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Stroke AND solitaire OR mechanical thrombectomy OR endovascular therapy

Jonathan T Caranfa, Elaine Nguyen, Rafay Ali, Iregi Francis, Albert Zichichi, Elliott Bosco, Craig I Coleman, William L Baker, Christine G Kohn
BACKGROUND: Randomized controlled trials (RCTs) have compared mechanical endovascular therapy (MET) in addition to intravenous tissue plasminogen activator (IVtPA) to IVtPA alone for the management of acute ischemic stroke (AIS). Direct comparative studies between individual METs are not available. In lieu of head-to-head randomized control trials, we performed an adjusted indirect treatment comparison (ITC) meta-analysis to assess the comparative efficacy and safety of different METs, Solitaire+IVtPA and Penumbra+IVtPA in AIS patients...
2018: PloS One
Dong-Hun Kang, Jaechan Park
Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays...
May 2017: Journal of Korean Neurosurgical Society
B Lapergue, R Blanc, P Guedin, J-P Decroix, J Labreuche, C Preda, B Bartolini, O Coskun, H Redjem, M Mazighi, F Bourdain, G Rodesch, M Piotin
BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers is now the standard therapy for selected patients with ischemic stroke. The technique of A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) appears promising with a high rate of recanalization. We compared ADAPT versus stent retrievers (the Solitaire device) for efficacy and safety as a front-line endovascular procedure. MATERIALS AND METHODS: We analyzed 243 consecutive patients with large intracranial artery occlusions of the anterior circulation, treated within 6 hours with mechanical thrombectomy by either ADAPT or the Solitaire stent...
June 2, 2016: AJNR. American Journal of Neuroradiology
Shaowei Jiang, Aihua Fei, Ya Peng, Jun Zhang, You-Ran Lu, Hai-Rong Wang, Miao Chen, Shuming Pan
BACKGROUND: Endovascular mechanical thrombectomy is emerging as a promising therapeutic approach for acute ischemic stroke and show some advantages. However, the data of predicting clinical outcome after thrombectomy with Solitaire retriever were limited. We attempt to identify prognostic factors of clinical outcome in patients with acute ischemic stroke undergoing thrombectomy with Solitaire retriever. METHODS: We conducted a retrospective analysis of consecutive acute ischemic strokes cases treated between December 2010 and December2013 where the Solitaire stent retriever was used for acute ischemic stroke...
2015: PloS One
Murugan Palaniswami, Bernard Yan
BACKGROUND: This review aims to summarize the findings of the recently published randomized controlled studies which provide overwhelming evidence in support of mechanical thrombectomy for acute ischemic stroke with large artery occlusion. The five studies, Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization with Solitaire Device versus Best Medical Therapy in Anterior Circulation Stroke within 8 h (REVASCAT), Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE), Solitaire™ FR as Primary Treatment for Acute Ischemic Stroke (SWIFT PRIME) and Extending the Time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial Therapy (EXTEND IA) have demonstrated the critical role of selecting patients by advanced neuroimaging, the superior recanalization capacity of stent retrievers and the effects of minimization of work processes delay...
October 2015: Interventional Neurology
J M Coutinho, D S Liebeskind, L-A Slater, R G Nogueira, B W Baxter, E I Levy, A H Siddiqui, M Goyal, O O Zaidat, A Davalos, A Bonafé, R Jahan, J Gralla, J L Saver, V M Pereira
BACKGROUND AND PURPOSE: Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies. MATERIALS AND METHODS: We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke...
April 2016: AJNR. American Journal of Neuroradiology
Ching-Jen Chen, Dale Ding, Robert M Starke, Prachi Mehndiratta, R Webster Crowley, Kenneth C Liu, Andrew M Southerland, Bradford B Worrall
OBJECTIVE: To compare the outcomes between endovascular and medical management of acute ischemic stroke in recent randomized controlled trials (RCT). METHODS: A systematic literature review was performed, and multicenter, prospective RCTs published from January 1, 2013, to May 1, 2015, directly comparing endovascular therapy to medical management for patients with acute ischemic stroke were included. Meta-analyses of modified Rankin Scale (mRS) and mortality at 90 days and symptomatic intracranial hemorrhage (sICH) for endovascular therapy and medical management were performed...
December 1, 2015: Neurology
Xabier Urra, Sònia Abilleira, Laura Dorado, Marc Ribó, Pere Cardona, Mònica Millán, Angel Chamorro, Carlos Molina, Erik Cobo, Antoni Dávalos, Tudor G Jovin, Miquel Gallofré
BACKGROUND AND PURPOSE: Recent trials have shown the superiority of endovascular thrombectomy (EVT) over medical therapy alone in certain stroke patients with proximal arterial occlusion. Using data from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within 8-Hours of Symptom Onset (REVASCAT) and a parallel reperfusion treatment registry, we sought to assess the utilization of EVT in a defined patient population, comparing the outcomes of patients treated in and outside the REVASCAT trial...
December 2015: Stroke; a Journal of Cerebral Circulation
Daniel Knap, Maciej Honkowicz, Tomasz Kirmes, Marcin Koroński, Marzena Kysiak, Mateusz Bukański, Dominik Sieroń, Izabela Dymon, Jan Baron
Occlusion of the basilar artery (BAO) is a rare cause of stroke, making up approximately 1% of all cases. Ischemic stroke within the basilar artery is associated with serious complications and high mortality (75-91%). BAO may occur initially in the form of mild prodromal symptoms with neurological disorders, the consequences of which can lead to death. For these reasons, BAO requires rapid diagnosis and treatment. We report the case of a 26-year-old man who suffered basilar artery occlusion and was treated with endovascular therapy...
2015: Neurologia i Neurochirurgia Polska
Cumara B O'Carroll, Mark N Rubin, Brian W Chong
Intravenous recombinant tissue plasminogen activator continues to be first-line therapy for patients with acute ischemic stroke presenting within the appropriate time window, but one potential limitation is the low rate of recanalization in the setting of large artery occlusions. Intra-arterial (IA) treatment is effective for emergency revascularization of proximal intracranial arterial occlusions, but proof of benefit has been lacking until recently. Our goal is to outline the history of endovascular therapy and review both IA thrombolysis and mechanical interventions...
July 2015: Neurohospitalist
Jae-Hyung Choi, Hyun-Seok Park, Dae-Hyun Kim, Jae-Kwan Cha, Jae-Taeck Huh, Myongjin Kang
BACKGROUND: Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system...
May 2015: Journal of Korean Neurosurgical Society
Mario Zanaty, Nohra Chalouhi, Robert M Starke, Stavropoula Tjoumakaris, David Hasan, Shannon Hann, Norman Ajiboye, Kenneth C Liu, Robert H Rosenwasser, Philip Manasseh, Pascal Jabbour
OBJECT: This study aims to evaluate the use of endovascular therapy to treat very young (≤ 35 years) patients with acute ischemic stroke from large vessel occlusion. METHODS: We identified from a prospectively maintained database young patients (≤ 35 years) undergoing endovascular intervention for AIS at two cerebrovascular referral centers. The study only included patients with a confirmed large vessel occlusion. Modified Rankin scale (mRS) scores were determined at 90 days during a follow-up visit...
December 2014: Clinical Neurology and Neurosurgery
H Asadi, R Dowling, B Yan, S Wong, P Mitchell
Over the past decade, there have been rapid advancements in ischaemic stroke reperfusion treatments. However, clear clinical benefit is yet to be shown in large clinical trials. In this review, the major studies in different types of endovascular treatments including intra-arterial thrombolysis, aspiration devices, mechanical clot retrievers and the new stent retrievers are discussed. First-generation mechanical thrombectomy devices such as the MERCI Retriever (Stryker, Kalamazoo, MI, USA) and Penumbra aspiration device (Penumbra Inc...
August 2015: Internal Medicine Journal
Omer Goktekin, Abdurrahman Tasal, Huseyin Uyarel, Mehmet Akif Vatankulu, Osman Sonmez, Seref Kul, Nuray Ay, Hatice Yamac, Ozge Altintas, Hasan Karadeli, Mehmet Kolukisa, Ayse Aralasmak, Talip Asil
AIMS: We report our single-centre experience with the Solitaire AB self-expanding retrievable stent system in patients with acute ischaemic stroke. METHODS AND RESULTS: Demographic, clinical, and angiographic findings of thirty-eight consecutive patients with acute ischaemic stroke who underwent mechanical thrombectomy were evaluated retrospectively. The mean initial National Institutes of Health Stroke Scale (NIHSS) score was 17.8±4.6. Nearly half of the patients had a middle cerebral artery (MCA) occlusion (45%)...
November 2014: EuroIntervention
Alicia C Castonguay, Osama O Zaidat, Roberta Novakovic, Thanh N Nguyen, M Asif Taqi, Rishi Gupta, Chung-Huan J Sun, Coleman Martin, William E Holloway, Nils Mueller-Kronast, Joey E English, Italo Linfante, Guilherme Dabus, Tim W Malisch, Franklin A Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Michael T Froehler, Aamir Badruddin, Michael G Abraham, Vallabh Janardhan, Hashem Shaltoni, Albert J Yoo, Alex Abou-Chebl, Peng R Chen, Gavin W Britz, Ritesh Kaushal, Ashish Nanda, Mohammad A Issa, Raul G Nogueira
BACKGROUND AND PURPOSE: The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry...
December 2014: Stroke; a Journal of Cerebral Circulation
Jaechan Park, Yang-Ha Hwang, Seung Huh, Dong-Hun Kang, Yongsun Kim
BACKGROUND: An intra-arterial (IA) mechanical thrombectomy has increased the recanalization rates for acute occlusion of proximal intracranial arteries. However, the current failure rate of endovascular recanalization remains at approximately 10%, resulting in the need for surgical rescue treatment. The authors applied a minimally invasive and rapid surgical embolectomy (MIRSE) as a final rescue treatment after the failure of endovascular recanalization, and investigated the incidence, technical feasibility, and treatment results...
November 2014: Acta Neurochirurgica
Vikram Huded, Rithesh R Nair, Romnesh de Souza, Devashish D Vyas
BACKGROUND: In India, late presentation due to poor awareness about stroke precludes intravenous thrombolysis (IVT). Endovascular therapy can be used in these circumstances. We present our experience of endovascular treatment of acute ischemic stroke in a tertiary care center. AIM: Endovascular treatment of acute ischemic stroke in a tertiary care center in India. SETTINGS, DESIGN, MATERIALS, AND METHODS: The study period was from 2009 till 2013. Consecutive patients with acute ischemic stroke, who either had contraindications to IVT or had failed IVT, underwent endovascular treatment...
May 2014: Neurology India
D Behme, W Weber, A Mpotsaris
PURPOSE: Acute basilar artery occlusion is associated with high rates of major morbidity and mortality. In rare cases, the underlying pathology is a high-grade stenosis of the basilar artery. We report on a series of seven cases with occluded high-grade basilar artery stenosis who received endovascular therapy at our center. MATERIAL AND METHODS: Our prospective database since October 2009 until September 2013 was screened for patients with acute basilar artery occlusion and underlying high-grade stenosis who underwent endovascular therapy...
September 2015: Clinical Neuroradiology
David S Liebeskind
Numerous acute ischemic stroke trials have recently published detailed results, providing an opportunity to consider the role of collaterals in stroke pathophysiology and their influential effect on patient outcomes. Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke (SENTIS), the largest randomized controlled trial of device therapy to date, tested the potential augmentation of collateral perfusion. SYNTHESIS Expansion, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and Interventional Management of Stroke (IMS) III chronicled the saga of endovascular therapy trialed against medical treatment for acute ischemic stroke...
May 2014: Neurological Research
Eric M Deshaies, Amit Singla, Mark R Villwock, David J Padalino, Sameer Sharma, Amar Swarnkar
UNLABELLED: OBJECT.: There is limited information regarding patient outcomes following interventions for stroke during the window for endovascular therapy. Studies have suggested that recently approved stent retrievers are safer and more effective than earlier-generation thrombectomy devices. The authors compared cases in which the Solitaire-FR device was used to those in which a MERCI or Penumbra device was used. METHODS: This study is a single-center retrospective review of 102 consecutive cases of acute stroke in which patients were treated with mechanical thrombectomy devices between 2007 and 2013...
July 2014: Journal of Neurosurgery
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