scholarly journals Stroke thrombectomy complication management

2021 ◽  
pp. neurintsurg-2021-017349
Author(s):  
Sara M Pilgram-Pastor ◽  
Eike I Piechowiak ◽  
Tomas Dobrocky ◽  
Johannes Kaesmacher ◽  
Juergen Den Hollander ◽  
...  
Keyword(s):  
Treatment Efficacy ◽  
Mechanical Thrombectomy ◽  
Complication Management ◽  
Line Treatment ◽  
Large Vessel Occlusion ◽  
First Line ◽  
Invasive Treatment ◽  
Vessel Occlusion ◽  
Endovascular Mechanical Thrombectomy ◽  
First Line Treatment

Endovascular mechanical thrombectomy (EVT) is widely accepted as the first-line treatment for acute ischemic stroke in patients with large vessel occlusion. Being an invasive treatment, this method is associated with various preoperative, perioperative, and postoperative complications. These complications may influence peri-interventional morbidity and mortality and therefore treatment efficacy and clinical outcome. The aim of this review is to discuss the most common types of complications associated with EVT, the probable mechanisms of injury, and effective methods to manage and prevent complications.

scholarly journals Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Samuel Heller ◽  
Jean-Claude Lubanda ◽  
Petr Varejka ◽  
Miroslav Chochola ◽  
Pavel Prochazka ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Limb Ischemia ◽  
Performance Outcomes ◽  
Amputation Rate ◽  
Acute Limb Ischemia ◽  
Line Treatment ◽  
First Line ◽  
Invasive Treatment ◽  
Percutaneous Mechanical Thrombectomy ◽  
First Line Treatment

Purpose. To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. Methods. In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. Results. Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. Conclusion. Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

Mechanical thrombectomy as a first-line treatment for arterial occlusion

2001 ◽  
Vol 14 (2) ◽  
pp. 123-131 ◽  
Author(s):  
Karthikeshwar Kasirajan ◽  
John M. Marek ◽  
Mark Langsfeld
Keyword(s):  
Mechanical Thrombectomy ◽  
Arterial Occlusion ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals Selecting the Appropriate First-Line Strategy Based on Hyperdense Vessel Sign in Acute Ischemic Stroke Increases First Pass Recanalization: A Tertiary Center Experience

2022 ◽  
Author(s):  
Uday Bhanu Kovilapu ◽  
Narendra Jain ◽  
Atul Mishra ◽  
Virender Malik
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Large Vessel Occlusion ◽  
First Line ◽  
Vessel Occlusion ◽  
Tertiary Center ◽  
First Pass ◽  
Noncontrast Computed Tomography

Abstract Background: The data pertaining to selecting an optimal first-line strategy (stent retriever [SR] vs. contact aspiration [CA]) based on noncontrast computed tomography (NCCT) in cases of acute ischemic stroke consequent to large vessel occlusion (LVO) is lacking. Aims: This article studies the influence of hyperdense vessel sign (HVS) in selecting optimal first-line strategy, with intention of increasing first-pass recanalization (FPR). Methods: Upfront approach at our center is SR technique with rescue therapy (CA) adoption consequent to three failed SR attempts to achieve successful recanalization. Data of patients with acute LVO who underwent mechanical thrombectomy from June 2017 to May 2020 was retrospectively analyzed. Patients were classified into HVS (+) and HVS (–) cohort. Rate of successful recanalization (first pass, early, and final) and efficacy of rescue therapy was assessed between the two cohorts. Results: Of 52 patients included, 28 and 24 were assigned to the HVS (+) and HVS (–) cohort, respectively. FPR was observed in 50% of HVS (+) and 20.9% of HVS (–) (p = 0.029). Early recanalization was documented in 64.2% of HVS (+) and 37.5% of HVS (–) (p = 0.054). Rescue therapy need was higher in patients not demonstrating HVS (p = 0.062). Successful recanalization was achieved with rescue therapy in 50% of HVS (–) group. Conclusion: A higher FPR is achievable following individualized first-pass strategy (based on NCCT appearance of clot), instead of a generalized SR first-pass approach. This CT imaging-based strategy is a step closer to achieving primary angiographic goal of FPR.

scholarly journals Mechanical thrombectomy using the new Tigertriever in acute ischemic stroke patients – A Swiss prospective multicenter study

2020 ◽  
Vol 26 (5) ◽  
pp. 598-601
Author(s):  
Philipp Gruber ◽  
Michael Diepers ◽  
Alexander von Hessling ◽  
Johannes Weber ◽  
Timo Kahles ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
First Line ◽  
Prospective Multicenter Study ◽  
Vessel Occlusion ◽  
First Pass ◽  
Reperfusion Rate

Purpose Tigertriever is a novel operator-adjustable clot retriever designed to enhance the operator's options to control the interaction of retriever and clot. The aim of this study was to assess the feasibility, safety and efficacy of the Tigertriever device system. Methods Prospective multi-center registry study at three comprehensive stroke centers in Switzerland from 2017 to 2019 of patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO) using Tigertriever as a first-line device. Results 30 AIS patients (median age 72.5 years (IQR 64–79), 50% women) with a median NIHSS on admission of 11 (IQR 6-13) and a median ASPECT score of 9 (IQR 7–10) were treated with the new Tigertriever and included in this study. The first-pass effect was 24% (n = 7). A good recanalization (eTICI 2 b/2c/3) was achieved in 94% of the cases. Median mRS at 90 days was 1 (IQR 1–2). Conclusion This study demonstrated feasibility, safety and effectiveness of the Tigertriever in AIS patients with LVO with a high reperfusion rate.

Abstract P496: Clot Characteristics in Mechanical Thrombectomy: Interim Analysis of the EXCELLENT Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raul Nogueira ◽  
Adnan H Siddiqui ◽  
Simon F De Meyer ◽  
Karen Doyle ◽  
Jens Fiehler ◽  
...  
Keyword(s):  
Interim Analysis ◽  
Mechanical Thrombectomy ◽  
Large Artery ◽  
Large Vessel Occlusion ◽  
First Line ◽  
Vessel Occlusion ◽  
Stroke Etiology ◽  
Standardized Protocol ◽  
Artery Disease ◽  
Abstract Submission

Introduction: Red blood cell (RBC) rich vs fibrin rich clots have different mechanical properties and greater knowledge about clot composition in the context of clinical, imaging, and procedural factors in mechanical thrombectomy (MT) may help with procedural optimization. The EXCELLENT Registry (NCT03685578) is a prospective, global, multi-center, observational registry of EmboTrap as the first line MT device for large vessel occlusion (LVO). We present an interim analysis of clot collected per pass in the registry. Methods: Five hundred thirty-three clot specimens from 376 subjects were collected by 20 sites and sent for analysis by independent Central Labs under standardized protocol. Analysis was interrupted by COVID-19, but the labs were fully operational as of June 2020 and on track to deliver results for 300 subjects in Q4. At the time of abstract submission, composition data for 234 clots from 163 subjects was available. All available data will be presented at the time of the conference. Results: Cardioembolic etiology (n=100) was associated with lower RBC (40.2 vs 47.2%) and higher fibrin content (31.7 vs 26.7%) compared to large artery disease (n=12). Hyperdense/vessel susceptibility sign (78+, 24-, per independent imaging core lab) corresponded to higher mean RBC content (44.4 vs 34.9%). Treatment with IV tPA (60+, 91-) had no clear impact on clot composition (42.3 vs 40.6% RBC; 30.4 vs 30.0% fibrin). Notably, clots retrieved with the first 2 passes of were more RBC rich (42.1 vs 28.0%) and clots retrieved in higher passes had a higher average fibrin content (35.5 vs 29.6%) suggesting that higher fibrin content leads to greater refractoriness. Conclusions: Clot density/susceptibility on baseline imaging, stroke etiology and number of thrombectomy passes were associated with differential clot composition. These findings may have potential implications for the development of better MT strategies.

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