Direct versus Bridging Mechanical Thrombectomy in Elderly Patients with Acute Large Vessel Occlusion: A Multicenter Cohort Study

AbstractData on the impact of kidney dysfunction on outcome in patients with stroke due to large vessel occlusion are scarce. The few available studies are limited by only considering single kidney parameters measured at one time point. We thus investigated the influence of both chronic kidney disease (CKD) and acute kidney injury (AKI) on outcome after mechanical thrombectomy. We included consecutive patients with anterior circulation large vessel occlusion stroke receiving mechanical thrombectomy at our center over an 8-year period. We extracted clinical data from a prospective registry and investigated kidney serum parameters at admission, the following day and throughout hospital stay. CKD and AKI were defined according to established nephrological criteria. Unfavorable outcome was defined as scores of 3–6 on the modified Rankin Scale 3 months post-stroke. Among 465 patients, 31.8% had an impaired estimated glomerular filtration rate (eGFR) at admission (< 60 ml/min/1.73 m2). Impaired admission eGFR was related to unfavorable outcome in univariable analysis (p = 0.003), but not after multivariable adjustment (p = 0.96). Patients frequently met AKI criteria at admission (24.5%), which was associated with unfavorable outcome in a multivariable model (OR 3.03, 95% CI 1.73–5.30, p < 0.001). Moreover, patients who developed AKI during hospital stay also had a worse outcome (p = 0.002 in multivariable analysis). While CKD was not associated with 3-month outcome, we identified AKI either at admission or throughout the hospital stay as an independent predictor of unfavorable prognosis in this study cohort. This finding warrants further investigation of kidney–brain crosstalk in the setting of acute stroke.

Download Full-text

PCV37 Cost-Effectiveness Analysis of IV-TPA Followed By Mechanical Thrombectomy with Stent-Retriever Versus IV-TPA ALONE in the Treatment of ACUTE Ischemic Stroke Due to Large Vessel Occlusion in Portugal

Value in Health ◽

10.1016/j.jval.2020.08.528 ◽

2020 ◽

Vol 23 ◽

pp. S493

Author(s):

V. Genovez ◽

J. Sargento ◽

L. Veloso ◽

E. Machado ◽

M. Ribeiro ◽

...

Keyword(s):

Ischemic Stroke ◽

Cost Effectiveness ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Cost Effectiveness Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Effectiveness Analysis ◽

Iv Tpa

Download Full-text

Acute occlusion of the fetal posterior cerebral artery: diagnosis and management paradigms

The Neuroradiology Journal ◽

10.1177/19714009211019383 ◽

2021 ◽

pp. 197140092110193

Author(s):

Mohamad Abdalkader ◽

Anurag Sahoo ◽

Julie G Shulman ◽

Elie Sader ◽

Courtney Takahashi ◽

...

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Mechanical Thrombectomy ◽

Posterior Cerebral Artery ◽

Management Strategies ◽

Artery Occlusion ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Cerebral Artery Occlusion

Background and purpose The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. Methods We performed a retrospective review of consecutive patients presenting with acute large vessel occlusion who underwent cerebral angiogram and/or mechanical thrombectomy between January 2015 and January 2021. Patients diagnosed with fetal posterior cerebral artery occlusion were included. Demographic data, clinical presentation, imaging findings and management strategies were reviewed. Results Between January 2015 and January 2021, three patients with fetal posterior cerebral artery occlusion were identified from 400 patients who underwent angiogram and/or mechanical thrombectomy for acute stroke (0.75%). The first patient presented with concomitant fetal posterior cerebral artery and middle cerebral artery occlusions. Thrombectomy was performed with recanalisation of the fetal posterior cerebral artery but the patient died from malignant oedema. The second patient presented with isolated fetal posterior cerebral artery occlusion. No endovascular intervention was performed and the patient was disabled from malignant posterior cerebral artery infarct. The third patient presented with carotid occlusion and was found to have fetal posterior cerebral artery occlusion after internal carotid artery recanalisation. No further intervention was performed. The patient was left with residual contralateral homonymous hemianopia and mild left sided weakness. Conclusion Fetal posterior cerebral artery occlusion is a rare, but potentially disabling, cause of ischaemic stroke. Endovascular treatment is feasible. Further investigation is needed to compare the efficacy of medical versus endovascular management strategies.

Download Full-text

O-037 Comparative safety and efficacy of combined intravenous thrombolysis and mechanical thrombectomy with mechanical thrombectomy alone in emergent large vessel occlusion

10.1136/neurintsurg-2017-snis.37 ◽

2017 ◽

Author(s):

N Goyal ◽

G Tsivgoulis ◽

D Frei ◽

A Turk ◽

B Baxter ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Comparative Safety

Download Full-text

High Mobility Group Box 1 Protein in Cerebral Thromboemboli

International Journal of Molecular Sciences ◽

10.3390/ijms222011276 ◽

2021 ◽

Vol 22 (20) ◽

pp. 11276

Author(s):

Fabian Essig ◽

Lilith Babilon ◽

Christoph Vollmuth ◽

Alexander M. Kollikowski ◽

Mirko Pham ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

High Mobility ◽

Large Vessel ◽

High Mobility Group ◽

Neutrophil Extracellular Trap ◽

Spatial Proximity ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Molecular Pattern ◽

Hmgb1 Expression

High-mobility group box 1 protein (HMGB1) is a damage-associated molecular pattern (DAMP) involved in neutrophil extracellular trap (NET) formation and thrombosis. NETs are regularly found in cerebral thromboemboli. We here analyzed associated HMGB1 expression in human thromboemboli retrieved via mechanical thrombectomy from 37 stroke patients with large vessel occlusion. HMGB1 was detected in all thromboemboli, accounting for 1.7% (IQR 0.6–6.2%) of the total thromboemboli area and was found to be colocalized with neutrophils and NETs and in spatial proximity to platelets. Correlation analysis revealed that the detection of HMGB1 was strongly related to the number of neutrophils (r = 0.58, p = 0.0002) and platelets (r = 0.51, p = 0.001). Our results demonstrate that HMGB1 is a substantial constituent of thromboemboli causing large vessel occlusion stroke.

Download Full-text

Favorable outcome of repeat mechanical thrombectomy in a geriatric patient: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case2140 ◽

2021 ◽

Vol 1 (24) ◽

Author(s):

Ali A. Alsarah ◽

Omar M. Hussein ◽

Andrew P. Carlson

Keyword(s):

Geriatric Patients ◽

Unusual Case ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Favorable Outcome ◽

Illustrative Case ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Common Procedure ◽

Favorable Neurological Outcome

BACKGROUND The authors presented their experience with a case of repeat thrombectomy in a 93-year-old patient who showed a favorable outcome after recurrent large vessel occlusion treated with emergency mechanical thrombectomy. OBSERVATIONS Mechanical thrombectomy has been proven to be effective in treating large vessel occlusion types of ischemic stroke. Most of the patient populations involved in the thrombectomy-related studies were younger than 80 years. In addition, recurrent mechanical thrombectomy is not a common procedure in clinical practice. This unusual case demonstrated the potential to achieve a favorable outcome with thrombectomy even in a patient older than 85 years with recurrent large vessel occlusion. LESSONS There can be a favorable neurological outcome after one or repeat thrombectomies for geriatric patients older than 90 years, and age should not be a deterrent to treatment.

Download Full-text