Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry

Background and Purpose Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse.Methods INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months.Results Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9).Conclusions Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.

Download Full-text

Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment

Frontiers in Neurology ◽

10.3389/fneur.2021.668363 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zongjie Shi ◽

Shunyuan Guo ◽

Jie Pan ◽

Chao Xu ◽

Yu Geng ◽

...

Keyword(s):

Clinical Outcomes ◽

Primary Outcome ◽

Mechanical Thrombectomy ◽

Fasting Glucose ◽

Independent Predictor ◽

Secondary Outcome ◽

Vessel Occlusion ◽

Glucose Levels ◽

Increased Risk ◽

Symptomatic Intracranial Hemorrhage

Background and objective: Hyperglycemia on admission was associated with worse clinical outcomes after mechanical thrombectomy (MT) of acute ischemic stroke (AIS). We evaluated whether increased postoperative fasting glucose (PFG) was also related to poor clinical outcomes in patients who underwent MT treatment.Methods: Consecutive patients with large vessel occlusion underwent MT in our center were included. Admission glucose and fasting glucose levels after MT treatment were evaluated. Primary outcome was 90-day unfavorable outcomes (modified Rankin Scale score of 3–6). Secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH) after MT treatment. The association of PFG and 90-day clinical outcome after MT treatment was determined using logistic regression analyses.Results: One hundred twenty seven patients were collected. The median postoperative fasting glucose level was 6.27 mmol/L (IQR 5.59–7.62). Fourteen patients (11.02%) had sICH, and fifty-eight patients (45.67%) had unfavorable outcomes at 90-day after MT. After adjustment for potential confounding factors, PFG level was an independent predictor of 90-day unfavorable outcome (OR 1.265; 95% CI 1.017–1.575; p = 0.035) and sICH (OR 1.523; 95% CI 1.056–2.195; p = 0.024) after MT. In addition, older age, higher baseline NIHSS score, and higher postoperative NLR were also associated with unfavorable outcomes at 90-day after MT treatment.Conclusions: Increased PFG is associated with unfavorable outcomes at 90-day and an increased risk of sICH in patients underwent MT treatment.

Download Full-text

Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017193 ◽

2021 ◽

pp. neurintsurg-2020-017193

Author(s):

Ching-Jen Chen ◽

Reda Chalhoub ◽

Dale Ding ◽

Jeyan S Kumar ◽

Natasha Ironside ◽

...

Keyword(s):

Primary Outcome ◽

Mechanical Thrombectomy ◽

National Institutes Of Health ◽

Stroke Patients ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Symptomatic Intracerebral Hemorrhage ◽

History Of ◽

Multivariable Models ◽

Secondary Outcomes

BackgroundThe benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3.MethodsThis is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage.ResultsThe unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041).ConclusionsComplete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.

Download Full-text

Abstract TP10: Intra-Arterial Thrombolysis After Failed Mechanical Thrombectomy: A STRATIS Registry Subgroup Analysis

Stroke ◽

10.1161/str.51.suppl_1.tp10 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Syed Zaidi ◽

Alicia Castonguay ◽

Mouhammad Jumaa ◽

Nils Mueller-Kronast ◽

Osama Zaidat

Keyword(s):

Mechanical Thrombectomy ◽

Rescue Therapy ◽

Recombinant Tissue Plasminogen Activator ◽

Prospective Data ◽

Increased Risk ◽

First Choice ◽

Tissue Plasminogen ◽

Symptomatic Intracranial Hemorrhage ◽

Number Of Passes ◽

Arterial Thrombolysis

Background: Limited prospective data exists on the use of intra-arterial (IA) thrombolytics as rescue therapy(RT) after failed mechanical thrombectomy(MT) in acute ischemic stroke(AIS) patients with large vessel occlusions LVO). The aim of this study is to investigate the use of IA recombinant tissue plasminogen activator(IA-rtPA) as RT in the prospective STRATIS Registry. Methods: Data from the STRATIS Registry, a multicenter study of AIS patients treated with the Solitaire stent-retriever as the first choice therapy within 8 hours from symptoms onset, were analyzed. Clinical and angiographic outcomes were compared between patients treated with and without IA-rtPA. Both anterior and posterior circulation occlusions were included in this substudy. Results: Of the 938 STRATIS patients with IA-tPA use reported, 809 and 129 were in the no IA-rtPA(83.2%) and IA-rtPA(13.8%)groups, respectively. No difference was seen in baseline demographics. Site of occlusion was similar between the groups, with the majority occurring in the MCA(72.4% versus 73.6%, p=0.74). IV-rtPA was administered in 63.0% and 70.5% of no IA-rtPA and IA-rtPA patients(p=0.11). Median IA-rtPA dose was 4mg(IQR 2-12). Mean onset to arterial puncture time was shorter in the IA-rtPA group(200.2±104.6 versus 228.2±98.5 minutes, p=0.003); however, mean puncture to procedure end time was longer in the IA-rtPA group(78.7±43.1 versus 63.1±35.9 minutes). Mean number of passes (2.2±1.4 versus 1.8±1.2,p=0.001) and rate of distal embolization(67.8% versus 54.5%, p=0.007) was significantly higher in the IA-rtPA group. Core lab adjudicated substantial reperfusion (mTICI≥2b) was achieved in 88.4% and 84.7% of no IA-rtPA and IA-rtPA patients(p=0.16). No difference was observed in rates of symptomatic intracranial hemorrhage(sICH) (1.4% versus 1.6%,p=0.70), good functional outcome (mRS≥2, 57.3% versus 59.2%, p=0.86), or mortality (15.5% versus 13.3%,p=0.80) at 90-days. Conclusion: Use of IA-rtPA after failed thrombectomy was not associated with an increased risk of sICH or mortality in the STRATIS Registry. These results suggest that IA thrombolysis may be a safe option as rescue therapy in select patients.

Download Full-text

Abstract WP20: Efficacy and Safety of Mechanical Thrombectomy in Emergent Large Vessel Occlusions with Concomitant Cervical Internal Carotid Artery Occlusion

Stroke ◽

10.1161/str.48.suppl_1.wp20 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Abhi Pandhi ◽

Yasser M Khorchid ◽

Abhishek Ojha ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Efficacy And Safety ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Cervical Internal Carotid Artery

Introduction: Recently, five published major randomized controlled clinical trials have demonstrated that timely mechanical thrombectomy (MT) of acute ischemic strokes (AIS) with emergent large vessel occlusion (ELVO) is safe and improves functional outcomes. However, data evaluating the efficacy and safety of MT in ELVO patients with concomitant cervical internal carotid artery (cICA) occlusion is limited. The purpose of this study is to evaluate efficacy and safety of MT in ELVO patients with concomitant cICA occlusion Methods: We prospectively analyzed consecutive AIS patients with anterior circulation ELVO who underwent stent-retriever or primary aspiration thrombectomy at two tertiary stroke centers. Outcome measures in our study were 3-month mortality and modified ranking scale (mRS), as well as symptomatic intracranial hemorrhage (sICH). Safety and efficacy outcomes were compared between ELVO patients with and without concomitant cICA occlusion. Results: A total of 137 AIS patients had anterior circulation ELVO and underwent MT (age 63 ± 14, 49% male, median NIHSS 17, IQR [13-20]). ELVO patients with concomitant cICA occlusion (n=19) did not differ in terms of rates of sICH (0% versus 11%, p=0.21), complete recanalization (68 % versus 68%, p=1.00), onset to groin puncture time (minutes [IQR] 268 [211-379] versus 225 [165-312], p=0.47), 3-month mortality (35% versus 26 %, p=0.55), and mRS of 0-2 at 3 months (41% versus 45%, p=0.80) when compared with ELVO patients without concomitant cICA occlusion (n=118). Admission NIHSS was higher among ELVO patients with concomitant cICA occlusion (median [IQR], 18 [15-22] versus 16 [12-19], p=0.01), and they tended to have higher groin puncture to recanalization time (minutes [IQR] 74 [42-97] versus 49 [38-78], p=0.09). The ordinal shift analysis did not show any difference in favorable outcomes in two groups in unadjusted analyses or after adjustment for admission NIHSS and groin to recanalization time (common OR=0.78 [95% CI: 0.27-2.29, p=0.66]). Angioplasty was performed in 11 of 19 ELVO patients with concomitant cICA occlusion. Three patients required stent placement. Discussion: Our study indicates that MT can be performed safely and effectively in ELVO patients with concomitant cICA occlusion.

Download Full-text

Drip and ship for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria

Neurology ◽

10.1212/wnl.0000000000008753 ◽

2019 ◽

Vol 94 (5) ◽

pp. e453-e463 ◽

Cited By ~ 6

Author(s):

Katharina Feil ◽

Jan Rémi ◽

Clemens Küpper ◽

Moriz Herzberg ◽

Franziska Dorn ◽

...

Keyword(s):

Rural Areas ◽

Mechanical Thrombectomy ◽

Stroke Care ◽

Care Organization ◽

Vessel Occlusion ◽

Nihss Score ◽

Symptomatic Intracerebral Hemorrhage ◽

Stroke Study ◽

Comparable Time

ObjectiveTo determine feasibility and safety of stroke care organization within our Neurovascular Network of Southwest Bavaria (NEVAS) in a rural area with distances of up to 100 kilometers, we compared patients who underwent mechanical thrombectomy (MT) in large vessel occlusion admitted directly to our center (direct to center [DTC]) to patients who were transferred for MT via NEVAS (drip and ship [DS]).MethodsThis is a retrospective analysis of prospectively collected data of all MT patients between January 2015 and May 2018. Successful recanalization was defined as a thrombolysis in cerebral infarction score of 2b-3. Symptomatic intracerebral hemorrhage (sICH) was defined according to European Cooperative Acute Stroke Study 3. Modified Rankin Scale (mRS) score of 0–2 at 3 months indicated good outcome.ResultsMT was performed in 410 patients: 221 DTC and 189 DS. Median NIH Stroke Scale (NIHSS) score was 16 and premorbid mRS score was 0. Thrombolysis was applied in 62.2% with the same time from symptom onset in both groups (94.5 vs 95 minutes). Successful recanalization (79.3% vs 77.8%) and NIHSS score reduction from admission to discharge (16–7 vs 17–6) were comparable. Time delay from onset to revascularization was 96 minutes in DS (212 vs 308 minutes, p = 0.001). At follow-up, DTC patients had a trend to better outcome (33.5% vs 24.3%, p = 0.056). Neither sICH (6.3% vs 5.9%, p = 0.840) nor mortality (31.2% vs 34.4%, p = 0.387) differed between the groups.ConclusionDS patients benefit from MT without relevant safety concerns, but with a trend to unfavorable outcome compared to DTC patients. These results suggest that DS is suitable to provide MT in rural areas where DTC is not possible.

Download Full-text

Mechanical thrombectomy in nonagenarians with acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014785 ◽

2019 ◽

Vol 11 (11) ◽

pp. 1091-1094 ◽

Cited By ~ 17

Author(s):

Lukas Meyer ◽

Maria Alexandrou ◽

Hannes Leischner ◽

Fabian Flottmann ◽

Milani Deb-Chatterji ◽

...

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Very Elderly ◽

Anterior Circulation ◽

Serious Adverse Events ◽

Good Functional Outcome ◽

Symptomatic Intracranial Hemorrhage

BackgroundMechanical thrombectomy (MT) is a safe and effective therapy for ischemic stroke. Nevertheless, very elderly patients aged ≥90 years were either excluded or under-represented in previous trials. It remains uncertain whether MT is warranted for this population or whether there should be an upper age limit.MethodsWe retrospectively reviewed 79 patients with stroke aged ≥90 years from three neurointerventional centers who underwent MT between 2013 and 2017. Good functional outcome was defined as modified Rankin scale (mRS) ≤2 and assessed at 90-day follow-up. Successful recanalization was graded by Thrombolysis in Cerebral Infarction Scale (TICI) ≥2 b. Feasibility and safety assessments included unsuccessful recanalization attempts (TICI 0), time from groin puncture to recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and intervention-related serious adverse events.ResultsOnly occlusions within the anterior circulation were included. Median time from groin puncture to recanalization was 39 min (IQR 25–57 min). The rate of successful recanalization (TICI ≥2 b) was 69.6% (55/79). Good functional outcome (mRS ≤2) at 90 days was observed in 16% (12/75) of patients. In-hospital mortality was 29.1% (23/79) and increased significantly at 90 days (46.7%, 35/75; p<0.001). sICH occurred in 5.1% (4/79) of patients. No independent predictor for good functional outcome (mRS ≤2) at 90 days was identified through logistic regression analysis.ConclusionMT in nonagenarians leads to high mortality rates and less frequently good functional outcome compared with younger patient cohorts in previous large randomized trials. However, MT appears to be safe and beneficial for a certain number of very elderly patients and therefore should generally not be withheld from nonagenarians.

Download Full-text

Catch Plus thrombectomy device in acute stroke: initial evaluation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012760 ◽

2016 ◽

Vol 9 (12) ◽

pp. 1214-1218 ◽

Cited By ~ 3

Author(s):

Ahmet Peker ◽

Ethem Murat Arsava ◽

Mehmet Akif Topçuoğlu ◽

Anıl Arat

Keyword(s):

Mechanical Thrombectomy ◽

National Institutes Of Health ◽

Initial Experience ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Nihss Score ◽

Thrombectomy Device ◽

Baseline Characteristics ◽

Mean Time

ObjectiveTo report our initial experience with the Catch Plus thrombectomy device (CPD) in patients with acute ischemic stroke (AIS).Materials and methodsWe retrospectively evaluated the procedural variables as well as the clinical and angiographic outcomes of patients with acute occlusion of a major intracranial artery in the anterior circulation who were treated with CPD at our center. Baseline characteristics (gender, age, comorbidities, cardiovascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, and vessel occlusion sites) of these patients were recorded. Thrombolysis in Cerebral Infarction (TICI) score, incidence of symptomatic and asymptomatic bleeding, and 90 day modified Rankin Scale (mRS) scores were evaluated as indicators of outcome.Results38 patients with a mean age of 67.5 years were treated with CPD. Mean time from symptom onset to procedure initiation was 226.7 min. Recanalization (TICI 2b–3) was achieved in 27 patients (71.1%). The median NIHSS score on admission was 20. Rates of symptomatic and asymptomatic intracerebral hemorrhage were 7.9% and 13.2%, respectively. The 90 day clinical follow-up data were available for 37 patients. The 90 day mortality rate was 18.9%, and the 90 day clinically acceptable functional outcome (mRS score ≤2) rate was 43.2% (mRS score 0–3, 54.1%). Very distal thrombectomy involving the cortical arteries was performed on four patients without complications.ConclusionsOur initial experience suggests that mechanical thrombectomy with the CPD improves 90 day outcomes of patients with AIS by facilitating effective recanalization.

Download Full-text

Predictors of 30-day mortality after endovascular thrombectomy for large vessel occlusion in the elderly

Interventional Neuroradiology ◽

10.1177/15910199211069259 ◽

2021 ◽

pp. 159101992110692

Author(s):

Yen-Jun Lai ◽

Szu-Hsiang Peng ◽

Wei-Jen Lai ◽

Ai-Hsien Li ◽

Ho-Hsian Yen ◽

...

Keyword(s):

Primary Outcome ◽

The Elderly ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Age Range ◽

Number Of Passes

Objectives Elderly acute ischemic stroke (AIS) patients (≥80 years) would have dismal clinical outcomes even after successful endovascular revascularization for large vessel occlusion (LVO) in the anterior circulation. We aimed to identify predictors of 30-day mortality after endovascular thrombectomy (EVT) in the elderly. Materials and Methods We included older patients who underwent EVT for AIS due to LVO within 6 h after stroke onset in the anterior circulation between 2017 and 2019. Patients due to posterior circulation stroke, with intracerebral hemorrhage (ICH) or pre-stroke modified Rankin Scale (mRS) score of 4 and 5 were excluded. The primary outcome was mortality within 30 days of EVT. The association between clinical, imaging, procedural, follow-up imaging and mortality were analyzed. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3. Possible predictors of 30-day mortality were assessed by univariate and multivariable logistic regression. Results Total 238 AIS patients eligible for EVT were identified with 58 patients aged 80 years or more. 48 patients met inclusion criteria. Median age was 86 years (age range, 82–102 years). Successful reperfusion was achieved in 38 (79.2%) patients. The 30-day and 90-day mortality rate were 25% and 33.3%, respectively. The independent predictors of 30-day mortality were collateral scores <3 on mCTA (adjusted OR, 16.571; 95% CI, 1.041–263.868; p = 0.047) and number of passes (adjusted OR, 2.475; 95% CI, 1.047–5.847; p = 0.039). Conclusions Lower collateral scores on mCTA and higher number of passes in thrombectomy were independently predictive of 30-day mortality in the elderly.

Download Full-text

Intravenous Tissue Plasminogen Activator in Combination With Mechanical Thrombectomy: Clot Migration, Intracranial Bleeding, and the Impact of “Drip and Ship” on Effectiveness and Outcomes

Frontiers in Neurology ◽

10.3389/fneur.2020.585929 ◽

2020 ◽

Vol 11 ◽

Author(s):

Adam Chang ◽

Elham Beheshtian ◽

Edward J. Llinas ◽

Oluwatoyin R. Idowu ◽

Elisabeth B. Marsh

Keyword(s):

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Mechanical Thrombectomy ◽

Hemorrhagic Transformation ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

The Impact ◽

Iv Tpa

Purpose: Intravenous tissue plasminogen activator (tPA) is indicated prior to mechanical thrombectomy (MT) to treat large vessel occlusion (LVO). However, administration takes time, and rates of clot migration complicating successful retrieval and hemorrhagic transformation may be higher. Given time-to-effectiveness, the benefit of tPA may vary significantly based on whether administration occurs at a thrombectomy-capable center or transferring hospital.Methods: We prospectively evaluated 170 individuals with LVO involving the anterior circulation who underwent MT at our Comprehensive Stroke Center over a 3.5 year period. Two thirds (n = 114) of patients were admitted through our Emergency Department (ED). The other 33% were transferred from outside hospitals (OSH). Patients meeting criteria were bridged with IV tPA; the others were treated with MT alone. Clot migration, recanalization times, TICI scores, and hemorrhage rates were compared for those bridged vs. treated with MT alone, along with modified Rankin scores (mRS) at discharge and 90-day follow-up. Multivariable regression was used to determine the relationship between site of presentation and effect of tPA on outcomes.Results: Patients presenting to an OSH had longer mean discovery to puncture/recanalization times, but were actually more likely to receive IV tPA prior to MT (70 vs. 42%). The rate of clot migration was low (11%) and similar between groups, though slightly higher for those receiving IV tPA. There was no difference in symptomatic ICH rate after tPA. TICI scores were also not significantly different; however, more patients achieved TICI 2b or higher reperfusion (83 vs. 67%, p = 0.027) after tPA, and TICI 0 reperfusion was seen almost exclusively in patients who were not treated with tPA. Those bridged at an OSH required fewer passes before successful recanalization (2.4 vs. 1.6, p = 0.037). Overall, mean mRS scores on discharge and at 90 days were significantly better for those receiving IV tPA (3.9 vs. 4.6, 3.4 vs. 4.4 respectively, p ~ 0.01) and differences persisted when comparing only patients recanalized in under 6 h.Conclusion: Independent of site of presentation, IV tPA before MT appears to lead to better radiographic outcomes, without increased rates of clot migration or higher intracranial hemorrhage risk, and overall better functional outcomes.

Download Full-text

Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012122 ◽

2015 ◽

Vol 8 (11) ◽

pp. 1123-1128 ◽

Cited By ~ 93

Author(s):

Josser E Delgado Almandoz ◽

Yasha Kayan ◽

Mark L Young ◽

Jennifer L Fease ◽

Jill M Scholz ◽

...

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Independent Predictor ◽

National Institutes Of Health ◽

Good Clinical Outcome ◽

Anterior Circulation ◽

First Pass ◽

Symptomatic Intracranial Hemorrhage

PurposeTo compare rates of symptomatic intracranial hemorrhage (SICH) and good clinical outcome at 90 days in patients with ischemic strokes from anterior circulation emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy using either Solumbra or A Direct Aspiration first-Pass Thrombectomy (ADAPT) techniques.MethodsWe compared clinical characteristics, procedural variables, and clinical outcomes in patients with anterior circulation ELVOs treated with mechanical thrombectomy using either a Solumbra or ADAPT technique at our institution over a 38-month period. SICH was defined using the SITS-MOST criteria. A good clinical outcome was defined as a modified Rankin Scale score of 0–2 at 90 days.ResultsOne hundred patients were included, 55 in the Solumbra group and 45 in the ADAPT group. Patients in the ADAPT group had higher National Institutes of Health Stroke Scale (NIHSS) (19.2 vs 16.8, p=0.02) and a higher proportion of internal carotid artery terminus thrombi (42.2% vs 20%, p=0.03) than patients in the Solumbra group. Patients in the ADAPT group had a trend toward a lower rate of SICH than patients in the Solumbra group (2.2% vs 12.7%, p=0.07). Patients in the ADAPT group had a significantly higher rate of good clinical outcome at 90 days than patients in the Solumbra group (55.6% vs 30.9%, p=0.015). Use of the ADAPT technique (OR 6 (95% CI 1.0 to 31.2), p=0.049) was an independent predictor of a good clinical outcome at 90 days in our cohort.ConclusionsIn our cohort, the ADAPT technique was associated with significantly higher good clinical outcomes at 90 days in patients with acute ischemic stroke due to anterior circulation ELVOs treated with mechanical thrombectomy.

Download Full-text