1
|
Navia P, Espinosa de Rueda M, Rodriguez-Benitez A, Ballenilla Marco F, Pumar JM, Gallego-Leon JI, Diaz-Valiño JL, Mendez JC, Hernández Fernández F, Rodriguez-Paz CM, Hernandez D, Maynar FJ, Vega-Villar J, García-Benassi JM, Martínez-Galdámez M, Larrea JA, Fernandez-Prieto A. Endovascular thrombectomy first-pass reperfusion and ancillary device placement. J Neurointerv Surg 2024; 16:902-907. [PMID: 37607823 DOI: 10.1136/jnis-2023-020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT). METHODS Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device. RESULTS From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0-2). CONCLUSIONS Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.
Collapse
Affiliation(s)
- Pedro Navia
- Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
- La Paz University Hospital Health Research Institute, Madrid, Spain
| | | | | | | | - José Manuel Pumar
- Neuroradiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Ignacio Gallego-Leon
- Alicante General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | | | - Jose Carlos Mendez
- Interventional Neuroradiology Unit. Radiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Interventional Neuroradiology.Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain
| | - Jose-Angel Larrea
- Interventional Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Andres Fernandez-Prieto
- Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
- La Paz University Hospital Health Research Institute, Madrid, Spain
| |
Collapse
|
2
|
Patki P, Simon S, Costanzo F, Manning KB. Current Approaches and Methods to Understand Acute Ischemic Stroke Treatment Using Aspiration Thrombectomy. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00735-0. [PMID: 38886306 DOI: 10.1007/s13239-024-00735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/21/2024] [Indexed: 06/20/2024]
Abstract
Acute ischemic stroke occurs when a blood clot occludes a cerebral artery. Mechanical interventions, primarily stent retrievers and aspiration thrombectomy, are used currently for removing the occluding clot and restoring blood flow. Aspiration involves using a long catheter to traverse the cerebral vasculature to reach the blood clot, followed by application of suction through the catheter bore. Aspiration is also used in conjunction with other techniques such as stent retrievers and balloon guide catheters. Despite the wide use of aspiration, our physical understanding of the process and the causes of the failure of aspiration to retrieve cerebral clots in certain scenarios is not well understood. Experimental and computational studies can help develop the capability to provide deeper insights into the procedure and enable development of new devices and more effective treatment methods. We recapitulate the aspiration-based thrombectomy techniques in clinical practice and provide a perspective of existing engineering methods for aspiration. We articulate the current knowledge gap in the understanding of aspiration and highlight possible directions for future engineering studies to bridge this gap, help clinical translation of engineering studies, and develop new patient-specific stroke therapy.
Collapse
Affiliation(s)
- Priyanka Patki
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Scott Simon
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Francesco Costanzo
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA.
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA.
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
| |
Collapse
|
3
|
Campos JK, Meyer BM, Khan MW, Laghari FJ, Zarrin DA, Collard de Beaufort J, Amin G, Golshani K, Bender MT, Colby GP, Lin LM, Coon AL. Feasibility of super-bore 0.088″ mechanical thrombectomy in M1 vessels smaller than 8 French: Experience in 20 consecutive cases. Interv Neuroradiol 2024:15910199241229198. [PMID: 38418397 DOI: 10.1177/15910199241229198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Superbore 0.088″ catheters provide a platform for optimizing aspiration efficiency and flow control during stroke mechanical thrombectomy procedures. New superbore catheters have the distal flexibility necessary to navigate complex neurovascular anatomy while providing the proximal support of traditional 8F catheters. The safety and feasibility of Zoom 88™ superbore angled-tip catheters in the middle cerebral artery (MCA) segments smaller than the catheter diameter have not been previously described. METHODS Twenty consecutive cases of acute MCA mechanical thrombectomy were retrospectively identified from the senior authors' prospectively maintained Institutional Review Board-approved database, in which the Zoom 88 (Imperative Care, Campbell, CA) catheter was successfully navigated to at least the M1 segment. Patient demographics, procedural details, and periprocedural information were analyzed. Rates and averages (standard errors) are generally reported. RESULTS The average National Institutes of Health Stroke Scale at presentation and age were 15 ± 2 and 73 ± 3 years, respectively. The M1 and M2 occlusions were evenly distributed. The average M1 measurements before thrombectomy ranged from 2.36 ± 0.07 mm proximally to 2.00 ± 0.11 mm distally, and after thrombectomy, they ranged from 2.34 ± 0.07 mm proximally to 1.97 ± 0.10 mm distally. First-pass modified thrombolysis in cerebral infarction (mTICI) 2C/3 recanalization was achieved in 40% of cases, and final mTICI 2C/3 recanalization was achieved in 90% of cases. A single case of mild vasospasm was managed with verapamil. No hemorrhagic or periprocedural complications were noted. CONCLUSION Superbore 0.088″ catheters with flexible distal segments can be safely navigated to the MCA to augment mechanical thrombectomy even when the MCA segment is smaller than the catheter.
Collapse
Affiliation(s)
- Jessica K Campos
- Department of Neurological Surgery, University of California Irvine, Orange, CA, USA
| | | | | | - Fahad J Laghari
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
| | - David A Zarrin
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Gizal Amin
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
| | - Kiarash Golshani
- Department of Neurological Surgery, University of California Irvine, Orange, CA, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
| |
Collapse
|
4
|
Wang W, Xu Y, Zhang B, Liu S, Ma Z, Wang S, Zhang P, Wei M. Mechanical thrombectomy using the retrograde semi-retrieval technique for patients with underlying intracranial atherosclerotic stenosis. Front Neurol 2024; 14:1280181. [PMID: 38283684 PMCID: PMC10811598 DOI: 10.3389/fneur.2023.1280181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/13/2023] [Indexed: 01/30/2024] Open
Abstract
Background The retrograde semi-retrieval technique (RESET) has been described as a modified technique for endovascular thrombectomy (EVT) whose safety and efficacy for intracranial atherosclerosis stenosis (ICAS) patients remain uncertain. This article presents our single-center experience, comparing RESET vs. non-RESET in ICAS patients. Materials and methods We analyzed 327 consecutive ICAS patients who underwent EVT at Tianjin Huanhu Hospital from January 2018 and December 2022. Patients were categorized into two groups: RESET and non-RESET. The primary outcome was the first-pass effect (FPE). Secondary outcomes included successful reperfusion, functional independence at 90 days, mortality, and symptomatic intracranial hemorrhage (sICH). Results RESET was significantly associated with FPE [adjusted odds ratio (aOR) 2.00, 95% confidence interval (CI) 1.03-3.87, p = 0.040]. RESET was not significantly associated with successful reperfusion (aOR 1.5, CI 0.55-4.06, p = 0.425), an mRS of 0-2 at 90 days (aOR 1.36, CI 0.83-2.21, p = 0.223), sICH (aOR 0.39, CI 0.12-1.23, p = 0.108), and mortality (aOR 0.49, CI 0.16-1.44, p = 0.193). After propensity score matching, the results were consistent with the primary analysis. Conclusion Compared to non-RESET, patients treated with RESET showed increased FPE incidence and significantly decreased puncture-to-reperfusion time. RESET was proven to be safe and effective in enhancing reperfusion for LVO patients receiving EVT with underlying ICAS.
Collapse
Affiliation(s)
- Wei Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Yongbo Xu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Bohao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Shuling Liu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhenjian Ma
- Department of Neurosurgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Sifei Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Pinyuan Zhang
- Department of Neurosurgery (Cerebrovascular Disease), The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ming Wei
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
- Department of Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| |
Collapse
|
5
|
Lee IH, Ha SK, Lim DJ, Choi JI. Distal placement of balloon guide catheter facilitates stent-retriever mechanical thrombectomy for acute ischemic stroke in the anterior circulation. Acta Neurochir (Wien) 2023; 165:3759-3768. [PMID: 37816916 DOI: 10.1007/s00701-023-05818-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Although balloon guide catheters (BGCs) have been demonstrated to improve recanalization and functional outcomes by enabling proximal flow control and forced aspiration during mechanical thrombectomy (MT), the significance of the BGC location has been overlooked. We evaluated the impact of BGC location during MT for anterior circulation acute ischemic stroke (AIS). METHODS Patients were divided into the proximal and distal BGC groups according to the BGC tip location relative to the lower margin of the C1 vertebral body. Endovascular and clinical outcomes were compared between the two groups, including subgroup analyses of the two types of extracranial internal carotid artery (ICA) anatomy, categorized based on cerebral angiography. RESULTS A total of 124 patients were analyzed, with 62 each in the proximal and distal BGC placement groups. The distal BGC group had higher rates of first-pass recanalization (FPR) (38.7% vs. 17.7%, P = 0.009) and favorable outcomes (64.5% vs. 46.8%, P = 0.047) with shorter procedure time (47.5 min vs. 65 min, P = 0.001) and fewer distal embolization (3.2% vs. 12.9%, P = 0.048) than the proximal BGC group. FPR was also more frequently achieved in the distal BGC group of patients with tortuous ICA (37.0% vs. 12.5%, P = 0.029). Multivariate analysis showed that distal BGC placement was an independent predictor of FPR (odds ratio, 3.092; 95% confidence interval, 1.326-7.210; P = 0.009). CONCLUSION Distal BGC placement facilitates MT for AIS in the anterior circulation. Therefore, we suggest distal BGC placement to maximize the effect of thrombectomy, even for tortuous extracranial ICA.
Collapse
Affiliation(s)
- In-Hyoung Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea.
| |
Collapse
|
6
|
Munoz A, Jabre R, Orenday-Barraza JM, Eldin MS, Chen CJ, Al-Saiegh F, Abbas R, El Naamani K, Gooch MR, Jabbour PM, Tjoumakaris S, Rosenwasser RH, Herial NA. A review of mechanical thrombectomy techniques for acute ischemic stroke. Interv Neuroradiol 2023; 29:450-458. [PMID: 35238227 PMCID: PMC10399505 DOI: 10.1177/15910199221084481] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Mechanical thrombectomy is established as standard of care in the management of acute ischemic stroke due to large vessel occlusion and evidence-based guidelines for mechanical thrombectomy have been defined. As research continues to further expand the eligibility criteria for thrombectomy and the number of thrombectomy procedures increase worldwide, there is also growing focus on innovation of thrombectomy devices, procedural techniques, and related outcomes. Thrombectomy primarily involves use of stent retrievers and distal aspiration techniques, but variations and different combinations of techniques have been reported. As this is a rapidly evolving area in stroke management, there is debate as to which, if any, of these techniques leads to improved clinical outcomes over another and there is a lack of data comparing them. In this review, currently published and distinct techniques of mechanical thrombectomy are described methodically along with illustrations to aid in understanding the subtle differences between the techniques. The perceived benefits of each variation are discussed.
Collapse
Affiliation(s)
- Alfredo Munoz
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Roland Jabre
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jose M Orenday-Barraza
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Mohamed Shehab Eldin
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Fadi Al-Saiegh
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael Reid Gooch
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal M Jabbour
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Bageac DV, Gershon BS, Vargas J, Mokin M, Ren Z, Chada D, Turk AS, Chaudry MI, Turner RD, Fifi JT, Shigematsu T, De Leacy R. Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology. J Neurointerv Surg 2021; 14:390-396. [PMID: 34039682 DOI: 10.1136/neurintsurg-2021-017341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation. METHODS This is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement. RESULTS Each study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0-2%, and 10.26% were deceased. CONCLUSIONS Tracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.
Collapse
Affiliation(s)
- Devin V Bageac
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Blake S Gershon
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Jan Vargas
- Department of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Maxim Mokin
- Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Zeguang Ren
- Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Deeksha Chada
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Aquilla S Turk
- Department of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - M Imran Chaudry
- Department of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Raymond D Turner
- Department of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | | | - Reade De Leacy
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| |
Collapse
|
8
|
Abdalla RN, Cantrell DR, Shaibani A, Hurley MC, Jahromi BS, Potts MB, Ansari SA. Refractory Stroke Thrombectomy: Prevalence, Etiology, and Adjunctive Treatment in a North American Cohort. AJNR Am J Neuroradiol 2021; 42:1258-1263. [PMID: 33888454 DOI: 10.3174/ajnr.a7124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/26/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute stroke intervention refractory to mechanical thrombectomy may be due to underlying vessel wall pathology including intracranial atherosclerotic disease and intracranial arterial dissection or recalcitrant emboli. We studied the prevalence and etiology of refractory thrombectomy, the safety and efficacy of adjunctive interventions in a North American-based cohort. MATERIALS AND METHODS We performed a multicenter, retrospective study of refractory thrombectomy, defined as unsuccessful recanalization, vessel reocclusion in <72 hours, or required adjunctive antiplatelet glycoprotein IIb/IIIa inhibitors, intracranial angioplasty and/or stenting to achieve and maintain reperfusion. Clinical and imaging criteria differentiated etiologies for refractory thrombectomy. Baseline demographics, cerebrovascular risk factors, technical/clinical outcomes, and procedural safety/complications were compared between refractory and standard thrombectomy groups. Multivariable logistic regression analysis was performed to determine independent predictors of refractory thrombectomy. RESULTS Refractory thrombectomy was identified in 25/302 cases (8.3%), correlated with diabetes (44% versus 22%, P = .02) as an independent predictor with OR = 2.72 (95% CI, 1.05-7.09; P = .04) and inversely correlated with atrial fibrillation (16% versus 45.7%, P = .005). Refractory etiologies were secondary to recalcitrant emboli (20%), intracranial atherosclerotic disease (60%), and/or intracranial arterial dissection (44%). Four (16%) patients were diagnosed with early vessel reocclusion, and 21 patients underwent adjunctive salvage interventions with glycoprotein IIb/IIIa inhibitor infusion alone (32%) or intracranial angioplasty and/or stenting (52%). There were no significant differences in TICI 2b/3 reperfusion efficacy (85.7% versus 90.9%, P = .48), symptomatic intracranial hemorrhage rates (0% versus 9%, P = .24), favorable clinical outcomes (39.1% versus 48.3%, P = .51), or mortality (13% versus 28.3%, P = .14) versus standard thrombectomy. CONCLUSIONS Refractory stroke thrombectomy is encountered in <10% of cases, independently associated with diabetes, and related to underlying vessel wall pathology (intracranial atherosclerotic disease and/or intracranial arterial dissection) or, less commonly, recalcitrant emboli. Emergent salvage interventions with glycoprotein IIb/IIIa inhibitors or intracranial angioplasty and/or stenting are safe and effective adjunctive treatments.
Collapse
Affiliation(s)
- R N Abdalla
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois.,Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt
| | - D R Cantrell
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A Shaibani
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M C Hurley
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - B S Jahromi
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M B Potts
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - S A Ansari
- From the Departments of Radiology (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.) .,Neurology (S.A.A.).,Neurological Surgery (R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
9
|
Gershon BS, Bageac DV, Shigematsu T, Majidi S, De Leacy R. Republished: First clinical report of aspiration through a novel 0.088-inch catheter positioned in the M1 middle cerebral artery for ELVO thrombectomy. J Neurointerv Surg 2020; 13:e4. [PMID: 33060123 DOI: 10.1136/neurintsurg-2020-016780.rep] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022]
Abstract
Two patients, separated by 1 year, underwent mechanical thrombectomy using next generation, highly navigable 0.088-inch large bore catheters, which were navigated to and aspirated within the M1 middle cerebral artery segment. Case 1 demonstrates the first reported clinical application of this technique used in conjunction with stent retriever and direct aspiration through an intermediate catheter, resulting in modified thrombolysis in cerebral infarction (mTICI) score 3 recanalisation, and a 90-day modified Rankin Score of 1. In case 2, direct on-clot aspiration was applied through a 0.088-inch guide catheter in the left M1 segment, resulting in mTICI score 3 recanalisation and a National Institutes of Health Stroke Scale score of 1 at discharge. There was no evidence of untoward events in either case. Advancement of a 0.088-inch catheter into the M1 segment offers potential benefits to thrombectomy by improving device-thrombus interaction, inducing local flow arrest and protecting proximal vessels from embolus to new territories.
Collapse
Affiliation(s)
- Blake S Gershon
- College of Medicine, SUNY Downstate, Brooklyn, New York, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Devin V Bageac
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tomoyoshi Shigematsu
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurosurgery, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Japan
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
10
|
Gershon BS, Bageac DV, Shigematsu T, Majidi S, De Leacy R. First clinical report of aspiration through a novel 0.088-inch catheter positioned in the M1 middle cerebral artery for ELVO thrombectomy. BMJ Case Rep 2020; 13:13/10/e016780. [PMID: 33033000 DOI: 10.1136/bcr-2020-016780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Two patients, separated by 1 year, underwent mechanical thrombectomy using next generation, highly navigable 0.088-inch large bore catheters, which were navigated to and aspirated within the M1 middle cerebral artery segment. Case 1 demonstrates the first reported clinical application of this technique used in conjunction with stent retriever and direct aspiration through an intermediate catheter, resulting in modified thrombolysis in cerebral infarction (mTICI) score 3 recanalisation, and a 90-day modified Rankin Score of 1. In case 2, direct on-clot aspiration was applied through a 0.088-inch guide catheter in the left M1 segment, resulting in mTICI score 3 recanalisation and a National Institutes of Health Stroke Scale score of 1 at discharge. There was no evidence of untoward events in either case. Advancement of a 0.088-inch catheter into the M1 segment offers potential benefits to thrombectomy by improving device-thrombus interaction, inducing local flow arrest and protecting proximal vessels from embolus to new territories.
Collapse
Affiliation(s)
- Blake S Gershon
- College of Medicine, SUNY Downstate, Brooklyn, New York, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Devin V Bageac
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tomoyoshi Shigematsu
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurosurgery, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Japan
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|