scholarly journals Mechanical thrombectomy in patients with acute basilar occlusion using stent retrievers

2015 ◽  
Vol 21 (6) ◽  
pp. 710-714 ◽  
Author(s):  
Angelo António Silva Carneiro ◽  
João Tiago Lopes Rodrigues ◽  
José Pedro Rocha Pereira ◽  
José Viriato Alves ◽  
João Abel Marques Xavier
Keyword(s):  
Clinical Outcome ◽  
Mechanical Thrombectomy ◽  
Clinical Results ◽  
Basilar Artery Occlusion ◽  
Good Clinical Outcome ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
Poor Outcome ◽  
Stent Retrievers

Background Early arterial recanalisation with stent retrievers (SR) has been recently demonstrated to improve clinical outcome of patients with large-vessel occlusion of the anterior circulation. However, the benefit of SR thrombectomy in the setting of acute basilar artery occlusion (BAO) has not been proven yet. This study evaluated a series of consecutive patients with BAO treated with SR, focusing on the efficacy, safety and clinical results. Methods We analysed 24 consecutive patients with acute BAO who were treated with SR mechanical thrombectomy. Good clinical outcome at three months was defined as mRS ≤ 2. Data from patients with good outcome were compared to that from patients with poor outcome. Results Sufficient recanalisation (TICI 2 b or 3) was achieved in 63% (15/24) of patients. At three months, 33% (8/24) of patients had died; good clinical outcome was obtained in 21% (5/24). Age (46 vs. 60 years old, p = 0.05) and time from symptoms onset to recanalisation (370 vs. 521 minutes, p = 0.048) was significantly lower in patients with good outcome as compared to patients with poor outcome. There were three cases (12.5%) of periprocedural complications, all of them related to arterial wall dissection/perforation. Conclusions SR thrombectomy might be an efficient and safe treatment for patients with acute BAO occlusion and might help improve outcome.

scholarly journals Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

2017 ◽  
Vol 01 (03) ◽  
pp. 139-143 ◽  
Author(s):  
Yosuke Tajima ◽  
Michihiro Hayasaka ◽  
Koichi Ebihara ◽  
Masaaki Kubota ◽  
Sumio Suda
Keyword(s):  
Clinical Outcome ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Complete Revascularization ◽  
Anterior Circulation ◽  
Clinical Imaging ◽  
Good Outcome ◽  
Poor Outcome ◽  
Favorable Clinical Outcome

AbstractSuccessful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

scholarly journals Internal Carotid Artery and the Proximal M1 Segment Are Optimal Targets for Mechanical Thrombectomy

2017 ◽  
Vol 6 (3-4) ◽  
pp. 207-218 ◽  
Author(s):  
Niko Sillanpää ◽  
Sara Protto ◽  
Jukka T. Saarinen ◽  
Juha-Pekka Pienimäki ◽  
Janne Seppänen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Mechanical Thrombectomy ◽  
Statistical Tests ◽  
Intravenous Thrombolysis ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Good Clinical Outcome ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Outcome Differences

Background and Purpose: Mechanical thrombectomy (MT) is an established treatment of acute anterior circulation stroke caused by large vessel occlusion (LVO). We compared the clinical outcome (3-month modified Rankin Scale, mRS) in hyperacute (<3h from the onset of symptoms) ischemic stroke between an MT and an intravenous thrombolysis (IVT) cohort in proximal (ICA and the proximal M1 segment of the middle cerebral artery) and distal (the distal M1 and the M2 segment) LVOs. Methods: We prospectively reviewed 67 patients who underwent MT with newer-generation stent retrievers. The IVT cohort consisted of 98 patients who received IVT without MT. We recorded baseline clinical, procedural and imaging variables, technical outcome, 24-h imaging outcome, and the clinical outcome. Differences between the groups were studied with theoretically appropriate statistical tests and binary logistic regression analysis. Results: The proportion of patients who had a proximal LVO and experienced good (mRS ≤2) or excellent (mRS ≤1) clinical outcome was significantly larger in the MT group (62 vs. 7%, p < 0.001; 47 vs. 3%, p < 0.001, respectively). In a regression model including relevant confounding variables, good clinical outcome was seen significantly more often among patients with proximal occlusions (OR = 6.0, CI 95% 1.9-18.3, p = 0.002). In a similar model, no statistically significant differences were observed in patients with more distal occlusions. Conclusions: MT is superior to IVT in achieving good clinical outcome in hyperacute anterior circulation stroke in the most proximal occlusions (ICA and proximal M1 segment). In the distal M1 and M2 segments neither of these therapies clearly outperforms the other.

scholarly journals In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

2020 ◽  
Author(s):  
Juha-Pekka Pienimäki ◽  
Jyrki Ollikainen ◽  
Niko Sillanpää ◽  
Sara Protto
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ordinal Logistic Regression Analysis ◽  
Stroke Center

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

Impact of thrombus length on recanalization and clinical outcome following mechanical thrombectomy in acute ischemic stroke

2016 ◽  
Vol 9 (10) ◽  
pp. 937-939 ◽  
Author(s):  
Fatih Seker ◽  
Johannes Pfaff ◽  
Marcel Wolf ◽  
Silvia Schönenberger ◽  
Simon Nagel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Outcome ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Artery Occlusion ◽  
Good Clinical Outcome ◽  
Stent Retrievers ◽  
The Impact

PurposeThe impact of thrombus length on recanalization in IV thrombolysis for acute intracranial artery occlusion has been well studied. Here we analyzed the influence of thrombus length on the number of thrombectomy maneuvers needed for recanalization, intraprocedural complications, recanalization success, and clinical outcome after mechanical thrombectomy.MethodsWe retrospectively analyzed angiographic and clinical data from 72 consecutive patients with acute occlusion of the M1 segment of the middle cerebral artery who were treated with mechanical thrombectomy using stent retrievers. Successful recanalization was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. Good neurological outcome was defined as a modified Rankin Scale score of ≤2 at 90 days after stroke onset.ResultsMean thrombus length was 13.4±5.2 mm. Univariate binary logistic regression did not show an association of thrombus length with the probability of a good clinical outcome (OR 0.95, 95% CI 0.84 to 1.03, p=0.176) or successful recanalization (OR 0.92, 95% CI 0.81 to 1.05, p=0.225). There was no significant correlation between thrombus length and the number of thrombectomy maneuvers needed for recanalization (p=0.112). Furthermore, thrombus length was not correlated with the probability of intraprocedural complications (p=0.813), including embolization in a new territory (n=3).ConclusionsIn this study, thrombus length had no relevant impact on recanalization, neurological outcome, or intraprocedural complications following mechanical thrombectomy of middle cerebral artery occlusions. Therefore, mechanical thrombectomy with stent retrievers can be attempted with large clots.

TREVO and Capture LP have equal technical success rates in mechanical thrombectomy of proximal and distal anterior circulation occlusions

2016 ◽  
Vol 9 (7) ◽  
pp. 644-649 ◽  
Author(s):  
Sara Protto ◽  
Juha-Pekka Pienimäki ◽  
Janne Seppänen ◽  
Ira Matkaselkä ◽  
Jyrki Ollikainen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Mechanical Thrombectomy ◽  
Randomized Study ◽  
Success Rates ◽  
Technical Success ◽  
Good Clinical Outcome ◽  
Anterior Circulation ◽  
Excellent Outcome ◽  
Proximal Internal Carotid Artery ◽  
Device Selection

PurposeMechanical thrombectomy (MT) is a proven method to treat large vessel occlusions in acute anterior circulation stroke. We compared the technical, imaging, and clinical outcomes of MT performed with either TREVO or Capture LP devices.MethodsThere were 42 and 43 patients in the TREVO and Capture LP groups, respectively. Baseline variables, technical outcome (Thrombolysis In Cerebral Infarction, TICI), 24 hours imaging outcome, and 3-month clinical outcome (modified Rankin Scale, mRS) were prospectively recorded. The patients were stratified according to clot location, groups compared, and logistic regression models devised to study the effect of device selection on the clinical outcome.ResultsThe technical success rates were equal in both proximal (internal carotid artery and proximal M1 segment) and distal occlusions (distal M1 and M2 segments). The proportion of TICI 2b or 3 was 96% and 87% with TREVO and 87% and 89% with Capture LP (p=0.25 and p=0.80, respectively). Device selection did not significantly predict good clinical outcome (mRS ≤2) in either proximal or distal occlusions. In multivariate analysis, selecting Capture LP borderline significantly increased the odds of an excellent outcome close to sixfold both in proximal and distal occlusions (OR 6.7, 95% CI 0.82 to 53.7, p=0.08 and OR 5.7, 95% CI 0.88 to 37.8, p=0.07, respectively).ConclusionsTREVO and Capture LP perform equally well in proximal and distal occlusions in the anterior circulation when technical and good clinical outcome are considered. Capture LP may have a small advantage in reaching mRS ≤1 at 3 months. However, this needs to be confirmed in a randomized study.

scholarly journals “Y-stent retriever”: a new rescue technique for refractory large-vessel occlusions?

2018 ◽  
Vol 128 (5) ◽  
pp. 1349-1353 ◽  
Author(s):  
Roberto Crosa ◽  
Alejandro M. Spiotta ◽  
Matías Negrotto ◽  
Alejandra Jaume ◽  
Walter Casagrande
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Large Vessel ◽  
Positive Trial ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Flow Restoration ◽  
Stent Retrievers

Long-awaited positive trial data have shown the efficacy of endovascular treatment in patients with ischemic stroke who arrive at the hospital within the first 6 hours with large-vessel occlusion of the anterior circulation. With the introduction of stent retrievers (SRs) for mechanical thrombectomy, efficient and safe large-artery recanalization treatment can be achieved. However, sometimes there are patients who do not attain complete flow restoration following attempts with traditional maneuvers. The authors present the case of a 57-year-old man with acute ischemic stroke due to an M1 embolus that extended into both M2 trunks. This patient was successfully treated with an innovative technique in which a Solitaire SR (Covidien) and a Catch SR (Balt) were used in a “Y” configuration, for which the authors coined the term “Y-stent retriever.”

Endovascular therapy versus thrombolysis in patients with large vessel occlusions within the anterior circulation aged ≥80 years

2018 ◽  
Vol 10 (11) ◽  
pp. 1053-1056 ◽  
Author(s):  
Andreas Kastrup ◽  
Freimuth Brunner ◽  
Helmut Hildebrandt ◽  
Christian Roth ◽  
Michael Winterhalter ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Hospital Death ◽  
Anterior Circulation ◽  
Excellent Outcome ◽  
Good Outcome ◽  
Poor Outcome ◽  
Clinical And Radiological Outcome ◽  
Stent Retrievers ◽  
Symptomatic Intracranial Hemorrhage

Background and purposeIn patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, the effectiveness of ET in elderly patients is uncertain.MethodsUsing our stroke database, we compared the rates of good outcome (modified Rankin scale (mRS) ≤2), excellent outcome (mRS 0–1), poor outcome (mRS 5–6) at discharge, in-hospital death, infarct size, and symptomatic intracranial hemorrhage (SICH) in patients aged ≥80 years with distal intracranial carotid artery, M1 and M2 occlusions during two time periods.ResultsFrom January 2008 to October 2012, 217 patients were treated with IVT and, from November 2012 to October 2017, 209 patients received ET with stent retrievers (with or without IVT). Significantly more patients in the ET group than in the IVT group had a good outcome (25% vs 16%, P<0.05), as well as an excellent outcome (12% vs 4%, P<0.01). Significantly fewer patients in the ET group than in the IVT group died (14% vs 22%, P<0.05) or had a poor outcome (35% vs 52%, P<001). The SICH rates were lower after ET than after IVT (1% vs 6%, P<0.01), and the infarct sizes were smaller after ET than after IVT.ConclusionsCompared with IVT, the routine use of ET significantly improved the early clinical and radiological outcome in patients with anterior circulation large vessel occlusions aged ≥80 years. Nevertheless, poor outcome rates were high so the role of ET needs to be defined further in this population.

Clinical results of a new concept of neurothrombectomy coverage at a remote hospital—“drive the doctor”

2018 ◽  
Vol 13 (7) ◽  
pp. 696-699 ◽  
Author(s):  
Fatih Seker ◽  
Markus A Möhlenbruch ◽  
Simon Nagel ◽  
Christian Ulfert ◽  
Silvia Schönenberger ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Tertiary Care ◽  
Clinical Results ◽  
University Hospital ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Remote Hospital ◽  
After Hours ◽  
Tertiary Care Hospitals

Background Many tertiary care hospitals cannot provide a continuous thrombectomy service due to the lack of a neurointerventionalist. Aims In this study, we present procedural and clinical results of a new concept in which neuroradiologists of a university hospital provide neurointerventional stroke service to a remote hospital (“drive the doctor”). Methods All consecutive patients with acute ischemic stroke due to large vessel occlusion of the anterior circulation treated with mechanical thrombectomy after hours at a remote hospital (distance of about 100 km) between 2012 and 2016 were analyzed retrospectively. These patients were compared to a group of patients referred to the above mentioned university hospital for MT over a comparable distance (“drip and ship”). Results A total of 60 patients were treated by “drive the doctor” and 66 patients were treated by “drip and ship.” Time from onset to imaging was similar in both groups (77 vs. 70 min, P = 0.6847). However, time from imaging to groin puncture was significantly lower in the “drive the doctor” model (112 vs. 232 min, P < 0.0001). Nonetheless, recanalization rate and clinical outcome were similar in both cohorts. Conclusions “Drive the doctor” is a feasible concept of neurothrombectomy coverage at remote hospitals. The presented data suggest that “drive the doctor” is not inferior compared to established stroke concepts such as “drip and ship” regarding recanalization rate and outcome. However, larger and prospective studies are necessary to confirm this finding.

scholarly journals Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 482-490
Author(s):  
Fabian Flottmann ◽  
Caspar Brekenfeld ◽  
Gabriel Broocks ◽  
Hannes Leischner ◽  
Rosalie McDonough ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cerebral Infarction ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Functional Independence ◽  
Good Clinical Outcome ◽  
Anterior Circulation ◽  
Vessel Occlusion

Background and Purpose: Endovascular therapy is the standard of care in the treatment of acute ischemic stroke due to large-vessel occlusion. Often, more than one retrieval attempt is needed to achieve reperfusion. We aimed to quantify the influence of endovascular therapy on clinical outcome depending on the number of retrievals needed for successful reperfusion in a large multi-center cohort. Methods: For this observational cohort study, 2611 patients from the prospective German Stroke Registry included between June 2015 and April 2018 were analyzed. Patients who received endovascular therapy for acute anterior circulation stroke with known admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score, final Thrombolysis in Cerebral Infarction score, and number of retrievals were included. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. The primary outcome was defined as functional independence (modified Rankin Scale score of 0–2) at day 90. Multivariate mixed-effects models were used to adjust for cluster effects of the participating centers and confounders. Results: The inclusion criteria were met by 1225 patients. The odds of good clinical outcome decreased with every retrieval attempt required for successful reperfusion: the first retrieval had the highest odds of good clinical outcome (adjusted odds ratio, 6.45 [95% CI, 4.0–10.4]), followed by the second attempt (adjusted odds ratio, 4.56 [95% CI, 2.7–7.7]), and finally the third (adjusted odds ratio, 3.16 [95% CI, 1.8–5.6]). Conclusions: Successful reperfusion within the first 3 retrieval attempts is associated with improved clinical outcome compared with patients without reperfusion. We conclude that at least 3 retrieval attempts should be performed in endovascular therapy of anterior circulation strokes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03356392.

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