Interventional treatment for acute cerebral infarction with large vessel occlusion combined with aortic arch interruption

Cases of patients complicated with dextrocardia who suffer from acute cerebral infarction with large vessel occlusion and receive emergency thrombectomy are particularly rare and have not been widely reported. This article aimed to increase the awareness and knowledge of these cases. We report the case of a patient with mirror-image dextrocardia who suffered from cerebral infarction with large vessel occlusion and received emergency thrombectomy. A male patient in his early 60s with dextrocardia had acute cerebral infarction with posterior circulation large vessel occlusion and underwent emergency thrombectomy. During the operation, the rapid confirmation of dextrocardia and use of flexible interventional instruments helped establish a pathway for blood flow. We used an intracranial thrombectomy stent and intracranial balloon dilation catheter to restore the cerebral blood supply. The Modified Rankin Scale score was 0 at 3 months after thrombectomy, indicating a good prognosis of the patient. Acute cerebral infarction with large vessel occlusion in patients with dextrocardia is extremely rare. Emergency thrombectomy is feasible to recanalize cerebral blood flow and give patients a chance to recover.

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European Multicenter Study of ET-COVID-19

Stroke ◽

10.1161/strokeaha.120.031514 ◽

2021 ◽

Vol 52 (1) ◽

pp. 31-39

Author(s):

Federico Cagnazzo ◽

Michel Piotin ◽

Simon Escalard ◽

Benjamin Maier ◽

Marc Ribo ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Lymphocyte Count ◽

Interquartile Range ◽

National Institutes Of Health ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Neurological Improvement ◽

Symptomatic Intracranial Hemorrhage

Background and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0–1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59–79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11–21) and 8 (interquartile range, 7–9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3–87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20–39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8–29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7–12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21–5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22–5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43–12.91] per SD-log increase in LDH). Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient’s profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04406090.

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Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014485 ◽

2019 ◽

Vol 11 (9) ◽

pp. 874-878 ◽

Cited By ~ 38

Author(s):

Stephanie H Chen ◽

Brian M Snelling ◽

Samir Sur ◽

Sumedh Subodh Shah ◽

David J McCarthy ◽

...

Keyword(s):

Aortic Arch ◽

Mechanical Thrombectomy ◽

Vascular Anatomy ◽

Patient Characteristics ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Cohort Differences ◽

Number Of Passes

BackgroundA transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. Nonetheless, TRA may confer added benefits in MT since navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory.ObjectiveTo compare outcomes in patients who underwent MT via TRA versus TFA.MethodsWe performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2018. Patient characteristics, procedural techniques, and outcomes were recorded. TFA and TRA cohorts were compared.ResultsOf the 51 patients, 18 (35%) underwent MT via TRA. There were no significant cohort differences in patient characteristics, clot location, or aortic arch type and presence of carotid tortuosity. There were no significant differences in outcomes between the two cohorts, including single-pass recanalization rate (54.5% vs 55.6%, p=0.949) and average number of passes (1.9 vs 1.7, p=0.453). Mean access-to-reperfusion time (61.9 vs 61.1 min, p=0.920), successful revascularization rates (Thrombolysis in Cerebral Infarction score ≥2b 87.9% vs 88.9%, p=1.0) and functional outcomes (modified Rankin Scale score≤2, 39.4% vs 33.3%, p=0.669) were similar between TFA and TRA cohorts, respectively.ConclusionsOur results demonstrate equivalence in efficacy and efficiency between TRA and TFA for MT of anterior circulation large vessel occlusion in patients with challenging vascular anatomy. TRA may be better than TFA in well-selected patients undergoing MT.

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Endovascular Application of Magnetic Resonance Double Mismatch Technique for Acute Anterior Circulation Large Vessel Occlusion with Cerebral Infarction in an Unknown Time Window

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i5.1485 ◽

2020 ◽

Vol 4 (5) ◽

Author(s):

Xiangkong Song ◽

Qing Zhang ◽

Lilin Gao ◽

Jie Qi ◽

Guoqing Wang

Keyword(s):

Magnetic Resonance ◽

Cerebral Infarction ◽

Endovascular Treatment ◽

Time Window ◽

Research Work ◽

Large Vessel ◽

Clinical Effects ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion

Objective: To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation, large vessel occlusion with cerebral infarction in an unknown time window. Methods: The research work was carried out in our hospital, the work was carried out from November 2018 to November 2019, the patients with acute anterior circulation large vessel occlusion with cerebral infarction who were treated in our hospital during this period, 100 patients, 50 patients with an unknown time window and 50 patients with definite time window were selected, and they were named as the experimental and control groups, given different examination methods, were given to investigate the clinical treatment effect. Results: Patients' data on HIHSS score before treatment, the incidence of intracranial hemorrhage and rate of Mrs?2 rating after 90 days of treatment were not significantly different(P>0.05), which was not meaningful. The differences in data between the two groups concerning HIHSS scores were relatively significant before, and after treatment(P<0.05). Conclusion: The magnetic resonance double mismatch technique will be applied in the endovascular treatment of acute anterior circulation large vessel occlusion with cerebral infarction of unknown time window.

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The relation between aortic arch branching types and the location of large vessel occlusion in cardioembolic stroke

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.05.013 ◽

2021 ◽

Vol 89 ◽

pp. 171-176

Author(s):

Lu Xu ◽

Juan Liao ◽

Li Liu ◽

Li-Bo Zhao ◽

Shu-Dong Liu ◽

...

Keyword(s):

Aortic Arch ◽

Large Vessel ◽

Cardioembolic Stroke ◽

Large Vessel Occlusion ◽

Vessel Occlusion

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Balloon anchoring technique for thrombectomy in hostile craniocervical arterial anatomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015347 ◽

2020 ◽

Vol 12 (8) ◽

pp. 763-767

Author(s):

Vera Sharashidze ◽

Raul G Nogueira ◽

Alhamza R Al-Bayati ◽

Jonathan A Grossberg ◽

Diogo C Haussen

Keyword(s):

Aortic Arch ◽

Vascular Anatomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Guide Catheter ◽

Procedural Time ◽

Type 3 ◽

Arterial Anatomy ◽

Anchoring Technique

BackgroundCraniocervical catheter access in large vessel occlusion acute ischemic strokes can be challenging in cases of unfavorable aortic arch/cervical vascular anatomy, leading to lower recanalization rates, increased procedural time and worse clinical outcomes. We aim to demonstrate the feasibility of the balloon-anchoring technique (BAT) that can be attempted before switching to alternative access sites.MethodsRetrospective review of prospectively collected information on 11 patients in which two variants of the BAT (proximal anchoring: balloon guide catheter (BGC) is inflated to provide support for distal access; distal anchoring: compliant balloon is inflated in an intracranial artery to allow advancement of the support system) were utilized to facilitate craniocervical access due to failure of conventional maneuvers.ResultsTen patients had anterior and one patient had posterior circulation large vessel occlusions. Mean age was 81 years and 81% were females. Type 3 arches were found in 82% and a 9 French balloon guide catheter was used in 82%. Proximal anchoring with BGC was used in four cases while distal anchoring was used in seven patients to allow access to the target vessel, avoiding the need to puncture alternative access sites. Successful reperfusion (modified treatment in cerebral ischemia 2b-3) was achieved in all cases and no complications were observed.ConclusionBAT is safe and feasible. It can be considered as a rescue maneuver in order to avoid switching to a different access during thrombectomy in individuals with unfavorable aortic arch/craniocervical anatomy.

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Number of Retrieval Attempts Rather Than Procedure Time Is Associated With Risk of Symptomatic Intracranial Hemorrhage

Stroke ◽

10.1161/strokeaha.120.031242 ◽

2021 ◽

Vol 52 (5) ◽

pp. 1580-1588

Author(s):

Máté Elöd Maros ◽

Caspar Brekenfeld ◽

Gabriel Broocks ◽

Hannes Leischner ◽

Rosalie McDonough ◽

...

Keyword(s):

Cerebral Infarction ◽

Intracranial Hemorrhage ◽

Endovascular Therapy ◽

Odds Ratio ◽

National Institutes Of Health ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Procedure Time ◽

Vessel Occlusion ◽

Symptomatic Intracranial Hemorrhage

Background and Purpose: Endovascular therapy is the standard of care in the treatment of acute ischemic stroke due to large-vessel occlusion. A direct association between the number of device passes and the occurrence of symptomatic intracranial hemorrhage (SICH) has been suggested. This study represents an in-depth investigation of the hypothesis that >3 retrieval attempts is associated with an increased rate of SICH in a large multicenter patient cohort. Methods: Two thousand six hundred eleven patients from the prospective German Stroke Registry were analyzed. Patients who received Endovascular therapy for acute large-vessel occlusion of the anterior circulation with known admission National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score, final Thrombolysis in Cerebral Infarction, and number of retrieval passes were included. The primary outcome was defined as SICH. The secondary outcome was any type of radiologically confirmed intracranial hemorrhage within the first 24 hours. Multivariate mixed-effects models were used to adjust for cluster effects of the participating centers, as well as for confounders. Results: Five hundred ninety-three patients fulfilled the inclusion criteria. The median number of retrieval passes was 2 [interquartile range, 1–3]. SICH occurred in 26 cases (4.4%), whereas intracranial hemorrhage was identified by neuroimaging in 85 (14.3%) cases. More than 3 retrieval passes was the strongest predictor for SICH (odds ratio, 3.61 [95% CI, 1.38–9.42], P =0.0089) following adjustment for age, admission National Institutes of Health Stroke Scale, admission Alberta Stroke Program Early CT Score, and Thrombolysis in Cerebral Infarction, as well as time from symptom onset to flow restoration. Baseline Alberta Stroke Program Early CT Score of 8 to 9 (odds ratio, 0.26 [95% CI, 0.07–0.89], P =0.032) or 10 (odds ratio, 0.21 [95% CI, 0.06–0.78], P =0.020) were significant protective factors against the occurrence of SICH. Conclusions: More than 3 retrieval attempts is associated with a significant increase in SICH risk, regardless of patient age, baseline National Institutes of Health Stroke Scale, or procedure time. This should be considered when deciding whether to continue a procedure, especially in patients with large baseline infarctions. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03356392.

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