Arterial wall injury and miRNA expression induced by stent retriever thrombectomy under stenotic conditions in a dog model

BackgroundAcute ischemic stroke can be caused by in situ stenotic vessel occlusion. In the present study, we compared the extent of arterial wall damage and miRNA expression following stent retriever use under normal and stenotic conditions.MethodsThe stent retriever procedure was simulated in three dogs by the creation of four stenoses on each side of the common carotid artery (CCA) to allow five stent passages. Device safety was also assessed in normal control models by five passages through both CCAs. Device manipulation-related damage to the arterial walls was evaluated and compared between groups by angiography and pathological analysis. Real-time PCR was used to evaluate the differences in the expression of miRNAs between the two groups.ResultsTwenty-four stenoses were created in three model dogs, and the mean stenosis rate was 65.58%±18.95%. Angiography revealed greater vasospasm in the stenotic group than in the non-stenotic group (1.17±0.17 vs 0.5±0.23; P=0.04). Pathological examination revealed that SR passage through the stenotic lumen caused higher injury scores (1.63±0.19 vs 0.25±0.09 for the non-stenotic lumen; P<0.001), more endothelial denudation (1.79±0.13 vs 0.58±0.13 for the non-stenotic lumen; P<0.001), and increased thrombus deposition (0.71±0.14 vs 0±0 for the non-stenotic lumen; P<0.001). miR21-3p, miR29-3p, and miR26a were upregulated in stenotic vessels compared with non-stenotic vessels after SR thrombectomy (P<0.001).ConclusionIn our model dogs, SR thrombectomy resulted in more severe tissue damage to the arterial wall under stenotic conditions than under non-stenotic conditions. The damage may have resulted from upregulation of miR21-3p, miR29-3p, and miR26a expression.

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Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration

Journal of Neurosurgery ◽

10.3171/2019.1.jns182905 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1202-1208 ◽

Cited By ~ 4

Author(s):

Dong-Hun Kang ◽

Woong Yoon ◽

Byung Hyun Baek ◽

Seul Kee Kim ◽

Yun Young Lee ◽

...

Keyword(s):

Binary Logistic Regression ◽

Stent Retriever ◽

Large Vessel ◽

Binary Logistic Regression Analysis ◽

Large Vessel Occlusion ◽

Front Line ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Atherosclerotic Stenosis ◽

Antegrade Flow

OBJECTIVEThe optimal front-line thrombectomy choice for primary recanalization of a target artery remains unknown for patients with acute large-vessel occlusion (LVO) and an underlying intracranial atherosclerotic stenosis (ICAS). The authors aimed to compare procedural characteristics and outcomes between patients who received a stent-retriever thrombectomy (SRT) and patients who received a contact aspiration thrombectomy (CAT), as the front-line approach for treating LVO due to severe underlying ICAS.METHODSOne hundred thirty patients who presented with acute LVO and underlying severe ICAS at the occlusion site were included. Procedural characteristics and treatment outcomes were compared between patients treated with front-line SRT (n = 70) and those treated with front-line CAT (n = 60). The primary outcomes were the rate of switching to an alternative thrombectomy technique, time from groin puncture to initial reperfusion, and duration of the procedure. Initial reperfusion was defined as revealing the underlying culprit stenosis with an antegrade flow after thrombectomy.RESULTSThe rate of switching to an alternative thrombectomy after failure of the front-line technique was significantly higher in the CAT group than in the SRT group (40% vs 4.3%; OR 2.543, 95% CI 1.893–3.417, p < 0.001). The median time from puncture to initial reperfusion (17 vs 31 minutes, p < 0.001) and procedure duration (39 vs 75.5 minutes, p < 0.001) were significantly shorter in the SRT group than in the CAT group. In the binary logistic regression analysis, a longer time from puncture to initial reperfusion was an independent predictor of a 90-day poor (modified Rankin Scale score 3–6) functional outcome (per 1-minute increase; OR 1.029, 95% CI 1.008–1.050, p = 0.006).CONCLUSIONSThe authors’ results suggest that SRT may be more effective than CAT for identifying underlying culprit stenosis and therefore considered the optimal front-line thrombectomy technique in acute stroke patients with LVO and severe underlying ICAS.

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Comparison of Mammography and Ultrasonography for Tumor Size of DCIS of Breast Cancer

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180131163321 ◽

2019 ◽

Vol 15 (2) ◽

pp. 209-213

Author(s):

Yu Wang ◽

Jiantao Wang ◽

Haiping Wang ◽

Xinyu Yang ◽

Liming Chang ◽

...

Keyword(s):

Breast Cancer ◽

Correlation Coefficient ◽

Tumor Size ◽

Ductal Carcinoma ◽

Pearson Correlation ◽

Dense Breast ◽

Pathological Examination ◽

Negative Group ◽

The Difference

Objective: Accurate assessment of breast tumor size preoperatively is important for the initial decision-making in surgical approach. Therefore, we aimed to compare efficacy of mammography and ultrasonography in ductal carcinoma in situ (DCIS) of breast cancer. Methods: Preoperative mammography and ultrasonography were performed on 104 women with DCIS of breast cancer. We compared the accuracy of each of the imaging modalities with pathological size by Pearson correlation. For each modality, it was considered concordant if the difference between imaging assessment and pathological measurement is less than 0.5cm. Results: At pathological examination tumor size ranged from 0.4cm to 7.2cm in largest diameter. For mammographically determined size versus pathological size, correlation coefficient of r was 0.786 and for ultrasonography it was 0.651. Grouped by breast composition, in almost entirely fatty and scattered areas of fibroglandular dense breast, correlation coefficient of r was 0.790 for mammography and 0.678 for ultrasonography; in heterogeneously dense and extremely dense breast, correlation coefficient of r was 0.770 for mammography and 0.548 for ultrasonography. In microcalcification positive group, coeffient of r was 0.772 for mammography and 0.570 for ultrasonography. In microcalcification negative group, coeffient of r was 0.806 for mammography and 0.783 for ultrasonography. Conclusion: Mammography was more accurate than ultrasonography in measuring the largest cancer diameter in DCIS of breast cancer. The correlation coefficient improved in the group of almost entirely fatty/ scattered areas of fibroglandular dense breast or in microcalcification negative group.

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EXPRESS: Stent Retriever Alone vs. Aspiration and Stent-Retriever Combination in Large Vessel Occlusion Stroke: A Matched Analysis

International Journal of Stroke ◽

10.1177/17474930211019204 ◽

2021 ◽

pp. 174749302110192

Author(s):

Mahmoud H Mohammaden ◽

Diogo C. Haussen ◽

Leonardo Pisani ◽

Alhamza Al-Bayati ◽

Aaron Anderson ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Functional Independence ◽

Stent Retriever ◽

Sensitivity Analyses ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Guide Catheter ◽

First Pass ◽

Combined Technique

Background Three randomized clinical trials have reported similar safety and efficacy for contact aspiration (CA) and Stent-retriever (SR) thrombectomy. Aim We aimed to determine whether the Combined Technique (SR+CA) was superior to SR alone as first-line thrombectomy strategy in a patient cohort where balloon-guide catheter was universally used. Methods A prospectively maintained mechanical thrombectomy database from January 2018-December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent SR alone thrombectomy or SR+CA as first-line therapy. The primary outcome was the first-pass effect (FPE) (mTICI2c-3). Secondary outcomes included modified FPE (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS â¤2). Safety outcomes included rate of parenchymal hematoma (PH) type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. Results A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16[11-21]). As compared to first-line SR alone, first-line SR+CA resulted in similar rates of FPE (53% vs. 51%,aOR 1.122, 95%CI[0.745-1.691],p=0.58), mFPE (63% vs. 60.4%,aOR1.250, 95%CI[0.782-2.00],p=0.35), final successful reperfusion (97.6% vs. 98%,p=0.75) and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%,aOR 2.033, 95%CI[1.209-3.419],p=0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line SR+CA treatment (81.8% vs. 73.6%,aOR 1.881, 95%CI[1.039-3.405],p=0.037). Conclusions Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a Combined Technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, addition of contact aspiration after initial SR failure might be beneficial in achieving earlier reperfusion.

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Endovascular therapy in patients with large vessel occlusion due to cardioembolism versus large-artery atherosclerosis

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286421999017 ◽

2021 ◽

Vol 14 ◽

pp. 175628642199901

Author(s):

Meredeth Zotter ◽

Eike I. Piechowiak ◽

Rupashani Balasubramaniam ◽

Rascha Von Martial ◽

Kotryna Genceviciute ◽

...

Keyword(s):

Heart Failure ◽

Endovascular Therapy ◽

Independent Predictor ◽

Intravenous Thrombolysis ◽

Stent Retriever ◽

Large Vessel ◽

Large Artery ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Significant Difference

Background and aims: To investigate whether stroke aetiology affects outcome in patients with acute ischaemic stroke who undergo endovascular therapy. Methods: We retrospectively analysed patients from the Bernese Stroke Centre Registry (January 2010–September 2018), with acute large vessel occlusion in the anterior circulation due to cardioembolism or large-artery atherosclerosis, treated with endovascular therapy (±intravenous thrombolysis). Results: The study included 850 patients (median age 77.4 years, 49.3% female, 80.1% with cardioembolism). Compared with those with large-artery atherosclerosis, patients with cardioembolism were older, more often female, and more likely to have a history of hypercholesterolaemia, atrial fibrillation, current smoking (each p < 0.0001) and higher median National Institutes of Health Stroke Scale (NIHSS) scores on admission ( p = 0.030). They were more frequently treated with stent retrievers ( p = 0.007), but the median number of stent retriever attempts was lower ( p = 0.016) and fewer had permanent stent placements ( p ⩽ 0.004). Univariable analysis showed that patients with cardioembolism had worse 3-month survival [72.7% versus 84%, odds ratio (OR) = 0.51; p = 0.004] and modified Rankin scale (mRS) score shift ( p = 0.043) and higher rates of post-interventional heart failure (33.5% versus 18.5%, OR = 2.22; p < 0.0001), but better modified thrombolysis in cerebral infarction (mTICI) score shift ( p = 0.025). Excellent (mRS = 0–1) 3-month outcome, successful reperfusion (mTICI = 2b–3), symptomatic intracranial haemorrhage and Updated Charlson Comorbidity Index were similar between groups. Propensity-matched analysis found no statistically significant difference in outcome between stroke aetiology groups. Stroke aetiology was not an independent predictor of favourable mRS score shift, but lower admission NIHSS score, younger age and independence pre-stroke were (each p < 0.0001). Stroke aetiology was not an independent predictor of heart failure, but older age, admission antithrombotics and dependence pre-stroke were (each ⩽0.027). Stroke aetiology was not an independent predictor of favourable mTICI score shift, but application of stent retriever and no permanent intracranial stent placement were (each ⩽0.044). Conclusion: We suggest prospective studies to further elucidate differences in reperfusion and outcome between patients with cardioembolism and large-artery atherosclerosis.

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Basal Cell Carcinoma of Prostate With MSMB–NCOA4 Fusion and a Probable Basal Cell Carcinoma In Situ: Case Report

International Journal of Surgical Pathology ◽

10.1177/10668969211017321 ◽

2021 ◽

pp. 106689692110173

Author(s):

Vilde Pedersen ◽

Katrine S. Petersen ◽

Klaus Brasso ◽

Olga Østrup ◽

Anand C. Loya

Keyword(s):

Prostate Cancer ◽

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Basal Cell ◽

Carcinoma In Situ ◽

Pathological Examination ◽

Molecular Characteristics ◽

Histological Lesion ◽

Basal Cell Carcinomas

Basal cell carcinomas of prostate (BCCP) are very rare. Most arise in the transition zone and thus are associated with lower urinary tract symptoms and rarely associated with elevated prostate-specific antigen (PSA). These features make diagnosis/early diagnosis difficult because of the routine protocols followed. Basal cell carcinomas have distinctive histopathological, immunohistochemical, and to some extent also different molecular characteristics. Basal cell carcinoma in situ (BCCIS) is a nonexistent histological lesion as per the current literature, but here is an attempt to describe it through this case. A 74-year-old man presented with hematuria and previous diagnosis of prostatic hyperplasia. Based on this history, he underwent a prostatectomy ad modum Freyer. Pathological examination surprisingly revealed a diffusely infiltrative tumor with nonacinar adenocarcinoma morphology and many glandular structures probably representing BCCIS. Tumor was diagnosed as BCCP. Patient presented with metastasis to the abdominal wall 8 months postprostatectomy. BCCP is an aggressive type of prostate cancer, which might be challenging to diagnose based on routine protocols. This results in delayed diagnosis and treatment and thus poor prognosis. Furthermore, patients with this subtype of prostate cancer need appropriately designed, and maybe a totally different follow-up regimen as PSA is of no use for BCCP patients. Finally, diagnosis of BCCIS, if agreed upon its existence needs to be studied in larger cohorts as a precursor lesion.

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Microangiopathy in Ocular Sarcoidosis Using Fluorescein Gonio and Fundus Angiography from Diagnostic and Therapeutic Aspects

Diagnostics ◽

10.3390/diagnostics11010039 ◽

2020 ◽

Vol 11 (1) ◽

pp. 39

Author(s):

Teruhiko Hamanaka ◽

Noriko Akabane ◽

Tetsuro Sakurai ◽

Soichiro Ikushima ◽

Toshio Kumasaka ◽

...

Keyword(s):

Blood Vessel ◽

Pathological Examination ◽

Fundus Fluorescein Angiography ◽

Retinal Blood Vessel ◽

Vessel Occlusion ◽

Vascular Abnormalities ◽

Ocular Sarcoidosis ◽

Group I ◽

Bilateral Hilar Lymphadenopathy ◽

Iop Elevation

In this retrospective study, we investigated vascular abnormalities in sarcoidosis using fluorescein gonioangiography (FGA) to detect angle neovascularization (ANV), fundus fluorescein angiography (FFA), and pathological specimens from the aspects of microangiopathy. In 57 sarcoidosis patients, clinical data was reviewed by dividing the cases into three groups (Group I: histologically diagnosed; Group II: positive bilateral hilar lymphadenopathy (BHL); Group III: negative BHL). The FFA, FGA, and pathological examination data in the autopsy eyes and trabeculectomy specimens were investigated. FGA and FFA detected ANV (91%) and nodule-associated abnormalities (87%), respectively. No intraocular pressure (IOP) elevation was observed after continuous topical betamethasone, except in the steroid responder group. Maximum IOP had significant correlation with nodules in the angle (p = 0.02696) and visual field defect (p = 0.0151). Granulomas adjacent to blood vessels, including the Schlemm’s canal, and thickening of the retinal blood vessel wall caused occlusion of those vessels. Photocoagulation was required for retinal tears (14%) and the retinal blood vessel occlusion (7%). Suppression of IOP elevation via continuous topical betamethasone may be important to avoid irreversible outflow-route changes and optic-nerve damage, and the concept of microangiopathy in ocular sarcoidosis may be important for understanding the proper treatment of serious complications.

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Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective

Life ◽

10.3390/life11070658 ◽

2021 ◽

Vol 11 (7) ◽

pp. 658

Author(s):

Piotr Piasecki ◽

Marek Wierzbicki ◽

Piotr Tulik ◽

Katarzyna Potocka ◽

Adam Stępień ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Clinical Course ◽

Phantom Study ◽

Stent Retriever ◽

Vessel Occlusion ◽

Intracranial Vessel ◽

Mechanical Study ◽

Stent Retrievers ◽

Phantom Studies ◽

Stroke Centre

Background: The inadvertent detachment of stent retrievers during mechanical thrombectomy is an extremely rare but feared complication associated with poor clinical outcomes. We discuss management considerations after an unexpected disconnection of the pRESET stent retriever during mechanical thrombectomy, based on clinical experience and mechanical and phantom studies. Methods: We present a clinical course of rare accidents of stent-retriever separation inside an intracranial vessel that occurred in patients in a comprehensive stroke centre between 2018 and 2020. We designed a phantom study to assess the Tigertriever’s ability to remove a detached stent retriever from intercranial vessels. In the mechanical study, several types of stent retrievers were evaluated in order to find the weakest point at which detachment occurred. Results: Two patients (~0.7%) with inadvertent stent-retriever detachment were found in our database. Failed attempts of endovascular removal with no recanalization at the end of procedure were reported in both cases. mRS after 3 months was three and four respectively. In the mechanical study, the Tigertriever was the most resistant to detachment and was followed by Embotrap > pRESET > 3D Separator. In the phantom study, the pRESET device detached in a configuration resembling the M1 segment was successfully removed with the Tigertriever. Conclusions: Conservative management of the inadvertent detachment of stent retrievers during mechanical thrombectomy in large vessel occlusion may be acceptable in order to avoid further periprocedural complications after unsuccessful device removal attempts. Based on the phantom and mechanical studies, the Tigertriever may be a useful tool for the removal of detached pRESET devices.

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Inadvertent Stent Retriever Detachment: A Multicenter Case Series and Review of Device Experience FDA Reports

Interventional Neurology ◽

10.1159/000441920 ◽

2015 ◽

Vol 4 (3-4) ◽

pp. 75-82 ◽

Cited By ~ 9

Author(s):

Hesham Masoud ◽

Thanh N. Nguyen ◽

Coleman O. Martin ◽

William E. Holloway ◽

Sudheer Ambekar ◽

...

Keyword(s):

First Generation ◽

Mechanical Thrombectomy ◽

Rare Complication ◽

Case Series ◽

Standard Of Care ◽

Stent Retriever ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

The Us ◽

Solitaire Fr

Mechanical thrombectomy using retrievable stents or stent retriever devices has become the mainstay of intra-arterial therapy for acute ischemic stroke. The recent publication of a series of positive trials supporting intra-arterial therapy as standard of care for the treatment of large vessel occlusion will likely further increase stent retriever use. Rarely, premature stent detachment during thrombectomy may be encountered. In our multicenter case series, we found a rate of detachment of less than 1% (n = 7/1,067), and all were first-generation Solitaire FR devices. A review of the US Food and Drug Administration database of device experience yielded 90 individual adverse reports of detachment. There were 82, 1 and 7 detachments of Solitaire FR (first generation), Solitaire FR2 (second generation) and Trevo devices, respectively. We conclude with a brief overview of the technical and procedural considerations which may be helpful in avoiding this rare complication.

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Heterogeneity between proximal and distal aspects of occlusive thrombi on pretreatment imaging in acute ischemic stroke

The Neuroradiology Journal ◽

10.1177/19714009211049713 ◽

2021 ◽

pp. 197140092110497

Author(s):

Tetsuya Hashimoto ◽

Takenobu Kunieda ◽

Tristan Honda ◽

Fabien Scalzo ◽

Latisha K Sharma ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Region Of Interest ◽

Hounsfield Unit ◽

Distal Segment ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

The Difference

Background The potential heterogeneity in occlusive thrombi caused by in situ propagation by secondary thrombosis after embolic occlusion could obscure the characteristics of original thrombi, preventing the clarification of a specific thrombus signature for the etiology of ischemic stroke. We aimed to investigate the heterogeneity of occlusive thrombi by pretreatment imaging. Methods Among consecutive stroke patients with acute embolic anterior circulation large vessel occlusion treated with thrombectomy, we retrospectively reviewed 104 patients with visible occlusive thrombi on pretreatment non-contrast computed tomography admitted from January 2015 to December 2018. A region of interest was set on the whole thrombus on non-contrast computed tomography under the guidance of computed tomography angiography. The region of interest was divided equally into the proximal and distal segments and the difference in Hounsfield unit densities between the two segments was calculated. Results Hounsfield unit density in the proximal segment was higher than that in the distal segment (mean difference 4.45; p < 0.001), regardless of stroke subtypes. On multivariate analysis, thrombus length was positively correlated (β = 0.25; p < 0.001) and time from last-known-well to imaging was inversely correlated (β = −0.0041; p = 0.002) with the difference in Hounsfield unit densities between the proximal and distal segments. Conclusions The difference in density between the proximal and distal segments increased as thrombi became longer and decreased as thrombi became older after embolic occlusion. This time/length-dependent thrombus heterogeneity between the two segments is suggestive of secondary thrombosis initially occurring on the proximal side of the occlusion.

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Spontaneous Resolution of a Ruptured Dissecting PICA Aneurysm

Interventional Neuroradiology ◽

10.1177/159101999800400404 ◽

1998 ◽

Vol 4 (4) ◽

pp. 287-292 ◽

Cited By ~ 5

Author(s):

R.L. Piske ◽

R. Darwich ◽

C.M.S. Campos ◽

N.C. Fonseca ◽

E. Oliveira ◽

...

Keyword(s):

Subarachnoid Haemorrhage ◽

Arterial Wall ◽

Similar Case ◽

Clinical Course ◽

Dissecting Aneurysm ◽

Occipital Artery ◽

Minor Trauma ◽

Vessel Occlusion ◽

Dissecting Aneurysms

Spontaneous dissecting aneurysms (SDAs) seldom involve the intradural vertebral artery VA, the posterior cerebral, basilar or postero inferior cerebellar arteries (PICAs), where they produce subarachnoid haemorrhage and/or ischaemia. These lesions may develop spontaneously or occasionally after minor trauma and occur in young people in whom there is no underlying abnormality to explain the appearance of the dissection in most cases. Spontaneous dissecting aneurysm of the PICA is rare and its natural history is not well understood. Surgery or endovascular treatment for PICA dissection remain controversial because they suggest vessel occlusion. Only in a few cases is the bypass between the occipital artery and the PICA possible with trapping of the dissected segment. Reinforcement of the arterial wall does not seem efficient and the surgical approach per se with sole exclusion of the aneurysm may be disastrous. We describe two cases of SDA of PICA that presented with subarachnoid haemorrhage (SAH), treated conservatively, with spontaneous cure of the lesions, angiographically confirmed at mid-time follow-up of five and four months. These favourable spontaneous thromboses, like 11 other similar case reported in the literature, did not show any rebleed. The possibility of a benign clinical course of this lesion exists; clinical and angiographic management of the patient before a decision for a aggressive treatment is proposed.

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