Abstract P101: Mechanical Thrombectomy in COVID-19 Positive Patients With Large Vessel Occlusion: Pooled Review of Individual Case Series

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Muhammad Z Memon ◽  
Taha Nisar ◽  
Amit Singla ◽  
Anil Nanda ◽  
Gaurav Gupta ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Historic Data ◽  
Meta Analyses

Background: COVID-19 has been shown to induce a hypercoagulable state thereby increasing the risk of arterial thrombosis resulting in Large Vessel Occlusion Stroke (LVOs) Objective: We performed a systematic review of published reports to study the clinical characteristics, and outcomes of COVID-19 acute ischemic stroke (AIS) patients with LVO treated with mechanical thrombectomy (MT) and compared them with historical controls. Methods: We conducted a systematic literature search from December 2019 to July 2020 using multiple combinations of keywords from PubMed and Ovid databases according to the PRISMA meta-analyses and systemic reviews guidelines and then pooled data from individual case series. We included studies where COVID -19 associated LVO cases were treated with MT and their clinical outcomes were reported. We then compared these findings with the historic patient data from the five landmark randomized MT trials, the Hermes collaborators (HC). Results: An initial search generated 12 studies but after excluding case reports and multiple reports comprising of the same series of patients, a total of five reports consisting of 51 patients were analyzed. The mean age of patients was 59 years (IQR 36-75), and 40 (78 %) were men. Median NIHSS on presentation was 20 (IQR 10-29). AIS with LVO was the presenting manifestation of COVID-19 in 16 (20%) of patients. Intracranial ICA was the most common site of occlusion found in 27 (53%) of patients with multi-territory occlusion in 10 (20 %). Final recanalization TICI ≥ 2b was achieved in 33 (64%) of patients but reocclusion was noted in 7 (14 %). Modified Rankin score (mRS) 0-2 was reported in 12 (23 %) of patients with 40 % in-hospital mortality. When compared to historic data from HC, COVID -19 patients were younger (59 vs 69 years), presented with a higher median NIHSS score (20 vs 17), and had a higher prevalence of ICA terminus occlusion (53% vs 21% ). Similarly, patient outcomes were poor in the COVID -19 group with mRs 0-2 in (23 % versus 46 %) and mortality (40 % vs 15 %) compared to Hermes group. Conclusion: COVID -19 AIS patients with LVO who underwent MT were younger, had multiple territory occlusions with a propensity for ICA terminus location, and had poor angiographic and clinical outcomes as compared to historic data.

scholarly journals Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

2020 ◽  
Author(s):  
Anas S. Al-Smadi ◽  
Srishti Abrol ◽  
Ali Luqman ◽  
Parthasarathi Chamiraju ◽  
Hani Abujudeh
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Ischemic Disease ◽  
Patient Demographics

Abstract Background and PurposeStroke is a drastic complication and a poor prognostic marker of COVID-19 disease which emphasizes the importance of early identification and management of this complication. In this case series, we describe our experience of mechanical thrombectomy of large vessel occlusions (LVO) in patients with COVID-19.MethodsWe performed a retrospective study of a series of confirmed COVID-19 patients who underwent endovascular thrombectomy for acute cerebrovascular ischemic disease with large vessel occlusion. Patient demographics, presentations, lab values, angiographic and clinical outcomes were also reviewed.ResultsThree COVID-19 patients with large vessel occlusion who underwent endovascular thrombectomy were identified in our multi-center institution. Two patients had respiratory symptoms prior presentation and one patient presented initially with clinical deficits. Two patients had anterior circulation occlusion in the middle cerebral artery territory vs one had posterior circulation occlusion in the basilar artery. There was good angiographic outcome post thrombectomy in all patients, however poor clinical outcomes noted with no significant improvement in neurological manifestations in comparison with baseline at presentation. All patients developed critically severe symptoms during hospitalization requiring intubation and one patient died of COVID-19 related respiratory failure.ConclusionIn this small case series, we noted worse clinical outcomes in COVID-19 related LVO stroke despite effective thrombectomy, which may be related to the underlying COVID-19 disease and/or the nature of clot in these patients.

scholarly journals Predicting Clinical Outcomes of Large Vessel Occlusion Before Mechanical Thrombectomy Using Machine Learning

Stroke ◽  
2019 ◽  
Vol 50 (9) ◽  
pp. 2379-2388 ◽  
Author(s):  
Hidehisa Nishi ◽  
Naoya Oishi ◽  
Akira Ishii ◽  
Isao Ono ◽  
Takenori Ogura ◽  
...  
Keyword(s):  
Machine Learning ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

scholarly journals Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature

2020 ◽  
Vol 41 (12) ◽  
pp. 3517-3525
Author(s):  
Lucio D’Anna
Keyword(s):  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel ◽  
Controlled Trials ◽  
Large Vessel Occlusion ◽  
Review Of The Literature ◽  
Vessel Occlusion

Abstract Background Mechanical thrombectomy is the standard of care, in selected patients, for acute ischemic stroke with large vessel occlusion but its use in patients with stroke secondary to infective endocarditis is controversial. We report three cases of acute ischemic stroke treated by mechanical thrombectomy and we propose an extensive review of the literature to evaluate the clinical safety and efficacy of thrombectomy in patients with stroke secondary to infective endocarditis. Methods A comprehensive literature search was performed following a pre-specified protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Case reports, cases series, cross-sectional studies, case control studies, randomized controlled trials or nonrandomized controlled trials were considered that included endocarditis-related acute ischemic stroke patients who underwent mechanical thrombectomy. Results The database search yielded 431 relevant records published until January 2020. Nineteen articles fulfilled the eligibility criteria that described thirty patients. After the thrombectomy, 13.3% of the patients experienced intracranial haemorrhage. After the procedure, the median National Institutes of Health Stroke Scale score dropped from 15 (IQR 7) to 2.5 (IQR 5.75). At 90 days, mortality was 23.3% while 46.7% of the patients were functionally independent (mRS ≤ 2). Discussion Based on our review, the use of mechanical thrombectomy in patients with large vessel occlusion due to endocarditis-associated stroke might improve patient outcome but it should be considered on a case by case base as the safety has not been well established yet. Further research on risk stratification is needed to drive clinician during the decision-making process.

scholarly journals Mechanical Thrombectomy for Large Vessel Occlusion via the Transbrachial Approach: Case Series

2020 ◽  
Vol 15 (2) ◽  
pp. 89-95
Author(s):  
Yuichiro Tsuji ◽  
Takanori Miki ◽  
Hiroto Kakita ◽  
Kimitoshi Sato ◽  
Takashi Yoshida ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Access Site ◽  
Transfemoral Approach ◽  
Vessel Occlusion ◽  
Aged Patients ◽  
Transbrachial Approach ◽  
Symptomatic Intracranial Hemorrhage

Mechanical thrombectomy has become a standard treatment for acute ischemic stroke with large vessel occlusion. In aged patients, it is difficult to guide the catheter via the transfemoral approach due to vessel tortuosity and aortic elongation. We report our preliminary clinical experience using the transbrachial approach. Among the 119 patients who underwent thrombectomy from April 2018 to December 2019, a total of 5 patients were treated via the transbrachial approach. Clinical outcomes were retrospectively analyzed. Successful reperfusion was achieved in 4 out of 5 cases. There was 1 death due to symptomatic intracranial hemorrhage. One patient had a good outcome at discharge. There were no access-site complications associated with any of these cases. Transbrachial access for mechanical thrombectomy is feasible and can provide an alternative to the transfemoral approach.

Abstract WMP108: Endovascular Therapy in Children With Large Vessel Occlusion: a Clinical Series of Five Cases

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Tomas Bryndziar ◽  
Nestor R Gonzalez ◽  
Satoshi Tateshima ◽  
Neal M Rao ◽  
Jason D Hinman ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Interventional Procedure ◽  
Case Series ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Post Intervention ◽  
Vessel Occlusion ◽  
Patients Âgés ◽  
Clinical Series

Background & Purpose: Children were excluded from the recent positive mechanical thrombectomy trials and the literature on endovascular therapy in this population needs to be built. We report here case series of pediatric patients who received mechanical thrombectomy at our institution. Methodology: Our prospectively collected UCLA acute stroke database from 2000 to present was retrospectively reviewed. Only patients <18 years old with large vessel occlusion who underwent acute endovascular therapy were included in this study. Demographic, clinical, pre- and post-intervention imaging, and the interventional procedure data were analyzed. The Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score at presentation and at discharge, as well as pediatric-modified Rankin Scale (Ped-mRS) up-to 90 days were used. Results: All five patients (ages 2-15) suffered an embolic stroke. Three of them had congenital heart disease and one had repeated episodes of syncope and bradycardia. No risk factors other than PFO were identified in the fifth patient. Occlusion sites were ICA-M1 (n=2), M1 (n=2), and M1-M2 (n=1). IV tPA was used in one case. Time from last known well to reperfusion ranged from 3h to 9h 28min and the patients’ initial collaterals were scored between grades 2 - 3. AOL score of 3 was achieved in all cases, TICI 2a in two and TICI 2b in three cases. Merci was used in two cases, Penumbra, Solitaire and Mindframe Capture were used each in one case. One patient developed intracerebral hemorrhage that required hemicraniectomy. The PedNIHSS score at discharge ranged from 0 to 8 and the Ped-mRS score up-to 90 days ranged from 0 to 4, with 80% of children having Ped-mRS ≤ 3. Conclusion: Mechanical thrombectomy may be a safe and feasible treatment option in pediatric stroke patients with large vessel occlusion.

Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: A case–control study

2020 ◽  
pp. 174749302092536 ◽  
Author(s):  
Gaultier Marnat ◽  
Igor Sibon ◽  
Benjamin Gory ◽  
Sébastien Richard ◽  
Stéphane Olindo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Infective Endocarditis ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Mortality Rates ◽  
Case Control ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Symptomatic Intracranial Hemorrhage

Background and purpose Successful reperfusion can be achieved in more than two-thirds of patients with usual large-vessel occlusion stroke causes treated with mechanical thrombectomy. However, the safety and outcomes after mechanical thrombectomy in the setting of large-vessel occlusion related to infective endocarditis is not known. In this study, we investigated the impact of mechanical thrombectomy in infective endocarditis patients on angiographic and clinical outcomes. Methods This was a multicenter study from five comprehensive stroke centers. We compared the outcomes of mechanical thrombectomy treated stroke patients due to infective endocarditis with patients presenting atrial fibrillation. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage, and mortality. Results Between June 2013 and March 2019, 28 patients presenting large-vessel occlusion stroke due to IE were included. These cases were matched with 84 large-vessel occlusion stroke related to atrial fibrillation. Successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) was obtained in 85.7%. Symptomatic intracranial hemorrhage, favorable outcome and mortality rates were respectively 8.0%, 25.9%, and 25.9%. In the case–control analysis, we demonstrated no difference in terms of successful reperfusion, procedural complication, symptomatic intracranial hemorrhage, and mortality rates. Three-month favorable outcome was less often achieved in the infective endocarditis group. Conclusions Mechanical thrombectomy of infective endocarditis patients presents similar safety and angiographic results compared to patients suffering from atrial fibrillation.

scholarly journals Repeated Mechanical Thrombectomy in Recurrent Large Vessel Occlusion Acute Ischemic Stroke

2016 ◽  
Vol 6 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Mehdi Bouslama ◽  
Diogo C. Haussen ◽  
Leticia C. Rebello ◽  
Jonathan A. Grossberg ◽  
Michael R. Frankel ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Recurrent Stroke ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Common Etiology ◽  
Potential Benefits ◽  
The Mean

Background: Endovascular therapy has been proven effective for the treatment of large vessel occlusion strokes (LVOS). However, the feasibility and potential benefits of repeat thrombectomy for recurrent stroke is unclear. We aim to report our experience with repeat thrombectomy for recurrent LVOS. Methods: We reviewed our prospectively collected endovascular database for patients who underwent repeated mechanical thrombectomy. Baseline characteristics, procedural data and outcomes were evaluated. Patients with repeat thrombectomy were compared to patients with single thrombectomy. For patients with repeat thrombectomy, imaging and procedural variables were compared between first and last procedures. Results: Out of 697 patients treated within the study period, 15 patients (2%) had repeat thrombectomies (14 treated twice and one thrice). The mean age was 63 ± 15 years and 40% were males. The median time between the first and last procedure was 18 (1-278) days. Cardioembolism (66%) was the most common etiology, followed by intracranial atherosclerosis (13%) and large vessel atherosclerosis (6%). At 90 days after the last thrombectomy, 60% of patients achieved a modified Rankin Scale score of 0-2 and 20% were deceased. There were no statistically significant differences in demographics, stroke severity, time from last known normal to puncture, reperfusion rates, hemorrhagic complications, good clinical outcomes and mortality between patients who underwent repeat thrombectomy and those who had a single thrombectomy. Conclusion: In properly selected patients suffering recurrent LVOS, repeated mechanical thrombectomy appears to be feasible and safe. A previous thrombectomy should not discourage aggressive treatment as these patients may achieve similar rates of good clinical outcomes as those who undergo single thrombectomy.

Abstract TP19: Impact of Single-Pass Complete Reperfusion on Clinical Outcomes in Emergent Large Vessel Occlusion (ELVO) Patients Treated With Mechanical Thrombectomy (MT)

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Abhi Pandhi ◽  
Georgios Tsivgoulis ◽  
Nitin Goyal ◽  
Rashi Krishnan ◽  
Muhammad Ishfaq ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Single Pass

Abstract 1122‐000238: Feasibility of Successful Mechanical Thrombectomy of Large Vessel Occlusion Stroke Due to Calcified Emboli:Technical Note

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Alhamza R Al‐Bayati ◽  
Agostinho Camara Pinheiro ◽  
Haussen C Diogo ◽  
Raul G Nogueira
Keyword(s):  
Clinical Improvement ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel ◽  
Basilar Artery Occlusion ◽  
Secondary Outcome ◽  
Dramatic Improvement ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
High Calcium

Introduction : Clot composition has been identified as a predictor of successful recanalization in mechanical thrombectomy (MT). Emboli with high calcium content may affect the extraction ability of thrombectomy devices. We aimed to evaluate the recanalization rates of calcified emboli in patients with large vessel occlusion (LVO) who underwent MT. Methods : A prospectively maintained MT database from January 2019 to June 2021 was reviewed. We included patients with LVO in whom a calcified embolus was identified. The primary outcome was successful reperfusion (eTICI2B50‐3) at the end of the procedure. Secondary outcome included rates of dramatic clinical improvement at discharge defined as an improvement of NIHSS score ≥10 points or to 0–2. Safety measures included procedural complications and rates of symptomatic intracranial hemorrhage (SICH). Results : Seven patients (age,∼57‐89 years; sex, 5 females; baseline NIHSS,∼6‐27) were identified. Six patients had anterior circulation occlusion (four MCA‐M1, one MCA‐M2, and one case with ICA occlusion) whereas, one patient had basilar artery occlusion. The thrombus attenuation ranged from 122.5 to 457 Hounsfield unit, and only two patients had preprocedural IV‐tPA administration. All procedures were performed under monitored anesthesia care with procedural duration ranged from 22 to 240 minutes and 1 to 7 MT passes. Successful recanalization was achieved with aspiration thrombectomy alone (two cases) or combined with stent‐retriever (three cases) whereas two cases underwent rescue intracranial stenting. There were no reported intraprocedural complications or SICH. Dramatic clinical improvement was achieved in 3/7 (43%) cases. One patient expired at discharge from non‐stroke‐related causes Conclusions : Even though calcified thrombi are associated with longer procedure time and a higher number of passes, our case series demonstrates a favorable safety profile for aggressive treatment of this condition including rescue stenting when necessary. Specifically, there were no cases of SICH or procedure‐related mortality. Successful repression can be achieved in the majority of these patients with rates of dramatic improvement in nearly half of cases.

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