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Belachew NF, Piechowiak EI, Dobrocky T, Meinel TR, Hakim A, Barvulsky EA, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Fischer U, Gralla J, Kaesmacher J, Mordasini P. Stent-Based Retrieval Techniques in Acute Ischemic Stroke Patients with and Without Susceptibility Vessel Sign. Clin Neuroradiol 2022; 32:407-418. [PMID: 34463776 PMCID: PMC9187552 DOI: 10.1007/s00062-021-01079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Randomized controlled trials have challenged the assumption that reperfusion success after mechanical thrombectomy varies depending on the retrieval techniques applied; however, recent analyses have suggested that acute ischemic stroke (AIS) patients showing susceptibility vessel sign (SVS) may respond differently. We aimed to compare different stent retriever (SR)-based thrombectomy techniques with respect to interventional outcome parameters depending on SVS status. METHODS We retrospectively reviewed 497 patients treated with SR-based thrombectomy for anterior circulation AIS. Imaging was conducted using a 1.5 T or 3 T magnetic resonance imaging (MRI) scanner. Logistic regression analyses were performed to test for the interaction of SVS status and first-line retrieval technique. Results are shown as percentages, total values or adjusted odds ratio (aOR) with 95% confidence intervals (CI). RESULTS An SVS was present in 87.9% (n = 437) of patients. First-line SR thrombectomy was used to treat 293 patients, whereas 204 patients were treated with a combined approach (COA) of SR and distal aspiration. An additional balloon-guide catheter (BGC) was used in 273 SR-treated (93.2%) and 89 COA-treated (43.6%) patients. On logistic regression analysis, the interaction variable of SVS status and first-line retrieval technique was not associated with first-pass reperfusion (aOR 1.736, 95% CI 0.491-6.136; p = 0.392), overall reperfusion (aOR 3.173, 95% CI 0.752-13.387; p = 0.116), periinterventional complications, embolization into new territories, or symptomatic intracerebral hemorrhage. The use of BGC did not affect the results. CONCLUSION While previous analyses indicated that first-line SR thrombectomy may promise higher rates of reperfusion than contact aspiration in AIS patients with SVS, our data show no superiority of any particular SR-based retrieval technique regardless of SVS status.
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Affiliation(s)
- Nebiyat F. Belachew
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Eike I. Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Thomas R. Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Enrique A. Barvulsky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Jan Vynckier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland ,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
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152
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Vega P, Murias E, Jimenez JM, Chaviano J, Rodriguez J, Calleja S, Delgado M, Benavente L, Castañon M, Puig J, Cigarran H, Arias F, Chapot R. First-line Double Stentriever Thrombectomy for M1/TICA Occlusions : Initial Experiences. Clin Neuroradiol 2022; 32:971-977. [PMID: 35416489 PMCID: PMC9744691 DOI: 10.1007/s00062-022-01161-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large-vessel occlusion; however, mechanical thrombectomy fails to achieve adequate recanalization in nearly one third of these cases. Rescue therapy using two stentrievers simultaneously yields good results in clots refractory to single stentriever treatment. We aimed to determine the safety and efficacy of first-line double stentriever thrombectomy for acute occlusion of the M1 segment of the middle cerebral artery and/or terminal internal carotid artery (TICA). METHODS This single-center study prospectively enrolled consecutive patients with a single M1/TICA occlusion to undergo double stentriever thrombectomy between May and October 2020. Outcomes included successful recanalization (modified thrombolysis in cerebral infarction, TICI 2b/3), first-pass effect, procedure times, number of device passes, symptomatic intracerebral hemorrhage, National Institutes of Health Stroke Scale Score (NIHSS) at discharge, 90-day functional independence (modified Rankin scale 0-2), and 90-day mortality. RESULTS We analyzed 39 patients median age 79 years (range 42-96 years); 23 (58.9%) female; 19 (48.7%) with TICA occlusions; 5 (12.8%) with mRS 3-5 at admission; mean NIHSS at admission, 17 ± 4.39). Mean time from symptom onset to final angiogram was 238.0 ± 94.6 min; mean intervention duration was 36.0 ± 24.2 min. The mean number of device passes was 1.5 ± 1.07. All patients had final TICI 2b/3, and 27 (69%) had TICI 2c/3 after the first pass. We observed 3 (7.9%) cases of intracerebral symptomatic hemorrhages. At 90 days, 16 (41%) patients were functionally independent and 9 (23%) had died. The percentage of patients with good clinical outcome at 90 days was 55.5% in the first-pass subgroup. CONCLUSION Our findings suggest that first-line double stentriever thrombectomy is safe and effective for M1/TICA occlusions.
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Affiliation(s)
- Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Eduardo Murias
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Jose Maria Jimenez
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Juan Chaviano
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Jose Rodriguez
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Sergio Calleja
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Montserrat Delgado
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Lorena Benavente
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Maria Castañon
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Josep Puig
- IDI-Radiology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Helena Cigarran
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Faustino Arias
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Rene Chapot
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
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153
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Chen Q, Ling WT, Han DK. Study on the Association of Homocysteine and C-Reactive Protein with Neurofunctional Changes in Patients with Acute Ischemic Stroke After Endovascular Stent Treatment. Neuropsychiatr Dis Treat 2022; 18:881-889. [PMID: 35444419 PMCID: PMC9014111 DOI: 10.2147/ndt.s356331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the association of homocysteine (HCY) and C-reactive protein (CRP) with neurofunctional changes in patients with acute ischemic stroke (AIS) after stent treatment. METHODS A total of 110 patients with AIS treated with stents were divided into a high HCY group (n = 59) and a normal HCY group (n = 51) based on the HCY level. Pearson correlation analysis and logistic linear regression analysis were used to analyze the related factors that affect the National Institutes of Health Stroke Scale (NIHSS) score changes after stent treatment. RESULTS (1) The area under the receiver operating characteristic (ROC) curve for HCY was 0.995 (95% confidence interval [CI]: 0.984-1.005, P = 0.000), and the best predictive value was 12.75 µmol/L (sensitivity 89.9%, specificity 98.0%). The area under the ROC curve for CRP was 0.665 (95% CI: 0.564-0.767, P = 0.003), and the best predictive value was 9.7 mg/L; (2) comparison between the high HCY group and the normal HCY group showed statistical differences (P < 0.05) in HCY, CRP, and the NIHSS score at admission, the NIHSS score after treatment, gender, history of diabetes, and history of atrial fibrillation; (3) both HCY and CRP were proven to be correlated with the NIHSS score after treatment (0.188, P = 0.050) and (0.194, P = 0.042), respectively, using Pearson correlation analysis; (4) HCY, low-density lipoprotein, CRP, cystatin C, glucose, history of atrial fibrillation, history of diabetes, and the NIHSS score at admission as the risk factors. CONCLUSION High HCY and CRP levels are related to the neurofunctional changes in patients with AIS treated with stents and can be used as indicators to assess the risk of treating AIS with stents and as serum markers to predict prognoses.
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Affiliation(s)
- Qiong Chen
- Teaching and Research Department, Foshan Fosun Chancheng Hospital, Foshan, 52800, People's Republic of China
| | - Wen-Tong Ling
- Department of Neurology, Zhongshan City People Hospital, Zhongshan, 528400, People's Republic of China
| | - Deng-Ke Han
- Clinical Laboratory Medicine Center, Zhongshan City People Hospital, Zhongshan, 528400, People's Republic of China
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154
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Trombectomía con aspiración por captura (embaspiración) en el ictus isquémico agudo. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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155
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Jahan R, Saver JL. Endovascular Treatment of Acute Ischemic Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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156
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Design of Stroke-Related Clinical Trials. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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157
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Kuribara T, Sato H, Iihoshi S, Tsukagoshi E, Teranishi A, Kinoshita Y, Sugasawa S, Kohyama S, Takahashi S, Kurita H. Preprocedural Prediction of Underlying Atherosclerotic Lesions in Cerebral Large-Vessel Occlusions: Clinical Backgrounds, Radiological Findings, and Treatment Outcomes. J Atheroscler Thromb 2021; 29:1613-1624. [PMID: 34937834 DOI: 10.5551/jat.63135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Mechanical thrombectomy using a standard device has been effective for acute cerebral large-vessel occlusions, particularly those due to cardiogenic embolism. However, evidence for those with underlying atherosclerotic lesions is lacking. In this study, we evaluated the predictive factors, treatment details, and outcomes of acute cerebral large-vessel occlusions with underlying atherosclerotic lesions in patients who underwent mechanical thrombectomy. METHODS We retrospectively analyzed consecutive patients with acute large-vessel occlusions who underwent mechanical thrombectomy at our institution between August 2014 and May 2021. Predictive factors of underlying atherosclerotic lesions were evaluated using univariate and multivariate analyses. In addition, treatment details and outcomes were evaluated and compared with those of other etiologies. RESULTS Among 322 included patients, 202 (62.7%) were males and 65 (20.2%) had underlying atherosclerotic lesions. Multivariate analysis identified dyslipidemia, lack of arterial fibrillation documented on admission, smoking, internal carotid artery lesions, and stenosis ≥ 25% in non-occluded large vessels as predictive factors of underlying atherosclerotic lesions. Regarding treatment for underlying atherosclerotic lesions, the need for percutaneous transluminal angioplasty, stent placement, medical therapy, and longer procedure time were observed, while successful reperfusion rates, favorable outcomes, and mortality rates showed no significant differences with those of other etiologies. CONCLUSION Coexisting diseases and radiological findings were useful for predicting underlying atherosclerotic lesions. Further understanding these characteristics may lead to the early detection of underlying atherosclerotic lesions, optimal treatment strategies, and better outcomes.
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Affiliation(s)
- Tomoyoshi Kuribara
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Hiroki Sato
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Satoshi Iihoshi
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Eisuke Tsukagoshi
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Akio Teranishi
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Yu Kinoshita
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Shin Sugasawa
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Shinya Kohyama
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center
| | - Shinichi Takahashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center
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158
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Preclinical modeling of mechanical thrombectomy. J Biomech 2021; 130:110894. [PMID: 34915309 DOI: 10.1016/j.jbiomech.2021.110894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022]
Abstract
Mechanical thrombectomy to treat large vessel occlusions (LVO) causing a stroke is one of the most effective treatments in medicine, with a number needed to treat to improve clinical outcomes as low as 2.6. As the name implies, it is a mechanical solution to a blocked artery and modeling these mechanics preclinically for device design, regulatory clearance and high-fidelity physician training made clinical applications possible. In vitro simulation of LVO is extensively used to characterize device performance in representative vascular anatomies with physiologically accurate hemodynamics. Embolus analogues, validated against clots extracted from patients, provide a realistic simulated use experience. In vitro experimentation produces quantitative results such as particle analysis of distal emboli generated during the procedure, as well as pressure and flow throughout the experiment. Animal modeling, used mostly for regulatory review, allows estimation of device safety. Other than one recent development, nearly all animal modeling does not incorporate the desired target organ, the brain, but rather is performed in the extracranial circulation. Computational modeling of the procedure remains at the earliest stages but represents an enormous opportunity to rapidly characterize and iterate new thrombectomy concepts as well as optimize procedure workflow. No preclinical model is a perfect surrogate; however, models available can answer important questions during device development and have to date been successful in delivering efficacious and safe devices producing excellent clinical outcomes. This review reflects on the developments of preclinical modeling of mechanical thrombectomy with particular focus on clinical translation, as well as articulate existing gaps requiring additional research.
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159
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Dose-Response Relationship and Threshold Drug Dosage Identification for a Novel Hybrid Mechanical-Thrombolytic System with an Ultra-Low Dose Patch. Cell Mol Bioeng 2021; 14:627-637. [PMID: 34900015 DOI: 10.1007/s12195-021-00683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction Ischemic stroke treatment has advanced in the last two decades and intravenous thrombolysis is now considered the standard of care for selected patients. Recanalization can also be achieved by mechanical endovascular treatment for patients with large vessel occlusions. Complicating treatment-related symptomatic intracerebral hemorrhage and prolonged needle-to-recanalization times have been identified as major determinants of poor three-month functional outcomes. A hybrid mechanical-thrombolytic system with a patch imbued with an ultra-low dose of thrombolytic agents loaded onto a stent-retriever has been developed. Methods In this study, the in situ dose-response relationship of the thrombolytic patch imbued with up to 1000 IU of urokinase plasminogen activator (uPA) was quantified using Raman spectroscopy. Results Thrombi of up to 400 μm thickness dissolved within 15 min when patches imbued with < 1% of the conventional thrombolysis therapy dosage were applied. The results demonstrated that low-dose thrombolytic patches can dissolve normal clots compressed in the blood vessel in a short time. 500 IU is the threshold uPA dosage in the thrombolytic patch that most effectively dissolves the clots. Conclusion This study suggests that a novel endovascular stent-retriever loaded with an ultra-low drug dose fibrinolytic patch may be a suitable treatment for patients who are ineligible for conventional thrombolytic therapy.
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160
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Caldwell J, McGuinness B, Lee SS, Barber PA, Holden A, Wu T, Krauss M, Laing A, Collecutt W, Liebeskind DS, Hetts SW, Brew S. Aspiration thrombectomy using a novel 088 catheter and specialized delivery catheter. J Neurointerv Surg 2021; 14:1239-1243. [PMID: 34907007 DOI: 10.1136/neurintsurg-2021-018318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND We describe the first-in-human experience using the Route 92 Medical Aspiration System to perform thrombectomy in the initial 45 consecutive stroke patients enrolled in the SUMMIT NZ trial. This aspiration system includes a specifically designed delivery catheter which enables delivery of 0.070 inch and 0.088 inch aspiration catheters. METHODS The SUMMIT NZ trial is a prospective, multicenter, single-arm study with core lab imaging adjudication. Patients presenting with acute ischemic stroke from large vessel occlusion are eligible to enrol. The study has had three phases which transitioned from use of the 0.070 inch to the 0.088 inch catheter. RESULTS Vessel occlusions were located in the internal carotid artery (27%), M1 (60%) and M2 (13%). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16 (IQR 10). Across the three phases, the first-pass reperfusion rate of modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b was 62% using the Route 92 Medical system; this rate was 29% in phase 1, 56% in phase 2, and 80% in phase 3. The first-pass reperfusion rate of mTICI ≥2c was 42% overall, 29% in phase 1, 33% in phase 2, and 55% in phase 3. A final reperfusion rate of mTICI ≥2b was achieved in 96% of cases, with 36% of cases using adjunctive devices. Patients had an average improvement of 6.7 points in NIHSS from baseline at 24 hours, and at 90 days 48% were functionally independent (modified Rankin Scale 0-2). CONCLUSIONS In this early experience, the Route 92 Medical Aspiration System has been effective and safe. The system has design features that improve catheter deliverability and have the potential to increase first-pass reperfusion rates in aspiration thrombectomy.
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Affiliation(s)
- James Caldwell
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
| | - Ben McGuinness
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
| | - Shane S Lee
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
| | - P Alan Barber
- Medicine, University of Auckland, Auckland, New Zealand.,Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Holden
- Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Teddy Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Martin Krauss
- Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - Andrew Laing
- Radiology, Christchurch Hospital, Christchurch, New Zealand
| | | | | | | | - Stefan Brew
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
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161
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Vogt ML, Kollikowski AM, Weidner F, Strinitz M, Feick J, Essig F, Neugebauer H, Haeusler KG, Pham M, Maerz A. Safety and Effectiveness of the New Generation APERIO® Hybrid Stent-retriever Device in Large Vessel Occlusion Stroke. Clin Neuroradiol 2021; 32:141-151. [PMID: 34936016 PMCID: PMC8894307 DOI: 10.1007/s00062-021-01122-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
Background It is unknown whether technological advancement of stent-retriever devices influences typical observational indicators of safety or effectiveness. Methods Observational retrospective study of APERIO® (AP) vs. new generation APERIO® Hybrid (APH) (Acandis®, Pforzheim, Germany) stent-retriever device (01/2019–09/2020) for mechanical thrombectomy (MT) in large vessel occlusion (LVO) stroke. Primary effectiveness endpoint was successful recanalization eTICI (expanded Thrombolysis In Cerebral Ischemia) ≥ 2b67, primary safety endpoint was occurrence of hemorrhagic complications after MT. Secondary outcome measures were time from groin puncture to first pass and successful reperfusion, and the total number of passes needed to achieve the final recanalization result. Results A total of 298 patients with LVO stroke who were treated by MT matched the inclusion criteria: 148 patients (49.7%) treated with AP vs. 150 patients (50.3%) treated with new generation APH. Successful recanalization was not statistically different between both groups: 75.7% for AP vs. 79.3% for APH; p = 0.450. Postinterventional hemorrhagic complications and particularly subarachnoid hemorrhage as the entity possibly associated with stent-retriever device type was significantly less frequent in the group treated with the APH: 29.7% for AP and 16.0% for APH; p = 0.005; however, rates of symptomatic hemorrhage with clinical deterioration and in domo mortality were not statistically different. Neither the median number of stent-retriever passages needed to achieve final recanalization, time from groin puncture to first pass, time from groin puncture to final recanalization nor the number of cases in which successful recanalization could only be achieved by using a different stent-retriever as bail-out device differed between both groups. Conclusion In the specific example of the APERIO® stent-retriever device, we observed that further technological developments of the new generation device were not associated with disadvantages with respect to typical observational indicators of safety or effectiveness.
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Affiliation(s)
- Marius L Vogt
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany.
| | - Alexander M Kollikowski
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Franziska Weidner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Marc Strinitz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Jörn Feick
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Fabian Essig
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Neugebauer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | - Mirko Pham
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Maerz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
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162
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Maïer B, Gory B, Lapergue B, Sibon I, Escalard S, Kyheng M, Labreuche J, de Havenon A, Petersen N, Anadani M, Gayat E, Boursin P, Ben Maacha M, Desilles JP, Blanc R, Piotin M, Halimi JM, Mazighi M. Effect of blood pressure variability in the randomized controlled BP TARGET trial. Eur J Neurol 2021; 29:771-781. [PMID: 34821437 DOI: 10.1111/ene.15194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The Blood Pressure Target in Acute Ischemic Stroke to Reduce Hemorrhage After Endovascular Therapy (BP TARGET) trial evaluated whether an intensive systolic blood pressure (SBP) target resulted in reduced rates of intracranial hemorrhage (ICH) after successful endovascular therapy (EVT) but did not assess the effect of blood pressure variability (BPV) on functional outcomes and ICH occurrence. We sought to evaluate this question in the BP TARGET trial. METHODS We performed a post hoc analysis of the BP TARGET trial and included patients with at least 50% of blood pressure (BP) recordings during the first 24 h after EVT. BPV parameters were SBP and diastolic BP (DBP) coefficient of variation (CV), standard deviation (SD), maximum-minimum (max-min), successive variation (SV), and time rate. The primary outcome was favorable functional outcome (3-month modified Rankin Scale between 0 and 2); the secondary outcome was the rate of ICH at 24 h. RESULTS We included 290 patients (mean number of BP measures = 30.4, SD = 8.0). BPV parameters (SBPSD , SBPmax-min , SBPCV ) were higher in the intensive SBP target group. Only DBP BPV parameters were associated with worse functional outcomes in the unadjusted model (DBPSD , DBPmax-min , DBPCV , and DBPSV ), but not after adjustment. Higher SBPmax-min was associated with worse functional outcomes in Thrombolysis in Cerebral Infarction 2B patients (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.38-1.02), but not in patients with complete reperfusion (OR = 1.27, 95% CI = 0.80-2.02, p for heterogeneity (phet =0.037). None of the BPV parameters was associated with ICH, regardless of the randomization group or the reperfusion grade. CONCLUSIONS BPV was significantly higher in the intensive SBP target group but was not associated with functional outcome or ICH.
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Affiliation(s)
- Benjamin Maïer
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, University of Lorraine, Nancy, France.,IADI, INSERM U1254, University of Lorraine, Nancy, France
| | - Bertrand Lapergue
- Division of Neurology, Department of Neurology, Stroke Center, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Maeva Kyheng
- University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
| | - Julien Labreuche
- University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
| | - Adam de Havenon
- Neurology Department, University of Utah, Salt Lake City, Utah, USA
| | - Nils Petersen
- Neurocritical Care and Emergency Neurology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Mohammad Anadani
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Etienne Gayat
- University of Paris, Paris, France.,Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, Paris, France.,INSERM UMR-S 942, Cardiovascular Makers in Stress Conditions, Paris, France
| | - Perrine Boursin
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Malek Ben Maacha
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
| | - Jean-Michel Halimi
- EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France.,Nephrology Department, Tours Hospital, Tours, France.,University of Tours, Tours, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.,University of Paris, Paris, France.,FHU NeuroVasc, Paris, France.,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
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163
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Bhambri A, Adapa AR, Liu Y, Boeckh-Behrens T, Procházka V, Hernández-Fernández F, Barbella-Aponte RA, Hashimoto T, Savastano LE, Gemmete JJ, Chaudhary N, Shih AJ, Pandey AS. Thrombus Histology as It Relates to Mechanical Thrombectomy: A Meta-Analysis and Systematic Review. Neurosurgery 2021; 89:1122-1131. [PMID: 34634805 DOI: 10.1093/neuros/nyab366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Appropriate thrombus-device interaction is critical for recanalization. Histology can serve as a proxy for mechanical properties, and thus inform technique selection. OBJECTIVE To investigate the value of histologic characterization, we conducted a systematic review and meta-analysis on the relationship between thrombus histology and recanalization, technique, etiology, procedural efficiency, and imaging findings. METHODS In this meta-analysis, we identified studies published between March 2010 and March 2020 reporting findings related to the histologic composition of thrombi in large vessel occlusion stroke. Studies with at least 10 patients who underwent mechanical thrombectomy using stent retriever or aspiration were considered. Only studies in which retrieved thrombi were histologically processed were included. Patient-level data were requested when data could not be directly extracted. The primary outcome assessed was the relationship between thrombus histology and angiographic outcome. RESULTS A total of 22 studies encompassing 1623 patients met inclusion criteria. Clots associated with good angiographic outcome had higher red blood cell (RBC) content (mean difference [MD] 9.60%, 95% CI 3.85-15.34, P = .008). Thrombi retrieved by aspiration had less fibrin (MD -11.39, 95% CI -22.50 to -0.27, P = .046) than stent-retrieved thrombi. Fibrin/platelet-rich clots were associated with longer procedure times (MD 13.20, 95% CI 1.30-25.10, P = .037). Hyperdense artery sign was associated with higher RBC content (MD 14.17%, 95% CI 3.07-25.27, P = .027). No relationship was found between composition and etiology. CONCLUSION RBC-rich thrombi were associated with better recanalization outcomes and shorter procedure times, suggesting that preinterventional compositional characterization may yield important prognostic and therapeutic guidance.
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Affiliation(s)
- Ankur Bhambri
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | | | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Václav Procházka
- Department of Imaging Methods, University of Ostrava, Ostrava, Czech Republic
| | - Francisco Hernández-Fernández
- Interventional Neuroradiology Unit, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Tetsuya Hashimoto
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Luis E Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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164
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Ajiboye N, Yoo AJ. Biomarkers of Technical Success After Embolectomy for Acute Stroke. Neurology 2021; 97:S91-S104. [PMID: 34785608 DOI: 10.1212/wnl.0000000000012800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE REVIEW Stent retrievers and large-bore aspiration catheters have doubled substantial reperfusion rates compared to first-generation devices. This has been accompanied by a 3-fold reduction in procedural time to revascularization. To measure future thrombectomy improvements, new benchmarks for technical efficacy are needed. This review summarizes the recent literature concerning biomarkers of procedural success and harm and highlights future directions. RECENT FINDINGS Expanded Treatment in Cerebral Ischemia (eTICI), which incorporates scores for greater levels of reperfusion, improves outcome prediction. Core laboratory-adjudicated studies show that outcomes following eTICI 2c (90%-99% reperfusion) are superior to eTICI 2b50 and nearly equivalent to eTICI 3. Moreover, eTICI 2c improves scale reliability. Studies also confirm the importance of rapid revascularization, whether measured as first pass effect or procedural duration under 30 minutes. Distal embolization is a complication that impedes the extent and speed of revascularization, but few studies have reported its per-pass occurrence. Distal embolization and emboli to new territory should be measured after each thrombectomy maneuver. Collaterals have been shown to be an important modifier of thrombectomy benefit. A drawback of the currently accepted collateral grading scale is that it does not discriminate among the broad spectrum of partial collateralization. Important questions that require investigation include reasons for failed revascularization, the utility of a global Treatment in Cerebral Ischemia scale, and the optimal grading system for vertebrobasilar occlusions. SUMMARY Emerging data support a lead technical efficacy endpoint that combines the extent and speed of reperfusion. Efforts are needed to better characterize angiographic measures of treatment harm and of collateralization.
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Affiliation(s)
| | - Albert J Yoo
- From the Texas Stroke Institute, Dallas-Fort Worth.
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165
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Al Kasab S, Almallouhi E, Spiotta AM. Rescue Endovascular Treatment for Emergent Large Vessel Occlusion With Underlying Intracranial Atherosclerosis: Current State and Future Directions. Front Neurol 2021; 12:734971. [PMID: 34759882 PMCID: PMC8573125 DOI: 10.3389/fneur.2021.734971] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Intracranial atherosclerosis (ICAS) is one of the most common causes of stroke worldwide and is associated with high risk of stroke recurrence. While the most common clinical presentation is acute–subacute transient ischemic attack or ischemic stroke, occasionally, patients with underlying ICAS present with acute occlusion of the affected vessel. Diagnosis and endovascular management of ICAS-related emergent large vessel occlusion (ELVO) can be challenging. Herein, we review the current evidence supporting endovascular management of ICAS-related ELVO and discuss future directions.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Alejandro M Spiotta
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
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166
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First-Line Stent Retriever versus Direct Aspiration for Acute Basilar Artery Occlusions: A Systematic Review and Meta-analysis. World Neurosurg 2021; 158:258-267.e1. [PMID: 34775090 DOI: 10.1016/j.wneu.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/03/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) for anterior circulation stroke has been proven to be highly effective. In comparison, MT for basilar artery occlusion (BAO) continues to lack definitive evidence of efficacy. The main MT modalities are stent retriever (SR) and direct aspiration (DA). Several studies have been published comparing the 2 approaches. OBJECTIVE We sought to directly compare and synthesize safety and efficacy outcomes with SR versus DA for acute BAO. METHODS A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Overall, 8 studies comprising 693 patients with BAO were included (SR: 457; DA: 236). The SR group was associated with statistically significant lower odds of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.31-0.94) and mTICI3 (OR: 0.47; 95% CI: 0.23-0.95) compared with DA. Favorable outcome rates were similar between the 2 groups (OR: 0.83; 95% CI: 0.60-1.16). The rates of symptomatic intracerebral hemorrhage (OR: 3.57; 95% CI: 0.75-16.95), subarachnoid hemorrhage (SAH) (OR: 4.71; 95% CI: 0.82-26.90), and vessel perforation (OR: 2.64; 95% CI: 0.43-16.33) were higher in the SR group, but statistical significance was not reached. The rates of 90-day mortality were similar between the 2 groups (OR: 1.07; 95% CI: 0.67-1.70). Procedure duration was significantly shorter when DA was used compared with SR (weighted mean difference: 26.10 minutes; 95% CI: 13.28-38.92). CONCLUSIONS SR is associated with statistically significant lower odds of mTICI 2b/3 and mTICI 3 recanalization rates compared with DA. SR appears to be associated with a higher complication rate, but significance was not reached.
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167
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Oyekole O, Simon S, Manning KB, Costanzo F. Modeling acute ischemic stroke recanalization through cyclic aspiration. J Biomech 2021; 128:110721. [PMID: 34496311 DOI: 10.1016/j.jbiomech.2021.110721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
We model the deformation of a thromboembolus lodged in a cerebral artery under the application of aspiration pressure as it would be provided by an aspiration catheter during a mechanical thrombectomy procedure. The system considered consists of (i) a clot modeled as a viscoelastic solid; (ii) an artery modeled as a hyperelastic solid; and (iii) a viscoelastic cohesive interface between the clot and the artery. For the chosen system and geometry, we show that the application of aspiration pressure results in the impingement of the thrombus against the inner arterial wall near the aspiration location. Conditions leading to interfacial failure are nucleated at the distal end of the clot and, depending on the details of the loading conditions, propagate toward the proximal end. The results provide useful information in identifying the circumstances that play a decisive role for clot removal by aspiration alone.
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Affiliation(s)
- Oyekola Oyekole
- Department of Biomedical Engineering, Penn State University, University Park, PA, USA
| | - Scott Simon
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, Penn State University, University Park, PA, USA; Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Francesco Costanzo
- Department of Biomedical Engineering, Penn State University, University Park, PA, USA; Department of Engineering Science and Mechanics, Penn State University, University Park, PA, USA.
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168
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Yang W, Zhang L, Li Z, Zhang Y, Li H, Hua W, Li J, Zhang H, Shen H, Xing P, Zhang Y, Hong B, Liu J, Yang P. Endovascular Treatment for Acute Basilar Artery Occlusion: A Comparison of Arteriosclerotic, Embolic and Tandem Lesions. Cardiovasc Intervent Radiol 2021; 44:1954-1963. [PMID: 34741196 DOI: 10.1007/s00270-021-02994-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/16/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to intracranial atherosclerosis-related basilar artery occlusion (ICAS-related BAO) by comparison with embolic and tandem occlusion. METHODS We retrospectively reviewed consecutive patients with AIS due to BAO who underwent EVT. Patients were assigned to the ICAS-related group and embolic group, and tandem group based on the etiology. Baseline data, procedural details, and clinical outcomes were compared between the three groups. RESULTS A total of 100 patients (ICAS-related group: 31; embolic group: 41; tandem group: 28) were included. No significant difference was observed in the successful reperfusion (mTICI 2b or 3), but the procedural time differed significantly (60 min vs. 43 min vs. 60 min, P = 0.010). There were no differences in the different intracranial hemorrhage grades among the three groups (P = 0.134). After adjusting for baseline differences, there was no significant difference in pairwise comparisons regarding favorable outcome (mRS 0-2), moderate outcome (mRS 0-3), and mortality. CONCLUSIONS Endovascular treatment for patients with acute ICAS-related BAO had equal efficacy and safety compared with embolic BAO and tandem BAO. Primary endovascular treatment and rescue modalities were effective treatments for acute ICAS-related BAO.
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Affiliation(s)
- Wenjin Yang
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.,Department of Neurosurgery, Pudong New Area People's Hospital, 490 Chuanhuan South Road, Shanghai, 201299, China
| | - Lei Zhang
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zifu Li
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yongxin Zhang
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - He Li
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Weilong Hua
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jianan Li
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Hongjian Zhang
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Hongjian Shen
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Pengfei Xing
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yongwei Zhang
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Bo Hong
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jianmin Liu
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Pengfei Yang
- Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
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169
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Qiu K, Zhao LB, Xu XQ, Wang Y, Liu J, Liu S, Shi HB, Zu QQ. Non-negligible clinical relevance of haemorrhagic transformation after endovascular thrombectomy with successful reperfusion in acute ischaemic stroke. Clin Radiol 2021; 77:e99-e105. [PMID: 34756700 DOI: 10.1016/j.crad.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022]
Abstract
AIM To explore the association between haemorrhagic transformation (HT) subtypes and functional outcome in acute ischaemic stroke (AIS) patients with successful recanalization treated by endovascular thrombectomy (EVT). MATERIALS AND METHODS Consecutive patients with AIS due to large-vessel occlusion in the anterior circulation, who were treated between January 2015 and June 2019 and achieved successful EVT, were enrolled in this retrospective study. HT was categorized according to the Heidelberg Bleeding Classification. Functional outcome was evaluated using the 90-day modified Rankin Scale (mRS) after stroke onset. Ordinal logistic regression analysis was performed to determine the association of HT subtypes with functional outcomes. RESULTS A total of 243 patients were included for further analysis. Among them, 121 (49.8%) had HT. Ten (4.1%) patients were classified as haemorrhagic infarction (HI) subtype 1, 61 (25.1%) as HI subtype 2, 17 (7.0%) as parenchymal haematoma (PH) subtype 1, and 33 (13.6%) as PH subtype 2. Ordinal logistic regression analysis suggested that HI subtype 2 (adjusted common OR 0.357, 95% CI: 0.192-0.667), PH1 (adjusted common OR 0.254, 95% CI: 0.093-0.696) and PH subtype 2 (adjusted common OR 0.017, 95% CI: 0.006-0.051) were significantly associated with poor functional outcomes. CONCLUSION The present study shows that HI subtype 2, PH subtype 1, and PH subtype 2 are independently associated with poor clinical outcomes in AIS patients with successful recanalization after EVT.
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Affiliation(s)
- K Qiu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - L-B Zhao
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - X-Q Xu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Y Wang
- Department of Emergency Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - J Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - S Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - H-B Shi
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Q-Q Zu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China.
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170
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Happi Ngankou E, Gory B, Marnat G, Richard S, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Maïer B, Blanc R, Lapergue B, Consoli A, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Clarençon F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Viguier A, Cognard C, Lebras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Eugène F, Finitsis S. Thrombectomy Complications in Large Vessel Occlusions: Incidence, Predictors, and Clinical Impact in the ETIS Registry. Stroke 2021; 52:e764-e768. [PMID: 34706564 DOI: 10.1161/strokeaha.121.034865] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice. METHODS We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications. RESULTS Procedural complications occurred in 7.99% (95% CI, 7.17%-8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03-12.31]; P<0.001) and an increased total number of passes (OR, 1.22 [95% CI, 1.05-1.41]; P=0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0-2; adjusted OR, 0.4 [95% CI, 0.25-0.63]; P<0.001), increased mortality (adjusted OR, 1.74 [95% CI, 1.2-2.53]; P<0.001), and symptomatic intracerebral hemorrhage (adjusted OR, 1.87 [95% CI, 1.15-3.03]; P=0.011). Perforations occurred in 1.69% (95% CI, 1.31%-2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%; P=0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%-1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years; P=0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique. CONCLUSIONS Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.
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Affiliation(s)
- Emmanuel Happi Ngankou
- Department of Diagnostic and Therapeutic Neuroradiology (E.H.N., B.G.), Université de Lorraine, CHRU-Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology (E.H.N., B.G.), Université de Lorraine, CHRU-Nancy, France.,IADI, INSERM U1254, Université de Lorraine, Nancy, France (B.G.)
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France (G.M.)
| | - Sébastien Richard
- Department of Neurology, Stroke Unit (S.R.), Université de Lorraine, CHRU-Nancy, France.,CIC-P 1433, INSERM U1116, CHRU-Nancy, France (S.R.)
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, France (R.B.)
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France (I.S.)
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology (C.D.), CHRU Gui de Chauliac, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (B.M., R.B.)
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (B.M., R.B.)
| | - Bertrand Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Stéphane Vannier
- Department of Neurology, Stroke Unit (S.V.), University Hospital of Rennes, France
| | - Laurent Spelle
- Neuroradiolology (L.S.), CHU Kremlin Bicêtre, Paris, France
| | - Christian Denier
- Departments of Neurology (C.D.), CHU Kremlin Bicêtre, Paris, France
| | | | | | - Suzana Saleme
- Department of Interventional Neuroradiology (S.S.), CHU Limoges, France
| | | | | | - Charlotte Rosso
- Departments of Neurology (C.R.), CHU Pitié-Salpétrière, Paris, France
| | | | - Guillaume Turc
- Departments of Neurology (G.T.), Hôpital Saint Anne, Paris, France
| | | | | | - Alain Viguier
- Departments of Neurology (A.V.), CHU Toulouse, France
| | | | - Anthony Lebras
- Departments of Neurology (A.L.), CH Bretagne Atlantique, Vannes, France
| | - Sarah Evain
- Neuroradiolology (S.E.), CH Bretagne Atlantique, Vannes, France
| | - Valérie Wolff
- Departments of Neurology (V.W.), CHU Strasbourg, France
| | - Raoul Pop
- Neuroradiolology (R.P.), CHU Strasbourg, France
| | - Serge Timsit
- Departments of Neurology (S.T.), CHU Brest, France
| | | | | | - Louis Veunac
- Neuroradiolology (L.V.), CH Côte Basque, Bayonne, France
| | - François Eugène
- Department of Neuroradiology (F.E.), University Hospital of Rennes, France
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171
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Mulder IA, van Bavel ET, de Vries HE, Coutinho JM. Adjunctive cytoprotective therapies in acute ischemic stroke: a systematic review. Fluids Barriers CNS 2021; 18:46. [PMID: 34666786 PMCID: PMC8524879 DOI: 10.1186/s12987-021-00280-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
With the introduction of endovascular thrombectomy (EVT), a new era for treatment of acute ischemic stroke (AIS) has arrived. However, despite the much larger recanalization rate as compared to thrombolysis alone, final outcome remains far from ideal. This raises the question if some of the previously tested neuroprotective drugs warrant re-evaluation, since these compounds were all tested in studies where large-vessel recanalization was rarely achieved in the acute phase. This review provides an overview of compounds tested in clinical AIS trials and gives insight into which of these drugs warrant a re-evaluation as an add-on therapy for AIS in the era of EVT. A literature search was performed using the search terms “ischemic stroke brain” in title/abstract, and additional filters. After exclusion of papers using pre-defined selection criteria, a total of 89 trials were eligible for review which reported on 56 unique compounds. Trial compounds were divided into 6 categories based on their perceived mode of action: systemic haemodynamics, excitotoxicity, neuro-inflammation, blood–brain barrier and vasogenic edema, oxidative and nitrosative stress, neurogenesis/-regeneration and -recovery. Main trial outcomes and safety issues are summarized and promising compounds for re-evaluation are highlighted. Looking at group effect, drugs intervening with oxidative and nitrosative stress and neurogenesis/-regeneration and -recovery appear to have a favourable safety profile and show the most promising results regarding efficacy. Finally, possible theories behind individual and group effects are discussed and recommendation for promising treatment strategies are described.
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Affiliation(s)
- I A Mulder
- Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - E T van Bavel
- Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H E de Vries
- Department of Molecular Cell Biology and Immunology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J M Coutinho
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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172
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Luraghi G, Cahalane RME, van de Ven E, Overschie SCM, Gijsen FJH, Akyildiz AC. In vitro and in silico modeling of endovascular stroke treatments for acute ischemic stroke. J Biomech 2021; 127:110693. [PMID: 34450517 DOI: 10.1016/j.jbiomech.2021.110693] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022]
Abstract
Acute ischemic stroke occurs when a thrombus obstructs a cerebral artery, leading to sub-optimal blood perfusion to brain tissue. A recently developed, preventive treatment is the endovascular stroke treatment (EVT), which is a minimally invasive procedure, involving the use of stent-retrievers and/or aspiration catheters. Despite its increasing use, many critical factors of EVT are not well understood. In this respect, in vitro, and in silico studies have the great potential to help us deepen our understanding of the procedure, perform further device and procedural optimization, and help in clinical training. This review paper provides an overview of the previous in vitro and in silico evaluations of EVT treatments, with a special emphasis on the four main aspects of the adopted experimental and numerical set-ups: vessel, thrombus, device, and procedural settings.
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Affiliation(s)
- Giulia Luraghi
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | - Rachel M E Cahalane
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Emma van de Ven
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Serena C M Overschie
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Frank J H Gijsen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ali C Akyildiz
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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173
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Ospel JM, van der Lugt A, Gounis M, Goyal M, Majoie CBLM. A clinical perspective on endovascular stroke treatment biomechanics. J Biomech 2021; 127:110694. [PMID: 34419825 DOI: 10.1016/j.jbiomech.2021.110694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
Acute ischemic stroke (AIS) is caused by blockage of an arterial blood vessel in the brain by a thrombus, which interrupts oxygen supply to the brain parenchyma. The goal of endovascular stroke treatment (mechanical thrombectomy) is to restore blood flow as quickly and completely as possible. There are numerous factors that influence endovascular treatment success. They can be broadly grouped into a) factors related to blood vessels, b) factors related to the thrombus, c) factors related to endovascular treatment technique and tools and d) operator-related factors. While blood vessel and tgthro thrombus-related factors are mostly non-modifiable in the acute setting, operator and technique-related factors can be modified, and extensive research is currently being done to investigate the complex interplay of all these variables, and to optimize the modifiable factors to the maximum possible extent. In this review, we will describe these factors and how they interact with each other in detail, and outline some of their practical implications. We will conclude with a short summary and outlook on future directions for optimizing endovascular treatment success.
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Affiliation(s)
- Johanna M Ospel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Neuroradiology, University Hospital Basel, Basel, Switzerland; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Matthew Gounis
- Department of Radiology, University of Massachusetts Medical School, Worcester, United States
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Charles B L M Majoie
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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174
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Patel TR, Waqas M, Sarayi SMMJ, Ren Z, Borlongan CV, Dossani R, Levy EI, Siddiqui AH, Snyder KV, Davies JM, Mokin M, Tutino VM. Revascularization Outcome Prediction for A Direct Aspiration-First Pass Technique (ADAPT) from Pre-Treatment Imaging and Machine Learning. Brain Sci 2021; 11:brainsci11101321. [PMID: 34679386 PMCID: PMC8534082 DOI: 10.3390/brainsci11101321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 01/14/2023] Open
Abstract
A direct aspiration-first pass technique (ADAPT) has recently gained popularity for the treatment of large vessel ischemic stroke. Here, we sought to create a machine learning-based model that uses pre-treatment imaging metrics to predict successful outcomes for ADAPT in middle cerebral artery (MCA) stroke cases. In 119 MCA strokes treated by ADAPT, we calculated four imaging parameters-clot length, perviousness, distance from the internal carotid artery (ICA) and angle of interaction (AOI) between clot/catheter. We determined treatment success by first pass effect (FPE), and performed univariate analyses. We further built and validated multivariate machine learning models in a random train-test split (75%:25%) of our data. To test model stability, we repeated the machine learning procedure over 100 randomizations, and reported the average performances. Our results show that perviousness (p = 0.002) and AOI (p = 0.031) were significantly higher and clot length (p = 0.007) was significantly lower in ADAPT cases with FPE. A logistic regression model achieved the highest accuracy (74.2%) in the testing cohort, with an AUC = 0.769. The models had similar performance over the 100 train-test randomizations (average testing AUC = 0.768 ± 0.026). This study provides feasibility of multivariate imaging-based predictors for stroke treatment outcome. Such models may help operators select the most adequate thrombectomy approach.
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Affiliation(s)
- Tatsat R. Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14228, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Seyyed M. M. J. Sarayi
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14228, USA
| | - Zeguang Ren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33613, USA; (Z.R.); (C.V.B.); (M.M.)
| | - Cesario V. Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33613, USA; (Z.R.); (C.V.B.); (M.M.)
| | - Rimal Dossani
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Elad I. Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Jason M. Davies
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33613, USA; (Z.R.); (C.V.B.); (M.M.)
| | - Vincent M. Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14228, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228, USA
- Correspondence: ; Tel./Fax: +1-(716)-829-5400
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175
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Belachew NF, Dobrocky T, Aleman EB, Meinel TR, Hakim A, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Mordasini P, Gralla J, Fischer U, Piechowiak EI, Kaesmacher J. SWI Susceptibility Vessel Sign in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:1949-1955. [PMID: 34593377 DOI: 10.3174/ajnr.a7281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The frequency and clinical significance of the susceptibility vessel sign in patients with acute ischemic stroke remains unclear. We aimed to assess its prevalence in patients with acute ischemic stroke undergoing mechanical thrombectomy and to analyze its association with interventional and clinical outcome parameters in that group. MATERIALS AND METHODS Six hundred seventy-six patients with acute ischemic stroke and admission MR imaging were reviewed retrospectively. Of those, 577 met the eligibility criteria for further analysis. Imaging was performed using a 1.5T or 3T MR imaging scanner. Associations between baseline variables, interventional and clinical outcome parameters, and susceptibility vessel sign were determined with multivariable logistic regression models. Results are shown as adjusted ORs with 95% CIs. RESULTS The susceptibility vessel sign was present in 87.5% (n = 505) of patients and associated with tandem occlusion (adjusted OR, 3.3; 95% CI, 1.1-10.0; P = .032) as well as successful reperfusion, defined as an expanded TICI score of ≥2b (adjusted OR, 2.4; 95% CI, 1.28-4.6; P = .007). The susceptibility vessel sign was independently associated with functional independence (mRS ≤ 2: adjusted OR, 2.1; 95% CI, 1.1-4.0; P = .028) and lower mortality (adjusted OR, 0.4; 95% CI, 0.2-0.7; P = .003) at 90 days, even after adjusting for successful reperfusion. The susceptibility vessel sign did not influence the number of passes performed during mechanical thrombectomy, the first-pass reperfusion, or the risk of peri- or postinterventional complications. CONCLUSIONS The susceptibility vessel sign is an MR imaging phenomenon frequently observed in patients with acute ischemic stroke and is associated with successful reperfusion after mechanical thrombectomy. However, superior clinical functional outcome and lower mortality noted in patients showing the susceptibility vessel sign could not be entirely attributed to higher reperfusion rates.
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Affiliation(s)
- N F Belachew
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - T Dobrocky
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - E B Aleman
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - T R Meinel
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - A Hakim
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Vynckier
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - M Arnold
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - D J Seiffge
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - R Wiest
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - U Fischer
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - E I Piechowiak
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Kaesmacher
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.).,Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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176
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Lapergue B, Blanc R, Costalat V, Desal H, Saleme S, Spelle L, Marnat G, Shotar E, Eugene F, Mazighi M, Houdart E, Consoli A, Rodesch G, Bourcier R, Bracard S, Duhamel A, Ben Maacha M, Lopez D, Renaud N, Labreuche J, Gory B, Piotin M. Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER2 Randomized Clinical Trial. JAMA 2021; 326:1158-1169. [PMID: 34581737 PMCID: PMC8479584 DOI: 10.1001/jama.2021.13827] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Mechanical thrombectomy using a stent retriever or contact aspiration is widely used for treatment of patients with acute ischemic stroke due to anterior circulation large vessel occlusion, but the additional benefit of combining contact aspiration with stent retriever is uncertain. OBJECTIVE To determine whether mechanical thrombectomy for treatment of anterior circulation large vessel occlusion stroke with initial contact aspiration and stent retriever combined results in better final angiographic outcome than with standard stent retriever alone. DESIGN, SETTING, AND PARTICIPANTS This trial was a multicenter randomized, open-label, blinded end point evaluation that enrolled 408 patients from October 16, 2017, to May 29, 2018, in 11 French comprehensive stroke centers, with a 12-month outcome follow-up. Patients with a large vessel occlusion in the anterior circulation were included up to 8 hours after symptom onset. The final date of follow-up was June, 19, 2019. INTERVENTIONS Patients were randomly assigned (1:1 allocation) to receive initial thrombectomy with contact aspiration and stent retriever combined (205) or stent retriever alone (203). MAIN OUTCOMES AND MEASURES The primary outcome was the rate of expanded Thrombolysis In Cerebral Infarction score of 2c or 3 (eTICI 2c/3; ie, scores indicate near-total and total reperfusion grades) at the end of the procedure. RESULTS Among the 408 patients who were randomized, 3 were excluded, and 405 (99.3%) patients (mean age, 73 years; 220 [54%] women and 185 [46%] men) were included in the primary analysis. The rate of eTICI 2c/3 at the end of the endovascular procedure was not significantly different between the 2 thrombectomy groups (64.5% [131 of 203 patients] for contact aspiration and stent retriever combined vs 57.9% [117 of 202 patients] for stent retriever alone; risk difference, 6.6% [95% CI, -3.0% to 16.2%]; adjusted odds ratio [OR], 1.33 [95% CI, 0.88 to 1.99]; P = .17). Of 14 prespecified secondary efficacy end points, 12 showed no significant difference. A higher rate of successful reperfusion was achieved in the contact aspiration combined with stent retriever group vs the stent retriever alone group (eTICI 2b50/2c/3, 86.2% vs 72.3%; adjusted OR, 2.54 [95% CI, 1.51 to 4.28]; P < .001) and of near-total or total reperfusion (eTICI 2c/3, 59.6% vs 49.5%; adjusted OR, 1.52 [95% CI, 1.02 to 2.27]; P = .04) after the assigned initial intervention alone. CONCLUSIONS AND RELEVANCE Among patients with acute ischemic stroke due to large vessel occlusion, an initial thrombectomy technique consisting of contact aspiration and stent retriever combined, compared with stent retriever alone, did not significantly improve the rate of near-total or total reperfusion (eTICI 2c/3) at the end of the endovascular procedure, although the trial may have been underpowered to detect smaller differences between groups. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03290885.
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Affiliation(s)
- Bertrand Lapergue
- Department of Neurology, Stroke Center, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Vincent Costalat
- Department of Neuroradiology, University Hospital Güi-de-Chauliac, Hospital Center University of Montpellier, Montpellier, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Thorax Institute, INSERM 1087, CNRS, UNIV Nantes, Nantes, Pays de la Loire, France
| | - Susanna Saleme
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Laurent Spelle
- Bicêtre Hospital, Department of Interventional Neuroradiology, Le Kremlin-Bicêtre, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Francois Eugene
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, Paris, France
| | - Arturo Consoli
- Department of Neurology, Stroke Center, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
- Department of Diagnostic and Therapeutic Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Georges Rodesch
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
- Department of Diagnostic and Therapeutic Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Thorax Institute, INSERM 1087, CNRS, UNIV Nantes, Nantes, Pays de la Loire, France
| | - Serge Bracard
- University of Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France and University of Lorraine, IADI, INSERM U1254, F-54000 Nancy, France
| | - Alain Duhamel
- University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France
| | - Maalek Ben Maacha
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Delphine Lopez
- Department of Neurology, Stroke Center, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Nicholas Renaud
- Department of Neurology, Stroke Center, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Julien Labreuche
- University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France
| | - Benjamin Gory
- University of Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France and University of Lorraine, IADI, INSERM U1254, F-54000 Nancy, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
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177
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Yeo LLL, Jing M, Bhogal P, Tu T, Gopinathan A, Yang C, Tan BYQ, Arnberg F, Sia CH, Holmin S, Andersson T. Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices. Front Neurol 2021; 12:712527. [PMID: 34566856 PMCID: PMC8459011 DOI: 10.3389/fneur.2021.712527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/30/2021] [Indexed: 01/23/2023] Open
Abstract
Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS) and is now the standard of care according to international guidelines. However, in about 20% of EVT procedures, recanalization is not achieved, and over 50% of patients who undergo EVT still do not have good functional outcome. In this article, we provide an extensive review of the latest evidence and developments in the field of EVT, with particular focus on the factors that improve patient outcomes. These factors include new and adjunctive techniques such as combination of direct aspiration and stent retriever, intra-arterial urokinase or 2b/3a inhibitors, rescue stenting, as well as novel devices including balloon guide catheters and the newer generations of aspiration catheters and stent retrievers. We also examined the latest notion of using first-pass effect (FPE) as the target to achieve during EVT, which has been associated with an improved functional outcome. While the field of EVT has been rapidly evolving, further research is required in specific AIS patient populations such as those with large ischemic core, late presentation beyond 24 h, posterior circulation strokes, and with distal medium vessel occlusion or tandem lesions to better assess its efficacy and safety.
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Affiliation(s)
- Leonard L L Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Mingxue Jing
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Pervinder Bhogal
- Department of Neuroradiology, St. Bartholomew's and the Royal London Hospital, London, United Kingdom
| | - Tianming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Anil Gopinathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Cunli Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Benjamin Y Q Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
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178
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Londhe SR, Gg SK, Keshava SN, Mohan C. Indian College of Radiology and Imaging (ICRI) Consensus Guidelines for the Early Management of Patients with Acute Ischemic Stroke: Imaging and Intervention. Indian J Radiol Imaging 2021; 31:400-408. [PMID: 34556925 PMCID: PMC8448212 DOI: 10.1055/s-0041-1734346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The medical science has witnessed significant change in the management of acute stroke patients as a result of recent advances in the field of stroke imaging and endovascular mechanical thrombectomy in addition to intravenous thrombolysis and optimization of stroke services in balance with available resources. Despite initial negative trials, we witnessed the publication of five multicenter randomized clinical trials showing superiority of the endovascular approach over standard medical management in patients with large vessel occlusion. The aim of this study is to provide comprehensive set of evidence-based recommendations regarding imaging and endovascular interventions in acute ischemic stroke patients.
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Affiliation(s)
- Shrikant R Londhe
- Department of Interventional Neuroradiology, Noble Hospital, Pune, Maharashtra, India
| | - Sharath Kumar Gg
- Department of Diagnostic and Interventional Neuroradiology, Apollo Hospitals, Bangalore, Karnataka, India
| | - Shyamkumar N Keshava
- Department of Interventional Radiology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Chander Mohan
- Interventional Radiology, ICRI Director, Interventional Radiology, BLK Super Specialty Hospital, Pusa Road, New Delhi, India
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179
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Zaidat OO, Fifi JT, Nanda A, Atchie B, Woodward K, Doerfler A, Tomasello A, Tekle W, Singh IP, Matouk C, Thalwitzer J, Jargiełło T, Skrypnik D, Beuing O, Berge J, Katz JM, Biondi A, Bonovich D, Sheth SA, Yoo AJ, Hassan AE. Endovascular Treatment of Acute Ischemic Stroke With the Penumbra System in Routine Practice: COMPLETE Registry Results. Stroke 2021; 53:769-778. [PMID: 34547927 PMCID: PMC8884134 DOI: 10.1161/strokeaha.121.034268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. The purpose of the COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device) registry was to evaluate the generalizability of the safety and efficacy of the Penumbra System (Penumbra, Inc, Alameda) in a real-world setting.
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Affiliation(s)
- Osama O Zaidat
- Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.)
| | - Johanna T Fifi
- Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.)
| | | | | | - Keith Woodward
- Fort Sanders Regional Medical Center, Knoxville, TN (K.W.)
| | | | | | - Wondwossen Tekle
- University of Texas Rio Grande Valley - Valley Baptist Health System, Harlingen (W.T.)
| | | | | | | | - Tomasz Jargiełło
- Samodzielny Publiczny Szpital Kliniczny nr 4, Lublin, Poland (T.J.)
| | - Dmitry Skrypnik
- Moscow City Clinical Hospital named after Davydovsky, Russia (D.S.)
| | | | - Jérôme Berge
- CHU de Bordeaux- Hôpital Pellegrin, Bordeaux, France (J.B.)
| | - Jeffrey M Katz
- North Shore University Hospital, Northwell Health, Manhasset, NY (J.M.K.)
| | | | | | - Sunil A Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (S.A.S.)
| | - Albert J Yoo
- Texas Stroke Institute, Dallas-Fort Worth (A.J.Y.)
| | - Ameer E Hassan
- Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.).,University of Texas Rio Grande Valley - Valley Baptist Medical Center, Harlingen (A.E.H.)
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180
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Nagy C, Héger J, Balogh G, Gubucz I, Nardai S, Lenzsér G, Bajzik G, Fehér M, Moizs M, Repa I, Nagy F, Vajda Z. Endovascular Recanalization of Tandem Internal Carotid Occlusions Using the Balloon-assisted Tracking Technique. Clin Neuroradiol 2021; 32:375-384. [PMID: 34546383 DOI: 10.1007/s00062-021-01078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Tandem occlusive lesions are responsible for up to 20% of acute ischemic stroke cases and are associated with poor prognosis if complete recanalization cannot be achieved. Endovascular recanalization might be challenging due to difficulties in the safe passage of the occluded plaque at the origin of the internal carotid artery (ICA). The balloon-assisted tracking technique (BAT), where a partially deflated balloon is exposed out of the catheter tip to facilitate its passage through stenosed or spastic arterial segments was introduced by interventional cardiologists and the applicability of the technique has been recently proposed in the field of neurointervention as well. Here we describe our experience using the BAT technique in the endovascular recanalization of tandem occlusive lesions. METHODS Procedures were performed from June 2013 to December 2020 in a single center. Baseline clinical and imaging data, procedural and follow-up details and clinical outcomes were retrospectively collected. RESULTS In this study 107 patients, median age 66 years, median admission NIHSS 14 and median ASPECTS 8 were included. Successful recanalization of the ICA using the BAT technique was achieved in 100 (93%) and successful intracranial revascularization in 88 (82%) patients. There were no complications attributable to the BAT technique. Intraprocedural complications occurred in 9 (8%) patients. Emergent stenting was performed in 40 (37%) at the end of the procedure. Postprocedural adverse events (intracerebral hemorrhage [ICH], malignant infarction) occurred in 6 (5%) patients. Good clinical outcome at 3 months (modified Rankin scale [mRS] 0-2) was 54 (50%) and mortality 26 (24%). Delayed stent placement during follow-up occurred in 21 cases. CONCLUSION Application of BAT technique in tandem occlusions appears feasible, safe, and efficient. Further evaluation of this technique is awaited.
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Affiliation(s)
- Csaba Nagy
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary.,Department of Neurosurgery, University of Pécs, Pécs, Hungary
| | - Júlia Héger
- Department of Emergency Medicine, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Gábor Balogh
- Department of Surgery, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - István Gubucz
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary.,National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Sándor Nardai
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Gábor Lenzsér
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary.,Department of Neurosurgery, University of Pécs, Pécs, Hungary
| | - Gábor Bajzik
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Máté Fehér
- Department of Neurosurgery, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Mariann Moizs
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Imre Repa
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Vajda
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary. .,Department of Neurosurgery, University of Pécs, Pécs, Hungary.
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181
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Okuda T, Arimura K, Matsuo R, Tokunaga S, Hara K, Yamaguchi S, Yoshida H, Kurogi R, Kameda K, Ito O, Tsumoto T, Iihara K, Mizokami T, Uwatoko T, Nishimura A, Iwaki K, Mizoguchi M. Efficacy of combined use of a stent retriever and aspiration catheter in mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg 2021; 14:892-897. [PMID: 34544828 DOI: 10.1136/neurintsurg-2021-017837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The efficacy of combined stent retriever (SR) and aspiration catheter (AC; combined technique: CBT) use for acute ischemic stroke (AIS) is unclear. We investigated the safety and efficacy of single-unit CBT (SCBT)-retrieving the thrombus as a single unit with SR and AC into the guide catheter-compared with single use of either SR or contact aspiration (CA). METHODS We analysed 763 consecutive patients who underwent mechanical thrombectomy for AIS between January 2013 and January 2020, at six comprehensive stroke centers. Patients were divided into SCBT and single device (SR/CA) groups. The successful recanalization with first pass (SRFP) and other procedural outcomes were compared between groups. RESULTS Overall, 240 SCBT and 301 SR/CA (SR 128, CA 173) patients were analyzed. SRFP (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2c, 43.3% vs 27.9%, p<0.001; mTICI 3, 35.8% vs 25.5%, p=0.009) and final mTICI ≥2b recanalization (89.1% vs 82.0%, p=0.020) rates were significantly higher, puncture-to-reperfusion time was shorter (median (IQR) 43 (31.5-69) vs 55 (38-82.2) min, p<0.001), and the number of passes were fewer (mean±SD 1.72±0.92 vs 1.99±1.01, p<0.001) in the SCBT group. Procedural complications were similar between the groups. In subgroup analysis, SCBT was more effective in women, cardioembolic stroke patients, and internal carotid artery and M2 occlusions. CONCLUSIONS SCBT increases the SRFP rate and shortens the puncture-to-reperfusion time without increasing procedural complications.
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Affiliation(s)
- Tomohiro Okuda
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - So Tokunaga
- Department of Neuroendovascular Therapy, National Hospital Organisation Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Kenta Hara
- Department of Neuroendovascular Therapy, National Hospital Organisation Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Shinya Yamaguchi
- Department of Neurosurgery, Steel Memorial Yawata Hospital, Kita-Kyushu, Fukuoka, Japan
| | - Hidenori Yoshida
- Department of Neurosurgery, Fukuoka Tokushukai Medical Center, Kasuga, Fukuoka, Japan
| | - Ryota Kurogi
- Department of Neurosurgery, Fukuoka Tokushukai Medical Center, Kasuga, Fukuoka, Japan
| | - Katsuharu Kameda
- Department of Neurosurgery, Shin Koga Hospital, Kurume, Fukuoka, Japan
| | - Osamu Ito
- Department of Neurosurgery, Shin Koga Hospital, Kurume, Fukuoka, Japan.,Department of Neurosurgery, Kieikai Hospital, Fukuoka, Japan
| | - Tomoyuki Tsumoto
- Department of Neuroendovascular Therapy, National Hospital Organisation Kyushu Medical Center, Fukuoka, Fukuoka, Japan.,Department of Neurosurgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan
| | - Taichiro Mizokami
- Department of Neurosurgery, Saga -Ken Medical Centre Koseikan, Saga, Saga, Japan
| | - Takeshi Uwatoko
- Department of Cerebrovascular Medicine, Saga Prefecture Medical Center Koseikan, Saga, Saga, Japan
| | - Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuma Iwaki
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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182
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Hassan AE, Ringheanu VM, Preston L, Tekle WG, Qureshi AI. Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease. Interv Neuroradiol 2021; 28:419-425. [PMID: 34515574 PMCID: PMC9326867 DOI: 10.1177/15910199211039403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. METHODS Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. RESULTS There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group (p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization (p = 0.758), or good modified Rankin Scale scores (p = 0.806). CONCLUSION Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.
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Affiliation(s)
- Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA.,Department of Clinical Research, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA.,Neuroscience Department, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA
| | - Victor M Ringheanu
- Department of Clinical Research, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA
| | - Laurie Preston
- Department of Clinical Research, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA.,Neuroscience Department, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA
| | - Wondwossen G Tekle
- Department of Neurology, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA.,Neuroscience Department, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA.,Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri, USA
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183
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Nam JW, Jung NY, Park ES, Kwon SC. Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience. J Korean Neurosurg Soc 2021; 64:732-739. [PMID: 34503313 PMCID: PMC8435647 DOI: 10.3340/jkns.2020.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/26/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Early successful reperfusion is associated with favorable outcomes in acute ischemic stroke (AIS). The purpose of this study was to achieve successful recanalization by a combined mechanical thrombectomy technique, the Aspiration-Retriever Technique for Stroke (ARTS), which is composed of a flexible large lumen distal access catheter and a retrievable stent as the first-line strategy of mechanical thrombectomy.
Methods We retrospectively reviewed 62 patients with AIS who underwent mechanical thrombectomy from 2018 to 2019 at our institute by a senior neurointerventionalist. Among them, patients who were treated using the ARTS technique with the soft torqueable catheter optimized for intracranial access (SOFIA®; MicroVention-Terumo, Tustin, CA, USA) as the first-line treatment were included. Patients who had tandem occlusions or underlying intracranial artery stenosis were excluded. The angiographic and clinical outcomes were evaluated. The angiographic outcome was analyzed by the rate of successful recanalization, defined as a Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all procedures and the rate of successfully achieving the first pass effect (FPE), defined as complete recanalization with a single pass of the device. The clinical outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), and mortality.
Results A total of 27 patients (mean age, 59.3 years) fulfilled the inclusion criteria. The successful recanalization rate was 96% (n=26) while the FPE rate was 41% (n=11). The mean post-procedural NIHSS change was -3.0. Thirteen patients (48%) showed good clinical outcomes after thrombectomy with the ARTS technique (mRS at 90 days ≤2). Postoperative complications occurred in seven of 25 patients : hemorrhagic transformation in six patients (22%) and distal embolization in one patient (4%). Mortality was 15% (n=4).
Conclusion Although the clinical outcomes using the ARTS technique with a flexible large lumen distal access catheter performed as the frontline thrombectomy in patients with AIS were not significantly superior than those of other studies, this study showed a high rate of successful endovascular recanalization which was comparable to that of other studies. Therefore, ARTS using the SOFIA® catheter can be considered as the first choice of treatment for AIS due to large vessel occlusion.
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Affiliation(s)
- Ji Won Nam
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Na Young Jung
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Suk Park
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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184
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Shigeta K, Suzuki K, Matsumaru Y, Takeuchi M, Morimoto M, Kanazawa R, Takayama Y, Kamiya Y, Okubo S, Hayakawa M, Ishii N, Koguchi Y, Ota T, Takigawa T, Inoue M, Naito H, Hirano T, Kato N, Ueda T, Akaji K, Iguchi Y, Miki K, Tsuruta W, Fujimoto S, Enomoto M, Aoyama J, Nakano T, Kimura K. Intravenous Alteplase is Associated with First Pass Effect in Stent-retriever but not ADAPT Thrombectomy : Post Hoc Analysis of the SKIP Study. Clin Neuroradiol 2021; 32:153-162. [PMID: 34498093 DOI: 10.1007/s00062-021-01085-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the effect of alteplase, either combined with stent-retriever thrombectomy or a direct aspiration first pass technique (ADAPT), in patients with large-vessel occlusion stroke. METHODS This was a retrospective post hoc analysis of data from The Direct Mechanical Thrombectomy in Acute LVO Stroke (SKIP) study. Patients were divided into two groups according to the first-line thrombectomy technique: stent-retriever and ADAPT. Each group was further divided into two subgroups, namely MT and MT + alteplase. The procedural outcomes, such as first pass effect (FPE) ratio and number of passes, were evaluated. The clinical outcomes included mRS score at 3 months. RESULTS A total of 180 patients were included (116 in the stent-retriever group and 64 in the ADAPT group). No interaction was detected between the first-line technique and alteplase administration. In the stent-retriever group, after adjusting for factors associated with FPE, the adjusted odds ratio (95% confidence interval) of FPE of the MT + alteplase subgroup versus the MT subgroup was 3.57 (1.5-8.48) and in the ADAPT group it was 1.35 (0.37-4.91). With alteplase, the number of passes decreased with adjusted odds ratios of 0.59 (0.37-0.93) in the stent-retriever group but not in the ADAPT group. In both first-line technique groups, clinical outcomes did not differ between subgroups. CONCLUSION In the SKIP study, alteplase administration was associated with increased FPE when combined with stent-retriever thrombectomy, but not with ADAPT. We found no differences in the clinical outcomes.
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Affiliation(s)
- Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Masafumi Morimoto
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgery Hospital, Kanagawa, Japan
| | | | - Yohei Takayama
- Department of Neurology, Akiyama Neurosurgical Hospital, Kanagawa, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Seiji Okubo
- Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Norihiro Ishii
- Department of Neurosurgery, New Tokyo Hospital, Chiba, Japan
| | - Yorio Koguchi
- Department of Neurology and Neurosurgery, Chiba Emergency Medical Center, Chiba, Japan
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Masato Inoue
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiromichi Naito
- Department of Neurosurgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center, Ibaraki, Japan
| | - Toshihiro Ueda
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kanagawa, Japan
| | - Kazunori Akaji
- Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Kazunori Miki
- Department of Endovascular surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masaya Enomoto
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Jiro Aoyama
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tomoyuki Nakano
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
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185
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To support safe provision of mechanical thrombectomy services for patients with acute ischaemic stroke: 2021 consensus guidance from BASP, BSNR, ICSWP, NACCS, and UKNG. Clin Radiol 2021; 76:862.e1-862.e17. [PMID: 34482987 DOI: 10.1016/j.crad.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 01/01/2023]
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186
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Familiarization with Contact Aspiration using Non-Penetrating of the Thrombus (CANP) Technique as the Initial Procedure for Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:106066. [PMID: 34488006 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/14/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study aimed to prove the safety and efficacy of the contact aspiration using non-penetrating of thrombus (CANP) technique for the initial procedure for acute ischemic stroke and to increase operator familiarization with the technical aspects of the CANP technique. MATERIALS AND METHODS A total of 103 patients with large-vessel stroke who were treated using thrombectomy alone at our institution between April 2019 and March 2021 were included in this study. CANP technique was performed using a large lumen catheter (inner diameter, ≥0.060 in.) without penetrating a thrombus. Results of the CANP technique, including the procedure time; first-pass effect (FPE); angiographical recanalization; functional independence; thrombus migration; and intracerebral hemorrhage (ICH) were compared with combined technique. RESULTS A total of 77 patients (74.8%) were scheduled to undergo the CANP technique for initial procedure, and 50 (64.9%) attempted the CANP technique. Of 50 patients with CANP technique, 33 (66.0%) achieved angiographically good recanalization using CANP technique alone. FPE was achieved in 31 patients (62.0%) in CANP technique group; the rate of FPE was significantly higher (p = 0.008). Asymptomatic ICH were significantly smaller in the CANP technique group (p = 0.008). The median interval of only the CANP technique was 20 (IQR, 16-29.5) min for groin puncture to final recanalization, and was significantly faster (p < 0.001). CONCLUSIONS CANP technique was safe with low risk of hemorrhagic complication and effective for the initial procedure of acute ischemic stroke.
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187
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Kuribara T, Iihoshi S, Tsukagoshi E, Teranishi A, Kinoshita Y, Sugasawa S, Kohyama S, Takahashi S, Kurita H. Thrombectomy for acute large vessel occlusion in posterior and anterior circulation: a single institutional retrospective observational study. Neuroradiology 2021; 64:565-574. [PMID: 34477913 PMCID: PMC8850247 DOI: 10.1007/s00234-021-02799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/28/2021] [Indexed: 12/04/2022]
Abstract
Purpose Thrombectomy has been the gold standard therapy for anterior circulation occlusion; however, studies regarding thrombectomy in posterior circulation are lacking. In this study, we compared the efficiency of thrombectomy for acute large vessel occlusion between the posterior and anterior circulation at a single institution. Methods We retrospectively analyzed consecutive patients who underwent thrombectomy for acute large vessel occlusion at our institution between August 2014 and April 2021. Differences in the clinical background, time course, and treatment technique and outcomes were evaluated between anterior and posterior circulation occlusions. Results Overall, 353 patients (225 men and 128 women) were included: 314 patients had anterior circulation occlusion and 39 patients had posterior circulation occlusion. Between the patients with anterior and posterior circulation occlusions, the National Institutes of Health Stroke Scale (NIHSS) score (16 [12–21] vs. 29 [19–34], respectively, p < 0.001), door-to-puncture time (65 [45–99] vs. 99 [51–121] min, respectively, p = 0.018), and mortality (22 [7%] vs. 8 [20.5%] patients, respectively, p = 0.010) were significantly different; however, favorable outcome was not significantly different. Conclusion Higher NIHSS score, delayed treatment, and higher mortality were observed in posterior circulation occlusion than in anterior circulation occlusion; successful reperfusion and favorable outcomes were similar between them. Similar favorable outcomes and reperfusion ratio to the anterior circulation might be achieved also in the posterior circulation; however, delayed treatment and the optimal first-pass strategy might need further improvement.
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Affiliation(s)
- Tomoyoshi Kuribara
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Satoshi Iihoshi
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Eisuke Tsukagoshi
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Akio Teranishi
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yu Kinoshita
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shin Sugasawa
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shinya Kohyama
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shinichi Takahashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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188
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Onodera K, Kurisu K, Sakurai J, Wada H, Takebayashi S, Kobayashi T, Kobayshi R, Gotoh S, Takizawa K. A Direct Aspiration First Pass Technique for Vertebra-Basilar Occlusion: A Retrospective Comparison to Stent Retriever. J Stroke Cerebrovasc Dis 2021; 30:106069. [PMID: 34461445 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/01/2021] [Accepted: 08/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to assess the clinical usefulness of a direct aspiration first pass technique as a first-line strategy for mechanical thrombectomy in posterior circulation. MATERIALS AND METHODS We examined 34 consecutive patients treated with mechanical thrombectomy for acute vertebrobasilar artery occlusion. Procedural and clinical outcomes were assessed and compared between patients treated with a direct aspiration first pass technique first-line strategy (ADAPT group) and stent retriever system first-line strategy (stent retriever group). RESULTS Overall, successful reperfusion, complete reperfusion, and first-pass effects were achieved in 94.1%, 61.8%, and 50% of patients with acute ischemic stroke in vertebra-basilar artery occlusion treated with mechanical thrombectomy, respectively. The ADAPT group required a significantly shorter procedural time (p=.015) and fewer attempts (p=.0498) to achieve successful recanalization than the stent retriever group. The ADAPT group also tended to show better recanalization rates and first-pass effects than the stent retriever group. The rates of favorable outcomes seemed to be better, although insignificant, in the ADAPT group than in the stent retriever group (52.2% vs. 27.3%, p=.217). However, a significant correlation between the time required for reperfusion and clinical outcome was detected, and this will serve as the rationale for encouraging a direct aspiration first pass technique as a first-line strategy in the acute vertebra-basilar artery. CONCLUSIONS The a direct aspiration first pass technique first-line strategy for mechanical thrombectomy in posterior circulation may achieve successful recanalization with fewer attempts and shorter durations than the stent retriever first-line strategy.
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Affiliation(s)
- Koki Onodera
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan
| | - Kota Kurisu
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Juro Sakurai
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Hajime Wada
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Seiji Takebayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Tohru Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Rina Kobayshi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Shuho Gotoh
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
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189
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Kurisu K, Sakurai J, Wada H, Takebayashi S, Kobayashi T, Kobayshi R, Gotoh S, Onodera K, Takizawa K. ADAPT First-Line Strategy for MCA Mainstem Occlusion; Analysis for Optimal Salvage Therapy and its Related Factor. J Stroke Cerebrovasc Dis 2021; 30:106070. [PMID: 34461443 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/28/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES A direct first-pass aspiration technique (ADAPT) is an attractive interventional technique for mechanical thrombectomy (MT), which could achieve recanalization quickly and safely at a small amount of material resources. To clarify its usefulness, our ADAPT first-line strategy for middle cerebral artery (MCA)-mainstem occlusion was retrospectively analyzed. MATERIALS AND METHODS We reviewed 54 consecutive patients who underwent MT for MCA-mainstem occlusion using ADAPT first-line strategy. A salvage procedure was concurrently conducted in cases that failed to achieve successful recanalization by ADAPT attempt alone. Procedural and clinical outcome were assessed in both ADAPT alone and Salvage groups. Further investigation was performed in cases that required salvage procedure to determine the reason, risk factors, and optimal procedure. RESULTS Forty-one patients (75.9%) were able to achieve successful recanalization with ADAPT technique alone. In salvage group, the procedural time was longer, and rates of successful recanalization were lower than in ADAPT-alone group. No significant difference in the rates of favorable outcomes was observed. Among 13 patients who required salvage therapy, the major reason (eight cases) was intra-procedural "thrombus distal migration". Failure of recanalization was seen in two cases due to "inaccessibility". In patients who had "thrombus distal migration", occlusion in the proximal portion was more frequently observed than in patients who did not (p = 0.032, 63.6% vs. 23.3%). CONCLUSIONS Our ADAPT first-line strategy for MCA-mainstem occlusion demonstrated favorable procedural and clinical outcomes, even in cases that required additional procedures. Further investigation and better understanding are required to refine this promising procedure.
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Affiliation(s)
- Kota Kurisu
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Juro Sakurai
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Hajime Wada
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Seiji Takebayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Tohru Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Rina Kobayshi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Shuho Gotoh
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Koki Onodera
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
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190
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Blasco J, Puig J, López-Rueda A, Daunis-I-Estadella P, Llull L, Zarco F, Macias N, Macho J, González E, Labayen I, Vega P, Murias E, Jimenez-Gomez E, Bravo Rey I, Moreu M, Pérez-García C, Chirife Chaparro O, Aixut S, Terceño M, Werner M, Pumar JM, Aguilar Tejedor Y, Mendez JC, Moliner S, Nogueira RG, San Roman L. Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke. J Neurointerv Surg 2021; 14:863-867. [PMID: 34452989 DOI: 10.1136/neurintsurg-2021-017760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS. METHODS Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after single device pass. RESULTS We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68-85) vs 73.5 (65-82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14-46) vs 37 (24.5-63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0-2) at 3 months across these techniques. CONCLUSIONS Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.
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Affiliation(s)
- Jordi Blasco
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep Puig
- IDI-Radiology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Antonio López-Rueda
- Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Laura Llull
- Neurology Department, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
| | - Federico Zarco
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Napoleon Macias
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Juan Macho
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Eva González
- Interventional Neuroradiology, Radiology, Hospital Cruces, Bilbao, Spain
| | - Ion Labayen
- Cruces University Hospital, Barakaldo, País Vasco, Spain
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Elvira Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain
| | - Isabel Bravo Rey
- Neurorradiologia, Hospital universitario Reina Sofia, Córdoba, Spain
| | - Manuel Moreu
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Interventional Neuroradiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | - Sonia Aixut
- Neuroradiology, Hospital Universitari de Bellvitge, Barcelona, Cataluña, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.,Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mariano Werner
- Department of Radiology, Hospital Clinic I Provincial de Barcelona, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - José Manuel Pumar
- Neuroradiology, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Yeray Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Jose Carlos Mendez
- Interventional Neuroradiology Unit, Radiology, Hospital Ramón y Cajal, Madrid, Spain
| | - Sarai Moliner
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
| | - Raul G Nogueira
- Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis San Roman
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
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191
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Ko HC. The clinical outcomes of mechanical thrombectomy for proximal M1 occlusion involving lenticulostriate perforators: Is it worse than distal M1 occlusion? Retrospective observational study. Medicine (Baltimore) 2021; 100:e27036. [PMID: 34449484 PMCID: PMC8389878 DOI: 10.1097/md.0000000000027036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/09/2021] [Indexed: 01/04/2023] Open
Abstract
Although the success rate of recanalization in acute intracranial artery occlusion is high, there is a poor rate of improvement in functional clinical outcome. The purpose of this study was to assess the functional outcome of mechanical thrombectomy for proximal M1 occlusion involving lenticulostriate arteries (LSAs) compared with distal M1 occlusion-sparing the LSAs.A retrospective analysis was conducted in patients with middle cerebral artery (MCA) M1 occlusions who had a successful recanalization subsequent to mechanical thrombectomy. The recanalization results were estimated using the thrombolysis in cerebral infarction grade assessed by digital subtraction angiography. To confirm the ischemic change resulting from the lenticulostriate artery occlusion, we reviewed the neuroimaging findings from magnetic resonance imaging 1 day after mechanical thrombectomy. The functional outcomes were then evaluated using the modified Rankin scale at 90 days.In total, 28 patients with MCA M1 occlusion had successful recanalization outcomes with thrombolysis in cerebral infarction grades IIa, IIb, and III. Among the 28 patients, 17 had proximal M1 occlusions and 11 had distal M1 occlusions. Demographic factors, including initial National Institutes of Health Stroke Scale score, time from symptom to recanalization, and recanalization rate did not differ considerably between patients with proximal and distal M1 occlusions. Regarding infarctions in the basal ganglia, internal capsule, and corona radiata, there were statistically significant differences between the proximal and distal M1 occlusions. However, there were no significant differences in good functional outcome (modified Rankin scale ≤2) observed between the groups at 90 days after mechanical thrombectomy.Although proximal M1 occlusion had more frequent infarctions associated with the LSA territories, these were not related to poor functional outcomes. Both proximal and distal M1 occlusion demonstrated comparably good outcomes.
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Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- College of Medicine, Kyung Hee University, Seoul, South Korea
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192
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Aubertin M, Weisenburger-Lile D, Gory B, Richard S, Blanc R, Ducroux C, Piotin M, Labreuche J, Lucas L, Dargazanli C, Benali A, Bourcier R, Detraz L, Vannier S, Guillen M, Eugene F, Walker G, Lun R, Guenego A, Consoli A, Marnat G, Maier B, Lapergue B, Fahed R. First-Pass Effect in Basilar Artery Occlusions: Insights From the Endovascular Treatment of Ischemic Stroke Registry. Stroke 2021; 52:3777-3785. [PMID: 34433309 DOI: 10.1161/strokeaha.120.030237] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In the settings of thrombectomy, the first-pass effect (FPE), defined by a complete recanalization after one pass with no rescue therapy, has been shown to be associated with an improved outcome. As this phenomenon has been predominantly described in anterior circulation strokes, we aimed to study the prevalence, outcomes, and predictors of FPE in patients with a basilar artery occlusion. METHODS From a prospective multicentric registry, we collected the data of all consecutive basilar artery occlusion patients who underwent thrombectomy and compared the outcomes of patients who achieved FPE and those who did not. We also compared FPE patients with those who achieved a complete recanalization with >1 pass. Finally, a multivariate analysis was performed to determine the predictors of FPE. RESULTS Data from 280 patients were analyzed in our study, including 84 of 280 patients (30%) with an atheromatous etiology. An FPE was achieved in 93 patients (33.2%), with a significantly higher proportion of good outcomes (modified Rankin Scale score 0-2 at 3 months) and lower mortality than non-FPE patients. An FPE was also associated with improved outcomes compared with patients who went on to have full recanalization with >1 pass. Contact aspiration as first-line strategy was a strong predictor of FPE, whereas baseline antiplatelets and atheromatous etiology were negative predictors. CONCLUSIONS In our study, an FPE was achieved in approximately one-third of patients with a basilar artery occlusion and was associated with improved outcomes. More research is needed to improve devices and techniques to increase the incidence of FPE. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.
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Affiliation(s)
- Mathilde Aubertin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F.)
| | | | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, France. (B.G.).,Imagerie Adaptative Diagnostique et Interventionnelle, INSERM U1254, Université de Lorraine, France. (B.G.)
| | - Sébastien Richard
- Stroke Unit, Department of Neurology, CHRU-Nancy, Université de Lorraine, France. (S.R.).,INSERM U1116, CHRU-Nancy, France (S.R.)
| | - Raphael Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F.)
| | - Célina Ducroux
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F.)
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F.)
| | - Julien Labreuche
- Université de Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, France (J.L.)
| | - Ludovic Lucas
- Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, France (L.L.)
| | - Cyril Dargazanli
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France (C. Dargazanli, A.B.)
| | - Amel Benali
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France (C. Dargazanli, A.B.)
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, Université de Nantes, France (R. Bourcier, L.D.)
| | - Lili Detraz
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, Université de Nantes, France (R. Bourcier, L.D.)
| | - Stéphane Vannier
- Department of Neurology, Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (S.V., M.G.)
| | - Maud Guillen
- Department of Neurology, Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (S.V., M.G.)
| | - François Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (F.E.)
| | - Gregory Walker
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada (G.W., R.L., R.F.).,Department of Medicine, Division of Neurology, Royal Columbian Hospital, New Westminster, University of British Columbia, Canada (G.W.)
| | - Ronda Lun
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada (G.W., R.L., R.F.)
| | - Adrien Guenego
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F.).,Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.)
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France (A.C.)
| | - Gaultier Marnat
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, France (G.M.)
| | - Benjamin Maier
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F.)
| | | | - Robert Fahed
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F.).,Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada (G.W., R.L., R.F.)
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193
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Ni CF, Cheng SJ, Chen CY, Yeh TH, Hsieh KLC. Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them? Front Neurol 2021; 12:689606. [PMID: 34421793 PMCID: PMC8375030 DOI: 10.3389/fneur.2021.689606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Recent trials have demonstrated the superior efficacy of mechanical thrombectomy over other medical treatments for acute ischemic stroke; however, not every large vessel occlusion (LVO) can be recanalized using a single thrombectomy device. Rescue devices were proved to increase the reperfusion rate, but the efficacy is unclear. Objective: In this retrospective study, we evaluated the efficacy of rescue therapy in different locations of LVO. Methods: We analyzed the outcomes of mechanical thrombectomy from a prospective registry of consecutive 82 patients in Taipei Medical University Hospital. The reperfusion rate and the functional outcome were compared in patients who received first-line therapy only and patients who need rescue therapy. Results: An 84.1% reperfusion rate was achieved in our cohort. We applied first-line stent retriever (SR) treatment in 6 patients, among which 4 (66.6%) achieved successful reperfusion. We applied a direct-aspiration first-pass technique (ADAPT) as the first-line treatment in 76 patients, among which 46 (60.5%) achieved successful reperfusion. Successful reperfusion could not be achieved in 30 cases (39.5%); therefore, we applied a second-line rescue SR for 28 patients, and reperfusion was established in 18 (64.3%) of them. These results revealed that the LVO in anterior circulation has a higher chance to respond to SR rescue therapy than posterior circulation lesions (68 vs. 33.3%, P < 0.001). Patients who received only first-line therapy exhibited significantly better functional outcomes than those who were also treated with rescue SR therapy (41.2 vs. 16.7%, P = 0.001). In addition, patients with LVO in the anterior circulation were found to have a higher probability of achieving functional independence than patients with posterior circulation lesions (10.7 vs. 0.0%, P < 0.001). The adjusted multivariate analysis revealed that successful reperfusion and treatment type (first-line or rescue therapy) were significantly related to a modified Rankin Scale (mRS) score at 90 days. Conclusion: This study reveals that rescue SR therapy improves the reperfusion rate. Patients who require rescue SR therapy have a lower likelihood of functional independence. LVO in the anterior circulation responds better to rescue SR therapy and results in better functional outcomes than posterior circulation lesions.
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Affiliation(s)
- Cheng-Fu Ni
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Yu Chen
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tu-Hsueh Yeh
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Gusev EI, Martynov MY, Nikonov AA, Shamalov NA, Semenov MP, Gerasimets EA, Yarovaya EB, Semenov AM, Archakov AI, Markin SS. Non-immunogenic recombinant staphylokinase versus alteplase for patients with acute ischaemic stroke 4·5 h after symptom onset in Russia (FRIDA): a randomised, open label, multicentre, parallel-group, non-inferiority trial. Lancet Neurol 2021; 20:721-728. [PMID: 34418399 DOI: 10.1016/s1474-4422(21)00210-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Non-immunogenic staphylokinase is modified recombinant staphylokinase with low immunogenicity, high thrombolytic activity, and selectivity to fibrin. We aimed to assess the safety and efficacy of a single intravenous bolus of non-immunogenic staphylokinase compared with alteplase in patients with acute ischaemic stroke within 4·5 h after symptom onset. METHODS We did a randomised, open-label, multicentre, parallel-group, non-inferiority trial in 18 clinical sites in Russia. We included patients aged 18 years and older with a diagnosis of acute ischaemic stroke (up to 25 points on the National Institutes of Health Stroke Scale). The study drug had to be administered within 4·5 h after the onset of symptoms. Patients were randomly assigned to receive either non-immunogenic staphylokinase (10 mg) or alteplase (0·9 mg/kg, maximum 90 mg), both administered intravenously. The randomisation sequence was created by an independent biostatistician using computer-generated random numbers. 84 blocks (block size of four) of opaque sealed envelopes were numbered sequentially from 1 to 336 and were opened in numerical order. Patients were unaware of their assigned treatment and were assessed by the study investigators who were also unaware of the treatment assignment on all trial days. Emergency department staff, who administered the assigned drug and opened the envelopes, were not masked to treatment. The primary efficacy endpoint was a favourable outcome, defined as a modified Rankin scale (mRS) score of 0-1 on day 90. The margin of non-inferiority was established as 16% for the difference in mRS score of 0-1 on day 90. Non-inferiority was tested using Welch's t-test for the primary outcome only. Endpoints were analysed in the per-protocol population, which comprised all randomly assigned patients who completed treatment without any protocol violations; this population was identical to the intention-to-treat population. This trial is completed and registered at ClinicalTrials.gov, NCT03151993. FINDINGS Of 385 patients recruited from March 18, 2017, to March 23, 2019, 336 (87%) were included in the trial. 168 (50%) patients were randomly assigned to receive non-immunogenic staphylokinase and 168 (50%) to receive alteplase. The median duration of follow-up was 89 days (IQR 89-89). 84 (50%) of 168 patients in the non-immunogenic staphylokinase group had a favourable outcome at day 90 compared with 68 (40%) of 168 patients in the alteplase group (odds ratio [OR] 1·47, 95% CI 0·93 to 2·32; p=0·10). The difference in the rate of favourable outcome at day 90 was 9·5% (95% CI -1·7 to 20·7) and the lower limit did not cross the margin of non-inferiority (pnon-inferiority <0·0001). Symptomatic intracranial haemorrhage occurred in five (3%) patients in the non-immunogenic staphylokinase group and in 13 (8%) patients in the alteplase group (p=0·087). On day 90, 17 (10%) patients in the non-immunogenic staphylokinase group and 24 (14%) patients in the alteplase group had died (p=0·32). 22 (13%) patients in the non-immunogenic staphylokinase group had serious adverse events, compared with 37 (22%) patients in the alteplase group (p=0·044). INTERPRETATION Non-immunogenic staphylokinase was non-inferior to alteplase for patients with acute ischaemic stroke. Mortality, symptomatic intracranial haemorrhage, and serious adverse events did not differ significantly between groups. Future studies are needed to continue to assess the safety and efficacy of non-immunogenic staphylokinase in patients with acute ischaemic stroke within the 4·5 h time window, and to assess the drug in patients with acute ischaemic stroke outside this time window with reperfusion CT or magnetic resonance angiography followed by thrombectomy if necessary. FUNDING The Russian Academy of Sciences.
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Affiliation(s)
- Eugene I Gusev
- Department of Neurology, Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow, Russia.
| | - Mikhail Yu Martynov
- Department of Neurology, Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow, Russia
| | - Alexey A Nikonov
- Department of Neurology, Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow, Russia
| | - Nikolay A Shamalov
- Federal State Budgetary Institution, Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency, Moscow, Russia
| | - Michail P Semenov
- Medical Department, Peoples' Friendship University of Russia, Moscow, Russia
| | - Eugene A Gerasimets
- Medical Department, Peoples' Friendship University of Russia, Moscow, Russia
| | - Elena B Yarovaya
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia
| | - Andrey M Semenov
- Medical Department, Peoples' Friendship University of Russia, Moscow, Russia; SuperGene, Moscow, Russia
| | | | - Sergey S Markin
- Institute of Biomedical Chemistry, Moscow, Russia; SuperGene, Moscow, Russia
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195
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Rozes C, Maier B, Gory B, Bourcier R, Kyheng M, Labreuche J, Consoli A, Mazighi M, Blanc R, Caroff J, Eugene F, Naggara O, Gariel F, Sibon I, Lapergue B, Marnat G. Influence of prior intravenous thrombolysis on outcome after failed mechanical thrombectomy: ETIS registry analysis. J Neurointerv Surg 2021; 14:688-692. [PMID: 34413246 DOI: 10.1136/neurintsurg-2021-017867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/15/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite constant improvements in recent years, sufficient reperfusion after mechanical thrombectomy (MT) is not reached in up to 15% of patients with large vessel occlusion stroke (LVOS). The outcome of patients with unsuccessful reperfusion after MT especially after intravenous thrombolysis (IVT) use is not known. We investigated the influence of initial IVT in this particular group of patients with failed intracranial recanalization. METHODS We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry from January 2015 to December 2019. Patients presenting with LVOS of the anterior circulation and final modified Thrombolysis in Cerebral Infarction score (mTICI) of 0, 1 or 2a were included. Posterior circulation, isolated cervical carotid occlusions and successful reperfusions (mTICI 2b, 2c or 3) were excluded. The primary endpoint was favorable outcome (modified Rankin Scale score of 0-2) after 3 months. Secondary endpoints were safety outcomes including mortality, any intracranial hemorrhage (ICH), parenchymal hematoma (PH) and symptomatic intracranial hemorrhage (sICH) rates. RESULTS Among 5076 patients with LVOS treated with MT, 524 patients with insufficient recanalization met inclusion criteria, of which 242 received IVT and 282 did not. Functional outcome was improved in the MT+IVT group compared with the MT alone group, although the difference did not reach statistical significance (23.0% vs 12.9%; adjusted OR=1.82; 95% CI 0.98 to 3.38; p=0.058). However, 3 month mRS shift analysis showed a significant benefit of IVT (adjusted OR=1.68; 95% CI 1.56 to 6.54). ICH and sICH rates were similar in both groups, although PH rate was higher in the MT+IVT group (adjusted OR=3.20; 95% CI 1.56 to 6.54). CONCLUSIONS Among patients with LVOS in the anterior circulation and unsuccessful MT, IVT was associated with improved functional outcome even after unsuccessful MT. Despite recent trials questioning the place of IVT in the LVOS reperfusion strategy, these findings emphasize a subgroup of patients still benefiting from IVT.
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Affiliation(s)
- Claire Rozes
- Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Maier
- Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France.,INSERM U1254, Université de Lorraine, Nancy, France
| | - Romain Bourcier
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Maeva Kyheng
- CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, Université de Lille, Lille, Hauts-de-France, France
| | | | | | - Mikael Mazighi
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.,Université de Paris, Paris, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | - Olivier Naggara
- Neuroradiology, Centre Hospitalier Sainte Anne, Paris, Île-de-France, France.,INSERM UMR 894, Paris, France
| | - Florent Gariel
- Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- UMR 5287 CNRS; EPHE PSL Research University, Université de Bordeaux, Bordeaux, France.,Neurology Department, CHU de Bordeaux, Bordeaux, France
| | | | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
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196
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Diana F, Vinci SL, Ruggiero M, Semeraro V, Bracco S, Frauenfelder G, Paolucci A, Cirillo L, Pesce A, Tessitore A, Commodaro C, Ganimede MP, Zanoni M, Saponiero R, Zini A, Velo M, Modello B, Burdi N, Cioni S, Simonetti L, Romano DG. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience. J Neurointerv Surg 2021; 14:666-671. [PMID: 34349012 DOI: 10.1136/neurintsurg-2021-017585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is no consensus on the most effective endovascular technique to use in patients with acute ischemic stroke due to terminal internal carotid artery (ICA) occlusion. The aim of this study was to compare safety and efficacy of the aspiration technique (AT) and combined technique (CT) as first-line approach in terminal ICA occlusions. METHODS We performed a retrospective analysis of prospectively collected databases from seven Italian stroke centers. Patients were divided into two subgroups according to the first-line approach: AT group or CT group. We followed the STROBE guidelines for cohort studies. We used Chi-square test, one-way and multivariate ANOVA analysis, together with contrast analysis and post hoc tests, logistic regression and Pearson's bivariate correlation for the statistical analyses. RESULTS Between January 2018 and August 2020, 353 patients were treated for a terminal ICA occlusion, with either AT or CT. CT was associated with a higher Thrombolysis in Cerebral Infarction (TICI) 2B-3 after the first pass (51.0% vs 26.9%) and at the end of the procedure (84% vs 73.3%) and with an improved clinical outcome at discharge (modified Rankin Scale (mRs) 0-2 of 47.8% vs 34.0%) and at 3 months' follow-up (mRs 0-2 of 56.5% vs 38.9%) compared with AT. CONCLUSION Thrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.
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Affiliation(s)
- Francesco Diana
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Vittorio Semeraro
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Sandra Bracco
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Giulia Frauenfelder
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Aldo Paolucci
- Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Luigi Cirillo
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.,DIBINEM, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Pesce
- Department of Neurosurgery, Ospedale Santa Maria Goretti, Latina, Italy
| | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Christian Commodaro
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Maria Porzia Ganimede
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Matteo Zanoni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Renato Saponiero
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Mariano Velo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Beatrice Modello
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Nicola Burdi
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Samuele Cioni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Luigi Simonetti
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Daniele Giuseppe Romano
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
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197
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Liang C, Zhang T, Shi X, Jia L, Wang Y, Yan C. Modified Renshen Yangrong decoction enhances angiogenesis in ischemic stroke through promotion of MicroRNA-210 expression by regulating the HIF/VEGF/Notch signaling pathway. Brain Behav 2021; 11:e2295. [PMID: 34337881 PMCID: PMC8413772 DOI: 10.1002/brb3.2295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aims to investigate the efficacy of modified Ginseng Yangrong decoction (GSYRD) promoting angiogenesis after ischemic stroke. METHODS In an in vivo study, rats that survived surgery were allocated into four groups: the control group and model group were treated with normal saline, the GSYRD group was treated with 18.9 mg/kg of GSYRD daily, and the positive control group was treated with Tongxinluo (TXL) (1 g/kg/d). At the end of the seven-day treatment, the area of cerebral infarction, the expression changes of miRNA-210 and ephrin A3 were determined. In an in vitro study, HUVECs were divided into a normal control serum group (NC group), normal control serum OGD group (Oxygen Glucose Deprivation group) (OGD group), OGD + drug-containing serum group (OGD+GSYRD group), and OGD + drug-containing serum + ES group (Endostatin group) (OGD+GSYRD+ES group). The cells in all groups except the NC group were cultured in a sugar-free DMEM medium under hypoxia for 48 h. Cell proliferation, angiogenic structure formation ability, the expression changes of miRNA-210, ephrin A3, and the HIF/VEGF/Notch signaling pathway-related molecules were determined. RESULTS In vivo, GSYRD significantly reduced infarct size (p < .01), the expression of miRNA-210 and ephrin A3 were decreased in the GSYRD group (p < .05). In vitro, the cell proliferation and tube formation ability were significantly increased in the GSYRD group (p < .05), and the expression of miRNA-210 and ephrin A3 was decreased (p < .05). In addition, in the GSYRD group, the expression of the HIF/VEGF/Notch signaling pathway-related molecules was significantly increased (p < .01 or p < .05). CONCLUSION GSYRD promotes cerebral protection following angiogenesis and ischemic brain injury. The specific mechanism was activating the HIF/VEGF/Notch signaling pathway via miRNA-210.
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Affiliation(s)
- Ce Liang
- Department of Hebei TCM Formula Granule Innovation CenterHebei University of Chinese MedicineShijiazhuangChina
| | - Teng Zhang
- Department of Health Commission of Hebei ProvinceDepartment of Health of Traditional Chinese MedicineShijiazhuangChina
| | - Xu‐Liang Shi
- Department of Acupuncture and MoxibustionHebei University of Chinese MedicineShijiazhuangChina
| | - Lin Jia
- Department of RespiratoryHebei Provincial Hospital of Traditional Chinese MedicineShijiazhuangChina
| | - Ya‐Li Wang
- Department of Teaching and Research Section of Integrative MedicineHebei Medical UniversityShijiazhuangChina
| | - Cui‐Huan Yan
- Department of Internal MedicineHebei University of Chinese MedicineShijiazhuangChina
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198
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Marnat G, Delvoye F, Finitsis S, Lapergue B, Gariel F, Consoli A, Desilles JP, Mazighi M, Dargazanli C, Bourcier R, Darcourt J, Chalumeau V, Elhorany M, Clarençon F, Richard S, Gory B, Sibon I. A Multicenter Preliminary Study of Cangrelor following Thrombectomy Failure for Refractory Proximal Intracranial Occlusions. AJNR Am J Neuroradiol 2021; 42:1452-1457. [PMID: 34117019 DOI: 10.3174/ajnr.a7180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/09/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Rescue endovascular and pharmacologic approaches are increasingly being adopted after recanalization failure of acute large-vessel occlusion strokes with mechanical thrombectomy, with encouraging results. The safety and efficacy of glycoprotein IIb/IIIa inhibitors in ischemic stroke have been investigated, though cangrelor, a recent intravenous P2Y12-receptor inhibitor with a rapid onset/offset of action and a short half-life, may be a valuable option. We compared the safety and efficacy of cangrelor with those of glycoprotein IIb/IIIa inhibitors for refractory occlusions. MATERIALS AND METHODS We performed a retrospective analysis of the ongoing prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke Registry in France between May 2012 and February 2020. Refractory intracranial occlusions of the anterior and posterior circulation were included and defined as recanalization failure of large-vessel occlusion stroke, perioperative target artery reocclusion, or high risk of early reocclusion related to an arterial wall lesion. The primary end point was a favorable outcome, defined as a 90-day mRS of 0-2. Secondary end points were reperfusion, intracranial hemorrhage, and procedural complications. RESULTS Among 69 patients, 15 were treated with cangrelor, and 54, with glycoprotein IIb/IIIa inhibitors. The favorable outcome (adjusted OR = 2.22; 95% CI, 0.42-11.75; P = .348) and mortality (adjusted OR = 0.44; 95% CI, 0.06-3.16; P = .411) rates were similar in both groups. There was no difference in the rates of any intracranial hemorrhage (adjusted OR = 0.40; 95% CI, 0.08-2.09; P = .280), symptomatic intracranial hemorrhage (6.7% versus 0.0%, P = .058), or procedural complications (6.7% versus 20.4%, P = .215). Reperfusion rates were higher in the cangrelor group, though the difference did not reach statistical significance (93.3% versus 75.0% for modified TICI 2b-3; adjusted OR =10.88; 95% CI, 0.96-123.84; P = .054). CONCLUSIONS Cangrelor seems to be as safe as glycoprotein IIb/IIIa inhibitors for managing refractory intracranial occlusion and leads to satisfactory brain reperfusion. Cangrelor is a promising agent in this setting, and additional studies are warranted to confirm our findings.
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Affiliation(s)
- G Marnat
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - F Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - S Finitsis
- Aristotle University of Thessaloniki (S.F.), Ahepa Hospital, Thessaloniki, Greece
| | - B Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - F Gariel
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - A Consoli
- Department s of Neuroradiology (A.C.) and Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - J-P Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - C Dargazanli
- Department of Neuroradiology (C.D.), Centre Hospitalier Régional Universitaire Gui de Chauliac, Montpellier, France
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - J Darcourt
- Department of Neuroradiology (J.D.), University Hospital of Toulouse, Toulouse, France
| | - V Chalumeau
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - M Elhorany
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - F Clarençon
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - S Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Régional Universitaire-Nancy, Stroke Unit, Nancy, France
- Institut national de la santé et de la recherche médicale U1116 (S.R.), Centre Hospitalier Régional Universitaire-Nancy, Nancy, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, CHRU-Nancy, Nancy, France
- Institut National de la Santé et de la Recherche Mmédicale U1254 (B.G.), Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
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199
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Endovascular Thrombectomy Treatment: Beyond Early Time Windows and Small Core. Top Magn Reson Imaging 2021; 30:173-180. [PMID: 34397966 DOI: 10.1097/rmr.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Tremendous advancements in the treatment of acute ischemic stroke in the last 25 years have been based on the principle of reperfusion in early time windows and identification of small core infarct for intravenous thrombolysis and mechanical thrombectomy. Advances in neuroimaging have made possible the safe treatment of patients with acute ischemic stroke in longer time windows and with more specific selection of patients with salvageable brain tissue. In this review, we discuss the history of endovascular stroke thrombectomy trials and highlight the neuroimaging-based trials that validated mechanical thrombectomy techniques in the extended time window with assessment of penumbral tissue. We conclude with a survey of currently open trials that seek to safely expand eligibility for this highly efficacious treatment.
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200
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Guo X, Miao Z. Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions. Stroke Vasc Neurol 2021; 6:649-657. [PMID: 34285134 PMCID: PMC8717796 DOI: 10.1136/svn-2021-000972] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Advances in endovascular treatment of acute ischaemic stroke from intracranial large vessel occlusions have continued in the past decade. Here, we performed a detailed review of all the new trials and studies that had the highest evidence, the guidelines for mechanical thrombectomy, the selection of the particular population outside the guidelines and endovascular therapeutic strategies for acute ischemic stroke from occluded intracranial arteries.
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Affiliation(s)
- Xu Guo
- Intervetional Neurology, Capital Medical University Affiliated Anzhen Hospital, Chaoyang-qu, China
| | - Zhongrong Miao
- Interventinal Neuroradiology, Beijing Tiantan Hospital, Beijing, China
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