Browsing by Author "Al Kasab, Sami"

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    Association of Noncontrast Computed Tomography and Perfusion Modalities with Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy
    (American Medical Association, 2022-11-11) Porto, Guilherme B. F.; Chen, Ching-Jen; Al Kasab, Sami; Essibayi, Muhammed Amir; Almallouhi, Eyad; Hubbard, Zachary; Chalhoub, Reda; Alawieh, Ali; Maier, Ilko; Psychogios, Marios-Nikos; Wolfe, Stacey Q.; Jabbour, Pascal; Rai, Ansaar; Starke, Robert M.; Shaban, Amir; Arthur , Adam; Kim, Joon-Tae; Yoshimura, Shinichi; Grossberg, Jonathan; Kan , Peter; Fragata, Isabel; Polifka, Adam; Osbun, Joshua; Mascitelli, Justin; Levitt, Michael R .; Williamson, Richard, Jr.; Romano, Daniele G.; Crosa, Roberto; Gory, Benjamin; Mokin, Maxim; Limaye, Kaustubh S.; Casagrande, Walter; Moss, Mark; Grandhi, Ramesh; Yoo, Albert; Spiotta, Alejandro M.; Park, Min S.; Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators; Neurology, School of Medicine
    Importance There is substantial controversy with regards to the adequacy and use of noncontrast head computed tomography (NCCT) for late-window acute ischemic stroke in selecting candidates for mechanical thrombectomy. Objective To assess clinical outcomes of patients with acute ischemic stroke presenting in the late window who underwent mechanical thrombectomy stratified by NCCT admission in comparison with selection by CT perfusion (CTP) and diffusion-weighted imaging (DWI). Design, Setting, and Participants In this multicenter retrospective cohort study, prospectively maintained Stroke Thrombectomy and Aneurysm (STAR) database was used by selecting patients within the late window of acute ischemic stroke and emergent large vessel occlusion from 2013 to 2021. Patients were selected by NCCT, CTP, and DWI. Admission Alberta Stroke Program Early CT Score (ASPECTS) as well as confounding variables were adjusted. Follow-up duration was 90 days. Data were analyzed from November 2021 to March 2022. Exposures Selection by NCCT, CTP, or DWI. Main Outcomes and Measures Primary outcome was functional independence (modified Rankin scale 0-2) at 90 days. Results Among 3356 patients, 733 underwent late-window mechanical thrombectomy. The median (IQR) age was 69 (58-80) years, 392 (53.5%) were female, and 449 (65.1%) were White. A total of 419 were selected with NCCT, 280 with CTP, and 34 with DWI. Mean (IQR) admission ASPECTS were comparable among groups (NCCT, 8 [7-9]; CTP, 8 [7-9]; DWI 8, [7-9]; P = .37). There was no difference in the 90-day rate of functional independence (aOR, 1.00; 95% CI, 0.59-1.71; P = .99) after adjusting for confounders. Symptomatic intracerebral hemorrhage (NCCT, 34 [8.6%]; CTP, 37 [13.5%]; DWI, 3 [9.1%]; P = .12) and mortality (NCCT, 78 [27.4%]; CTP, 38 [21.1%]; DWI, 7 [29.2%]; P = .29) were similar among groups. Conclusions and Relevance In this cohort study, comparable outcomes were observed in patients in the late window irrespective of neuroimaging selection criteria. Admission NCCT scan may triage emergent large vessel occlusion in the late window.
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    Macrowire for intracranial thrombectomy: An early experience of a new device and technique for anterior circulation large vessel occlusion stroke
    (Sage, 2024-12-18) Limaye, Kaustubh; Al Kasab, Sami; Dolia, Jaidevsinh; Ezzeldin, Mohamad; Vela Duarte, Daniel; Doss, Vinodh; Lahoti, Sourabh; Hasan, David; Spiotta, Alejandro; Asi, Khaled; Saini, Vasu; Mehta, Tapan; Hassan, Ameer; Haussen, Diogo; Yavagal, Dileep; Jones, Jesse; Tanweer, Omar; Brinjikji, Waleed; Neurology, School of Medicine
    Background and purpose: Mechanical thrombectomy (MT) has become the standard of care for treatment of acute ischemic stroke secondary to large vessel occlusion up to 24 h from the last known normal time. With ADAPT and SOLUMBRA techniques, classically, a large bore aspiration catheter is delivered over a microcatheter and microwire crossing the clot to perform thrombectomy. Recently, a novel macrowire (Colossus 035 in.) has been introduced as a potential alternative to the use of microwire-microcatheter to allow the delivery of the aspiration catheter (ID = 0.070 in. up to 0.088 in.) over a macrowire alone. Objective: To test the feasibility of delivering an aspiration catheter to clot interface over a macrowire alone. Materials and methods: A retrospective evaluation of prospectively maintained Macrowire for Intracranial Thrombectomy (MINT) Registry where this novel technique was utilized for thrombectomy. Consecutive patients undergoing MT using the MINT technique were included. We collected baseline demographics, imaging and clinical characteristics, rate of procedural success, conversion to traditional MT, and complications. Results: Fifty consecutive patients were recruited during the initial 4 months of the larger study duration. The aspiration catheter was able to be advanced to the clot interface successfully in 46/50 (92%) using the MINT technique. Median time from vascular access to the first pass was 11.30 min (IQR = 7.45-14.30 min) and successful thrombectomy was 14 min (IQR = 10-22.15). The modified first-pass effect with this procedure was 71%. One vasospasm was reported as a procedural complication. Conclusions: MINT is safe and feasible for large vessel occlusion recanalization based on our initial clinical experience in this multicenter study.