Bellante, Flavio
Mayo Clinic
Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
Citations 2
Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study
Musmar, Basel , Salim, Hamza , Kobeissi, Hassan , Shaikh, Hamza , Khalife, Jane , Abdalkader, Mohamad , Klein, Piers , Heit, Jeremy J. , Regenhardt, Robert W. , Cancelliere, Nicole M , Amllay, Abdelaziz , Dusart, Anne , Bellante, Flavio, Rouchaud, Aymeric , Puri, Ajit S , Dyzmann, Christian , Kan, Peter , Colasurdo, Marco , Berge, Jérôme , Barreau, Xavier , Nedelcu, Simona , Henninger, Nils , Marotta, Thomas R. , Stapleton, Christopher J. , Rabinov, James D. , Dofuku, Shogo , Tan, Benjamin Yong‐Qiang , Salazar‐Marioni, Sergio , Capirossi, Carolina , Chervak, Lina , Adeeb, Nimer , Tjoumakaris, Stavropoula , Khandelwal, Priyank , Biswas, Arundhati , Clarençon, Frédéric , Elhorany, Mahmoud , Premat, Kévin , Valente, Iacopo , Filipe, João Pedro , Varela, Ricardo , Quintero‐Consuegra, Miguel , Gonzalez, Nestor R. , Möhlenbruch, Markus , Costalat, Vincent , Yedavalli, Vivek , Aziz, Yasmin , Stracke, Christian Paul , Kadirvel, Ramanathan , Hsieh, Cheng‐Yang , Liebeskind, David S. , Alexandre, Andrea , Tancredi, Illario , Faizy, Tobias D. , Lubicz, Boris , Patel, Aman B. , Guenego, Adrien , Musmar, Basel , Salim, Hamza , Kobeissi, Hassan , Klein, Piers , Nguyen, Thanh N , Regenhardt, Robert W , Bellante, Flavio , Forestier, Géraud , Marnat, Gaultier , Ota, Takahiro , Dofuku, Shogo , Yeo, Leonard Ll , Salazar-Marioni, Sergio , Jabbour, Pascal , Gonzalez, Nestor R , Möhlenbruch, Markus A , Jesser, Jessica , Aziz, Yasmin , Alexandru Radu, Răzvan , Faizy, Tobias D , Fahed, Robert , Liebeskind, David S. , Heit, Jeremy J , Yedavalli, Vivek S , Cancelliere, Nicole M , Rouchaud, Aymeric , Colasurdo, Marco , Henninger, Nils , Tan, Benjamin Yq , Alexandre, Andrea M , Varela, Ricardo , Dmytriw, Adam A. , Ghozy, Sherief , Siegler, James E. , Nguyen, Thanh N. , Bernstock, Joshua D. , Naamani, Kareem El , Meyer, Lukas , Forestier, Géraud , Saleme, Suzana , Mounayer, Charbel , Fiehler, Jens , Kühn, Anna Luisa , Sibon, Igor , Gopinathan, Anil , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A , Renieri, Leonardo , Mowla, Ashkan , Vagal, Achala , Cuellar, Hugo , Jabbour, Pascal , Khandelwal, Priyank , Pedicelli, Alessandro , Schiphorst, Adrien ter , Harker, Pablo , Gory, Benjamin , Hecker, Constantin , Killer-Oberpfalzer, Monika , Griessenauer, Christoph J. , Thomas, Ajith J , Radu, Răzvan Alexandru , Fahed, Robert , Weyland, Charlotte S. , Mendes Pereira, Vitor
European Stroke Journal | February 27, 2024 | Volume: 9 | Issue: 2 | Pages: 328-337
Abstract Background: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. Methods: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. Results: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0–1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0–2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 0.008). Conclusion: This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.
First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study
Radu, Răzvan Alexandru , Costalat, Vincent , Fahed, Robert , Ghozy, Sherief , Shaikh, Hamza , Khalife, Jane , Abdalkader, Mohamad , Klein, Piers , Nguyen, Thanh N. , Heit, Jeremy J. , Regenhardt, Robert W. , Diestro, Jose Danilo Bengzon , Cancelliere, Nicole M , Amllay, Abdelaziz , Dusart, Anne , Bellante, Flavio, Rouchaud, Aymeric , Puri, Ajit S., Dyzmann, Christian , Kan, Peter , Colasurdo, Marco , Berge, Jérôme , Barreau, Xavier , Nedelcu, Simona , Henninger, Nils , Kyheng, Maéva , Marotta, Thomas R. , Stapleton, Christopher J. , Rabinov, James D. , Dofuku, Shogo , Tan, Benjamin Yong‐Qiang , Salazar‐Marioni, Sergio , Capirossi, Carolina , Mowla, Ashkan , Tjoumakaris, Stavropoula I, Khandelwal, Priyank , Biswas, Arundhati , Clarençon, Frédéric , Elhorany, Mahmoud , Premat, Kévin , Valente, Iacopo , Filipe, João Pedro , Varela, Ricardo , Quintero‐Consuegra, Miguel , Gonzalez, Nestor R. , Möhlenbruch, Markus , Tancredi, Illario , Yedavalli, Vivek , Chervak, Lina , Aziz, Yasmin , Stracke, Christian Paul , Hecker, Constantin , Hsieh, Cheng‐Yang , Liebeskind, David S. , Alexandre, Andrea , Faizy, Tobias D. , Patel, Aman B. , Lubicz, Boris , Guenego, Adrien , Klein, Piers , Nguyen, Thanh N , Heit, Jeremy J , Sweid, Ahmad , Bellante, Flavio , Forestier, Géraud , Kühn, Anna Luisa , Marnat, Gaultier , Ota, Takahiro , Dofuku, Shogo , Yeo, Leonard Ll , Salazar-Marioni, Sergio , Jabbour, Pascal , Gonzalez, Nestor R , Möhlenbruch, Markus A , Jesser, Jessica , Aziz, Yasmin , Faizy, Tobias D , Liebeskind, David S. , Ghozy, Sherief , Diestro, Jose Danilo B , Regenhardt, Robert W , Alexandru Radu, Răzvan , Fahed, Robert , Yedavalli, Vivek S , Cancelliere, Nicole M , Rouchaud, Aymeric , Colasurdo, Marco , Hecker, Constantin , Henninger, Nils , Tan, Benjamin Yq , Alexandre, Andrea M , Mowla, Ashkan , Varela, Ricardo , Siegler, James E. , Naamani, Kareem El , Meyer, Lukas , Forestier, Géraud , Saleme, Suzana , Mounayer, Charbel , Fiehler, Jens , Kühn, Anna Luisa , Puri, Ajit S , Sibon, Igor , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A , Renieri, Leonardo , Tjoumakaris, Stavropoula , Jabbour, Pascal , Khandelwal, Priyank , Pedicelli, Alessandro , Schiphorst, Adrien ter , Harker, Pablo , Gory, Benjamin , Killer-Oberpfalzer, Monika , Griessenauer, Christoph J. , Thomas, Ajith J , Weyland, Charlotte S. , Mendes Pereira, Vitor , Dmytriw, Adam A.
European Stroke Journal | October 27, 2023 | Volume: 9 | Issue: 1 | Pages: 114-123
Abstract Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.