Abstract 1122‐000222: Repeated Mechanical Thrombectomy for Recurrent Large Vessel Occlusion: A Meta‐Analysis of Individual Participant Data

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mohamed Elfil ◽  
Mohamed Elfil ◽  
Mohammad Aladawi ◽  
Mohamed Eldokmak ◽  
Ahmed Bayoumi ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Large Vessel ◽  
Individual Participant Data ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Minimal Filling ◽  
Significant Difference ◽  
Individual Participant ◽  
The Mean

Introduction : Mechanical thrombectomy (MT) has become the standard treatment of acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), with different techniques used to achieve revascularization of the occluded vessel. However, early re‐occlusion of the target vessels could still take place in a considerable proportion of patients who already underwent MT for LVO. Therefore, we conducted this systematic review and individual participant data (IPD) meta‐analysis to provide more comprehensive evidence regarding the efficacy of repeat thrombectomy for recurrent LVO in early after successful first‐time MT. Methods : A computerized search on MEDLINE via PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane library using the relevant keywords was performed. The retrieved references were screened, and the relevant data were extracted. STATA and SPSS were used to perform this IPD meta‐analysis. Results : Twenty studies were included, of which ten studies were observational studies (n = 21,251 patients) and 10 cases reports (n = 10 patients). Out of the included patients, 266 patients (62.78% females) were identified with recurrent LVO. The overall prevalence of recurrent LVO was 1.6%, 95% CI (1.0% to 2.8%), p<0.001. The mean age of the included patients was 65.67±16.23 years. Cardiac embolism was the most common cause of stroke in both times (52%). The median number of days between the first and second LVO was 15 days (IQR: 4–191). Regarding the National Institute of Health Stroke Scale (NIHSS), the first and second MT reduced it significantly (MD = ‐8.91, 95% CI: ‐10.02 to ‐7.82) and (MD = ‐5.97, 95% CI: ‐7.53 to ‐4.43), respectively, with a significant difference between both procedures (p = 0.001). The mean ASPECT after the first MT was 8.65±1.45, and after the second MT was 8.01±1.88. A significant weak correlation was observed between the ASPECT of first MT and NIHSS before it (r = ‐0.270, p = 0.001). Based on the thrombolysis in cerebral infarction (TICI) grading system, the first MT resulted in 57.3% complete perfusion, 42.1% partially filling, and 0.7% no/minimal filling, while the second MT resulted in 48% complete perfusion, 30% partially filling, and 6.67% no/minimal filling, with a significant difference between both MTs (p = 0.042). Regarding the modified Rankin scale (mRS) at 90 days after the first MT, “0” was the most frequent outcome (26.9%), followed by “2” (13.0%), “1” (12.4%), and “4” (7.3%). On the other hand, the 90‐day mRS after the second MT was categorized as the following: “6” in 13.5%, “3” in 13.5%, “2” in 11.9%, “1” in 11.9%, and “4” in 9.3%. Conclusions : In properly selected patients with recurrent LVO, repeated MT appears to be feasible and safe. A prior MT procedure should not discourage aggressive treatment as these patients may achieve similar rates of good clinical outcomes as those who undergo single MT.

Abstract 1122‐000182: Histological Composition of Large Vessel Occlusion Stroke‐Causing Thrombi to Identify Etiologies: Systematic Review and Meta‐Analysis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Paul Yeung‐Lai‐Wah ◽  
Kunakorn Atchaneeyasakul ◽  
Kyle Sheu ◽  
Neal Rao ◽  
David Liebeskind ◽  
...  
Keyword(s):  
Blood Cells ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Cryptogenic Stroke ◽  
Large Vessel ◽  
Large Artery ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Histological Difference ◽  
Significant Difference

Introduction : More than a third of large vessel occlusion ischemic strokes do not have clear etiology. Mechanical thrombectomy provides a method to retrieve stroke‐causing thrombi and potentially identifying the etiology. A systematic meta‐analysis is performed to determine if there is a histological difference in red blood cell (RBC) composition of thrombi after the etiology of the stroke is known. Methods : We performed a systematic search through PUBMED and EMBASE. Studies meeting inclusion criteria were identified in which the large vessel occlusion stroke‐causing thrombi histology and etiology of the stroke were determined as either large artery atherosclerotic (LAA), cardioembolic (CE) or cryptogenic. Studies that had the data available or extractable data were selected. Random‐effect models were used to compare the histological difference between each etiology. Results : From inception to August 2021, 4 studies (n = 1022) were used to compare CE vs LAA, 5 studies (n = 1247) were used to compare CE vs cryptogenic and 4 studies (n = 654) were used to compare LAA vs cryptogenic. There was no significant difference in the red blood cells vs white blood cells/fibrin/platelets component between the stroke origins of CE vs LAA (mean difference (MD) ‐1.87; 95% confidence internal [CI]: ‐16.51, 12.78), CE vs cryptogenic (MD 1.18; 95% CI: ‐1.49, 3.86) and LAA vs cryptogenic (MD 7.20; 95% CI: ‐3.93, 18.34). Conclusions : There was no significant gross histological difference between CE, LAA and cryptogenic stroke etiologies and of the large vessel occlusion stroke‐causing thrombi retrieved by mechanical thrombectomy. Further studies into biochemical or genetic markers may be needed to identify stroke etiology.

EXPRESS: Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion, a systematic review and meta-analysis

2021 ◽  
pp. 174749302110125
Author(s):  
Mingming Zha ◽  
Qingwen Yang ◽  
Shuo Liu ◽  
Min Wu ◽  
Kangmo Huang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Working Hours ◽  
Good Prognosis ◽  
Large Vessel ◽  
Cochrane Library ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference

Background There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO). Aims This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours. Summary of review Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through February 23rd, 2021. The primary outcomes were onset to door, door to imaging, door to puncture, puncture to recanalization, procedural time, successful recanalization, symptomatic intracerebral hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale [mRS] score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture, onset to puncture, onset to recanalization, door to recanalization time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer onset to door (WMD [95%CI], 12.83 [1.84-23.82] min), door to puncture (WMD [95%CI], 11.45 [5.93-16.97] min), imaging to puncture (WMD [95%CI], 10.39 [4.61-16.17] min), onset to puncture (WMD [95%CI], 25.30 [13.11-37.50] min), onset to recanalization (WMD [95%CI], 25.16 [10.28-40.04] min), and door to recanalization (WMD [95%CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95%CI], 0.85 [0.76-0.95]; P=0.004; I2=0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend towards lower OR of good prognosis was witnessed in the off-hour group (OR [95%CI], 0.92 [0.84-1.01]; P=0.084; I2=0%). Conclusions Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend towards worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.

Abstract 1122‐000223: Direct to Angiography Suite versus Conventional Imaging in Suspected Large Vessel Occlusion Strokes: A Meta‐Analysis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Mohamed Elfil ◽  
Mohamed Fahmy Doheim ◽  
Agostinho Camara Pinheiro ◽  
Alhamza R Al‐Bayati ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Functional Independence ◽  
Large Vessel ◽  
Cochrane Library ◽  
Conventional Imaging ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Angiography Suite ◽  
Significant Difference

Introduction : Direct transfer to angiography suite (DTAS) for patients with suspected large vessel occlusion strokes potentially requiring mechanical thrombectomy has been shown to shorten treatment times and improve outcomes compared to conventional imaging (CI) selection. This meta‐analysis compares both approaches to build more concrete evidence. Methods : The potentially relevant studies that were published in four electronic databases/search engines (PubMed, Web of Science, Cochrane Library, and Scopus) till August 2021 were reviewed. Eligible studies were included if they enrolled >10 patients in both groups, were published in English and reported baseline and procedural characteristics and 90‐day outcomes. Relevant data were then extracted and analyzed. Results : Among 4514 searched studies, six qualified for the analysis. Time from door to puncture (MD = ‐26.76minutes, 95 % CI [‐39.48, ‐14.03], P< 0.0001) as well as door to reperfusion (MD = ‐27.21 minutes,95% CI [‐47.42, ‐7.01], P = 0.008) were significantly shorter and the rates of functional independence(mRS0‐2: RR = 1.28, 95% CI [1.03, 1.60], P = 0.03) at 90‐days were significantly higher in the DTAS versus the CI approach. There was no statistically significant difference between DTAS and CI groups in terms of successful reperfusion (modified Thrombolysis In Cerebral Infraction [mTICI] score2B‐3: RR = 0.99, 95% CI [0.93, 1.06], P = 0.86), near complete/ full reperfusion (mTICI 2C‐3: RR = 0.84,95% CI [0.68, 1.04], P = 0.11), or fair outcomes at 90‐days (mRS 0–3: RR = 1.05, 95% CI [0.67, 1.64],P = 0.84). Moreover, there was no difference between groups regarding symptomatic intracranial hemorrhage (RR = 0.81, 95% CI [0.55, 1.17], P = 0.26) or 90 day‐mortality (RR = 0.85, 95% CI [0.59, 1.24],P = 0.41). Conclusions : Our meta‐analysis showed that DTAS significantly improves time metrics and functional outcome with comparable safety to the CI approach. Multicenter randomized clinical trials are ongoing to confirm these results.

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 Trevo 6 × 25mm vs. 4 × 30mm in Mechanical Thrombectomy of M1 LVO

2021 ◽  
Vol 12 ◽  
Author(s):  
Marion John Oliver ◽  
Emily Brereton ◽  
Muhib A. Khan ◽  
Alan Davis ◽  
Justin Singer
Keyword(s):  
Mechanical Thrombectomy ◽  
Perioperative Complications ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
First Pass Effect ◽  
Significant Difference ◽  
First Pass ◽  
Stent Retrievers ◽  
Complications And Mortality

Objectives: Our primary objective was to determine the successful rate of recanalization of M1 large vessel occlusion using either the Trevo 4 × 30 mm or 6 × 25 mm stent during mechanical thrombectomy. Our secondary objectives were to determine differences between the use of these two stent retrievers regarding first-pass effect, periprocedural complications, and mortality in the first 90 days.Methods: This is a retrospective cohort study. Data regarding the stent used, recanalization, number of passes, periprocedural complications, and mortality were determined via our mechanical thrombectomy database along with chart review.Conclusion: When comparing Trevo 4 × 30 mm to 6 × 25 mm stent retrievers used in mechanical thrombectomy for middle cerebral artery large-vessel occlusion causing stroke, there is no statistically significant difference in successful recanalization rates, first-pass effect, perioperative complications, or mortality at 90 days. Studies like this will hopefully lead to further prospective, randomized controlled trials that will help show experts in the field an additional way to perform this procedure effectively and safely.

scholarly journals Heart Failure Is Not Associated with a Poor Outcome after Mechanical Thrombectomy in Large Vessel Occlusion of Cerebral Arteries

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Marlena Schnieder ◽  
Anneki von Glasenapp ◽  
Amelie Hesse ◽  
Marios N. Psychogios ◽  
Mathias Bähr ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Thrombectomy ◽  
Left Ventricular ◽  
Large Vessel ◽  
Left Ventricular Ejection ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
The Impact

The impact of heart failure on outcome in stroke patients is not fully understood. There is evidence for an increased mortality and morbidity, but it remains uncertain whether thrombectomy in patients with large vessel occlusion (LVO) in the anterior circulation is less effective in patients with heart failure compared to patients without. Retrospectively, we analyzed echocardiographic data of all patients in our stroke database, who underwent mechanical thrombectomy (n=668) for the presence of heart failure. Furthermore, we collected baseline characteristics and neurological and neuroradiological parameters. In the analysis, 373 of the 668 patients of our stroke database underwent echocardiography. Of these 373 patients, 90 patients (24%) suffered from heart failure with reduced left ventricular ejection fraction measured by echocardiography according to the current guidelines. After adjustment for age, the Alberta stroke program early CT score (ASPECTS), and time from symptom onset to recanalization, the analysis revealed that thrombectomy in patients with heart failure and LVO is not associated with less favorable outcome measured by the modified Rankin Scale after 90 days (3 (0-6) vs. 3 (1-5); p=0.380). Moreover, we could not find a significant difference in mortality compared to patients without heart failure (11.0% vs. 7.4%; p=0.313).

Abstract WP31: Fibrin Rich Thrombus versus Erythrocyte Rich Thrombus in Acute Large Vessel Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kota Maekawa ◽  
Masunari Shibata ◽  
Masaru Seguchi ◽  
Kazuto Kobayashi ◽  
Hidetaka Nakajima ◽  
...  
Keyword(s):  
Blood Cells ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
White Blood Cells ◽  
Functional Independence ◽  
Large Vessel ◽  
Basilar Artery Occlusion ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference

Objective: The aim of this study was to evaluate thrombus composition and its association with clinical, laboratory, and neurointerventional findings in patients treated by mechanical thrombectomy due to acute large vessel occlusion. Methods: From August 2015 to June 2016, 72 patients were treated in our hospital by mechanical thrombectomy using stent retriever and/or aspiration catheter. Retrieved thrombi underwent semiquantitative analysis to quantify red blood cells, white blood cells, and fibrin by area. We divided patients into two groups as fibrin rich group or erythrocyte rich group according to predominant composition in thrombus. Two groups were compared with respect to imaging, clinical, and neurointerventional data. Results: Histopathologic analysis of retrieved thrombus from 37 patients with acute stroke due to internal carotid artery, middle cerebral artery, or basilar artery occlusion was performed. Erythrocyte rich thrombi were present in 13 (35%) of cases, and fibrin rich thrombi in 24 (65%). Cardioembolic etiology was significantly more in patients with fibrin rich thrombi than those with erythrocyte rich thrombi (79% vs. 38%; p=0.01). All other clinical and laboratory characteristics did not differ. Patients with fibrin rich thrombi had greater number of recanalization maneuvers (2.8 ± 1.2 vs. 1.8 ± 1.6, p=0.04) and longer interval time between puncture and recanalization (62 ± 33.6 minutes vs. 42 ± 21.3 minutes; p=0.04). There is no significant difference in occluded vessels and mechanical thrombectomy devices between two groups. Patients with fibrin rich thrombi were lower rate of functional independence (mRS score, 0-2) at 90 days (33% vs. 75%; p=0.04). Conclusion: This study showed that fibirin rich thrombus was associated with extended procedure time, unfavorable clinical outcome and cardioembolic etiology.

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