Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry.

BACKGROUND: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes. METHODS: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended Thrombolysis in Cerebral Infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days). RESULTS: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P<0.001 and 236 versus 270 minutes; P<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile. CONCLUSIONS: Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.

Superior cerebellar artery aneurysms: incidence, clinical presentation and midterm outcome of endovascular treatment.

INTRODUCTION: The aim of this retrospective study was to determine the incidence, clinical presentation and midterm clinical and imaging outcome of endovascular treatment of 34 superior cerebellar artery (SCA) aneurysms in 33 patients. METHODS: Between January 1995 and January 2007, 2,112 aneurysms were treated in our institution, and 36 aneurysms in 35 patients were located on the SCA (incidence 1.7%). Two of three distal SCA aneurysms were excluded. All the remaining 34 SCA aneurysms, of which 22 (65%) were ruptured and 12 (35%) were unruptured, in 33 patients were treated by endovascular techniques. There were 6 men and 27 women ranging from 29-72 years. In 14 patients (42%) multiple aneurysms were present. RESULTS: Initial angiographic occlusion was (near) complete in 32 aneurysms (94%) and incomplete in 2 aneurysms (6%). Complications leading to permanent morbidity or death occurred in two patients (6.1%, 95% CI 0.6 to 20.60%). Outcome at 6 months follow-up in 31 surviving patients was GOS5 in 26 (84%), GOS4 in 4 (13%) and GOS3 in 1 patient (3%). There were no episodes of (re)bleeding during 118 patient-years of follow-up. The 6-month angiographic follow up in 28 SCA aneurysms and extended angiographic follow-up in 19 showed stable occlusion in 27 aneurysms. No additional treatments were performed. CONCLUSION: SCA aneurysms are rare with an incidence of 1.7% of treated aneurysms at our institution. They are frequently associated with other aneurysms. Endovascular treatment is effective and safe in excluding the aneurysms from the circulation.