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Li J, Tiberi R, Bhogal P, Buhk JH, Behme D, Tomasello A, Ribo M. Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation. J Neurointerv Surg 2024; 16:285-289. [PMID: 37147003 DOI: 10.1136/jnis-2023-020382] [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: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Repeated number of passes, clot fragmentation, and distal embolization during mechanical thrombectomy (MT) lead to worse clinical outcomes in acute ischemic stroke. This study aimed to assess the recanalization and embolic outcomes of different stent-retrievers (SRs): open-tip SR (Solitaire X 6×40 mm), closed-tip SR (EmboTrap II 5×33 mm), and filter-tip SR (NeVa NET 5.5×37 mm). METHODS Stiff-friable clot analogs were used to create middle cerebral artery (M1-MCA) occlusions in a benchtop model. After occlusion, experiments were randomized into one of the three treatment arms. The thrombectomy technique consisted of retrieving the SR into a balloon guide catheter under proximal flow arrest and continuous aspiration. A total of 150 single-attempt cases were performed (50 cases/treatment arm). Distal emboli (>100 µm) were collected and analyzed after each experiment. RESULTS Filter-tip SR achieved a non-significantly higher first-pass recanalization rate than open-tip SR and closed-tip SR (66% vs 48% vs 44%; P=0.064). Filter-tip SR prevented clot fragments>1 mm from embolizing distal territories in 44% of cases, compared with 16% in open-tip SR and 20% in closed-tip (P=0.003). There were no significant differences between treatment arms in terms of total emboli count (open-tip=19.2±13.1, closed-tip=19.1±10.7, filter-tip=17.2±13.0; P=0.660). Nonetheless, the number of large emboli (>1 mm) and total area of emboli were significantly lower in the filter-tip arm (n=0.88±1.2, A=2.06±1.85 mm2) than in the closed-tip arm (n=2.34±3.38, A=4.06±4.80 mm2; P<0.05). CONCLUSIONS When facing fragment-prone clots, the filter-tip SR significantly reduces the number of large clots (>1 mm) that embolize distally during an MT procedure, which in turn may increase the chances of first-pass complete recanalization.
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Affiliation(s)
- Jiahui Li
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pervinder Bhogal
- Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Jan-Hendrik Buhk
- Neuroradiology, Asklepios Hospital Hamburg St Georg, Hamburg, Germany
| | - Daniel Behme
- Neuroradiology, University Medical Center Magdeburg, Magdeburg, Germany
| | - Alejandro Tomasello
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ribo
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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Li J, Tiberi R, Canals P, Vargas D, Castaño O, Molina M, Tomasello A, Ribo M. Double stent-retriever as the first-line approach in mechanical thrombectomy: a randomized in vitro evaluation. J Neurointerv Surg 2023; 15:1224-1228. [PMID: 36627194 DOI: 10.1136/jnis-2022-019887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND A repeated number of passes during mechanical thrombectomy leads to worse clinical outcomes in acute ischemic stroke. Initial experiences with the simultaneous double stent-retriever (double-SR) technique as the first-line treatment showed promising safety and efficacy results. OBJECTIVE To characterize the potential benefits of using the double-SR as first-line technique as compared with the traditional single-SR approach. METHODS Three types of clot analogs (soft, moderately stiff, and stiff) were used to create terminal internal carotid artery (T-ICA=44) and middle cerebral artery (MCA=88) occlusions in an in vitro neurovascular model. Sixty-six cases were randomized into each treatment arm: single-SR or double-SR, in combination with a 0.071" distal aspiration catheter. A total of 132 in vitro thrombectomies were performed. Primary endpoints were the rate of first-pass recanalization (%FPR) and procedural-related distal emboli. RESULTS FPR was achieved in 42% of the cases. Overall, double-SR achieved a significantly higher %FPR than single-SR (52% vs 33%, P=0.035). Both techniques showed similar %FPR in T-ICA occlusions (single vs double: 23% vs 27%, P=0.728). Double-SR significantly outperformed single-SR in MCA occlusions (63% vs 38%, P=0.019), most notably in saddle occlusions (64% vs 14%, P=0.011), although no significant differences were found in single-branch occlusions (64% vs 50%, P=0.275). Double-SR reduced the maximal size of the clot fragments migrating distally (Feret diameter=1.08±0.65 mm vs 2.05±1.14 mm, P=0.038). CONCLUSIONS This randomized in vitro evaluation demonstrates that the front-line double-SR technique is more effective than single-SR in achieving FPR when treating MCA bifurcation occlusions that present saddle thrombus.
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Affiliation(s)
- Jiahui Li
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pere Canals
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniel Vargas
- Department of Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Oscar Castaño
- Electronics and Biomedical Engineering, University of Barcelona, Barcelona, Spain
- Biomaterials for Regenerative Therapies, Institute for Bioengineering in Catalonia, Barcelona, Spain
| | - Marc Molina
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Kaneko N, Sakuta K, Imahori T, Gedion H, Ghovvati M, Tateshima S. Devices and Techniques. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:257-262. [PMID: 38025255 PMCID: PMC10657731 DOI: 10.5797/jnet.ra.2023-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 12/01/2023]
Abstract
This extensive review explores the intricacies of the three principal mechanical thrombectomy techniques: the stent retriever technique, contact aspiration technique, and a combined approach, and their application in managing acute ischemic stroke. Each technique operates uniquely on the thrombus, leading to differences in their efficacy. Factors including clot size, clot stiffness, vessel tortuosity, and the angle of interaction between the aspiration catheter and the clot significantly influence these differences. Clinical trials and meta-analyses have shown the overall equivalency of these techniques for the treatments of large vessel occlusion and distal medium vessel occlusions. However, there are nuanced differences that emerge under specific clinical circumstances, highlighting the absence of a one-size-fits-all strategy in acute ischemic stroke management. We emphasize the need for future investigations to elucidate these nuances further, aiming to refine procedural strategies and individualize patient care for optimal outcomes.
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Affiliation(s)
- Naoki Kaneko
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kenichi Sakuta
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Taichiro Imahori
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Neurosurgery, Kita-harima Medical Center, Ono, Hyogo, Japan
| | | | - Mahsa Ghovvati
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Hindsholm MF, Damgaard D, Gurol ME, Gaist D, Simonsen CZ. Management and Prognosis of Acute Stroke in Atrial Fibrillation. J Clin Med 2023; 12:5752. [PMID: 37685819 PMCID: PMC10489015 DOI: 10.3390/jcm12175752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Atrial fibrillation (AF) is an important risk factor for ischemic stroke (IS). Oral anticoagulation (OAC) significantly reduces the risk of IS in AF but also increases the risk of systemic bleeding, including intracerebral hemorrhage (ICH). AF-related strokes are associated with greater disability and mortality compared to non-AF strokes. The management of patients with AF-related strokes is challenging, and it involves weighing individual risks and benefits in the acute treatment and preventive strategies of these patients. This review summarizes the current knowledge of the acute management of ischemic and hemorrhagic stroke in patients with AF, and the prognosis and potential implications for management both in the acute and long-term setting.
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Affiliation(s)
- Mette F. Hindsholm
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus, Denmark; (D.D.); (C.Z.S.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus, Denmark; (D.D.); (C.Z.S.)
| | - M. Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - David Gaist
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark;
| | - Claus Z. Simonsen
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus, Denmark; (D.D.); (C.Z.S.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
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Pero G, Dória HM, Piano M, Macera A, Quilici L, Cervo A. Intracranial Carotid Occlusions : ADAPT versus SAVE and the role of Balloon Guide Catheters. Clin Neuroradiol 2023; 33:825-831. [PMID: 37099134 PMCID: PMC10450001 DOI: 10.1007/s00062-023-01286-y] [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: 05/07/2022] [Accepted: 11/21/2022] [Indexed: 04/27/2023]
Abstract
PURPOSE Specific decisions made by neurointerventionists are often lost behind the data of large-scale trials, and many of these studies have taken place before the development of new techniques and devices. This study compares the stent-retriever assisted vacuum-locked extraction (SAVE) technique with a direct aspiration first pass (ADAPT), as well as the use of a balloon guide catheter (BGC), in intracranial internal carotid artery (IC-ICA) occlusions. METHODS Observational and retrospective study from an Italian hospital, including patients who underwent thrombectomy for IC-ICA occlusion between 1 January 2019 and 31 March 2021. RESULTS Out of 91 IC-ICA occlusions, the ADAPT was the first choice in 20 (22%) and the SAVE in 71 (78%). A BGC was used in 32 (35%) cases, always in conjunction with the SAVE technique. The use of SAVE technique without BGC was associated with the least risk of distal embolization (DE) in the territory occluded (44% vs. 75% when ADAPT technique was used; p = 0.03) and achieved first pass effect (FPE) more frequently (51% vs. 25%, p = 0.09). When the SAVE technique was used, BGC (BGC-SAVE) compared to no BGC (NoBGC-SAVE) was associated with a tendency for less DE (31% vs. 44%, p = 0.3), more FPE (63% vs. 51%, p = 0.5), the same median number of passes (1, p = 0.8) and similar groin-to-recanalization times (36.5 vs. 35.5 min, p = 0.5), none of which reached statistical significance. CONCLUSION Our findings support the use of SAVE technique for IC-ICA occlusions; the added benefit of BGC compared to long sheaths was not remarkable in this sample.
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Affiliation(s)
- Guglielmo Pero
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Hugo Mota Dória
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
- Department of Neuroradiology, Hospital Central do Funchal, Funchal, Madeira, Portugal
- Universidade da Madeira, Funchal, Madeira, Portugal
| | - Mariangela Piano
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Antonio Macera
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Luca Quilici
- Department of Neuroradiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Amedeo Cervo
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
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Huang Y, Shu X, Huang L, Li W, Jin Z, Chen X, Wang K, Zhan Y, Lan W, Cai X. The evaluation and treatment of acute anterior circulation occlusion stroke with high clot burden: Progressive stratified aspiration thrombectomy vs. stent retriever thrombectomy. Clin Neurol Neurosurg 2023; 230:107793. [PMID: 37245456 DOI: 10.1016/j.clineuro.2023.107793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/27/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of the progressive stratified aspiration thrombectomy (PSAT) in treatment of patients with acute ischemic stroke and large vessel occlusion (AIS-LVO). METHODS 117 AIS-LVO patients with high clot burden who underwent emergency endovascular treatment were included. All patients were divided into two groups according to surgical technique: PSAT group, stent retriever thrombectomy (SRT) group. The primary outcome was the 90-day mRS, the secondary outcomes included recanalization rate, the 24-h and 7-day NIHSS, the 7-day symptomatic intracranial hemorrhage (SICH) rate and 90-days mortality. RESULTS 65 patients underwent PSAT, and 52 patients underwent SRT. The PSAT group performed better than SRT group regarding the successful recanalization rate (86.3 % vs. 71.2 %, P < 0.05) and time from puncture to recanalization (70 min [IQR, 58-87 min] vs. 87 min [IQR, 68-103 min], P < 0.05). The 7-day NIHSS score of the PSAT group was lower than that of the SRT group (12 [10-18] vs. 12 [8-25], P < 0.05). It was worth noting that at the 90-day follow-up, the favorable functional outcome (mRS 0-2) rate of PSAT group was higher (P < 0.05). There was no significant difference in terms of the 24-h NIHSS score after surgery (15 [10-18] vs. 15 [10-22], P > 0.05), SICH (23.1 % vs. 26.9 %, P > 0.05) and mortality rate between the two groups (13.4 % vs. 19.2 %, P > 0.05). CONCLUSIONS It is safe and effective to treat high clot burden AIS-LVO patients with PSAT, which has a better reperfusion rate and prognostic outcome than SRT.
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Affiliation(s)
- Yijie Huang
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Xiaohuan Shu
- Department of Neurology, People's Hospital of Jinyun County, Jinyun County, Zhejiang 321400, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China
| | - Liangtong Huang
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Wei Li
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Zheyu Jin
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Xueping Chen
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China
| | - Ke Wang
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Yanli Zhan
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China
| | - Weiming Lan
- Department of Neurology, People's Hospital of Jingning Shezu Autonomous County, Jingning County, Zhejiang 323500, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China.
| | - Xueli Cai
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China.
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Toh KZX, Koh MY, Loh EDW, Kwok GYR, Teo YH, Teo YN, Goh CXY, Syn NLX, Ho AFW, Sia CH, Brouwer PA, Andersson T, Meyer L, Fiehler J, Bhogal P, Sharma VK, Tan BYQ, Yeo LLL. Distal medium vessel occlusions in acute ischaemic stroke - Stent retriever versus direct aspiration: A systematic review and meta-analysis. Eur Stroke J 2023; 8:434-447. [PMID: 37231692 PMCID: PMC10334182 DOI: 10.1177/23969873231151262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/28/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Acute ischaemic stroke due to distal medium vessel occlusion (AIS-DMVO) causes significant morbidity. Endovascular thrombectomy advancement has made treating AIS-DMVO with stent retrievers (SR) and aspiration catheters (AC) possible, however the optimal technique remains unknown. We performed a systematic review and meta-analysis to investigate the efficacy and safety of SR use compared to purely AC use in patients with AIS-DMVO. METHODS We systematically searched PubMed, Cochrane Library and EMBASE, from inception to 2nd September 2022, for studies comparing SR or primary combined (SR/PC) against AC in AIS-DMVO. We adopted the Distal Thrombectomy Summit Group's definition of DMVO. Efficacy outcomes were functional independence (modified Rankin Scale (mRS) 0-2 at 90 days), first pass effect (modified Thrombolysis in Cerebral Infarction scale (mTICI) 2c-3 or expanded Thrombolysis in Cerebral Infarction scale (eTICI) 2c-3 at first pass), successful final recanalisation (mTICI or eTICI 2b-3), and excellent final recanalisation (mTICI or eTICI 2c-3). Safety outcomes were symptomatic intracranial haemorrhage (sICH) and 90-day mortality. RESULTS 12 cohort studies and 1 randomised-controlled trial were included, involving 1881 patients with 1274 receiving SR/PC and 607 receiving AC only. SR/PC achieved higher odds of functional independence (odds ratio (OR) 1.33, 95% confidence interval (CI) 1.06-1.67) and lower odds of mortality (OR 0.69, 95% CI 0.50-0.94) than AC. Odds of successful/excellent recanalisation and sICH were similar between both groups. Stratified to compare only SR and only AC, the use of only SR, achieved significantly higher odds of successful recanalisation as compared to only AC (OR 1.80, 95% CI 1.17-2.78). CONCLUSION There is potential for efficacy and safety benefits in SR/PC use as compared to AC only in AIS-DMVO. Further trials are necessary to validate the efficacy and safety of SR use in AIS-DMVO.
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Affiliation(s)
- Keith Zhi Xian Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ming Yi Koh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Enver De Wei Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gabriel Yi Ren Kwok
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Claire Xin Yi Goh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Li Xun Syn
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Program, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Patrick A Brouwer
- Cerenovus (Johnson & Johnson), Galway Neuro Technology Centre, Galway, Ireland
| | | | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Benjamin YQ Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
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Adusumilli G, Kobeissi H, Ghozy S, Kallmes KM, Brinjikji W, Kallmes DF, Heit JJ. Comparing Tigertriever 13 to other thrombectomy devices for distal medium vessel occlusion: A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231152510. [PMID: 36655307 DOI: 10.1177/15910199231152510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is limited evidence on the optimal endovascular strategy for treatment of distal medium-vessel occlusions (DMVO). The low-profile Tigertriever 13 stent-triever shows early promise as an adaptable device that can navigate the distal vasculature without increasing complication risk in DMVO. METHODS Using Nested Knowledge, we screened literature for RCTs and cohort studies on the endovascular treatment of DMVO. The primary outcome was reperfusion success, as measured by thrombolysis in cerebral infarction (TICI) ≥ 2b and secondary outcomes included rate of symptomatic intracranial hemorrhage (sICH), mortality at 90 days, and modified Rankin scale (mRS) scores 0-2 at 90 days. A random-effects model was used to compute pooled prevalence rates and their corresponding 95% confidence intervals (CI). RESULTS Eleven studies with 1402 patients, 167 patients treated by Tigertriever 13 and 1235 patients treated by other devices, were included in the meta-analysis. The rate of reperfusion success was similar in patients treated by Tigertriever 13 (83.2% [95% CI: 71.5-96.7%]) versus other devices (81.6% [95% CI: 75.3-88.4%], p > 0.05). The rate of sICH was also similar in patients treated by Tigertriever 13 (7.2% [95% CI: 4.1-12.5%]) versus other devices (6.9% [95% CI: 5.5-8.8%]). There was significant heterogeneity in the reporting of mortality and mRS. CONCLUSIONS Tigertriever 13 had similar rates of reperfusion success and sICH as other devices used for the treatment of DMVO. Heterogeneity in data element reporting prevented further analyses. Further studies evaluating Tigertriever 13 and other potential devices in DMVO should attempt to harmonize data element reporting.
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Affiliation(s)
| | - Hassan Kobeissi
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Sherief Ghozy
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | | | | | - David F Kallmes
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Jeremy J Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, CA, USA
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Narloch J, Piasecki A, Ziecina P, Dȩbiec A, Wierzbicki M, Staszewski J, Piasecki P. Is aspiration an effective acute stroke treatment in older adults? Front Neurol 2023; 14:1149531. [PMID: 37200781 PMCID: PMC10185788 DOI: 10.3389/fneur.2023.1149531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/21/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction Clinical outcomes after interventional stroke treatment rely on several factors, with older age being associated with poorer results, which are mainly attributed to patient's comorbidities and medications. The delivery of an aspiration catheter could be hindered by carotid tortuosity, which is more prevalent in elderly patients with increasing age. In this study, we aimed to compare the clinical and angiographic outcomes of a direct aspiration first-pass technique in interventional stroke treatment for elderly patients compared with younger patients. Materials and methods A total of 162 patients (92 women and 70 men, aged between 35 and 94 years +/- 12.4 years) were included in this study. Patients who were treated in a comprehensive stroke center due to a large-vessel occlusion stroke using aspiration as the first-choice treatment were included in this study. To evaluate carotid arteries, the tortuosity index (TI) was calculated for each segment of each carotid pathway. Results Age correlated significantly with the presence of carotid tortuosity (R = 0.408, p = 0.000), extracranial length ratio (R = 0.487, p = 0.000), and overall length ratio (R = 0.467, p = 0.000). No significant associations were found with coiling, kinking, or intracranial length ratio. Successful aspiration-based recanalization rate decreased with increasing age, and the differences between the age subgroups were not statistically significant. A comparison of the extreme subgroups, i.e., <60 years old vs. ≥80 years old, did not yield a statistically significant change (p = 0.068). Conclusion Successful aspiration-based recanalization rate decreased with increasing age; however, these differences were not significant. Clinical outcomes did not significantly differ with regard to carotid tortuosity, regardless of the time of assessment. Neither intracranial nor extracranial tortuosity was significantly associated with reperfusion-related complications in either of the age subgroups.
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Affiliation(s)
- Jerzy Narloch
- Department of Interventional Radiology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
- *Correspondence: Jerzy Narloch
| | - Adam Piasecki
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Ziecina
- Department of Interventional Radiology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
| | - Aleksander Dȩbiec
- Department of Neurology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
| | - Marek Wierzbicki
- Department of Interventional Radiology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
| | - Jacek Staszewski
- Department of Neurology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
| | - Piotr Piasecki
- Department of Interventional Radiology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
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10
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Bilgin C, Hardy N, Hutchison K, Pederson JM, Mebane A, Olaniran P, Kobeissi H, Kallmes KM, Fiorella D, Kallmes DF, Brinjikji W. First-line thrombectomy strategy for distal and medium vessel occlusions: a systematic review. J Neurointerv Surg 2022; 15:539-546. [PMID: 36223996 DOI: 10.1136/jnis-2022-019344] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The benefit of mechanical thrombectomy (MT) and efficacy of different first-line MT techniques remain unclear for distal and medium vessel occlusions (DMVOs). In this systematic review, we aimed to compare the performance of three first-line MT techniques in DMVOs. METHODS The PubMed database was searched for studies examining the utility of MT in DMVOs (middle cerebral artery M2-3-4, anterior cerebral artery, and posterior cerebral artery). Studies providing data for aspiration thrombectomy (ASP), stent retriever thrombectomy (SR), and combined SR+ASP technique were included. Non-comparative studies were excluded. Safety and efficacy data were collected for each technique. The Nested Knowledge AutoLit platform was utilized for literature search, screening, and data extraction. Pooled data were presented as descriptive statistics. RESULTS 13 studies comprising 2422 MT procedures were identified. The overall successful recanalization rate was 77.0% (1513/1964) for DMVOs. SR+ASP had a successful recanalization rate of 83.7% (297/355), SR had a 75.6% rate (638/844), while ASP alone had a 74.2% rate (386/520). The overall functional independence rate was 51.3% (851/1659) among DMVOs. The ASP alone group had a functional independence rate of 46.9% (219/467), while functional independence rates of the SR and SR+ASP groups were 51.5% (372/723) and 61.7% (174/282), respectively. Finally, the subarachnoid hemorrhage rates were 1.8% (4/217) for the ASP group, 9.3% (26/281) for the SR group, and 11.9% (41/344) for the SR+ASP group. CONCLUSIONS Our systematic review supports the proposition that MT is a safe and effective treatment option for DMVOs. Additionally, while the SR+ASP group had consistently high rates of clot clearance and good neurological outcomes, the SR and SR+ASP groups also had higher rates of subarachnoid hemorrhage, highlighting the need for improved DMVO treatment devices.
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Affiliation(s)
- Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole Hardy
- Nested Knowledge, Inc, Saint Paul, Minnesota, USA
| | | | - John Michael Pederson
- Nested Knowledge, Inc, Saint Paul, Minnesota, USA.,Superior Medical Experts, Inc, St. Paul, Minnesota, USA
| | | | | | - Hassan Kobeissi
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | | | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Sun D, Liu R, Huo X, Jia B, Tong X, Wang A, Ma G, Ma N, Gao F, Mo D, Miao Z. Endovascular treatment for acute ischaemic stroke due to medium vessel occlusion: data from ANGEL-ACT registry. Stroke Vasc Neurol 2022; 8:svn-2022-001561. [PMID: 36219803 PMCID: PMC9985797 DOI: 10.1136/svn-2022-001561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/03/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the safety and efficacy of endovascular treatment (EVT) for acute medium vessel occlusion (MeVO) in the anterior circulation and to explore the independent predictors of the 90-day good outcome for such patients. METHODS Data from ANGEL-ACT Registry were analysed in our study. The outcomes, such as the modified Rankin Scale (mRS) at 90 days, successful recanalisation rate and symptomatic intracranial haemorrhage (SICH) rate, were compared between MeVO and acute large vessel occlusions (LVO). Then, the independent predictors of the good outcome at 90 days in MeVO patients were determined by the logistic regression analyses. RESULTS We included 1032 subjects in the analysis, of which, 147 were MeVO and 885 were LVO. mRS at 90 days distribution (3 (0-4) vs 3 (0-5), common odds ratio (OR) =1.00, 95% confidence interval (CI) 0.73 to 1.38, p=0.994), SICH rate (4.8% vs 8.9%; OR=0.59, 95% CI 0.26 to 1.34, p=0.205) and successful recanalisation rate (89.8% vs 89.7%; OR=1.00 95% CI 0.51 to 1.93, p=0.992) were similar between the MeVO and LVO groups after adjusting for the confounders. We identified that baseline neutrophil-to-lymphocyte ratio ≤4.1 (OR=2.13, 95% CI 1.14 to 3.99, p=0.019), baseline National Institutes of Health Stroke Scale ≤14 (OR=1.96, 95% CI 1.02 to 3.80, p=0.045) and mechanical thrombectomy passes ≤1 (OR=2.16, 95% CI 1.14 to 4.11, p=0.021) were independent predictors of the 90-day good outcome in MeVO patients undergoing EVT. CONCLUSIONS Patients with MeVO achieved similar 90-day mRS, SICH rate and successful recanalisation rate after EVT compared with patients with LVO. Several independent predictors of 90-day good outcome in MeVO patients undergoing EVT were determined, which should be highly considered in MeVO stroke management.
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Affiliation(s)
- Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Fengtai You anmen Hospital, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Gaoting Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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12
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Li X, Li C, Zhou J, Liu AF, Zhang YY, Zhang AP, Lai CC, Lv J, Jiang WJ. Predictors of ninety-day mortality following mechanical thrombectomy for acute large vessel occlusion stroke. Clin Neurol Neurosurg 2022; 221:107402. [DOI: 10.1016/j.clineuro.2022.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022]
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13
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Bernsen MLE, Bruggeman AAE, Brouwer J, Emmer BJ, Majoie CBLM, Coutinho JM, Goldhoorn RJB, van Oostenbrugge RJ, van Zwam WH, van der Leij C, Schonewille WJ, Martens JM, Hofmeijer J. Aspiration Versus Stent Retriever Thrombectomy for Posterior Circulation Stroke. Stroke 2021; 53:749-757. [PMID: 34666507 DOI: 10.1161/strokeaha.121.034926] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whereas a clear benefit of endovascular treatment for anterior circulation stroke has been established, randomized trials assessing the posterior circulation have failed to show efficacy. Previous studies in anterior circulation stroke suggest that advanced thrombectomy devices were of great importance in achieving clinical benefit. Little is known about the effect of thrombectomy techniques on outcomes in posterior circulation stroke. In this study, we compare first-line strategy of direct aspiration to stent retriever thrombectomy for posterior circulation stroke. METHODS We analyzed data of patients with a posterior circulation stroke who were included in the Multicentre Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry between March 2014 and December 2018, a prospective, nationwide study, in which data were collected from consecutive patients who underwent endovascular treatment for ischemic stroke in the Netherlands. We compared patients who underwent first-line aspiration versus stent retriever thrombectomy. Primary outcome was functional outcome according to the modified Rankin Scale. Secondary outcomes were reperfusion grade, complication rate, and procedure duration. Associations between thrombectomy technique and outcome measures were estimated with multivariable ordinal logistic regression analyses. RESULTS Overall, 71 of 205 patients (35%) were treated with aspiration, and 134 (65%) with stent retriever thrombectomy. Patients in the aspiration group had a lower pc-ASPECTS on baseline computed tomography, and general anesthesia was more often applied in this group. First-line aspiration was associated with better functional outcome compared with stent retriever thrombectomy (adjusted common odds ratio for a 1-point improvement on the modified Rankin Scale 1.94 [95% CI, 1.03-3.65]). Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2B) was achieved more often with aspiration (87% versus 73%, P=0.03). Symptomatic hemorrhage rates were comparable (3% versus 4%). Procedure times were shorter in the aspiration group (49 versus 69 minutes P<0.001). CONCLUSIONS In this retrospective nonrandomized cohort study, our findings suggest that first-line aspiration is associated with a shorter procedure time, better reperfusion, and better clinical outcome than stent retriever thrombectomy in patients with ischemic stroke based on large vessel occlusion in the posterior circulation.
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Affiliation(s)
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC. (A.A.E.B., B.J.E., C.B.L.M.M.)
| | - Josje Brouwer
- Department of Neurology , Amsterdam University Medical Center, Location AMC.(J.B., J.M.C.)
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC. (A.A.E.B., B.J.E., C.B.L.M.M.)
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC. (A.A.E.B., B.J.E., C.B.L.M.M.)
| | - Jonathan M Coutinho
- Department of Neurology , Amsterdam University Medical Center, Location AMC.(J.B., J.M.C.)
| | - Robert-Jan B Goldhoorn
- Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM). (R.-J.B.G., R.J.v.O.)
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM). (R.-J.B.G., R.J.v.O.)
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM). (W.H.v.Z., C.v.d.L.)
| | - Christiaan van der Leij
- Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM). (W.H.v.Z., C.v.d.L.)
| | | | - Jasper M Martens
- Department of Radiology, Rijnstate Hospital, Arnhem. (M.L.E.B., J.M.M.)
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem. (J.H.).,Technical Medical Center, Faculty of Science and Technology, University of Twente, Enschede (J.H.)
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14
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Volovici V, van Doormaal PJ. Distal Cerebral Vessel Occlusions and Mechanical Thrombectomy: Straightforward Questions, Generating Evidence, and Gearing Toward Submillimetric Vessels. World Neurosurg 2021; 154:51-52. [PMID: 34298136 DOI: 10.1016/j.wneu.2021.07.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Victor Volovici
- Department of Neurosurgery, Erasmus MC, Rotterdam, the Netherlands.
| | - Pieter Jan van Doormaal
- Department of Radiology, Division of Neuro-interventional Radiology, Erasmus MC, Rotterdam, the Netherlands
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15
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Zeleňák K, Krajina A, Meyer L, Fiehler J, Behme D, Bulja D, Caroff J, Chotai AA, Da Ros V, Gentric JC, Hofmeister J, Kass-Hout O, Kocatürk Ö, Lynch J, Pearson E, Vukasinovic I. How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods. Life (Basel) 2021; 11:life11060488. [PMID: 34072071 PMCID: PMC8229281 DOI: 10.3390/life11060488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and collecting of extremely big databases. Nowadays, the speed of internet connection is a limiting factor for robotic systems, which can be controlled and commanded potentially from various places in the world. Innovative technologies can be implemented for acute stroke patient management soon. Artificial intelligence (AI) and robotics are used increasingly often without the exception of medicine. Their implementation can be achieved in every level of stroke care. In this article, all steps of stroke health care processes are discussed in terms of how to improve them (including prehospital diagnosis, consultation, transfer of the patient, diagnosis, techniques of the treatment as well as rehabilitation and usage of AI). New ethical problems have also been discovered. Everything must be aligned to the concept of “time is brain”.
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Affiliation(s)
- Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Correspondence: ; Tel.: +421-43-4203-990
| | - Antonín Krajina
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, CZ-500 05 Hradec Králové, Czech Republic;
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | - Jens Fiehler
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | | | - Daniel Behme
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- University Clinic for Neuroradiology, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Deniz Bulja
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Diagnostic-Interventional Radiology Department, Clinic of Radiology, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Jildaz Caroff
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Interventional Neuroradiology–NEURI Brain Vascular Center, Bicêtre Hospital, APHP, 94270 Paris, France
| | - Amar Ajay Chotai
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne NE14LP, UK
| | - Valerio Da Ros
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Biomedicine and Prevention, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Jean-Christophe Gentric
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Interventional Neuroradiology Unit, Hôpital de la Cavale Blanche, 29200 Brest, France
| | - Jeremy Hofmeister
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Unité de Neuroradiologie Interventionnelle, Service de Neuroradiologie Diagnostique et Interventionnelle, 1205 Genève, Switzerland
| | - Omar Kass-Hout
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Stroke and Neuroendovascular Surgery, Rex Hospital, University of North Carolina, 4207 Lake Boone Trail, Suite 220, Raleigh, NC 27607, USA
| | - Özcan Kocatürk
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Balikesir Atatürk City Hospital, Gaziosmanpaşa Mahallesi 209., Sok. No: 26, 10100 Altıeylül/Balıkesir, Turkey
| | - Jeremy Lynch
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Ernesto Pearson
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- CH Bergerac-Centre Hospitalier, Samuel Pozzi 9 Boulevard du Professeur Albert Calmette, 24100 Bergerac, France
| | - Ivan Vukasinovic
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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16
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Maïer B, Finitsis S, Bourcier R, Papanagiotou P, Richard S, Marnat G, Sibon I, Dargazanli C, Arquizan C, Blanc R, Piotin M, Lapergue B, Consoli A, Eugene F, Vannier S, Saleme S, Macian F, Clarençon F, Rosso C, Naggara O, Turc G, Viguier A, Cognard C, Wolff V, Pop R, Mazighi M, Gory B. First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry. J Neurointerv Surg 2021; 14:neurintsurg-2021-017505. [PMID: 33972458 DOI: 10.1136/neurintsurg-2021-017505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA). OBJECTIVE To compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT. METHODS We analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0-2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes. RESULTS We included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA. CONCLUSIONS Despite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.
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Affiliation(s)
- Benjamin Maïer
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France .,Université de Paris, Paris, Île-de-France, France
| | - Stephanos Finitsis
- Department of Interventional Neuroradiology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Romain Bourcier
- Department of Interventional Neuroradiology, CHU Nantes, Nantes, Pays de la Loire, France
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany.,First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens - Aretaiio Hospital, Athens, Greece
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Gaultier Marnat
- Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neurology Department, CHU de Bordeaux, Bordeaux, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, Languedoc-Roussillon, France
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France
| | - Bertrand Lapergue
- Department of Neurology, Hospital Foch, Suresnes, Île-de-France, France
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Suzana Saleme
- Department of Interventional Neuroradiology, CHU Limoges, Limoges, Limousin, France
| | | | - Frédéric Clarençon
- Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France.,Sorbonne University, Paris, Île-de-France, France
| | - Charlotte Rosso
- Urgences cérébro-vasculaires, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Olivier Naggara
- Department of Neuroradiology, Saint Anne Hospital Centre, Paris, Île-de-France, France
| | - Guillaume Turc
- Université de Paris, Paris, Île-de-France, France.,Department of Neurology, Saint Anne Hospital Centre, Paris, Île-de-France, France
| | - Alain Viguier
- Department of Neurology, CHU Toulouse, Toulouse, Occitanie, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hospital Purpan, Toulouse, Midi-Pyrénées, France
| | - Valerie Wolff
- Stroke unit, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Raoul Pop
- Department of Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.,Department of Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
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