scholarly journals Mechanical Thrombectomy by Direct Aspiration First-Pass Technique in Ischemic Stroke: Initial Experience

2020 ◽  
Author(s):  
Arvind Nanda ◽  
Krishan Kumar Jain ◽  
Rahul Handa ◽  
Dhruv Zutshi ◽  
Rajiv Anand ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Initial Experience ◽  
First Pass

scholarly journals Detailed histological analysis of a thrombectomy-resistant ischemic stroke thrombus: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Senna Staessens ◽  
Olivier François ◽  
Linda Desender ◽  
Peter Vanacker ◽  
Tom Dewaele ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Von Willebrand Factor ◽  
Histological Analysis ◽  
Mechanical Thrombectomy ◽  
Neutrophil Extracellular Traps ◽  
Extracellular Dna ◽  
Extracellular Traps ◽  
First Pass ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract Background Mechanical removal of a thrombus by thrombectomy can be quite challenging. For reasons that are not fully understood, some thrombi require multiple passes to achieve successful recanalization, whereas other thrombi are efficiently removed in a single pass. Since first pass success is associated with better clinical outcome, it is important to better understand the nature of thrombectomy resistant thrombi. The aim of this study was therefore to characterize the cellular and molecular composition of a thrombus that was very hard to retrieve via mechanical thrombectomy. Case presentation In a patient that was admitted with a right middle cerebral artery M1-occlusion, 11 attempts using various thrombectomy devices and techniques were required for removal of the thrombus. This peculiar case provided a rare opportunity to perform an in-depth histopathological study of a difficult to retrieve thrombus. Thrombus material was histologically analyzed using hematoxylin and eosin, Martius Scarlet Blue stain (red blood cells and fibrin), Feulgen stain (DNA), von Kossa stain (calcifications) and immunohistochemical analysis of von Willebrand factor, platelets, leukocytes and neutrophil extracellular traps. Histological analysis revealed abnormally high amounts of extracellular DNA, leukocytes, von Willebrand factor and calcifications. Extracellular DNA stained positive for markers of leukocytes and NETs, suggesting that a significant portion of DNA is derived from neutrophil extracellular traps. Conclusion In this unique case of a nearly thrombectomy-resistant stroke thrombus, our study showed an atypical composition compared to the common structural features found in ischemic stroke thrombi. The core of the retrieved thrombus consisted of extracellular DNA that colocalized with von Willebrand factor and microcalcifications. These results support the hypothesis that von Willebrand factor, neutrophil extracellular traps and microcalcifications contribute to mechanical thrombectomy resistance. Such information is important to identify novel targets in order to optimize technical treatment protocols and techniques to increase first pass success rates.

Abstract P488: The Impact of First Pass Effect on Acute Ischemic Stroke Clinical Outcomes: Why We Need to Continue to Improve Mechanical Thrombectomy?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Mahmoud Dibas ◽  
Amr Ehab El-Qushayri ◽  
Sherief Ghozy ◽  
Adam A Dmytriw ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Vessel Occlusion ◽  
First Pass Effect ◽  
Improved Outcomes ◽  
First Pass ◽  
The Impact

Background: Mechanical thrombectomy (MT) has significantly improved outcomes of acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). The first-pass effect (FPE), defined as achieving complete reperfusion (mTICI3/2c) with a single pass, was reported to be associated with higher functional independence rates following EVT and has been emphasized as an important procedural target. We compared MT outcomes in patients who achieved FPE to those who did not in a real world large database. Method: A retrospective analysis of LVO pts who underwent MT from a single center prospectively collected database. Patients were stratified into those who achieved FPE and non-FPE. The primary outcome (discharge and 90 day mRS 0-2) and safety (sICH, mortality and neuro-worsening) were compared between the two groups. Results: Of 580 pts, 261 (45%) achieved FPE and 319 (55%) were non-FPE. Mean age was (70 vs 71, p=0.051) and mean initial NIHSS (16 vs 17, p=0.23) and IV tPA rates (37% bs 36%, p=0.9) were similar between the two groups. Other baseline characteristics were similar. Non-FPE pts required more stenting (15% vs 25%, p=0.003), and angioplasty (19% vs 29%, p=0.01). The FPE group had significantly more instances of discharge (33% vs 17%, p<0.001), and 90-day mRS score 0-2 (29% vs 20%, p<0.001), respectively. Additionally, the FPE group had a significant lower mean discharge NIHSS score (12 vs 17, p<0.001). FPE group had better safety outcomes with lower mortality (14.2% vs 21.6%, p=0.03), sICH (5.7% vs 13.5, p=0.004), and neurological worsening (71.3% vs 78.4%, p=0.02), compared to the non-FPE group. Conclusion: Patients with first pass complete or near complete reperfusion with MT had higher functional independence rates, reduced mortality, symptomatic hemorrhage and neurological worsening. Improvement in MT devices and techniques is vital to increase first pass effect and improve clinical outcomes.

scholarly journals Mechanical Thrombectomy Using a Solitaire Stent in Acute Ischemic Stroke; Initial Experience in 40 Patients

2012 ◽  
Vol 14 (3) ◽  
pp. 164 ◽  
Author(s):  
Gyu-Seong Bae ◽  
Hyon-Jo Kwon ◽  
Chang-Woo Kang ◽  
Seung-Won Choi ◽  
Seon-Hwan Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Initial Experience

Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: Results from a multicentric prospective registry

2020 ◽  
pp. 174749302092305 ◽  
Author(s):  
Federico Di Maria ◽  
Maéva Kyheng ◽  
Arturo Consoli ◽  
Jean-Philippe Desilles ◽  
Benjamin Gory ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Lower Systolic Blood Pressure ◽  
Excellent Outcome ◽  
First Pass Effect ◽  
First Pass ◽  
Thrombectomy Device

Background The first-pass effect, defined as a complete or near-complete recanalization after one pass (first-pass effect) of a mechanical thrombectomy device, has been related to better clinical outcome than good recanalization after more than one pass in acute ischemic stroke. We searched for predictors of first-pass effect by analyzing the results within a large prospective multicentric registry. Methods We included patients treated by mechanical thrombectomy for isolated anterior intracranial occlusions. A multi-variate logistic regression analysis was carried out to search for predictors of first-pass effect. We also analyzed the percentage of patients with 90-day modified Rankin Scale score 0 to 2, excellent outcome (90-day modified Rankin Scale 0 to 1), 24-h NIHSS change, and 90-day all-cause mortality. Results Among the 1832 patients included, clinical outcome at 90 days was significantly better in first-pass effect patients (50.6% vs. 38.9% in patients without first-pass effect), with a center-adjusted OR associated with first-pass effect of 1.74 (95%CI, 1.24 to 1.77). Older age, a lower systolic blood pressure, an MCA-M1 occlusion, higher DWI-ASPECTS at admission, mechanical thrombectomy under local anesthesia, and combined first-line device strategy were independent predictors of first-pass effect. Conclusions In this study, a strategy combining thrombectomy and thrombo-aspiration was more effective than other strategies in achieving first-pass effect. In addition, we confirm that clinical outcome was better in patients with first-pass effect compared to non-first-pass effect patients.

Initial experience with SOFIA as an intermediate catheter in mechanical thrombectomy for acute ischemic stroke

2016 ◽  
Vol 9 (11) ◽  
pp. 1103-1106 ◽  
Author(s):  
Johnny H Y Wong ◽  
Huy M Do ◽  
Nicholas A Telischak ◽  
Adrienne M Moraff ◽  
Robert L Dodd ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Initial Experience

scholarly journals Selecting the Appropriate First-Line Strategy Based on Hyperdense Vessel Sign in Acute Ischemic Stroke Increases First Pass Recanalization: A Tertiary Center Experience

2022 ◽  
Author(s):  
Uday Bhanu Kovilapu ◽  
Narendra Jain ◽  
Atul Mishra ◽  
Virender Malik
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Large Vessel Occlusion ◽  
First Line ◽  
Vessel Occlusion ◽  
Tertiary Center ◽  
First Pass ◽  
Noncontrast Computed Tomography

Abstract Background: The data pertaining to selecting an optimal first-line strategy (stent retriever [SR] vs. contact aspiration [CA]) based on noncontrast computed tomography (NCCT) in cases of acute ischemic stroke consequent to large vessel occlusion (LVO) is lacking. Aims: This article studies the influence of hyperdense vessel sign (HVS) in selecting optimal first-line strategy, with intention of increasing first-pass recanalization (FPR). Methods: Upfront approach at our center is SR technique with rescue therapy (CA) adoption consequent to three failed SR attempts to achieve successful recanalization. Data of patients with acute LVO who underwent mechanical thrombectomy from June 2017 to May 2020 was retrospectively analyzed. Patients were classified into HVS (+) and HVS (–) cohort. Rate of successful recanalization (first pass, early, and final) and efficacy of rescue therapy was assessed between the two cohorts. Results: Of 52 patients included, 28 and 24 were assigned to the HVS (+) and HVS (–) cohort, respectively. FPR was observed in 50% of HVS (+) and 20.9% of HVS (–) (p = 0.029). Early recanalization was documented in 64.2% of HVS (+) and 37.5% of HVS (–) (p = 0.054). Rescue therapy need was higher in patients not demonstrating HVS (p = 0.062). Successful recanalization was achieved with rescue therapy in 50% of HVS (–) group. Conclusion: A higher FPR is achievable following individualized first-pass strategy (based on NCCT appearance of clot), instead of a generalized SR first-pass approach. This CT imaging-based strategy is a step closer to achieving primary angiographic goal of FPR.

Abstract WP8: Initial Clinical Experience with the Double Aspiration Modification of the ADAPT Technique

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Logan Chastain ◽  
Robert Burke ◽  
Casey Muehle ◽  
Fazeel Siddiqui ◽  
William E Greer ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Mechanical Thrombectomy ◽  
National Institutes Of Health ◽  
Initial Experience ◽  
Primary Method ◽  
Retrospective Evaluation ◽  
First Pass ◽  
Aspiration Technique ◽  
Procedural Complications ◽  
Initial Results

Background: The improvement of revascularization techniques has decreased recanalization times, increased rates, and improved patient outcomes. We report our initial results using a double aspiration modification to the direct aspiration first pass technique as the primary method for vessel recanalization. Methods: A retrospective evaluation of a prospectively captured group of 15 patients at one institution was performed on patients where the double aspiration modification of the ADAPT technique was used. Results: The double aspiration technique by itself was adequate for recanalization of TICI 2b/3 in 13 of 14 (93%) cases without any instance of downstream emboli needing additional aspiration. Two cases needed the addition of a stent retriever to achieve recanalization. Average time from groin puncture to at least TICI 2b was 39 minutes, and all cases but one was successfully revascularized. TICI 3 recanalization was achieved 57% of the time. The average National Institutes of Health Stroke Scale (NIHSS) on admission was 14.3 and this improved to an average NIHSS of 7.25 prior to discharge. The modified Rankin Score at 90 days showed 7 of 14 (50%) with a score of one. There were no procedural complications. Discussion: As previous studies have shown, aspiration technique is just as important as the aspiration device. This initial experience shows that the double-aspiration modification of the ADAPT technique is an effective method for mechanical thrombectomy in acute ischemic stroke. Utilizing the double-aspiration modification may decrease the incidence of downstream embolization, but further studies are needed to confirm this finding.

Abstract WP15: Rates of Successful First-pass Recanalization During Thrombectomy for Acute Ischemic Stroke are Higher in the Absence of a Hyper-dense Vessel Sign

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Cynthia L Kenmuir ◽  
Alhamza R Al-Bayati ◽  
Hazem Shoirah ◽  
Amin Aghaebrahim ◽  
Andrew F Ducruet ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
High Quality ◽  
Aspiration Thrombectomy ◽  
Endovascular Thrombectomy ◽  
First Pass ◽  
Multimodal Methods ◽  
Ratio Versus

Background and Purpose: Rates of high quality recanalization after endovascular thrombectomy in acute ischemic stroke are excellent, but not all vessels are easily or quickly recanalized. Physical characteristics of the occlusion may affect recanalization. The hyper-dense vessel sign (HDVS) is an easily obtained marker of clot density and was hypothesized to predict success of recanalization. Methods: A prospectively maintained database of patients undergoing mechanical thrombectomy was retrospectively analyzed. The final quality of recanalization was scored by the treating interventionalist. The presence or absence of HDVS was scored blinded. HDVS was defined as an absolute HU >43 and ratio versus contralateral vessel of >1.2 on non-contrast head CT. Results: 408 patients were treated with endovascular thrombectomy between August 2012 to July 2015. Mean age was 67.7. 53% were men. Mean NIHSS was 17. 88% were MCA occlusions and 11% were basilar occlusions. Mean ASPECT was 8.6 for MCA occlusions. 90.6% of patients were successfully revascularized with TICI2b/3. HDVS was identified in 43.3% of patients. 40.5% of patients had TICI2b/3 reperfusion after the first pass of attempted thrombectomy. Manual aspiration thrombectomy was the first technique in 45.6% and stentreiver mediated manual aspiration thrombectomy was used first in 54.4% of cases. Of 357 attempted MCA thrombectomies, 43.3% had a HDVS. Of 44 attempted basilar thrombectomies, 56.7% had a HDVS. TICI 2b/3 reperfusion on first-pass was associated with absence of HDVS (p=0.001). Time from puncture to reperfusion was significantly increased with HDVS (p=0.003). Conclusion: Patients with a hyper-dense vessel sign have less successful first-pass revascularization with increased times to reperfusion versus patients without a hyper-dense vessel sign. The presence of HDVS may be indicative of more refractory occlusions and may warrant novel and multimodal methods of revascularization.

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