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Meder G, Żuchowski P, Skura W, Płeszka P, Dura M, Rajewski P, Nowaczewska M, Meder M, Alexandre AM, Pedicelli A. Mechanical Thrombectomy in Stroke-Retrospective Comparison of Methods: Aspiration vs. Stent Retrievers vs. Combined Method-Is Aspiration the Best Starting Point? J Clin Med 2024; 13:1477. [PMID: 38592324 PMCID: PMC10934276 DOI: 10.3390/jcm13051477] [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: 01/22/2024] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Background: There are three main methods of mechanical thrombectomy (MT): using a stent retriever (SR) only (SO), aspiration catheter (AC) only (AO) and the combined method (CM) using both the SR and AC. This paper describes a real-life, single-center experience using SO, AO and CM during 276 consecutive MTs. Methods: The primary endpoint was the frequency of first-pass complete (FPE TICI3). The secondary endpoints were final mTICI 2b-3, procedure duration, clinical outcome and the total number of device passes. The third aim of this study was to test the association between the clinical outcomes in patients treated with each method and various factors. Results: There was a significant difference (p = 0.016) between the groups' FPE TICI3 rates with 46% mTICI 3 in the AO group, 41% in the CM group and 21% in the SO group. AO resulted in procedure time shortening to a mean duration of 43 min, and the scores were 56 min for CM and 63 min for SO (p < 0.0001). There were no significant differences in clinical outcomes or in-hospital mortality. The analysis showed a correlation between good clinical outcomes and the administration of IVT: OR 1.71 (1.03-2.84) p = 0.039. Patients ≥66 years old had higher odds of a bad outcome compared to younger patients in general (OR, 1.99 95% CI, 1.17-3.38; p = 0.011). FPE TICI3 was associated with good functional outcomes in the whole treated cohort (OR, 1.98; 95% CI, 1.21-3.25; p = 0.006). Conclusions: In our series, AO proved to be the best starting point in most cases. It demonstrates good technical efficacy regarding FPE, it is fast and clinical outcomes seem to be the least age- and FPE TICI3-dependent. It can be easily converted into the combined method, which had the second-best outcomes in our cohort.
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Affiliation(s)
- Grzegorz Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
- Department of Radiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Paweł Żuchowski
- Department of Rheumatology and Connective Tissue Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Wojciech Skura
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Piotr Płeszka
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Marta Dura
- Department of Radiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Piotr Rajewski
- Department of Neurology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Skłodowskiej—Curie 9, 85-090 Bydgoszcz, Poland
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery and Laryngological Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Skłodowskiej—Curie 9, 85-090 Bydgoszcz, Poland
| | - Magdalena Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Andrea M Alexandre
- Unità Operativa Semplice Autonoma Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Alessandro Pedicelli
- Unità Operativa Semplice Autonoma Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
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Ringheanu VM, Tekle WG, Preston L, Sarraj A, Hassan AE. Higher number of stent-retriever thrombectomy passes significantly increases risk of mass effect, poor functional outcome, and mortality. Interv Neuroradiol 2023; 29:674-682. [PMID: 35637163 PMCID: PMC10680954 DOI: 10.1177/15910199221104624] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion (LVO). Through this method of treatment, it has been hypothesized that a lower number of thrombectomy passes is an indicator of higher rates of modified Thrombolysis in Cerebral Infarction 2B-3 (mTICI) reperfusion and favorable outcomes at 90-days defined as modified Rankin Scale 0-2 (mRS). METHODS Through the utilization of a prospectively collected endovascular database between 2012-2020, variables such as demographics, co-morbid conditions, intracerebral hemorrhage, mass effect, mortality rate, and good/poor outcomes regarding mTICI score and mRS assessment at 90-days were examined. The outcomes between patients receiving EVT who were treated with < 3 thrombectomy passes or ≥3 passes were compared. RESULTS Out of 454 patients treated with mechanical thrombectomy of qualifying intracranial internal carotid artery (ICA) or middle cerebral artery occlusion, site of occlusion (ICA, ICA-T M1, and M2/M3), a total of 372 (81.9%) were treated with < 3 passes (average age 70.34 ± 13.75 years, 46.0% women), and 82 (18.1%) were treated with ≥3 passes (average age 70.30 ± 13.72 years, 48.8% women). Significantly higher rates of mass effect (p = 0.043), mRS score 3-6 (p = 0.029), mortality (p = 0.025), and poor reperfusion (p < 0.0001) were noted in patients treated with ≥3 passes. CONCLUSION A higher number of thrombectomy passes, characterized as ≥3 in this study, was associated with significantly worsened patient outcome regarding mRS and mortality. Further research is required to determine whether the number of thrombectomy passes is an accurate predictor of treatment outcome.
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Affiliation(s)
- Victor M. Ringheanu
- Clinical Research Department, Valley Baptist Medical Center, Harlingen, TX, United States
| | - Wondwossen G. Tekle
- Clinical Research Department, Valley Baptist Medical Center, Harlingen, TX, United States
- Department of Neurology, UTRGV School of Medicine, Edinburg, TX, United States
- Neuroscience Department, Valley Baptist Medical Center-Harlingen, TX, United States
| | - Laurie Preston
- Clinical Research Department, Valley Baptist Medical Center, Harlingen, TX, United States
| | - Amrou Sarraj
- Department of Neurology, McGovern Medical School, San Antonio, TX, United States
| | - Ameer E. Hassan
- Clinical Research Department, Valley Baptist Medical Center, Harlingen, TX, United States
- Department of Neurology, UTRGV School of Medicine, Edinburg, TX, United States
- Neuroscience Department, Valley Baptist Medical Center-Harlingen, TX, United States
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3
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Bilgin C, Kobeissi H, Ghozy S, Mohammed MA, Kadirvel R, Kallmes DF. First-line thrombectomy strategy for carotid terminus occlusions: A systematic review and meta-analysis. World Neurosurg X 2023; 19:100208. [PMID: 37213688 PMCID: PMC10193023 DOI: 10.1016/j.wnsx.2023.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023] Open
Abstract
Background Little research has focused on the performance of mechanical thrombectomy (MT) in carotid terminus occlusions (CTOs). Therefore, the best first-line thrombectomy strategy for CTOs remains unclear. Purpose To compare the safety and efficacy outcomes of three first-line thrombectomy techniques in CTOs. Methods A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies providing safety and efficacy outcomes for endovascular treatment of CTOs were included. Data regarding successful recanalization, functional independence, symptomatic intracranial hemorrhage (sICH), and first pass efficacy (FPE) were extracted from the included studies. A random-effects model was used to calculate prevalence rates and their corresponding 95% confidence intervals (CI), and subgroup analyses were performed to assess the impact of the initial MT technique on safety and efficacy outcomes. Results Six studies with 524 patients were included. The overall successful recanalization rate was 85.84% (95% CI = 77.96-94.52), and subgroup analysis did not show a significant difference among the three first-line MT techniques. Overall rates of functional independence and FPE were 39.73% (95% CI = 32.95-47.89) and 32.09% (95% CI = 22.93-44.92), respectively. The combined stent retriever (SR) and aspiration (ASP) technique achieved significantly higher first-pass efficacy rates compared to SR or ASP alone. The overall sICH rate was 9.89% (95% CI = 4.88-20.07), and subgroup analysis did not demonstrate a significant difference across groups. The sICH rates of SR, ASP, and SR + ASP were 8.49% (95% CI = 1.76-40.93), 6.8% (95% CI = 4.59-10.09), and 7.12% (95% CI = 0.27-100), respectively. Conclusions Our results support that MT is highly effective for CTOs with functional independence rates of 39%. Additionally, in our meta-analysis, the SR + ASP technique was associated significantly greater rates of FPE compared to SR or ASP alone, without an increase in sICH rates. Prospective, large-scale studies are necessary to determine the optimal first-line MT technique in the endovascular treatment of CTOs.
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Affiliation(s)
- Cem Bilgin
- Department of Radiology, Mayo Clinic Rochester, Minnesota, USA
- Corresponding author. 200 First St. SW, Rochester, MN, 55902, USA.
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic Rochester, Minnesota, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic Rochester, Minnesota, USA
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Settecase F, Kim WT, English JD. AXS Vecta 0.071-0.074 Inch Aspiration Catheters for Mechanical Thrombectomy: Case Series and Literature Review. Neurointervention 2023; 18:47-57. [PMID: 36328761 PMCID: PMC9986352 DOI: 10.5469/neuroint.2022.00283] [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: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Aspiration catheters are widely used for thrombectomy either alone or in combination with a stent-retriever, with a distal inner diameter and trackability keys to their success. In an illustrative case series, we report our clinical experience with AXS Vecta (Stryker Neurovascular, Fremont, CA, USA), available in both 0.071-inch and 0.074-inch distal inner diameters, including the first 2 Vecta 74 cases reported. A literature review on AXS Vecta is also provided. In our series, 9 thrombectomies were performed (Vecta 71: 2 M1, 5 M2 occlusions; Vecta 74: 1 M1 and 1 ICA-terminus occlusion). The AXS Vecta was successfully delivered to the target site in all cases. In 7 of 9 cases, the catheter was delivered over a Tenzing 7 delivery catheter (Route 92 Medical, San Mateo, CA, USA). For 2 of 9 combination approach cases, Vecta was delivered using the stent-retriever wire as a rail. The median improvement in NIHSS score during hospitalization was 9 (IQR 5-12). Successful mTICI 2C or 3 recanalization was achieved in 8 of 9 (89%) patients after a median 2 (IQR 1-2) passes. Our median groin-to-reperfusion time was 23 (IQR 12.5-32) minutes, with no procedural complications. Two previous clinical studies of a total of 29 patients treated with Vecta 71 reported successful mTICI 2b-3 recanalization in 89-90% of cases. The Median groin-to-reperfusion time was 30 minutes. Complications were seen in 2 of 29 (6.9%) cases (vessel perforation and/or intracerebral hemorrhage). These data support the efficacy, deliverability, and safety of AXS Vecta for mechanical thrombectomy.
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Affiliation(s)
- Fabio Settecase
- Neurointerventional Radiology, California Pacific Medical Center, San Francisco, CA, USA.,Neurointerventional Radiology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Warren T Kim
- Neurointerventional Radiology, California Pacific Medical Center, San Francisco, CA, USA.,Neurointerventional Radiology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Joey D English
- Neurointerventional Radiology, California Pacific Medical Center, San Francisco, CA, USA.,Neurointerventional Radiology, Mills-Peninsula Medical Center, Burlingame, CA, USA
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5
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Courret T, Tourdias T, Papaxanthos J, Labreuche J, Gariel F, Liegey JS, Olindo S, Renou P, Berge J, Barreau X, Sagnier S, Menegon P, Lucas L, Briau P, Poli M, Debruxelles S, Rouanet F, Dousset V, Sibon I, Marnat G. Etiologic and prognostic value of external carotid artery thrombus detection during endovascular therapy for anterior circulation proximal occlusions. Eur J Neurol 2023; 30:380-388. [PMID: 36325682 PMCID: PMC10100328 DOI: 10.1111/ene.15623] [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: 08/17/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE An early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous external carotid artery (ECA) embolism detection during MT is associated with stroke etiology and clinical outcome. METHODS We retrospectively reviewed our prospectively maintained institutional database including consecutive patients with anterior circulation LVOS treated with MT between January 2015 and August 2020. RESULTS An ECA embolus was detected in 68 of 1298 patients (5.2%). The kappa coefficient for interobserver agreement was 0.89 (95% confidence interval [CI] 0.82-0.95). ECA embolism was significantly associated with intracranial internal carotid artery (ICA) occlusion (p < 0.001), cardioembolic etiology (p < 0.001) and a lower clot burden score (p < 0.001). Day-1 variation of National Institutes of Health Stroke Scale score (adjusted odds ratio [OR] -2.7, 95% CI -4.9 to 0.3; p = 0.021) and delta Alberta Stroke Program Early Computed Tomography Score (adjusted OR 0.9, 95% CI 0.2 to 1.5; p = 0.004) were worse among patients with ECA emboli. There was no significant difference in 90-day functional outcome between groups (adjusted OR 0.8, 95% CI 0.42 to 1.52; p = 0.50). CONCLUSION In patients with anterior circulation LVOS treated with MT, ECA embolism was significantly associated with cardioembolic etiology, high thrombus burden and proximal intracranial ICA occlusions. This underexplored angiographic pattern might provide a valuable etiologic clue to the underlying cause of anterior circulation LVOS and may also help determine the appropriate revascularization strategy.
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Affiliation(s)
- Thomas Courret
- Neuroradiology Department, CHU Bordeaux, Bordeaux, France
| | - Thomas Tourdias
- Neuroradiology Department, CHU Bordeaux, Bordeaux, France
- INSERM-U862, Neurocentre Magendie, Bordeaux, France
| | | | - Julien Labreuche
- Department of Biostatistics, Université de Lille, CHU de Lille, Lille, France
| | - Florent Gariel
- Neuroradiology Department, CHU Bordeaux, Bordeaux, France
| | | | | | - Pauline Renou
- Neurology Department, CHU Bordeaux, Bordeaux, France
| | - Jerome Berge
- Neuroradiology Department, CHU Bordeaux, Bordeaux, France
| | - Xavier Barreau
- Neuroradiology Department, CHU Bordeaux, Bordeaux, France
| | - Sharmila Sagnier
- Neurology Department, CHU Bordeaux, Bordeaux, France
- UMR-5287-CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France
| | | | - Ludovic Lucas
- Neurology Department, CHU Bordeaux, Bordeaux, France
| | - Pierre Briau
- Neurology Department, CHU Bordeaux, Bordeaux, France
| | - Mathilde Poli
- Neurology Department, CHU Bordeaux, Bordeaux, France
| | | | | | - Vincent Dousset
- Neuroradiology Department, CHU Bordeaux, Bordeaux, France
- INSERM-U862, Neurocentre Magendie, Bordeaux, France
| | - Igor Sibon
- Neurology Department, CHU Bordeaux, Bordeaux, France
- UMR-5287-CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France
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6
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Ohta T, Tanaka K, Koge J, Yoshimoto T, Kushi Y, Shiozawa M, Inoue M, Satow T, Iihara K, Ihara M, Koga M, Toyoda K, Kataoka H. Stent Retriever or Aspiration Catheter Alone vs Their Combination as the First-Line Thrombectomy in Acute Stroke. Neurosurgery 2023; 92:159-166. [PMID: 36156056 DOI: 10.1227/neu.0000000000002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The single-device simplicity for mechanical thrombectomy (MT) is now challenged by the complementary efficacy of dual-device first-line with a stent retriever and an aspiration catheter. OBJECTIVE To compare the outcomes after MT initiated with a single device vs dual devices in acute anterior circulation large vessel occlusion. METHODS Patients who underwent MT for acute internal carotid artery (ICA) or M1 occlusion between 2015 and 2020 were retrospectively analyzed. We divided patients into 2 groups: single-device first-line, defined as patients who underwent first-device pass with either a stent retriever or aspiration catheter, and dual-device first-line, defined as first-device pass with both devices. RESULTS One hundred forty-one patients were in the single-device group, and 119 were in the dual-device group. In the dual-device group, coiling or kinking of the extracranial ICA was more frequent ( P = .07) and the guide catheters were less frequently navigated to the ICA ( P < .001). 37% of the single-device group was converted to dual-device use. The proportions of mTICI ≥ 2c after the first pass were similar (33% vs 32%. adjusted odds ratio 0.91, 95% CI 0.51-1.62). An mRS score of 0 to 2 at 3 months was achieved similarly (53% vs 48%, P = .46). The total cost for thrombectomy devices was lower in the single-device group ( P < .001). CONCLUSION The proportions of first-pass mTICI ≥ 2c were not different between the 2 groups with similar functional outcomes, although the dual-device group more likely to have unfavorable vascular conditions.
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Affiliation(s)
- Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
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7
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Macdonald IR, Cora EA, Grant I, Volders D. Practical use and underlying physics of the BENCHMARK™ BMX™ 96 for large-bore aspiration thrombectomy: Case report of initial institutional experience. Neuroradiol J 2022; 35:250-254. [PMID: 34342548 PMCID: PMC8958568 DOI: 10.1177/19714009211036691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endovascular thrombectomy (EVT) is part of first-line intervention for acute ischemic stroke management. Recent technological advances have demonstrated that large-bore catheters are an attractive approach for EVT. A multitude of approaches such as A Direct Aspiration first Pass Technique (ADAPT) or in conjunction with stent retrieval (Solumbra technique) have been developed with increasingly large-bore catheters, demonstrating safety and efficacy. Furthermore, these techniques have demonstrated promise for the intervention of cerebral venous thrombosis as well as posterior circulation ischemic events. Recently, advances in neurointerventional catheters have focused on improved maneuverability to navigate the neurovasculature, as well as larger inner diameters for improved procedural versatility, including aspiration. We describe a case report highlighting our early institutional experience with the recently developed large-bore catheter, the BENCHMARK™ BMX™ 96. The case report entails near complete occlusion of the internal carotid artery from acute thrombus and the utility of the BMX™ 96 catheter for treatment of such extensive clot burden. The applicability of large-bore aspiration catheters, with an emphasis on recent advances, for mechanical thrombectomy in arterial as well as venous systems is discussed. To our knowledge, this is the first reported case of use of the BENCHMARK™ BMX™ 96 access system for EVT in acute ischemic stroke. Such new-generation large-bore catheters are a promising advance in neurointervention, and our early institution experience highlights the ease of use and versatility for neurointerventional procedures such as EVT.
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Affiliation(s)
- Ian R Macdonald
- Division of Neuroradiology, Department of
Diagnostic Radiology, Dalhousie University, Canada
| | - Elena A Cora
- Division of Neuroradiology, Department of
Diagnostic Radiology, Dalhousie University, Canada
| | - Ian Grant
- Division of Neurology, Department of
Medicine, Dalhousie University, Canada
| | - David Volders
- Division of Neuroradiology, Department of
Diagnostic Radiology, Dalhousie University, Canada
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8
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Romano DG, Frauenfelder G, Diana F, Saponiero R. JET 7 catheter for direct aspiration in carotid T occlusions: preliminary experience and literature review. Radiol Med 2022; 127:330-340. [PMID: 35034326 DOI: 10.1007/s11547-022-01451-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We report our preliminary experience with the Penumbra JET 7 reperfusion catheter (JET 7), a new large-bore (0.072″) aspiration catheter, in patients with acute ischemic stroke (AIS) due to carotid T occlusion. METHODS Data of all eligible patients who received A Direct Aspiration First Pass Technique (ADAPT) for AIS due to carotid T occlusion at our center from March 2018 through June 2020 were retrospectively reviewed. The safety and performance of JET 7 cases and smaller large-bore catheters (LBCs) were compared. RESULTS JET 7 was used in 19 patients, and smaller LBCs were used in 41 patients. Median puncture to revascularization time was significantly different between the JET 7 and the smaller LBCs (16 vs. 27 min; P = 0.011). The rate of patients who received rescue therapy with a stent retriever was also significantly different between the JET 7 cases and the smaller LBCs cases (5.3% vs. 22.0%; P = 0.046). Successful revascularization (TICI ≥ 2b) was achieved in 94.7% of JET 7 cases and 75.6% of smaller LBCs cases (P = 0.148). Good functional outcome (mRS 0-2) at 90 days occurred in 63.2% of JET 7 cases and 46.3% of smaller LBCs cases (P = 0.274). CONCLUSIONS In this early experience, ADAPT with JET 7 could be considered as one of the possible first-line therapies in carotid T occlusion, showing good rate of vascularization and lower rate of rescue therapy in comparison with smaller LBCs.
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Affiliation(s)
- Daniele Giuseppe Romano
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy
| | - Giulia Frauenfelder
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy.
| | - Francesco Diana
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy
| | - Renato Saponiero
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy
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9
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Al Kasab S, Sattur M, Porto G, Spiotta AM. Mechanical Thrombectomy of Carotid Terminus Occlusion Using Direct Aspiration Technique-Video Illustration: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E441-E442. [PMID: 34332504 DOI: 10.1093/ons/opab272] [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: 10/06/2020] [Accepted: 06/14/2021] [Indexed: 11/12/2022] Open
Abstract
Acute carotid terminus occlusion (CTO) is responsible for up to 5% of acute ischemic strokes secondary to emergent large vessel occlusion (ELVO) and up to 20% of acute internal carotid artery (ICA) occlusions.1 The term "CTO" has also been used to describe occlusions in the supra-clinoid segment or at the bifurcation of the ICA. Compared to other ELVOs, patients with CTO present with higher stroke severity and larger infarct volume, likely to be a result of disruption of direct Circle of Willis collaterals across the anterior communicating artery (AComA) and posterior communicating artery (PComA).2,3 Similary, CTO is usually associated with worse prognosis compared to other ELVOs in general. With regard to response to treatment, previous studies have reported significantly lower recanalization rates with intravenous alteplase with CTO compared to M1 segment occlusion. With regard to the safety and efficacy of mechanical thrombectomy, prior reports provide conflicting results with some reporting lower successful recanalization rates with CTO compared to M1 occlusion, and others reporting similar results. In our experience, we have found that successful recanalization of CTO can be achieved with a similar approach to M1 occlusions utilizing a direct aspiration first pass technique (ADAPT).3,4 Herein, we present a case of CTO for which we performed mechanical thrombectomy using ADAPT. This procedure was an emergent standard of care procedure for which a consent was not required and so not obtained.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mithun Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme Porto
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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10
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Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter. J Clin Med 2021; 10:jcm10091802. [PMID: 33918999 PMCID: PMC8122633 DOI: 10.3390/jcm10091802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 01/22/2023] Open
Abstract
Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. METHODS The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days' modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients' admission and discharge; and the total number of device passes. RESULTS Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group-94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)-and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). CONCLUSIONS Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.
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11
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Lee JS, Hwang YH, Sohn SI. Factors Contributing to an Efficacious Endovascular Treatment for Acute Ischemic Stroke in Asian Population. Neurointervention 2021; 16:91-110. [PMID: 33765729 PMCID: PMC8261106 DOI: 10.5469/neuroint.2020.00339] [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: 09/20/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Although randomized control trials about endovascular treatment (EVT) of emergent large vessel occlusion (LVO) have demonstrated the success of mechanical thrombectomy as the choice of treatment, a wide range of caveats remain unaddressed. Asian patients were rarely included in the trials, thereby raising the question of whether the treatment could be generalized. In addition, there remains a concern on the feasibility of the method with respect to its application against intracranial atherosclerosis (ICAS)-related LVO, frequently observed in the Asian population. It is important to include evidence on ICAS LVO from Asian countries in the future for a comprehensive understanding of LVO etiology. Besides the issues with EVT, prognostic concerns in diabetes patients, acute kidney injury following EVT, neuroprotective management against reperfusion injury, and other peri-EVT issues should be considered in clinical practice. In the current article, we present an in-depth review of the literature that revises information pertaining to such concerns.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Kyemyung University School of Medicine, Daegu, Korea
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12
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Jiang C, Li Y, Hao F, Yang J, Wang B, Fan Y. Y-configuration double-stent-retriever thrombectomy for refractory thrombus in middle cerebral artery bifurcation: A case report. Medicine (Baltimore) 2021; 100:e24993. [PMID: 33725971 PMCID: PMC7982166 DOI: 10.1097/md.0000000000024993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Stent retriever mechanical thrombectomy is a recommended treatment for acute ischemic stroke. However, refractory thrombus in artery bifurcation can reduce the rate of successful revascularization. PATIENT CONCERNS A 72-year-old male, owing to the acute onset of almost complete right-sided hemiplegia and global aphasia, received bridging therapy. National Institutes of Health Stroke Scale score was 16 at the time of admission. DIAGNOSES Cerebral digital subtraction angiography revealed occlusion of the M1 segment of the left MCA. INTERVENTIONS Thrombectomy with 3 passes of the Solitaire FR device (Medtronic, Minneapolis, MN) was unsuccessful. Two stent retrievers were inserted in parallel by one microcatheter access point to each M2 branch, and then both stents were gradually retrieved out of the catheter while continuous suction was maintained. OUTCOMES After thrombectomy, subsequent follow-up angiograms showed mTICI 3 reperfusion of MCA. The patient has mRS 2 at discharge and the 3-month mRS score after stroke is 1 score. LESSONS The presented Y-configuration double-stent-retriever thrombectomy technique constitutes a safe and effective rescue treatment method for refractory thrombus in MCA bifurcation.
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13
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Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052670. [PMID: 33800902 PMCID: PMC7967538 DOI: 10.3390/ijerph18052670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 01/01/2023]
Abstract
Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03–1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7); p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS.
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14
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Li ZS, Zhou TF, Li Q, Guan M, Liu H, Zhu LF, Wang ZL, Li TX, Gao BL. Endovascular Management of Intracranial Atherosclerosis-Related Large Vessel Occlusion With the A Direct Aspiration First-Pass Thrombectomy Compared With Solumbra Technique. Front Neurol 2021; 12:643633. [PMID: 33737905 PMCID: PMC7960763 DOI: 10.3389/fneur.2021.643633] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background: To investigate the effect of the A Direct Aspiration First-Pass Thrombectomy (ADAPT) vs. Solumbra technique in the treatment of acute intracranial atherosclerosis-related large vessel occlusion (LVO). Methods: Patients with acute atherosclerosis-related LVO who had undergone endovascular treatment were retrospectively enrolled into two groups: The Solumbra and ADAPT groups. The clinical data were analyzed. Results: Patients (104) were enrolled with 48 in the Solumbra and 56 in the ADAPT group. The mean time from femoral access to recanalization was significantly (P < 0.05) shorter in the ADAPT than in the Solumbra group. The recanalization time at the first line was significantly shorter in the ADAPT group than in the Solumbra group (17 ± 10.21 vs. 26 ± 15.55 min, P = 0.02). However, the rate of switching to the alternative was significantly higher in the ADAPT group than that in the Solumbra group (46.42 vs. 33.33%, P = 0.01). Eighty-two patients had eventual recanalization, resulting in a final recanalization rate of 78.85%. At 3-month clinical follow-up for all patients, the good prognosis rate reached 51.92% with good prognosis in 24 patients (50%) in the Solumbra and 30 (53.57%) in the ADAPT group. The rate of symptomatic intracranial hemorrhage was 18.75% (n = 9) in the Solumbra and 19.64% (n = 11) in the ADAPT group. The mortality rate was 21.15% (22/104). Among 80 (76.92%) patients who had angiographic follow-up (3–30 months), five (6.25%) patients experienced in-stent stenosis, and two (2.5%) experienced asymptomatic stent occlusion. Conclusion: In patients with acute intracranial atherosclerosis-related LVO, clinical outcomes treated using the ADAPT technique are comparable with those using the Solumbra technique, and more patients need additional remedial measures if treated with the ADAPT technique.
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Affiliation(s)
- Zhao-Shuo Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Teng-Fei Zhou
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Qiang Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Min Guan
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Huan Liu
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Liang-Fu Zhu
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Zi-Liang Wang
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Tian-Xiao Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Bu-Lang Gao
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
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15
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Abstract
Endovascular therapy (EVT) has become the standard treatment for large-vessel occlusion (LVO) acute ischemic stroke (AIS). EVT is now indicated in patients up to 24h from their last known well, provided that the patient meets specific clinical and imaging criteria. Improvements in thrombectomy devices, techniques, and operator experience have allowed successful EVT of ICA terminus, M1-MCA occlusions as well as proximal M2-MCA, basilar artery occlusions, and revascularization of tandem lesions. Mechanical thrombectomy failures still occur due to several factors, however, highlighting the need for further device and technical improvements. An ongoing debate exists regarding the need for pre-EVT thrombolytic agents, thrombectomy techniques, distal occlusions, anesthesia methods, the role of advanced neuroimaging, the treatment of patients with larger infarct core, and those presenting with milder stroke symptoms. Many of these questions are the subject of current or upcoming clinical trials. This review aims to provide an outline and discussion about the established recommendations and emerging topics regarding EVT for LVO AIS.
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Affiliation(s)
- Fabio Settecase
- Neuroradiology Division, Department of Radiology, University of British Columbia, Vancouver, BC, Canada; Diagnostic and Interventional Neuroradiology Division, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States.
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16
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Patel P, Yavagal D, Khandelwal P. Hyperacute Management of Ischemic Strokes: JACC Focus Seminar. J Am Coll Cardiol 2020; 75:1844-1856. [PMID: 32299596 DOI: 10.1016/j.jacc.2020.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging.
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Affiliation(s)
- Pratit Patel
- Departments of Neurological Surgery, Rutgers University-New Jersey Medical School, Newark, New Jersey
| | - Dileep Yavagal
- Department of Neurology and Neurological Surgery, Jackson Memorial & University of Miami Hospitals, University of Miami Miller School of Medicine, Miami, Florida
| | - Priyank Khandelwal
- Departments of Neurological Surgery, Rutgers University-New Jersey Medical School, Newark, New Jersey.
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17
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Lee SJ, Hwang YH, Hong JM, Choi JW, Kang DH, Kim YW, Kim YS, Hong JH, Yoo J, Kim CH, Ovbiagele B, Demchuk A, Sohn SI, Lee JS. Predictors and prognoses of Willisian collateral failure during mechanical thrombectomy. Sci Rep 2020; 10:20874. [PMID: 33257735 PMCID: PMC7704636 DOI: 10.1038/s41598-020-77946-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/17/2020] [Indexed: 11/09/2022] Open
Abstract
During mechanical thrombectomy in the anterior cerebral circulation, thrombus embolization resulting in Willisian collateral failure may lead to critical stroke outcomes due to a shutdown of leptomeningeal collaterals. We hypothesized that the outcomes of dynamic Willisian collateral failure (DWF), induced during mechanical thrombectomy, would be associated with grave outcomes. We evaluated this hypothesis in consecutive patients, between January 2011 and May 2016, who underwent mechanical thrombectomy for anterior circulation occlusions, with an onset-to-puncture of 24 h. Patients with initial Willisian collateral failure (IWF) were identified first, with remaining patients classified into the DWF and Willisian collateral sparing (WCS) groups. Comparative and multivariable analyses were performed to predict grave outcomes (3-month modified Rankin Scale score of 5–6). Among 567 patients, 37 were in the IWF group, 38 in the DWF group, and 492 in the WCS group. Compared to the WCS and DWF groups, the IWF group had a higher baseline National Institute of Health Stroke Scale score and lower Alberta Stroke Program Early CT Score. The prevalence of grave outcomes was similarly high in the IWF (48.6%) and DWF (47.4%) groups, but lower in the WCS group (22.0%; p < 0.001). IWF and DWF were independent risk factors for a grave outcome.
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Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Won Kim
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Dongsan Medical Center, Brain Research Institute, Keimyung University School of Medicine, 56 Dalseong-ro Joong-gu, Daegu, 41931, Republic of Korea
| | - Joonsang Yoo
- Department of Neurology, Dongsan Medical Center, Brain Research Institute, Keimyung University School of Medicine, 56 Dalseong-ro Joong-gu, Daegu, 41931, Republic of Korea.,Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Franscisco, USA
| | - Andrew Demchuk
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Medical Center, Brain Research Institute, Keimyung University School of Medicine, 56 Dalseong-ro Joong-gu, Daegu, 41931, Republic of Korea.
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, South Korea.
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18
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Meder G, Świtońska M, Płeszka P, Palacz-Duda V, Dzianott-Pabijan D, Sokal P. Endovascular Treatment of Stroke Caused by Carotid Artery Dissection. Brain Sci 2020; 10:brainsci10110800. [PMID: 33143117 PMCID: PMC7692463 DOI: 10.3390/brainsci10110800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
Ischemic stroke due to large vessel occlusion (LVO) is a devastating condition. Most LVOs are embolic in nature. Arterial dissection is responsible for only a small proportion of LVOs, is specific in nature and poses some challenges in treatment. We describe 3 cases where patients with stroke caused by carotid artery dissection were treated with mechanical thrombectomy and extensive stenting with good outcome. We believe that mechanical thrombectomy and stenting is a treatment of choice in these cases.
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Affiliation(s)
- Grzegorz Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-52-3655-143; Fax: +48-52-3655-364
| | - Milena Świtońska
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland; (M.Ś.); (P.P.); (V.P.-D.)
- Department of Neurosurgery and Neurology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland;
| | - Piotr Płeszka
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland; (M.Ś.); (P.P.); (V.P.-D.)
| | - Violetta Palacz-Duda
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland; (M.Ś.); (P.P.); (V.P.-D.)
| | - Dorota Dzianott-Pabijan
- Neurological Rehabilitation Ward Kuyavian-Pomeranian Pulmonology Centre, Meysnera 9 Street, 85-472 Bydgoszcz, Poland;
| | - Paweł Sokal
- Department of Neurosurgery and Neurology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland;
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19
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Blanc R, Escalard S, Baharvadhat H, Desilles JP, Boisseau W, Fahed R, Redjem H, Ciccio G, Smajda S, Maier B, Delvoye F, Hebert S, Mazighi M, Piotin M. Recent advances in devices for mechanical thrombectomy. Expert Rev Med Devices 2020; 17:697-706. [DOI: 10.1080/17434440.2020.1784004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Humain Baharvadhat
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Jean Philippe Desilles
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - William Boisseau
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Robert Fahed
- Department of Medicine/Division of Neurology, Department of Medical Imaging/Division of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Solène Hebert
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
- Université Paris Denis Diderot, Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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20
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Munich SA, Vakharia K, Levy EI. Overview of Mechanical Thrombectomy Techniques. Neurosurgery 2019; 85:S60-S67. [DOI: 10.1093/neuros/nyz071] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/12/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
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21
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Bang OY, Kim BM, Seo WK, Jeon P. Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin-Neuroimaging Perspectives. Front Neurol 2019; 10:269. [PMID: 30949124 PMCID: PMC6435574 DOI: 10.3389/fneur.2019.00269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/28/2019] [Indexed: 12/18/2022] Open
Abstract
Large vessel occlusion (LVO) due to intracranial atherosclerosis (ICAS) is a common cause of acute ischemic stroke (AIS) in Asians. Endovascular therapy (EVT) has been established as the mainstay of treatment in patients with AIS and LVO. However, only a few patients of Asian descent with ICAS-related LVO (ICAS-LVO) were included in recent randomized controlled trials of EVT for AIS. Therefore, the findings of these trials cannot be directly applied to Asian patients with ICAS-LVO. In embolic LVO due to thrombus from the heart or a more proximal vessel, rapid, and complete recanalization can be achieved in more than 70-80% of patients, and it is important to exclude patients with large cores. In contrast, patients with ICAS-LVO usually have favorable hemodynamic profiles (good collateral status, small core, and less severe perfusion deficit), but poor response to EVT (more rescue treatments and longer procedure times are required for successful recanalization due to higher rates of reocclusion). Patients with ICAS-LVO may have different anatomic (plaque, angioarchitecture), hemodynamic (collateral status), and pathophysiologic (thrombus composition) features on neuroimaging compared to patients with embolic LVO. In this review, we discuss these neuroimaging features, their clinical implications with respect to determination of EVT responses, and the need for development of specific EVT devices and procedures for patients with ICAS-LVO.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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22
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Boulanger M, Lapergue B, Turjman F, Touzé E, Anxionnat R, Bracard S, Piotin M, Gory B. First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis. Interv Neuroradiol 2019; 25:244-253. [PMID: 30864466 DOI: 10.1177/1591019918821074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. PURPOSE The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion. METHODS We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. We determined rates of final complete reperfusion (defined as modified Thrombolysis In Cerebral Infarction score = 3), periprocedural complications and 90-day functional independence (defined as modified Rankin Scale (mRS) score 0-2), and excellent outcome (defined as mRS score 0-1) after contact aspiration and after stent-retriever thrombectomy using random-effects meta-analyses. Any differential effects in rates between the two strategies were assessed using random-effects meta-regressions. RESULTS Fifteen studies (1817 patients) were included. There was no difference in rates of final complete reperfusion at the end of all endovascular procedures between contact aspiration and stent retrievers (51.1%, 95% confidence interval (CI) 39.3-62.9; vs 38.3%, 95% CI 28.6-48.0; pint = 0.14), 90-day functional independence (45.0%, 40.7-49.2; vs 52.4%, 47.7-57.1; pint = 0.45) and excellent outcome (32.1%, 25.7-38.5; vs 34.1%, 21.2-46.9; pint = 0.94). Rates of periprocedural complications did not differ between the two strategies. CONCLUSIONS Current data suggest no difference in efficacy and safety between first-line contact aspiration and stent-retriever thrombectomy in stroke patients with large-artery occlusion.
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Affiliation(s)
- Marion Boulanger
- 1 Normandie University, UNICAEN, Inserm U1237, CHU Caen, Stroke Unit, Caen, France
| | - Bertrand Lapergue
- 2 Department of Neurology, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - Francis Turjman
- 3 Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Touzé
- 1 Normandie University, UNICAEN, Inserm U1237, CHU Caen, Stroke Unit, Caen, France
| | - René Anxionnat
- 4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,5 University of Lorraine, INSERM U1254, IADI, F-54000, Nancy, France
| | - Serge Bracard
- 4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,5 University of Lorraine, INSERM U1254, IADI, F-54000, Nancy, France
| | - Michel Piotin
- 6 Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Benjamin Gory
- 4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,5 University of Lorraine, INSERM U1254, IADI, F-54000, Nancy, France
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23
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Delgado Almandoz JE, Kayan Y, Wallace AN, Tarrel RM, Fease JL, Scholz JM, Milner AM, Roohani P, Mulder M, Young ML. Larger ACE 68 aspiration catheter increases first-pass efficacy of ADAPT technique. J Neurointerv Surg 2018; 11:141-146. [PMID: 29970617 DOI: 10.1136/neurintsurg-2018-013957] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE To report the efficacy of A Direct Aspiration first-Pass Thrombectomy (ADAPT) technique with larger-bore ACE aspiration catheters as first-line treatment for anterior circulation emergent large vessel occlusions (ELVOs), and assess for the presence of a first-pass effect with ADAPT. METHODS We retrospectively reviewed 152 consecutive patients with anterior circulation ELVOs treated with the ADAPT technique as first-line treatment using ACE60, 64, or 68 at our institution. Baseline characteristics, procedural variables, and modified Rankin Scale (mRS) at 90 days were recorded. RESULTS Fifty-seven patients were treated with ACE60 (37.5%), 35 with ACE64 (23%), and 60 with ACE68 (39.5%). Median groin puncture to reperfusion time was 30 min with ACE60, 26 min with ACE64, and 19.5 min with ACE68. Successful reperfusion after the first ADAPT pass was 33% with ACE60 and 53% with ACE68 (P=0.04). The stent-retriever rescue rate was 26% with ACE60, 3% with ACE64, and 10% with ACE68 (P=0.004). In multivariate logistic regression analysis, use of the ACE68 aspiration catheter was an independent predictor of successful reperfusion after the first ADAPT pass (P=0.016, OR1.67, 95% CI 1.1 to 2.54), and successful reperfusion after the first ADAPT pass was an independent predictor of good clinical outcome at 90 days (P=0.0004, OR6.2, 95% CI 2.27 to 16.8). CONCLUSION Use of the larger-bore ACE 68 aspiration catheter was associated with shorter groin puncture to reperfusion time, higher rate of successful reperfusion after the first ADAPT pass, and lower rate of stent-retriever rescue. Further, a first-pass effect was demonstrated in our ADAPT patient cohort.
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Affiliation(s)
- Josser E Delgado Almandoz
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yasha Kayan
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Adam N Wallace
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ronald M Tarrel
- Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Jennifer L Fease
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Jill Marie Scholz
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Anna M Milner
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pezhman Roohani
- Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maximilian Mulder
- Division of Critical Care Medicine, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mark L Young
- Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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24
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Samaniego EA, Roa JA, Limaye K, Adams HP. Mechanical Thrombectomy: Emerging Technologies and Techniques. J Stroke Cerebrovasc Dis 2018; 27:2555-2571. [PMID: 29960666 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The treatment of acute ischemic stroke due to large vessel occlusion (LVO) has revolutionized in the last decade. We sought to compile the most relevant literature published about the evolution in treating this disabling and fatal disease. METHODS A literature review of recent studies describing early treatment options like intravenous tissue plasminogen activator to the latest mechanical thrombectomy (MT) techniques was performed. We described in a chronological order the evolution of LVO treatment. RESULTS Recanalization rates with newer techniques and MT devices approach a 90% of effectiveness. Timely interventions have also resulted in better clinical outcomes with approximately 50% of patient achieving functional independence at 90 days. At least 14 new third generation thrombectomy devices are currently being evaluated in in vitro and clinical studies. CONCLUSIONS The treatment of LVO with MT is feasible and safe. MT is standard of care in treating acute ischemic stroke due to LVO.
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Affiliation(s)
- Edgar A Samaniego
- Division of Cerebrovascular Diseases Department of Neurology, Neurosurgery and Radiology, Carver College of Medicine, UIHC Comprehensive Stroke Center, University of Iowa, Iowa City, Iowa.
| | - Jorge A Roa
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | - Kaustubh Limaye
- Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, UIHC Comprehensive Stroke Center, University of Iowa, Iowa City, Iowa
| | - Harold P Adams
- Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, UIHC Comprehensive Stroke Center, University of Iowa, Iowa City, Iowa
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25
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Maegerlein C, Mönch S, Boeckh-Behrens T, Lehm M, Hedderich DM, Berndt MT, Wunderlich S, Zimmer C, Kaesmacher J, Friedrich B. PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy – evaluation of a double embolic protection approach in endovascular stroke treatment. J Neurointerv Surg 2017; 10:751-755. [DOI: 10.1136/neurintsurg-2017-013558] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 01/19/2023]
Abstract
PurposeStent retriever-based mechanical thrombectomy (MT) for emergent large vessel occlusions (ELVO) is often complicated by thrombus fragmentation causing distal embolization and embolization to new vascular territories. Well-established embolic protection approaches include proximal flow arrest and distal aspiration techniques during stent retriever maneuvers. Aiming at the reduction of thrombus fragmentation during MT we evaluated a technical approach combining proximal balloon occlusion together with direct thrombus aspiration during MT: the PROTECT technique.MethodsWe performed a case-control study comparing the PROTECT technique with sole distal aspiration during MT regarding technical and procedural parameters, n=200 patients with ELVO of either the terminus of the internal carotid artery or the proximal middle artery were included.ResultsPROTECT resulted in a shorter procedure time (29 vs 40 min; P=0.002), in a higher rate of successful recanalizations (100% vs 78%; P=0.001) and a higher rate of complete reperfusions (70% vs 39%; P<0.001) compared with sole distal aspiration during MT.ConclusionThe PROTECT technique is a promising new approach to significantly reduce thrombus fragmentation and, hence distal embolization during MT. This safe and efficient technique needs to be validated in larger trials to confirm our results.
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26
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Maegerlein C, Friedrich B, Berndt M, Lucia KE, Schirmer L, Poppert H, Zimmer C, Pelisek J, Boeckh-Behrens T, Kaesmacher J. Impact of histological thrombus composition on preinterventional thrombus migration in patients with acute occlusions of the middle cerebral artery. Interv Neuroradiol 2017; 24:70-75. [PMID: 29058984 DOI: 10.1177/1591019917733733] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The occurrence of thrombus migration (TM) in middle cerebral arteries (MCAs) prior to mechanical thrombectomy (MT) in patients suffering from acute ischemic strokes is a crucial aspect as TM is associated with lower rates of complete reperfusion and worse clinical outcomes. In this study, we sought to clarify whether histological thrombus composition influences TM. Methods We included 64 patients with acute MCA occlusions who had undergone MT. In 11 of the cases (17.2%) we identified TM prior to the interventions. The extracted clots were collected and histologically examined. The hematoxylin and eosin-stained specimens were quantitatively analyzed in terms of the relative fractions of the main constituents (red and white blood cells and fibrin/platelets). The histologic patterns were correlated with the occurrence of TM. Results Patients in whom TM could be observed were more often treated in a drip-and-ship fashion (90.9% vs 41.5%, p = 0.003). Stroke etiology did not differ between migrated and stable thrombi. A weak tendency for higher RBC and lower F/P content could be observed in thrombi that had migrated when compared with stable thrombi (RBC: median 41% vs 37%, p = 0.022 and F/P: median 54% vs 57%, p = 0.024). When using a cut-off of 60% RBC content for the definition of RBC-rich thrombi, a higher portion of RBC-rich thrombi could be identified in the migrated group as opposed to the stable group (36.4% vs 5.7%, p = 0.003). Conclusion Preinterventional TM may be influenced by the histological thrombus composition in a way that RBC-rich thrombi are more prone to migrate.
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Affiliation(s)
- Christian Maegerlein
- 1 Department of Neuroradiology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | - Benjamin Friedrich
- 1 Department of Neuroradiology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | - Maria Berndt
- 1 Department of Neuroradiology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | | | - Lucas Schirmer
- 3 Eli and Edythe Broad Center for Stem Cell Research and Regeneration Medicine, University of California, San Francisco, San Francisco, CA, USA.,4 Department of Neurology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | - Holger Poppert
- 4 Department of Neurology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | - Claus Zimmer
- 1 Department of Neuroradiology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | - Jaroslav Pelisek
- 5 Clinic of Vascular and Endovascular Surgery, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | - Tobias Boeckh-Behrens
- 1 Department of Neuroradiology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
| | - Johannes Kaesmacher
- 1 Department of Neuroradiology, 27190 Klinikum rechts der Isar, Technical University of Munich , Munich, Germany
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27
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Kang DH, Park J. Endovascular Stroke Therapy Focused on Stent Retriever Thrombectomy and Direct Clot Aspiration: Historical Review and Modern Application. J Korean Neurosurg Soc 2017; 60:335-347. [PMID: 28490161 PMCID: PMC5426444 DOI: 10.3340/jkns.2016.0809.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/02/2017] [Accepted: 01/11/2017] [Indexed: 01/19/2023] Open
Abstract
Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. Huge progress was made in 2015, as there were five randomized clinical trials which all demonstrated the safety and efficacy of endovascular stroke treatment. Despite differences in detail patient enrollment criteria, all 5 trials employed key factors for good functional recovery; (1) screening with non-invasive imaging to identify the proximal occlusion and exclude a large infarct core, (2) using highly effective modern thrombectomy devices mainly with stent retriever, and (3) establishment of a fast workflow to achieve effective reperfusion. The results of those trials indicate that modern thrombectomy devices can allow for faster and more effective reperfusion, which can lead to improved clinical outcomes compared to intravenous thrombolysis alone. These advances in mechanical thrombectomy are promising in the global fight against ischemic stroke-related disability and mortality. Two current mainstreams among such mechanical thrombectomy techniques, “stent retriever thrombectomy” and “direct clot aspiration”, are the topic of this review. Stent retriever thrombectomy using Solitaire and Trevo retriever will be firstly discussed. And, the commonalities and the differences between two major clot aspiration thrombectomy techniques; a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be additionally explained. Finally, details regarding the combination of direct clot aspiration and stent retriever thrombectomy, the switching strategy and the Solumbra technique, will be described.
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Affiliation(s)
- Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu-Gyeongbuk Cardiocerebrovascular Center, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Radiology, Kyungpook National University Hospital, Daegu-Gyeongbuk Cardiocerebrovascular Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jaechan Park
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu-Gyeongbuk Cardiocerebrovascular Center, School of Medicine, Kyungpook National University, Daegu, Korea
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28
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Okada H, Matsuda Y, Chung J, Crowley RW, Lopes DK. Utility of a Y-configured stentriever technique as a rescue method of thrombectomy for an intractable rooted thrombus located on the middle cerebral artery bifurcation: technical note. Neurosurg Focus 2017; 42:E17. [DOI: 10.3171/2017.1.focus16511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mechanical thrombectomy with stentriever and/or aspiration is the new gold standard for the treatment of acute strokes with large-vessel occlusion. As many as 20% of cases remain refractory to current stentriever and/or aspiration devices. “Saddle clots” obstructing a bifurcation may be a particular challenge for recanalization with conventional techniques and devices. The authors describe an alternative technique to bifurcation occlusions resistant to the conventional mechanical thrombectomy approach in which they simultaneously deployed 2 stentrievers into both branches of an occluded bifurcation. This stentriever Y-configuration was very effective in managing a challenging intracranial bifurcation occlusion.
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Affiliation(s)
- Hideo Okada
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
- 2Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan
| | - Yoshikazu Matsuda
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
- 5Department of Neurosurgery, Wakayama Medical University, Wakayama City, Japan
| | - Joonho Chung
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
- 3Department of Neurosurgery, Gangnam Severance Hospital, and
- 4Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - R. Webster Crowley
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Demetrius K. Lopes
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
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29
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Intraprocedural Thrombus Fragmentation During Interventional Stroke Treatment: A Comparison of Direct Thrombus Aspiration and Stent Retriever Thrombectomy. Cardiovasc Intervent Radiol 2017; 40:987-993. [DOI: 10.1007/s00270-017-1614-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/26/2017] [Indexed: 11/26/2022]
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30
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Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O, Wiesmann M, Knauth M, Mpotsaris A, Psychogios MN. Maximizing First-Pass Complete Reperfusion with SAVE. Clin Neuroradiol 2017; 28:327-338. [PMID: 28194477 DOI: 10.1007/s00062-017-0566-z] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Volker Maus
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Daniel Behme
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Borggrefe
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ioannis Tsogkas
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Aachen, Aachen, Germany
| | - Michael Knauth
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Marios Nikos Psychogios
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
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31
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Aspiration thrombectomy in clinical routine interventional stroke treatment. Clin Neuroradiol 2017; 28:217-224. [DOI: 10.1007/s00062-016-0555-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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32
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Lee SU, Hong JM, Kim SY, Bang OY, Demchuk AM, Lee JS. Differentiating Carotid Terminus Occlusions into Two Distinct Populations Based on Willisian Collateral Status. J Stroke 2016; 18:179-86. [PMID: 26915505 PMCID: PMC4901942 DOI: 10.5853/jos.2015.01529] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/07/2016] [Accepted: 01/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose The outcomes of acute internal carotid artery (ICA) terminus occlusions are poor. We classified ICA terminus occlusions into 2 groups according to the occlusion pattern of the circle of Willis and hypothesized that clinical outcomes would significantly differ between them. Methods Consecutive patients with acute ICA terminus occlusions evaluated by baseline computed tomographic angiography were enrolled. We investigated the occlusion patterns in the circle of Willis, retrospectively classified patients into simple ICA terminus occlusion (STO; with good Willisian collaterals from neighboring cerebral circulation) and complex ICA terminus occlusion (CTO; with one or more of A2 anterior cerebral artery, fetal posterior cerebral artery occlusion, or hypoplastic/absent contralateral A1; or with poor collaterals from anterior communicating artery) groups, and compared their baseline characteristics and outcomes. Results The STO group (n=58) showed smaller infarct volumes at 72 hours than the CTO group (n=34) (median, 81 mL [interquartile range, 38-192] vs. 414 mL [193-540], P<0.001) and more favorable outcomes (3-month modified Rankin Scale 0-3, 44.8% vs. 8.8%, P<0.001; 3-month mortality, 24.1% vs. 67.6%, P<0.001). In multivariable analyses, STO remained an independent predictor for favorable outcomes (odds ratio 6.1, P=0.010). Conclusions Favorable outcomes in STO group suggested that the outcomes of acute ICA terminus occlusions depend on Willisian collateral status. Documenting the subtypes on computed tomographic angiography would help predict patient outcome.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Sun Yong Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Andrew M Demchuk
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
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33
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Delgado Almandoz JE, Kayan Y, Young ML, Fease JL, Scholz JM, Milner AM, Hehr TH, Roohani P, Mulder M, Tarrel RM. Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg 2015; 8:1123-1128. [PMID: 26667250 DOI: 10.1136/neurintsurg-2015-012122] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/16/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare rates of symptomatic intracranial hemorrhage (SICH) and good clinical outcome at 90 days in patients with ischemic strokes from anterior circulation emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy using either Solumbra or A Direct Aspiration first-Pass Thrombectomy (ADAPT) techniques. METHODS We compared clinical characteristics, procedural variables, and clinical outcomes in patients with anterior circulation ELVOs treated with mechanical thrombectomy using either a Solumbra or ADAPT technique at our institution over a 38-month period. SICH was defined using the SITS-MOST criteria. A good clinical outcome was defined as a modified Rankin Scale score of 0-2 at 90 days. RESULTS One hundred patients were included, 55 in the Solumbra group and 45 in the ADAPT group. Patients in the ADAPT group had higher National Institutes of Health Stroke Scale (NIHSS) (19.2 vs 16.8, p=0.02) and a higher proportion of internal carotid artery terminus thrombi (42.2% vs 20%, p=0.03) than patients in the Solumbra group. Patients in the ADAPT group had a trend toward a lower rate of SICH than patients in the Solumbra group (2.2% vs 12.7%, p=0.07). Patients in the ADAPT group had a significantly higher rate of good clinical outcome at 90 days than patients in the Solumbra group (55.6% vs 30.9%, p=0.015). Use of the ADAPT technique (OR 6 (95% CI 1.0 to 31.2), p=0.049) was an independent predictor of a good clinical outcome at 90 days in our cohort. CONCLUSIONS In our cohort, the ADAPT technique was associated with significantly higher good clinical outcomes at 90 days in patients with acute ischemic stroke due to anterior circulation ELVOs treated with mechanical thrombectomy.
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Affiliation(s)
- Josser E Delgado Almandoz
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yasha Kayan
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mark L Young
- Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Jennifer L Fease
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Jill M Scholz
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Anna M Milner
- Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Timothy H Hehr
- Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pezhman Roohani
- Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maximilian Mulder
- Division of Critical Care Medicine, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ronald M Tarrel
- Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Eom YI, Hwang YH, Hong JM, Choi JW, Lim YC, Kang DH, Kim YW, Kim YS, Kim SY, Lee JS. Forced arterial suction thrombectomy with the penumbra reperfusion catheter in acute basilar artery occlusion: a retrospective comparison study in 2 Korean university hospitals. AJNR Am J Neuroradiol 2014; 35:2354-9. [PMID: 25034774 DOI: 10.3174/ajnr.a4045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE A performance of forced arterial suction thrombectomy was not reported for the treatment of acute basilar artery occlusion. This study compared revascularization performance between intra-arterial fibrinolytic treatment and forced arterial suction thrombectomy with a Penumbra reperfusion catheter in patients with acute basilar artery occlusion. MATERIALS AND METHODS Fifty-seven patients with acute basilar artery occlusion were treated with intra-arterial fibrinolysis (n = 25) or forced arterial suction thrombectomy (n = 32). Baseline characteristics, successful revascularization rate, and clinical outcomes were compared between the groups. RESULTS Baseline characteristics, the frequency of patients receiving intravenous recombinant tissue plasminogen activator, and mean time interval between symptom onset and femoral puncture did not differ between groups. The forced arterial suction thrombectomy group had a shorter procedure duration (75.5 minutes versus 113.3 minutes, P = .016) and higher successful revascularization rate (88% versus 60%, P = .017) than the fibrinolysis group. Fair outcome, indicated by a modified Rankin Scale 0-3, at 3 months was achieved in 34% of patients undergoing forced arterial suction thrombectomy and 8% of patients undergoing fibrinolysis (P = .019), and the mortality rate was significantly higher in the fibrinolysis group (25% versus 68%, P = .001). Multiple logistic regression analysis identified the forced arterial suction thrombectomy method as an independent predictor of fair outcome with adjustment for age, sex, initial NIHSS score, and the use of intravenous recombinant tissue plasminogen activator (odds ratio, 7.768; 95% CI, 1.246-48.416; P = .028). CONCLUSIONS In acute basilar artery occlusion, forced arterial suction thrombectomy demonstrated a higher revascularization rate and improved clinical outcome compared with traditional intra-arterial fibrinolysis. Further clinical trials with the newer Penumbra catheter are warranted.
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Affiliation(s)
- Y-I Eom
- From the Departments of Neurology (Y.-I.E., J.M.H., J.S.L.)
| | - Y-H Hwang
- Departments of Neurology (Y.-H.H., Y.-W.K.)
| | - J M Hong
- From the Departments of Neurology (Y.-I.E., J.M.H., J.S.L.)
| | - J W Choi
- Radiology (J.W.C., S.Y.K.), Ajou University Medical Center, Suwon, South Korea
| | - Y C Lim
- Department of Neurosurgery (Y.C.L.), Ajou University Hospital, Daegu, South Korea
| | - D-H Kang
- Neurosurgery (D.-H.K.) Radiology (D.-H.K., Y.-W.K., Y.-S.K.), Kyungpook National University Hospital, Daegu, South Korea
| | - Y-W Kim
- Departments of Neurology (Y.-H.H., Y.-W.K.) Radiology (D.-H.K., Y.-W.K., Y.-S.K.), Kyungpook National University Hospital, Daegu, South Korea
| | - Y-S Kim
- Radiology (D.-H.K., Y.-W.K., Y.-S.K.), Kyungpook National University Hospital, Daegu, South Korea
| | - S Y Kim
- Radiology (J.W.C., S.Y.K.), Ajou University Medical Center, Suwon, South Korea
| | - J S Lee
- From the Departments of Neurology (Y.-I.E., J.M.H., J.S.L.)
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Kim SK, Yoon W, Moon SM, Park MS, Jeong GW, Kang HK. Outcomes of manual aspiration thrombectomy for acute ischemic stroke refractory to stent-based thrombectomy. J Neurointerv Surg 2014; 7:473-7. [PMID: 24811741 DOI: 10.1136/neurintsurg-2014-011203] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/15/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE The optimal treatment for patients with acute stroke refractory to stent-based thrombectomy (SBT) is unclear. This study aimed to report clinical outcomes of manual aspiration thrombectomy (MAT) for the treatment of acute ischemic stroke refractory to SBT. METHODS We retrospectively analyzed clinical and angiographic data of 30 patients who underwent MAT with a Penumbra reperfusion catheter because of refractory occlusion after SBT with a Solitaire stent as first-line endovascular therapy. Refractory occlusion was defined by a lack of successful revascularization (defined as Thrombolysis In Cerebral Infarction ≥2b) after five retrieval attempts. A good outcome was defined as a modified Rankin scale score of ≤2 at 3 months. RESULTS Successful revascularization was achieved in 83.3% (25/30) of the patients who underwent MAT after failed SBT. There was no arterial rupture or dissection or symptomatic intracranial hemorrhage. Two embolic occlusions in a new arterial territory and five subarachnoid hemorrhages occurred, neither of which caused neurological worsening. At the 3-month follow-up, 36.7% (11/30) of patients exhibited a good outcome. The mortality rate was 6.7% (2/30) at 3 months. CONCLUSIONS This study suggests that MAT with the Penumbra reperfusion catheter can further increase the revascularization rate without serious complications in patients with acute stroke with refractory occlusions after SBT with a Solitaire stent.
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Affiliation(s)
- Seul Kee Kim
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sung Min Moon
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Gwang Woo Jeong
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Heoung Keun Kang
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
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Kappelhof M, Marquering HA, Berkhemer OA, Majoie CBLM. Intra-arterial treatment of patients with acute ischemic stroke and internal carotid artery occlusion: a literature review. J Neurointerv Surg 2014; 7:8-15. [DOI: 10.1136/neurintsurg-2013-011004] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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