Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit?

2015 ◽  
Vol 8 (8) ◽  
pp. 778-782 ◽  
Author(s):  
Christoph Kabbasch ◽  
Anastasios Mpotsaris ◽  
De-Hua Chang ◽  
Sonja Hiß ◽  
Franziska Dorn ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Outcome Data ◽  
Stent Retriever ◽  
Large Artery ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Reported Data

PurposeTo investigate the efficacy and safety of the Trevo ProVue (TPV) stent retriever in stroke patients with large artery occlusions, with particular attention to the full structural radiopacity of the TPV.Materials and methodsCase files and images of TPV treatments were reviewed for clinical and technical outcome data, including revascularization rates, device and procedure related complications, and outcome at discharge and after 90 days.Results76 patients were treated with TPV. Mean National Institutes of Health Stroke Scale (NIHSS) score was 18 and 68% had additional intravenous thrombolysis. 63 occlusions were in the anterior circulation: 44 M1 (58%), 8 M2 (11%), 8 internal carotid artery-terminus (11%), 2 internal carotid artery- left (3%), 1 A2 (1%), and 13 vertebrobasilar (17%). 58 of 76 (76%) were solely treated with TPV; the remainder were treated with additional stent retrievers. Mean number of passes in TPV only cases was 2.2 (SD 1.2). In rescue cases, 3.2 (SD 2.2) passes were attempted with the TPV followed by 2.6 rescue device passes (SD 2). TPV related adverse events occurred in 4/76 cases (5%) and procedural events in 6/76 cases (8%). Mean procedural duration was 64 min (SD 42). Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization was achieved in 69/76 patients (91%), including 50% TICI 3. Of 56 survivors (74%), 37 (49%) showed a favorable outcome at 90 days (Solitaire With the Intention for Thrombectomy trial criteria), statistically associated with age, baseline NIHSS, onset to revascularization time, and TICI 2b–3 reperfusion. TPV radiopacity allowed for visual feedback, changing the methodology of stent retriever use in 44/76 cases (58%).ConclusionsNeurothrombectomy with TPV is feasible, effective, and safe. The recanalization rate compares favorably with reported data in the literature. Improved structural radiopacity may facilitate neurothrombectomy or influence the course of action during retrieval.

scholarly journals Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience

2016 ◽  
Vol 23 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Anastasios Mpotsaris ◽  
Christoph Kabbasch ◽  
Jan Borggrefe ◽  
Vamsi Gontu ◽  
Michael Soderman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Retrospective Analysis ◽  
Stent Placement ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Tissue Type ◽  
Extracranial Internal Carotid Artery ◽  
Anterior Circulation

Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results A total of 63 patients with a median age of 67 years (range 33–84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1–29). Median time from stroke onset to recanalization was 408 minutes (range 165–1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15–202 minutes] vs. 130 minutes [range 60–280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0–2) after three months. Conclusions Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high technical success, reasonable clinical outcomes and acceptable rates of symptomatic intracranial haemorrhage in carefully chosen patients which are triaged interdisciplinary based on clinical and computed tomography imaging criteria. This warrants further study in a randomised prospective trial.

Abstract 41: Endovascular Treatment Alone versus Endovascular Treatment With Intravenous Thrombolysis in Patients With Tandem Occlusion: Analysis of the TITAN and ETIS Registries

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Anadani ◽  
Gaultier Marnat ◽  
Consoli Arturo ◽  
Papanagiotou Panagiotis ◽  
Adnan Siddiqui ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Favorable Outcome ◽  
Anterior Circulation ◽  
Lower Odds ◽  
Tandem Occlusion ◽  
Cervical Internal Carotid Artery

Introduction: The benefit of intravenous thrombolysis (IVT) prior to endovascular treatment (EVT) in patients with acute ischemic stroke due to anterior circulation tandem occlusion is not well established. In this study, we aimed to investigate the effect of IVT on the outcome of EVT for anterior circulation tandem occlusions Methods: Individual data were pulled from the prospective TITAN and ETIS registries. Patients with anterior circulation tandem occlusion treated with EVT with and without cervical internal carotid artery ( c-ICA) stenting were included. Patents were divided into two groups (IVT+/IVT-) based on IVT treatment. Inverse Probability Treatment Weighting (IPTW) analysis were used to compare the outcomes between the two groups. Results: A total of 602 patients were included of whom 380 (62%) patients received IVT prior to EVT (IVT+). Mean age was 64 and 62 years in IVT+ and IVT - groups, respectively. Median NIHSS was 16 in both groups. Onset to imaging time was shorter in IVT+ group (median 103 vs. 140 minutes). In contrast, imaging to puncture time was longer in IVT+ group (median, 107 vs. 91 minutes). In IPTW analysis, IVT was associated with higher odds of favorable outcome (90-day modified Rankin Scale [mRS] 0-2), excellent outcome (mRS 0-1) and successful reperfusion (modified Treatment in Cerebral Ischemia [mTICI] 2b-3). IVT was also associated with lower odds of any intracranial hemorrhage but not with symptomatic hemorrhage or parenchymal hemorrhage. In secondary analysis of patients treated with cervical internal carotid artery stenting, IVT was associated with higher odds of favorable outcome, and lower odds of mortality. Conclusion: Up to our knowledge, this is the first study comparing EVT alone to EVT+IVT in anterior circulation tandem occlusion patients. IVT prior to EVT was associated with better functional outcome and higher odds of successful reperfusion.

scholarly journals PHIL Migration to Internal Carotid Artery and Middle Cerebral Artery: Late Mechanical Retrieval with Solitaire AB Stent

2020 ◽  
Author(s):  
Giancarlo Saal-Zapata ◽  
Walter Durand ◽  
Ricardo Vallejos ◽  
Dante Valer ◽  
Jesús Flores ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Venous Drainage ◽  
Stent Retriever ◽  
Embolic Agent ◽  
Anterior Circulation ◽  
Liquid Embolic

AbstractPrecipitating hydrophobic injecting liquid (PHIL) is a novel embolic agent used in the endovascular treatment of arteriovenous malformations (AVM) and arteriovenous fistulas. Complications can occur during embolization with migration of the liquid embolic material to normal vasculature. In these cases, use of a stent retriever is an option for removal of the plug. Herein, we present the case of a patient who presented with a right occipital hemorrhage due to a ruptured occipital AVM fed by the calcarine and parieto-occipital arteries with venous drainage to the straight sinus. Embolization via the anterior circulation through the right posterior communicating artery was attempted but PHIL migrated to right internal carotid artery and middle cerebral artery due to kinking and rupture of the microcatheter. The patient developed mild left hemiparesis. When this complication occurred, no stent retriever was available at our institution and 1 day later, the Solitaire AB stent was used to remove the plug of PHIL successfully, with good reperfusion of the proximal and distal vessels. The patient improved after the procedure and was discharged home without deficit. Mechanical stent retrievers can be used in cases of migration of liquid embolic agents to normal vasculature with good clinical and radiological results.

scholarly journals Successful Bridging Therapy in a 103-Year-Old Woman with Acute Terminal Internal Carotid Artery Occlusion

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 9-14
Author(s):  
Trung Quoc Nguyen ◽  
Hoang Thi Phan ◽  
Tinh Quang Dang ◽  
Vu Thanh Tran ◽  
Thang Huy Nguyen
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Left Internal Carotid Artery ◽  
Bridging Therapy ◽  
Nihss Score ◽  
Current Guidelines

The efficacy of intravenous thrombolysis and endovascular therapy and their favorable treatment outcomes have been established in clinical trials irrespective of age. Current guidelines do not recommend an age limit in selecting eligible patients for reperfusion treatment as long as other criteria are satisfied. A 103-year-old woman was admitted at our hospital within 1 h of stroke onset secondary to a left internal carotid artery terminus occlusion. On admission, her National Institutes of Health Stroke Scale (NIHSS) score was 30, with a small left thalamic diffusion restriction lesion on MRI. Her medical history included paroxysmal atrial fibrillation, prior myocardial infarction, hypertension, chronic kidney disease, and diabetes mellitus. Her pre-stroke modified Rankin Scale score was 0, and she was fully independent before stroke. Once intravenous thrombolysis was started, the patient successfully underwent mechanical thrombectomy, and thrombolysis in cerebral infarction-3 recanalization was achieved 225 min after symptom onset. She showed dramatic recovery (NIHSS score of 5 after 48 h) and was discharged on day 7 with a modified Rankin Score of 1. To our knowledge, our patient is the second oldest documented patient who successfully underwent bridging therapy for stroke.

scholarly journals Effect of intravenous thrombolysis in stroke depends on pattern of intracranial internal carotid artery calcification

2021 ◽  
Vol 316 ◽  
pp. 8-14
Author(s):  
Frans Kauw ◽  
Pim A. de Jong ◽  
Richard A.P. Takx ◽  
Hugo W.A.M. de Jong ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Carotid Artery Calcification

Abstract P573: The Interplay Between Mineral and Skeletal Metabolism Biomarkers and Intracranial Internal Carotid Artery Calcifications in Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ethem M Arsava ◽  
Dogan Dinc Oge ◽  
Ozge Berna Gultekin-Zaim ◽  
Ekim Gumeler ◽  
Jeong-Min Kim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
The Body ◽  
Stroke Patients ◽  
Vitamin D Levels ◽  
History Of ◽  
Medial Calcification

Background: Intracranial internal carotid artery calcifications (IICAC), considered a phenomenon within the spectrum of atherosclerosis and vascular aging, are frequently encountered in ischemic stroke patients. While intimal IICAC directly contributes to ischemic stroke pathophysiology, the medial counterpart is generally deemed as a risk factor for vascular end-points. Apart from aging and cardiovascular risk factors, the underlying pathophysiology that contributes to development of IICAC is not well understood; herein we studied the interplay between mineral and skeletal metabolism biomarkers, and IICAC presence and pattern. Methods: In a prospective series of 194 ischemic stroke patients (mean±SD age: 69±14 yr), blood samples were collected to determine calcium, phosphorus, magnesium, osteocalcin, parathyroid hormone, and vitamin D levels within 72 hours of symptom onset. IICAC presence and type was determined on admission CT-angiography source images; a medial or intimal type of IICAC category was assigned according to Kockelkoren criteria. Results: A total of 45 (23%) patients had no calcifications, while 95 (49%) had an intimal pattern and 54 (28%) had non-intimal (or medial) pattern. Apart from the well-known factors related with IICAC, such as age, lower glomerular filtration rate (GFR), history of hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation, we identified admission magnesium levels to be associated with IICAC presence and pattern (no calcification: 1.96±0.18 mEq/L, intimal calcification 1.93±0.19 mEq/L, medial calcification: 1.81±0.28 mEq/L; p=0.006). None of the other biomarkers had any significant relationship to IICAC. In multivariate models, a lower magnesium level was significantly associated with medial calcification (each 0.1 mEq/L drop increased the odds by 1.2 (95% CI 1.0-1.4; p=0.046)), in addition to older age, history of diabetes mellitus and lower GFR. Conclusion: Hypomagnesemia is one of the factors well-known to be associated with vascular calcifications in the body. Our findings, extend this relationship to the intracranial vascular bed. No similar association was observed for other biomarkers related to mineral and skeletal metabolism. (Funding: TUBITAK grant 218S753)

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