Abstract T P15: Could Intra-Arterial Thrombolysis Safely Enhance Efficacy of Mechanical Thrombectomy for Acute Ischemic Stroke?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yi Zhang ◽  
Adam Kelly ◽  
Wan Tang ◽  
Robert Griggs ◽  
Henry Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Mortality Rates ◽  
Hemorrhagic Transformation ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Procedure Duration ◽  
Intracranial Arteries ◽  
Arterial Thrombolysis ◽  
Median Admission

Background: Occlusion of large intracranial arteries is associated with disability and death. In this study we assess whether intra-arterial thrombolysis(IAT) safely enhances efficacy of mechanical thrombectomy. Method: We studied consecutive patients with acute large vessel occlusion. We compared 2 groups:(1) thrombectomy plus IAT and(2) thrombectomy alone (non-IAT). Recanalization was defined by TIMI ≥ 2. Results: Between 12/2007 and 10/2012, 87 patients(age 67±16years) received 88 thrombectomy procedures. The median admission NIHSS was18. Forty six cases were treated IAT. Overall recanalization was 60%. Recanalization was seen more frequently in cases using IAT (72%) compared to non-IAT(48%)( p=0.02 ). IAT tended to associate with fewer numbers of arterial attempts than non-IAT (2.37±1.76 vs. 3.07± 1.98) (p=0.08) but longer procedure duration(119± 53 minutes vs. 90± 55 minutes)( p=0.02 ). The rate of symptomatic hemorrhagic transformation, in-hospital and 3 month mortality rates were not significantly different between IAT and non-IAT(p=0.90, p=0.99 and p=0.72), respectively. Conclusions: During mechanical thrombectomy, IAT is associated with increased recanalization rate and longer procedure duration. Mechanical thrombectomy with concomitant IAT appeared relatively safe.

scholarly journals Individualized intravenous thrombolytic strategy for acute ischemic stroke with large vessel occlusion on the era of mechanical thrombectomy: cases report

2019 ◽  
Vol 41 (3) ◽  
pp. 605-610 ◽  
Author(s):  
Pengfei Xing ◽  
Hongjian Shen ◽  
Zifu Li ◽  
Pengfei Yang ◽  
Yongwei Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Optimal Dose ◽  
Hemorrhagic Transformation ◽  
Large Vessel ◽  
Individual Treatment ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

AbstractIntravenous thrombolysis for acute ischemic stroke within 4.5 h after the onset of symptoms has become a standard therapy that is recommended by many trials and clinical guidelines. As on the era of mechanical thrombectomy for acute ischemic stroke with large vessel occlusions, whether intravenous thrombolysis (IVT) is still necessary, and how to choose the optimal dose are still controversy. Here, we reported two cases of acute ischemic stroke with large vessel occlusions that both achieved complete recanalization after IVT. Then, IVT was terminated in advance, and dynamic surveillance by DSA was performed to achieve individual treatment. However, both of the cases presented with hemorrhagic transformation. We analyzed the probable reasons and put forward thoughts from ourselves.

Abstract 1122‐000206: Predictors of Hemorrhagic Transformation after Mechanical Thrombectomy in Large Vessel Occlusion Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Vera Sharashidze ◽  
Vasu Saini ◽  
Amer Malik ◽  
Jose Romano
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Hemorrhagic Transformation ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Procedure Time ◽  
Inpatient Mortality ◽  
Vessel Occlusion ◽  
Symptomatic Intracranial Hemorrhage ◽  
Iv Tpa

Introduction : Stroke is a major cause of morbidity and mortality around the globe. Mechanical thrombectomy (MT) is the standard of care for patients with large vessel occlusion strokes. However, mechanical thrombectomy is associated with a number of complications. Symptomatic intracranial hemorrhage is one of the most feared complications of mechanical thrombectomy. In the pooled analysis of five trials, 4.4% of patients developed symptomatic intracranial hemorrhage. Treating physicians should have a good understanding of the potential complications of MT in order to optimize the safety and benefits of this procedure. Yet, the causes of hemorrhagic transformation are largely unknown and the predictors identified in previous studies vary. The goal of our study is to identify the rate and reliable predictors of radiological hemorrhagic transformation (RHT) and symptomatic hemorrhagic transformation (sICH) post mechanical thrombectomy in large vessel ischemic strokes. Methods : This was a retrospective analysis of consecutive large vessel occlusion acute ischemic stroke patients undergoing mechanical thrombectomy in a comprehensive stroke center (spanning 02/2015 ‐ 09/2018). Outcome measures included radiological hemorrhagic transformation (RHT) and symptomatic hemorrhagic transformation (sICH). sICH was defined as RHT with worsening of 4points in 24–36h NIHSS (ECASS II criteria) and by at least 1point (NINDS criteria).RHT was further classified according to Heidelberg‐bleeding classification as HI1, HI2, PH1, PH2, and SAH. Independent covariates predictive of RHT or symptomatic hemorrhage (sICH) were identified with multivariable logistic regression. Clinical opinion and the existing literature were used to reduce the number of variables collected at baseline to those considered potentially predictive of stroke progression. Results : Out of 341 patients who underwent thrombectomy, 32% had a radiological hemorrhagic transformation. The median age was 71. Smoking, IV tPA, longer procedure time, and lower TICI scores were associated with RHT. On a separate multivariate analysis, coronary artery disease was a separate predictor of hemorrhagic transformation. Patients with RHT had higher inpatient mortality and less mRs < 3 at discharge. Conclusions : RHT is associated with poor functional outcomes and inpatient mortality. Factors such as smoking, IV tPA, longer procedure time, and lower TICI scores were associated with RHT.

Abstract TP19: Clinical Outcomes In Patients With Acute Ischemic Stroke Due To Large Vessel Occlusion In The Modern Era: 2010-2011 Experience With 423 Patients.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Maxim Mokin ◽  
Tareq Kass-Hout ◽  
Omar Kass-Hout ◽  
Erol Veznedaroglu ◽  
Fadi Nahab ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Medical Management ◽  
Mortality Rates ◽  
Artery Occlusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Background and Purpose: Acute ischemic stroke due to large vessel occlusion is associated with a poor prognosis. With no consensus about the best treatment option, various treatment modalities including conservative management, intravenous tissue plasminogen activator, and endovascular approach are currently being used. Methods: Retrospective data including demographic information, baseline NIHSS score, site of occlusion (based on CTA, MRA or angiogram), type of treatment and clinical outcomes were collected from 4 centers in the United States during the period of 2010-2011. Results: A total of 423 were included in final analysis: 175 patients received conservative medical management, 54 patients received intravenous (IV) thrombolysis alone, and 194 patients had endovascular treatment (with or without prior IV tPA). Younger patients were more likely to receive endovascular treatment (p<0.001). There was no statistically significant difference among the sex and co-morbid conditions among the three groups. Proximal middle cerebral artery was the most commonly involved vessel. Strokes due to basilar artery occlusion or internal carotid artery occlusion were associated with worst outcomes in all three groups. Conservative medical management had the lowest rates of symptomatic intracerebral hemorrhage but also the highest mortality rates at 3 months. Patients who received endovascular treatment within the first 3 hrs had better outcome and lower mortality rates as compared to patients with intervention during 3-8 hours or beyond 8 hrs. Conclusions: Our study represents real world experience on the management and outcomes of acute ischemic strokes due to large vessel occlusion. Our results help understand natural history of strokes with large vessel occlusion, as well as modern trends in managing these patients with intravenous and intraarterial treatment approaches.

The Safety and Feasibility of Mechanical Thrombectomy for Mild Acute Ischemic Stroke With Large Vessel Occlusion

Neurosurgery ◽  
2019 ◽  
Vol 86 (6) ◽  
pp. 802-807 ◽  
Author(s):  
Gabor Toth ◽  
Santiago Ortega-Gutierrez ◽  
Jenny P Tsai ◽  
Russell Cerejo ◽  
Sami Al Kasab ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Invasive Procedure ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Abstract BACKGROUND Prospective evidence to support mechanical thrombectomy (MT) for mild ischemic stroke with large vessel occlusion (LVO) is lacking. There is uncertainty about using an invasive procedure in patients with mild symptoms. OBJECTIVE To evaluate the safety and feasibility of MT in patients with mild symptoms and LVO. METHODS Our single-arm prospective pilot study recruited patients with LVO and initial National Institute of Health Stroke Scale (NIHSS) &lt;6, who underwent standard MT. Primary safety endpoints were symptomatic intracerebral hemorrhage (sICH), and/or worsening NIHSS by ≥4 points. Secondary endpoints included angiographic recanalization, NIHSS change, final infarct volume, and modified Rankin score (mRS). RESULTS We enrolled 20 patients (mean age 65.6 ± 12.3 yr; 45% females). Thrombolysis in Cerebral Ischemia 2B/3 thrombectomy was achieved in 95%. No patients suffered sICH. One patient (5%) had neurologic worsening within 24 h because of underlying intracranial stenosis. No other complications or safety concerns were identified. Median NIHSS was significantly better at discharge (0.5, P = .007) and at last follow-up (0, P &lt; .001) than before treatment (3). Mean post vs preintervention infarct volumes were small without significant difference (1.2 ml, P = .434). Most patients (85%) were discharged directly home. Excellent clinical outcome (mRS 0-1) at last follow-up was seen in 95% of patients. CONCLUSION This is one of the first specifically designed prospective studies showing that MT is safe and feasible in patients with low NIHSS and LVO. Chronic underlying vasculopathy may be a challenging dilemma. We observed excellent clinical and radiographic outcomes, but randomized controlled trials are needed to demonstrate the efficacy of MT in this unique cohort.

scholarly journals Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0–5

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 880-888 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Panagiotis Chaloulos-Iakovidis ◽  
Leonidas Panos ◽  
Pasquale Mordasini ◽  
Patrik Michel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Favorable Outcome ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage

Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov . Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.

scholarly journals Intra-arterial thrombolysis for acute ischemic stroke: Our institutional experience

2012 ◽  
Vol 01 (01) ◽  
pp. 038-040
Author(s):  
R.V. Narayana ◽  
Rajesh Pati ◽  
Sibasankar Dalai
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Reports ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Multicentric Study ◽  
Feasible Option ◽  
Institutional Experience ◽  
Arterial Thrombolysis

Abstract The standard treatment for acute ischemic stroke is intravenous (IV) rtPA for patients who can reach the hospital within 3 to 4.5 h. There are case reports, where IA thrombolysis has helped patients in case an IV thrombolysis has failed. We report 14 cases of acute ischemic stroke treated by intra-arterial (IA) thrombolysis. We have retrospectively analyzed 14 cases of acute ischemic stroke treated at our department between December 2008 and October 2011 by intra-arterial thrombolysis. The patients with suspected large vessel occlusion (11 patients) and patients not responding to IV rtPA (3 patients) were considered for the IA thrombolysis. We achieved complete recanalization (TIMI 3) in 11 patients. One patient had a bleed following the procedure but recovered well during the hospital stay. All the patients were followed up to 90 days. Majority of them have good functional outcome. Our study suggests that intra-arterial thrombolysis is a feasible option in the subgroup of patients with large vessel occlusion. However, there is a need for a randomized multicentric study to support our results.

scholarly journals Intra-Arterial Adjunctive Medications for Acute Ischemic Stroke During Mechanical Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (4) ◽  
pp. 1192-1202
Author(s):  
Vanessa H.E. Chen ◽  
Grace K.H. Lee ◽  
Choon-Han Tan ◽  
Aloysius S.T. Leow ◽  
Ying-Kiat Tan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Risk Ratio ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Tissue Type ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: In patients with acute ischemic stroke with large vessel occlusion, the role of intra-arterial adjunctive medications (IAMs), such as urokinase, tPA (tissue-type plasminogen activator), or glycoprotein IIb/IIIa inhibitors, during mechanical thrombectomy (MT) has not been clearly established. We aim to evaluate the efficacy and safety of concomitant or rescue IAM for acute ischemic stroke with large vessel occlusion patients undergoing MT. Methods: We searched Medline, Embase, and Cochrane Stroke Group Trials Register databases from inception until March 13, 2020. We analyzed all studies with patients diagnosed with acute ischemic stroke with large vessel occlusion in the anterior or posterior circulation that provided data for the two treatment arms, (1) MT+IAM and (2) MT only, and also reported on at least one of the following efficacy outcomes, recanalization and 90-day modified Rankin Scale, or safety outcomes, symptomatic intracranial hemorrhage and 90-day mortality. Data were collated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Sixteen nonrandomized observational studies with a total of 4581 patients were analyzed. MT only was performed in 3233 (70.6%) patients, while 1348 (29.4%) patients were treated with both MT and IAM. As compared with patients treated with MT alone, patients treated with combination therapy (MT+IAM) had a higher likelihood of achieving good functional outcome (risk ratio, 1.13 [95% CI, 1.03–1.24]) and a lower risk of 90-day mortality (risk ratio, 0.82 [95% CI, 0.72–0.94]). There was no significant difference in successful recanalization (risk ratio, 1.02 [95% CI, 0.99–1.06]) and symptomatic intracranial hemorrhage between the two groups (risk ratio, 1.13 [95% CI, 0.87–1.46]). Conclusions: In acute ischemic stroke with large vessel occlusion, the use of IAM together with MT may achieve better functional outcomes and lower mortality rates. Randomized controlled trials are warranted to establish the safety and efficacy of IAM as adjunctive treatment to MT.

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