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Chen F, Chen X, Zhang Q, Wen S, Zhou C. Repeated intravenous thrombolysis in early recurrent ischemic stroke: a case report of an elderly low weight female. Neurol Sci 2024; 45:345-348. [PMID: 37725194 PMCID: PMC10761452 DOI: 10.1007/s10072-023-07060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Feifei Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, No. 9 Shuangxing Avenue, Bishan District, Chongqing, 402760, China
| | - Xiangting Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, No. 9 Shuangxing Avenue, Bishan District, Chongqing, 402760, China
| | - Qian Zhang
- Department of Neurology, Bishan Hospital of Chongqing Medical University, No. 9 Shuangxing Avenue, Bishan District, Chongqing, 402760, China
| | - Siyuan Wen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, No. 9 Shuangxing Avenue, Bishan District, Chongqing, 402760, China
| | - Changqing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, No. 9 Shuangxing Avenue, Bishan District, Chongqing, 402760, China.
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2
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Oliveira R, Correia MA, Marto JP, Carvalho Dias M, Mohamed GA, Nguyen TN, Nogueira RG, Aboul-Nour H, Marin H, Bou Chebl A, Mohammaden MH, Al-Bayati AR, Haussen DC, Abdalkader M, Fifi JT, Ortega-Gutierrez S, Yavagal DR, Mayer SA, Tsivgoulis G, Neto LL, Aguiar de Sousa D. Reocclusion after successful endovascular treatment in acute ischemic stroke: systematic review and meta-analysis. J Neurointerv Surg 2023; 15:964-970. [PMID: 36328479 DOI: 10.1136/jnis-2022-019382] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). OBJECTIVE To systematically review the available data on: (1) incidence, predictors, and outcomes of patients with reocclusion after successful EVT for AIS and, (2) the characteristics, complications, and outcomes of patients with reocclusion treated with repeated EVT (rEVT) within 30 days of the first procedure. METHODS PubMed was searched (between January 2012 and April 2021) to identify studies reporting reocclusion following successful EVT (Thrombolysis in Cerebral Infarction ≥2b) in patients with AIS due to LVO. Pooled incidence of reocclusion per 100 patients with successful recanalization following EVT was calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Extracted incidences of reocclusion according to etiology and use of intravenous thrombolysis were pooled using random-effects meta-analytic models. RESULTS A total of 840 studies was identified and seven studies qualified for the quantitative analysis, which described 91 same-vessel reocclusions occurring within the first 7 days after treatment among 2067 patients (4.9%; 95% CI 3% to 7%, I2=70.2%). Large vessel atherosclerosis was associated with an increased risk of reocclusion (OR=3.44, 95% CI 1.12 to 10.61, I2=50%). We identified 90 patients treated with rEVT for recurrent LVO, described in five studies. The rates of procedural complications, mortality, and unfavorable functional outcome at 3 months were 18.0%, 18.9%, and 60.3%, respectively. CONCLUSION In cohorts of patients with AIS due to LVO, 5% of patients experienced reocclusion within 7 days after successful EVT. Repeated EVT can be a safe and effective treatment for selected patients with reocclusion.
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Affiliation(s)
- Renato Oliveira
- Department of Neurology, Hospital da Luz Lisboa, Lisboa, Portugal
- Department of Geriatrics, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuel A Correia
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Lisboa, Portugal
| | - Mariana Carvalho Dias
- Department of Neurology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Ghada A Mohamed
- Department of Neurology, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Raul G Nogueira
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hassan Aboul-Nour
- Department of Neurology, Emory University Hospitals, Atlanta, Georgia, USA
| | - Horia Marin
- Department of Radiology, Henry Ford Health, Detroit, Michigan, USA
| | - Alex Bou Chebl
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Alhamza R Al-Bayati
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Diogo C Haussen
- Department of Neurology and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Lia Lucas Neto
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Diana Aguiar de Sousa
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal
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3
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Bageac DV, Gershon BS, Chada D, Siddiqui N, Majidi S, Fifi JT, De Leacy R. Laterality of previous stoke affects endovascular thrombectomy outcomes. J Neurointerv Surg 2023; 15:238-241. [PMID: 35101957 DOI: 10.1136/neurintsurg-2021-018011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Investigations into the effect of previous stroke on thrombectomy outcomes have yielded conflicting results, and are limited by small sample sizes. We present the results of a large single center retrospective study aimed at investigating the effect of chronic stroke laterality on thrombectomy outcomes. METHODS A prospectively maintained database was queried for all thrombectomy cases conducted between December 2014 and January 2020, and patient imaging was prospectively reviewed for evidence of prior supratentorial infarction. Procedural, clinical, and demographic characteristics were recorded, and good clinical outcome was defined as a 90 day modified Rankin Scale (mRS) score of <2 or mRS score unchanged if baseline was >2. RESULTS The final analysis cohort included 555 patients, 79 of whom were found to have radiographic evidence of prior chronic infarcts. On univariate analysis, patients with any chronic supratentorial infarct achieved a lower rate of good clinical outcome than patients with no chronic infarct (22.8% vs 41.0%, p=0.0021). With regard to subgroups, this difference remained only in patients with ipsilateral (14.3%, p=0.0018) and bilateral (11.8%, p=0.015) lesions. Patients with chronic contralateral supratentorial infarcts were no less likely to achieve good outcomes (40.7%, p=0.98). After multivariate regression controlling for age, sex, and baseline mRS, chronic ipsilateral infarcts (OR 0.22, CI 0.07 to 0.67) and chronic bilateral infarcts (OR 0.19, CI 0.04 to 0.85) were the only independent predictors of poor outcome in endovascular thrombectomy patients. CONCLUSIONS In this single center retrospective study of thrombectomy patients with chronic supratentorial infarcts, the laterality of the previous stroke significantly affected the likelihood of good clinical outcomes.
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Affiliation(s)
- Devin V Bageac
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Blake S Gershon
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deeksha Chada
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neha Siddiqui
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shahram Majidi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Icahn School of Medicine at Mount Sinai Department of Neurosurgery, New York, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Icahn School of Medicine at Mount Sinai Department of Neurosurgery, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA .,Icahn School of Medicine at Mount Sinai Department of Neurosurgery, New York, New York, USA
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4
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Elfil M, Bahbah EI, Bayoumi A, Aladawi M, Eldokmak M, Salem MM, Aboutaleb PE, Villafuerte-Trisolini B, Al-Mufti F, Ortega-Gutierrez S, A Gonzalez-Castellon M. Repeated mechanical thrombectomy for recurrent large vessel occlusion: A systematic review and meta-analysis. Interv Neuroradiol 2022:15910199221134307. [PMID: 36285483 DOI: 10.1177/15910199221134307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) is the standard treatment for acute large vessel occlusion (LVO). Recurrent LVO can still occur in patients who already underwent MT for the first LVO. This study aimed to evaluate the efficacy of repeating MT for recurrent LVO. METHODS This meta-analysis of the available literature was conducted to summarize the current evidence regarding repeated MT outcomes in patients with recurrent LVO. All studies with ≥ 1 outcomes of interest were included. The Newcastle-Ottawa Scale (NOS) was used for risk of bias assessment. RESULTS Twenty studies, 10 observational (n = 21,251 patients) and 10 case reports (n = 10 patients), were included. 266 patients (62.78% females) with recurrent LVO were identified, with an overall prevalence of 1.6% and a mean age of 65.67 ± 16.23 years. Cardio-embolism was the most common mechanism in both times, with a median of 15 days between the first and second LVOs. Compared with pre-intervention, the first and second MTs significantly reduced the National Institute of Health Stroke Scale (NIHSS) score, (mean difference (MD) = -8.91) and (MD = -5.97) respectively, with a significant difference (p = 0.001). The rate of favorable outcome (modified Rankin scale (mRS) score 0-3) was 82.6% and 59.2% after the first and second MTs respectively, with a significant difference (p < 0.001). CONCLUSION In properly selected recurrent LVO patients, repeated MT is efficacious and safe. A prior MT procedure should not discourage aggressive treatment as many patients may achieve favorable outcomes.
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Affiliation(s)
- Mohamed Elfil
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Eshak I Bahbah
- 486471Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ahmed Bayoumi
- 12339McGovern Medical School, UT Houston, Houston, TX, USA
| | - Mohammad Aladawi
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Eldokmak
- Department of Neurology, 12298SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the 6572University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, Hospital of the 6572University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | | | - Fawaz Al-Mufti
- Department of Neurosurgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Department of Neurology, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, 21782University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Neurosurgery, 21782University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Radiology, 21782University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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5
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Dell'Aera C, Giammello F, Caragliano AA, Ciacciarelli A, Francalanza I, Currò CT, Pitrone A, Grillo F, Casella C, Fazio MC, La Spina P, Cotroneo M, Crea P, Toscano A, Vinci SL, Musolino RF. Repeated reperfusion treatment in recurrent ischemic stroke: A retrospective single-center case series. J Neurol Sci 2022; 434:120147. [PMID: 35033745 DOI: 10.1016/j.jns.2022.120147] [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: 08/23/2021] [Revised: 12/15/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
Data regarding repeated reperfusion therapy (rRT) in acute ischemic stroke (AIS), including intravenous thrombolysis and endovascular treatment (EVT), are quite poor. To date, there are only few case reports and five larger studies on repeated EVT. We aimed to report our single-center experience and describe different clinical scenarios of recurrent AIS with emergent large vessel occlusion (LVO), for which the decision-making process could be challenging in the emergency setting. We retrospectively reviewed 765 consecutive AIS patients with LVO, who underwent reperfusion procedures at our comprehensive stroke center, from 2014 to 2020, and identified rRT patients. We identified and reviewed the medical records of eight patients (1.05%), who repeated reperfusive treatment for recurrent stroke within 30 days (early arterial reocclusion, EAR) and after 30 days (late arterial reocclusion, LAR). We assigned collected data to three clinical scenarios, each divided into EAR and LAR cases. All patients had recurrent emergent LVO in the same vessel territory previously affected, both in EAR and LAR patients. A good clinical outcome has been achieved in EAR patients (modified Rankin Score ≤ 2). Artery-to-artery embolic mechanism was more common in the EAR group, while LAR was more frequently associated with cardioembolic source. RRT appears to be an effective treatment option for recurrent LVO, and it should not be withheld in carefully selected patients. EVT should be considered, including aspiration-only and stenting procedures in patients with AIS and recurrent LVO after previous reperfusive treatments, even after a very short time.
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Affiliation(s)
- Cristina Dell'Aera
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Antonio Armando Caragliano
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Ciacciarelli
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Isabella Francalanza
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo Tiberio Currò
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Francesco Grillo
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmela Casella
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Carolina Fazio
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Masina Cotroneo
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale Crea
- Cardiology Unit with U.T.I.C., Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Toscano
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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6
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Lee H, Qureshi AM, Mueller-Kronast NH, Zaidat OO, Froehler MT, Liebeskind DS, Pereira VM. Subarachnoid Hemorrhage in Mechanical Thrombectomy for Acute Ischemic Stroke: Analysis of the STRATIS Registry, Systematic Review, and Meta-Analysis. Front Neurol 2021; 12:663058. [PMID: 34113310 PMCID: PMC8185211 DOI: 10.3389/fneur.2021.663058] [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: 02/02/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The indications for mechanical thrombectomy in acute ischemic stroke continue to broaden, leading neurointerventionalists to treat vessel occlusions at increasingly distal locations farther in time from stroke onset. Accessing these smaller vessels raises the concern of iatrogenic subarachnoid hemorrhage (SAH) owing to increasing complexity in device navigation and retrieval. This study aims to determine the prevalence of SAH following mechanical thrombectomy, associated predictors, and resulting functional outcomes using a multicenter registry and compare this with a systematic review and meta-analysis of the literature. Methods: Data from STRATIS (The Systematic Evaluation of Patients Treated with Neurothrombectomy Devices for Acute Ischemic Stroke) registry were analyzed dichotomized by the presence or absence of SAH after thrombectomy. Only patients with 24-h post-procedural neuroimaging were included (n = 841). Multivariable logistic regression was performed to identify significant predictors of SAH. A systematic review and random-effects meta-analysis was also conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) protocol. Results: The prevalence of post-thrombectomy SAH was 5.23% in STRATIS with 15.9% (1.84% overall) experiencing neurological decline. Distal location of vessel occlusion (OR 3.41 [95% CI: 1.75-6.63], p < 0.001) and more than 3 device passes (OR 1.34 [95% CI: 1.09-1.64], p = 0.01) were associated with a higher probability of SAH in contrast to a reduction with administration of intravenous tissue plasminogen activator (tPA) (OR 0.48 [95% CI: 0.26-0.89], p = 0.02). There was a trend toward a higher discharge NIHSS (8.3 ± 8.7 vs. 5.3 ± 6.6, p = 0.07) with a significantly reduced proportion achieving functional independence at 90 days (modified Rankin Score 0-2: 32.5% vs. 57.8%, p = 0.002) in SAH patients. Pooled analysis of 10,126 patients from 6 randomized controlled trials and 64 observational studies demonstrated a prevalence of 5.85% [95% CI: 4.51-7.34%, I 2: 85.2%]. Only location of vessel occlusion was significant for increased odds of SAH at distal sites (OR 2.89 [95% CI: 1.14, 7.35]). Conclusions: Iatrogenic SAH related to mechanical thrombectomy is more common with treatment of distally-situated occlusions and multiple device passes. While low in overall prevalence, its effect is not benign with fewer patients reaching post-procedural functional independence, particularly if symptomatic.
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Affiliation(s)
- Hubert Lee
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ayman M Qureshi
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | | | - Osama O Zaidat
- Neuroscience Institute, St Vincent Mercy Medical Center, Toledo, OH, United States
| | - Michael T Froehler
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vitor M Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.,Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
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Pham BN, Phan HT, Nguyen TQ, Nguyen TH. A Case of Successful Intravenous Thrombolysis Bridged with Repeated Endovascular Treatment in Acute Basilar Artery Occlusion. Case Rep Neurol 2021; 12:34-40. [PMID: 33505270 DOI: 10.1159/000507752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/03/2020] [Indexed: 11/19/2022] Open
Abstract
Acute basilar artery occlusion (BAO) is a neurological emergency that has a high rate of mortality and poor functional outcome. Endovascular therapy (ET) is the gold standard therapy for large vessel occlusion stroke of the anterior circulation. Whether ET can also be effectively and safely performed in early recurrent large vessel occlusion, especially in BAO, is unclear. We describe a case of successful recanalization and independent functional outcome of a BAO patient treated with intravenous thrombolysis combined with repeated ET. The patients was a 32-year-old man with a history of heavy smoking and drinking who presented to the Emergency Department with dizziness and hypertension, and progressed over the next 13 h to left hemiparesis and mild dysarthria with an NIHSS score of 7. CT angiography demonstrated occlusion of the proximal basilar artery (BA). Intravenous alteplase was given followed by ET. The first intervention failed and over the next 8 h, the patient's NIHSS score increased to 12. A second attempt with balloon angioplasty managed to reconstitute arterial blood flow with a severe residual stenosis of the proximal BA. Subsequently, the patient progressed into deep coma with reocclusion of the BA demonstrated on transcranial Doppler. A third intervention with emergent stenting resulted in complete recanalization of the BA and excellent neurological recovery. This patient received three endovascular treatments within 24 h due to reocclusion of the BA and achieved good outcomes. In conclusion, repeated ET for early recurrent BAO is feasible in carefully selected patients.
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Affiliation(s)
| | - Hoang Thi Phan
- 115 People's Hospital, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Thang Huy Nguyen
- 115 People's Hospital, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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8
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Lee HJ, Kwak HS, Chung GH, Park JS. Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center. J Stroke Cerebrovasc Dis 2020; 30:105457. [PMID: 33188951 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion (LVO). The purpose of this study is to report the frequency, timing, and outcomes of rEVT in a single center. MATERIALS AND METHODS We retrospectively reviewed our databases for anterior or posterior circulation rEVT cases. Patient characteristics, procedural data, and functional outcomes (modified Rankin scale at 90 days) were analyzed. Early and late recurrence of stroke was divided at 30 days. RESULTS Of 1025 patients treated between January 2011 and January 2020, 23 (2.2%) underwent rEVT. The median time between the first and second procedure was 185 days; 7 (30.4%) patients were re-treated within 30 days. Eleven patients (47.8%) had different occlusion sites between the two procedures. Good clinical outcome of patients with late ipsilateral recurrence was significantly higher than that of patients with late contralateral recurrence (83.3% vs. 16.7, p = 0.027). Overall good functional outcome after the second procedure was 43.5% (10/23). Overall good functional outcome of early and late recurrence groups were similar (57.1% vs. 37.5%, p = 0.650). One patient died due to an underlying cardiac problem. CONCLUSION rEVT can be performed in patients with recurrent stroke of LVO. Ipsilateral recurrence of stroke was associated with good clinical outcome after rEVT.
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Affiliation(s)
- Hyun Jin Lee
- Jeonbuk National University Medical School, Republic of Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 567 Baekje-daero, deokjin-gu, Jeonju-si, Jeollabuk-do 561-756, Republic of Korea.
| | - Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 567 Baekje-daero, deokjin-gu, Jeonju-si, Jeollabuk-do 561-756, Republic of Korea.
| | - Jung-Soo Park
- Departments of Neurosurgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea.
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9
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Styczen H, Maegerlein C, Yeo LL, Clajus C, Kastrup A, Abdullayev N, Behme D, Maurer CJ, Meyer L, Goertz L, Ikenberg B, Tan BYQ, Lobsien D, Papanagiotou P, Kabbasch C, Hesse AC, Berlis A, Fiehler J, Fischer S, Forsting M, Maus V. Repeated mechanical thrombectomy in short-term large vessel occlusion recurrence: multicenter study and systematic review of the literature. J Neurointerv Surg 2020; 12:1186-1193. [PMID: 32376657 DOI: 10.1136/neurintsurg-2020-015938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Data on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature. METHODS A retrospective analysis was conducted of consecutive acute stroke patients treated with MT repeatedly within 30 days at 10 tertiary care centers between January 2007 and January 2020. Baseline demographics, etiology of stroke, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at 90 days were noted. Additionally, a systematic review of reports with repeated MT due to large vessel occlusion (LVO) recurrence was performed. RESULTS We identified 30 out of 7844 (0.4%) patients who received two thrombectomy procedures within 30 days due to recurrent LVO. Through systematic review, three publications of 28 participants met the criteria for inclusion. Combined, a total of 58 participants were analyzed: cardioembolic events were the most common etiology for the first (65.5%) and second LVO (60.3%), respectively. Median baseline NIHSS (National Institutes of Health Stroke Scale) was 13 (IQR 8-16) before the first MT and 15 (IQR 11-19) before the second MT (p=0.031). Successful reperfusion was achieved in 91.4% after the first MT and in 86.2% patients after the second MT (p=0.377). The rate of functional independence (mRS 0-2) was 46% at 90 days after the second procedure. CONCLUSION Repeated MT in short-term recurrent LVO is a rarity but appears to be safe and effective. The second thrombectomy should be pursued with the same extensive effort as the first procedure as these patients may achieve similar good outcomes.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Leonard Ll Yeo
- Division of Neurology, National University Health System, Singapore
| | - Christin Clajus
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | | | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, Georg-August-University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Johannes Maurer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Goertz
- Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Benno Ikenberg
- Department of Neurology, Klinikum rechts der Isar, Munich, Germany
| | - Benjamin Y Q Tan
- Division of Neurology, National University Health System, Singapore
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | | | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Amelie Carolina Hesse
- Institute for Diagnostic and Interventional Neuroradiology, Georg-August-University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Fischer
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
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10
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Klepanec A, Harsany J, Haring J, Mako M, Hoferica M, Rusina M, Cisar J, Krastev G. Endovascular treatment of acute ischemic stroke in patients with recurrent intracranial large vessel occlusion. Interv Neuroradiol 2020; 26:376-382. [PMID: 32183596 DOI: 10.1177/1591019920911532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Data on the treatment with recurrent mechanical thrombectomy of patients with acute ischemic stroke with recurrent large vessel occlusion are limited. We report our experience with recurrent mechanical thrombectomy for recurrent large vessel occlusion. METHODS During the period between May 2013 and August 2018, data on patients with recurrent large vessel occlusion were collected. Baseline clinical characteristics, recanalization technique, recanalization rates and clinical outcomes of patients with recurrent large vessel occlusion treated with mechanical thrombectomy were analyzed. Patients with recurrent large vessel occlusion treated with mechanical thrombectomy were compared with patients who underwent single mechanical thrombectomy. RESULTS During the study period, 7 of 474 patients (1.5%) were treated with mechanical thrombectomy for recurrent large vessel occlusion. The mean age of these patients was 64.4 (±7.9) years, and the mean time interval between thrombectomies was 47 (±48) h. The median baseline National Institutes of Health Stroke Scale (NIHSS) was 12 (range 5-24) before the first and 20 (range 3-34) before the second procedure; the mean NIHSS at discharge was 5 (range 2-25). Good clinical outcome after repeated mechanical thrombectomy defined as modified Rankin scale of 0-2 was achieved in 29% of patients at three months of follow-up. CONCLUSIONS Repeat mechanical thrombectomy is a rare procedure, but appears to be a feasible, safe and effective treatment option in patients with acute ischemic stroke and early recurrent large vessel occlusion.
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Affiliation(s)
- Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Jan Harsany
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Miroslav Mako
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Matus Hoferica
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Matej Rusina
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Juraj Cisar
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Georgi Krastev
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
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11
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Pirson FAV, van Oostenbrugge RJ, van Zwam WH, Remmers MJ, Dippel DW, van Es AC, van den Wijngaard IR, Schonewille WJ, Staals J. Repeated Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Stroke 2020; 51:526-532. [DOI: 10.1161/strokeaha.119.027525] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion. Data on safety and efficacy of these interventions is scarce. Our aim is to report on frequency, timing, and outcome of rEVT in a large nation-wide multicenter registry.
Methods—
In the Netherlands, all patients with endovascular thrombectomy have been registered since 2002 (MR CLEAN Pretrial registry, MR CLEAN Trial [Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands], and MR CLEAN Registry). We retrospectively reviewed these databases for anterior circulation rEVT cases. Patient characteristics, procedural data, and functional outcome (modified Rankin Scale at 90 days) were analyzed.
Results—
Of 3928 patients treated between 2002 and 2017, 27 (0.7%) underwent rEVT. Median time between first and second procedure was 78 (1–1122) days; 11/27 patients were re-treated within 30 days. Cardioembolism was the most common etiology (18 patients [67%]). In 19 patients (70%), recurrent occlusion occurred ipsilateral to previous occlusion. At 90 days after rEVT procedure, 44% of the patients had achieved functional independence (modified Rankin Scale score of 0–2), and 33% had died. Adverse events were 2/27 (7.4%) intracranial hemorrhage, 1/27 (3.7%) stroke progression, and 1/27 (3.7%) pneumonia.
Conclusions—
In this large nationwide cohort of patients with acute ischemic stroke treated with endovascular thrombectomy, rEVT was rare. Stroke cause was mainly cardio-embolic, and most recurrent large vessel occlusions in which rEVT was performed occurred ipsilateral. Although there probably is a selection bias on repeated treatment in case of recurrent large vessel occlusion, rEVT appears safe, with similar outcome as in single-treated cases.
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Affiliation(s)
- France Anne Victoire Pirson
- From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands
| | - Robert J. van Oostenbrugge
- From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands
| | - Wim H. van Zwam
- Department of Radiology (W.H.v.Z.), Maastricht University Medical Center, the Netherlands
| | | | - Diederik W.J. Dippel
- Department of Neurology (D.W.J.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan C.G.M. van Es
- Department of Radiology and Nuclear Medicine (A.C.G.M.v.E.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Wouter J. Schonewille
- Department of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.)
| | - Julie Staals
- From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands
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12
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Ikenberg B, Rösler J, Seifert CL, Wunderlich S, Kaesmacher J, Zimmer C, Boeckh-Behrens T, Friedrich B, Maegerlein C. Etiology of recurrent large vessel occlusions treated with repeated thrombectomy. Interv Neuroradiol 2019; 26:195-204. [PMID: 31822162 DOI: 10.1177/1591019919892126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Repeated mechanical thrombectomy for acute stroke treatment in individual patients has been proven feasible. However, less is known about the etiology of recurrent vessel occlusions after prior thrombectomy. We aimed to understand if the etiology of such recurrent events differs from the first stroke. METHODS Retrospectively, we identified all patients at our center who received a repeated mechanical thrombectomy between 2007 and 2019. Clinical data were retrieved from medical records. Etiology of stroke was evaluated retrospectively, and angiographic studies were revisited. RESULTS Twenty-three patients (1.5%) were identified. Median age was 68 years (IQR 56-77). Median NIHSS at first admission was 11 points (IQR 5-15). In nine cases (39.1%), the recurrent vessel occlusion was located exactly at the same position as the prior occlusion. Overall, five (21.7%) patients had a remarkable extracranial pathology as likely cause of stroke recurrence. In 16 patients (69.6%), the etiology of the first stroke and its recurrence was considered as likely being the same, mostly of cardioembolic or unknown origin. In the seven remaining patients (30.4%), the cause of stroke possibly differed from the first event, with five patients (21.7%) having a postinterventional intracranial intimal lesion as possible cause of stroke. CONCLUSION Incidence of repeated thrombectomy was low. However, the high number of patients with known origin of stroke etiology raises the question how their monitoring may be optimized. The number of patients with remarkable extracranial pathologies or intracranial endothelial lesions supports current clinical practice to pay attention to final angiographic series.
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Affiliation(s)
- B Ikenberg
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - J Rösler
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - C L Seifert
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - S Wunderlich
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - J Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland.,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - C Zimmer
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
| | - T Boeckh-Behrens
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
| | - B Friedrich
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
| | - C Maegerlein
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
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