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Murias E, Puig J, Serna-Candel C, Gonzalez EM, Moreu M, Jiménez-Gómez E, SanRoman L, Aparici-Robles F, Terceño M, Martínez AM, Aixut S, Romero V, Mendez JC, Sagredo-Barra A, Aguilar Y, Espinosa de Rueda M, Blázquez MAC, Bashir S, Rodríguez Castro J, Lopez-Frías A, Jiménez JM, Chaviano J, Maestro V, Manso J, Lopez-Rueda A, Remollo S, Morales-Caba L, Comas-Cufí M, Vega P. Enhancing the First-Pass Effect in Acute Stroke: The Impact of Stent Retriever Characteristics. J Clin Med 2024; 13:3123. [PMID: 38892834 PMCID: PMC11173089 DOI: 10.3390/jcm13113123] [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: 04/08/2024] [Revised: 05/06/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: Although stentrievers (SRs) have been a mainstay of mechanical thrombectomy (MT), and current guidelines recommend the use of SRs in the treatment of large vessel occlusion stroke (LVO), there is a paucity of studies in the literature comparing SRs directly against each other in terms of mechanical and functional properties. Timely access to endovascular therapy and the ability to restore intracranial flow in a safe, efficient, and efficacious manner have been critical to the success of MT. This study aimed to investigate the impact of contemporary SR characteristics, including model, brand, size, and length, on the first-pass effect (FPE) in patients with acute ischemic stroke. Methods: Consecutive patients with M1 occlusion treated with a single SR+BGC were recruited from the ROSSETTI registry. The primary outcome was the FPE that was defined as modified (mFPE) or true (tFPE) for the achievement of modified thrombolysis in cerebral infarction (mTICI) grades 2b-3 or 3 after a single device pass, respectively. We compared patients who achieved mFPE with those who achieved tFPE according to SR characteristics. Results: We included 610 patients (52.3% female and 47.7% male, mean age 75.1 ± 13.62 years). mFPE was achieved in 357 patients (58.5%), whereas tFPE was achieved in 264 (43.3%). There was no significant association between SR characteristics and mFPE or tFPE. Specifically, the SR size did not show a statistically significant relationship with improvement in FPE. Similarly, the length of the SR did not yield significant differences in the mFPE and tFPE, even when the data were grouped. Conclusions: Our data indicate that contemporary SR-mediated thrombectomy characteristics, including model, brand, size, and length, do not significantly affect the FPE.
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Affiliation(s)
- Eduardo Murias
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, 33007 Oviedo, Spain;
| | - Josep Puig
- Hospital Clínic de Barcelona and IDIBAPS, 08023 Barcelona, Spain;
| | - Carmen Serna-Candel
- Hospital General Universitario de Alicante Doctor Balmis, 03010 Alicante, Spain; (C.S.-C.); (A.S.-B.)
| | | | - Manuel Moreu
- Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.); (A.L.-F.)
| | | | - Luis SanRoman
- Hospital Clínic de Barcelona and IDIBAPS, 08023 Barcelona, Spain;
| | | | - Mikel Terceño
- Hospital Universitario de Girona Doctor Josep Trueta, 17007 Girona, Spain; (M.T.); (S.B.)
| | | | - Sonia Aixut
- Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (S.A.); (A.L.-R.)
| | - Veredas Romero
- Hospital Universitario Reina Sofía, 14004 Cordoba, Spain; (E.J.-G.); (V.R.)
| | | | - Antonio Sagredo-Barra
- Hospital General Universitario de Alicante Doctor Balmis, 03010 Alicante, Spain; (C.S.-C.); (A.S.-B.)
| | - Yeray Aguilar
- Complejo Hospitalario Universitario Insular Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain;
| | | | | | - Saima Bashir
- Hospital Universitario de Girona Doctor Josep Trueta, 17007 Girona, Spain; (M.T.); (S.B.)
| | - José Rodríguez Castro
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain; (J.R.C.); (J.M.J.); (J.C.); (V.M.); (P.V.)
| | | | - Jose María Jiménez
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain; (J.R.C.); (J.M.J.); (J.C.); (V.M.); (P.V.)
| | - Juan Chaviano
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain; (J.R.C.); (J.M.J.); (J.C.); (V.M.); (P.V.)
| | - Victor Maestro
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain; (J.R.C.); (J.M.J.); (J.C.); (V.M.); (P.V.)
| | - Javier Manso
- Hospital Universitario De Cruces, 48903 Bilbao, Spain; (E.M.G.); (J.M.)
| | - Antonio Lopez-Rueda
- Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (S.A.); (A.L.-R.)
| | - Sebastià Remollo
- Hospital Universitario Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain;
| | - Lluis Morales-Caba
- Hospital Universitario y Politécnico La Fe, 46009 Valencia, Spain; (F.A.-R.); (L.M.-C.)
| | - Marc Comas-Cufí
- Departamento de Informática, Matemática Aplicada y Estadística, Universidad de Girona, 17003 Girona, Spain;
| | - Pedro Vega
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain; (J.R.C.); (J.M.J.); (J.C.); (V.M.); (P.V.)
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Kuwahara S, Uchida K, Sakai N, Yamagami H, Imamura H, Takeuchi M, Shirakawa M, Sakakibara F, Haraguchi K, Kimura N, Suzuki K, Yoshimura S. Technical and clinical outcomes of thrombectomy in patients with acute medium vessel occlusion and large vessel occlusion; sub-analyses of Japan Trevo registry. J Neurol Sci 2024; 459:122956. [PMID: 38498954 DOI: 10.1016/j.jns.2024.122956] [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: 11/27/2023] [Revised: 02/27/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Little is known about endovascular therapy (EVT) for patients with medium vessel occlusion (MeVO) and more work is needed to establish its efficacy and to understand hemorrhagic complications. METHODS We analyzed the Japan Trevo Registry, which enrolled patients with acute stroke who underwent EVT using Trevo Retriever alone or in combination with an aspiration catheter. The primary outcome was effective reperfusion, and the secondary outcome was modified Rankin scale 0-2 at 90 days. Safety outcomes, including intracranial hemorrhage (ICH), were evaluated using a subgroup analyses focused on any ICH. RESULTS Among 1041 registered patients, 1025 patients were analyzed. 253 patients had MeVOs, and the majority (89.3%) had middle cerebral artery segment 2 (M2). The median National Institutes of Health Stroke Scale scores at admission were 15 and 19 for the MeVO and LVO groups (p < 0.0001). The primary outcome was 88.9% in MeVO vs. 91.8% in LVO group: adjusted odds ratio (aOR) [95% confidence interval (CI)] 0.60 [0.35-1.03], p = 0.07, and the secondary outcome was 43.2% vs. 42.2%, and the aOR [95%CI] was 0.70 [0.48-1.002], p = 0.051. However, the incidence of any ICH was more prominent in MeVO than in LVO group (35.7% vs. 28.8%, aOR [95%CI] 1.54 [1.10-2.15], p = 0.01). In subgroup analyses, the incidences of any ICH in MeVO group were generally higher than those in LVO group. CONCLUSIONS The effective reperfusion rate did not differ significantly between MeVO and LVO groups. Future development of devices and treatments for MeVO with fewer hemorrhagic complications is desirable.
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Affiliation(s)
- Shuntaro Kuwahara
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | | | - Koichi Haraguchi
- Department of Neurosurgery, Hakodate Shintoshi Hospital, Hakodate, Japan
| | - Naoto Kimura
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
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Ding Y, Mao X, Bao L, Zhai T, Wang W, Gu Z, Liu Y, Niu J. Impact of stent retriever size on clinical outcomes in the RECO registry. Heliyon 2024; 10:e28873. [PMID: 38596132 PMCID: PMC11002272 DOI: 10.1016/j.heliyon.2024.e28873] [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: 06/27/2023] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Objective In the RECO study, we investigated the impact of the operator's choice of stent retriever size on patients with internal carotid artery (ICA) occlusion. Methods Data from the RECO Registry, a prospective multicentre study, were utilized. Patients who underwent mechanical thrombectomy (MT) were divided according to the size of the stent into the RECO 4 × 20 group, the RECO 5 × 30 group and the RECO 6 × 30 group. The outcome measures assessed in the study were the 3-month modified Rankin Scale (mRS) score, occurrence of any intracranial haemorrhage (aICH), workflow timing, recanalization success rate, number of attempts, and all-cause mortality within a 3-month period. Results Analysis was conducted on a total of 89 patients with ICA occlusion. RECO 4 × 20, 5 × 30, and 6 × 30 stent retrievers were used in 19 (21.3%), 52 (58.4%), and 18 (20.2%) patients, respectively. The demographic and baseline characteristics showed considerable similarity across the three groups. The puncture-to-recanalization time of the RECO 6 × 30 group [56.5 min (IQR, 41.5-80.8)] was significantly shorter than that of the RECO 4 × 20 group [110 min (IQR, 47-135)]. In 10 out of 18 patients (55.6%), the RECO 6 × 30 stent retriever achieved reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score 2b-3) after the initial attempt, surpassing the rates of 31.6% in the RECO 4 × 20 group and 32.7% in the RECO 5 × 30 group. In the RECO 4 × 20 group, the median number of passes was 2 (IQR, 1-3); in the RECO 5 × 30 group, it was 2 (IQR, 1-3); and in the RECO 6 × 30 groups, it was 1 (IQR, 1-2.5). There were no statistically significant differences observed among the three groups concerning aICH or good outcomes (mRS score 0-2). Conclusion Our study demonstrated the practical implications of stent-retriever size selection in the context of the MT for ICA occlusion. The routine use of a RECO 6 × 30 stent retriever holds the potential for early revascularization in clinical practice. The significant reduction in the puncture-to-reperfusion time and the greater first-pass effect associated with this stent size underscore its efficiency in treating ICA occlusion.
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Affiliation(s)
- Yunlong Ding
- Department of Neurology, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
| | - Xiaoxiao Mao
- Department of Imaging, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
| | - Lei Bao
- Intensive Care Unit, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
| | - Tingting Zhai
- Department of Neurology, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
| | - Wenjuan Wang
- Department of Neurology, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
| | - Zhiqun Gu
- Department of Neurology, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
| | - Yan Liu
- Department of Neurology, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
| | - Jiali Niu
- Department of Clinical Pharmacy, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China
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Sgreccia A, Desilles JP, Costalat V, Dargazanli C, Bourcier R, Tessier G, Rouchaud A, Saleme S, Spelle L, Caroff J, Marnat G, Barreau X, Clarençon F, Shotar E, Eugene F, Houdart E, Gory B, Zhu F, Labreuche J, Piotin M, Lapergue B, Consoli A. Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial. Stroke 2024; 55:376-384. [PMID: 38126181 DOI: 10.1161/strokeaha.123.045227] [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: 09/17/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions. METHODS Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III [European Cooperative Acute Stroke Study] grades, and 3-month modified Rankin Scale). RESULTS Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32-60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39-11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA. CONCLUSIONS First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03290885.
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Affiliation(s)
- Alessandro Sgreccia
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Guillaume Tessier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Aymeric Rouchaud
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Suzana Saleme
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Laurent Spelle
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Jildaz Caroff
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Xavier Barreau
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - François Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (F.E.)
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, Paris, France (E.H.)
| | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - François Zhu
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Equipe d'accueil 2694 Santé Publique: Epidémiologie et Qualité des Soins, University Lille, France (J.L.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Bertrand Lapergue
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
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Luo G, Yan X, Xiao G, Wei L, Nai Bi Jiang YLK, Ma R, Chen W, Fang C, Zhou Z, Wan J, Peng Y, Zhang G, Zhao J, Li L, Yuan H, Wu J, Li B, Zhang F, Cheng Y, Gao F, Miao Z. Comparing a novel Catfish flow restoration device and the Solitaire stent retriever for thrombectomy revascularisation in emergent largevessel occlusion stroke: a prospective randomised controlled study. Stroke Vasc Neurol 2023; 8:435-443. [PMID: 37045544 PMCID: PMC10800261 DOI: 10.1136/svn-2022-002036] [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: 09/30/2022] [Accepted: 02/26/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The Catfish stent retriever is a newly developed mechanical thrombectomy device for rapid recanalisation in emergent large vessel occlusion (ELVO) stroke. The current trial aimed to assess whether the Catfish stent retriever is non-inferior to the Solitaire stent retriever in terms of outcomes in ELVO stroke. METHODS This was a randomised, prospective, parallel-group, multicentre, open-label, non-inferiority study conducted at 18 sites in China. The primary outcome was the proportion of cases with successful recanalisation (modified thrombolysis in cerebral infarction score of 2b or 3) following the procedure. Secondary efficacy outcomes included the National Institutes of Health Stroke Scale scores at 24 hours and 7 days or discharge if earlier, time from artery puncture to successful recanalisation and good clinical outcome (modified Rankin scale score ≤2) at 90 days. Safety outcomes included symptomatic intracranial haemorrhage, all cause-death and severe adverse events at 90 days. RESULTS Between 3 March 2019 and 5 June 2021, 118 and 120 patients were randomly allocated to the Catfish and Solitaire groups, respectively. The primary endpoint after all endovascular procedures was non-inferior in the Catfish group (88.5%, 100/113) than in the Solitaire group (87.7%, 100/114), with a rate difference (RD) of 0.78% (95% CI -7.64 to -9.20; p=0.001). Sensitivity analysis only considering the per-protocol set also yielded similar results, with an RD of 0.83% (95% CI -7.03 to -8.70; p<0.001). Additionally, the proportions of cases with good clinical outcomes (47.8% vs 50.0%, p=0.739) and all-cause death rates (17.7% vs 18.8%, p=0.700) were similar in both groups at 90 days. CONCLUSIONS The Catfish stent retriever is an effective and safe device for endovascular recanalisation in ELVO stroke. TRIAL REGISTRATION NUMBER NCT03820882.
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Affiliation(s)
- Gang Luo
- Department of Intervention, Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Intervention, Interventional Neuroradiology Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaoyan Yan
- Biostatistics, Peking University Clinical Research Institute, Beijing, China
| | - Guodong Xiao
- Neurology, The Second Affiliated Hospital of Suzhou University, Jiangsu, China
| | - Liping Wei
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | | | - Rongyao Ma
- Neurology, Nanshi Hospital of Nanyang, Nanyang, China
| | - Wenhuo Chen
- Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Chun Fang
- Department of Intervention, Tongji Hospital Affiliated to Tongji University, Shanghai, Shanghai, China
| | - Zhiming Zhou
- Department of Intervention, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Jieqing Wan
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Ya Peng
- Department of Neurosurgery, Changzhou No. 1 People's Hospital, Changzhou, China
| | - Guilian Zhang
- Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junfeng Zhao
- Neurology, Siping Central People's Hospital, Siping, China
| | - Li Li
- Department of Intervention, Xijing Hospital of Air Force Military Medical University, Xi'an, China
| | - Haicheng Yuan
- Neurology, Qingdao Central Medical Group, Qingdao, China
| | - Jin Wu
- Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bing Li
- Department of Intervention, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Fan Zhang
- Neurology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Yuhong Cheng
- Department of Intervention, Linfen Central Hospital, Linfen, Shanxi, China
| | - Feng Gao
- Department of Intervention, Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Intervention, Interventional Neuroradiology Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhongrong Miao
- Department of Intervention, Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Intervention, Interventional Neuroradiology Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Byer SH, Madarang EJ, Abraham MG. Dual-Stent retriever thrombectomy for extensive dural sinus thrombosis. Int J Neurosci 2023; 133:1374-1379. [PMID: 35593753 PMCID: PMC9744960 DOI: 10.1080/00207454.2022.2080675] [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: 10/06/2021] [Accepted: 05/12/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION First line treatment for cerebral venous thrombosis (CVT) is systemic anticoagulation. In cases with symptoms of elevated ICP, endovascular thrombectomy (EVT) is pursued. We describe two cases in which dual stent-retrievers were used for EVT. OBJECTIVES The use of dual stent-retrievers has been described in arterial stroke when clot is present in the M1 artery and both M2 branches as a rescue therapy after 1 stent-retriever failed to remove the clot. We applied this same thinking to our EVT patients. METHODS A 17-year-old female with imaging demonstrating occlusion of the superior sagittal sinus (SSS), dominant right transverse sinus (TS), right sigmoid sinus (SS), and upper right internal jugular vein (IJV). A 20-year-old female with a magnetic resonance venography (MRV) noting CVT in the dominant lateral left TS, SS, and upper left IJV. RESULTS Both were taken for EVT due to severity of symptoms. Two 6 × 40 mm stent-retrievers were deployed into the CVT and then remove with continuous aspiration with significant recanalization. CONCLUSIONS The average diameter of the dural sinuses is 8 mm compared to the average size of the middle cerebral artery 3-4 mm. The largest available SR in the United States is 6 mm, and the largest outer diameter of available aspiration catheters is 2-3 mm. Due to the larger size of the dural sinuses, using two SRs can result in more efficient recanalization and less radiation.
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Affiliation(s)
- Stefano H. Byer
- Department of Neurology, University of Kansas Medical Center
| | | | - Michael G. Abraham
- Department of Neurology, University of Kansas Medical Center
- Department of Radiology, University of Kansas Medical Center
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Kraehling H, Akkurt BH, Elsharkawy M, Schwindt W, Köhler M, Werring N, Masthoff M, Cox A, Minks D, Stracke CP. Evaluation of effectiveness and safety of the large-format pRESET 6-50 thrombectomy stent-retriever in the endovascular treatment of ischemic stroke: real-world experiences from two tertiary comprehensive stroke centers. Front Neurol 2023; 14:1256365. [PMID: 38046595 PMCID: PMC10690812 DOI: 10.3389/fneur.2023.1256365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Objective Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). First-pass (FP) reperfusion of the occluded vessel and fewer passes with stent retrievers show improvement in functional outcomes in stroke patients, while higher numbers of passes are associated with higher complication rates and worse outcomes. Studies indicate that a larger size of the stent-retriever is associated with a higher rate of first-pass reperfusion and improved clinical outcomes. In this retrospective study, we investigated the clinical performance of a recently developed and one of the largest stent-retrievers available in the treatment of LVO (pRESET 6-50, phenox GmbH, Bochum). Materials and methods All consecutive patients with ischemic stroke due to proximal large vessel occlusion treated with MT using the pRESET 6-50 stent-retriever in two tertiary stroke centers between 09/2021 and 07/2022 were included in this study. The reperfusion rate after MT was quantified by the modified thrombolysis in cerebral infarction (mTICI) score, and functional neurological outcome was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score and the major early neurological recovery (mENR) rate after 24 h. Successful FP reperfusion was defined as mTICI ≥ 2b. Successful and complete reperfusion were defined as mTICI ≥ 2b and mTICI ≥ 2c, respectively. Results In total, 98 patients (52 men and 46 women) with a median age of 75 (range 25-95 years) were included. A total of 70 (72%) patients presented with an occlusion of the middle cerebral artery (MCA) in the M1 segment, 6 (6%) patients with an occlusion of the M2 segment, 17 (17%) patients with an occlusion of the internal carotid artery (ICA), and 5 (5%) patients with an occlusion of the obstructed basilar artery (BA). Successful FP reperfusion was achieved in 58 patients (62%). Successful and complete reperfusion were achieved in 95 (97%) and 82 (83%) patients, respectively. The median National Institutes of Health Stroke Scale (NIHSS) in all treated patients improved from 17 to 7.5. Major early neurological recovery (mENR) was observed in 34 patients (35.1%). Conclusion MT with the pRESET 6-50 stent-retriever achieves high successful first-pass and final reperfusion rates in patients with AIS and LVO. The results of this study support the thesis to use large-format stent-retriever in proximal vessel occlusion MT whenever feasible in order to improve high FP and final reperfusion rate, which are known predictors of good clinical outcome.
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Affiliation(s)
- Hermann Kraehling
- Department of Radiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
- Department of Radiology and Department of Interventional Neuroradiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
| | - Burak Han Akkurt
- Department of Radiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
| | - Mohamed Elsharkawy
- Department of Radiology and Department of Interventional Neuroradiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
| | - Wolfram Schwindt
- Department of Radiology and Department of Interventional Neuroradiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
| | - Michael Köhler
- Department of Radiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
| | - Nils Werring
- Department of Neurology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
| | - Max Masthoff
- Department of Radiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
- Department of Radiology and Department of Interventional Neuroradiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
| | - Anthony Cox
- Department of Interventional Neuroradiology, North Bristol NHS Trust, Bristol, United Kingdom
| | - David Minks
- Department of Interventional Neuroradiology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Christian Paul Stracke
- Department of Radiology and Department of Interventional Neuroradiology, Westfalian Wilhelms-University Münster and University Hospital Münster, Münster, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Kupcs K, Sproge P, Kupca K, Bhogal P. The Stream Device-A Retrospective Review of 51 Cases. J Clin Med 2023; 12:6384. [PMID: 37835028 PMCID: PMC10573462 DOI: 10.3390/jcm12196384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Mechanical thrombectomy is the gold-standard treatment for patients that have suffered large-vessel occlusion (LVO) stroke. Various different stent-retrievers, aspiration catheters, and techniques have been developed to perform this procedure. We present our initial results regarding the Stream device. MATERIALS AND METHODS We performed a retrospective review of a prospectively maintained database at our high-volume centre to identify all patients treated with the Stream device between February 2021 and January 2023. We recorded baseline demographics, NIHSS, ASPECT scores, eTICI scores, complications, and 90-day mRS. RESULTS We identified 51 patients, 49.0% of whom were male (n = 25), with a median age of 73 (range: 51-89) and a median NIHSS score of 17 (range 4-22), and 68.6% received IV tPA. The median ASPECT score was 10 (range 6-10). Hyperdense clots were seen in 34 cases (66.7%), with a mean clot length of 12 ± 6.2 mm (range 2-26 mm). Clots were located in the anterior circulation in 49 patients. The standard Stream device was used in 78.4% of cases, with Stream 17 being used in 19.6% of cases. The FPE was observed in 25.5% of cases (n = 13), with the mFPE being seen in 31.4% of cases (n = 16). A final eTICI score of ≥2b was achieved in 90.2% of cases (n = 46), and eTICI 2c/3 was seen in 84.3% of cases (n = 43). Furthermore, 24 h CT scans showed that the median ASPECT score was 8 (range 0-10). Good functional outcomes at 90 days (mRS ≤ 2) were achieved in 21.6% of cases (n = 11). CONCLUSIONS The Stream device shows acceptable rates of FPE and mFPE compared to existing devices. Further larger studies are required alongside an understanding of the optimal technique for this device's use.
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Affiliation(s)
- Karlis Kupcs
- Department of Neuroradiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.K.); (P.S.); (K.K.)
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Patricija Sproge
- Department of Neuroradiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.K.); (P.S.); (K.K.)
| | - Katrina Kupca
- Department of Neuroradiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.K.); (P.S.); (K.K.)
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London E1 1BB, UK
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9
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Remollo S, Werner M, Blasco J, López-Rueda A, San Roman L, Jimenez-Gomez E, Bravo Rey I, Vega P, Murias E, Rosati S, Pérez-García C, González E, Manso X, Aixut S, Chirife Chaparro O, Terceño M, Bashir S, Pumar JM, Ruiz-González E, Méndez JC, Aguilar Tejedor Y, Zamarro J, Castaño M, Daunis-I-Estadella P, Puig J. First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy. Clin Neuroradiol 2023; 33:701-708. [PMID: 36856786 DOI: 10.1007/s00062-023-01264-4] [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: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
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Affiliation(s)
- S Remollo
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Werner
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Blasco
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A López-Rueda
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L San Roman
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - I Bravo Rey
- Neuroradiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - P Vega
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Murias
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Rosati
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - C Pérez-García
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - E González
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - X Manso
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - S Aixut
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - O Chirife Chaparro
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - M Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - S Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - J M Pumar
- Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ruiz-González
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - J C Méndez
- Interventional Neuroradiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Y Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
| | - J Zamarro
- Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Castaño
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - J Puig
- Department of Radiology (IDI) and Institut d'Investigació Biomèdica de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain.
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Bala F, Cimflova P, Singh N, Zhang J, Kappelhof M, Kim BJ, Najm M, Golan R, Elebute I, Benali F, Terreros NA, Marquering H, Majoie C, Almekhlafi M, Goyal M, Hill MD, Qiu W, Menon BK. Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial. Eur Stroke J 2023; 8:675-683. [PMID: 37345551 PMCID: PMC10472967 DOI: 10.1177/23969873231183766] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. PATIENTS AND METHODS Patients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms. RESULTS Among 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83-0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00-1.06]). CONCLUSION Our study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.
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Affiliation(s)
- Fouzi Bala
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France
| | - Petra Cimflova
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Medical Imaging, St Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Jianhai Zhang
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Mohamed Najm
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Rotem Golan
- Circle Neurovascular Imaging Inc., Calgary, AB, Canada
| | | | - Faysal Benali
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ MUMC+, Maastricht, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Henk Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Wu Qiu
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bijoy K Menon
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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Alwahdy AS, Dongoran RA. Double stent retriever technique for rescue recanalization in refractory large vessel occlusions. Radiol Case Rep 2023; 18:2860-2863. [PMID: 37334327 PMCID: PMC10275971 DOI: 10.1016/j.radcr.2023.05.050] [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: 03/12/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Acute ischemic stroke patients with large vessel occlusion (LVO) involving bifurcation usually have a difficult and high clot burden. By using conventional technique often resulting in a reduction in the possibility of successful recanalization. The double stent retriever technique can be considered for rescue recanalization. We reported a case of refractory terminal left internal carotid occlusion that was treated using double stent retriever technique. Two microcatheter were advanced across the occlusion were one to the superior branch of middle cerebral artery and another was on inferior branch. Both stent retrievers were pulled back together and complete recanalization was achieved. This technique were reported in some case series to be effective and based on our initial experience using this technique it seems the expansion improved after deployment of the second stent retriever and it traps the clot within its stent struts, to facilitate clot retrieval. Therefore, double stent retriever technique can be one of the choices for rescue recanalization in refractory clot occlusion and it may potentially help other clinicians in similar situations.
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Affiliation(s)
- Ahmad Sulaiman Alwahdy
- Department of Neurology, Interventional Neurology Subdivision, Fatmawati Central General Hospital, RS. Fatmawati Raya Street No.4, South Jakarta, 12430, Indonesia
| | - Rifka Annisa Dongoran
- Faculty of Medicine, University of UIN Syarif Hidayatullah, South Tangerang, Banten, Indonesia
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Nariai Y, Takigawa T, Kawamura Y, Hyodo A, Suzuki K. Possible Contribution of the Aspiration Catheter in Preventing Post-stent Retriever Thrombectomy Subarachnoid Hemorrhage. Clin Neuroradiol 2022; 33:509-518. [PMID: 36550356 DOI: 10.1007/s00062-022-01240-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to identify factors related to the incidence of post-thrombectomy subarachnoid hemorrhage (PTSAH). METHODS This retrospective, observational cohort study enrolled consecutive patients with acute ischemic stroke (AIS) due to the internal carotid artery (IC) top or middle cerebral artery (MCA) M1 or M2 segment occlusion who underwent single-pass stent retriever (SR) treatment between January 2015 and May 2022 at two acute care hospitals. RESULTS Of the 54 included patients, 10 were in the PTSAH group (18.5%). The occlusion sites were IC top (31.5%), M1 segment (48.1%), and M2 segment (20.4%). Aspiration catheters (ACs) were used in 32 (59.3%) patients; however, the combined technique (AC advancement at least to the most proximal marker of SR) was actually used in 26 (48.1%) patients because a ledge effect at the ophthalmic artery origin from the IC interfered with distal navigation of the ACs. The baseline patient characteristics did not differ between the groups. M2 segment occlusion in the PTSAH and non-PTSAH groups were 40.0% and 15.9%, respectively (p = 0.19). More ACs were used in the non-PTSAH group (65.9% vs. 30.0%, p = 0.07). Significantly fewer combined techniques were performed in the PTSAH group (10.0% vs. 56.8%, p = 0.01). In multivariate analysis adjusted by variables with M2 segment occlusion and the combined technique, the combined technique (odds ratio 0.098; 95% confidence interval, 0.011-0.887; p = 0.039) was identified as a significantly associated factor for PTSAH. There was one PTSAH case (1.9%) with symptom worsening. CONCLUSION The combined technique significantly influenced PTSAH occurrence as a preventive factor.
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Affiliation(s)
- Yasuhiko Nariai
- Department of Neurosurgery, Kamagaya General Hospital, 929-6 Hatsutomi, 273-0121, Kamagaya-shi, Chiba, Japan.
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yosuke Kawamura
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Kamagaya General Hospital, 929-6 Hatsutomi, 273-0121, Kamagaya-shi, Chiba, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Omrani O, Hafezi-Bakhtiari N, DeSouza P, Nikola C, Wong K, Lansley J, Dhillon P, Makalanda L, Chan N, Harrison T, Andrews A, Siow I, Lee KS, Yeo L, Spooner O, Bhogal P. The initial experience with the Embotrap III stent-retriever in a real world setting. Interv Neuroradiol 2022:15910199221142097. [PMID: 36523190 DOI: 10.1177/15910199221142097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
MATERIALS AND METHODS We performed a retrospective review of our prospectively maintained database to identify all patients treated with the Embotrap 3 stent-retriever between January 2021 and January 2022. We recorded the baseline demographics, NIHSS, ASPECT score and clot characteristics, first pass and final eTICI scores, complications and 90 day mRS. RESULTS One hundred and ten patients met the inclusion criteria, average age 69 ± 14 years, 50% were male (n = 55). The median NIHSS at presentation was 18 (range 3-30) and 58.2% received IV tPA prior to MT. The median ASPECT score on plain CT was 8 with average clot length 20.2 ± 14.8 mm (n = 93). The first pass effect (FPE) was seen in 41.8% of cases with modified FPE seen in 59.1%. A 24-hour CT scan (n = 97) showed median ASPECTs of 7. 43.8% of patients achieve mRS ≤ 2 at 90-day mRS (n = 64). CONCLUSION The Embotrap 3 stent-retriever has a high rate of FPE and final recanalization in this real world cohort of patients.
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Affiliation(s)
- Osama Omrani
- Department of Radiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Nema Hafezi-Bakhtiari
- Department of Radiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Peter DeSouza
- Department of Diagnostic Neuroradiology, Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Christos Nikola
- Department of Stroke Medicine, Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Ken Wong
- Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Joseph Lansley
- Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Permesh Dhillon
- Department of Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Levansri Makalanda
- Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Nathan Chan
- Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Thomas Harrison
- Department of Stroke Medicine, Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Alex Andrews
- Department of Stroke Medicine, Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Isabel Siow
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keng Siang Lee
- 152331Bristol Medical School, University of Bristol, Bristol, UK
| | - Leonard Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Oliver Spooner
- Department of Stroke Medicine, Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
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14
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Liu H, He Y, Zhou T, Zhu L, Zhao Y, Ding Y, He Y, Li T. Evaluation of using a double helical, closed-cell stent-retriever (Skyflow) for thrombectomy procedures in acute arterial occlusion: A preclinical study and a clinical trial. J Interv Med 2022; 5:190-195. [DOI: 10.1016/j.jimed.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
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15
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Hernández D, Serrano E, Molins G, Zarco F, Chirife O, Werner M, Lara B, Ramos A, Llull L, Requena M, Cuevas MDDL, Remollo S, Piñana C, López-Rueda A. Comparison of First-Pass Effect in Aspiration vs. Stent-Retriever for Acute Intracranial ICA Occlusion. Front Neurol 2022; 13:925159. [PMID: 35847206 PMCID: PMC9279887 DOI: 10.3389/fneur.2022.925159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retriever) and the impact of stent retriever size and length on clinical and angiographic outcomes in patients with acute intracranial ICA occlusion. We conducted a retrospective analysis of a prospective database of consecutive patients with acute intracranial ICA occlusion undergoing endovascular treatment in four Comprehensive Stroke Center between June-2019 and December-2020. We include 121 patients; Stent-retriever (SR) was used as first technical approach in 107 patients (88.4%) and aspiration was used in 14 patients (11.6%). SR group had higher rate of FPE compared to aspiration group (29 vs. 0%, p = 0.02). In SR subgroup, treatment highlighted higher FPE in the 6 × 50 SR (37.7%), than in the rest of the SR which are 21.2% (4–5 mm size and 20–50 mm length SR) and 19% (6 mm size and 25–40 mm length SR), but it was not found to be statistically significant. There were no other significant differences across the groups regarding primary angiographic or clinical outcomes. In our intracranial ICA occlusion series, stent retrievers were superior to direct aspiration in obtaining FPEs and mFPEs, and longer devices achieved better results with no statistically significant difference. Further studies evaluating the effects of different ICA clot removal approaches are warranted to confirm these results.
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Affiliation(s)
| | | | - Gemma Molins
- Institute for Medical Engineering and Science (IMES), Massachusetts Institute of Technology (MIT), Cambridge, MA, United States
| | | | - Oscar Chirife
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mariano Werner
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Blanca Lara
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Ramos
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Laura Llull
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | | | | | - Carlos Piñana
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - Antonio López-Rueda
- Hospital Clínic de Barcelona, Barcelona, Spain
- *Correspondence: Antonio López-Rueda
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16
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Yoshihara T, Kanazawa R, Uchida T, Higashida T, Ohbuchi H, Arai N, Takahashi Y. Short-Vessel Occlusion Might Indicate Higher Possibility of Success in Reperfusion following Mechanical Thrombectomy in Acute Middle Cerebral Artery Occlusion. Cerebrovasc Dis Extra 2021; 11:131-136. [PMID: 34775381 PMCID: PMC8647116 DOI: 10.1159/000519556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The impact of the length of the occluded vessel in acute large-vessel occlusion on successful reperfusion by mechanical thrombectomy remains unclear. This study evaluated whether diameter and length of the occluded vessel in acute middle cerebral artery (MCA) occlusion might relate to successful reperfusion following mechanical thrombectomy. METHODS This retrospective study included patients with acute MCA occlusion who underwent intra-aortic injection of contrast medium to obtain maximum intensity projection (MIP) images acquired by flat-panel detector computed tomography (FD-CT) equipped with an angiographic system. All patients received mechanical thrombectomy and were divided into two groups: those with successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b/3) and those without. We compared the diameter and length of the occluded vessel between the groups. In the sub-analysis of patients with stent retriever use, ratio of length of occluded vessel to length of the active zone was compared. RESULTS We enrolled 29 patients (median age: 73, M1 occlusion: 51%, stent retriever use: 72%). Eighteen patients achieved TICI 2b/3 with significantly larger distal end diameter (1.7 [interquartile range: 1.5-1.9] vs. 1.2 [1.2-1.5] mm, p = 0.007) and shorter length (7.1 [4.9-9.7] vs. 12.3 [7.2-15.8] mm, p = 0.043) of the occluded vessel. Sub-analysis of 21 patients showed that the cut-off value for TICI 2b/3 reperfusion was 0.32 as the ratio between the occluded vessel and stent retriever active zone (receiver operating characteristic area under the curve: 0.90). CONCLUSION In acute MCA occlusion, larger diameter of the distal end and shorter length of the occluded vessel on FD-CT MIP images might indicate a higher possibility of achieving TICI 2b/3 following mechanical thrombectomy.
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Affiliation(s)
- Tomoyuki Yoshihara
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Osaka, Japan
| | | | - Takanori Uchida
- Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan
| | | | - Hidenori Ohbuchi
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoyuki Arai
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichi Takahashi
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo, Japan
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17
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Belachew NF, Dobrocky T, Meinel TR, Hakim A, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Piechowiak EI, Fischer U, Gralla J, Mordasini P, Kaesmacher J. Risks of Undersizing Stent Retriever Length Relative to Thrombus Length in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:2181-2187. [PMID: 34649917 DOI: 10.3174/ajnr.a7313] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Results regarding the association of thrombus length, stent retriever length, and recanalization success in patients with acute ischemic stroke are inconsistent. We hypothesized that the ratio of thrombus length to stent retriever length may be of particular relevance. MATERIALS AND METHODS Patients with acute ischemic stroke undergoing stent retriever thrombectomy at our institution between January 2010 and December 2018 were reviewed retrospectively. Thrombus length was assessed by measuring the susceptibility vessel sign on SWI using a 1.5T or 3T MR imaging scanner. Multivariable logistic regression models were used to determine the association between thrombus length, stent retriever length, and thrombus length/stent retriever length ratio with first-pass recanalization, overall recanalization, and embolization in new territories. Results are shown as adjusted ORs with 95% CIs. Additional mediation analyses were performed to test for indirect effects on first-pass recanalization and overall recanalization success. RESULTS The main analysis included 418 patients (mean age, 74.9 years). Increasing stent retriever length was associated with first-pass recanalization. Decreasing thrombus length and lower thrombus length/stent retriever length ratios were associated with first-pass recanalization and overall recanalization. Thrombus length and stent retriever length showed no association with first-pass recanalization or overall recanalization once thrombus length/stent retriever length ratio was factored in, while thrombus length/stent retriever length ratio remained a significant factor in both models (adjusted OR, 0.316 [95% CI, 0.112-0.892]; P = .030 and adjusted OR, = 0.366 [95% CI, 0.194-0.689]; P = .002). Mediation analyses showed that decreasing thrombus length and increasing stent retriever length had a significant indirect effect on first-pass recanalization mediated through thrombus length/stent retriever length ratio. The only parameter associated with embolization in new territories was an increasing thrombus length/stent retriever length ratio (adjusted OR, 5.079 [95% CI, 1.332-19.362]; P = .017). CONCLUSIONS Information about thrombus and stent length is more valuable when combined. High thrombus length/stent retriever length ratios, which may raise the risk of unsuccessful recanalization and embolization in new territories, should be avoided by adapting stent retriever selection to thrombus length whenever possible.
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Affiliation(s)
- N F Belachew
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T Dobrocky
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T R Meinel
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - A Hakim
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Vynckier
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - M Arnold
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - D J Seiffge
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - R Wiest
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - E I Piechowiak
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - U Fischer
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Kaesmacher
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.).,Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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18
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Vega P, Murias E, Jimenez JM, Chaviano J, Benavente L, Gonzalez-Delgado M, García-Arias F, Pumar JM. Initial Experience Performing Mechanical Thrombectomy With the CatchView Mini Device for Distal M2 Segment Middle Cerebral Artery Occlusions. Front Neurol 2021; 12:724811. [PMID: 34594298 PMCID: PMC8478170 DOI: 10.3389/fneur.2021.724811] [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: 06/14/2021] [Accepted: 08/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke due to large vessel occlusion; however, its safety and efficacy in patients with distal strokes remains unclear. In this study, we investigated the safety and efficacy of MT for distal middle cerebral artery (MCA) occlusions using the CatchView Mini (CVM; Balt, Montmorency, France). Methods: This was a prospective single-center analysis of patients with a single MCA-M2 occlusion treated with the CVM device. Consecutive patients were prospectively enrolled from October 2018 to March 2020. Efficacy outcomes included successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3], procedure times, and number of device passes. Clinical outcomes included National Institutes of Health Stroke Scale Score (NIHSS) at discharge, 90-day functional independence (modified Rankin Scale 0–2) and safety outcomes included hemorrhagic complications, and 90-day mortality. Results: A total of 45 patients (mean age: 74.0 ± 12.6; 53.3% [24/45] female) were included in the study. Upon admission, 33.3% (15/45) of patients were mRS 3–5; and mean NIHSS was 13.2 ± 4.2 Mean time from symptom onset to final angiography was 250.0 ± 83.4 min with a mean intervention duration of 34.0 ± 12.6 min. The mean number of device passes was 1.8 ± 1.5 final mTICI 2b/3 was achieved in 91.1% (41/45) of patients. Eight hemorrhagic complications (17.8%, 8/34) occurred, none of which were symptomatic. At 90-days, 57.8% (26/45) patients were functionally independent and the rate of mortality was 15.6% (7/45). Conclusions: The present analysis demonstrates a low risk profile and high recanalization success for patients with distal M2 occlusions treated with the CVM device.
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Affiliation(s)
- Pedro Vega
- Department of Radiology, Central University Hospital of Asturias, Oviedo, Spain.,Cátedra Institucional de Neurorradiología Intervencionista, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Eduardo Murias
- Department of Radiology, Central University Hospital of Asturias, Oviedo, Spain.,Cátedra Institucional de Neurorradiología Intervencionista, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,University of Oviedo, Oviedo, Spain
| | - Jose María Jimenez
- Department of Radiology, Central University Hospital of Asturias, Oviedo, Spain
| | - Juan Chaviano
- Department of Radiology, Central University Hospital of Asturias, Oviedo, Spain
| | - Lorena Benavente
- Department of Neurology, Central University Hospital of Asturias, Oviedo, Spain
| | | | | | - José Manuel Pumar
- Cátedra Institucional de Neurorradiología Intervencionista, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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19
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Cabral LS, Mont'Alverne F, Silva HC, Passos Filho PE, Magalhães PSC, Bianchin MM, Nogueira RG. Device size selection can enhance Y-stentrieving efficacy and safety as a rescue strategy in stroke thrombectomy. J Neurointerv Surg 2021; 14:558-563. [PMID: 34233944 DOI: 10.1136/neurintsurg-2021-017751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite advancements in stroke treatment, refractory clots are relatively common, prompting the exploration of alternative techniques. Bifurcation occlusions pose specific intraprocedural challenges, occasionally dealt with by two stentrievers deployed in Y-configuration. Previous studies have portrayed this strategy as feasible, yet little is known about its safety and efficacy, and how to best select retrievers. OBJECTIVE To determine whether device selection influences the efficacy and safety of Y-stentrieving. METHODS We performed a multicentric, retrospective analysis of patients undergoing Y-stentrieving rescue for bifurcation occlusions. Demographics, devices, procedural metrics, neurological severity, reperfusion, disability, and safety were assessed. RESULTS Y-configuration stents were used as a rescue maneuver after 2.16±1.5 failed attempts with other techniques in 20 patients. Successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b-3) was achieved in 70% of patients after the first Y-stentrieving attempt. The first stentriever more often had a larger diameter (5.15±0.92 vs 3.67±0.57 mm, p=0.017) and longer length (33.12±5.78 vs 20.67±1.15 mm, p=0.002) in successfully reperfused cases. Also, the diameter of the first device was associated with both any parenchymal (6.0 vs 4.71±0.99 mm, p=0.045) and symptomatic (6.0 vs 4.86±1.02 mm, p<0.001) hemorrhages. Exact logistic regression demonstrated that a longer length first stentriever independently predicted better angiographic outcomes (OR=1.26, p=0.036), and a 6 mm diameter first stentriever independently predicted more intracranial hemorrhages (OR=15.28, p=0.044). No periprocedural mortality was recorded. CONCLUSION Y-stentrieving is an effective and safe bail-out strategy for refractory bifurcation clots. Longer stents may promote better angiographic outcomes, whereas avoidance of disproportionately large retrievers may mitigate intracranial hemorrhage. Future studies should account for these factors when evaluating alternative stentriever techniques.
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Affiliation(s)
- Lucas Scotta Cabral
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Francisco Mont'Alverne
- Department of Interventional Neuroradiology, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Henrique Coelho Silva
- Department of Interventional Neuroradiology, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | | | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,B.R.A.I.N., Division of Neurology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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20
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Serna Candel C, Aguilar Pérez M, Bäzner H, Henkes H, Hellstern V. First-Pass Reperfusion by Mechanical Thrombectomy in Acute M1 Occlusion: The Size of Retriever Matters. Front Neurol 2021; 12:679402. [PMID: 34267722 PMCID: PMC8276778 DOI: 10.3389/fneur.2021.679402] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Single-pass complete reperfusion using stent retrievers has been shown to improve functional outcome in patients with large vessel occlusion strokes. The aim of this study was to investigate the optimal size of stent retrievers to achieve one-pass complete reperfusion by mechanical thrombectomy. Methods: The study evaluated the results of aspiration-assisted mechanical thrombectomy of acute isolated occlusion of the middle cerebral artery in the M1 segment with a novel 5 × 40-mm stent retriever compared to the usual 4 × 20-mm device. Reperfusion status was quantified using the Thrombolysis In Cerebral Infarction (TICI) scale. We hypothesized that thrombectomy of M1 occlusions with 5 × 40-mm stent retriever yields higher rates of complete first-pass reperfusion (FP) (TICI ≥2c after one pass) and successful or modified FP (mFP) (TICI ≥2b after one pass) than thrombectomy with 4 × 20. We included isolated M1 occlusions treated with pRESET 5 × 40 (phenox) as first-choice device for thrombectomy and compared with M1 occlusions treated with pRESET 4 × 20. We excluded patients with additional occlusions or tandem stenosis or who received an intracranial stent or angioplasty as a part of the endovascular treatment. Results: One hundred thirteen patients were included in the 4 × 20 group and 57 patients in the 5 × 40 group. The 5 × 40 group achieved higher FP compared to 4 × 20 group [61.4% (35 of 57 patients) vs. 40.7% (46 of 113), respectively; adjusted odds ratio (OR) and 95% confidence interval (95% CI) = 2.20 (1.08-4.48), p = 0.030] and a higher mFP [68.4%, 39 of 57 patients vs. 48.7%, 55 of 113; adjusted OR (95% CI) = 2.11 (1.04-4.28), p = 0.037]. Frequency of successful reperfusion (TICI ≥2b) was similar in both groups (100 vs. 97.3%), but frequency of complete reperfusion (TICI ≥2c) was higher in the 5 × 40 group [82.5 vs. 61.9%, adjusted OR (95% CI) = 2.47 (1.01-6.04), p = 0.047]. Number of passes to achieve reperfusion was lower in the 5 × 40 group than in the 4 × 20 group [1.6 ± 1.1 vs. 2 ± 1.4, p = 0.033; adjusted incidence rate ratio (95% CI) = 0.84 (0.69-1.03), p = 0.096]. Modified Rankin scale at 90 days was similar in 5 × 40 and 4 × 20 groups. Conclusions: The size of stent retriever matters in acute M1 occlusions treated with aspiration-assisted mechanical thrombectomy. A longer stent retriever with a larger nominal diameter achieves a higher complete and successful FP and higher successful reperfusion compared to a shorter stent retriever.
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Affiliation(s)
| | | | - Hansjörg Bäzner
- Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
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21
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Mohammaden MH, Haussen DC, Pisani L, Al-Bayati AR, Anderson A, Liberato B, Schachter D, Navalkele D, Frankel MR, Nogueira RG. Stent-retriever alone vs. aspiration and stent-retriever combination in large vessel occlusion stroke: A matched analysis. Int J Stroke 2021; 17:465-473. [PMID: 33988063 DOI: 10.1177/17474930211019204] [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: 11/15/2022]
Abstract
BACKGROUND Three randomized clinical trials have reported similar safety and efficacy for contact aspiration and stent-retriever thrombectomy. AIM We aimed to determine whether the combined technique (stent-retriever + contact aspiration) was superior to stent-retriever alone as first-line thrombectomy strategy in a patient cohort where balloon guide catheter was universally used. METHODS A prospectively maintained mechanical thrombectomy database from January 2018 to December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent stent-retriever alone thrombectomy or stent-retriever + contact aspiration as first-line therapy. The primary outcome was the first-pass effect (mTICI2c-3). Secondary outcomes included modified first-pass effect (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS ≤ 2). Safety outcomes included rate of parenchymal hematoma type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. RESULTS A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16 (11-21)). As compared to first-line stent-retriever alone, first-line stent-retriever + contact aspiration resulted in similar rates of first-pass effect (53% vs. 51%, adjusted odds ratio (aOR) 1.122, 95%CI (0.745-1.691), p = 0.58), modified first-pass effect (63% vs. 60.4%, aOR1.250, 95%CI (0.782-2.00), p = 0.35), final successful reperfusion (97.6% vs. 98%, p = 0.75), and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%, aOR 2.033, 95%CI (1.209-3.419), p = 0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line stent-retriever + contact aspiration treatment (81.8% vs. 73.6%, aOR 1.881, 95%CI (1.039-3.405), p = 0.037). CONCLUSIONS Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a combined technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, the addition of contact aspiration after initial stent-retriever failure might be beneficial in achieving earlier reperfusion.
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Affiliation(s)
- Mahmoud H Mohammaden
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Leonardo Pisani
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Aaron Anderson
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Bernardo Liberato
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Daniel Schachter
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Digvijaya Navalkele
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Michael R Frankel
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
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22
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Zeleňák K, Krajina A, Meyer L, Fiehler J, Behme D, Bulja D, Caroff J, Chotai AA, Da Ros V, Gentric JC, Hofmeister J, Kass-Hout O, Kocatürk Ö, Lynch J, Pearson E, Vukasinovic I. How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods. Life (Basel) 2021; 11:life11060488. [PMID: 34072071 PMCID: PMC8229281 DOI: 10.3390/life11060488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and collecting of extremely big databases. Nowadays, the speed of internet connection is a limiting factor for robotic systems, which can be controlled and commanded potentially from various places in the world. Innovative technologies can be implemented for acute stroke patient management soon. Artificial intelligence (AI) and robotics are used increasingly often without the exception of medicine. Their implementation can be achieved in every level of stroke care. In this article, all steps of stroke health care processes are discussed in terms of how to improve them (including prehospital diagnosis, consultation, transfer of the patient, diagnosis, techniques of the treatment as well as rehabilitation and usage of AI). New ethical problems have also been discovered. Everything must be aligned to the concept of “time is brain”.
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Affiliation(s)
- Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Correspondence: ; Tel.: +421-43-4203-990
| | - Antonín Krajina
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, CZ-500 05 Hradec Králové, Czech Republic;
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | - Jens Fiehler
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | | | - Daniel Behme
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- University Clinic for Neuroradiology, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Deniz Bulja
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Diagnostic-Interventional Radiology Department, Clinic of Radiology, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Jildaz Caroff
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Interventional Neuroradiology–NEURI Brain Vascular Center, Bicêtre Hospital, APHP, 94270 Paris, France
| | - Amar Ajay Chotai
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne NE14LP, UK
| | - Valerio Da Ros
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Biomedicine and Prevention, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Jean-Christophe Gentric
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Interventional Neuroradiology Unit, Hôpital de la Cavale Blanche, 29200 Brest, France
| | - Jeremy Hofmeister
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Unité de Neuroradiologie Interventionnelle, Service de Neuroradiologie Diagnostique et Interventionnelle, 1205 Genève, Switzerland
| | - Omar Kass-Hout
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Stroke and Neuroendovascular Surgery, Rex Hospital, University of North Carolina, 4207 Lake Boone Trail, Suite 220, Raleigh, NC 27607, USA
| | - Özcan Kocatürk
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Balikesir Atatürk City Hospital, Gaziosmanpaşa Mahallesi 209., Sok. No: 26, 10100 Altıeylül/Balıkesir, Turkey
| | - Jeremy Lynch
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Ernesto Pearson
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- CH Bergerac-Centre Hospitalier, Samuel Pozzi 9 Boulevard du Professeur Albert Calmette, 24100 Bergerac, France
| | - Ivan Vukasinovic
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Kasab SA, Bathla G, Varon A, Roa JA, Sabotin R, Raghuram A, Chaorong W, Hasan DM, Turan TN, Chatterjee R, Samaniego EA. High-resolution vessel wall imaging after mechanical thrombectomy. Neuroradiol J 2021; 34:593-599. [PMID: 34014780 DOI: 10.1177/19714009211017782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES High-resolution magnetic resonance imaging has the potential of characterising arterial wall changes after endovascular mechanical thrombectomy. The purpose of this study is to evaluate high-resolution magnetic resonance imaging features of large intracranial arteries following mechanical thrombectomy. METHODS Patients who presented with acute ischaemic stroke due to large vessel occlusion and underwent mechanical thrombectomy were prospectively recruited. Subjects underwent high-resolution magnetic resonance imaging within 24 hours of the procedure. Magnetic resonance imaging sequences included whole brain T1 pre and post-contrast black-blood imaging, three-dimensional T2, contrast-enhanced magnetic resonance angiography and susceptibility-weighted imaging. Arterial wall enhancement was objectively assessed after normalisation with the pituitary stalk. The contrast ratio of target vessels was compared with non-affected reference vessels. RESULTS Twenty patients with 22 target vessels and 20 reference vessels were included in the study. Sixteen patients were treated with stentriever with or without aspiration, and four with contact aspiration only. Significantly higher arterial wall enhancement was identified on the target vessel when compared to the reference vessel (U = 22.5, P < 0.01). The stentriever group had an 82% increase in the contrast ratio of the target vessel (x̄ = 0.75 ± 0.21) when compared to the reference vessel (x̄ = 0.41 ± 0.13), whereas the contact aspiration group had a 64% increase of the contrast ratio difference between target (x̄ = 0.62 ± 0.07) and reference vessels (x̄ = 0.38 ± 0.12). Approximately 65% of patients in the stentriever group had a positive parenchymal susceptibility-weighted imaging versus 25% in the contact aspiration group. There was no statistically significant correlation between susceptibility-weighted imaging volume and the percentage increase in the contrast ratio (rs = 0.098, P = 0.748). CONCLUSIONS This prospective pilot study used the objective quantification of arterial wall enhancement in determining arterial changes after mechanical thrombectomy. Preliminary data suggest that the use of stentrievers is associated with a higher enhancement as compared to reperfusion catheters.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurology, Medical University of South Carolina,USA
| | - Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics,USA
| | - Alberto Varon
- Department of Neurology, University of Iowa Hospitals and Clinics, USA
| | - Jorge A Roa
- Department of Neurology, University of Iowa Hospitals and Clinics, USA.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, USA
| | - Ryan Sabotin
- Department of Neurology, University of Iowa Hospitals and Clinics, USA
| | - Ashrita Raghuram
- Department of Neurology, University of Iowa Hospitals and Clinics, USA
| | - Wu Chaorong
- Institute for Clinical and Translational Science, University of Iowa, USA
| | - David M Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, USA
| | - Tanya N Turan
- Department of Neurology, Medical University of South Carolina,USA
| | - Rano Chatterjee
- Department of Radiology, Washington University in St Louis, USA
| | - Edgar A Samaniego
- Department of Radiology, University of Iowa Hospitals and Clinics,USA.,Department of Neurology, University of Iowa Hospitals and Clinics, USA.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, USA
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Jiang C, Li Y, Hao F, Yang J, Wang B, Fan Y. Y-configuration double-stent-retriever thrombectomy for refractory thrombus in middle cerebral artery bifurcation: A case report. Medicine (Baltimore) 2021; 100:e24993. [PMID: 33725971 PMCID: PMC7982166 DOI: 10.1097/md.0000000000024993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Stent retriever mechanical thrombectomy is a recommended treatment for acute ischemic stroke. However, refractory thrombus in artery bifurcation can reduce the rate of successful revascularization. PATIENT CONCERNS A 72-year-old male, owing to the acute onset of almost complete right-sided hemiplegia and global aphasia, received bridging therapy. National Institutes of Health Stroke Scale score was 16 at the time of admission. DIAGNOSES Cerebral digital subtraction angiography revealed occlusion of the M1 segment of the left MCA. INTERVENTIONS Thrombectomy with 3 passes of the Solitaire FR device (Medtronic, Minneapolis, MN) was unsuccessful. Two stent retrievers were inserted in parallel by one microcatheter access point to each M2 branch, and then both stents were gradually retrieved out of the catheter while continuous suction was maintained. OUTCOMES After thrombectomy, subsequent follow-up angiograms showed mTICI 3 reperfusion of MCA. The patient has mRS 2 at discharge and the 3-month mRS score after stroke is 1 score. LESSONS The presented Y-configuration double-stent-retriever thrombectomy technique constitutes a safe and effective rescue treatment method for refractory thrombus in MCA bifurcation.
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25
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Dibas M, Tekle W, Ghozy S, Desai S, Sarraj A, Hassan AE. Impact of stent retrievers length on the outcomes of acute ischemic stroke: do longer devices cause less hemorrhage? J Neurosurg Sci 2021; 66:160-161. [PMID: 33491354 DOI: 10.23736/s0390-5616.21.05278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mahmoud Dibas
- Sulaiman Al Rajhi University, College of Medicine, Saudi Arabia
| | - Wondwossen Tekle
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
| | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Neurosurgery Department, El Sheikh Zayed specialized hospital, Giza, Egypt
| | - Sohum Desai
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
| | - Amrou Sarraj
- Department of Neurology, University of Texas at Houston Stroke Center, Houston, TX, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA -
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26
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Abbasi M, Liu Y, Fitzgerald S, Mereuta OM, Arturo Larco JL, Rizvi A, Kadirvel R, Savastano L, Brinjikji W, Kallmes DF. Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes. J Neurointerv Surg 2021; 13:212-216. [PMID: 33441394 DOI: 10.1136/neurintsurg-2020-016869] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND First pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes. OBJECTIVE To determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE. METHODS In July 2020, a literature search on FPE (defined as modified Thrombolysis in Cerebral Infarction (TICI) 2c-3 after a single pass) and modified FPE (mFPE, defined as TICI 2b-3 after a single pass) and mechanical thrombectomy for stroke was performed. Using a random-effects meta-analysis, we evaluated the following outcomes for both FPE and mFPE: overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale score ≤2 at day 90), mortality, and symptomatic intracerebral hemorrhage (sICH) rate. RESULTS Sixty-seven studies comprising 16 870 patients were included. Overall rates of FPE and mFPE were 28% and 45%, respectively. Thrombectomy techniques shared similar FPE (p=0.17) and mFPE (p=0.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR=1.78) and mFPE with non-mFPE (57% vs 44%, OR=1.73). FPE had a lower mortality rate (17% vs 25%, OR=0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared with non-FPE and non-mFPE (4% vs 18%, OR=0.41 for FPE; 5% vs 7%, OR=0.98 for mFPE). CONCLUSIONS Our findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques. FPE and mFPE are associated with better clinical outcomes.
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Affiliation(s)
- Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | - Oana Madalina Mereuta
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | | | - Asim Rizvi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Endovascular therapy (EVT) has become the standard treatment for large-vessel occlusion (LVO) acute ischemic stroke (AIS). EVT is now indicated in patients up to 24h from their last known well, provided that the patient meets specific clinical and imaging criteria. Improvements in thrombectomy devices, techniques, and operator experience have allowed successful EVT of ICA terminus, M1-MCA occlusions as well as proximal M2-MCA, basilar artery occlusions, and revascularization of tandem lesions. Mechanical thrombectomy failures still occur due to several factors, however, highlighting the need for further device and technical improvements. An ongoing debate exists regarding the need for pre-EVT thrombolytic agents, thrombectomy techniques, distal occlusions, anesthesia methods, the role of advanced neuroimaging, the treatment of patients with larger infarct core, and those presenting with milder stroke symptoms. Many of these questions are the subject of current or upcoming clinical trials. This review aims to provide an outline and discussion about the established recommendations and emerging topics regarding EVT for LVO AIS.
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Affiliation(s)
- Fabio Settecase
- Neuroradiology Division, Department of Radiology, University of British Columbia, Vancouver, BC, Canada; Diagnostic and Interventional Neuroradiology Division, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States.
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28
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Yokota M, Ohshima T, Nagano Y, Kawaguchi R, Miyachi S. A Method to Evaluate Vessel Deviation during Withdrawal of a Stent Retriever Using a Silicon Vascular Model. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:417-420. [PMID: 37502787 PMCID: PMC10370886 DOI: 10.5797/jnet.oa.2020-0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/08/2020] [Indexed: 07/29/2023]
Abstract
Objective Catastrophic complications may develop because of vessel deviation during device delivery into intracranial vessels for neurointerventions. We report a novel method using a silicon model capable of evaluating vessel deviation as a numerical value. Methods In all, 10 tiny markers, each with a pitch of approximately 5 mm, were attached to the vessel model along the long axis. We used a high-resolution camera to record movies of the deviation of the vessel model while employing different stent retrievers. The movies were reviewed to determine the maximum deviation of each marker on the vessel model. Results As expected, stent retrievers of the same type exhibited more vessel shifts when they had a larger diameter and longer length. On the other hand, stents with a segmental structure demonstrated less vessel deviation than those with a tubular structure, regardless of the large lumen and long length. Conclusion If the degree of vessel stress can be represented by a numerical value, areas where the careful use of different devices for neurointerventions is required may be able to be identified. Moreover, this method may be useful for training.
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Affiliation(s)
- Mao Yokota
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomotaka Ohshima
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshitaka Nagano
- Department of Electronic Control and Robot Engineering, Aichi University of Technology, Gamagori, Aichi, Japan
| | - Reo Kawaguchi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shigeru Miyachi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan
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29
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Velioglu M, Onal Y, Agackiran A, Dogan Ak P, Karakas HM. Initial experience with the CatchView thrombectomy device for acute ischemic stroke. J Neurointerv Surg 2020; 13:946-950. [PMID: 33273045 DOI: 10.1136/neurintsurg-2020-016784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND We report our initial experience with the CatchView (CV) thrombectomy device in patients with acute ischemic stroke (AIS). METHODS A retrospective analysis of 53 of 284 AIS patients (mean age 66.6±14.8 years, range 37-94) treated with a CV device between January 2019 and February 2020 was performed. The baseline characteristics (gender, age, comorbidities, National Institutes of Health Stroke Scale (NIHSS) score, intravenous tissue plasminogen activator (IV-tPA) administration, and occlusion localization) of these subjects were recorded. Modified Thrombolysis in Cerebral Ischemia (mTICI) scores of 2b and 3 were considered to indicate successful recanalization, and subjects with a modified Rankin Scale score of ≤2 on day 90 was considered a good clinical outcomes. RESULTS The mean NIHSS score was 12.3±3. Successful recanalization was achieved in 45 subjects (84.90%), and the rate of good clinical outcomes on day 90 was 43.39%. The secondary distal embolus rate was 5.66%. Symptomatic hemorrhage was observed in 3.77% of the subjects, and the mortality rate was 13.2%. CONCLUSIONS Mechanical thrombectomy devices include a wide array of endovascular tools for removing clots in AIS patients. In terms of successful recanalization and good clinical outcomes on day 90, our initial experience with the CV devices was encouraging.
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Affiliation(s)
- Murat Velioglu
- Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Yilmaz Onal
- Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | | | - Pelin Dogan Ak
- Neurology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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30
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Machi P, Luft A, Winklhofer S, Anagnostakou V, Kulcsár Z. Endovascular treatment of acute ischemic stroke. J Neurosurg Sci 2020; 65:259-268. [PMID: 33245221 DOI: 10.23736/s0390-5616.20.05109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular treatment of acute ischemic stroke has become the first choice of treatment in large cerebral vessel occlusions, with a very high efficacy in terms of revascularization and reducing disability of affected patients. Revolutionizing acute therapy, it induced important paradigm shifts in the concepts of time and salvageable brain. In this review we focus on the current concepts of patient selection, imaging, techniques and perspectives of endovascular stroke treatment.
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Affiliation(s)
- Paolo Machi
- Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Andreas Luft
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,Clinical Neurocenter, University Hospital of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Clinical Neurocenter, University Hospital of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Vaia Anagnostakou
- Department of Radiology, New England Center for Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zsolt Kulcsár
- Clinical Neurocenter, University Hospital of Zurich, Zurich, Switzerland - .,Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland.,Center of Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
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31
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Double Stent Retriever (SR) Technique: A Novel Mechanical Thrombectomy Technique to Facilitate the Device-Clot Interaction for Refractory Acute Cerebral Large Vessel Occlusions. World Neurosurg 2020; 141:175-183. [DOI: 10.1016/j.wneu.2020.05.268] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
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32
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Yi HJ, Sung JH, Lee DH, Song SY. Effectiveness and Technical Considerations of Solitaire Platinum 4×40 mm Stent Retriever in Mechanical Thrombectomy with Solumbra Technique. J Korean Neurosurg Soc 2020; 64:30-38. [PMID: 32759627 PMCID: PMC7819789 DOI: 10.3340/jkns.2020.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/01/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The Solitaire Platinum 4×40 mm stent retriever contains radiopaque markers with a long length. We evaluated the effect of Solitaire Platinum 4×40 mm stent retriever in Solumbra technique thrombectomy, and compared it with shorter Solitaire stent retrievers. METHODS A total of 70 patients who underwent Solumbra technique thrombectomy with equal diameter (4 mm) and different length (40 vs. 20 mm) Solitaire stent retrievers were divided into two groups : the Solitaire Platinum 4×40 mm stent (4×40) group and the Solitaire FR 4×20 mm stent or Solitaire Platinum 4×20 mm stent (4×20) group. The clinical outcomes, Thrombolysis in Cerebral Infarction score, the first pass reperfusion status, and complications were evaluated and compared between the two groups. Multivariate analysis was performed to evaluate the predictive factors for reperfusion and complete reperfusion from the first pass. RESULTS Higher first-pass reperfusion and complete reperfusion were achieved in the 4×40 group (68.0% and 48.0%) than in the 4×20 group (46.7% and 33.3%; p=0.004 and 0.007, respectively). In multivariate analysis, radiopaque device and longer stent retriever were correlated with first-pass reperfusion (p=0.014 and 0.008, respectively) and first-pass complete reperfusion (p=0.022 and 0.012, respectively). CONCLUSION Our study demonstrated the usefulness of the Solitaire Platinum 4×40 mm stent retriever, which led to higher firstpass reperfusion and complete reperfusion rates than the Solitaire FR 4×20 mm stent or the Solitaire Platinum 4×20 mm stent, especially in Solumbra technique thrombectomy.
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Affiliation(s)
- Ho Jun Yi
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.,Department of Neurosurgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seung Yoon Song
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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33
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McTaggart RA, Ospel JM, Psychogios MN, Puri AS, Maegerlein C, Lane KM, Jayaraman MV, Goyal M. Optimization of Endovascular Therapy in the Neuroangiography Suite to Achieve Fast and Complete (Expanded Treatment in Cerebral Ischemia 2c-3) Reperfusion. Stroke 2020; 51:1961-1968. [DOI: 10.1161/strokeaha.119.026736] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ryan A. McTaggart
- Department of Diagnostic Imaging (R.A.M., M.V.J.), Warren Alpert School of Medicine at Brown University, Providence, RI
- Department of Neurology (R.A.M., M.V.J.), Warren Alpert School of Medicine at Brown University, Providence, RI
- Department of Neurosurgery (R.A.M., K.M.L., M.V.J.), Warren Alpert School of Medicine at Brown University, Providence, RI
- The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence (R.A.M., K.M.L., M.V.J.)
| | - Johanna M. Ospel
- Department of Clinical Neurosciences, University of Calgary, Canada (J. M.O., M.G.)
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Switzerland (J.M.O., M.-N. P.)
| | - Marios-Nikos Psychogios
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Switzerland (J.M.O., M.-N. P.)
| | - Ajit S. Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester (A.S.P.)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany (C.M.)
| | - Kendall M. Lane
- Department of Neurosurgery (R.A.M., K.M.L., M.V.J.), Warren Alpert School of Medicine at Brown University, Providence, RI
- The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence (R.A.M., K.M.L., M.V.J.)
| | - Mahesh V. Jayaraman
- Department of Diagnostic Imaging (R.A.M., M.V.J.), Warren Alpert School of Medicine at Brown University, Providence, RI
- Department of Neurology (R.A.M., M.V.J.), Warren Alpert School of Medicine at Brown University, Providence, RI
- Department of Neurosurgery (R.A.M., K.M.L., M.V.J.), Warren Alpert School of Medicine at Brown University, Providence, RI
- The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence (R.A.M., K.M.L., M.V.J.)
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Canada (J. M.O., M.G.)
- Department of Radiology, Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Canada (M.G.)
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Styczen H, Huseynov E, Abdullayev N, Maus V, Borggrefe J, Goertz L, Onur OA, Stockero A, Mpotsaris A, Kabbasch C. Adjustment of Stent Retriever Length to Clot Extent Affects First-Pass Reperfusion in Endovascular Treatment of Acute Ischemic Stroke. Cerebrovasc Dis 2020; 49:277-284. [PMID: 32544906 DOI: 10.1159/000508028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stent retriever technology has evolved, and significantly longer devices have become available for mechanical thrombectomy (MT) of large cerebral vessel occlusions in ischemic stroke. We hypothesized that increased stent retriever length may improve the rate of complete angiographic reperfusion and decrease the respective number of attempts, resulting in a better clinical outcome. METHODS Retrospective analysis of patients with large vessel occlusion in the anterior and posterior circulation treated with stent retriever MT. The study group was dichotomized into short (20 mm) and long (>20 mm) retrievers using propensity matching. In the anterior circulation, the clot burden score was evaluated. Primary end points were first-pass modified thrombolysis in cerebral infarction (mTICI) 3 reperfusion and first-pass mTICI ≥ 2b reperfusion, and the secondary end point was functional independence (defined as modified Rankin Scale score 0-2) at discharge and 90 days. RESULTS Overall, 394 patients were included in the analysis. In the anterior circulation, short stent retrievers had a significantly higher rate of first-pass reperfusion in cases with low clot burden (mTICI 3: 27% vs. 17%; p = 0.009; mTICI ≥ 2b: 42 vs. 30%; p = 0.005) and in middle cerebral artery occlusions (mTICI ≥ 2b: 51 vs. 41%; p = 0.024). Higher rates of favorable outcome at discharge and 90 days were observed for the short stent retriever group (p < 0.001). CONCLUSION Stent retriever length should be adjusted to clot burden score and vessel occlusion site.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany,
| | - Elvin Huseynov
- Department of Internal Medicine, Helios Hospital Siegburg, Siegburg, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
| | - Jan Borggrefe
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Lukas Goertz
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Oezguer A Onur
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Andrea Stockero
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
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35
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Mokin M, Primiani CT, Castonguay AC, Nogueira RG, Haussen DC, English JD, Satti SR, Chen J, Farid H, Borders C, Veznedaroglu E, Binning MJ, Puri A, Vora NA, Budzik RF, Dabus G, Linfante I, Janardhan V, Alshekhlee A, Abraham MG, Edgell R, Taqi MA, Khoury RE, Majjhoo AQ, Kabbani MR, Froehler MT, Finch I, Ansari SA, Novakovic R, Nguyen TN, Zaidat OO. First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis. Front Neurol 2020; 11:83. [PMID: 32132966 PMCID: PMC7040359 DOI: 10.3389/fneur.2020.00083] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objective: The first pass effect (FPE; achieving complete recanalization with a single thrombectomy device pass) has been shown to be associated with higher rates of good clinical outcomes in patients with acute ischemic stroke. Here, we investigate clinical and radiographic factors associated with FPE in a large U.S. post-marketing registry (TRACK, Trevo Stent-Retriever Acute Stroke). Methods: We analyzed the TRACK database (multicenter registry of 634 patients from 23 centers from March 2013 through August 2015), which 609 patients were included in the final analysis. FPE was defined as a single pass/use of device, TICI 2c/3 recanalization, and no use of rescue therapy. Analysis of individual patient data from TRACK were performed to analyze clinical and radiographic characteristics associated with FPE as well-compared clinical outcomes defined as modified Rankin Scale (mRS) score at 30 and 90 days from hospital discharge to the non-FPE group. Results: The rate of FPE in TRACK was 23% (140/609). There was no association between patient demographics and FPE, including age (p = 0.36), sex (p = 0.50), race (p = 0.50), location of occlusion (p = 0.26), baseline NIHSS (p = 0.62), or past medical history. There was no difference in the use of a balloon-guide catheter or general anesthesia (49 and 57% with FPE vs. 47 and 64%, p = 0.63 and p = 0.14, respectively). Clinical outcomes were significantly associated with FPE; 63 vs. 44% in non-FPE patients achieved mRS 0–2 at 90 days (p = 0.0004). Conclusion: Our study showed that achieving complete recanalization with a single thrombectomy pass using the Trevo device was highly beneficial. The most common clinical factors that are used to determine eligibility for endovascular therapy, such as NIHSS severity, location of occlusion or patient age were not predictive of the ability to achieve FPE.
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Affiliation(s)
- Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Christopher T Primiani
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | | | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Joey D English
- Department of Neurology, California Pacific Medical Center, San Francisco, CA, United States
| | - Sudhakar R Satti
- Department of Neurointerventional Surgery, Christiana Care Health Center, Newark, DE, United States
| | - Jennifer Chen
- Department of Radiology, Sidney Kimmel Medical College, Philadelphia, PA, United States
| | - Hamed Farid
- Department of Neurointerventional Radiology, St. Jude Medical Center, Fullerton, CA, United States
| | - Candace Borders
- Department of Neurosurgery, Irvine School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Erol Veznedaroglu
- Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, United States
| | - Mandy J Binning
- Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, United States
| | - Ajit Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nirav A Vora
- Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, OH, United States
| | - Ron F Budzik
- Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, OH, United States
| | - Guilherme Dabus
- Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL, United States
| | - Italo Linfante
- Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL, United States
| | - Vallabh Janardhan
- Comprehensive Stroke Program and Neurointerventional, Texas Stroke Institute, Plano, TX, United States
| | - Amer Alshekhlee
- Department of Vascular and Interventional Neurology, DePaul Stroke Center-SSM Neuroscience Institutes, St. Louis, MO, United States
| | - Michael G Abraham
- Neurology and Interventional Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Randall Edgell
- Department of Neurology, St. Louis University, St. Louis, MO, United States
| | - Muhammad Asif Taqi
- Department of Neurology and Neurosurgery, Los Robles Hospital and Medical Center, Thousand Oaks, CA, United States
| | - Ramy El Khoury
- Department of Neurology, Tulane University, New Orleans, LA, United States
| | - Aniel Q Majjhoo
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States
| | - Mouhammed R Kabbani
- Department of Neurosurgery, Gundersen Health System, La Crosse, WI, United States
| | - Michael T Froehler
- Department of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ira Finch
- Interventional Radiology, John Muir Health, Walnut Creek, CA, United States
| | - Sameer A Ansari
- Department of Radiology, Neurology, and Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Roberta Novakovic
- Department of Radiology, Neurology, and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, United States
| | - Osama O Zaidat
- Department of Endovascular Neurosurgery and Stroke, St. Vincent Mercy Medical Center, Toledo, OH, United States
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36
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Mortality reduction after thrombectomy for acute intracranial large vessel occlusion: meta-analysis of randomized trials. J Neurointerv Surg 2019; 12:568-573. [DOI: 10.1136/neurintsurg-2019-015383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 01/19/2023]
Abstract
BackgroundThrombectomy for patients with emergent large vessel occlusion (ELVO) is currently recognized as the standard of care for appropriately selected patients. As proven in several randomized clinical trials and meta-analyses, treatment with thrombectomy lowers rates of poor functional outcomes after ELVO, compared with standard medical management. However, combined mortality rates of the most recent, high-quality clinical trials have not been collectively assessed.ObjectiveThe goal of this study was to assess the combined mortality rates of patients with ELVO following thrombectomy using data from the most recent, high-quality clinical trials.MethodsMeta-analysis was performed in clinical trials comparing thrombectomy and medical management for patients with anterior circulation ELVO. Cumulative rates of mortality (mRS 6) as well as mortality or severe disability (mRS 5-6) were calculated.ResultsTen clinical trials fit the inclusion criteria, including PISTE, REVASCAT, DAWN, THRACE, SWIFT PRIME, ESCAPE, DEFUSE 3, THERAPY, EXTEND-IA, and MR CLEAN, with 2233 patients assessed for mortality alone and 2229 for mortality or severe disability. There was a significantly reduced risk of death with thrombectomy compared with standard medical care (14.9% vs 18.3%, P=0.03; RR 0.81, 95% CI 0.67 to 0.98), as well as a reduced risk of mortality or severe disability (mRS 5–6) in ELVO patients treated with thrombectomy (21.1% vs 30.5%, P<0.0001; RR 0.69, 95% CI 0.60 to 0.80).ConclusionsOverall, these results suggest a lower risk of death, as well as death or severe disability, in patients with ELVO treated with thrombectomy compared with medical management alone.
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37
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Girdhar G, Epstein E, Nguyen K, Gregg C, Kumar T, Wainwright J, Liu AY, Linfante I. Longer 6-mm Diameter Stent Retrievers Are Effective for Achieving Higher First Pass Success with Fibrin-Rich Clots. INTERVENTIONAL NEUROLOGY 2019; 8:187-195. [PMID: 32508901 DOI: 10.1159/000499974] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/28/2019] [Indexed: 11/19/2022]
Abstract
First pass success (FPS) can be defined as in vitro retrieval of clot in a single pass during mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). Despite advancements in MT technology, retrieval of fibrin-rich clots remains a challenge. Therefore, the effect of stent retriever length on FPS for fibrin-rich clots was investigated by using SolitaireTM 6 × 40 versus 6 × 30 mm devices with a balloon guide catheter (BGC) or distal access catheter (DAC) and sheath, in an in vitro model of anterior circulation neurovascular anatomy. Additionally, vascular safety of the SolitaireTM 6 × 40 versus 6 × 30 mm devices was evaluated in a porcine model for differences in: luminal thrombus, inflammation, endothelial coverage, fibrin deposits, smooth muscle cell loss, elastic lamina and adventitia disruption, intimal hyperplasia, and lumen reduction, at 0, 30, and 90 days post-treatment. In vitro overall FPS was measured as: SolitaireTM 6 × 40 (95%) and SolitaireTM 6 × 30 (67%). FPS for clot location in middle cerebral artery was: (a) BGC (6 × 40 mm: 100%; 6 × 30 mm: 100%; n = 8); (b) DAC with 088 sheath (6 × 40 mm: 83%; 6 × 30 mm: 33%; n = 12). FPS for clot location in internal carotid artery was: (a) BGC (6 × 40 mm: 100%; 6 × 30 mm: 80%; n = 11); (b) DAC with 088 sheath (6 × 40 mm: 100%; 6 × 30 mm: 67%; n = 10). Stent length had a significant effect (Fisher's exact test; p < 0.05) on FPS. In vivo evaluation in the porcine model showed no difference in vascular safety parameters between the SolitaireTM 6 × 40 and 6 × 30 mm devices (p > 0.05) at all time points in the study. Longer stent retrievers may be safe and effective in improving FPS for fibrin-rich clots in in vitro and in vivo models of LVO.
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Affiliation(s)
- Gaurav Girdhar
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Evan Epstein
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Kevin Nguyen
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Chelsea Gregg
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Tejashri Kumar
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - John Wainwright
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Amon Y Liu
- AYL Consulting LLC, Redwood City, California, USA
| | - Italo Linfante
- Interventional Neuroradiology and Endovascular Neurosurgery, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA
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38
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Tomasello A, Ribò M, Gramegna LL, Melendez F, Rosati S, Moreu M, Aixut S, Lüttich A, Werner M, Remollo S, Quintana M, Coscojuela P, Hernandez D, Dinia L, Lopez-Rueda A, Rubiera M, Rovira À. Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke. Interv Neuroradiol 2019; 25:491-496. [PMID: 31072248 DOI: 10.1177/1591019919847623] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE. METHODS We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus 'Push and Fluff' technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c-3. Associations were sought between cFPE and procedural approaches and angiographic signs. RESULTS A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28-9.29, p = 0.010), PBGC (OR 3.81, 95% CI: 1.41-10.22, p = 0.008) and ACPS (OR 4.71, 95% CI: 1.78-12.44, p = 0.002) were independently associated with cFPE. Concurrence of these three variables led to cFPE in 82 vs 35% of the remaining cases (p = 0.002). CONCLUSIONS The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials.
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Affiliation(s)
- Alejandro Tomasello
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ribò
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Fernando Melendez
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Santiago Rosati
- Department of Radiology, Clinical San Carlos Hospital, Madrid, Spain
| | - Manuel Moreu
- Department of Radiology, Clinical San Carlos Hospital, Madrid, Spain
| | - Sonia Aixut
- Department of Radiology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandre Lüttich
- Department of Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Mariano Werner
- Department of Radiology, Hospital Clinic I Provincial de Barcelona, Barcelona, Spain
| | - Sebastian Remollo
- Department of Neurosciences, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Manuel Quintana
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pilar Coscojuela
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Hernandez
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lavinia Dinia
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonio Lopez-Rueda
- Department of Radiology, Hospital Clinic I Provincial de Barcelona, Barcelona, Spain
| | - Marta Rubiera
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Àlex Rovira
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.,Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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39
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Jeong DE, Kim JW, Kim BM, Hwang W, Kim DJ. Impact of Balloon-Guiding Catheter Location on Recanalization in Patients with Acute Stroke Treated by Mechanical Thrombectomy. AJNR Am J Neuroradiol 2019; 40:840-844. [PMID: 30948374 DOI: 10.3174/ajnr.a6031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/07/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy with proximal flow control and forced aspiration may improve the outcome of endovascular revascularization therapy for patients with acute stroke. The purpose of this study was to compare the impact of balloon-guiding catheter locations in patients treated for anterior circulation acute ischemic stroke using mechanical thrombectomy. MATERIALS AND METHODS The influence of the balloon-guiding catheter location (proximal, balloon-guiding catheter tip proximal to C1 vertebral body; distal, between the skull base and the C1 vertebral body) was analyzed in patients with acute anterior circulation stroke treated with stent-retriever thrombectomy. The baseline angiographic/clinical characteristics, time intervals, recanalization rates, and clinical outcomes were compared. RESULTS The clinical analysis included 102 patients (mean age, 69.5 ± 12.8 years; male/female ratio = 52:50). The balloon-guiding catheter was located distally in 49 patients and proximally in 53 patients for flow control and forced aspiration during stent retrieval. The puncture-to-recanalization time was shorter in the distal group than in the proximal group (40 versus 56 minutes, P = .02). Successful and complete recanalizations were more frequently achieved in the distal group compared with the proximal group (98.0% versus 75.5%. P = .003; 67.3% versus 45.3%, P = .04, respectively). Multivariate analysis showed that the distal catheterization location was independently associated with successful recanalization (adjusted OR, 13.4; 95% CI, 2.4-254.8; P = .02). CONCLUSIONS Location of the balloon-guiding catheter has a significant impact on recanalization in patients with acute stroke. The balloon-guiding catheter should be positioned as distally as safely possible in the cervical ICA for maximally effective thrombectomy.
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Affiliation(s)
- D E Jeong
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
- Department of Neurology (D.E.J.), YeongNam University College of Medicine, Daegu, South Korea
| | - J W Kim
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - B M Kim
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - W Hwang
- Department of Mechanical and Aerospace Engineering (W.H.), Seoul National University, Seoul, South Korea
| | - D J Kim
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
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40
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Zaidat OO, Haussen DC, Hassan AE, Jadhav AP, Mehta BP, Mokin M, Mueller-Kronast NH, Froehler MT. Impact of Stent Retriever Size on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry. Stroke 2019; 50:441-447. [DOI: 10.1161/strokeaha.118.022987] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Osama O. Zaidat
- From the Mercy Health - St. Vincent Mercy Medical Center, Toledo, OH (O.O.Z.)
| | - Diogo C. Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA (D.C.H.)
- Grady Memorial Hospital, Atlanta, GA (D.C.H.)
| | | | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J.)
| | | | - Maxim Mokin
- Department of Neurosurgery, University of South Florida College of Medicine, Tampa (M.M.)
| | | | - Michael T. Froehler
- Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.)
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