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endovascular thrombectomy after larg-vessel

Naoki Matsumoto, Hitoshi Fukuda, Akira Handa, Toshinari Kawasaki, Yoshitaka Kurosaki, Masaki Chin, Sen Yamagata
The mechanism of thrombus formation in Trousseau syndrome remains unclear. The purpose of this study was to investigate specific pathological findings of the thrombi in Trousseau syndrome. The authors report on 2 cases of thrombi in Trousseau syndrome from large cerebral vessels removed by endovascular therapy and compared with thrombi in atherosclerosis or cardiac embolism. The first patient, a 67-year-old man, was transferred to our hospital for sudden onset consciousness disturbance and tetraparesis. He had been diagnosed with stage IV lung cancer...
October 6, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Jeffrey L Saver, Mayank Goyal, Aad van der Lugt, Bijoy K Menon, Charles B L M Majoie, Diederik W Dippel, Bruce C Campbell, Raul G Nogueira, Andrew M Demchuk, Alejandro Tomasello, Pere Cardona, Thomas G Devlin, Donald F Frei, Richard du Mesnil de Rochemont, Olvert A Berkhemer, Tudor G Jovin, Adnan H Siddiqui, Wim H van Zwam, Stephen M Davis, Carlos Castaño, Biggya L Sapkota, Puck S Fransen, Carlos Molina, Robert J van Oostenbrugge, Ángel Chamorro, Hester Lingsma, Frank L Silver, Geoffrey A Donnan, Ashfaq Shuaib, Scott Brown, Bruce Stouch, Peter J Mitchell, Antoni Davalos, Yvo B W E M Roos, Michael D Hill
IMPORTANCE: Endovascular thrombectomy with second-generation devices is beneficial for patients with ischemic stroke due to intracranial large-vessel occlusions. Delineation of the association of treatment time with outcomes would help to guide implementation. OBJECTIVE: To characterize the period in which endovascular thrombectomy is associated with benefit, and the extent to which treatment delay is related to functional outcomes, mortality, and symptomatic intracranial hemorrhage...
September 27, 2016: JAMA: the Journal of the American Medical Association
Diogo C Haussen, Mehdi Bouslama, Jonathan A Grossberg, Aaron Anderson, Samir Belagage, Michael Frankel, Nicolas Bianchi, Leticia C Rebello, Raul G Nogueira
INTRODUCTION: The minimal stroke severity justifying endovascular intervention remains elusive; however, a significant proportion of patients presenting with large vessel occlusion (LVO) and mild symptoms subsequently decline and face poor outcomes. OBJECTIVE: To evaluate our experience with these patients by comparing best medical therapy with thrombectomy in an intention-to-treat analysis. METHODS: Analysis of prospectively collected data of all consecutive patients with National Institutes of Health Stroke Scale (NIHSS) score ≤5, LVO on CT angiography, and baseline modified Rankin Scale (mRS) score 0-2 from November 2014 to May 2016...
September 2, 2016: Journal of Neurointerventional Surgery
Gustavo Saposnik, Mayank Goyal, Charles Majoie, Diederik Dippel, Yvo Roos, Andrew Demchuk, Bijoy Menon, Peter Mitchell, Bruce Campbell, Antoni Dávalos, Tudor Jovin, Michael D Hill
BACKGROUND: Acute stroke care represents a challenge for decision makers. Recent randomized trials showed the benefits of endovascular therapy. Our goal was to provide a visual aid tool to guide clinicians in the decision process of endovascular intervention in patients with acute ischemic stroke. METHODS: We created visual plots (Cates' plots; representing benefits of standard of care vs. endovascular thrombectomy from the pooled analysis of five RCTs using stent retrievers...
August 16, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
J Mocco, Osama O Zaidat, Rüdiger von Kummer, Albert J Yoo, Rishi Gupta, Demetrius Lopes, Don Frei, Harish Shownkeen, Ron Budzik, Zahra A Ajani, Aaron Grossman, Dorethea Altschul, Cameron McDougall, Lindsey Blake, Brian-Fred Fitzsimmons, Dileep Yavagal, John Terry, Jeffrey Farkas, Seon Kyu Lee, Blaise Baxter, Martin Wiesmann, Michael Knauth, Donald Heck, Syed Hussain, David Chiu, Michael J Alexander, Timothy Malisch, Jawad Kirmani, Laszlo Miskolczi, Pooja Khatri
BACKGROUND AND PURPOSE: Thrombectomy, primarily with stent retrievers with or without adjunctive aspiration, provided clinical benefit across multiple prospective randomized trials. Whether this benefit is exclusive to stent retrievers is unclear. METHODS: THERAPY (The Randomized, Concurrent Controlled Trial to Assess the Penumbra System's Safety and Effectiveness in the Treatment of Acute Stroke; NCT01429350) was an international, multicenter, prospective, randomized (1:1), open label, blinded end point evaluation, concurrent controlled clinical trial of aspiration thrombectomy after intravenous alteplase (IAT) administration compared with intravenous-alteplase alone in patients with large vessel ischemic stroke because of a thrombus length of ≥8 mm...
September 2016: Stroke; a Journal of Cerebral Circulation
Thabele Leslie-Mazwi, James Rabinov, Joshua A Hirsch
Endovascular thrombectomy is an effective treatment for major acute ischemic stroke syndromes caused by major anterior circulation artery occlusions (commonly referred to as large vessel occlusion) and is superior to intravenous thrombolysis and medical management. Treatment should occur as quickly as is reasonably possible. All patients with moderate to severe symptoms (National Institutes of Health stroke scale >8) and a treatable occlusion should be considered. The use of neuroimaging is critical to exclude hemorrhage and large ischemic cores...
2016: Handbook of Clinical Neurology
Ansaar T Rai, Aaron E Seldon, SoHyun Boo, Paul S Link, Jennifer R Domico, Abdul R Tarabishy, Noelle Lucke-Wold, Jeffrey S Carpenter
BACKGROUND: Data on large vessel strokes are important for resource allocation and infrastructure development. OBJECTIVE: To determine an annual incidence of large vessel occlusions (LVOs) and a thrombectomy eligible patient population. METHODS: All patients with acute ischemic stroke discharged over 3 years from a tertiary-level hospital serving a large geographic area were evaluated for an LVO (M1, internal carotid artery terminus, basilar artery)...
July 15, 2016: Journal of Neurointerventional Surgery
J Diego Lozano, Francesco Massari, Mary C Howk, Katyucia de Macedo Rodrigues, Christopher Brooks, Mary Perras, David E Rex, Ajay K Wakhloo, Anna Luisa Kühn, Ajit S Puri
The endovascular management of acute ischemic stroke (AIS) due to emergency large vessel occlusion (ELVO) has become the standard of care after the recent publication of landmark randomized, controlled trials. Mechanical thrombectomy, in addition to intravenous thrombolysis (within 4.5 hours when eligible), is now part of the algorithm of the standard of care when treating AIS in patients with ELVO in the anterior circulation up to six hours after symptom onset. A newly introduced device, the Arc™ intracranial support catheter (Medtronic, Irvine, USA), is specifically designed for the introduction of neurointerventional devices into the cerebral vasculature and facilitates the delivery of microcatheters into smaller, more distal intracranial vessels...
2016: Curēus
Shuta Aketa, Daisuke Wajima, Taekyun Kim, Rinsei Tei, Taiji Yonezawa
BACKGROUND: There is no published report of ruptured cerebral aneurysm accompanied by target vessel occlusion. We present a case of ruptured basilar tip aneurysm with concomitant basilar artery (BA) occlusion. CASE DESCRIPTION: A 53-year-old man presented to our emergency room with the acute onset of disturbance. Plain head computed tomography showed diffuse subarachnoid hemorrhage. Computed tomography angiography and digital subtraction angiography showed a BA tip aneurysm with BA trunk occlusion...
September 2016: World Neurosurgery
Justin M Moore, Christoph J Griessenauer, Raghav Gupta, Nimer Adeeb, Apar S Patel, Christopher S Ogilvy, Ajith J Thomas
The management of cerebrovascular disease has advanced considerably in 2015. Five randomized control trials have firmly established the role of endovascular thrombectomy for ischemic strokes due to large vessel occlusion. The randomized trial of intraarterial treatment for acute ischemic stroke (MR CLEAN) (Berkhemer et al. NEJM 2015;372:11-20) was the first of a series on the topic. There was a total of 5 randomized controlled trials published showing benefit in terms of functional outcomes at 90days for mechanical thrombectomy including the Endovascular Therapy for Ischemic stroke with perfusion-imaging selection (EXTEND IA) (Campbell et al...
September 2016: Clinical Neurology and Neurosurgery
D G Romano, S Cioni, S Leonini, P Gennari, I M Vallone, A Zandonella, A Puliti, R Tassi, A Casasco, G Martini, S Bracco
BACKGROUND: For intracranial large vessel occlusion in acute ischemic stroke (AIS), a high degree of revascularization in the minimal amount of time predicts good outcomes. Recently, different studies have shown that the direct aspiration first pass technique (ADAPT technique) for AIS obtains high recanalization rates, fast interventions and low costs when it works as first attempt. This study retrospectively describes revascularization efficacy, duration of procedure, intra and post-procedural complications, early and after 90-days clinical outcome in a group of patients who underwent ADAPT as the primary endovascular approach, eventually followed by stent retriever thrombectomy, for recanalization of large vessels in the anterior circulation...
October 2016: Interventional Neuroradiology
Gregory M Weiner, Rafey A Feroze, Nitin Agarwal, David M Panczykowski, William J Ares, Ali Kooshkabadi, Dana D Cummings, Vincent Carson, Amin Aghaebrahim, Brian T Jankowitz
BACKGROUND: Timely recognition of stroke at major pediatric medical centers is improving, and although treatment guidelines for pediatric stroke exist, no extensive study establishing the efficacy of surgical or thrombolytic treatment has been completed. Extrapolation of adult guidelines to pediatric patients remains the mainstay of treatment in the absence of adequate information regarding safety and efficacy in children. Recent trials have demonstrated revascularization and clinical improvement after endovascular retrieval therapy in adults with acute large vessel occlusive stroke...
August 2016: Pediatric Neurology
Georgios Tsivgoulis, Apostolos Safouris, Aristeidis H Katsanos, Adam S Arthur, Andrei V Alexandrov
BACKGROUND AND PURPOSE: After numerous attempts to prove efficacy for endovascular treatment of ischemic stroke, a series of recent randomized controlled clinical trials (RCTs) established fast mechanical thrombectomy (MT) as a safe and effective novel treatment for emergent large vessel occlusion (ELVO) in the anterior cerebral circulation. METHODS: We reviewed five recent RCTs that evaluated the safety and efficacy of MT in ELVO patients and captured available information on recanalization/reperfusion, symptomatic intracranial hemorrhage (sICH), clinical outcome, and mortality...
February 2016: Brain and Behavior
Sadaharu Torikoshi, Yoshinori Akiyama
BACKGROUND: Based on the results of several randomized controlled trials, acute endovascular thrombectomy is strongly recommended for patients with acute ischemic stroke due to large artery occlusion (LAO). The incidence of an intracranial aneurysm has been reported to be approximately 5% in the general population. Therefore, the possibility of the coincidence of LAO and an intracranial aneurysm at the distal part of an occluded vessel should be considered. SUMMARY: A 74-year-old female patient presented with the sudden onset of consciousness disturbance and left-sided weakness...
March 2016: Interventional Neurology
D G Romano, S Cioni, S L Vinci, G Pero, C Comelli, A Comai, S Peschillo, D Mardighian, L Castellan, F Resta, M G Piano, S Comelli, L Barletta, A Puliti, S Leonini, S Bracco
BACKGROUND AND PURPOSE: Aspiration thrombectomy of large vessel occlusions has made a comeback among recanalization techniques thanks to recent advances in catheter technology resulting in faster recanalization and promising clinical results when used either alone or as an adjunct to stent retriever. This multicenter retrospective study reports angiographic data, complications, and clinical outcome in patients treated with aspiration thrombectomy as the first-line option. MATERIALS AND METHODS: We analysed the clinical and procedural data of patients treated from January 2014 to March 2015...
March 16, 2016: Journal of Neurointerventional Surgery
F Akbik, J A Hirsch, R V Chandra, D Frei, A B Patel, J D Rabinov, N Rost, L H Schwamm, T M Leslie-Mazwi
Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care...
March 16, 2016: Journal of Neurointerventional Surgery
G Marnat, I Mourand, O Eker, P Machi, C Arquizan, C Riquelme, X Ayrignac, A Bonafé, V Costalat
BACKGROUND AND PURPOSE: Internal carotid artery dissection is a common cause of stroke in young adults. It may be responsible for tandem occlusion defined by a cervical steno-occlusive carotid wall hematoma associated with an intracranial large-vessel stroke. Intravenous thrombolysis is associated with a poor clinical outcome in these cases, and endovascular treatment has not been specifically evaluated to date. Our aim was to evaluate endovascular treatment technical and clinical efficiency in this specific occlusion topography, in comparison with treatment of isolated anterior circulation stroke...
July 2016: AJNR. American Journal of Neuroradiology
Rohini Bhole, Nitin Goyal, Katherine Nearing, Andrey Belayev, Vinodh T Doss, Lucas Elijovich, Daniel A Hoit, Georgios Tsivgoulis, Andrei V Alexandrov, Adam S Arthur, Anne W Alexandrov
BACKGROUND: Recent guidelines for endovascular management of emergent large vessel occlusion (ELVO) award top tier evidence to the same selective criteria in recent trials. We aimed to understand how guideline adherence would have impacted treatment numbers and outcomes in a cohort of patients from a comprehensive stroke center. METHODS: A retrospective observational study was conducted using consecutive emergent endovascular patients. Mechanical thrombectomy (MT) was performed with stent retrievers or large bore clot aspiration catheters...
March 1, 2016: Journal of Neurointerventional Surgery
Mayank Goyal, Bijoy K Menon, Wim H van Zwam, Diederik W J Dippel, Peter J Mitchell, Andrew M Demchuk, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Maria A de Miquel, Geoffrey A Donnan, Yvo B W E M Roos, Alain Bonafe, Reza Jahan, Hans-Christoph Diener, Lucie A van den Berg, Elad I Levy, Olvert A Berkhemer, Vitor M Pereira, Jeremy Rempel, Mònica Millán, Stephen M Davis, Daniel Roy, John Thornton, Luis San Román, Marc Ribó, Debbie Beumer, Bruce Stouch, Scott Brown, Bruce C V Campbell, Robert J van Oostenbrugge, Jeffrey L Saver, Michael D Hill, Tudor G Jovin
BACKGROUND: In 2015, five randomised trials showed efficacy of endovascular thrombectomy over standard medical care in patients with acute ischaemic stroke caused by occlusion of arteries of the proximal anterior circulation. In this meta-analysis we, the trial investigators, aimed to pool individual patient data from these trials to address remaining questions about whether the therapy is efficacious across the diverse populations included. METHODS: We formed the HERMES collaboration to pool patient-level data from five trials (MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND IA) done between December, 2010, and December, 2014...
April 23, 2016: Lancet
Scott L Zuckerman, Ahilan Sivaganesan, Chi Zhang, Michael C Dewan, Peter J Morone, Nishant Ganesh Kumar, J Mocco
BACKGROUND: Recent data have demonstrated that mechanical thrombectomy (MT) is beneficial for patients presenting within zero to six hours of symptom onset after stroke. However, transferring all patients with possible strokes for endovascular therapy and MT would be inefficient and costly. We conducted a case-control study to identify a subset of the National Institutes of Health Stroke Scale (NIHSS) to identify patients with large-vessel occlusion (LVO) to a high degree of specificity, in order to select those patients for whom transfer is most appropriate...
June 2016: Interventional Neuroradiology
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