Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke

Introduction: Larger distal access catheter systems for treatment of acute intracranial vessel occlusion enable both clot aspiration and introduction of flow restoration devices. We present the first clinical data of a large lumen hyperflexible intracranial distal aspiration catheter (ReFlex™ 5F, 058” ID x 125cm, Covidien, Irvine, CA) combined with the ReStore™ Thrombectomy microcatheter (Reverse Medical, Irvine, CA) for endovascular treatment of acute ischemic stroke. Patients and Methods: The ReStore™ consists of a flexible, tapered microcatheter with a braided mesh retrieval element attached to its distal segment. The retrieval element is deployed through the advancement of a guidewire or the ReAct™ stylet through the lumen to radially expand the retrieval element. Infusion of rt-PA within the thrombus is possible through small side holes of the ReStore™. Nine patients (62 y - 88 y, 5f/4m) with acute occlusion of the MCA were treated with the combination of ReStore™ and the ReFlex™ aspiration catheter within 6 hours after symptom onset. Median NIHSS score upon arrival was 16 (range 8 - 18). TICI flow in the target vessel segment was assessed prior and after recanalization procedure. Results: Thrombectomy with the combination of ReStore™ and ReFlex™ was performed as initial mechanical treatment in 8 cases. In one case, prior treatment with other stentriever systems failed, whereas the combination of ReStore™ and ReFlex™ lead to TICI 3. TICI 2b or 3 was achieved in 7 patients (77.8%); in 2 patients, TICI 2a was achieved. Immediate flow restoration while activating ReStore™ was accomplished in all 9 cases. Mean time from first angiopgraphy to first perfusion was 39.1 min (range 9-88 min). In 4 cases, additional rt-PA (10 mg) was administered directly into the thrombus through the ReStore™. In 2 cases, subsequent implantation of a permanent intracranial stent was performed. The mean number of ReStore™ activations to achieve final TICI score was 2.2 ± 1.1. One patient experienced periprocedural subarachnoid hemorrhage as a severe adverse event. Conclusion: The combination of ReStore™ and the ReFlex™ aspiration catheter is a promising new treatment option for both flow restoration and aspiration in patients suffering from acute intracranial arterial occlusion.

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Preventing vessel perforations in endovascular thrombectomy: feasibility and safety of passing the clot with a microcatheter without microwire: the wireless microcatheter technique

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014267 ◽

2018 ◽

Vol 11 (7) ◽

pp. 653-658 ◽

Cited By ~ 7

Author(s):

Annika Keulers ◽

Omid Nikoubashman ◽

Anastasios Mpotsaris ◽

Scott D Wilson ◽

Martin Wiesmann

Keyword(s):

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Acute Ischemic Stroke ◽

Complication Rates ◽

Anterior Circulation ◽

Contrast Extravasation ◽

Endovascular Thrombectomy ◽

Mechanical Recanalization ◽

Video Recordings ◽

Interventional Ct

BackgroundTo place a stent retriever for thrombectomy in acute ischemic stroke, the clot has to be passed first. A microwire is usually used for this maneuver. As an alternative, a wireless microcatheter can be used to pass the clot.ObjectiveTo analyze the feasibility and complication rates of passing the clot using either a microwire or a wireless microcatheter.MethodsA retrospective non-randomized analysis of 110 consecutive patients with acute ischemic stroke in the anterior circulation was performed, in whom video recordings of mechanical thrombectomies were available. In total, 203 attempts at mechanical recanalization were performed.ResultsSuccessful recanalization (TICI 2b–3) was achieved in 97.3% of patients. In 71.8% of attempts the clot was successfully passed using a wireless microcatheter only. When a microwire was used initially, clot passage was successful in 95.3% of attempts. Complication rates for angiographically detectable subarachnoid hemorrhage were 6.1% when a microwire was used to pass the clot compared with 0% when a wireless microcatheter was used (p<0.001). Complication rates for angiographically occult circumscribed subarachnoid contrast extravasation observed on post-interventional CT scans were 18.2% when a microwire was used to pass the clot and 4.5% when a wireless microcatheter was used (p<0.001).ConclusionsIn most cases of mechanical recanalization the clot can be passed with a wireless microcatheter instead of a microwire. In our study this method significantly reduced the risk for vessel perforation and subarachnoid hemorrhage. We therefore recommend the use of this technique whenever possible.

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Predictors of Outcome, Complications, and Recanalization of the Solitaire Device

Neurosurgery ◽

10.1227/neu.0000000000000830 ◽

2015 ◽

Vol 77 (3) ◽

pp. 355-361 ◽

Cited By ~ 12

Author(s):

Badih Daou ◽

Nohra Chalouhi ◽

Robert M. Starke ◽

Richard Dalyai ◽

Kate Hentschel ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Acute Ischemic Stroke ◽

Scale Score ◽

Univariate Analysis ◽

Favorable Outcome ◽

Modified Rankin Scale ◽

Nihss Score ◽

Flow Restoration ◽

The Mean

Abstract BACKGROUND: The use of mechanical thrombectomy in the management of acute ischemic stroke is becoming increasingly popular. OBJECTIVE: To identify notable factors that affect outcome, revascularization, and complications in patients with acute ischemic stroke treated with the Solitaire Flow Restoration Revascularization device. METHODS: Eighty-nine patients treated with the Solitaire Flow Restoration Revascularization device (ev3/Covidien Vascular Therapies, Irvine, California) were retrospectively analyzed. Three endpoints were considered: revascularization (Thrombolysis In Cerebral Infarction), outcome (modified Rankin Scale score), and complications. Univariate analysis and multivariate logistic regression were conducted to determine significant predictors. RESULTS: The mean time from onset of symptoms to the start of intervention was 6.7 hours. The average procedure length was 58 minutes. The mean NIH Stroke Scale (NIHSS) score was 16 on arrival and 8 at discharge. Of the patients, 6.7% had a symptomatic intracerebral hemorrhage, 16.8% had fatal outcomes within 3 months post-intervention, and 81.4% had a successful recanalization. Thrombus location in the M1 segment of the middle cerebral artery was associated with successful recanalization (thrombolysis in cerebral infarction 2b/3) (P = .003). Of the patients, 56.6% had a favorable outcome (modified Rankin Scale score at 3 months: 0–2). In patients younger than 80 years of age, 66.7% had favorable outcome. Increasing age (P = .01) and NIHSS score (P = .002) were significant predictors of a poor outcome. On multivariate analysis, NIHSS score on admission (P = .05) was a predictor of complications. On univariate analysis, increasing NIHSS score from admission to 24 hours after the procedure (P = .05) and then to discharge (P = .04) was a predictor of complications. Thrombus location in the posterior circulation (P = .04) and increasing NIHSS score (P = .04) predicted mortality. CONCLUSION: The Solitaire device is safe and effective in achieving successful recanalization after acute ischemic stroke. Important factors to consider include age, NIHSS score, and location.

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Solitaire Flow-Restoration Device for Treatment of Acute Ischemic Stroke: Safety and Recanalization Efficacy Study in a Swine Vessel Occlusion Model

American Journal of Neuroradiology ◽

10.3174/ajnr.a2169 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1938-1943 ◽

Cited By ~ 50

Author(s):

R. Jahan

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Efficacy Study ◽

Vessel Occlusion ◽

Occlusion Model ◽

Flow Restoration

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Successful Utilization of Mechanical Thrombectomy in a Presentation of Pediatric Acute Ischemic Stroke

Case Reports in Pediatrics ◽

10.1155/2018/5378247 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Esther S. Kim ◽

Erica K. Mason ◽

Andrew Koons ◽

Shawn M. Quinn ◽

Robert L. Williams

Keyword(s):

Emergency Department ◽

Interventional Radiology ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Pediatric Population ◽

Acute Onset ◽

Mechanical Recanalization ◽

Clot Removal

Guidelines regarding the management of acute ischemic stroke (AIS) in the pediatric population using mechanical recanalization procedures are lacking. We present a case of a 14-year-old male diagnosed in the Emergency Department with an acute onset stroke who underwent successful mechanical clot removal by interventional radiology.

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