1
|
Sacks D. Correspondence on 'Technique and impact on first pass effect primary results of the ASSIST global registry' by Gupta et al. J Neurointerv Surg 2024:jnis-2024-021772. [PMID: 39004504 DOI: 10.1136/jnis-2024-021772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 07/16/2024]
Affiliation(s)
- David Sacks
- Department of Radiology, Tower Health, West Reading, Pennsylvania, USA
| |
Collapse
|
2
|
Knapen RRMM, Celen M, Pinckaers FME, Wagemans BAJM, van Zwam WH, van Oostenbrugge RJ, van der Leij C. Comparison of Clinical and Radiological Outcomes Between Different (Balloon) Guide Catheter With and Without Inflated Balloon in Acute Ischemic Stroke Patients: A MaSQ-Registry Study. Cardiovasc Intervent Radiol 2024; 47:918-928. [PMID: 38639780 PMCID: PMC11239717 DOI: 10.1007/s00270-024-03718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/23/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Balloon guide catheters (BGCs) are used in endovascular treatment (EVT) for ischemic stroke. Previous literature did not distinguish between BGC use with and without inflated balloon. This study aims to compare outcomes between non-BCG and BGC use with and without inflated balloon during EVT. METHODS Patients who underwent EVT for anterior circulation ischemic stroke between September 2020 and February 2023 were analyzed. Patients were divided into three groups: non-BGC, BGC with inflated balloon, or BGC without inflated balloon. The primary outcome was the ordinal modified Rankin Scale (mRS) at 90-day follow-up. Secondary outcomes included expanded Thrombolysis In Cerebral Ischemia score (eTICI) and periprocedural complications. Regression analyses with BGC with inflated balloon as comparator were performed with adjustments. Subgroup analyses were conducted based on first-line thrombectomy technique. RESULTS Out of 511 patients, 428 patients were included. Compared to BCG with inflated balloon, the mRS at 90 days did not differ in the group without inflated balloon (adjusted common [ac]OR: 1.07, 95%CI 0.67-1.73) or non-BGC (acOR: 1.42, 95%CI 0.83-2.42). Compared to patients treated with a BGC with inflated balloon, those treated with BGC without inflated balloon had lower eTICI scores (acOR: 0.59, 95%CI 0.37-0.94), and patients treated with non-BGC had lower chances of periprocedural complications (aOR: 0.41, 95%CI 0.20-0.86). CONCLUSIONS This study shows no clinical differences in ischemic stroke patients treated with BGC with inflated balloon compared to non-BGC and BGC without inflated balloon, despite lower periprocedural complication rates in the non-BGC group and lower eTICI scores in the BGC without inflated balloon group. LEVEL OF EVIDENCE Level 3, non-controlled retrospective cohort study.
Collapse
Affiliation(s)
- R R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.
- School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - M Celen
- Department of Neurology, Zuyderland MC, Heerlen, Sittard-Geleen, The Netherlands
| | - F M E Pinckaers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - B A J M Wagemans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - W H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - R J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht, The Netherlands
| | - C van der Leij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
3
|
Moreu M, Gómez-Escalonilla C, Miralbes S, Naravetla B, Spiotta AM, Loehr C, Martínez-Galdámez M, McTaggart RA, Defreyne L, Vega P, Zaidat OO, Price LL, Liebeskind DS, Möhlenbruch MA, Gupta R, Rosati S. Placing the balloon-guide catheter in the high cervical segment of the internal carotid artery is associated with improved recanalization. J Neurointerv Surg 2024:jnis-2024-021650. [PMID: 38906685 DOI: 10.1136/jnis-2024-021650] [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: 02/28/2024] [Accepted: 05/18/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is part of the standard of care for stroke treatment, and improving its efficacy is one of the main objectives of clinical investigation. Of importance is placement of the distal end of balloon-guided catheters (BGC). We aim to determine if this influences outcomes. METHODS We analyzed data from the ASSIST Registry, an international, multicenter prospective study of 1492 patients. We divided patients treated with BGC according to the placement of the BGC: low cervical (LCG (the lower 2/3 of cervical internal carotid artery (ICA)) or high cervical (HCG (upper 1/3 of cervical ICA, petro-lacerum or higher)). We analyzed characteristics and outcomes overall and stratified on the primary MT technique: Stent-Retriever only (SR Classic), Combined use of aspiration catheter and SR (Combined), and Direct Aspiration (ADAPT). RESULTS Our study included 704 subjects -323 in the low cervical and 381 in the high cervical groups. Statistical differences were seen in the proportion of females and tandem lesions (both higher for LCG). Placing the BGC in the high cervical segment is associated with better recanalization rates (expanded treatment in cerebral infarction (eTICI) score of 2c-3) at the end of the procedure (P<0.0001) and shorter procedures (P=0.0005). After stratifying on the three primary techniques (SR Classic, Combined, and ADAPT), placing the BGC in the high segment is associated with a better first-pass effect (FPE), less distal emboli, and better clinical outcomes in the SR Classic technique. CONCLUSIONS Placing the distal end of the BGC at the high cervical segment or higher is associated with better recanalization.
Collapse
Affiliation(s)
- Manuel Moreu
- Radiology department, Neurointerventional unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | - Salvador Miralbes
- Neuroradiology, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | | | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest GmbH, Recklinghausen, Nordrhein-Westfalen, Germany
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Interventional Neuroradiology, Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain
| | | | - Luc Defreyne
- Interventional Neuroradiology, University Hospital Ghent, Ghent, Belgium
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Osama O Zaidat
- Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA
| | - Lori Lyn Price
- Clinical Affairs, Stryker Neurovascular, Fremont, California, USA
| | | | | | - Rishi Gupta
- Wellstar Health System Inc, Marietta, Georgia, USA
| | - Santiago Rosati
- Radiology department, Neurointerventional unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| |
Collapse
|
4
|
Shen H, Huasen BB, Killingsworth MC, Bhaskar SMM. Introducing the Futile Recanalization Prediction Score (FRPS): A Novel Approach to Predict and Mitigate Ineffective Recanalization after Endovascular Treatment of Acute Ischemic Stroke. Neurol Int 2024; 16:605-619. [PMID: 38921949 PMCID: PMC11206671 DOI: 10.3390/neurolint16030045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Objective: This study aims to develop and validate the Futile Recanalization Prediction Score (FRPS), a novel tool designed to predict the severity risk of FR and aid in pre- and post-EVT risk assessments. Methods: The FRPS was developed using a rigorous process involving the selection of predictor variables based on clinical relevance and potential impact. Initial equations were derived from previous meta-analyses and refined using various statistical techniques. We employed machine learning algorithms, specifically random forest regression, to capture nonlinear relationships and enhance model performance. Cross-validation with five folds was used to assess generalizability and model fit. Results: The final FRPS model included variables such as age, sex, atrial fibrillation (AF), hypertension (HTN), diabetes mellitus (DM), hyperlipidemia, cognitive impairment, pre-stroke modified Rankin Scale (mRS), systolic blood pressure (SBP), onset-to-puncture time, sICH, and NIHSS score. The random forest model achieved a mean R-squared value of approximately 0.992. Severity ranges for FRPS scores were defined as mild (FRPS < 66), moderate (FRPS 66-80), and severe (FRPS > 80). Conclusions: The FRPS provides valuable insights for treatment planning and patient management by predicting the severity risk of FR. This tool may improve the identification of candidates most likely to benefit from EVT and enhance prognostic accuracy post-EVT. Further clinical validation in diverse settings is warranted to assess its effectiveness and reliability.
Collapse
Affiliation(s)
- Helen Shen
- Global Health Neurology Lab, Sydney, NSW 2150, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
| | - Bella B. Huasen
- Department of Interventional Neuroradiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Murray C. Killingsworth
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Cell-Based Disease Intervention Group, Clinical Sciences Stream, Liverpool, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Department of Anatomical Pathology, NSW Health Pathology, Correlative Microscopy Facility, Ingham Institute for Applied Medical Research and Western Sydney University, Liverpool, NSW 2170, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology Lab, Sydney, NSW 2150, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Cell-Based Disease Intervention Group, Clinical Sciences Stream, Liverpool, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital, South West Sydney Local Health District, Liverpool, NSW 2170, Australia
| |
Collapse
|
5
|
Findlay MC, Bounajem M, Grandhi R. Correspondence on 'Matched-pair analysis of patients with ischemic stroke undergoing thrombectomy using next-generation balloon guide catheters' by Kim et al. J Neurointerv Surg 2024; 16:632-633. [PMID: 38124175 DOI: 10.1136/jnis-2023-021342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Matthew C Findlay
- Spencer Fox Eccles School of Medicine, University of Utah Health, Salt Lake City, Utah, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Michael Bounajem
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
| |
Collapse
|
6
|
Orscelik A, Kallmes DF, Bilgin C, Musmar B, Senol YC, Kobeissi H, Elawady SS, Cunningham C, Matsukawa H, Zandpazandi S, Sowlat MM, Maier I, Al Kasab S, Jabbour P, Kim JT, Wolfe SQ, Rai A, Starke RM, Psychogios MN, Samaniego EA, Arthur AS, Yoshimura S, Cuellar H, Howard BM, Alawieh A, Romano DG, Tanweer O, Mascitelli J, Fragata I, Polifka AJ, Osbun JW, Crosa RJ, Matouk C, Park MS, Levitt MR, Moss M, Dumont TM, Williamson R, Navia P, Kan P, De Leacy R, Chowdhry SA, Ezzeldin M, Spiotta AM, Brinjikji W. Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion. J Neurointerv Surg 2024; 16:587-594. [PMID: 37918906 DOI: 10.1136/jnis-2023-020925] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Several studies have established the safety and efficacy of balloon guide catheters (BGCs) for large vessel occlusions. However, the utility of BGCs remains largely unexplored for distal medium vessel occlusions (DMVOs). In this study, we aim to compare the outcomes of BGC vs. Non-BGC in patients undergoing mechanical thrombectomy (MT) for DMVO. METHOD This retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) encompassed adult patients with acute anterior cerebral artery, posterior cerebral artery, and middle cerebral artery-M2-3-4 occlusions. Procedure times, safety, recanalization, and neurological outcomes were compared between the two groups, with subgroup analysis based on first-line thrombectomy techniques. RESULTS A total of 1508 patients were included, with 231 patients (15.3%) in the BGC group and 1277 patients (84.7%) in the non-BGC group. The BGC group had a lower modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2C (43.2% vs 52.7%, P=0.01), longer time from puncture to intracranial access (15 vs 8 min, P<0.01), and from puncture to final recanalization (97 vs 34 min, P<0.01). In the Solumbra subgroup, the first pass effect (FPE) rate was lower in the BGC group (17.4% vs 30.7%, P=0.03). Regarding clinical outcomes, the BGC group had a lower rate of distal embolization (8.8% vs 14.9%, P=0.03). CONCLUSION Our study found that use of BGC in patients with DMVO was associated with lower mTICI scores, decreased FPE rates, reduced distal embolization, and longer procedure times.
Collapse
Affiliation(s)
- Atakan Orscelik
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Basel Musmar
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Yigit Can Senol
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Conor Cunningham
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Sara Zandpazandi
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ilko Maier
- Department of Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Gwangju, Korea (the Republic of)
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Ansaar Rai
- Department of Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Edgar A Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center/Semmes Murphey Foundation, Memphis, Tennessee, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hugo Cuellar
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Daniele G Romano
- Department of Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Justin Mascitelli
- Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Joshua W Osbun
- Department of Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Roberto Javier Crosa
- Department of Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Mark Moss
- Department of Interventional Neuroradiology, Washington Regional Medical Center, Fayetteville, Arkansas, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Richard Williamson
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Pedro Navia
- Department of Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | - Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shakeel A Chowdhry
- Department of Neurosurgery, North Shore University Health System, Evanston, Illinois, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, University of Houston, HCA Houston Healthcare, Kingwood, Texas, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| |
Collapse
|
7
|
Pederson JM, Hardy N, Lyons H, Sheffels E, Touchette JC, Brinjikji W, Kallmes DF, Kallmes KM. Comparison of Balloon Guide Catheters and Standard Guide Catheters for Acute Ischemic Stroke: An Updated Systematic Review and Meta-analysis. World Neurosurg 2024; 185:26-44. [PMID: 38296042 DOI: 10.1016/j.wneu.2024.01.110] [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: 01/08/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The objective of this study was to update our 2021 systematic review and meta-analysis which reported that balloon guide catheters (BGC) are associated with superior clinical and angiographic outcomes compared to standard guide catheters for treatment of acute ischemic stroke. METHODS We conducted a systematic review of 7 electronic databases to identify literature published between January 2010 and September 2023 reporting BGC versus non-BGC approaches. Primary outcomes were final modified thrombolysis in cerebral infarction (mTICI) ≥2b, first-pass effect (mTICI ≥2c on first pass), and modified Rankin scale 0-2 at 90 days. The risk of bias was assessed using the Newcastle Ottawa Scale. A separate random effects model was fitted for each outcome. Subgroup analyses by first-line approach were conducted. RESULTS Twenty-four studies comprising 8583 patients were included (4948 BGC; 3635 non-BGC; 1561 BGC + Stent-retriever; 1297 non-BGC + Stent-retriever). Nine studies had low risk of bias, 3 were moderate risk, and 12 were high risk. Patients treated with BGCs had higher odds of achieving mTICI 2b/3, first-pass effect mTICI 2c/3, and modified Rankin scale 0-2 at 90 days (P < 0.001). The number of patients needed to treat in order to achieve one additional successful recanalization is 17. BGC + Stent-retriever was associated with higher odds of mTICI≥2b, 90-day modified Rankin scale 0-2, and reduced odds of 90-day mortality compared to non-BGC + Stent-retrievers. The main limitation was the absence of randomized trials. CONCLUSIONS These findings corroborate our previous results suggesting that MT using BGCs is associated with better safety and effectiveness outcomes for acute ischemic stroke, especially BGC + Stent-retrievers.
Collapse
Affiliation(s)
- John M Pederson
- Superior Medical Experts, St. Paul, Minnesota, USA; Nested Knowledge, Inc, St. Paul, Minnesota, USA.
| | - Nicole Hardy
- Superior Medical Experts, St. Paul, Minnesota, USA
| | - Hannah Lyons
- Superior Medical Experts, St. Paul, Minnesota, USA
| | | | | | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin M Kallmes
- Superior Medical Experts, St. Paul, Minnesota, USA; Nested Knowledge, Inc, St. Paul, Minnesota, USA
| |
Collapse
|
8
|
Wassélius J, Hall E, Ramgren B, Andersson T, Ullberg T. Procedural factors associated with successful recanalization in patients with acute ischemic stroke treated with endovascular thrombectomy-a nationwide register-based observational study. Interv Neuroradiol 2024:15910199241248268. [PMID: 38646674 DOI: 10.1177/15910199241248268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Several studies have addressed technical aspects of endovascular thrombectomy (EVT), but it is not well known how procedural factors contribute to technical success in routine healthcare. The aim was to explore factors associated with technically successful EVT on nationwide scale. METHODS We did an observational register-based study assessing factors associated with technical success off anterior circulation EVT in Sweden. The main outcome was successful recanalization defined as modified treatment in cerebral ischemia score 2b-3. The association between baseline and treatment variables and successful recanalization were explored using Chi-square(d) test and univariable logistic regression. Multivariable logistic regression was used to define predictors of successful recanalization. RESULTS The study included 3211 patients treated during 2015 to 2020. Successful recanalization was achieved in 83.1% (2667) with a gradual improvement in technical outcome over the period. After adjustment for age and occlusion location, thet use of general anesthesia, balloon guide catheter (BGC) and an operator with an overall success rate of >85% were independent predictors of successful recanalization. An overall operator success rate of <80% or 80-85%, and an annual center volume lower than 50 were predicitors of recanalization failure. CONCLUSION This study illustrates factors associated with procedural success in endovascular thrombectomy on a nationwide scale including the use of general anesthesia, BGC, annual center volumes >50 cases per year and the overall success rate of the individual operator. It highlights the potential benefit of systematic performance measurements, benchmarking, and continuous training to bring all centers and operators to the highest level of performance.
Collapse
Affiliation(s)
- Johan Wassélius
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, , Lund, Sweden
| | - Emma Hall
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, , Lund, Sweden
| | - Birgitta Ramgren
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, , Lund, Sweden
| | - Tommy Andersson
- Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Teresa Ullberg
- Department of Clinical Sciences Lund, Lund University, , Lund, Sweden
- Department of Neurology, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
9
|
Saei HM, Miller SE, Pope HM, Hassan AE. Fubuki XF Long Sheath guide catheter use in neuroendovascular procedures: Institutional experience in 60 cases. Interv Neuroradiol 2024:15910199241245601. [PMID: 38592015 DOI: 10.1177/15910199241245601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Endovascular treatment devices require compatible guide catheters to navigate complex vessels and anatomy. The Fubuki XF Long Sheath guide catheter (Fubuki XF) was developed with a 0.090-inch internal diameter with hydrophilic coating, an atraumatic rounded tip, and enhanced trackability and support with gradual shaft transition zones. METHODS We retrospectively analyzed a prospectively maintained database of neuroendovascular patients treated using Fubuki XF at our center (July 2022─May 2023). Baseline/procedural characteristics were collected. Outcomes of interest included technical success (procedure completion with Fubuki XF without alternative guide catheter use) and peri-procedural complications. RESULTS This study included 60 patients (43.3% [26/60] female; mean age: 69.6 ± 9.7) presenting with stenosis (45.0% [27/60]), unruptured aneurysms (31.7% [19/60]), ruptured aneurysm (1.7% [1/60]), arteriovenous fistula (5.0% [3/60]), arteriovenous malformation (3.3% [2/60]), chronic subdural hematoma (3.3% [2/60]), stroke/emboli (6.7% [4/60]), vasospasm (1.7% [1/60]), or carotid web (5.0% [1/60]). Fubuki XF was used to deliver endovascular treatment devices for stenting (43.3% [26/60]), flow diversion (23.3% [14/60]), embolization (11.7% [7/60]), coiling (10.0% [6/60]), balloon angioplasty (10.0% [6/60]), and mechanical thrombectomy (1.7% [1/60]). The Fubuki XF tip was placed in the internal carotid artery in 38.3% (23/60) of cases. Technical success was achieved in all cases. One V1 non-flow-limiting dissection (not related to Fubuki XF) and one failed closure occurred (1.7% [1/60] each). No iatrogenic strokes or intraprocedural ruptures occurred. CONCLUSION We used Fubuki XF to safely and effectively deliver a variety of compatible neuroendovascular devices. Fubuki XF was stable in all cases and locations, and there were no device-related complications or dissections.
Collapse
Affiliation(s)
- Hamzah M Saei
- Department of Vascular Neurology, Rio Grande Regional Hospital, McAllen, TX, USA
| | - Samantha E Miller
- Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | | | - Ameer E Hassan
- Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| |
Collapse
|
10
|
Behme D, Wiesmann M, Nikoubashman O, Ridwan H, Hassan D, Liebig T, Trumm C, Holtmannspötter M, Szikora I. Initial clinical experience with a novel mechanical thrombectomy device-the ThrombX retriever. Interv Neuroradiol 2024; 30:183-188. [PMID: 36468971 PMCID: PMC11095356 DOI: 10.1177/15910199221118146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND PURPOSE The ThrombX Retriever is a novel mechanical thrombectomy device that adjusts the distance between two mesh segments to axially hold thrombus. A post-market study assessed safety and performance in acute ischemic stroke patients with large artery occlusion. METHODS A single-arm prospective multi-center study enrolled patients at 5 European Centers. Patients had a symptomatic large-artery occlusion of the intracranial Internal Carotid or the Middle Cerebral Artery, M1 segment. The primary outcome measure was the modified treatment in cerebral infarction (mTICI) score, on the immediate post-procedure angiogram after up to three device passes. Key secondary outcome measures were the mTICI score after a single pass and functional independence, defined as an mRS score ≤ 2 at 90 days. RESULTS Thirty patients (16 Females, mean age 72 years), with NIHSS 4-25 (mean 15.5) were treated. Twenty-eight (93%) achieved mTICI 2b-3 within 3 passes, and 24 (80%) were with the first pass (FP). FP mTICI 2c-3 reperfusion was achieved in 19 (63%) cases. Seventeen of 24 (71%) patients treated with a balloon guide and the ThrombX Retriever had a FP mTICI 2c-3 reperfusion. After all interventions, mTICI 2b-3 was seen in 30 (100%) patients. Twenty-one of the 29 (73%) patients with 90-day follow-up were functionally independent (mRS≤2). No device-related serious adverse events were observed. CONCLUSION This preliminary study suggests the ThrombX Retriever is safe and has a high rate of substantial reperfusion. A larger prospective trial to assess the device effectiveness is planned.
Collapse
Affiliation(s)
- Daniel Behme
- Department of Neuroradiology, Otto-von-Guericke University Clinic, Magdeburg, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Dimah Hassan
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - Christoph Trumm
- Department of Neuroradiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - Markus Holtmannspötter
- Department of Neuroradiology, Nuremburg Clinic South, Paracelsus Medizinische Privatuniversität (PMU), Nuremberg, Germany
| | - Istvan Szikora
- Department of Neurointerventions, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| |
Collapse
|
11
|
Uysal E, von Bodelschwingh B, Tabakci ON, Basarir CI, Bulut S. Combined Aspiration and Stent Retriever Thrombectomy for Distal Carotid Artery Occlusion Using Balloon Guide versus Non-Balloon Guide Catheter. J Clin Med 2024; 13:1978. [PMID: 38610743 PMCID: PMC11012368 DOI: 10.3390/jcm13071978] [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: 03/03/2024] [Revised: 03/17/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The introduction of endovascular thrombectomy dramatically changed acute stroke management and became the standard treatment. Balloon guide catheters provide flow arrest during the clot retrieval process and have several advantages.This study aimed to compare balloon guide catheters (BGCs) versus non-balloon guide catheters (NBGCs) as a part of a combined treatment modality in patients presenting with acute ischemic stroke. Methods: This retrospective study included n = 65 patients who underwent a combined endovascular stroke treatment for distal internal carotid artery (ICA) occlusion. Patients underwent aspiration and stent retriever thrombectomy with the use of BGCs (Group 1, n = 27) or NBGCs (Group 2, n = 38). Results: The groups were compared for outcomes: the National Institutes of Health Stroke Scale (NIHSSS) score change, successful recanalization, good functional outcome at three months, and in-hospital mortality. Conclusion: The two groups didn't differ in terms of the NIHSS score change compared to baseline (p > 0.05). Moreover, there were no significant differences between the two groups in terms of the successful recanalization rate, three-month favorable functional outcome rate, and in-hospital mortality (p = 0.292, p = 0.952, p = 0.178), respectively. Further prospective studies with a larger number of patients and better methodology are warranted.
Collapse
Affiliation(s)
- Ender Uysal
- Radiology Clinic Antalya, Antalya Training and Research Hospital, University of Health Sciences, Antalya 07100, Turkey
| | - Bade von Bodelschwingh
- Radiology Clinic, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (B.v.B.); (O.N.T.)
| | - Omer Naci Tabakci
- Radiology Clinic, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (B.v.B.); (O.N.T.)
| | - Celal Ilker Basarir
- Neurology Clinic Istanbul, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (C.I.B.); (S.B.)
| | - Serpil Bulut
- Neurology Clinic Istanbul, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (C.I.B.); (S.B.)
| |
Collapse
|
12
|
Caldwell J, Lee SSH, Sarrafzadeh M, Rhodes DS, McGuinness BJ. Flow reversal during stroke thrombectomy. Interv Neuroradiol 2024:15910199241238252. [PMID: 38489832 DOI: 10.1177/15910199241238252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
When performing mechanical thrombectomy for stroke patients, some physicians use balloon guide catheters (BGCs) in order to achieve flow reversal and thereby improve reperfusion quality. There is substantial evidence favoring the use of BGCs to improve reperfusion rates and clinical outcomes for thrombectomy patients; however, as we will outline in this review, there is also evidence that BGCs do not achieve reliable flow reversal in many circumstances. Therefore, if we are able to modify our techniques to improve the likelihood of flow reversal during thrombectomy maneuvers, we may be able to further improve reperfusion quality and clinical outcomes. This paper provides an overview of concepts on this topic and outlines some potential techniques to facilitate flow reversal more consistently, including a method to visually confirm it, with the aim of making iterative improvements towards optimal reperfusion for stroke patients.
Collapse
Affiliation(s)
- James Caldwell
- Department of Radiology, Auckland City Hospital, Grafton, Auckland, New Zealand
- FRANZCR, Auckland, New Zealand
| | - Shane S H Lee
- Department of Radiology, Auckland City Hospital, Grafton, Auckland, New Zealand
- FRANZCR, Auckland, New Zealand
| | - Mikal Sarrafzadeh
- Department of Radiology, Auckland City Hospital, Grafton, Auckland, New Zealand
- MBChB, Auckland, New Zealand
| | - Dave S Rhodes
- B.S. Mech. Eng, San Luis Obispo, CA, USA
- Engineered Outcomes, Redwood City, CA, USA
| | - Ben J McGuinness
- Department of Radiology, Auckland City Hospital, Grafton, Auckland, New Zealand
- FRANZCR, Auckland, New Zealand
| |
Collapse
|
13
|
Meder G, Żuchowski P, Skura W, Płeszka P, Dura M, Rajewski P, Nowaczewska M, Meder M, Alexandre AM, Pedicelli A. Mechanical Thrombectomy in Stroke-Retrospective Comparison of Methods: Aspiration vs. Stent Retrievers vs. Combined Method-Is Aspiration the Best Starting Point? J Clin Med 2024; 13:1477. [PMID: 38592324 PMCID: PMC10934276 DOI: 10.3390/jcm13051477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Background: There are three main methods of mechanical thrombectomy (MT): using a stent retriever (SR) only (SO), aspiration catheter (AC) only (AO) and the combined method (CM) using both the SR and AC. This paper describes a real-life, single-center experience using SO, AO and CM during 276 consecutive MTs. Methods: The primary endpoint was the frequency of first-pass complete (FPE TICI3). The secondary endpoints were final mTICI 2b-3, procedure duration, clinical outcome and the total number of device passes. The third aim of this study was to test the association between the clinical outcomes in patients treated with each method and various factors. Results: There was a significant difference (p = 0.016) between the groups' FPE TICI3 rates with 46% mTICI 3 in the AO group, 41% in the CM group and 21% in the SO group. AO resulted in procedure time shortening to a mean duration of 43 min, and the scores were 56 min for CM and 63 min for SO (p < 0.0001). There were no significant differences in clinical outcomes or in-hospital mortality. The analysis showed a correlation between good clinical outcomes and the administration of IVT: OR 1.71 (1.03-2.84) p = 0.039. Patients ≥66 years old had higher odds of a bad outcome compared to younger patients in general (OR, 1.99 95% CI, 1.17-3.38; p = 0.011). FPE TICI3 was associated with good functional outcomes in the whole treated cohort (OR, 1.98; 95% CI, 1.21-3.25; p = 0.006). Conclusions: In our series, AO proved to be the best starting point in most cases. It demonstrates good technical efficacy regarding FPE, it is fast and clinical outcomes seem to be the least age- and FPE TICI3-dependent. It can be easily converted into the combined method, which had the second-best outcomes in our cohort.
Collapse
Affiliation(s)
- Grzegorz Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
- Department of Radiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Paweł Żuchowski
- Department of Rheumatology and Connective Tissue Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Wojciech Skura
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Piotr Płeszka
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Marta Dura
- Department of Radiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Piotr Rajewski
- Department of Neurology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Skłodowskiej—Curie 9, 85-090 Bydgoszcz, Poland
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery and Laryngological Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Skłodowskiej—Curie 9, 85-090 Bydgoszcz, Poland
| | - Magdalena Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Andrea M Alexandre
- Unità Operativa Semplice Autonoma Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Alessandro Pedicelli
- Unità Operativa Semplice Autonoma Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
| |
Collapse
|
14
|
Topiwala K, Quinn C, Mehta T, Masood K, Grande A, Tummala R, Jagadeesan B. BOBBY balloon guide catheter thrombectomy in large-vessel occlusion stroke: Initial experience. Interv Neuroradiol 2024; 30:80-85. [PMID: 35645160 PMCID: PMC10956468 DOI: 10.1177/15910199221104920] [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: 04/08/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Nonrandomized studies have found Balloon Guide Catheter (BGC) use to improve technical and functional outcomes in patients undergoing mechanical thrombectomy (MT). MATERIALS AND METHODS We performed a retrospective analysis on prospectively collected data of consecutive ischemic stroke patients undergoing MT at our institution (December 2020-October 2021). Interventions where BOBBY BGC (BBGC, MicroVentionTM, Aliso Viejo, CA) was used were identified. Baseline demographics and clinico-radiographic characteristics were retrospectively collected and analysed using descriptive statistics. RESULTS A total of 43 patients received BBGC-MT (male: female = 26:17, median age 72 years [IQR 62-82]). The most common occlusion site was the middle cerebral artery (MCA) (60.4%). Over half (51.2%) received intravenous thrombolytics. The BBGC tracked well over tortuous aortic arches (type II 34.8%, type III 16.3%), with median arteriotomy-to-perfusion time of 29 min (IQR 20-46). Thromboaspiration was used as first-line MT technique in 69.7% cases, with 1 (IQR 1-2) median MT pass achieving modified TICI (thrombolysis in cerebral ischemia) scores of 3 and 2b/3 in 74.4% and 95.3% respectively. Our overall first pass effect (FPE, defined as mTICI 3 after firs-pass) and modified FPE (defined as, mTICI 2b/3 after first-pass) rates were 51.1% and 79.1% respectively, with rates of 92.3% and 100% respectively when stentretriever and thromboaspiration were combined. The median reduction in National Institutes of Health Stroke Scale (NIHSS) was 9 (IQR 4-15, p < 0.0001), with a median 90-day modified Rankin Score (mRS) of 1.5 (IQR 0-2). CONCLUSIONS BOBBY BGC use resulted in a high first-pass effect rate and may contribute towards improved functional outcomes.
Collapse
Affiliation(s)
- Karan Topiwala
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Coridon Quinn
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Tapan Mehta
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Kamran Masood
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Andrew Grande
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Ramachandra Tummala
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Bharathi Jagadeesan
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| |
Collapse
|
15
|
Waqas M, Monteiro A, Cappuzzo JM, Kruk MD, Almayman F, Housley SB, Lim J, Dossani RH, Snyder KV, Siddiqui AH, Davies JM, Levy EI. Mechanical thrombectomy with a balloon-guide catheter: sheathless transradial versus transfemoral approach. J Neurointerv Surg 2024; 16:187-191. [PMID: 36581453 DOI: 10.1136/jnis-2022-019607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The transradial approach (TRA) for mechanical thrombectomy (MT) for acute ischemic stroke has been limited by the size of catheters usable in the radial artery, with the smaller access site precluding balloon-guide catheter (BGC) use. However, promising results have been reported for a TRA with a sheathless BGC (sTRA). We sought to perform a comparative study of MT with a BGC via the sTRA versus the transfemoral approach (TFA). METHODS A retrospective review of our MT database was conducted. Baseline, procedure-related, and outcome data were compared for patients aged ≥18 years with anterior circulation large vessel occlusion, Alberta Stroke Program Early CT Score ≥6, and prestroke modified Rankin Scale score ≤2 treated with either approach. RESULTS Ninety-three consecutive patients (34 sTRA and 59 TFA) were included. Both groups had similar demographics, comorbidities, stroke severity, intravenous alteplase use, and occlusion location. Mean time from puncture to final recanalization was faster in the sTRA group (29 vs 36 min, p=0.059) despite a higher access site crossover rate in the sTRA group (11.8% vs 0%, p=0.016). There were no differences between groups regarding last modified Thombolysis in Cerebral Infarction score; first-pass or modified first-pass effect; time from last known well to puncture; use of stent-retriever, aspiration, or combination first approach; number of passes; symptomatic intracranial hemorrhage; hospital stay; 90-day functional independence; and mortality. National Institutes of Health Scale score and modified first-pass effect were the only independent predictors of poor outcomes. CONCLUSIONS Comparable patients treated with MT via the sTRA or TFA had similar angiographic and clinical outcomes.
Collapse
Affiliation(s)
- Muhammad Waqas
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Andre Monteiro
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Marissa D Kruk
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Faisal Almayman
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Steven B Housley
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Jaims Lim
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Rimal H Dossani
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jason M Davies
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| |
Collapse
|
16
|
Baig AA, Waqas M, Turner RC, Kuo CC, Donnelly BM, Lai PMR, Raygor KP, Bouslama M, Lim J, Neumaier Bs J, Cappuzzo JM, Davies JM, Snyder KV, Siddiqui AH, Levy EI. A propensity score-matched comparative study of balloon guide catheters versus conventional guide catheters for concurrent mechanical thrombectomy with carotid stenting in tandem strokes: comparison of first pass effect, symptomatic intracranial hemorrhage, and 90-day functional outcomes. J Neurointerv Surg 2024; 16:124-130. [PMID: 37076277 DOI: 10.1136/jnis-2023-020114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Extensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown the benefit of balloon guide catheters (BGCs) in MT and carotid artery stenting. OBJECTIVE In view of this potential benefit, to investigate the safety and effectiveness of proximal flow arrest using a BGC during concurrent MT and carotid revascularization for tandem stroke treatment in a comparative, propensity score-matched (PSM) study. METHODS Patients with a tandem stroke identified from our endovascular database were dichotomized into groups treated with BGCs versus conventional guide catheters. One-to-one PSM adjustment for baseline demographics and treatment selection bias using nearest-neighbor matching was performed. Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes assessed were final modified Thrombolysis in Cerebral Infarction (mTICI) grade, periprocedural symptomatic intracranial hemorrhage (sICH) rate, in-hospital mortality, and 90-day modified Rankin Scale (mRS) score. Mann-Whitney U test and multivariate logistic regression were performed to compare procedural parameters and clinical outcomes. RESULTS Concurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC: 85; no BGC: 40). After PSM (40 patients/group), the BGC group had a significantly shorter procedure duration (77.9 vs 61.5 min; OR=0.996; P=0.006), lower discharge National Institutes of Health Stroke Scale score (8.0 vs 11.0; OR=0.987; P=0.042), and higher odds of 90-day mRS 0-2 score (52.3% vs 27.5%; OR=0.34; P=0.040). On multivariate regression, the BGC group had a significantly higher first pass effect rate (mTICI 2b or 3)(OR=1.115, 95% CI 1.015 to 1.432; P=0.013) and lower periprocedural sICH rate (OR=0.615, 95% CI 0.406 to 0.932; P=0.025). No difference in in-hospital mortality was observed (OR=1.591, 95% CI 0.976 to 2.593; P=0.067). CONCLUSION BGCs used for concurrent MT-carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in patients with a tandem stroke.
Collapse
Affiliation(s)
- Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ryan C Turner
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Mehdi Bouslama
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jenna Neumaier Bs
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
17
|
Sreenivasan S, Gupta G, Wu R, Nourollah-Zadeh E, Sun H, Nanda A, Sundararajan S, Roychowdhury S. Radially adjustable stent retriever for mechanical thrombectomy in acute ischemic stroke: Improved first-pass effect with rapid-inflation deflation technique. Interv Neuroradiol 2024:15910199231222667. [PMID: 38192104 DOI: 10.1177/15910199231222667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Evidence for improved first-pass effect with the novel radially adjustable radio-opaque stent retriever Tigertriever is lacking. OBJECTIVE To compare improvement in first pass success with Tigertriever using two different techniques-rapid inflation deflation (RID) and suction thrombectomy (ST). METHODS Retrospective analysis of patients with acute ischemic stroke who underwent mechanical thrombectomy with Tigertriever at a single comprehensive stroke center. RESULTS Thirty patients were included. Mean age was 72.8 years. Twelve patients (48%) experienced successful first passes with Tigertriever. Successful revascularization (modified thrombolysis in cerebral infarction (mTICI) 2b/3) was achieved in all (100%) patients who received RID or ST technique for thrombectomy. Good clinical outcome (modified Rankin score = 0-2) was noted in 40% (n = 10). Total mortality in the cohort was 8% (n = 2). RID and ST groups comprised of 10 and 15 patients, respectively. Five patients underwent MT with Tigertriever as a rescue device. RID VS ST No difference was noted in mean age (p = 0.27), gender (p = 0.29), location of occlusion (p = 0.46), and device used for first pass (p = 0.57). A 70% first-pass success rate in RID group and 37.5% in ST group was noticed (p = 0.06). Mean time from groin puncture to reperfusion (TICI 2b//3) was statistically similar (p = 0.29, RID: 19.9 min vs ST: 25 min). Both groups noted a 100% complete recanalization rate. The rate of mortality between the two groups were not statistically different (p = 0.46). CONCLUSION The preliminary first-pass success rates of RID technique with Tigertriever compared to ST technique, are encouraging. Longitudinal studies with longer follow up are needed to elucidate the smaller learning curve with this device.
Collapse
Affiliation(s)
- Sanjeev Sreenivasan
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Robert Wu
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Emad Nourollah-Zadeh
- Department of Neurology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Hai Sun
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Srihari Sundararajan
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| |
Collapse
|
18
|
Lee IH, Choi JI, Ha SK, Lim DJ. Predictive Factors of First-Pass Effect in Patients Who Underwent Successful Endovascular Thrombectomy for Emergent Large Vessel Occlusion. J Korean Neurosurg Soc 2024; 67:14-21. [PMID: 37424093 PMCID: PMC10788560 DOI: 10.3340/jkns.2023.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE The primary treatment goal of current endovascular thrombectomy (EVT) for emergent large-vessel occlusion (ELVO) is complete recanalization after a single maneuver, referred to as the 'first-pass effect' (FPE). Hence, we aimed to identify the predictive factors of FPE and assess its effect on clinical outcomes in patients with ELVO of the anterior circulation. METHODS Among the 129 patients who participated, 110 eligible patients with proximal ELVO (intracranial internal carotid artery and proximal middle cerebral artery) who achieved successful recanalization after EVT were retrospectively reviewed. A comparative analysis between patients who achieved FPE and all others (defined as a non-FPE group) was performed regarding baseline characteristics, clinical variables, and clinical outcomes. Multivariate logistic regression analyses were subsequently conducted for potential predictive factors with p<0.10 in the univariate analysis to determine the independent predictive factors of FPE. RESULTS FPE was achieved in 31 of the 110 patients (28.2%). The FPE group had a significantly higher level of functional independence at 90 days than did the non-FPE group (80.6% vs. 50.6%, p=0.002). Pretreatment intravenous thrombolysis (IVT) (odds ratio [OR], 3.179; 95% confidence interval [CI], 1.025-9.861; p=0.045), door-to-puncture (DTP) interval (OR, 0.959; 95% CI, 0.932-0.987; p=0.004), and the use of balloon guiding catheter (BGC) (OR, 3.591; 95% CI, 1.231-10.469; p=0.019) were independent predictive factors of FPE. CONCLUSION In conclusion, pretreatment IVT, use of BGC, and a shorter DTP interval were positively associated with FPE, increasing the chance of acquiring better clinical outcomes.
Collapse
Affiliation(s)
- In-Hyoung Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| |
Collapse
|
19
|
Parra-Fariñas C, Diestro JDB, Dmytriw AA, Almusalam N, Rajendram P, Phillips R, Alqabbani A, Qazi E, Hui N, Li Y, Montanera W, Sarma D, Spears J, Marotta TR, Bharatha A. The proximal balloon occlusion together with direct thrombus aspiration (protect plus) technique: Experience at a tertiary comprehensive stroke center. Neuroradiol J 2023; 36:686-692. [PMID: 37211821 PMCID: PMC10649534 DOI: 10.1177/19714009231177359] [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] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Timely restoration of cerebral blood flow using reperfusion therapy is the most effective maneuver for salvaging penumbra. We re-evaluated the previously described PROTECT (PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy) Plus technique at a tertiary comprehensive stroke center. METHODS We retrospectively analyzed all patients who underwent mechanical thrombectomy with stentrievers between May 2011 and April 2020. Patients were divided between those who underwent PROTECT Plus and those who did not (proximal balloon occlusion with stent retriever only). We compared the groups in terms of reperfusion, groin to reperfusion time, symptomatic intracranial hemorrhage (sICH), modified Rankin Scale (mRS) score at discharge. RESULTS Within the study period, 167 (71.4%) PROTECT Plus and 67 (28.6%) non-PROTECT patients which met our inclusion criteria. There was no statistically significant difference in the number of patients with successful reperfusion (mTICI >2b) between the techniques (85.0% vs 82.1%; p = 0.58). The PROTECT Plus group had lower rates of mRS ≤2 at discharge (40.1% vs 57.6%; p = 0.016). The rate of sICH was comparable (p = 0.35) between the PROTECT Plus group (7.2%) and the non-PROTECT group (3.0%). CONCLUSION The PROTECT Plus technique using a BGC, a distal reperfusion catheter and stent retriever is feasible for recanalization of large vessel occlusions. Successful recanalization, first-pass recanalization and complication rates are similar between PROTECT Plus and non-PROTECT stent retriever techniques. This study adds to an existing body of literature detailing techniques that use both a stent retriever and a distal reperfusion catheter to maximize recanalization for patients with large vessel occlusions.
Collapse
Affiliation(s)
- Carmen Parra-Fariñas
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Jose Danilo Bengzon Diestro
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Adam A Dmytriw
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Noora Almusalam
- Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Phavalan Rajendram
- Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Rebecca Phillips
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Abdullah Alqabbani
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Emmad Qazi
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Nicholas Hui
- Faculty of Medicine, University of New South Wales, Sydney, AU-NSW, Australia
| | - Yangmei Li
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Walter Montanera
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Dipanka Sarma
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Julian Spears
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Thomas R Marotta
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Aditya Bharatha
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Guerreiro H, Flottmann FA, Kyselyova AA, Wagner M, Brekenfeld C, Eckert B, Illies T, Wodarg F, Fiehler J, Bester M. First experience with Walrus balloon guide catheter in a whole-body flow model. Neuroradiology 2023; 65:1787-1792. [PMID: 37640884 PMCID: PMC10654250 DOI: 10.1007/s00234-023-03214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Flow arrest using a balloon guide catheter (BGC) in mechanical thrombectomy (MT) due to large vessel occlusion has been associated with better outcomes. Known limitations of currently commercially available BGCs are incompatibility with large bore aspiration catheters (AC) and lack of distal flexibility. Walrus presents variable stiffness and compatibility with large bore AC. The goal of this study is to describe the first experience with Walrus in a realistic stroke simulation model. METHODS A full-length modular vascular model under physiological conditions was used. 8F+-Walrus inner-diameter (ID) 0.087in 95 cm combined with 6F-Sofia AC ID 0.070in 131 cm and an 8F-Flowgate2 BGC ID 0.084in 95 cm with a 5F-Sofia AC ID 0.055in 125 cm were used to perform aspiration MT. User surveys, access to target and occlusion site, technique, time of delivery, anatomical change, and catheter kick-back were assessed. RESULTS Seven neuroradiologists with average of 10 years-experience in MT performed primary aspiration using the above-mentioned combinations in three different anatomies (N = 41). All operators would likely (29%) or very likely (71%) use again Walrus in combination with large bore AC and the majority (86%) found its navigability easier than with other BGCs. Time to reach final BGC position and catheter kick-back did not differ significantly among anatomies or catheter combinations (p > 0.05). However, Walrus was more likely to reach ICA petrous segment (p < 0.05) and intracranial occlusion with AC (p < 0.01). CONCLUSION The Walrus combined with large bore AC presented significantly better distal access and navigability for primary aspiration in an in vitro stroke model.
Collapse
Affiliation(s)
- Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Fabian A Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Anna A Kyselyova
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Maximilian Wagner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Bernd Eckert
- Department of Radiology and Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Till Illies
- Department of Radiology and Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| |
Collapse
|
21
|
Lee IH, Ha SK, Lim DJ, Choi JI. Distal placement of balloon guide catheter facilitates stent-retriever mechanical thrombectomy for acute ischemic stroke in the anterior circulation. Acta Neurochir (Wien) 2023; 165:3759-3768. [PMID: 37816916 DOI: 10.1007/s00701-023-05818-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Although balloon guide catheters (BGCs) have been demonstrated to improve recanalization and functional outcomes by enabling proximal flow control and forced aspiration during mechanical thrombectomy (MT), the significance of the BGC location has been overlooked. We evaluated the impact of BGC location during MT for anterior circulation acute ischemic stroke (AIS). METHODS Patients were divided into the proximal and distal BGC groups according to the BGC tip location relative to the lower margin of the C1 vertebral body. Endovascular and clinical outcomes were compared between the two groups, including subgroup analyses of the two types of extracranial internal carotid artery (ICA) anatomy, categorized based on cerebral angiography. RESULTS A total of 124 patients were analyzed, with 62 each in the proximal and distal BGC placement groups. The distal BGC group had higher rates of first-pass recanalization (FPR) (38.7% vs. 17.7%, P = 0.009) and favorable outcomes (64.5% vs. 46.8%, P = 0.047) with shorter procedure time (47.5 min vs. 65 min, P = 0.001) and fewer distal embolization (3.2% vs. 12.9%, P = 0.048) than the proximal BGC group. FPR was also more frequently achieved in the distal BGC group of patients with tortuous ICA (37.0% vs. 12.5%, P = 0.029). Multivariate analysis showed that distal BGC placement was an independent predictor of FPR (odds ratio, 3.092; 95% confidence interval, 1.326-7.210; P = 0.009). CONCLUSION Distal BGC placement facilitates MT for AIS in the anterior circulation. Therefore, we suggest distal BGC placement to maximize the effect of thrombectomy, even for tortuous extracranial ICA.
Collapse
Affiliation(s)
- In-Hyoung Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea.
| |
Collapse
|
22
|
Payne ES, Krost-Reuhl S, Heimann A, Keric N, Masomi-Bornwasser J, Gerber T, Seidman L, Kirschner S, Brockmann MA, Tanyildizi Y. In vitro testing of a funnel-tip catheter with different clot types to decrease clot migration in mechanical thrombectomy. Interv Neuroradiol 2023; 29:637-647. [PMID: 36047782 PMCID: PMC10680968 DOI: 10.1177/15910199221122843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mechanical thrombectomy is the standard treatment for acute ischemic stroke in patients with large vessel occlusion and can be performed up to 24h after symptom onset. Despite high recanalization rates, embolism in new territories has been reported in 8.6% of the cases. Causes for this could be clot abruption during stent retrieval into the smaller opening of a standard distal access catheter, and antegrade blood flow via collaterals despite proximal balloon protection. A funnel-shaped tip with a larger internal diameter was developed to increase the rate of first-pass recanalization and to improve the safety and efficacy of mechanical thrombectomy. METHODS This in vitro study compared the efficacy of a funnel-shaped tip with a standard tip in combination with different clot compositions. Mechanical thrombectomy was performed 80 times for each tip, using two stent retrievers (Trevo XP ProVue 3/20 mm, 4/20 mm) and four different clot types (hard vs. soft clots, 0-24h vs. 72h aged clots). RESULTS Significantly higher first-pass recanalization rates (mTICI 3) were observed for the funnel-shaped tip, 70.0% versus 30.0% for the standard tip (absolute difference, 32; relative difference 57.1%; P < .001), regardless of the clot type and stent retriever. Recanalization could be increased using harder Chandler loop clots versus softer statically generated clots, as well as 0-24h versus 72h aged clots, respectively. CONCLUSION The funnel-shaped tip achieved higher first-pass recanalization rates than the smaller standard tip and lower rates of clot abruption at the tip. Clot compositions and aging times impacted recanalization rates.
Collapse
Affiliation(s)
- Emily S. Payne
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Samantha Krost-Reuhl
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Axel Heimann
- Translational Animal Research Center, University Medical Center, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Center, Mainz, Germany
| | | | - Tiemo Gerber
- Institute of Pathology, University Medical Center, Mainz, Germany
| | - Larissa Seidman
- Institute of Pathology, University Medical Center, Mainz, Germany
| | - Stefanie Kirschner
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc A. Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Yasemin Tanyildizi
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
23
|
Capirossi C, Laiso A, Renieri L, Capasso F, Limbucci N. Epidemiology, organization, diagnosis and treatment of acute ischemic stroke. Eur J Radiol Open 2023; 11:100527. [PMID: 37860148 PMCID: PMC10582298 DOI: 10.1016/j.ejro.2023.100527] [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] [Received: 06/17/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
The management of acute ischemic stroke is changing. Over the period of 2010-2050, the number of incident strokes is expected to be more than double. Rapid access to mechanical thrombectomy for patients with large vessel occlusion is critically associated with their functional outcome. Moreover, patients with first pass effect had a better clinical outcome, lower mortality, and fewer procedural adverse events. We discuss some advances in acute ischemic stroke regarding the organization, the diagnosis and the treatment.
Collapse
Affiliation(s)
- Carolina Capirossi
- Interventional Neuroradiology Unit, University Hospital Careggi, Florence, Italy
| | - Antonio Laiso
- Interventional Neuroradiology Unit, University Hospital Careggi, Florence, Italy
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, University Hospital Careggi, Florence, Italy
| | - Francesco Capasso
- Interventional Neuroradiology Unit, University Hospital Careggi, Florence, Italy
| | - Nicola Limbucci
- Interventional Neuroradiology Unit, University Hospital Careggi, Florence, Italy
| |
Collapse
|
24
|
Samaniego EA, Boltze J, Lyden PD, Hill MD, Campbell BCV, Silva GS, Sheth KN, Fisher M, Hillis AE, Nguyen TN, Carone D, Favilla CG, Deljkich E, Albers GW, Heit JJ, Lansberg MG. Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke. Stroke 2023; 54:3190-3201. [PMID: 37942645 PMCID: PMC10841844 DOI: 10.1161/strokeaha.123.044985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STAIR XII (12th Stroke Treatment Academy Industry Roundtable) included a workshop to discuss the priorities for advancements in neuroimaging in the diagnostic workup of acute ischemic stroke. The workshop brought together representatives from academia, industry, and government. The participants identified 10 critical areas of priority for the advancement of acute stroke imaging. These include enhancing imaging capabilities at primary and comprehensive stroke centers, refining the analysis and characterization of clots, establishing imaging criteria that can predict the response to reperfusion, optimizing the Thrombolysis in Cerebral Infarction scale, predicting first-pass reperfusion outcomes, improving imaging techniques post-reperfusion therapy, detecting early ischemia on noncontrast computed tomography, enhancing cone beam computed tomography, advancing mobile stroke units, and leveraging high-resolution vessel wall imaging to gain deeper insights into pathology. Imaging in acute ischemic stroke treatment has advanced significantly, but important challenges remain that need to be addressed. A combined effort from academic investigators, industry, and regulators is needed to improve imaging technologies and, ultimately, patient outcomes.
Collapse
Affiliation(s)
- Edgar A. Samaniego
- Department of Neurology, Radiology and Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Johannes Boltze
- School of Life Sciences, The University of Warwick, Coventry, United Kingdom
| | - Patrick D. Lyden
- Zilkha Neurogenetic Institute of the Keck School of Medicine at USC, Los Angeles, California, United States
| | - Michael D. Hill
- Department of Clinical Neuroscience & Hotchkiss Brain Institute, University of Calgary & Foothills Medical Centre, Calgary, Canada
| | - Bruce CV Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Kevin N Sheth
- Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, United States
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United Stated
| | - Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Massachusetts, United States
| | - Davide Carone
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher G. Favilla
- Department of Neurology, University of Pennsylvania Philadelphia, Pennsylvania, Unites States
| | | | - Gregory W. Albers
- Department of Neurology, Stanford University, Stanford, California, United States
| | - Jeremy J. Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, California, United States
| | - Maarten G Lansberg
- Department of Neurology, Stanford University, Stanford, California, United States
| |
Collapse
|
25
|
Terceño M, Bashir S, Puig J, I-Estadella JD, Murias E, Jiménez JM, Díaz EG, Monso JF, Bravo-Rey I, Romero V, Werner M, López-Rueda A, Román LS, Anadaluz JB, Doncel-Moriano A, Rosati S, Pérez-García C, Remollo S, Caamaño IR, Aixut S, Chaparro OSC, Garcia JMS, Porto-Álvarez J, Mendez-Cendón JC, Rayon-Aledo JC, Aguilar Y, Parrilla G, Castaño M, Serena J, Silva Y. Impact of Balloon Guide Catheters in Elderly Patients Treated with Mechanical Thrombectomy: Insights from the ROSSETTI Registry. AJNR Am J Neuroradiol 2023; 44:1275-1281. [PMID: 37827717 PMCID: PMC10631533 DOI: 10.3174/ajnr.a8003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Several nonrandomized studies have demonstrated the effectiveness of balloon guide catheters in treating patients with anterior circulation large-vessel occlusion. However, their impact on the elderly populations has been underreported. We aimed to analyze the effect of balloon guide catheters in a cohort of elderly patients (80 years of age or older) with anterior circulation large-vessel occlusion. MATERIALS AND METHODS Consecutive patients from June 2019 to June 2022 were collected from the ROSSETTI Registry. Demographic and clinical data, angiographic endovascular technique, and clinical outcome were compared between balloon guide catheter and non-balloon guide catheter groups. We studied the association between balloon guide catheters and the rate of complete recanalization after a single first-pass effect modified TICI 2c-3, as well as their association with functional independence at 3 months. RESULTS A total of 808 patients were included during this period, 465 (57.5%) of whom were treated with balloon guide catheters. Patients treated with balloon guide catheters were older, had more neurologic severity at admission and lower baseline ASPECTS, and were less likely to receive IV fibrinolytics. No differences were observed in terms of the modified first-pass effect between groups (45.8 versus 39.9%, P = .096). In the multivariable regression analysis, balloon guide catheter use was not independently associated with a modified first-pass effect or the final modified TICI 2c-3, or with functional independence at 3 months. CONCLUSIONS In our study, balloon guide catheter use during endovascular treatment of anterior circulation large-vessel occlusion in elderly patients did not predict the first-pass effect, near-complete final recanalization, or functional independence at 3 months. Further studies, including randomized clinical trials, are needed to confirm these results.
Collapse
Affiliation(s)
- Mikel Terceño
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Saima Bashir
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Josep Puig
- Department of Radiology (J.P.), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain
| | - Josep Daunis- I-Estadella
- Department of Computer Science (J.D.-I.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Eduardo Murias
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Jose María Jiménez
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eva González Díaz
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Jon Fondevila Monso
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Isabel Bravo-Rey
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Veredas Romero
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Mariano Werner
- Neurointerventional Department CDI (M.W.), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Antonio López-Rueda
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Luis San Román
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Jordi Blasco Anadaluz
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | | | - Santiago Rosati
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Sebastian Remollo
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Isabel Rodríguez Caamaño
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Sonia Aixut
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Sabino Chirife Chaparro
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jacobo Porto-Álvarez
- Department of Neuroradiology (J.P.-A.), Complexo Hospitalario Universitario de Santiago de, Compostela, Galicia, Spain
| | - Jose Carlos Mendez-Cendón
- Interventional Neuroradiology Unit (J.C.M.-C.), Department of Radiology, Hospital Ramón y Cajal, Madrid, Spain
| | - Jose Carlos Rayon-Aledo
- Department of Interventional Neuroradiology (J.C.R.-A.), Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
| | - Yeray Aguilar
- Department of Radiology (Y.A.), Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Guillermo Parrilla
- Department of Interventional Neuroradiology (G.P.), Department of Radiology, Hospital Clínico Universitario Virgen de la, Murcia, Spain
| | - Miguel Castaño
- Department of Interventional Neuroradiology (M.S.), Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Joaquín Serena
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Yolanda Silva
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| |
Collapse
|
26
|
Tomasello A, Gramegna LL, Vega P, Castaño C, Moreu M, Dominguez C, Macho J. Mechanical thrombectomy with a new intermediate balloon catheter combining the BGC and DAC features: Initial clinical experience with the iNedit device. Interv Neuroradiol 2023:15910199231207407. [PMID: 37847747 DOI: 10.1177/15910199231207407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION The iNedit balloon distal access catheter is a novel thrombectomy device. It has an inner diameter of 0.058″, proximal outer diameter of 2.13 mm, and distal outer diameter of 1.67mm. It is compatible with a 0.088″ guide catheter and includes a balloon located 5 cm from the catheter tip, enabling proximal flow restriction and combined therapy with stent retrievers. We investigate the appraisal of the use, safety, and efficacy of the iNedit catheter in the first-in-human study. METHODS In the preliminary cases that demanded training on the product previous to a multicentric study, prospective data were collected on 22 consecutive patients treated with the iNedit catheter to perform thrombectomy for acute ischemic stroke due to large vessel occlusion within 24 h. The outcome measures consisted of several evaluations of user experience rated on a 5-point scale ranging from 1 (bad) to 5 (excellent), as well as assessments of procedural safety outcomes such as artery perforation and arterial occlusion, procedural efficacy outcomes including first-pass effect (Thrombolysis In Cerebral Infarction [TICI] 2c/3) and final recanalization (TICI 2b/3), and clinical efficacy outcomes such as a 3-month 0-2 modified Rankin Scale (mRS). RESULTS The mean age was 72 ± 12 years old; median National Institute Health Stroke Scale was 17 (11-19). Sites of primary occlusion were: 2 internal carotid artery, 12 M1-MCA, 7 M2-MCA, and one P1. Median score evaluation of the appraisal of use was 4- IQR [4-5]. The median number of passes was 1 [IQR 1-2]. First pass complete recanalization rate was 50% and the final recanalization rate was 94.45%. No artery perforation and arterial occlusion. Good functional outcome mRS 0-2 was achieved in 50% of patients. CONCLUSIONS In this initial clinical experience, iNedit device achieved a high rate of first-pass effect and final recanalization rate with no safety concerns, thus favoring a high percentage of good clinical outcomes.
Collapse
Affiliation(s)
- Alejandro Tomasello
- Interventional Neuroradiology Section, Vall d Hebron University Hospital, Barcelona, Spain
| | | | - Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Castaño
- Interventional Neuroradiology Unit, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Manuel Moreu
- Interventional Neuroradiology, Radiology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Carlos Dominguez
- Interventional Neuroradiology, Hospital General Universitario Alicante, Alicante, Spain
| | - Juan Macho
- Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Spain
| |
Collapse
|
27
|
Rahman H, Ghosh P, Kaluski E. Editorial: Perfecting Left Carotid Interventions from Right Wrist: Is Right Radial All-Right? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:61-62. [PMID: 37208214 DOI: 10.1016/j.carrev.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Hammad Rahman
- Division of Cardiovascular Disease, Robert Packer Hospital, The Guthrie Health Services, Sayre, PA, USA; The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Priyanka Ghosh
- Division of Cardiovascular Disease, Robert Packer Hospital, The Guthrie Health Services, Sayre, PA, USA; The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Edo Kaluski
- Division of Cardiovascular Disease, Robert Packer Hospital, The Guthrie Health Services, Sayre, PA, USA; The Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
| |
Collapse
|
28
|
Cuoco JA, Entwistle JJ, Siddiq F, Puri AS, Woodward K, Hanel RA, Ansari SA, Frei D, Patel BM. The balloon occlusion sheath for stroke (BOSS) balloon guide catheter for stroke intervention: Safety and technical success. Interv Neuroradiol 2023:15910199231198273. [PMID: 37649344 DOI: 10.1177/15910199231198273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND We describe the first-in-human experience using the Balloon Occlusion Stroke Sheath (BOSSTM) balloon-guide catheter to perform stroke thrombectomy in 50 consecutive patients enrolled in the Flow Arrest Safety and Technical success with balloon-guide catheters trial. This aspiration system includes a novel 9.4F balloon-guide catheter conduit for the insertion and guidance of catheters with a balloon providing temporary flow arrest. METHODS The Flow Arrest Safety and Technical success with balloon-guide catheter trial is a single-arm, prospective, multi-center, non-randomized, observational registry evaluating the use of the market-released BOSSTM balloon-guide catheter in adult patients diagnosed with an acute ischemic stroke attributable to large vessel occlusion. The purpose of the current trial was to assess the safety and technical success associated with the use of the BOSSTM balloon-guide catheter. RESULTS Fifty patients met inclusion criteria with a mean baseline National Institutes of Health Stroke Scale (NIHSS) of 16. Treatment devices, including aspiration and stent retriever devices, were used in a total of 88 passes. The BOSSTM balloon-guide catheter was compatible with all stroke thrombectomy treatment devices used in 98% (49/50) of procedures. Balloon inflation and flow arrest were achieved in 100% (50/50) and 98% (49/50) of cases, respectively. Balloon deflation and retraction were observed in 100% (50/50) of cases. Successful reperfusion (modified thrombolysis in cerebral infarction score > 2b) was achieved in 100% of cases with single-pass reperfusion achieved in 62% (31/50) of cases. CONCLUSIONS The BOSSTM balloon-guide catheter is a safe and technically effective adjunctive device for mechanical thrombectomy of acute ischemic stroke due to large vessel occlusion.
Collapse
Affiliation(s)
- Joshua A Cuoco
- Department of Neurosurgery, Carilion Clinic, Roanoke, VA, USA
| | | | - Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, MO, USA
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Keith Woodward
- Department of Neurointerventional Radiology, Fort Saunders Regional Medical Center, Knoxville, TN, USA
| | - Ricardo A Hanel
- Department of Neurosurgery, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA
- Baptist Medical Center Jacksonville, FL, USA
| | - Sameer A Ansari
- Department of Radiology, Neurology, Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Donald Frei
- Department of Neurointerventional Surgery, Swedish Medical Center, Denver, CO, USA
- Radiology Imaging Associates, RIA Neurovascular Clinic, Englewood, CO, USA
| | - Biraj M Patel
- Department of Neurosurgery, Carilion Clinic, Roanoke, VA, USA
- Department of Radiology, Carilion Clinic, Roanoke, VA, USA
| |
Collapse
|
29
|
Dhillon PS, Butt W, Podlasek A, Bhogal P, McConachie N, Lenthall R, Nair S, Malik L, Lynch J, Goddard T, Barrett E, Krishnan K, Dineen RA, England TJ. Effect of proximal blood flow arrest during endovascular thrombectomy (ProFATE): Study protocol for a multicentre randomised controlled trial. Eur Stroke J 2023; 8:581-590. [PMID: 37231682 DOI: 10.1177/23969873231166194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Observational studies have demonstrated improved outcomes with the adjunctive use of balloon guide catheters (BGC) during endovascular thrombectomy (EVT) for anterior circulation acute ischaemic stroke (AIS). However, the lack of high-level evidence and global practice heterogeneity justifies a randomised controlled trial (RCT) to investigate the effect of transient proximal blood flow arrest on the procedural and clinical outcomes of patients with AIS following EVT. HYPOTHESIS Proximal blood flow arrest in the cervical internal carotid artery during EVT for proximal large vessel occlusion is superior to no flow arrest in achieving complete vessel recanalisation. METHODS ProFATE is an investigator-initiated, pragmatic, multicentre RCT with blinding of participants and outcome assessment. An estimated 124 participants with an anterior circulation AIS due to large vessel occlusion, an NIHSS of ⩾2, ASPECTS ⩾ 5 and eligible for EVT using a first-line combined technique (contact aspiration and stent retriever) or contact aspiration only will be randomised (1:1) to receive BGC balloon inflation or no inflation during EVT. OUTCOMES The primary outcome is the proportion of patients achieving near-complete/complete vessel recanalisation (eTICI 2c-3) at the end of the EVT procedure. Secondary outcomes include the functional outcome (modified Rankin Scale at 90 days), new or distal vascular territory clot embolisation rate, near-complete/complete recanalisation after the first pass, symptomatic intracranial haemorrhage, procedure-related complications and death at 90 days. DISCUSSION This is the first RCT to investigate the effect of proximal blood flow arrest during EVT using a BGC on the procedural and clinical outcomes of patients with AIS due to large vessel occlusion.
Collapse
Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Waleed Butt
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Anna Podlasek
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Norman McConachie
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jeremy Lynch
- Interventional Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tony Goddard
- Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Barrett
- Department of Research and Innovation (Medical Statistics), Manchester University NHS Foundation Trust, Manchester, UK
- Centre for Biostatistics, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Kailash Krishnan
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
| | - Robert A Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
- Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| |
Collapse
|
30
|
Klancik V, Kočka V, Sulzenko J, Widimsky P. The many roles of urgent catheter interventions: from myocardial infarction to acute stroke and pulmonary embolism. Expert Rev Cardiovasc Ther 2023; 21:123-132. [PMID: 36706282 DOI: 10.1080/14779072.2023.2174101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously increasing, and from 1990 to 2019, it has doubled. Global cardiovascular mortality has increased from 12.1 million in 1990 to 18.6 million cases in 2019. The development of therapeutic options for these diseases is at the forefront of interest concerning the extensive socio-economic consequences. Modern endovascular transcatheter therapeutic options contribute to the reduction of cardiovascular morbidity and mortality. AREAS COVERED The article concentrates on the triad of the most common causes of acute cardiovascular mortality and morbidity - myocardial infarction, ischemic stroke, and pulmonary embolism. Current evidence-based indications, specific interventional techniques, and remaining unsolved issues are reviewed and compared. A personal perspective on the possible implications for the future is provided. EXPERT OPINION Primary angioplasty for ST-segment elevation myocardial infarction is a well-established therapeutic option with proven mortality benefits. We suppose that catheter-based interventions for acute stroke will spread quickly from centers of excellence to routine clinical practice. We believe that ongoing research will provide a basis for the expansion of interventional treatment of pulmonary embolism soon.
Collapse
Affiliation(s)
- Viktor Klancik
- Department of Cardiology, Ceske Budejovice Hospital, Inc, Ceske Budejovice, Czech Republic.,Department of Cardiology, Charles University, Czech Republic
| | - Viktor Kočka
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| | - Jakub Sulzenko
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| | - Petr Widimsky
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| |
Collapse
|
31
|
Comparison of mechanical thrombectomy techniques in an in vitro stroke model: How to obtain a first pass recanalization? J Neuroradiol 2022; 50:438-443. [PMID: 36526015 DOI: 10.1016/j.neurad.2022.12.002] [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: 06/28/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since mechanical thrombectomy (MT) has proven to be effective in the treatment of acute ischemic stroke (AIS), significant research has been dedicated to establishing procedural techniques offering best rate of first pass effect (FPE). In this study, we compared the efficacy of different techniques in vitro to achieve the first pass recanalisation (FPR). METHODS In vitro MT procedures were performed using a realistic silicone model of the human cerebral vasculature. The MT with stent retriever (SR) were performed with manual co-aspiration through the respective access catheter and intermediate catheter (IC), with Solumbra or partial retrieval techniques into the IC. Two SRs (Solitaire and EmboTrap) were selected to retrieve both red blood cells (RBC) rich and fibrin-rich clots. FPR rates were recorded for each case. RESULTS Overall, 144 MT were performed. FPR rates using the partial retrieval and Solumbra technique were of 100% and 87%, respectively (p = 0.01). The rate of FPR was of 92% using the balloon-guide catheter (BGC) compared to 64% with the guide catheter (GC) (p = 0.0001). With an IC, no differences were found between using a BGC or a GC (87.9% vs 89,6%, p = 0.75). No significant difference was observed between the Embotrap and the Solitaire device for the rate of FPR (82% and 74%, respectively; p = 0.23). CONCLUSIONS In this study, FPR rates were higher with the use of an IC associated with the partial retrieval technique, regardless the guide catheter, the SR, or the clot composition. The less effective technique was the association of GC and SR, without an IC.
Collapse
|
32
|
Widimsky P, Snyder K, Sulzenko J, Hopkins LN, Stetkarova I. Acute ischaemic stroke: recent advances in reperfusion treatment. Eur Heart J 2022; 44:1205-1215. [PMID: 36477996 PMCID: PMC10079392 DOI: 10.1093/eurheartj/ehac684] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
During the last 5–7 years, tremendous progress was achieved in the reperfusion treatment of acute ischaemic stroke during its first few hours from symptom onset. This review summarizes the latest evidence from randomized clinical trials and prospective registries with a focus on endovascular treatment using stent retrievers, aspiration catheters, thrombolytics, and (in selected patients) carotid stenting. Novel approaches in prehospital (mobile interventional stroke teams) and early hospital (direct transfer to angiography) management are described, and future perspectives (‘all-in-one’ laboratories with angiography and computed tomography integrated) are discussed. There is reasonable chance for patients with moderate-to-severe acute ischaemic stroke to survive without permanent sequelae when the large-vessel occlusion is removed by means of modern pharmaco-mechanic approach. Catheter thrombectomy is now the golden standard of acute stroke treatment. The role of cardiologists in stroke is expanding from diagnostic help (to reveal the cause of stroke) to acute therapy in those regions where such up-to-date Class I. A treatment is not yet available.
Collapse
Affiliation(s)
- Petr Widimsky
- Cardiocenter, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
| | - Kenneth Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY , USA
| | - Jakub Sulzenko
- Cardiocenter, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
| | - Leo Nelson Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY , USA
| | - Ivana Stetkarova
- Department of Neurology at the Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
| |
Collapse
|
33
|
Lee H, Park T, Baek J, Kim S, Lee S, Ryou K. Undeflatable balloon guide catheter (BGC) during endovascular procedure: Rescue strategy. J Cerebrovasc Endovasc Neurosurg 2022; 24:372-379. [PMID: 35794749 PMCID: PMC9829560 DOI: 10.7461/jcen.2022.e2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/27/2021] [Indexed: 01/21/2023] Open
Abstract
The use of a balloon guide catheter (BGC) in the endovascular management of acute ischemic stroke is known to improve the efficacy and efficiency of the procedure by reducing the risk of distal embolization. During the procedure, the balloon of the catheter causes a temporary arrest of cerebral blood flow. However, failure of the balloon to deflate during the BGC procedure can result in catastrophic complications, including aggravated hypoxic damage.<br/> This paper aims to share the resolution and methodological analysis of our experience with BGC balloon deflation failure, which was confirmed by a reproducible experiment under similar conditions.
Collapse
Affiliation(s)
- Hyungkyu Lee
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Taejoon Park
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea,Correspondence to Taejoon Park Department of Neurosurgery, Cheju Halla General Hospital, 65 Doryeong-ro, Jeju-si, Jeju-do 63127, Korea Tel +82-64-740-5000 Fax +82-64-743-3110 E-mail
| | - Jinwook Baek
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Seonghwan Kim
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Sangpyung Lee
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Kyoungsoo Ryou
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| |
Collapse
|
34
|
Matsumoto T, Takeuchi M, Uyama A, Konishi Y, Iwabuchi S. Support and guide performance comparison of balloon guide catheters. Surg Neurol Int 2022; 13:490. [DOI: 10.25259/sni_749_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/01/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Several types of balloon guide catheters (BGCs) are used in mechanical thrombus retrieval. However, direct comparisons of their supporting and guiding performance have not been reported. We compared the supporting and guiding performance of the Branchor, Flowgate, and Optimo BGCs using a type 3 aorta artificial vascular model.
Methods:
An inner catheter was pushed into the artificial vascular model using a linear actuator for the supporting performance evaluation. A previously placed BGC in the internal carotid artery was then intentionally caused to slip. Supporting performance was evaluated by measuring the distance the BGC slipped and generated maximum resistance during Inner catheter insertion. For the guiding performance experiment, a linear actuator was used to guide the BGC into the internal carotid artery of the artificial vessel model. The guiding performance was evaluated by measuring the distance reached by the BGC, maximum resistance generated during insertion of the guiding catheter, and distance the inner catheter slipped. Each experiment was replicated 5 times.
Results:
No statistically significant differences were observed in the results of the five supporting performance experiments. However, the results of the first and second experiments suggested that the Optimo offers better supporting performance. In the guiding performance experiment, significant differences were observed, suggesting that the Branchor and Flowgate have superior guiding performance in comparison with the Optimo.
Conclusion:
The Optimo offered superior supporting performance, while the Branchor and Flowgate showed better guiding performance than the Optimo.
Collapse
Affiliation(s)
- Takashi Matsumoto
- Department of Neurosurgery, Graduate School of Medicine, Toho University, Tokyo, Japan
| | | | - Atsushi Uyama
- Department of Neurosurgery, Seisho Hospital, Kanagawa, Japan
| | | | - Satoshi Iwabuchi
- Department of Neurosurgery, Toho University Ohashi Medical Center, Tokyo, Japan
| |
Collapse
|
35
|
Efficacy of Balloon Guide Catheter-Assisted Thrombus Repair in Stroke Treatment: A Retrospective Survey in China. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4278048. [PMID: 36212711 PMCID: PMC9534624 DOI: 10.1155/2022/4278048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 12/17/2022]
Abstract
Background The first-pass (FP) effect, defined by successful cerebral reperfusion from a single pass of an endovascular stentriever, was associated with shorter procedural times and possible improved outcomes in patients with ischemic stroke secondary to large vessel occlusion. The adjunctive use of balloon guide catheter (BGC) may increase the rates of the first-pass effect. In this retrospective study we examined the impact of BGC on the first-pass effect in acute stroke patients. Methods We included patients with acute ischemic stroke with large vessel occlusion treated by endovascular thrombectomy from 2018 to 2019. We categorized the cases into BGC and non-BGC groups. Differences in time metrics and outcomes were compared. Result One hundred and thirty-two patients were included, and sixty-two were in BGC group (47.0%). The median procedural time was shorter (83.0 minutes vs 120.0 minutes, P = 0.000), and FP rate was higher in BGC group (58.1% vs 32.9%, P = 0.004) compared with non-BGC group. Proportion of modified Thrombolysis in Cerebral Infarction (mMTICI) 3 was higher (66.1% vs 37.1%, P = 0.001), and modified Rankin Scale (mRS) 0 to 2 was higher (59.7% vs 41.4%, P = 0.036) in BGC group compared with non-BGC group. In addition, BGC was associated with successful reperfusion odds ratio, 0.383; 95% confidence interval: 0.174-0.847; P = 0.018). The FP rate of BGC in the distal ICA was higher than that in the proximal ICA (87.5% vs 39.5%, P = 0.000), and the good clinical outcome rate at 90 days in the distal ICA was also higher than that in the proximal ICA (91.7% vs 39.5%, P = 0.000). Conclusion We showed that BGC shortened the procedural time and increased the rate of the successful FP. We recommend that BGC could be considered the preferred technique for endovascular intervention in stroke.
Collapse
|
36
|
Martínez-Galdámez M, Schüller M, Galvan J, de Lera M, Kalousek V, Ortega-Gutierrez S, Arenillas JF. Safety and feasibility of transradial use of 8F balloon guide catheter Flowgate 2 for endovascular thrombectomy in acute ischemic stroke. Interv Neuroradiol 2022; 28:22-28. [PMID: 33892601 PMCID: PMC8905076 DOI: 10.1177/15910199211013186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND While Balloon Guide Catheters (BGC) have been shown to increase the rate of reperfusion during mechanical thrombectomy (MT), its implementation with transfemoral approach is at times limited due to unfavorable vascular anatomy. OBJECTIVE to determine safety, feasibility and performance of the transradial use of 8 F BGC Flowgate2 during mechanical thrombectomy procedures in patients with unfavorable vascular anatomies (type 3 or bovine arch)Material/Methods: We performed a retrospective cohort study of consecutive transradial mechanical thrombectomies performed with BGC Flowgate2 between January and December 2019. Patient demographics, procedural and radiographic metrics, and clinical data were analyzed. RESULTS 20 (8.7%) out of 230 overall thrombectomy procedures underwent transradial approach using an 8 F BGC Flowgate.2 Successful approach was achieved in 17/20 cases, and in 3 cases radial was switched to femoral, after failure. TICI 2 C/3 was achieved in 18 cases (90%), followed by TICI 2 b and 2a in 1 (5%) case respectively. The average number of passes was 1.8. The average radial puncture-to-first pass time was 22 min. Radial vasospasm was observed in 3/20 cases. The Flowgate2 was found kinked in 4/20 cases (20%), all of them during right internal carotid procedures. There were no postprocedural complications at puncture site, as hematoma, pseudoaneurysm or local ischemic events. CONCLUSION The use of 8 F Balloon Guide Catheter during MT via transradial approach might represent an alternative in selected cases with unfavorable vascular anatomies. Its use in right ICA catheterizations was associated with a high rate of catheter kinking.
Collapse
Affiliation(s)
- Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain,Mario Martínez-Galdámez, Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Av Ramón y Cajal 3, Valladolid PC 47005, Spain.
| | - Miguel Schüller
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jorge Galvan
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mercedes de Lera
- Stroke Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Vladimir Kalousek
- Interventional Neuroradiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Santiago Ortega-Gutierrez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA,Department of Radiology and Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Juan F Arenillas
- Stroke Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain,Clinical Neurosciences Research Group, Department of Medicine, University of Valladolid, Valladolid, Spain
| |
Collapse
|
37
|
Initial Clinical Experience of Repeat Thrombectomy with a Retrieval Stent (RTRS) with Continuous Proximal Flow Arrest by Balloon Guide Catheter for Acute Intracranial Carotid Occlusion. Behav Neurol 2022; 2021:7607324. [PMID: 35003387 PMCID: PMC8741371 DOI: 10.1155/2021/7607324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Balloon guide catheters (BGCs) have good performance in terms of radiological outcomes in acute ischemic thrombectomy. It is not uncommon for BGCs to be blocked by thrombi, especially in cases with acute intracranial internal carotid artery (ICA) occlusion. Our initial experience using repeat thrombectomy with a retrieval stent (RTRS) with continuous proximal flow arrest by BGC for acute intracranial ICA occlusion is presented. Methods In patients with acute intracranial ICA occlusion treated with RTRS, clinical data, including the National Institutes of Health Stroke Scale (NIHSS) score at admission and modified Rankin Scale (mRS) score at 90 days, and procedural data, including the Extended treatment in Cerebral Infarction (eTICI) score, procedural time, and complications, were analyzed. Results Thirty-two consecutive patients (12 men (37.5%); mean age: 73 years) were treated with RTRS using a BGC. The median NIHSS score was 19. The median puncture-to-reperfusion time was 46 minutes (range: 22-142 minutes). All patients were successfully revascularized; eTICI 2c or better recanalization was achieved in 30 (93.8%) patients. No procedure-related complications or symptomatic intracranial hemorrhage occurred. Two cases (6.3%) had distal emboli, but none had emboli to the anterior cerebral artery. Fourteen patients (43.8%) achieved a good outcome with an mRS score of 0-2 at 90 days, and 8 patients (25.0%) died. Conclusions In patients with intracranial ICA occlusion, RTRS with proximal flow arrest by BGC is effective and safe, achieving good clinical and angiographic outcomes. This method may reduce the incidence of distal emboli in thrombectomy with stent retrievers.
Collapse
|
38
|
Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy : Results from the ESCAPE-NA1 Trial. Clin Neuroradiol 2022; 32:799-807. [PMID: 34993582 DOI: 10.1007/s00062-021-01123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/08/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial. METHODS Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b-3 per attempt. The secondary outcome was successful reperfusion eTICI 2b-3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built. RESULTS Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24-3.40 and OR 1.92; 95% CI: 1.16-3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07-2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47-5.35 and OR 2.05; 95% CI: 1.09-3.84, respectively) was associated with first-pass eTICI 2b-3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b-3 reperfusion (OR 1.95; 95% CI: 1.10-3.46). CONCLUSION The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.
Collapse
|
39
|
Salem MM, Kvint S, Choudhri OA, Burkhardt JK. Endovascular Transcarotid Artery Revascularization Using the Walrus Balloon Guide Catheter: Preliminary Experience. World Neurosurg 2021; 156:e175-e182. [PMID: 34534717 DOI: 10.1016/j.wneu.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Walrus Balloon Guided System Catheter is a new generation of balloon guide catheter (BGC) designed to bypass some technical limitations of conventional BGC devices. Their utility in cervical carotid disease treatment has not been reported. We report our preliminary experience in cervical carotid treatment using the Walrus BGC to perform a modified endovascular transcarotid artery revascularization technique. METHODS Patients with cervical carotid disease undergoing endovascular treatment using the Walrus BGC at our institution were identified. The pertinent baseline demographics and procedural outcomes were collected and analyzed. RESULTS Twelve patients were included (median age, 70; 58.3% females). All patients had an imaging-confirmed cervical carotid disease that indicated intervention: 6 with high-grade cervical arteriosclerotic carotid stenosis, 2 with intraluminal thrombi, 1 with traumatic carotid dissection, and 3 patients with cervical carotid tandem occlusion along with acute ischemic stroke secondary to large vessel occlusion that required mechanical thrombectomy. Carotid artery stenting was performed in all cases, except 2 of the 3 mechanical thrombectomy cases (angioplasty only). All patients had at least periprocedural follow-up of 30 days, with no stroke, myocardial infarction, or death encountered. CONCLUSIONS We describe a modified endovascular transcarotid artery revascularization technique. We used a standard femoral access to navigate the Walrus catheter in the common carotid artery, followed by balloon inflation for proximal flow arrest or flow reversal (when connected to the aspiration pump) to deploy the carotid stent across the stenosis, while avoiding distal external carotid artery balloon occlusion. Successful treatment was achieved in all cases, with no periprocedural complications encountered.
Collapse
Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Svetlana Kvint
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Omar A Choudhri
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
40
|
Chen W, Gong J, Song R, Liu J, Wang M, Zhang T, Sun H, Zhao Z, Liu Y, Zhu Q, Wang X. Efficacy and safety of direct balloon angioplasty in the treatment of large atherosclerotic stroke. Clin Neurol Neurosurg 2021; 211:107035. [PMID: 34826756 DOI: 10.1016/j.clineuro.2021.107035] [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: 09/25/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Based on the unclear safety and effectiveness of direct balloon angioplasty as a first-line treatment for patients with acute ischemic stroke caused by large artery atherosclerosis (LAA), our paper would center on investigating the safety and effectiveness of this novel strategy. PATIENTS AND METHODS A consecutive series of acute ischemic stroke patients due to intracranial atherosclerosis and short thrombus who underwent thorough direct balloon angioplasty from October 2019 to March 2021 were enrolled. The primary end point included arterial recanalization (modified Thrombolysis in Cerebral Infarction [mTICI]: 2b-3), and 90-day functional independence (modified Rankin Scale[mRS]: 0-2). The secondary end point was symptomatic intracerebral hemorrhage (sICH) and perioperative restenosis and re-occlusion of offending vessel. RESULTS 68 patients were included. Mean time from onset to groin puncture was 342.5 min and 50 min for groin puncture to successful recanalization. 61 (89.7%) patients achieved successful recanalization and 41 (60.3%) acquired functional independence. 11 (16.0%) patients experienced ICH and only 3 (4.4%) for sICH. 8 (11.8%) patients developed symptomatic restenosis or re-occlusion within seven days after the operation. In addition, 16 (23.5%) patients received rescue stenting and 3 (18.8%) of this subgroup appeared immediate intra-stent thrombosis. CONCLUSION Direct balloon angioplasty may be a safe and effective method for the treatment of stroke caused by intracranial large arteriosclerosis occlusion.
Collapse
Affiliation(s)
- Wang Chen
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Jian Gong
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Rao Song
- Department of Cardiology, Linyi People's Hospital, Linyi, Shandong, China
| | - Ji Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Mengen Wang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Tongtong Zhang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Hongyang Sun
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Zhenyu Zhao
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Yan Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Qiyi Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Xianjun Wang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China.
| |
Collapse
|
41
|
Jadhav AP, Desai SM, Zaidat OO, Nogueira RG, Jovin TG, Haussen DC, Mueller-Kronast N, Liebeskind DS. First Pass Effect With Neurothrombectomy for Acute Ischemic Stroke: Analysis of the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke Registry. Stroke 2021; 53:e30-e32. [PMID: 34784741 DOI: 10.1161/strokeaha.121.035457] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Achieving complete revascularization after a single pass of a mechanical thrombectomy device (first pass effect [FPE]) is associated with good clinical outcomes in patients with acute ischemic stroke due to large vessel occlusion. We assessed patient characteristics, outcomes, and predictors of FPE among a large real-world cohort of patients (Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke registry). METHODS Demographics, clinical outcomes, and procedural characteristics were analyzed among patients in whom FPE (modified Thrombolysis in Cerebral Infarction 2c/3 after first pass) was achieved versus those requiring multiple passes (MP). Modified FPE and modified MP included patients achieving modified Thrombolysis in Cerebral Infarction 2B-3. Primary outcomes included 90-day modified Rankin Scale (mRS) score and mortality. RESULTS Among 984 Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke patients, 930 had complete 90-day follow-up. FPE was achieved in 40.5% (377/930) of patients and MP in 20.0% (186/930). Baseline characteristics were similar across all groups. The FPE group had fewer internal carotid artery occlusions compared with MP (P=0.029). The FPE group had faster puncture to recanalization time (P≤0.001), higher rates of 90-day mRS score of 0 to 1 (52.6% versus 38.6%, P=0.003), mRS score of 0 to 2 (65.4% versus 52.0%, P=0.003), and lower 90-day mortality compared with the MP group (12.0% versus 18.7%, P=0.038). Similarly, compared with modified MP patients, the modified FPE group had fewer internal carotid artery occlusions (P=0.004), faster puncture to recanalization time (P≤0.001), and higher rates of 90-day mRS score of 0 to 1 (P=0.002) and mRS score of 0 to 2 (P=0.003). CONCLUSIONS Our findings demonstrate that FPE and modified FPE are associated with superior clinical outcomes.
Collapse
Affiliation(s)
- Ashutosh P Jadhav
- Department of Neurology and Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.)
| | | | - Osama O Zaidat
- Mercy Health-St. Vincent Mercy Medical Center, Toledo, OH (O.O.Z)
| | - Raul G Nogueira
- Department of Neurology, Emory University Grady Memorial Hospital, Atlanta, GA (R.G.N., D.H.)
| | - Tudor G Jovin
- Department of Neurology, Cooper University, Camden, NJ (T.G.J)
| | - Diogo C Haussen
- Department of Neurology, Emory University Grady Memorial Hospital, Atlanta, GA (R.G.N., D.H.)
| | - Nils Mueller-Kronast
- Advanced Neuroscience Network/Tenet South Florida, Boynton Beach, FL (N.H.M.-K.)
| | - David S Liebeskind
- Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, UCLA, Los Angeles, CA (D.S.L.)
| |
Collapse
|
42
|
Pérez-García C, Rosati S, Gómez-Escalonilla C, Arrazola J, López-Frías A, González E, Fondevila J, Vega P, Murias E, Jimenez-Gomez E, Bravo Rey I, Macho J, San Roman L, Rodriguez Caamaño I, Paipa AJ, Remollo S, Aguilar Tejedor Y, Bermúdez-Coronel I, Moliner S, Pumar JM, Bashir S, Puig J, López-Rueda A, Blasco J, Nogueira RG, Moreu M. Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis. J Neurointerv Surg 2021; 14:1062-1067. [PMID: 34750112 DOI: 10.1136/neurintsurg-2021-017987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The optimal endovascular treatment (EVT) technique for middle cerebral artery (MCA) M2 segment occlusions remains unknown. We aim to analyze whether reperfusion rate, procedure times, procedure-related complications, and clinical outcome differed between patients with isolated M2 occlusions who underwent stent-retriever (SR) alone versus combined SR and contact aspiration (CA) as a front-line EVT. METHODS Patients who underwent EVT for isolated MCA-M2 occlusion were recruited from the prospectively ongoing ROSSETTI registry. Patients were divided regarding the EVT approach into SR alone versus SR+CA and propensity score matching was used to achieve baseline balance. Demographic, procedural, safety, and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of first-pass effect (FPE) and 90-day modified Rankin scale (mRS) 0-2. RESULTS 214 patients underwent EVT for M2 occlusion, 125 treated with SR alone and 89 with SR+CA. Propensity score matchnig analysis selected 134 matched patients. The rates of FPE (42% vs 40%, p=1.000) and 90-day mRS 0-2 (60% vs 51%, p=0.281) were comparable between groups. Patients treated with SR alone had lower need of rescue therapy (p=0.006), faster times to reperfusion (p<0.001), and lower procedure-related complications (p=0.031). Higher initial Alberta Stroke Program Early CT Score was an independent predictor of FPE. Age, baseline National Institutes of Health Stroke Scale score, and procedure duration were significant predictors of good clinical outcome at 3 months. CONCLUSIONS As front-line modality in M2 occlusions, the SR alone approach results in similar rates of reperfusion and good clinical outcomes to combined SR+CA and might be advantageous due to faster reperfusion times and fewer adverse events.
Collapse
Affiliation(s)
| | - Santiago Rosati
- Interventional Neuroradiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Juan Arrazola
- Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Eva González
- Interventional Neuroradiology, Hospital Universitario de Cruces, Bilbao, Spain
| | - Jon Fondevila
- Interventional Neuroradiology, Hospital Universitario de Cruces, Bilbao, Spain
| | - Pedro Vega
- Interventional Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Eduardo Murias
- Interventional Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Elvira Jimenez-Gomez
- Interventional Neuroradiology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Isabel Bravo Rey
- Interventional Neuroradiology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Juan Macho
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Luis San Roman
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Isabel Rodriguez Caamaño
- Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Andres Julián Paipa
- Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Yeray Aguilar Tejedor
- Interventional Radiology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Sarai Moliner
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - José Manuel Pumar
- Interventional Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Saima Bashir
- Neurology, University Hospital Dr Josep Trueta, Girona, Spain
| | - Josep Puig
- Radiology, University Hospital Dr Josep Trueta, Girona, Spain
| | - Antonio López-Rueda
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jordi Blasco
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raul G Nogueira
- Neurology and Interventional Radiology, Grady Memorial Hospital, Chickasha, Oklahoma, USA
| | - Manuel Moreu
- Interventional Neuroradiology, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|
43
|
Salem MM, Kvint S, Baig AA, Monteiro A, Cortez GM, Kuhn AL, Goren O, Dalal S, Jankowitz BT, Choudhri O, Raper D, Tanweer O, Jabbour P, Kan P, Starke RM, Levy EI, Griessenauer CJ, Puri AS, Hanel R, Siddiqui AH, Burkhardt JK. Carotid artery revascularization using the Walrus balloon guide catheter: safety and feasibility from a US multicenter experience. J Neurointerv Surg 2021; 14:709-717. [PMID: 34686574 DOI: 10.1136/neurintsurg-2021-018126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Walrus balloon guide catheter (BGC) is a new generation of BGC, designed to eliminate conventional limitations during mechanical thrombectomy. OBJECTIVE To report a multi-institutional experience using this BGC for proximal flow control (PFC) in the setting of carotid artery angioplasty/stenting (CAS) in elective (eCAS) and tandem strokes (tCAS). METHODS Prospectively maintained databases at 8 North American centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with a Walrus BGC. RESULTS 110 patients (median age 68, 64.6% male), 80 (72.7%) undergoing eCAS and 30 (27.3%) tCAS procedures, were included (median cervical carotid stenosis 90%; 46 (41.8%) with contralateral stenosis). Using a proximal flow-arrest technique in 95 (87.2%) and flow-reversal in 14 (12.8%) procedures, the Walrus was navigated into the common carotid artery successfully in all cases despite challenging arch anatomy (31, 28.2%), with preferred femoral access (103, 93.6%) and in monitored anesthesia care (90, 81.8%). Angioplasty and distal embolic protection devices (EPDs) were used in 91 (83.7%) and 58 (52.7%) procedures, respectively. tCAS led to a modified Thrombolysis in Cerebral Infarction 2b/3 in all cases. Periprocedural ischemic stroke (up to 30 days postoperatively) rate was 0.9% (n=1) and remote complications occurred in 2 (1.8%) cases. Last follow-up modified Rankin Scale score of 0-2 was seen in 95.3% of eCAS cohort, with no differences in complications in the eCAS subgroup between PFC only versus PFC and distal EPD (median follow-up 4.1 months). CONCLUSION Walrus BGC for proximal flow control is safe and effective during eCAS and tCAS. Procedural success was achieved in all cases, with favorable safety and functional outcomes on short-term follow-up.
Collapse
Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Svetlana Kvint
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ammad A Baig
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Science, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Science, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Gustavo M Cortez
- Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Anna L Kuhn
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Oded Goren
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Shamsher Dalal
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar Choudhri
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Raper
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Omar Tanweer
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Robert M Starke
- Department of Neurosurgery and Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Science, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA.,Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ricardo Hanel
- Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Science, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
44
|
Yeo LLL, Jing M, Bhogal P, Tu T, Gopinathan A, Yang C, Tan BYQ, Arnberg F, Sia CH, Holmin S, Andersson T. Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices. Front Neurol 2021; 12:712527. [PMID: 34566856 PMCID: PMC8459011 DOI: 10.3389/fneur.2021.712527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/30/2021] [Indexed: 01/23/2023] Open
Abstract
Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS) and is now the standard of care according to international guidelines. However, in about 20% of EVT procedures, recanalization is not achieved, and over 50% of patients who undergo EVT still do not have good functional outcome. In this article, we provide an extensive review of the latest evidence and developments in the field of EVT, with particular focus on the factors that improve patient outcomes. These factors include new and adjunctive techniques such as combination of direct aspiration and stent retriever, intra-arterial urokinase or 2b/3a inhibitors, rescue stenting, as well as novel devices including balloon guide catheters and the newer generations of aspiration catheters and stent retrievers. We also examined the latest notion of using first-pass effect (FPE) as the target to achieve during EVT, which has been associated with an improved functional outcome. While the field of EVT has been rapidly evolving, further research is required in specific AIS patient populations such as those with large ischemic core, late presentation beyond 24 h, posterior circulation strokes, and with distal medium vessel occlusion or tandem lesions to better assess its efficacy and safety.
Collapse
Affiliation(s)
- Leonard L L Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Mingxue Jing
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Pervinder Bhogal
- Department of Neuroradiology, St. Bartholomew's and the Royal London Hospital, London, United Kingdom
| | - Tianming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Anil Gopinathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Cunli Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Benjamin Y Q Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| |
Collapse
|
45
|
Londhe SR, Gg SK, Keshava SN, Mohan C. Indian College of Radiology and Imaging (ICRI) Consensus Guidelines for the Early Management of Patients with Acute Ischemic Stroke: Imaging and Intervention. Indian J Radiol Imaging 2021; 31:400-408. [PMID: 34556925 PMCID: PMC8448212 DOI: 10.1055/s-0041-1734346] [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: 11/26/2022] Open
Abstract
The medical science has witnessed significant change in the management of acute stroke patients as a result of recent advances in the field of stroke imaging and endovascular mechanical thrombectomy in addition to intravenous thrombolysis and optimization of stroke services in balance with available resources. Despite initial negative trials, we witnessed the publication of five multicenter randomized clinical trials showing superiority of the endovascular approach over standard medical management in patients with large vessel occlusion. The aim of this study is to provide comprehensive set of evidence-based recommendations regarding imaging and endovascular interventions in acute ischemic stroke patients.
Collapse
Affiliation(s)
- Shrikant R Londhe
- Department of Interventional Neuroradiology, Noble Hospital, Pune, Maharashtra, India
| | - Sharath Kumar Gg
- Department of Diagnostic and Interventional Neuroradiology, Apollo Hospitals, Bangalore, Karnataka, India
| | - Shyamkumar N Keshava
- Department of Interventional Radiology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Chander Mohan
- Interventional Radiology, ICRI Director, Interventional Radiology, BLK Super Specialty Hospital, Pusa Road, New Delhi, India
| |
Collapse
|
46
|
To support safe provision of mechanical thrombectomy services for patients with acute ischaemic stroke: 2021 consensus guidance from BASP, BSNR, ICSWP, NACCS, and UKNG. Clin Radiol 2021; 76:862.e1-862.e17. [PMID: 34482987 DOI: 10.1016/j.crad.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 01/01/2023]
|
47
|
Burke DJ, Aziz YN, Shah K, Jadhav AP. Transcirculation Embolization to New Territory During Mechanical Thrombectomy for Acute Ischemic Stroke. Neurohospitalist 2021; 12:323-327. [PMID: 35419143 PMCID: PMC8995584 DOI: 10.1177/19418744211041284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Embolization in new territories (ENT) is a known complication of mechanical thrombectomy with incidence dependent upon a variety of procedural factors. We present 2 cases of anterior circulation to posterior circulation ENT. These cases were managed with manual aspiration thrombectomy with excellent radiographic and clinical outcome. We present the available literature involving ENT along with our experience in management.
Collapse
Affiliation(s)
- Devin J. Burke
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Neuroscience Unit, Feil Family and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Yasmin N. Aziz
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Kavit Shah
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| |
Collapse
|
48
|
Podlasek A, Dhillon PS, Jewett G, Shahein A, Goyal M, Almekhlafi M. Clinical and Procedural Outcomes with or without Balloon Guide Catheters during Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis with First-line Technique Subgroup Analysis. AJNR Am J Neuroradiol 2021; 42:1464-1471. [PMID: 34045301 DOI: 10.3174/ajnr.a7164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Balloon guide catheters are increasingly used to improve clot retrieval by temporarily stopping proximal blood flow during endovascular thrombectomy. PURPOSE Our aim was to provide a summary of the literature comparing the procedural and clinical outcomes of endovascular thrombectomy with or without balloon guide catheters, depending on the first-line technique used. DATA SOURCES We used PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. STUDY SELECTION We chose studies that compared using balloon guide catheters with not using them. DATA ANALYSIS Random effects meta-analysis was performed to compare the procedural outcomes measured as the first-pass effect, successful reperfusion, number of passes, procedural duration, arterial puncture to reperfusion time, distal emboli, and clinical outcomes. DATA SYNTHESIS Overall, a meta-analysis of 16 studies (5507 patients, 50.8% treated with balloon guide catheters and 49.2% without them) shows that the use of balloon guide catheters increases the odds of achieving a first-pass effect (OR = 1.92; 95% CI, 1.34-2.76; P < .001), successful reperfusion (OR = 1.85; 95% CI, 1.42-2.40; P < .001), and good functional outcome (OR =1.48; 95% CI, 1.27-1.73; P < .001). Balloon guide catheters reduce the number of passes (mean difference = -0.35; 95% CI, -0.65 to -0.04; P = .02), procedural time (mean difference = -19.73; 95% CI, -34.63 to -4.83; P = .009), incidence of distal or new territory emboli (OR = 0.5; 95% CI, 0.26-0.98; P = .04), and mortality (OR = 0.72; 95% CI, 0.62-0.85; P < .001). Similar benefits of balloon guide catheters are observed when the first-line technique was a stent retriever or contact aspiration, but not for a combined approach. LIMITATIONS The analysis was based on nonrandomized trials with a moderate risk of bias. CONCLUSIONS Current literature suggests improved clinical and procedural outcomes associated with the use of balloon guide catheters during endovascular thrombectomy, especially when using the first-line stent retriever.
Collapse
Affiliation(s)
- A Podlasek
- From the Department of Neuroscience and Vascular Simulation (A.P.), School of Medicine, Anglia Ruskin University, Chelmsford, Essex, UK
- National Institute of Health Research Nottingham Biomedical Research Centre (A.P., P.S.D.), University of Nottingham, Nottingham, UK
- Clinical Radiology (A.P., P.S.D.), Queens Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - P S Dhillon
- National Institute of Health Research Nottingham Biomedical Research Centre (A.P., P.S.D.), University of Nottingham, Nottingham, UK
- Clinical Radiology (A.P., P.S.D.), Queens Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - G Jewett
- Department of Clinical Neurosciences (G.J., A.S., M.G., M.A.), University of Calgary, Calgary, Alberta, Canada
| | - A Shahein
- Department of Clinical Neurosciences (G.J., A.S., M.G., M.A.), University of Calgary, Calgary, Alberta, Canada
| | - M Goyal
- Department of Clinical Neurosciences (G.J., A.S., M.G., M.A.), University of Calgary, Calgary, Alberta, Canada
- Department of Radiology (M.G., M.A.), University of Calgary, Calgary, Alberta, Canada
| | - M Almekhlafi
- Department of Clinical Neurosciences (G.J., A.S., M.G., M.A.), University of Calgary, Calgary, Alberta, Canada
- Department of Radiology (M.G., M.A.), University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
49
|
Goyal M, Kappelhof M, Ospel JM, Bala F. Balloon guide catheters: use, reject, or randomize? Neuroradiology 2021; 63:1179-1183. [PMID: 34100099 DOI: 10.1007/s00234-021-02739-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
Thrombectomy devices played an important role in the success of endovascular treatment trials over the past five years. A balloon guide catheter (BGC) is an adjunctive device used to arrest and reverse flow by inflating the balloon at its tip, which allows for flow reversal in intracranial arteries during retrieval of thrombectomy devices by applying concomitant aspiration through its lumen. Thereby, it can decrease the risk of clot fragmentation and distal embolization. Despite the numerous benchtop and clinical observational studies showing the superiority of BGC to conventional guide catheters in improving reperfusion quality and clinical outcome, its use is still low in clinical practice. The reasons behind this reluctance might be related to technical and cost issues. Therefore, high level evidence data, i.e., a randomized clinical trial, are needed to increase its implementation in thrombectomy procedures. Nonetheless, several obstacles and challenges can prevent the completion of such a trial, and efforts are needed to overcome them. We provide an overview of the current opinions about BGCs in the neurointerventional community and discuss the feasibility and challenges of a possible randomized trial to answer the question "should a BGC be routinely used in endovascular treatment of acute ischemic stroke?"
Collapse
Affiliation(s)
- Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
- Department of Diagnostic Imaging, University of Calgary, Calgary, Canada.
| | - Manon Kappelhof
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Johanna M Ospel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basil, Switzerland
| | - Fouzi Bala
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| |
Collapse
|
50
|
Guo X, Miao Z. Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions. Stroke Vasc Neurol 2021; 6:649-657. [PMID: 34285134 PMCID: PMC8717796 DOI: 10.1136/svn-2021-000972] [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: 03/01/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Advances in endovascular treatment of acute ischaemic stroke from intracranial large vessel occlusions have continued in the past decade. Here, we performed a detailed review of all the new trials and studies that had the highest evidence, the guidelines for mechanical thrombectomy, the selection of the particular population outside the guidelines and endovascular therapeutic strategies for acute ischemic stroke from occluded intracranial arteries.
Collapse
Affiliation(s)
- Xu Guo
- Intervetional Neurology, Capital Medical University Affiliated Anzhen Hospital, Chaoyang-qu, China
| | - Zhongrong Miao
- Interventinal Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| |
Collapse
|