Background: Efficacy and safety of endovascular thrombectomy (EVT) in large vessel occlusion (LVO... more Background: Efficacy and safety of endovascular thrombectomy (EVT) in large vessel occlusion (LVO) patients with mild deficits is unclear. Methods: Pooled cohort of pts with mild deficits (NIHSS<6) due to (ICA, M1, M2) LVO from EXTEND IA TNK I & II RCTs and prospective data from 12 centers (US, AUS, NZ, Canada, Spain) from 1/2013 to 2/2020 was divided into medical management (MM) vs EVT. All pts had baseline CT, CTA, CTPRAPID software estimated ischemic core and mismatch. Pts stratified into with or without target profile (≥1cc core / mismatch ratio ≥ 1.8 / mismatch volume ≥ 15cc). Primary outcome- excellent (90 day mRS 0-1); Secondary- mRS shift, safety (sICH, neuro-worsening, mortality). Results: Of 371 pts, 189 (51%) had EVT. Time LKW to EVT center: EVT 165 (70- 416) vs MM 200 (72-564) min, p=0.35 were similar. EVT pts had larger perfusion lesions (51 cc (23-86) vs 30.1 (5, 65), p<0.001), higher NIHSS 4 (2-5) vs 3 (2-4), p=0.009), less IV tPA (30% vs 41%, p=0.044), more M1s...
BackgroundSex disparities in acute ischemic stroke outcomes are well reported with IV thrombolysi... more BackgroundSex disparities in acute ischemic stroke outcomes are well reported with IV thrombolysis. Despite several studies, there is still a lack of consensus on whether endovascular thrombectomy (EVT) outcomes differ between men and women.ObjectiveTo compare sex differences in EVT outcomes at 90-day follow-up and assess whether progression in functional status from discharge to 90-day follow-up differs between men and women.MethodsFrom the Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) prospective cohort study (2016–2018), adult men and women (≥18 years) with anterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery M1/M2) treated with EVT up to 24 hours from last known well were matched using propensity scores. Discharge and 90-day modified Rankin Scale (mRS) scores were compared between men and women. Furthermore, we evaluated the improvement in mRS scores from discharge to 90 days in men and women using a repeated-measu...
Supplemental material, ONLINE_SUPPLEMENT for Outcome, efficacy and safety of endovascular thrombe... more Supplemental material, ONLINE_SUPPLEMENT for Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry by Thomas Raphael Meinel, Johannes Kaesmacher, Pasquale Mordasini, Pascal J. Mosimann, Simon Jung, Marcel Arnold, Mirjam Rachel Heldner, Patrik Michel, Steven D. Hajdu, Marc Ribo, Manuel Requena, Christian Maegerlein, Benjamin Friedrich, Vincent Costalat, Amel Benali, Laurent Pierot, Matthias Gawlitza, Joanna Schaafsma, Vitor Mendes Pereira, Jan Gralla and Urs Fischer in Therapeutic Advances in Neurological Disorders
Background and Purpose: Whether intravenous thrombolysis (IVT) increases the risk for symptomatic... more Background and Purpose: Whether intravenous thrombolysis (IVT) increases the risk for symptomatic intracranial hemorrhage (sICH) in patients treated with mechanical thrombectomy (MT) is a matter of debate. Purpose of this study was to evaluate the extent of early ischemia as a possible factor influencing the risk for sICH after IVT+MT versus direct MT. Methods: An explorative analysis of the BEYOND-SWIFT (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy) multicenter cohort was performed. We hypothesized that the sICH risk between IVT+MT versus direct MT differs across the strata of Alberta Stroke Program Early CT Scores (ASPECTS). For this purpose, all patients with ICA, M1, and M2 vessel occlusions and available noncontrast computed tomography or diffusion-weighed imaging ASPECTS (n=2002) were analyzed. We used logistic regression analysis in subgroups,...
Sarraj A, et al. J NeuroIntervent Surg Month 2021 Vol 0 Selection criteria for large core trials:... more Sarraj A, et al. J NeuroIntervent Surg Month 2021 Vol 0 Selection criteria for large core trials: dogma or data? Amrou Sarraj , Bruce Campbell, Marc Ribo , Muhammad Shazam Hussain , Michael Chen , Michael G Abraham, Maarten G Lansberg, Vitor Mendes Pereira , Spiros Blackburn, Clark W Sitton, Ronald F Budzik, Natalia Pérez de la Ossa, Juan F Arenillas, Teddy Wu , Jordi Blasco, Michael Mullen, Joanna Schaafsma, Jenny P Tsai, Navdeep Sangha, Osman Kozak, Daniel Gibson, Steven Warach, Dennis Cordato, Nathan W Manning , Timothy J Kleinig, JeanMarc Olivot , Lucas Elijovich , Georgios Tsivgoulis, Andrei Alexandrov, Pascal Jabbour , Bernard Yan, Scott E Kasner, Adam S Arthur , Mark Parsons, James C Grotta, Ameer E Hassan , Gregory W Albers, On behalf of SELECT2 Investigators and SELECT2 Steering Committee
Journal of neurosurgical anesthesiology, Jan 31, 2018
Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute isch... more Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) are potential contributors to the success of revascularization. The aims of our study were to review the hemodynamic management by anesthesiologists and clinical outcomes in patients undergoing MT under conscious sedation. Retrospective cohort study of patients with anterior circulation AIS from January 2012 to March 2016. Primary outcome was hemodynamic intervention, defined as administration of vasoactive drugs to maintain systolic blood pressure (BP) between 140 and 180 mm Hg. The secondary outcome was poor hemodynamic control, defined as BP outside target for >15 minutes despite hemodynamic intervention. We performed regression analysis to determine the predictors of hemodynamic intervention and poor hemodynamic control. A total of 126 patients were included in this study; 92% (116) receiving conscious sedation and 8% (10) no sedation. Upon arrival to the neurora...
Objectives: Patients with symptomatic atherosclerotic vertebrobasilar disease are at high risk fo... more Objectives: Patients with symptomatic atherosclerotic vertebrobasilar disease are at high risk for recurrent stroke and we have demonstrated that distal flow status is independently associated with this risk. Our aim was to assess the mechanism of recurrent strokes in these patients related to their distal flow status. Methods: Patients with symptomatic atherosclerotic vertebrobasilar disease were enrolled in a prospective longitudinal cohort study (VERiTAS) with a median follow-up of 23 months. Large-vessel flow in the posterior circulation distal to the stenosis and/or occlusion was measured on quantitative MR angiography and dichotomized into normal or low flow. Three observers, who were blinded to the distal flow status, independently reviewed the imaging done at the time of the recurrent stroke to classify the most likely stroke mechanism. Results: Ten out of 72 enrolled patients had a recurrent stroke in the posterior circulation. Four patients were determined to have embolic ...
ObjectiveTo test the hypothesis that selection by initial imaging modality (MRI vs CT) is associa... more ObjectiveTo test the hypothesis that selection by initial imaging modality (MRI vs CT) is associated with rate of futile recanalizations (FR) after mechanical thrombectomy (MT), we assessed this association in a multicenter, retrospective observational registry (BEYOND-SWIFT, NCT03496064).MethodsIn 2011 patients (49.7% female, median age 73 [61–81]) included between 2009 and 2017, we performed univariate and multivariate analyses regarding the occurrence of FR. FR were defined as 90 days modified Rankin Scale (mRS) 4–6 despite successful recanalization in patients selected by MRI (N = 690) and CT (N = 1,321) with a sensitivity analysis considering only patients with mRS 5–6 as futile.ResultsMRI as compared to CT resulted in similar rates of subsequent MT (aOR 1.048, 95% CI 0.677–1.624). Rates of FR were as follows: 571/1,489 (38%) FR mRS 4–6 including 393/1,489 (26%) FR mRS 5–6. CT based selection was associated with increased rates of futile recanalizations compared to MRI (44% [41...
Background and purposeThe Alberta Stroke Program Early CT Score (ASPECTS) is a commonly used scor... more Background and purposeThe Alberta Stroke Program Early CT Score (ASPECTS) is a commonly used scoring system to select patients with stroke for endovascular treatment (EVT). However, the inter- and intra-reader variability is high.ObjectiveTo determine whether the inter- and intra-reader variability is different for various regions of the ASPECTS scoring system by evaluating the interobserver variability of ASPECTS between different readers in a per-region analysis.Materials and methodsAll patients with acute ischemic stroke who proceeded to EVT in our institutions over a 4-year period were retrospectively identified from a prospectively maintained database. Images were reviewed by two experienced neuroradiologists, who recalculated the ASPECTS independently. We examined each region of the ASPECTS system to evaluate agreement between the raters in each area.Results375 patients were included. The median total ASPECTS was 9 (IQR 8–9). The most common region showing ischemic change was ...
Background and Purpose— We aimed to determine the safety and mortality after mechanical thrombect... more Background and Purpose— We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods— In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Additionally, we performed a systematic review and meta-analysis of literature on this topic. Results— Altogether, 1932 patients were included (VKA, n=222; DOAC, n=98; no anticoagulation, n=1612); median age, 74 years (interquartile range, 62–82); 49.6% women. VKA prescription was associated with increased odds for sICH and mortality (adjusted odds ratio [aOR], 2.55 [95% CI, 1.35–4.84]...
Background: Efficacy and safety of endovascular thrombectomy (EVT) in large vessel occlusion (LVO... more Background: Efficacy and safety of endovascular thrombectomy (EVT) in large vessel occlusion (LVO) patients with mild deficits is unclear. Methods: Pooled cohort of pts with mild deficits (NIHSS<6) due to (ICA, M1, M2) LVO from EXTEND IA TNK I & II RCTs and prospective data from 12 centers (US, AUS, NZ, Canada, Spain) from 1/2013 to 2/2020 was divided into medical management (MM) vs EVT. All pts had baseline CT, CTA, CTPRAPID software estimated ischemic core and mismatch. Pts stratified into with or without target profile (≥1cc core / mismatch ratio ≥ 1.8 / mismatch volume ≥ 15cc). Primary outcome- excellent (90 day mRS 0-1); Secondary- mRS shift, safety (sICH, neuro-worsening, mortality). Results: Of 371 pts, 189 (51%) had EVT. Time LKW to EVT center: EVT 165 (70- 416) vs MM 200 (72-564) min, p=0.35 were similar. EVT pts had larger perfusion lesions (51 cc (23-86) vs 30.1 (5, 65), p<0.001), higher NIHSS 4 (2-5) vs 3 (2-4), p=0.009), less IV tPA (30% vs 41%, p=0.044), more M1s...
BackgroundSex disparities in acute ischemic stroke outcomes are well reported with IV thrombolysi... more BackgroundSex disparities in acute ischemic stroke outcomes are well reported with IV thrombolysis. Despite several studies, there is still a lack of consensus on whether endovascular thrombectomy (EVT) outcomes differ between men and women.ObjectiveTo compare sex differences in EVT outcomes at 90-day follow-up and assess whether progression in functional status from discharge to 90-day follow-up differs between men and women.MethodsFrom the Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) prospective cohort study (2016–2018), adult men and women (≥18 years) with anterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery M1/M2) treated with EVT up to 24 hours from last known well were matched using propensity scores. Discharge and 90-day modified Rankin Scale (mRS) scores were compared between men and women. Furthermore, we evaluated the improvement in mRS scores from discharge to 90 days in men and women using a repeated-measu...
Supplemental material, ONLINE_SUPPLEMENT for Outcome, efficacy and safety of endovascular thrombe... more Supplemental material, ONLINE_SUPPLEMENT for Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry by Thomas Raphael Meinel, Johannes Kaesmacher, Pasquale Mordasini, Pascal J. Mosimann, Simon Jung, Marcel Arnold, Mirjam Rachel Heldner, Patrik Michel, Steven D. Hajdu, Marc Ribo, Manuel Requena, Christian Maegerlein, Benjamin Friedrich, Vincent Costalat, Amel Benali, Laurent Pierot, Matthias Gawlitza, Joanna Schaafsma, Vitor Mendes Pereira, Jan Gralla and Urs Fischer in Therapeutic Advances in Neurological Disorders
Background and Purpose: Whether intravenous thrombolysis (IVT) increases the risk for symptomatic... more Background and Purpose: Whether intravenous thrombolysis (IVT) increases the risk for symptomatic intracranial hemorrhage (sICH) in patients treated with mechanical thrombectomy (MT) is a matter of debate. Purpose of this study was to evaluate the extent of early ischemia as a possible factor influencing the risk for sICH after IVT+MT versus direct MT. Methods: An explorative analysis of the BEYOND-SWIFT (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy) multicenter cohort was performed. We hypothesized that the sICH risk between IVT+MT versus direct MT differs across the strata of Alberta Stroke Program Early CT Scores (ASPECTS). For this purpose, all patients with ICA, M1, and M2 vessel occlusions and available noncontrast computed tomography or diffusion-weighed imaging ASPECTS (n=2002) were analyzed. We used logistic regression analysis in subgroups,...
Sarraj A, et al. J NeuroIntervent Surg Month 2021 Vol 0 Selection criteria for large core trials:... more Sarraj A, et al. J NeuroIntervent Surg Month 2021 Vol 0 Selection criteria for large core trials: dogma or data? Amrou Sarraj , Bruce Campbell, Marc Ribo , Muhammad Shazam Hussain , Michael Chen , Michael G Abraham, Maarten G Lansberg, Vitor Mendes Pereira , Spiros Blackburn, Clark W Sitton, Ronald F Budzik, Natalia Pérez de la Ossa, Juan F Arenillas, Teddy Wu , Jordi Blasco, Michael Mullen, Joanna Schaafsma, Jenny P Tsai, Navdeep Sangha, Osman Kozak, Daniel Gibson, Steven Warach, Dennis Cordato, Nathan W Manning , Timothy J Kleinig, JeanMarc Olivot , Lucas Elijovich , Georgios Tsivgoulis, Andrei Alexandrov, Pascal Jabbour , Bernard Yan, Scott E Kasner, Adam S Arthur , Mark Parsons, James C Grotta, Ameer E Hassan , Gregory W Albers, On behalf of SELECT2 Investigators and SELECT2 Steering Committee
Journal of neurosurgical anesthesiology, Jan 31, 2018
Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute isch... more Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) are potential contributors to the success of revascularization. The aims of our study were to review the hemodynamic management by anesthesiologists and clinical outcomes in patients undergoing MT under conscious sedation. Retrospective cohort study of patients with anterior circulation AIS from January 2012 to March 2016. Primary outcome was hemodynamic intervention, defined as administration of vasoactive drugs to maintain systolic blood pressure (BP) between 140 and 180 mm Hg. The secondary outcome was poor hemodynamic control, defined as BP outside target for >15 minutes despite hemodynamic intervention. We performed regression analysis to determine the predictors of hemodynamic intervention and poor hemodynamic control. A total of 126 patients were included in this study; 92% (116) receiving conscious sedation and 8% (10) no sedation. Upon arrival to the neurora...
Objectives: Patients with symptomatic atherosclerotic vertebrobasilar disease are at high risk fo... more Objectives: Patients with symptomatic atherosclerotic vertebrobasilar disease are at high risk for recurrent stroke and we have demonstrated that distal flow status is independently associated with this risk. Our aim was to assess the mechanism of recurrent strokes in these patients related to their distal flow status. Methods: Patients with symptomatic atherosclerotic vertebrobasilar disease were enrolled in a prospective longitudinal cohort study (VERiTAS) with a median follow-up of 23 months. Large-vessel flow in the posterior circulation distal to the stenosis and/or occlusion was measured on quantitative MR angiography and dichotomized into normal or low flow. Three observers, who were blinded to the distal flow status, independently reviewed the imaging done at the time of the recurrent stroke to classify the most likely stroke mechanism. Results: Ten out of 72 enrolled patients had a recurrent stroke in the posterior circulation. Four patients were determined to have embolic ...
ObjectiveTo test the hypothesis that selection by initial imaging modality (MRI vs CT) is associa... more ObjectiveTo test the hypothesis that selection by initial imaging modality (MRI vs CT) is associated with rate of futile recanalizations (FR) after mechanical thrombectomy (MT), we assessed this association in a multicenter, retrospective observational registry (BEYOND-SWIFT, NCT03496064).MethodsIn 2011 patients (49.7% female, median age 73 [61–81]) included between 2009 and 2017, we performed univariate and multivariate analyses regarding the occurrence of FR. FR were defined as 90 days modified Rankin Scale (mRS) 4–6 despite successful recanalization in patients selected by MRI (N = 690) and CT (N = 1,321) with a sensitivity analysis considering only patients with mRS 5–6 as futile.ResultsMRI as compared to CT resulted in similar rates of subsequent MT (aOR 1.048, 95% CI 0.677–1.624). Rates of FR were as follows: 571/1,489 (38%) FR mRS 4–6 including 393/1,489 (26%) FR mRS 5–6. CT based selection was associated with increased rates of futile recanalizations compared to MRI (44% [41...
Background and purposeThe Alberta Stroke Program Early CT Score (ASPECTS) is a commonly used scor... more Background and purposeThe Alberta Stroke Program Early CT Score (ASPECTS) is a commonly used scoring system to select patients with stroke for endovascular treatment (EVT). However, the inter- and intra-reader variability is high.ObjectiveTo determine whether the inter- and intra-reader variability is different for various regions of the ASPECTS scoring system by evaluating the interobserver variability of ASPECTS between different readers in a per-region analysis.Materials and methodsAll patients with acute ischemic stroke who proceeded to EVT in our institutions over a 4-year period were retrospectively identified from a prospectively maintained database. Images were reviewed by two experienced neuroradiologists, who recalculated the ASPECTS independently. We examined each region of the ASPECTS system to evaluate agreement between the raters in each area.Results375 patients were included. The median total ASPECTS was 9 (IQR 8–9). The most common region showing ischemic change was ...
Background and Purpose— We aimed to determine the safety and mortality after mechanical thrombect... more Background and Purpose— We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods— In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Additionally, we performed a systematic review and meta-analysis of literature on this topic. Results— Altogether, 1932 patients were included (VKA, n=222; DOAC, n=98; no anticoagulation, n=1612); median age, 74 years (interquartile range, 62–82); 49.6% women. VKA prescription was associated with increased odds for sICH and mortality (adjusted odds ratio [aOR], 2.55 [95% CI, 1.35–4.84]...
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Papers by Joanna Schaafsma