e-ASPECTS Correlates with and Is Predictive of Outcome after Mechanical Thrombectomy.

BACKGROUND AND PURPOSE: The e-ASPECTS software is a tool for the automated use of ASPECTS. Our aim was to analyze whether baseline e-ASPECT scores correlate with outcome after mechanical thrombectomy. MATERIALS AND METHODS: Patients with ischemic strokes in the anterior circulation who were admitted between 2010 and 2015, diagnosed by CT, and received mechanical thrombectomy were included. The ASPECTS on baseline CT was scored by e-ASPECTS and 3 expert raters, and interclass correlation coefficients were calculated. The e-ASPECTS was correlated with functional outcome (modified Rankin Scale) at 3 months by using the Spearman rank correlation coefficient. Unfavorable outcome was defined as mRS 4-6 at 3 months, and a poor scan was defined as e-ASPECTS 0-5. RESULTS: Two hundred twenty patients were included, and 147 (67%) were treated with bridging protocols. The median e-ASPECTS was 9 (interquartile range, 8-10). Intraclass correlation coefficients between e-ASPECTS and raters were 0.72, 0.74, and 0.76 (all, P < .001). e-ASPECTS (Spearman rank correlation coefficient = -0.15, P = .027) correlated with mRS at 3 months. Patients with unfavorable outcome had lower e-ASPECTS (median, 8; interquartile range, 7-10 versus median, 9; interquartile range, 8-10; P = .014). Sixteen patients (7.4%) had a poor scan, which was associated with unfavorable outcome (OR, 13.6; 95% CI, 1.8-104). Independent predictors of unfavorable outcome were e-ASPECTS (OR, 0.79; 95% CI, 0.63-0.99), blood sugar (OR, 1.01; 95% CI, 1.004-1.02), atrial fibrillation (OR, 2.64; 95% CI, 1.22-5.69), premorbid mRS (OR, 1.77; 95% CI, 1.21-2.58), NIHSS (OR, 1.11; 95% CI, 1.04-1.19), general anesthesia (OR, 0.24; 95% CI, 0.07-0.84), failed recanalization (OR, 8.47; 95% CI, 3.5-20.2), and symptomatic intracerebral hemorrhage (OR, 25.8; 95% CI, 2.5-268). CONCLUSIONS: The e-ASPECTS correlated with mRS at 3 months and was predictive of unfavorable outcome after mechanical thrombectomy, but further studies in patients with poor scan are needed.

Mechanical Thrombectomy of Distal Occlusions in the Anterior Cerebral Artery: Recanalization Rates, Periprocedural Complications, and Clinical Outcome.

BACKGROUND AND PURPOSE: Patients with acute ischemic stroke in the anterior circulation are at risk for either primary or, following mechanical thrombectomy, secondary occlusion of the anterior cerebral artery. Because previous studies had only a limited informative value, we report our data concerning the frequency and location of distal anterior cerebral artery occlusions, recanalization rates, periprocedural complications, and clinical outcome. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data of patients with acute ischemic stroke undergoing mechanical thrombectomy in the anterior circulation between June 2010 and April 2015. RESULTS: Of 368 patients included in this analysis, we identified 30 (8.1%) with either primary (n = 17, 4.6%) or secondary (n = 13, 3.5%) embolic occlusion of the distal anterior cerebral artery. The recanalization rate after placement of a stent retriever was 88%. Periprocedural complications were rare and included vasospasms (n = 3, 10%) and dissection (n = 1, 3.3%). However, 16 (53.5%) patients sustained an (at least partial) infarction of the anterior cerebral artery territory. Ninety days after the ictus, clinical outcome according to the modified Rankin Scale score was the following: 0-2, n = 11 (36.6%); 3-4, n = 9 (30%); 5-6, n = 10 (33.3%). CONCLUSIONS: Occlusions of the distal anterior cerebral artery affect approximately 8% of patients with acute ischemic stroke in the anterior circulation receiving mechanical thrombectomy. Despite a high recanalization rate and a low complication rate, subsequent (partial) infarction in the anterior cerebral artery territory occurs in approximately half of patients. Fortunately, clinical outcome appears not to be predominately unfavorable.

Adopting hybrid pension plans: financial and communication issues.

This article provides a systematic framework for the evaluation of the movement toward hybrid pension plans by examining the reasons given by firms for converting their existing pension plans to hybrid plans, illustrating the impact of plan changes on expected pension benefits, and identifying winners and losers.

Communicating the need for additional savings in the face of retiree health benefit cutbacks.

In preparing for retirement, employees need to consider not only their pension benefits but also the challenge of financing their retirement health care needs. Various trends evolving in our society indicate that future retirees will be increasingly dependent on their own retirement savings. Evidence suggests that employees are not fully aware of the significance of health costs in retirement and must be educated to the need to save for retiree health care expenses. This article discusses the issues of Medicare reduction and retiree health benefit cutbacks and the relative communication and education challenges such issues pose to employers.

Analysis of nonparticipation in the SSI program.

This article addresses a range of questions about participation and nonparticipation in the supplemental security income (SSI) program with data collected by the Survey of Low-Income Aged and Disabled (SLIAD) during 1973 and 1974: (1) Can SSI's relatively modest growth be attributed to initial overestimates of the eligible population or to low rates of participation among eligibles? (2) If the latter, what factors inhibited program participation? (3) What is the relation between program participation in SSI's initial years and at the present time? (4) If the factors that initially inhibited participation have not significantly changed, what are the present implications for program policy? The first section of this article discusses the size and composition of the program's target population. Various estimates of the eligible SSI population are compared with microsimulation estimates based on SLIAD. The second section presents the theoretical and empirical framework used to analyze the factors associated with nonparticipation in SSI. The theory of nonparticipation, developed in the context of the "alternative income hypothesis," is presented in a series of propositions used to empirically verify the theory. The third section discusses the factors related to participation in the SSI program during and after the phase-in period. Subsequent response to SSI is presented in a discussion of outreach efforts and trends in program applications and program enrollments. The final section discusses the implications of the existence of an eligible nonparticipant population and what, if any, changes could be made to increase program involvement.

First year impact of SSI on economic status of 1973 adult assistance populations.

During 1973, interviews were conducted with more than 11,000 adult assistance recipients in the Survey of the Low-Income Aged and Disabled. The sample members were reinterviewed during the last 3 months of 1974, approximately 1 year after the implementation of SSI. This article analyzes the impact of SSI on the economic status of the 1973 adult assistance populations. The analysis considers the United States sample as well as samples for five individual States. Most of the 1973 adult assistance recipients were automatically transferred to SSI on January 1, 1974. The majority realized an improved economic situation during 1974, at least in part because of their transferral to SSI. There was significant improvement for the residents of each of the separate States considered because of increased assistance payments, but SSI generally proved most beneficial to the poorest persons transferred from the State public assistance programs.