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Mierzwa AT, Al Kasab S, Nelson A, Gutierrez SO, Vivanco-Suarez J, Farooqui M, Jadhav AP, Desai S, Toth G, Alrohimi A, Nguyen TN, Klein P, Abdalkader M, Salahuddin H, Pandey A, Koduri S, Wilseck Z, Vora N, Aladamat N, Gharaibeh K, Afreen E, Zaidi S, Jumaa M. Thrombectomy Outcomes in Acute Basilar Artery Occlusions Due to Intracranial Atherosclerotic Disease. Neurosurgery 2024:00006123-990000000-01224. [PMID: 38904392 DOI: 10.1227/neu.0000000000003035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/05/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Intracranial atherosclerotic disease (ICAD) large vessel occlusion (LVO) is responsible for up to 30% of LVO. In this study, we aimed to determine the likelihood of favorable functional outcomes (modified Rankin Scale 0-3) in acute ICAD-LVO basilar occlusion compared with embolic basilar occlusion. METHODS This is an analysis of the Posterior Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intraprocedural Predictors for Mechanical Thrombectomy Registry in which patients with acute basilar artery occlusions from 8 comprehensive stroke centers were included from 2015 to 2021. Patients were dichotomized into with (ICAD-LVO) or without underlying ICAD (embolic). Descriptive statistics for each group and multivariate logistic analysis were performed on the primary outcome. RESULTS Three hundred forty-six patients were included. There were 215 patients with embolic (62%) and 131 patients with ICAD-LVO (38%). Baseline demographics were equivalent between the 2 groups except for sex (male 47% vs 67%; P < .001), history of stroke (12% vs 25%; P = .002), and atrial fibrillation (31% vs 17%; P = .003). At 90 days, patients in the ICAD-LVO cohort were less likely to achieve favorable functional outcomes (odds ratio [OR] 0.41, 95% CI 0.22-0.72; P = .003) after adjusting for potentially confounding factors. In addition, ICAD-LVO strokes were less likely to achieve thrombolysis in cerebral infarction ≥2b (OR 0.29, 95% CI 0.14-0.57; P < .001). ICAD-LVO lesions were more likely to require stent placement (OR 14.94, 95% CI 4.91-45.49; P < .001). Subgroup analysis demonstrated favorable functional outcomes in patients who underwent stenting and angioplasty compared with failed recanalization cohort (OR 4.96, 95% CI 1.68-14.64; P < .004). CONCLUSION Patients with acute basilar ICAD-LVO have higher morbidity and mortality compared with patients with embolic source. Lower rates of successful recanalization in the ICAD-LVO cohort support this finding. Our subgroup analysis demonstrates that stenting should be considered in patients with recanalization failure. Rates of symptomatic intracranial hemorrhage were similar between the ICAD-LVO and embolic cohorts.
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Affiliation(s)
- Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
- Department of Neurology, Promedica Stroke Network, Toledo, Ohio, USA
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ashley Nelson
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Juan Vivanco-Suarez
- Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Mudassir Farooqui
- Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Shashvat Desai
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas Alrohimi
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, USA
| | - Piers Klein
- Department of Neurology, Radiology, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Neurology, Radiology, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, USA
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Hospital, Los Angeles, California, USA
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Zachary Wilseck
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nirav Vora
- Department of Neurology, Ohio Health Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Ehad Afreen
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
- Department of Neurology, Promedica Stroke Network, Toledo, Ohio, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
- Department of Neurology, Promedica Stroke Network, Toledo, Ohio, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
- Department of Neurology, Promedica Stroke Network, Toledo, Ohio, USA
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Sabeva N, Castro W, Acosta YF, Ferchmin PA, Eterović VA, Sierra-Mercado D, Rios NP, Rivas-Tumanyan S, Martins AH. Determining the safety of the tobacco cembranoid (1S,2E,4R,6R,7E,11E)-Cembratriene-4,6-diol (4R): A translational study in nonhuman primates. Toxicol Appl Pharmacol 2024; 482:116772. [PMID: 38036230 PMCID: PMC10872440 DOI: 10.1016/j.taap.2023.116772] [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: 07/06/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
The tobacco cembranoid known as (1S,2E,4R,6R,7E,11E)-2,7,11-cembratriene-4,6-diol (4R) has been shown to offer neuroprotection against conditions such as brain ischemia, systemic inflammation, Parkinson's disease, and organophosphate toxicity in rodents. Previous safety studies conducted on male and female Sprague Dawley rats revealed no significant side effects following a single injection of 4R at varying concentrations (6, 24, or 98 mg/kg of body weight). This study aimed to assess the potential of 4R for clinical trials in neurotherapy in male nonhuman primates. Ten macaques (Macacca mulatta) were randomly separated into two groups of 5 and then intravenously injected with 4R or vehicle for 11 consecutive days at a dose of 1.4 mg/kg. Throughout the study, we monitored brain activity by electroencephalogram, somatosensory evoked potentials, and transcranial motor evoked potentials on days 0, 4, 8, and 12 and found no significant changes. The spontaneous behavior of the primates remained unaffected by the treatment. Minor hematological and blood composition variations were also detected in the experimental animals but lacked clinical significance. In conclusion, our results reinforce the notion that 4R is non-toxic in nonhuman primates under the conditions of this study.
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Affiliation(s)
- Nadezhda Sabeva
- Department of Neurosciences, Universidad Central del Caribe, School of Medicine, Bayamón, PR 00956, USA
| | | | - Yancy Ferrer Acosta
- Department of Neurosciences, Universidad Central del Caribe, School of Medicine, Bayamón, PR 00956, USA; Department of Anatomy and Neurobiology University of Puerto Rico, Medical Sciences Campus, Guillermo Arbona, Área de Centro Médico Río Piedras, PR 00935, USA.
| | | | | | - Demetrio Sierra-Mercado
- Department of Anatomy and Neurobiology University of Puerto Rico, Medical Sciences Campus, Guillermo Arbona, Área de Centro Médico Río Piedras, PR 00935, USA.
| | - Naydi Pérez Rios
- Biostatistics, Epidemiology, and Research Design Core, Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico, Medical Sciences Campus, Área de Centro Médico Río Piedras, PR 00935, USA.
| | - Sona Rivas-Tumanyan
- Biostatistics, Epidemiology, and Research Design Core, Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico, Medical Sciences Campus, Área de Centro Médico Río Piedras, PR 00935, USA; Office of Assistant Dean for Research and Department of Surgical Sciences, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, Área de Centro Médico Río Piedras, PR 00935, USA.
| | - Antonio H Martins
- Department of Pharmacology and Toxicology, University of Puerto Rico, Medical Sciences Campus, Guillermo Arbona, Área de Centro Médico Río Piedras, PR 00935, USA.
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Deng G, Chu YH, Xiao J, Shang K, Zhou LQ, Qin C, Tian DS. Risk Factors, Pathophysiologic Mechanisms, and Potential Treatment Strategies of Futile Recanalization after Endovascular Therapy in Acute Ischemic Stroke. Aging Dis 2023; 14:2096-2112. [PMID: 37199580 PMCID: PMC10676786 DOI: 10.14336/ad.2023.0321-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/22/2023] [Indexed: 05/19/2023] Open
Abstract
Endovascular therapy is the first-line treatment for acute ischemic stroke. However, studies have shown that, even with the timely opening of occluded blood vessels, nearly half of all patients treated with endovascular therapy for acute ischemic stroke still have poor functional recovery, a phenomenon called "futile recanalization.". The pathophysiology of futile recanalization is complex and may include tissue no-reflow (microcirculation reperfusion failure despite recanalization of the occluded large artery), early arterial reocclusion (reocclusion of the recanalized artery 24-48 hours post endovascular therapy), poor collateral circulation, hemorrhagic transformation (cerebral bleeding following primary ischemic stroke), impaired cerebrovascular autoregulation, and large hypoperfusion volume. Therapeutic strategies targeting these mechanisms have been attempted in preclinical research; however, translation to the bedside remains to be explored. This review summarizes the risk factors, pathophysiological mechanisms, and targeted therapy strategies of futile recanalization, focusing on the mechanisms and targeted therapy strategies of no-reflow to deepen the understanding of this phenomenon and provide new translational research ideas and potential intervention targets for improving the efficacy of endovascular therapy for acute ischemic stroke.
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Affiliation(s)
- Gang Deng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yun-hui Chu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jun Xiao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ke Shang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Luo-Qi Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chuan Qin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dai-Shi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Ahmed R, Maqsood H, Bains RS, Gulraiz A, Kamal M. Intracranial atherosclerotic disease: current management strategies. Ann Med Surg (Lond) 2023; 85:4903-4908. [PMID: 37811034 PMCID: PMC10552953 DOI: 10.1097/ms9.0000000000001145] [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: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 10/10/2023] Open
Abstract
A stroke due to underlying intracranial large artery occlusion, which is atherosclerotic in nature, is known as intracranial atherosclerotic disease (ICAD). It is important to recognize that ischaemic stroke due to ICAD differs from extracranial disease and other stroke aetiologies and requires a nuanced approach. It is a significant cause of stroke worldwide, and severe symptomatic ICAD can present challenges from a therapeutic standpoint, including recurrent ischaemic stroke despite optimal management. Furthermore, exploring the underlying pathophysiological mechanisms responsible for the disease may be necessary while considering treatment options. This narrative review aims to provide an all-encompassing overview of this disease. Epidemiology and clinical pathophysiology will be explored in detail. The findings of large clinical trials will serve as a guide to finding the most optimized management strategies. Another critical question that arises is the treatment of acute ischaemic stroke due to large vessel occlusion with underlying intracranial atherosclerosis, is the treatment and clinical diagnosis the same as for other aetiologies of stroke (i.e. extracranial disease and nonvalvular atrial fibrillation)? Consequently, secondary prevention of patients with ischaemic stroke or transient ischaemic attack will be divided into medical therapy, risk factor control, and endovascular and surgical treatment options.
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Affiliation(s)
| | | | | | | | - Meraj Kamal
- BP Koirala Institute of Health Sciences, Dharan-18, Nepal
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5
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Wang D, Shang ZY, Cui Y, Yang BQ, Ntaios G, Chen HS. Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion. Stroke Vasc Neurol 2023; 8:387-398. [PMID: 36914215 PMCID: PMC10648047 DOI: 10.1136/svn-2022-002071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source using 3.0 T high-resolution MRI (HR-MRI). METHODS We retrospectively enrolled eligible patients from January 2015 to July 2021. The multidimensional parameters of plaque such as remodelling index (RI), plaque burden (PB), percentage lipid-rich necrotic core (%LRNC), presence of discontinuity of plaque surface (DPS), fibrous cap rupture, intraplaque haemorrhage and complicated plaque were evaluated by HR-MRI. RESULTS Among 279 stroke patients, intracranial plaque proximal to LVO was more prevalent in the ipsilateral versus contralateral side to stroke (75.6% vs 58.8%, p<0.001). The larger PB (p<0.001), RI (p<0.001) and %LRNC (p=0.001), the higher prevalence of DPS (61.1% vs 50.6%, p=0.041) and complicated plaque (63.0% vs 50.6%, p=0.016) were observed in the plaque ipsilateral versus contralateral to stroke. Logistic analysis showed that RI and PB were positively associated with an ischaemic stroke (RI: crude OR: 1.303, 95% CI 1.072 to 1.584, p=0.008; PB: crude OR: 1.677, 95% CI 1.381 to 2.037, p<0.001). In subgroup with <50% stenotic plaque, the greater PB, RI, %LRNC and the presence of complicated plaque were more closely related to stroke, which was not evident in subgroup with ≥50% stenotic plaque. CONCLUSION This is the first study to report the characteristics of intracranial plaque proximal to LVO in non-cardioembolic stroke. It provides potential evidence to support different aetiological roles of <50% stenotic vs ≥50% stenotic intracranial plaque in this population.
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Affiliation(s)
- Dan Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Zi-Yang Shang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Ben-Qiang Yang
- Radiology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
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Shibata A, Yanagawa T, Sugasawa S, Ikeda S, Ikeda T. Multiple large vessel occlusions resulting in vessel perforation in single pass of mechanical thrombectomy with stent retriever. Radiol Case Rep 2023; 18:3206-3211. [PMID: 37448599 PMCID: PMC10338195 DOI: 10.1016/j.radcr.2023.06.024] [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: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Mechanical thrombectomy (MT) is a highly effective treatment for acute ischemic stroke, and hemorrhagic complications caused by vessel injury are rare. However, there is no evidence regarding the efficacy of MT for multiple large vessel occlusion or its procedural strategy. Herein, we report a case of MT with a stent retriever for multiple large vessel occlusion in the internal carotid artery and middle cerebral artery M1 distal, which resulted in vessel perforation in a single pass. A 79-year-old woman underwent MT for internal carotid artery occlusion, and multiple large vessel occlusion was observed on digital subtraction angiography. A longer and larger stent retriever was selected for thrombus retrieval in a single pass. Immediately after retrieval, digital subtraction angiography revealed internal carotid artery recanalization. Then, extravasation was observed from the M1 distal occlusion. Treatment was interrupted after hemostasis was confirmed. Nevertheless, rebleeding occurred after 4 hours. Emergency trapping was performed, and vessel perforation of >1 mm was observed. When retrieving a thrombus in a single pass with a stent retriever for multiple large vessel occlusion, vessel perforation may occur if the device is selected according to the diameter of the proximal occluded vessel. Based on the type of device, even a single pass may result in vessel perforation. Although aggressive MT intervention should be performed for multiple large vessel occlusion, a device that is appropriate for the pathological condition must be selected.
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7
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Kass-Hout T, Morsi RZ, Thind S, Karrison T, Lee H, Nahab F, Gupta R, Carrión-Penagos J, Awad IA, Coleman E, Brorson JR, McKoy C, Morales J, Mendelson S, Mansour A, Prabhakaran S. Underlying intracranial atherosclerotic disease is associated with worse outcomes in acute large vessel occlusion undergoing endovascular thrombectomy. J Stroke Cerebrovasc Dis 2023; 32:107227. [PMID: 37437522 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107227] [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: 12/24/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Data on large vessel occlusion (LVO) management due to intracranial atherosclerotic disease (ICAD) are scarce. OBJECTIVE To compare clinical outcomes between patients with ICAD and those without ICAD following mechanical thrombectomy (MT). METHODS We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center, and compared in-hospital mortality, 90-day mortality, favorable functional outcome at 90 days, and symptomatic intracranial hemorrhage (ICH) using chi-squared tests and multivariate logistic regression analyses. We defined ICAD as observable plaque at occlusion site post-thrombectomy. RESULTS Among 215 patients (mean age 67.1 ± 16.0 years; 60.5% female; 83.6% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p = 0.027 and 29.0% vs. 14.7%, p = 0.035, respectively). Substantial reperfusion (TICI ≥2b) was achieved less often (84.2% vs. 94.4%, p = 0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p = 0.081). In-hospital and 90-day mortality were more common (36.8% vs. 15.8%, p = 0.003 and 52.6% vs. 26.6%, p = 0.002, respectively) and favorable functional outcome (mRS 0-2) at 90 days was less common (7.9% vs. 33.9%, p = 0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in-hospital mortality (OR=4.1, 95% CI 1.7-9.7), 90-day mortality (OR=3.7, 95% CI 1.6-8.6), and poor functional outcome at 90 days (OR=5.5, 95% CI 1.6-19.4). CONCLUSION Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT.
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Affiliation(s)
- Tareq Kass-Hout
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States.
| | - Rami Z Morsi
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Sonam Thind
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
| | - Harrison Lee
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Rishi Gupta
- Department of Neurosurgery, WellStar Health System, Marietta, GA, United States
| | - Julián Carrión-Penagos
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Issam A Awad
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Elisheva Coleman
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - James R Brorson
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Cedric McKoy
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Jacqueline Morales
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Scott Mendelson
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Ali Mansour
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
| | - Shyam Prabhakaran
- Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States
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de Havenon A, Zaidat OO, Amin-Hanjani S, Nguyen TN, Bangad A, Abassi M, Anadani M, Almallouhi E, Chatterjee R, Mazighi M, Mistry E, Yaghi S, Derdeyn C, Hong KS, Kvernland A, Leslie-Mazwi T, Al Kasab S. Large Vessel Occlusion Stroke due to Intracranial Atherosclerotic Disease: Identification, Medical and Interventional Treatment, and Outcomes. Stroke 2023; 54:1695-1705. [PMID: 36938708 PMCID: PMC10202848 DOI: 10.1161/strokeaha.122.040008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Large vessel occlusion stroke due to underlying intracranial atherosclerotic disease (ICAD-LVO) is prevalent in 10 to 30% of LVOs depending on patient factors such as vascular risk factors, race and ethnicity, and age. Patients with ICAD-LVO derive similar functional outcome benefit from endovascular thrombectomy as other mechanisms of LVO, but up to half of ICAD-LVO patients reocclude after revascularization. Therefore, early identification and treatment planning for ICAD-LVO are important given the unique considerations before, during, and after endovascular thrombectomy. In this review of ICAD-LVO, we propose a multistep approach to ICAD-LVO identification, pretreatment and endovascular thrombectomy considerations, adjunctive medications, and medical management. There have been no large-scale randomized controlled trials dedicated to studying ICAD-LVO, therefore this review focuses on observational studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Eyad Almallouhi
- Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Mikael Mazighi
- Neurology, Lariboisière hospital-APHP NORD, FHU Neurovasc, Paris Cité University, INSERM 1144, France
| | - Eva Mistry
- Neurology and Rehabilitation Medicine, University of Cincinnati, OH
| | - Shadi Yaghi
- Neurology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Colin Derdeyn
- Neurosurgery, Carver College of Medicine, Iowa City, Iowa
| | - Keun-Sik Hong
- Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | | | | | - Sami Al Kasab
- Neurology, Medical University of South Carolina, Charleston, SC
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Kim JH, Jung YJ. Should we always retrieve? Endovascular treatment outcomes in emergent large-vessel occlusion due to underlying intracranial atherosclerotic stenosis. Clin Neurol Neurosurg 2022; 222:107464. [DOI: 10.1016/j.clineuro.2022.107464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
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10
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Hernández D, Cuevas JL, Gramegna LL, Requena M, Piñana C, de Dios M, Coscojuela P, Esteves M, Li J, Gil A, Ribó M, Tomasello A. Increased Number of Passes and Double Stent Retriever Technique Induces Cumulative Injury on Arterial Wall After Mechanical Thrombectomy in a Swine Model. Transl Stroke Res 2022; 14:425-433. [PMID: 35672562 DOI: 10.1007/s12975-022-01044-1] [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: 02/22/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
The number of stentriever passes during endovascular thrombectomy impacts clinical outcomes in acute ischemic stroke. Previous studies suggest that the simultaneous double stent retriever technique (DSRT) could improve the efficacy and reduce the number of passes. We aim to analyze the degree of vessel wall injury according to the number of passes and technique (single vs. simultaneous devices). Histological changes were evaluated in renal arteries (RAs) of swine models after thrombectomy (1, 2, or 3 passes) with single stent (SSRT) and DSRT. Thrombectomy passes were performed in 12 RA: 3 samples from each artery were studied by optical microscopy to assess a vascular damage score. All thirty-six samples showed endothelial denudation and different degrees of damage in the deepest layers of the arterial wall; however, all arteries remained patent by the time of assessment. In all cases, the degree of vascular injury increased with the number of passes. Compared with a SSRT, DSRT showed a higher severity of histological damage corresponding to the damage caused by 1.4 SSRT passes. However, in distal arteries, vascular damage was relatively similar when comparing SSRT with multiple passes and DSRT with one pass. The degree of vessel injury increases with the number of passes. Even though histological damage per pass was 1.4 higher with DSRT than SSRT, short-term vessel patency was not compromised after up to 3 DSRT passes. Further studies are needed to characterize the risk-benefit ratio of the DSRT in routine clinical practice.
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Affiliation(s)
- David Hernández
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José Luis Cuevas
- Neurosurgery and Interventional Neuroradiology, Hospital de Puerto Montt, Puerto Montt, Chile
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Motor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Manuel Requena
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Piñana
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marta de Dios
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Pilar Coscojuela
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marielle Esteves
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jiahui Li
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alberto Gil
- Interventional Neuroradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marc Ribó
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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11
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Al Kasab S, Almallouhi E, Spiotta AM. Rescue Endovascular Treatment for Emergent Large Vessel Occlusion With Underlying Intracranial Atherosclerosis: Current State and Future Directions. Front Neurol 2021; 12:734971. [PMID: 34759882 PMCID: PMC8573125 DOI: 10.3389/fneur.2021.734971] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Intracranial atherosclerosis (ICAS) is one of the most common causes of stroke worldwide and is associated with high risk of stroke recurrence. While the most common clinical presentation is acute–subacute transient ischemic attack or ischemic stroke, occasionally, patients with underlying ICAS present with acute occlusion of the affected vessel. Diagnosis and endovascular management of ICAS-related emergent large vessel occlusion (ELVO) can be challenging. Herein, we review the current evidence supporting endovascular management of ICAS-related ELVO and discuss future directions.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Alejandro M Spiotta
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
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12
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Kutsuna F, Yamashita K, Kanamoto T, Kurohama H, Tateishi Y, Tsujino A. [Nonrecanalization after mechanical thrombectomy in acute ischemic stroke due to infective endocarditis: an autopsy case]. Rinsho Shinkeigaku 2021; 61:671-675. [PMID: 34565752 DOI: 10.5692/clinicalneurol.cn-001616] [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: 11/05/2022]
Abstract
An 86-year-old man was admitted for the abrupt onset of right hemiparesis and aphasia. DWI revealed the high intensity legion in the left insular cortex, and MRA demonstrated the left middle cerebral artery occlusion. Recanalization of the artery was not achieved after mechanical thrombectomy. The diagnosis of infective endocarditis was made as Enterococcus faecalis was cultured from the blood, and mobile vegetation was detected at the aortic valve by transthoracic echocardiography. The patient died from multiple organ failure at 19 days. Autopsy findings revealed fibrin-rich thrombus in the left middle cerebral artery containing neutrophils and bacteria. At the occluded site, neutrophils had intensively infiltrated into the vessel wall, and endothelial cells had partially disappeared. Moreover, disrupted internal elastic lamina was discovered. These findings could indicate that the thrombus had adhered to the vessel wall. The adhesion of the thrombus and vessel wall could be associated with unsuccessful recanalization after endovascular thrombectomy in patients with ischemic stroke due to infective endocarditis.
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Affiliation(s)
- Fumiya Kutsuna
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Hirokazu Kurohama
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
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13
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Al Kasab S, Almallouhi E, Alawieh A, Wolfe S, Fargen KM, Arthur AS, Goyal N, Dumont T, Kan P, Kim JT, De Leacy R, Maier I, Osbun J, Rai A, Jabbour P, Grossberg JA, Park MS, Starke RM, Crosa R, Spiotta AM. Outcomes of Rescue Endovascular Treatment of Emergent Large Vessel Occlusion in Patients With Underlying Intracranial Atherosclerosis: Insights From STAR. J Am Heart Assoc 2021; 10:e020195. [PMID: 34096337 PMCID: PMC8477850 DOI: 10.1161/jaha.120.020195] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Some emergent large vessel occlusions (ELVOs) are refractory to reperfusion because of underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy (RT) with balloon angioplasty, stenting, or both. In this study, we investigate the safety, efficacy, and long‐term outcomes of RT in the setting of mechanical thrombectomy for ICAS‐related ELVO. Methods and Results We queried the databases of 10 thrombectomy‐capable centers in North America and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). Patients with ELVO who underwent ICAS‐related RT were included. A matched sample was produced for variables of age, admission National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, onset to groin puncture time, occlusion site, and final recanalization. Out of 3025 patients with MT, 182 (6%) patients required RT because of underlying ICAS. Balloon angioplasty was performed on 122 patients, and 117 patients had intracranial stenting. In the matched analysis, 141 patients who received RT matched to a similar number of controls. The number of thrombectomy passes was higher (3 versus 1, P<0.001), and procedural time was longer in the RT group (52 minutes versus 36 minutes, P=0.004). There was a higher rate of symptomatic hemorrhagic transformation in the RT group (7.8% versus 4.3%, P=0.211), however, the difference was not significant. There was no difference in 90‐day modified Rankin scale of 0 to 2 (44% versus 47.5%, P=0.543) between patients in the RT and control groups. Conclusions In patients with ELVO with underlying ICAS requiring RT, despite longer procedure time and a more thrombectomy passes, the 90 days favorable outcomes were comparable with patients with embolic ELVO.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurology Medical University of South Carolina Charleston SC.,Department of Neurosurgery Medical University of South Carolina Charleston SC
| | - Eyad Almallouhi
- Department of Neurology Medical University of South Carolina Charleston SC.,Department of Neurosurgery Medical University of South Carolina Charleston SC
| | - Ali Alawieh
- Department of Neurosurgery Emory University School of Medicine Atlanta GA
| | - Stacey Wolfe
- Department of Neurosurgery Wake Forest School of Medicine Winston Salem NC
| | - Kyle M Fargen
- Department of Neurosurgery Wake Forest School of Medicine Winston Salem NC
| | - Adam S Arthur
- Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis TN
| | - Nitin Goyal
- Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis TN.,Department of Neurology University of Tennessee Health Science Center Memphis TN
| | - Travis Dumont
- Department of Neurosurgery University of Arizona Health Sciences Tucson AZ
| | - Peter Kan
- Department of Neurosurgery Baylor School of Medicine Houston TX
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Seoul South Korea
| | - Reade De Leacy
- Department of Neurosurgery Mount Sinai Health System New York NY
| | - Ilko Maier
- Department of Neurology University Medical Center Göttingen Göttingen Germany
| | - Joshua Osbun
- Department of Neurosurgery Washington University of School of Medicine St. Louis MO
| | - Ansaar Rai
- Department of Radiology West Virginia School of Medicine Morgantown WV
| | - Pascal Jabbour
- Department of Neurosurgery Thomas Jefferson University Hospitals Philadelphia PA
| | | | - Min S Park
- Department of Neurosurgery University of Virginia Charlottesville VA
| | - Robert M Starke
- Department of Neurosurgery University of Miami Health System Miami FL
| | - Roberto Crosa
- Department of Neurosurgery Endovascular Neurological Center Médica Uruguaya Montevideo Uruguay
| | - Alejandro M Spiotta
- Department of Neurosurgery Medical University of South Carolina Charleston SC
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14
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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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15
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Lee SH, Shin HS, Oh I. The Protective Effects of Statins Towards Vessel Wall Injury Caused by a Stent Retrieving Mechanical Thrombectomy Device : A Histological Analysis of the Rabbit Carotid Artery Model. J Korean Neurosurg Soc 2021; 64:693-704. [PMID: 33985322 PMCID: PMC8435644 DOI: 10.3340/jkns.2020.0303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/03/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Endovascular mechanical thrombectomy (MT) has been regarded as one of the standard treatments for acute ischemic stroke caused by large vessel occlusion. Despite the wide use of stent retrievers for MT, arterial intimal damage caused when deployed stent is pulled has been a certain disadvantage. We hypothesized that statin could protect and stabilize vessel damage after endovascular MT using a stent retriever. In this animal study, we observed the protective effects of the statins towards MT-induced vessel wall injury. Methods Twenty-eight carotid arteries of fourteen rabbits were used in the experiments with MT using stent retriever. We divided the rabbits into four groups as follows : group 1, negative control; group 2, positive control; group 3, statin before MT; and group 4, statin after MT. After MT procedures, we harvested the carotid arteries and performed histomorphological and immunohistochemical analyses. Results In histomorphological analysis with hematoxylin and eosin and Masson's trichrome stain, significant intimal thickening (p<0.05) was observed in the positive control (group 2), compared to in the negative control (group 1). Intimal thickening was improved in the statin-administered groups (groups 3 and 4 vs. group 2, p<0.05). We also observed that statin administration after MT (group 4) resulted in a more effective decrease in intimal thickness than statin administration before MT (group 3) (p<0.05). We performed immunohistochemical analysis with the antibodies for tumor necrosis factor-alpha (TNF-α), cluster of differentiation (CD)11b, and CD163. In contrast to the negative control (group 1), the stained percentage areas of all immunological markers were markedly increased in the positive control (group 2) (p<0.05). Based on statin administration, the percentage area of TNF-α staining was significantly reduced (p<0.05) in group 3, compared to the positive control group (group 2). However, significant differences were not observed for CD11b and CD163 staining. In group 4, no significant differences were observed for TNF-α, CD11b, and CD163 staining (p≥0.05). The differences in the percentage areas of the different markers between the statin-administered groups (groups 3 and 4) were also not revealed. Conclusion We presented that statin administration before and after MT exerted protective effects towards vessel wall injury. The efficacy of statins was greater post-administration than pre-administration. Thus, statin administration in routine prescriptions in the peri-procedural period is strongly advised.
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Affiliation(s)
- Seung Hwan Lee
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Inho Oh
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
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16
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Mereuta OM, Abbasi M, Fitzgerald S, Dai D, Kadirvel R, Hanel RA, Yoo AJ, Almekhlafi MA, Layton KF, Delgado Almandoz JE, Kvamme P, Mendes Pereira V, Jahromi BS, Nogueira RG, Gounis MJ, Patel B, Aghaebrahim A, Sauvageau E, Bhuva P, Soomro J, Demchuk AM, Thacker IC, Kayan Y, Copelan A, Nazari P, Cantrell DR, Haussen DC, Al-Bayati AR, Mohammaden M, Pisani L, Rodrigues GM, Puri AS, Entwistle J, Meves A, Arturo Larco JL, Savastano L, Cloft HJ, Kallmes DF, Doyle KM, Brinjikji W. Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy. J Neurointerv Surg 2021; 14:356-361. [PMID: 33975922 PMCID: PMC8581068 DOI: 10.1136/neurintsurg-2021-017310] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/12/2022]
Abstract
Background Several animal studies have demonstrated that mechanical thrombectomy (MT) for acute ischemic stroke (AIS) may cause vessel wall injury (VWI). However, the histological changes in human cerebral arteries following MT are difficult to determine. Objective To investigate the occurrence of VWI during MT by histological and immunohistochemical evaluation of AIS clots. Methods As part of the multicenter STRIP registry, 277 clots from 237 patients were analyzed using Martius Scarlett Blue stain and immunohistochemistry for CD34 (endothelial cells) and smooth muscle actin (smooth muscle cells). Results MT devices used were aspiration catheters (100 cases), stentriever (101 cases), and both (36 cases). VWI was found in 33/277 clots (12%). There was no significant correlation between VWI and MT device. The degree of damage varied from grade I (mild intimal damage, 24 clots), to grade II (relevant intimal and subintimal damage, 3 clots), and III (severe injury, 6 clots). VWI clots contained significantly more erythrocytes (p=0.006*) and less platelets/other (p=0.005*) than non-VWI clots suggesting soft thrombus material. Thrombolysis correlated with a lower rate of VWI (p=0.04*). VWI cases showed a significantly higher number of passes (2 [1–4] vs 1 [1–3], p=0.028*) and poorer recanalization outcome (p=0.01*) than cases without VWI. Conclusions Histological markers of VWI were present in 12% of AIS thrombi, suggesting that VWI might be related to MT. VWI was associated with soft thrombus consistency, higher number of passes and poorer revascularization outcome. There was no significant correlation between VWI and MT device.
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Affiliation(s)
- Oana Madalina Mereuta
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA .,CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Albert J Yoo
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Josser E Delgado Almandoz
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Vitor Mendes Pereira
- Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Babak S Jahromi
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - Biraj Patel
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Amin Aghaebrahim
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Parita Bhuva
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Jazba Soomro
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Copelan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pouya Nazari
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Donald Robert Cantrell
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Diogo C Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Gabriel Martins Rodrigues
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - John Entwistle
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge L Arturo Larco
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Karen M Doyle
- CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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17
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Yoo J, Lee SJ, Hong JH, Kim YW, Hong JM, Kim CH, Kang DH, Choi JW, Kim YS, Sohn SI, Hwang YH, Lee JS. Immediate effects of first-line thrombectomy devices for intracranial atherosclerosis-related occlusion: stent retriever versus contact aspiration. BMC Neurol 2020; 20:283. [PMID: 32682406 PMCID: PMC7368707 DOI: 10.1186/s12883-020-01862-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although stent retriever (SR) is recommended as a frontline device of endovascular treatment (EVT) for embolic large artery occlusion causing acute ischemic stroke, contact aspiration (CA) device showed similar efficacy in the recent trials. However, the efficacy of the both devices as first-line therapy for intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion has not yet been established. Therefore, we compared the immediate effects and final outcomes of SR and CA as first-line devices for treating ICAS-related occlusions. METHODS We retrospectively analyzed the data of patients who underwent EVT for acute ischemic stroke from the registry of three Korean hospitals. Patients with ICAS-related occlusion who were treated within 24 h of onset of the symptoms were included. We investigated immediate reperfusion performance, immediate safety outcomes, and 3-month clinical outcomes for the two first-line devices. RESULTS Of the 720 registered patients, 111 were eligible for this study. Forty-nine patients (44.1%) used SR and 62 (55.9%) used CA as the first-line device. Achieving successful reperfusion immediately after first-line thrombectomy was more frequent in the SR group than that in the CA group (77.6% vs. 43.5%, p = 0.001), with fewer additional rescue treatments (12.2% vs. 59.7%, p < 0.001). The incidence of iatrogenic dissection or rupture was lower in the SR group than that in the CA group (8.2% vs. 29.0%, p = 0.012). After additional rescue treatments, however, the final successful reperfusion rate did not differ between the two groups (SR 87.8% vs. CA 77.4%, p = 0.247), and there was no significant difference in the 3-month good outcomes (modified Rankin Scale, p = 0.524). CONCLUSIONS First-line SR thrombectomy showed higher immediate reperfusion and less vessel injury for ICAS-related occlusions than CA. However, there was no significant difference in the final reperfusion status or 3-month outcomes from additional rescue treatments.
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Affiliation(s)
- Joonsang Yoo
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.,Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University Medical Center, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Yong-Won Kim
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University Medical Center, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University School of Medicine, Daegu, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Yong-Sun Kim
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea.
| | - Jin Soo Lee
- Department of Neurology, Ajou University Medical Center, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
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18
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Matsunaga Y, Morofuji Y, Horie N. Delayed Vasospasm Associated with Mechanical Thrombectomy for Acute Ischemic Stroke. World Neurosurg 2020; 138:197-199. [PMID: 32173552 DOI: 10.1016/j.wneu.2020.03.027] [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: 01/16/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Abstract
Vasospasm related to mechanical thrombectomy for acute ischemic stroke sometimes occurs as a periprocedural complication, although it is usually a transient and asymptomatic event. Herein we describe the second case of symptomatic delayed vasospasm associated with mechanical thrombectomy, highlighting its unique device-related adverse event. When intraoperative vasospasm occurs, we should pay attention to this phenomenon, and close follow-up is necessary.
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Affiliation(s)
- Yuki Matsunaga
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Pasarikovski CR, Keith J, da Costa L, Ramjist J, Dobashi Y, Black SE, Yang VXD. Optical coherence tomography imaging after endovascular thrombectomy: a novel method for evaluating vascular injury in a swine model. J Neurosurg 2020; 134:870-877. [PMID: 32059182 DOI: 10.3171/2019.12.jns192881] [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: 10/22/2019] [Accepted: 12/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although studies have shown that some degree of iatrogenic endothelial injury occurs during endovascular thrombectomy (EVT), the clinical significance of such injury is uncertain. Furthermore, it is likely that iatrogenic effects such as endothelial denudation, intimal dissection, and tunica media edema will have varying clinical implications. The purpose of this study was to assess the feasibility of endovascular optical coherence tomography (OCT) in quantifying vessel injury in real time after EVT, correlate vessel injury with histological findings, and perform imaging at varying time intervals after EVT to assess the impact of prolonged direct exposure of the vessel to the thrombus. METHODS Yorkshire swine weighing 35-40 kg were selected for use as the animal model, with a total of 9 vessels from 3 swine examined. Thrombectomy was performed using a second-generation stent retriever 1, 3, and 6 hours after thrombus deposition. The presence and degree of denudation of the endothelium, detachment and separation of the layers of the tunic media, hemorrhage within the media, dissection of the vessels, and thrombus within the lumina were assessed using OCT images acquired immediately after EVT. Bland-Altman analysis indicated that these OCT findings were correlated with postmortem histological findings. RESULTS OCT image acquisition was technically successful in all cases. Endothelial denudation was present in 65% ± 16%, 87% ± 8%, and 93% ± 7% of the vessel surface 1, 3, and 6 hours, respectively, after thrombus deposition and subsequent EVT. Residual intraluminal thrombus was present in vessels at all time intervals despite complete angiographic revascularization. Bland-Altman plots showed good agreement between OCT and histological analysis with respect to the degree of endothelial denudation and elevation, separation of the tunica media, and hemorrhage within the media. OCT appears to be more specific than histological analysis in detecting endothelial elevation. CONCLUSIONS OCT is a feasible method that can be used to assess vascular injury after EVT with histological accuracy. Varying degrees of vessel injury occur after EVT, and residual luminal thrombus can be present despite complete angiographic revascularization.
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Affiliation(s)
| | - Julia Keith
- 2Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Leodante da Costa
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Joel Ramjist
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Yuta Dobashi
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Sandra E Black
- 4Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto; and.,5Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Victor X D Yang
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto.,4Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto; and
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20
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Imaging Clot Characteristics in Stroke and its Possible Implication on Treatment. Clin Neuroradiol 2019; 30:27-35. [DOI: 10.1007/s00062-019-00841-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
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21
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Tsang ACO, Orru E, Klostranec JM, Yang IH, Lau KK, Tsang FCP, Lui WM, Pereira VM, Krings T. Thrombectomy Outcomes of Intracranial Atherosclerosis-Related Occlusions. Stroke 2019; 50:1460-1466. [DOI: 10.1161/strokeaha.119.024889] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anderson Chun On Tsang
- Division of Neurosurgery, Department of Surgery (A.C.O.T., F.C.P.T., W.M.L.), The University of Hong Kong
- Division of Neuroradiology, Joint Department of Medical Imaging (A.C.O.T., E.O., J.M.K., I.-H.Y., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Canada
| | - Emanuele Orru
- Division of Neuroradiology, Joint Department of Medical Imaging (A.C.O.T., E.O., J.M.K., I.-H.Y., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Canada
| | - Jesse M. Klostranec
- Division of Neuroradiology, Joint Department of Medical Imaging (A.C.O.T., E.O., J.M.K., I.-H.Y., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Canada
| | - I-Hsiao Yang
- Division of Neuroradiology, Joint Department of Medical Imaging (A.C.O.T., E.O., J.M.K., I.-H.Y., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Canada
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine (K.K.L.), The University of Hong Kong
| | - Frederick Chun Pong Tsang
- Division of Neurosurgery, Department of Surgery (A.C.O.T., F.C.P.T., W.M.L.), The University of Hong Kong
| | - Wai Man Lui
- Division of Neurosurgery, Department of Surgery (A.C.O.T., F.C.P.T., W.M.L.), The University of Hong Kong
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging (A.C.O.T., E.O., J.M.K., I.-H.Y., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Canada
- Division of Neurosurgery, Department of Surgery, University Health Network (V.M.P.), Toronto Western Hospital, University of Toronto, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging (A.C.O.T., E.O., J.M.K., I.-H.Y., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Canada
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22
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Spangler TA, Katzman SA. Pathological Safety Assessment in Preclinical Neurothrombectomy Studies. Toxicol Pathol 2019; 47:264-279. [PMID: 30832552 DOI: 10.1177/0192623319826066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The design, production, and preclinical testing of neurothrombectomy devices is in a burgeoning phase as the demand escalates for safe and reliable treatment options following neurovascular stroke. Currently, there is a paucity of published data describing the development of iatrogenic vascular lesions occurring secondary to neurothrombectomy procedures. In an effort to test new devices, demonstrate device safety, satisfy regulatory requirements, and develop an understanding of the potential for associated vascular pathology, investigators are establishing appropriate methodology in suitable animal models. Significant challenges exist in identifying a single animal species that can be consistently utilized in all phases of device development. These aforementioned challenges are underscored by the intricacies of neurovascular pathology, thrombovascular interactions, and vascular responses to injury.
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Affiliation(s)
| | - Scott A Katzman
- 2 William R. Pritchard Veterinary Medical Teaching Hospital, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
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23
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Koge J, Kato S, Hashimoto T, Nakamura Y, Kawajiri M, Yamada T. Vessel Wall Injury After Stent Retriever Thrombectomy for Internal Carotid Artery Occlusion with Duplicated Middle Cerebral Artery. World Neurosurg 2019; 123:54-58. [DOI: 10.1016/j.wneu.2018.11.223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
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24
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Lin F, Pei L, Zhang Q, Han W, Jiang S, Lin Y, Dong B, Cui L, Li M. Ox-LDL induces endothelial cell apoptosis and macrophage migration by regulating caveolin-1 phosphorylation. J Cell Physiol 2018; 233:6683-6692. [PMID: 29323707 DOI: 10.1002/jcp.26468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/05/2018] [Indexed: 12/16/2022]
Abstract
Oxidative low-density lipoprotein (ox-LDL) is a risk factor for atherosclerosis. Ox-LDL leads to endothelial injury in the initial stage of atherosclerosis. In this study, we investigated the role of ox-LDL in endothelial injury and macrophage recruitment. We demonstrated that ox-LDL promoted a dose-dependent phosphorylation of caveolin-1 in human umbilical vein endothelial cells. Phosphorylated caveolin-1 increased ox-LDL uptake. Intracellular accumulation of ox-LDL induced NF-κB p65 phosphorylation, promoted HMGB1 translocation from nucleus to cytoplasm and cytochrome C release from mitochondria to cytoplasm, and activated caspase 3, resulting in cell apoptosis. NF-κB activation also facilitated cavolin-1 phosphorylation and HMGB1 expression. In addition, caveolin-1 phosphorylation favored HMGB1 release and nuclear translocation of EGR1. Nuclear translocation of EGR1 contributed to cytoplasmic translocation of HMGB1. The extracellular HMGB1 induced the migration of PMBC-derived macrophages toward HUVECs in a TLR4-dependent manner. Our results suggested that ox-LDL promoted HUVECs apoptosis and macrophage recruitment by regulating caveolin-1 phosphorylation.
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Affiliation(s)
- Fei Lin
- Department of Cardiology, Shandong Energy Zibo Mining Group Co., Ltd Central Hospital, Zibo, China
| | - Likai Pei
- Department of Cardiology, Shandong Energy Zibo Mining Group Co., Ltd Central Hospital, Zibo, China
| | - Qingbin Zhang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Weizhong Han
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shiliang Jiang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yanliang Lin
- Department of Center Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Bo Dong
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lianqun Cui
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Min Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Vinters HV, Zarow C, Borys E, Whitman JD, Tung S, Ellis WG, Zheng L, Chui HC. Review: Vascular dementia: clinicopathologic and genetic considerations. Neuropathol Appl Neurobiol 2018; 44:247-266. [DOI: 10.1111/nan.12472] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- H. V. Vinters
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - C. Zarow
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - E. Borys
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
- Department of Pathology; Loyola University Medical Center; Maywood IL USA
| | - J. D. Whitman
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
- Departments of Pathology & Laboratory Medicine; UC San Francisco Medical Center; San Francisco CA USA
| | - S. Tung
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - W. G. Ellis
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
| | - L. Zheng
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - H. C. Chui
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
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Yedavalli V, Sammet S. Contrast Extravasation versus Hemorrhage after Thrombectomy in Patients with Acute Stroke. J Neuroimaging 2017; 27:570-576. [PMID: 28514045 PMCID: PMC5665701 DOI: 10.1111/jon.12446] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Intra-arterial recanalization postprocedural imaging in stroke patients can result in diagnostic complications due to hyperdensities on noncontrast computed tomography (CT), which may represent either contrast extravasation or intracranial hemorrhage. If these lesions are hemorrhage, then they are risk factors becoming symptomatic, which, if not distinguished, can alter clinical management. We investigate the effects of iodinated contrast on postprocedural magnetic resonance imaging (MRI) and prevalence of equivocal imaging interpretations of postprocedural extravasated contrast versus hemorrhage while identifying protocol pitfalls. METHODS We identified 10 patients diagnosed with ischemic stroke who underwent intra-arterial recanalization in a 5-year period. These patients demonstrated a hyperdensity on a postprocedural CT within 24 hours, underwent an MRI within 48 hours, and an additional confirmatory noncontrast CT at least 72 hours postprocedure. RESULTS Postprocedural MRI in all 10 stroke patients demonstrated T1 - and T2 -relaxation time changes due to residual iodine contrast agents. This lead to false positive postprocedural hemorrhage MRI interpretations in 2/10 patients, 3/10 false negative interpretations of contrast extravasation, and 5/10 equivocal interpretations suggesting extravasation or hemorrhage. Of these five cases, two were performed with gadolinium. CONCLUSION MRI done within 48 hours postprocedure can lead to false positive hemorrhage or false negative contrast extravasation interpretations in stroke patients possibly due to effects from the administered angiographic contrast. Additionally, MRI should be done both after 72 hours for confirmation and without gadolinium contrast as the effects of the gadolinium contrast and residual angiographic contrast could lead to misdiagnosis.
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Affiliation(s)
- Vivek Yedavalli
- Department of Diagnostic Radiology, Advocate Illinois Masonic Medical Center, Chicago, IL
- Department of Radiology, University of Chicago, Chicago, IL
| | - Steffen Sammet
- Department of Radiology, University of Chicago, Chicago, IL
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27
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Renú A, Laredo C, Lopez-Rueda A, Llull L, Tudela R, San-Roman L, Urra X, Blasco J, Macho J, Oleaga L, Chamorro A, Amaro S. Vessel Wall Enhancement and Blood–Cerebrospinal Fluid Barrier Disruption After Mechanical Thrombectomy in Acute Ischemic Stroke. Stroke 2017; 48:651-657. [DOI: 10.1161/strokeaha.116.015648] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/22/2016] [Accepted: 12/19/2016] [Indexed: 01/23/2023]
Abstract
Background and Purpose—
Less than half of acute ischemic stroke patients treated with mechanical thrombectomy obtain permanent clinical benefits. Consequently, there is an urgent need to identify mechanisms implicated in the limited efficacy of early reperfusion. We evaluated the predictors and prognostic significance of vessel wall permeability impairment and its association with blood–cerebrospinal fluid barrier (BCSFB) disruption after acute stroke treated with thrombectomy.
Methods—
A prospective cohort of acute stroke patients treated with stent retrievers was analyzed. Vessel wall permeability impairment was identified as gadolinium vessel wall enhancement (GVE) in a 24- to 48-hour follow-up contrast-enhanced magnetic resonance imaging, and severe BCSFB disruption was defined as subarachnoid hemorrhage or gadolinium sulcal enhancement (present across >10 slices). Infarct volume was evaluated in follow-up magnetic resonance imaging, and clinical outcome was evaluated with the modified Rankin Scale at day 90.
Results—
A total of 60 patients (median National Institutes of Health Stroke Scale score, 18) were analyzed, of whom 28 (47%) received intravenous alteplase before mechanical thrombectomy. Overall, 34 (57%) patients had GVE and 27 (45%) had severe BCSFB disruption. GVE was significantly associated with alteplase use before thrombectomy and with more stent retriever passes, along with the presence of severe BCSFB disruption. GVE was associated with poor clinical outcome, and both GVE and severe BCSFB disruption were associated with increased final infarct volume.
Conclusions—
These findings may support the clinical relevance of direct vessel damage and BCSFB disruption after acute stroke and reinforce the need for further improvements in reperfusion strategies. Further validation in larger cohorts of patients is warranted.
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Affiliation(s)
- Arturo Renú
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Carlos Laredo
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Antonio Lopez-Rueda
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Laura Llull
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Raúl Tudela
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Luis San-Roman
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Xabier Urra
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Jordi Blasco
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Juan Macho
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Laura Oleaga
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Angel Chamorro
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Sergio Amaro
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
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Qureshi AI, Qureshi MH, Lobanova I, Bashir A, Khan AA, Bologna SM, Peterson M, Suri MFK. Histopathological Characteristics of IV Recombinant Tissue Plasminogen -Resistant Thrombi in Patients with Acute Ischemic Stroke. JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2016; 8:38-45. [PMID: 26958152 PMCID: PMC4762410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Adnan I. Qureshi
- Zeenat Qureshi Stroke Institute, St Cloud, MN, and CentraCare Health, St. Cloud, MN, USA
| | - Mushtaq H. Qureshi
- Zeenat Qureshi Stroke Institute, St Cloud, MN, and CentraCare Health, St. Cloud, MN, USA
| | - Iryna Lobanova
- JFK New Jersey Neuroscience Institute at Seton Hall University, Edison, NJ, USA
| | - Asif Bashir
- Zeenat Qureshi Stroke Institute, St Cloud, MN, and CentraCare Health, St. Cloud, MN, USA
| | - Asif A. Khan
- Zeenat Qureshi Stroke Institute, St Cloud, MN, and CentraCare Health, St. Cloud, MN, USA
| | - Stephen M. Bologna
- Zeenat Qureshi Stroke Institute, St Cloud, MN, and CentraCare Health, St. Cloud, MN, USA
| | - Michelle Peterson
- Zeenat Qureshi Stroke Institute, St Cloud, MN, and CentraCare Health, St. Cloud, MN, USA
| | - M. Fareed K. Suri
- Zeenat Qureshi Stroke Institute, St Cloud, MN, and CentraCare Health, St. Cloud, MN, USA
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Arai D, Ishii A, Chihara H, Ikeda H, Miyamoto S. Histological examination of vascular damage caused by stent retriever thrombectomy devices. J Neurointerv Surg 2015; 8:992-5. [DOI: 10.1136/neurintsurg-2015-011968] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/05/2015] [Indexed: 11/03/2022]
Abstract
Background and objectivesAlthough the recently marketed stent retriever thrombectomy devices have demonstrated a high recanalization rate and favorable clinical outcomes, there is a concern about the risks of intimal injuries when pulling out the stent in the unfolded position. In this study, the Solitaire Flow Restoration System and the Trevo retriever were used in a histopathological comparison of vascular injuries caused by stent retriever thrombectomy devices.MethodsRabbit carotid arteries were used in the experiments with stent retriever thrombectomy devices. Carotid artery samples were harvested either 1 or 2 weeks postoperatively for histological examination.ResultsHistological changes caused by the use of stent retriever thrombectomy devices were observed from the intimal to medial layers. With the Solitaire FR 4 mm, intimal and medial thickening was observed 1 week postoperatively, and progression of intimal thickening was observed 2 weeks postoperatively. The extent of intimal thickening tended to be greater with the Solitaire FR 6 mm than with the Solitaire FR 4 mm, but this difference was not significant. Compared with the Solitaire FR 4 mm, the Trevo had a significantly smaller area of intimal thickening.ConclusionsAlthough there are some differences among devices, results from this study indicate that stent retriever thrombectomy devices induce vascular damage that extends to the medial layer.
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30
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Hsieh K, Verma RK, Schroth G, Gratz PP, Kellner-Weldon F, Gralla J, Zubler C, Mordasini P, Jung S, Mattle HP, El-Koussy M. Multimodal 3 Tesla MRI Confirms Intact Arterial Wall in Acute Stroke Patients After Stent-Retriever Thrombectomy. Stroke 2014; 45:3430-2. [DOI: 10.1161/strokeaha.114.006665] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kety Hsieh
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Rajeev K. Verma
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Gerhard Schroth
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Pascal P. Gratz
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Frauke Kellner-Weldon
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Jan Gralla
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Christoph Zubler
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Pasquale Mordasini
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Simon Jung
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Heinrich P. Mattle
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Marwan El-Koussy
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
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Power S, Matouk C, Casaubon LK, Silver FL, Krings T, Mikulis DJ, Mandell DM. Vessel Wall Magnetic Resonance Imaging in Acute Ischemic Stroke. Stroke 2014; 45:2330-4. [DOI: 10.1161/strokeaha.114.005618] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah Power
- From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.)
| | - Charles Matouk
- From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.)
| | - Leanne K. Casaubon
- From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.)
| | - Frank L. Silver
- From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.)
| | - Timo Krings
- From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.)
| | - David J. Mikulis
- From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.)
| | - Daniel M. Mandell
- From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.)
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Mechanical Thrombectomy in Basilar Artery Thrombosis: Technical Advances and Safety in a 10-Year Experience. Cardiovasc Intervent Radiol 2014; 37:355-61. [DOI: 10.1007/s00270-013-0827-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
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Fujimoto M, Salamon N, Takemoto K, Takao H, Song L, Tateshima S, Viñuela F. Correlation of clot imaging with endovascular recanalization in internal carotid artery terminus occlusion. J Neurointerv Surg 2014; 7:131-4. [PMID: 24443411 DOI: 10.1136/neurintsurg-2013-010918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE In a swine stroke model we have previously demonstrated a high-intensity fluid attenuated inversion recovery (FLAIR) signal representing the erythrocyte component of the clot. We hypothesized that the intensity of the FLAIR clot signal in patients with acute stroke may predict the efficacy of recanalization by thrombectomy devices. In this study we compared the pretreatment FLAIR signal intensity of the clots in the distal internal carotid artery (ICA) and the degree of angiographic recanalization rate after mechanical thrombectomy. METHODS 25 consecutive acute stroke patients with ICA terminus (ICA-T) occlusion diagnosed with MRI at the UCLA Medical Center between 2002 and 2013 were retrospectively reviewed. The intensity of the FLAIR clot signal at the distal ICA was blindly compared with the angiographic recanalization status (successful recanalization defined as Thrombolysis In Cerebral Infarction (TICI) score of 2b-3) and non-successful recanalization as TICI score 0-2a) after endovascular treatment. Multivariate logistic regression analysis for successful recanalization was performed. RESULTS Successful recanalization was achieved in 40% of patients (10/25) and showed a significantly higher FLAIR intensity (p=0.014). The cut-off value for clot intensity on the FLAIR sequence to predict recanalization was 0.7952, with 70% sensitivity and 80% specificity (95% CI 0.59 to 0.96) using a receiver operating characteristic curve. In multivariate logistic regression analysis, only a high FLAIR clot intensity (>0.7952) was associated with successful recanalization (OR 16.79; 95% CI 1.29 to 218.92; p=0.031). CONCLUSIONS High signal intensity on FLAIR clot imaging may predict successful recanalization after endovascular therapy for ICA-T occlusion.
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Affiliation(s)
- Motoaki Fujimoto
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Noriko Salamon
- Section of Neuroradiology, Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Koichiro Takemoto
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Hiroyuki Takao
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Ligang Song
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Fernando Viñuela
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJB, Culebras A, Elkind MSV, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:2064-89. [PMID: 23652265 PMCID: PMC11078537 DOI: 10.1161/str.0b013e318296aeca] [Citation(s) in RCA: 1930] [Impact Index Per Article: 175.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.
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Abstract
BACKGROUND In 2003, Higashida et al proposed the Thrombolysis In Cerebral Infarction scale to evaluate angiographic intracranial flow. Our aim is to review how subsequently published studies define TICI. MATERIALS AND METHODS We used the ISI Web of Knowledge and SciVerse Scopus databases to search for "TICI" and "thrombolysis in cerebral infarction" and for articles that cited the original TICI paper from January 2004 through May 2012. Articles were categorized according to their definition of the TICI categories, typically grades 0-4, with grade 2 (partial reperfusion) subdivided into 2a and 2b, and rate of contrast entry to the perfused area. In addition, we catalogued the type of redefinitions of TICI subcategory 2 and additions of new categories. RESULTS Of 236 articles screened, 74 were included. Eight (11%) explicitly followed the TICI scale as originally defined. Thirty-seven (50%) cited Higashida but did not define their scale. Fifteen (21%) used and explained modified scales. Thirteen (18%) used the term TICI, but did not define the scale and did not cite Higashida. Eighteen (24%) specified a 2a subcategory. Nine defined grade 2a as <67% filling, 6 defined it as <50%, and 3 did not offer a percentage. Two studies added a 2c subcategory. Fifty-two (70%) used a cutoff level to define "successful reperfusion." Of these, 65% used TICI ≥2, 33% used TICI ≥2b, and 2% used TICI = 3. CONCLUSIONS There is substantial variability in the definition and/or application of the TICI scale in the literature. This variability could considerably impact our understanding of results of revascularization studies.
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Gory B, Bresson D, Kessler I, Perrin ML, Guillaudeau A, Durand K, Ponsonnard S, Couquet C, Yardin C, Mounayer C. Histopathologic evaluation of arterial wall response to 5 neurovascular mechanical thrombectomy devices in a swine model. AJNR Am J Neuroradiol 2013; 34:2192-8. [PMID: 23538407 DOI: 10.3174/ajnr.a3531] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Five commercial devices are available for mechanical thrombectomy in acute ischemic stroke. This study evaluated and compared the resultant arterial damage from these devices. MATERIALS AND METHODS Wall damage after 4 wall-contact devices (the Merci retriever, Catch thromboembolectomy system, and Solitaire FR revascularization devices of 4 and 6 mm) and 1 aspiration device (the Penumbra System) was evaluated in the superficial femoral arteries of 20 male swine. Each device was tested with and without intraluminal clot. Twenty control vessels were not subjected to any intervention. Acute histopathologic changes were evaluated. RESULTS In the device samples, endothelial denudation (72.8 ± 29.4% versus 0.9 ± 1.9%, P < .0001), medial layer edema (52 ± 35.9% versus 18.1 ± 27.8%, P = .004), and mural thrombus (5.3 ± 14.2% versus 0%, P = .05) were found to a greater extent compared with the control samples. The aspiration device provoked more intimal layer (100 ± 79.1% versus 58.8 ± 48.9%, P = .27) and medial layer (75 ± 35.4% versus 46.3 ± 34.8%, P = .13) edema than the wall-contact devices. CONCLUSIONS All devices caused vascular injuries extending into the medial layer. The aspiration device was associated with more intimal and medial layer edema, compared with the wall-contact devices except for the Catch thromboembolectomy system.
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Affiliation(s)
- B Gory
- Departments of Interventional Neuroradiology
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Turk AS, Campbell JM, Spiotta A, Vargas J, Turner RD, Chaudry MI, Battenhouse H, Holmstedt CA, Jauch E. An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke. J Neurointerv Surg 2013; 6:77-80. [DOI: 10.1136/neurintsurg-2012-010616] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kurre W, Pérez MA, Horvath D, Schmid E, Bäzner H, Henkes H. Does mechanical thrombectomy in acute embolic stroke have long-term side effects on intracranial vessels? An angiographic follow-up study. Cardiovasc Intervent Radiol 2012; 36:629-36. [PMID: 23086452 DOI: 10.1007/s00270-012-0496-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/15/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Mechanical thrombectomy (mTE) proved to be effective treating acute vessel occlusions with an acceptable rate of procedural complications. Potential long-term side effects of the vessel wall trauma caused by mechanical irritation of the endothelium are unknown up to now. METHODS From a retrospectively established database of 640 acute stroke treatments, we selected 261 patients with 265 embolic vessel occlusions treated successfully by mTE without permanent implantation of a stent. Analysis comprised the type of devices used and the number of passes performed. Digital subtraction angiography immediately after treatment was evaluated for vasospasm, dissection, and extravasation. Control angiographic images were evaluated for any morphological change compared to the immediate posttreatment angiographic run. RESULTS Recanalization was achieved with a median of one (range 1-10) mTE maneuvers. Vasospasm occurred in 69 territories (26.0 %) and was treated with glyceroltrinitrate in three. Dissection was observed in one vessel (0.4 %). Intraprocedural hemorrhage in two patients (0.8 %) was either wire or device induced. Follow-up digital subtraction angiography was available for 117 territories after a median of 107 days, revealing target vessel occlusion in one segment (0.9 %) and a de novo stenosis of four segments (3.4 %). All findings were clinically asymptomatic. Posttreatment vasospasm was more frequent in patients with de novo stenosis and occlusion (p = 0.038). CONCLUSION De novo stenoses and occlusions occur in a small proportion of patients after mTE. Because all lesions were clinically asymptomatic, this finding does not affect the overall benefit of the treatment. Vasospasm may predict late vessel wall changes.
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Affiliation(s)
- Wiebke Kurre
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174 Stuttgart, Germany.
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Fiehler J, Söderman M, Turjman F, White PM, Bakke SJ, Mangiafico S, von Kummer R, Muto M, Cognard C, Gralla J. Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients - a position paper endorsed by ESMINT and ESNR : part II: methodology of future trials. Neuroradiology 2012; 54:1303-12. [PMID: 22948788 DOI: 10.1007/s00234-012-1076-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/13/2012] [Indexed: 10/27/2022]
Abstract
Based on current data and experience, the joint working group of the European Society of Minimally Invasive Neurological Therapy (ESMINT) and the European Society of Neuroradiology (ESNR) make suggestions on trial design and conduct aimed to investigate therapeutic effects of mechanical thrombectomy (MT). We anticipate that this roadmap will facilitate the setting up and conduct of successful trials in close collaboration with our neighbouring disciplines.
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Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Yuki I, Kan I, Vinters HV, Kim RH, Golshan A, Vinuela FA, Sayre JW, Murayama Y, Vinuela F. The impact of thromboemboli histology on the performance of a mechanical thrombectomy device. AJNR Am J Neuroradiol 2011; 33:643-8. [PMID: 22207297 DOI: 10.3174/ajnr.a2842] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recently we published a novel method of thrombus preparation for use in a swine model for evaluation of thrombectomy designs. The clot (fibrin rich clot) is characterized by its similarity in histologic characteristics to the thromboemboli recovered from stroke patients. The purpose of this latest study was to evaluate if the performance of a mechanical thrombectomy device was affected by the histologic characteristics of thromboembolus. Erythrocyte rich clot, which was created using exogenous thrombin, and the novel experimental clot with abundance of fibrin/cellular component were used for comparison. The Merci clot retriever was used for the evaluation and the angiographic outcomes were analyzed. MATERIALS AND METHODS Two histologically different types of experimental clot, a conventionally used thrombin-induced clot (erythrocyte-rich clot) and a novel experimental clot that is similar in histologic characteristics to the thromboemboli recovered from patients with stroke (fibrin-rich clot), were prepared. Eight extracranial arteries in swine were occluded with erythrocyte-rich clot (group A), and 8 were occluded with fibrin-rich clot (group B), and MT by using the Merci clot retriever device was performed. Angiographic results in each group were evaluated. RESULTS A total of 48 attempts at MT were made. The average number of attempts to achieve TIMI grade II or III recanalization was 2.75 times in group A and 4.5 times in group B (P < .001), respectively. The mean time to achieve recanalization was 15.5 minutes in group A and 81.5 minutes in group B (P < .01). Every vessel in group A showed recanalization (100%), whereas only 3 of 8 samples (37.5%) achieved recanalization in group B. CONCLUSIONS In this model, arteries occluded by fibrin-rich clot demonstrated a significantly lower recanalization rate, lower final TIMI score, and a longer mean recanalization time than did arteries occluded by erythrocyte-rich clot. The angiographic outcome of MT by using the Merci clot retriever system was influenced by the histologic characteristics of the occluding thromboembolus.
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Affiliation(s)
- I Yuki
- Division of Interventional Neuroradiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-1721, USA.
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Suzuki M, Uchihara T, Toru S, Bae Y, Igari T, Kitagawa M, Uchiyama S, Hirokawa K, Kobayashi T. Correlative magnetic resonance imaging and autopsy findings in a patient with coagulation necrosis treated with tissue plasminogen activator. J Stroke Cerebrovasc Dis 2011; 21:512-4. [PMID: 22000524 DOI: 10.1016/j.jstrokecerebrovasdis.2010.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/01/2010] [Accepted: 10/10/2010] [Indexed: 10/16/2022] Open
Abstract
Coagulation necrosis is a peculiar type of ischemic necrosis that is characterized by firm, eosinophilic parenchyma with recognizable cell outlines without massive glial reactions. This is an autopsy report of coagulation necrosis 6 months after thrombolytic tissue plasminogen activator therapy against massive cerebral embolism in an 84-year-old man with atrial fibrillation.
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Affiliation(s)
- Miki Suzuki
- Department of Neurology, Tokyo Metropolitan Institute for Neuroscience, Tokyo, Japan.
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Labadzhyan A, Csiba L, Narula N, Zhou J, Narula J, Fisher M. Histopathologic evaluation of basilar artery atherosclerosis. J Neurol Sci 2011; 307:97-9. [PMID: 21624622 DOI: 10.1016/j.jns.2011.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There has been limited attention to pathological features of basilar artery atherosclerosis. It has been assumed that pathology of basilar artery atherosclerosis mimics that of other vascular beds. METHODS To define the nature of the basilar artery atherosclerotic lesions, we analyzed postmortem intracranial artery samples from eight subjects with history of stroke. RESULTS Atherosclerotic lesions were present in 7/8 arteries examined, with a mean estimated stenosis of 34%. Lumen thrombus with a disrupted fibrous cap was seen in 1 lesion; the remaining 6 lesions revealed a thick fibrous cap. Neovascularity and calcification were seen in 1 lesion and mild to moderate inflammation was seen in 3 lesions. Necrotic core was present in 4/7 lesions, and was associated with plaque rupture in the only disrupted lesion. CONCLUSIONS Basilar artery atherosclerotic lesions were relatively benign in this series of patients presenting with stroke. While confirmation is needed with larger sample size, the relative paucity of neovascularity suggests a possibly distinctive histopathological profile.
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Liebeskind DS, Sanossian N, Yong WH, Starkman S, Tsang MP, Moya AL, Zheng DD, Abolian AM, Kim D, Ali LK, Shah SH, Towfighi A, Ovbiagele B, Kidwell CS, Tateshima S, Jahan R, Duckwiler GR, Viñuela F, Salamon N, Villablanca JP, Vinters HV, Marder VJ, Saver JL. CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke 2011; 42:1237-43. [PMID: 21393591 DOI: 10.1161/strokeaha.110.605576] [Citation(s) in RCA: 393] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to provide the first correlative study of the hyperdense middle cerebral artery sign (HMCAS) and gradient-echo MRI blooming artifact (BA) with pathology of retrieved thrombi in acute ischemic stroke. METHODS Noncontrast CT and gradient-echo MRI studies before mechanical thrombectomy in 50 consecutive cases of acute middle cerebral artery ischemic stroke were reviewed blinded to clinical and pathology data. Occlusions retrieved by thrombectomy underwent histopathologic analysis, including automated quantitative and qualitative rating of proportion composed of red blood cells (RBCs), white blood cells, and fibrin on microscopy of sectioned thrombi. RESULTS Among 50 patients, mean age was 66 years and 48% were female. Mean (SD) proportion was 61% (±21) fibrin, 34% (±21) RBCs, and 4% (±2) white blood cells. Of retrieved clots, 22 (44%) were fibrin-dominant, 13 (26%) RBC-dominant, and 15 (30%) mixed. HMCAS was identified in 10 of 20 middle cerebral artery stroke cases with CT with mean Hounsfield Unit density of 61 (±8 SD). BA occurred in 17 of 32 with gradient-echo MRI. HMCAS was more commonly seen with RBC-dominant and mixed than fibrin-dominant clots (100% versus 67% versus 20%, P=0.016). Mean percent RBC composition was higher in clots associated with HMCAS (47% versus 22%, P=0.016). BA was more common in RBC-dominant and mixed clots compared with fibrin-dominant clots (100% versus 63% versus 25%, P=0.002). Mean percent RBC was greater with BA (42% versus 23%, P=0.011). CONCLUSIONS CT HMCAS and gradient-echo MRI BA reflect pathology of occlusive thrombus. RBC content determines appearance of HMCAS and BA, whereas absence of HMCAS or BA may indicate fibrin-predominant occlusive thrombi.
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