scholarly journals EP55 Keep it simple: the SNACE (Sofia non-wire aspiration contrast enhancement) technique for the endovascular management of acute ischemic stroke

2021 ◽  
Author(s):  
B Pabon ◽  
V Torres ◽  
J Mejia ◽  
M Patiño ◽  
O Vargas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Contrast Enhancement ◽  
Endovascular Management ◽  
Enhancement Technique

scholarly journals Mechanical thrombectomy in acute ischemic stroke with tandem occlusions: impact of extracranial carotid lesion etiology on endovascular management and outcome

2021 ◽  
Vol 51 (1) ◽  
pp. E6
Author(s):  
Valerio Da Ros ◽  
Jacopo Scaggiante ◽  
Francesca Pitocchi ◽  
Fabrizio Sallustio ◽  
Simona Lattanzi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Demographic Data ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Endovascular Management ◽  
Retrograde Approach ◽  
Antegrade Approach ◽  
Tandem Occlusion

OBJECTIVE Different etiologies of extracranial internal carotid artery steno-occlusive lesions (ECLs) in patients with acute ischemic stroke (AIS) and tandem occlusion (TO) have been pooled together in randomized trials. However, carotid atherosclerosis (CA) and carotid dissection (CD), the two most common ECL etiologies, are distinct nosological entities. The authors aimed to determine if ECL etiology has impacts on the endovascular management and outcome of patients with TO. METHODS A multicenter, retrospective study of prospectively collected data was conducted. AIS patients were included who had TO due to internal CA or CD and ipsilateral M1 middle cerebral artery occlusion and underwent endovascular treatment (EVT). Comparative analyses including demographic data, safety, successful recanalization rates, and clinical outcome were performed according to EVT and ECL etiology. RESULTS In total, 214 AIS patients with TOs were included (77.6% CA related, 22.4% CD related). Patients treated with a retrograde approach were more often functionally independent at 3 months than patients treated with an antegrade approach (OR 0.6, 95% CI 0.4–0.9). Patients with CD-related TOs achieved 90-day clinical independence more often than patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.0). Emergency stenting use was associated with good 3-month clinical outcome only in patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.1). Symptomatic intracranial hemorrhage (sICH) occurred in 10.7% of patients, without differences associated with ECL etiology. CONCLUSIONS ECL etiology impacts both EVT approach and clinical outcome in patients with TOs. Patients with CD-related TO achieved higher 3-month functional independence rates than patients with CA-related TOs. A retrograde approach can be desirable for both CA- and CD-related TOs, and emergency stenting is likely better justified in CA-related TOs.

Abstract 3274: Early Symptom Onset to Arterial Puncture Time in the Endovascular Management of Acute Ischemic Stroke Predicts Successful Revascularization

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Richard S Jung ◽  
Jitendra Sharma ◽  
Tanzila Shams ◽  
Numthip Chitravas ◽  
Kristine A Blackham
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Treatment Time ◽  
Intravenous Thrombolysis ◽  
Endovascular Management ◽  
Intravenous Tissue Plasminogen Activator ◽  
Flow Improvement ◽  
Relationship Of

Background: As is seen in the early door-to-needle times of intravenous thrombolysis in the treatment of acute ischemic stroke (AIS), prior endovascular management trials have demonstrated early revascularization can lead to improved outcomes. We aimed to study the relationship of the time from acute stroke onset to the time of arterial groin puncture (OTP) as a possible predictor of successful revascularization. Methods: We retrospectively analyzed 149 patients who presented to our hospital with AIS and underwent emergent endovascular treatment from January 1, 2008 to March 31, 2011. Charts were reviewed for baseline characteristics, OTP times, and endovascular therapies employed. Primary outcomes included successful revascularization (TIMI 2 to 3 flow), improvement of baseline NIHSS ≥ 4, symptomatic ICH (increase of NIHSS ≥ 4), in-hospital mortality, and mRS two or less at discharge. We excluded patients with OTP times greater than eight hours to ensure consistency with approved usage of mechanical thrombectomy devices. Independent samples T-tests were performed to determine relationships of OTP with our primary outcomes. Results: Of the 149 patients who underwent endovascular therapy, 120 had OTP times less than eight hours. Of these 120, 44% were male, median age was 73 years (range 17, 93), median baseline NIHSS was 18 (range 5, 28), 53% received intravenous tissue plasminogen activator (tPA), 69% received intra-arterial tPA, and mechanical thrombectomy was performed in 69%. Internal carotid artery occlusions were seen in 32% of patients, 50% had M1 segment occlusions, and only five patients had posterior circulation occlusions. Successful revascularization was achieved in 70% of interventions, 10% of patients had mRS ≤ 2 at discharge, symptomatic hemorrhage was 18%, and in-hospital mortality was 24%. Patients with TIMI 2 to 3 flow had significantly shorter mean OTP times (3.9 vs 4.5 hours; p=0.024). No significant associations of mean OTP times were found with symptomatic hemorrhage rate (4.4 vs 4.0; p=0.628), in-hospital mortality (4.0 vs 4.0; p=0.677), improvement in NIHSS (3.9 vs 4.2; p=0.283), or a mRS ≤ 2 at discharge (3.7 vs 4.1; p=0.185). Conclusions: The recanalization rate in our study is comparable to prior endovascular trials. Patients with OTP times less than 3.9 hours were more likely to result in successful revascularization. Onset to groin puncture did not predict in-hospital mortality, symptomatic hemorrhage, or condition at discharge in our study. Further study is needed to determine if advanced perfusion imaging prior to intervention may impact treatment time and ultimately clinical outcome.

Endovascular management of cerebral septic embolism: three recent cases and review of the literature

2016 ◽  
Vol 9 (5) ◽  
pp. 463-465 ◽  
Author(s):  
Eugene L Scharf ◽  
Tia Chakraborty ◽  
Alejandro Rabinstein ◽  
Amrendra S Miranpuri
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Bacterial Endocarditis ◽  
Endovascular Management ◽  
Review Of The Literature ◽  
Aspiration Thrombectomy ◽  
Septic Embolus ◽  
Stent Retrieval ◽  
Pathologic Analysis ◽  
Anticoagulated Patients

Endovascular management of acute ischemic stroke secondary to septic emboli from bacterial endocarditis is case-specific and outside established guidelines. We report three new cases of an acute ischemic stroke secondary to septic embolus from two different centers. All cases reported here were large vessel occlusions of the middle cerebral artery in anticoagulated patients. In one case the embolus was noted to be firm and aspiration thrombectomy was attempted in lieu of stent retrieval. Thrombolysis in Cerebral Ischemia (TICI) 3 recanalization was achieved and the patient experienced a good outcome with resolution of deficits. In this case, pathologic analysis of the embolus was available. These additional three cases from two centers add to the small but growing literature for interventional management of acute ischemic stroke in bacterial endocarditis.

Future directions for endovascular management of patients with acute ischemic stroke

2014 ◽  
Vol 41 (3) ◽  
pp. 151-152 ◽  
Author(s):  
Laurent Pierot ◽  
Azzedine Benaissa ◽  
Vitor Pereira ◽  
Karl-Olof Lövblad
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Management ◽  
Future Directions

scholarly journals Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience

2012 ◽  
Vol 7 (4) ◽  
pp. 166 ◽  
Author(s):  
Gavin Britz ◽  
Abhishek Agrawal ◽  
David Golovoy ◽  
Shahid Nimjee ◽  
Andrew Ferrell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Endovascular Management ◽  
Stroke Center

scholarly journals Magnetic resonance imaging of the aortic wall as a risk index for acute ischemic stroke in patients with resistant arterial hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Ryumshina ◽  
A E Sukhareva ◽  
O V Mochula ◽  
T A Shelkovnikova ◽  
A S Maksimova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Arterial Hypertension ◽  
Acute Ischemic Stroke ◽  
Contrast Enhancement ◽  
Renal Denervation ◽  
Aortic Wall ◽  
Control Group ◽  
Contrast Enhanced ◽  
Resistant Arterial Hypertension

Abstract Aim To value the possible relationship between the intensity of neoangiogenesis in the aortic wall in patients with resistant arterial hypertension and the subsequent development of ischemic cerebral disorders in them over a three-year follow-up. Materials and methods This study comprised 36 patients with resistant hypertension, in whom the renal denervation was carried out. MRI of the brain and also with contrast enhancement of the aorta and kidneys were examined. MRI studies included T2 and T1 spin-echo MRI, and also coronal slices, with suppression of the signal from adipose tissue (TR=150 ms, TE = 4 ms), before and in 12–15 minutes after contrast-enhanced. The diameter and thickness of the wall of the descending aorta were measured. Index of the enhancement of the aortic wall was calculated as the ratio of intensities of the wall after, and before contrast-enhanced. 9 according to MRI data - developed an acute ischemic stroke during this period, and 27 had no cerebral circulation disorders. The control group consisted of individuals without hypertension (n=12). Results After renal denervation, the systolic blood pressure significantly decreased in all patients for more than 15 mm Hg. In groups of patients with ischemic stroke, and without it, the diameter of the aortic lumen at the level above the renal arteries was 22,1±2,4 mm and 22,8±2,7 mm, respectively; the aortic wall thickness was 3,9±0,7 mm and 3,7±0,8 mm. In control subjects without hypertension, the wall thickness was less than 2,7 mm (on average 2,2±0,4 mm), with an aortic diameter of 21,3±0,9. As to the index of enhancement (as a marker of neoangiogenesis intensity) in the control group, in everybody, the IE was <1,12. In patients with stroke within 3 years after renal denervation, IE = 2,12±0,31, and in patients without stroke IE = 1,66±0,19. The value of IE = 1,82 was the best for separating groups with and without stroke in the three years endpoint, as from the ROC analysis. Conclusion Contrast enhancement of the aortic wall in MRI is associated with the risk of brain ischemic stroke in patients with resistant arterial hypertension, even when blood pressure control is achieved by renal denervation. This makes it possible to predict the risk of stroke in these patients more reliably and encourages the inclusion of agents that reduce the activity of inflammation and pathological neoangiogenesis in the aortic wall, to the spectrum of antihypertensive therapy. FUNDunding Acknowledgement Type of funding sources: None. Brain MRI T2WI MRI of the kidneys and aorta, T1WI

scholarly journals Multimodal endovascular management of acute ischemic stroke in patients over 75 years old is safe and effective

2012 ◽  
Vol 5 (suppl 1) ◽  
pp. i33-i37 ◽  
Author(s):  
George M Ghobrial ◽  
Nohra Chalouhi ◽  
Lana Rivers ◽  
Samantha Witte ◽  
Justin Davanzo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Management

Abstract T P34: Residual Contrast Enhancement of Middle Cerebral Artery on Non-contrast Ct (ncct) After Endovascular Treatment in Ischemic Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Seyedmehdi Payabvash ◽  
Mushtaq H Qureshi ◽  
Shahram Majidi ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Contrast Enhancement ◽  
Cerebral Artery ◽  
Interquartile Range ◽  
Time Interval ◽  
Contrast Ct

Background: Residual contrast enhancement of cerebral arteries is frequently visualized on follow up non-contrast CT (NCCT) after endovascular treatment in acute ischemic stroke and may represent distal microvascular no-reflow phenomenon. Objective: To evaluated the prevalence of and correlation between post- endovascular treatment residual contrast enhancement of middle cerebral artery (MCA) on follow up NCCT with clinical and imaging outcomes in patients with acute ischemic stroke. Methods: We analyzed clinical and radiographic data from all patients with acute MCA occlusion who underwent endovascular treatment at two centers over a 6-year period. The M1 segment of affected MCA was selected with free-hand region of interest on the first post-angiography NCCT; and the average attenuation was determined in Hounsfield units (HU). Bivariate correlation between the MCA contrast enhancement and clinical/imaging outcome was determined. Results: A total of 89 patients (mean age ± SD, 66.4 ± 15.5 years) with MCA occlusion were included. The median time interval between the first follow up NCCT and the time of catheterization, and the time of recanalization (if successful) were 1.7 h (interquartile range: 1.2 - 2.4), and 0.8 h (interquartile range: 0.5 - 1.6), respectively. MCA contrast enhancement with an average attenuation of >40 HU was seen in 74 of 89 patients. There was no significant correlation between the average attenuation of the affected MCA on post- endovascular treatment NCCT and post- endovascular treatment “Thrombolysis in Cerebral Infarction” (TICI) score (p=0.43), Qureshi score (p=0.61), discharge National Institutes of Health Stroke Scale (NIHSS) score (p=0.34), or 3-month modified Rankin score (p=0.51). However, the MCA contrast enhancement was inversely correlated with time interval between NCCT and catheterization (p<0.001) and angiographic recanalization (p<0.001). Conclusion: In patients with acute ischemic stroke, the residual contrast enhancement of the affected MCA on NCCT post- endovascular treatment does not correlate with status of recanalization or clinical outcome.

Sign in / Sign up

Export Citation Format

Share Document