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Ajiboye N, Yoo AJ. Biomarkers of Technical Success After Embolectomy for Acute Stroke. Neurology 2021; 97:S91-S104. [PMID: 34785608 DOI: 10.1212/wnl.0000000000012800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE REVIEW Stent retrievers and large-bore aspiration catheters have doubled substantial reperfusion rates compared to first-generation devices. This has been accompanied by a 3-fold reduction in procedural time to revascularization. To measure future thrombectomy improvements, new benchmarks for technical efficacy are needed. This review summarizes the recent literature concerning biomarkers of procedural success and harm and highlights future directions. RECENT FINDINGS Expanded Treatment in Cerebral Ischemia (eTICI), which incorporates scores for greater levels of reperfusion, improves outcome prediction. Core laboratory-adjudicated studies show that outcomes following eTICI 2c (90%-99% reperfusion) are superior to eTICI 2b50 and nearly equivalent to eTICI 3. Moreover, eTICI 2c improves scale reliability. Studies also confirm the importance of rapid revascularization, whether measured as first pass effect or procedural duration under 30 minutes. Distal embolization is a complication that impedes the extent and speed of revascularization, but few studies have reported its per-pass occurrence. Distal embolization and emboli to new territory should be measured after each thrombectomy maneuver. Collaterals have been shown to be an important modifier of thrombectomy benefit. A drawback of the currently accepted collateral grading scale is that it does not discriminate among the broad spectrum of partial collateralization. Important questions that require investigation include reasons for failed revascularization, the utility of a global Treatment in Cerebral Ischemia scale, and the optimal grading system for vertebrobasilar occlusions. SUMMARY Emerging data support a lead technical efficacy endpoint that combines the extent and speed of reperfusion. Efforts are needed to better characterize angiographic measures of treatment harm and of collateralization.
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Affiliation(s)
| | - Albert J Yoo
- From the Texas Stroke Institute, Dallas-Fort Worth.
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50:e344-e418. [PMID: 31662037 DOI: 10.1161/str.0000000000000211] [Citation(s) in RCA: 3218] [Impact Index Per Article: 643.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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Ahn JH, Cho SS, Kim SE, Kim HC, Jeon JP. The Effects of Balloon-Guide Catheters on Outcomes after Mechanical Thrombectomy in Acute Ischemic Strokes : A Meta-Analysis. J Korean Neurosurg Soc 2019; 62:389-397. [PMID: 31064042 PMCID: PMC6616979 DOI: 10.3340/jkns.2018.0165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Mechanical thrombectomies with balloon-guide catheters (BGC) are thought to improve successful recanalization rates and to decrease the incidence of distal emboli compared to thrombectomies without BGC. We aimed to assess the effects of BGC on the outcomes of mechanical thrombectomy in acute ischemic strokes.
Methods Studies from PubMed, EMBASE, and the Cochrane library database from January 2010 to February 2018 were reviewed. Random effect model for meta-analysis was used. Analyses such as meta-regression and the “trim-and-fill” method were additionally carried out.
Results A total of seven articles involving 2223 patients were analyzed. Mechanical thrombectomy with BGC was associated with higher rates of successful recanalization (odds ratio [OR], 1.632; 95% confidence interval [CI], 1.293–2.059). BGC did not significantly decrease distal emboli, both before (OR, 0.404; 95% CI, 0.108–1.505) and after correcting for bias (adjusted OR, 1.165; 95% CI, 0.310–4.382). Good outcomes were observed more frequently in the BGC group (OR, 1.886; 95% CI, 1.564–2.273). Symptomatic intracranial hemorrhage and mortality did not differ significantly with BGC use.
Conclusion Our meta-analysis demonstrates that BGC enhance recanalization rates. However, BGC use did not decrease distal emboli after mechanical thrombectomies. This should be interpreted with caution due to possible publication bias and heterogeneity. Additional meta-analyses based on individual patient data are needed to clarify the role of BGC in mechanical thrombectomies.
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Affiliation(s)
- Jun Hyong Ahn
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Steve S Cho
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea
| | - Heung Cheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea.,Genetic and Research, Hallym University College of Medicine, Chuncheon, Korea
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Experience of the New FlowGate 2 Device as a Balloon Guide Catheter for Ischemic Stroke Intervention. World Neurosurg 2019; 126:e736-e742. [PMID: 30851472 DOI: 10.1016/j.wneu.2019.02.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND We report the experience of the FlowGate2 (FG2) as a new balloon guide catheter in endovascular stroke intervention. METHODS We evaluated the various outcomes and complications of patients with intracranial large artery occlusion undergoing endovascular stroke intervention with FG2 at our center. Baseline characteristics (failure rate of device application, sex, age, risk factors, arterial occlusion sites, and time intervals) were reviewed. Outcomes were evaluated according to National Institutes of Health Stroke Scale score, modified Rankin Scale (mRS) score, number of stent passages required, and Thrombolysis in Cerebral Infarction score. The incidence of hemorrhage, vessel damage, distal emboli, and mortality rate were evaluated as indicators of complications. RESULTS Overall, 70 patients were enrolled, except the 2 patients with application failure of FG2. Seventy patients with a median age of 69 years were treated with FG2. Arterial occlusion involved the M1 (50%) and M2 (14.3%) segments, internal carotid artery (25.7%), and posterior circulation (10%). Median value of mRS at 90 days was 2.8, and 37 patients (52.8%) had a mRS score ≤2. The recanalization rate in patients with a Thrombolysis in Cerebral Infarction score of 2b or 3 was 91.4%. The hemorrhage rate was 5.7%, but none were symptomatic. In terms of complications, distal emboli occurred in 4.3% of cases. CONCLUSIONS Endovascular stroke intervention with the FG2 is safe and effective with good accessibility and less occurrence of distal emboli. Its trackability, stability, and luminal size make the FG2 suitable for stroke intervention.
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Kang DH, Kim JW, Kim BM, Heo JH, Nam HS, Kim YD, Hwang YH, Kim YW, Baek JH, Yoo J, Kim DJ, Jeon P, Bang OY, Baik SK, Suh SH, Lee KY, Kwak HS, Roh HG, Lee YJ, Kim SH, Ryu CW, Ihn YK, Kim B, Jeon HJ, Byun JS, Suh S, Park JJ, Roh J. Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy. J Neurointerv Surg 2019; 11:979-983. [DOI: 10.1136/neurintsurg-2018-014696] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/03/2022]
Abstract
BackgroudThe need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT.MethodsWe identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome.ResultsA total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870).ConclusionCA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.
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Kim C, Kim SE, Jeon JP. Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke: Meta-Analysis. Neurointervention 2019; 14:17-26. [PMID: 30827063 PMCID: PMC6433186 DOI: 10.5469/neuroint.2019.00045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/19/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To assess clinical and angiographic outcomes after endovascular treatment (EVT) in ischemic stroke patients according to anesthesia types (general anesthesia vs. conscious sedation). MATERIALS AND METHODS A systematic literature review through an online data base between January 1990 and September 2017 was performed. A fixed effect model was used in cases of <50% heterogeneity. The primary outcomes were good clinical outcome at the 3-month follow-up and successful recanalization. A meta-regression analysis was done to estimate primary outcomes of log odds ratio (OR) on onset-to-puncture time (OTP) differences. Publication bias was determined using Begg's funnel plot and additional the Trim and Fill method. RESULTS Sixteen articles including 2,662 patients (general anesthesia, n=1,275; conscious sedation, n=1,387) were included. General anesthesia significantly decreased good outcomes than conscious sedation (OR, 0.564; 95% confidence interval [CI], 0.354-0.899). However, outcomes did not differ significantly in randomized controlled trials (RCTs; OR, 1.101; 95% CI, 0.395-3.071). Anesthesia type was not associated with successful recanalization (OR, 0.985; 95% CI, 0.787-1.233). General anesthesia increased the risk of mortality (OR, 1.532; 95% CI, 1.187-1.976) and pneumonia (OR, 1.613; 95% CI, 1.172-2.221), but not symptomatic intracranial hemorrhage (OR, 1.125; 95% CI, 0.767-1.652). The meta-regression analysis showed no linear relationship between OTP differences and log OR of good outcome (coefficient, 0.0004; P=0.95) or successful recanalization (coefficient, 0.0005; P=0.94), respectively. CONCLUSION General anesthesia seemed to be associated with adverse clinical outcome after EVT. However, its efficacy was not demonstrated in RCTs. Successful recanalization did not differ according to anesthesia type. Studies using individual patient data based on further RCTs are necessary to elucidate anesthesia effect on procedural and clinical outcomes.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.,Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon, Korea.,Genetic and Research, Hallym University College of Medicine, Chuncheon, Korea
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Kim CH, Kim SE, Jeon JP. Meta-Analysis of Endovascular Treatment for Acute M2 Occlusion. J Korean Neurosurg Soc 2019; 62:193-200. [PMID: 30840974 PMCID: PMC6411567 DOI: 10.3340/jkns.2017.0299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/24/2018] [Indexed: 12/26/2022] Open
Abstract
Objective Endovascular treatment (EVT) outcomes for acute M2 segment of middle cerebral artery occlusion remains unclear because most results are obtained from patients with large artery occlusion in the anterior circulation. The objective of this study was to assess procedural outcomes for acute M2 occlusion and compare outcomes according to thrombus location (M1 vs. M2).
Methods A systematic review was performed for online literature published from January 2004 to December 2016. Primary outcome was successful recanalization rate and symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used if heterogeneity was less than 50%.
Results Eight articles were included. EVT showed successful recanalization rate of 69.1% (95% confidence interval [CI], 54.9–80.4%) and S-ICH rate of 6.1% (95% CI, 4.5–8.3%). The rates of good clinical outcome at 3 months and mortality were 59.4% (95% CI, 49.9–68.2%) and 14.9% (95% CI, 11.4–19.3%), respectively. According to thrombus location (M1 vs. M2), successful recanalization (odds ratio [OR], 1.539; 95% CI, 0.293–8.092; p=0.610) and S-ICH (OR, 1.313; 95% CI, 0.603–2.861; p=0.493) did not differ significantly. Good clinical outcome was more evident in M2 occlusion after EVT than that in M1 occlusion (OR, 1.639; 95% CI, 1.135–2.368; p=0.008). However, mortality did not differ significantly according to thrombus location (OR, 0.788; 95% CI, 0.486–1.276; p=0.332). Conclusion EVT seems to be technically feasible for acute M2 occlusion. Direct comparative studies between EVT and medical treatment are needed further to find specific beneficiary group after EVT in patient with M2 occlusion.
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Affiliation(s)
- Chul Ho Kim
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea
| | - Jin Pyeong Jeon
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon, Korea.,Genetic and Research Incorporation, Chuncheon, Korea.,Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
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Kim CH, Jeon JP, Kim SE, Choi HJ, Cho YJ. Endovascular Treatment with Intravenous Thrombolysis versus Endovascular Treatment Alone for Acute Anterior Circulation Stroke : A Meta-Analysis of Observational Studies. J Korean Neurosurg Soc 2018; 61:467-473. [PMID: 29631383 PMCID: PMC6046573 DOI: 10.3340/jkns.2017.0505.006] [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: 05/16/2017] [Accepted: 09/08/2017] [Indexed: 11/27/2022] Open
Abstract
Objective The aim of this study was to determine outcome of ischemic stroke patients in the anterior circulation treated with endovascular treatment (EVT) with intravenous thrombolysis (IVT) versus EVT alone group. Methods A systemic literature review was performed using online database from January 2004 to January 2017. Primary outcomes were successful recanalization seen on finial angiography and good outcome at three months. Secondary outcomes were mortality and the development of symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used when heterogeneity was less than 50%. Egger’s regression test was used to assess publication bias. Results Five studies were included for final analysis. Between EVT with IVT and EVT alone group, successful recanalization (odds ratio [OR] 1.467, p=0.216), good clinical outcome at three months (OR 1.199, p=0.385), mortality (OR 0.776, p=0.371), and S-ICH (OR 1.820, p=0.280) did not differ significantly. Egger’s regression intercept with 95% confidence interval (CI) was 1.99 (95% CI -2.91 to 6.89) in successful recanalization and -0.27 (95% CI -6.35 to 5.80) in good clinical outcome, respectively. Conclusion The two treatment modalities, EVT with IVT and EVT alone, could be comparable in treating acute anterior circulation stroke. Studies to find specific beneficiary group for EVT alone, without primary IVT, are needed further.
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Affiliation(s)
- Chul Ho Kim
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Jun Cho
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49:e46-e110. [PMID: 29367334 DOI: 10.1161/str.0000000000000158] [Citation(s) in RCA: 3453] [Impact Index Per Article: 575.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. RESULTS These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. CONCLUSIONS These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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Bhaskar S, Stanwell P, Cordato D, Attia J, Levi C. Reperfusion therapy in acute ischemic stroke: dawn of a new era? BMC Neurol 2018; 18:8. [PMID: 29338750 PMCID: PMC5771207 DOI: 10.1186/s12883-017-1007-y] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022] Open
Abstract
Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). In this paper, we present an extensive overview of intravenous and endovascular reperfusion strategies, recent advances in AIS neurointervention, limitations of various treatment paradigms, and provide insights on imaging-guided reperfusion therapies. A roadmap for imaging guided reperfusion treatment workflow in AIS is also proposed. Both systemic thrombolysis and endovascular treatment have been incorporated into the standard of care in stroke therapy. Further research on advanced imaging-based approaches to select appropriate patients, may widen the time-window for patient selection and would contribute immensely to early thrombolytic strategies, better recanalization rates, and improved clinical outcomes.
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Affiliation(s)
- Sonu Bhaskar
- Western Sydney University (WSU), School of Medicine, South West Sydney Clinical School, Sydney, NSW 2170 Australia
- Liverpool Hospital, Department of Neurology & Neurophysiology, Liverpool, 2170 NSW Australia
- The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Liverpool, NSW Australia
- Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW Australia
- Priority Research Centre for Stroke & Brain Injury, Faculty of Health & Medicine, Hunter Medical Research institute (HMRI) and School of Medicine & Public Health, University of Newcastle, Newcastle, NSW Australia
| | - Peter Stanwell
- Priority Research Centre for Stroke & Brain Injury, Faculty of Health & Medicine, Hunter Medical Research institute (HMRI) and School of Medicine & Public Health, University of Newcastle, Newcastle, NSW Australia
| | - Dennis Cordato
- Liverpool Hospital, Department of Neurology & Neurophysiology, Liverpool, 2170 NSW Australia
- Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- School of Medicine, University of New South Wales (UNSW), Sydney, NSW Australia
| | - John Attia
- Priority Research Centre for Stroke & Brain Injury, Faculty of Health & Medicine, Hunter Medical Research institute (HMRI) and School of Medicine & Public Health, University of Newcastle, Newcastle, NSW Australia
- Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW Australia
| | - Christopher Levi
- Western Sydney University (WSU), School of Medicine, South West Sydney Clinical School, Sydney, NSW 2170 Australia
- Liverpool Hospital, Department of Neurology & Neurophysiology, Liverpool, 2170 NSW Australia
- The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Liverpool, NSW Australia
- Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- School of Medicine, University of New South Wales (UNSW), Sydney, NSW Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW Australia
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Gandhi CD, Al Mufti F, Singh IP, Abruzzo T, Albani B, Ansari SA, Arthur AS, Bain M, Baxter BW, Bulsara KR, Caplan JM, Chen M, Dabus G, Frei D, Hetts SW, Hussain MS, Jayaraman MV, Kayan Y, Klucznik RP, Lee SK, Mack WJ, Leslie-Mazwi T, McTaggart RA, Meyers PM, Mokin M, Patsalides AT, Prestigiacomo CJ, Pride GL, Starke RM, Sunenshine PJ, Fraser JF. Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery. J Neurointerv Surg 2018; 10:315-320. [DOI: 10.1136/neurintsurg-2017-013554] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
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Jeon JP, Kim SE, Kim CH. Primary suction thrombectomy for acute ischemic stroke: A meta-analysis of the current literature. Clin Neurol Neurosurg 2017; 163:46-52. [DOI: 10.1016/j.clineuro.2017.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 01/19/2023]
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Mansour OY, Ali AMI, Megahed M. Primary Endovascular Treatment of Acute Ischemic Stroke Using Stent Retrievers: Initial Egyptian Experience. JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2017; 9:20-25. [PMID: 29445434 PMCID: PMC5805904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Several mechanical thrombectomy (MT) devices have been designed with the goal of improving the recanalization rates of major intracranial artery occlusions. OBJECTIVE In this single-center experience, we analyzed the acute ischemic stroke (AIS) treatment with Primary MT; safety and efficacy and clinical results in our patients with large vessel occlusion (LVO). METHODS During a five-year period (from September 2011 to July 2016), out of 996 patients who presented to our center with a diagnosis of AIS, 113 (11.4%) patients (55 men and 58 women) underwent primary mechanical recanalization within three hours from onset of signs and symptoms for anterior and 12 hours for posterior circulation (with computer tomography angiography/perfusion ELVO). Successful recanalization (thrombolysis in cerebral infarction 2b-3), good outcome (modified Rankin scale score 0-2) and overall mortality rate, and symptomatic intracranial hemorrhage [sICH: parenchymal hematoma Type 1 or Type 2; National Institutes of Health Stroke Scale (NIHSS) score increment ≥4 points] were prospectively assessed. RESULTS The mean age of the patients was 62 ± 11.73 years, with a baseline mean admission NIHSS score of 16.7 ± 3.2. The mean time from onset to puncture (time to treatment) was 208.55 ± 53.49. Successful recanalization was achieved in 104 (92%) cases. Good outcome was observed in 89 (78.8%) patients, and mortality was 11.5% (n = 13). sICH occurred in five (4.4%) patients. CONCLUSION MT, within the first 4.5 hours, as primary treatment of acute LVO stroke provides high rate of recanalization and favorable clinical outcomes with low procedural complications.
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Affiliation(s)
- Ossama Yassin Mansour
- Faculty of Medicine, Stroke and Endovascular Unit, University of Alexandria, Alexandria, Egypt
| | | | - Mohamed Megahed
- Faculty of Medicine, Department of Critical Care, University of Alexandria, Alexandria, Egypt
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Malisch TW, Zaidat OO, Castonguay AC, Marden FA, Gupta R, Sun CHJ, Martin CO, Holloway WE, Mueller-Kronast N, English J, Linfante I, Dabus G, Bozorgchami H, Xavier A, Rai AT, Froehler M, Badruddin A, Nguyen TN, Taqi MA, Abraham MG, Janardhan V, Shaltoni H, Novakovic R, Yoo AJ, Abou-Chebl A, Chen PR, Britz GW, Kaushal R, Nanda A, Nogueira RG. Clinical and Angiographic Outcomes with the Combined Local Aspiration and Retriever in the North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry. INTERVENTIONAL NEUROLOGY 2017; 7:26-35. [PMID: 29628942 DOI: 10.1159/000480353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. Summary Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC, p = 0.04 and 26% in CGC, p = 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with CGC (54 vs. 91 min, p = 0.001) and was comparable to the BGC time (54 vs. 67, p = 0.11). Final degree of reperfusion was comparable among the groups (TICI [modified Thrombolysis in Cerebral Infarction] score 2b or higher was 72 vs. 70% for CGC vs. 78% for BGC). Procedural complications, mortality, and good clinical outcome at 90 days were similar between the groups. Key Messages The ARTS mechanical thrombectomy in acute ischemic stroke patients appears to yield better results as compared to the use of CGCs with no significant difference when compared to BGC. This early ARTS technique NASA registry data are limited by the earlier generation distal large bore catheters and small sample size. Future studies should focus on the comparison of ARTS and BGC techniques.
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Affiliation(s)
- Tim W Malisch
- Department of Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Osama O Zaidat
- St Vincent Mercy Hospital, Toledo, Ohio, USA.,Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA
| | | | - Franklin A Marden
- Department of Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Rishi Gupta
- St Vincent Mercy Hospital, Toledo, Ohio, USA.,Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA
| | - Chung-Huan J Sun
- St Vincent Mercy Hospital, Toledo, Ohio, USA.,Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA
| | | | | | | | - Joey English
- California Pacific Medical Center, San Francisco, California, USA
| | - Italo Linfante
- Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Guilherme Dabus
- Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | | | - Andrew Xavier
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ansaar T Rai
- Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Michael Froehler
- Department of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Thanh N Nguyen
- Department of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - M Asif Taqi
- Desert Regional Medical Center, Palm Springs, California, USA
| | | | | | - Hashem Shaltoni
- University of Texas Health Science Center, Houston, Texas, USA
| | - Robin Novakovic
- Department of Radiology, Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Albert J Yoo
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Peng Roc Chen
- Department of Neurosurgery, University of Texas, Houston, Texas, USA
| | - Gavin W Britz
- Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA
| | | | | | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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15
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Jeon JP, Kim SE, Kim CH. Endovascular treatment of acute ischemic stroke in octogenarians: A meta-analysis of observational studies. Clin Neurol Neurosurg 2017; 161:70-77. [PMID: 28863285 DOI: 10.1016/j.clineuro.2017.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, South Korea
| | - Chul Ho Kim
- Department of Neurology, Hallym University College of Medicine, Chuncheon, South Korea.
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16
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Yang D, Hao Y, Zi W, Wang H, Zheng D, Li H, Tu M, Wan Y, Jin P, Xiao G, Xiong Y, Xu G, Liu X. Effect of Retrievable Stent Size on Endovascular Treatment of Acute Ischemic Stroke: A Multicenter Study. AJNR Am J Neuroradiol 2017; 38:1586-1593. [PMID: 28596196 PMCID: PMC7960417 DOI: 10.3174/ajnr.a5232] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/24/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes. MATERIALS AND METHODS Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device. We matched patients treated with the 2 stent sizes using propensity score analysis. The successful outcome was reperfusion as measured by the modified Thrombolysis in Cerebral Infarction score immediately postprocedure and the dichotomized modified Rankin Scale score at 90 days. Symptomatic intracerebral hemorrhage and in-hospital mortality were also recorded. RESULTS After propensity score analysis, group outcomes did not differ. In addition, in patients with atherosclerosis-related occlusion, a higher reperfusion rate (P = .021) was observed in the Solitaire 4 group, as well as a shorter time interval (P = .002) and fewer passes (P = .025). Independent predictors of successful reperfusion in patients with atherosclerotic disease on logistic analysis were the small stent (OR, 3.217; 95% CI, 1.129-9.162; P = .029) and the propensity score acting as a covariate (OR, 52.84; 95% CI, 3.468-805.018; P = .004). CONCLUSIONS We found no evidence of a differential effect of intra-arterial therapy based on the size of Solitaire retrievers. In patients with atherosclerotic disease, favorable reperfusion was associated with deployment of a small stent.
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Affiliation(s)
- D Yang
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
| | - Y Hao
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Emergency Medicine (Y.H.), First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - W Zi
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - H Wang
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang, Shandong Province, China
| | - D Zheng
- Department of Neurology (D.Z.), 175th Hospital of the People's Liberation Army, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian Province, China
| | - H Li
- Department of Neurology (H.L.), 476th Hospital of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - M Tu
- Department of Neurology (M.T.), Hubei Wuchang Hospital, Wuhan, Hubei Province, China
| | - Y Wan
- Department of Neurology (Y.W.), Hubei Zhongshan Hospital, Wuhan, Hubei Province, China
| | - P Jin
- Department of Neurology (P.J.), Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, Anhui Province, China
| | - G Xiao
- Department of Neurology (G.Xiao), Second Affiliated Hospital of Soochow University; Suzhou, Jiangsu Province, China
| | - Y Xiong
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - G Xu
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - X Liu
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
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17
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Flynn D, Francis R, Halvorsrud K, Gonzalo-Almorox E, Craig D, Robalino S, McMeekin P, Cora A, Balami J, Ford GA, White P. Intra-arterial mechanical thrombectomy stent retrievers and aspiration devices in the treatment of acute ischaemic stroke: A systematic review and meta-analysis with trial sequential analysis. Eur Stroke J 2017; 2:308-318. [PMID: 31008323 DOI: 10.1177/2396987317719362] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/10/2017] [Indexed: 01/19/2023] Open
Abstract
Purpose Intra-arterial mechanical thrombectomy combined with appropriate patient selection (image-based selection of acute ischaemic stroke patients with large artery occlusion) yields improved clinical outcomes. We conducted a systematic review and meta-analysis, with trial sequential analysis to understand the benefits, risks and impact of new trials reporting in 2016 on the magnitude/certainty of the estimates for clinical effectiveness and safety of mechanical thrombectomy. Method Random effects' models were conducted of randomised clinical trials comparing mechanical thrombectomy (stent retriever or aspiration devices) with/without adjuvant intravenous thrombolysis with intravenous thrombolysis and other forms of best medical/supportive care in the treatment of acute ischaemic stroke. Study inclusion and risk of bias were assessed independently by two reviewers. Functional independence (modified Rankin Scale 0-2) and mortality at 90 days, including symptomatic intracranial haemorrhage rate were extracted. Trial sequential analysis established the strength of the evidence derived from the meta-analyses. Findings Eight trials of mechanical thrombectomy with a total sample size of 1841 (916 patients treated with mechanical thrombectomy and 925 treated without mechanical thrombectomy) fulfilled review inclusion criteria. The three most recent trials more precisely defined the effectiveness of mechanical thrombectomy (modified Rankin Scale 0 to 2; OR = 2.07, 95% CI = 1.70 to 2.51 based on data from eight trials versus OR = 2.39, 95% CI = 1.88 to 3.04 based on data from five trials). Meta-analyses showed no effect on mortality (OR = 0.81, 95% CI = 0.61 to 1.07) or symptomatic intracranial haemorrhage (OR = 1.22, 95% CI = 0.80 to 1.85) as found in analysis of first five trials. Trial sequential analysis indicated that the information size requirement was fulfilled to conclude the evidence for mechanical thrombectomy is robust. Discussion The impact of three recent trials on effectiveness and safety of mechanical thrombectomy was a more precise pooled effect size for functional independence. Trial sequential analysis demonstrated sufficient evidence for effectiveness and safety of mechanical thrombectomy. Conclusion No further trials of mechanical thrombectomy versus no mechanical thrombectomy are indicated to establish clinical effectiveness. Uncertainty remains as to whether mechanical thrombectomy reduces mortality or increases risk of symptomatic intracranial haemorrhage.
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Affiliation(s)
- Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Richard Francis
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle Upon Tyne, UK
| | | | | | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Peter McMeekin
- School of Health, Community and Education Studies, Northumbria University, UK
| | - Adela Cora
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle Upon Tyne, UK
| | - Joyce Balami
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Gary A Ford
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle Upon Tyne, UK.,Oxford University Hospitals NHS Trust and Oxford University, UK
| | - Phil White
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle Upon Tyne, UK
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18
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Widimsky P, Koznar B, Peisker T, Vasko P, Rohac F, Vavrova J, Kroupa J, Stetkarova I. Feasibility and safety of direct catheter-based thrombectomy in the treatment of acute ischaemic stroke. Cooperation among cardiologists, neurologists and radiologists. Prospective registry PRAGUE-16. EUROINTERVENTION 2017; 13:131-136. [DOI: 10.4244/eij-d-16-00979] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O, Wiesmann M, Knauth M, Mpotsaris A, Psychogios MN. Maximizing First-Pass Complete Reperfusion with SAVE. Clin Neuroradiol 2017; 28:327-338. [PMID: 28194477 DOI: 10.1007/s00062-017-0566-z] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Volker Maus
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Daniel Behme
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Borggrefe
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ioannis Tsogkas
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Aachen, Aachen, Germany
| | - Michael Knauth
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Marios Nikos Psychogios
- Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany
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20
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Velasco A, Buerke B, Stracke CP, Berkemeyer S, Mosimann PJ, Schwindt W, Alcázar P, Cnyrim C, Niederstadt T, Chapot R, Heindel W. Comparison of a Balloon Guide Catheter and a Non-Balloon Guide Catheter for Mechanical Thrombectomy. Radiology 2016; 280:169-76. [PMID: 26789499 DOI: 10.1148/radiol.2015150575] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose To evaluate the effectiveness of mechanical thrombectomy with the use of a stent retriever in acute ischemic stroke, performed by using a balloon guide catheter or non-balloon guide catheter. Materials and Methods In accordance with the institutional review board approval obtained at the two participating institutions, retrospective analysis was performed in 183 consecutive patients treated between 2013 and 2014 for occlusions in the middle cerebral artery or carotid terminus by using a stent retriever with a balloon guide catheter (n = 102) at one center and a non-balloon guide catheter (n = 81) at the other center. Data on procedure duration, number of passes, angiographic findings, type of stent retriever used, and expertise of the operators were collected. Successful recanalization was defined as grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization accomplished in up to three passes. Univariate and multivariate subgroup analyses were conducted to control for the confounding variables of prior thrombolysis, location of occlusion, and operator expertise. Results Successful recanalization with the balloon guide catheter was achieved in 89.2% of thrombectomies (91 of 102) versus 67.9% (55 of 81) achieved with the non-balloon guide catheter (P = .0004). The one-pass thrombectomy rate with the balloon guide catheter was significantly higher than for that with the non-balloon guide catheter (63.7% [65 of 102] vs 35.8% [29 of 81], respectively; P = .001). The procedure duration was significantly shorter by using the balloon guide catheter than the non-balloon guide catheter (median, 20.5 minutes vs 41.0 minutes, respectively; P < .0001). Conclusion The effectiveness of mechanical thrombectomy with stent retrievers in acute ischemic stroke in the anterior circulation in terms of angiographic results and procedure duration was improved when performed in combination with the balloon guide catheter. (©) RSNA, 2016.
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Affiliation(s)
- Aglaé Velasco
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Boris Buerke
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Christian P Stracke
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Shoma Berkemeyer
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Pascal J Mosimann
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Wolfram Schwindt
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Pedro Alcázar
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Christian Cnyrim
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Thomas Niederstadt
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - René Chapot
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
| | - Walter Heindel
- From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.)
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21
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Yarbrough CK, Ong CJ, Beyer AB, Lipsey K, Derdeyn CP. Endovascular Thrombectomy for Anterior Circulation Stroke. Stroke 2015; 46:3177-83. [DOI: 10.1161/strokeaha.115.009847] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/21/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Chester K. Yarbrough
- From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.)
| | - Charlene J. Ong
- From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.)
| | - Alexander B. Beyer
- From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.)
| | - Kim Lipsey
- From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.)
| | - Colin P. Derdeyn
- From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.)
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Widimsky P, Hopkins LN. Catheter-based interventions for acute ischaemic stroke. Eur Heart J 2015; 37:3081-3089. [PMID: 26429799 PMCID: PMC5091327 DOI: 10.1093/eurheartj/ehv521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 01/19/2023] Open
Abstract
Catheter-based interventions for acute ischaemic stroke currently include clot removal (usually from the medial cerebral artery) with modern stent-retrievers and in one of five patients (who have simultaneous or stand-alone internal carotid occlusion) also extracranial carotid intervention. Several recently published randomized trials clearly demonstrated superiority of catheter-based interventions (with or without bridging thrombolysis) over best medical therapy alone. The healthcare systems should adopt the new strategies for acute stroke treatment (including fast track to interventional lab) to offer the benefits to all suitable acute stroke patients.
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Affiliation(s)
- Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague, Srobarova 50, 100 34 Prague 10, Czech Republic
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Liu Y, Zhang L, Hong P. Efficacy and Safety of Mechanical Thrombectomy in Treating Acute Ischemic Stroke: A Meta Analysis. J INVEST SURG 2015; 29:106-11. [PMID: 26366836 DOI: 10.3109/08941939.2015.1067738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Mechanical thrombectomy (MT) is a promising treatment for acute ischemic stroke (AIS). But the results of completed trials were contradictory. Hence, we performed a meta-analysis to evaluate the efficacy and safety of MT in treating AIS. METHODS Literatures were searched in the databases including Pubmed, Cochrane Library, Web of Science and Ovid-SP. The bias and quality of publications with randomized controlled trials (RCTs) were assessed with the Cochrane collaboration's tool for assessing risk of bias. RESULTS Totally 16 publications matched the inclusion criteria, including seven independent RCTs and 2043 AIS patients. The results showed that the recanalization rate and the modified Rankin score of 0-2 at 90 days after treatment were better in MT combining standard care group, but the mortality had no significant difference, even the incidence of intracerebral hemorrhage during follow-up period was worse, as compared with standard care group. CONCLUSION MT combining standard care would be an effective and promising treatment for AIS patients according to the present study.
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Affiliation(s)
- Yao Liu
- b Xindu Hospital of Traditional Chinese Medicine , Chengdu , Sichuan Province , China
| | - Lin Zhang
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , Sichuan Province , China
| | - Peiwei Hong
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , Sichuan Province , China
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Grech R, Mizzi A, Pullicino R, Thornton J, Downer J. Functional outcomes and recanalization rates of stent retrievers in acute ischaemic stroke: A systematic review and meta-analysis. Neuroradiol J 2015; 28:152-71. [PMID: 26156097 DOI: 10.1177/1971400915576678] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Intra-arterial therapy for acute ischaemic stroke has evolved rapidly in the last few years. Stent retrievers have now replaced 'first-generation' devices, which have been the principle devices tested in stroke trials.Our aims were to determine the rates of successful recanalization and functional independence in acute stroke patients treated with stent retrievers. We also sought to assess the safety outcomes of stent retrievers by assessing the rates of mortality and intra-cranial haemorrhage. MATERIALS AND METHODS We conducted a systematic review and meta-analysis of studies which utilized stent retrievers as sole treatment or as part of a multi-modal approach in acute ischaemic stroke. RESULTS We identified 20 eligible studies: 17 on Solitaire (ev3/Covidien, Irvine, California, USA) (n = 762) and three on Trevo (Stryker, Kalamazoo, Michigan, USA) (n = 210). The mean age of participants was 66.8 (range 62.1-73.0) years and the M:F ratio was 1.1:1. The average stroke severity score (National Institutes of Health Stroke Scale (NIHSS)) at presentation was 17.2. The weighted mean symptom onset to arterial puncture and procedural duration were 265.4 minutes and 54.8 minutes, respectively.Successful recanalization was achieved in 84.5% of patients with a weighted mean of 2.0 stent retriever passes. Independent functional outcome was achieved in 51.2% and the mortality rate was 16.8%. CONCLUSION Stent retrievers have the potential to achieve a high rate of recanalization and functional independence whilst being relatively safe. They should be assessed in well-designed randomized controlled trials to determine their efficacy and assess whether they compare favourably with 'standard treatment' in stroke.
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Affiliation(s)
- Reuben Grech
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - Adrian Mizzi
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | | | - John Thornton
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| | - Jonathan Downer
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
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Jayaraman MV, Hussain MS, Abruzzo T, Albani B, Albuquerque FC, Alexander MJ, Ansari SA, Arthur AS, Baxter B, Bulsara KR, Chen M, Delgado-Almandoz JA, Fraser JF, Heck DV, Hetts SW, Kelly M, Lee SK, Leslie-Mawzi T, McTaggart RA, Meyers PM, Prestigiacomo C, Pride GL, Patsalides A, Starke RM, Tarr RW, Frei D, Rasmussen P. Embolectomy for stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery: Table 1. J Neurointerv Surg 2015; 7:316-21. [DOI: 10.1136/neurintsurg-2015-011717] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/04/2022]
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Translational Stroke Research: Where Have We Been and Where are We Going? Interviewing Dr. Marc Fisher (editor of Stroke). Can J Neurol Sci 2014; 42:2-6. [PMID: 25511193 DOI: 10.1017/cjn.2014.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Almekhlafi MA, Menon BK, Goyal M. Lessons learnt from recent endovascular stroke trials: finding a way to move forward. Expert Rev Cardiovasc Ther 2014; 12:429-36. [PMID: 24650311 DOI: 10.1586/14779072.2014.894885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The advent of stentrievers provided momentum for endovascular stroke therapy. Hopes were dampened after three randomized trials showed no clear benefit of endovascular therapy. This review discusses the results of these trials results and shortcomings. A detailed discussion will follow on the design, conduct and analysis of current and future endovascular stroke trials. Steps to improve the workflow of acute stroke cases from the time they enter the emergency department until endovascular reperfusion is achieved can significantly shorten the time from onset to successful reperfusion. These factors in addition to using novel approaches to analyze data and minimize delays caused by the consent process are perceived to be sufficient to demonstrate the efficacy of endovascular stroke therapy.
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Affiliation(s)
- Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
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Widimsky P, Koznar B, Peisker T, Vasko P, Vavrova J, Stetkarova I. Direct catheter-based thrombectomy in acute ischaemic stroke performed collaboratively by cardiologists, neurologists and radiologists: the single-centre pilot experience (PRAGUE-16 study). EUROINTERVENTION 2014; 10:869-75. [DOI: 10.4244/eijy14m05_12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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30
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Goktekin O, Tasal A, Uyarel H, Vatankulu MA, Sonmez O, Kul S, Ay N, Yamac H, Altintas O, Karadeli H, Kolukisa M, Aralasmak A, Asil T. Endovascular therapy of acute ischaemic stroke by interventional cardiologists: single-centre experience from Turkey. EUROINTERVENTION 2014; 10:876-83. [DOI: 10.4244/eijv10i7a149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Maingard J, Yan B. Future directions for intra-arterial therapy for acute ischaemic stroke: is there life after three negative randomized controlled studies? INTERVENTIONAL NEUROLOGY 2014; 2:97-104. [PMID: 25187785 PMCID: PMC4062314 DOI: 10.1159/000356087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: The three randomised controlled trials, Interventional Management of Stroke III (IMS3), Mechanical Retrieval and Revascularization of Stroke Clots Using Embolectomy (MR RESCUE) and Synthesis Expanasion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischaemic Stroke (SYNTHESIS EXP) showed no significant difference in clinical outcomes comparing intra-arterial (IA) therapy with intravenous thrombolysis. This article will explore the reasons for failure to show superiority of IA therapy. Summary: There are many reasons for the disappointing results of the three randomised controlled trials. Opposing views on IA therapy exist. Critics argue that only a small percentage of patients will be eligible for IA therapy and that it will never be cost-effective. Additionally, current trials have failed to address superior recanalization rates of new generation devices and lack of patient selection by advanced imaging. Time-to-treatment is longer in these randomised controlled trials and stroke outcomes were worse than anticipated. The current randomised controlled trials also took long periods to complete. There is emerging evidence that general anesthetic negatively influences outcome. Next generation trials will attempt to address these issues. Key Messages: There are disparate explanations for the disappointing results from the three IA therapy randomized controlled studies. Poor recanalisation rates with first generation endovascular devices, lack of advanced neuroimaging to aid in patient selection, lack of data surrounding the use of general anaesthesia, and prolonged time-to-treatment are potential contributors to negative results. The new generation of trials has the potential of addressing these pressing issues.
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Affiliation(s)
- Julian Maingard
- Melbourne Brain Centre, Department of Radiology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Bernard Yan
- Melbourne Brain Centre, Department of Radiology, Royal Melbourne Hospital, Melbourne, Vic., Australia ; Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Vic., Australia
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Birns J, Qureshi S, Chen R, Bhalla A. Endovascular stroke therapy. Eur J Intern Med 2014; 25:584-91. [PMID: 25034389 DOI: 10.1016/j.ejim.2014.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 04/11/2014] [Accepted: 06/26/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Following the development of intravenous thrombolysis as a successful treatment for ischaemic stroke, advances in neurointerventional radiology have facilitated endovascular approaches to treatment. This article reviews the available endovascular therapeutic options and their evidence-base. SUMMARY Initial studies demonstrated that endovascular treatment of ischaemic stroke with intra-arterial thrombolysis and/or the use of clot-retrieval, thrombus aspiration and stent-retriever devices produced early recanalisation and reperfusion and improved neurological outcome. More recent randomised trials, however, have failed to show translation of recanalisation into successful clinical outcome with 'time to treatment' proving crucial. In this rapidly evolving field, combined therapy incorporating intravenous and intra-arterial thrombolysis in combination with endovascular clot-retrieval has been developed and further studies are expected to yield better evidence to guide the optimal treatment of acute cerebral ischaemia.
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Affiliation(s)
- Jonathan Birns
- Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom.
| | - Sam Qureshi
- Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom
| | - Ruoling Chen
- Department of Health and Social Care Research, King's College London, London, United Kingdom
| | - Ajay Bhalla
- Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom; Department of Health and Social Care Research, King's College London, London, United Kingdom
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Almekhlafi MA, Davalos A, Bonafe A, Chapot R, Gralla J, Pereira VM, Goyal M. Impact of age and baseline NIHSS scores on clinical outcomes in the mechanical thrombectomy using solitaire FR in acute ischemic stroke study. AJNR Am J Neuroradiol 2014; 35:1337-40. [PMID: 24557701 DOI: 10.3174/ajnr.a3855] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Age and stroke severity are inversely correlated with the odds of favorable outcome after ischemic stroke. A previously proposed score for Stroke Prognostication Using Age and NIHSS Stroke Scale (SPAN) indicated that SPAN-100-positive patients (ie, age + NIHSS score = 100 or more) do not benefit from IV-tPA. If this finding holds true for endovascular therapy, this score can impact patient selection for such interventions. This study investigated whether a score combining age and NIHSS score can improve patients' selection for endovascular stroke therapy. MATERIALS AND METHODS The SPAN index was calculated for patients in the prospective Solitaire FR Thrombectomy for Acute Revascularization study: an international single-arm multicenter cohort for anterior circulation stroke treatment by using the Solitaire FR. The proportion with favorable outcome (90-day mRS score ≤2) was compared between SPAN-100-positive versus-negative patients. RESULTS Of the 202 patients enrolled, 196 had baseline NIHSS scores. Fifteen (7.7%) patients were SPAN-100-positive. There was no difference in the rate of successful reperfusion (Thrombolysis In Cerebral Infarction 2b or 3) between SPAN-100-positive versus -negative groups (93.3% versus 82.8%, respectively; P = .3). Stroke SPAN-100-positive patients had a significantly lower proportion of favorable clinical outcomes (26.7% versus 60.8% in SPAN-100-negative, P = .01). In a multivariable analysis, SPAN-100-positive status was associated with lower odds of favorable outcome (OR, 0.3; 95% CI, 0.1-0.9; P = .04). A higher baseline Alberta Stroke Program Early CT Score and a short onset to revascularization time also predicted favorable outcome in the multivariable analysis. CONCLUSIONS A significantly lower proportion of patients with a positive SPAN-100 achieved favorable outcome in this cohort. SPAN-100 was an independent predictor of favorable outcome after adjusting for time to treatment and the extent of preintervention tissue damage according to the Alberta Stroke Program Early CT Score.
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Affiliation(s)
- M A Almekhlafi
- From the Departments of Clinical Neurosciences (M.A.A.)Radiology (M.A.A., M.G.), University of Calgary, Calgary, Alberta, CanadaFaculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia
| | - A Davalos
- Department of Neurology (A.D.), University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - A Bonafe
- Department of Neuroradiology (A.B.), Centre Hospitalier Universitaire de Montpellie-Guy de Chauliac, Montpellier, France
| | - R Chapot
- Department of Neuroradiology (R.C.), Alfred Krupp Krankenhaus, Essen, Germany
| | - J Gralla
- Department of Diagnostic and Interventional Neuroradiology (J.G.), Inselspital, University of Bern, Bern, Switzerland
| | - V M Pereira
- Department of Neuroradiology (V.M.P.), University Hospital of Geneva, Geneva, Switzerland
| | - M Goyal
- Radiology (M.A.A., M.G.), University of Calgary, Calgary, Alberta, CanadaDepartment for Radiology (M.G.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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Deshaies EM, Singla A, Villwock MR, Padalino DJ, Sharma S, Swarnkar A. Early experience with stent retrievers and comparison with previous-generation mechanical thrombectomy devices for acute ischemic stroke. J Neurosurg 2014; 121:12-7. [DOI: 10.3171/2014.2.jns131372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
There is limited information regarding patient outcomes following interventions for stroke during the window for endovascular therapy. Studies have suggested that recently approved stent retrievers are safer and more effective than earlier-generation thrombectomy devices. The authors compared cases in which the Solitaire-FR device was used to those in which a MERCI or Penumbra device was used.
Methods
This study is a single-center retrospective review of 102 consecutive cases of acute stroke in which patients were treated with mechanical thrombectomy devices between 2007 and 2013. Multivariate models, adjusted for confounding factors, were used to investigate functional independence (modified Rankin Scale [mRS] score ≤ 2, and successful reperfusion (thrombolysis in cerebral infarction [TICI] score ≥ 2b).
Results
Thrombectomy device had a significant impact on functional independence (mRS score ≤ 2) at discharge from the hospital (p = 0.040). Solitaire-FR treatment resulted in significantly more patients being discharged as functionally independent in comparison with MERCI treatment (p = 0.016). A multivariate model found the use of Solitaire-FR to improve the odds of good clinical outcome in comparison with prior-generation devices (OR 6.283, 95% CI 1.785–22.119, p = 0.004). Additionally, the use of Solitaire-FR significantly increased the odds of successful reperfusion (OR 3.247, 95% CI 1.160–9.090, p = 0.025).
Conclusions
The stent retriever Solitaire-FR significantly improved the odds of functional independence and successful revascularization of the arterial tree. New interventional technology for stroke continues to mature, but randomized trials are needed to establish the actual benefit to specific patient populations.
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Affiliation(s)
| | | | | | | | | | - Amar Swarnkar
- 3Radiology, SUNY Upstate Medical University, Syracuse, New York
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Shindo A, Kawanishi M, Kawakita K, Okauchi M, Kawai N, Hayashi N, Osaka N, Tamiya T. Treatment of acute cerebral artery occlusion using the Penumbra system: our early experience. Neurol Med Chir (Tokyo) 2014; 54:441-9. [PMID: 24759097 PMCID: PMC4533451 DOI: 10.2176/nmc.oa.2013-0233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Intravenous recombinant tissue-type plasminogen activator (rt-PA) therapy is highly recommended to patients who are diagnosed with ischemic stroke within 4.5 hours after the onset while mechanical clot retrieval can be attempted in patients who are not indicated for or cannot effectively receive intravenous rt-PA therapy. In this article, we report early treatment outcomes and discuss the usefulness of mechanical clot retrieval using the Penumbra system (Penumbra Inc., Alameda, California, USA), especially in terms of technical cautions during the procedure and adaptability to elderly and high National Institutes of Health Stroke Scale (NIHSS) patients. We included 7 patients with thromboembolic occlusion. Pre-treatment NIHSS score ranged from 11 to 36 (mean: 24.9). All patients achieved good recanalization [thrombolysis in cerebral infarction (TICI) grade 2a or greater] without complications. The NIHSS score at 30 days after the treatment ranged between 0 and 28 (mean: 12.4), and improved more than 10 points in 4 of the 7 patients (57.1%). To obtain good recanalization without complications, selection of suitable reperfusion catheter and careful manipulation of separator prefiguring the occluded distal vessels are essential. The improved NIHSS score at 30 days after the treatment may have led to favorable results, such as an increased participation in available rehabilitation programs and the alleviation of the burden of care. Our findings suggest that the Penumbra system might be effective for treatment in elderly patients or patients with high NIHSS score wherein rt-PA therapy is inadvisable or ineffective in ischemic stroke secondary to large vessel occlusion. Recanalization can improve their quality of life on condition that the procedure is performed successfully without serious complications.
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Affiliation(s)
- Atsushi Shindo
- Department of Neurological Surgery, Kagawa University Faculty of Medicine
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Gaha M, Roy C, Estrade L, Gevry G, Weill A, Roy D, Chagnon M, Raymond J. Inter- and intraobserver agreement in scoring angiographic results of intra-arterial stroke therapy. AJNR Am J Neuroradiol 2014; 35:1163-9. [PMID: 24481332 DOI: 10.3174/ajnr.a3828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Angiographic results are commonly used as surrogate markers of the success of intra-arterial therapies for acute stroke. Inter- and intraobserver agreement in judging angiographic results remain poorly characterized. Our goal was to assess 2 commonly used revascularization scales. MATERIALS AND METHODS A portfolio of 148 pre- and post treatment images of 37 cases of proximal anterior circulation occlusions was electronically sent to 12 expert observers who were asked to grade treatment outcomes according to recanalization (of arterial occlusive lesion) or reperfusion (TICI) scales. Three expert observers had to score treatment outcomes by using a similar portfolio of 32 patients or when they had full access to all angiographic data, twice for each method 3-12 months apart. Results were analyzed by using κ statistics. RESULTS Agreement among 9 responding observers was moderate for both the TICI (κ = 0.45 ± 0.01) and arterial occlusive lesion (κ = 0.39 ± 0.16) scales. Agreement was similar (moderate) when 3 observers had access to a portfolio (κ = 0.59 ± 0.06 and 0.49 ± 0.07, respectively) or to the full angiographic data (κ = 0.54 ± 0.06 and 0.59 ± 0.07, respectively). Intraobserver agreement was "fair to moderate" for both methods. Interobserver agreement became "substantial" (>0.6) when outcomes were dichotomized into "success" (TICI 2b, 3; arterial occlusive lesion II, III or "failure"; the results were judged more favorably when the arterial occlusive lesion rather than the TICI scale was used. CONCLUSIONS There is an important variability in the assessment of angiographic outcomes of endovascular treatments, invalidating comparisons among publications. A simple dichotomous judgment can be used as a surrogate outcome when treatments are assessed by the same observers in randomized trials.
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Affiliation(s)
- M Gaha
- From the Department of Radiology (M.G., C.R., G.G., A.W., D.R., M.C., J.R.), Centre Hospitalier de l'Université de Montréal Notre-Dame Hospital, Montreal, Quebec, Canada
| | - C Roy
- From the Department of Radiology (M.G., C.R., G.G., A.W., D.R., M.C., J.R.), Centre Hospitalier de l'Université de Montréal Notre-Dame Hospital, Montreal, Quebec, Canada
| | - L Estrade
- Service de Radiologie (L.E.), Hôpital Maison Blanche, CHU Reims, France
| | - G Gevry
- From the Department of Radiology (M.G., C.R., G.G., A.W., D.R., M.C., J.R.), Centre Hospitalier de l'Université de Montréal Notre-Dame Hospital, Montreal, Quebec, Canada
| | - A Weill
- From the Department of Radiology (M.G., C.R., G.G., A.W., D.R., M.C., J.R.), Centre Hospitalier de l'Université de Montréal Notre-Dame Hospital, Montreal, Quebec, Canada
| | - D Roy
- From the Department of Radiology (M.G., C.R., G.G., A.W., D.R., M.C., J.R.), Centre Hospitalier de l'Université de Montréal Notre-Dame Hospital, Montreal, Quebec, Canada
| | - M Chagnon
- From the Department of Radiology (M.G., C.R., G.G., A.W., D.R., M.C., J.R.), Centre Hospitalier de l'Université de Montréal Notre-Dame Hospital, Montreal, Quebec, CanadaDepartment of Mathematics and Statistics (M.C.), Université de Montréal, Montreal, Quebec, Canada
| | - J Raymond
- From the Department of Radiology (M.G., C.R., G.G., A.W., D.R., M.C., J.R.), Centre Hospitalier de l'Université de Montréal Notre-Dame Hospital, Montreal, Quebec, Canada
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Goyal M, Almekhlafi MA, Fan L, Menon BK, Demchuk AM, Yeatts SD, Hill MD, Tomsick T, Khatri P, Zaidat OO, Jauch EC, Eesa M, Jovin TG, Broderick JP. Evaluation of interval times from onset to reperfusion in patients undergoing endovascular therapy in the Interventional Management of Stroke III trial. Circulation 2014; 130:265-72. [PMID: 24815501 DOI: 10.1161/circulationaha.113.007826] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Meaningful delays occurred in the Interventional Management of Stroke (IMS) III trial. Analysis of the work flow will identify factors contributing to the in-hospital delays. METHODS AND RESULTS In the endovascular arm of the IMS III trial, the following time intervals were calculated: stroke onset to emergency department arrival; emergency department to computed tomography (CT); CT to intravenous tissue plasminogen activator start; intravenous tissue plasminogen activator start to randomization; randomization to groin puncture; groin puncture to thrombus identification; thrombus identification to start of endovascular therapy; and start of endovascular therapy to reperfusion. The effects of enrollment time, CT angiography use, interhospital transfers, and intubation on work flow were evaluated. Delays occurred notably in the time intervals from intravenous tissue plasminogen activator initiation to groin puncture (median 84 minutes) and start of endovascular therapy to reperfusion (median 85 minutes). The CT to groin puncture time was significantly shorter during working hours than after. Times from emergency department to reperfusion and groin puncture to reperfusion decreased over the trial period. Patients with CT angiography had shorter emergency department to reperfusion and onset to reperfusion times. Transfer of patients resulted in a longer onset to reperfusion time compared with those treated in the same center. Age, sex, National Institutes of Health Stroke Scale score, and intubation did not affect delays. CONCLUSIONS Important delays were identified before reperfusion in the IMS III trial. Delays decreased as the trial progressed. Use of CT angiography and endovascular treatment in the same center were associated with time savings. These data may help in optimizing work flow in current and future endovascular trials. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
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Affiliation(s)
- Mayank Goyal
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
| | - Mohammed A Almekhlafi
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Liqiong Fan
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Bijoy K Menon
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Andrew M Demchuk
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Sharon D Yeatts
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Michael D Hill
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Thomas Tomsick
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Pooja Khatri
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Osama O Zaidat
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Edward C Jauch
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Muneer Eesa
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Tudor G Jovin
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
| | - Joseph P Broderick
- Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.)
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Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients. Neuroradiology 2014; 56:325-32. [DOI: 10.1007/s00234-014-1329-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Manning NW, Campbell BCV, Oxley TJ, Chapot R. Acute ischemic stroke: time, penumbra, and reperfusion. Stroke 2014; 45:640-4. [PMID: 24399376 DOI: 10.1161/strokeaha.113.003798] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nathan W Manning
- From the Florey Institute of Neuroscience and Mental Health (N.W.M., B.C.V.C., T.J.O.) and Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (B.C.V.C., T.J.O.), University of Melbourne, Parkville, Australia; and Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (R.C.)
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Almekhlafi MA, Hockley A, Desai JA, Nambiar V, Mishra S, Volny O, Eesa M, Demchuk AM, Menon BK, Goyal M. Overcoming the evening/weekend effects on time delays and outcomes of endovascular stroke therapy: the Calgary Stroke Program experience. J Neurointerv Surg 2013; 6:729-32. [DOI: 10.1136/neurintsurg-2013-011000] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Widimsky P, Coram R, Abou-Chebl A. Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences. Eur Heart J 2013; 35:147-55. [PMID: 24096325 PMCID: PMC3890694 DOI: 10.1093/eurheartj/eht409] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The evolution of reperfusion therapy in acute myocardial infarction and acute ischaemic stroke has many similarities: thrombolysis is superior to placebo, intra-arterial thrombolysis is not superior to intravenous (i.v.), facilitated intervention is of questionable value, and direct mechanical recanalization without thrombolysis is proven (myocardial infarction) or promising (stroke) to be superior to thrombolysis-but only when started with no or minimal delay. However, there are also substantial differences. Direct catheter-based thrombectomy in acute ischaemic stroke is more difficult than primary angioplasty (in ST-elevation myocardial infarction [STEMI]) in many ways: complex pre-intervention diagnostic workup, shorter time window for clinically effective reperfusion, need for an emergent multidisciplinary approach from the first medical contact, vessel tortuosity, vessel fragility, no evidence available about dosage and combination of peri-procedural antithrombotic drugs, risk of intracranial bleeding, unclear respective roles of thrombolysis and mechanical intervention, lower number of suitable patients, and thus longer learning curves of the staff. Thus, starting acute stroke interventional programme requires a lot of learning, discipline, and humility. Randomized trials comparing different reperfusion strategies provided similar results in acute ischaemic stroke as in STEMI. Thus, it might be expected that also a future randomized trial comparing direct (primary) catheter-based thrombectomy vs. i.v. thrombolysis could show superiority of the mechanical intervention if it would be initiated without delay. Such randomized trial is needed to define the role of mechanical intervention alone in acute stroke treatment.
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Affiliation(s)
- Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague, Ruska 87, 100 00 Prague 10, Czech Republic
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Widimský P, Kožnar B, Vaško P, Peisker T, Štětkářová I. Acute myocardial infarction and acute stroke: what are the differences? Focus on reperfusion therapy. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2013.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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