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

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.

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O-001 Pre-treatment CTA ASPECTS as a predictor of clinical outcome in endovascular stroke therapy (EVT): results from the penumbra START trial

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2012-010455a.1 ◽

2012 ◽

Vol 4 (Suppl 1) ◽

pp. A1.1-A1 ◽

Cited By ~ 1

Author(s):

D Frei ◽

A Yoo ◽

D Heck ◽

F Hellinger ◽

V McCollom ◽

...

Keyword(s):

Clinical Outcome ◽

Stroke Therapy ◽

Pre Treatment ◽

Start Trial ◽

Endovascular Stroke Therapy

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

Stroke ◽

10.1161/str.43.suppl_1.a3232 ◽

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.

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Angiographic Outcome of Endovascular Stroke Therapy Correlated with MR Findings, Infarct Growth, and Clinical Outcome in the DEFUSE 2 Trial

International Journal of Stroke ◽

10.1111/ijs.12271 ◽

2014 ◽

Vol 9 (7) ◽

pp. 860-865 ◽

Cited By ~ 16

Author(s):

Michael P. Marks ◽

Maarten G. Lansberg ◽

Michael Mlynash ◽

Stephanie Kemp ◽

Ryan A. McTaggart ◽

...

Keyword(s):

Clinical Outcome ◽

Stroke Therapy ◽

Endovascular Stroke Therapy

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Abstract TMP7: Endovascular Stroke Therapy Abrogates Sex-Related Differences in Recanalization in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp7 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sunil A Sheth ◽

Steven Warach ◽

Jan Gralla ◽

Reza Jahan ◽

Mayank Goyal ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Functional Independence ◽

Stent Retriever ◽

Stroke Therapy ◽

Procedural Time ◽

History Of ◽

Sex Disparities ◽

The Impact ◽

Endovascular Stroke Therapy

Background: Ischemic stroke affects women differently than men. Prior studies evaluating recanalization treatment with IV tpA showed that while women are more likely to achieve recanalization, there are strong sex disparities with respect to clinical outcome. We evaluated the effect of endovascular stroke therapy (ET) on recanalization and outcomes in women versus men. Methods: In the combined databases of the SWIFT, STAR, and SWIFT-PRIME trials, we identified patients treated with the Solitaire stent retriever to determine the effects of sex on recanalization and clinical outcome. Results: Among 389 patients treated with ET, mean age was 67±13, 55% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 [8-28]. There were no differences between females vs. males in presentation NIHSS (17 vs. 17, p=0.21), occlusion location (69% vs. 64% M1, p=0.62), or ASPECTS score (9 vs. 8, p=0.24). Rates of successful TICI 2b/3 recanalization were nearly identical (87% vs. 83%, p=0.374). There were no differences in onset to recanalization time (OTR) (277 vs. 306, p=0.46), procedural time (44 vs. 48 minutes, p=0.23), number of stent-retriever passes (1.7 vs. 1.8, p=0.17), rate of PH2 hemorrhage (1.9% vs. 1.1%, p=0.70), or functional independence at 90 days (53% vs. 56%, p=0.54). In ordinal multivariate analysis, collateral grade (OR 1.4, p=0.007) but not sex, age, or history of atrial fibrillation predicted improved TICI recanalization. In logistic (Figure) and ordinal regression analysis, the impact of delayed OTR was no different between men and women (1% versus 1.2% likelihood of worsened mRS outcome per 5 minute delay, p=0.27). Conclusions: In our prospective multicenter randomized cohort of nearly 400 patients undergoing ET, presentation and treatment characteristics of women were similar to men. Women were equally likely to achieve successful recanalization and good clinical outcomes.

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Abstract WP57: Perfusion Angiography Improves Clinical Outcomes Prediction in Endovascular Stroke Therapy

Stroke ◽

10.1161/str.48.suppl_1.wp57 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sunil A Sheth ◽

Julius Weng ◽

Priscilla McElhinney ◽

Benjamin Quachtran ◽

David S Liebeskind ◽

...

Keyword(s):

Clinical Outcome ◽

Predictive Power ◽

Important Determinant ◽

Treatment Success ◽

Regions Of Interest ◽

Modified Rankin Scale ◽

Stroke Therapy ◽

Post Intervention ◽

Quantitative Changes ◽

Endovascular Stroke Therapy

Background: Successful reperfusion is a key determinant of outcome in endovascular stroke therapy (ET). However, present methods of grading treatment success using the Thrombolysis in Cerebral Infarction (TICI) scale fail to measure quantitative changes in cerebral blood flow and volume (CBF and CBV) and as such, may not fully represent treatment effect. Methods: From our prospectively maintained institutional registry, we identified patients treated with ET between February 2014 and May 2016. CBF and CBV maps were calculated automatically for both AP and Lateral projections and regions of interest (ROIs) were drawn by two experienced neuroimagers over the middle cerebral artery territories. Delta CBF and CBV scores were determined by subtracting pre- from post-intervention maps and averaging over the ROIs. Non-linear regression was used to calculate correlations against clinical outcome (modified Rankin scale at discharge). Results: Among 104 patients treated with ET, average age was 70, 50% were female, and median presentation NIHSS was 16 (IQR 10-19). Target occlusion location was ICA in 14%, M1 in 67%, and M2 in 18%. TICI scores ranged from 0 (4%), 1 (13%), 2a (2%), 2b (22%), 3 (58%). Relative increases in CBF and CBV ranged from 0.4-17% (CBF) and 0.3-14% (CBV). Delta CBF and CBV maps correlated well with angiographic TICI (CBF p<0.05, CBV p<0.05). TICI alone did not correlate significantly with outcome (r=0.24, p=0.14). However, including delta CBF and CBV with TICI resulted in a stronger correlation (r=0.37, p<0.05) against outcome. Conclusions: TICI is an important determinant of outcome in EST. The incorporation of perfusion angiography measurements (CBF and CBV) improves the predictive power of angiography for clinical outcome.

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Blood Pressure After Endovascular Stroke Therapy-II

Case Medical Research ◽

10.31525/ct1-nct04116112 ◽

2019 ◽

Author(s):

Keyword(s):

Blood Pressure ◽

Stroke Therapy ◽

Endovascular Stroke Therapy

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Mechanical thrombectomy beyond the circle of Willis: efficacy and safety of different techniques for M2 occlusions

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017425 ◽

2021 ◽

pp. neurintsurg-2021-017425

Author(s):

Leonardo Renieri ◽

Iacopo Valente ◽

Adam A Dmytriw ◽

Ajit S Puri ◽

Jasmeet Singh ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Mechanical Thrombectomy ◽

Circle Of Willis ◽

Stent Retriever ◽

National Institutes Of Health ◽

Neurological Deficits ◽

Stent Retrievers ◽

Subarachnoid Hemorrhages ◽

Combined Technique

BackgroundM2 segment occlusions represent approximately one-third of non-lacunar ischemic stroke and can lead to permanent neurological deficits. Various techniques are available for mechanical thrombectomy beyond the circle of Willis, but data evaluating their effectiveness and safety are lacking.MethodsA retrospective review of patients with ischemic stroke undergoing mechanical thrombectomy for M2 occlusions from 13 centers in North American and Europe was performed. Tandem or multiple-territory occlusions were excluded. The primary outcome was 90-day modified Rankin Scale and reperfusion rates across stent-retriever, direct aspiration and combined techniques.ResultsThere were 465 patients (mean age 71.48±14.03 years, 53.1% female) with M2 occlusions who underwent mechanical thrombectomy. Stent-retriever alone was used in 133 (28.6%), direct aspiration alone in 93 (20.0%) and the combined technique in 239 (51.4%) patients. Successful reperfusion was achieved with the combined technique in 198 (82.2%; OR 2.6 (1.1–6.9)), with stent-retriever alone in 112 (84.2%; OR 9.2 (1.9–44.6)) and with direct aspiration alone in 62 (66.7%; referencecategory). Intraprocedural subarachnoid hemorrhages (iSAH) were 36 (7.7%) and were more likely to occur in patients treated with the stent-retrievers (OR 5.0 (1.1–24.3)) and combined technique (OR 4.6 (1.1–20.9)). Good clinical outcome was achieved in 260 (61.8%) patients, while 59 (14.0%) patients died. Older age, higher baseline NIHSS (National Institutes of Health Stroke Scale), parenchymal hemorrhage and iSAH were associated with poor outcome while successful recanalization and higher baseline ASPECTS (Alberta Stroke Program Early CT Score) were associated with good outcome. No differences were found among the three techniques in terms of clinical outcome.ConclusionStent-retrievers and a combined approach for M2 occlusions seem more effective than direct aspiration, but with higher rates of iSAH. This leads to no detectable difference in clinical outcome at 3 months.

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Improving surgical reduction in radial fractures using a ‘dowel’ pinning technique in miniature and toy breed dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-10-05-0077 ◽

2011 ◽

Vol 24 (01) ◽

pp. 45-49 ◽

Cited By ~ 4

Author(s):

C. E. DeCamp ◽

R. Rooks ◽

J. Yu

Keyword(s):

Clinical Outcome ◽

Bone Healing ◽

Medical Records ◽

Closed Reduction ◽

Surgical Repair ◽

Reduction Technique ◽

Good Clinical Outcome ◽

Distal Radial Fractures ◽

Radiographic Images ◽

Small Delay

Summary Objectives: A retrospective approach was used to detail and evaluate a ‘dowel’ pinning technique in distal radial fractures in miniature and toy breed dogs. Methods: Medical records and radiographs from 2003–2009 of miniature and toy breed dog radial fractures were examined. Sixty cases were divided into two groups: 51 radial fractures repaired with a ‘dowel’ pinning and external skeletal fixation (ESF) and nine radial fractures repaired with closed reduction and ESF. Each dog was evaluated and radiographic images were obtained at presentation, postoperatively, and at 1, 2, 4, 8, and 12 weeks postoperatively. Signalment, reduction, alignment, time to clinical bone healing and ESF removal, and implant morbidity were determined for each group. Results: Radial fractures repaired with a ‘dowel’ pin and ESF had improved reduction compared to closed reduction and ESF alone (p <0.0001 as evaluated with lateral radiographs and p <0.0004 with cranial/caudal radiographs). Both surgical groups resulted in good clinical outcome with low morbidity, however it was observed that the time to clinical union and ESF removal was an average of 2.5 weeks less with closed reduction technique compared to the open reduction and ‘dowel’ pinning technique (p <0.031). Clinical Significance: Incorporating a ‘dowel’ pin to the surgical repair enhances the reduction of distal radial fractures in miniature and toy breed dogs and results in excellent clinical outcomes but causes a small delay in bone healing.

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