Read by QxMD icon Read

Acute ischemic stroke AND mechanical thrombectomy

Gregory M Weiner, Rafey Feroze, David M Panczykowski, Amin Aghaebrahim, William Ares, Nitin Agarwal, John Enis, Xiao Zhu, Andrew F Ducruet
INTRODUCTION: Tandem occlusion resulting in acute ischemic stroke (AIS) is associated with high morbidity and mortality and a poor response to thrombolytic therapy. The use of endovascular strategies for tandem stroke cases results in an improved outcome for this subgroup of patients. We present two cases with a pattern of tandem occlusion consisting of proximal obstruction at the origin of the common carotid artery (CCA) with concomitant intracranial occlusion treated by endovascular techniques...
October 14, 2016: World Neurosurgery
Naoyuki Uchiyama, Kouichi Misaki, Masanao Mohri, Tomoya Kamide, Yuichi Hirota, Ryo Higashi, Hisato Minamide, Yukihiko Kohda, Takashi Asahi, Katsuo Shoin, Masayuki Iwato, Daisuke Kita, Yoshitaka Hamada, Yuya Yoshida, Mitsutoshi Nakada
Five recent multicenter randomized controlled trials (RCTs) have clearly shown the superiority of mechanical thrombectomy in large vessel occlusion acute ischemic stroke compared to systemic thrombolysis. Although 14 hospitals in Ishikawa prefecture have uninterrupted availability of systemic thrombolysis, mechanical thrombectomy is not available at all of these hospitals. Therefore, we established a Kanazawa mobile embolectomy team (KMET), which could travel to these hospitals and perform the acute reperfusion therapy...
October 11, 2016: Neurologia Medico-chirurgica
Giancarlo Nicosia, Domenico Cicala, Giuseppe Mirone, Pietro Spennato, Vincenzo Trischitta, Claudio Ruggiero, Gianluigi Guarneri, Mario Muto, Giuseppe Cinalli
INTRODUCTION: Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents...
October 4, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Maxim Mokin, Kyle M Fargen, Christopher T Primiani, Zeguang Ren, Travis M Dumont, Leonardo B C Brasiliense, Guilherme Dabus, Italo Linfante, Peter Kan, Visish M Srinivasan, Mandy J Binning, Rishi Gupta, Aquilla S Turk, Lucas Elijovich, Adam Arthur, Hussain Shallwani, Elad I Levy, Adnan H Siddiqui
BACKGROUND: Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported. OBJECTIVE: To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance. METHODS: Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis...
September 29, 2016: Journal of Neurointerventional Surgery
Fabrizio Sallustio, Caterina Motta, Silvia Pizzuto, Marina Diomedi, Angela Giordano, Vittoria Carla D'Agostino, Domenico Samà, Salvatore Mangiafico, Valentina Saia, Jacopo Maria Legramante, Daniel Konda, Enrico Pampana, Roberto Floris, Paolo Stanzione, Roberto Gandini, Giacomo Koch
BACKGROUND: Collateral flow (CF) is an effective predictor of outcome in acute ischemic stroke (AIS) with potential to sustain the ischemic penumbra. However, the clinical prognostic value of CF in patients with AIS undergoing mechanical thrombectomy has not been clearly established. We evaluated the relationship of CF with clinical outcomes in patients with large artery anterior circulation AIS treated with mechanical thrombectomy. METHODS: Baseline collaterals of patients with AIS (n=135) undergoing mechanical thrombectomy were independently evaluated by CT angiography (CTA) and conventional angiography and dichotomized into poor and good CF...
September 23, 2016: Journal of Neurointerventional Surgery
Tanja Schneider, Tobias Mahraun, Julian Schroeder, Andreas Frölich, Philip Hoelter, Marlies Wagner, Jean Darcourt, Christophe Cognard, Alain Bonafé, Jens Fiehler, Susanne Siemonsen, Jan-Hendrik Buhk
PURPOSE: The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions. METHODS: This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy...
September 16, 2016: Clinical Neuroradiology
Fatih Seker, Johannes Pfaff, Marcel Wolf, Silvia Schönenberger, Simon Nagel, Christian Herweh, Mirko Pham, Martin Bendszus, Markus A Möhlenbruch
PURPOSE: The impact of thrombus length on recanalization in IV thrombolysis for acute intracranial artery occlusion has been well studied. Here we analyzed the influence of thrombus length on the number of thrombectomy maneuvers needed for recanalization, intraprocedural complications, recanalization success, and clinical outcome after mechanical thrombectomy. METHODS: We retrospectively analyzed angiographic and clinical data from 72 consecutive patients with acute occlusion of the M1 segment of the middle cerebral artery who were treated with mechanical thrombectomy using stent retrievers...
September 15, 2016: Journal of Neurointerventional Surgery
Kojiro Ishikawa, Tomotaka Ohshima, Masahiro Nishihori, Tasuku Imai, Shunsaku Goto, Taiki Yamamoto, Toshihisa Nishizawa, Shinji Shimato, Kyozo Kato
The optional endovascular approach for acute ischemic stroke is unclear. The Trevo stent retriever can be used as first-line treatment for fast mechanical recanalization. The authors developed a treatment protocol for acute ischemic stroke based on the assessment of clot quality during clot removal with the Trevo. This prospective single-center study included all patients admitted for acute ischemic stroke between July 2014 and February 2015, who underwent emergency endovascular treatment. According to the protocol, the Trevo was used for first-line treatment...
August 2016: Nagoya Journal of Medical Science
Åsa Kuntze Söderqvist, Tommy Andersson, Niaz Ahmed, Nils Wahlgren, Magnus Kaijser
BACKGROUND: New recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy. METHODS: The new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007...
August 26, 2016: Journal of Neurointerventional Surgery
Shin Saito, Seigo Shindo, Shun Tsudaka, Kazutaka Uchida, Manabu Shirakawa, Shinichi Yoshimura
Here we report first 2 cases of patients with nonvalvular atrial fibrillation with acute cardioembolic stroke in whom thrombi in the left atrial appendage (LAA) were resolved by edoxaban administration. Case 1 reports an 86-year-old woman who suddenly showed right hemiparesis and aphasia due to occlusion of the left middle cerebral artery. She received mechanical thrombectomy and recovered neurologically. Transesophageal echocardiography (TEE) performed on day 1 demonstrated thrombus in the LAA. The thrombus was resolved on day 13 after initiation of edoxaban (30 mg once daily) instead of warfarin, which was administered before stroke onset...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Shouri Lahiri, Konrad Schlick, Tapan Kavi, Shlee Song, Asma Moheet, Taizoon Yusufali, Axel Rosengart, Michael J Alexander, Patrick D Lyden
Endovascular mechanical thrombectomy is a new standard of care for acute ischemic stroke (AIS). The majority of these patients receive mechanical ventilation (MV), which has been associated with poor outcomes. The implication of this is significant, as most neurointerventionalists prefer general compared to local anesthesia during the procedure. Consequences of hemodynamic and respiratory perturbations during general anesthesia and MV are thought to contribute significantly to the poor outcomes that are encountered...
August 19, 2016: Journal of Intensive Care Medicine
Friederike Austein, Christian Riedel, Tina Kerby, Johannes Meyne, Andreas Binder, Thomas Lindner, Monika Huhndorf, Fritz Wodarg, Olav Jansen
BACKGROUND AND PURPOSE: Computed tomographic perfusion represents an interesting physiological imaging modality to select patients for reperfusion therapy in acute ischemic stroke. The purpose of our study was to determine the accuracy of different commercial perfusion CT software packages (Philips (A), Siemens (B), and RAPID (C)) to predict the final infarct volume (FIV) after mechanical thrombectomy. METHODS: Single-institutional computed tomographic perfusion data from 147 mechanically recanalized acute ischemic stroke patients were postprocessed...
September 2016: Stroke; a Journal of Cerebral Circulation
Ozge Altintas, Mehmet Ozgen Altintas, Abdurrahman Tasal, Okkes Taha Kucukdagli, Talip Asil
OBJECTIVES: Of all strokes, 85% are ischemic and intracranial artery occlusion accounts for 80% of these ischemic strokes. Endovascular therapy for acute ischemic stroke was a new modality aiming at resolution of clots in occluded cerebral arteries. The platelet-to-lymphocyte ratio (PLR) was introduced as a potential marker to determine increased inflammation, which is a result of releasing many mediators from the platelets. In this study we aimed to evaluate whether the PLR had a prognostic role in stroke patients undergoing thrombectomy and attempted to determine the effect that this ratio had on their survival...
September 2016: Neurological Research
Tomas Peisker, Boris Koznar, Ivana Stetkarova, Petr Widimsky
This review summarizes the modern early diagnosis and acute phase treatment of acute stroke. The guidelines for treatment of acute ischemic stroke underwent major changes in 2015 and endovascular therapy (catheter-based mechanical thrombectomy with a stent retriever) became the class IA indication for patients presenting within less than 6h from symptom onset who have proven occlusion of large intracerebral artery in anterior circulation. Acute stroke care organization should enable to perform effective revascularization therapy as soon as possible after the initial brain imaging whenever this examination provides indication for the procedure...
June 24, 2016: Trends in Cardiovascular Medicine
Sudhakar Satti, Jennifer Chen, Thinesh Sivapatham, Mahesh Jayaraman, Darren Orbach
OBJECTIVE: Given recent strongly positive randomized controlled adult mechanical thrombectomy trials, we sought to perform a comprehensive review of available literature on IA pediatric stroke intervention, with a focus on modern mechanical devices. METHODS: PubMed search for pediatric patients undergoing IA treatment of acute ischemic stroke (AIS) using modern devices between 2008 and 2015. 29 patients were included in this analysis. RESULTS: Average age was 10...
July 22, 2016: Journal of Neurointerventional Surgery
Fabien Scalzo, David S Liebeskind
Visualization and quantification of blood flow are essential for the diagnosis and treatment evaluation of cerebrovascular diseases. For rapid imaging of the cerebrovasculature, digital subtraction angiography (DSA) remains the gold standard as it offers high spatial resolution. This paper lays out a methodological framework, named perfusion angiography, for the quantitative analysis and visualization of blood flow parameters from DSA images. The parameters, including cerebral blood flow (CBF) and cerebral blood volume (CBV), mean transit time (MTT), time-to-peak (TTP), and T max, are computed using a bolus tracking method based on the deconvolution of the time-density curve on a pixel-by-pixel basis...
2016: Computational and Mathematical Methods in Medicine
Fawaz Al-Mufti, Elie Dancour, Krishna Amuluru, Charles Prestigiacomo, Stephan A Mayer, E Sander Connolly, Jan Claassen, Joshua Z Willey, Philip M Meyers
Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. Peri- and postinterventional neurocritical care of the patient who has had an emergent large-vessel occlusion is likely an equally important contributor to the outcome but has been relatively neglected. Critical periprocedural management issues include streamlining care to speed intervention, blood pressure optimization, reversal of anticoagulation, management of agitation, and selection of anesthetic technique (ie, general vs monitored anesthesia care)...
July 19, 2016: Journal of Intensive Care Medicine
Vishal B Jani, Chiu Yuen To, Achint Patel, Prashant S Kelkar, Boyd Richards, Richard D Fessler
INTRODUCTION: We aim to analyze the impact of annual hospital volume on outcomes of endovascular mechanical thrombectomy (EMT) for acute ischemic stroke (AIS). In the recent past, increasing number of hospitals are acquiring capabilities for EMT procedure for the treatment of AIS, including some low-volume centers. There are few data on outcomes comparing these hospitals with high-volume centers. METHODS: We queried the National Inpatient Sample from 2008 to 2011 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) diagnosis codes 433 to 437...
August 2016: Neurosurgery
Xuanqian Xie, Anna Lambrinos, Brian Chan, Irfan A Dhalla, Timo Krings, Leanne K Casaubon, Cheemun Lum, Nancy Sikich, Aditya Bharatha, Vitor Mendes Pereira, Grant Stotts, Gustavo Saposnik, Christina O'Callaghan, Linda Kelloway, Michael D Hill
BACKGROUND: The beneficial effects of endovascular treatment with new-generation mechanical thrombectomy devices compared with intravenous thrombolysis alone to treat acute large-artery ischemic stroke have been shown in randomized controlled trials (RCTs). This study aimed to estimate the cost utility of mechanical thrombectomy compared with the established standard of care. METHODS: We developed a Markov decision process analytic model to assess the cost-effectiveness of treatment with mechanical thrombectomy plus intravenous thrombolysis versus treatment with intravenous thrombolysis alone from the public payer perspective in Canada...
April 2016: CMAJ Open
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
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"