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Pilgram-Pastor SM, Piechowiak EI, Dobrocky T, Kaesmacher J, Den Hollander J, Gralla J, Mordasini P. Stroke thrombectomy complication management. J Neurointerv Surg 2021; 13:912-917. [PMID: 34158401 PMCID: PMC8458081 DOI: 10.1136/neurintsurg-2021-017349] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Abstract
Endovascular mechanical thrombectomy (EVT) is widely accepted as the first-line treatment for acute ischemic stroke in patients with large vessel occlusion. Being an invasive treatment, this method is associated with various preoperative, perioperative, and postoperative complications. These complications may influence peri-interventional morbidity and mortality and therefore treatment efficacy and clinical outcome. The aim of this review is to discuss the most common types of complications associated with EVT, the probable mechanisms of injury, and effective methods to manage and prevent complications.
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Affiliation(s)
- Sara M Pilgram-Pastor
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Eike I Piechowiak
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Tomas Dobrocky
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Juergen Den Hollander
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
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Lindenholz A, van der Schaaf IC, van der Kolk AG, van der Worp HB, Harteveld AA, Kappelle LJ, Hendrikse J. MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2020; 41:624-631. [PMID: 32139427 DOI: 10.3174/ajnr.a6460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 01/28/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction. MATERIALS AND METHODS From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre- and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences. RESULTS In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n = 18.5) compared with the contralateral side (n = 3, P = .005). Enhancement was more often concentric on the ipsilateral side (n = 8) compared with contralateral side (n = 0, P = .01). No differences were found in the group without intra-arterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci. CONCLUSIONS Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke.
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Affiliation(s)
- A Lindenholz
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - I C van der Schaaf
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - A G van der Kolk
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - H B van der Worp
- Neurology and Neurosurgery (H.B.v.d.W., L.J.K.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A A Harteveld
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - L J Kappelle
- Neurology and Neurosurgery (H.B.v.d.W., L.J.K.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Hendrikse
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
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Brandel MG, Elsawaf Y, Rennert RC, Steinberg JA, Santiago-Dieppa DR, Wali AR, Olson SE, Pannell JS, Khalessi AA. Antiplatelet therapy within 24 hours of tPA: lessons learned from patients requiring combined thrombectomy and stenting for acute ischemic stroke. J Cerebrovasc Endovasc Neurosurg 2020; 22:1-7. [PMID: 32596137 PMCID: PMC7307608 DOI: 10.7461/jcen.2020.22.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
Abstract
Objective Although stroke guidelines recommend antiplatelets be started 24 hours after tissue plasminogen activator (tPA), select mechanical thrombectomy (MT) patients with luminal irregularities or underlying intracranial atherosclerotic disease may benefit from earlier antiplatelet administration. Methods We explore the safety of early (<24 hours) post-tPA antiplatelet use by retrospectively reviewing patients who underwent MT and stent placement for acute ischemic stroke from June 2015 to April 2018 at our institution. Results Six patients met inclusion criteria. Median presenting and pre-operative National Institutes of Health Stroke Scale scores were 14 (Interquartile Range [IQR] 5.5–17.3) and 16 (IQR 13.7–18.7), respectively. Five patients received standard intravenous (IV) tPA and one patient received intra-arterial tPA. Median time from symptom onset to IV tPA was 120 min (IQR 78–204 min). Median time between tPA and antiplatelet administration was 4.9 hours (IQR 3.0–6.7 hours). Clots were successfully removed from the internal carotid artery (ICA) or middle cerebral artery (MCA) in 5 patients, the anterior cerebral artery (ACA) in one patient, and the vertebrobasilar junction in one patient. All patients underwent MT before stenting and achieved thrombolysis in cerebral infarction 2B recanalization. Stents were placed in the ICA (n=4), common carotid artery (n=1), and basilar artery (n=1). The median time from stroke onset to endovascular access was 185 min (IQR 136–417 min). No patients experienced symptomatic post-procedure intracranial hemorrhage (ICH). Median modified Rankin Scale score on discharge was 3.5. Conclusions Antiplatelets within 24 hours of tPA did not result in symptomatic ICH in this series. The safety and efficacy of early antiplatelet administration after tPA in select patients following mechanical thrombectomy warrants further study.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Yasmeen Elsawaf
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Jeffrey A Steinberg
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | | | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Scott E Olson
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
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Pirson FAV, van Oostenbrugge RJ, van Zwam WH, Remmers MJ, Dippel DW, van Es AC, van den Wijngaard IR, Schonewille WJ, Staals J. Repeated Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Stroke 2020; 51:526-532. [DOI: 10.1161/strokeaha.119.027525] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion. Data on safety and efficacy of these interventions is scarce. Our aim is to report on frequency, timing, and outcome of rEVT in a large nation-wide multicenter registry.
Methods—
In the Netherlands, all patients with endovascular thrombectomy have been registered since 2002 (MR CLEAN Pretrial registry, MR CLEAN Trial [Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands], and MR CLEAN Registry). We retrospectively reviewed these databases for anterior circulation rEVT cases. Patient characteristics, procedural data, and functional outcome (modified Rankin Scale at 90 days) were analyzed.
Results—
Of 3928 patients treated between 2002 and 2017, 27 (0.7%) underwent rEVT. Median time between first and second procedure was 78 (1–1122) days; 11/27 patients were re-treated within 30 days. Cardioembolism was the most common etiology (18 patients [67%]). In 19 patients (70%), recurrent occlusion occurred ipsilateral to previous occlusion. At 90 days after rEVT procedure, 44% of the patients had achieved functional independence (modified Rankin Scale score of 0–2), and 33% had died. Adverse events were 2/27 (7.4%) intracranial hemorrhage, 1/27 (3.7%) stroke progression, and 1/27 (3.7%) pneumonia.
Conclusions—
In this large nationwide cohort of patients with acute ischemic stroke treated with endovascular thrombectomy, rEVT was rare. Stroke cause was mainly cardio-embolic, and most recurrent large vessel occlusions in which rEVT was performed occurred ipsilateral. Although there probably is a selection bias on repeated treatment in case of recurrent large vessel occlusion, rEVT appears safe, with similar outcome as in single-treated cases.
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Affiliation(s)
- France Anne Victoire Pirson
- From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands
| | - Robert J. van Oostenbrugge
- From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands
| | - Wim H. van Zwam
- Department of Radiology (W.H.v.Z.), Maastricht University Medical Center, the Netherlands
| | | | - Diederik W.J. Dippel
- Department of Neurology (D.W.J.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan C.G.M. van Es
- Department of Radiology and Nuclear Medicine (A.C.G.M.v.E.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Wouter J. Schonewille
- Department of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.)
| | - Julie Staals
- From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands
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Mukherjee S, McCullagh H, Goddard T, Patankar T. Delayed mid-basilar artery stenosis following paediatric acute mechanical thrombectomy: a rare complication from a rare case. BMJ Case Rep 2019; 12:12/8/e216876. [PMID: 31377714 DOI: 10.1136/bcr-2016-216876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There is limited literature on the use of mechanical thrombectomy with stent-retrievers in paediatric stroke, especially in the posterior circulation. We report a paediatric case of acute basilar artery occlusion successfully treated by mechanical thrombectomy using stent-retriever but complicated by delayed basilar artery stenosis. This case emphasises prudent selection of thrombectomy device and meticulous long-term follow-up when employed in paediatric stroke.
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Affiliation(s)
| | - Helen McCullagh
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Tony Goddard
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Tufail Patankar
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
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Ikenberg B, Scharsich B, Mönch S, Wunderlich S, Bernkopf K, Boeckh-Behrens T, Friedrich B, Maegerlein C, Poppert H, Seifert CL. Neurosonography After Mechanical Thrombectomy for Acute Stroke Treatment. J Neuroimaging 2019; 29:364-370. [PMID: 30600871 DOI: 10.1111/jon.12592] [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: 11/13/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy has been shown to be effective for acute stroke treatment, but lesions of cerebral vessels can develop thereafter. Such lesions of recanalized vessels and altered cerebral hemodynamics after mechanical thrombectomy are poorly investigated. In particular for neurosonography, data are sparse. We aimed to describe hemodynamic changes and incidence of de-novo stenosis after mechanical thrombectomy with neurosonography. METHODS Retrospective analysis of patients after successful mechanical thrombectomy for acute stroke therapy who received one neurosonography at baseline and during follow up. Peak systolic velocity (PSV) of all intracranial recanalized and reference vessels was extracted for analysis. Patients with an isolated increase or decrease of PSV (50% or 50 cm/second for anterior and 30% or 30 cm/second for posterior circulation) were identified and characterized. RESULTS Eighty-eight patients (mean age 64.4; 34.1% female) were included in this study. In 9 (10.2%) patients, the vessel occlusion was located in the posterior, and in 79 (89.9%) patients the vessel occlusion was located in the anterior circulation. With predominance to the recanalized vessel, mean PSV decreased at both, the recanalized and the reference vessel during follow up. In 3 (3.4%) patients, an isolated increase of PSV was observed in the recanalized vessel, and in 6 (6.8%) patients an isolated decrease of PSV was observed in the recanalized vessel. CONCLUSION Sonographic incidence of de-novo stenosis following mechanical thrombectomy seems to be low, in line with prior angiographic studies. However, as measured by neurosonography, cerebral hemodynamic in the recanalized vessel is dynamic after thrombectomy. This result is of interest for further prospective analysis.
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Affiliation(s)
- Benno Ikenberg
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, München, Germany
| | - Benjamin Scharsich
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, München, Germany
| | - Sebastian Mönch
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, München, Germany
| | - Silke Wunderlich
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, München, Germany
| | - Kathleen Bernkopf
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, München, Germany
| | - Tobias Boeckh-Behrens
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, München, Germany
| | - Benjamin Friedrich
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, München, Germany
| | - Christian Maegerlein
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, München, Germany
| | - Holger Poppert
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, München, Germany.,Klinik für Neurologie, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Christian L Seifert
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, München, Germany
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Yamaguchi S, Hamabe J, Horie N, Yamashita A, Irie J, Tokuda Y, Mutsukura K, Yagi N, Suyama K. Iatrogenic Removal of the Intima in the Middle Cerebral Artery by a Stent Retriever: A Report of Two Cases. World Neurosurg 2018; 118:203-208. [PMID: 30048785 DOI: 10.1016/j.wneu.2018.07.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mechanical thrombectomy improves functional outcomes in patients with acute ischemic stroke. However, stent retrievers have the risk of vascular damage. CASE DESCRIPTION We present 2 cases of patients with acute internal carotid artery occlusion who experienced removal of the intima by a stent retriever. In both patients, a 6 × 30-mm Solitaire stent was fully deployed from the M2 portion and slowly withdrawn. White membranes were retrieved outside the strut in both patients. Histopathologic examination showed that one membrane consisted of thickened intima and internal elastic lamina and the other consisted of calcified intima and internal elastic lamina. One patient who suffered embolic stroke experienced recurrent infarction within 24 hours after operation, and the damaged vessel was occluded on magnetic resonance angiography 21 days after stroke. In another patient with carotid artery dissection, the damaged vessel showed asymptomatic stenosis on magnetic resonance angiography 90 days after stroke. Arteries with both atherosclerosis and vessel dissection may be vulnerable to high radial expansion force. CONCLUSIONS Full deployment of a relatively large-sized stent into a vulnerable vessel may cause vessel dissection after removal of the intima. Appropriate material selection and treatment strategy while considering stroke etiology and the occlusion site are important to prevent vessel damage.
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Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan.
| | - Junpei Hamabe
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Aya Yamashita
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Junji Irie
- Department of Pathology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Yoshihiro Tokuda
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kazuo Mutsukura
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Nobuhiro Yagi
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kazuhiko Suyama
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan
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Bourcier R, Abed D, Piotin M, Redjem H, Ferré J, Eugène F, Raoult H, Mirza M, Chapot R, Desal H, Nordmeyer H. Multicenter initial experience with the EmboTrap device in acute anterior ischemic stroke. J Neuroradiol 2018; 45:230-235. [DOI: 10.1016/j.neurad.2018.01.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/04/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
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Brouwer PA, Yeo LLL, Holmberg A, Andersson T, Kolloch J, KuntzeSöderqvist Å, Ohlsson M, Holmin S, Anastasios M, Gontu VK, Bhogal P, Söderman M. Thrombectomy using the EmboTrap device: core laboratory-assessed results in 201 consecutive patients in a real-world setting. J Neurointerv Surg 2018; 10:964-968. [DOI: 10.1136/neurintsurg-2018-013765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/02/2018] [Accepted: 03/08/2018] [Indexed: 11/03/2022]
Abstract
BackgroundWe studied patients treated with the EmboTrap revascularization device in a prospective registry which is core laboratory evaluated by physicians from external centers. The goal was to determine how the EmboTrap would perform under the everyday conditions of a high-volume stroke center.MethodsWe examined all patients with acute stroke treated with the Embotrap device from October 2013 to March 2017 in our center. Imaging parameters and times were adjudicated by core laboratory personnel blinded to clinical information, treating physician, and clinical outcomes. Clinical evaluation was performed by independent neurologists and entered in a national registry. Evaluated endpoints were: successful revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2b–3) and good clinical outcomes at 3 months (modified Rankin Scale (mRS) 0–2).Results201 consecutive patients with a median NIH Stroke Scale (NIHSS) score of 15 (range 2–30) were included. 170 patients (84.6%) achieved mTICI 2b–3 reperfusion. The median number of attempts was 2 (range 1–10) with 52.8% of the population achieving good functional outcomes (mRS 0–2) at 3 months. On univariate analysis, good functional outcome was associated with the number of attempts, puncture-to-reperfusion time, anterior circulation occlusion, and NIHSS score. On multivariate analysis, pre-treatment NIHSS (OR 0.845 per point, 95% CI 0.793 to 0.908, P<0.001) and puncture-to-reperfusion time (OR 0.9952 per min, 95% CI 0.9914 to 0.9975, P=0.023) were associated with good functional outcomes at 3 months.ConclusionThe Embotrap device has a high rate of successful reperfusion. Our core laboratory-audited single-center experience suggests the technical feasibility and safety of the Embotrap for first-line use in a real-world setting.
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Kurre W, Bäzner H, Henkes H. [Mechanical thrombectomy: Acute complications and delayed sequelae]. Radiologe 2016; 56:32-41. [PMID: 26631170 DOI: 10.1007/s00117-015-0050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Due to the positive evidence for mechanical thrombectomy (mTE), it will be increasingly used in future. Profound knowledge of potential complications, prevention and management of complications is necessary to safely implement mTE into clinical practice. AIM Description of specific complications of mTE and their clinical relevance, measures for prevention and management. Summary of the current knowledge on long-term side effects of mTE. MATERIAL AND METHODS Analysis of current trial results and selected case series to address specific topics. Summary of own practical clinical experience. RESULTS Vascular injury (1-5%) and emboli (5-9%) are the most relevant intraprocedural complications but the clinical outcome is variable. Measures for prevention and management are described in detail. Vasospasms frequently occur (20-26%) but rarely need specific treatment and do not affect the clinical course. In the case of restrictive indications the frequency of symptomatic hemorrhage is similar to that for medicinal treatment (up to 8%). Contrast medium enhancement in the area of the infarction on post-treatment imaging should not be mistaken for hemorrhages. Focal subarachnoid contrast medium enhancement or hemorrhage occurs in up to 24% of cases and is predominantly benign. In follow-up imaging stenoses or occlusions can be detected in 4-10% of the treated vessels, most of which are asymptomatic. They are considered to be caused by microtrauma to the vascular wall. CONCLUSION Clinically relevant complications of mTE are rare. Preventive measures and effective management of complications may even increase safety. Stenoses occasionally occur as a long-term side effect but are asymptomatic in the majority of cases.
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Affiliation(s)
- W Kurre
- Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Deutschand.
| | - H Bäzner
- Neurologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Deutschland
| | - H Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Deutschand
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Raoult H, Redjem H, Bourcier R, Gaultier-Lintia A, Daumas-Duport B, Ferré JC, Eugène F, Fahed R, Bartolini B, Piotin M, Desal H, Gauvrit JY, Blanc R. Mechanical thrombectomy with the ERIC retrieval device: initial experience. J Neurointerv Surg 2016; 9:574-577. [DOI: 10.1136/neurintsurg-2016-012379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/20/2016] [Accepted: 04/29/2016] [Indexed: 11/03/2022]
Abstract
ObjectiveTo report our experience with the Embolus Retriever with Interlinked Cage (ERIC) stentriever for use in mechanical endovascular thrombectomy (MET).MethodsThirty-four consecutive patients with acute stroke (21 men and 13 women; median age 66 years) determined appropriate for MET were treated with ERIC and prospectively included over a 6-month period at three different centers. The ERIC device differs from typical stentrievers in that it is designed with a series of interlinked adjustable nitinol cages that allow for fast thrombus capture, integration, and withdrawal. The evaluated endpoints were successful revascularization (Thrombolysis in Cerebral Infarction (TICI) 2b–3) and good clinical outcomes at 3 months (modified Rankin Scale (mRS) 0–2).ResultsLocations of the occlusions included the middle cerebral artery (13 patients), terminal carotid artery (11 patients), basilar artery (1 patient), and tandem occlusions (9 patients). IV thrombolysis was performed in 20/34 (58.8%) patients. Median times from symptom onset to recanalization and from puncture to recanalization were 325.5 min (180–557) and 78.5 min (14–183), respectively. Used as the first-line device, ERIC achieved a successful recanalization in 20/24 (83.3%) patients. Successful recanalization was associated with lower National Institutes of Health Stroke Scale scores at 24 h (8±6.5 vs 21.5±2.1; p=0.008) and lower mRS at 3 months (2.7±2.1 vs 5.3±1.1; p=0.04). Three procedural complications and four asymptomatic hemorrhages were recorded. Good clinical outcomes at 3 months were seen in 15/31 (48.4%) patients.ConclusionsThe ERIC device is an innovative stentriever allowing fast, effective, and safe MET.
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12
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Li Z, Li N, Qu Y, Gai F, Zhang G, Zhang G. Application of 3.0T magnetic resonance arterial spin labeling (ASL) technology in mild and moderate intracranial atherosclerotic stenosis. Exp Ther Med 2016; 12:297-301. [PMID: 27347052 PMCID: PMC4907036 DOI: 10.3892/etm.2016.3318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/06/2016] [Indexed: 11/05/2022] Open
Abstract
The application value of 3.0T magnetic resonance arterial spin labeling (ASL) technology in mild and moderate intracranial atherosclerotic stenosis was evaluated. A total of 58 cases of transient ischemic attack (TIA) and 60 cases of ischemic cerebral apoplexy cases were selected. The cases were analysed using a GE Healthcare Signa HDx 3.0T superconducting whole-body magnetic resonance scan within 24 h of attack. Eight-channel head phased array coils and conventional sequence were used to create T1-weighted images (T1WI), T2WI, diffusion-weighted imaging, magnetic resonance angiography (MRA) and ASL imaging, which were generated into ASL pseudo-color images (blue was hypoperfusion area) through post-processing in order to compare and analyze the correlation and differences between ASL and conventional imaging in terms of lesion location, size, blood perfusion situation and signal range of relative cerebral blood flow (rCBF). The results showed that, 13 TIA cases of abnormal signal in conventional magnetic resonance imaging (MRI) can also be found through ASL technology. Diameter stenosis beyond 30% in MRA can also be tested in ASL. A positive rate in ASL was significantly higher than that of conventional MRI (χ2=29.078, P<0.001) and hypoperfusion area was greatly increased (t=32.526, P<0.001). The rCBF value was positively correlated with the degree of diameter stenosis shown in MRA (r=0.524, P=0.012). Additionally, the positive rate of ASL was positively correlated with the attack times of TIA (r=0.352, P=0.027). A total of 39 cerebral apoplexy cases of abnormal signal in conventional MRI were also found through ASL technology. A positive rate in ASL was significantly higher than that of conventional MRI (χ2=7.685, P=0.006) and hypoperfusion area was greatly increased (t=9.425, P<0.001). The rCBF value was positively correlated with the degree of diameter stenosis (r=0.635, P=0.009). In conclusion, 3.0T ASL correlated with early diagnosis of TIA and mild and moderate intracranial arterial stenosis of cerebral apoplexy.
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Affiliation(s)
- Zhongwei Li
- CT Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Naikun Li
- Department of Medical Imaging, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Yanyan Qu
- Department of Endocrinology, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Feng Gai
- Department of Radiology, Yantai Municipal Laiyang Central Hospital, Yantai, Shandong 265200, P.R. China
| | - Guowei Zhang
- CT Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Guanghui Zhang
- Department of Medical Imaging, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
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Dr. Enomoto responds:. J Vasc Interv Radiol 2016; 27:780. [DOI: 10.1016/j.jvir.2016.01.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/22/2022] Open
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Enomoto Y, Takagi T, Matsubara H, Tsujimoto M, Yamauchi K, Yoshimura S, Iwama T. Delayed Stenosis in the Intracranial Vessels following Endovascular Treatment for Acute Stroke. J Vasc Interv Radiol 2015; 26:1814-9. [PMID: 26428879 DOI: 10.1016/j.jvir.2015.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/07/2015] [Accepted: 08/13/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate delayed stenosis of the vessels after endovascular thrombectomy using magnetic resonance (MR) angiography. MATERIALS AND METHODS Of 82 consecutive patients who underwent successful endovascular treatment for acute intracranial large vessel occlusion between October 2010 and October 2014 at a single institution, 57 patients for whom 3-month radiologic follow-up examinations using MR angiography were available were included in the analysis. MR angiography images were assessed to detect delayed stenosis, which was defined as a decrease in the diameter of treated vessels > 50% compared with MR angiography images obtained 24 hours after endovascular treatment. RESULTS MR angiography images obtained 3 months after endovascular treatment revealed delayed stenosis of treated vessels in five (8.8%) of 57 patients. All cases of delayed stenosis were asymptomatic and occurred in the middle cerebral artery (MCA). Further serial radiologic follow-up showed gradual improvement of all delayed stenosis over 12 months. CONCLUSIONS Endovascular treatment poses a risk of delayed stenosis of treated vessels, especially in the MCA. MR angiography is a useful modality in long-term follow-up to evaluate delayed stenosis after endovascular treatment.
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Affiliation(s)
- Yukiko Enomoto
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Toshinori Takagi
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hirofumi Matsubara
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Masanori Tsujimoto
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Keita Yamauchi
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Graduate School of Medicine, Hyogo Medical University, Hyogo, Japan
| | - Toru Iwama
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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