scholarly journals Fibrin Clot Architecture in Acute Ischemic Stroke Treated With Mechanical Thrombectomy With Stent-Retrievers　― Cohort Study ―

2018 ◽  
Vol 82 (3) ◽  
pp. 866-873 ◽  
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Ivo Šteiner ◽  
Oldřich Vyšata ◽  
Roman Herzig ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Fibrin Clot ◽  
Stent Retrievers

scholarly journals Comparison of non–stent retriever and stent retriever mechanical thrombectomy devices for the endovascular treatment of acute ischemic stroke

2017 ◽  
Vol 126 (4) ◽  
pp. 1123-1130 ◽  
Author(s):  
Kate A. Hentschel ◽  
Badih Daou ◽  
Nohra Chalouhi ◽  
Robert M. Starke ◽  
Shannon Clark ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Standard Of Care ◽  
Stent Retriever ◽  
Radiographic Outcomes ◽  
Scale Scores ◽  
Stent Retrievers

OBJECTIVE Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. However, limited data are available from assessment of outcomes of FDA-approved devices. The objective of this study is to compare clinical outcomes, efficacy, and safety of non–stent retriever and stent retriever thrombectomy devices. METHODS Between January 2008 and June 2014, 166 patients treated at Jefferson Hospital for Neuroscience for acute ischemic stroke with mechanical thrombectomy using Merci, Penumbra, Solitaire, or Trevo devices were retrospectively reviewed. Primary outcomes included 90-day modified Rankin Scale (mRS) score, recanalization rate (thrombolysis in cerebral infarction [TICI score]), and incidence of symptomatic intracranial hemorrhages (ICHs). Univariate analysis and multivariate logistic regression determined predictors of mRS Score 3–6, mortality, and TICI Score 3. RESULTS A total of 99 patients were treated with non–stent retriever devices (Merci and Penumbra) and 67 with stent retrievers (Solitaire and Trevo). Stent retrievers yielded lower 90-day NIH Stroke Scale scores and higher rates of 90-day mRS scores ≤ 2 (22.54% [non–stent retriever] vs 61.67% [stent retriever]; p < 0.001), TICI Score 2b–3 recanalization rates (79.80% [non–stent retriever] vs 97.01% [stent retriever]; p < 0.001), percentage of parenchyma salvaged, and discharge rates to home/rehabilitation. The overall incidence of ICH was also significantly lower (40.40% [non–stent retriever] vs 13.43% [stent retriever]; p = 0.002), with a trend toward lower 90-day mortality. Use of non–stent retriever devices was an independent predictor of mRS Scores 3–6 (p = 0.002), while use of stent retrievers was an independent predictor of TICI Score 3 (p < 0.001). CONCLUSIONS Stent retriever mechanical thrombectomy devices achieve higher recanalization rates than non–stent retriever devices in acute ischemic stroke with improved clinical and radiographic outcomes and safety.

scholarly journals Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use

2018 ◽  
Vol 7 (6) ◽  
pp. 327-333 ◽  
Author(s):  
Mohamed S. Teleb
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Guide Catheter ◽  
Stent Retrievers ◽  
Number Of Passes ◽  
Single Center Observational Study

Background: Treatment of large vessel occlusion acute ischemic stroke with mechanical thrombectomy has become the standard of care after recent clinical trials. However, the degree of recanalization with stent retrievers remains very important in overall outcomes. We sought to review the utility of a new balloon guide catheter (BGC) in improving the degree of recanalization in conjunction with mechanical thrombectomy. Methods: The medical records of a prospectively collected endovascular ischemic stroke database were reviewed. All consecutive strokes when a FlowGate BGC was used with a thrombectomy stent retriever were identified. Use of a FlowGate BGC, number of passes, final Thrombolysis in Cerebral Infarction (TICI) score, trackability, and use of adjunct devices were all collected and analyzed. Results: Use of a FlowGate BGC resulted in 64% (33/52) first-pass effect (FPE) of TICI 2b/3, and specifically 46% (24/52) TICI 3 FPE (true FPE). A total of 52/62 (84%) of thrombectomy cases were treated with BGCs. In the remaining 10, the BGC was not inflated or used due to the clot not being visualized or the lesions being distal and BGC use thus not deemed appropriate. Adjunct use of an aspiration catheter was seen in 12% (6/52) of cases. The overall success with FlowGate BGCs with one or more passes of TICI 2b/3 was 94% (49/52). Trackability was achieved in 92% (57/62) of cases. Conclusions: Use of the FlowGate BGC as an adjunct to mechanical thrombectomy was associated with good FPE and an overall recanalization of TICI 2b/3 of 94%.

scholarly journals Recent guidelined for the early endovascular management of patients with acute ischemic stroke and practical aspects of their implementation

2018 ◽  
Vol 24 (2) ◽  
pp. 20-29
Author(s):  
А.М. Netliukh ◽  
V.М. Shevaga ◽  
A.V. Payenok ◽  
В.M. Salo ◽  
О.Ya. Kobyletskyi
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Cerebral Ischaemia ◽  
Mechanical Thrombectomy ◽  
Radiology Department ◽  
Stroke Treatment ◽  
Stent Retrievers ◽  
Reperfusion Rate ◽  
Arterial Thrombolysis

Objective — to estimate safety and effectiveness of intra-arterial treatment for acute ischemic stroke in the interventional radiology department of multiprofile hospital. Materials and methods. Urgent endovascular treatment was applied at 15 patients with acute ischemic stroke in carotid circulation during 2015–2017. Mechanical intra-arterial therapy with thrombectomy by stent-retrievers and thromboaspiration was used at accordingly six and two recent cases (during 2017); in 7 cases intra-arterial thrombolysis was the treatment option (2015–2016). Results. The article consist brief review of literature about acute ischemic stroke treatment and discussion concerning results of treatment of selected patients. Mechanical thrombectomy or thromboaspiration were effective in 75.0 % of cases with good recanalization rate opposite to 42.9 % at 7 patients treated by either intra-arterial or bridging thrombolysis with rt-PA. Unexpected technical failures of mechanical thrombectomy regarding recent clinical guidelines for ischemic stroke management following are discussed on example of 2 clinical cases. Conclusions. Endovascular treatment of ischemic stroke has a high safety and well-known efficacy. It became evident at our patients that following current management guidelines for thrombectomy with stent-retrievers or thromboaspiration after thrombotic occlusions of extracranial and proximal segments of intracranial arteries allowed attaining in 2017 reperfusion rate 2b/3 Modified Treatment in Cerebral Ischaemia Scale in majority of cases. Intra-arterial thrombolysis contributed to the reperfusion rate 2b/3 on the Modified Treatment in Cerebral Ischaemia scale just in 42.9 % of cases, which indicates its lower effectiveness.

Large Vessel Occlusion

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Stent Retrievers ◽  
Iv Tpa

Select patients who are not eligible for IV tPA, or who do not recanalize with IV thrombolysis alone, may be treated with acute endovascular therapies within a 6-hour window. Mechanical thrombectomy, with or without intra-arterial tPA, has recently been shown to be effective in treating acute ischemic stroke caused by large vessel occlusion. Intra-arterial therapy using approved stent retrievers has become the standard of care for acute large vessel occlusion.

Abstract WMP10: Comparison of 6 mm Diameter and 3-4 mm Diameter Stent Retrievers for Mechanical Thrombectomy in Acute Ischemic Stroke Patients. Is Bigger Better?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Christina Sanchez ◽  
Asad Ahrar ◽  
Saqib A Chaudhry ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Stent Retriever ◽  
Optimal Size ◽  
Stroke Patients ◽  
Nihss Score ◽  
Significant Difference ◽  
Stent Retrievers

Background: There is controversy regarding the optimal size of stent retriever for achieving timely recanalization in acute ischemic stroke patients. Objective: To determine the relationship between stent retriever diameter and procedure time, and rates of recanalization, and functional independence among acute ischemic stroke patients undergoing mechanical thrombectomy. Methods: We analyzed data from consecutive acute ischemic stroke patients treated with mechanical thrombectomy derived from a prospective database. Baseline demographic and clinical characteristics, NIHSS score on admission and discharge, intracranial hemorrhage occurrence, and mRS at discharge were analyzed. Thrombolysis In Cerebral Infarction (TICI) scale was used to grade pre and post procedure angiographic recanalization. Procedural time was defined by the time interval between microcatheter placement and recanalization. We compared the rates of thrombectomy attempts, complete recanalization (TICI grade of 3), and functional independence (defined by mRS 0-2) between patients treated with 6 mm and 3-4 mm diameter stent retrievers. Results: A total of 230 acute ischemic stroke patients (mean age 71.8 ±12.5; 46.6% women) were treated with stent retrievers. Thrombectomy was performed with a 6mm diameter stent retriever in 107 patients and 3 or 4 mm diameter stent retriever in 123 patients. There were no statistically significant differences in demographics or baseline characteristics, or admission NIHSS score between the two groups. There was a trend towards a fewer number of thrombectomy attempts required with a 6mm diameter stent retriever (p=0.06). There was a higher rate of complete recanalization in patients treated with 6mm diameter stent retriever compared with 3 or 4 mm diameter stent retriever (72% vs 57.7% p=0.02). There was no statistically significant difference in rates of functional independence between the two groups (24.3% vs 25.2% p=0.84) at discharge. Conclusion: Among acute ischemic stroke patients undergoing mechanical thrombectomy, use of a 6 mm diameter stent retriever was associated with a higher rate of complete recanalization and a lower number of thrombectomy attempts compared with 3-4 mm diameter stent retrievers.

Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center

2015 ◽  
Vol 8 (3) ◽  
pp. 230-234 ◽  
Author(s):  
Annika Kowoll ◽  
Anushe Weber ◽  
Anastasios Mpotsaris ◽  
Daniel Behme ◽  
Werner Weber
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Intention To Treat ◽  
First Pass ◽  
Stent Retrievers ◽  
Stroke Center

IntroductionOver the past decade, endovascular techniques for the treatment of acute ischemic stroke have emerged significantly. However, revascularization rates are limited at approximately 80%, and mechanical thrombectomy procedures still last about 1 h. Therefore, we investigated the novel direct aspiration first pass technique for its efficacy and safety.MethodsOur neurointerventional database was screened for patients who received mechanical thrombectomy for acute ischemic stroke using the Penumbra 5MAX ACE aspiration catheter on an intention to treat basis between November 2013 and June 2014. Procedural data, including modified Thrombolysis in Cerebral Infarction (mTICI) score, procedural timings, and complications, as well as clinical data at admission and discharge, were analyzed.Results54 patients received mechanical thrombectomy using the 5MAX ACE. Median age was 69 (39–94) years (54% were men). Baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (2–27) and 44/54 (81%) patients received intravenous thrombolysis. Vessel occlusion sites were 91% anterior circulation and 9% posterior circulation. A successful revascularization result (mTICI ≥2b) was achieved in 93% of cases whereas direct aspiration alone was successful in 30/54 (56%) cases; among these, median time from groin puncture to revascularization was 30 min (9–113). Symptomatic intracranial hemorrhage occurred in 2/54 (4%) patients, and embolization to new territories in 3/54 (6%). Median NIHSS at discharge was 6 (0–24); 46% of patients were independent at discharge.ConclusionsThe direct aspiration first pass technique proofed to be fast, effective, and safe. Promising revascularization results can be achieved quickly in more than 50% of patients using this technique as the firstline option. Nevertheless, stent retrievers are still warranted in approximately 40% of cases to achieve a favorable revascularization result.

scholarly journals Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (9) ◽  
pp. 2591-2598 ◽  
Author(s):  
Jeban Ganesalingam ◽  
Elena Pizzo ◽  
Stephen Morris ◽  
Tom Sunderland ◽  
Diane Ames ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Stent Retrievers
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