ABSTRACT
BACKGROUND: Performing endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) allows a port of entry for intracranial biological sampling. OBJECTIVE: To test the hypothesis that specific immune players are molecular contributors to disease, outcome biomarkers, and potential targets for modifying AIS. METHODS: We examined 75 subjects presenting with large vessel occlusion of the anterior circulation and undergoing EVT. Intracranial blood samples were obtained by microcatheter aspiration, as positioned for stent deployment. Peripheral blood samples were collected from the femoral artery. Plasma samples were quality controlled by electrophoresis and analyzed using a Mesoscale multiplex for targeted inflammatory and vascular factors. RESULTS: We measured 37 protein biomarkers in our sample cohort. Through multivariate analysis, adjusted for age, intravenous thrombolysis, pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores, we found that post-clot blood levels of interleukin-6 (IL-6) were significantly correlated (adjusted P value <0.05) with disability assessed by the modified Rankin Scale (mRS) score at 90 days, with medium effect size. Chemokine (C-C) ligand 17 CCL17/TARC levels were inversely correlated with the mRS score. Examination of peripheral blood showed that these correlations did not reach statistical significance after correction. Intracranial biomarker IL-6 level was specifically associated with a lower likelihood of favorable outcome, defined as a mRS score of 0-2. CONCLUSIONS: Our findings show a signature of blood inflammatory factors at the cerebrovascular occlusion site. The correlations between these acute-stage biomarkers and mRS score outcome support an avenue for add-on and localized immune modulatory strategies in AIS.
ABSTRACT
BACKGROUND: Precise localization and understanding of the origin of cerebrospinal fluid (CSF) leak is crucial to allow targeted treatment. We report the technical feasibility and utility of dorsal-decubitus dynamic computed tomography (DDDCT) myelography to localize posteriorly located dural defects in patients with suspicion of posterolateral dural tears. METHODS: This study reports a series of four consecutive patients with posteriorly located SLEC and suspicion of posterolateral CSF leak who received DDDCT to localize the site of the leak. Patients were collected between October 2022 and October 2023. The technique of DDDCT and its efficacy to detect the site of CSF leak are reported. RESULTS: In all four patients (three females, one male, mean age 39 years), DDDCT myelography was technically successful and precisely demonstrated the site of the CSF leak. In one patient with both anterior and posterior SLEC, DDDCT allowed to exclude the presence of a posteriorly located leak, while a subsequent ventral decubitus dynamic CT myelography localized the leak. Leak sites were all thoracic, except for one that was cervical. Information obtained from the DDDCT myelography was considered useful to target the treatment of the leak. CONCLUSIONS: Based on our experience, DDDCT provided sufficient spatial and temporal resolution to pinpoint fast CSF leaks and it may be considered to localize posterolateral dural defects.
ABSTRACT
BACKGROUND: Cangrelor is an intravenous P2Y12 inhibitor with rapid onset and fast offset of antiplatelet action. Dose adjusted cangrelor based on platelet function testing is suggested to be advantageous for use during neuroendovascular procedures. In this study, we aimed to assess the efficacy and safety of this strategy. METHODS: This retrospective study included consecutive patients who received low dose intravenous cangrelor (5 µg/kg; infusion 1 µg/kg/min) for ruptured (RIA) and unruptured (UIA) intracranial aneurysms, and acute ischemic stroke (AIS). Indications were acute stenting or intraluminal thrombus. Outcomes were assessed at 24 hours by brain CT and CT angiography. The primary efficacy outcome was the rate of stent occlusion or persistent intraluminal thrombus. The primary safety outcome was the rate of major hemorrhages. RESULTS: 101 patients (56 men; median age (IQR) 59 (51-70) years) received low dose cangrelor for acute stenting (79/101 (78%)) and intraprocedural thrombus (22/101 (22%)). Overall, 5 (4.9%) patients experienced stent occlusion within 24 hours (RIA 3/28; AIS 2/52). There were no cases of failure among UIA patients. Stent mis-opening (fish mouthing or stenosis >50%) was significantly associated with stent occlusion (P<0.001). The overall rate of major hemorrhage was 2% (2/101), which occurred in AIS patients. Platelet reactivity unit (PRU) values were lower in those presenting with major hemorrhage (PRU 4 (SD 1.4) vs PRU 60 (SD 63); P=0.043). Mortality rate after cangrelor related hemorrhage was 1%. CONCLUSIONS: Low dose cangrelor appears to be effective in preventing stent thrombosis and arterial patency with a low hemorrhagic risk.
