scholarly journals Repeated mechanical thrombectomy in short-term large vessel occlusion recurrence: multicenter study and systematic review of the literature

2020 ◽  
pp. neurintsurg-2020-015938 ◽  
Author(s):  
Hanna Styczen ◽  
Christian Maegerlein ◽  
Leonard LL Yeo ◽  
Christin Clajus ◽  
Andreas Kastrup ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Thrombectomy ◽  
Tertiary Care ◽  
Functional Independence ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Review Of The Literature ◽  
Short Term ◽  
Vessel Occlusion ◽  
Similar Good

BackgroundData on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature.MethodsA retrospective analysis was conducted of consecutive acute stroke patients treated with MT repeatedly within 30 days at 10 tertiary care centers between January 2007 and January 2020. Baseline demographics, etiology of stroke, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at 90 days were noted. Additionally, a systematic review of reports with repeated MT due to large vessel occlusion (LVO) recurrence was performed.ResultsWe identified 30 out of 7844 (0.4%) patients who received two thrombectomy procedures within 30 days due to recurrent LVO. Through systematic review, three publications of 28 participants met the criteria for inclusion. Combined, a total of 58 participants were analyzed: cardioembolic events were the most common etiology for the first (65.5%) and second LVO (60.3%), respectively. Median baseline NIHSS (National Institutes of Health Stroke Scale) was 13 (IQR 8–16) before the first MT and 15 (IQR 11–19) before the second MT (p=0.031). Successful reperfusion was achieved in 91.4% after the first MT and in 86.2% patients after the second MT (p=0.377). The rate of functional independence (mRS 0–2) was 46% at 90 days after the second procedure.ConclusionRepeated MT in short-term recurrent LVO is a rarity but appears to be safe and effective. The second thrombectomy should be pursued with the same extensive effort as the first procedure as these patients may achieve similar good outcomes.

Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature

2018 ◽  
Vol 11 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Nikita Lakomkin ◽  
Mandip Dhamoon ◽  
Kirsten Carroll ◽  
Inder Paul Singh ◽  
Stanley Tuhrim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Review Of The Literature ◽  
Qualitative Synthesis ◽  
Vessel Occlusion ◽  
Number Of Patients ◽  
Meta Analyses

BackgroundAccurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention.ObjectiveTo perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis.MethodsA systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper.ResultsSixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study.ConclusionsDespite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.

Presence of the hyperintense acute reperfusion marker on MRI after mechanical thrombectomy for large vessel occlusion is associated with worse early neurological recovery

2016 ◽  
Vol 9 (7) ◽  
pp. 641-643 ◽  
Author(s):  
Rishi Gupta ◽  
Chung-Huan Johnny Sun ◽  
Dustin Rochestie ◽  
Kumiko Owada ◽  
Ahmad Khaldi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Reperfusion Injury ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Functional Independence ◽  
Large Vessel ◽  
Neurological Recovery ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Nihss Score

BackgroundMechanical thrombectomy has become the accepted treatment for large vessel occlusion in acute ischemic stroke. Unfortunately, a large cohort of patients do not achieve functional independence with treatment, even though the results are more robust than with medical management. The hyperintense acute reperfusion marker (HARM) on MRI is an indication of the breakdown of the blood–brain barrier and reperfusion injury.ObjectiveTo examine the hypothesis that the presence of HARM on MRI correlates with worse neurological recovery after reperfusion therapy.MethodsWe retrospectively reviewed 35 consecutive patients who between February 24, 2016 and April 23, 2016 underwent MRI to determine the presence of HARM after thrombectomy for anterior circulation large vessel occlusion. Demographic, radiographic imaging, and outcome data were collected. Univariate and binary logistic regression models were performed to assess predictors for improvement of the National Institutes of Health Stroke Scale (NIHSS) score by ≥8 points at 24 hours.ResultsThe 35 patients studied had an average age of 64±14 years of age with a median NIHSS score of 15 (IQR 9–20). Eighteen patients (51%) were found to have a HARM-positive MRI. In univariate analysis, patients with HARM were older, had lower reperfusion rates and more postprocedural hemorrhages. In binary logistic regression modeling, the absence of HARM was independently associated with a ≥8-point NIHSS score improvement at 24 hours (OR=7.14, 95% CI 1.22 to 41.67).ConclusionsThis preliminary analysis shows that the presence of HARM may be linked to worse neurological recovery 24 hours after thrombectomy. Reperfusion injury may affect the number of patients achieving functional independence after treatment.

scholarly journals Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

2019 ◽  
Author(s):  
Tianli Zhang ◽  
Xiaolong Wang ◽  
Chao Wen ◽  
Feng Zhou ◽  
Shengwei Gao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Area Under The Curve ◽  
Functional Independence ◽  
Large Vessel ◽  
Multivariable Logistic Regression Analysis ◽  
Large Vessel Occlusion ◽  
Short Term ◽  
Vessel Occlusion ◽  
Blood Pressures

Abstract Background: Endovascular treatment (EVT) is advocated for acute ischemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging.This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients. Methods: We retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 hours post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Three-month functional independence was defined as a modified Rankin Scale (mRS) score of 0-2. Results: For 58.3% patients with favorable outcomes, median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3±16.8] vs. [163.5±15.6], P=0.02), systolic CV ([8. 8%±2.0%] vs. [11.0%±1.8%], P<0.001), SV ([11.4±2.3] vs. [14.6±2.0], P<0.001), and SD ([10.5±2.4] vs. [13.8±3.9], P<0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P=0.045) independently predicted unfavorable prognosis. The area under the curve was 0.868 (95% CI: 0.781 to 0.955, P<0.001), and sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent value for 3-month poor-outcome predictions. Conclusions: Decreased systolic SV following intra-arterial therapies result in favorable 3-month outcomes. Systolic SV may be a novel predictor of functional prognosis in LVO patients.

scholarly journals Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature

2020 ◽  
Vol 41 (12) ◽  
pp. 3517-3525
Author(s):  
Lucio D’Anna
Keyword(s):  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel ◽  
Controlled Trials ◽  
Large Vessel Occlusion ◽  
Review Of The Literature ◽  
Vessel Occlusion

Abstract Background Mechanical thrombectomy is the standard of care, in selected patients, for acute ischemic stroke with large vessel occlusion but its use in patients with stroke secondary to infective endocarditis is controversial. We report three cases of acute ischemic stroke treated by mechanical thrombectomy and we propose an extensive review of the literature to evaluate the clinical safety and efficacy of thrombectomy in patients with stroke secondary to infective endocarditis. Methods A comprehensive literature search was performed following a pre-specified protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Case reports, cases series, cross-sectional studies, case control studies, randomized controlled trials or nonrandomized controlled trials were considered that included endocarditis-related acute ischemic stroke patients who underwent mechanical thrombectomy. Results The database search yielded 431 relevant records published until January 2020. Nineteen articles fulfilled the eligibility criteria that described thirty patients. After the thrombectomy, 13.3% of the patients experienced intracranial haemorrhage. After the procedure, the median National Institutes of Health Stroke Scale score dropped from 15 (IQR 7) to 2.5 (IQR 5.75). At 90 days, mortality was 23.3% while 46.7% of the patients were functionally independent (mRS ≤ 2). Discussion Based on our review, the use of mechanical thrombectomy in patients with large vessel occlusion due to endocarditis-associated stroke might improve patient outcome but it should be considered on a case by case base as the safety has not been well established yet. Further research on risk stratification is needed to drive clinician during the decision-making process.

scholarly journals Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tianli Zhang ◽  
Xiaolong Wang ◽  
Chao Wen ◽  
Feng Zhou ◽  
Shengwei Gao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Area Under The Curve ◽  
Functional Independence ◽  
Large Vessel ◽  
Multivariable Logistic Regression Analysis ◽  
Large Vessel Occlusion ◽  
Short Term ◽  
Vessel Occlusion ◽  
Poor Outcomes

Abstract Background Endovascular treatment (EVT) is advocated for acute ischaemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging. This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients. Methods We retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 h post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Functional independence at 3 months was defined as a modified Rankin Scale (mRS) score of 0–2. Results For 58.3% patients with favorable outcomes, the median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3 ± 16.8] vs. [163.5 ± 15.6], P = 0.02), systolic CV ([8. 8% ± 2.0%] vs. [11.0% ± 1.8], P < 0.001), SV ([11.4 ± 2.3] vs. [14.6 ± 2.0], P < 0.001), and SD ([10.5 ± 2.4] vs. [13.8 ± 3.9], P < 0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P = 0.045) independently predicted unfavorable prognosis. The area under the curve was 0.868 (95% CI: 0.781 to 0.955, P < 0.001), and sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent predictive value for 3-month poor-outcomes. Conclusions Decreased systolic SV following intra-arterial therapies result in favorable outcomes at 3 months. Systolic SV may be a novel predictor of functional prognosis in LVO patients.

Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy

2017 ◽  
Vol 10 (2) ◽  
pp. 112-117 ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Abhi Pandhi ◽  
Kira Dillard ◽  
Aristeidis H Katsanos ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Serum Glucose ◽  
Adverse Outcomes ◽  
Large Vessel ◽  
Functional Improvement ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Logistic Regression Models ◽  
Median Admission

Background and purposeHigher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT).MethodsConsecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0–2), and functional improvement (shift in mRS score) at 3 months. The association of admission serum glucose and admission hyperglycemia (>140 mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models.Results231 AIS patients with ELVO (mean age 62±14 years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12–21), median admission serum glucose 125 mg/dL (IQR 104–162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion.ConclusionsHigher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.

Intraarterial urokinase for thrombus migration after mechanical thrombectomy for large vessel ischemic stroke

2021 ◽  
pp. 159101992110694
Author(s):  
Hiroaki Neki ◽  
Takehiro Katano ◽  
Takuma Maeda ◽  
Aoto Shibata ◽  
Hiroyuki Komine ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Large Vessel ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Procedure Time ◽  
Vessel Occlusion ◽  
The Uk ◽  
Ultimate Purpose

Background Achieving rapid and complete reperfusion is the ultimate purpose for ischemic stroke with large vessel occlusion (LVO). Although mechanical thrombectomy (MT) had been a proverbially important procedure, medium vessel occlusion (MeVO) with thrombus migration can sporadically occur after MT. Moreover, the safe and effective approach for such had been unknown. We reported thrombolysis with intraarterial urokinase for MeVO with thrombus migration after MT. Methods We included 122 patients who were treated by MT with LVO stroke at our institution between April 2019 and March 2021. Of 26 patients (21.3%) who developed MeVO with thrombus migration after MT, 11 (9.0%) underwent additional MT (MT group) and 15 (12.3%) received intraarterial urokinase (UK group). The procedure time; angiographically modified Treatment in Cerebral Ischemia Scale (mTICI); functional independence, which was defined as modified Rankin Scale 0–2, on day 30 or upon discharge; and symptomatic and asymptomatic intracerebral hemorrhage (ICH) were compared between the UK and MT groups. Results The procedure time, mTICI, and asymptomatic ICH did not significantly differ between the groups. In the UK group, 8 of 15 (53.3%) patients obtained functional independence, and the functional independence rate was significantly higher in the UK group than in the MT group ( p < 0.05). Symptomatic ICH did not occur in the UK group, and its incidence was significantly smaller than that in the MT group ( p < 0.05). Conclusion The results of this study suggest that intraarterial urokinase for MeVO with thrombus migration after MT may safely improve angiographic reperfusion.

Abstract WP31: Fibrin Rich Thrombus versus Erythrocyte Rich Thrombus in Acute Large Vessel Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kota Maekawa ◽  
Masunari Shibata ◽  
Masaru Seguchi ◽  
Kazuto Kobayashi ◽  
Hidetaka Nakajima ◽  
...  
Keyword(s):  
Blood Cells ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
White Blood Cells ◽  
Functional Independence ◽  
Large Vessel ◽  
Basilar Artery Occlusion ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference

Objective: The aim of this study was to evaluate thrombus composition and its association with clinical, laboratory, and neurointerventional findings in patients treated by mechanical thrombectomy due to acute large vessel occlusion. Methods: From August 2015 to June 2016, 72 patients were treated in our hospital by mechanical thrombectomy using stent retriever and/or aspiration catheter. Retrieved thrombi underwent semiquantitative analysis to quantify red blood cells, white blood cells, and fibrin by area. We divided patients into two groups as fibrin rich group or erythrocyte rich group according to predominant composition in thrombus. Two groups were compared with respect to imaging, clinical, and neurointerventional data. Results: Histopathologic analysis of retrieved thrombus from 37 patients with acute stroke due to internal carotid artery, middle cerebral artery, or basilar artery occlusion was performed. Erythrocyte rich thrombi were present in 13 (35%) of cases, and fibrin rich thrombi in 24 (65%). Cardioembolic etiology was significantly more in patients with fibrin rich thrombi than those with erythrocyte rich thrombi (79% vs. 38%; p=0.01). All other clinical and laboratory characteristics did not differ. Patients with fibrin rich thrombi had greater number of recanalization maneuvers (2.8 ± 1.2 vs. 1.8 ± 1.6, p=0.04) and longer interval time between puncture and recanalization (62 ± 33.6 minutes vs. 42 ± 21.3 minutes; p=0.04). There is no significant difference in occluded vessels and mechanical thrombectomy devices between two groups. Patients with fibrin rich thrombi were lower rate of functional independence (mRS score, 0-2) at 90 days (33% vs. 75%; p=0.04). Conclusion: This study showed that fibirin rich thrombus was associated with extended procedure time, unfavorable clinical outcome and cardioembolic etiology.

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