Setareh Salehi Omran, MD

Mistry EA, Yeatts S, de Havenon A, Mehta T, Arora N, De Los Rios La Rosa F, Starosciak AK, Siegler III JE, Mistry AM, Yaghi S, Khatri P. Predicting 90-Day Outcome After Thrombectomy: Baseline-Adjusted 24-Hour NIHSS Is More Powerful Than NIHSS Score Change. Stroke. 2021.

Endovascular therapy (ET) is the recommended treatment for acute ischemic stroke due to a large vessel occlusion. Early neurological improvement and recovery, most commonly measured using the 24-hour National Institutes of Health Stroke Scale score (NIHSS), can occur in some patients undergoing thrombolysis or ET. Early measurements of NIHSS are associated with a favorable long-term functional outcome^1-4 and are frequently used as an outcome measure in ET trials. Despite its utility, there appears to be a lack of consensus on the definition of early neurological recovery. An absolute decrease in NIHSS score of 4,⁵ 8,⁶ or 10⁷ or binary NIHSS outcomes have all been used to reflect early neurological recovery in various trials. However, a change in NIHSS from baseline and an arbitrarily chosen dichotomous outcome both have limitations. A change in NIHSS (from baseline to 24-hour) does not account for the baseline NIHSS and its accompanying deficits. While dichotomization can simplify statistical analyses, it also comes with several major drawbacks. Dichotomization of continuous variables such as NIHSS may lead to the loss of critical clinical information and a reduction in statistical power, underestimation of the degree of variation in outcomes between groups, and a concealment of non-linearity between the variable and outcome. Given the lack of a standardized approach, it is important to identify the best early NIHSS-based outcome measure to predict the 90-day functional outcome in ischemic stroke patients.  

Burton J. Tabaac, MD
@burtontabaac

Chen M-H, Tsai S-J, Su T-P, Li C-T, Lin W-C, Chen T-J, Pan T-L, Bai Y-M. Increased Risk of Stroke in Patients With Obsessive-Compulsive Disorder: A Nationwide Longitudinal Study. Stroke. 2021.

The World Health Organization has categorized obsessive compulsive disorder (OCD) as one of the top ten disabling conditions worldwide, noting a lifetime prevalence of 1-3%. The authors of this comprehensive study cite mounting evidence supporting an association between OCD and stroke-related risk factors inclusive of obesity and diabetes. Using data collected between 2001 and 2010 by Taiwan’s National Health Insurance Research Database, it was demonstrated that patients with OCD have an elevated risk of suffering an acute ischemic stroke compared to non-OCD controls, with no difference in hazard ratio for hemorrhagic stroke.

Obsessive compulsive disorder secondary to cerebral infarction has been reported in the medical literature, yet the relationship between OCD and subsequent stroke has been minimally investigated. This study included patients aged 20 years and older diagnosed with OCD by psychiatrist expertise between January 2001 and December 2010, and who had no history of stroke prior to enrollment. In a follow up analysis (up to 11 years), the use of OCD medications was assessed, with study cohorts separated into subgroups: nonusers, short-term users (1 month to 1 year), and long-term users (more than 1 year). Medication use included SSRIs, SNRIs, and norepinephrine-dopamine reuptake inhibitors, e.g., bupropion.

Isabella Canavero, MD

Ziai WC, Cho S-M, Johansen MC, Ergin B, Bahouth MN. Transcranial Doppler in Acute COVID-19 Infection: Unexpected Associations. Stroke. 2021.

COVID-19 has been reported to increase the risk of ischemic stroke, especially from large vessel disease, probably due to a combination of hypercoagulability and vascular inflammation. To explore the pathophysiology of COVID-19–related neurological and especially cerebrovascular diseases, Ziai et al. analyzed TCD findings in patients with and without COVID-19 infection, some of which also suffered from acute ischemic stroke. Indeed, differently from other radiological techniques, specific practical advantages make TCD easy to perform in the critical care setting. In cerebrovascular patients, TCD allows the identification of useful information such as detection of circulating microemboli and the assessment of cerebral blood flow velocity (CBV).

Sishir Mannava, MD
@sishmannMD

Mohamed GA, Aboul Nour H, Nogueira RG, Mohammaden MH, Haussen DC, Al-Bayati AR, Nguyen TN, AbdalkaderM, Kaliaev A, Ma A, et al. Repeated Mechanical Endovascular Thrombectomy for Recurrent Large Vessel Occlusion: A Multicenter Experience. Stroke. 2021.

In this article, Mohamed et al. report on the outcome of repeat mechanical thrombectomy (rMT) for patients who have recurrent LVO in a multicenter retrospective cohort study involving 6 tertiary institutions in the United States over a period of four years. The study collected patients who had MT via various interventional approaches, (e.g., aspiration catheters, stent retriever devices, stents, angioplasty balloons, or combinations thereof) depending on each participating hospital’s protocols. Out of their large cohort of 3,059 patients who underwent MT, 56 patients (1.8%) had at least one rMT. Fifty patients (93%) had one rMT, three (6%) underwent two rMT procedures, and one (2%) had rMT performed three times. Of these patients, 54 of 56 patients (96%) were analyzed. Of note, the interval between index MT (iMT) and rMT was 2 days, and 35 patients (65%) had recurrent LVO (rLVO) during the index hospitalization.

A final modified Thrombolysis in Cerebral Infarction (mTICI) recanalization score of 2b or 3 was achieved in all 54 patients during iMT (100%) and in 51 of 54 patients (94%) of those patients who underwent rMT, mostly with the combination of stent retrieval and aspiration. Mechanism of stroke in rLVO was cardioembolism in 30 patients (56%), intracranial atherosclerosis in four patients (7%), extracranial atherosclerosis in two patients (4%), and other causes in 18 patients (33%).