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Piano M, Jansen O, Marnat G, Gory B, Nordmeyer H, Eckert B, Pedicelli A, Cognard C, Loehr C, Zanoni M, Schaefer A, Macera A, Fiehler J, Doyle K, Lobotesis K. Prospective evaluation to characterize the real-world performance of the EMBOVAC aspiration catheter for neurothrombectomy: a post-market clinical follow-up trial. J Neurointerv Surg 2024:jnis-2023-021407. [PMID: 38609174 DOI: 10.1136/jnis-2023-021407] [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: 12/20/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND A direct aspiration first pass technique (ADAPT) is an effective alternative to stent retriever thrombectomy for patients with large vessel occlusion (LVO). The PERFECT study evaluated direct aspiration with the EMBOVAC large bore aspiration catheter in patients with LVO strokes. METHODS PERFECT was a prospective, post-market, single-arm, multicenter, observational study of patients enrolled across 11 European centers between October 2020 and July 2022. Three direct aspiration passes with EMBOVAC were mandated before switching strategy. The primary endpoint was core-lab assessed successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) post-procedure. Other outcomes included first pass mTICI ≥2c, independent 90-day modified Rankin Scale (mRS) evaluation, and symptomatic intracerebral hemorrhage (sICH) at 24 hours by a clinical events committee. RESULTS EMBOVAC was used in 100 patients (mean age 70.4±14.0 years, 59.0% (59/100) female). Final mTICI ≥2b was achieved in 98.0% (97/99), final mTICI ≥2b with no change in frontline therapy or thrombolytics use during the procedure was achieved in 87.9% (87/99), final mTICI ≥2c in 86.9% (86/99), and first pass mTICI ≥2c in 53.5% (53/99). sICH at 24 hours was 0%. The 90-day mRS ≤2 rate was 56.6% (56/99) and all-cause mortality was 12.9%. One device-related serious adverse event occurred within 90 days (1.0%). CONCLUSIONS PERFECT demonstrates that EMBOVAC achieves successful reperfusion rates and favorable clinical outcomes when used in the endovascular treatment of acute ischemic stroke (AIS) using a direct aspiration technique as first line therapy in a real-world setting in patients with AIS secondary to large vessel occlusion. TRIAL REGISTRATION www. CLINICALTRIALS gov Unique identifier: NCT04531904.
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Affiliation(s)
| | - Olav Jansen
- University Hospital, Christian-Albrechts - University Kiel, Kiel, Germany
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Hannes Nordmeyer
- Neuroradiology, Städtisches Klinikum Solingen, Department of Diagnostic and Interventional Neuroradiology, Solingen, Germany
- Witten/Herdecke University, Department of Health, School of Medicine, Witten, Germany
| | - Bernd Eckert
- Neuroradiology, Asklepios Clinic Altona, Hamburg, Germany
| | - Alessandro Pedicelli
- Radiological Sciences, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Rome, Italy
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest GmbH, Recklinghausen, Nordrhein-Westfalen, Germany
| | - Matteo Zanoni
- Department of Medicine, Surgery and Neurosciences, Diagnostic Imaging Unit, University of Siena, Siena, Siena, Italy
| | - Axel Schaefer
- Klinikum Vest Knappschaftskrankenhaus Recklinghausen, Department of Radiology and Neuroradiology, Recklinghausen, Germany
| | - Antonio Macera
- Department of Advanced Biomedical Sciences, Ospedale Niguarda Ca Granda, Milano, Lombardia, Italy
| | - Jens Fiehler
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Eppdata GmbH, Hamburg, Germany
| | - Karen Doyle
- Physiology, CURAM, University of Galway, Galway, Ireland
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Huang Y, Shu X, Huang L, Li W, Jin Z, Chen X, Wang K, Zhan Y, Lan W, Cai X. The evaluation and treatment of acute anterior circulation occlusion stroke with high clot burden: Progressive stratified aspiration thrombectomy vs. stent retriever thrombectomy. Clin Neurol Neurosurg 2023; 230:107793. [PMID: 37245456 DOI: 10.1016/j.clineuro.2023.107793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/27/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of the progressive stratified aspiration thrombectomy (PSAT) in treatment of patients with acute ischemic stroke and large vessel occlusion (AIS-LVO). METHODS 117 AIS-LVO patients with high clot burden who underwent emergency endovascular treatment were included. All patients were divided into two groups according to surgical technique: PSAT group, stent retriever thrombectomy (SRT) group. The primary outcome was the 90-day mRS, the secondary outcomes included recanalization rate, the 24-h and 7-day NIHSS, the 7-day symptomatic intracranial hemorrhage (SICH) rate and 90-days mortality. RESULTS 65 patients underwent PSAT, and 52 patients underwent SRT. The PSAT group performed better than SRT group regarding the successful recanalization rate (86.3 % vs. 71.2 %, P < 0.05) and time from puncture to recanalization (70 min [IQR, 58-87 min] vs. 87 min [IQR, 68-103 min], P < 0.05). The 7-day NIHSS score of the PSAT group was lower than that of the SRT group (12 [10-18] vs. 12 [8-25], P < 0.05). It was worth noting that at the 90-day follow-up, the favorable functional outcome (mRS 0-2) rate of PSAT group was higher (P < 0.05). There was no significant difference in terms of the 24-h NIHSS score after surgery (15 [10-18] vs. 15 [10-22], P > 0.05), SICH (23.1 % vs. 26.9 %, P > 0.05) and mortality rate between the two groups (13.4 % vs. 19.2 %, P > 0.05). CONCLUSIONS It is safe and effective to treat high clot burden AIS-LVO patients with PSAT, which has a better reperfusion rate and prognostic outcome than SRT.
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Affiliation(s)
- Yijie Huang
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Xiaohuan Shu
- Department of Neurology, People's Hospital of Jinyun County, Jinyun County, Zhejiang 321400, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China
| | - Liangtong Huang
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Wei Li
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Zheyu Jin
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Xueping Chen
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China
| | - Ke Wang
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China; Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui, Zhejiang 323000, China
| | - Yanli Zhan
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China
| | - Weiming Lan
- Department of Neurology, People's Hospital of Jingning Shezu Autonomous County, Jingning County, Zhejiang 323500, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China.
| | - Xueli Cai
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui City, Zhejiang 323000, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China; Department of Neurology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang 323000, China.
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Leone G, Muto M, Giordano F, Guarnieri G, Donna AD, Russo C, Romano DG, Candelaresi P, Servillo G, Spina E, Mase AD, Andreone V, Muto M. Initial Experience Using the New pHLO 0.072-inch Large-Bore Catheter for Direct Aspiration Thrombectomy in Acute Ischemic Stroke. Neurointervention 2023; 18:30-37. [PMID: 36792060 PMCID: PMC9986350 DOI: 10.5469/neuroint.2022.00479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE A direct aspiration, first pass technique (ADAPT) has been introduced as a rapid and safe thrombectomy strategy in patients with intracranial large vessel occlusion (LVO). The aim of the study is to determine the technical feasibility, safety, and functional outcome of ADAPT using the newly released large bore pHLO 0.072-inch aspiration catheter (AC; Phenox). MATERIALS AND METHODS We performed a retrospective analysis of data collected prospectively (October 2019-November 2021) from 2 comprehensive stroke centers. Accessibility of the thrombus, vascular recanalization, time to recanalization, and procedure-related complications were evaluated. National Institutes of Health stroke scale scores at presentation and discharge and the modified Rankin scale (mRS) score at 90 days post-procedure were recorded. RESULTS Twenty-five patients (14 female, 11 male) with occlusions of the anterior circulation were treated. In 84% of cases, ADAPT led to successful recanalization with a median procedure time of 28 minutes. In the remaining cases, successful recanalization required (to a total of 96%; modified thrombolysis in cerebral infarction score 2b/3) the use of stent retrievers. No AC-related complications were reported. Other complications included distal migration of the thrombus, requiring a stent-retriever, and symptomatic PH2 hemorrhage in 16% and 4%, respectively. After 3 months, 52% of the patients had mRS scores of 0-2 with an overall mortality rate of 20%. CONCLUSION Results from our retrospective case series revealed that thrombectomy of LVOs with pHLO AC is safe and effective in cases of large-vessel ischemic stroke. Rates of complete or near-complete recanalization after the first pass with this method might be used as a new benchmark in future trials.
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Affiliation(s)
- Giuseppe Leone
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Napoli, Italy
| | - Massimo Muto
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Napoli, Italy
| | - Flavio Giordano
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Napoli, Italy
| | - Gianluigi Guarnieri
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Napoli, Italy
| | - Antonio Di Donna
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Napoli, Italy
| | - Camilla Russo
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Napoli, Italy
| | - Daniele Giuseppe Romano
- Unit of Neuroradiology, AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Paolo Candelaresi
- Unit of Neurology and Stroke, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Naples, Italy
| | - Giovanna Servillo
- Unit of Neurology and Stroke, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Naples, Italy
| | - Emanuele Spina
- Unit of Neurology and Stroke, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Naples, Italy
| | - Antonio De Mase
- Unit of Neurology and Stroke, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Naples, Italy
| | - Vincenzo Andreone
- Unit of Neurology and Stroke, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Naples, Italy
| | - Mario Muto
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Napoli, Italy
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4
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Azzam AY, Ghozy S, Kallmes KM, Adusumilli G, Heit JJ, Hassan AE, Kadirvel R, Kallmes DF. Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: evaluating the overlapping meta-analyses. J Neurointerv Surg 2023; 15:34-38. [PMID: 35584912 PMCID: PMC9898825 DOI: 10.1136/neurintsurg-2022-018849] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies comparing a direct aspiration first pass technique (ADAPT) and stent retrievers have inconsistent methodologies and data reporting, limiting the ability to accurately assimilate data from different studies that would inform treatment of acute ischemic stroke (AIS) treatment. OBJECTIVE To conduct a systematic review to discuss and compare the findings of all relevant meta-analysis studies comparing the efficacy of the ADAPT and stent retriever techniques. METHODS The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), where meta-analyses comparing the efficacy of the ADAPT technique and stent retrievers in the treatment of AIS were included. We extracted all relevant data from the included studies and assessed the quality of the included meta-analyses using the Assessment of Multiple Systematic Review (AMSTAR-2). RESULTS Seven relevant studies met our inclusion criteria and were suitable for the qualitative synthesis. All included studies obtained data from randomized controlled trials (RCTs) and observational investigations (including levels II, III, and IV). At the same time, none of them used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for quality assessment. In accordance with AMSTAR-2, two studies were rated 'high', while the other five were rated 'moderate'. CONCLUSIONS Present evidence is insufficient to clarify the superiority of one modality over the other. Further RCTs on this comparison must be conducted prior to designing further meta-analyses or making conclusive interpretations. Procedure duration and cost should be taken into consideration for any future studies.
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Affiliation(s)
- Ahmed Y Azzam
- October 6 University Faculty of Medicine, 6th of October City, Egypt
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | | | - Gautam Adusumilli
- Department of Radiology and Neurosurgery, Stanford University, Stanford, California, USA
| | - Jeremy J Heit
- Radiology, Neuroadiology, and Neurointervention Division, Stanford University, Stanford, California, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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5
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Kim S, Lee JY. Comparison of vacuum pressures and suction forces generated by different pump systems for aspiration thrombectomy. Front Neurol 2022; 13:978584. [PMID: 36277930 PMCID: PMC9582518 DOI: 10.3389/fneur.2022.978584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Aspiration thrombectomy is used to treat endovascular stroke treatment by clot removal through vacuum and suction forces. We aimed to investigate the pressures and suction forces generated by different pump systems for aspiration. Methods Vacuum pressure was measured using a vacuum gauge with a closed tip for a 60cc syringe and aspiration pumps. Using an artificial thrombus made from polyvinyl alcohol hydrogel and latex membrane, we assessed the catheter tip force generated on an artificial thrombus using 5Fr Sofia and 6Fr Sofia PLUS intermediate catheters combined with Penumbra Jet Engine or Stryker Medela AXS Universal Aspiration Set. Subsequently, we calculated the catheter tip forces based on the pressure [catheter tip size (force = area × pressure)], and compared with the measured catheter tip force. Results The 60cc syringe generated the highest vacuum pressure. Among the automatic pumps, the Penumbra jet engine generated the highest vacuum pressure. The catheter tip forces on the artificial thrombus and latex membrane were 18.5 ± 1.70 and 8.0 ± 1.23 gf, respectively, and 13.9 ± 1.37 and 5.6 ± 0.83 gf, respectively using the 5 Fr Sofia with the Penumbra Jet Engine and the Stryker Medela AXS Universal Aspiration Set, respectively. The corresponding values for the 6 Fr Sofia PLUS with the Penumbra Jet Engine and Stryker Medela AXS Universal Aspiration Set were 39.7 ± 3.88 and 20.7 ± 0.92 gf and 25.4 ± 4.96 and 18.0 ± 0.84 gf. For a constant catheter diameter and the automatic pump, the catheter tip force was significantly larger in the artificial thrombus than latex membrane (p < 0.001, ANOVA). Conclusion The catheter diameter, vacuum pressure, and clot softness are positively correlated with the catheter tip force.
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Qiu K, Zhao LB, Xu XQ, Wang Y, Liu J, Liu S, Shi HB, Zu QQ. Acute embolic stroke with large-vessel occlusion: does contact aspiration thrombectomy show superiority? Clin Radiol 2022; 77:577-583. [PMID: 35753814 DOI: 10.1016/j.crad.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/29/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022]
Abstract
AIM To compare the efficacy between contact aspiration thrombectomy and stent retriever thrombectomy in the treatment of acute embolic stroke patients with large vessel occlusion. MATERIALS AND METHODS Between January 2019 and June 2020, data from consecutive acute ischaemic stroke patients who underwent either endovascular contact aspiration or stent retriever thrombectomy were analysed at one institution. The primary outcome was the full 90-day modified Rankin Scale (mRS) score. Ordinal logistic regression analysis was used to assess the association between thrombectomy approach and functional outcomes. RESULTS A total of 156 patients were analysed. Among them, 57 (36.5%) patients underwent primary aspiration thrombectomy, while 99 (63.5%) patients underwent primary stent retriever thrombectomy. The median procedure time was significantly shorter in patients treated with aspiration (37 versus 56 minutes; p<0.001). Compared with those of patients who underwent stent retriever thrombectomy, successful recanalisation rates and favourable functional outcome rates were higher in patients who underwent the aspiration approach (94.7% versus 77.8%, p=0.006; 49.1% versus 27.3%, p=0.006, respectively). Ordinal logistic regression analysis showed that aspiration thrombectomy was independently associated with a good functional outcome (adjusted common odds ratio, 0.30, 95% confidence interval: 0.16-0.60, p<0.001). CONCLUSION Among the specific patients with large vessel occlusion in acute embolic stroke, the use of aspiration thrombectomy compared with stent retriever thrombectomy resulted in a greater likelihood of favourable neurological outcomes; however, because of study limitations, these findings should be interpreted as preliminary and require further study to confirm these results.
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Affiliation(s)
- K Qiu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - L-B Zhao
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - X-Q Xu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Y Wang
- Department of Emergency Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - J Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - S Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - H-B Shi
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Q-Q Zu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China.
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Espinosa de Rueda M, Ballenilla Marco F, Garmendia Lopetegui E, Pumar JM, Zamarro J, García-Villalba B, Díaz-Pérez J, Mosqueira A, Lüttich A, Larrea JA, Parrilla G. Thrombectomy aspiration post-market study in acute stroke with the Q aspiration catheter: the TAPAS study. J Neurointerv Surg 2022:neurintsurg-2022-018649. [PMID: 35641183 DOI: 10.1136/neurintsurg-2022-018649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Q Aspiration Catheter (MIVI Neuro) has demonstrated greater aspiration flow rates and ingestion forces compared with conventional catheters in vitro. The safety and performance of the Q Catheter was assessed using a direct aspiration first pass technique in patients with acute ischemic stroke at four neurointerventional centers in Spain. METHODS We included adult patients who underwent mechanical thrombectomy between March 2019 and March 2020 using the Q Catheter as first-line therapy. Performance endpoints included final successful revascularization of the target vessel (defined as modified thrombolysis in cerebral infarction (mTICI) grade 2B/3), first pass revascularization, and overall Q Catheter revascularization. Safety endpoints were symptomatic intracranial hemorrhage (sICH), embolization to new territory (ENT), and procedural complications. Modified Rankin Scale (mRS) score and all-cause mortality were also assessed. RESULTS Forty-five subjects were enrolled. The Q Catheter successfully navigated to the lesion in 95.5% (43/45) of patients. Final successful mTICI 2B/3 revascularization was achieved in 93.3% (42/45), first pass mTICI 2B/3 revascularization with the Q Catheter was 55.3% (21/38), and overall with Q Catheter mTICI 2B/3 revascularization was 65.8% (25/38). Favorable clinical outcome of mRS 0-2 was achieved in 55.6% (25/45). There were no cases of ENT. sICH and mortality rates were 2.2% (1/45) and 13.3% (6/45), respectively. CONCLUSION In this multicenter, observational study, the Q Aspiration Catheter used as first-line therapy demonstrated a good and safe profile in terms of navigation, revascularization, and safety in patients with acute ischemic stroke.
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Affiliation(s)
- Mariano Espinosa de Rueda
- Department of Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Eñaut Garmendia Lopetegui
- Department of Interventional Neuroradiology, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Jose M Pumar
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Joaquin Zamarro
- Department of Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Blanca García-Villalba
- Department of Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jose Díaz-Pérez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Antonio Mosqueira
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alex Lüttich
- Department of Interventional Neuroradiology, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Jose-Angel Larrea
- Department of Interventional Neuroradiology, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Guillermo Parrilla
- Department of Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Negida A, Ghaith HS, Gabra MD, Aziz MA, Elfil M, Al-Shami H, Bahbah EI, Kanmounye US, Esene I, Raslan AM. Should the direct aspiration first pass technique be advocated over the stent-retriever technique for acute ischemic stroke? A systematic review and meta-analysis of 7692 patients. Surg Neurol Int 2022; 12:597. [PMID: 34992914 PMCID: PMC8720438 DOI: 10.25259/sni_903_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/09/2021] [Indexed: 01/02/2023] Open
Abstract
Background: The present meta-analysis aimed to synthesize evidence from all published studies with head-to-head data on the outcomes of a direct aspiration first pass technique (ADAPT) and the stent-retriever (SR) in acute ischemic stroke (AIS) patients. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to March 2021 for relevant clinical trials and observational studies. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis random-effects model of DerSimonian-Laird. Results: Thirty studies were included in the meta-analysis with a total of 7868 patients. Compared with the SR, the ADAPT provides slightly higher rates of successful recanalization (RR 1.06, 95% CI [1.02 to 1.10]) and complete recanalization (RR 1.20, 95% CI [1.01 to 1.43]) but with more need for rescue therapy (RR 1.81, 95% CI [1.29 to 2.54]). There were no significant differences between the two techniques in terms of mortality at discharge, mortality at 90 days, change in the National Institutes of Health Stroke Scale score, the favorable outcome (modified Rankin scale (mRS) of 0-2), time to the groin puncture, or frequency of complications as intracerebral hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), embolus in a new territory (ENT), hemorrhagic infarction, parenchymal hematoma, subarachnoid hemorrhage, or procedural complications (all P > 0.05). Conclusion: Current evidence supports the use of the ADAPT technique to achieve successful and complete recanalization while considering the higher need for rescue therapy in some patients.
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Affiliation(s)
- Ahmed Negida
- Faculty of Medicine, Zagazig University, Zagazig University, Zagazig, Sharkia, Egypt
| | | | | | | | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, Egypt
| | - Haider Al-Shami
- Department of Neurosurgery, National Bank Hospital, Cairo, Egypt
| | - Eshak I Bahbah
- Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
| | - Ulrick Sidney Kanmounye
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon, Africa
| | - Ignatius Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon, Africa
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
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9
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Diana F, Vinci SL, Ruggiero M, Semeraro V, Bracco S, Frauenfelder G, Paolucci A, Cirillo L, Pesce A, Tessitore A, Commodaro C, Ganimede MP, Zanoni M, Saponiero R, Zini A, Velo M, Modello B, Burdi N, Cioni S, Simonetti L, Romano DG. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience. J Neurointerv Surg 2021; 14:666-671. [PMID: 34349012 DOI: 10.1136/neurintsurg-2021-017585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is no consensus on the most effective endovascular technique to use in patients with acute ischemic stroke due to terminal internal carotid artery (ICA) occlusion. The aim of this study was to compare safety and efficacy of the aspiration technique (AT) and combined technique (CT) as first-line approach in terminal ICA occlusions. METHODS We performed a retrospective analysis of prospectively collected databases from seven Italian stroke centers. Patients were divided into two subgroups according to the first-line approach: AT group or CT group. We followed the STROBE guidelines for cohort studies. We used Chi-square test, one-way and multivariate ANOVA analysis, together with contrast analysis and post hoc tests, logistic regression and Pearson's bivariate correlation for the statistical analyses. RESULTS Between January 2018 and August 2020, 353 patients were treated for a terminal ICA occlusion, with either AT or CT. CT was associated with a higher Thrombolysis in Cerebral Infarction (TICI) 2B-3 after the first pass (51.0% vs 26.9%) and at the end of the procedure (84% vs 73.3%) and with an improved clinical outcome at discharge (modified Rankin Scale (mRs) 0-2 of 47.8% vs 34.0%) and at 3 months' follow-up (mRs 0-2 of 56.5% vs 38.9%) compared with AT. CONCLUSION Thrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.
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Affiliation(s)
- Francesco Diana
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Vittorio Semeraro
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Sandra Bracco
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Giulia Frauenfelder
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Aldo Paolucci
- Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Luigi Cirillo
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.,DIBINEM, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Pesce
- Department of Neurosurgery, Ospedale Santa Maria Goretti, Latina, Italy
| | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Christian Commodaro
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Maria Porzia Ganimede
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Matteo Zanoni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Renato Saponiero
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Mariano Velo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Beatrice Modello
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Nicola Burdi
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Samuele Cioni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Luigi Simonetti
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Daniele Giuseppe Romano
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
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10
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Waqas M, Li W, Patel TR, Chin F, Tutino VM, Dossani RH, Ren Z, Guerrero WR, Borlongan CV, Pressman E, Snyder K, Davies JM, Ley EI, Ionita CN, Siddiqui AH, Mokin M. Clot imaging characteristics predict first pass effect of aspiration-first approach to thrombectomy. Interv Neuroradiol 2021; 28:152-159. [PMID: 34000868 DOI: 10.1177/15910199211019174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown. METHODS We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt). RESULTS Patients (n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65-46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8-29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84-7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55-29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden's index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728-0.904, P < 0.001). In a validation cohort (n = 30), sensitivity, specificity, positive and negative predictive value of a score of 6-10 were 72.7%, 73.6%, 61.5% and 82.3%. CONCLUSIONS Clot imaging predicts the likelihood of achieving FPE in patients with MCA ELVO treated with the aspiration-first approach.
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Affiliation(s)
- Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Weizhe Li
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Tatsat R Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Felix Chin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Rimal H Dossani
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Zeguang Ren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.,Tampa General Hospital, Neurosciences Center, Tampa, FL, USA
| | - Waldo R Guerrero
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.,Tampa General Hospital, Neurosciences Center, Tampa, FL, USA
| | - Cesario V Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Kenneth Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Elad I Ley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Ciprian N Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.,Tampa General Hospital, Neurosciences Center, Tampa, FL, USA
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11
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Sila D, Lenski M, Vojtková M, Elgharbawy M, Charvát F, Rath S. Efficacy of Mechanical Thrombectomy using Penumbra ACE TM Aspiration Catheter Compared to Stent Retriever Solitaire TM FR in Patients with Acute Ischemic Stroke. Brain Sci 2021; 11:brainsci11040504. [PMID: 33923489 PMCID: PMC8073348 DOI: 10.3390/brainsci11040504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.
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Affiliation(s)
- Dalibor Sila
- Department of Neurosurgery and Interventional Neuroradiology, Donau-Isar Klinikum, Perlasberger Str. 41, 94469 Deggendorf, Germany;
- Correspondence: ; Tel.: +49-(0)991-3803867
| | - Markus Lenski
- Neurosurgical Clinic, Campus Grosshadern, Clinic of the University of Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany;
| | - Maria Vojtková
- Department of Statistics, Faculty of Economic Informatics, University of Economics in Bratislava, Dolnozemska cesta 1/b, 85235 Bratislava, Slovakia;
| | - Mustafa Elgharbawy
- Department of Radiology and Interventional Radiology, Donau-Isar Klinikum, Perlasberger Str. 41, 94469 Deggendorf, Germany;
| | - František Charvát
- Radiodiagnostic Departement, Military University Hospital Prague, U Vojenské nemocnice 1200, 16902 Praha, Czech Republic;
| | - Stefan Rath
- Department of Neurosurgery and Interventional Neuroradiology, Donau-Isar Klinikum, Perlasberger Str. 41, 94469 Deggendorf, Germany;
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12
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Sultan S, Acharya Y, Barrett N, Hynes N. A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1275. [PMID: 33178807 PMCID: PMC7607101 DOI: 10.21037/atm-2020-cass-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in ischemic stroke management. As tPA is time-dependent, delays can occur in definitive treatment while passively waiting to observe a clinical response to intravenous thrombolysis. Until today, uncertainty exists in the management strategy of wake-up stroke patients or those presenting beyond the therapeutic tPA window. Clinical dilemmas in these situations can prolong the transitional period of inertia, resulting in an adverse neurological outcome. We propose and review an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains-targeted hypothermia, systemic induced hypertension, and barbiturates infusion, to protect the brain during carotid endarterectomy after failed tPA and/or beyond the 24-hour therapeutic mechanical thrombectomy window. This proposal assimilates discussion on the clinical evidence of the individual domains of TNP with our own clinical experience with TNP. Our first TNP was successfully employed in a 55-year-old man in 2015 while performing emergency carotid endarterectomy after he was referred to us 72 hours post tPA failure. The patient had a successful clinical outcome despite being in therapeutic inertia with 90–99% ipsilateral carotid stenosis and contralateral occlusion on presentation. In the last five years, we have safely used TNP in 25 selected cases with favourable clinical outcomes.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland.,Department of Vascular & Endovascular Surgery, Galway Clinic, Royal College of Surgeons of Ireland/National University of Ireland Affiliated Teaching Hospitals, Doughiska, Galway, Ireland
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nora Barrett
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular & Endovascular Surgery, Galway Clinic, Royal College of Surgeons of Ireland/National University of Ireland Affiliated Teaching Hospitals, Doughiska, Galway, Ireland
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13
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Fredrickson VL, Bonney PA, Rangwala SD, Catapano JS, Cole TS, Cavalcanti DD, Majmundar N, Wilkinson DA, San Roman L, Waters MF, Albuquerque FC, Ducruet AF. Comparison of aspiration-first versus stentriever-first techniques in performing mechanical thrombectomy for large vessel occlusions. J Neurointerv Surg 2020; 13:614-618. [PMID: 32958518 DOI: 10.1136/neurintsurg-2020-016547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Both stentriever and direct-aspiration thrombectomy effectively treat large-vessel occlusions. However, data are limited comparing clinical outcomes after aspiration-first versus stentriever-assisted aspiration for thrombectomy. METHODS A retrospective cohort study compared procedure times and radiographic outcomes after two mechanical thrombectomy techniques (aspiration first or stentriever). To minimize bias and variability inherent to multi-operator series, we assessed consecutive patients with cerebrovascular occlusions treated by a single surgeon during a 1 year period at two stroke centers. Expanded Thrombolysis in Cerebral Infarction (eTICI) grades were assessed by an investigator blinded to treatment. RESULTS Data from 93 patients (median age 70 years) were analyzed: 73 patients (78.5%) were treated with a strentriever-first strategy and 20 (21.5%) were treated with aspiration first, with stentriever rescue therapy required in only three of these cases following unsuccessful aspiration. There were no significant differences in patient demographics, sites of occlusion, or rates of tandem occlusions between aspiration-first and stentriever-assisted groups (p≥0.36). The rate of first-pass eTICI ≥2b was 75.0% (15/20) for aspiration-first and 52.1% (38/73) for strentriever-first groups (p=0.07), while the rate of final eTICI ≥2b was 100% (20/20) and 82.2% (60/72), respectively (p=0.04). The aspiration-first technique was associated with procedural times ≤25 min in a multivariable analysis (adjusted OR 4.77, 95% CI 1.15 to 18.39; p=0.03). CONCLUSIONS In this single-surgeon series, an aspiration-first technique was associated with a statistically significant improvement in eTICI outcomes and faster procedure times compared with stentriever-assisted aspiration. Further prospective studies are necessary to minimize selection bias inherent in this study design.
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Affiliation(s)
- Vance L Fredrickson
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.,Neurological Surgery, USC Keck School of Medicine, Los Angeles, California, USA
| | - Phillip A Bonney
- Neurological Surgery, USC Keck School of Medicine, Los Angeles, California, USA
| | - Shivani D Rangwala
- Neurological Surgery, USC Keck School of Medicine, Los Angeles, California, USA
| | | | - Tyler S Cole
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Neil Majmundar
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Luis San Roman
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Michael F Waters
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.,Neurosurgery, Honor Health Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Andrew F Ducruet
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA .,Neurosurgery, Honor Health Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
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14
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Malhotra A, Boltyenkov A, Wu X, Matouk CC, Forman HP, Gandhi D, Sanelli P. Endovascular Contact Aspiration versus Stent Retriever for Revascularization in Patients with Acute Ischemic Stroke and Large Vessel Occlusion: A Cost-Minimization Analysis. World Neurosurg 2020; 139:e23-e31. [DOI: 10.1016/j.wneu.2020.02.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
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15
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Boisseau W, Escalard S, Fahed R, Lapergue B, Smajda S, Maier B, Desilles JP, Delvoye F, Ciccio G, Redjem H, Hebert S, Ben Maacha M, Walker G, Gory B, Richard S, Mazighi M, Piotin M, Blanc R. Direct aspiration stroke thrombectomy: a comprehensive review. J Neurointerv Surg 2020; 12:1099-1106. [PMID: 32532857 DOI: 10.1136/neurintsurg-2019-015508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 01/22/2023]
Abstract
Mechanical thrombectomy is now the standard of care for acute ischemic stroke patients with large vessel occlusions, and can be performed with several devices and techniques. One of these techniques, direct aspiration (DA), consists of navigating a large-bore catheter up to the face of the clot and initiating forceful suction. This comprehensive review has three objectives: (1) to describe the direct aspiration technique; (2) to present the available evidence regarding predictive factors of DA success and performance compared with other techniques; and (3) to discuss the forthcoming improvements in distal aspiration.
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Affiliation(s)
- William Boisseau
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Simon Escalard
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Robert Fahed
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Department of Medicine - Division of Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Stanislas Smajda
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Benjamin Maier
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Jean Philippe Desilles
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - François Delvoye
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Gabriele Ciccio
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Hocine Redjem
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Solène Hebert
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Malek Ben Maacha
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | - Gregory Walker
- Department of Medicine - Division of Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine - Division of Neurology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Benjamin Gory
- Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | - Mikael Mazighi
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France.,Université de Paris, Paris, Île-de-France, France
| | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France .,Université de Paris, Paris, Île-de-France, France
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16
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Xing PF, Yang PF, Li ZF, Zhang L, Shen HJ, Zhang YX, Zhang YW, Liu JM. Comparison of Aspiration versus Stent Retriever Thrombectomy as the Preferred Strategy for Patients with Acute Terminal Internal Carotid Artery Occlusion: A Propensity Score Matching Analysis. AJNR Am J Neuroradiol 2020; 41:469-476. [PMID: 32054612 DOI: 10.3174/ajnr.a6414] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is no consensus on endovascular treatment for terminal ICA. The purpose of this study was to evaluate the comparative safety and efficacy of preferred aspiration thrombectomy and stent retriever thrombectomy for revascularization in patients with isolated terminal ICA occlusion. MATERIALS AND METHODS We conducted a retrospective analysis of patients with terminal ICA occlusion treated with aspiration thrombectomy or stent retriever thrombectomy in our center, from September 2013 to November 2018. To minimize the case bias, propensity score matching was performed. The primary outcomes were successful reperfusion defined by expanded TICI grades 2b-3 at the end of all endovascular procedures and puncture-to-reperfusion time. RESULTS A total of 109 consecutive patients with terminal ICA occlusion were divided into the aspiration thrombectomy group (40 patients) and the stent retriever thrombectomy group (69 patients), and 30 patients were included in each group after propensity score matching. The proportion of complete reperfusion was significantly higher in the aspiration thrombectomy group (OR 4.75 [95% CI, 1.10-1.38]; P = .002). The median puncture-to-reperfusion time in the aspiration thrombectomy group was shorter than that in the stent retriever thrombectomy group (38 versus 69 minutes; P = .001). Fewer intracerebral hemorrhage events were recorded in the aspiration thrombectomy group (OR 0.29 [95% CI, 0.09-0.90]; P = .028). No significant differences were observed for good outcomes (OR 1.92 [95% CI, 0.86-4.25]) and mortality (OR 0.84 [95% CI, 0.29-2.44]) at 90 days. CONCLUSIONS For the treatment of terminal ICA occlusion, aspiration thrombectomy was technically superior to stent retriever thrombectomy in the absence of a balloon guide catheter in achieving successful reperfusion with shorter puncture-to-reperfusion time and procedure-related adverse events.
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Affiliation(s)
- P F Xing
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - P F Yang
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Z F Li
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - L Zhang
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - H J Shen
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Y X Zhang
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Y W Zhang
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - J M Liu
- From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
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17
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Raymond SB, Nasir-Moin M, Koch MJ, Rabinov JD, Leslie-Mazwi T, Patel AB. Initial experience with React 68 aspiration catheter. Interv Neuroradiol 2020; 26:358-363. [PMID: 31969073 DOI: 10.1177/1591019919898923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION We describe our initial experience with the React 68 catheter (Medtronic, Dublin, Ireland), an FDA-approved catheter designed for aspiration in cases of emergent large vessel occlusion, as compared with the ACE 68 catheter (Penumbra, Alameda, CA). METHODS This observational study followed consecutive patients treated with the React catheter over a seven-month period at a comprehensive stroke center. Use of the device was per discretion of the operator. Patient demographics, thrombectomy technique, reperfusion scoring, and disposition were assessed. Performance was compared with patients treated with the ACE 68 catheter over a comparable period. RESULTS We treated 47 patients using the React 68 catheter using either aspiration alone or a combination of aspiration and stent retriever technique. The catheter was used in a variety of circumstances including proximal and distal occlusions involving the anterior and posterior circulation. Modified TICI 2b-3 was achieved in 45 of the 47 patients. The React 68 was comparable to the ACE 68 by all performance measures. CONCLUSION The React 68 catheter is a large-bore reperfusion catheter with trackability suitable for use in direct aspiration for recanalization of emergent large vessel occlusion.
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Affiliation(s)
- Scott B Raymond
- Department of Radiology, the University of Vermont Medical Center, Burlington, VT, USA
| | - Mehr Nasir-Moin
- Department of Neurosurgery, the Massachusetts General Hospital, Boston, MA, USA
| | - Matthew J Koch
- Department of Neurosurgery, the Massachusetts General Hospital, Boston, MA, USA
| | - James D Rabinov
- Department of Neurosurgery, the Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, the Massachusetts General Hospital, Boston, MA, USA
| | - Thabele Leslie-Mazwi
- Department of Neurosurgery, the Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, the Massachusetts General Hospital, Boston, MA, USA
| | - Aman B Patel
- Department of Neurosurgery, the Massachusetts General Hospital, Boston, MA, USA
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18
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Yi HJ, Sung JH, Lee DH. Safety and Efficacy of Intra-arterial Tirofiban Injection During Mechanical Thrombectomy for Large Artery Occlusion. Curr Neurovasc Res 2020; 16:416-424. [DOI: 10.2174/1567202616666191023154956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/22/2019] [Accepted: 09/27/2019] [Indexed: 11/22/2022]
Abstract
Objective:
The safety and effect of intra-arterial (IA) tirofiban, a glycoprotein IIb/IIIa
inhibitor, during the stent retriever mechanical thrombectomy (MT) was investigated.
Methods:
From January 2015 to May 2019, a total of 327 patients underwent mechanical thrombectomy
of large artery occlusions (LAO). Patients were classified into two groups: MT with IA
tirofiban (MTT) group and MT only (MTO, without IA tirofiban) group. Clinical outcomes, radiological
results, and various complications, such as post thrombectomy hemorrhage, symptomatic
hemorrhage, other systemic bleeding, and hemorrhagic transformation of infarct were evaluated by
comparing the MTT group and MTO group. In addition, subgroup analysis was performed for patients
who underwent MT with prior intravenous (IV) tissue plasminogen activator (t-PA).
Results:
The MTT group needed a lower mean number of stent passes and showed a re-occlusion
rate as compared with the MTO group (P=0.038 and 0.022, respectively). Between the two groups,
there were no statistically significant differences in post thrombectomy hemorrhage, symptomatic
hemorrhage, other systemic bleeding complications, or hemorrhagic transformation of infarct (P =
0.511, 0.397, 0.429, and 0.355, respectively). In the subgroup analysis, similar findings were observed.
Conclusion:
The use of IA tirofiban during MT seems to be safe and potentially more effective
than only MT without IA tirofiban, even in patients who used IV t-PA before MT.
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Affiliation(s)
- Ho J. Yi
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae H. Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong H. Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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19
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O'Neill D, Griffin E, Doyle KM, Power S, Brennan P, Sheehan M, O'Hare A, Looby S, da Silva Santos AM, Rossi R, Thornton J. A Standardized Aspiration-First Approach for Thrombectomy to Increase Speed and Improve Recanalization Rates. AJNR Am J Neuroradiol 2019; 40:1335-1341. [PMID: 31320463 DOI: 10.3174/ajnr.a6117] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/31/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Direct aspiration is a recognized technique for revascularization in large-vessel ischemic strokes. There is ongoing debate regarding its efficacy compared with stent retrievers. Every delay in achieving revascularization and a decrease in reperfusion rates reduces the likelihood of patients achieving functional independence. We propose a standardized setup technique for aspiration-first for all anterior circulation thrombectomy procedures for increasing speed and recanalization rates. MATERIALS AND METHODS We analyzed 127 consecutive patients treated by a standardized approach to thrombectomy with an intention to perform aspiration-first compared with 127 consecutive patients treated with a stent retriever-first approach. Key time metrics evaluated included groin to first angiogram, first angiogram to reperfusion, groin to first reperfusion, and length of the procedure. The degree of successful recanalization (TICI 2b-3) and the number of passes were compared between the 2 groups. RESULTS In 127 patients who underwent the standardized technique, the median time from groin puncture to first reperfusion was 18 minutes compared with 26 minutes (P < .001). The duration of the procedure was shorter compared with the stent retriever group (26 minutes in the aspiration first group versus 47 minutes, P < .001) and required fewer passes (mean, 2.4 versus 3.1; P < .05). A higher proportion of patients had a TICI score of 2b-3 in the aspiration-first group compared with stent retriever group (96.1% versus 85.8%, P < .005). CONCLUSIONS Our study highlights the increasing speed and recanalization rates achieved with fewer passes in a standardized approach to thrombectomy with an intention to attempt aspiration-first. Any attempt to reduce revascularization time and increase successful recanalization should be used.
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Affiliation(s)
- D O'Neill
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - E Griffin
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland .,Royal College of Surgeons (E.G., J.T.), Dublin, Ireland
| | - K M Doyle
- Department of Physiology (K.M.D., A.M.d.S.S., R.R.), School of Medicine, National University of Ireland, Galway, Ireland
| | - S Power
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - P Brennan
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - M Sheehan
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - A O'Hare
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - S Looby
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - A M da Silva Santos
- Department of Physiology (K.M.D., A.M.d.S.S., R.R.), School of Medicine, National University of Ireland, Galway, Ireland
| | - R Rossi
- Department of Physiology (K.M.D., A.M.d.S.S., R.R.), School of Medicine, National University of Ireland, Galway, Ireland
| | - J Thornton
- From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons (E.G., J.T.), Dublin, Ireland
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20
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Kim YW, Hwang YH, Kim YS, Kang DH. Frontline contact aspiration thrombectomy using SOFIA catheter for acute ischemic stroke: period-to-period comparison with Penumbra catheter. Acta Neurochir (Wien) 2019; 161:1197-1204. [PMID: 31037498 DOI: 10.1007/s00701-019-03914-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent aspiration thrombectomy devices tend to have a more flexible distal tip and larger bore for easy target access and effective reperfusion. Here, this study primarily focused on the efficacy and safety of the SOFIA catheters when it was used as a frontline contact aspiration thrombectomy (CAT) tool for acute intracranial large vessel occlusion in comparison with the data from a period when the Penumbra catheter was used. METHODS The subjects comprised 189 patients who underwent CAT (90 with Penumbra Max family and 99 with SOFIA/SOFIA plus). Patients' data were retrospectively analyzed to evaluate overall clinical and angiographic outcomes and compared between the devices. RESULTS Baseline characteristics were similar between groups. But, intravenous alteplase was more frequently administered in the Penumbra group (43.3% vs. 29.3%, p = 0.045), while incidence of ICA occlusion was higher in SOFIA group (18.9% vs. 38.4%, p = 0.013). The modified thrombolysis in cerebral infarction 2b-3 of reperfusion was 94.4% for the Penumbra group and 92.9% for the SOFIA group (p = 0.656). The first-pass effect was more frequently achieved in the SOFIA group (20.0% vs. 39.4%, p = 0.004) and endovascular procedure time was significantly shorter (55.5 min vs. 36 min, p < 0.001). However, clinical outcomes did not differ significantly regarding mortality (11.1% vs. 6.1%, p = 0.213), hemorrhagic complications, and mRS 0-2 at 3 months (63.3% vs. 58.6%; p = 0.504). CONCLUSION CAT using SOFIA may be safe and comparable to thrombectomy using the Penumbra reperfusion catheter. And, the SOFIA catheter could be advantageous for rapid reperfusion and first-pass effect without any significant complications.
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Affiliation(s)
- Yong-Won Kim
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong-Hun Kang
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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21
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Boulanger M, Lapergue B, Turjman F, Touzé E, Anxionnat R, Bracard S, Piotin M, Gory B. First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis. Interv Neuroradiol 2019; 25:244-253. [PMID: 30864466 DOI: 10.1177/1591019918821074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. PURPOSE The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion. METHODS We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. We determined rates of final complete reperfusion (defined as modified Thrombolysis In Cerebral Infarction score = 3), periprocedural complications and 90-day functional independence (defined as modified Rankin Scale (mRS) score 0-2), and excellent outcome (defined as mRS score 0-1) after contact aspiration and after stent-retriever thrombectomy using random-effects meta-analyses. Any differential effects in rates between the two strategies were assessed using random-effects meta-regressions. RESULTS Fifteen studies (1817 patients) were included. There was no difference in rates of final complete reperfusion at the end of all endovascular procedures between contact aspiration and stent retrievers (51.1%, 95% confidence interval (CI) 39.3-62.9; vs 38.3%, 95% CI 28.6-48.0; pint = 0.14), 90-day functional independence (45.0%, 40.7-49.2; vs 52.4%, 47.7-57.1; pint = 0.45) and excellent outcome (32.1%, 25.7-38.5; vs 34.1%, 21.2-46.9; pint = 0.94). Rates of periprocedural complications did not differ between the two strategies. CONCLUSIONS Current data suggest no difference in efficacy and safety between first-line contact aspiration and stent-retriever thrombectomy in stroke patients with large-artery occlusion.
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Affiliation(s)
- Marion Boulanger
- 1 Normandie University, UNICAEN, Inserm U1237, CHU Caen, Stroke Unit, Caen, France
| | - Bertrand Lapergue
- 2 Department of Neurology, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
| | - Francis Turjman
- 3 Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Touzé
- 1 Normandie University, UNICAEN, Inserm U1237, CHU Caen, Stroke Unit, Caen, France
| | - René Anxionnat
- 4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,5 University of Lorraine, INSERM U1254, IADI, F-54000, Nancy, France
| | - Serge Bracard
- 4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,5 University of Lorraine, INSERM U1254, IADI, F-54000, Nancy, France
| | - Michel Piotin
- 6 Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Benjamin Gory
- 4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,5 University of Lorraine, INSERM U1254, IADI, F-54000, Nancy, France
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22
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Dmytriw AA, Zhang Y, Mendes Pereira V. Mechanical thrombectomy and the future of acute stroke treatment. Eur J Radiol 2019; 112:214-221. [PMID: 30777213 DOI: 10.1016/j.ejrad.2019.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 01/19/2023]
Abstract
After being staggered by numerous negative trials in 2013, the interventional stroke community saw four years of vindication for mechanical thrombectomy showing efficacy and safety, even beyond a hopeful 6-8 hour window out to 24 h. A landmark set of five trials in 2015 provided a foundation upon which years of incremental follow-ups, meta-analyses and new breakthroughs would be built. With optimized devices for thrombectomy and image analysis, the neurointerventional community has turned to workflow and systemization in this new era of acute ischemic stroke treatment. The aim of this review is to chronicle the evidence in the epoch of positive trials, synthesize ancillary studies to these, and discuss the imminent challenges that remain.
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Affiliation(s)
- Adam A Dmytriw
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
| | - Yuchen Zhang
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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23
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Ye G, Lu J, Qi P, Yin X, Wang L, Wang D. Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion: a systematic review and meta-analysis. J Neurointerv Surg 2019; 11:740-746. [PMID: 30692214 DOI: 10.1136/neurintsurg-2018-014573] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Acute basilar artery occlusion (BAO) can result in extremely high disability and mortality. Stent retrievers (SRs) can achieve a high recanalization rate for BAO, therefore improving favorable outcomes. However, the efficacy of a direct aspiration first pass technique (ADAPT) to treat BAO is unclear. Our aim was to compare the efficacy and safety of firstline ADAPT with that of firstline SR for patients with acute BAO. METHODS Three databases were systematically searched for literature reporting outcomes on thrombectomy for acute BAO with both firstline ADAPT and firstline SR. The modified Newcastle-Ottawa scale was applied to assess bias risk. The random effects model was used. RESULTS Of 50 articles, 5 cohort studies (2 prospective and 3 retrospective) were included in our research. 193 cases were treated with firstline ADAPT and 283 cases received firstline SR. Successful recanalization rate was significantly higher in the firstline ADAPT group (OR=2.0, 95% CI 1.1 to 3.5). Procedure time (mean difference=-27.6 min, 95% CI -51.0 to -4.3) and the incidence of new territory embolic event (OR=0.2, 95% CI 0.05 to 0.83) was significantly less in the firstline ADAPT group. No significant difference was observed between the firstline ADAPT and firstline SR groups for rate of complete recanalization, rescue therapy, any hemorrhagic complication, favorable outcomes, or mortality at 90 days. CONCLUSIONS Our meta-analysis suggested that for patients with acute BAO, firstline ADAPT might achieve higher and faster recanalization, comparable neurological improvement and safety compared with firstline SR. Further studies are needed to confirm these results.
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Affiliation(s)
- Gengfan Ye
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Xiaoliang Yin
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Lijun Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
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Ares WJ, Zussman BM, Kenmuir CL, Weiner GM, Ziayee H, Burke D, Jadhav AP, Jovin TG, Jankowitz BT, Gross BA. Seeing Is Believing: Headway27 as a Highly Visible and Versatile Microcatheter with Ideal Dimensions for Stroke Thrombectomy. INTERVENTIONAL NEUROLOGY 2018; 7:341-346. [PMID: 30410511 DOI: 10.1159/000489017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
Abstract
Introduction Microcatheter selection is an infrequent focus of stroke thrombectomy technique evaluation. The Headway27 microcatheter strikes an excellent balance of microcatheter dimensions (156 cm length, 2.6 Fr distal OD, ID 0.027 inches) and visibility, making it ideal for stroke thrombectomy. Methods We evaluated a prospectively maintained acute stroke thrombectomy database containing 50 consecutive cases using the Headway27 microcatheter. From the database, patient demographics, clinical and angiographic information as well as procedural technical details and complications were extracted. Results Manual aspiration thrombectomy (MAT) was performed alone in 72% of cases, stentriever-assisted MAT was performed in 6% of cases, and a combination was used in 22% of cases. Median groin puncture to final recanalization time was 27 min and mTICI 2B/3 recanalization was achieved in 94% of cases. There were 2 intra-procedural complications, neither related to the microcatheter. In all cases, the Headway27 reached the intended target vessel: M1 (n = 4), M2 (n = 26), M3 (n = 13), P2 (n = 3), P3 (n = 1), and basilar artery (n = 3). There were no cases requiring usage of an additional or alternative microcatheter. In 45/47 cases of MAT, the reperfusion catheter tracked over the Headway to the clot/intended target; in two cases, the microcatheter was used to deploy a stentriever that then allowed the reperfusion catheter to track to the clot. Conclusion The Headway27 microcatheter reliably facilitated rapid clot access in anterior and posterior circulation acute large vessel occlusions with no microcatheter-associated complications.
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Affiliation(s)
- William J Ares
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Benjamin M Zussman
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Cynthia L Kenmuir
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gregory M Weiner
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Habibullah Ziayee
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Devin Burke
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashutosh P Jadhav
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian T Jankowitz
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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25
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Tsang COA, Cheung IHW, Lau KK, Brinjikji W, Kallmes DF, Krings T. Outcomes of Stent Retriever versus Aspiration-First Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:2070-2076. [PMID: 30337435 DOI: 10.3174/ajnr.a5825] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is ongoing debate regarding the optimal first-line thrombectomy technique for large-vessel occlusion. PURPOSE We performed a systematic review and meta-analysis of comparative studies on stent retriever-first and aspiration-first thrombectomy. DATA SOURCES We searched Ovid MEDLINE, PubMed, and EMBASE from 2009 to February 2018. STUDY SELECTION Two reviewers independently selected the studies. The primary end point was successful reperfusion (TICI 2b/3). DATA ANALYSIS Random-effects meta-analysis was used for analysis. DATA SYNTHESIS Eighteen studies including 2893 patients were included. There was no significant difference in the rate of final successful reperfusion (83.9% versus 83.3%; OR = 0.87; 95% CI, 0.62%-1.27%) or good functional outcome (mRS 0-2) at 90 days (OR = 1.07; 95% CI, 0.80-1.44) between the stent-retriever thrombectomy and aspiration groups. The stent-retriever thrombectomy-first group achieved a statistically significant higher TICI 2b/3 rate after the first-line device than the aspiration-first group (74.9% versus 66.4%; OR = 1.53; 95% CI, 1.14%-2.05%) and resulted in lower use of a rescue device (19.9% versus 32.5%; OR = 0.36; 95% CI, 0.14%-0.90%). The aspiration-first approach resulted in a statistically shorter groin-to-reperfusion time (weighted mean difference, 7.15 minutes; 95% CI, 1.63-12.67 minutes). There was no difference in the number of passes, symptomatic intracerebral hemorrhage, vessel dissection or perforation, and mortality between groups. LIMITATIONS Most of the included studies were nonrandomized. There was significant heterogeneity in some of the outcome variables. CONCLUSIONS Stent-retriever thrombectomy-first and aspiration-first thrombectomy were associated with comparable final reperfusion rates and functional outcome. Stent-retriever thrombectomy was superior in achieving reperfusion as a stand-alone first-line technique, with lower use of rescue devices but a longer groin-to-reperfusion time.
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Affiliation(s)
- C O A Tsang
- From the Division of Neurosurgery (C.O.A.T.), Department of Surgery .,Department of Medical Imaging (C.O.A.T., W.B., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - I H W Cheung
- Department of Diagnostic Radiology (I.H.W.C.), Queen Mary Hospital, Hong Kong
| | - K K Lau
- Division of Neurology (K.K.L.), Department of Medicine, University of Hong Kong, Hong Kong
| | - W Brinjikji
- Department of Medical Imaging (C.O.A.T., W.B., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Radiology (W.B., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- Department of Radiology (W.B., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - T Krings
- Department of Medical Imaging (C.O.A.T., W.B., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
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26
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Qin C, Shang K, Xu SB, Wang W, Zhang Q, Tian DS. Efficacy and safety of direct aspiration versus stent-retriever for recanalization in acute cerebral infarction: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12770. [PMID: 30313091 PMCID: PMC6203566 DOI: 10.1097/md.0000000000012770] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 09/15/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Whether the direct aspiration approach of thrombectomy for recanalization in patients with acute ischemic stroke has a similar efficacy and safety compared to the stent-retriever remains uncertain. METHODS We conducted a meta-analysis of 9 studies obtained through PubMed and Embase database searches to determine whether successful recanalization rate, good functional outcome at 3 months (modified Rankin score, mRS≤2), procedure time from groin puncture to maximal revascularization and procedure-related adverse events differed between patients who underwent the direct aspiration and those receiving stent-retriever for recanalization in acute cerebral infarction. RESULTS There was no significant difference between the direct aspiration group and the stent-retriever group in rate of successful recanalization (summary odds ratio [OR], 0.86 [95% confidence interval (CI), 0.45-1.52]; P = .60), but a better functional outcomes in the direct aspiration group at 3 months defined as a mRS score of 0 to 2 (OR, 0.77; 95% CI, 0.66-0.97; P = .03). Furthermore, the direct aspiration patients compared with the stent-retriever patients had a tendency of shorter procedural time (Mean difference [MD], -8.77 [95% CI, from-18.90 to 1.37]; P = .09). Finally, there were less adverse events especially in symptomatic intracerebral hemorrhage (sICH) (OR, 0.56; 95% CI, 0.33-0.98; P = .04) and embolization to a new territory (ENT) (OR, 0.49; 95% CI, 0.28-0.84; P = .01) in the direct aspiration group when compared with the stent-retriever group, although no difference between them in the rate of any ICH (OR, 0.81; 95% CI, 0.41-1.60; P = .54). CONCLUSIONS The results support that the direct aspiration technique for those acute ischemic stroke patients may have better functional outcomes, less procedure related-adverse events and a tendency of faster revascularization time as compared to the stent-retriever thrombectomy, with a similar successful recanalization rate. However, major limitations of current evidence (mainly from retrospective and observational studies and a small number of patients population) indicate a need for adequately powered, multicenter randomized controlled trials (RCT) to answer this question.
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Phan K, Maingard J, Kok HK, Dmytriw AA, Goyal S, Chandra R, Brooks DM, Thijs V, Asadi H. Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis. Neurointervention 2018; 13:100-109. [PMID: 30196680 PMCID: PMC6132031 DOI: 10.5469/neuroint.2018.00997] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus contact aspiration for M2 occlusions. MATERIALS AND METHODS Study selection included cohorts of patients with distal MCA occlusions in acute ischemic strokes treated with an endovascular approach including stent-retrieval or contact aspiration. Twelve studies were selected for meta-analysis for a total of 835 cases. Meta-analysis by proportions was conducted on parameters including baseline and procedural characteristics, thrombolysis in cerebral infarction (TICI) 2b-3 outcomes, and 90-day modified Rankin scale (mRS) outcomes. RESULTS Hypertension and hyperlipidemia were more prevalent in stent-retriever patients. Pooled baseline National Institute of Health Stroke Scale scores and Alberta Stroke Program Early Computed Tomography Score imaging scores were similar. Pooled time onset of symptoms to door arrival was higher for the stent-retrieval group (154 vs. 97.4 minutes, P=0.01), as was time to groin puncture (259.9 vs. 156.2 minutes, P=0.02), but there was no difference in procedure time. The TICI 2b-3 recanalization rate was similar (80.5% vs. 86.8%, P=0.168). The frequency of mRS 0-2 at 90-day was also similar (74.5% vs. 59.9%, P=0.120), and an excellent mRS 0-1 was lower for stent-retrievers (39.9% vs. 65.6%, P=0.003). A significant negative correlation was found between onset to groin puncture time and the proportion of patients with a good mRS (r=-0.71, P=0.048). CONCLUSION Both endovascular techniques achieved recanalization rates greater than 80% and 90-day outcomes of minimal disability with similar complication rates. The literature is skewed by aspiration cases being performed sooner after onset of stroke compared to stent-retriever cases.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Randwick, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Randwick, Australia
| | - Julian Maingard
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia.,Department of Radiology, School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Hong Kuan Kok
- Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adam A Dmytriw
- Department of Radiology, University of Toronto, Toronto, Canada
| | - Sourabh Goyal
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Randwick, Australia
| | - Ronil Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Australia
| | - Duncan Mark Brooks
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia.,Department of Radiology, School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Neurology, Austin Health, Heidelberg, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia.,Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Australia
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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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