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Bhatia S, Riccobono G, Lima NJ, Cruz JT, Prusener DW, Domingo R, Ghaith AK, Rios-Zermeno J, Kashyap S, Tawk RG. Percutaneous Closure Device for the Carotid artery: An integrated review and design analysis. J Neurointerv Surg 2024; 16:567-571. [PMID: 37739794 DOI: 10.1136/jnis-2023-020702] [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: 06/16/2023] [Accepted: 08/11/2023] [Indexed: 09/24/2023]
Abstract
Endovascular thrombectomies (EVTs) are the current standard of care therapy for treating acute ischemic strokes. While access through the femoral or radial arteries is routine, up to 20% of EVTs through these sites are unable to access the cerebral vasculature on the first pass. These shortcomings are commonly due to tortuous vasculature, atherosclerotic arteries, and type III aortic arch, seen especially in the elderly population. Recent studies have shown the benefits of accessing the cerebral vasculature through a percutaneous direct carotid puncture (DCP), which can reduce the time of the procedure by half. However, current vascular closure devices (VCDs) designed for the femoral artery are not suited to close the carotid artery due to the anatomical differences. This unmet clinical need further limits a DCP approach. Thus, to foster safe adoption of this potential approach, a VCD designed specifically for the carotid artery is needed. In this review, we outline the major biomechanical properties and shortcomings of current VCDs and propose the requirements necessary to effectively design and develop a carotid closure device.
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Affiliation(s)
- Shovan Bhatia
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Nicholas J Lima
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Joshua T Cruz
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Derek W Prusener
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ricardo Domingo
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Jorge Rios-Zermeno
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Samir Kashyap
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Rabih G Tawk
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
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Abbasi MH, Patel SD, Ashour RR, Miley JT, Paydarfar D, Warach S, Saber H. National trends in the endovascular and surgical treatment of idiopathic intracranial hypertension. J Stroke Cerebrovasc Dis 2024; 33:107637. [PMID: 38360251 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107637] [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: 09/28/2023] [Revised: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The pattern of surgical treatments for Idiopathic Intracranial Hypertension (IIH) in the United States is not well-studied, specifically the trend of utilizing endovascular venous stenting (EVS) as an emerging technique. METHODS In this cross-sectional study, we aimed to explore the national trend of utilizing different procedures for the treatment of IIH including EVS, Optic Nerve Sheath Fenestration (ONSF), and CSF Shunting, with a focus on novel endovascular procedures. Moreover, we explored rates of 90-day readmission and length of hospital stay following different procedures, besides the effects of sociodemographic and clinical parameters on procedure choice. RESULTS 36,437 IIH patients were identified from records between 2010 and 2018. Those in the EVS group were 29 years old on average, and 93.4 % were female. Large academic hospital setting was independently associated with higher EVS utilization, while other factors were not predictive of procedure choice. The proportion of EVS use in IIH hospitalizations increased significantly from 2010 to 2018 (P < 0.001), while there was a relative decline in the frequency of shunting procedures (P = 0.001), with ONSF utilization remaining stable (P = 0.39). The rate of 90-day readmission and length of hospital stay were considerably lower following EVS compared to other procedures (Ps < 0.001). CONCLUSION This study presents novel population-level data on national trends in the frequency and outcome of EVS for IIH therapy. EVS was associated with shorter length of hospital stays and fewer readmission rates. In addition, a continuous increase in venous stenting compared to other procedures suggests an increasing role for endovascular therapies in IIH.
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Affiliation(s)
- Mohammad Hossein Abbasi
- Department of Neurology, University of Texas at Austin Dell Medical School, 1601 Trinity street, Austin, TX, USA
| | - Smit D Patel
- Department of Neurology, Hartford Hospital, Hartford, CT, USA
| | - Ramsey R Ashour
- Department of Neurosurgery, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Jefferson T Miley
- Department of Neurology, University of Texas at Austin Dell Medical School, 1601 Trinity street, Austin, TX, USA; Department of Neurosurgery, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - David Paydarfar
- Department of Neurology, University of Texas at Austin Dell Medical School, 1601 Trinity street, Austin, TX, USA
| | - Steven Warach
- Department of Neurology, University of Texas at Austin Dell Medical School, 1601 Trinity street, Austin, TX, USA
| | - Hamidreza Saber
- Department of Neurology, University of Texas at Austin Dell Medical School, 1601 Trinity street, Austin, TX, USA; Department of Neurosurgery, University of Texas at Austin Dell Medical School, Austin, TX, USA.
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Charan BD, Gaikwad SB, Jain S, Garg A, Sebastian LJD, Srivastava MVP, Bhatia R, Pandit AK, Kale SS. An Institutional Perspective on the Number of Stent Retriever Pass and Rate of Recanalization in Mechanical Thrombectomy for Acute Ischemic Stroke: When to Stop? Acta Med Litu 2024; 31:75-80. [PMID: 38978857 PMCID: PMC11227687 DOI: 10.15388/amed.2024.31.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 07/10/2024] Open
Abstract
Background and purpose Mechanical thrombectomy is the standard treatment modality for flow restoration in acute ischemic stroke. In cases of persistent occlusion, the optimal number of retrieval attempts before considering procedure termination is currently undetermined and is a topic for research. Therefore in this study, we studied the impact of the number of stent retrieval maneuvers on the recanalization of vessels. Methods In this retrospective single-center observational study we included 52 patients with large vessel occlusion who underwent stent retriever mechanical thrombectomy. Successful recanalization rate was defined as modified TICI (Thrombolysis in Cerebral Infarction) 2b or 3. Result The overall successful recanalization rate was 44.24%. The recanalization rate per stent retrieval attempt was the highest in 1st attempt (28.84%) and no recanalization was observed with the 3rd, 5th, and 6th attempts (p<0.001). At most 6 retrieval attempts were used. Conclusions After two retrieval attempts, 91% of the patients were successfully recanalized and other after the 5th attempt could not result in recanalization.
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Affiliation(s)
- Bheru Dan Charan
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Savyasachi Jain
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishore Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Webb M, Essibayi MA, Al Kasab S, Maier IL, Psychogios MN, Grossberg JA, Alawieh A, Wolfe SQ, Arthur A, Dumont T, Kan P, Kim JT, De Leacy R, Osbun J, Rai A, Jabbour P, Park MS, Crosa R, Levitt MR, Polifka A, Yoshimura S, Matouk C, Williamson RW, Fragata I, Chowdhry SA, Starke RM, Samaniego EA, Cuellar H, Spiotta A, Mascitelli J. Predictors of Angiographic Outcome After Failed Thrombectomy for Large Vessel Occlusion: Insights from the Stroke Thrombectomy and Aneurysm Registry. Neurosurgery 2023; 93:1168-1179. [PMID: 37377425 DOI: 10.1227/neu.0000000000002560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Mechanical thrombectomy failure (MTF) occurs in approximately 15% of cases. OBJECTIVE To investigate factors that predict MTF. METHODS This was a retrospective review of prospectively collected data from the Stroke Thrombectomy and Aneurysm Registry. Patients who underwent mechanical thrombectomy (MT) for large vessel occlusion (LVO) were included. Patients were categorized by mechanical thrombectomy success (MTS) (≥mTICI 2b) or MTF ( RESULTS A total of 6780 patients were included, and 1001 experienced anterior circulation MTF. Patients in the MTF group were older (73 vs 72, P = .044) and had higher poor premorbid modified Rankin Scale (mRS) (10.8% vs 8.4%, P = .017). Onset to puncture time was greater in the MTF group (273 vs 260 min, P = .08). No significant differences were found between the access site, use of balloon guide catheter, frontline technique, or first-pass devices between the MTF and MTS groups. More complications occurred in the MTF group (14% vs 5.8%), including symptomatic intracerebral hemorrhage (9.4% vs 6.1%) and craniectomies (10% vs 2.8%) ( P < .001). On UVA, age, poor pretreatment mRS, increased number of passes, and increased procedure time were associated with MTF. Internal carotid artery, M1, and M2 occlusions had decreased odds of MTF. Poor preprocedure mRS, number of passes, and procedure time remained significant on MVA. A subgroup analysis of posterior circulation LVO revealed that number of passes and total procedure time correlated with increased odds of MTF ( P < .001) while rescue stenting was associated with less odds of MTF (odds ratio 0.20, 95% CI 0.06-0.63). Number of passes remained significant on MVA of posterior circulation occlusion subgroup analysis. CONCLUSION Anterior circulation MTF is associated with more complications and worse outcomes. No differences were found between techniques or devises used for the first pass during MT. Rescue intracranial stenting may decrease the likelihood of MTF for posterior circulation MT.
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Affiliation(s)
- Matthew Webb
- Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio , Texas , USA
| | | | - Sami Al Kasab
- Medical University of South Carolina, Charleston , South Carolina , USA
| | - Ilko L Maier
- University Medical Center Göttingen, Göttingen , Germany
| | | | | | | | | | - Adam Arthur
- University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Travis Dumont
- Bannner University of Arizona Medical Center, Tucson , Arizona , USA
| | - Peter Kan
- University of Texas Medical Branch, Galveston , Texas , USA
| | - Joon-Tae Kim
- Chonnam National University Hospital, Gwangju , South Korea
| | | | - Joshua Osbun
- Washington University in St. Louis, St. Louis , Missouri , USA
| | - Ansaar Rai
- Department of Neuroradiology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Pascal Jabbour
- Department of Neuroradiology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Min S Park
- Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA
| | - Roberto Crosa
- University of Virginia, Charlottesville , Virginia , USA
| | - Michael R Levitt
- Centro Endovascular Neurológico, Médica Uruguaya, Montevideo , Uruguay
| | - Adam Polifka
- University of Washington, Seattle , Washington , USA
| | | | | | | | - Isabel Fragata
- Allegheny General Hospital, Pittsburgh , Pennsylvania , USA
| | | | - Robert M Starke
- NorthShore University Health System, Evanston , Illinois , USA
| | | | | | - Alejandro Spiotta
- Medical University of South Carolina, Charleston , South Carolina , USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio , Texas , USA
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Mohammaden MH, Haussen DC, Al-Bayati AR, Hassan AE, Tekle W, Fifi JT, Matsoukas S, Kuybu O, Gross BA, Lang M, Narayanan S, Cortez GM, Hanel RA, Aghaebrahim A, Sauvageau E, Farooqui M, Ortega-Gutierrez S, Zevallos CB, Galecio-Castillo M, Sheth SA, Nahhas M, Salazar-Marioni S, Nguyen TN, Abdalkader M, Klein P, Hafeez M, Kan P, Tanweer O, Khaldi A, Li H, Jumaa M, Zaidi SF, Oliver M, Salem MM, Burkhardt JK, Pukenas B, Kumar R, Lai M, Siegler JE, Peng S, Alaraj A, Nogueira RG. General anesthesia vs procedural sedation for failed NeuroThrombectomy undergoing rescue stenting: intention to treat analysis. J Neurointerv Surg 2023; 15:e240-e247. [PMID: 36597943 DOI: 10.1136/jnis-2022-019376] [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: 07/11/2022] [Accepted: 10/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA). METHODS We searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study. In our review we included patients if they had anterior circulation large vessel occlusion strokes due to intracranial internal carotid artery (ICA) or middle cerebral artery (MCA-M1/M2) segments, failed MT, and underwent rescue ICAS. The cohort was divided into two groups: GA and non-GA. We used propensity score matching to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included functional independence (90-day mRS0-2) and successful reperfusion defined as mTICI2B-3. Safety measures included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. RESULTS Among 253 patients who underwent rescue ICAS, 156 qualified for the matching analysis at a 1:1 ratio. Baseline demographic and clinical characteristics were balanced between both groups. Non-GA patients had comparable outcomes to GA patients both in terms of the overall degree of disability (mRS ordinal shift; adjusted common odds ratio 1.29, 95% CI [0.69 to 2.43], P=0.43) and rates of functional independence (33.3% vs 28.6%, adjusted odds ratio 1.32, 95% CI [0.51 to 3.41], P=0.56) at 90 days. Likewise, there were no significant differences in rates of successful reperfusion, sICH, procedural complications or 90-day mortality among both groups. CONCLUSIONS Non-GA seems to be a safe and effective anesthesia strategy for patients undergoing rescue ICAS after failed MT. Larger prospective studies are warranted for more concrete evidence.
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Affiliation(s)
- Mahmoud H Mohammaden
- Neurology, Emory University, Atlanta, Georgia, USA
- Marcus Stroke and Neuroscience center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Neurology, Emory University, Atlanta, Georgia, USA
- Marcus Stroke and Neuroscience center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | | | - Ameer E Hassan
- Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Wondwossen Tekle
- Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stavros Matsoukas
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Okkes Kuybu
- Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
| | | | - Michael Lang
- Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Gustavo M Cortez
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Amin Aghaebrahim
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Mudassir Farooqui
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Cynthia B Zevallos
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Sunil A Sheth
- Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael Nahhas
- Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Thanh N Nguyen
- Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Piers Klein
- Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Muhammad Hafeez
- Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | - Ahmad Khaldi
- Neurosurgery, WellStar Health System, Marietta, Georgia, USA
| | - Hanzhou Li
- Department of Neurosciences, WellStar Health System, Marietta, Georgia, USA
| | - Mouhammad Jumaa
- Neurology, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Syed F Zaidi
- Neurology, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Marion Oliver
- Neurology, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Mohamed M Salem
- Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Bryan Pukenas
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rahul Kumar
- Cooper Hospital University Medical Center, Camden, New Jersey, USA
| | - Michael Lai
- Cooper Hospital University Medical Center, Camden, New Jersey, USA
| | - James E Siegler
- Cooper Hospital University Medical Center, Camden, New Jersey, USA
| | - Sophia Peng
- Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Raul G Nogueira
- Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
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Jesser J, Awounvo S, Vey JA, Vollherbst DF, Hilgenfeld T, Chen M, Nguyen TN, Schönenberger S, Bendszus M, Möhlenbruch MA, Weyland CS. Prediction and outcomes of cerebral vasospasm in ischemic stroke patients receiving anterior circulation endovascular stroke treatment. Eur Stroke J 2023; 8:684-691. [PMID: 37254510 PMCID: PMC10472964 DOI: 10.1177/23969873231177766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/07/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Vasospasm is a common complication of endovascular therapy (EVT). There is a lack of understanding of risk factors for periprocedural vasospasm. Here, we aimed to identify factors associated with vasospasm in patients with acute ischemic stroke who undergo EVT. METHODS We conducted a retrospective single-center analysis of patients receiving EVT for anterior circulation vessel occlusion between January 2015 and December 2021. Patients were excluded if they showed signs of intracranial atherosclerotic disease (ICAD) or if they underwent intra-arterial thrombolysis. Study groups were defined as patients developing vasospasm during EVT (V+) and patients who did not (V-). The study groups were compared in univariable analysis. Multivariable regression models were developed to predict the patient's risk for developing vasospasm based on pre-identified potential prognostic factors. The secondary endpoint was clinical outcome defined as the modified Rankin Scale (mRS) difference between pre-stroke mRS and discharge mRS (delta mRS) and likelihood of successful reperfusion (TICI 2b/3). RESULTS In total, 132/1768 patients (7.5%) developed vasospasm during EVT. Vasospasm was more likely to occur in EVT with multiple thrombectomy attempts and after several stent retriever maneuvers. Factors associated with developing vasospasm were younger age (OR = 0.967, 95% CI = 0.96-0.98) and lower pre-stroke mRS (OR = 0.759, 95% CI = 0.63-0.91). The prediction model incorporating patient age, pre-stroke mRS, stent retriever thrombectomy attempts, and total attempts as prognostic factors was found to predict vasospasm with good accuracy (AUC = 0.714, 95% CI = 0.709-0.720). V+ patients showed higher median (IQR) delta mRS (2 (1-4) vs 2 (1-3); p = 0.014). There was no difference in successful reperfusion (TICI 2b-3) between those with or without vasospasm. CONCLUSION Vasospasm was a common complication in EVT affecting younger and previously healthy patients. Presence of vasospasm did not reduce the likelihood of successful reperfusion. As independent predictors, patient age, pre-stroke mRS, thrombectomy maneuvers, and stent retriever attempts predict the occurrence of vasospasm during EVT with good accuracy.
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Affiliation(s)
- Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sinclair Awounvo
- Department of Medical Biometry, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes A Vey
- Department of Medical Biometry, Heidelberg University Hospital, Heidelberg, Germany
| | - Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Min Chen
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thanh N Nguyen
- Department of Neurology and Department of Radiology, Boston Medical Center, Boston, MA, USA
| | | | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Comparison of Safety and Efficacy after Emergency Stenting in Patients Exhibiting Intracranial Atherosclerotic Stenosis Associated with Large-vessel Occlusion with and without Intravenous Infusion of Tirofiban. Cardiovasc Intervent Radiol 2023; 46:377-384. [PMID: 36797426 PMCID: PMC10014670 DOI: 10.1007/s00270-023-03372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Intracranial rescue stent angioplasty is a bailout strategy for acute stroke patients in cases of unsuccessful endovascular thrombectomy due to underlying atherosclerotic stenosis. However, there is no consensus on a preprocedural and intraprocedural antiplatelet regimen. The aim of this single-centre study was to compare the safety and efficacy of emergency stenting in patients exhibiting intracranial atherosclerotic stenosis-related acute large-vessel occlusion with or without peri-interventional intravenous infusion of tirofiban. MATERIALS AND METHODS We performed a retrospective analysis of 78 patients who were treated with rescuestent angioplasty between 2010 and 2019 due to acute ischaemic stroke. The patients were divided into 2 groups: those who received peri-interventional intravenous tirofiban and those who did not receive tirofiban. We compared clinical safety and functional outcomes in both treatment groups with symptomatic haemorrhage as the primary endpoint. Bivariate and multivariable logistic regression was performed to investigate the association between tirofiban and outcome measures. RESULTS Thirty-seven patients were treated with intravenous tirofiban (47.4%), and 41 patients did not receive intravenous tirofiban (52.6%). Statistical analysis revealed no significant difference between the two groups in the rate of symptomatic haemorrhage (16.2% in the tirofiban group versus 14.6% in the control group, p = 0.847). The 3-month mortality (21.6% in the tirofiban group versus 17.1% in the control group, p = 0.611) and good functional outcomes according to the modified Rankin scale (45.9% versus 34.1%, p = 0.289) were comparable. CONCLUSION The results of our study suggest that the application of tirofiban for rescue stenting after failed mechanical thrombectomy is safe.
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Sidiq M, Scheidecker E, Potreck A, Neuberger U, Weyland CS, Mundiyanapurath S, Bendszus M, Möhlenbruch MA, Seker F. Aortic Arch Variations and Supra-aortic Arterial Tortuosity in Stroke Patients Undergoing Thrombectomy : Retrospective Analysis of 1705 Cases. Clin Neuroradiol 2023; 33:49-56. [PMID: 35695910 PMCID: PMC10014756 DOI: 10.1007/s00062-022-01181-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Unfavorable vascular anatomy can impede thrombectomy in patients with acute ischemic stroke. The aim of this study was to determine the prevalence of aortic arch types, aortic arch branching patterns and supra-aortic arterial tortuosity in stroke patients with large vessel occlusion. METHODS Computed tomography (CT) and magnetic resonance (MR) images of all stroke patients in an institutional thrombectomy registry were retrospectively reviewed. Aortic arch types and branching patterns of all patients were determined. In patients with anterior circulation stroke, the prevalence of tortuosity (elongation, kinking or coiling) of the supra-aortic arteries of the affected side was additionally assessed. RESULTS A total of 1705 aortic arches were evaluated. Frequency of aortic arch types I, II and III were 777 (45.6%), 585 (34.3%) and 340 (19.9%), respectively. In 1232 cases (72.3%), there was a normal branching pattern of the aortic arch. The brachiocephalic trunk and the left common carotid artery had a common origin in 258 cases (15.1%). In 209 cases (12.3%), the left common carotid artery arose from the brachiocephalic trunk. Of 1598 analyzed brachiocephalic trunks and/or common carotid arteries, 844 (52.8%) had no vessel tortuosity, 592 (37.0%) had elongation, 155 (9.7%) had kinking, and 7 (0.4%) had coiling. Of 1311 analyzed internal carotid arteries, 471 (35.9%) had no vessel tortuosity, 589 (44.9%) had elongation, 150 (11.4%) had kinking, and 101 (7.7%) had coiling. CONCLUSION With 20%, type III aortic arches are found in a relevant proportion of stroke patients eligible for mechanical thrombectomy. Nearly half of the stroke patients present with supra-aortic arterial tortuosity, mostly arterial elongation.
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Affiliation(s)
- Maiwand Sidiq
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Emilia Scheidecker
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Arne Potreck
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ulf Neuberger
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Charlotte S Weyland
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | | | - Martin Bendszus
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Fatih Seker
- Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Jesser J, Potreck A, Vollherbst D, Seker F, Chen M, Schönenberger S, Do TD, Bendszus M, Möhlenbruch MA, Weyland CS. Effect of intra-arterial nimodipine on iatrogenic vasospasms during endovascular stroke treatment - angiographic resolution and infarct growth in follow-up imaging. BMC Neurol 2023; 23:5. [PMID: 36604639 PMCID: PMC9814217 DOI: 10.1186/s12883-022-03045-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The treatment of vasospasms during endovascular stroke treatment (EST) with intra-arterial nimodipine (NM) is routinely performed. However, the efficacy of resolving iatrogenic vasospasms during the angiographic intervention and the infarct development in follow-up imaging after EST has not been studied yet. METHODS Retrospective single-center analysis of patients receiving EST for anterior circulation vessel occlusion between 01/2015 and 12/2021. The primary endpoint was ASPECTS in follow-up imaging. Secondary endpoints were the clinical outcome (combined endpoint NIHSS 24 h after EST and difference between modified Rankin Scale (mRS) before stroke and at discharge (delta mRS)) and intracranial hemorrhage (ICH) in follow-up imaging. Patients with vasospasms receiving NM (NM+) or not (NM-) were compared in univariate analysis. RESULTS Vasospasms occurred in 79/1283 patients (6.2%), who consecutively received intra-arterial NM during EST. The targeted vasospasm angiographically resolved in 84% (66/79) under NM therapy. ASPECTS was lower in follow-up imaging after vasospasms and NM-treatment (NM - 7 (6-9), NM + 6 (4.5-8), p = 0.013) and the clinical outcome was worse (NIHSS 24 h after EST was higher in patients treated with NM (median, IQR; NM+: 14, 5-21 vs. NM-: 9, 3-18; p = 0.004), delta-mRS was higher in the NM + group (median, IQR; NM+: 3, 1-4 vs. NM-: 2, 1-2; p = 0.011)). Any ICH (NM+: 27/79, 34.2% vs. NM-: 356/1204, 29.6%; p = 0.386) and symptomatic ICH (NM+: 2/79, 2.5% vs. NM-: 21/1204, 1.7%; p = 0.609) was equally distributed between groups. CONCLUSION Intra-arterial nimodipine during EST resolves iatrogenic vasospasms efficiently during EST without increasing intracranial hemorrhage rates. However, patients with vasospasms and NM treatment show higher infarct growth resulting in lower ASPECTS in follow-up imaging.
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Affiliation(s)
- Jessica Jesser
- grid.5253.10000 0001 0328 4908Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Arne Potreck
- grid.5253.10000 0001 0328 4908Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Dominik Vollherbst
- grid.5253.10000 0001 0328 4908Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Fatih Seker
- grid.5253.10000 0001 0328 4908Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Min Chen
- grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Silvia Schönenberger
- grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Thuy D. Do
- grid.5253.10000 0001 0328 4908Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Martin Bendszus
- grid.5253.10000 0001 0328 4908Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Markus A. Möhlenbruch
- grid.5253.10000 0001 0328 4908Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Charlotte S. Weyland
- grid.5253.10000 0001 0328 4908Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Mutke MA, Potreck A, Schmitt N, Seker F, Ringleb PA, Nagel S, Möhlenbruch MA, Bendszus M, Weyland CS, Jesser J. Exact Basilar Artery Occlusion Location Indicates Stroke Etiology and Recanalization Success in Patients Eligible for Endovascular Stroke Treatment. Clin Neuroradiol 2022; 33:483-490. [DOI: 10.1007/s00062-022-01236-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022]
Abstract
Abstract
Introduction
Endovascular stroke treatment (EST) is commonly performed for acute basilar artery occlusion (BAO). We aimed to identify the role of the exact location of BAO in patients receiving EST regarding the stroke etiology, recanalization success and prediction of favorable clinical outcome.
Methods
Retrospective analysis of 191 consecutive patients treated for BAO with EST from 01/2013 until 06/2021 in a tertiary stroke center. Groups were defined according to exact location of BAO in I: proximal third, II: middle third, III: distal third and IV: tip of the basilar artery. Univariate and multivariate analyses were performed for BAO location comparing stroke etiology, recanalization result and favorable clinical outcome according to mRS 0–3 90 days after stroke onset.
Results
Occlusion sides types I–IV were evenly distributed (37, 36, 60 and 58 patients). Types I and II were more often associated with large artery atherosclerosis (50 vs. 10 patients, p < 0.001). Distal/tip occlusion (types III/IV) occurred mostly in cardiac embolism or embolic stroke of unknown source (89 vs. 12 in types I/II, p < 0.001). Occlusion site correlated with the underlying stroke etiology (AUC [Area under the curve] 0.89, p < 0.0001, OR [odds ratio] for embolism in type IV: 245). Recanalization rates were higher in patients with distal occlusions (type III/IV OR 3.76, CI [95% confidence interval] 1.51–9.53, p = 0.0076). The BAO site is not predicting favorable clinical outcome.
Conclusion
The exact basilar artery occlusion site in patients eligible for endovascular stroke treatment reflects the stroke etiology and is associated with differing recanalization success but does not predict favorable clinical outcome.
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11
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Outcomes Following Mechanical Thrombectomy in Different Etiological Subtypes of Acute Basilar Artery Occlusion : Stroke Etiology and Outcome after EVT in BAO. Clin Neuroradiol 2022; 33:361-374. [PMID: 36175676 DOI: 10.1007/s00062-022-01217-3] [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: 06/09/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Vertebrobasilar occlusion stroke (VBOS) is innately associated with high morbimortality despite advances in endovascular thrombectomy (EVT). Nonetheless, notable outcome dissimilarities exist between angiographically categorized stroke subtypes. We aim to evaluate potential differences concerning clinical angiographic outcomes among etiological subtypes of VBOS based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. METHODS We retrospectively reviewed prospective EVT databases at two tertiary care stroke centers for consecutive patients with VBOS who had preinterventional MRI and underwent EVT from January 2015 to December 2019. We identified three groups: large artery atherosclerosis (LAA), cardioembolic stroke (CES), and embolic stroke of undetermined source (ESUS). The primary endpoints were the rates of poor outcome (identified as 90-day modified Rankin scale score of 3-6) and mortality, while the secondary endpoint included the rates of incomplete reperfusion (identified as modified treatment in cerebral infarction scale mTICI 0-2b), and periprocedural symptomatic intracranial hemorrhage. We evaluated the association between the etiology and clinical angiographic outcomes through stepwise logistic regression analysis. RESULTS Out of 1823 patients, 139 (91 men; median age, 69 (61-76) years) with VBOS were qualified for the final analysis with incidence as follows: LAA (41%, n = 57), CES (35%, n = 48), and ESUS (24%, n = 34). Overall, incomplete reperfusion was realized in 41% (57/139) of the patients, a poor outcome in 65% (90/139), and mortality in 40% (55/139). Longer puncture to reperfusion interval (aOR 1.0182 [95% CI: 1.008-1.029]; p < 0.001) and utilization of combined aspiration-retriever technique (aOR 0.1998 [95% CI: 0.066-0.604]; p = 0.004) were associated with a greater likelihood of incomplete reperfusion (mTICI 0-2b) irrespective of the stroke etiology. After adjustment for confounding factors in the regression analysis, ESUS was an independent predictor of poor outcome (aOR 5.315 [95% CI: 1.646-17.163]; p = 0.005) and mortality (aOR 4.667 [95% CI: 1.883-11.564]; p < 0.001) at 90 days following EVT. CONCLUSION The functional outcome following EVT for VBOS might depend on stroke etiology. According to our results, ESUS seems to be associated with the worst outcome, which needs further investigation to tailor the appropriate therapeutic plan.
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12
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Kniep H, Bechstein M, Broocks G, Brekenfeld C, Flottmann F, van Horn N, Geest V, Faizy TD, Deb‐Chatterji M, Alegiani A, Thomalla G, Gellißen S, Fiehler J, Hanning U, Meyer L. Early Surrogates of Outcome after Thrombectomy in Posterior Circulation Stroke. Eur J Neurol 2022; 29:3296-3306. [DOI: 10.1111/ene.15519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Noel van Horn
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Vincent Geest
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Tobias D. Faizy
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | | | - Anna Alegiani
- Department of Neurology, Asklepios Klinik Altona Hamburg Germany
| | - Götz Thomalla
- Department of Neurology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg
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13
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The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches. J Clin Med 2022; 11:jcm11071864. [PMID: 35407472 PMCID: PMC8999747 DOI: 10.3390/jcm11071864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 02/06/2023] Open
Abstract
Ischemic stroke accounts for over 80% of all strokes and is one of the leading causes of mortality and permanent disability worldwide. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is an approved treatment strategy for acute ischemic stroke of large arteries within 4.5 h of onset, and mechanical thrombectomy can be used for large arteries occlusion up to 24 h after onset. Improving diagnostic work up for acute treatment, reducing onset-to-needle time and urgent radiological access angiographic CT images (angioCT) and Magnetic Resonance Imaging (MRI) are real problems for many healthcare systems, which limits the number of patients with good prognosis in real world compared to the results of randomized controlled trials. The applied endovascular procedures demonstrated high efficacy, but some cellular mechanisms, following reperfusion, are still unknown. Changes in the morphology and function of mitochondria associated with reperfusion and ischemia-reperfusion neuronal death are still understudied research fields. Moreover, future research is needed to elucidate the relationship between continuously refined imaging techniques and the variable structure or physical properties of the clot along with vascular permeability and the pleiotropism of ischemic reperfusion lesions in the penumbra, in order to define targeted preventive procedures promoting long-term health benefits.
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14
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Penide J, Mirza M, McCarthy R, Fiehler J, Mordasini P, Delassus P, Morris L, Gilvarry M. Systematic Review on Endovascular Access to Intracranial Arteries for Mechanical Thrombectomy in Acute Ischemic Stroke. Clin Neuroradiol 2021; 32:5-12. [PMID: 34642788 DOI: 10.1007/s00062-021-01100-7] [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: 03/26/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE In acute ischemic stroke for large vessel occlusions, delayed or failed access to intracranial occlusions has a negative impact on procedural and clinical outcomes. The aim of this review is to identify and quantify access failures and challenges in mechanical thrombectomy. METHODS A systematic literature review of PubMed and Scopus databases from January 2014 to October 2020 was performed. Articles reporting consecutive patients were used to calculate a crude failure rate of femoral and alternative accesses. RESULTS A total of 50 articles met the inclusion criteria, totalling 12,838 interventions. Failure to access the occlusion through transfemoral access occurred in 4.4% of patients, most commonly due to challenging supra-aortic vessel anatomy, decreasing to 3.6% when all alternative access routes were attempted. Failed access from alternative routes (direct carotid, radial and brachial approaches) attempted first-line or after failed femoral attempt were reported in 7.3% of patients. The occurrence rate of potentially challenging features (anatomical, diseases or others) ranged from 4.7% to 47.4%, primarily impacting the access time, procedure time, recanalization and clinical outcomes. CONCLUSION Failure to access the occlusion is a significant contributor to failed recanalization, regardless of access routes. Challenging, but eventually successful access is also a relevant factor in procedural and clinical outcomes; however challenging access requires a universal definition to enable quantification, so that methods for procedural optimization can be critically assessed.
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Affiliation(s)
- Joaquin Penide
- Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, MET Gateway, Galway, Ireland.
| | - Mahmood Mirza
- Galway Neuro Technology Centre, Cerenovus, Galway, Ireland
| | - Ray McCarthy
- Galway Neuro Technology Centre, Cerenovus, Galway, Ireland
| | - Jens Fiehler
- Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Universitatsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Patrick Delassus
- Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, MET Gateway, Galway, Ireland
| | - Liam Morris
- Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, MET Gateway, Galway, Ireland
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15
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Weyland CS, Chen M, Potreck A, Jäger LB, Seker F, Schönenberger S, Bendszus M, Möhlenbruch M. Sedation Mode During Endovascular Stroke Treatment in the Posterior Circulation-Is Conscious Sedation for Eligible Patients Feasible? Front Neurol 2021; 12:711558. [PMID: 34603184 PMCID: PMC8484320 DOI: 10.3389/fneur.2021.711558] [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] [Received: 05/18/2021] [Accepted: 08/02/2021] [Indexed: 01/17/2023] Open
Abstract
Background and Purpose: To compare safety and efficacy of conscious sedation (CS) vs. general anesthesia (GA) in endovascular stroke treatment (EST) of the posterior circulation (PC). Methods: Retrospective single-center analysis of patients receiving EST for large-vessel occlusion (LVO) in PC between January 2015 and November 2020. Exclusion criteria were severe stroke syndromes (NIHSS > 20), decreased level of consciousness, intubation for transport, and second stroke within 3 months of follow-up. The primary endpoint was a favorable clinical outcome 90 days after stroke onset (mRS 0–2 or 3 if pre-stroke mRS 3). Secondary endpoints were the rate of EST failure and procedural complications. Results: Of 111 included patients, 45/111 patients (40.5%) were treated under CS and 60/111 (54.0%) under GA. In 6/111 cases (5.4%), sedation mode was changed from CS to GA during EST. Patients treated under CS showed a lower mRS 90 days after stroke onset [mRS, median (IQR): 2.5 (1–4) CS vs. 3 (2–6) GA, p = 0.036] and a comparable rate of good outcome [good outcome, n (%): 19 (42.2) CS vs. 15 (32.6) GA, p = 0.311]. There was no difference in complication rates during EST (6.7% CS vs. 8.3% GA) or intracranial bleeding in follow-up imaging [n (%): 4 (8.9) CS vs. 7 (11.7) GA), p = 0.705]. The rate of successful target vessel recanalization did not differ (84.4% CS vs. 85.0 % GA). Conclusions: In this retrospective study, EST of the posterior circulation under conscious sedation was for eligible patients comparably safe and effective to patients treated under general anesthesia.
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Affiliation(s)
| | - Min Chen
- Neurologische Klinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Arne Potreck
- Neurologische Klinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | | | - Fatih Seker
- Neurologische Klinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | | | - Martin Bendszus
- Neurologische Klinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Markus Möhlenbruch
- Neurologische Klinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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