Abstract 3232: Distal Embolization Predicts Infarct Growth and Futile Recanalization after Endovascular Stroke Therapy

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Mohammed A Almekhlafi ◽  
Jayesh Modi ◽  
Bijoy Menon ◽  
Ankur Goel ◽  
Andrew M Demchuk ◽  
...  
Keyword(s):  
Filling Defect ◽  
Stroke Therapy ◽  
Arterial Tree ◽  
Distal Embolization ◽  
Anterior Circulation ◽  
Cerebral Angiogram ◽  
Single Center Experience ◽  
Radiographic Outcomes ◽  
Endovascular Stroke Therapy

OBJECTIVE With the growing use of intra-arterial devices in acute stroke therapy, distal embolization (DE) is increasingly encountered. Reports described the incidence of these emboli but none so far linked them to the futile recanalization phenomenon. We report DE impact on clinical and radiographic outcomes in relation to futile recanalization. METHODS This is a retrospective longitudinal cohort including all anterior circulation stroke patients treated using intra-arterial therapy in our center between 2005 and 2011. Patients enrolled in randomized trials were excluded. Baseline and follow-up CT scans were scored by a stroke neurologist and a neuro-radiologist blinded to the clinical and angiographic data. Angiograms were reviewed by an experienced interventional neuro-radiologist blinded to the clinical and radiographic outcome. DE is defined as any luminal filling defect in the arterial tree distal to the thrombus or any new luminal filling defect in a different arterial territory evaluated at final cerebral angiogram. Infarct growth was defined as a drop of two points in ASPECTS on noncontrast CT follow up scan compared to baseline. RESULTS Eighty two patients (mean age 68 [13.8] years, median NIHSS 17[IQR 7], median ASPECTS 8[2]) were studied. Intravenous tPA was used in 63%. The median onset-to-puncture time was 209 (119) minutes. The occlusion site was the L/T-type carotid occlusion in 22%, proximal MCA in 53.7%, and M2-MCA in 24.3%. The Merci device was used in 28%, Penumbra system in 31.7%, angioplasty balloon in 18.3%, and retrievable stents in 11%. Intra-arterial tPA was also used in 59% of cases. Successful recanalization (TICI 2b/3) was achieved in 43%. Distal emboli occurred in 45.1% of cases, 10% of which were in the ACA territory. Despite successful recanalization, infarct growth occurred in 28.6% of patients. DE occurred in 80% (8/10) of those with infarct growth and recanalized vs. 60% (15/25) in those who had no infarct growth and recanalized. Good clinical outcome (mRS 0-2) at discharge was noted in 58.3% of patients with successful recanalization and no DE, 30.4% in those with successful recanalization and DE, and 17% in those who did not recanalize (TICI 0-2a) (p=0.015). CONCLUSIONS DE is common in the setting of endovascular stroke therapy and is associated with infarct growth and worse outcomes despite successful recanalization. DE may be one factor contributing to the futile recanalization phenomenon. This retrospective, single center experience needs to be validated in endovascular clinical trials.

Abstract WP23: Comparison of Suction Thrombectomy, Stentriever, and Combined Approach: Thrombus Size, Fragmentation, and Outcome - A Single Center Analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Wolfgang Leesch ◽  
Pankajavalli Ramakrishnan ◽  
Dean Kostov ◽  
O’Brien Gossage ◽  
Frank Sanderson
Keyword(s):  
Clinical Outcome ◽  
Combined Approach ◽  
Stroke Therapy ◽  
Distal Embolization ◽  
Radiographic Images ◽  
Single Pass ◽  
Size Number ◽  
Data Points ◽  
Combined Technique ◽  
Endovascular Stroke Therapy

Introduction: Few reports have compared the commonly used technical approaches of stentriever, suction thrombectomy, and combined technique, particularly with emphasis on thrombus volume, fragmentation, distal embolization, and clinical outcome. Methods: Medical records and radiographic images of patients undergoing endovascular stroke therapy at our institution between 2014 and 2015 were reviewed for the following data points: Patient age, sex, NIH stroke scale (NIHSS) at presentation, number of passes, presence of distal embolization on angiography, TICI score, and Modified Rankin Scale (MRS) at discharge. When available, photographic images of the retrieved thrombus were analyzed for number of fragments and size of the largest fragment. Parameters were compared for the three thrombectomy techniques of suction (ADAPT technique), stentriever, and the combined approach. Results: Of 63 patients receiving endovascular stroke therapy, 47 (75%) underwent mechanical thrombectomy: Stentriever 17 (36%), Suction 18 (38%), and combined 12 (26%). Average age and presenting NIH stroke scales were similar in the groups. A single pass thrombectomy was more common in the suction group (72%) than in the stentriever (29%) and combined groups (8%). There were more thrombus fragments in the stentriever (2.3) and combined groups (3.4) than in the suction group (1.4), correlating to more frequent distal embolization (suction 22%, stentriever 70%, combined 50%). The retrieved thrombus was largest in the suction group (12.9 mm; stentriever 6.6 mm; combined 10.4 mm). Overall outcome at discharge was better in the suction group (61% MRS 0-2) than in the stentriever (35%) and combined groups (17%). Conclusions: In our patient sample suction thrombectomy outperformed the stentriever and combined techniques in the categories of achieved reperfusion grade, single pass, retrieved thrombus size, number of fragments, distal embolization and clinical outcome. While stent retriever and suction thrombetomy were used as primary approaches, the combined technique was commonly utilized as a rescue attempt once the primary approach had failed, constituting a potential limitation of the analysis in this category.

Abstract TP9: ASPECTS Values in Patients With Large Vessel Occlusion and Time of Arrival to Emergency Department: Estimation of Eligibility for Endovascular Stroke Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Maxim Mokin ◽  
Aparna Pendurthi ◽  
Christopher Primiani ◽  
William S Burgin
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Endovascular Therapy ◽  
Stroke Onset ◽  
Time Of Arrival ◽  
Large Vessel Occlusion ◽  
Stroke Therapy ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Stroke Therapy

Background: Favorable imaging profile according to The Alberta Stroke Program Early CT Score (ASPECTS) is an important selection criterion for endovascular therapy in patients with acute stroke from anterior circulation large vessel occlusion (LVO). The goal of this study was analyze the relationship between ASPECTS values and time of arrival to emergency department (ED) after stroke onset, and its impact on patient’s eligibility for endovascular stroke therapy. Methods: analysts of ASPECTS values in consecutive patients with acute stroke from anterior circulation LVO admitted within 24 hours of onset was performed. Criteria from American Heart Association/American Stroke Association (AHA/ASA) guidelines based on the proposed class I-II recommendations, including the ‘favorable’ ASPECTS range of 6-10 were applied to determine frequency of potentially eligible patients for endovascular stroke therapy. Results: Of 641 patients with acute ischemic stroke presenting within the first 24 hours of onset, 71 (11%) had anterior circulation LVO. Medium time from arrival to ED to noncontrast head CT was 6 minutes. 72% of patients arrived to ED within the first 6 hours, 18% within 6-12 hours, and 10% within 12-24 hours of symptom onset. Based on ‘favorable’ ASPECTS criterion alone, 80% of patients with anterior circulation LVO who arrive to the ED within the first 6 hours of stroke onset would qualify for endovascular therapy. Of those who arrived to ED within 6-24 hours of stroke onset, 50% had ‘favorable’ ASPECTS. Conclusions: 50% of patients with stroke from anterior circulation LVO who arrive to ED within 6-24 hours of onset have ‘favorable’ ASPECTS, making them potentially eligible for endovascular stroke therapy.

Abstract WP85: Flow-diverter Embolization for Tandem Intracranial Aneurysms: A Single Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Russell Cerejo ◽  
Seby John ◽  
Andrew Bauer ◽  
Mark Bain ◽  
Thomas Masaryk ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Single Center ◽  
Anterior Circulation ◽  
Single Center Experience ◽  
Flow Diverter Stent ◽  
Artery Segment ◽  
Treat All

Introduction: Flow diverter embolization is a novel method to treat intracranial aneurysms. The device has been shown to reduce procedure time and radiation exposure along with excellent long-term occlusion rates for single lesions. However, the effect of flow diversion on multiple adjacent aneurysms has not been well studied. We present our single center experience with flow diverter treatment of tandem aneurysms. Methods: We retrospectively collected clinical, imaging, procedural and follow up data on patients in whom flow diverters were used to treat intracranial anterior circulation aneurysms between 2011 and 2016. We included patients who had 2 or more tandem aneurysms of the internal carotid artery segment and where flow diverter was intended to treat all the aneurysms either as primary or secondary method. Results: We identified 21 patients with 52 aneurysms that met inclusion criteria. All were females with median age of 57 (Interquartile range [IQR] 51 - 69). Seventeen patients had 2 adjacent aneurysms, while 4 patients had 3 contiguous aneurysms. Of these, only one patient was treated acutely for ruptured aneurysm. The median largest aneurysm diameter was 3.1mm (IQR 2.5 - 4.8) with most common locations being cavernous and ophthalmic aneurysms. In 19 patients (90.5%) only a single flow diverter stent was used; only one patient required concurrent coiling. One patient (4.8%) suffered a post procedural mild stroke but improved rapidly. There were no other procedural complications. Follow up data in 13 patients (61.9%) with a median follow up of 8 months (IQR 6 - 13) demonstrated that 20 out of 28 aneurysms showed complete occlusion (71.4%). None of the patients at follow up required re-treatment, and there were no delayed/late aneurysm ruptures. Conclusion: Flow diverter is a feasible, efficacious and safe treatment option in patients with multiple tandem aneurysms, in a single session with good early outcomes. Long term follow up data and large cohort studies are required.

scholarly journals Three-year clinical and radiological results of a cruciate-retaining type of the knee prosthesis with anatomical geometry developed in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Arata Nakajima ◽  
Manabu Yamada ◽  
Masato Sonobe ◽  
Yorikazu Akatsu ◽  
Masahiko Saito ◽  
...  
Keyword(s):  
Knee Prosthesis ◽  
Cruciate Retaining ◽  
Radiolucent Lines ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Clinical And Radiological Results ◽  
Anatomical Geometry

Abstract Background The FINE total knee was developed in Japan and clinical use began in 2001. It has unique design features, including an oblique 3o femorotibial joint line that reproduces anatomical geometry. Although 20 years have passed since the FINE knee was clinically used for the first time in Japan, a formal clinical evaluation including patient-reported and radiographic outcomes has not been undertaken. Methods A total of 175 consecutive primary cruciate-retaining (CR)-FINE total knee arthroplasties (TKAs) at our hospital between February 2015 and March 2017 were included in this study. Three years postoperatively, range of motion (ROM), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were recorded and compared with preoperative scores. Radiographic analyses including mechanical alignment, component alignment, and incidence of radiolucent lines also were undertaken based on the radiographs 3 years postoperatively. Results One-hundred twenty-two knees (70%) were available for 3-year follow-up data using KOOS, except for the sports subscale. Postoperative KOOS-symptom, −pain and -ADL were > 85 points, but KOOS-sports, −QOL and FJS were less satisfactory. ROM, KSS and all the subscales of KOOS were significantly improved compared with preoperative scores. Postoperative mean FJS was 66 and was significantly correlated with all the subscales of KOOS, but not with postoperative ROM. Radiolucent lines ≧1 mm wide were detected in five knees (4.1%). There were no major complications needing revision surgeries. Conclusions Patient-reported outcomes (PROs) for symptoms, pain and ADL after the CR-FINE TKA were generally improved, but those for sports, QOL and FJS were improved less. The incidence of radiolucent lines was rare but detected around the femoral components. With the mid- to long-term follow-up, improvements of surgical technique will be necessary to achieve better PROs from patients receiving the FINE knee.

scholarly journals Camptodactyly-Arthropathy-Coxa Vara-Pericarditis Syndrome Resembling Juvenile Idiopathic Arthritis: A Single-Center Experience from Southern Turkey

2021 ◽  
pp. 1-6
Author(s):  
Rabia Miray Kisla Ekinci ◽  
Sibel Balci ◽  
Haldun Dogan ◽  
Serdar Ceylaner ◽  
Celal Varan ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Pericardial Effusion ◽  
Early Onset ◽  
Joint Space ◽  
Coxa Vara ◽  
Single Center ◽  
The Third ◽  
Single Center Experience ◽  
Southern Turkey

Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome, caused by biallelic pathogenic mutations in the <i>PRG4</i> gene, is characterized by early-onset camptodactyly, noninflammatory arthropathy, coxa vara deformity, and rarely, pericardial effusion. Herein, we report 3 patients with CACP syndrome from 2 unrelated families. All patients are female, born to consanguineous parents, and had camptodactyly since the first years of their lives. Two patients had a prior diagnosis of juvenile idiopathic arthritis. Hip changes were present in 2 patients, and 2 of 3 patients had undergone surgery for camptodactyly. Routine echocardiographic evaluations were normal during the 2-year follow-up. This paper represents the third study including CACP patients from Turkey. Clinically, all 3 patients resembled juvenile idiopathic arthritis cases and received unnecessary medication. There is also an ongoing need for improving awareness of CACP and an effective treatment focusing on the lubrication of the joint space in CACP patients.

Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

2021 ◽  
pp. neurintsurg-2021-017341
Author(s):  
Devin V Bageac ◽  
Blake S Gershon ◽  
Jan Vargas ◽  
Maxim Mokin ◽  
Zeguang Ren ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Control Group ◽  
Anterior Circulation ◽  
Guide Catheter ◽  
Catheter Failure ◽  
Catheter Technology ◽  
Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

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