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Yusuying S, Lu Y, Zhang S, Wang J, Chen J, Wang D, Lu J, Qi P. CT-based thrombus radiomics nomogram for predicting secondary embolization during mechanical thrombectomy for large vessel occlusion. Front Neurol 2023; 14:1152730. [PMID: 37251225 PMCID: PMC10213392 DOI: 10.3389/fneur.2023.1152730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Background and aims Secondary embolization (SE) during mechanical thrombectomy (MT) for cerebral large vessel occlusion (LVO) could reduce the anterior blood flow and worsen clinical outcomes. The current SE prediction tools have limited accuracy. In this study, we aimed to develop a nomogram to predict SE following MT for LVO based on clinical features and radiomics extracted from computed tomography (CT) images. Materials and methods A total of 61 patients with LVO stroke treated by MT at Beijing Hospital were included in this retrospective study, of whom 27 developed SE during the MT procedure. The patients were randomly divided (7:3) into training (n = 42) and testing (n = 19) cohorts. The thrombus radiomics features were extracted from the pre-interventional thin-slice CT images, and the conventional clinical and radiological indicators associated with SE were recorded. A support vector machine (SVM) learning model with 5-fold cross-verification was used to obtain the radiomics and clinical signatures. For both signatures, a prediction nomogram for SE was constructed. The signatures were then combined using the logistic regression analysis to construct a combined clinical radiomics nomogram. Results In the training cohort, the area under the receiver operating characteristic curve (AUC) of the nomograms was 0.963 for the combined model, 0.911 for the radiomics, and 0.891 for the clinical model. Following validation, the AUCs were 0.762 for the combined model, 0.714 for the radiomics model, and 0.637 for the clinical model. The combined clinical and radiomics nomogram had the best prediction accuracy in both the training and test cohort. Conclusion This nomogram could be used to optimize the surgical MT procedure for LVO based on the risk of developing SE.
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Affiliation(s)
- Shadamu Yusuying
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yao Lu
- Beijing Hospital, National Center of Gerontology, Beijing Institute of Geriatrics, Beijing, China
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Shun Zhang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kaloss AM, Theus MH. Leptomeningeal anastomoses: Mechanisms of pial collateral remodeling in ischemic stroke. WIREs Mech Dis 2022; 14:e1553. [PMID: 35118835 PMCID: PMC9283306 DOI: 10.1002/wsbm.1553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/13/2022]
Abstract
Arterial collateralization, as determined by leptomeningeal anastomoses or pial collateral vessels, is a well‐established vital player in cerebral blood flow restoration and neurological recovery from ischemic stroke. A secondary network of cerebral collateral circulation apart from the Circle of Willis, exist as remnants of arteriole development that connect the distal arteries in the pia mater. Recent interest lies in understanding the cellular and molecular adaptations that control the growth and remodeling, or arteriogenesis, of these pre‐existing collateral vessels. New findings from both animal models and human studies of ischemic stroke suggest a multi‐factorial and complex, temporospatial interplay of endothelium, immune and vessel‐associated cell interactions may work in concert to facilitate or thwart arteriogenesis. These valuable reports may provide critical insight into potential predictors of the pial collateral response in patients with large vessel occlusion and may aid in therapeutics to enhance collateral function and improve recovery from stroke. This article is categorized under:Neurological Diseases > Molecular and Cellular Physiology
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Affiliation(s)
- Alexandra M Kaloss
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Michelle H Theus
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.,School of Neuroscience, Virginia Tech, Blacksburg, Virginia, USA.,Center for Regenerative Medicine, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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3
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Lee SJ, Hwang YH, Hong JM, Choi JW, Kang DH, Kim YW, Kim YS, Hong JH, Yoo J, Kim CH, Ovbiagele B, Demchuk A, Sohn SI, Lee JS. Predictors and prognoses of Willisian collateral failure during mechanical thrombectomy. Sci Rep 2020; 10:20874. [PMID: 33257735 PMCID: PMC7704636 DOI: 10.1038/s41598-020-77946-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/17/2020] [Indexed: 11/09/2022] Open
Abstract
During mechanical thrombectomy in the anterior cerebral circulation, thrombus embolization resulting in Willisian collateral failure may lead to critical stroke outcomes due to a shutdown of leptomeningeal collaterals. We hypothesized that the outcomes of dynamic Willisian collateral failure (DWF), induced during mechanical thrombectomy, would be associated with grave outcomes. We evaluated this hypothesis in consecutive patients, between January 2011 and May 2016, who underwent mechanical thrombectomy for anterior circulation occlusions, with an onset-to-puncture of 24 h. Patients with initial Willisian collateral failure (IWF) were identified first, with remaining patients classified into the DWF and Willisian collateral sparing (WCS) groups. Comparative and multivariable analyses were performed to predict grave outcomes (3-month modified Rankin Scale score of 5–6). Among 567 patients, 37 were in the IWF group, 38 in the DWF group, and 492 in the WCS group. Compared to the WCS and DWF groups, the IWF group had a higher baseline National Institute of Health Stroke Scale score and lower Alberta Stroke Program Early CT Score. The prevalence of grave outcomes was similarly high in the IWF (48.6%) and DWF (47.4%) groups, but lower in the WCS group (22.0%; p < 0.001). IWF and DWF were independent risk factors for a grave outcome.
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Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Won Kim
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Dongsan Medical Center, Brain Research Institute, Keimyung University School of Medicine, 56 Dalseong-ro Joong-gu, Daegu, 41931, Republic of Korea
| | - Joonsang Yoo
- Department of Neurology, Dongsan Medical Center, Brain Research Institute, Keimyung University School of Medicine, 56 Dalseong-ro Joong-gu, Daegu, 41931, Republic of Korea.,Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Franscisco, USA
| | - Andrew Demchuk
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Medical Center, Brain Research Institute, Keimyung University School of Medicine, 56 Dalseong-ro Joong-gu, Daegu, 41931, Republic of Korea.
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, South Korea.
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Zhao W, Wu C, Dornbos D, Li S, Song H, Wang Y, Ding Y, Ji X. Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes. Brain Circ 2020; 6:11-18. [PMID: 32166195 PMCID: PMC7045534 DOI: 10.4103/bc.bc_58_19] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/29/2019] [Accepted: 01/17/2020] [Indexed: 12/24/2022] Open
Abstract
While several large pivotal clinical trials recently revealed a substantial benefit of endovascular thrombectomy for acute ischemic stroke (AIS) caused by large-vessel occlusion, many patients still experience mediocre prognosis. Enlargement of the ischemic core, failed revascularization, incomplete reperfusion, distal embolization, and secondary reperfusion injury substantially impact the salvaging of brain tissue and the functional outcomes of AIS. Here, we propose novel concept of “Multiphase Adjuvant Neuroprotection” as a new paradigm that may help guide our search for adjunctive treatments to be used together with thrombectomy. The premise of multiphase adjuvant neuroprotection is based on the diverse and potentially nonoverlapping pathophysiologic mechanisms that are triggered before, during, and after thrombectomy therapies. Before thrombectomy, strategies should focus on preventing the growth of the ischemic core; during thrombectomy, improving recanalization while reducing distal embolization and maximizing reperfusion are of significant importance; after reperfusion, strategies should focus on seeking targets to reduce secondary reperfusion injury. The concept of multiphase adjuvant neuroprotection, wherein different strategies are employed throughout the various phases of clinical care, might provide a paradigm to minimize the final infarct size and improve functional outcome in AIS patients treated with thrombectomy. With the success of thrombectomy in selected AIS patients, there is now an opportunity to revisit stroke neuroprotection. Notably, if the underlying mechanisms of these neuroprotective strategies are identified, their role in the distinct phases will provide further avenues to improve patient outcomes of AIS.
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Affiliation(s)
- Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - David Dornbos
- Department of Neurological Surgery, Semmes-Murphey Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sijie Li
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Hsu CCT, Watkins T, Kato K, Fomin I, Hapugoda S, Cheng J, Krings T. Iodine-stained fragmented thromboembolism. Neuroradiol J 2019; 32:445-451. [PMID: 31505991 DOI: 10.1177/1971400919874508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM Iodine-stained fragmented thromboembolism (ISFT) is a rare phenomenon encountered in the immediate aftermath of mechanical thrombectomy or rarely as a complication of post-carotid stenting. The aim was to describe the imaging appearance and discuss its pathophysiology. METHOD This is a retrospective review of patients who underwent mechanical thrombectomy for acute stroke at a single institution over the period of one year. All patients underwent the standard acute stroke imaging protocol (CT head, CT angiogram (CTA) and CT brain perfusion) and when clinically appropriate followed by catheter angiogram and mechanical thrombectomy. ISFT was defined as an arterial luminal filling defect with Hounsfield density equal to or greater than iodine seen on the biplanar CT or conventional CT. The presence and location of ISFT were documented. Standard CT angiogram (CTA) or magnetic resonance angiogram (MRA) was performed 24-48 hours after the neurointerventional procedure to assess for recanalization, volume of infarction and the fate of the ISFT. RESULTS ISFTs were identified in eight (five males and three females, age range 18-80 years) out of 49 patients in the following locations: distal M1 (n = 1), M2 (n = 4), M3 (n = 1), A1 (n = 1), distal A2 (n = 1). ISFT and vessel recanalization occurred in five patients on follow-up. ISFT and vessel occlusion persisted in two patients. CONCLUSION ISFT is likely the result of mechanical disruption of a thromboembolus, and porosity of the thromboembolus fragment may transiently retain iodinated contrast. Recognition of this entity may be important to aid detection of residual thromboembolism and avoid misinterpretation as calcified thromboembolism.
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Affiliation(s)
- Charlie Chia-Tsong Hsu
- Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Australia
| | - Trevor Watkins
- Department of Medical Imaging, Princess Alexandra Hospital, Australia
| | - Kosuke Kato
- Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Australia
| | - Igor Fomin
- Division of Neuroradiology, Department of Medical Imaging, Gold Coast University Hospital, Australia
| | - Sachintha Hapugoda
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Australia
| | - Jeffery Cheng
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Australia
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Canada
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Yeo LLL, Bhogal P, Gopinathan A, Cunli Y, Tan B, Andersson T. Why Does Mechanical Thrombectomy in Large Vessel Occlusion Sometimes Fail? Clin Neuroradiol 2019; 29:401-414. [DOI: 10.1007/s00062-019-00777-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
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7
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Chalumeau V, Blanc R, Redjem H, Ciccio G, Smajda S, Desilles JP, Botta D, Escalard S, Boisseau W, Maïer B, Labreuche J, Obadia M, Piotin M, Mazighi M. Anterior cerebral artery embolism during thrombectomy increases disability and mortality. J Neurointerv Surg 2018; 10:1057-1062. [DOI: 10.1136/neurintsurg-2018-013793] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveDuring thrombectomy, thromboembolic migration in previously unaffected territory may occur and is not systematically notified. We report our data on the incidence, predictors, and clinical outcome of anterior cerebral artery emboli (ACAE).MethodsFrom a prospectively collected thrombectomy database of consecutive patients with anterior circulation stroke between January 2012 and December 2016, 690 angiographic images were analyzed to assess ACAE. The primary outcome was a favorable outcome, defined as a 3 month modified Rankin Scale score of 0–2 or equal to the pre-stroke score.ResultsACAE occurred in 65 patients (9.4%; 95% CI 7.2% to 11.6%). Internal carotid artery occlusion (tandem or terminal), Alberta Stroke Program Early CT Score <7, increasing number of passes, and use of stent retriever alone (compared with distal aspiration alone or combined with stent retriever) were found to be independent predictors of ACAE. Compared with patients without ACAE, patients with ACAE had lower rates, with an adjusted OR (95% CI) of 0.48 (0.25 to 0.92; P=0.027) for favorable outcome and 0.49 (0.25 to 0.96; P=0.038) for early neurologic improvement. ACAE was significantly associated with a higher mortality (adjusted OR 1.93; 95% CI 1.03 to 3.61; P=0.039) and intracranial hemorrhagic complications (adjusted OR 2.45; 95% CI 1.33 to 4.47; P=0.004). Despite a successful reperfusion modified Thrombolysis in Cerebral Infarction score of 2b–3 at the end of the procedure, a favorable outcome was reached in 30% of patients with ACAE compared with 52.4% in the other patients (OR 0.39; 95% CI 0.19 to 0.78; P=0.008).ConclusionsProcedural ACAE was not an uncommon condition, and was associated with increased mortality and disability rates, regardless of the success of reperfusion.
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8
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Yeo LLL, Holmberg A, Mpotsaris A, Söderman M, Holmin S, Kuntze Söderqvist A, Ohlsson M, Bhogal P, Gontu V, Andersson T, Brouwer PA. Posterior Circulation Occlusions May Be Associated with Distal Emboli During Thrombectomy : Factors for Distal Embolization and a Review of the Literature. Clin Neuroradiol 2018; 29:425-433. [PMID: 29569010 PMCID: PMC6710331 DOI: 10.1007/s00062-018-0679-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023]
Abstract
Background Distal embolization or movement of the thrombus to previously uninvolved vasculature are feared complications during stroke thrombectomy. We looked at associated factors in a consecutive series of patients who underwent thrombectomy with the same endovascular device. Methods We included all patients with acute ischemic stroke in the anterior or posterior circulation, who underwent thrombectomy with the same thrombectomy device for acute stroke from 2013 to 2016. Distal embolization was defined as any movement of the thrombus into a previously uninvolved portion of the cerebral vasculature or the presence of thrombotic material further downstream in the affected vessel, which occurred after the initial angiogram. We studied patient-related as well as technical factors to determine their association with distal emboli. Results In this study 167 consecutive acute stroke patients treated with the emboTrap® device (Cerenovus, Irvine, CA, USA) were included with a median National Institutes of Health Stroke Scale (NIHSS) of 15 (range 2–30) and mean age of 67 years (SD 13.1 years). Of the patients in our cohort 20 (11.9%) experienced distal emboli, with 2.3% into a new territory and 9.6% into a territory distal to the primary occlusion. On univariate analysis, age, intravenous tissue plasminogen activator (tPA), posterior circulation occlusions, and general anesthesia were associated with distal emboli. On multivariate analysis, only posterior circulation occlusions (odds ratio OR 4.506 95% confidence interval CI 1.483–13.692, p = 0.008) were significantly associated with distal emboli. Distal embolization was not significantly associated with worse functional outcomes at 3 months, increased mortality or increased bleeding risk. Conclusion Posterior circulation occlusions were significantly associated with distal emboli during thrombectomy, possibly due to the lack of flow arrest during such procedures. New techniques and devices should be developed to protect against embolic complications during posterior circulation stroke thrombectomy.
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Affiliation(s)
- Leonard L L Yeo
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden. .,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
| | - Ake Holmberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | | | - Michael Söderman
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Asa Kuntze Söderqvist
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Pervinder Bhogal
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden.,Neuroradiology Clinic, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Vamsi Gontu
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Patrick A Brouwer
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Solnavägen 1, 171 77, Solna, Stockholm, Sweden
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Liu ZS, Zhou LJ, Sun Y, Kuang XW, Wang JX, Zhang XJ. Thrombectomy Using “Clamping Embolus with Semi-Retrieval” Technique in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:733-739. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022] Open
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Mechanical Recanalization Using Solitaire AB Device for Severe Thromboembolic Events in Endovascular Treatment of Intracranial Aneurysms. Cardiovasc Intervent Radiol 2017; 40:1706-1712. [DOI: 10.1007/s00270-017-1711-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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