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Masthoff M, Krähling H, Akkurt BH, Elsharkawy M, Köhler M, Ergawy M, Thomas C, Schwindt W, Minnerup J, Stracke P. Evaluation of effectiveness and safety of the multizone NeVa TM stent retriever for mechanical thrombectomy in ischemic stroke. Neuroradiology 2023; 65:1777-1785. [PMID: 37878032 PMCID: PMC10654155 DOI: 10.1007/s00234-023-03236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE This study aimed to evaluate the effectiveness and safety of the NeVaTM stent retriever as first- and second-line device for mechanical thrombectomy in acute ischemic stroke. METHODS In this retrospective single-center study, all consecutive patients that underwent mechanical thrombectomy with NeVaTM stent retriever as first- or second-line device due to intracranial vessel occlusion with acute ischemic stroke between March and November 2022 were included. RESULTS Thirty-nine patients (m=18, f=21) with a mean age of 69.9 ± 13.3 years were treated with the NeVaTM stent retriever. NeVaTM stent retriever was used as first-line device in 24 (61.5%) of patients and in 15 (38.5%) as second-line device. First-pass rate (≥mTICI 2c) of NeVaTM stent retriever was both 66.7% when used as first- or second-line device. Final recanalization rate including rescue strategies was 92.3% for ≥mTICI2c and 94.9% for ≥mTICI2b. No device-related minor or major adverse events were observed. A hemorrhage was detected in 33.3% of patients at 24h post-thrombectomy dual-energy CT, of which none was classified as symptomatic intracerebral hemorrhage. NIHSS and mRS improved significantly at discharge compared to admission (p<0.05). CONCLUSION The NeVaTM stent retriever has a high effectivity and good safety profile as first- and second-line device for mechanical thrombectomy in acute ischemic stroke.
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Affiliation(s)
- Max Masthoff
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Hermann Krähling
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Burak Han Akkurt
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Mohamed Elsharkawy
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- Clinic for Radiology and Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Michael Köhler
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Mostafa Ergawy
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Christian Thomas
- Institute of Neuropathology, University of Muenster and University Hospital Muenster, Muenster, Germany
| | - Wolfram Schwindt
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Paul Stracke
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- Clinic and Policlinic for Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Melki GJ, Demeestere J, Laenen A, Bonne L, Claus E, Lambert J, Buyck PJ, Peluso J, Demaerel P, Lemmens R, Maleux G. Immediate and 90-Day Clinical Outcome of Patients with Acute Stroke Treated with the NeVa-Vesalio Mechanical Thrombectomy Device: A Retrospective Case Series. World Neurosurg 2023; 179:e212-e221. [PMID: 37611801 DOI: 10.1016/j.wneu.2023.08.053] [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] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The NeVa stent retriever is a newly designed mechanical thrombectomy device for the treatment of acute ischemic stroke caused by large vessel occlusion. We investigate the procedural characteristics and patients' clinical outcomes at discharge and at 90 days of follow-up. METHODS We retrospectively reviewed a cohort of 75 patients (median age, 74 years) treated with the NeVa device for acute large vessel occlusion stroke. Per pass modified Treatment in Cerebral Infarction (mTICI) scores, procedural complications, and clinical outcome parameters including the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, and mortality were analyzed, based on patients' electronic medical records. RESULTS Complete first pass effect was observed in 24 patients (32%). Vasospasm, repeated re-thrombosis, failure to advance the NeVa device through the microcatheter, and symptomatic intracranial hemorrhage were observed in 2, 1, 1, and 2 patient(s) respectively. The rate of complete (mTICI 2c-3) reperfusion was achieved in 61 patients (81.33%), with a median number of 2 passes (1-3). Median NIHSS score on admission, after 24 hours, and after 5-10 days or at discharge was 19 (15-23), 11 (4-19), and 3 (2-13.5), respectively. The number of patients with a functional mRS score (0-2) at 90 days follow-up was 29 (39%). CONCLUSIONS Endovascular stroke management with use of the NeVa-Vesalio stent retriever may be associated with a 90-day functional mRS score in nearly 40% of treated patients.
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Affiliation(s)
| | - Jelle Demeestere
- Department of Neurology, University Hospitals KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Eveline Claus
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Julie Lambert
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Pieter-Jan Buyck
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Jo Peluso
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals KU Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium.
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Cernigliaro M, Stanca C, Galbiati A, Spinetta M, Coda C, Negroni D, Laganà D, Minici R, Airoldi C, Carriero A, Guzzardi G. Innovation in Acute Ischemic Stroke Patients over 80 y/o-A Retrospective Monocentric Study on Mechanical Thrombectomy of Consecutive Patients: Is Age an Adequate Selection Criterion? J Clin Med 2023; 12:jcm12113688. [PMID: 37297883 DOI: 10.3390/jcm12113688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Although it is clear that stroke is a time-dependent and age-associated disease, we still need more evidence regarding the efficacy and outcomes in elderly patients who were excluded from the first trials of mechanical thrombectomy. The aim of this study is to highlight patient characteristics, the timing of medical attention and therapy, successful recanalization, and functional outcomes in patients over 80 y/o who underwent mechanical thrombectomy at the Ospedale Maggiore della Carità di Novara (Hub) since endovascular stroke treatment was first started here. METHODS all 122 consecutive patients over 80 y/o at admission who underwent mechanical thrombectomy between 2017 and 2022 at our Hub center were retrospectively included in our database. A good functional outcome in these elderly patients was considered as the 90 days modified Rankin Scale (mRS) ≤ 3 and/or a decrease in functional status as ∆mRS ≤ 1 in order to interpret the results for patients with intact intellect and basal mRS > 3. Successful recanalization as a score of TICI ≥ 2b (Thrombolysis in Cerebral Infarction) was analyzed as a secondary outcome. RESULTS Good functional outcome (mRS ≤ 3 and/or ∆mRS ≤ 1) was observed in 45.90% (56/122). The rate of successful recanalization (TICI ≥ 2b) was 65.57% (80/122). CONCLUSION Our data confirm that a good outcome in the elderly age group has a correlation with age; being younger, with a milder NIHSS (National Institutes of Health Stroke Scale) at the onset and with a lower pre-morbid mRS is statistically associated with a better outcome. However, age should not be a criterion to exclude older patients from mechanical thrombectomy. Decision-making should take into consideration the pre-morbid mRS and the severity of the stroke on the NIHSS scale, especially in the age group over 85 y/o.
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Affiliation(s)
- Massimiliano Cernigliaro
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Carmelo Stanca
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Andrea Galbiati
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Marco Spinetta
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Carolina Coda
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Davide Negroni
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Chiara Airoldi
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Alessandro Carriero
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Giuseppe Guzzardi
- Radiodiagnostica ed Interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
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Chen J, Huang C, Hong C, Ye L, Yao B. Regression analysis of bleeding factors and the correlation between FPE and NLR after mechanical thrombectomy for acute anterior circulation large vessel occlusion. Biotechnol Genet Eng Rev 2023:1-12. [PMID: 36881001 DOI: 10.1080/02648725.2023.2186611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
Acute anterior circulation large vessel occlusion refers to a blockage in the blood flow of one of the major blood vessels in the anterior (front) part of the brain. Acute anterior circulation large vessel occlusion can lead to a range of symptoms, including sudden headache, difficulty speaking or understanding speech, weakness or numbness on one side of the body and loss of vision in one eye. According to relevant data, mechanical thrombectomy in the treatment of the large vessel recanalization rate can reach 70%. However, hemorrhage is one of the serious complications after mechanical thrombectomy, and it is the main factor leading to the deterioration of neurological function and death of patients after large blood vessels. Therefore, the risk factors of bleeding in patients were analyzed before surgery, and effective prevention during and after surgery had positive significance for patients undergoing mechanical thrombectomy. This study uses regression analysis to analyze the correlation between bleeding factors and FPE and NLR after mechanical thrombectomy for acute anterior circulation large vessel occlusion. We retrospectively analyzed 81 patients with acute anterior circulation large vessel occlusion who underwent mechanical embolization in our hospital from September 2019 to January 2022 and separated them into a bleeding group (46 patients) and a non-bleeding group (35 patients) based on the presence or absence of bleeding after surgery.
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Affiliation(s)
- Jixing Chen
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Cuiqin Huang
- Department of Neurology, Quanzhou Hospital of Traditional Chinese Medicine, Quanzhou, Fujian, China
| | - Chunzhan Hong
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Lichao Ye
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Boxin Yao
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Goertz L, Weiss D, Abdullayev N, Moenninghoff C, Borggrefe J, Phung TH, Haage P, Schlamann M, Dorn F, Kaschner M, Kabbasch C, Nordmeyer H. Safety and Efficacy of the Novel Low-Profile APERIO Hybrid 17 for a Treatment of Proximal and Distal Vessel Occlusion in Acute Ischemic Stroke: A Multi-Center Experience. World Neurosurg 2022; 167:e386-e396. [PMID: 35963612 DOI: 10.1016/j.wneu.2022.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To report our initial experience with the novel low-profile APERIO Hybrid17 Thrombectomy Device (AP17) for proximal and distal vessel occlusions in acute ischemic stroke. METHODS A multicentric retrospective analysis of patients treated with the AP17 was performed. The primary effectiveness endpoint was first-pass TICI ≥2b (Thrombolysis in cerebral infarction scale). The primary safety endpoint was the occurrence of hemorrhagic complications. Further outcome measures were number of passes, device-related complications, and 3-month functional outcome. RESULTS The AP17 was used in 71 patients (mean age: 73 years) with a median baseline National Institutes of Health Stroke Scale score of 9. Treated vessels were the carotid-T in 8 cases (11%), the M1-segment in 16 (23%), the M2-segment in 29 (41%), the anterior cerebral artery in 3 (4%), and basilar/posterior cerebral arteries in 15 (21%). The rates of first-pass and final TICI ≥2b were 75.6% and 92.7%, retrospectively, with a mean number of passes of 3 ± 2. Final TICI ≥2b rates were comparable between large and medium vessel occlusions. Symptomatic intracranial hemorrhages were recorded in 2 cases (2.8%). At 3-month clinical follow-up, a modified Rankin scale score ≤2 was achieved in 69.0% (29/42). The all-cause mortality at discharge was 17.4%. CONCLUSIONS The AP17 was associated with a reasonable safety and efficacy profile for both proximal and distal vessel occlusions. These results may contribute to establish mechanical thrombectomy for distal occlusions.
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Affiliation(s)
- Lukas Goertz
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany.
| | - Daniel Weiss
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Nuran Abdullayev
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Christoph Moenninghoff
- University Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Jan Borggrefe
- University Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Timo Huan Phung
- Institute for interventional Radiology and Neuroradiology, Neurozentrum Solingen, Radprax St. Lukas Hospital, Solingen, Germany
| | - Patrick Haage
- Department of Diagnostic and Interventional Radiology, Helios University Hospital, Wuppertal, Germany; School of Medicine, Department of Health, Witten/Herdecke University, Witten, Germany
| | - Marc Schlamann
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Bonn, Bonn, Germany
| | - Marius Kaschner
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Hannes Nordmeyer
- Institute for interventional Radiology and Neuroradiology, Neurozentrum Solingen, Radprax St. Lukas Hospital, Solingen, Germany; School of Medicine, Department of Health, Witten/Herdecke University, Witten, Germany
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Bajrami A, Ertugrul O, Senadim S, Erdem E, Baltacioglu F, Geyik S. First pass results of mechanical thrombectomy with two-drop zone NeVa TM device. Interv Neuroradiol 2022:15910199221135309. [PMID: 36314456 DOI: 10.1177/15910199221135309] [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: 06/16/2023] Open
Abstract
BACKGROUND Occlusive thrombi in acute ischemic stroke can be in various types which limits the success of the thrombectomy. The NeVaTM (Vesalio, Nashville, Tennessee) thrombectomy device was originally designed for all types of clot. Our aim was to evaluate the efficacy and safety of the NeVaTM device for mechanical thrombectomy. METHODS Retrospective review of prospectively collected mechanical thrombectomy database revealed 145 patients who had fullfilled the inclusion criteria. The data collected includes clinical patient characteristics, procedural measures, timestamp at each stage, and patient outcome. IV thrombolytics application, pre and post-intervention imaging findings, device related adverse event and any type of intracranial hemorrhage were recorded. RESULTS There was female pre-dominance (54.5%). Median presenting national institutes of health stroke scale (NIHSS) was 16 (IQR, 3-32). 88 MCA-m1 (60,6%), 43 ICA-tip (29,6%), 11 MCA-m2 (7,5%), 2 ACA (1,4%) and 1 basilar (0,7%) occlusions were underwent for mechanical thrombectomy. Median procedure time was 25 min (IQR, 7-136). First-pass reperfusion scores were mTICI 0-2a 22.7%, mTICI 2b 23.4%, mTICI 2c 17.9% and mTICI 3 35.9%. Mean number of pass was 1,84 ± 1,14. Final mTICI 2b-3 score was 97.9% and TICI2c-3 score was 87.6%. No device related adverse event occurred. The mean 24-h NIHSS score was 6 (IQR 0-33). CONCLUSION In conclusion, the NeVa thrombectomy device offers a high rate of first-pass success along with favorable safety profile. Larger series and multi-center studies are needed for further investigation.
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Affiliation(s)
- Arsida Bajrami
- Department of Neurology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | - Ozgur Ertugrul
- Department of Radiology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | - Songul Senadim
- Department of Neurology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | - Eren Erdem
- Department of Radiology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | | | - Serdar Geyik
- Department of Radiology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
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