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Acute ischemic stroke AND mechanical thrombectomy

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https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#1
Julian Bösel
Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27871458/eligibility-for-mechanical-thrombectomy-in-acute-ischemic-stroke-a-phase-iv-multi-center-screening-log-registry
#2
Georgios Tsivgoulis, Nitin Goyal, Robert Mikulik, Vijay K Sharma, Aristeidis H Katsanos, Ramin Zand, Prakash R Paliwal, Andromachi Roussopoulou, Ondrej Volny, Abhi Pandhi, Christina Zompola, Lucas Elijovich, Apostolos Safouris, Jason Chang, Andrei V Alexandrov, Anne W Alexandrov
No eligibility screening logs were kept in recent mechanical thrombectomy (MT) RCTs establishing safety and efficacy of endovascular reperfusion therapies for acute ischemic stroke (AIS). We sought to evaluate the potential eligibility for MT among consecutive AIS patients in a prospective international multicenter study. We prospectively evaluated consecutive AIS patients admitted in four tertiary-care stroke centers during a twelve-month period. Potential eligibility for MT was evaluated using inclusion criteria from MR CLEAN & REVASCAT...
December 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27863833/rapid-systematic-review-intra-arterial-thrombectomy-clot-retrieval-for-selected-patients-with-acute-ischemic-stroke
#3
William J Meurer, Bradley E Barth, Gary Gaddis, Gary M Vilke, Samuel H F Lam
BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. However, precisely defining the optimal treatment for individual patients early after AIS onset remains elusive. There has recently been a surge in published studies documenting the effectiveness of mechanical intra-arterial thrombectomy for treatment of a subset of patients with AIS. This therapy has been proposed and studied for the small (<1.2%) subgroup of patients with ischemic strokes who have "large vessel" strokes or strokes that fail to improve after the administration of tissue plasminogen activator (t-PA)...
November 15, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27799374/where-did-the-clot-go-an-unusual-complication-of-mechanical-thrombectomy-caused-by-malignancy-related-subclavian-steal-phenomenon-in-a-patient-with-acute-basilar-artery-occlusion
#4
Nikkie Randhawa, Jonathan P Squires, Manraj Kanwal Singh Heran, Sharanpal K Mann
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically...
October 31, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27797875/where-did-the-clot-go-an-unusual-complication-of-mechanical-thrombectomy-caused-by-malignancy-related-subclavian-steal-phenomenon-in-a-patient-with-acute-basilar-artery-occlusion
#5
Nikkie Randhawa, Jonathan P Squires, Manraj Kanwal Singh Heran, Sharanpal K Mann
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically...
October 25, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27789787/initial-experience-with-sofia-as-an-intermediate-catheter-in-mechanical-thrombectomy-for-acute-ischemic-stroke
#6
Johnny H Y Wong, Huy M Do, Nicholas A Telischak, Adrienne M Moraff, Robert L Dodd, Michael P Marks, Shreya M Ingle, Jeremy J Heit
BACKGROUND: The benefits of mechanical thrombectomy for emergent large vessel occlusion (ELVO) have been established. Combined mechanical/aspiration (Solumbra) and a direct aspiration as a first pass technique (ADAPT) are valid procedures requiring an intermediate catheter for clot suction. Recently, SOFIA (Soft torqueable catheter Optimized For Intracranial Access) was developed as a single lumen flexible catheter with coil and braid reinforcement, but its suitability for mechanical thrombectomy had not been evaluated...
October 27, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27789149/noncontrast-computed-tomography-versus-computed-tomography-angiography-source-images-for-predicting-final-infarct-size-in-anterior-circulation-acute-ischemic-stroke-a-prospective-cohort-study
#7
Amritendu Mukherjee, Prakash Muthusami, Aneesh Mohimen, Srinivasan K, Babunath B, Sylaja Pn, Chandrasekharan Kesavadas
BACKGROUND: There has been a recent debate regarding the superiority of computed tomography angiography source images (CTASIs) over noncontrast computed tomography (NCCT) to predict the final infarct size in acute ischemic stroke (AIS). We hypothesized that the parenchymal abnormality on CTASI in faster scanners would overestimate ischemic core. METHODS: This prospective study assessed the correlation of Alberta Stroke Program Early CT Score (ASPECTS) on NCCT, CTASI, and computed tomography perfusion (CTP) with final infarct size in patients within 8 hours of AIS...
October 24, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27773790/partial-mhc-class-ii-constructs-as-novel-immunomodulatory-therapy-for-stroke
#8
Gil Benedek, Arthur A Vandenbark, Nabil J Alkayed, Halina Offner
The worldwide prevalence of stroke continues to rise despite recent successes in treating acute ischemic stroke. With limited patient eligibility and associated risk of tPA and mechanical thrombectomy, new preventive and therapeutic modalities are needed to stave the rising wave of stroke. Inflammation plays a key role in brain damage after cerebral ischemia, and novel therapies that target pro-inflammatory cells have demonstrated promise for treatment for stroke. Partial MHC class II constructs have been shown to prevent and/or reverse clinical signs of various inflammatory diseases such as experimental autoimmune encephalomyelitis, collagen-induced arthritis and experimental autoimmune uveitis, by reducing the number and frequency of activated cells in the damaged CNS...
October 31, 2016: Neurochemistry International
https://www.readbyqxmd.com/read/27751921/endovascular-treatment-of-tandem-common-carotid-artery-origin-and-distal-intracranial-occlusion-in-acute-ischemic-stroke
#9
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
https://www.readbyqxmd.com/read/27725522/treatment-result-in-the-initial-stage-of-kanazawa-mobile-embolectomy-team-for-acute-ischemic-stroke
#10
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
https://www.readbyqxmd.com/read/27704247/childhood-acute-basilar-artery-thrombosis-successfully-treated-with-mechanical-thrombectomy-using-stent-retrievers-case-report-and-review-of-the-literature
#11
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
https://www.readbyqxmd.com/read/27688267/vessel-perforation-during-stent-retriever-thrombectomy-for-acute-ischemic-stroke-technical-details-and-clinical-outcomes
#12
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
https://www.readbyqxmd.com/read/27663559/ct-angiography-based-collateral-flow-and-time-to-reperfusion-are-strong-predictors-of-outcome-in-endovascular-treatment-of-patients-with-stroke
#13
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
https://www.readbyqxmd.com/read/27637922/intraparenchymal-hyperattenuations-on-flat-panel-ct-directly-after-mechanical-thrombectomy-are-restricted-to-the-initial-infarct-core-on-diffusion-weighted-imaging
#14
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
https://www.readbyqxmd.com/read/27634955/impact-of-thrombus-length-on-recanalization-and-clinical-outcome-following-mechanical-thrombectomy-in-acute-ischemic-stroke
#15
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
https://www.readbyqxmd.com/read/27578909/treatment-protocol-based-on-assessment-of-clot-quality-during-endovascular-thrombectomy-for-acute-ischemic-stroke-using-the-trevo-stent-retriever
#16
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
https://www.readbyqxmd.com/read/27566492/thrombectomy-in-acute-ischemic-stroke-estimations-of-increasing-demands
#17
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
https://www.readbyqxmd.com/read/27562709/resolving-thrombus-in-the-left-atrial-appendage-by-edoxaban-treatment-after-acute-ischemic-stroke-report-of-2-cases
#18
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
https://www.readbyqxmd.com/read/27543141/optimizing-outcomes-for-mechanically-ventilated-patients-in-an-era-of-endovascular-acute-ischemic-stroke-therapy
#19
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
https://www.readbyqxmd.com/read/27507864/comparison-of-perfusion-ct-software-to-predict-the-final-infarct-volume-after-thrombectomy
#20
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
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