Quiz – Day 1, the answers!

 

Here are the answers to our quiz

 

1) With today’s current technology, is it safe to treat  distal vessel occlusions?

a) Distal MT is not supported by the current guidelines
b) Yes, it is safe both with stent retrievers and contact aspiration
c) Yes, but only with contact aspiration
d) No: the risk of perforation is excessively high

Read more on Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration. Menon BK et al, 2019, JNIS

 

2) A 4yo boy with an acute ischemic stroke (AIS) due to MCA occlusion. Which of the following options is correct?

a) MT in pediatric stroke is level II evidence and is not recommended
b) The iliac artery reached adult diameter in the first 36 months of life
c) For MCA the adult size was attained almost always before 48 months of age
d) The use of tissue plasminogen activator (tPA) is recommended in children presenting with AIS , but in a lower dose 0,6 mg/kg

Read more on Management of Stroke in Neonates and Children – A Scientific Statement From the American Heart Association/American Stroke Association. Ferrierio DM, Stroke, 2019

 

3) Use of pre-hospital scales to identify LVO patients (as the RACE, LAMS or FAST-ED) is useful for all the following reasons except one …

a) Indicate a direct transfer to an endovascular center (mother ship) in selected patients with a high probability of having an LVO
b) Give IV tPA in the field in patients with a high probability of having an LVO
c) Accelerate in-hospital workflow by giving accurate information about the severity and location of the stroke to the receptor center
d) Improve the knowledge about stroke of pre-hospital professionals, technicians and paramedics

Read more on Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes. Lima FO, Stroke, 2016

 

4) Choose the scenarios in which neuroprotection is most effective…

a) Large core infarct and young patients
b) Large vessel occlusion + small core infarct + good collaterals
c) Distal occlusion
d) Large vessel occlusion + IVT therapy

Read more on Combining Neuroprotection With Endovascular Treatment of Acute Stroke – Is There Hope? Tymianski, STROKE, 2017

 

5) What is the overall rate of functional independency at 90 days after MT among patients with ASPECTS <6?

a) 5%
b) Close to 30%
c) Close to 60%
d) None of the above reported answers

Read more on Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis. Cagnazzo et al, 2019, JNIS.

 

6) The rate of ICH after MT vs medical treatment among patients with ASPECTS 0-5 …

a) Is reported higher in the HERMES meta-analysis
b) Is not significantly increased both for recanalized and non-recanalized patients (based on meta-analysis from retrospective series)
c) Ongoing clinical trials are necessary
d) a + b + c

Read more on Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis. Cagnazzo et al, 2019, JNIS.

 

7) Is patient age a factor influencing the benefit of MT among patients with ASPECTS <6?

a) No, based on the current guidelines, there is not a limit of age for those patients
b) Patients >70 years showed a significant decrease of the probability of mRS 0-2 at 90 days
c) Recent retrospective series showed 30% reduction every 10 years of the probability to achieve functional independence
d) b + c

Read more on Acute Stroke With Large Ischemic Core Treated by Thrombectomy Predictors of Good Outcome and Mortality. Panni et al, 2019, Stroke and Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis. Cagnazzo et al, 2019, JNIS.

 

8) Is there a clinical benefit of the recanalization after MT of LVO and ASPECTS<6 …

a) Yes, and it is likely related to oedema reduction
b) Outcomes among recanalized vs non recanalized patients are similar
c) No, recanalized patients with ASPECTS <6 presented a worse outcome
d) There is not data in the literature

Read more on Clinical benefit of thrombectomy in stroke patients with low ASPECTS is mediated by oedema reduction. Broocks G, Brain, 2019

 

9) MT for M2 occlusions …

a) Successful reperfusion is close to 60%
b) Data from the HERMES study showed that treatment effect favored MT for 90-days mRS0-2 vs conservative treatment
c) a + b
d) MT for M2 occlusions is not supported by the current guidelines

Read more on Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration. Menon BK et al, 2019, JNIS

 

10) The rate of sICH after MT for M2 occlusions …

a) Is reported to be low
b) Is higher compared to MT for M1 occlusion
c) Data from the HERMES meta-analysis suggests a lower rate compared to conservative treatment
d) a + c

Read more on Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration. Menon BK et al, 2019, JNIS

 

11) What is the scenario in which neuroprotection would be futile?

a) Older patients
b) Distal occlusion
c) Patients who are reperfused so rapidly after LVO that ischemic damage could not set in
d) Tandem occlusions

Read more on Combining Neuroprotection With Endovascular Treatment of Acute Stroke – Is There Hope? Tymianski, STROKE, 2017

 

12) Is neuroprotection without recanalization possible?

a) Yes, it is effective
b) Neuroprotection in permanent ischemia is more effective than in ischemia–reperfusion
c) The lack of reperfusion reduces substantially the power of a stand-alone neuroprotection
d) a + b

Read more on Combining Neuroprotection With Endovascular Treatment of Acute Stroke – Is There Hope? Tymianski, STROKE, 2017

 

13) For patients aged 80 years or more with LVO-related acute ischaemic stroke, does MT plus BMM compared with BMM alone improve functional outcome?

a) Patients aged 80 years or more with LVO-related acute ischaemic stroke within 6 hours of symptom onset should be treated with MT plus BMM, including IVT whenever indicated
b) Application of an upper age limit for MT is not justified
c) 85 years is the limit of age reported in the current guidelines
d) a + b

Read more on European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic Stroke. Endorsed by Stroke Alliance for Europe. Turc G, European Stroke Journal. 2019 

 

14) For adults with LVO-related acute ischaemic stroke undergoing MT, does maintaining blood pressure to a particular target compared with an alternative target improve functional outcome?

a) It has been suggested to keep blood pressure below 180/105 mmHg during and 24 hours after MT
b) Lower systolic blood pressure during MT increases the rate of recanalization
c) During MT, systolic blood pressure drops should be avoided
d) a + c

Read more on European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic Stroke. Endorsed by Stroke Alliance for Europe. Turc G, European Stroke Journal. 2019 

 

15) Based on the AHA/ASA STROKE guidelines, routine use of magnetic resonance imaging (MRI) to exclude cerebral microbleeds (CMBs) before administration of IV alteplase …

a) is not recommended
b) is recommended
c) is recommended only for patients older than 80 years
d) is recommended only among hypertensive patients