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endovascular thrombectomy after larg-vessel

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https://www.readbyqxmd.com/read/29127196/mechanical-thrombectomy-for-acute-ischemic-stroke-with-occlusion-of-the-m2-segment-of-the-middle-cerebral-artery-a-meta-analysis
#1
Hamidreza Saber, Sandra Narayanan, Mohan Palla, Jeffrey L Saver, Raul G Nogueira, Albert J Yoo, Sunil A Sheth
BACKGROUND: Endovascular thrombectomy has demonstrated benefit for patients with acute ischemic stroke from proximal large vessel occlusion. However, limited evidence is available from recent randomized trials on the role of thrombectomy for M2 segment occlusions of the middle cerebral artery (MCA). METHODS: We conducted a systematic review and meta-analysis to investigate clinical and radiographic outcomes, rates of hemorrhagic complications, and mortality after M2 occlusion thrombectomy using modern devices, and compared these outcomes against patients with M1 occlusions...
November 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29114095/direct-mechanical-intervention-versus-bridging-therapy-in-stroke-patients-eligible-for-intravenous-thrombolysis-a-pooled-analysis-of-2-registries
#2
Sebastian Bellwald, Ralph Weber, Tomas Dobrocky, Hannes Nordmeyer, Simon Jung, Jeffrie Hadisurya, Pasquale Mordasini, Marie-Luise Mono, Christian P Stracke, Hakan Sarikaya, Corrado Bernasconi, Klaus Berger, Marcel Arnold, René Chapot, Jan Gralla, Urs Fischer
BACKGROUND AND PURPOSE: Randomized controlled trials have shown that mechanical thrombectomy (MT) plus best medical treatment improves outcome in stroke patients with large-vessel occlusion in the anterior circulation. Whether direct MT is equally effective as bridging thrombolysis (intravenous thrombolysis plus MT) in intravenous thrombolysis eligible patients remains unclear. METHODS: We compared clinical and radiological outcomes at 3 months in 249 bridging patients with 111 patients receiving direct MT for large-vessel occlusion anterior circulation stroke from 2 prospective registries (study period Essen: June 2012 to August 2013, Bern February 2009 to August 2014)...
November 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29097075/endovascular-thrombectomy-for-acute-ischemic-stroke-a-single-center-experience-in-taiwan
#3
Hai-Jui Chu, Sung-Chun Tang, Chung-Wei Lee, Jiann-Shing Jeng, Hon-Man Liu
BACKGROUND/PURPOSE: Endovascular thrombectomy has been strongly recommended for treatment of acute ischemic stroke (AIS) with large vessel occlusion. This study aimed to evaluate its efficacy and safety in an Asian population from a single center in Taiwan. METHODS: Patients who experienced AIS and received endovascular thrombectomy during the period of September 2014 to September 2016 at National Taiwan University Hospital were included. Factors related to favorable outcome, defined as modified Rankin scale 0-2 at 90 days after stroke, were analyzed...
October 30, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/29075880/endovascular-stroke-treatment-how-far-downstream-should-we-go
#4
Benjamin Friedrich, Donald Lobsien, Silke Wunderlich, Christian Maegerlein, David Pree, Karl-Titus Hoffmann, Claus Zimmer, Johannes Kaesmacher
BACKGROUND: Endovascular thrombectomy has become the de facto standard in the treatment of large vessel occlusion. Previously, a correlation between good outcome and the occlusion site, measured by the 'distance to thrombus' (DT)-as the distance from the carotid T to the beginning of the thrombus-after thrombolysis could be shown. In the present study, we analyze the differences between the chances of a good outcome in respect of DT between patients treated endovascularly or intravenously...
October 26, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28981224/-endovascular-treatment-of-ischemic-strokes-outcomes-and-practical-issues
#5
N Ligot, B Lubicz, G Naeije
Ischemic stroke is a leading cause of disability and death due to brain arterial occlusion and subsequent ischemia. Acute treatment aims to recanalize the occluded artery as soon as possible. Treatment to achieve recanalization of the occluded artery has evolved during the last couple of years. First therapeutic improvement : intra-veinous thrombolysis (IV rt-PA) was the first validated treatment to achieve reduction in ischemic stroke morbi-mortality. However, rt-PA is efficient in the first hours of stroke onset and for small calibers occluded vessels...
2017: Revue Médicale de Bruxelles
https://www.readbyqxmd.com/read/28959484/determinants-of-the-impact-of-blood-pressure-variability-on-neurological-outcome-after-acute-ischaemic-stroke
#6
Adam de Havenon, Alicia Bennett, Gregory J Stoddard, Gordon Smith, Lee Chung, Steve O'Donnell, J Scott McNally, David Tirschwell, Jennifer J Majersik
INTRODUCTION: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. METHODS: We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (mRS) 30-365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission...
March 2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28894887/-endovascular-thrombectomy-for-ischemic-stroke
#7
REVIEW
B Kallmünzer, M Köhrmann
The standard of care for patients with acute stroke of the anterior circulation and large vessel occlusion is the combined treatment with intravenous rt-PA (recombinant tissue-type plasminogen activator) and endovascular thrombectomy. The therapy is highly effective while reducing functional deficits and long-term disability. International guidelines recommend thrombectomy during the first 6 h after symptom onset, but new evidence supports its use in selected patients within a time window of up to 24 h...
November 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28887393/white-matter-hyperintensity-volume-and-outcome-of-mechanical-thrombectomy-with-stentriever-in-acute-ischemic-stroke
#8
Kunakorn Atchaneeyasakul, Thabele Leslie-Mazwi, Kathleen Donahue, Anne-Katrin Giese, Natalia S Rost
BACKGROUND AND PURPOSE: Finding of white matter hyperintensity (WMH) has been associated with an increased risk of parenchymal hematoma and poor clinical outcomes after mechanical thrombectomy using old-generation endovascular devices. Currently, no data exist with regard to the risk of mechanical thrombectomy using stentriever devices in patients with significant WMH. We hypothesized that WMH volume will not affect the hemorrhagic and clinical outcome in patients with acute ischemic stroke undergoing thrombectomy using new-generation devices...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28875550/outcomes-of-endovascular-treatment-for-acute-large-vessel-ischaemic-stroke-more-than-6-h-after-symptom-onset
#9
R Motyer, H K Kok, H Asadi, A O'Hare, P Brennan, S Power, S Looby, P Nicholson, D Williams, S Murphy, M D Hill, M Goyal, J McManus, P O'Brien, J Thornton
BACKGROUND AND OBJECTIVES: Benefit from endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) acute ischaemic stroke (AIS) is well demonstrated. Furthermore, emerging evidence supports efficacy in appropriately selected patients treated beyond current recommendations of 6 h. We evaluated clinical outcomes in patients undergoing late EVT at our institution. METHODS: Retrospective review of prospectively collected clinical database on 355 patients who underwent EVT for LVO AIS...
September 5, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/28855390/tissue-selective-salvage-of-the-white-matter-by-successful-endovascular-stroke-therapy
#10
Justus F Kleine, Mirjam Kaesmacher, Benedikt Wiestler, Johannes Kaesmacher
BACKGROUND AND PURPOSE: White matter (WM) is less vulnerable to ischemia than gray matter. In ischemic stroke caused by acute large-vessel occlusion, successful recanalization might therefore sometimes selectively salvage the WM, leading to infarct patterns confined to gray matter. This study examines occurrence, determinants, and clinical significance of such effects. METHODS: Three hundred twenty-two patients with acute middle cerebral artery occlusion subjected to mechanical thrombectomy were included...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28843801/endovascular-stroke-treatment-of-patients-over-80-years-old-cumulative-evidence-from-the-real-world
#11
Sofia Figueiredo, Andreia Carvalho, Marta Rodrigues, André Cunha, Ludovina Paredes, Henrique Costa, Pedro Barros, Tiago Gregório, Manuel Ribeiro, Sérgio Castro, Miguel Veloso
BACKGROUND: Evidence on stent retriever-based thrombectomy (SRT) efficacy in elderly patients is controversial. This study aimed to analyze safety and efficacy outcomes in octogenarians submitted to SRT. METHODS: Analysis was based on a prospective observational registry of patients with stroke because of anterior circulation large-vessel occlusion treated with SRT at our center between January 2015 and September 2016. Patients were dichotomized into 2 age groups: ≤80 and >80 years old...
August 23, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28798267/pretreatment-predictors-of-malignant-evolution-in-patients-with-ischemic-stroke-undergoing-mechanical-thrombectomy
#12
Alessandro Davoli, Caterina Motta, Giacomo Koch, Marina Diomedi, Simone Napolitano, Angela Giordano, Marta Panella, Daniele Morosetti, Sebastiano Fabiano, Roberto Floris, Roberto Gandini, Fabrizio Sallustio
BACKGROUND: Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET. METHODS: Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed...
August 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28702769/short-and-long-term-outcomes-after-combined-intravenous-thrombolysis-and-mechanical-thrombectomy-versus-direct-mechanical-thrombectomy-a-prospective-single-center-study
#13
Giovanni Merlino, Massimo Sponza, Benedetto Petralia, Alessandro Vit, Vladimir Gavrilovic, Andrea Pellegrin, Michele Rana, Iacopo Cancelli, Sara Naliato, Simone Lorenzut, Roberto Marinig, Ferdinando Calzolari, Roberto Eleopra
Recent clinical trials demonstrated that mechanical thrombectomy (MT) using second-generation endovascular devices has beneficial effects in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, it remains controversial if intravenous thrombolysis (IVT) prior to MT is superior compared to direct mechanical thrombectomy (DMT). The aims of this study were to compare short and long-term outcomes between IVT + MT and DMT patients. We prospectively recruited AIS patients with LVO in the anterior or posterior circulation eligible for MT with and without prior IVT...
August 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28611827/repeated-mechanical-thrombectomy-in-recurrent-large-vessel-occlusion-acute-ischemic-stroke
#14
Mehdi Bouslama, Diogo C Haussen, Leticia C Rebello, Jonathan A Grossberg, Michael R Frankel, Raul G Nogueira
BACKGROUND: Endovascular therapy has been proven effective for the treatment of large vessel occlusion strokes (LVOS). However, the feasibility and potential benefits of repeat thrombectomy for recurrent stroke is unclear. We aim to report our experience with repeat thrombectomy for recurrent LVOS. METHODS: We reviewed our prospectively collected endovascular database for patients who underwent repeated mechanical thrombectomy. Baseline characteristics, procedural data and outcomes were evaluated...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28596447/impact-of-thrombus-length-on-outcomes-after-intra-arterial-aspiration-thrombectomy-in-the-therapy-trial
#15
RANDOMIZED CONTROLLED TRIAL
Albert J Yoo, Pooja Khatri, J Mocco, Osama O Zaidat, Rishi Gupta, Donald Frei, Demetrius Lopes, Harish Shownkeen, Olvert A Berkhemer, Denise Meyer, Susana S Hak, Sophia S Kuo, Hope Buell, Arani Bose, Siu Po Sit, Rüdiger von Kummer
BACKGROUND AND PURPOSE: Increasing thrombus length (TL) impedes recanalization after intravenous (IV) thrombolysis. We sought to determine whether the clinical benefit of aspiration thrombectomy relative to IV r-tPA (recombinant tissue-type plasminogen activator) may be greater at longer TL. METHODS: THERAPY was a randomized trial of aspiration thrombectomy plus IV r-tPA versus IV r-tPA alone in large-vessel stroke patients with prospective TL measurement ≥8 mm...
July 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28596192/the-impact-of-conscious-sedation-versus-general-anesthesia-for-stroke-thrombectomy-on-the-predictive-value-of-collateral-status-a-post-hoc-analysis-of-the-siesta-trial
#16
S Schönenberger, J Pfaff, L Uhlmann, C Klose, S Nagel, P A Ringleb, W Hacke, M Kieser, M Bendszus, M A Möhlenbruch, J Bösel
BACKGROUND AND PURPOSE: Radiologic selection criteria to identify patients likely to benefit from endovascular stroke treatment are still controversial. In this post hoc analysis of the recent randomized Sedation versus Intubation for Endovascular Stroke TreAtment (SIESTA) trial, we aimed to investigate the impact of sedation mode (conscious sedation versus general anesthesia) on the predictive value of collateral status. MATERIALS AND METHODS: Using imaging data from SIESTA, we assessed collateral status with the collateral score of Tan et al and graded it from absent to good collaterals (0-3)...
August 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28592218/first-line-use-of-contact-aspiration-for-thrombectomy-versus-a-stent-retriever-for-recanalization-in-acute-cerebral-infarction-the-randomized-aster-study-protocol
#17
Bertrand Lapergue, Julien Labreuche, Raphael Blanc, Xavier Barreau, Jérome Berge, Arturo Consoli, Georges Rodesch, Susanna Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Alain Duhamel, Sandrine Baffert, Mikael Mazighi, Benjamin Gory, Francis Turjman, Michel Piotin
Rationale Mechanical thrombectomy with a stent retriever is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion. New techniques for mechanical thrombectomy, such as contact aspiration, appear promising to increase reperfusion status and improve clinical outcome. Aim We aim at ascertaining whether contact aspiration is more efficient than the stent retriever as a first-line endovascular procedure. Sample size estimates With a two-sided test (alpha = 5%, power = 90%) and an anticipated rate of spontaneous recanalization and catheterization failures of 15%, we estimate that a sample size of 380 patients will be necessary to detect an absolute difference of 15% in primary outcome (superiority design)...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28508117/single-center-experience-using-the-3max-reperfusion-catheter-for-the-treatment-of-acute-ischemic-stroke-with-distal-arterial-occlusions
#18
Kévin Premat, Bruno Bartolini, Flore Baronnet-Chauvet, Eimad Shotar, Vincent Degos, Paul Muresan, Federico Di Maria, Joseph Gabrieli, Charlotte Rosso, Silvia Pistocchi, Jacques Chiras, Nader Sourour, Sonia Alamowitch, Yves Samson, Frédéric Clarençon
PURPOSE: Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3...
May 15, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28504557/carotid-angioplasty-assisted-mechanical-thrombectomy-without-urgent-stenting-may-be-a-better-option-in-acute-tandem-occlusions
#19
Cetin K Akpinar, Erdem Gürkaş, Emrah Aytac
Background The aim of the study was to assess the efficacy of balloon angioplasty-assisted mechanical thrombectomy without urgent stenting in the carotid artery as another approach for endovascular treatment of tandem occlusions. Methods Fifteen consecutive cases of tandem occlusions treated with the endovascular approach between January 2014 and May 2016 were reviewed. The study cohort included patients with an etiology of large vessel atherosclerosis. Extracranial carotid stenting was performed in another session if post-thrombectomy mRS modified Rankin Score (mRS) was 0-2...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28503386/mechanical-thrombectomy-for-acute-ischemic-stroke-after-cardiac-surgery
#20
Ali S Haider, Prabhat Garg, Ian T Watson, Dean Leonard, Umair Khan, Ahmed Haque, Phu Nguyen, Kennith F Layton
Ischemic stroke is a rare yet devastating complication that may occur following cardiothoracic surgery. Fibrinolytic treatment is contraindicated due to elevated risk for hemorrhage. Mechanical thrombectomy entails a catheterized approach wherein the thrombus is physically removed from the vessel without the use of fibrinolytics, minimizing the possibility of intracranial hemorrhage. Here, we present two original cases of mechanical thrombectomy as treatment for patients experiencing emergent large vessel occlusion following cardiothoracic surgery...
April 11, 2017: Curēus
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