Fast Stent Retrieval during Mechanical Thrombectomy Improves Recanalization in Patients with the Negative Susceptibility Vessel Sign

2021 ◽  
Author(s):  
S. Soize ◽  
J.-B. Eymard ◽  
S. Cheikh-Rouhou ◽  
P.-F. Manceau ◽  
C. Gelmini ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Stent Retrieval ◽  
Negative Susceptibility

scholarly journals Mechanical Thrombectomy with Solitaire Stent Retrieval for Acute Cardioembolic Stroke

2017 ◽  
Vol 60 (6) ◽  
pp. 627-634 ◽  
Author(s):  
Hokyun Han ◽  
Hyunho Choi ◽  
Keun-Tae Cho ◽  
Byong-Cheol Kim
Keyword(s):  
Mechanical Thrombectomy ◽  
Cardioembolic Stroke ◽  
Stent Retrieval

Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis of Stent Retrievers vs Direct Aspiration vs a Combined Approach

Neurosurgery ◽  
2019 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Theofilos Karasavvidis ◽  
Leonardo Rangel-Castilla ◽  
Dennis J Rivet ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Combined Approach ◽  
First Line ◽  
Vessel Occlusion ◽  
Stent Retrieval ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stent Retrievers ◽  
Meta Analyses ◽  
Event Rates

Abstract BACKGROUND Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke due to a large vessel occlusion. OBJECTIVE To compare the safety and efficacy profile of the different mechanical thrombectomy strategies. METHODS A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Nineteen studies with a total of 2449 patients were included. No differences were identified between the stent retrieval and direct aspiration groups in terms of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 and mTICI 3 recanalization rates, and favorable outcomes (modified Rankin Scale [mRS] ≤ 2). Adverse event rates, including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH), were similar between the stent retrieval and direct aspiration groups. The use of the stent retrieval was associated with a higher risk of vasospasm (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.10-8.09; I2: 0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.47; 95% CI: 1.02-2.12; I2: 0%) and mTICI 3 recanalization (OR: 3.65; 95% CI: 1.56-8.54), although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32). CONCLUSION Stent retrieval thrombectomy and direct aspiration did not show significant differences. Current available evidence is not sufficient to draw conclusions on the best surgical approach. The combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates, although with a higher risk of 24-h SAH, when compared with direct aspiration.

Effect on successful recanalization of thrombus length in susceptibility-weighted imaging in mechanical thrombectomy with stent-retrieval

2021 ◽  
Vol 18 ◽  
Author(s):  
Dong Hoon Lee ◽  
Jae Hoon Sung ◽  
Min Hyung Lee ◽  
Ho Jun Yi ◽  
Seung Yoon Song
Keyword(s):  
Success Rate ◽  
Mechanical Thrombectomy ◽  
Multivariate Analyses ◽  
Maximum Intensity Projection ◽  
Significant Decline ◽  
Maximum Intensity ◽  
Stent Retriever ◽  
Susceptibility Weighted Imaging ◽  
Stent Retrieval ◽  
Baseline Characteristics

Introduction: Susceptibility-weighted imaging (SWI) enables visualization of thrombotic material in acute ischemic stroke. We analyzed the association between thrombus length on SWI and the success rate of recanalization in stent-retriever mechanical thrombectomy. Materials and Methods: A retrospective study was performed on 128 patients with middle cerebral artery (MCA) thrombus on pretreatment SWI. The patients were divided into 2 groups, the successful recanalization and the failed recanalization group. Thrombus visibility and location on SWI were compared to those on maximum intensity projection (MIP) in computed tomography (CT) angiography. A comparative analysis was performed in terms of clinical and radiologic outcomes as well as complications with respect to multiple categories. Results: No significant differences were noted in terms of baseline characteristics and clinical outcomes between the 2 groups. However, compared with the successful recanalization group, the failed recanalization group had a larger number of stent-retriever passages and a longer thrombus length (p = 0.027 and 0.014, respectively). Multivariate analyses revealed that a larger mean number of stent-retriever passages was a predictive factor for failure of recanalization (odds ratio [OR] 1.60; 95% confidence interval [CI] 1.12 – 2.08; p = 0.04). Thrombus length (OR 9.91; 95% CI 3.89–13.87; p < 0.001) and atrial fibrillation (OR 5.38; 95% CI 1.51 – 9.58; p = 0.008) were separately associated with more than 3 stent-retriever passages. Conclusions: Thrombus length has been identified as a predictor of recanalization failure in mechanical thrombectomy. A significant decline in the success rate of recanalization was associated with longer thrombus length.

scholarly journals Mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke in a Brazilian population

Clinics ◽  
2012 ◽  
Vol 67 (12) ◽  
pp. 1379-1386 ◽  
Author(s):  
LH Castro-Afonso ◽  
TG Abud ◽  
OM Pontes-Neto ◽  
LM Monsignore ◽  
GS Nakiri ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Brazilian Population ◽  
Stent Retrieval

Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis

2017 ◽  
Vol 10 (8) ◽  
pp. 746-750 ◽  
Author(s):  
BaiXue Jia ◽  
Lei Feng ◽  
David S Liebeskind ◽  
Xiaochuan Huo ◽  
Feng Gao ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Intervention Group ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Arterial Stenosis ◽  
Large Artery ◽  
Stent Retrieval ◽  
Rescue Treatment ◽  
Significant Difference

ObjectiveTo investigate the safety and efficacy of mechanical thrombectomy plus rescue therapy for intracranial large artery occlusion (ILAO) with underlying intracranial atherosclerosis (ICAS).MethodsPatients enrolled in the intervention group of EAST (Endovascular Therapy for Acute ischemic Stroke Trial) were analyzed. For underlying ICAS identified during the stent retrieval procedure, rescue treatment was required for those with (1) a degree of arterial stenosis >70% or (2) any degree of arterial with blood flow impairment or (3) evidence of re-occlusion. Outcomes were compared between the ICAS group and the embolic group. Multivariate logistic regression was performed to determine independent predictors of functional independence at 90 days.ResultsAmong the 140 patients included in the analysis, underlying ICAS was identified in 47 (34%), and 30 patients (21.4%) were considered to be eligible to receive rescue treatment. Of the 30 patients, 27 (90%) actually received rescue therapy. Recanalization rate (95.7% vs 96.8%, P=0.757) and functional independence at 90 days (63.8% vs 51.6%, P=0.169) were comparable between the ICAS group and the embolic group. No significant difference in symptomatic hemorrhage (4.3% vs 4.3%, P=1.000) or death (12.8% vs 12.9%, P=0.982) was found between the two groups. National Institutes of Health Stroke Scale score at presentation (OR=0.865, 95% CI 0.795 to 0.941; P=0.001) and modified Thrombolysis in Cerebral Infarction after the procedure (OR=2.864, 95% CI 1.018 to 8.061; P=0.046) were independently associated with functional independence at 90 days.ConclusionsMechanical thrombectomy is safe in patients with ILAO with underlying ICAS. By employing a standard rescue therapy, favorable outcomes could be achieved in such patients.Clinical trial registrationNCT02350283 (Post-results).

scholarly journals ”Missing clot” during mechanical thrombectomy in acute stroke using Solitaire stent retrieval system

2016 ◽  
Vol 19 (2) ◽  
pp. 279
Author(s):  
Vikram Huded ◽  
Vivek Nambiar ◽  
Romnesh De Souza ◽  
Vikram Bohra ◽  
Ritesh Ramankutty
Keyword(s):  
Acute Stroke ◽  
Retrieval System ◽  
Mechanical Thrombectomy ◽  
Stent Retrieval

Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

VASA ◽  
2016 ◽  
Vol 45 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Frantisek Stanek ◽  
Radoslava Ouhrabkova ◽  
David Prochazka
Keyword(s):  
Mechanical Thrombectomy ◽  
Clinical Success ◽  
Major Amputation ◽  
Peripheral Arteries ◽  
Duration Of Symptoms ◽  
Efficient Treatment ◽  
Percutaneous Mechanical Thrombectomy ◽  
Single Centre Study ◽  
Crural Arteries

Abstract. Background: The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method. Patients and methods: Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18 - 92 years (median 72 years). In all, 128 procedures were performed. Results: Angiographic success was obtained in 120 interventions (93.8 %). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention - percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5 %. Major amputation was performed in 10 % of cases. Cumulative patency rates were 75 % after one month, 71 % after six months, 38 % after 12 months, 33 % after 18 months and 30 % after 24, 30, 36 and 42 months. Conclusions: Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and efficient treatment of acute and subacute occlusions of peripheral arteries in one session.

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