total of 9934 EVT cases (7835 from Korea and 2099 from Taiwan) were included from 2011 to 2023. Patients had a mean age of 70.1±12.9 years (57.6% male; median National Institutes of Health Stroke Scale score, 14 [interquartile range, 9–19]). Compared with Korean patients, Taiwanese patients had a higher prevalence of risk factors and more severe strokes, contributing to lower rates of favorable 3-month outcomes. Increasing age was associated with poorer EVT results; among patients ≥80 years, 18% achieved a modified Rankin Scale score of 0 to 2, compared with 46% of younger patients. However, the risk of symptomatic intracranial hemorrhage did not significantly increase with age (adjusted odds ratio per year, 1.01 [0.99–1.02]; adjusted odds ratio of ≥80 years, 0.98 [0.75–1.29]). Prestroke functional independence, baseline hemoglobin, and bridging thrombolysis were identified as significant modifiers of outcomes in the oldest patients. CONCLUSIONS: Taiwanese EVT patients had more risk factors and worse outcomes than Korean patients. Advanced age is associated with poorer functional recovery, yet selected older patients, particularly those who were functionally independent before the stroke or received bridging thrombolysis, demonstrated meaningful benefit. These results underscore the importance of individualized treatment strategies and careful patient selection, especially as populations continue to age.

Association Between Intravenous Antihypertensives and Functional Outcome After Successful Endovascular Thrombectomy

Tue, 31 Dec 2024 15:00:00 GMT

Title: Association Between Intravenous Antihypertensives and Functional Outcome After Successful Endovascular Thrombectomy Author(s): Jae Wook Jung; Young Dae Kim; JoonNyung Heo; Hyungwoo Lee; Byung Moon Kim; Dong Joon Kim; Na-Young Shin; Haram Joo; Bang-Hoon Cho; Seong Hwan Ahn; Hyungjong Park; Sung-Il Sohn; Jeong-Ho Hong; Jaeseob Yun; Tae-Jin Song; Yoonkyung Chang; Gyu Sik Kim; Kwon-Duk Seo; Kijeong Lee; Jun Young Chang; Jung Hwa Seo; Sukyoon Lee; Jang-Hyun Baek; Han-Jin Cho; Dong Hoon Shin; Jinkwon Kim; Joonsang Yoo; Minyoul Baik; Yo Han Jung; Yang-Ha Hwang; Chi Kyung Kim; Jae Guk Kim; Il Hyung Lee; Jin Kyo Choi; Chan Joo Lee; Sungha Park; Soyoung Jeon; Hye Sun Lee; Kwang Hyun Kim; Sun U Kwon; Oh Young Bang; Ji Hoe Heo; Hyo Suk Nam Abstract: BACKGROUND: Intravenous antihypertensives are frequently used to control blood pressure after successful endovascular thrombectomy (EVT), yet studies investigating the relationship between intravenous antihypertensive use and functional outcomes after successful EVT remain limited. METHODS: We conducted an exploratory secondary analysis of the OPTIMAL-BP trial (Outcome in Patients Treated With Intra-Arterial Thrombectomy–Optimal Blood Pressure Control), which compared intensive (systolic blood pressure <140 mm Hg) versus conventional blood pressure management (systolic blood pressure, 140–180 mm Hg) within the first 24 hours after successful recanalization across 19 stroke centers in South Korea between June 2020 and November 2022. Patients were classified according to the administration of intravenous antihypertensives within the initial 24 hours after enrollment. The primary efficacy outcome was functional independence (modified Rankin Scale score of 0–2) at 3 months. RESULTS: Of the 302 patients (median, 75 years; 180 [59.6%] men), 141 (46.7%) received intravenous antihypertensives within the first 24 hours after EVT. Among the 141 patients who received intravenous antihypertensives, 133 (94.3%) were treated with nicardipine, 10 (7.0%) received labetalol, and 2 (1.4%) were administered both drugs. Patients who received intravenous antihypertensives had significantly lower rates of functional independence at 3 months (adjusted odds ratio, 0.51 [95% CI, 0.27–0.95]; P=0.035) and excellent neurological recovery at 24 hours (adjusted odds ratio, 0.46 [95% CI, 0.22–0.94]; P=0.036), as well as higher stroke-related mortality rates (adjusted odds ratio, 4.21 [95% CI, 1.24–16.4]; P=0.027), compared with patients who did not receive intravenous antihypertensives. Symptomatic intracerebral hemorrhage was not significantly different between groups (adjusted odds ratio, 1.67 [95% CI, 0.68–4.19]; P=0.267). CONCLUSIONS: The use of intravenous antihypertensives within the first 24 hours after successful EVT was associated with worse functional outcomes at 3 months. This finding highlights the need for a cautious assessment of the risks and benefits of administering intravenous antihypertensives immediately after EVT.

Mild Hypothermia After Endovascular Treatment for Acute Ischemic Stroke: A Pilot Randomized Controlled Trial

Tue, 31 Dec 2024 15:00:00 GMT

Title: Mild Hypothermia After Endovascular Treatment for Acute Ischemic Stroke: A Pilot Randomized Controlled Trial Author(s): Jin-Heon Jeong; Jeong-Ho Hong; Sung-Il Sohn; Hyungjong Park; Jun Young Chang; Kyu Sun Yum; Jihoon Kang; Moon-Ku Han Abstract: BACKGROUND: Therapeutic hypothermia is a potent neuroprotective therapy that mitigates ischemic brain injury. This study aimed to investigate the safety and feasibility of mild therapeutic hypothermia after successful endovascular recanalization in patients with acute ischemic stroke due to major vessel occlusion. METHODS: We conducted a prospective, multicenter, open-label pilot randomized clinical trial at 5 stroke centers in South Korea between December 2016 and November 2019. Patients with acute ischemic stroke who achieved successful recanalization within 8 hours of symptom onset were included. The participants were randomly assigned in a 1:1 ratio to receive either mild therapeutic hypothermia, targeted at 35 °C for 48 hours, or standard care. The primary objective was to assess feasibility and safety outcomes, including protocol adherence, achievement and maintenance of the target temperature, and adverse events related to the intervention. Exploratory efficacy outcomes included a modified Rankin Scale score of 0 to 2 at 3 months and neurological improvement (≥4-point reduction on the National Institutes of Health Stroke Scale score at discharge). Exploratory safety outcomes included mortality, hemorrhagic transformation, and any bleeding. RESULTS: Forty patients were enrolled in this study, with 20 patients in each group. The target temperature was successfully achieved and maintained in all patients of the mild hypothermia group in accordance with the intervention protocol. At 3 months, the mortality rates were 5% in the mild hypothermia group and 0% in the control group (P=1). A modified Rankin Scale score of 0 to 2 was achieved in 70% and 65% of the mild hypothermia and control groups, respectively (P=0.736). Few adverse events (bradycardia and rhabdomyolysis) were more frequent in the mild hypothermia group but were manageable. CONCLUSIONS: Mild hypothermia at 35 °C after successful recanalization via endovascular treatment in acute ischemic stroke is safe and feasible, despite some adverse events. This pilot study demonstrated that mild hypothermia is well tolerated in this patient population, and further study is needed to confirm its effectiveness.

Deep learning to identify stroke within 4.5h using DWI and FLAIR in a prospective multicenter study

Tue, 31 Dec 2024 15:00:00 GMT

Title: Deep learning to identify stroke within 4.5h using DWI and FLAIR in a prospective multicenter study Author(s): Eun Namgung; Young Sun Kim; Eun-Jae Lee; Dae-Il Chang; Han Jin Cho; Jun Lee; Jae-Kwan Cha; Man-Seok Park; Kyung Ho Yu; Jin-Man Jung; Seong Hwan Ahn; Dong-Eog Kim; Ju Hun Lee; Keun-Sik Hong; Sung-Il Sohn; Kyung-Pil Park; Jun Young Chang; Bum Joon Kim; Sun U Kwon; Gayoung Park; Hye-Soo Jung; Jihoun Hong; Dong-Wha Kang Abstract: To enhance thrombolysis eligibility in acute ischemic stroke, we developed a deep learning model to estimate stroke onset within 4.5 h using diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images. Given the variability in human interpretation, our multimodal Res-U-Net (mRUNet) model integrates a modified U-Net and ResNet-34 to classify stroke onset as < 4.5 or ≥ 4.5 h. Using DWI and FLAIR images from patients scanned within 24 h of symptom onset, the modified U-Net generated a DWI–FLAIR mismatch image, while ResNet-34 performed the final classification. mRUNet was evaluated against ResNet-34 and DenseNet-121 on an internal test set (n = 123) and two external test sets: a single-center (n = 468) and a multi-center (n = 1151). mRUNet achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.903 on the internal set and 0.910 and 0.868 on external sets, significantly outperforming ResNet-34 and DenseNet-121. Our mRUNet model demonstrated robust and consistent classification of the 4.5-h onset-time window across datasets. By leveraging DWI and FLAIR images as a tissue clock, this model may support timely and individualized thrombolysis in patients with unclear stroke onset, such as those with wake-up stroke, in clinical settings.