One-year single-center experience with the Aperio thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome

Introduction : In‐hospital stroke (IHS) is defined as stroke that occurs during hospitalization for non‐stroke conditions. We aimed to understand the timing of symptom recognition for patients who experienced IHS and its impact on the care they receive. Methods : A prospective, single center registry of adult patients (9/20/19‐2/28/21) was queried for acute anterior circulation IHS. Indications for hospitalization, delays from last known well (LKW) to symptom recognition, imaging, and treatment were explored. Results : Of 928 consecutively evaluated adults with acute stroke, 85 (9%) developed an anterior circulation IHS, 39 (46%) of whom were female, with a median age of 67 years (IQR 60–76) and median NIHSS of 15 (IQR 4–22). Sixty‐eight (80%) had a >1 hour delay from last known well to symptom recognition. Two patients (2%) received IV thrombolysis, although another 38 (45%) would have been eligible if not for a delay in symptom recognition. An ICA, M1, or M2 occlusion was observed in 18 patients (21%), 7 of whom were treated at a median of 174 minutes after LKW (IQR 65–219). Compared to the 11 patients who did not undergo thrombectomy with large vessel occlusion, those who underwent thrombectomy had non‐significantly shorter delays from LKW until neuroimaging (median 85 [IQR 65‐162] vs. 216 [IQR 133‐507], p = 0.12). Conclusions : While uncommon, patients with IHS experience delays in symptom recognition and treatment, which lead to exclusion from acute care treatment such as thrombolysis and thrombectomy. Earlier detection with more frequent nursing assessments or advanced neuromonitoring devices in at‐risk patients may reduce delays in care.

Download Full-text

Abstract WP502: Predictors Of First Pass Reperfusion In Anterior Circulation Large Vessel Occlusion Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp502 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mahmoud Mohammaden ◽

Leonardo Pisani ◽

Catarina Perry da Camara ◽

Mehdi Bousalma ◽

Alhamza Al bayati ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Multivariate Regression Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Performance Metric ◽

First Pass ◽

Thrombectomy Device

Introduction: The speed and completeness of endovascular reperfusion strongly correlate with functional outcomes. First-Pass Reperfusion (FPR) has been recently established as a critical procedural performance metric for mechanical thrombectomy (MT). We aimed to study the predictors of FPR and its effect on the outcome Methods: Review of a prospectively collected database of MT patients with large vessel occlusion strokes (LVOS) from 05/2012-11/2018. Patients were included in the analysis if they had an anterior circulation LVOS that was successfully reperfused (mTICI 2b-3). FPR was defined as the achievement of mTICI 2c-3 after a single pass with any thrombectomy device. Uni- and multivariate analyses were performed to identify the independent predictors of FPR. Results: A total of 563 patients qualified for the analysis (mean age, 64.4±12.3 years, baseline NIHSS 16.2). FPR was achieved in 202 (35.9%) patients. On univariate analysis, FPR was significantly associated with higher ASPECTS (8.1 vs. 7.8, p=0.008), higher usage of balloon guide catheters (BGC) (88.1% vs. 75.3%, p<0.001), lower use of general anesthesia (9.5% vs. 18.2%, p= 0.006), and shorter procedure duration (mean, 45.5 vs. 79.9 min, p <0.001 and 90.5%). Both BGC (OR, 2.26; 95%CI [1.32-3.87], p=0.003) and ASPECTS (OR, 1.15; 95% CI [1.03-1.28], p= 0.01) were independent predictors of FPE on multivariate regression analysis. Conclusion: Higher baseline ASPECTS score and the use of BGC are strong predictors of First-Pass Reperfusion in mechanical thrombectomy.

Download Full-text

Corrigendum: Learning Curve for Endovascular Treatment of Anterior Circulation Large Vessel Occlusion at a Single Center

Frontiers in Neurology ◽

10.3389/fneur.2021.703055 ◽

2021 ◽

Vol 12 ◽

Author(s):

Qiankun Cai ◽

Yuyou Zhu ◽

Xianjun Huang ◽

Lulu Xiao ◽

Mengmeng Gu ◽

...

Keyword(s):

Learning Curve ◽

Endovascular Treatment ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Single Center ◽

Anterior Circulation ◽

Vessel Occlusion

Download Full-text

Open Embolectomy of Large Vessel Occlusion in the Endovascular Era: Results of a 12-Year Single-Center Experience

World Neurosurgery ◽

10.1016/j.wneu.2017.02.108 ◽

2017 ◽

Vol 102 ◽

pp. 65-71 ◽

Cited By ~ 3

Author(s):

Tetsuyoshi Horiuchi ◽

Junpei Nitta ◽

Yoshinari Miyaoka ◽

Alhusain Nagm ◽

Keiji Tsutsumi ◽

...

Keyword(s):

Large Vessel ◽

Large Vessel Occlusion ◽

Single Center ◽

Vessel Occlusion ◽

Single Center Experience

Download Full-text

Learning Curve for Endovascular Treatment of Anterior Circulation Large Vessel Occlusion at a Single Center

Frontiers in Neurology ◽

10.3389/fneur.2020.587409 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qiankun Cai ◽

Yuyou Zhu ◽

Xianjun Huang ◽

Lulu Xiao ◽

Mengmeng Gu ◽

...

Keyword(s):

Learning Curve ◽

Endovascular Treatment ◽

Functional Independence ◽

Large Vessel ◽

Cusum Chart ◽

Large Vessel Occlusion ◽

Single Center ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Curve Effect

Background and purpose: Data concerning the learning curve for endovascular treatment (EVT) of anterior circulation large vessel occlusion are scarce. This study aimed to investigate the relationship between operator experience and the outcome of EVT and to further identify the number of cases needed to acquire the ability to perform successful reperfusion.Materials and methods: Four hundred and thirty-four patients who underwent EVT by seven operators at a single center from January 2016 to September 2019 were enrolled. Procedural experience was defined by the number of cases performed by each operator. Multivariable backward regression analyses were used to investigate the association between procedural experience and functional independence (defined as a modified Rankin Scale score of 0–2), 90-days mortality, successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3), and puncture-to-reperfusion time after adjusting for covariates. A risk-adjusted cumulative sum (RA-CUSUM) chart was utilized to identify the number of caseloads needed to overcome the learning curve effect.Results: Procedural experience was independently associated with functional independence, 90-days mortality, successful reperfusion, and puncture-to-reperfusion time reduction (per 10-case increment: OR 1.219, 95% CI: 1.079–1.383, P < 0.001; OR 0.847, 95% CI: 0.738–0.968, P = 0.016; OR 1.553, 95% CI: 1.332–1.830, P < 0.001 and β 8.087 min, 95% CI: 6.184–9.991, P < 0.001, respectively). The RA-CUSUM chart indicated that at least 29 cases were required to overcome the learning curve effect.Conclusions: There was a dose-response relationship between operator case volume and clinical outcome, procedure time, and successful reperfusion. The experience needed for successful EVT was at least 29 cases.

Download Full-text

Aspiration Thrombectomy in Patients with Large Vessel Occlusion and Mild Stroke: A Single-Center Experience

Medical Science Monitor ◽

10.12659/msm.930014 ◽

2021 ◽

Vol 27 ◽

Author(s):

Jozef Haring ◽

Miroslav Mako ◽

Ján Haršány ◽

Georgi Krastev ◽

Matúš Hoferica ◽

...

Keyword(s):

Large Vessel ◽

Large Vessel Occlusion ◽

Single Center ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Single Center Experience ◽

Mild Stroke

Download Full-text

Abstract WP40: Balloon Guide Catheter Utilization With Continuous Aspiration Prior to Intracranial Vascular Embolectomy (BGC-CAPTIVE) Associated With Greater Recanalization

Stroke ◽

10.1161/str.51.suppl_1.wp40 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Weiyi Le ◽

Mahesh V Jayaraman ◽

Grayson L Baird ◽

Brian C Mac Grory ◽

Tina M Burton ◽

...

Keyword(s):

Clinical Outcome ◽

Post Treatment ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

First Pass Effect ◽

Guide Catheter ◽

First Pass

Background: Among thrombectomy techniques, Continuous Aspiration Prior to Intracranial Vascular Embolectomy (CAPTIVE) is associated with higher rates of recanalization. Initially, CAPTIVE was performed without a balloon guide catheter (BGC). We aimed to determine the association between BGC usage with final recanalization as well as first pass effect in patients with anterior circulation emergent large vessel occlusion. Methods: We retrospectively reviewed consecutive patients with ICA and M1 occlusions treated with thrombectomy using CAPTIVE over a 45-month period. Post-treatment angiograms were scored by an experienced neurointerventionalist who was blinded to BGC usage and clinical outcome. For both BGC and non-BGC groups, we compared degree of recanalization (using the mTICI 2c scale), first-pass successful recanalization (mTICI 2c/3), and time to recanalization. We examined these results for all patients as well as based on clot location (ICA vs. M1). Results: 357 patients met criteria (median age: 73, median NIHSS: 17) for whom BGC was used in 37/70 (53%) with ICA and 116/287 (40%) with M1 occlusion. Odds of successful reperfusion increased 2.4-fold and odds of complete reperfusion increased 3-fold using BGC (both p<.01). Odds of successful first-pass recanalization (mTICI 2c/3) increased 5-fold for ICA occlusions (p=.004) and 1.7-fold for M1 (p=.03) (See Figure). Recanalization time with BGC for ICA occlusions was faster (22 vs. 36 min, p=.02) but there was no difference in time for M1 occlusions (24 vs. 26 min). Conclusions: BGC usage with the CAPTIVE technique is associated with higher recanalization rates, markedly higher first pass effect (mTICI 2c/3) for both ICA and M1 occlusions, and faster recanalization for ICA occlusions.

Download Full-text

Effect of balloon guide catheter on clinical outcomes and reperfusion in Trevo thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014452 ◽

2019 ◽

Vol 11 (9) ◽

pp. 861-865 ◽

Cited By ~ 8

Author(s):

Thanh N Nguyen ◽

Alicia C Castonguay ◽

Raul G Nogueira ◽

Diogo C Haussen ◽

Joey D English ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Stent Retriever ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Good Clinical Outcome ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Guide Catheter

IntroductionThe Solitaire stent retriever registry showed improved reperfusion, faster procedure times, and better outcome in acute stroke patients with large vessel occlusion treated with a balloon guide catheter (BGC) and Solitaire stent retriever compared with a conventional guide catheter. The goal of this study was to evaluate whether use of a BGC with the Trevo stent retriever improves outcomes compared with a conventional guide catheter.MethodsThe TRACK registry recruited 23 sites to submit demographic, clinical, and site adjudicated angiographic and outcome data on consecutive patients treated with the Trevo stent retriever. BGC use was at the discretion of the physician.Results536 anterior circulation patients (of whom 279 (52.1%) had BGC placement) were included in this analysis. Baseline characteristics were notable for younger patients in the BGC group (65.4±15.3 vs 68.1±13.6, P=0.03) and lower rate of hypertension (72% vs 79%, P=0.06). Mean time from symptom onset to groin puncture was longer in the BGC group (357 vs 319 min, P=0.06).Thrombolysis in Cerebral Infarction 2b/3 scores were higher in the BGC cohort (84% vs 75.5%, P=0.01). There was no difference in reperfusion time, first pass effect, number of passes, or rescue therapy. Good clinical outcome at 3 months was superior in patients with BGC (57% vs 40%; P=0.0004) with a lower mortality rate (13% vs 23%, P=0.008). Multivariate analysis demonstrated that BGC use was an independent predictor of good clinical outcome (OR 2; 95% CI 1.3 to 3.1, P=0.001).ConclusionsIn acute stroke patients presenting with anterior circulation large vessel occlusion, use of a BGC with the Trevo stent retriever resulted in improved reperfusion, improved clinical outcome, and lower mortality.

Download Full-text

CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion

BMC Medical Imaging ◽

10.1186/s12880-021-00593-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tiegong Wang ◽

Luguang Chen ◽

Xianglan Jin ◽

Yuan Yuan ◽

Qianwen Zhang ◽

...

Keyword(s):

Clinical Outcome ◽

Diagnostic Performance ◽

Ct Perfusion ◽

Roc Curves ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Scoring Method ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Poor Outcomes

Abstract Background ASPECTS scoring method varies, but which one is most suitable for predicting the prognosis still unclear. We aimed to evaluate the diagnostic performance of Automated (Auto)-, noncontrast CT (NCCT)- and CT perfusion (CTP) -ASPECTS for early ischemic changes (EICs) in acute ischemic stroke patients with large vessel occlusion (LVO) and to explore which scoring method is most suitable for predicting the clinical outcome. Methods Eighty-one patients with anterior circulation LVO were retrospectively enrolled and grouped as having a good (0–2) or poor (3–6) clinical outcome using a 90-day modified Rankin Scale score. Clinical characteristics and perfusion parameters were compared between the patients with good and poor outcomes. Differences in scores obtained with the three scoring methods were assessed. Diagnosis performance and receiver operating characteristic (ROC) curves were used to evaluate the value of the three ordinal or dichotomized ASPECTS methods for predicting the clinical outcome. Results Sixty-three patients were finally included, with 36 (57.1%) patients having good clinical outcome. Significant differences were observed in the ordinal or dichotomized Auto-, NCCT- and CTP-ASPECTS between the patients with good and poor clinical outcomes (all p < 0.01). The areas under the curves (AUCs) of the ordinal and dichotomized CTP-ASPECTS were higher than that of the other two methods (all p < 0.01), but the AUCs of the Auto-ASPECTS was similar to that of the NCCT-ASPECTS (p > 0.05). Conclusions The CTP-ASPECTS is superior to the Auto- and NCCT-ASPECTS in detecting EICs in LVO. CTP-ASPECTS with a cutoff value of 6 is a good predictor of the clinical outcome at 90-day follow-up.

Download Full-text

Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

Scientific Reports ◽

10.1038/s41598-021-84269-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hai-fei Jiang ◽

Yi-qun Zhang ◽

Jiang-xia Pang ◽

Pei-ning Shao ◽

Han-cheng Qiu ◽

...

Keyword(s):

Ischemic Stroke ◽

Large Vessel ◽

Susceptibility Weighted Imaging ◽

Regression Analyses ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Factors Associated ◽

Univariate Analyses

AbstractThe prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.

Download Full-text