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Reymond P, Roussinova E, Brina O, Hofmeister J, Bernava G, Rosi A, Galand W, Lovblad KO, Pereira VM, Bouri M, Machi P. Can micro-guidewire advancement forces predict clot consistency and location to assist the first-line technique for mechanical thrombectomy? J Neurointerv Surg 2024:jnis-2024-021477. [PMID: 38637149 DOI: 10.1136/jnis-2024-021477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The identification of specific clot characteristics before mechanical thrombectomy (MTB) might allow the selection of the most effective first-line technique, thus potentially improving the procedural outcome. We aimed to evaluate if the microwire push forces could extrapolate information on clot consistency and extension before MTB, based on clot mechanical properties. METHODS We measured in vitro the forces exerted on the proximal extremity of the guidewire during the advancement and retrieval of the guidewire through clot analogs of different compositions. In addition, we analyzed the forces exerted on the guidewire to extrapolate information about the location of the proximal and distal extremities of the clot analogs. RESULTS The maximum forces recorded during the whole penetration phase were significantly different for hard and soft clots (median values, 55.6 mN vs 15.4 mN, respectively; P<0.0001). The maximum slope of the force curves recorded during the advancement of the guidewire for the first 3 s of penetration also significantly differentiated soft from hard clot analogs (7.6 mN/s vs 23.9 mN/s, respectively; P<0.0001). In addition, the qualitative analysis of the shape of the force curves obtained during the advancement and retrieval of the guidewire showed a good potential for the identification of the proximal and distal edges of the clot analogs. CONCLUSION Our results demonstrated that it was possible to differentiate between soft and hard clot analogs. Furthermore, force measurements could give important information about the location of the clot extremities. Such an approach might support the selection of the first-line MTB technique, with the potential to improve the outcome.
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Affiliation(s)
- Philippe Reymond
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Evgenia Roussinova
- Translational Neural Engineering Lab (TNE), Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland
| | - Olivier Brina
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Andrea Rosi
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | - William Galand
- Biorobotics Laboratory (BioRob), Swiss Federal Institute of Technology Lausanne, EPFL, Lausanne, Switzerland
| | | | - Vitor M Pereira
- Department of Neurosurgery, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mohamed Bouri
- Translational Neural Engineering Lab (TNE), Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland
- Biorobotics Laboratory (BioRob), Swiss Federal Institute of Technology Lausanne, EPFL, Lausanne, Switzerland
| | - Paolo Machi
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
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2
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Iida Y, Mori K, Kawahara Y, Fukui I, Yamashita R, Takeda M, Nakano T, Hori S, Suenaga J, Shimizu N, Nomura M, Yamamoto T. "The microcatheter contrast injection technique": A novel technique to detect the proximal end of a thrombus in mechanical thrombectomy. Neuroradiol J 2023:19714009231224427. [PMID: 38151895 DOI: 10.1177/19714009231224427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: An aspiration catheter needs to attach to a thrombus in order to achieve first-pass recanalization by mechanical thrombectomy (MT) for acute ischemic stroke (AIS), particularly that using a direct aspiration first pass technique. The meniscus sign, which is defined as meniscoid contrast opacification indicating the proximal edge of a thrombus, has been suggested to contribute to successful recanalization. In some cases, the meniscus sign is not detected following an injection of contrast medium through a guiding catheter. To precisely identify the location of a thrombus, we use "the microcatheter contrast injection (MCI) technique," which accurately shows the proximal edge of a thrombus. We herein introduce this novel technique and discuss its efficacy in MT. Methods: In cases without the meniscus sign, a microcatheter was advanced to the distal end of contrast opacification, and contrast medium was injected through the microcatheter to detect the meniscus sign. An aspiration catheter was then advanced to the thrombus indicated by the meniscus sign and slowly withdrawn under aspiration. Results: 29 patients underwent MT for AIS using the MCI technique. Even in cases without the meniscus sign on initial angiography, the MCI technique accurately revealed the proximal edge of the thrombus. Moreover, middle cerebral artery occlusion due to atherosclerotic stenosis and displacement of the aspiration catheter and thrombus axis were detected using this technique. Conclusions: The MCI technique may effectively reveal the exact site of a thrombus and increase the success rate of first-pass recanalization.
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Affiliation(s)
- Yu Iida
- Department of Neurosurgery, Yokohama City University, Japan
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Kentaro Mori
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Yosuke Kawahara
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Issei Fukui
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | | | - Mutsuki Takeda
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Japan
| | - Tatsu Nakano
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Japan
| | - Satoshi Hori
- Department of Neurosurgery, Yokohama City University, Japan
| | - Jun Suenaga
- Department of Neurosurgery, Yokohama City University, Japan
| | | | - Motohiro Nomura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
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Liu R, He H, Zhang L, Fan Y, Wang J, Wang W. In vitro models for the experimental evaluation of mechanical thrombectomy devices in acute ischemic stroke. Interv Neuroradiol 2023; 29:759-767. [PMID: 35971288 PMCID: PMC10680957 DOI: 10.1177/15910199221118404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Mechanical thrombectomy has become an important method for the treatment of acute ischemic stroke for large vessel occlusions. The current hotspots of mechanical thrombectomy are optimizing the treatment methods, improving the recanalization rate and reducing complications. The in vitro model has become a common and convenient method for mechanical thrombectomy research. This review summarizes the in vitro model in the following aspects: the preparation of clot analogues; the experimental platform; the application of the in vitro model in the testing of thrombectomy devices; and the advantages, limitations and future trends of the in vitro experimental model. This review describes the characteristics and applications of the in vitro experimental model with the hope that the in vitro experimental model will be further improved and play a more effective role in the study of mechanical thrombectomy.
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Affiliation(s)
- Ronghui Liu
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Hongping He
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Luo Zhang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
| | - Jun Wang
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Weidong Wang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
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4
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Reymond P, Brina O, Girdhar G, Bolanos O, Lovblad KO, Machi P. Experimental evaluation of the performance of large bore aspiration catheters. J Neuroradiol 2023; 50:74-78. [PMID: 35192867 DOI: 10.1016/j.neurad.2022.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy using an aspiration catheter (AC) is widely performed in patients with acute ischemic stroke due to large vessel occlusion. AC diameter directly impacts aspiration performance, which has led device companies to develop large bore ACs. The purpose of this study was to evaluate the in vitro performance of several commercially available large bore ACs. MATERIALS AND METHODS We conceived an experimental set up to assess tracking force, aspiration flow rate, and distal end tensile force pre- and post-thrombectomy of ACs including Sofia 6 (Microvention Inc., California, USA), React 71 (Medtronic Neurovascular, Irvine, California, USA), Jet 7 (Penumbra Inc, Alameda, California, USA), Catalyst 7 (Stryker Neurovascular, Kalamazoo, Michigan, USA) and Embovac 071 (Johnson & Johnson Medical Ltd, UK). RESULTS React 71 and Sofia 6 had significantly lower trackability force compared to the other ACs tested. Distal AC segment tensile force was highest for React 71 and lowest for Jet 7. Jet 7 had the highest internal diameter and the highest aspiration flow rate. CONCLUSION The data from this comparative analysis may assist clinicians in selecting the appropriate AC and highlights the need for key performance criteria during the development of next-generation large-bore ACs for optimal AC performance.
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Affiliation(s)
- Philippe Reymond
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Geneva CH-1205, Switzerland
| | - Olivier Brina
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Geneva CH-1205, Switzerland
| | | | | | - Karl-Olof Lovblad
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Geneva CH-1205, Switzerland
| | - Paolo Machi
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Geneva CH-1205, Switzerland.
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Bernava G, Brina O, Reymond P, Rosi A, Hofmeister J, Yilmaz H, Muster M, Kulcsar Z, Lovblad KO, Machi P. In vitro evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter. Interv Neuroradiol 2022:15910199221135040. [PMID: 36348632 DOI: 10.1177/15910199221135040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Several variations of the combined thrombectomy technique for acute ischemic stroke using a stent retriever and aspiration catheter have been described. The aim of our study was to assess how the presence of the microcatheter and stent retriever affect the basic aspiration parameters, namely, flow rate and aspiration force, depending on their position within the aspiration catheter. METHODS Two experimental set-ups were designed to assess changes in flow rate and aspiration force according to the position of the stent retriever and microcatheter within the aspiration catheter. RESULTS The transition of the stent retriever and microcatheter from the distal to proximal position resulted in a progressive increase in the flow rate, but with no impact on aspiration force. Additionally, the size of the stent retriever had no significant effect on flow rate changes and the reduction in flow rate was related to the microcatheter diameter. Negative pressure generated inside the aspiration catheter impacted on its distal segment located beyond the radiopaque marker, thus leading to its partial collapse. As a consequence, the measured aspiration force was lower than the theoretical aspiration force level for all tested aspiration catheters. CONCLUSIONS In our experimental model, the position of the stent retriever and microcatheter within the aspirator catheter affected the flow rate, but not the aspiration force. Negative pressure generated within the aspiration catheter appeared to determine a partial collapse of the distal segment that resulted in a less effective aspiration force than the theoretical aspiration force level.
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Affiliation(s)
- Gianmarco Bernava
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Rosi
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jeremy Hofmeister
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Hasan Yilmaz
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Michel Muster
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Zsolt Kulcsar
- Division of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Karl-Olof Lovblad
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
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Kim JH, Kim BM, Kim DJ. In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models. AJNR Am J Neuroradiol 2022; 43:1431-1436. [PMID: 36574330 PMCID: PMC9575538 DOI: 10.3174/ajnr.a7633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/17/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Achieving complete recanalization with the front-line endovascular thrombectomy device improves the outcome of acute stroke. The aim of this study was to evaluate whether various thrombectomy techniques including contact aspiration, stent retriever thrombectomy, and combination therapy differ in first-pass effect and distal emboli in acute large-vessel occlusion simulated using 3D printed nontortuous and tortuous cerebrovascular anatomy models. MATERIALS AND METHODS 3D printed flow models were manufactured using angiographic data of nontortuous and acutely angulated tortuous vascular anatomy from real patients. Three thrombectomy techniques, contact aspiration, stent retriever, and combined methods, were tested under proximal protection with the balloon-guiding catheter. The first-pass effect and distal emboli rates were analyzed in addition to the thrombectomy-failure mechanisms of the respective techniques. RESULTS A total of 30 thrombectomy experiments were performed. The overall incidence of first-pass effect in the nontortuous and tortuous anatomy was 80.0% versus 46.7%. The overall incidence of distal emboli in the nontortuous and tortuous anatomy was 26.7% versus 46.7%. The contact aspiration technique showed better first-pass effect (80.0%) and distal emboli rates (20%) in the tortuous model compared with other techniques. The combined technique did not show remarkable superiority of the first-pass effect and distal emboli in either the nontortuous or tortuous anatomy. Shearing off of the thrombus was the main mechanism of thrombectomy failure in the combined group. CONCLUSIONS The tortuous vascular anatomy may worsen the first-pass effect and distal emboli rates. The combined techniques failed to show improvement in outcome due to the shearing-off phenomenon of the thrombus during retrieval.
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Affiliation(s)
- J H Kim
- From the Department of Radiology (J.H.K.), Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - B M Kim
- Department of Radiology (B.M.K., D.J.K.), Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - D J Kim
- Department of Radiology (B.M.K., D.J.K.), Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Mormina E, Tessitore A, Cavallaro M, Caragliano AA, Buonomo O, Longo M, Granata F, Caponnetto M, Vinci SL. Magnetic Resonance Angiography and Cisternography fused images in acute ischemic stroke may save time during endovascular procedure revealing vessel anatomy. Heliyon 2022; 8:e10288. [PMID: 36046522 PMCID: PMC9421192 DOI: 10.1016/j.heliyon.2022.e10288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/29/2022] [Accepted: 08/10/2022] [Indexed: 12/13/2022] Open
Abstract
Background and purpose Endovascular treatment (EVT) is a time-dependent procedure that aims to remove the arterial blood flow obstruction in brain vessels in acute ischemic stroke. In our center, the MRI patient selection protocol in acute ischemic stroke is performed with DWI, FLAIR, MR angiography (MRA) and MR cisternography (MRC) sequences. MRA and MRC are promptly and automatically fused in order to have a clear detection of vessel anatomy, before and during EVT. Our study aim is to evaluate if the fusion process between MRA and MRC could be considered time-safe and could influence EVT duration or outcome. Materials and methods 45 patients were retrospectively selected for the study and divided into 2 groups according to the presence of MRC sequence fused with MRA (Group 1) or not (Group 2 - controls). Results MRA and MRC fusion was able to depict vessel anatomy in all subjects of Group 1 (22 patients, 12 females; age 75.59 years ± 10.87). Group 1 presented EVT time reduction (p < 0.05;p = 0.040) (51.59 min ± 30.94) when compared to Group 2 (23 patients, 13 females; age 75.04 years ± 12.12) (71.96 min ± 34.55) of 20.37 min average. No differences between groups were detected evaluating: NIHSS at admission (p = 0.49) and discharge (p = 0.67), pre-stroke mRS (p = 0.89), mRS at 90 days (p = 0.62), ASPECT (p = 0.98) and ASPECT-DWI scores (p = 0.93), time from symptom onset to groin puncture (p = 0.80), thromboaspiration vs combined technique (p = 0.67), EVT success (p = 0.63). Conclusion Fusion of MRA and MRC is a safe and promising technique in promptly revealing vascular anatomy beyond vessel obstruction, and can play a role in EVT duration reduction.
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Affiliation(s)
- Enricomaria Mormina
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Agostino Tessitore
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Marco Cavallaro
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Armando Caragliano
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Orazio Buonomo
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Mirta Longo
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Francesca Granata
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Michele Caponnetto
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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8
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A high resolution scanning electron microscopy analysis of intracranial thrombi embedded along the stent retrievers. Sci Rep 2022; 12:8027. [PMID: 35577906 PMCID: PMC9110407 DOI: 10.1038/s41598-022-11830-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/27/2022] [Indexed: 12/16/2022] Open
Abstract
Endovascular treatment with stent retriever thrombectomy is a major advancement in the standard of care in acute ischemic stroke (AIS). The modalities through which thrombi embed along stent retriever following mechanical thrombectomy (MTB) have not yet been elucidated. Using scanning electron microscopy (SEM), we analyzed the appearance of thrombi retrieved by MTB from AIS patients, when embedded into the stent retriever. We observed that the organization and structural compactness vary for compositionally different thrombi. The modalities of attachment onto the stent vary according to thrombus composition and organization.
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Diana F, Vinci SL, Ruggiero M, Semeraro V, Bracco S, Frauenfelder G, Paolucci A, Cirillo L, Pesce A, Tessitore A, Commodaro C, Ganimede MP, Zanoni M, Saponiero R, Zini A, Velo M, Modello B, Burdi N, Cioni S, Simonetti L, Romano DG. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience. J Neurointerv Surg 2021; 14:666-671. [PMID: 34349012 DOI: 10.1136/neurintsurg-2021-017585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is no consensus on the most effective endovascular technique to use in patients with acute ischemic stroke due to terminal internal carotid artery (ICA) occlusion. The aim of this study was to compare safety and efficacy of the aspiration technique (AT) and combined technique (CT) as first-line approach in terminal ICA occlusions. METHODS We performed a retrospective analysis of prospectively collected databases from seven Italian stroke centers. Patients were divided into two subgroups according to the first-line approach: AT group or CT group. We followed the STROBE guidelines for cohort studies. We used Chi-square test, one-way and multivariate ANOVA analysis, together with contrast analysis and post hoc tests, logistic regression and Pearson's bivariate correlation for the statistical analyses. RESULTS Between January 2018 and August 2020, 353 patients were treated for a terminal ICA occlusion, with either AT or CT. CT was associated with a higher Thrombolysis in Cerebral Infarction (TICI) 2B-3 after the first pass (51.0% vs 26.9%) and at the end of the procedure (84% vs 73.3%) and with an improved clinical outcome at discharge (modified Rankin Scale (mRs) 0-2 of 47.8% vs 34.0%) and at 3 months' follow-up (mRs 0-2 of 56.5% vs 38.9%) compared with AT. CONCLUSION Thrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.
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Affiliation(s)
- Francesco Diana
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Vittorio Semeraro
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Sandra Bracco
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Giulia Frauenfelder
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Aldo Paolucci
- Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Luigi Cirillo
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.,DIBINEM, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Pesce
- Department of Neurosurgery, Ospedale Santa Maria Goretti, Latina, Italy
| | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Christian Commodaro
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Maria Porzia Ganimede
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Matteo Zanoni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Renato Saponiero
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Mariano Velo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Beatrice Modello
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Nicola Burdi
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Samuele Cioni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Luigi Simonetti
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Daniele Giuseppe Romano
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
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