scholarly journals The Feasibility of Mechanical Thrombectomy on Single-Plane Angiosuite: An In-Depth Analysis of Procedure Time

2021 ◽  
pp. 112-117
Author(s):  
Hiroyasu Inoue ◽  
Masahiro Oomura ◽  
Yusuke Nishikawa ◽  
Mitsuhito Mase ◽  
Noriyuki Matsukawa
Keyword(s):  
Scale Score ◽  
Mechanical Thrombectomy ◽  
Catheter Placement ◽  
Tissue Type ◽  
Procedure Time ◽  
Anterior Circulation ◽  
Single Plane ◽  
Good Outcome ◽  
Significant Difference ◽  
Guiding Catheter

<b><i>Introduction:</i></b> Mechanical thrombectomy (MT) is usually performed on biplane (BP) angiosuites. When the BP angiosuite is not available, the single-plane (SP) angiosuite may be a substitute. However, the feasibility of MT performed on the SP angiosuite is yet to be elucidated. Therefore, we investigated the alternative effect of the SP angiosuite on the detailed division of procedure time, recanalization rate, and outcome in patients with anterior circulation infarction. <b><i>Methods:</i></b> The subjects included 80 consecutive patients with anterior circulation infarction who underwent MT at our hospital between May 2015 and December 2020. Demographics and characteristics of the BP and SP groups were assessed and compared. The time from puncture to guiding catheter placement (P-G), time from guiding catheter placement to recanalization (G-R), and time from puncture to recanalization (P-R) were also extracted. A good outcome was defined as a modified Rankin scale score ≤2 at 3 months. <b><i>Results:</i></b> Of the 80 patients, 67 and 13 were treated with BP and SP angiosuites, respectively. There were no differences in age, sex, complications, Alberta Stroke Program Early CT Score, National Institutes of Health Stroke Scale score at onset, occlusion site, rate of recombinant tissue-type plasminogen activator administration, stroke subtype, recanalization rate, and complications between the 2 groups. The rate of a good outcome was not different between the 2 groups. P-G was significantly longer in the SP group than in the BP group, whereas there was no significant difference in G-R and P-R between the 2 groups (P-G: BP 29.9 ± 21.8 vs. SP 48.5 ± 43.6 min, <i>p</i> = 0.04). <b><i>Conclusion:</i></b> MT performed on the SP angiosuite tended to prolong the time for guiding catheter placement. However, there was no difference in the overall procedure time, recanalization rate, or outcome between BP and SP angiosuites. Therefore, if the BP angiosuite is not available, the use of the SP angiosuite should be encouraged.

Abstract P468: Functional Outcome of Patients Undergoing Mechanical Thrombectomy Outside of the Dawn and Defuse Criteria

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Asish Gulati ◽  
Owen Owens ◽  
Patrick Reynolds ◽  
Amy K Guzik ◽  
Sudhir Datar
Keyword(s):  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Multivariate Logistic Regression Model ◽  
Confounding Factors ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Factors Affecting ◽  
Good Outcome ◽  
Significant Difference ◽  
Core Infarct

Background: The DAWN and DEFUSE trials (D&D) extended the mechanical thrombectomy (MT) window to 16-24 hours from last known normal (LKN) in patients with internal carotid artery (ICA) or proximal middle cerebral artery (M1) large vessel occlusions (LVO), with limits on core infarct and penumbra size. With advances in imaging and procedural techniques, many have extended these results to patients outside of the study criteria, yet there is limited analysis of outcomes in those receiving MT beyond these guidelines. This study evaluates the functional outcome of MT in acute stroke patients presenting within 24 hours of LKN outside of the D&D criteria vs those meeting study criteria at a single Comprehensive Stroke Center. Methods: An IRB approved study was performed in which consecutive anterior circulation ischemic stroke patients presenting to Wake Forest Baptist Health from 12/1/18-12/31/19 within 0-24 hours of LKN were retrospectively studied. Patients were grouped by eligibility for DAWN or DEFUSE (mRS ≦1, ICA/M1 occlusion, age <80 NIHSS ≧10 and core 0-30, or age <80 NIHSS ≧20 and core 31-51, or age ≧80 NIHSS ≧10 and core 0-20; or mRS ≦2, NIHSS ≧6, ICA/M1 occlusion with core <70, mismatch volume >15, and mismatch ratio >1.8) or neither. Good outcome was defined as mRS ≦3 within 3 months of discharge. If not available, discharge mRS was used. A multivariate logistic regression model analyzed the outcome controlling for confounding factors. Results: Of 130 patients, 57 (44%) fell outside D&D criteria. There was no significant difference between age, rate of IV tPA, admission NIHSS, baseline co-morbidities, or core infarct size between groups. Median mismatch volume was greater in the D&D group compared to patients in the non D&D group (97cc, IQR 67-146 vs 67cc, IQR 30-111; p=0.002). Good outcome was seen in 34 (47%) D&D patients vs 30 (53%) in the non D&D group; controlling for confounding factors affecting 3 month mRS (age, NIHSS, time to revascularization, atrial fibrillation, prior stroke), this was not statistically significant (p=0.25). Conclusion: The outcome of MT in patients with anterior circulation LVO is not different between those meeting and not meeting D&D criteria. MT should be considered in patients presenting within 24 hours outside study guidelines.

Abstract TP195: Pre-Stroke Cognitive Impairment is Associated With Poor Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takuya Kanamaru ◽  
Satoshi Suda ◽  
Junya Aoki ◽  
Kentaro Suzuki ◽  
Yuki Sakamoto ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Good Outcome ◽  
Poor Outcome ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Significant Difference

Background: It is reported that pre-stroke cognitive impairment is associated with poor functional outcome after stroke associated with small vessel disease. However, it is not clear that pre-stroke cognitive impairment is associated with poor outcome in patients treated with mechanical thrombectomy. Method: We enrolled 127 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke from December 2016 to November 2018. Pre-stroke cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We retrospectively compared poor outcome (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=75) with good outcome (a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=52) and examined that IQCODE could be the predictor of PO. Result: IQCODE was significantly higher in poor outcome group than in good outcome group (89 vs. 82, P=0.0012). Moreover, age (77.2 years old vs. 71.6 years old, P= 0.0009), the percentage of female (42.7% vs. 17.3%, P= 0.0021), complication of hypertension (HT, 68.0% vs. 44.2%, P=0.0076), National Institutes of Health Stroke Scale (NIHSS) at admission (20 vs. 11, P<0.0001), the percentage of postoperative intracerebral hemorrhage (ICH, 33.3% vs. 15.4%, P=0.0233) were higher in poor outcome group than in good outcome group, too. However, there was no significant difference between poor outcome and good outcome groups in occlusion site (P= 0.1229), DWI-ASPECTS (P= 0.2839), the duration from onset to recanalization (P=0.4871) and other risk factors. Multivariable logistic regression analysis demonstrated that IQCODE, HT and NIHSS at admission were associated with poor outcome (P= 0.0128, P=0.0061 and P<0.0001, respectively). Conclusion: Cognitive impairment could be associated with poor outcome in patients treated with mechanical thrombectomy.

scholarly journals Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

2017 ◽  
Vol 01 (03) ◽  
pp. 139-143 ◽  
Author(s):  
Yosuke Tajima ◽  
Michihiro Hayasaka ◽  
Koichi Ebihara ◽  
Masaaki Kubota ◽  
Sumio Suda
Keyword(s):  
Clinical Outcome ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Complete Revascularization ◽  
Anterior Circulation ◽  
Clinical Imaging ◽  
Good Outcome ◽  
Poor Outcome ◽  
Favorable Clinical Outcome

AbstractSuccessful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre

2021 ◽  
Keyword(s):  
General Anaesthesia ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Significant Difference ◽  
Epidemiological Characteristics

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.

scholarly journals Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

2019 ◽  
Vol 11 (12) ◽  
pp. 1174-1180 ◽  
Author(s):  
Thomas Raphael Meinel ◽  
Johannes Kaesmacher ◽  
Panagiotis Chaloulos-Iakovidis ◽  
Leonidas Panos ◽  
Pasquale Mordasini ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Secondary Outcome ◽  
Stroke Severity ◽  
Anterior Circulation ◽  
Link Type ◽  
Significant Difference

BackgroundPerforming mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.ObjectiveTo compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.MethodsIn the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms.ResultsMT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 – 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 – 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO.ConclusionsIn selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR.Trial registration numberNCT03496064

Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo

2018 ◽  
Vol 46 (1-2) ◽  
pp. 89-96 ◽  
Author(s):  
Satoshi Koizumi ◽  
Takahiro Ota ◽  
Keigo Shigeta ◽  
Tatsuo Amano ◽  
Masayuki Ueda ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Scale Score ◽  
Mechanical Thrombectomy ◽  
Treatment Strategies ◽  
Onset Time ◽  
Standard Of Care ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Factors Affecting ◽  
Good Outcome

Background: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke with large vessel occlusion; however, evidence remains insufficient for MT for elderly patients, especially with respect to factors affecting their outcomes. Methods: This study was a retrospective analysis of a multicenter registry of MT, called Tama Registry of Acute Endovascular Thrombectomy. Patients were divided by their age into 2 groups: Nonelderly (NE; < 80) and elderly (E; ≥80). Factors related to a good outcome (modified Rankin scale score ≤2) were examined in each group. Onset to reperfusion time (OTR) was stratified into 4 categories: category 1, 0 – ≤180 min; category 2, > 180 – ≤360 min; category 3, > 360 min or onset time not identified; and category 4, effective recanalization not achievable. Results: 143 NE patients and 78 E patients were included in this study. The E group had less chance of achieving a good outcome (NE group 51%, E group 35%; p = 0.024). In the NE group, lower OTR category was an independent prognostic factor for good outcome (p = 0.037, OR = 1.09). However, in the E group, OTR category was not a significant predictor on multivariate analysis. Instead, effective recanalization (p = 0.0081, OR 1.40) and lower National Institute of Health Stroke Scale score at presentation (p = 0.0032, OR 1.02) were the independent predictors. Conclusions: In MT for elderly patients, effective recanalization improved the patients’ outcome but OTR affected less. Further studies are warranted to establish the appropriate patient selection and treatment strategies.

A novel nomogram for predicting prognosis after mechanical thrombectomy in patients with acute ischemic stroke

2021 ◽  
Vol 18 ◽  
Author(s):  
Huiling Sun ◽  
Feng Zhou ◽  
Guoxing Zhang ◽  
Jiankang Hou ◽  
Yukai Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Bridging Therapy ◽  
Anterior Circulation ◽  
Interval Time ◽  
Good Outcome

Background: Mounting evidence has shown that mechanical thrombectomy [MT] improves clinical outcomes for large vessel occlusions [LVOs] in patients with acute ischemic stroke [AIS] of the anterior circulation. The present study aimed to provide a comprehensive analysis of risk factors associated with clinical outcomes in AIS patients receiving MT. Methods: A total of 212 consecutive patients who underwent MT for AIS were enrolled in the present study. Clinical characteristics were recorded at admission. Two endpoints were defined according to the 3-month modified Rankin scale [mRS] score after AIS [good outcome, mRS 0-2; and death, mRS 6]. Additionally, we compared the clinical outcomes and safety of MT alone and bridging therapy in AIS patients. Results: Of the 212 patients treated with MT, 114 [53.77%] patients had a good outcome and 31 [14.62%] died. The incidence of a worse outcome after MT was significantly elevated in males and patients with high WBC counts, high admission blood glucose levels, high baseline NIHSS scores and a long interval time from groin puncture to reperfusion in AIS patients treated with MT after adjustment for covariates [P<0.05]; these risk factors were further confirmed by our constructed nomograms. In addition, we observed no significant benefit of bridging therapy compared to MT alone in AIS patients. Conclusion: Our constructed nomogram based on male sex, admission WBC, admission blood glucose, NIHSS, and the interval time from groin puncture to reperfusion predicts prognosis after mechanical thrombectomy in patients with acute ischemic stroke.

Abstract W P10: Lower Intraprocedural Mean Arterial Pressure Predicts Good Outcome and Lower Mortality in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Seby John ◽  
Ken Uchino ◽  
Dolora Wisco ◽  
Gabor Toth ◽  
Ferdinand Hui ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Independent Predictor ◽  
Multivariable Logistic Regression Analysis ◽  
Anterior Circulation ◽  
Good Outcome ◽  
Outcome Group

Introduction: Several factors influence the outcome of patients who undergo intra-arterial therapy (IAT) for acute ischemic stroke (AIS). The influence of intra-procedural hemodynamics on functional outcome and mortality has not been studied. There is no data to guide intraprocedural blood pressure (BP) management and it is unknown whether systolic, diastolic, or mean arterial pressure (MAP) is important for determining outcomes. Methods: Retrospective study of patents that underwent IAT for anterior circulation AIS between 1/08- 12/12 was conducted. Detailed intra-procedural hemodynamics, demographics, NIH stroke scale score, IV tPA use, thrombus location, recanalization grade, intracranial hemorrhage were collected. Outcomes measured were in-hospital mortality and 30-day good outcome defined as modified Rankin Scale score of 0-2. Successful recanalization was defined as TICI 2b-3 and ICH was classified into parenchymal hematoma (PH1+2) and hemorrhagic infarction (HI 1+ 2). Results: The cohort in the analysis consisted of 190 patients (56% females, mean age 67 + 15 years). Thirty-six (19%) patients died in-hospital, and 25 (17%) achieved an mRS 0-2. Intra-procedural maximum systolic BP (SBP) and maximum MAP were significantly lower in the good outcome group (Table 1). In multivariable logistic regression analysis, maximum MAP was an independent predictor of good outcomes along with baseline CT ASPECTS score, and successful recanalization. Maximum MAP was also an independent predictor of mortality along with age and presence of PH 1+2 ICH. Conclusions: Maximum intraprocedural MAP was an independent predictor of good outcome and mortality in in patients undergoing IAT for AIS. This results may have implications for intraprocedural BP management.

scholarly journals Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases

2020 ◽  
pp. svn-2020-000624
Author(s):  
Timothy John Phillips ◽  
Matthew Thomas Crockett ◽  
Gregory D Selkirk ◽  
Ruchi Kabra ◽  
Albert Ho Yuen Chiu ◽  
...  
Keyword(s):  
Gold Standard ◽  
Mechanical Thrombectomy ◽  
Imaging Techniques ◽  
Statistical Significance ◽  
High Volume ◽  
Access Site ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Access Site Complication ◽  
Significant Difference

ObjectiveTo compare transradial artery access (TRA) to the gold standard of transfemoral artery access (TFA) in mechanical thrombectomy (MT) for stroke caused by anterior circulation large vessel occlusion.MethodsThe clinical outcomes, procedural speed, angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional service.ResultsThere was no significant difference in patient characteristics, stroke parameters, imaging techniques or intracranial techniques. The median time elapsed between CT scanning and reperfusion was 96.5 min (IQR 68–123) in the TFA group and 95 min (IQR 68–123) in the TRA group (p=0.456). Of 336 patients who were independent at presentation 58% (124/214) of the TFA group and 67% (82/122) of the TRA group had a modified Rankin score of 0–2 at 90-day follow-up (p=0.093). Cross-over from radial to femoral was 4.6% (4/130) compared with 1.6% cross-over from femoral to radial (4/245), but did not meet the predetermined level of statistical significance (OR 2.92, 95% CI 0.81 to 10.52), p=0.088) and did not impact median procedural speed. Adequate angiographic reperfusion, first pass reperfusion, embolisation to new territory and symptomatic intracranial haemorrhage were similar in both groups. There was a significant difference in major access site complications requiring an additional procedure. None of the TRA cases had a major access site complication but 6.5% (16/245) of the TFA cases did (p=0.003).ConclusionThis study suggests that using TRA for anterior circulation MT is fast, efficacious, safe and not inferior to the gold standard of TFA.

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