Endovascular Treatment of Phlegmasia Cerulea Dolens with Impending Venous Gangrene: Manual Aspiration Thrombectomy as the First-Line Thrombus Removal Method

Introduction: Pervious thrombi benefit more from intravenous thrombolysis, but the role of perviousness in endovascular treatment (EVT) is not completely clear. Thrombus length is negatively associated with outcome after EVT. Pervious, long thrombi may be more difficult to aspirate, or fragment more easily than non-pervious, short thrombi. We assessed the effect of perviousness and thrombus length on results of first-line aspiration thrombectomy in EVT, in comparison to stent-retrievers. Methods: We included MR CLEAN Registry patients (N=1526) with thin-slice imaging available, and aspiration or stent-retriever as first EVT attempt (N=391). Thrombus perviousness was measured by thrombus attenuation increase (Houndsfield Units; HU). Associations with 90-day modified Rankin Scale score (mRS), and final and first-pass reperfusion (eTICI 2B-3) were tested with adjusted logistic regression analyses. Results: Sixty-five (21%) patients were treated with first-line aspiration, 252 (79%) with stent-retrievers. Perviousness was not significantly associated with mRS after either first-line approach (Figure 1). Analysis per perviousness quartile did show improved mRS for stent-retrievers in the highest quartile only (>12.3 HU; acOR for mRS shift with stent-retriever treatment 3.08, 95%CI 1.06-8.96). Thrombus length was negatively associated with mRS after first-line stent-retriever thrombectomy (acOR 0.96, 95%CI 0.93-0.99). First-pass reperfusion and thrombus length were significantly, negatively associated in the first-line aspiration group (acOR 0.88, 95%CI 0.80-0.96). Conclusions: Patients with longer thrombi may show worse outcomes after both aspiration and stent-retriever thrombectomy. In patients with high perviousness values, stent-retriever thrombectomy may be related to improved outcomes as compared to first-line aspiration.

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Manual Aspiration Thrombectomy with Stent Placement: Rapid and Effective Treatment for Phlegmasia Cerulea Dolens with Impending Venous Gangrene

CardioVascular and Interventional Radiology ◽

10.1007/s00270-007-9156-9 ◽

2007 ◽

Vol 31 (1) ◽

pp. 205-208 ◽

Cited By ~ 19

Author(s):

Levent Oguzkurt ◽

Fahri Tercan ◽

Ugur Ozkan

Keyword(s):

Effective Treatment ◽

Stent Placement ◽

Aspiration Thrombectomy ◽

Venous Gangrene ◽

Phlegmasia Cerulea Dolens

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First-Line Sofia Aspiration Thrombectomy Approach within the Endovascular Treatment of Ischemic Stroke Multicentric Registry: Efficacy, Safety, and Predictive Factors of Success

American Journal of Neuroradiology ◽

10.3174/ajnr.a6074 ◽

2019 ◽

Vol 40 (6) ◽

pp. 1006-1012 ◽

Cited By ~ 5

Author(s):

G. Marnat ◽

X. Barreau ◽

L. Detraz ◽

R. Bourcier ◽

B. Gory ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Predictive Factors ◽

First Line ◽

Aspiration Thrombectomy ◽

Factors Of Success

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Venous Gangrene (Phlegmasia Cerulea Dolens) Complicating Heart Failure from Severe Mitral Stenosis—A Case History

Angiology ◽

10.1177/000331979104200808 ◽

1991 ◽

Vol 42 (8) ◽

pp. 654-658 ◽

Cited By ~ 4

Author(s):

Chu-Pak Lau ◽

Wing-Hung Leung ◽

Cheuk-Kit Wong ◽

Chun-Ho Cheng

Keyword(s):

Heart Failure ◽

Case History ◽

Mitral Stenosis ◽

Venous Gangrene ◽

Phlegmasia Cerulea Dolens

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A Retrospective Single-Center Case Series of Direct Aspiration Thrombectomy as First-Line Approach in Ischemic Stroke and Review of the Literature

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2018.11.004 ◽

2019 ◽

Vol 28 (3) ◽

pp. 640-648 ◽

Cited By ~ 2

Author(s):

Marius Georg Kaschner ◽

Christian Rubbert ◽

Julian Caspers ◽

Jennifer Karsten ◽

Bastian Kraus ◽

...

Keyword(s):

Ischemic Stroke ◽

Case Series ◽

Review Of The Literature ◽

Single Center ◽

First Line ◽

Aspiration Thrombectomy

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Endovascular Treatment of Tentorial Dural Arteriovenous Fistulas Using the Transarterial Approach as a First-Line Strategy

Neurosurgery ◽

10.1093/neuros/opaa477_s166 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S166-S166

Author(s):

Marco Túlio Salles Rezende ◽

Felipe Padovani Trivelato ◽

Luis Henrique de Castro-Afonso ◽

Guilherme Seizem Nakiri ◽

Caio César Molina Silva ◽

...

Keyword(s):

Endovascular Treatment ◽

First Line ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

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Combined use of contact aspiration and the stent retriever technique versus stent retriever alone for recanalization in acute cerebral infarction: the randomized ASTER 2 study protocol

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014735 ◽

2020 ◽

Vol 12 (5) ◽

pp. 471-476 ◽

Cited By ~ 4

Author(s):

Bertrand Lapergue ◽

Julien Labreuche ◽

Raphaël Blanc ◽

Gaultier Marnat ◽

Arturo Consoli ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Endovascular Treatment ◽

Scale Score ◽

Stent Retriever ◽

Large Vessel Occlusion ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Combined Use

RationaleMechanical thrombectomy (MT) using a stent retriever (SR) device is currently the recommended treatment in ischemic stroke due to anterior circulation large vessel occlusion. Combining contact aspiration (CA) with SR is a promising new treatment, although it was not found to be superior to SR alone as first-line treatment for achieving successful reperfusion.AimTo determine whether endovascular treatment combining first-line use of CA and SR is more efficient than SR alone.MethodsThe ASTER 2 clinical trial is a prospective, randomized, multicenter, open-label trial with a blinded endpoint. We included patients admitted with suspected anterior circulation ischemic stroke secondary to large vessel occlusion <8 hours from symptom onset. They were randomly allocated in a 1:1 ratio to one of two treatment groups (combined CA and SR or SR alone). In the case of failure of the assigned technique after three attempts, other adjunctive techniques were applied.Study outcomeThe primary outcome is the rate of successful/complete reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score 2c/3) after the entire endovascular procedure. Secondary outcomes include reperfusion rates after the assigned first-line intervention alone and at the end of the procedure, procedural times, change in NIH Stroke Scale score at 24 hours, intracerebral hemorrhage at 24 hours, procedure-related serious adverse events, the modified Rankin Scale score, and all-cause mortality at 90 days and 1 year. The cost effectiveness of the two procedures will also be analyzed.DiscussionThis is the first head-to-head randomized trial to directly compare the efficacy of the combined use of CA and SR versus SR alone. This prospective trial aims to demonstrate the synergistic effects of CA and SR devices in first-line endovascular treatment.

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Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

BMC Neurology ◽

10.1186/s12883-020-02013-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jin Wook Choi ◽

Miran Han ◽

Jung Hyun Park ◽

Woo Sang Jung

Keyword(s):

Basilar Artery ◽

Mechanical Thrombectomy ◽

Treatment Method ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Procedure Time ◽

First Line ◽

Aspiration Thrombectomy ◽

First Pass ◽

First Line Treatment

Abstract Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.

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Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014696 ◽

2019 ◽

Vol 11 (10) ◽

pp. 979-983 ◽

Cited By ~ 9

Author(s):

Dong-Hun Kang ◽

Jin Woo Kim ◽

Byung Moon Kim ◽

Ji Hoe Heo ◽

Hyo Suk Nam ◽

...

Keyword(s):

Stent Retriever ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Endovascular Thrombectomy ◽

Negatively Associated ◽

Good Outcome ◽

Rescue Treatment ◽

First Pass

BackgroudThe need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT.MethodsWe identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome.ResultsA total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870).ConclusionCA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.

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Balloon Guide Catheter is Not Superior to Conventional Guide Catheter when Stent Retriever and Contact Aspiration are Combined for Stroke Treatment

Neurosurgery ◽

10.1093/neuros/nyaa315 ◽

2020 ◽

Vol 88 (1) ◽

pp. E83-E90

Author(s):

Romain Bourcier ◽

Gaultier Marnat ◽

Julien Labreuche ◽

Hubert Desal ◽

Federico Di Maria ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Clinical Outcomes ◽

Stent Retriever ◽

Added Value ◽

Complete Revascularization ◽

First Line ◽

Stroke Treatment ◽

Guide Catheter ◽

Significant Difference

Abstract BACKGROUND The effectiveness of balloon guide catheter (BGC) use has not been prospectively studied and its added value for improving reperfusion in acute ischemic stroke (AIS) treatment has only been reported in studies in which no contact aspiration was combined with the stent retriever (CA + SR). OBJECTIVE To compare the reperfusion results and clinical outcomes with and without BGC use when a combined CA + SR strategy is employed in first line to treat AIS. METHODS From January 2016 to April 2019, data from the ETIS registry (Endovascular Treatment in Ischemic Stroke) were reviewed. We included patients having undergone endovascular treatment with a combined CA + SR strategy and use or not of a BGC according to the operator's discretion. We compared BGC and nonBGC populations with matching and inverse probability of treatment weighting propensity scores. Primary outcome was the final near-complete/complete revascularization (mTICI2c/3) rate. Secondary outcomes included clinical outcomes and safety considerations. RESULTS Among 607 included patients, BGC was used in 32.9% (n = 200), and 190 matched pairs could be found. We found no significant difference in final mTICI2c/3 between patients with and without BGC (60.1% in BGC group compared to 62.7% in nonBGC group (matched RR, 0.92; 95%CI, 0.80 to 1.14)), first-pass mTICI2c/3 (35.1% vs 37.3%, matched RR, 0.94; 95%CI, 0.68 to 1.30), clinical outcome (matched RR of 1.12 (95%CI, 0.85 to 1.47) for favorable outcome. CONCLUSION The reperfusion and clinical results with and without BGC use are not significantly different when combined CA + SR are used as a first-line strategy for large vessel occlusion in the setting of AIS.

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