Introduction The WISE (WEB Implant Safety and long term Efficacy: A pooled analysis of seven clinical trials) study combines data from seven fully adjudicated clinical trials totaling 601 enrolled patients, of which 143 were ruptured aneurysms. This analysis evaluates the safety and effectiveness of the Woven EndoBridge (WEB) device for the treatment of wide neck bifurcation aneurysms in the ruptured aneurysm cohort.Methods WISE is a pooled analysis that combined patient level data from seven prospective multicenter WEB studies, each conducted with independent core laboratory review of imaging and independent adjudication of adverse events. Patients treated for ruptured aneurysms were identified, and baseline characteristics, procedural details, and 12 month clinical and angiographic outcomes were evaluated. Safety events, including thromboembolic and hemorrhagic complications, vasospasm, and hydrocephalus were assessed.Results Among 143 patients with ruptured aneurysms, technical success was achieved in 97.2% of cases. Adequate occlusion was achieved in 87.5% of patients with available imaging, including 60.0% with complete occlusion. Retreatment up to 12 months occurred in 6.5% of patients. No rebleeding of WEB treated aneurysms was reported. Safety events up to 12 months included procedural thromboembolic events in 13.3% and stroke events in 8.4% of patients, with low 12 month mortality (1.4%) and morbidity (6.4%), mostly related to the initial aneurysm rupture.Conclusions WEB treatment provided complete protection against rebleeding and is a safe and effective option for patients with ruptured wide neck bifurcation aneurysms.
BACKGROUND:Randomized trials showed that endovascular thrombectomy (EVT) did not improve outcomes in medium vessel occlusion (MeVO) stroke compared with usual care. We investigated whether patients randomized to EVT who achieved near-complete/complete reperfusion had improved clinical outcomes compared with patients randomized to usual care. METHODS:Post-hoc analysis of ESCAPE-MeVO, which randomized patients with MeVO stroke to undergo EVT in addition to usual care or usual care only. Reperfusion grade in EVT patients was assessed with the MeVO expanded Thrombolysis in Cerebral Infarction (meTICI) score. Regression analyses were used to compare clinical outcomes between EVT patients with near-complete/complete (meTICI 2c-3) reperfusion and usual care patients, and the association between reperfusion grade and clinical outcomes in EVT patients. RESULTS:Overall, 253 of 255 (99.2%) patients randomized to EVT had final meTICI scores, of whom 133 (52.2%) achieved meTICI 2c-3 reperfusion. Infarct volumes were lower in EVT meTICI 2c-3 patients than in usual care patients, but there were no significant differences between EVT meTICI 2c-3 and usual care patients for 90-day modified Rankin Scale (mRS) score (adjusted common OR 1.17, 95% CI 0.79 to 1.75). Higher final meTICI scores were associated with improved 90-day mRS and lower infarct volumes in EVT patients. CONCLUSION:Although higher reperfusion grade was associated with smaller infarct volumes, there was no statistically significant difference in 90-day mRS between patients achieving meTICI 2c-3 and those receiving usual care.
Background and Purpose: Patients with active cancer face an increased risk of ischemic stroke. Also, stroke may be an initial indicator of cancer. In patients with large vessel occlusion (LVO) stroke treated with thrombectomy, analysis of the clot composition may contribute new insights into the pathological connections between these two conditions. Methods: We compared the content of 64 consecutively retrieved clots from LVO stroke patients with concomitant active cancer and 64 clots from matched-control LVO stroke patients without a history of cancer. Clots were analyzed with respect to histological composition by Martius Scarlet Blue, von Willebrand factor (vWF), citrullinated histone H3 (H3Cit, a biomarker of NETS), CD42b, and CD3 expression by immunohistochemistry. Orbit Image Analysis was used for quantification. Differences between groups were tested using the Mann-Whitney U-test and Chi-square Test. Results: Clots from patients with concomitant cancer had a significantly higher content of vWF (median 26 [IQR13-38]% vs. 10 [4-18]%, p < 0.0001) and H3Cit (median 0.11 [IQR0.02-0.46]% vs. 0.05 [0.00-0.28]% p = 0.027) than controls. The presence of collagen >1% within the retrieved clots was highly indicative of cancer, occurring in 16/64 with active cancer and in 3/64 controls, p = 0.002. After correction for multiple comparisons, the statistical significance for H3Cit was lost. Red and white blood cells, platelets, fibrin, and expression of CD3 and CD42b did not differ between the groups. Conclusions: Clots from LVO patients with concomitant active cancer possess distinct characteristics, indicating an influence of cancer on the innate immune system, fibroblasts, and the vascular endothelium in the formation of LVO clots.
