June 2023 Stroke Highlights.

HomeStrokeVol. 54, No. 6June 2023 Stroke Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBJune 2023 Stroke Highlights Nicole B. Sur Nicole B. SurNicole B. Sur Correspondence to: Nicole B. Sur, MD, Department of Neurology, Stroke Division, University of Miami Miller School of Medicine, 1120 NW 14th St, CRB 1358, Miami, FL 33136. Email E-mail Address: [email protected] Search for more papers by this author Originally published22 May 2023https://doi.org/10.1161/STROKEAHA.123.043538Stroke. 2023;54:1463is related toInfarcts in a New Territory: Insights From the ESCAPE-NA1 TrialEffect of Imaging Selection Paradigms on Endovascular Thrombectomy Outcomes in Patients With Acute Ischemic StrokeFive-Year Stroke Risk and Its Predictors in Asymptomatic Moyamoya Disease: Asymptomatic Moyamoya Registry (AMORE)Five-Year Stroke Risk and Its Predictors in Asymptomatic Moyamoya Disease: Asymptomatic Moyamoya Registry (AMORE)Moyamoya disease is characterized by progressive stenosis of the distal intracranial carotid arteries or proximal middle and anterior cerebral arteries, resulting in dilation of the perforator arteries and development of deep collateral pathways. Stroke—both hemorrhagic and ischemic—is a known consequence of moyamoya disease. The long-term risk of cerebrovascular events in asymptomatic moyamoya disease, however, is not well characterized. In this multicenter prospective cohort study, investigators followed 103 patients with asymptomatic moyamoya disease (189 hemispheres) in Japan with the goal of evaluating the 5-year risk and predictors of stroke. The average age was 44 years, female-to-male ratio was 2:1, and family history of moyamoya disease was found in 20% of cases. The 5-year risk of stroke in this cohort was 6.8% (7 individuals), with an annual risk of 1.4% per person and 0.8% per hemisphere. Of the 7 cases of stroke, 6 were hemorrhagic and 1 was ischemic, with relatively poor outcomes in the individuals with hemorrhagic stroke. There were no stroke events in the 5-year follow-up period in the 39 individuals categorized as questionable moyamoya. When evaluated hemisphere by hemisphere, grade 2 choroidal anastomosis (most dilated and peripherally running perforators) and presence of microbleeds on brain imaging were significant predictors for stroke. The annual risk of hemorrhagic stroke was elevated in patients with grade 2 choroidal anastomoses (3.2%) compared with those without (0.4%). This study highlights the high risk of 5-year stroke events in patients with asymptomatic moyamoya disease and radiographic predictors of high-risk cases. Although the study is ongoing with the long-term goal of assessing 10-year outcomes, these interim results provide valuable insight that may influence stroke prevention strategies. See p 1494.Infarcts in a New Territory: Insights From the ESCAPE-NA1 TrialThe ESCAPE-NA1 trial (Safety and Efficacy of Nerinetide [NA-1] in Subjects Undergoing Endovascular Thrombectomy for Stroke) was a clinical trial of patients with large vessel occlusion stroke within 12 hours of onset who underwent endovascular thrombectomy and were randomized to receive intravenous nerinetide versus placebo, resulting in no significant difference in modified Rankin Scale score of 0 to 2 at 90 days between both groups. In this substudy of the ESCAPE-NA1 cohort (n=1092), investigators sought to identify the rate, characteristics, and outcomes of individuals with infarcts in a new territory (INT), after endovascular thrombectomy. The overall cohort comprised patients with severe anterior circulation stroke (median age, 70.8 years; 49.7% women), of whom 60% received intravenous thrombolysis and half received nerinetide. INT occurred in 9.4% of the cohort: 77% were >2 mm, 56.5% were single INTs, 43.5% were multiple INTs, and the anterior cerebral artery territory was most affected. There was no association between INT and procedural catheter type or number of passes. Patients with INT had significantly lower chance of functional independence at 90 days, larger infarct volumes, and higher mortality compared with the no-INT group. Radiographic and symptomatic intracerebral hemorrhage was similar across both groups, and there was no effect of thrombolysis or nerinetide administration on INT. This study illustrates how common INTs are after endovascular therapy. Given the association with worse functional outcomes, preventing INTs may be an important strategy for improving stroke outcomes after thrombectomy. See p 1477Effect of Imaging Selection Paradigms on Endovascular Thrombectomy Outcomes in PATIENTS WITH ACUTE ISCHEMIC STROKEThe decision-making process for the use of endovascular thrombectomy (EVT) in patients with large vessel occlusion stroke is largely dependent on acute brain imaging to rule out hemorrhagic stroke (or other causes), assess for signs of ischemia, and identify the affected vessel. With advanced imaging technology, such as perfusion imaging that leverages artificial intelligence to estimate ischemic core and penumbra volumes, the acute stroke imaging paradigms have become quite complex. Some studies suggest, however, that these paradigms might be too selective and may exclude patients who might otherwise benefit from EVT. In this study utilizing pooled data from 2 large EVT trials in China (n=1182), investigators compared outcomes of acute large vessel occlusion stroke patients who presented in early (0–6 hours) versus extended (6–24 hours) window and had basic imaging (noncontrast head computed tomography with or without computed tomography angiography) versus advanced imaging (basic imaging plus magnetic resonance imaging or computed tomography perfusion) to decide on candidacy for EVT. In the early window, most patients underwent basic imaging, whereas in the advanced window, most patients had advanced imaging. There were no differences in time metrics in the early window; however, patients in the extended window group had shorter onset-to-puncture times with basic imaging compared with advanced imaging. After adjustment, there was no significant difference in functional independence at 90 days, mortality, or any hemorrhage between basic versus advanced imaging in either the early or extended treatment windows. Similar to prior trials in North America and Europe, this study suggests that simpler imaging paradigms for selection of EVT candidates in patients with acute large vessel occlusion stroke do not significantly impact clinical outcomes and might be sufficient for deciding on whether to proceed with thrombectomy. See p 1569FootnotesCorrespondence to: Nicole B. Sur, MD, Department of Neurology, Stroke Division, University of Miami Miller School of Medicine, 1120 NW 14th St, CRB 1358, Miami, FL 33136. Email [email protected]miami.edu eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesInfarcts in a New Territory: Insights From the ESCAPE-NA1 TrialNishita Singh, et al. Stroke. 2023;54:1477-1483Effect of Imaging Selection Paradigms on Endovascular Thrombectomy Outcomes in Patients With Acute Ischemic StrokeJian Miao, et al. Stroke. 2023;54:1569-1577Five-Year Stroke Risk and Its Predictors in Asymptomatic Moyamoya Disease: Asymptomatic Moyamoya Registry (AMORE)Satoshi Kuroda, et al. Stroke. 2023;54:1494-1504 June 2023Vol 54, Issue 6 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.123.043538PMID: 37307084 Originally publishedMay 22, 2023 PDF download Advertisement