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Navia P, Espinosa de Rueda M, Rodriguez-Benitez A, Ballenilla Marco F, Pumar JM, Gallego-Leon JI, Diaz-Valiño JL, Mendez JC, Hernández Fernández F, Rodriguez-Paz CM, Hernandez D, Maynar FJ, Vega-Villar J, García-Benassi JM, Martínez-Galdámez M, Larrea JA, Fernandez-Prieto A. Endovascular thrombectomy first-pass reperfusion and ancillary device placement. J Neurointerv Surg 2024; 16:902-907. [PMID: 37607823 DOI: 10.1136/jnis-2023-020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT). METHODS Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device. RESULTS From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0-2). CONCLUSIONS Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.
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Affiliation(s)
- Pedro Navia
- Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
- La Paz University Hospital Health Research Institute, Madrid, Spain
| | | | | | | | - José Manuel Pumar
- Neuroradiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Ignacio Gallego-Leon
- Alicante General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | | | - Jose Carlos Mendez
- Interventional Neuroradiology Unit. Radiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Interventional Neuroradiology.Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain
| | - Jose-Angel Larrea
- Interventional Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Andres Fernandez-Prieto
- Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
- La Paz University Hospital Health Research Institute, Madrid, Spain
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Pinckaers FME, Robbe MMQ, Olthuis SGH, Boogaarts HD, van Zwam WH, van Oostenbrugge RJ, Postma AA. Prognostic implications of intracranial haemorrhage on dual-energy CT immediately following endovascular treatment for acute ischemic stroke. J Neuroradiol 2024; 51:101168. [PMID: 37984705 DOI: 10.1016/j.neurad.2023.11.003] [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: 07/16/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To describe the incidence, risk factors, and prognostic relevance of intracranial haemorrhage (ICH) immediately after endovascular treatment (EVT) for ischaemic stroke in the anterior circulation. METHODS EVT records from 2010 to 2019 were screened. Included patients underwent DECT within 3h post-EVT. Virtual native reconstructions were evaluated for ICH according to the Heidelberg criteria and grouped into Heidelberg classes (HCs): [HC1] haemorrhagic infarction (HI)1, HI2 and parenchymal haematoma (PH)1; [HC2] PH2; [HC3] i.a. intraventricular and subarachnoid haemorrhage. If ICH corresponding to multiple HCs was observed, we assumed that the (largest) parenchymal ICH would have the greatest prognostic impact. Hence, a single HC was attributed by the following order of severity: HC2, HC1, HC3. The primary outcome was the modified Rankin Scale (mRS) at 90 days. The effect of asymptomatic ICH (aICH) and symptomatic ICH (sICH) of (1) HC1 or HC2 and (2) HC3 on patient outcomes was evaluated with multivariable regression after multiple imputation. RESULTS Out of 651 records, 498 patients were included. Eighty-one (16%) patients showed ICH on post-EVT DECT, of which 19 were classified as HC1 (21% symptomatic), 6 as HC2 (100% symptomatic), and 56 as HC3 (14% symptomatic). ICH development was mainly associated with unfavourable procedural characteristics. Both aICH and sICH of HC1 or HC2 were associated with the mRS (aICH: adjusted [a]cOR 4.92, 95%CI [1.48-16.35]; sICH: acOR 12.97, 95%CI [2.39-70.26]) and mortality (aICH: aOR 10.08, 95%CI [2.48-40.88]; sICH: aOR 9.92, 95%CI [1.48-66.31]). Likewise, sICH of HC3 was associated with the mRS and mortality (acOR 19.91, 95%CI [4.03-98.35], and aOR 13.23, 95%CI [2.27-77.18], respectively). aICH of HC3 was not significantly associated with the mRS or mortality (acOR 0.87, 95%CI [0.48-1.57], and cOR 0.84, 95%CI [0.32-2.20], respectively). CONCLUSIONS Immediate post-EVT ICH is a frequent finding. Except for aICH of HC3, any ICH is associated with poor long-term clinical outcomes.
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Affiliation(s)
- Florentina M E Pinckaers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Magretha M Q Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Susanne G H Olthuis
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Robert J van Oostenbrugge
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, the Netherlands
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Zhao ZA, Qiu J, Li W, Nguyen T, Wang S, Shi H, Wei M, Wang F, Li D, Chen HS. Intra-arterial tenecteplase during thrombectomy for acute stroke (BRETIS-TNK II): rationale and design. Stroke Vasc Neurol 2024; 9:59-65. [PMID: 37169399 PMCID: PMC10961245 DOI: 10.1136/svn-2023-002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Our recent pilot study suggests intra-arterial tenecteplase (TNK) during the first pass of endovascular treatment (EVT) seems safe, may increase first-pass reperfusion and good outcome in acute ischaemic stroke (AIS) patients with large-vessel occlusion (LVO). AIMS To determine the efficacy and safety of intra-arterial TNK administration during EVT in AIS-LVO patients presenting up to 24 hours from symptom onset. SAMPLE SIZE ESTIMATES A maximum of 380 patients are required to test the superiority hypothesis with 80% power according to a two-side 0.05 level of significance, stratified by age, gender, baseline systolic blood pressure, prestroke modified Rankin Scale (mRS), baseline National Institute of Health stroke scale, baseline ASPECTS, time from onset to groin puncture, intravenous thrombolysis before EVT, stroke territory and stroke aetiology. DESIGN Intra-arterial TNK during thrombectomy for acute stroke (BRETIS-TNK II) study is a prospective, randomised, adaptive enrichment, open-label, blinded end point, multicentre study. Eligible AIS-LVO patients are randomly assigned into the experimental group and control group with a ratio of 1:1. The experimental group will be treated with intra-arterial infusion of TNK during EVT. The control group will be treated with standard EVT. OUTCOME The primary end point is a favourable outcome, defined as an mRS score of 0-2 at 90 days. The primary safety end point is symptomatic intracranial haemorrhage within 48 hours, which is defined as an increase in the National Institutes of Health Stroke Scale score of ≥4 points as a result of the intracranial haemorrhage. CONCLUSIONS The results of BRETIS-TNK II will provide evidence for the efficacy and safety of intra-arterial TNK administration during EVT in AIS patients with LVO.
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Affiliation(s)
- Zi-Ai Zhao
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Jing Qiu
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Wei Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Thanh Nguyen
- Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Shouchun Wang
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, Jilin, China
| | - Huaizhang Shi
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ming Wei
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, Tianjin, China
| | - Feng Wang
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Di Li
- Neurological Intervention Department, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
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van der Sluijs PM, Su R, Cornelissen SAP, van Es ACGM, Lycklama A Nijeholt G, Roozenbeek B, van Doormaal PJ, Hofmeijer J, van der Lugt A, van Walsum T. Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke. Neuroradiology 2024; 66:237-247. [PMID: 38010403 DOI: 10.1007/s00234-023-03246-2] [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: 06/06/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry. METHODS We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90 days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR). RESULTS Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome. CONCLUSION The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.
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Affiliation(s)
- P Matthijs van der Sluijs
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - R Su
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S A P Cornelissen
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A C G M van Es
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - B Roozenbeek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P J van Doormaal
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - T van Walsum
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Zhao ZA, Qiu J, Wang L, Zhao YG, Sun XH, Li W, Liu X, Li XL, Liu L, Chen MR, Chen HS. Intra-arterial tenecteplase is safe and may improve the first-pass recanalization for acute ischemic stroke with large-artery atherosclerosis: the BRETIS-TNK trial. Front Neurol 2023; 14:1155269. [PMID: 37143999 PMCID: PMC10151652 DOI: 10.3389/fneur.2023.1155269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
Background and purpose The first-pass recanalization of endovascular treatment (EVT) is closely correlated with clinical outcome of patients with large vessel occlusion (LVO) stroke. The aim of the study was to explore whether intra-arterial tenecteplase (TNK) during the first pass of EVT can increase first-pass successful reperfusion and improve the neurological outcome in AIS-LVO patients. Materials and methods The BRETIS-TNK trial (ClinicalTrials.gov Identifier: NCT04202458) was a prospective, single-arm, single center study. Twenty-six eligible AIS-LVO patients with large-artery atherosclerosis etiology were consecutively enrolled from December 2019 to November 2021. Intra-arterial TNK (4 mg) after microcatheter navigation through the clot was administered, followed by TNK (0.4 mg/min) given continuously for 20 min after the first retrieval attempt of EVT without confirmation of the reperfusion status by DSA. The 50 control patients comprised of a historical cohort before the BRETIS-TNK trial (from March 2015 to November 2019). Successful reperfusion was defined as modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b. Results The first-pass successful reperfusion rate was higher in the BRETIS-TNK vs. control group (53.8% vs. 36%, p = 0.14), and the difference became statistically significant after propensity score matching (53.8% vs. 23.1%, p = 0.03). There was no difference in symptomatic intracranial hemorrhage between the BRETIS-TNK and control groups (7.7% vs. 10.0%, p = 0.92). There was a trend toward higher proportion of functional independence at 90 days in the BRETIS-TNK comparing with the control group (50% vs. 32%, p = 0.11). Conclusion This is the first study to report that intra-arterial TNK during the first pass of EVT seems safe and feasible in AIS-LVO patients.
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6
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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] [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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Renú A, Laredo C, Rodríguez-Vázquez A, Santana D, Werner M, Llull L, Lopez-Rueda A, Urra X, Rudilosso S, Obach V, Amaro S, Chamorro Á. Characterization of Subarachnoid Hyperdensities After Thrombectomy for Acute Stroke Using Dual-Energy CT. Neurology 2021; 98:e601-e611. [PMID: 34921104 DOI: 10.1212/wnl.0000000000013198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The presence of post-interventional subarachnoid hyperdensities (SA-HD) is a relatively common finding after mechanical thrombectomy (MT). We aimed to assess the incidence, characteristics, clinical relevance and predictors of SA-HD after MT as categorized through the use of post-interventional Dual Energy-CT (DE-CT). METHODS A single-center consecutive series of acute stroke patients treated with MT were retrospectively reviewed. Post-treatment SA-HD were defined as incident extra-axial hyperdensities in a follow-up DE-CT performed within a median of 8 hours after MT. SA-HD were further classified according to their content (isolated contrast extravasation versus blood extravasation) and extension [diffuse (hyperdensities in more than one extraparenchymal compartments) versus non-diffuse]. Adjusted logistic regression models assessed the association of SA-HD with pretreatment and procedural variables and with bad clinical outcome (shift towards worse categories in the ordinal Rankin Scale at 90 days). RESULTS SA-HD were observed in 120 (28%) of the 424 included patients (isolated contrast extravasation n=22, blood extravasation n=98). In this group, SA-HD were diffuse in 72 (60%) patients (isolated contrast extravasation n=7, blood extravasation n=65) and non-diffuse in 48 (40%) patients (isolated contrast extravasation n=15, blood extravasation n=33). Diffuse SA-HD were significantly associated with worse clinical outcome in adjusted models (cOR=2.3, 95%CI=1.36-4.00, p=0.002), unlike the specific SA-HD content alone. In contrast with the absence of SA-HD, only the diffuse pattern with blood extravasation was significantly associated with worse clinical outcome (cOR=2.4, 95%CI=1.36-4.15, p=0.002). Diffuse SA-HD patterns were predicted by M2 occlusions, more thrombectomy passes and concurrent parenchymal hematomas. DISCUSSION In our cohort of patients imaged within a median of 8 hours after MT, post-interventional SA-HD showed a diffuse pattern in 17% of thrombectomies and were associated with more arduous procedures. Diffuse SA-HD but not local collections of blood or contrast extravasations were associated with an increased risk of poor outcome and death. These findings reinforce the need for improvement in reperfusion strategies. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in individuals with proximal carotid artery territory occlusions treated with mechanical thrombectomy, diffuse post-interventional subarachnoid hyperdensities on imaging 8 hours post-procedure are associated with worse clinical outcomes at 90 days.
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Affiliation(s)
- Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carlos Laredo
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alejandro Rodríguez-Vázquez
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Daniel Santana
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Víctor Obach
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Sergi Amaro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ángel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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8
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Etter MM, Möhlenbruch M, Weyland CS, Pérez-García C, Moreu M, Capasso F, Limbucci N, Nikoubashman O, Wiesmann M, Blackham K, Tsogkas I, Sporns P, Ospel JM, Brehm A, Psychogios MN. Initial Experience With the Trevo NXT Stent Retriever. Front Neurol 2021; 12:704329. [PMID: 34335458 PMCID: PMC8322523 DOI: 10.3389/fneur.2021.704329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The application of a new coating to the delivery wire of the Trevo retriever has the potential to improve its handling. We therefore report our initial experience with this new stent retriever for mechanical thrombectomy of large and medium vessel occlusions. Methods: We pooled data of four high-volume European stroke centers over the time period from October 2020 to February 2021. Patients were included in our study if the Trevo NXT stent retriever was used as a first-line device. Primary endpoints were first-pass near-complete or complete reperfusion, defined as mTICI score of ≥2c. Secondary endpoints were final reperfusion, National Institutes of Health Stroke Scale (NIHSS) at 24 h and discharge, device malfunctions, complications during the procedure, and subjective ratings of the interventionalists regarding device functionality. Results: Eighty patients (39 women, mean age 74 ± 14 years) were eligible for our study. Median NIHSS at admission was 15 (IQR, 8-19), and median Alberta Stroke Program Early CT Score at baseline was 9 (IQR, 8-10). In 74 (93%) patients a primary combined approach was used as first-line technique. First-pass near-complete reperfusion was achieved in 43 (54%) and first-pass complete reperfusion in 34 (43%) patients. Final near-complete reperfusion was achieved in 66 (83%) patients after a median of 1.5 (1-3) passes, while final successful reperfusion was observed in 96% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR, 0-5), and 3 patients (4%) suffered a symptomatic intracranial hemorrhage. Conclusions: Based on our initial data, we conclude that the Trevo NXT is an effective and safe tool for mechanical thrombectomy especially when used for combined approaches.
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Affiliation(s)
- Manina M Etter
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Markus Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte S Weyland
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Manuel Moreu
- Department of Neuroradiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Francesco Capasso
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Nicola Limbucci
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Kristine Blackham
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Ioannis Tsogkas
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Johanna Maria Ospel
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Alex Brehm
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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9
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Zeleňák K, Krajina A, Meyer L, Fiehler J, Behme D, Bulja D, Caroff J, Chotai AA, Da Ros V, Gentric JC, Hofmeister J, Kass-Hout O, Kocatürk Ö, Lynch J, Pearson E, Vukasinovic I. How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods. Life (Basel) 2021; 11:life11060488. [PMID: 34072071 PMCID: PMC8229281 DOI: 10.3390/life11060488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and collecting of extremely big databases. Nowadays, the speed of internet connection is a limiting factor for robotic systems, which can be controlled and commanded potentially from various places in the world. Innovative technologies can be implemented for acute stroke patient management soon. Artificial intelligence (AI) and robotics are used increasingly often without the exception of medicine. Their implementation can be achieved in every level of stroke care. In this article, all steps of stroke health care processes are discussed in terms of how to improve them (including prehospital diagnosis, consultation, transfer of the patient, diagnosis, techniques of the treatment as well as rehabilitation and usage of AI). New ethical problems have also been discovered. Everything must be aligned to the concept of “time is brain”.
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Affiliation(s)
- Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Correspondence: ; Tel.: +421-43-4203-990
| | - Antonín Krajina
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, CZ-500 05 Hradec Králové, Czech Republic;
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | - Jens Fiehler
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.M.); (J.F.)
| | | | - Daniel Behme
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- University Clinic for Neuroradiology, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Deniz Bulja
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Diagnostic-Interventional Radiology Department, Clinic of Radiology, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Jildaz Caroff
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Interventional Neuroradiology–NEURI Brain Vascular Center, Bicêtre Hospital, APHP, 94270 Paris, France
| | - Amar Ajay Chotai
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne NE14LP, UK
| | - Valerio Da Ros
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Biomedicine and Prevention, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Jean-Christophe Gentric
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Interventional Neuroradiology Unit, Hôpital de la Cavale Blanche, 29200 Brest, France
| | - Jeremy Hofmeister
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Unité de Neuroradiologie Interventionnelle, Service de Neuroradiologie Diagnostique et Interventionnelle, 1205 Genève, Switzerland
| | - Omar Kass-Hout
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Stroke and Neuroendovascular Surgery, Rex Hospital, University of North Carolina, 4207 Lake Boone Trail, Suite 220, Raleigh, NC 27607, USA
| | - Özcan Kocatürk
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Balikesir Atatürk City Hospital, Gaziosmanpaşa Mahallesi 209., Sok. No: 26, 10100 Altıeylül/Balıkesir, Turkey
| | - Jeremy Lynch
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Ernesto Pearson
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- CH Bergerac-Centre Hospitalier, Samuel Pozzi 9 Boulevard du Professeur Albert Calmette, 24100 Bergerac, France
| | - Ivan Vukasinovic
- ESMINT Artificial Intelligence and Robotics Ad hoc Committee, ESMINT, 8008 Zurich, Switzerland; (E.A.I.R.A.h.C.); (D.B.); (D.B.); (J.C.); (A.A.C.); (V.D.R.); (J.-C.G.); (J.H.); (O.K.-H.); (Ö.K.); (J.L.); (E.P.); (I.V.)
- Department of Neuroradiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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10
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Memon MZ, Daniel D, Chaudhry MRA, Grewal M, Saini V, Lukas J, Siddu M, Algahtani R, Nisar T, Majidi S, Leon Guerrero CR, Burger KM, Greenberg E, Khandelwal P, Malik AM, Starke RM, Koch S, Yavagal DR. Clinical impact of the first pass effect on clinical outcomes in patients with near or complete recanalization during mechanical thrombectomy for large vessel ischemic stroke. J Neuroimaging 2021; 31:743-750. [PMID: 33930218 DOI: 10.1111/jon.12864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The first pass effect has been reported as a mechanical thrombectomy (MT) success metric in patients with large vessel occlusive stroke. We aimed to compare the clinical and neuroimagign outcomes of patients who had favorable recanalization (mTICI 2c or mTICI 3) achieved in one pass versus those requiring multiple passes. METHODS In this "real-world" multicenter study, patients with mTICI 2c or 3 recanalization were identified from three prospectively collected stroke databases from January 2016 to December 2019. Clinical outcomes were a favorable functional outcome at 90 days (modified Rankin Scale score 0-2), and the rate of symptomatic intracranial hemorrhage (ICH) any ICH, and 90-day mortality. RESULTS Favorable recanalization was achieved in 390/664 (59%) of consecutive patients who underwent MT (age 71.2 ± 13.2 years, 188 [48.2%] women). This was achieved after a single thrombectomy pass (n = 290) or multiple thrombectomy passes (n = 100). The rate of favorable clinical outcome was higher (41% vs. 28 %, p = .02) in the first pass group with a continued trend on multivariate analysis that did not reaching statistical significance (OR 1.68 95% confidence interval [CI] 1.0-2.95, p = .07). Similarly, the odds of any ICH were significantly lower (OR 0.56 CI 0.32-0.97, p = .03). A similar trend of favorable clinical outcomes was noticed on subgroup analysis of patients with M1 occlusion (OR 1.81 CI 1.01-3.61, p = .08). CONCLUSION The first-pass reperfusion was associated with a trend toward favorable clinical outcome and lower rates of ICH. These data suggest that the first-pass effect should be the mechanical thrombectomy procedure goal.
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Affiliation(s)
- Muhammad Zeeshan Memon
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - David Daniel
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, George Washington University, Washington, DC, USA
| | | | - Manjot Grewal
- Department of Neurology, George Washington University, Washington, DC, USA
| | - Vasu Saini
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Joshua Lukas
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Mithilesh Siddu
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurology, George Washington University, Washington, DC, USA
| | - Rami Algahtani
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurology, George Washington University, Washington, DC, USA.,Department of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Taha Nisar
- Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Shahram Majidi
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, George Washington University, Washington, DC, USA
| | | | - Kathleen M Burger
- Department of Neurology, George Washington University, Washington, DC, USA
| | | | - Priyank Khandelwal
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurosurgery Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Amer M Malik
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Sebastian Koch
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Dileep R Yavagal
- Department of Neurology, University of Miami, Miami, Florida, USA.,Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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11
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Abdullayev N, Maus V, Behme D, Barnikol UB, Kutschke S, Stockero A, Goertz L, Celik E, Zaeske C, Borggrefe J, Schlamann M, Liebig T, Kabbasch C, Mpotsaris A. True first-pass effect in basilar artery occlusions: First-pass complete reperfusion improves clinical outcome in stroke thrombectomy patients. J Clin Neurosci 2021; 89:33-38. [PMID: 34119289 DOI: 10.1016/j.jocn.2021.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/20/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete reperfusion (mTICI 3) in anterior circulation ischemic stroke patients after a single mechanical thrombectomy (MT) pass has been identified as a predictor of favorable outcome (modified Rankin Score 0-2) and defined as true first-pass effect recently. This effect has not yet been demonstrated in posterior circulation ischemic stroke. We hypothesized a true first-pass effect for the subgroup of acute basilar artery occlusions (BAO). METHODS Consecutive patients with acute thromboembolic occlusions in the posterior circulation, treated between 2010 and 2017, were screened and all BAO patients with complete angiographic reperfusion and known symptom onset included for unmatched and matched analysis after adjustment for multiple confounding factors (demographics, time intervals, stroke severity, posterior circulation Alberta Stroke Program early computed tomography Score and comorbidity. The primary objective was outcome at 90 days between matched cohorts of single pass vs. multi pass complete reperfusion patients. RESULTS 90 MTs in BAO were analyzed, yielding 56 patients with known symptom onset, in whom we achieved complete reperfusion (mTICI 3), depending on whether complete reperfusion was achieved after a single pass (n = 28) or multiple passes (n = 28). Multivariable analysis of 56 non-matched patients revealed a significant association between first-pass complete reperfusion and favorable outcome (p < 0.01). In matched cohorts (n = 7 vs. n = 7), favorable outcome was only seen if complete reperfusion was achieved after a single pass (86% vs. 0%). CONCLUSION Single pass complete reperfusion in acute basilar artery occlusion is an independent predictor of favorable outcome. Achieving complete reperfusion after multiple passes might impair favorable patient recovery.
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Affiliation(s)
- N Abdullayev
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany.
| | - V Maus
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - D Behme
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - U B Barnikol
- Department of Child and Adolescence Psychiatry, Research Unit Ethics in Translational Oncology Clinica1 of Internal Medicine, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - S Kutschke
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - A Stockero
- Department of Neuroradiology, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - L Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - E Celik
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - C Zaeske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - J Borggrefe
- Institute of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Klinikum Minden, Hans-Nolte-Straße 1, 32429 Minden, Germany
| | - M Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - T Liebig
- Institute of Neuroradiology, University Hospital Munich (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - C Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - A Mpotsaris
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
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12
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Kokuzawa J, Kaku Y, Sasaki N, Kano K, Oka N, Matsuda A, Sasaki Y. Attempt to delineate occluded arteries with initial plain computed tomography in acute cerebral arterial occlusion. J Stroke Cerebrovasc Dis 2020; 29:105390. [PMID: 33254376 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105390] [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: 03/09/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We used initial plain computed tomography to delineate acutely occluded internal carotid arteries or horizontal segments of middle cerebral arteries. If affected arteries could be delineated using initial plain computed tomography, useful information might be obtained that could support endovascular thrombectomies. METHODS In 15 patients with occluded internal carotid arteries or horizontal segments of middle cerebral arteries, the affected middle cerebral artery was automatically traced using the extender function for blood vessel tracing with reference to the default value (window setting, 40; window width, 90) on Ziostation 2 (Ziosoft Inc., Tokyo, Japan) based on initial plain computed tomography data. RESULTS The horizontal and sylvian segments of the middle cerebral artery were delineated in 15 and nine patients, respectively, based on plain computed tomography volume data. Images of occluded vessels delineated by plain computed tomography closely correlated with digital subtraction angiography. CONCLUSIONS Initial plain computed tomography combined with a new generation workstation enabled the rapid delineation of occluded segments of intracranial vessels and could provide useful information that might improve the safety of endovascular thrombectomy.
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Affiliation(s)
- Jouji Kokuzawa
- Department of Neurosurgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu 500-8523, Japan.
| | - Yasuhiko Kaku
- Department of Neurosurgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu 500-8523, Japan.
| | - Nozomi Sasaki
- Department of Neurosurgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu 500-8523, Japan.
| | - Kiyomitsu Kano
- Department of Neurosurgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu 500-8523, Japan
| | - Naoki Oka
- Department of Neurosurgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu 500-8523, Japan.
| | - Akihide Matsuda
- Department of Neurosurgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu 500-8523, Japan
| | - Yousuke Sasaki
- Department of Neurosurgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu 500-8523, Japan.
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Styczen H, Fischer S, Yeo LL, Yong-Qiang Tan B, Maurer CJ, Berlis A, Abdullayev N, Kabbasch C, Kastrup A, Papanagiotou P, Clajus C, Lobsien D, Piechowiak E, Kaesmacher J, Maus V. Approaching the Boundaries of Endovascular Treatment in Acute Ischemic Stroke : Multicenter Experience with Mechanical Thrombectomy in Vertebrobasilar Artery Branch Occlusions. Clin Neuroradiol 2020; 31:791-798. [PMID: 33108470 DOI: 10.1007/s00062-020-00970-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Little is known about catheter-based endovascular treatment of vertebrobasilar artery branch occlusion (VEBABO) in acute ischemic stroke (AIS). Nonetheless, the experience of mechanical thrombectomy (MT) in distal small sized arteries of the anterior circulation seems promising in AIS. In this multicenter study, we report the feasibility, efficacy and safety of MT in VEBABO. METHODS Retrospective analysis of consecutive AIS patients treated with MT due to VEBABO including posterior and anterior inferior cerebellar artery (PICA, AICA) and superior cerebellar artery (SCA) occlusions at seven tertiary care centers between January 2013 and May 2020. Baseline demographics and angiographic outcomes including recanalization success of the affected cerebellar arteries and procedural complications were recorded. Clinical outcomes were evaluated by the modified Rankin scale (mRS) at discharge and 90 days. RESULTS Out of 668 endovascularly treated posterior circulation strokes we identified 16 (0.02%) cases with MT for VEBABO. Most frequently, MT of the SCA was done (13/16, 81%). Most VEBABOs occurred after MT of initial basilar/posterior cerebral artery occlusion (9/16, 56%). In 10/16 (63%) procedures, the affected VEBABO was successfully recanalized. Out of four patients three (75%) with isolated VEBABO had benefited from endovascular therapy. Subarachnoid hemorrhage was observed in 3/16 (19%) procedures. The rate of favorable outcome (mRS ≤2) was 40% at discharge and 47% at 90-day follow-up. Mortality was 13% (2/15). CONCLUSION The use of MT for VEBABO is rare but appears to be feasible and effective; however, the comparatively high rate of procedure-related hemorrhage highlights that the indications for MT in these occlusion sites should be carefully weighed up.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Sebastian Fischer
- Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany
| | - Leonard Ll Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christoph J Maurer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | | | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany.,Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christin Clajus
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Eike Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.,University Institute of Diagnostic and Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany
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14
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Continuous real-time monitoring of pulmonary arterial pressure using a tip deflecting microcatheter in an infant with pulmonary arterial hypertension. Cardiol Young 2020; 30:1032-1034. [PMID: 32484128 DOI: 10.1017/s1047951120001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present the case of a 3-month-old boy with pulmonary arterial hypertension after corrective repair of total anomalous pulmonary venous connection. The patient developed severe pulmonary arterial hypertension with a high mean pulmonary arterial pressure of 45 mmHg. We performed continuous monitoring of pulmonary arterial pressure using a tip deflecting microcatheter in the intensive care unit. We successfully managed this patient based on real-time pulmonary arterial pressure measurements. Continuous real-time monitoring of pulmonary arterial pressure using this microcatheter enables individualized targeted therapy for infants with pulmonary arterial hypertension.
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15
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Styczen H, Huseynov E, Abdullayev N, Maus V, Borggrefe J, Goertz L, Onur OA, Stockero A, Mpotsaris A, Kabbasch C. Adjustment of Stent Retriever Length to Clot Extent Affects First-Pass Reperfusion in Endovascular Treatment of Acute Ischemic Stroke. Cerebrovasc Dis 2020; 49:277-284. [PMID: 32544906 DOI: 10.1159/000508028] [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] [Received: 02/06/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stent retriever technology has evolved, and significantly longer devices have become available for mechanical thrombectomy (MT) of large cerebral vessel occlusions in ischemic stroke. We hypothesized that increased stent retriever length may improve the rate of complete angiographic reperfusion and decrease the respective number of attempts, resulting in a better clinical outcome. METHODS Retrospective analysis of patients with large vessel occlusion in the anterior and posterior circulation treated with stent retriever MT. The study group was dichotomized into short (20 mm) and long (>20 mm) retrievers using propensity matching. In the anterior circulation, the clot burden score was evaluated. Primary end points were first-pass modified thrombolysis in cerebral infarction (mTICI) 3 reperfusion and first-pass mTICI ≥ 2b reperfusion, and the secondary end point was functional independence (defined as modified Rankin Scale score 0-2) at discharge and 90 days. RESULTS Overall, 394 patients were included in the analysis. In the anterior circulation, short stent retrievers had a significantly higher rate of first-pass reperfusion in cases with low clot burden (mTICI 3: 27% vs. 17%; p = 0.009; mTICI ≥ 2b: 42 vs. 30%; p = 0.005) and in middle cerebral artery occlusions (mTICI ≥ 2b: 51 vs. 41%; p = 0.024). Higher rates of favorable outcome at discharge and 90 days were observed for the short stent retriever group (p < 0.001). CONCLUSION Stent retriever length should be adjusted to clot burden score and vessel occlusion site.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany,
| | - Elvin Huseynov
- Department of Internal Medicine, Helios Hospital Siegburg, Siegburg, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
| | - Jan Borggrefe
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Lukas Goertz
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Oezguer A Onur
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Andrea Stockero
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
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16
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Ato F, Ohshima T, Miyachi S, Matsuo N, Kawaguchi R, Takayasu M. Efficacy and Safety of a Modified Pigtail-Shaped Microguidewire during Endovascular Thrombectomy. Asian J Neurosurg 2019; 14:1040-1043. [PMID: 31497161 PMCID: PMC6703001 DOI: 10.4103/ajns.ajns_28_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 75-year-old man presented with right-sided hemiplegia and was diagnosed with a left middle cerebral artery occlusion. He underwent endovascular thrombectomy, and a bulge was found. A modified pigtail-shaped microguidewire (MPMGW) proved useful for diagnosis because it allowed differentiation between the occluded artery and a saccular aneurysm as the etiology. When a clot was partially retrieved, a previously unidentified vessel dilatation appeared. The dilatation origin was unclear and could have resulted from either the occluded artery or an unruptured saccular aneurysm. We tried to navigate the MPMGW into the bulging area. The patient showed unusual body movement attributed to pain and the dilatation was diagnosed as an aneurysm. Subsequent 3-dimensional angiography revealed a recanalized artery and the aneurysm. With no subarachnoid hemorrhage or extravasation of the contrast medium. The hemiplegia dramatically improved. An MPMGW may be useful in acute thrombectomy where the target vessel cannot be visualized during the procedure.
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Affiliation(s)
- Fuminori Ato
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomotaka Ohshima
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shigeru Miyachi
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoki Matsuo
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Reo Kawaguchi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masakazu Takayasu
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
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17
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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: 17] [Impact Index Per Article: 3.4] [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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18
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The ReWiSed CARe Technique : Simultaneous Treatment of Atherosclerotic Tandem Occlusions in Acute Ischemic Stroke. Clin Neuroradiol 2019; 30:489-494. [PMID: 31119326 DOI: 10.1007/s00062-019-00795-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endovascular treatment of acute cerebral large vessel occlusions and concomitant atherosclerotic lesions of the ipsilateral internal carotid artery (ICA) are a matter of debate. This article reports a multi-center experience using the retriever wire supported carotid artery revascularization (ReWiSed CARe) technique allowing simultaneous treatment of both lesions. METHODS The study retrospectively analyzed 23 patients with acute tandem occlusions (TO) who underwent ReWiSed CARe at 3 German centers. Clinical, including demographics and National Institutes of Health Stroke Scale (NIHSS) and procedural, including angiographic evaluation of recanalization, data were evaluated. Favorable clinical outcome was defined as modified Rankin Scale (mRS) score ≤2 at 90 days. RESULTS The median age was 70 years (interquartile range [IQR] 65-80 years) and 70% were male. The median baseline NIHSS was 15 (IQR 11-17). Out of 23 patients, 22 (96%) had an intracranial occlusion of the anterior circulation. Successful stent retriever deployment with subsequent carotid artery treatment was feasible in all cases without displacement of the stent retriever during the procedure. Overall, successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b) was achieved in 22/23 (96%) patients with 10/23 (44%) individuals completely reperfused (mTICI 3). The median groin puncture to stent retriever deployment was 29 min (IQR 23-46) and groin puncture to final revascularization was 63 min (IQR 56-78). The median NIHSS at discharge was 5 (IQR 3-12) with favorable clinical outcome at 90 days in 11 out of 20 patients (55%). CONCLUSION Endovascular treatment using ReWiSed CARe is safe, fast and efficient in TO patients with underlying atherosclerotic lesion of the extracranial ICA.
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19
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Comparison of Superior and Inferior Division Occlusions Treated with Endovascular Thrombectomy. Clin Neuroradiol 2019; 30:339-343. [DOI: 10.1007/s00062-019-00767-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/02/2019] [Indexed: 01/01/2023]
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20
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Intra-arterial pulse wave analysis during thrombectomy for the assessment of collateral status - A feasibility study. PLoS One 2019; 14:e0210572. [PMID: 30629721 PMCID: PMC6328207 DOI: 10.1371/journal.pone.0210572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Knowledge of the collateralization of an occluded vessel is important for the risk-benefit analysis of difficult revascularization maneuvers during mechanical thrombectomy. If the territory behind a clot is well perfused, one could desist from performing a risky thrombectomy maneuver. The arterial pulse pressure curve may serve as an indicator for the collateralization of an occluded target vessel. We investigated the feasibility of arterial pulse measurements with a standard microcatheter. Methods We measured the intra-arterial blood pressure proximal and distal to the clot in 40 thrombectomy maneuvers in a porcine stroke model. We used a microcatheter (Trevo Pro 18, Stryker, Kalamazoo, CA, USA), a pressure transducer (MEMSCAP SP844), an AdInstruments Powerlab 16/35 workstation, and LabChart 8 Software (AdInstruments, Dunedin, New Zealand). Results Median arterial blood pressure proximal and distal to the clot was 96.0 mmHg (IQR, 23.8 mmHg) and 47.5 mmHg (IQR, 43.5 mmHg), respectively (p < .001). The median difference between systolic maximum and diastolic minimum proximal and distal to the clot decreased significantly from 1.8 mmHg (IQR, 3.6 mmHg) to 0.0 mmHg (IQR, 0.5 mmHg) (p < .001). There was loss of the curve in 26 of 40 cases and loss of pressure in 23 of 40 cases (p = .008). There was no significant correlation between vessel diameter and either loss of the pulse pressure curve (p = .20) or overall pressure loss (p = .31). Conclusion It is possible to measure the pulse pressure proximal and distal to the clot with a standard microcatheter used during mechanical thrombectomy.
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