E-136 endovascular rescue therapy post-stentriever use in large vessel occlusion; real world experience from a regional stroke network

2015 ◽  
Vol 7 (Suppl 1) ◽  
pp. A103.2-A104
Author(s):  
K Patel ◽  
P Bhuva ◽  
P Hansen ◽  
R Gianatasio ◽  
T Shams ◽  
...  
Keyword(s):  
Real World ◽  
Rescue Therapy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

SOFIA catheter for direct aspiration of large vessel occlusion stroke: A single-center cohort and meta-analysis

2021 ◽  
pp. 159101992110053
Author(s):  
Federico Bolognini ◽  
Pablo A Lebedinsky ◽  
Mariano Musacchio ◽  
Mariette Delaitre ◽  
Abdoulaye M Traoré ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Meta Analysis ◽  
Functional Independence ◽  
Large Vessel ◽  
Study Cohort ◽  
Large Vessel Occlusion ◽  
First Line ◽  
Vessel Occlusion ◽  
Global Rate ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose Direct aspiration (DA) using large-bore distal aspiration catheters is an established strategy for the endovascular thrombectomy (EVT) of large-vessel occlusion stroke (LVOS). However, the performance of individual catheters like SOFIA has yet to be examined. Methods We present a cohort of 144 consecutive patients treated with first-line DA and SOFIA 6 F Plus catheter for LVOS. We also conducted a systematic review of the literature searching multiple databases for reports on thrombectomy with DA and SOFIA catheters and performed a meta-analysis of recanalization, safety, and clinical outcomes. Results In the study cohort a successful recanalization (mTICI 2b-3) rate of 75.7% was achieved with DA alone, the global rate for functional independence (90-day mRS 0-2) was 40.3%. For the metanalysis we selected nine articles that included a total of 758 patients treated with first-line thrombectomy with the SOFIA catheters. The mTICI 2b-3 rate was 71.6% (95%CI, 66.3-76.5%) while a rescue stent-retriever was used in 24.1% (95%CI, 17.7-31.9%) of cases. The overall mTICI2b-3 rate after DA and rescue therapy was 88.9% (95%CI, 82.6-93.1%). We found a pooled estimate of 45.6% (95%CI, 38.6-52.8%) for functional independence, a mortality within 90 days of 19% (95%CI, 14.1-25.0%) and a rate of 5.8% (95%CI, 4.2-8.0%) of symptomatic intracranial hemorrhage. Conclusion The DA approach for LVOS with the SOFIA catheters is highly effective with an efficacy and safety profile comparable to those found in contemporary thrombectomy trials and observational studies that use other devices or approaches.

Abstract TP34: Real World Efficacy of Endovascular Thrombectomy in Patients With Acute Cerebral Large Vessel Occlusion in Japan - First Report From RESCUE-Japan Registry 2

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Shinichi Yoshimura ◽  
Nobuyuki Sakai ◽  
Kazutaka Uchida ◽  
Masayuki Ezura ◽  
Yasushi Okada ◽  
...  
Keyword(s):  
Real World ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
First Report

scholarly journals Thrombectomy Versus Combined Thrombolysis and Thrombectomy in Patients With Acute Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Xu Tong ◽  
Yilong Wang ◽  
Jens Fiehler ◽  
Clayton T. Bauer ◽  
Baixue Jia ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Real World ◽  
Odds Ratio ◽  
Large Vessel ◽  
Practice Setting ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: A recent randomized controlled trial DIRECT-MT (Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals) compared the safety and efficacy of mechanical thrombectomy (MT) versus combined intravenous thrombolysis (IVT) and MT for acute large vessel occlusion. The current study utilized a prospective, nationwide registry to validate the results of the DIRECT-MT trial in a real-world practice setting. Methods: Subjects were selected from a prospective cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals from 26 provinces in China (ANGEL-ACT registry [Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke]) between November 2017 and March 2019. All patients eligible for IVT and receiving MT were reviewed and then grouped according to whether prior IVT or not (MT and combined IVT+MT). After a 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale, successful recanalization, door-to-puncture time, symptomatic intracranial hemorrhage, and intraprocedural embolization were compared. Results: A total of 1026 patients, 600 in the MT group and 426 in the combined group, were included. Among 788 patients identified after matching, there were no significant differences in the 90-day modified Rankin Scale (median, 3 versus 3 points; P =0.82) and successful recanalization (86.6% versus 89.3%; P =0.23) between the two groups; however, patients of the MT group had a shorter door-to-puncture time (median, 112 versus 136 minutes; β=−45.02 [95% CI, −68.31 to −21.74]), lower rates of symptomatic intracranial hemorrhage (5.5% versus 10.1%; odds ratio, 0.52 [95% CI, 0.30–0.91]), and embolization (4.6% versus 8.1%; odds ratio, 0.54 [95% CI, 0.30–0.98]) than those of the combined group. Conclusions: This matched-control study largely confirmed the findings of the DIRECT-MT trial in a real-world practice setting, suggesting that MT may carry similar effectiveness to combined IVT+MT for acute large vessel occlusion patients, despite MT alone seems to be associated with a shorter in-hospital delay until procedure, lower risks of symptomatic intracranial hemorrhage, and embolization. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03370939.

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

Stroke ◽  
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:

‘Real-world’ comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study

2019 ◽  
Vol 11 (10) ◽  
pp. 957-963 ◽  
Author(s):  
Michael Martini ◽  
J Mocco ◽  
Aquilla Turk ◽  
Adnan H Siddiqui ◽  
David Fiorella ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Large Vessel ◽  
Treatment Technique ◽  
Large Vessel Occlusion ◽  
First Line ◽  
Vessel Occlusion

BackgroundThrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to ’real-world' practice.ObjectiveTo compare revascularization rates and outcomes for direct aspiration (ADAPT) and stent retriever thrombectomy following anterior acute ischemic stroke (AIS) in a real-life setting.MethodsData from the most recent 20 consecutive patients with AIS treated with mechanical thrombectomy between 2015 and 2016 were collected from 15 high-volume stroke centers across North America for a total of 300 cases. Patients with proximal anterior large vessel occlusions were dichotomized by primary treatment technique. Ordinal logistic regression assessed the effects of clinical variables on patient disability using 90-day modified Rankin Scale (mRS) scores.ResultsAdequate revascularization (Thrombolysis in Cerebral Infarction ≥2b) was ultimately achieved in 91.2% of first-line direct aspiration (ADAPT) cases with an average of 1.9±1.9 passes and in 87.5% of stent retriever cases with an average of 1.7±1.0 passes. Time from groin puncture to revascularization was shorter for ADAPT cases. The mean 90-day mRS score for both groups was 3.0±2.4. Number of passes using primary technique, and postintervention intracranial hemorrhage, were significant predictors of 90-day mRS scores after ADAPT, while age and preprocedure mRS score were predictive of outcomes following first-line stent retriever.ConclusionsOur data show similar adequate revascularization rates and 90-day functional outcomes for first-line direct aspiration and stent retrievers for anterior large vessel occlusion in a real-world setting. These results support the findings of other prospective trials evaluating the two techniques.

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