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Bao L, Liu Y, Chen L, Wang F, Zhu Y, Liang S, Wang Y, Quan H, Li P. Effects of Solitaire AB stent thrombectomy with tirofiban and butylphthalide on neurological function and inflammatory factors in acute cerebral infarction patients. Int J Neurosci 2024:1-10. [PMID: 38300017 DOI: 10.1080/00207454.2024.2309464] [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: 12/19/2023] [Accepted: 01/13/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Acute cerebral infarction profoundly affects patients' neurological function and quality of life. This study explores the impact of Solitaire AB stent thrombectomy, combined with tirofiban and butylphthalide, on neurological function and inflammatory factors in patients with acute cerebral infarction. METHODS Seventy-three eligible patients treated between 2021 and 2023 were divided into a control group (Solitaire AB stent thrombectomy) and a treatment group (Solitaire AB stent thrombectomy with tirofiban and butylphthalide). Postoperative neurological function scores and inflammatory factor levels were analyzed. RESULTS The treatment group demonstrated a higher clinical effective rate, lower National Institutes of Health Stroke Scale scores at one day and seven days and higher Mini-Mental State Examination and Montreal Cognitive Assessment scores post-treatment. Inflammatory factor levels (Neuron Specific Enolase (NSE), S100-β, TNF-α and IL-6) were lower in the treatment group. No significant differences in adverse outcomes were observed. CONCLUSION Solitaire AB stent thrombectomy with tirofiban and butylphthalide shows superior efficacy, improving neurological function and inflammatory factors without increasing adverse outcomes. This offers valuable insights for clinical treatment of acute cerebral infarction.
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Affiliation(s)
- Le Bao
- Department of Interventional Radiology, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Ying Liu
- Department of Traditional Chinese Medicine and Acupuncture, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Long Chen
- Department of Interventional Radiology, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Fei Wang
- Emergency and Intensive Care Medicine Department, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Yuzhi Zhu
- Information Department, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Shuang Liang
- Department of Interventional Radiology, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Youbin Wang
- Department of Interventional Radiology, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
- Medical Affairs Department, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Hetai Quan
- Department of Interventional Radiology, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
| | - Pengfei Li
- Department of Interventional Radiology, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
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Li W, Xing X, Wen C, Liu H. Risk factors and functional outcome were associated with hemorrhagic transformation after mechanical thrombectomy for acute large vessel occlusion stroke. J Neurosurg Sci 2023; 67:585-590. [PMID: 33320467 DOI: 10.23736/s0390-5616.20.05141-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Risk factors and functional outcome of hemorrhagic transformation (HT) after mechanical thrombectomy (MT) are to be elucidated in patients with acute large vessel occlusion stroke. METHODS We retrospectively analyzed data from 88 patients who underwent MT treatment. Independent risk factors of hemorrhagic infarction (HI), parenchymal hematoma (PH) and symptomatic intracranial hemorrhage (sICH) were implemented to determine. Association between HI, PH, sICH and mortality at 90 days after treatment were analyzed. RESULTS Of 88 patients, 44.3%had HT (N.=39). 64.1% had HI (N.=25), 35.9% had PH (N.=14) and 12.5% had sICH (N.=11). Independent risk factors for HI were associated with higher NIHSS Score (OR 1.190; 95% CI 1.073~1.319, P=0.001, per 1 score increase), history of coronary heart disease (OR 4.645; 95% CI 1.092~19.758, P=0.038), and use of intravenous thrombolysis (OR 3.438; 95% CI 1.029~11.483, P=0.045). Independent risk factors for PH were associated with higher NIHSS Score (OR 1.227; 95% CI 1.085~1.387, P=0.001, per 1 score increase) and history of oral antiplatelet and/or anticoagulation drugs (OR 6.694; 95% CI 1.245~35.977, P=0.027). Independent risk factors for sICH were associated with higher NIHSS Score (OR 1.393; 95% CI 1.138~1.704, P=0.001, per 1 score increase), increased systolic blood pressure (OR 1.061; 95% CI 1.006~1.120, P=0.030, per 1 mmHg increase) and history of coronary heart disease (OR 13.699; 95% CI 1.019~184.098, P=0.048). Patients who had PH were more likely to cause mortality at 90 days (OR 10.15; 95% CI 1.455~70.914, P=0.019). CONCLUSIONS Higher NIHSS Score was associated with HI, PH, and sICH. History of coronary heart was associated with HI and sICH. Use of intravenous thrombolysis was associated with HI. History of oral antiplatelet and/or anticoagulation drugs was associated with PH. Increased systolic blood pressure was associated with sICH. PHs was remarkably associated with mortality at 90 days.
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Affiliation(s)
- Weirong Li
- Department of Neurology, Tai Yuan Central Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiaolian Xing
- Department of Neurology, Tai Yuan Central Hospital, Shanxi Medical University, Taiyuan, China
| | - Chao Wen
- Department of Neurology, Tai Yuan Central Hospital, Shanxi Medical University, Taiyuan, China
| | - Hongwei Liu
- Department of Neurology, Tai Yuan Central Hospital, Shanxi Medical University, Taiyuan, China -
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Yao QY, Fu ML, Zhao Q, Zheng XM, Tang K, Cao LM. Image-based visualization of stents in mechanical thrombectomy for acute ischemic stroke: Preliminary findings from a series of cases. World J Clin Cases 2023; 11:5047-5055. [PMID: 37583850 PMCID: PMC10424012 DOI: 10.12998/wjcc.v11.i21.5047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/17/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window. Typically, an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not. Thus, improving the visualization of a stent in interventional therapy will be helpful for clinicians. AIM To analyze stent imaging findings to enhance clinicians' understanding of a special circumstance, wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy. METHODS This was a retrospective study with four acute ischemic stroke (AIS) patients who underwent stent-based mechanical thrombectomy. RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion; angiography revealed basilar artery occlusion. We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus. Patient 2 was a 74-year-old man admitted with confusion, which lasted approximately 3 h. Angiography revealed a left middle cerebral artery (MCA)-M1 segment occlusion. A stent was deployed in the distal M2 segment, and we could visualize the stent by capturing the thrombus. Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h. We deployed a stent at the distal right MCA-M2 segment, and the developing stent captured a large thrombus. Patient 4 was an 82-year-old man who presented with confusion for 3 h. A developing stent was placed in the distal left MCA-M1 segment, which captured a large thrombus and several fragmented thrombi. CONCLUSION To the best of our knowledge, this is the first report of stent imaging in patients with AIS. We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.
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Affiliation(s)
- Qing-Yang Yao
- Department of Neurology, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Mao-Lin Fu
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Qing Zhao
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Xiao-Ming Zheng
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Kai Tang
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Li-Ming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
- Hunan Provincial Key Laboratory of The Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China
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Dong X, Xu G, Song Y, Ma L, Huo T, Yin N, Meng N. Comparative study on treatment of acute cerebral infarction between mechanical thrombectomy by micro catheter and thrombectomy by Solitaire AB stent. Medicine (Baltimore) 2022; 101:e28968. [PMID: 35446289 PMCID: PMC9276357 DOI: 10.1097/md.0000000000028968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/08/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Acute cerebral artery occlusion is a common disease with high morbidity and mortality. At present, the commonly used mechanical thrombectomy schemes are mechanical thrombectomy and stent thrombectomy. However, the clinical differences between the two methods is not fully understood. The present study aimed to evaluate the clinical effectiveness of Solitaire AB stent thrombectomy for acute cerebral infarction (ACI). METHODS A retrospective study was carried out in 96 ACI patients admitted to our department from January 2017 to January 2020. According to the treatment they received, they were divided into group A (conventional microcatheter mechanical thrombectomy, n = 48) and group B (Solitaire AB stent thrombectomy, n = 48). All patients were followed up for 3 months. Their pre- and post-operative nerve function indices were compared between the 2 groups. The therapeutic effects were evaluated by thrombolysis in cerebral infarction scale system, Glasgow coma scale (GCS), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin scale statistics. RESULTS Two groups of patients with NIHSS scores postoperative 3 and 30 days decreased significantly compared with preoperation. NIHSS score of group A 3 and 30 days postoperation was significantly higher than group B (P < .05). Two groups of patients with GCS scores postoperative 3 and 30 days increased significantly compared with preoperation. GCS score of group A 3 and 30 days postoperation was significantly lower than group B (P < .05). Group B with vascular recanalization ratio postoperative 30 days was higher than group A, however with no significant differences (P > .05). Moreover, group B with outcomes (modified Rankin scale score ≤2 points) postoperative 3 months was better than group A, however with no significant differences (P > .05). CONCLUSION Solitaire AB stent embolectomy shows similar efficacy as mechanical thrombectomy in the treatment of ACI patients.
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Affiliation(s)
- Xiaoli Dong
- Department of Neurology, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, 050000, China
| | - Guodong Xu
- Department of Neurology, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, 050000, China
| | - Yaxue Song
- Department of Neurology, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, 050000, China
| | - Liang Ma
- Department of Oncology, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, 050001, China
| | - Tiantian Huo
- Department of Neurology, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, 050000, China
| | - Nan Yin
- Department of Neurology, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, 050000, China
| | - Nan Meng
- Department of Neurology, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, 050000, China
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5
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Cao J, Mo Y, Chen R, Shao H, Xuan J, Peng Y, Zhu X. Predictors of Functional Outcome and Mortality in Endovascular Treatment for Acute Basilar Artery Occlusion: A Single-Centre Experience. Front Neurol 2021; 12:731300. [PMID: 34721264 PMCID: PMC8548650 DOI: 10.3389/fneur.2021.731300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: The objective of this study was to identify prognostic factors of endovascular treatment in patients with acute basilar artery occlusion and add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion. Materials and Methods: We reviewed the data of 101 patients with acute basilar artery occlusion receiving endovascular treatment from January 2013 to September 2019. Baseline characteristics and outcomes were evaluated. A favourable functional outcome was defined as a mRS of 0 to 2 assessed at the 3 month follow-up. The association of clinical and procedural characteristics with the functional outcome and mortality was assessed. Results: The study population consisted of 101 patients: 83 males and 18 females. Successful recanalization was achieved in 99 patients (97.1%). A favourable clinical outcome was observed in 50 patients (49.5%), and the overall mortality rate was 26.7%. A favourable outcome was significantly associated with NIHSS score at admission and lung infection. Mortality was associated with NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, and diabetes mellitus. Conclusions: This study suggested that NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, diabetes mellitus, and lung infection can predict the functional outcome and mortality. These initial results add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion and need to be confirmed by further prospective studies.
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Affiliation(s)
- Jie Cao
- Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Mo
- Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ronghua Chen
- Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Huaming Shao
- Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jinggang Xuan
- Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ya Peng
- Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xucheng Zhu
- Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, China
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Onodera K, Kurisu K, Sakurai J, Wada H, Takebayashi S, Kobayashi T, Kobayshi R, Gotoh S, Takizawa K. A Direct Aspiration First Pass Technique for Vertebra-Basilar Occlusion: A Retrospective Comparison to Stent Retriever. J Stroke Cerebrovasc Dis 2021; 30:106069. [PMID: 34461445 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/01/2021] [Accepted: 08/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to assess the clinical usefulness of a direct aspiration first pass technique as a first-line strategy for mechanical thrombectomy in posterior circulation. MATERIALS AND METHODS We examined 34 consecutive patients treated with mechanical thrombectomy for acute vertebrobasilar artery occlusion. Procedural and clinical outcomes were assessed and compared between patients treated with a direct aspiration first pass technique first-line strategy (ADAPT group) and stent retriever system first-line strategy (stent retriever group). RESULTS Overall, successful reperfusion, complete reperfusion, and first-pass effects were achieved in 94.1%, 61.8%, and 50% of patients with acute ischemic stroke in vertebra-basilar artery occlusion treated with mechanical thrombectomy, respectively. The ADAPT group required a significantly shorter procedural time (p=.015) and fewer attempts (p=.0498) to achieve successful recanalization than the stent retriever group. The ADAPT group also tended to show better recanalization rates and first-pass effects than the stent retriever group. The rates of favorable outcomes seemed to be better, although insignificant, in the ADAPT group than in the stent retriever group (52.2% vs. 27.3%, p=.217). However, a significant correlation between the time required for reperfusion and clinical outcome was detected, and this will serve as the rationale for encouraging a direct aspiration first pass technique as a first-line strategy in the acute vertebra-basilar artery. CONCLUSIONS The a direct aspiration first pass technique first-line strategy for mechanical thrombectomy in posterior circulation may achieve successful recanalization with fewer attempts and shorter durations than the stent retriever first-line strategy.
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Affiliation(s)
- Koki Onodera
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan
| | - Kota Kurisu
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Juro Sakurai
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Hajime Wada
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Seiji Takebayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Tohru Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Rina Kobayshi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
| | - Shuho Gotoh
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
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Xun K, Mo J, Ruan S, Dai J, Zhang W, Lv Y, Du N, Chen S, Shen Z, Wu Y. A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy. Cerebrovasc Dis 2020; 50:185-199. [PMID: 33378751 DOI: 10.1159/000512609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Posterior circulation stroke is characterized by poor prognosis because its optimal thrombolysis "time window" is always missed. After mechanical thrombectomy (MT), the recanalization rate of posterior circulation obstruction is significantly increased, but prognosis remains poor. To best manage patients, prognostic factors are needed to inform MT triaging after posterior circulation stroke. METHODS A systematic literature search was done for the period through April 2020. Studies included those with posterior circulation stroke cases that underwent MT. The primary outcome measure in this study was the modified Rankin Scale on day 90. RESULTS No outcome differences were found in gender, atrial fibrillation, smoking, and coronary artery disease (OR = 1.07, 95% CI: 0.90-1.28; OR = 1.02, 95% CI: 0.82-1.26; OR = 1.26, 95% CI: 0.94-1.68; and OR = 0.84, 95% CI: 0.58-1.22, respectively). Hypertension, diabetes mellitus, and previous stroke correlated with poorer prognosis (OR = 0.61, 95% CI: 0.48-0.77; OR = 0.60, 95% CI: 0.50-0.73; and OR = 0.74, 95% CI: 0.55-0.99, respectively). However, hyperlipidemia correlated with better prognosis (OR = 1.28, 95% CI: 1.04-1.58). CONCLUSION Our analysis indicates that hypertension, diabetes mellitus, or previous stroke correlate with poorer outcomes. Intriguingly, hyperlipidemia correlates with better prognosis. These factors may help inform triage decisions when considering MT for posterior circulation stroke patients. However, large, multicenter, randomized controlled trials are needed to validate these observations.
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Affiliation(s)
- Kai Xun
- Department of Emergency, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiahang Mo
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shunyi Ruan
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinyao Dai
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenting Zhang
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuqi Lv
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Nannan Du
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shengyue Chen
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zefeng Shen
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yuanxi Wu
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China,
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8
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Choi JW, Han M, Park JH, Jung WS. Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system. BMC Neurol 2020; 20:434. [PMID: 33250061 PMCID: PMC7702718 DOI: 10.1186/s12883-020-02013-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.
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Affiliation(s)
- Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Miran Han
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Jung Hyun Park
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea.
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9
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Lee SH, Han JH, Jung I, Jung JM. Do thrombolysis outcomes differ between anterior circulation stroke and posterior circulation stroke? A systematic review and meta-analysis. Int J Stroke 2020; 15:849-857. [PMID: 32122288 DOI: 10.1177/1747493020909634] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It remains unclear whether thrombolysis outcomes can be influenced by the affected vascular territory (i.e. anterior circulation stroke vs. posterior circulation stroke) in stroke patients owing to the lack of randomized controlled trials. AIMS Using multiple comprehensive databases, we searched for observational studies of the safety and efficacy of intravenous thrombolytics and intra-arterial treatment with or without intravenous thrombolytics in accordance with the affected vascular territory. We performed a systematic review and meta-analysis. We evaluated symptomatic intracerebral hemorrhage, all-type intracerebral hemorrhage, mortality, and functional outcomes at three months. The recanalization rate was assessed in the intra-arterial treatment group. SUMMARY OF REVIEW Twenty-one studies including a report from our own stroke registry were included through quantitative synthesis. Compared with the anterior circulation stroke group, the posterior circulation stroke group had a lower risk of ICH, including symptomatic intracerebral hemorrhage and all-type intracerebral hemorrhage, after intravenous thrombolytics and tended to have favorable functional outcomes at three months. Mortality was similar between the two groups. Regarding intra-arterial treatment, the symptomatic intracerebral hemorrhage and post-procedural recanalization rates were comparable between the two groups, although the posterior circulation stroke group had a higher mortality risk and lower tendency for a favorable functional outcome. CONCLUSIONS Safety and efficacy of thrombolysis in posterior circulation stroke depends on involvement of large vessel occlusion and reperfusion modality such that intravenous thrombolytics is more effective and safer than in anterior circulation stroke; the safety and efficacy of intra-arterial treatment is comparable or lower than anterior circulation stroke. Considering the limitations of our meta-analysis, further studies are needed to provide high level evidence of a beneficial effect of intra-arterial treatment, and to identify patients' profiles associated with benefit of treatment.
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Affiliation(s)
- Sang-Hun Lee
- Department of Neurology, 65356Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Jung Hoon Han
- Department of Neurology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ileok Jung
- Department of Neurology, 65356Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Jin-Man Jung
- Department of Neurology, 65356Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
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10
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Wang F, Wang J, He Q, Wang L, Cao Y, Zhang H, Xu Z. Mechanical Thrombectomy for Posterior Circulation Occlusion: A Comparison of Outcomes with the Anterior Circulation Occlusion - A Meta-Analysis. J Atheroscler Thromb 2020; 27:1325-1339. [PMID: 32062629 PMCID: PMC7840169 DOI: 10.5551/jat.54221] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: There is no randomized controlled trial to compare the effectiveness and safety of mechanical thrombectomy (MT) to intravenous thrombolysis in patients with posterior circulation occlusion (PCO). Hence, we firstly performed a meta-analysis to investigate the outcomes of MT in PCO and then compared these outcomes to anterior circulation occlusion (ACO) to provide fundamental data to further studies. Methods: We searched the PubMed, EMBASE, and Cochrane Library from dates of inception to June 2019 for relevant studies. Outcomes including functional independence at 90 days, successful recanalization, mortality, symptomatic intracranial hemorrhage (sICH), and futile recanalization were extracted. Results: Seven studies involving 474 patients with PCO thrombectomy were analyzed. There was a lower rate of functional independence at 90 days and a higher rate of mortality after thrombectomy in PCO versus ACO (odds ratios (OR) 0.72; 95% confidence interval (CI) 0.57–0.90; OR 2.03; 95% CI 1.30–3.18). Recanalization rates were comparable (OR 1.01; 95% CI 0.62–1.65), but a higher futile recanalization rate was found in basilar artery occlusion (BAO) (OR 1.75; 95% CI 1.30–2.37). There was a lower rate of sICH in MT for patients with PCO versus ACO (OR 0.54; 95% CI 0.29–0.99). Conclusions: We found that the outcomes of MT for patients with PCO were poorer than with ACO. On the other hand, MT appears to have lower rates of sICH and to increase successful recanalization. Given the high recanalization rate, MT may serve as an adjunct to standard treatment. The key point to improve outcomes is recognizing reliable factors associated with futile recanalization and optimizing the results of MT. But in view of the different characteristics of posterior circulation stroke and anterior circulation stroke, the results are far from robust.
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Affiliation(s)
- Fengzhi Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University.,Department of Neurology, People's Hospital of China Medical University, People's Hospital of Liaoning Province
| | - Jiaoqi Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University
| | - Qiu He
- Department of Neurology, People's Hospital of China Medical University, People's Hospital of Liaoning Province
| | - Liyu Wang
- Department of Neurology, People's Hospital of China Medical University, People's Hospital of Liaoning Province.,Graduate School of Dalian Medical University
| | - Yumeng Cao
- Department of Neurology, People's Hospital of China Medical University, People's Hospital of Liaoning Province.,Graduate School of China Medical University
| | - Hemin Zhang
- Department of Neurology, People's Hospital of China Medical University, People's Hospital of Liaoning Province
| | - Zhongxin Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University
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García Jurado P, Bravo Rey I, Jiménez Gómez E, Oteros Fernández R, Valverde Moyano R, Bravo-Rodríguez F, Delgado Acosta F. Treatment of posterior circulation strokes by mechanical thrombectomy with a stent-retriever: a retrospective observational study at a single centre. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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García Jurado PB, Bravo Rey IM, Jiménez Gómez E, Oteros Fernández R, Valverde Moyano R, Bravo-Rodríguez FA, Delgado Acosta F. Treatment of posterior circulation strokes by mechanical thrombectomy with a stent-retriever: a retrospective observational study at a single center. RADIOLOGIA 2019; 62:51-58. [PMID: 31445762 DOI: 10.1016/j.rx.2019.06.002] [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: 12/15/2018] [Revised: 05/18/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the rate of recanalization, functional outcome at three months, and independent prognostic factors in patients with posterior circulation strokes treated with stent-retrievers and to compare these results with those of patients in an earlier series treated with "classical methods". MATERIAL AND METHODS This was a retrospective study of consecutive patients with posterior circulation strokes treated with stent-retrievers at our center between December 1, 2011 and May 1, 2018. The main outcome variables were the rate of recanalization according to the Thrombosis in Cerebral Infarction (TICI) scale and functional independence score 90 days after treatment according to the modified Rankin Scale (mRS). We analyzed demographics, cerebrovascular risk factors, clinical findings, and probable origin. Descriptive statistics and a binary logistic regression model were used to analyze the data. RESULTS We included 75 patients: 27 treated with "classical methods" and 48 treated with stent-retrievers (10 women; mean age, 63.9 years; median National Institute of Health Stroke Score, 15.8 (IQR 9-25); median Glasgow Coma Scale (GCS), 9.1 (IQR 6-14,5). TICI 2b-3 recanalization was achieved in 46 (95.8%) patients treated with stent-retrievers and in 15 (55.6%) patients treated with "classical methods" (p<0.0001). No significant differences were observed in the rate of patients achieving mRS 0-2 at 90 days (19 (39.6%) of those treated with stent-retrievers vs. 6 (22.2%) of those treated with "classical methods"). Mortality was lower among patients treated with stent-retrievers (14 (29.2% vs. 15 (55.6%) in those treated with "classical methods", p=0.024). GCS score was independently associated with mRS at 90 days (OR:0.67; 95%CI:0.5-0.91; p=0.01). CONCLUSIONS In patients with posterior circulation infarcts, treatment with stent-retrievers achieved high rates of recanalization and functional independence at 90 days. The rate of complications was similar to those reported in other studies. GCS is an independent predictor of functional independence at 90 days.
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Affiliation(s)
- P B García Jurado
- Sección de Neurorradiología Diagnóstica y Terapéutica, Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, España.
| | - I M Bravo Rey
- Sección de Neurorradiología Diagnóstica y Terapéutica, Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, España
| | - E Jiménez Gómez
- Sección de Neurorradiología Diagnóstica y Terapéutica, Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, España
| | - R Oteros Fernández
- Sección de Neurorradiología Diagnóstica y Terapéutica, Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, España
| | - R Valverde Moyano
- Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, España
| | - F A Bravo-Rodríguez
- Sección de Neurorradiología Diagnóstica y Terapéutica, Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, España
| | - F Delgado Acosta
- Sección de Neurorradiología Diagnóstica y Terapéutica, Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, España
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Liu ZS, Zhou LJ, Sun Y, Kuang XW, Wang JX, Zhang XJ. Thrombectomy Using “Clamping Embolus with Semi-Retrieval” Technique in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:733-739. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022] Open
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14
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Mechanical Thrombectomy in Basilar Artery Occlusion. Clin Neuroradiol 2017; 29:153-160. [DOI: 10.1007/s00062-017-0651-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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Wyszomirski A, Szczyrba S, Tomaka D, Karaszewski B. Treatment of acute basilar artery occlusion: Systematic review and meta-analysis. Neurol Neurochir Pol 2017; 51:486-496. [DOI: 10.1016/j.pjnns.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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