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Ohshima T, Miyachi S. Repeated Middle Cerebral Artery Occlusion Possibly Caused by Endoluminal Injury Due to Stent Clot Retriever: A Case Report. Asian J Neurosurg 2024; 19:301-304. [PMID: 38974445 PMCID: PMC11226273 DOI: 10.1055/s-0044-1787083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
In acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best device or technique for the first attempt at mechanical thrombectomy remains a matter of debate. We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. A 74-year-old man presented with left-sided hemiplegia and was diagnosed with a right internal carotid artery occlusion. He underwent endovascular thrombectomy using a stent clot retriever. Although complete recanalization was achieved in the first pass, repeated middle cerebral artery occlusion occurred. Angiography revealed an irregular inner surface and thrombus formation in the superior branch of the second segment of the right middle cerebral artery. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against small branches. Antiplatelet therapy may be effective for preventing recurrent occlusion. Key Messages We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against nonvisible small branches.
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Affiliation(s)
- Tomotaka Ohshima
- Neuroendovascular Therapy Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Shigeru Miyachi
- Neuroendovascular Therapy Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
- Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
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Zhang Y, Liu P, Li Z, Peng Y, Chen W, Zhang L, Chu J, Kuai D, Chen Z, Wu W, Xu Y, Zhang Y, Zhou B, Geng Y, Yin C, Li J, Wang M, Zhai N, Peng X, Ji Z, Xiao Y, Zhu X, Cai X, Zhang L, Hong B, Xing P, Shen H, Zhang Y, Li M, Shang M, Liu J, Yang P. Endovascular treatment of acute ischemic stroke with a fully radiopaque retriever: A randomized controlled trial. Front Neurol 2022; 13:962987. [PMID: 36588884 PMCID: PMC9796564 DOI: 10.3389/fneur.2022.962987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The Neurohawk retriever is a new fully radiopaque retriever. A randomized controlled non-inferiority trial was conducted to compare the Neurohawk and the Solitaire FR in terms of safety and efficacy. In order to evaluate the efficacy and safety of endovascular treatment in acute ischemic stroke (AIS) caused by intracranial atherosclerotic disease (ICAD) larger vessel occlusion (LVO), a sub-analysis was performed. Methods Acute ischemic stroke patients aged 18-80 years with LVO in the anterior circulation were randomly assigned to undergo thrombectomy with either the Neurohawk or the Solitaire FR. The primary efficacy endpoint was successful reperfusion (mTICI 2b-3) rate by the allocated retriever. A relevant non-inferiority margin was 12.5%. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and all-cause mortality within 90 days. Secondary endpoints included first-pass effect (FPE), modified FPE, and favorable outcomes at 90 days. In subgroup analysis, the patients were divided into the ICAD group and non-ICAD group according to etiology, and baseline characteristics, angiographic, and clinical outcomes were compared. Results A total of 232 patients were involved in this analysis (115 patients in the Neurohawk group and 117 in the Solitaire group). The rates of successful reperfusion with the allocated retriever were 88.70% in the Neurohawk group and 90.60% in the Solitaire group (95%CI of the difference, -9.74% to 5.94%; p = 0.867). There were similar results in FPE and mFPE in both groups. The rate of sICH seemed higher in the Solitaire group (13.16% vs. 7.02%, p = 0.124). All-cause mortality and favorable outcome rates were comparable as well. In subgroup analysis, 58 patients were assigned to the ICAD group and the remaining 174 to the non-ICAD group. The final successful reperfusion and favorable outcome rates showed no statistically significant differences in two groups. Mortality within 90 days was relatively lower in the ICAD group (6.90% vs. 17.24%; p = 0.054). Conclusion The Neurohawk retriever is non-inferior to the Solitaire FR in the mechanical thrombectomy of large vessel occlusion-acute ischemic stroke (LVO-AIS). The sub-analysis suggested that endovascular treatment including thrombectomy with the retriever and essential rescue angioplasty is effective and safe in AIS patients with intracranial atherosclerotic disease-larger vessel occlusion (ICAD-LVO). Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04995757, number: NCT04995757.
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Affiliation(s)
- Yongxin Zhang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Pei Liu
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Zifu Li
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Ya Peng
- Department of Neurosurgery, Changzhou First People's Hospital, Changzhou, China
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital Brain Hospital, Liaocheng, China
| | - Jianfeng Chu
- Department of Neurology, The First People's Hospital of Jining City, Jining, China
| | - Dong Kuai
- Department of Neurosurgery, Shanxi Provincial Cardiovascular Hospital, Taiyuan, China
| | - Zhen Chen
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Yun Xu
- Department of Neurology, Nanjing Gulou Hospital, Nanjing, China
| | - Yong Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Zhou
- Department of Neurointervention, Cerebrovascular Disease Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yu Geng
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Congguo Yin
- Department of Neurology, Hangzhou First People's Hospital, Hangzhou, China
| | - Jiang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Ming Wang
- Department of Neurointervention, Nanyang Second People's Hospital, Nanyang, China
| | - Naichi Zhai
- Department of Neurosurgery, Zibo Central Hospital, Zibo, China
| | - Xiaoxiang Peng
- Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Zhong Ji
- Department of Neurology, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Yaping Xiao
- Department of Neurology, Shanghai Oriental Hospital, Shanghai, China
| | - Xingen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xueli Cai
- Department of Neurology, Lishui Municipal Central Hospital, Lishui, China
| | - Lei Zhang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Bo Hong
- Neurovascular Center, Shanghai General Hospital, Shanghai, China
| | - Pengfei Xing
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Hongjian Shen
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Yongwei Zhang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Minghua Li
- Institute of Diagnostic and Interventional Neuroradiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Meixia Shang
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China,*Correspondence: Jianmin Liu
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China,Pengfei Yang
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Tanaka Y, Kanoko Y, Yokoyama T, Nakaya K. Experimental Validation of Pullout Resistance for Stent Retrievers and Aspiration Catheters. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:446-451. [PMID: 37502796 PMCID: PMC10370986 DOI: 10.5797/jnet.oa.2022-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 07/29/2023]
Abstract
Objective Stretching or avulsion of a small perforating artery caused by mechanical traction contributes to intracranial hemorrhagic complications in mechanical thrombectomy, especially for medium and small-vessel occlusions. This study aimed to measure the pullout resistance during stent retriever (SR) traction and aspiration catheter (AC) traction with or without thrombi and characterize the mechanical properties of each device. Methods We placed the thrombectomy device in the area corresponding to the insular segment of the middle cerebral artery of a silicon carotid artery model. The thrombectomy device was automatically pulled out at a constant velocity using a horizontal motorized test stand, and pullout resistance was continuously measured 2000 times per second using a digital force gauge. Five types of SRs and two types of ACs with or without thrombus were evaluated. The data were divided into four groups for analysis: SR without clot, SR with clot, AC without clot, and AC with clot. Results The line graph was a jagged waveform during SR traction, and it was a gentle curve during AC traction. The maximum pullout resistance was higher in the SR with clot group than the other groups. The coefficient of variation was higher in the SR group than the AC group, with or without clot. Conclusion The pullout resistance during SR traction was more fluctuated than that during AC traction. In the presence of a thrombus, pullout resistance for SR was substantially increased, whereas AC resistance was less susceptible to thrombi. The differences in characteristics may reflect differences in the frequency of mechanical traction injury between the devices during clinical use.
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Affiliation(s)
- Yujiro Tanaka
- Department of Neurosurgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Yusuke Kanoko
- Department of Radiology, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Tomoya Yokoyama
- Department of Neurosurgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Kohei Nakaya
- Department of Neurosurgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
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Luraghi G, Cahalane RME, van de Ven E, Overschie SCM, Gijsen FJH, Akyildiz AC. In vitro and in silico modeling of endovascular stroke treatments for acute ischemic stroke. J Biomech 2021; 127:110693. [PMID: 34450517 DOI: 10.1016/j.jbiomech.2021.110693] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022]
Abstract
Acute ischemic stroke occurs when a thrombus obstructs a cerebral artery, leading to sub-optimal blood perfusion to brain tissue. A recently developed, preventive treatment is the endovascular stroke treatment (EVT), which is a minimally invasive procedure, involving the use of stent-retrievers and/or aspiration catheters. Despite its increasing use, many critical factors of EVT are not well understood. In this respect, in vitro, and in silico studies have the great potential to help us deepen our understanding of the procedure, perform further device and procedural optimization, and help in clinical training. This review paper provides an overview of the previous in vitro and in silico evaluations of EVT treatments, with a special emphasis on the four main aspects of the adopted experimental and numerical set-ups: vessel, thrombus, device, and procedural settings.
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Affiliation(s)
- Giulia Luraghi
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | - Rachel M E Cahalane
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Emma van de Ven
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Serena C M Overschie
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Frank J H Gijsen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ali C Akyildiz
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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Yokota M, Ohshima T, Nagano Y, Kawaguchi R, Miyachi S. A Method to Evaluate Vessel Deviation during Withdrawal of a Stent Retriever Using a Silicon Vascular Model. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:417-420. [PMID: 37502787 PMCID: PMC10370886 DOI: 10.5797/jnet.oa.2020-0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/08/2020] [Indexed: 07/29/2023]
Abstract
Objective Catastrophic complications may develop because of vessel deviation during device delivery into intracranial vessels for neurointerventions. We report a novel method using a silicon model capable of evaluating vessel deviation as a numerical value. Methods In all, 10 tiny markers, each with a pitch of approximately 5 mm, were attached to the vessel model along the long axis. We used a high-resolution camera to record movies of the deviation of the vessel model while employing different stent retrievers. The movies were reviewed to determine the maximum deviation of each marker on the vessel model. Results As expected, stent retrievers of the same type exhibited more vessel shifts when they had a larger diameter and longer length. On the other hand, stents with a segmental structure demonstrated less vessel deviation than those with a tubular structure, regardless of the large lumen and long length. Conclusion If the degree of vessel stress can be represented by a numerical value, areas where the careful use of different devices for neurointerventions is required may be able to be identified. Moreover, this method may be useful for training.
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Affiliation(s)
- Mao Yokota
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomotaka Ohshima
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshitaka Nagano
- Department of Electronic Control and Robot Engineering, Aichi University of Technology, Gamagori, Aichi, Japan
| | - Reo Kawaguchi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shigeru Miyachi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan
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Luraghi G, Rodriguez Matas JF, Dubini G, Berti F, Bridio S, Duffy S, Dwivedi A, McCarthy R, Fereidoonnezhad B, McGarry P, Majoie CBLM, Migliavacca F. Applicability assessment of a stent-retriever thrombectomy finite-element model. Interface Focus 2020; 11:20190123. [PMID: 33343873 DOI: 10.1098/rsfs.2019.0123] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/12/2023] Open
Abstract
An acute ischaemic stroke appears when a blood clot blocks the blood flow in a cerebral artery. Intra-arterial thrombectomy, a mini-invasive procedure based on stent technology, is a mechanical available treatment to extract the clot and restore the blood circulation. After stent deployment, the clot, trapped in the stent struts, is pulled along with the stent towards a receiving catheter. Recent clinical trials have confirmed the effectiveness and safety of mechanical thrombectomy. However, the procedure requires further investigation. The aim of this study is the development of a numerical finite-element-based model of the thrombectomy procedure. In vitro thrombectomy tests are performed in different vessel geometries and one simulation for each test is carried out to verify the accuracy and reliability of the proposed numerical model. The results of the simulations confirm the efficacy of the model to replicate all the experimental setups. Clot stress and strain fields from the numerical analysis, which vary depending on the geometric features of the vessel, could be used to evaluate the possible fragmentation of the clot during the procedure. The proposed in vitro/in silico comparison aims at assessing the applicability of the numerical model and at providing validation evidence for the specific in vivo thrombectomy outcomes prediction.
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Affiliation(s)
- Giulia Luraghi
- Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Jose Felix Rodriguez Matas
- Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Gabriele Dubini
- Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Francesca Berti
- Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Sara Bridio
- Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Sharon Duffy
- Cerenovus, Galway Neuro Technology Center, Galway, Ireland
| | | | - Ray McCarthy
- Cerenovus, Galway Neuro Technology Center, Galway, Ireland
| | - Behrooz Fereidoonnezhad
- Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Patrick McGarry
- Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Charles B L M Majoie
- Departments of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Francesco Migliavacca
- Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
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Ohshima T. Ideas Developed from the Routine Use of Problem-solving Skills in Neuroendovascular Therapy. JOURNAL OF NEUROENDOVASCULAR THERAPY 2019; 14:43-47. [PMID: 37502460 PMCID: PMC10370801 DOI: 10.5797/jnet.sr.2019-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/19/2019] [Indexed: 07/29/2023]
Abstract
Objective All physicians should endeavor to perform safe and rapid neuroendovascular operations. We describe the process of identifying novel methods and highlight some representative clinical examples from our practice. Methods We made a habit of asking questions regarding problems encountered during operations. Potential solutions are often identified and noted in our smartphones or as memos. These solutions are then evaluated by experiments in vascular models before assessing their efficacy in clinical settings. Results Some ideas based on our process of raising problems and finding solutions were published, and found to be relevant to the wider scientific community. Moreover, all ideas were applicable in most settings due to the use of conventional, familiar, and cheap methods and equipment. The paper rail method, modified pigtail shape microguidewire, microcatheter in vivo printing method, microcatheter shaping cast, and wireless trans-cell approach are presented as representative ideas. Conclusions We reported methods of neuroendovascular therapy identified through the routine practice of problem-solving by our team.
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Affiliation(s)
- Tomotaka Ohshima
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan
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