There is no difference in safety and efficacy with Tirofiban or Eptifibatide for patients undergoing treatment of large vessel occlusion and underlying intracranial atherosclerosis

OBJECTIVEThe optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%–77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO.METHODSThe authors retrospectively reviewed consecutive patients with acute ischemic stroke and intracranial ELVO of the anterior circulation who underwent EVT between January 2017 and December 2019 at Yeungnam University Medical Center. Large-vessel occlusion (LVO) of the anterior circulation was classified by etiology as follows: 1) no significant stenosis after recanalization (embolic group) and 2) remnant stenosis > 70% or lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during EVT (ICAS group). The ICAS group was divided into the SR thrombectomy group (SR thrombectomy) and the FRESH group.RESULTSA total of 105 patients (62 men and 43 women; median age 71 years, IQR 62.5–79 years) were included. The embolic, SR thrombectomy, and FRESH groups comprised 66 (62.9%), 26 (24.7%), and 13 (12.4%) patients, respectively. There were no significant differences between the SR thrombectomy and FRESH groups in symptom onset–to-door time, but puncture-to-recanalization time was significantly shorter in the latter group (39 vs 54 minutes, p = 0.032). There were fewer stent retrieval passes but more first-pass recanalizations in the FRESH group (p < 0.001). Favorable functional outcomes were significantly more frequent in the FRESH group (84.6% vs 42.3%, p = 0.017).CONCLUSIONSThis study’s findings suggest that FRESH, rather than rescue stenting, could be a treatment option for ICAS-related ELVO.

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Reader response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion

Neurology ◽

10.1212/wnl.0000000000006652 ◽

2018 ◽

Vol 91 (24) ◽

pp. 1114.2-1115

Author(s):

Aravind Ganesh ◽

Bijoy K. Menon ◽

Mayank Goyal ◽

Andrew M. Demchuk ◽

Michael D. Hill

Keyword(s):

Reader Response ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Comparative Safety

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Author response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion

Neurology ◽

10.1212/wnl.0000000000006654 ◽

2018 ◽

Vol 91 (24) ◽

pp. 1116-1116

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Andrei V. Alexandrov ◽

Adam S. Arthur

Keyword(s):

Large Vessel ◽

Author Response ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Comparative Safety

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O-037 Comparative safety and efficacy of combined intravenous thrombolysis and mechanical thrombectomy with mechanical thrombectomy alone in emergent large vessel occlusion

10.1136/neurintsurg-2017-snis.37 ◽

2017 ◽

Author(s):

N Goyal ◽

G Tsivgoulis ◽

D Frei ◽

A Turk ◽

B Baxter ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Comparative Safety

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Sonothrombolysis in Patients With Acute Ischemic Stroke With Large Vessel Occlusion: An Individual Patient Data Meta-Analysis

Stroke ◽

10.1161/strokeaha.120.030960 ◽

2021 ◽

Author(s):

Georgios Tsivgoulis ◽

Aristeidis H. Katsanos ◽

Jürgen Eggers ◽

Vincent Larrue ◽

Lars Thomassen ◽

...

Keyword(s):

Clinical Trials ◽

Individual Patient Data ◽

Intravenous Thrombolysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Controlled Clinical Trials ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Randomized Controlled Clinical Trials ◽

Randomized Controlled

Background and Purpose: Evidence about the utility of ultrasound-enhanced thrombolysis (sonothrombolysis) in patients with acute ischemic stroke (AIS) is conflicting. We aimed to evaluate the safety and efficacy of sonothrombolysis in patients with AIS with large vessel occlusion, by analyzing individual patient data of available randomized-controlled clinical trials. Methods: We included all available randomized-controlled clinical trials comparing sonothrombolysis with or without addition of microspheres (treatment group) to intravenous thrombolysis alone (control group) in patients with AIS with large vessel occlusion. The primary outcome measure was the rate of complete recanalization at 1 to 36 hours following intravenous thrombolysis initiation. We present crude odds ratios (ORs) and ORs adjusted for the predefined variables of age, sex, baseline stroke severity, systolic blood pressure, and onset-to-treatment time. Results: We included 7 randomized controlled clinical trials that enrolled 1102 patients with AIS. A total of 138 and 134 confirmed large vessel occlusion patients were randomized to treatment and control groups respectively. Patients randomized to sonothrombolysis had increased odds of complete recanalization compared with patients receiving intravenous thrombolysis alone (40.3% versus 22.4%; OR, 2.17 [95% CI, 1.03–4.54]; adjusted OR, 2.33 [95% CI, 1.02–5.34]). The likelihood of symptomatic intracranial hemorrhage was not significantly different between the 2 groups (7.3% versus 3.7%; OR, 2.03 [95% CI, 0.68–6.11]; adjusted OR, 2.55 [95% CI, 0.76–8.52]). No differences in the likelihood of asymptomatic intracranial hemorrhage, 3-month favorable functional and 3-month functional independence were documented. Conclusions: Sonothrombolysis was associated with a nearly 2-fold increase in the odds of complete recanalization compared with intravenous thrombolysis alone in patients with AIS with large vessel occlusions. Further study of the safety and efficacy of sonothrombolysis is warranted.

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The Safety and Efficacy of Mechanical Thrombectomy in Posterior VS. Anterior Emergent Large Vessel Occlusion: A Systematic Review and Meta-analysis

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2019.104545 ◽

2020 ◽

Vol 29 (3) ◽

pp. 104545

Author(s):

Weisong Zhao ◽

Pengju Ma ◽

Weiming Zhao ◽

Biao Yang ◽

Yue Zhang ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy

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Abstract 130: Outcomes of Rescue Endovascular Treatment of Acute Ischemic Stroke in Patients With Underlying Intracranial Atherosclerosis- Insights From the STAR Registry

Stroke ◽

10.1161/str.51.suppl_1.130 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sami Al Kasab ◽

Eyad Almallouhi ◽

Michael A Casey ◽

Ali Alawieh ◽

Reda M Chalhoub ◽

...

Keyword(s):

Balloon Angioplasty ◽

Rescue Therapy ◽

Large Vessel ◽

Complication Rates ◽

Intracranial Atherosclerosis ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Long Term Outcome ◽

Procedural Time

Introduction: Mechanical Thrombectomy (MT) is currently the standard of care for patients presenting with emergent large vessel occlusion (ELVO) with salvageable tissue. A subgroup of patients with ELVO are found to have refractory occlusion due to underlying intracranial atherosclerosis (ICAS), often requiring angioplasty with or without stenting. Whether this treatment is safe or effective in this group of patients remains to be established. The purpose of this study is to investigate the safety, efficacy and long-term outcome of MT with rescue therapy in patients with ICAS. Methods: STAR registry combined prospectively maintained databases of 11 thrombectomy-capable centers in the US, Europe and Asia. In this analysis, we included patients who underwent rescue balloon angioplasty and/or stenting in the setting of ELVO. A matched sample was produced by matching on the variables of age, admission NIHSS, and location of occlusion. Results: Out of 2827 thrombectomy patients included in STAR registry, 190 patients received MT and required rescue angioplasty and/or stenting. Balloon angioplasty was performed on 116 patients, and 84 patients had intracranial stenting. Compared to the 161 ICAS patients matched to similar number of controls. There was no difference in age, race, sex, rate of IV tPA administration, ASPECTS score, or onset to groin time. Successful first attempt was higher in patients with embolic LVO (22 vs 52, p=0.001), procedural time was longer in patients with ICAS (47 min Vs 31 min, p=<0.001). There was no difference in symptomatic intracranial hemorrhage, or long term functional outcome. Conclusion: In patients with ELVO with underlying ICAS requiring rescue angioplasty and/or stenting; despite longer procedural time and lower rate of first pass revascularization, rescue therapy appears to be safe with similar complication rates and long-term functional outcomes compared to patients with large vessel occlusion from embolic source. Table 1:

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