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Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.
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Objective@#Mechanical thrombectomy (MT) is now an established treatment foracute ischemic stroke (AIS) with large vessel occlusion (LVO) within 6 hours. Since2018, MT is also recommended from 6-24 hours after selecting with additional multimodalimaging including perfusion imaging. We sought to investigate patients withsignificant discrepancy in core infarct between computed tomography (CT) and CTperfusion (CTP). @*Methods@#In this retrospective study, patients with AIS who were evaluated for MTusing the RAPID software (IschemaView, Redwood City, CA, USA) from February2018 to March 2019 were included. Cases with discrepancy between infarct volumeon non-contrast CT and core volume (cerebral blood flow <30%) as analyzed by RAPIDon CTP were analyzed. @*Results@#In the study period, 635 patients were evaluated for acute stroke symptoms.Non-contrast head CT was performed in 635 patients, and CTP with RAPID softwarepost processing was performed in 134 patients. Among the 134 patients, 8 (5.9%)patients had gross discrepancy in core infarct between CT and CTP, with underestimationof infarct by CTP. Evaluation of these cases shows that the likely reason forthis discrepancy is recanalization of a LVO, which then leads to erroneously normal orgross underestimate of the core infarct volume determined from CTP post processinganalysis. @*Conclusions@#Recanalization of a LVO can lead to erroneously normal or gross underestimationof the core infarct as determined by post processing software analysisof CTP data. The whole composite of hyperacute CT imaging should be examinedwhile making decisions. This caveat of perfusion imaging interpretation has not beenreported previously.
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OBJECTIVES: The 5MAX ACE is a new large bore aspiration catheter available for vessel recanalization for treatment of acute ischemic stroke (AIS). We report our initial experience with its use. METHODS: A retrospective analysis of patients undergoing intra-arterial therapy for AIS using the 5MAX ACE reperfusion catheter at our institution was performed. Patient demographics, clinical characteristics and procedural data were obtained from chart review. Successful recanlization was defined as achievement of Thrombolysis in Cerebral Infarction score (TICI) 2b-3 and time to recanalization was defined as time from groin puncture to achievement of at least TICI 2b recanalization. RESULTS: The 5MAX ACE was used in 15 patients from July-October 2013. Direct aspiration was used as the primary technique in 10/15 (67%) patients. Out of these, aspiration alone was sufficient for recanalization in 3 (20%) patients. In the remaining 7 (47%) patients, additional devices were used. In 5/15 (33%) patients, combined aspiration/stentriever thrombectomy using Solitaire(TM) (3/5 patients) and Penumbra 3D Separator(TM) (2/5 patients) were used as the primary technique. Successful recanlization (TICI 2b-3) was achieved in 11/15 (73%) patients. Average time from groin puncture to successful recanalization was 46 +/- 30 minutes (range 14-98 minutes). There were no procedural complications. CONCLUSION: The 5MAX ACE is a useful recanalization tool, either by direct aspiration or combined stentriever/aspiration. It may be most advantageous with large clots in the internal carotid artery. The potential for effective and faster recanalization using this device alone or in combination may be a good topic for future study.