Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion: choice of therapeutic strategy according to underlying aetiological mechanism?

Introduction We report our experience with the novel stent-type clot-retrieval device EmboTrap II for the revascularization of large artery occlusions in acute ischaemic stroke. Materials and methods Twenty-nine patients with acute ischaemic stroke due to large artery occlusion underwent mechanical thrombectomy with the new EmboTrap II in two Italian centres. Clinical, procedural and radiological data were collected. Angiographic results and neurological outcomes were analysed. Results Only large vessel occlusions were included. Intravenous thrombolysis was administered in 72% of patients. Successful reperfusion (TICI 2b-3) was obtained in 76% of patients treated exclusively with EmboTrap II. No device-related permanent complications occurred. Conclusion In our experience, mechanical thrombectomy with EmboTrap II is safe and effective. Reperfusion rate was comparable to that obtained with other stent retrievers.

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Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry: study protocol for a prospective, multicentre registry in China

Stroke and Vascular Neurology ◽

10.1136/svn-2018-000188 ◽

2019 ◽

Vol 4 (1) ◽

pp. 57-60 ◽

Cited By ~ 4

Author(s):

Xiaochuan Huo ◽

Ning Ma ◽

Dapeng Mo ◽

Feng Gao ◽

Ming Yang ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Acute Ischaemic Stroke ◽

Treatment Algorithm ◽

Functional Independence ◽

Artery Occlusion ◽

Large Artery ◽

Vessel Occlusion ◽

Treatment Delivery ◽

Safety Endpoint

Background and purposeEndovascular treatment could improve functional outcomes and reduce mortality in patients with intracranial large artery occlusion. This registry aims to evaluate the endovascular treatment delivery and to improve endovascular treatment algorithm in clinical practice for patients with stroke in China.Methods and analysisThis multicentric, nationwide, prospective registry plans to include 20 stroke centres and recruit 900 consecutive AIS patients with large-artery occlusion under endovascular treatment. This registry will enrol acute large vessel occlusion patients suitable for endovascular treatment and the inclusion and exclusion criteria. In this study, 90 days functional independence (modified Rankin Scale score ≤2) is the primary efficacy endpoint. The procedural efficacy endpoint of this registry is target artery recanalisation defined by modified Thrombolysis in Cerebral Infarction score 2b or 3 after endovascular therapy. Symptomatic intracranial haemorrhage with 24±3 hours after the procedure is the primary safety endpoint of this registry.Ethics and disseminationBeijing Tiantan Hospital’s Ethics committee and all other participating centres approved the protocol and data collection of Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment registry. Each participant or representative had a written informed consent.

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Prevalence of intracranial large artery stenosis and occlusion in patients with acute ischaemic stroke or TIA

Neurological Sciences ◽

10.1007/s10072-013-1516-4 ◽

2013 ◽

Vol 35 (3) ◽

pp. 349-355 ◽

Cited By ~ 11

Author(s):

Alessia Mattioni ◽

Silvia Cenciarelli ◽

Geert Jan Biessels ◽

Tom van Seeters ◽

Ale Algra ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Artery Stenosis ◽

Large Artery ◽

Stenosis And Occlusion

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Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: a randomised study

The Lancet Neurology ◽

10.1016/s1474-4422(07)70079-0 ◽

2007 ◽

Vol 6 (5) ◽

pp. 407-413 ◽

Cited By ~ 87

Author(s):

Ka Sing Wong ◽

Christopher Chen ◽

Ping Wing Ng ◽

Tak Hong Tsoi ◽

Ho Lun Li ◽

...

Keyword(s):

Molecular Weight ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Low Molecular Weight Heparin ◽

Occlusive Disease ◽

Low Molecular Weight ◽

Large Artery ◽

Randomised Study ◽

Asian Patients

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Endovascular clot retrieval for acute ischaemic stroke due to basilar artery occlusion in childhood

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14449 ◽

2020 ◽

Vol 62 (10) ◽

pp. 1221-1223 ◽

Cited By ~ 1

Author(s):

Emma Macdonald‐Laurs ◽

Jason Wenderoth ◽

Michael Cardamone ◽

Hugo Sampaio ◽

P Ian Andrews

Keyword(s):

Ischaemic Stroke ◽

Basilar Artery ◽

Acute Ischaemic Stroke ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Comparison of a Simple Isotope Method of Predicting Likely Middle Cerebral Artery Occlusion with Transcranial Doppler Ultrasound in Acute Ischaemic Stroke

Cerebrovascular Diseases ◽

10.1159/000107990 ◽

1995 ◽

Vol 6 (1) ◽

pp. 32-39 ◽

Cited By ~ 5

Author(s):

J.M. Wardlaw ◽

M.V. Merrick ◽

C.M. Ferrington ◽

M.S. Dennis ◽

R.I. Lindley ◽

...

Keyword(s):

Ischaemic Stroke ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Doppler Ultrasound ◽

Acute Ischaemic Stroke ◽

Transcranial Doppler ◽

Transcranial Doppler Ultrasound ◽

Artery Occlusion ◽

Isotope Method ◽

Cerebral Artery Occlusion

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Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

Cerebrovascular Diseases Extra ◽

10.1159/000470855 ◽

2017 ◽

Vol 7 (2) ◽

pp. 95-102 ◽

Cited By ~ 16

Author(s):

Chee-Keong Wee ◽

William McAuliffe ◽

Constantine C. Phatouros ◽

Timothy J. Phillips ◽

David Blacker ◽

...

Keyword(s):

Ischaemic Stroke ◽

Functional Outcome ◽

Acute Ischaemic Stroke ◽

Controlled Trial ◽

Group Versus ◽

Large Artery ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Neurological Improvement

Background and Purpose: Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks. We aimed to survey the proportion of patients suitable for EVT who are alteplase-ineligible and to compare the safety and effectiveness of standard care of acute large artery ischaemic stroke by EVT plus thrombolysis with that of EVT alone in a tertiary hospital clinical stroke service. Methods: We performed a retrospective analysis of acute ischaemic stroke patients treated with EVT at our centre between October 2013 and April 2016, based on a registry with prospective and consecutive patient collection. Individual patient records were retrieved for review. Significant early neurological improvement was defined as a NIHSS score of 0–1, or a decrease from baseline of ≤8, at 24 h after stroke onset. Results: Fifty patients with acute ischaemic stroke secondary to LVO in the anterior circulation received EVT in this period, of whom 21 (42%) received concurrent alteplase and 29 (58%) EVT alone. The 2 groups had similar baseline characteristics and similar outcomes. Significant neurological improvement at 24 h occurred in 47.6% of the patients with EVT and bridging alteplase and in 51.7% of the patients with EVT alone (p = 0.774). Mortality during acute hospitalization was 20% for the bridging alteplase group versus 7.1% for EVT alone (p = 0.184). Intracranial haemorrhage rates were 14.3% for bridging alteplase versus 20.7% for EVT alone (p = 0.716). Local complications, groin haematoma (23.8 vs. 10.3%) and groin pseudoaneurysms (4.8 vs. 0%) (p = 0.170), were not significantly different. Conclusion: Our study highlights the relatively large proportion of patients suitable for EVT who have a contraindication to alteplase and raises the hypothesis that adding alteplase to successful EVT may not be necessary to optimize functional outcome. The results are consistent with observational data from other endovascular centres and support a randomised controlled trial of EVT versus EVT with bridging alteplase.

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Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry

BMJ Open ◽

10.1136/bmjopen-2020-043415 ◽

2021 ◽

Vol 11 (4) ◽

pp. e043415

Author(s):

Hao Li ◽

Shi-sheng Ye ◽

Yuan-Ling Wu ◽

Sheng-Ming Huang ◽

Yong-Xin Li ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Fasting Blood Glucose ◽

Area Under The Curve ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Clinical Trial Registry ◽

Previous Stroke ◽

Receiver Operator Curve Analysis

ObjectivesWe aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT).DesignAnalysis of a multicentre prospective registry.SettingIn six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively.Participants224 patients with AIS were treated by MT.ResultsOf 224 patients, 49 (21.9%) patients died, and 87 (38.8%) were independent. Variables associated with 90-day mortality were age, previous stroke, admission National Institutes of Health Stroke Scale (NIHSS), fasting blood glucose and occlusion site. Logistic regression identified four variables independently associated with 90-day mortality: age ≥80 years (OR 3.26, 95% CI 1.45 to 7.33), previous stroke (OR 2.33, 95% CI 1.04 to 5.21), admission NIHSS ≥18 (OR 2.37, 95% CI 1.13 to 4.99) and internal carotid artery or basilar artery occlusion (OR 2.92, 95% CI 1.34 to 6.40). Using these data, we developed predicting 90-day mortality of AIS with MT (PRACTICE) score ranging from 0 to 6 points. The receiver operator curve analysis found that PRACTICE score (area under the curve (AUC)=0.744, 95% CI 0.669 to 0.820) was numerically better than iScore (AUC=0.661, 95% CI 0.577 to 0.745) and Predicting Early Mortality of Ischemic Stroke score (AUC=0.638, 95% CI 0.551 to 0.725) for predicting 90-day mortality.ConclusionsWe developed a simple score to estimate the 90-day mortality of patients who had an AIS treated with MT. But the score needs to be prospectively validated.Trial registration numberChinese Clinical Trial Registry (ChiCTR-OOC-17013052).

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Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion

Stroke and Vascular Neurology ◽

10.1136/svn-2021-001242 ◽

2021 ◽

pp. svn-2021-001242

Author(s):

Ximing Nie ◽

David Wang ◽

Yuehua Pu ◽

Yufei Wei ◽

Qixuan Lu ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Basilar Artery ◽

Acute Ischaemic Stroke ◽

Functional Outcomes ◽

Meta Analysis ◽

Functional Independence ◽

Artery Occlusion ◽

Lower Percentage ◽

Basilar Artery Occlusion

Background and purposeIt remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO.MethodsPatients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO.ResultsOf 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01).ConclusionsThis study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.

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