scholarly journals A Case of Mechanical Thrombectomy with Stent-retriever Avoiding Vessel Linearization for Occluded Tortuous Distal Branch of Middle Cerebral Artery (M2)

2016 ◽  
Vol 10 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Tetsuya Ioku ◽  
Keisuke Imai ◽  
Masashi Hamanaka ◽  
Hidekazu Yamazaki ◽  
Masahiro Itsukage ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Distal Branch

scholarly journals Main Trunk and Division Middle Cerebral Artery Occlusions: Differences in Recanalization Times, Number of Stent Retriever Passes and Clinical Outcomes: A Single-Center Experience

2015 ◽  
Vol 4 (3-4) ◽  
pp. 83-89
Author(s):  
Ihtesham A. Qureshi ◽  
Alberto Maud ◽  
Salvador Cruz-Flores ◽  
Gustavo J. Rodriguez
Keyword(s):  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Univariate Analysis ◽  
Stent Retriever ◽  
Main Trunk ◽  
Single Center Experience ◽  
Mca Occlusion ◽  
Complex Anatomy

Background and Purpose: In this article, we present our experience with the recanalization of the middle cerebral artery (MCA), we hypothesize that there are higher rates of recanalization with fewer stent retriever passes and better clinical outcomes in patients with division MCA occlusions. A more complex anatomy at the bifurcation may prevent a faster recanalization in main trunk MCA occlusions. Methods: We retrospectively identified consecutive patients admitted with MCA occlusions who underwent mechanical thrombectomy using stent retrievers. We categorized patients into division MCA and main trunk MCA occlusions based on angiography. Variables were compared between the groups. We further analyzed patients with trunk MCA occlusions to identify reasons for delays in recanalization. Results: There were 32 MCA occlusions that underwent mechanical thrombectomy and eligible for the analysis during the study period. Of those, 11 were main trunk MCA occlusions. Univariate analysis disclosed a trend toward a lower GP-to-recanalization time (p = 0.05) and a lower number of passes required for recanalization in division MCA occlusions. However, there was a significantly better outcome in patients with division MCA occlusion after multivariate analysis. Analyzing main trunk MCA occlusion data, we found that the need for more than one pass to achieve recanalization led to a trend toward a longer GP-to-recanalization time and a worse outcome. When the stent was placed in the dominant division, the chances of recanalization were significantly higher. Conclusions: Division MCA occlusions have higher recanalization rates with fewer stent retriever passes and better clinical outcomes than main trunk MCA occlusions, likely due to a more favorable anatomy. Measures like placing the stent retriever in the dominant division may decrease recanalization times and improve clinical outcomes in main trunk MCA occlusions.

scholarly journals Short-Vessel Occlusion Might Indicate Higher Possibility of Success in Reperfusion following Mechanical Thrombectomy in Acute Middle Cerebral Artery Occlusion

2021 ◽  
pp. 131-136
Author(s):  
Tomoyuki Yoshihara ◽  
Ryuzaburo Kanazawa ◽  
Takanori Uchida ◽  
Tetsuhiro Higashida ◽  
Hidenori Ohbuchi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Active Zone ◽  
Mechanical Thrombectomy ◽  
Area Under The Curve ◽  
Maximum Intensity Projection ◽  
Stent Retriever ◽  
Vessel Occlusion ◽  
Mca Occlusion ◽  
The Impact

<b><i>Background:</i></b> The impact of the length of the occluded vessel in acute large-vessel occlusion on successful reperfusion by mechanical thrombectomy remains unclear. This study evaluated whether diameter and length of the occluded vessel in acute middle cerebral artery (MCA) occlusion might relate to successful reperfusion following mechanical thrombectomy. <b><i>Methods:</i></b> This retrospective study included patients with acute MCA occlusion who underwent intra-aortic injection of contrast medium to obtain maximum intensity projection (MIP) images acquired by flat-panel detector computed tomography (FD-CT) equipped with an angiographic system. All patients received mechanical thrombectomy and were divided into two groups: those with successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b/3) and those without. We compared the diameter and length of the occluded vessel between the groups. In the sub-analysis of patients with stent retriever use, ratio of length of occluded vessel to length of the active zone was compared. <b><i>Results:</i></b> We enrolled 29 patients (median age: 73, M1 occlusion: 51%, stent retriever use: 72%). Eighteen patients achieved TICI 2b/3 with significantly larger distal end diameter (1.7 [interquartile range: 1.5–1.9] vs. 1.2 [1.2–1.5] mm, <i>p</i> = 0.007) and shorter length (7.1 [4.9–9.7] vs. 12.3 [7.2–15.8] mm, <i>p</i> = 0.043) of the occluded vessel. Sub-analysis of 21 patients showed that the cut-off value for TICI 2b/3 reperfusion was 0.32 as the ratio between the occluded vessel and stent retriever active zone (receiver operating characteristic area under the curve: 0.90). <b><i>Conclusion:</i></b> In acute MCA occlusion, larger diameter of the distal end and shorter length of the occluded vessel on FD-CT MIP images might indicate a higher possibility of achieving TICI 2b/3 following mechanical thrombectomy.

Abstract P475: Intravenous Alteplase and Successful Recanalization Predict Good Outcome in Patients With M3 Segment Occlusions Undergoing Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Thomas Snyder ◽  
Adam H De Havenon ◽  
Thanh Nguyen ◽  
Osama O Zaidat ◽  
Shadi Yaghi
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Analysis Data ◽  
Artery Occlusion ◽  
Stent Retriever ◽  
Logistic Regression Models ◽  
Good Outcome ◽  
Intravenous Alteplase

Introduction: Advancements in the technology and techniques of clot removal has resulted in more distal clots becoming accessible for mechanical thrombectomy. The goal of this study was to assess the predictors of good outcome in stroke patients who underwent mechanical thrombectomy (MT) of the M3 segment of the middle cerebral artery. Methods: We performed a post-hoc analysis data from the North American Solitaire Stent Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries. We included patients with middle cerebral artery occlusion of the M3 segment treated with MT within 24 hours of last normal. The primary outcome was 90-day modified Rankin Scale of 0-2, which we termed good outcome. We fit logistic regression models and adjusted for variables selected with backwards stepwise selection set to p<0.05. Results: We included 131 patients; mean age 69.5, 43.5% male, and 13/131 (9.9%) had symptomatic intracranial hemorrhage. At 90 days, 66 patients (50.4%) had good outcome. The most predictive variable for good outcome was successful recanalization (103/131), which had an adjusted odds ratio (aOR) of 18.78 (95% confidence interval (CI) 4.07-86.7; p= <0.001). Intravenous alteplase was also associated with good outcome (aOR 3.13; 95% 1.20-8.12; p = 0.0019). Higher baseline mRS and NIHSS were associated with a decreased probability of good outcome, aOR= 0.39 (95% CI 0.22- 0.72; p = 0.002) and aOR = 0.89 (95% CI 0.82- 0.97; p = 0.006). Rescue endovascular therapy was also associated with a decreased probability of good outcome aOR 0.17; (95% CI 0.05-0.66; p = 0.010). Conclusion: Patients undergoing MT of the M3 segment were more likely to achieve good outcome if successfully recanalized or intravenous alteplase was administered prior to thrombectomy. Rescue treatments were associated with a lower likelihood of good outcome.

Sign in / Sign up

Export Citation Format

Share Document