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Orscelik A, Kallmes DF, Bilgin C, Musmar B, Senol YC, Kobeissi H, Elawady SS, Cunningham C, Matsukawa H, Zandpazandi S, Sowlat MM, Maier I, Al Kasab S, Jabbour P, Kim JT, Wolfe SQ, Rai A, Starke RM, Psychogios MN, Samaniego EA, Arthur AS, Yoshimura S, Cuellar H, Howard BM, Alawieh A, Romano DG, Tanweer O, Mascitelli J, Fragata I, Polifka AJ, Osbun JW, Crosa RJ, Matouk C, Park MS, Levitt MR, Moss M, Dumont TM, Williamson R, Navia P, Kan P, De Leacy R, Chowdhry SA, Ezzeldin M, Spiotta AM, Brinjikji W. Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion. J Neurointerv Surg 2023:jnis-2023-020925. [PMID: 37918906 DOI: 10.1136/jnis-2023-020925] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Several studies have established the safety and efficacy of balloon guide catheters (BGCs) for large vessel occlusions. However, the utility of BGCs remains largely unexplored for distal medium vessel occlusions (DMVOs). In this study, we aim to compare the outcomes of BGC vs. Non-BGC in patients undergoing mechanical thrombectomy (MT) for DMVO. METHOD This retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) encompassed adult patients with acute anterior cerebral artery, posterior cerebral artery, and middle cerebral artery-M2-3-4 occlusions. Procedure times, safety, recanalization, and neurological outcomes were compared between the two groups, with subgroup analysis based on first-line thrombectomy techniques. RESULTS A total of 1508 patients were included, with 231 patients (15.3%) in the BGC group and 1277 patients (84.7%) in the non-BGC group. The BGC group had a lower modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2C (43.2% vs 52.7%, P=0.01), longer time from puncture to intracranial access (15 vs 8 min, P<0.01), and from puncture to final recanalization (97 vs 34 min, P<0.01). In the Solumbra subgroup, the first pass effect (FPE) rate was lower in the BGC group (17.4% vs 30.7%, P=0.03). Regarding clinical outcomes, the BGC group had a lower rate of distal embolization (8.8% vs 14.9%, P=0.03). CONCLUSION Our study found that use of BGC in patients with DMVO was associated with lower mTICI scores, decreased FPE rates, reduced distal embolization, and longer procedure times.
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Affiliation(s)
- Atakan Orscelik
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Basel Musmar
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Yigit Can Senol
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Conor Cunningham
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Sara Zandpazandi
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ilko Maier
- Department of Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Gwangju, Korea (the Republic of)
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Ansaar Rai
- Department of Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Edgar A Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center/Semmes Murphey Foundation, Memphis, Tennessee, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hugo Cuellar
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Daniele G Romano
- Department of Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Justin Mascitelli
- Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Joshua W Osbun
- Department of Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Roberto Javier Crosa
- Department of Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Mark Moss
- Department of Interventional Neuroradiology, Washington Regional Medical Center, Fayetteville, Arkansas, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Richard Williamson
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Pedro Navia
- Department of Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | - Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shakeel A Chowdhry
- Department of Neurosurgery, North Shore University Health System, Evanston, Illinois, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, University of Houston, HCA Houston Healthcare, Kingwood, Texas, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Ducroux C, Boisseau W, Poppe AY, Daneault N, Deschaintre Y, Diestro JDB, Eneling J, Gioia LC, Iancu D, Maier B, Nauche B, Nico L, Odier C, Raymond J, Roy D, Stapf C, Weill A, Jacquin G. Successful Reperfusion is Associated with Favorable Functional Outcome despite Vessel Perforation during Thrombectomy: A Case Series and Systematic Review. AJNR Am J Neuroradiol 2022; 43:1633-1638. [PMID: 36175082 PMCID: PMC9731237 DOI: 10.3174/ajnr.a7650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/17/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arterial perforation is a potentially serious complication during endovascular thrombectomy. PURPOSE Our aim was to describe interventional approaches after arterial perforation during endovascular thrombectomy and to determine whether reperfusion remains associated with favorable outcome despite this complication. DATA SOURCES Data from consecutive patients with acute stroke undergoing endovascular thrombectomy were retrospectively collected between 2015 to 2020 from a single-center cohort, and a systematic review was performed using PubMed, EMBASE, and Ovid MEDLINE up to June 2020. STUDY SELECTION Articles reporting functional outcome after arterial perforation during endovascular thrombectomy were selected. DATA ANALYSIS Functional outcomes of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion in our single-center cohort. We then summarized the literature review to describe interventional approaches and outcomes after arterial perforation during endovascular thrombectomy. DATA SYNTHESIS In our single-center cohort, 1419 patients underwent endovascular thrombectomy, among whom 32 (2.3%) had vessel perforation and were included in the analysis. The most common hemostatic strategy was watchful waiting (71% of cases). Patients with successful reperfusion had a higher proportion of favorable 90-day mRS scores (60% versus 12.5%; P = .006) and a lower mortality rate (13.3% versus 56.3%, P = .01) than patients without successful reperfusion. Thirteen articles were included in the systematic review. Successful reperfusion also appeared to be associated with better outcomes. LIMITATIONS Given the low number of published reports, we performed only a descriptive analysis. CONCLUSIONS Arterial perforation during endovascular thrombectomy is rare but is associated with high mortality rates and poor outcome. However, successful reperfusion remains correlated with favorable outcome in these patients.
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Affiliation(s)
- C Ducroux
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Division of Neurology (C.D.), Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - W Boisseau
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
- Department of Interventional Neuroradiology (W.B., B.M.), Hopital Fondation A. De Rothschild, Paris, France
| | - A Y Poppe
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Neurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - N Daneault
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Neurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Y Deschaintre
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Neurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - J D B Diestro
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
| | - J Eneling
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
| | - L C Gioia
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Neurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - D Iancu
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
| | - B Maier
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
- Department of Interventional Neuroradiology (W.B., B.M.), Hopital Fondation A. De Rothschild, Paris, France
- Université Paris-Cité (B.M.), Paris, France
| | - B Nauche
- Bibliothèque du Centre Hospitalier de l'Université de Montréal (B.N.), Montreal, Quebec, Canada
| | - L Nico
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
| | - C Odier
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Neurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - J Raymond
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
| | - D Roy
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
| | - C Stapf
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Neurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - A Weill
- Radiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
| | - G Jacquin
- From the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
- Departments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
- Neurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
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Yu X, Richard SA, Fuhua Y, Jianfeng J, Xinmin Z, Min W. Mechanical thrombectomy for vertebral and basilar artery occlusions: An institutional experience with 17 patients. Med Int (Lond) 2022; 2:32. [PMID: 36699156 PMCID: PMC9829235 DOI: 10.3892/mi.2022.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/17/2022] [Indexed: 01/27/2023]
Abstract
Acute ischemic stroke of the posterior circulation as a result of vertebrobasilar artery occlusions is often associated with severe morbidity and mortality rates. Vertebrobasilar artery occlusion retrieval via mechanical thrombectomy (MT) is a novel treatment modality for occlusive strokes. Nevertheless, factors associated with positive outcomes have not yet been adequately investigated. Thus, the present study focused on factors associated with good prognosis following this type of treatment. The present study retrospectively analyzed a series of 17 patients with acute vertebral artery occlusions (VAOs) and basilar artery occlusions (BAOs) treated with MT. In all patients, information such as sex and age, time from admission to the onset of femoral artery access, the number of thrombi removed, the time of femoral artery access to recanalization, pre- and post-operative National Institutes of Health Stroke Scale (NIHSS) scores, pre- and post-operative thrombolysis in cerebral infarction, as well as modified Rankin scale scores were documented and analyzed. The analysis comprised of 11 patients with BAOs and 6 patients with VAOs. A recanalization rate of 70.6% was achieved with an overall good functional outcome of 58.8% at 90 days. Observationally, there was a notable improvement in outcomes when comparing the NIHSS prior to surgery with NIHSS at 1 week after the surgery. A lower NIHSS score prior to MT may be a good prognostic factor. An average time of ~5.5 h from patient admittance to recanalization with a 70.6% recanalization rate with an overall good functional outcome of 58.8% at 90 days suggested that, patients for whom the surgeries were performed within 5 h of admittance may still have hope for recanalization compared to an initial 1.5-h average time for recanalization.
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Affiliation(s)
- Xu Yu
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Seidu A. Richard
- Department of Medicine, Princefield University, P.O. Box MA-128, Ho, Volta Region, Ghana
| | - Ye Fuhua
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Jiang Jianfeng
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Zhou Xinmin
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China
| | - Wu Min
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, Jiangsu 214400, P.R. China,Correspondence to: Professor Wu Min, Department of Neurosurgery, Jiangyin Hospital, Southeast University, 16 Shou Mountain Road, Jiangyin, Jiangsu 214400, P.R. China
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Chen WH, Yi T, Wu YM, Pan ZN, Zheng XF, Lin XH, Lin DL, Chen RC. Initial Clinical Experience of Repeat Thrombectomy with a Retrieval Stent (RTRS) with Continuous Proximal Flow Arrest by Balloon Guide Catheter for Acute Intracranial Carotid Occlusion. Behav Neurol 2021; 2021:7607324. [PMID: 35003387 DOI: 10.1155/2021/7607324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Balloon guide catheters (BGCs) have good performance in terms of radiological outcomes in acute ischemic thrombectomy. It is not uncommon for BGCs to be blocked by thrombi, especially in cases with acute intracranial internal carotid artery (ICA) occlusion. Our initial experience using repeat thrombectomy with a retrieval stent (RTRS) with continuous proximal flow arrest by BGC for acute intracranial ICA occlusion is presented. Methods In patients with acute intracranial ICA occlusion treated with RTRS, clinical data, including the National Institutes of Health Stroke Scale (NIHSS) score at admission and modified Rankin Scale (mRS) score at 90 days, and procedural data, including the Extended treatment in Cerebral Infarction (eTICI) score, procedural time, and complications, were analyzed. Results Thirty-two consecutive patients (12 men (37.5%); mean age: 73 years) were treated with RTRS using a BGC. The median NIHSS score was 19. The median puncture-to-reperfusion time was 46 minutes (range: 22-142 minutes). All patients were successfully revascularized; eTICI 2c or better recanalization was achieved in 30 (93.8%) patients. No procedure-related complications or symptomatic intracranial hemorrhage occurred. Two cases (6.3%) had distal emboli, but none had emboli to the anterior cerebral artery. Fourteen patients (43.8%) achieved a good outcome with an mRS score of 0-2 at 90 days, and 8 patients (25.0%) died. Conclusions In patients with intracranial ICA occlusion, RTRS with proximal flow arrest by BGC is effective and safe, achieving good clinical and angiographic outcomes. This method may reduce the incidence of distal emboli in thrombectomy with stent retrievers.
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Miki K, Aizawa Y, Fujii S, Karakama J, Fujita K, Sasaki Y, Nemoto S, Sumita K. Combined Technique Thrombectomy with a Long Balloon-Guiding Catheter and Long Sheath Aids in Rapid and Stable Recanalization in Patients with Anterior Circulation Acute Ischemic Stroke. J Neuroendovasc Ther 2020; 15:281-287. [PMID: 37501899 PMCID: PMC10370978 DOI: 10.5797/jnet.oa.2020-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/26/2020] [Indexed: 07/29/2023]
Abstract
Objective The purpose of this study was to evaluate the combination of a 100-cm long balloon-guiding catheter (BGC) and 40-cm long sheath in patients treated by mechanical thrombectomy for anterior circulation acute ischemic stroke. Methods The subjects were 77 consecutive patients treated by endovascular recanalization for anterior circulation occlusion from January 2011. After February 2018, 24 patients were treated by mechanical thrombectomy using a long BGC and long sheath (L-BGC group), and were compared with 53 patients treated before January 2018 using a normal BGC and sheath (S-BGC group). The baseline angiographical/clinical characteristics, main procedures, BGC insertion time, internal carotid artery (ICA) cartelization rate, recanalization rate, and clinical outcome were compared between L-BGC and S-BGC groups. Results There was no significant difference in angiographical/clinical characteristics except for intravenous thrombolysis with recombinant tissue plasminogen activator (IVrtPA) treatment. In all, 22 patients were treated by combined technique (CoT) thrombectomy in the L-BGC group. The BGC insertion time was significantly shorter in the L-BGC group than in the S-BGC group (19 vs 13 minutes), and ICA catheterization of BGC was successful in the L-BGC group, whereas there were seven failures in the S-BGC group (100% vs 84%). The puncture-to-recanalization (PtoR) time was significantly shorter in the L-BGC group (90 vs 44 minutes). The successful recanalization (SR) rate was higher in the L-BGC group (96% vs 72%). Good outcomes (mRS 0-2) slightly increased in the L-BGC group (64% vs 49%). In the multivariable analysis, only CoT thrombectomy was associated with PtoR and SR. Conclusion The combination of a long BGC and long sheath results in rapid and stable BGC insertion to the ICA. CoT thrombectomy with these devices may be useful for SR and reducing the PtoR in anterior circulation mechanical thrombectomy.
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Affiliation(s)
- Kazunori Miki
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Aizawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Fujii
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Karakama
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyohei Fujita
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyuki Sasaki
- Medical Innovation Promotion Center, Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeru Nemoto
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Sumita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Nabil M, Chater G, Correia P, Wegener S, Baltsavias G. Thrombectomy-Related Emboli: Direct Aspiration versus Stent Retriever Thrombectomy for Acute Ischemic Stroke: Our Experience and Literature Review. World Neurosurg 2020; 135:e588-97. [DOI: 10.1016/j.wneu.2019.12.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/17/2022]
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Caroff J, King RM, Arslanian R, Marosfoi M, Langan ET, Gounis MJ, Chueh JY. Microcatheter navigation through the clot: does size matter? J Neurointerv Surg 2018; 11:271-274. [PMID: 30177546 DOI: 10.1136/neurintsurg-2018-014105] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite high recanalization rates achieved with endovascular treatment of acute ischemic strokes, around 50% of eligible patients will not achieve a good outcome. Parameters that may determine patient outcomes include: time from puncture to recanalization, the collateral status, the anesthesia regimen, blood pressure management, and distal emboli. Characterization of distal emboli generated during mechanical thrombectomy has been performed in previous studies. OBJECTIVE To further investigate the risk of distal embolization associated with microcatheter navigation across the clot. METHODS A contrast-enhanced clot analog was used in an in vitro model that mimicked a middle cerebral artery occlusion within a complete circle of Willis vascular replica. The clot was crossed with one of the following microcatheters: Pro18, XT-27 or 3MAX. The emboli generated during the procedure were collected and measured. RESULTS The use of Pro18 and XT-27 resulted in a significant reduction of visible particles (size ≥500 µm) as compared with the 3MAX catheter (P<0.003). For the size range between 8 and 200 µm, there was a trend for Pro18 to generate fewer particles (-18%) than XT-27 but without statistical significance (P>0.05). In comparison with previously published data, acquired under the same conditions, it was found that the clot crossing maneuver accounts approximately for 12% of the total number of small emboli (<200 µm) induced during a stent retriever-mediated mechanical thrombectomy procedure via a balloon guide catheter. CONCLUSIONS The clot crossing maneuver has a significant effect on the total number of small particles induced during mechanical thrombectomy. Smaller microcatheter sizes should be favored when possible.
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Affiliation(s)
- Jildaz Caroff
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Clichy, France
| | - Robert M King
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Rose Arslanian
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Miklos Marosfoi
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erin T Langan
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ju-Yu Chueh
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Affiliation(s)
- David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Sameer A Ansari
- Departments of Radiology, Neurology, and Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Osama O Zaidat
- Department of Neurology, St Vincent Mercy Medical Center, Toledo, Ohio, USA
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Chalumeau V, Blanc R, Redjem H, Ciccio G, Smajda S, Desilles JP, Botta D, Escalard S, Boisseau W, Maïer B, Labreuche J, Obadia M, Piotin M, Mazighi M. Anterior cerebral artery embolism during thrombectomy increases disability and mortality. J Neurointerv Surg 2018; 10:1057-1062. [DOI: 10.1136/neurintsurg-2018-013793] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveDuring thrombectomy, thromboembolic migration in previously unaffected territory may occur and is not systematically notified. We report our data on the incidence, predictors, and clinical outcome of anterior cerebral artery emboli (ACAE).MethodsFrom a prospectively collected thrombectomy database of consecutive patients with anterior circulation stroke between January 2012 and December 2016, 690 angiographic images were analyzed to assess ACAE. The primary outcome was a favorable outcome, defined as a 3 month modified Rankin Scale score of 0–2 or equal to the pre-stroke score.ResultsACAE occurred in 65 patients (9.4%; 95% CI 7.2% to 11.6%). Internal carotid artery occlusion (tandem or terminal), Alberta Stroke Program Early CT Score <7, increasing number of passes, and use of stent retriever alone (compared with distal aspiration alone or combined with stent retriever) were found to be independent predictors of ACAE. Compared with patients without ACAE, patients with ACAE had lower rates, with an adjusted OR (95% CI) of 0.48 (0.25 to 0.92; P=0.027) for favorable outcome and 0.49 (0.25 to 0.96; P=0.038) for early neurologic improvement. ACAE was significantly associated with a higher mortality (adjusted OR 1.93; 95% CI 1.03 to 3.61; P=0.039) and intracranial hemorrhagic complications (adjusted OR 2.45; 95% CI 1.33 to 4.47; P=0.004). Despite a successful reperfusion modified Thrombolysis in Cerebral Infarction score of 2b–3 at the end of the procedure, a favorable outcome was reached in 30% of patients with ACAE compared with 52.4% in the other patients (OR 0.39; 95% CI 0.19 to 0.78; P=0.008).ConclusionsProcedural ACAE was not an uncommon condition, and was associated with increased mortality and disability rates, regardless of the success of reperfusion.
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Kammerer S, du Mesnil de Rochemont R, Wagner M, You SJ, Tritt S, Mueller-Eschner M, Keil FC, Lauer A, Berkefeld J. Efficacy of Mechanical Thrombectomy Using Stent Retriever and Balloon-Guiding Catheter. Cardiovasc Intervent Radiol 2018; 41:699-705. [DOI: 10.1007/s00270-018-1901-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/07/2018] [Indexed: 11/25/2022]
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