Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

Introduction: Recent trials have demonstrated the superior efficacy of mechanical thrombectomy over other medical treatments for acute ischemic stroke; however, not every large vessel occlusion (LVO) can be recanalized using a single thrombectomy device. Rescue devices were proved to increase the reperfusion rate, but the efficacy is unclear.Objective: In this retrospective study, we evaluated the efficacy of rescue therapy in different locations of LVO.Methods: We analyzed the outcomes of mechanical thrombectomy from a prospective registry of consecutive 82 patients in Taipei Medical University Hospital. The reperfusion rate and the functional outcome were compared in patients who received first-line therapy only and patients who need rescue therapy.Results: An 84.1% reperfusion rate was achieved in our cohort. We applied first-line stent retriever (SR) treatment in 6 patients, among which 4 (66.6%) achieved successful reperfusion. We applied a direct-aspiration first-pass technique (ADAPT) as the first-line treatment in 76 patients, among which 46 (60.5%) achieved successful reperfusion. Successful reperfusion could not be achieved in 30 cases (39.5%); therefore, we applied a second-line rescue SR for 28 patients, and reperfusion was established in 18 (64.3%) of them. These results revealed that the LVO in anterior circulation has a higher chance to respond to SR rescue therapy than posterior circulation lesions (68 vs. 33.3%, P < 0.001). Patients who received only first-line therapy exhibited significantly better functional outcomes than those who were also treated with rescue SR therapy (41.2 vs. 16.7%, P = 0.001). In addition, patients with LVO in the anterior circulation were found to have a higher probability of achieving functional independence than patients with posterior circulation lesions (10.7 vs. 0.0%, P < 0.001). The adjusted multivariate analysis revealed that successful reperfusion and treatment type (first-line or rescue therapy) were significantly related to a modified Rankin Scale (mRS) score at 90 days.Conclusion: This study reveals that rescue SR therapy improves the reperfusion rate. Patients who require rescue SR therapy have a lower likelihood of functional independence. LVO in the anterior circulation responds better to rescue SR therapy and results in better functional outcomes than posterior circulation lesions.

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PIN30 ECONOMIC EVALUATION OF DAPTOMYCIN AS FIRST-LINE THERAPY VERSUS DAPTOMYCIN AS RESCUE THERAPY AFTER VANCOMYCIN OR LINEZOLID FAILURE IN GRAM-POSITIVE BACTEREMIA TREATMENT

Value in Health ◽

10.1016/s1098-3015(11)72829-7 ◽

2010 ◽

Vol 13 (7) ◽

pp. A435

Author(s):

R Lahoz ◽

J Galera ◽

B Font ◽

Parrado S Gil ◽

C Soengas ◽

...

Keyword(s):

Economic Evaluation ◽

Rescue Therapy ◽

First Line ◽

Gram Positive ◽

First Line Therapy ◽

Line Therapy

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Mechanical thrombectomy for pediatric stroke arising from an atrial myxoma: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.10.peds14292 ◽

2015 ◽

Vol 15 (3) ◽

pp. 301-305 ◽

Cited By ~ 27

Author(s):

Rafael A. Vega ◽

Julie L. Chan ◽

Tony I. Anene-Maidoh ◽

Margaret M. Grimes ◽

John F. Reavey-Cantwell

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Atrial Myxoma ◽

National Institutes Of Health ◽

Pediatric Stroke ◽

First Line ◽

Distal Extremity ◽

First Line Therapy ◽

Line Therapy

Children experiencing severe neurological deficit due to acute ischemic stroke may benefit from endovascular intervention. The authors describe the use of mechanical thrombectomy in the treatment of embolic occlusion secondary to an atrial myxoma in a pediatric patient. This case involved an 11-year-old boy with a history notable for Raynaud syndrome and a distal extremity rash who presented to the emergency department with dense hemiparesis secondary to thromboembolic occlusion of the M1 segment of the middle cerebral artery. Following mechanical thrombectomy, the patient's pediatric National Institutes of Health Stroke Scale score improved from a 16 to a 7. In the setting of acute pediatric stroke due to atrial myxoma emboli, mechanical thrombectomy may be a first-line therapy.

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Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014650 ◽

2019 ◽

Vol 11 (10) ◽

pp. 994-998 ◽

Cited By ~ 8

Author(s):

Xianjun Huang ◽

Qian Yang ◽

Xiaolei Shi ◽

Xiangjun Xu ◽

Liang Ge ◽

...

Keyword(s):

Ischemic Stroke ◽

Brain Edema ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Large Vessel Occlusion ◽

Midline Shift ◽

Anterior Circulation ◽

Vessel Occlusion

BackgroundMalignant brain edema (MBE) is a devastating complication in ischemic stroke. Data on MBE in patients who have had mechanical thrombectomy (MT) are relatively scarce.ObjectiveTo investigate the incidence, predictors, and clinical outcomes of MBE in patients after MT.MethodsWe included 130 consecutive patients after MT caused by anterior circulation large vessel occlusion stroke, treated with MT. MBE was defined as a midline shift of ≥5 mm on the follow-up imaging within 72 hours after MT. Characteristics of patients at admission and details of treatment were collected. The 90-day modified Rankin scale score was used as a measure of functional outcomes.ResultsOf the 130 patients (age, 68.6±10.9 years; male, 50%), 35 (26.9%) patients developed MBE. The patients with MBE had a lower rate of functional independence (OR=7.831; 95% CI 1.731 to 35.427; p=0.008) and significantly higher mortality at 90 days (OR=7.958; 95% CI 2.274 to 27.848; p=0.001) than patients without MBE. In 104 (80%) patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score of 2b–3), 24 (23.1%) patients exhibited MBE. After adjustment for confounding, ICA occlusion (OR=3.746; 95% CI 1.169 to 12.006; p=0.026) and worse collateral score (grade 1 vs grade 0: OR=0.727; 95% CI 0.192 to 2.753; p=0.638; grade 2 vs grade 0: OR=0.130; 95% CI 0.021 to 0.819; p=0.030) were significantly associated with the development of MBE, despite successful recanalization.ConclusionsMBE after MT is not uncommon and was related to poor functional outcomes. Localization of a vessel occlusion and collateral status may play a role in the development of MBE.

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Endovascular thrombectomy 2020: open issues

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa161 ◽

2020 ◽

Vol 22 (Supplement_M) ◽

pp. M13-M18

Author(s):

Peter Lanzer ◽

Petr Widimsky ◽

Diana A Gorog ◽

Mikael Mazighi ◽

David Liebeskind ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Posterior Circulation ◽

Large Artery ◽

First Line ◽

Anterior Circulation ◽

Endovascular Thrombectomy ◽

Optimal Outcomes ◽

Perfusion Defects ◽

First Line Treatment ◽

Open Issues

Abstract Mechanical thrombectomy is now well - established first - line treatment for selected patients with large artery occlusions of the anterior circulation. However, number of technical and procedural issues remains open to assure optimal outcomes in majority of patients including those suffering from posterior circulation perfusion defects. This brief review addresses some of the open issues and refers to the ongoing trials to close the existing knowledge gaps.

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Primary angioplasty and stenting may be superior to thrombectomy for acute atherosclerotic large-artery occlusion

Interventional Neuroradiology ◽

10.1177/1591019918763380 ◽

2018 ◽

Vol 24 (4) ◽

pp. 412-420 ◽

Cited By ~ 15

Author(s):

Dong Yang ◽

Min Lin ◽

Shuiping Wang ◽

Huaiming Wang ◽

Yonggang Hao ◽

...

Keyword(s):

Intracranial Hemorrhage ◽

Primary Angioplasty ◽

Large Vessel ◽

Large Vessel Occlusion ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

First Line Therapy ◽

Line Therapy ◽

Post Procedure

Objective The objective of this article is to compare the effectiveness of primary angioplasty and/or stenting with stent retriever thrombectomy in acute anterior large-vessel occlusion due to atherosclerotic disease. Methods Patients were retrospectively reviewed from the endovascular treatment for acute anterior circulation ischemic stroke registry. Patients with large-vessel occlusions due to atherosclerosis were selected. We evaluated modified Rankin Scale (mRS) score at 90 days, modified thrombolysis in cerebral infarction (mTICI) score immediately post-procedure, and symptomatic and asymptomatic intracranial hemorrhage within 72 hours. Results Of 302 patients with acute anterior circulation occlusion due to atherosclerotic disease, 269 were treated with stent retriever thrombectomy as first-line therapy and 33 with angioplasty and/or stenting. Patients who received primary angioplasty treatment showed favorable independent outcome at 90 days (69.7% (23/33) vs 47.6% (128/269), p = 0.02) and lower rate of asymptomatic intracranial hemorrhage (9.1% (3/23) vs 30.5% (82/269), p = 0.01). Recanalization immediately post procedure did not differ (78.8%% (26/33) vs 86.2% (232/269), p = 0.29). Primary angioplasty therapy (OR, 0.27; 95% confidence interval (CI): 0.08–0.90; p = 0.03) and small baseline infarct (OR 0.36: 0.16–0.82; p = 0.02) were protective factors against poor functional outcome, while old age (OR 1.04:1.01–1.07; p = 0.006), severe neurological deficits (OR 3.76: 2.00–7.07; p < 0.001), and high glucose (OR 1.11: 1.01–1.23; p = 0.03) were associated with poor prognosis. Conclusions Patients with acute anterior circulation large-vessel occlusion due to atherosclerosis may benefit from urgent angioplasty and/or stenting as first-line therapy. Randomized controlled trials are warranted.

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Clinical Signs, Treatment, and Outcome in Cats with Myeloma-Related Disorder Receiving Systemic Therapy

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6216 ◽

2015 ◽

Vol 51 (4) ◽

pp. 239-248 ◽

Cited By ~ 5

Author(s):

Claire M. Cannon ◽

Christina Knudson ◽

Antonella Borgatti

Keyword(s):

Prognostic Factors ◽

Rescue Therapy ◽

Clinical Signs ◽

Standard Of Care ◽

Response To Treatment ◽

Survival Times ◽

First Line ◽

Related Disorder ◽

First Line Therapy ◽

Line Therapy

Myeloma-related disorder (MRD) is an uncommon disease in cats, for which there is no established standard of care. In this retrospective study, we evaluated presentation, response to treatment, and toxicity in cats with MRD receiving systemic treatment. Previously reported prognostic factors were evaluated for their impact on survival in cats receiving chemotherapy. Of fifteen cases identified, thirteen received melphalan or cyclophosphamide +/- corticosteroids as first-line therapy. Chlorambucil was commonly used as rescue therapy in cats with progressive disease, or in cases of chemotherapy-related toxicity with first line agents. Overall response rates were 71% and 83% for melphalan- and cyclophosphamide-treated cats, respectively. Discontinuation of melphalan due to toxicity was common. Survival times for cats initially treated with melphalan or cyclophosphamide were not significantly different (median 252 and 394 days, respectively), and no statistically significant prognostic factors were identified. This study suggests that the combination of cyclophosphamide and corticosteroids is well tolerated and may be considered as first-line therapy for cats with systemic MRD.

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