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Sreenivasan S, Gupta G, Wu R, Nourollah-Zadeh E, Sun H, Nanda A, Sundararajan S, Roychowdhury S. Radially adjustable stent retriever for mechanical thrombectomy in acute ischemic stroke: Improved first-pass effect with rapid-inflation deflation technique. Interv Neuroradiol 2024:15910199231222667. [PMID: 38192104 DOI: 10.1177/15910199231222667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Evidence for improved first-pass effect with the novel radially adjustable radio-opaque stent retriever Tigertriever is lacking. OBJECTIVE To compare improvement in first pass success with Tigertriever using two different techniques-rapid inflation deflation (RID) and suction thrombectomy (ST). METHODS Retrospective analysis of patients with acute ischemic stroke who underwent mechanical thrombectomy with Tigertriever at a single comprehensive stroke center. RESULTS Thirty patients were included. Mean age was 72.8 years. Twelve patients (48%) experienced successful first passes with Tigertriever. Successful revascularization (modified thrombolysis in cerebral infarction (mTICI) 2b/3) was achieved in all (100%) patients who received RID or ST technique for thrombectomy. Good clinical outcome (modified Rankin score = 0-2) was noted in 40% (n = 10). Total mortality in the cohort was 8% (n = 2). RID and ST groups comprised of 10 and 15 patients, respectively. Five patients underwent MT with Tigertriever as a rescue device. RID VS ST No difference was noted in mean age (p = 0.27), gender (p = 0.29), location of occlusion (p = 0.46), and device used for first pass (p = 0.57). A 70% first-pass success rate in RID group and 37.5% in ST group was noticed (p = 0.06). Mean time from groin puncture to reperfusion (TICI 2b//3) was statistically similar (p = 0.29, RID: 19.9 min vs ST: 25 min). Both groups noted a 100% complete recanalization rate. The rate of mortality between the two groups were not statistically different (p = 0.46). CONCLUSION The preliminary first-pass success rates of RID technique with Tigertriever compared to ST technique, are encouraging. Longitudinal studies with longer follow up are needed to elucidate the smaller learning curve with this device.
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Affiliation(s)
- Sanjeev Sreenivasan
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Robert Wu
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Emad Nourollah-Zadeh
- Department of Neurology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Hai Sun
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Srihari Sundararajan
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
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Parvathy G, Dey RC, Kutikuppala LVS, Maheshwari AR, Josey E, Chintala JS, Abdullah M, Godugu S. Mechanical thrombectomy for AIS from large vessel occlusion - current trends and future perspectives. Ann Med Surg (Lond) 2023; 85:6021-6028. [PMID: 38098569 PMCID: PMC10718368 DOI: 10.1097/ms9.0000000000001385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/28/2023] [Indexed: 12/17/2023] Open
Abstract
Stroke is found to be one of the global top causes of mortality and the major factor in years of life with a handicap (DALYs). Ischemic strokes contributed to nearly 70% of all strokes worldwide. For endovascular thrombectomy in acute ischemic stroke with large vessel obstruction (AIS-LVO), using stent retrievers and/or reperfusion catheters has become the gold standard of therapy. The methodology involved keyword-based search in databases like PubMed, Embase, and Google Scholar for recent publications on mechanical thrombectomy (MT), AIS, large vessel occlusion (Large Vessel Occlusion (LVO)), screening relevant articles, retrieving full texts, and synthesizing key findings on procedural advancements, patient selection, COVID-19 (coronavirus disease 2019) impact, delay effects, effectiveness, clinical outcomes, and future perspectives. Only people with substantial cerebral artery obstruction may do well from MT. This includes the distal carotid artery and the proximal middle cerebral artery (segment M1). The size of a blocked vessel and NIHSS (National Institute of Health Stroke Scale) score are directly connected. Both the 2018 and 2019 versions of the AHA/ASA (American Heart Association/American Stroke Association) Guidelines for the Early Management of Patients with Acute Ischemic Stroke contained the recommendations that cases with AIS-LVO get endovascular therapy when administered during the time frame of 0-6 h after onset (Grade IA evidence). It is questionable whether this group of patients can be managed without the need for intravenous tissue plasminogen activator at the onset. When functional independence [modified Rankin Scale (mRS) score 2] was present at long-term follow-up, the endovascular intervention was favored. Tenecteplase, which differs from alteplase in terms of genetic variation, has a greater half-life and a higher level of fibrin selectivity, enabling bolus infusion. Studies have also demonstrated its efficacy and safety, as well as its long-term cost-effectiveness.
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Affiliation(s)
- Gauri Parvathy
- Department of Internal Medicine, Tbilisi State Medical University, Tbilisi, Georgia
| | - Rohit C. Dey
- Department of Internal Medicine, Altai State Medical University, Barnaul, Russia
| | | | - Aakansh R. Maheshwari
- Department of Internal Medicine, Pacific Medical College and Hospital, Rajasthan, India
| | - Elwy Josey
- Department of Internal Medicine, Dubai Academic Health Corporation
| | - Jyothi S. Chintala
- Department of Anesthesiology, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutpalli, Andhra Pradesh
| | | | - Swathi Godugu
- Department of Internal Medicine, Zaporozhye State Medical University, Zaporozhye, Ukraine
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3
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Abdelrady M, Ognard J, Cagnazzo F, Derraz I, Lefevre PH, Riquelme C, Gascou G, Arquizan C, Dargazanli C, Cheddad El Aouni M, Ben Salem D, Mourand I, Costalat V, Gentric JC. Frontline thrombectomy strategy and outcome in acute basilar artery occlusion. J Neurointerv Surg 2023; 15:27-33. [PMID: 34992148 DOI: 10.1136/neurintsurg-2021-018180] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Novel thrombectomy strategies emanate expeditiously day-by-day counting on access system, clot retriever device, proximity to and integration with the thrombus, and microcatheter disengagement. Nonetheless, the relationship between native thrombectomy strategies and revascularization success remains to be evaluated in basilar artery occlusion (BAO). PURPOSE To compare the safety and efficacy profile of key frontline thrombectomy strategies in BAO. METHODS Retrospective analyses of prospectively maintained stroke registries at two comprehensive stroke centers were performed between January 2015 and December 2019. Patients with BAO selected after MR imaging were categorized into three groups based on the frontline thrombectomy strategy (contact aspiration (CA), stent retriever (SR), or combined (SR+CA)). Patients who experienced failure of clot retrieval followed by an interchanging strategy were categorized as a fourth (switch) group. Clinicoradiological features and procedural variables were compared. The primary outcome measure was the rate of complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c-3). Favorable outcome was defined as a 90 day modified Rankin Scale score of 0-2. RESULTS Of 1823 patients, we included 128 (33 underwent CA, 35 SR, 35 SR +CA, and 25 switch techniques). Complete revascularization was achieved in 83/140 (59%) primarily analyzed patients. SR +CA was associated with higher odds of complete revascularization (adjusted OR 3.04, 95% CI 1.077 to 8.593, p=0.04) which was an independent predictor of favorable outcome (adjusted OR 2.73. 95% CI 1.152 to 6.458, p=0.02). No significant differences were observed for symptomatic intracranial hemorrhage, functional outcome, or mortality rate. CONCLUSION Among BAO patients, the combined technique effectively contributed to complete revascularization that showed a 90 day favorable outcome with an equivalent complication rate after thrombectomy.
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Affiliation(s)
- Mohamed Abdelrady
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France .,Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Julien Ognard
- Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Federico Cagnazzo
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Imad Derraz
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Pierre-Henri Lefevre
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Carlos Riquelme
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Gregory Gascou
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Caroline Arquizan
- Neurology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Cyril Dargazanli
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | | | - Douraied Ben Salem
- Diagnostic neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Isabelle Mourand
- Neurology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Vincent Costalat
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
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Joyce E, Sherrod B, Scoville JP, De Havenon A, Grandhi R. Acute Mirror M1 Occlusions Treated With Endovascular First-Pass Contact Aspiration Technique. Cureus 2022; 14:e27350. [PMID: 36043023 PMCID: PMC9411821 DOI: 10.7759/cureus.27350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
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5
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Guida A, Tortora F, Tortora M, Buono G, Marseglia M, Tarantino M, Rizzuti M, Loiudice G, Manganelli F, Briganti F. Dissective tandem stroke: an endovascular approach. Radiol Case Rep 2022; 17:2170-2174. [PMID: 35479967 PMCID: PMC9035657 DOI: 10.1016/j.radcr.2022.03.086] [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: 03/16/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Ischemic stroke due to internal carotid artery occlusion is a potential devastating condition. More frequently the occlusions are embolic in nature, but sometimes they are caused by arterial dissection and their treatment is a challenge. We describe an illustrative case where a young patient with middle cerebral artery stroke caused by carotid artery dissection was submitted to endovascular treatment of mechanical thrombectomy and stenting, giving an excellent outcome. We believe that tandem approach is a treatment of choice in these cases.
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Affiliation(s)
- Amedeo Guida
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
- Corresponding author.
| | - Fabio Tortora
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Mario Tortora
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Giuseppe Buono
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Mariano Marseglia
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Margherita Tarantino
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Michele Rizzuti
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Giovanni Loiudice
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience and Reproductive Sciences and Dentistry, University “Federico II”, Naples, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
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6
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Negida A, Ghaith HS, Gabra MD, Aziz MA, Elfil M, Al-Shami H, Bahbah EI, Kanmounye US, Esene I, Raslan AM. Should the direct aspiration first pass technique be advocated over the stent-retriever technique for acute ischemic stroke? A systematic review and meta-analysis of 7692 patients. Surg Neurol Int 2022; 12:597. [PMID: 34992914 PMCID: PMC8720438 DOI: 10.25259/sni_903_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/09/2021] [Indexed: 01/02/2023] Open
Abstract
Background: The present meta-analysis aimed to synthesize evidence from all published studies with head-to-head data on the outcomes of a direct aspiration first pass technique (ADAPT) and the stent-retriever (SR) in acute ischemic stroke (AIS) patients. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to March 2021 for relevant clinical trials and observational studies. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis random-effects model of DerSimonian-Laird. Results: Thirty studies were included in the meta-analysis with a total of 7868 patients. Compared with the SR, the ADAPT provides slightly higher rates of successful recanalization (RR 1.06, 95% CI [1.02 to 1.10]) and complete recanalization (RR 1.20, 95% CI [1.01 to 1.43]) but with more need for rescue therapy (RR 1.81, 95% CI [1.29 to 2.54]). There were no significant differences between the two techniques in terms of mortality at discharge, mortality at 90 days, change in the National Institutes of Health Stroke Scale score, the favorable outcome (modified Rankin scale (mRS) of 0-2), time to the groin puncture, or frequency of complications as intracerebral hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), embolus in a new territory (ENT), hemorrhagic infarction, parenchymal hematoma, subarachnoid hemorrhage, or procedural complications (all P > 0.05). Conclusion: Current evidence supports the use of the ADAPT technique to achieve successful and complete recanalization while considering the higher need for rescue therapy in some patients.
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Affiliation(s)
- Ahmed Negida
- Faculty of Medicine, Zagazig University, Zagazig University, Zagazig, Sharkia, Egypt
| | | | | | | | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, Egypt
| | - Haider Al-Shami
- Department of Neurosurgery, National Bank Hospital, Cairo, Egypt
| | - Eshak I Bahbah
- Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
| | - Ulrick Sidney Kanmounye
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon, Africa
| | - Ignatius Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon, Africa
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
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7
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Chen Q, Ling WT, Han DK. Study on the Association of Homocysteine and C-Reactive Protein with Neurofunctional Changes in Patients with Acute Ischemic Stroke After Endovascular Stent Treatment. Neuropsychiatr Dis Treat 2022; 18:881-889. [PMID: 35444419 PMCID: PMC9014111 DOI: 10.2147/ndt.s356331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the association of homocysteine (HCY) and C-reactive protein (CRP) with neurofunctional changes in patients with acute ischemic stroke (AIS) after stent treatment. METHODS A total of 110 patients with AIS treated with stents were divided into a high HCY group (n = 59) and a normal HCY group (n = 51) based on the HCY level. Pearson correlation analysis and logistic linear regression analysis were used to analyze the related factors that affect the National Institutes of Health Stroke Scale (NIHSS) score changes after stent treatment. RESULTS (1) The area under the receiver operating characteristic (ROC) curve for HCY was 0.995 (95% confidence interval [CI]: 0.984-1.005, P = 0.000), and the best predictive value was 12.75 µmol/L (sensitivity 89.9%, specificity 98.0%). The area under the ROC curve for CRP was 0.665 (95% CI: 0.564-0.767, P = 0.003), and the best predictive value was 9.7 mg/L; (2) comparison between the high HCY group and the normal HCY group showed statistical differences (P < 0.05) in HCY, CRP, and the NIHSS score at admission, the NIHSS score after treatment, gender, history of diabetes, and history of atrial fibrillation; (3) both HCY and CRP were proven to be correlated with the NIHSS score after treatment (0.188, P = 0.050) and (0.194, P = 0.042), respectively, using Pearson correlation analysis; (4) HCY, low-density lipoprotein, CRP, cystatin C, glucose, history of atrial fibrillation, history of diabetes, and the NIHSS score at admission as the risk factors. CONCLUSION High HCY and CRP levels are related to the neurofunctional changes in patients with AIS treated with stents and can be used as indicators to assess the risk of treating AIS with stents and as serum markers to predict prognoses.
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Affiliation(s)
- Qiong Chen
- Teaching and Research Department, Foshan Fosun Chancheng Hospital, Foshan, 52800, People's Republic of China
| | - Wen-Tong Ling
- Department of Neurology, Zhongshan City People Hospital, Zhongshan, 528400, People's Republic of China
| | - Deng-Ke Han
- Clinical Laboratory Medicine Center, Zhongshan City People Hospital, Zhongshan, 528400, People's Republic of China
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8
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Okuda T, Arimura K, Matsuo R, Tokunaga S, Hara K, Yamaguchi S, Yoshida H, Kurogi R, Kameda K, Ito O, Tsumoto T, Iihara K, Mizokami T, Uwatoko T, Nishimura A, Iwaki K, Mizoguchi M. Efficacy of combined use of a stent retriever and aspiration catheter in mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg 2021; 14:892-897. [PMID: 34544828 DOI: 10.1136/neurintsurg-2021-017837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The efficacy of combined stent retriever (SR) and aspiration catheter (AC; combined technique: CBT) use for acute ischemic stroke (AIS) is unclear. We investigated the safety and efficacy of single-unit CBT (SCBT)-retrieving the thrombus as a single unit with SR and AC into the guide catheter-compared with single use of either SR or contact aspiration (CA). METHODS We analysed 763 consecutive patients who underwent mechanical thrombectomy for AIS between January 2013 and January 2020, at six comprehensive stroke centers. Patients were divided into SCBT and single device (SR/CA) groups. The successful recanalization with first pass (SRFP) and other procedural outcomes were compared between groups. RESULTS Overall, 240 SCBT and 301 SR/CA (SR 128, CA 173) patients were analyzed. SRFP (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2c, 43.3% vs 27.9%, p<0.001; mTICI 3, 35.8% vs 25.5%, p=0.009) and final mTICI ≥2b recanalization (89.1% vs 82.0%, p=0.020) rates were significantly higher, puncture-to-reperfusion time was shorter (median (IQR) 43 (31.5-69) vs 55 (38-82.2) min, p<0.001), and the number of passes were fewer (mean±SD 1.72±0.92 vs 1.99±1.01, p<0.001) in the SCBT group. Procedural complications were similar between the groups. In subgroup analysis, SCBT was more effective in women, cardioembolic stroke patients, and internal carotid artery and M2 occlusions. CONCLUSIONS SCBT increases the SRFP rate and shortens the puncture-to-reperfusion time without increasing procedural complications.
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Affiliation(s)
- Tomohiro Okuda
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - So Tokunaga
- Department of Neuroendovascular Therapy, National Hospital Organisation Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Kenta Hara
- Department of Neuroendovascular Therapy, National Hospital Organisation Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Shinya Yamaguchi
- Department of Neurosurgery, Steel Memorial Yawata Hospital, Kita-Kyushu, Fukuoka, Japan
| | - Hidenori Yoshida
- Department of Neurosurgery, Fukuoka Tokushukai Medical Center, Kasuga, Fukuoka, Japan
| | - Ryota Kurogi
- Department of Neurosurgery, Fukuoka Tokushukai Medical Center, Kasuga, Fukuoka, Japan
| | - Katsuharu Kameda
- Department of Neurosurgery, Shin Koga Hospital, Kurume, Fukuoka, Japan
| | - Osamu Ito
- Department of Neurosurgery, Shin Koga Hospital, Kurume, Fukuoka, Japan.,Department of Neurosurgery, Kieikai Hospital, Fukuoka, Japan
| | - Tomoyuki Tsumoto
- Department of Neuroendovascular Therapy, National Hospital Organisation Kyushu Medical Center, Fukuoka, Fukuoka, Japan.,Department of Neurosurgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan
| | - Taichiro Mizokami
- Department of Neurosurgery, Saga -Ken Medical Centre Koseikan, Saga, Saga, Japan
| | - Takeshi Uwatoko
- Department of Cerebrovascular Medicine, Saga Prefecture Medical Center Koseikan, Saga, Saga, Japan
| | - Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuma Iwaki
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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9
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Ni CF, Cheng SJ, Chen CY, Yeh TH, Hsieh KLC. Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them? Front Neurol 2021; 12:689606. [PMID: 34421793 PMCID: PMC8375030 DOI: 10.3389/fneur.2021.689606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Recent trials have demonstrated the superior efficacy of mechanical thrombectomy over other medical treatments for acute ischemic stroke; however, not every large vessel occlusion (LVO) can be recanalized using a single thrombectomy device. Rescue devices were proved to increase the reperfusion rate, but the efficacy is unclear. Objective: In this retrospective study, we evaluated the efficacy of rescue therapy in different locations of LVO. Methods: We analyzed the outcomes of mechanical thrombectomy from a prospective registry of consecutive 82 patients in Taipei Medical University Hospital. The reperfusion rate and the functional outcome were compared in patients who received first-line therapy only and patients who need rescue therapy. Results: An 84.1% reperfusion rate was achieved in our cohort. We applied first-line stent retriever (SR) treatment in 6 patients, among which 4 (66.6%) achieved successful reperfusion. We applied a direct-aspiration first-pass technique (ADAPT) as the first-line treatment in 76 patients, among which 46 (60.5%) achieved successful reperfusion. Successful reperfusion could not be achieved in 30 cases (39.5%); therefore, we applied a second-line rescue SR for 28 patients, and reperfusion was established in 18 (64.3%) of them. These results revealed that the LVO in anterior circulation has a higher chance to respond to SR rescue therapy than posterior circulation lesions (68 vs. 33.3%, P < 0.001). Patients who received only first-line therapy exhibited significantly better functional outcomes than those who were also treated with rescue SR therapy (41.2 vs. 16.7%, P = 0.001). In addition, patients with LVO in the anterior circulation were found to have a higher probability of achieving functional independence than patients with posterior circulation lesions (10.7 vs. 0.0%, P < 0.001). The adjusted multivariate analysis revealed that successful reperfusion and treatment type (first-line or rescue therapy) were significantly related to a modified Rankin Scale (mRS) score at 90 days. Conclusion: This study reveals that rescue SR therapy improves the reperfusion rate. Patients who require rescue SR therapy have a lower likelihood of functional independence. LVO in the anterior circulation responds better to rescue SR therapy and results in better functional outcomes than posterior circulation lesions.
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Affiliation(s)
- Cheng-Fu Ni
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Yu Chen
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tu-Hsueh Yeh
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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10
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Li ZS, Zhou TF, Li Q, Guan M, Liu H, Zhu LF, Wang ZL, Li TX, Gao BL. Endovascular Management of Intracranial Atherosclerosis-Related Large Vessel Occlusion With the A Direct Aspiration First-Pass Thrombectomy Compared With Solumbra Technique. Front Neurol 2021; 12:643633. [PMID: 33737905 PMCID: PMC7960763 DOI: 10.3389/fneur.2021.643633] [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: 12/18/2020] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background: To investigate the effect of the A Direct Aspiration First-Pass Thrombectomy (ADAPT) vs. Solumbra technique in the treatment of acute intracranial atherosclerosis-related large vessel occlusion (LVO). Methods: Patients with acute atherosclerosis-related LVO who had undergone endovascular treatment were retrospectively enrolled into two groups: The Solumbra and ADAPT groups. The clinical data were analyzed. Results: Patients (104) were enrolled with 48 in the Solumbra and 56 in the ADAPT group. The mean time from femoral access to recanalization was significantly (P < 0.05) shorter in the ADAPT than in the Solumbra group. The recanalization time at the first line was significantly shorter in the ADAPT group than in the Solumbra group (17 ± 10.21 vs. 26 ± 15.55 min, P = 0.02). However, the rate of switching to the alternative was significantly higher in the ADAPT group than that in the Solumbra group (46.42 vs. 33.33%, P = 0.01). Eighty-two patients had eventual recanalization, resulting in a final recanalization rate of 78.85%. At 3-month clinical follow-up for all patients, the good prognosis rate reached 51.92% with good prognosis in 24 patients (50%) in the Solumbra and 30 (53.57%) in the ADAPT group. The rate of symptomatic intracranial hemorrhage was 18.75% (n = 9) in the Solumbra and 19.64% (n = 11) in the ADAPT group. The mortality rate was 21.15% (22/104). Among 80 (76.92%) patients who had angiographic follow-up (3–30 months), five (6.25%) patients experienced in-stent stenosis, and two (2.5%) experienced asymptomatic stent occlusion. Conclusion: In patients with acute intracranial atherosclerosis-related LVO, clinical outcomes treated using the ADAPT technique are comparable with those using the Solumbra technique, and more patients need additional remedial measures if treated with the ADAPT technique.
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Affiliation(s)
- Zhao-Shuo Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Teng-Fei Zhou
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Qiang Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Min Guan
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Huan Liu
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Liang-Fu Zhu
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Zi-Liang Wang
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Tian-Xiao Li
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
| | - Bu-Lang Gao
- Henan Provincial People's Hospital, Henan University, Zhengzhou, China
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11
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Piasecki P, Wierzbicki M, Narloch J. Safety and Efficacy of Mechanical Thrombectomy Using Tigertriever as a Rescue Device After Failed Aspiration-Single Center Experience. Front Neurol 2021; 11:603679. [PMID: 33551964 PMCID: PMC7859263 DOI: 10.3389/fneur.2020.603679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: We evaluated the safety and efficacy of a new stent retriever-Tigertriever-after failed aspiration. Materials and Methods: Patients with acute ischemic stroke treated with Tigertriever between January 2018 and March 2020 were included in the study. Treatment results of Tigertriever in rescue therapy (after failed aspiration) were evaluated. Periprocedural data were retrospectively analyzed. Results: Thirty patients were treated with Tigertriever (14M/16F). There were 20 rescue thrombectomies after failed aspiration. Tigertriver successful recanalization rate (mTICI ≥ 2B) was 70%: 65% in rescue therapy and 80% in first-line therapy. The type of first line treatment had no impact on mRS after 1 month and 3 months (ns). There was significant improvement in NIHSS in all patients (mean NIHSS: 17 vs. 10, p = 0.028), in rescue treatment (mean NIHSS: 17 vs. 11, p = 0.048) and in first line treatment (mean NIHSS: 16 vs. 8, p = 0.0005). Better results in NIHSS at discharge were linked with first pass success (p = 0.002), better mTICI at the end of the procedure (p = 0.0006), and administration of rtPA (p = 0.013). Conclusions: The new stent retriever Tigertriever is an efficient and safe tool to be used as a rescue device after an unsuccessful first line aspiration technique.
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Affiliation(s)
- Piotr Piasecki
- Interventional Radiology Department, Military Institute of Medicine, Warsaw, Poland
| | - Marek Wierzbicki
- Interventional Radiology Department, Military Institute of Medicine, Warsaw, Poland
| | - Jerzy Narloch
- Interventional Radiology Department, Military Institute of Medicine, Warsaw, Poland
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12
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Carvalho de Campos Martins E, Luiz de Melo Bernardi F, Maia Junior OT, Micari A, Hopkins LN, Cremonesi A, Castriota F. Similarities and Differences Between Primary Percutaneous Coronary Intervention and Mechanical Thrombectomy. JACC Cardiovasc Interv 2021; 13:1683-1696. [PMID: 32703592 DOI: 10.1016/j.jcin.2020.03.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023]
Abstract
Acute ischemic stroke is among the leading causes of mortality and disability worldwide. Since 2015, as was the case for primary percutaneous coronary intervention for acute myocardial infarction, catheter-based reperfusion via mechanical thrombectomy (MT) has become the gold-standard treatment for acute ischemic stroke caused by large-vessel occlusion. Despite that, only a fraction of the world's population currently would be able to undergo MT in time, mostly because of the scarcity of 24/7 coverage by neurointerventionalists to deal with this enormous burden. Interventional cardiologists have thus been considered a logical option to aid in combating this vast demand to diminish the burden of acute ischemic stroke. However, despite some seemingly evident similarities between primary percutaneous coronary intervention and MT, for interventional cardiologists to enter this new field, they must be well trained and fully aware of all the clinical, technical, and environmental differences between these two scenarios. The main objective of this state-of-the-art paper is to serve as an introductory and comprehensive guide to familiarize the interventional cardiology community with the most critical technical aspects of MT.
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Affiliation(s)
| | | | | | - Antonio Micari
- Cardiovascular Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Leo Nelson Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Jacobs Institute, Buffalo, New York
| | | | - Fausto Castriota
- Cardiovascular Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy
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13
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Comparision of Mechanical Thrombectomy With Contact Aspiration or Stent Retriever in Patients With Large-vessel Occlusion in Acute Ischemic Stroke. J Craniofac Surg 2020; 32:e364-e366. [PMID: 33235172 DOI: 10.1097/scs.0000000000007264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Whether the direct aspiration approach of thrombectomy for recanalization in patients with acute ischemic stroke has a similar efficacy and safety compared to the stent-retriever still remains uncertain. METHODS A retrospective data analysis was performed to identify patients with large cerebral artery acute ischemic stroke treated with endovascular thrombectomy. The study was conducted between January 2018 and December 2019 in a single stroke center. RESULTS Twenty patients met inclusion criteria for this study with a mean age 66.64 ± 17.92 years' old. The symptom occurred on the left side were in 13, and the right side in 7. The location of occlusion was 8 in M1 of the middle cerebral artery of M2, and 6 in internal carotid artery. Nine patients were randomized to first-line treatment with contact aspiration and eleven to first-line treatment with a stent retriever. The mean time from admission time to groin puncture was 55.51 ± 31.03 minutes. The average time from groin puncture to maximal revascularizion after mechanical thrombectomy was 50.9 ± 22.5 minutes in contact aspiration group, but this time was 71.37 ± 25.45 minutes in the group of stent retriever. The overall successful revascularization rate (TICI 2b-3) was 88.9% in contact aspiration (TICI2a = 1, TICI 2b = 4 patients, TICI 3 = 4 patients), and 90.1% in stent retriever (TICI2a = 1, TICI 2b = 6 patients, TICI 3 = 4 patients). DISCUSSION First-line thrombectomy with contact aspiration did not result in a higher successful revascularization rate at the end of the procedure but had a short time from groin puncture to maximal revascularizion.
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14
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Meder G, Świtońska M, Płeszka P, Palacz-Duda V, Dzianott-Pabijan D, Sokal P. Endovascular Treatment of Stroke Caused by Carotid Artery Dissection. Brain Sci 2020; 10:brainsci10110800. [PMID: 33143117 PMCID: PMC7692463 DOI: 10.3390/brainsci10110800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
Ischemic stroke due to large vessel occlusion (LVO) is a devastating condition. Most LVOs are embolic in nature. Arterial dissection is responsible for only a small proportion of LVOs, is specific in nature and poses some challenges in treatment. We describe 3 cases where patients with stroke caused by carotid artery dissection were treated with mechanical thrombectomy and extensive stenting with good outcome. We believe that mechanical thrombectomy and stenting is a treatment of choice in these cases.
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Affiliation(s)
- Grzegorz Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-52-3655-143; Fax: +48-52-3655-364
| | - Milena Świtońska
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland; (M.Ś.); (P.P.); (V.P.-D.)
- Department of Neurosurgery and Neurology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland;
| | - Piotr Płeszka
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland; (M.Ś.); (P.P.); (V.P.-D.)
| | - Violetta Palacz-Duda
- Stroke Intervention Centre, Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland; (M.Ś.); (P.P.); (V.P.-D.)
| | - Dorota Dzianott-Pabijan
- Neurological Rehabilitation Ward Kuyavian-Pomeranian Pulmonology Centre, Meysnera 9 Street, 85-472 Bydgoszcz, Poland;
| | - Paweł Sokal
- Department of Neurosurgery and Neurology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland;
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15
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Zhang Y, Zhang Y, Hu C, Zhao W, Zhang Z, Li W. A direct aspiration first-pass technique (ADAPT) versus stent retriever for acute ischemic stroke (AIS): a systematic review and meta-analysis. J Neurol 2020; 268:4594-4606. [PMID: 33123777 DOI: 10.1007/s00415-020-10284-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE There is an ongoing debate about whether a direct aspiration first-pass technique (ADAPT) or stent retriever should be used as the first-pass mechanical thrombectomy device for patients with acute ischemic stroke (AIS). This meta-analysis aimed to compare the safety and efficacy of ADAPT versus stent retriever in patients with AIS. METHODS Structured searches on the PubMed, Embase, and Cochrane Library databases were conducted through July 2020. The primary outcomes of this study were: successful and complete recanalization; excellent and favorable outcomes; all-cause mortality at 90 days; and symptomatic intracerebral hemorrhage (sICH). The secondary outcomes of this study were: successful recanalization by primary chosen device; additional therapy; occurrence of emboli in a new territory; hemorrhagic complication; hemorrhagic infarction; parenchymatous hematoma; and subarachnoid hemorrhage. The odds ratios (ORs) with 95% confidence intervals (CIs) of the primary and secondary outcomes were calculated using a random-effects model. I2 statistics were used to assess the heterogeneity for each outcome among the included studies. RESULTS Finally, 20 studies with a total of 6311 patients were included in our meta-analysis. There were no significant differences between the ADAPT group and the stent retriever group of the primary and secondary outcomes except additional therapy. Our pooled results indicated that patients in the ADAPT group needed more additional therapy than those in the stent retriever group (OR 2.24, 95% CI 1.41-3.57). CONCLUSION In conclusion, our meta-analysis showed similar clinical outcomes of ADAPT and stent retriever. However, patients in the ADAPT group had higher additional therapy rates than those in the stent retriever group. Due to several inevitable limitations of this meta-analysis, more large-scale randomized controlled trials are required to further investigate this topic.
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Affiliation(s)
- Yichi Zhang
- Department of Psychiatry, The Second Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China.,Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, No. 388 Jianshe Road, Xinxiang, 453000, Henan, China
| | - Yue Zhang
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China
| | - Chentao Hu
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China
| | - Weisong Zhao
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China
| | - Zhaohui Zhang
- Department of Psychiatry, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453000, Henan, China
| | - Wenqiang Li
- Department of Psychiatry, The Second Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China. .,Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, No. 388 Jianshe Road, Xinxiang, 453000, Henan, China. .,Henan Key Lab of Biological Psychiatry, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang Medical University, Xinxiang, 453000, Henan, China.
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16
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Maingard J, Foo M, Chandra RV, Leslie-Mazwi TM. Endovascular Treatment of Acute Ischemic Stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:89. [PMID: 31823080 DOI: 10.1007/s11936-019-0781-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Endovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke. RECENT FINDINGS The indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6-24 h after last-known-well, and improved device and operator proficiency allowing treatment of M2-MCA occlusions and tandem occlusions. Further inclusion of paediatric patients and patients with larger infarct core or milder stroke symptoms for ET has been proposed; however, this remains unproven. This growing applicability is supported by more efficient systems of care, employing modern techniques such as telemedicine, mobile stroke units and helicopter medical services. Ongoing debate exists regarding thrombolytic agent, thrombectomy technique, anaesthesia method and the role of advanced neuroimaging, with upcoming RCTs expected to provide clarification. The journey to further improving the efficacy of ET has advanced and diversified rapidly over recent years, involving improved patient selection, increased utility of advanced neuroimaging and ongoing device redevelopment, within the setting of more efficient, streamlined systems of care. This dynamic and ongoing influx of evidence-based refinements is key to further optimising outcomes for ELVO patients.
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Affiliation(s)
- Julian Maingard
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Michelle Foo
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Nursing and Heath Sciences, Monash University, Clayton, Victoria, Australia
| | - Thabele M Leslie-Mazwi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. .,Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
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