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Matsoukas S, Paz SG, Kellner CP, De Leacy R, Fifi JT, Mocco J, Majidi S. Endovascular thrombectomy for distal vessel occlusion stroke: Single-center experience. Interv Neuroradiol 2025; 31:255-261. [PMID: 36999213 DOI: 10.1177/15910199231162670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
BackgroundThe safety and efficacy of endovascular thrombectomy (EVT) in distal vessel occlusion (DVO) are not well described. We aimed to evaluate the technical feasibility and safety of EVT in patients with DVO.MethodsWe performed a retrospective analysis of consecutive DVOs (defined as M3/M4, A1/A2, and P1/P2 occlusion) who underwent EVT within 24 h since last known well. The primary efficacy outcome was successful reperfusion (mTICI ≥ 2B). Secondary outcomes included successful recanalization with ≤3 passes. The safety outcome measures included the rate of subarachnoid hemorrhage (SAH), all intracerebral hemorrhage (ICH), and symptomatic ICH (sICH).ResultsA total of 72 patients with DVO was identified: 39 (54%) with M3/M4, 13 (18%) with A1/A2, and 20 (28%) with P1/P2 occlusions. Admission NIHSS score median (IQR) was 12 (11), and 90% of the patients had baseline mRS ≤ 2. Thirty-six percent of the patients received intravenous thrombolytic therapy. Successful recanalization was achieved in 90% of the patients. The median number of passes was 2, with successful recanalization achieved with ≤3 passes in 83% of the patients. ICH was seen in 16% of the patients, including three SAHs. However, only one patient (1.4%) had sICH. Among 48 patients in whom 90-day outcome data were available, 33 (53.2%) had favorable clinical outcome (mRS ≤ 3). In a multivariable logistic regression, only baseline NIHSS was identified as an independent predictor of poor outcome.ConclusionThis single-center real-world experience demonstrates that EVT in patients with DVO stroke is safe and feasible and may lead to improved clinical outcome.
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Affiliation(s)
- Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Santiago Gomez Paz
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Wang T, Jin X, Yang P, Li S, Zhang Q, Shao C, Lu J, Jin X, Chen L. A clinical and computed tomography-based nomogram to predict the outcome in patients with anterior circulation large vessel occlusion after endovascular mechanical thrombectomy. Jpn J Radiol 2024; 42:973-982. [PMID: 38700623 DOI: 10.1007/s11604-024-01583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 08/31/2024]
Abstract
PURPOSE To explore the positive predictors of the clinical outcome in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (ACLVO) after endovascular mechanical thrombectomy (EMT) at a 90-day follow-up, and to establish a nomogram model to predict the clinical outcome. MATERIALS AND METHODS AIS patients with ACLVO detected by multimodal Computed Tomography imaging who underwent EMT were collected. Patients were divided into the favorable and the unfavorable groups according to the 90-day modified Rankin Scale (mRS) score. Univariate and multivariate analyses were performed to investigate predictors of the favorable outcome (mRS of 0-2). A nomogram model for predicting the clinical outcome after EMT was drawn, and the receiver operating characteristic (ROC) curve was used to evaluate its predictive value. RESULTS Totally 105 patients including 65 patients in the favorable group and 40 in the unfavorable group were enrolled. Multivariate logistic regression analysis showed that admission National Institute of Health Stroke scale (NIHSS) score [0.858 (95% CI 0.778-0.947)], ACLVO at M2 [20.023 (95% CI 2.204-181.907)] and infarct core (IC) volume [0.943 (95% CI 0.917-0.969)] was positively correlated with favorable outcome. The accuracy of the nomogram model in predicting the outcome was 0.923 (95% CI 0.870-0.976), with a cutoff value of 119.6 points. The area under the ROC curve was 0.848 (95% CI 0.780-0.917; sensitivity, 79.7%; specificity, 90.0%). CONCLUSION A low Admission NIHSS score, ACLVO at M2, and a small IC volume were positive predictors for favorable outcome. The nomogram model may well predict the outcome in AIS patients with ACLVO after EMT.
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Affiliation(s)
- Tiegong Wang
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Xiangyu Jin
- Hainan College of Economics and Business, Haikou, 571127, Hainan, China
| | - Panpan Yang
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Shuai Li
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Qianwen Zhang
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Xianglan Jin
- Department of Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchang Middle Road, Shanghai, 200072, China.
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
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Gok DU, Kim SY, Na YC, Cho JM. Extended Time Window (>6 Hour) Mechanical Thrombectomy; Good Clinical Outcome in the Younger Age Population in Thrombectomy Cases: Relationship between Age and Prognosis. J Pers Med 2023; 14:2. [PMID: 38276217 PMCID: PMC10821516 DOI: 10.3390/jpm14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/02/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) has become increasingly common in recent years, as studies have shown that it can be an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, the efficacy of MT in the extended time window (6 to 24 h) is still uncertain. Our study aims to evaluate the outcomes of MT in the extended time window for AIS patients. METHODS We reviewed data on AIS patients who received MT beyond six hours of stroke onset from 2015 to 2022. The patients' occlusions were in the internal carotid artery (ICA), middle cerebral artery (MCA), or posterior circulation. Our evaluation included the modified Rankin scale (mRS) and 90-day mortality rates, as well as complications, such as symptomatic intracranial hemorrhage (sICH). RESULTS Thirty-one patients were included in this study, with a mean age of 75.6 ± 15.1 years, of whom 54.8% were male. The median NIHSS score at presentation was 17. Successful recanalization (TICI 2b to 3) was achieved in 90.3% of patients and the rate of sICH was 6.4%. No difference was observed between the two age groups. The younger age group (<80 years old) showed a better clinical outcome (mRS 0-2; p < 0.05, Fisher's exact test) compared with the older age group. The overall mortality rate was 6.4%. CONCLUSION Our study shows that (MT) can be performed effectively and safely within an extended time window, resulting in satisfactory functional outcomes, particularly in the younger age group.
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Affiliation(s)
- Deok Un Gok
- Depatment of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon 22711, Republic of Korea
| | - So Yeon Kim
- Depatment of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon 22711, Republic of Korea
| | - Young Chul Na
- Depatment of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon 22711, Republic of Korea
| | - Jin Mo Cho
- Department of Neurosurgery, Serim General Hospital, Incheon 21364, Republic of Korea
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Liu C, Liu M, Yang X, Wang J, Li G. Efficacy and safety of bridging therapy versus direct thrombectomy for tandem lesions in acute stroke: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 234:108005. [PMID: 37837908 DOI: 10.1016/j.clineuro.2023.108005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Current studies have concluded that MT (Mechanical Thrombectomy) is safe and effective for tandem lesions (TL). However, The benefit of bridging therapy for TL is controversial. OBJECTIVE To compare efficacy and safety between bridging therapy and direct thrombectomy of tandem lesions. METHOD We conducted a systematic review and meta-analysis of studies comparing bridging therapy versus direct thrombectomy among TL patients with regards to symptomatic intracerebral hemorrhage(sICH), Parenchymal hemorrhage (PH), 3-month mortality, modified Rankin Scale (mRS) score within 3 months, successful reperfusion, and excellent reperfusion. The meta-analysis of proportions was conducted with a common effects model. RESULT Five studies (n = 1198 patients) were identified for the systematic review. For safety outcomes, the bridging group had no significant difference in the rate of symptomatic intracranial hemorrhage (OR = 0.78, 95% CI = 0.49-1.25, P = 0.31) and the rate of PH (OR = 0.67, 95% CI = 0.39-1.13, P = 0.13) but significantly lower rate of 3-month mortality (OR = 0.53, 95% CI = 0.37-0.75, P = 0.0004) compared to the direct thrombectomy group. In terms of efficacy outcomes, the bridging therapy group had a significantly higher rate of 3- month good functional outcome (mRS 0-2) (OR = 1.76, 95% CI = 1.38-2.24, P < 0.00001) and successful recanalization (OR = 1.69, 95% CI = 1.27-2.25, P = 0.0003) but no significant difference in the rate of excellent recanalization(OR = 1.21, 95% CI = 0.91-1.59, P = 0.19) in patients with TL compared to direct thrombectomy group. CONCLUSION Bridging therapy is effective in improving the 3-month functional prognosis and increasing the rate of arterial recanalization without increasing the risk of intracranial hemorrhage in patients with TL compared to direct thrombectomy. A large multicentre clinical RCT is expected, as are advanced intravenous thrombolysis and endovascular thrombectomy techniques.
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Affiliation(s)
- Chenxi Liu
- Department of Neurology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Mingsu Liu
- Department of Neurology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
| | - Xun Yang
- Department of Neurology, Hechuan District People's Hospital, Chongqing 401500, China
| | - Jinping Wang
- Department of Neurology, Chongqing University Central Hospital, Chongqing 400050, China
| | - Guangqin Li
- Department of Neurology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Kniep H, Meyer L, Broocks G, Bechstein M, Guerreiro H, Winkelmeier L, Brekenfeld C, Flottmann F, Deb-Chatterji M, Alegiani A, Hanning U, Thomalla G, Fiehler J, Gellißen S. Predictors of functional outcome after thrombectomy for M2 occlusions: a large scale experience from clinical practice. Sci Rep 2023; 13:18740. [PMID: 37907482 PMCID: PMC10618211 DOI: 10.1038/s41598-023-45232-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Mechanical thrombectomy (MT) for acute ischemic stroke with medium vessel occlusions is still a matter of debate. We sought to identify factors associated with clinical outcome after MT for M2-occlusions based on data from the German Stroke Registry-Endovascular Treatment (GSR-ET). All patients prospectively enrolled in the GSR-ET from 05/2015 to 12/2021 were analyzed (NCT03356392). Inclusion criteria were primary M2-occlusions and availability of relevant clinical data. Factors associated with excellent/good outcome (modified Rankin scale mRS 0-1/0-2), poor outcome/death (mRS 5-6) and mRS-increase pre-stroke to day 90 were determined in multivariable logistic regression. 1348 patients were included. 1128(84%) had successful recanalization, 595(44%) achieved good outcome, 402 (30%) had poor outcome. Successful recanalization (odds ratio [OR] 4.27 [95% confidence interval 3.12-5.91], p < 0.001), higher Alberta stroke program early CT score (OR 1.25 [1.18-1.32], p < 0.001) and i.v. thrombolysis (OR 1.28 [1.07-1.54], p < 0.01) increased probability of good outcome, while age (OR 0.95 [0.94-0.95], p < 0.001), higher pre-stroke-mRS (OR 0.36 [0.31-0.40], p < 0.001), higher baseline NIHSS (OR 0.89 [0.88-0.91], p < 0.001), diabetes (OR 0.52 [0.42-0.64], p < 0.001), higher number of passes (OR 0.75 [0.70-0.80], p < 0.001) and intracranial hemorrhage (OR 0.26 [0.14-0.46], p < 0.001) decreased the probability of good outcome. Additional predictors of mRS-increase pre-stroke to 90d were dissections, perforations (OR 1.59 [1.11-2.29], p < 0.05) and clot migration, embolization (OR 1.67 [1.21-2.30], p < 0.01). Corresponding to large-vessel-occlusions, younger age, low pre-stroke-mRS, low severity of acute clinical disability, i.v. thrombolysis and successful recanalization were associated with good outcome while diabetes and higher number of passes decreased probability of good outcome after MT in M2 occlusions. Treatment related complications increased probability of mRS increase pre-stroke to 90d.
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Affiliation(s)
- Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Laurens Winkelmeier
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Milani Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Yang L, Xu X, Wang L, Zeng KB, Wang XF. Edaravone administration and its potential association with a new clinical syndrome in cerebral infarction patients: Three case reports. World J Clin Cases 2023; 11:4648-4654. [PMID: 37469729 PMCID: PMC10353518 DOI: 10.12998/wjcc.v11.i19.4648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/24/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and, in most cases, edaravone-induced side effects are mild. However, edaravone-related adverse reactions have been receiving increasing attention.
CASE SUMMARY We treated three patients with acute cerebral infarction who died following treatment with edaravone. Edaravone is a widely used treatment for patients with cerebral infarction and, in most cases, edaravone-induced side effects are mild. However, edaravone-related adverse reactions have been receiving increasing attention.
CONCLUSION Our cases highlight the importance of educating clinicians regarding the new edaravone-induced clinical syndromes of cerebral infarction as potentially fatal adverse drug reactions. Considering that no laboratory or confirmatory test exists to diagnose edaravone-induced death from cerebral infarction, clinicians’ knowledge is the key element in recognizing this phenomenon.
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Affiliation(s)
- Liu Yang
- Department of Neurology, Central Hospital Affiliated to Chongqing University, Chongqing 400010, China
| | - Xin Xu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Ke-Bin Zeng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Xue-Feng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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Delgado Acosta F, Jiménez Gómez E, Bravo Rey I, Romero Saucedo V, Valverde Moyano R, Oteros Fernández R. Comparing data from thrombectomy in m2 occlusion and proximal middle cerebral artery. Interv Neuroradiol 2023; 29:102-107. [PMID: 35043725 PMCID: PMC9893234 DOI: 10.1177/15910199221074881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Mechanical thrombectomy for large vessel occlusion in the anterior circulation has been shown to be beneficial. The question of whether this technique is safe and effective in the distal vasculature remains unanswered. We wanted to compare outcome data from mechanical thrombectomy of M2 branches of the middle cerebral artery (MCA) with those of the M1 segment, and better understand the clinical predictors of these M2 occlusions. METHODS A retrospective analysis was performed of data prospectively collected between January 2017 and July 2021 from patients with acute ischemic stroke undergoing mechanical thrombectomy of isolated M1 or M2 branches of the MCA. RESULTS 350 patients were identified, 287 with M1 and 63 with M2 occlusions. Mean age was 70.71 ± 12.55 and 75.21 ± 10.21 years, respectively (p = 0.0083). Baseline Alberta Stroke Program Computed Tomography (ASPECT) score was worse in the M1 cohort (7.68 ± 1.73 vs. 8.32 ± 1.54; p = 0.0079), while there was no significant difference in National Institutes of Health Stroke Scale (NIHSS) scores. No statistical disparity existed in mean procedure duration for each cohort; fewer thrombectomy attempts were required in the M2 cohort (2.01 vs. 1.63; p = 0.0478). There was no statistical difference in total time to recanalization (559.19 vs. 629.97, p = 0.2506). Similar rates of successful reperfusion were observed (Thrombolysis in Ischaemic Stroke score [TICI] ≥ 2b 80.84% vs. 71.43% p = 0.1221). Good outcome (modified Rankin scale ≤ 2) was 56.10 in M1 occlusions and 63.49% on M2 groups. Intracranial haemorrhage rates were similar. CONCLUSIONS M2 thrombectomy is safe and a significant proportion of patients achieve a good clinical outcome. Advanced age, atrial fibrillation and previous treatment with anticoagulants were predictors for poor outcome. Good outcome was achieved when effective recanalization was obtained.
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Xu Y, Fu W, Wang Y, Bi Q, Wang Q, Yang L, Zhang Q, Wang F. Endovascular treatment for acute M2 occlusion stroke within 6 hours-a retrospective real-world evidence. Front Cardiovasc Med 2023; 9:1063078. [PMID: 36704481 PMCID: PMC9871547 DOI: 10.3389/fcvm.2022.1063078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Background We compared the efficacy and safety of endovascular therapy (EVT), intravenous (IV) thrombolysis and conservative treatment in M2 segment occlusion stroke based on a real-world database. Methods We retrospectively analyzed the database of admitted patients with M2 segment occlusion between January 2018 and December 2020. The patients who were eligible for reperfusion treatment were assigned to EVT, IV thrombolysis or conservative treatment according to the exact management proceeding. The primary outcome was a score of 0 and 1 on the modified Rankin scale (mRS) at 90 days. The odds ratio (OR) for the primary outcome was adjusted for age, baseline National Institute of Health Stroke Scale score, and door-to-treatment time. The secondary outcomes were based on a mRS score from 0 to 2 at 90 days and the safety outcomes including symptomatic intracranial hemorrhage, and all-cause mortality. The data were analyzed by the logistical regression model, including baseline adjustments. Results A total of 109 patients were included. Among them, 42 (38.5%) patients received EVT, 45 (42.5%) received IV thrombolysis and 22 (20.8%) received conservative treatment. The primary outcome based on a mRS score of 0 and 1, occurred in 66.7% of patients in the EVT group and 40% in the IV thrombolysis group (adjusted OR, 1.79; 95% confidence interval [CI], 1.19-2.68; P = 0.01). Symptomatic intracranial hemorrhage occurred in 1 patient (2.3%) in the EVT group and in 2 patients (4.4%) in the IV thrombolysis group (adjusted OR = 0.71, 95% CI: 0.13-4.07). Conclusion EVT showed better functional outcomes than IV thrombolysis and conservative treatment in moderate to severe acute stoke patients with M2 occlusion. There was no significant difference in the three groups concerning the incidence of symptomatic intracranial hemorrhage.
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Affiliation(s)
- Yi Xu
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wang Fu
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongpeng Wang
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qianqian Bi
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiwei Wang
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu Yang
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Quanbin Zhang
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,Quanbin Zhang,
| | - Feng Wang
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China,*Correspondence: Feng Wang,
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Effect of Standardized Perioperative Management on EEG Indexes and Nerve and Limb Functions of Patients with Acute Cerebral Infarction Undergoing Mechanical Thrombectomy. DISEASE MARKERS 2022; 2022:1686891. [PMID: 36199820 PMCID: PMC9529457 DOI: 10.1155/2022/1686891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022]
Abstract
Objective To explore the application value of standardized perioperative management in mechanical thrombectomy for acute cerebral infarction. Methods 98 patients with acute cerebral infarction admitted to our hospital from January 2019 to January 2022 were selected as the study sample in this study, and all patients were given the standardized perioperative management. According to the interventional methods, they were divided into the thrombolytic treatment group (arteriovenous combined thrombolysis, n = 49) and mechanical thrombectomy group (mechanical thrombectomy, n = 49) to compare the nerve function, limb function, thrombolysis in myocardial infarction (TIMI) flow grade, symptomatic intracranial hemorrhage within 24 hours, acute vascular reocclusion, and the death status within 1 year and incidence of adverse events in 90 days of the two groups after treatment. Results After treatment, the values of brain symmetry index (BSI) and power ratio indices (DTABR) in the two groups were obviously lower than those before treatment (P < 0.05), and the values of BSI and DTABR in the mechanical thrombectomy group were lower than those in the thrombolytic treatment group (P < 0.05). According to the statistical data of National Institutes of Health Stroke Scale (NIHSS) score in patients, the NIHSS scores of the two groups after treatment were visibly decreased (P < 0.05), while the NIHSS score in the mechanical thrombectomy group after treatment was lower than that in the thrombolytic treatment group (P < 0.05). The proportion of modified Rankin scale (mRS) score < 3 in the mechanical thrombectomy group was distinctly higher than that in the thrombolytic treatment group (P < 0.05). The proportion of TIMI flow grade ≥ 2 in the mechanical thrombectomy group was significantly higher than that in the thrombolytic treatment group (P < 0.05). The rate of symptomatic intracranial hemorrhage within 24 hours in the mechanical thrombectomy group was lower than that in the thrombolytic treatment group (P < 0.05), with the indistinctive difference between the two groups (P > 0.05). The incidence of acute vascular reocclusion in the mechanical thrombectomy group was markedly lower than that in the thrombolytic treatment group (P < 0.05). There was no significant difference in 1-year mortality between the two groups (P > 0.05). In the mechanical thrombectomy group, there were 1 case of gingiva bleeding, 1 case of hemorrhinia, and 2 cases of recurrent cerebral infarction in 90 days, with a total of 4 cases (8.16%), while in the thrombolytic treatment group, there were 4 cases of gingiva bleeding, 4 cases of hemorrhinia, and 15 cases of recurrent cerebral infarction in 90 days, with a total of 23 cases (46.94%), indicating that the incidence of adverse events in 90 days in the mechanical thrombectomy group was significantly lower than that in the thrombolytic treatment group (P < 0.05). Conclusion The standardized perioperative management is effective in patients with acute cerebral infarction who were treated with arteriovenous combined thrombolysis or mechanical thrombectomy, which can improve the neurological function and physical function of patients. However, the mechanical thrombectomy has a better improvement effect on the neurological function and physical function of patients, with the relatively better safety, thrombolytic effect, and long-term prognosis.
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Xing Y, Jiang X, Su K, Cheng R, Lai L. Mechanical Thrombectomy for M2 Segment Occlusion in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 165:e393-e400. [PMID: 35750141 DOI: 10.1016/j.wneu.2022.06.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The safety and benefit of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS) patients with M2 segment middle cerebral artery occlusions remain uncertain. OBJECTIVE To investigate the benefit of mechanical thrombectomy for M2 occlusion compared with M1 occlusion in patients with AIS. METHODS The PubMed, Embase, and Cochrane Library databases were searched from inception to April 2021 to identify relevant articles. The main results comprised 90-day functional independence (modified Rankin Score from 0-2), successful recanalization (thrombectomy in cerebral infarction [TICI] 2b/3), mortality, and rates of symptomatic intracerebral hemorrhage after using modern thrombectomy devices. Odds ratios (ORs) were generated for binary variants. ReviewManager 5.3 software was used. RESULTS Ultimately, a total of 14 trials were included, with 3454 participants enrolled. MT for M2 occlusion had a higher rate of 3-month functional independence than M1 occlusion, but the difference was nonsignificant (OR: 1.19, 95% confidence interval [CI]: 0.98 to 1.46). The TICI2b/3 scores (OR: 0.71, 95% CI: 0.58-0.88) in M2 occlusion were remarkably lower than those in M1. The mortality and symptomatic intracerebral hemorrhage rates were comparable between the 2 groups. When comparing M2 and M1 occlusions, we found that there was no significant difference between stent retriever and aspiration in the modified Rankin Score (0-2) after AIS, but aspiration exerted an eminently higher recanalization rate with regard to TICI2b/3 (OR: 0.77, 95% CI: 0.61-0.96). CONCLUSIONS Compared with M1 occlusion, patients with M2 occlusion treated by MT demonstrated similar clinical outcomes in this study. Moreover, there was no difference between stent retriever and aspiration in treating M2 occlusion in terms of functional independence at 90 days. However, aspiration exerted a conspicuously higher recanalization rate in M2 occlusion than in M1 occlusion.
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Affiliation(s)
- Yuxuan Xing
- The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xin Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Kangtai Su
- The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Ruoxi Cheng
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Lingfeng Lai
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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11
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Wang T, Dong S, Zhang M, Yu C, Xue M, Chen A. Effect of Solitaire FR Stent Thrombectomy Combined with the Suction Thrombus on the Clinical Effect and Prognosis of Acute Middle Cerebral Artery Occlusion. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:9227790. [PMID: 35942370 PMCID: PMC9356800 DOI: 10.1155/2022/9227790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
To determine the curative effect and prognosis of Solitaire FR stent thrombectomy integrated with the suction thrombus on the treatment of acute middle cerebral artery occlusion (AMCAO). Based on the treatment, patients suffering from AMCAO were separated into the Solitaire FR group (Solitaire FR stent + suction thrombus) and suction group (suction thrombus). Modified thrombolysis in cerebral infarction grading, National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale score, and safety performance were compared between the two groups. The operation time in the suction group was obviously shorter than the Solitaire FR group (P < 0.05). Significant differences were observed in the NIHSS scores 1 week and 4 weeks after the operation between the Solitaire FR group and the suction group (P < 0.05). The NIHSS scores 1 week and 4 weeks after operation were significantly lower than those before operation (P < 0.05). NIHSS scores 1 week after operation did not show obvious difference (P > 0.05). The Solitaire FR group showed obvious lower NIHSS scores than the suction group 4 weeks after surgery (P < 0.05). Statistically obvious difference in cerebral infarction grading of modified thrombolysis between the Solitaire FR group and the suction group were observed (P < 0.05). The recanalization rate of the Solitaire FR group was obviously higher than the suction group (P < 0.05). The difference in the monthly modified Rankin Scale score was obvious (P < 0.05). The good prognosis rate of the Solitaire FR group was obviously higher than the suction group (P < 0.05). No obvious differences in the incidence of internal bleeding, reocclusion, and 3-month postoperative mortality were observed (P > 0.05). These results showed that the treatment of the Solitaire FR stent + suction thrombus in AMCAO patients has a good thrombus recanalization rate and is helpful in improving the prognosis and safety performance.
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Affiliation(s)
- Tao Wang
- Department of Neurology, The First Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan 232007, Anhui, China
- School of Medicine, Anhui University of Science and Technology, Huainan 232001, Anhui, China
| | - Shuyang Dong
- Department of Neurology, The First Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan 232007, Anhui, China
| | - Mei Zhang
- Department of Neurology, The First Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan 232007, Anhui, China
| | - Chuangqing Yu
- Department of Neurology, The First Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan 232007, Anhui, China
| | - Min Xue
- Department of Neurology, The First Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan 232007, Anhui, China
| | - Anran Chen
- School of Medicine, Anhui University of Science and Technology, Huainan 232001, Anhui, China
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Predictors of Good Clinical Outcome after Thrombectomy for Distal Medium Vessel Occlusions. World Neurosurg 2022; 160:e566-e572. [PMID: 35077884 DOI: 10.1016/j.wneu.2022.01.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Good clinical outcome predictors have been emphasized in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO). MT for distal, medium vessel occlusions (DMVO) is still debated. We sought to assess the factors associated with clinical outcome after MT for DMVO. METHODS We retrospectively analyzed the data of consecutive patients who underwent MT for a primary DMVO in one large academic center and aimed to identify the baseline clinical, imaging and MT factors associated with good clinical outcome (defined as modified Rankin scale [mRS] of 0-2) at 3 months. RESULTS Between January 2018 and January 2021, 61 patients underwent a MT for an AIS with a primary DMVO. Overall, good clinical outcome was achieved in 56% (34/61) of our patients. In multivariate analysis, an older age (ODDS ratio 0.89 [0.83-0.96], p=0.003), longer puncture to recanalization time (ODDS ratio 0.97 [0.93-0.99], p=0.033), and higher baseline core volume (ODDS ratio 0.84 [0.75-0.94], p=0.003) decreased the probability of good clinical outcomes, while a final complete (or near-) recanalization (mTICI 2c-3) increased the probability of good outcome (ODDS ratio 14.19 [1.99-101.4], p=0.008). CONCLUSION An older age, a longer puncture to recanalization time and a higher baseline core volume decreased the probability of good clinical outcomes, while successful recanalization (mTICI 2c-3) was associated with better outcomes after MT for DMVO.
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13
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Guenego A, Mine B, Bonnet T, Elens S, Vazquez Suarez J, Jodaitis L, Ligot N, Naeije G, Lubicz B. Thrombectomy for distal medium vessel occlusion with a new generation of Stentretriever (Tigertriever 13). Interv Neuroradiol 2021; 28:444-454. [PMID: 34516332 PMCID: PMC9326865 DOI: 10.1177/15910199211039926] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of the Tigertriever 13 (Rapid Medical, Yoqneam, Israel) stent retriever in acute ischemic stroke (AIS) patients with primary or secondary distal, medium vessel occlusions (DMVO). METHODS We performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with the Tigertriever13 for DMVO. Patients' characteristics were reviewed, procedural complications, angiographic (modified thrombolysis in cerebral infarction score [mTICI]) and clinical (modified Rankin Scale [mRS]) outcomes were documented. RESULTS Between November 2019 and November 2020, 16 patients with 17 DMVO were included (40% female, median age 60 [50-65] years). The Tigertriever13 was used in 11/17 (65%, median NIHSS of 8 [6-15]) primary DMVO and in 6/17 (35%, median NIHSS of 20 [13-24]) cases of secondary DMVO after a proximal thrombectomy. The successful reperfusion rate (mTICI 2b, 2c, 3) was 94% (16/17) for the dedicated vessel. At day 1, CT imaging showed a subarachnoid hemorrhage in 29% of the cases and a parenchymal hematoma in 12%. At 3 months, 65% of the patients (11/17) had a favorable outcome (mRS 0-2). CONCLUSION Mechanical thrombectomy using the Tigertriever13 appears to be safe and effective for DMVO. Clinical and anatomical results are in line with those of patients with proximal occlusions.
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Affiliation(s)
- Adrien Guenego
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Benjamin Mine
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Stephanie Elens
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Juan Vazquez Suarez
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Lise Jodaitis
- Department of Neurology, 70496Erasme University Hospital, Brussels, Belgium
| | - Noémie Ligot
- Department of Neurology, 70496Erasme University Hospital, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, 70496Erasme University Hospital, Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
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Workflow and Outcomes of Endovascular Thrombectomy for In-Hospital Stroke a Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 30:105937. [PMID: 34174516 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/23/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Acute strokes due to large vessel occlusion in hospitalized patients is not uncommon. We performed a systematic review and meta-analysis to investigate the timing and outcome of endovascular thrombectomy (EVT) for in-hospital stroke. METHODS We conducted a meta-analysis of clinical studies published in English until September 2020 in the MEDLINE and Cochrane databases. Studies reporting original data on the characteristics and outcomes of in-hospital stroke patients treated with EVT were included. We extracted data on the time-metrics from last known well (LKW) until reperfusion was achieved. We also collected data on procedural and functional outcomes. RESULTS Out of 5093 retrieved studies, 8 were included (2,622 patients). The median age was 71.4 years and median NIHSS score on admission was 16. Patients were mostly admitted to the cardiology service (27.3%). The pooled time from LKW to recognition by staff was 72.9 min (95% CI: 40.7 to 105 min). 25.6% received IV tPA. The mean time from stroke recognition to arterial puncture was 134.5 min (95% CI: 94.9 to 174.1). Successful reperfusion occurred in 82.8.% with a pooled mean time from detection to reperfusion of 193.1 min (95% CI: 139.5 to 246.7). The 90-day independent functional outcome was reported in 42% of patients (95% CI 29 to 55%). CONCLUSION EVT can be performed safely and successfully for in-hospital strokes. Noticeable delays from LKW to detection and then to puncture are noted. This calls for better stroke pathways to identify and treat these patients. BACKGROUND Stroke in hospitalized patients, referred to as in-hospital stroke (IHS), accounts for 2.2-17% of all strokes.1 The majority of these are ischemic while intracranial hemorrhage represents 2-11% of all IHS.1 These patients are expected to have a rapid diagnosis and treatment given the ongoing medical supervision, and therefore favorable outcomes.1-3 However, existing studies report poor outcomes in patients with IHS with a mortality risk that exceeds that of community-onset stroke (COS): 24.7% vs 9.6%.4 Surviving IHS patients are also less likely to be discharged home compared to COS (27.7% vs 49.9%) and to be functionally independent at 3 months (31.0% vs 50.4%).1-4.
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15
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Zhang HB, Wang P, Wang Y, Wang JH, Li Z, Li R. Mechanical thrombectomy for acute occlusion of the posterior inferior cerebellar artery: A case report. World J Clin Cases 2021; 9:2268-2273. [PMID: 33869602 PMCID: PMC8026849 DOI: 10.12998/wjcc.v9.i10.2268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/01/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) has been demonstrated to be useful for the treatment of ischemic stroke in patients with large vessel occlusions. However, recanalization by MT is not recommended for distal vessels such as second-order branches of the middle cerebral artery and posterior inferior cerebellar artery (PICA). Because of the small size and tortuosity of these arteries, the risks of using the available endovascular devices outweigh the benefits of treatment. However, MT appears to be effective in patients with primary distal vessel occlusion in eloquent areas, those with a high National Institutes of Health Stroke Scale score, and those ineligible for recombinant tissue plasminogen activator therapy. Here, we report the use of MT for treating acute occlusion of the PICA using a direct-aspiration first-pass technique (ADAPT).
CASE SUMMARY In this case, the patient received acute occlusion of the PICA with ADAPT when right internal carotid artery stenting was performed.
CONCLUSION With the introduction of advanced endovascular devices, MT may now be a feasible treatment for acute occlusion of the PICA.
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Affiliation(s)
- Hong-Bo Zhang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan Province, China
| | - Pian Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan Province, China
| | - Yan Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan Province, China
| | - Jiang-Hong Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan Province, China
| | - Zheng Li
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan Province, China
| | - Rong Li
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan Province, China
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16
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Kitazawa K, Ito Y, Koyama M, Ohara H, Minagawa M. Thrombectomy for Small-Artery Occlusions with the Small-Diameter Stent Retriever, Tron Fx 2 mm × 15 mm: A Case Series. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:332-338. [PMID: 37501907 PMCID: PMC10370981 DOI: 10.5797/jnet.oa.2020-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/11/2020] [Indexed: 07/29/2023]
Abstract
Objective The safety and efficacy of thrombectomy for small-artery occlusions is still controversial. In April 2019, Tron Fx, a stent retriever with an expansion diameter of 2 mm, became reimbursed by health insurance in Japan. We report on cases of thrombectomy for small-artery occlusions performed using this device in seven patients. Methods The subjects were seven patients who underwent thrombectomy between July 2019 and June 2020 using Tron Fx with 2 mm in diameter. We analyzed clinical results including recanalization and complications. Results The mean age of the seven patients was 80.1 years, and the subjects included six men. The sites of occlusion were the middle cerebral artery M2 (n = 4), M4 (n = 1), anterior cerebral artery A2 (n = 1), and A3 (n = 1). One of the seven patients had an M2 occlusion that was formed during coil embolization for a ruptured cerebral aneurysm. In five cases, four cases were of primary occlusion and one case was of emboli into a new territory, treating with only Tron Fx 2 mm resulted in thrombolysis in cerebral infarction (TICI) 2b-3 in four cases. There was one case of grade 0, which was M4 occlusion. Finally, TICI 2b-3 were achieved in six of seven cases. No symptomatic intracranial hemorrhage occurred. Symptoms improved in five of six patients, excluding a vascular occlusion that occurred during surgery. Conclusion Tron Fx with 2 mm diameter can be used safely for small-artery occlusion. The introduction of Tron Fx with 2 mm diameter may contribute to expand indications for thrombectomy for small-artery occlusions.
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Affiliation(s)
- Keiko Kitazawa
- Department of Neurosurgery, Shinrakuen Hospital, Niigata, Niigata, Japan
| | - Yasushi Ito
- Department of Neurosurgery, Shinrakuen Hospital, Niigata, Niigata, Japan
| | - Miyako Koyama
- Department of Neurosurgery, Shinrakuen Hospital, Niigata, Niigata, Japan
| | - Hiroshi Ohara
- Department of Neurology, Shinrakuen Hospital, Niigata, Niigata, Japan
| | - Makoto Minagawa
- Department of Neurosurgery, Shinrakuen Hospital, Niigata, Niigata, Japan
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17
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Ospel JM, Goyal M. A review of endovascular treatment for medium vessel occlusion stroke. J Neurointerv Surg 2021; 13:623-630. [PMID: 33637570 DOI: 10.1136/neurintsurg-2021-017321] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/04/2022]
Abstract
Medium-vessel occlusions (MeVOs), that is, occlusions of the M2/3 middle cerebral artery, A2/3 anterior cerebral artery, and P2/3 posterior cerebral artery segments, account for 25%-40% of all acute ischemic stroke cases. Clinical outcomes of MeVO stroke with intravenous thrombolysis, which is the current standard of care, are moderate at best. With improving imaging technologies and a growing literature, MeVOs are increasingly recognized as a target for endovascular treatment (EVT). For the time being, there is limited but promising evidence for the safety and efficacy of MeVO EVT, and many neurointerventionists are already routinely offering EVT for MeVO stroke, despite the lack of clear guideline recommendations. In this article, we review the evidence on endovascular treatment for MeVO stroke and summarize the available literature on current imaging strategies, commonly used EVT selection criteria, EVT techniques, and outcome assessment for MeVO stroke.
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Affiliation(s)
- Johanna Maria Ospel
- Radiology, Universitatsspital Basel, Basel, Switzerland.,Clinical Neuroscienes, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Clinical Neuroscienes, University of Calgary, Calgary, Alberta, Canada .,Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
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18
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Bernsen MLE, Goldhoorn RJB, Lingsma HF, van Oostenbrugge RJ, van Zwam WH, Uyttenboogaart M, Roos YBWEM, Martens JM, Hofmeijer J. Importance of Occlusion Site for Thrombectomy Technique in Stroke: Comparison Between Aspiration and Stent Retriever. Stroke 2020; 52:80-90. [PMID: 33349023 DOI: 10.1161/strokeaha.120.030031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Thrombectomy with stent retriever and direct aspiration are equally effective in the endovascular treatment of anterior circulation acute ischemic stroke. We report efficacy and safety of initial treatment technique per occlusion segment. METHODS For this study, we analyzed data from the MR CLEAN Registry, a prospective, observational study in all centers that perform endovascular therapy in the Netherlands. We used ordinal logistic regression analysis to compare clinical and technical results of first line direct aspiration treatment with that of stent retriever thrombectomy stratified for occlusion segment. Primary outcome measure was functional outcome at 3 months. Secondary outcome measures included reperfusion grade expressed as the extended Thrombolysis in Cerebral Infarction score, periprocedural complication risk, time to reperfusion, and mortality. RESULTS Of the 2282 included patients, 1658 (73%) were initially treated with stent retriever and 624 (27%) with aspiration. Four hundred sixty-two patients had an occlusion of the intracranial part of the carotid artery, 1349 of the proximal middle cerebral artery, and 471 of the distal parts of the middle cerebral artery. There was no difference in functional outcome between aspiration and stent retriever thrombectomy (odds ratio, 1.0 [95% CI, 0.9-1.2]) in any of the occlusion segments (P value for interaction=0.2). Reperfusion rate was higher in the aspiration group (odds ratio, 1.4 [95% CI, 1.1-1.6]) and did not differ between occlusion segments (P value for interaction=0.6). Procedure times were shorter in the aspiration group (minutes 50 versus 65 minutes; P<0.0001). There was no difference in periprocedural complications or mortality. CONCLUSIONS In unselected patients with anterior circulation infarcts, we observed equal functional outcome of aspiration and stent retriever thrombectomy in all occlusion segments. When aspiration was the first line treatment modality, reperfusion rates were higher and procedure times shorter in all occlusion segments.
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Affiliation(s)
| | - Robert-Jan B Goldhoorn
- Department of Neurology (R.-J.B.G., R.J.v.O.), University Medical Center, Maastricht, the Netherlands
| | - Hester F Lingsma
- Public Health Department, Erasmus MC University Medical Center, Rotterdam, the Netherlands (H.F.L.)
| | - Robert J van Oostenbrugge
- Department of Neurology (R.-J.B.G., R.J.v.O.), University Medical Center, Maastricht, the Netherlands
| | - Wim H van Zwam
- Department of Radiology (W.H.v.Z.), University Medical Center, Maastricht, the Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology (M.U.), University Medical Center Groningen, the Netherlands.,Department of Radiology (M.U.), University Medical Center Groningen, the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam University Medical Center, Location AMC, the Netherlands (Y.B.W.E.M.)
| | - Jasper M Martens
- Department of Radiology (M.L.E.B., J.M.M.), Rijnstate Hospital, Arnhem, the Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology (J.H.), Rijnstate Hospital, Arnhem, the Netherlands.,Technical Medical Center, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands (J.H.)
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19
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de Havenon A, Narata AP, Amelot A, Saver JL, Bozorgchami H, Mattle HP, Ribo M, Andersson T, Zaidat OO. Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study. J Neurointerv Surg 2020; 13:779-783. [PMID: 33219148 PMCID: PMC8134506 DOI: 10.1136/neurintsurg-2020-016427] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 11/09/2022]
Abstract
Background The benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population. Objective To compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial. Methods We performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0–2, which we termed good outcome. Secondary outcomes included reperfusion rates and major adverse events. The primary predictor was M2 occlusion, which we compared with M1 occlusion. Results We included 183 patients, of whom 126 (69%) had M1 occlusion and 57 (31%) had M2 occlusion. There was no difference in the reperfusion rates or adverse events between M2 and M1 occlusions. The rate of good outcome was not different in M2 versus M1 occlusions (70.2% vs 69.7%, p=0.946). In a logistic regression model adjusted for age, sex, and baseline National Institutes of Health Stroke Scale score, M2 occlusions did not have a significantly different odds of good outcome compared with M1 occlusions (OR 0.94, 95% CI 0.47 to 1.88, p=0.87). Conclusion In ARISE II, M2 occlusions achieved a 70.2% rate of good outcome at 90 days, which is above published rates for untreated M2 occlusions and superior to prior reports of M2 occlusions treated with endovascular thrombectomy. We also report similar rates of good outcome, successful reperfusion, death, and other adverse events when comparing the M1 and M2 occlusions.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Ana Paula Narata
- Service of Radiology and Neuroradiology, University Hospital of Tours, Tours, France
| | - Aymeric Amelot
- Department of Neurosurgery, CHU Tours, Tours, France.,Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | | | | | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Tommy Andersson
- Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium.,Departments of Neuroradiology, Department of Clinical Neuroscience, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Osama O Zaidat
- Mercy Health St Vincent Medical Center, Toledo, Ohio, USA
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20
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Shao SJ, Zhang GZ, Zhao L, Huo FR, Ma HB, Zhu L, Yang ZQ, Yin R. Microcatheter infusion of bolus-dose tirofiban for acute ischemic stroke due to distal intracranial artery occlusion. Medicine (Baltimore) 2020; 99:e21366. [PMID: 32791743 PMCID: PMC7386989 DOI: 10.1097/md.0000000000021366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The utility of endovascular thrombectomy for acute occlusion of the distal intracranial artery (A2/A3/M2/M3/P2/P3) is unclear, and aspiration and stent thrombectomy are associated with risk of bleeding. We analyzed patients with acute occlusion of the distal intracranial artery to assess the safety and efficacy of microcatheter-based tirofiban infusion.We retrospectively reviewed data of the endovascular thrombectomy registry of our center between January 2018 and June 2019. Patients with distal intracranial artery occlusion who underwent endovascular thrombectomy with microcatheter-based infusion of tirofiban were recruited.Of 13 patients included, 1 presented with anterior cerebral artery occlusion, 2 with posterior cerebral artery occlusion, 2 with posterior inferior cerebellar artery occlusion, and 7 with middle cerebral artery M2 occlusion. The mean National Institute of Health Stroke scale score was 10.1 (3-19). Three patients (23.1%) underwent bridging treatment of intravenous thrombolysis with recombinant plasminogen activator and endovascular thrombectomy. The arithmetic mean onset-to-recanalization time was 696.3 minutes (140-1440) and average operating time was 47.1 minutes (30-80). After treatment, 10 patients (76.9%) underwent revascularization. No operative complications were observed in any case. All patients underwent angiography and were reviewed 7 to 14 days after surgery. Imaging revealed significant improvements in recanalization compared with the immediate postoperative period, with no reoccurrence of occlusion. The mean modified Rankin scale score at the 3-month follow-up was 0.54 (0-2).Microcatheter-based infusion of bolus-dose tirofiban can result in safe and effective recanalization of acute occlusion of the distal artery in the case of a relatively light thrombotic load.
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Findakly S, Maingard J, Phan K, Barras CD, Jhamb A, Chandra R, Thijs V, Brooks M, Asadi H. Endovascular clot retrieval for M2 segment middle cerebral artery occlusion: a systematic review and meta‐analysis. Intern Med J 2020; 50:530-541. [DOI: 10.1111/imj.14333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Julian Maingard
- Interventional Neuroradiology ServiceAustin Health Melbourne Victoria Australia
- School of MedicineDeakin University Geelong Victoria Australia
- Interventional Neuroradiology UnitMonash Imaging, Monash Health Melbourne Victoria Australia
| | - Kevin Phan
- NeuroSpine Surgery Research GroupPrince of Wales Private Hospital Sydney New South Wales Australia
| | - Christen D. Barras
- South Australian Health and Medical Research Institute Adelaide South Australia Australia
- The University of Adelaide Adelaide South Australia Australia
| | - Ashu Jhamb
- Interventional Neuroradiology ServiceAustin Health Melbourne Victoria Australia
| | - Ronil Chandra
- Interventional Neuroradiology UnitMonash Imaging, Monash Health Melbourne Victoria Australia
- Department of ImagingMonash University Melbourne Victoria Australia
| | - Vincent Thijs
- Stroke DivisionFlorey Institute of Neuroscience and Mental Health, University of Melbourne Melbourne Victoria Australia
- The University of Melbourne Melbourne Victoria Australia
- Department of NeurologyAustin Health Melbourne Victoria Australia
| | - Mark Brooks
- Interventional Neuroradiology ServiceAustin Health Melbourne Victoria Australia
- School of MedicineDeakin University Geelong Victoria Australia
| | - Hamed Asadi
- Interventional Neuroradiology ServiceAustin Health Melbourne Victoria Australia
- School of MedicineDeakin University Geelong Victoria Australia
- Interventional Neuroradiology UnitMonash Imaging, Monash Health Melbourne Victoria Australia
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22
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Harsany J, Haring J, Hoferica M, Mako M, Janega P, Krastev G, Klepanec A. Aspiration thrombectomy as the first-line treatment of M2 occlusions. Interv Neuroradiol 2020; 26:383-388. [PMID: 32397859 DOI: 10.1177/1591019920925678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of the present study was (i) to evaluate the safety and efficacy of aspiration thrombectomy in patients with M2 occlusions and (ii) to compare outcome of treatment of occlusion of different M2 segments. MATERIALS AND METHODS Between March 2016 and June 2019, 82 patients with acute ischemic stroke and isolated M2 occlusions were treated in cerebrovascular stroke center with aspiration thrombectomy as the first-line treatment. Functional outcomes of patients with different types of M2 occlusions were statistically compared. Multivariable logistic regression analysis was performed to determine the factors associated with good clinical outcome. RESULTS The mean age was 71.9 ± 13.4 years, 47.6% were men. Aspiration thrombectomy alone was utilized in 72.5% of patients, with 27.5% of patients being treated with a combination of aspiration thrombectomy and stent retriever. At the three-month follow-up, there was no statistically significant difference in functional outcome between different types of M2 occlusions (p = 0.662), however in the underpowered analysis because of the small sample size of patients, with good clinical outcome mRS 0-2 in 50% of all treated patients. Symptomatic intracranial hemorrhage was found in 6.1% of patients. Lower age (OR 0.932, 95% CI 0.878-0.988) and lower NIHSS score upon admission (OR 0.893, 95% CI 0.805-0.991) were independent predictors of good clinical outcome. CONCLUSION Aspiration thrombectomy appeared to be a safe and effective first-line treatment option for patients with M2 occlusion, being the first-line option for almost three-quarters of patients.
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Affiliation(s)
- Jan Harsany
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Matus Hoferica
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Miroslav Mako
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Pavol Janega
- Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Georgi Krastev
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
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23
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Aoki J, Suzuki K, Kanamaru T, Katano T, Kutsuna A, Sakamoto Y, Suda S, Nishiyama Y, Morita N, Harada M, Nagahiro S, Kimura K. Impact of complete recanalization on clinical recovery in cardioembolic stroke patients with M2 occlusion. J Neurol Sci 2020; 415:116873. [PMID: 32413798 DOI: 10.1016/j.jns.2020.116873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/20/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the impact of complete recanalization beyond partial recanalization in distal (M2) middle cerebral artery (MCA) occlusion. METHODS Data regarding M2 occlusion patients treated with endovascular thrombectomy (EVT) and/or intravenous thrombolysis (tPA) were reviewed from our prospective EVT registry and multicenter tPA (YAMATO study) data bank. Complete recanalization was modified thrombolysis with cerebral infarction score (TICI) of 3 at the end of EVT or similar appearances of both MCAs on magnetic resonance angiography (MRA) within 1.5 h after tPA. Partial recanalization was defined as TICI ≥2b or > 50% recanalization on MRA. At 3 months, favorable outcome was defined as a modified Rankin Scale score ≤ 2. RESULT Data on 121 patients were analyzed. EVT-alone was in 38 patients; combined EVT and tPA in 28; and tPA-alone in 55. Complete recanalization was achieved in 27 (22%), partial recanalization in 48 (40%), and no-to-limited recanalization in 46 (38%). At 3 months, 51% of patients had favorable outcomes, and this rate was significantly higher in the complete recanalization group than in the partial and no-to-limited recanalization groups (75% vs. 41% vs. 49%, p = .043). Multivariate regression analysis showed that complete recanalization was an independent parameter related to favorable outcomes (odds ratio 4.78, 95% CI: 1.16-19.73, p = .030). However, combined complete and partial recanalization was not associated with favorable outcomes (odds ratio 1.49, 95% CI 0.53-4.22, p = .449). CONCLUSION Complete recanalization, but not partial recanalization, at the end of EVT and tPA therapy is associated with favorable outcomes in patients with M2 occlusion.
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Affiliation(s)
- Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
| | - Kentaro Suzuki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takuya Kanamaru
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takehiro Katano
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Akihito Kutsuna
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yuki Sakamoto
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yasuhiro Nishiyama
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | | | - Masafumi Harada
- Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Tokushima University Hospital, Tokushima University, Tokushima, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
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24
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Ivan VL, Rubbert C, Caspers J, Lee JI, Gliem M, Jander S, Turowski B, Kaschner M. Mechanical thrombectomy in acute middle cerebral artery M2 segment occlusion with regard to vessel involvement. Neurol Sci 2020; 41:3165-3173. [DOI: 10.1007/s10072-020-04430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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25
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Clarençon F, Baronnet F, Shotar E, Degos V, Rolla-Bigliani C, Bartolini B, Veznedaroglu E, Budzik R, English J, Baxter B, Liebeskind DS, Krajina A, Gupta R, Miralbes S, Lüttich A, Nogueira RG, Samson Y, Alamowitch S, Sourour NA. Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry. Eur J Neurol 2020; 27:787-792. [PMID: 31997505 DOI: 10.1111/ene.14154] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/09/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the safety and effectiveness of mechanical thrombectomy (MT) in patients with acute ischaemic stroke related to isolated and primary posterior cerebral artery (PCA) occlusions amongst the patients enrolled in the multicentre post-market Trevo Registry. METHOD Amongst the 2008 patients enrolled in the Trevo Registry with acute ischaemic stroke due to large vessel occlusion treated by MT, 22 patients (1.1%) [10 females (45.5%), mean age 66.2 ± 14.3 years (range 28-91)] had a PCA occlusion [17 P1 (77.3%) and five P2 occlusions (22.7%)]. Recanalization after the first Trevo (Stryker, Fremont, CA, USA) pass and at the end of the procedure was rated using the modified Thrombolysis in Cerebral Infarction (mTICI) score. Procedure-related complications (i.e. groin puncture complication, perforation, symptomatic haemorrhage, embolus in a new territory) were also recorded. The modified Rankin Scale at 90 days was assessed. RESULTS Median National Institutes of Health Stroke Scale at admission was 14 (interquartile range 8-16). Stroke aetiology was cardio-embolic in 68.2% of cases. Half of the patients (11/22) received intravenous tissue plasminogen activator. 54.5% of the patients were treated under general anaesthesia. Reperfusion (i.e. mTICI 2b or 3) after first pass was obtained in 65% of cases. Final mTICI 2b-3 reperfusion was obtained in all cases. Only one (4.5%) procedure-related complication was recorded (puncture site) that resolved after surgery. At 90-day follow-up, modified Rankin Scale 0-2 was obtained in 59% of the patients and 9.1% died within the first 3 months after MT. CONCLUSION Mechanical thrombectomy for PCA occlusions seems to be safe (<5% procedure-related complications) and effective. Larger repository datasets are needed.
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Affiliation(s)
- F Clarençon
- Sorbonne University, Paris, France.,Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - F Baronnet
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - E Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - V Degos
- Sorbonne University, Paris, France.,Department of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France
| | - C Rolla-Bigliani
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - B Bartolini
- Department of Radiology, Interventional Neuroradiology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - E Veznedaroglu
- Endovascular Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, USA
| | - R Budzik
- Interventional Neuroradiology, Riverside Methodist Hospital/Ohio Health Research Institute, Columbus, OH, USA
| | - J English
- Interventional Neurology, California Pacific Medical Center, San Francisco, CA, USA
| | - B Baxter
- Interventional Neuroradiology, Erlanger, Chattanooga, TN, USA
| | - D S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - A Krajina
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - R Gupta
- Interventional Neurology, Wellstar Health System, Atlanta, GA, USA
| | - S Miralbes
- Hospital Universitario Son Espases, Mallorca, España
| | - A Lüttich
- Hospital de Donostia, San Sebastian, España
| | - R G Nogueira
- Department of Neurology, Marcus Stroke and Neuroscience Center/Grady Memorial Hospital/Emory University, Atlanta, GA, USA
| | - Y Samson
- Sorbonne University, Paris, France.,Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - S Alamowitch
- Sorbonne University, Paris, France.,Department of Vascular Neurology, Saint Antoine University Hospital, Paris, France
| | - N-A Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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26
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Li G, Huang R, Li W, Zhang X, Bi G. Mechanical thrombectomy with second-generation devices for acute cerebral middle artery M2 segment occlusion: A meta-analysis. Interv Neuroradiol 2019; 26:187-194. [PMID: 31684784 DOI: 10.1177/1591019919886405] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The benefit of mechanical thrombectomy for an acute ischemic stroke involving M2 segment occlusion is not clear, especially when performed with second-generation thrombectomy devices. METHOD We reviewed the literature to investigate clinical outcomes and the rates of recanalization, symptomatic intracerebral hematoma, and mortality in mechanical thrombectomy performed using second-generation thrombectomy devices. We compared the outcomes between patients treated for M2 and M1 occlusions. RESULTS Seven studies involving 805 patients with M2 thrombectomy were included in this meta-analysis. The functional independence rate 90 days after thrombectomy (modified Rankin Scale 0-2) was 59.3% (OR 1.81, 95% CI 1.74-1.88). The recanalization rate (thrombolysis in cerebral infarction 0-2) was 84.16% (OR 2.32, 95% CI 2.08-2.29). The symptomatic intracerebral hematoma rate was 4.9% (OR 1.05, 95% CI 1.03-1.09). The mortality was 7.7% (OR 1.08, 95% CI 1.03-1.13). The outcomes were better in patients with M2 occlusion than in those with M1 occlusion. In a subgroup analysis, we found that among patients with hypertension, mechanical thrombectomy achieved better functional outcomes and recanalization in M2 occlusion than M1 occlusion. CONCLUSION Mechanical thrombectomy performed with second-generation thrombectomy devices for M2 occlusion can provide a good functional outcome as well as satisfying recanalization. Moreover, there was no significant difference in the symptomatic intracerebral hematoma and mortality rates, suggesting this procedure is as safe in M2 occlusion as in M1 occlusion.
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Affiliation(s)
- Guangshuo Li
- Department of Neurology, Shengjing Hospital, Shenyang, China
| | - Rui Huang
- Department of Neurology, Shengjing Hospital, Shenyang, China
| | - Weishuai Li
- Department of Neurology, Shengjing Hospital, Shenyang, China
| | - Xiaotian Zhang
- Department of Neurology, Shengjing Hospital, Shenyang, China
| | - Guorong Bi
- Department of Neurology, Shengjing Hospital, Shenyang, China
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27
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Goebel J, Stenzel E, Wanke I, Paech D, Koehrmann M, Kleinschnitz C, Forsting M, Radbruch A, Moenninghoff C. Effectiveness of Endovascular Recanalization Treatment for M2 Segment Occlusion: Comparison Between Intracranial ICA, M1, and M2 Segment Thrombectomy. Acad Radiol 2019; 26:e298-e304. [PMID: 30587388 DOI: 10.1016/j.acra.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Mechanical thrombectomy is common practice in proximal anterior vessel occlusion. However, it remains unclear whether peripheral artery occlusions should be treated as well. This retrospective study aimed to prove the effectiveness of endovascular recanalization treatment for the M2 segment by comparison of intracranial internal carotid artery (ICA), M1 segment, and M2 segment thrombectomy. MATERIALS AND METHODS All patients who received endovascular treatment for distal ICA, M1, or M2 segment occlusions between January 2010 and July 2017 at our center were re-analyzed with respect to reperfusion success, interventional and clinical parameters. Statistical analysis was performed by Mann Whitney test, Chi square test, and Spearman correlation analysis. RESULTS A total of 261 patients (median age, 72 years), 100 with ICA, 137 with M1, and 24 with M2 segment occlusion, were included. Duration of endovascular treatment was significantly longer in ICA occlusions (median, 83 minutes, p < 0.001) compared to M1 (56 minutes) or M2 segment occlusions (49 minutes). Recanalization and reperfusion success and rate of endovascular complications did not differ between occlusion sites (AOL, p = 0.071; mTICI, p = 0.540; complications, p = 0.064). No significant difference in revascularization success was found between the different thrombectomy devices (direct thrombus aspiration, stent retrieving, or a sequential combined approach; p = 0.112). Successful M2 recanalization (mTICI 2b-3) correlated significantly with stronger posttherapeutic NIHSS reduction (r = 0.691, p < 0.001). CONCLUSION We found endovascular treatment of M2 segment occlusions as safe and successful as endovascular therapy of the ICA or M1 segment, with stronger posttherapeutic NIHSS reduction after successful compared to insufficient M2 recanalization.
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Affiliation(s)
- Juliane Goebel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.
| | - Elena Stenzel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Isabel Wanke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | | | | | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Alexander Radbruch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christoph Moenninghoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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28
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Choi BS, Lee H, Jin SC. Contralateral Mechanical Thrombectomy of Partial Deployed Stent Retrieval for Acute Anterior Inferior Cerebellar Artery Occlusion. World Neurosurg 2019; 129:318-321. [DOI: 10.1016/j.wneu.2019.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 12/29/2022]
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29
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Miura M, Shindo S, Nakajima M, Namitome S, Wada K, Nagao Y, Sugimura Y, Terasaki T, Ando Y. Stent Retriever-Assisted Continuous Aspiration for Distal Intracranial Vessel Embolectomy: The Distal Combined Technique. World Neurosurg 2019; 131:e495-e502. [PMID: 31382073 DOI: 10.1016/j.wneu.2019.07.202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We investigated the efficacy of a combined approach with stent retriever-assisted aspiration catheter for distal intracranial vessel occlusion (distal combined technique [DCT]). METHODS We evaluated consecutive patients with acute ischemic stroke with distal occlusion in anterior circulation, including occlusions of the M2/M3 or A2/A3 segments, who received endovascular therapy (EVT) in a single center. Modified Thrombolysis in Cerebral Infraction (mTICI) score including TICI 2C category, processing time from puncture to reperfusion, proportion of a favorable clinical outcome at discharge (modified Rankin Scale [mRS] score ≤2), and incidence of symptomatic intracranial hemorrhage (sICH) were compared between the DCT and single device approach technique (non-DCT) groups. RESULTS Of 65 patients, 28 were treated with EVT using the DCT and 37 were treated with EVT with a single device approach (non-DCT). In the DCT group, a higher reperfusion rate at the first pass (mTICI score ≥2B, 92% vs. 54%; P = 0.0008; mTICI score ≥2C, 71% vs. 16%; P < 0.0001; mTICI score 3, 57% vs. 14%; P = 0.0004) and shorter time from puncture to successful reperfusion (median, 31 vs. 43 minutes; P = 0.0006) were achieved, respectively. The final successful reperfusion rate was also higher in the DCT group than in the non-DCT group (mTICI score ≥2C, 85% vs. 51%; P = 0.004; mTICI score 3, 75% vs. 43%; P = 0.012), respectively. sICH occurred in 2 patients in the non-DCT group. Patients with mRS score ≤2 at discharge were more prevalent in the DCT than in the non-DCT group (57% vs. 27%, respectively; P = 0.021). CONCLUSIONS This retrospective analysis indicated that the DCT is a useful and safe strategy for patients with distal anterior intracranial vessel occlusion.
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Affiliation(s)
- Masatomo Miura
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seigo Shindo
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
| | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Namitome
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kuniyasu Wada
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yoichiro Nagao
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yusuke Sugimura
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tadashi Terasaki
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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30
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Ren Z, Mokin M, Bauer CT, Miao Z, Burgin WS, Wang Y. Indications for Mechanical Thrombectomy—Too Wide or Too Narrow? World Neurosurg 2019; 127:492-499. [DOI: 10.1016/j.wneu.2019.04.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
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31
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Zhang Y, Wen W, Chen C, Wu Z, Xiang X, Shi H, Guan S, Jiang G, Peng Y, Li Z, Li Z, Zhang L, Zhang Y, Hong B, Yang P, Liu J. Effectiveness of Revive SE in the RAPID registry : Revive Acute Ischemic Stroke Patients ImmeDiately (RAPID) Prospective Multicenter Trial. Clin Neuroradiol 2019; 30:495-502. [PMID: 31175375 DOI: 10.1007/s00062-019-00798-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The prospective, multicenter Revive Acute ischemic stroke Patients ImmeDiately (RAPID) trial was carried out to evaluate the real-world safety and efficacy of the Revive SE stent retriever. METHODS From January 2017 the study planned to enroll 100 patients with acute ischemic stroke who were treated with the Revive SE as a first pass. The study primary outcomes were rates of favorable reperfusion using the modified thrombolysis in cerebral infarction score [mTICI] 2b/3 and rates of favorable outcome with the modified Rankin Scale (mRS) ≤2 at 3 months. The secondary outcomes were time interval from puncture to vascular reperfusion, number of passes by Revive SE stent-retriever, incidence of distal embolization and into new territories and rate of symptomatic intracranial hemorrhage (SICH) within 24 h post intervention. RESULTS A total of 100 treated patients (mean age: 65.6 ± 11.3 years) were enrolled. The median National Institutes of Health Stroke Scale before the procedure was 16. Target vessel occlusions were as follows: middle cerebral artery (MCA) M1 in 48, M2 in 6, anterior cerebral artery (ACA) in 3, internal carotid artery (ICA) in 22, basilar artery (BA) in 17, and vertebral artery (VA) in 4. Reperfusion rate with Revive SE without rescue devices was 69%. Reperfusion rate with Revive SE only was 83.3% in MCA M2, followed by 82.4% in BA. Thromboembolic complications and SICH developed in 10% and 2% of patients, respectively. Overall, a satisfactory reperfusion was achieved in 92% and a favorable outcome at 90 days in 48%. CONCLUSION Use of the Revive SE for thrombectomy appeared to be effective and safe but these findings need be confirmed in larger clinical trials (RAPID ClinicalTrials.gov number, NCT03007082).
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Affiliation(s)
- Yongxin Zhang
- Department of Neurosurgery, Shanghai Changhai Hospital, Naval Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Wanling Wen
- Department of Neurology, the People's Liberation Army No. 306 Hospital, Beijing, China
| | - Changchun Chen
- Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, China
| | - Zhilin Wu
- Department of Neurosurgery, Yunfu People's Hospital, Yunfu, China
| | - Xin Xiang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | | | - Sheng Guan
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | | | - Ya Peng
- The First People's Hospital of Changzhou, Changzhou, China
| | - Zhiqing Li
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Zifu Li
- Department of Neurosurgery, Shanghai Changhai Hospital, Naval Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Lei Zhang
- Department of Neurosurgery, Shanghai Changhai Hospital, Naval Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yongwei Zhang
- Cerebrovascular Disease Center, Shanghai Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Shanghai Changhai Hospital, Naval Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Pengfei Yang
- Department of Neurosurgery, Shanghai Changhai Hospital, Naval Military Medical University, 168 Changhai Road, 200433, Shanghai, China.
| | - Jianmin Liu
- Department of Neurosurgery, Shanghai Changhai Hospital, Naval Military Medical University, 168 Changhai Road, 200433, Shanghai, China.
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32
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Miura M, Yoshimura S, Sakai N, Yamagami H, Uchida K, Nagao Y, Morimoto T. Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2. J Neurointerv Surg 2019; 11:964-969. [PMID: 30852524 DOI: 10.1136/neurintsurg-2018-014627] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the efficacy of endovascular therapy (EVT) with that of medical treatment in 'real-world 'patients with M2 occlusion. METHODS This was a post hoc analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2. Among 2420 patients in the registry, we evaluated patients with isolated M2 occlusion and those with functional independence before the stroke. Multivariable logistic regression analysis was used to evaluate and compare clinical outcomes between EVT and medical treatment. Additional propensity score-matched (PSM) analyses were performed. We performed subgroup analyses of the primary outcome (modified Rankin Scale score 0-2 at 90 days) using forest plots of treatment effects. RESULTS Overall, 372 patients with M2 occlusion (n=184 EVT; n=188, medical treatment) were evaluated. The EVT group had a higher baseline National Institutes of Health Stroke Scale score (median (IQR), 15 [9-19] vs 10 [5-16]) and earlier onset to hospital door time (110 [50-258] vs 150 [60-343] min) than the medical treatment group. After adjustment, EVT was significantly associated with higher odds of primary outcome (adjusted OR=2.09; 95% CI 1.26 to 3.47) and lower odds of mortality at 90 days (adjusted OR= 0.27; 95% CI 0.08 to 0.93). After PSM analyses (184 patients were 1:1 matched with each group), EVT was effective and safe relative to medical treatment. Effects favoring EVT were present in several subgroups of interest. CONCLUSION In patients with M2 occlusion, our registry suggests that EVT is effective and safe.
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Affiliation(s)
- Masatomo Miura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.,Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe City, Hyogo, Japan
| | | | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoichiro Nagao
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Comparison of Superior and Inferior Division Occlusions Treated with Endovascular Thrombectomy. Clin Neuroradiol 2019; 30:339-343. [DOI: 10.1007/s00062-019-00767-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/02/2019] [Indexed: 01/01/2023]
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Single-center experience using the 3MAX or 4MAX reperfusion catheter for the treatment of acute ischemic stroke with distal arterial occlusions in patients not eligible for intravenous fibrinolysis. Radiol Med 2018; 124:408-413. [PMID: 30547359 DOI: 10.1007/s11547-018-0965-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND In acute stroke, distal cerebrovascular occlusions can be linked to severe clinical symptoms, and treatment by mechanical thrombectomy may have an important clinical impact. When intravenous fibrinolytic therapy is firmly contraindicated, it remains the only treatment option. METHODS A total of 42 patients with isolated distal arterial occlusions and absolute contraindication for intravenous fibrinolytic therapy were retrospectively included. Mechanical thrombectomy was performed using Penumbra 4MAX or 3MAX aspiration catheters. When aspiration alone did not result in successful revascularization, a stent retriever was added. RESULTS Direct thromboaspiration was the first treatment option in all patients. 16.7% of cases required the additional use of a stent retriever. A TICI score ≥ 2b reperfusion at the end of the procedure was obtained in 76.2% and a Rankin Score of 2 or less at 90 days in 45.7%. Two hemorrhagic complications were observed. CONCLUSIONS Direct thromboaspiration appears a safe technique in acute isolated distal arterial occlusions. In a cohort of patients with absolute contraindication for intravenous fibrinolytic therapy, a significant percentage achieved good revascularization.
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Anadani M, Alawieh A, Vargas J, Chatterjee AR, Turk A, Spiotta A. First attempt recanalization with ADAPT: rate, predictors, and outcome. J Neurointerv Surg 2018; 11:641-645. [PMID: 30530772 DOI: 10.1136/neurintsurg-2018-014294] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The rate of first-attempt recanalization (FAR) with the newer-generation thrombectomy devices, and more specifically with aspiration devices, is not well known. Moreover, the effect of FAR on outcomes after mechanical thrombectomy is not properly understood. OBJECTIVE To report the rate of FAR using a direct aspiration first pass technique (ADAPT), investigate the association between FAR and outcomes, and identify the predictors of FAR. METHODS The ADAPT database was used to identify a subgroup of patients in whom FAR was achieved. Baseline characteristics, procedural, and postprocedural variables were collected. Outcome measures included 90-day modified Rankin scale (mRS) score, mortality, and hemorrhagic complications. Multivariate logistic regression was used to identify FAR predictors. RESULTS A total of 524 patients was included of whom 178 (34.0%) achieved FAR. More patients in the FAR group than in the non-FAR group received IV tPA (46.6% vs 37.6%; p<0.05). For the functional outcome, higher proportions of patients in the FAR group achieved functional independence (mRS score 0-2; 53% vs 37%; p<0.05). Additionally, we observed lower mortality and hemorrhagic transformation rates in the FAR group than the non-FAR group. Independent predictors of FAR in the anterior circulation were pretreatment IV tPA, non-tandem occlusion, and use of larger reperfusion catheters (Penumbra, ACE 64-68). Independent predictors of FAR in the posterior circulation were diabetes, onset-to-groin time, and cardioembolic etiology. CONCLUSION FAR was associated with better functional outcome and lower mortality rate. When ADAPT is used, a larger aspiration catheter and pretreatment IV tPA should be employed when indicated.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ali Alawieh
- Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jan Vargas
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Arindam Rano Chatterjee
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aquilla Turk
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Stent Retriever Thrombectomy with Mindframe Capture LP in Isolated M2 Occlusions. Clin Neuroradiol 2018; 30:51-58. [DOI: 10.1007/s00062-018-0739-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
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Spiotta AM, Fiorella D, Arthur AS, Frei D, Turk AS, Hirsch JA. The semiotics of distal thrombectomy: towards a TICI score for the target vessel. J Neurointerv Surg 2018; 11:213-214. [DOI: 10.1136/neurintsurg-2018-014353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 12/28/2022]
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Phan K, Maingard J, Kok HK, Dmytriw AA, Goyal S, Chandra R, Brooks DM, Thijs V, Asadi H. Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis. Neurointervention 2018; 13:100-109. [PMID: 30196680 PMCID: PMC6132031 DOI: 10.5469/neuroint.2018.00997] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus contact aspiration for M2 occlusions. MATERIALS AND METHODS Study selection included cohorts of patients with distal MCA occlusions in acute ischemic strokes treated with an endovascular approach including stent-retrieval or contact aspiration. Twelve studies were selected for meta-analysis for a total of 835 cases. Meta-analysis by proportions was conducted on parameters including baseline and procedural characteristics, thrombolysis in cerebral infarction (TICI) 2b-3 outcomes, and 90-day modified Rankin scale (mRS) outcomes. RESULTS Hypertension and hyperlipidemia were more prevalent in stent-retriever patients. Pooled baseline National Institute of Health Stroke Scale scores and Alberta Stroke Program Early Computed Tomography Score imaging scores were similar. Pooled time onset of symptoms to door arrival was higher for the stent-retrieval group (154 vs. 97.4 minutes, P=0.01), as was time to groin puncture (259.9 vs. 156.2 minutes, P=0.02), but there was no difference in procedure time. The TICI 2b-3 recanalization rate was similar (80.5% vs. 86.8%, P=0.168). The frequency of mRS 0-2 at 90-day was also similar (74.5% vs. 59.9%, P=0.120), and an excellent mRS 0-1 was lower for stent-retrievers (39.9% vs. 65.6%, P=0.003). A significant negative correlation was found between onset to groin puncture time and the proportion of patients with a good mRS (r=-0.71, P=0.048). CONCLUSION Both endovascular techniques achieved recanalization rates greater than 80% and 90-day outcomes of minimal disability with similar complication rates. The literature is skewed by aspiration cases being performed sooner after onset of stroke compared to stent-retriever cases.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Randwick, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Randwick, Australia
| | - Julian Maingard
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia.,Department of Radiology, School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Hong Kuan Kok
- Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adam A Dmytriw
- Department of Radiology, University of Toronto, Toronto, Canada
| | - Sourabh Goyal
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Randwick, Australia
| | - Ronil Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Australia
| | - Duncan Mark Brooks
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia.,Department of Radiology, School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Neurology, Austin Health, Heidelberg, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia.,Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Australia
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Wiącek M, Kaczorowski R, Sieczkowski B, Kanas N, Bartosik-Psujek H. Mechanical thrombectomy: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center. Neurol Neurochir Pol 2018; 52:359-363. [DOI: 10.1016/j.pjnns.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/19/2017] [Indexed: 11/27/2022]
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