Stent retrievers: the future treatment of choice for endovascular recanalization in acute ischemic stroke

2013 ◽  
Vol 5 (2) ◽  
pp. 145-147
Author(s):  
Tareq Kass-Hout ◽  
Omar Kass-Hout ◽  
Rishi Gupta ◽  
Raul G Nogueira
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Future Treatment ◽  
Endovascular Recanalization ◽  
The Future ◽  
Stent Retrievers

scholarly journals Mechanical thrombeсtomy and trombaspiration in stroke. Problem claims

2019 ◽  
Vol 27 (1) ◽  
pp. 58-66
Author(s):  
O.A. Pastushyn ◽  
D.V. Shchehlov ◽  
S.V. Konotopchyk ◽  
O.E. Sviridyuk
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intraoperative Complications ◽  
Cerebral Arteries ◽  
Nihss Score ◽  
Endovascular Recanalization ◽  
Endovascular Interventions ◽  
Results Of Treatment ◽  
Balloon Catheters ◽  
Stent Retrievers

Objective — to evaluate the effectiveness of endovascular mechanical recanalization methods in ischemic stroke and the analysis of problem cases.Materials and methods. A retrospective analysis of the results of treatment of 33 patients with acute ischemic stroke due to occlusion of a large vessel was performed. There were 18 (54.5 %) men and 15 (45.5 %) women. Endovascular interventions were performed in all patients to restore cerebral arteries patency using various methods and techniques of mechanical thrombectomy. All patients underwent neuroimaging (CT of the brain and selective cerebral subtraction angiography). A topographical assessment of early CT-changes in ischemic stroke was performed using the ASPECTS scale. The severity of neurological symptoms in the acute period of ischemic stroke was assessed according to the NIHSS score. The severity of the condition – on the NIHSS score. The mTICI scale was used to assess the success of recanalization (reperfusion) after mechanical thrombectomy.Results. Successful recanalization (mTICI 2b-3) with the use of stent retrievers and distal aspiration catheters was achieved in 22 (66.7 %) cases. The total number of intraoperative complications was 12.0 %. Mortality rate – 12.0 %.Conclusions. Endovascular reperfusion methods using stent retrievers and distal aspiration catheters for acute ischemic stroke are effective. Endovascular reperfusion advisable to start with a mechanical thrombus aspiration. When performing endovascular recanalization, the use of stent retrievers in combination with guide balloon catheters only without distal aspiration catheters increases the risk of distal reembolism and embolism of other arterial basins.

Successful recanalization for acute ischemic stroke via the transbrachial approach

2014 ◽  
Vol 8 (2) ◽  
pp. 122-125 ◽  
Author(s):  
Masakazu Okawa ◽  
Satoshi Tateshima ◽  
David Liebeskind ◽  
Latisha K Ali ◽  
Michael L Thompson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Specific ◽  
Ischemic Stroke Patient ◽  
Transfemoral Approach ◽  
Acute Ischemic Stroke Patient ◽  
Transbrachial Approach ◽  
Stent Retrievers ◽  
Endovascular Approach ◽  
Specific Factors

The recent development of revascularization devices, including stent retrievers, has enabled increasingly higher revascularization rates for arterial occlusions in acute ischemic stroke. Patient-specific factors such as anatomy, however, may occasionally limit endovascular deployment of these new devices via the conventional transfemoral approach. We report three cases of acute ischemic stroke where a transbrachial endovascular approach to revascularization was used, resulting in successful recanalization. These examples suggest that a transbrachial approach may be considered as an alternative in the endovascular treatment of acute ischemic stroke.

Abstract WP9: Primary Aspiration Thrombectomy in Acute Ischemic Stroke: A Single-Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Lana J Stein ◽  
Sandra K Hanson ◽  
Jeffrey P Lassig
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Single Center ◽  
Aspiration Thrombectomy ◽  
Discharge Disposition ◽  
Single Center Experience ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stent Retrievers

Background: Recent endovascular stroke studies utilizing primarily stent retrievers have proven clinical benefit among eligible patients. It remains unclear if this benefit is exclusive to stent retrievers. We present the results of a single-center experience for patients undergoing primary aspiration thrombectomy for acute ischemic stroke (AIS). Methods: A retrospective analysis of all AIS patients receiving primary aspiration thrombectomy from January 2014 to March 2016 was performed. We assessed stroke severity at admission and discharge as defined by the National Institutes of Health Stroke Scale score (NIHSSS), median onset to puncture and onset to recanalization times, location of target vessel treated, rate of concurrent intravenous (IV) alteplase use, and rate of TICI 2b/3 reperfusion. Outcomes adjudicated included rates of symptomatic intracerebral hemorrhage (sICH), favorable discharge disposition to home, and 90-day modified Rankin Scale (mRS) score ≤2. Results: During the study period, 121 patients (mean age 68.7±16.5 years, 53.7% women) received primary aspiration thrombectomy for 124 occlusions (26% terminal internal carotid artery, 45% M1, 15% M2, 11% basilar artery, 3% other). Median admission NIHSSS was 19 [11, 22] and improved to 6 [1, 15] upon discharge. Median onset to puncture and onset to recanalization times were 258 [148, 371] and 300 [180, 409] minutes, respectively. The rate of TICI 2b/3 reperfusion was 84.7%, and 52% received adjunctive IV alteplase. Rates of favorable discharge to home was 28.9% and 90-day mRS ≤2 was 39.8%. Only one patient developed sICH. Conclusion: Our single-center experience shows that primary aspiration thrombectomy can yield both favorable angiographic and clinical outcomes with minimal adverse effect.

scholarly journals CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study

2012 ◽  
Vol 5 (6) ◽  
pp. 523-527 ◽  
Author(s):  
Aquilla S Turk ◽  
Jordan Asher Magarick ◽  
Don Frei ◽  
Kyle Michael Fargen ◽  
Imran Chaudry ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Multicenter Study ◽  
Ct Perfusion ◽  
Endovascular Recanalization ◽  
Selection For

scholarly journals Endovascular Recanalization in Early Recurrent Ischemic Stroke: A Treatment Challenge

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 49-55
Author(s):  
Huong Bich Thi Nguyen ◽  
Thang Huy Nguyen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Large Artery ◽  
Limited Information ◽  
Anterior Circulation ◽  
Endovascular Recanalization

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

scholarly journals Choosing an Effective and Safe Direct Aspiration Setup for Tortuous Anatomy in Acute Ischemic Stroke: In vitro Study in a Physiological Flow Model

2020 ◽  
Author(s):  
Jawid Madjidyar ◽  
Lars Nerkada ◽  
Naomi Larsen ◽  
Fritz Wodarg ◽  
Johannes Hensler ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
In Vitro Study ◽  
Primary Endpoints ◽  
Key Points ◽  
First Pass ◽  
Stent Retrievers ◽  
Almost All ◽  
Number Of Passes

Purpose A direct aspiration first pass technique (ADAPT) is an effective thrombectomy option in patients with acute ischemic stroke. Balloon guide catheters (BGC) seem to improve the efficacy of stent retrievers and ADAPT. The last generation 6F aspiration catheters require 9F BGCs, which are rigid devices that are challenging to position in a tortuous anatomy. In this experimental study the efficacy of 6F ADAPT alone and 5F ADAPT combined with 8F BGC was evaluated. Materials and Methods Either a fibrin rich (white) clot or an RBC rich (red) clot was placed in the M1 segment of a transparent silicon phantom. Physiological hemodynamic conditions were maintained. The clots were retrieved by 6F aspiration catheter via 8F long sheath or 5F aspiration catheter via a flexible 8F BGC. Thrombectomy was performed under direct visual control. The primary endpoints were the number of passes and the number of distal emboli. Results Ten experiments were made with each clot model and thrombectomy technique (n = 40). Full recanalization could be achieved in every experiment. First pass mTICI 3 could be achieved by 6F ADAPT in 80 % of red clots and 90 % of white clots. Distal emboli were caused in 10 % and 20 %, respectively. When using 5F ADAPT combined with BGC, a first pass mTICI 3 rate of 90 % in red clots and 100 % in white clots could be achieved. A 10 % rate of distal emboli occurred in both groups. In almost all experiments (both techniques), the thrombi clogged the aspiration catheter. No statistically significant differences could be found between the techniques and clot models. Conclusion 6F ADAPT without BGC was as effective as 5F ADAPT combined with a flexible 8F BGC, with both techniques showing high first-pass recanalization rates and low distal emboli rates. Especially in the case of a tortuous anatomy, these setups should be considered as alternatives to a rigid 9F BGC. The thrombus compositions seemed to be irrelevant in this setting. Key Points:  Citation Format

scholarly journals ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy

2018 ◽  
Vol 10 (Suppl 1) ◽  
pp. i4-i7 ◽  
Author(s):  
Aquilla S Turk ◽  
Don Frei ◽  
David Fiorella ◽  
J Mocco ◽  
Blaise Baxter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
National Institutes Of Health ◽  
Nihss Score ◽  
First Pass ◽  
Procedural Complications ◽  
Intracerebral Hemorrhages ◽  
Stent Retrievers ◽  
A New Technique

BackgroundThe development of new revascularization devices has improved recanalization rates and time, but not clinical outcomes. We report a prospectively collected clinical experience with a new technique utilizing a direct aspiration first pass technique with large bore aspiration catheter as the primary method for vessel recanalization.Methods98 prospectively identified acute ischemic stroke patients with 100 occluded large cerebral vessels at six institutions were included in the study. The ADAPT technique was utilized in all patients. Procedural and clinical data were captured for analysis.ResultsThe aspiration component of the ADAPT technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 78% of cases. The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 95%. The average time from groin puncture to at least TICI 2b recanalization was 37 min. A 5MAX demonstrated similar success to a 5MAX ACE in achieving TICI 2b/3 revascularization alone (75% vs 82%, p=0.43). Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 17.0 (12.0–21.0) and improved to a median NIHSS score at discharge of 7.3 (1.0–11.0). Ninety day functional outcomes were 40% (modified Rankin Scale (mRS) 0–2) and 20% (mRS 6). There were two procedural complications and no symptomatic intracerebral hemorrhages.DiscussionThe ADAPT technique is a fast, safe, simple, and effective method that has facilitated our approach to acute ischemic stroke thrombectomy by utilizing the latest generation of large bore aspiration catheters to achieve previously unparalleled angiographic outcomes.

Leukoaraiosis and acute ischemic stroke: 90-day clinical outcome following endovascular recanalization, with proposed “L-ASPECTS”

2020 ◽  
pp. neurintsurg-2020-015957 ◽  
Author(s):  
John Benson ◽  
Seyed Mohammad Seyedsaadat ◽  
Ian Mark ◽  
Deena M Nasr ◽  
Alejandro A Rabinstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Area Under The Curve ◽  
Primary Outcome Measure ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Endovascular Recanalization ◽  
Poor Outcomes

BackgroundTo assess if leukoaraiosis severity is associated with outcome in patients with acute ischemic stroke (AIS) following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score.MethodsA retrospective review was completed of AIS patients that underwent mechanical thrombectomy for anterior circulation large vessel occlusion. The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). L-ASEPCTS score performance was validated using a consecutive cohort of 75 AIS LVO patients.Results174 patients were included in this retrospective analysis: average age: 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (P=0.0005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the area under the curve (AUC) was higher with L-ASPECTS (P<0.0001 and AUC=0.7 for L-ASPECTS; P=0.04 and AUC=0.59 for ASPECTS). In the validation cohort, the AUC for L-ASPECTS was 0.79 while the AUC for ASPECTS was 0.70. Of patients that had successful reperfusion (mTICI 2b/3), the AUC for traditional ASPECTS in predicting good functional outcome was 0.80: AUC for L-ASPECTS was 0.89.ConclusionsLeukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.

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