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Cao J, Lin H, Lin M, Ke K, Zhang Y, Zhang Y, Zheng W, Chen X, Wang W, Zhang M, Xuan J, Peng Y. RECO Flow Restoration Device Versus Solitaire FR With the Intention for Thrombectomy Study (REDIRECT): a prospective randomized controlled trial. J Neurosurg 2021; 134:1569-1577. [PMID: 32502991 DOI: 10.3171/2020.3.jns193356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The RECO flow restoration (FR) device is a new stent retriever designed for rapid flow restoration in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Here, the authors compared the efficacy and safety of the RECO device with the predicate Solitaire FR stent retriever. METHODS The RECO Flow Restoration Device Versus Solitaire FR With the Intention for Thrombectomy Study (REDIRECT) was a multicenter, prospective, open randomized controlled trial. Patients with acute LVO at 7 Chinese stroke centers participated in the study. The primary efficacy endpoint was defined as a modified thrombolysis in cerebral infarction (mTICI) reperfusion grade ≥ 2 within three passes. The primary safety endpoint comprised any serious adverse device effect, symptomatic intracerebral hemorrhage (sICH), and any serious adverse event (SAE; defined as cerebral palsy or death) within 24 hours after the procedure. The secondary efficacy endpoints consisted of functional independence (modified Rankin Scale score 0-2), procedure duration, and 90-day all-cause mortality. RESULTS Between January 2014 and August 2016, 67 patients were randomly allocated to the RECO group and 69 patients to the Solitaire FR group. The primary efficacy endpoint (mTICI grade ≥ 2 within three passes) was similar in the two treatment groups (91% vs 87%, respectively, p = 0.5861), and the rate of reperfusion with an mTICI grade 2b/3 was 87% versus 75% (p = 0.1272). There were no serious adverse device effects in any patient. The rates of sICH (1.5% vs 7.2%, p = 0.1027) and SAEs (6.0% vs 1.4%, p = 0.2050) within 24 hours after the procedure were similar in the two treatment groups. There was no significant difference in the rate of functional independence (63% vs 46%, p = 0.0609) or 90-day all-cause mortality (13% vs 23%, p = 0.1848) or in procedure duration (85.39 ± 47.01 vs 89.94 ± 53.34 minutes, p = 0.5986) between the two groups. CONCLUSIONS The RECO stent retriever is effective and safe as a mechanical thrombectomy device for AIS due to LVO. Clinical trial registration no.: NCT01983644 (clinicaltrials.gov).
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Affiliation(s)
- Jie Cao
- 1Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou
| | - Hang Lin
- 2Department of Neurology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou
| | - Min Lin
- 2Department of Neurology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou
| | - Kaifu Ke
- 3Department of Neurology, The Affiliated Hospital of Nantong University, Nantong
| | - Yunfeng Zhang
- 3Department of Neurology, The Affiliated Hospital of Nantong University, Nantong
| | - Yong Zhang
- 4Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao
| | - Weihong Zheng
- 5Department of Neurology, Zhongshan Hospital of Xiamen University, Xiamen
| | - Xingyu Chen
- 5Department of Neurology, Zhongshan Hospital of Xiamen University, Xiamen
| | - Wei Wang
- 6Department of Imaging, Yangzhou No. 1 People's Hospital, Yangzhou; and
| | - Meng Zhang
- 7Department of CCU, Daping Hospital, Chongqing, People's Republic of China
| | - Jinggang Xuan
- 1Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou
| | - Ya Peng
- 1Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou
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Virani K, Hu S, Christian C, Simpkin W, Phillips S, Shankar JJS. Endovascular Thrombectomy for Stroke Effectiveness Study—An Audit From a Small Tertiary Care Center. Can Assoc Radiol J 2020; 71:63-67. [DOI: 10.1177/0846537119885668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Endovascular thrombectomy (EVT) treatment for acute ischemic stroke is now recommended as a standard of care. However, implementing EVT in routine clinical practice poses many challenges, even in countries with advanced health-care systems. The aim of the current study is to delineate if EVT at our institution is an effective treatment for acute ischemic stroke. Methods: All patients who underwent EVT at our institution between December 2011 and July 2017 were retrospectively assessed from our prospective registry. Clinical and imaging (including the Alberta Stroke Program Early CT [ASPECT] score, single-phase computed tomography angiography, and computed tomography perfusion) criteria were utilized to determine EVT suitability. Primary outcomes included modified Rankin score (mRS) at 90 days and recanalization determined by the modified Treatment in Cerebral Infarction score. Effectiveness was assessed by comparing our cohort with patients receiving EVT in the ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke) trial. Results: Eighty-eight patients presented to our hospital after a median of 87 minutes last seen normal. Of these, median ASPECT score was 9. A majority (72%) also received intravenous alteplase. Successful recanalization (≥TICI 2b) was achieved in 79%. At 90 days, 48% (36/75) were functionally independent (mRS score of 0-2) and 28% (21/75) were disabled (mRS score of 3-5); 24% (18/75) died (mRS of 6) within 90 days. Conclusions: An audit of our initial experience with EVT for the treatment of acute ischemic stroke in a small tertiary care center yielded similar results compared to the ESCAPE trial, which is encouraging for implementing this treatment in routine clinical practice.
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Affiliation(s)
- Karim Virani
- Division of Neuroradiology, Department of Radiology, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sherry Hu
- Division of Neurology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Christine Christian
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Wendy Simpkin
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Stephen Phillips
- Division of Neuroradiology, Department of Radiology, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jai Jai Shiva Shankar
- Division of Neuroradiology, Department of Radiology, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Martini M, Mocco J, Turk A, Siddiqui AH, Fiorella D, Hanel RA, Woodward K, Rai A, Frei D, Delgado Almandoz JE, Kelly ME, Peeling L, Arthur AS, Baxter B, English J, Linfante I, De Leacy R. 'Real-world' comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study. J Neurointerv Surg 2019; 11:957-963. [PMID: 30975738 DOI: 10.1136/neurintsurg-2018-014624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Thrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to 'real-world' practice. OBJECTIVE To compare revascularization rates and outcomes for direct aspiration (ADAPT) and stent retriever thrombectomy following anterior acute ischemic stroke (AIS) in a real-life setting. METHODS Data from the most recent 20 consecutive patients with AIS treated with mechanical thrombectomy between 2015 and 2016 were collected from 15 high-volume stroke centers across North America for a total of 300 cases. Patients with proximal anterior large vessel occlusions were dichotomized by primary treatment technique. Ordinal logistic regression assessed the effects of clinical variables on patient disability using 90-day modified Rankin Scale (mRS) scores. RESULTS Adequate revascularization (Thrombolysis in Cerebral Infarction ≥2b) was ultimately achieved in 91.2% of first-line direct aspiration (ADAPT) cases with an average of 1.9±1.9 passes and in 87.5% of stent retriever cases with an average of 1.7±1.0 passes. Time from groin puncture to revascularization was shorter for ADAPT cases. The mean 90-day mRS score for both groups was 3.0±2.4. Number of passes using primary technique, and postintervention intracranial hemorrhage, were significant predictors of 90-day mRS scores after ADAPT, while age and preprocedure mRS score were predictive of outcomes following first-line stent retriever. CONCLUSIONS Our data show similar adequate revascularization rates and 90-day functional outcomes for first-line direct aspiration and stent retrievers for anterior large vessel occlusion in a real-world setting. These results support the findings of other prospective trials evaluating the two techniques.
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Affiliation(s)
- Michael Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J Mocco
- The Mount Sinai Health System, New York, USA
| | - Aquilla Turk
- Department of Neurosurgery, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA.,SUNY SB, New York, USA
| | - Ricardo A Hanel
- Stroke and Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | | | - Ansaar Rai
- Department of Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Don Frei
- Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
| | | | - Michael E Kelly
- Royal University Hospital, University of Saskatchewan, Department of Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Lissa Peeling
- Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam S Arthur
- UT Dept Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Blaise Baxter
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Joey English
- Department of Neurology and Radiology, UCSF, San Francisco, California, USA
| | - Italo Linfante
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Wee CK, McAuliffe W, Phatouros CC, Phillips TJ, Blacker D, Singh TP, Baker E, Hankey GJ. Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre. Cerebrovasc Dis Extra 2017; 7:95-102. [PMID: 28463832 PMCID: PMC6685497 DOI: 10.1159/000470855] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/28/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks. We aimed to survey the proportion of patients suitable for EVT who are alteplase-ineligible and to compare the safety and effectiveness of standard care of acute large artery ischaemic stroke by EVT plus thrombolysis with that of EVT alone in a tertiary hospital clinical stroke service. METHODS We performed a retrospective analysis of acute ischaemic stroke patients treated with EVT at our centre between October 2013 and April 2016, based on a registry with prospective and consecutive patient collection. Individual patient records were retrieved for review. Significant early neurological improvement was defined as a NIHSS score of 0-1, or a decrease from baseline of ≤8, at 24 h after stroke onset. RESULTS Fifty patients with acute ischaemic stroke secondary to LVO in the anterior circulation received EVT in this period, of whom 21 (42%) received concurrent alteplase and 29 (58%) EVT alone. The 2 groups had similar baseline characteristics and similar outcomes. Significant neurological improvement at 24 h occurred in 47.6% of the patients with EVT and bridging alteplase and in 51.7% of the patients with EVT alone (p = 0.774). Mortality during acute hospitalization was 20% for the bridging alteplase group versus 7.1% for EVT alone (p = 0.184). Intracranial haemorrhage rates were 14.3% for bridging alteplase versus 20.7% for EVT alone (p = 0.716). Local complications, groin haematoma (23.8 vs. 10.3%) and groin pseudoaneurysms (4.8 vs. 0%) (p = 0.170), were not significantly different. CONCLUSION Our study highlights the relatively large proportion of patients suitable for EVT who have a contraindication to alteplase and raises the hypothesis that adding alteplase to successful EVT may not be necessary to optimize functional outcome. The results are consistent with observational data from other endovascular centres and support a randomised controlled trial of EVT versus EVT with bridging alteplase.
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Affiliation(s)
- Chee-Keong Wee
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Washington, Australia
| | - William McAuliffe
- Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Washington, Australia
| | - Constantine C Phatouros
- Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Washington, Australia
| | - Timothy J Phillips
- Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Washington, Australia
| | - David Blacker
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Washington, Australia
| | - Tejinder P Singh
- Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Washington, Australia
| | - Ellen Baker
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Washington, Australia
| | - Graeme J Hankey
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Washington, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, Washington, Australia
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Sarzetto F, Gupta S, Alotaibi NM, Howard P, da Costa L, Heyn C, Maralani PJ, Guha D, Swartz RH, Boyle K, Yang VX. Outcome Evaluation of Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy: A Single-Institution Experience in the Era of Randomized Controlled Trials. World Neurosurg 2017; 99:593-598. [DOI: 10.1016/j.wneu.2016.12.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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