Minimally invasive and rapid surgical embolectomy (MIRSE) as rescue treatment following failed endovascular recanalization for acute ischemic stroke

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

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Leukoaraiosis and acute ischemic stroke: 90-day clinical outcome following endovascular recanalization, with proposed “L-ASPECTS”

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015957 ◽

2020 ◽

pp. neurintsurg-2020-015957 ◽

Cited By ~ 1

Author(s):

John Benson ◽

Seyed Mohammad Seyedsaadat ◽

Ian Mark ◽

Deena M Nasr ◽

Alejandro A Rabinstein ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Area Under The Curve ◽

Primary Outcome Measure ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Endovascular Recanalization ◽

Poor Outcomes

BackgroundTo assess if leukoaraiosis severity is associated with outcome in patients with acute ischemic stroke (AIS) following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score.MethodsA retrospective review was completed of AIS patients that underwent mechanical thrombectomy for anterior circulation large vessel occlusion. The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). L-ASEPCTS score performance was validated using a consecutive cohort of 75 AIS LVO patients.Results174 patients were included in this retrospective analysis: average age: 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (P=0.0005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the area under the curve (AUC) was higher with L-ASPECTS (P<0.0001 and AUC=0.7 for L-ASPECTS; P=0.04 and AUC=0.59 for ASPECTS). In the validation cohort, the AUC for L-ASPECTS was 0.79 while the AUC for ASPECTS was 0.70. Of patients that had successful reperfusion (mTICI 2b/3), the AUC for traditional ASPECTS in predicting good functional outcome was 0.80: AUC for L-ASPECTS was 0.89.ConclusionsLeukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.

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Endovascular Recanalization Therapy in Acute Ischemic Stroke: Updated Meta-analysis of Randomized Controlled Trials

Journal of Stroke ◽

10.5853/jos.2015.17.3.268 ◽

2015 ◽

Vol 17 (3) ◽

pp. 268-281 ◽

Cited By ~ 34

Author(s):

Keun-Sik Hong ◽

Sang-Bae Ko ◽

Ji Sung Lee ◽

Kyung-Ho Yu ◽

Joung-Ho Rha

Keyword(s):

Ischemic Stroke ◽

Randomized Controlled Trials ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Endovascular Recanalization

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Hospital Volume Threshold Associated with Higher Survival after Endovascular Recanalization Therapy for Acute Ischemic Stroke

Journal of Stroke ◽

10.5853/jos.2019.00955 ◽

2020 ◽

Vol 22 (1) ◽

pp. 141-149

Author(s):

Dong-Hyun Shim ◽

Youngsoo Kim ◽

Jieun Roh ◽

Jongsoo Kang ◽

Kyung-Pil Park ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hospital Volume ◽

Prediction Models ◽

Severity Index ◽

Stroke Severity ◽

Endovascular Recanalization ◽

Outcome Relationship ◽

Insurance Claims Data ◽

Health Insurance Claims Data

Background and Purpose Endovascular recanalization therapy (ERT) is becoming increasingly important in the management of acute ischemic stroke (AIS). However, the hospital volume threshold for optimal ERT remains unknown. We investigated the relationship between hospital volume of ERT and risk-adjusted patient outcomes.Methods From the National Health Insurance claims data in Korea, 11,745 patients with AIS who underwent ERT from July 2011 to June 2016 in 111 hospitals were selected. We measured the hospital’s ERT volume and patient outcomes, including the 30-day mortality, readmission, and postprocedural intracranial hemorrhage (ICH) rates. For each outcome measure, we constructed risk-adjusted prediction models incorporating demographic variables, the modified Charlson comorbidity index, and the stroke severity index (SSI), and validated them. Risk-adjusted outcomes of AIS cases were compared across hospital quartiles to confirm the volume-outcome relationship (VOR) in ERT. Spline regression was performed to determine the volume threshold.Results The mean AIS volume was 14.8 cases per hospital/year and the unadjusted means of mortality, readmission, and ICH rates were 11.6%, 4.6%, and 8.6%, respectively. The VOR was observed in the risk-adjusted 30-day mortality rate across all quartile groups, and in the ICH rate between the first and fourth quartiles (<i>P</i><0.05). The volume threshold was 24 cases per year.Conclusions There was an association between hospital volume and outcomes, and the volume threshold in ERT was identified. Policies should be developed to ensure the implementation of the AIS volume threshold for hospitals performing ERT.

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Clinical Results of Intravenous Recombinant t-PA and Endovascular Recanalization Treatment for Acute Ischemic Stroke

Surgery for Cerebral Stroke ◽

10.2335/scs.44.138 ◽

2016 ◽

Vol 44 (2) ◽

pp. 138-144 ◽

Cited By ~ 1

Author(s):

Daisuke IZAWA ◽

Takumi KAWAGUCHI ◽

Rie YAKO ◽

Katsuhisa HIRAYAMA ◽

Osamu MASUO ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Results ◽

Endovascular Recanalization

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Response to letter regarding article ‘Leukoaraiosis and acute ischemic stroke: 90-day clinical outcome following endovascular recanalization, with proposed ‘L- ASPECTS’'

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016866 ◽

2020 ◽

pp. neurintsurg-2020-016866

Author(s):

John C Benson ◽

Waleed Brinjikji

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Endovascular Recanalization

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Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review

Neurology ◽

10.1212/wnl.0000000000012069 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012069

Author(s):

Wenzhao Liang ◽

Yimeng Wang ◽

Zhihua Du ◽

Jing Mang ◽

Jun Wang

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Literature Search ◽

Systematic Analysis ◽

Endovascular Thrombectomy ◽

Endovascular Recanalization ◽

Ovid Medline ◽

Patient Prognosis ◽

Robust Statistical Methods ◽

Real Time Application

Objective:In the real-world practice of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the analysis of intraprocedural angiographic signs (IPASs) still challenges neurointerventionists. This review provides insights into the significance of these subtle changes for predicting underlying etiology, technical feasibility and patient prognosis, thus promoting the potential real-time application of these signs.Methods:A systematic literature search was conducted using PubMed, Ovid Medline/Embase, and Cochrane. The search focused on studies published between January 1995 and August 2020 that reported findings related to intraprocedural angiographic manifestations in endovascular recanalization therapy for AIS.Results:We identified 12 IPASs in 22 studies involving 1683 patients. The IPASs were assigned into 3 subsets according to their clinical meanings.Conclusion:The systematic analysis of IPAS in clinical trials and practice will lead to a better understanding of treatment effects, responses, and mechanisms during EVT. Studies of larger cohorts using more robust statistical methods are needed.

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