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https://www.readbyqxmd.com/read/28798266/thrombectomy-of-calcified-emboli-in-stroke-does-histology-of-thrombi-influence-the-effectiveness-of-thrombectomy
#1
Tomas Dobrocky, Eike Piechowiak, Alessandro Cianfoni, Felix Zibold, Luca Roccatagliata, Pascal Mosimann, Simon Jung, Urs Fischer, Pasquale Mordasini, Jan Gralla
BACKGROUND AND PURPOSE: Thrombus composition has been postulated to affect the success of endovascular therapy. Calcified clots are composed of large amounts of calcium phosphate which influences their mechanical properties and may serve as a model for testing this hypothesis. The aim of this study was to evaluate the recanalization and complication rates of calcified thromboemboli in patients with acute ischemic stroke who underwent thrombectomy. MATERIAL AND METHODS: A retrospective analysis was performed of all calcified intracranial thromboemboli in patients suffering an acute ischemic stroke, referred for endovascular therapy at two centers between January 2013 and July 2016...
August 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28731381/reperfusion-after-ischemic-stroke-is-associated-with-reduced-brain-edema
#2
Hannah J Irvine, Ann-Christin Ostwaldt, Matthew B Bevers, Simone Dixon, Thomas Wk Battey, Bruce Cv Campbell, Stephen M Davis, Geoffrey A Donnan, Kevin N Sheth, Reza Jahan, Jeffrey L Saver, Chelsea S Kidwell, W Taylor Kimberly
Rapid revascularization is highly effective for acute stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. We investigated the relationship between reperfusion and edema in patients from the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohorts. Reperfusion percentage was measured as the difference in perfusion-weighted imaging lesion volume between baseline and follow-up (day 3-5 for EPITHET; day 6-8 for MR RESCUE)...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28706106/detailed-assessment-of-benefits-and-risks-of-retrievable-inferior-vena-cava-filters-on-patients-with-complicated-injuries-the-da-vinci-multicentre-randomised-controlled-trial-study-protocol
#3
Kwok M Ho, Sudhakar Rao, Stephen Honeybul, Rene Zellweger, Bradley Wibrow, Jeffrey Lipman, Anthony Holley, Alan Kop, Elizabeth Geelhoed, Tomas Corcoran
INTRODUCTION: Retrievable inferior vena cava (IVC) filters have been increasingly used in patients with major trauma who have contraindications to anticoagulant prophylaxis as a primary prophylactic measure against venous thromboembolism (VTE). The benefits, risks and cost-effectiveness of such strategy are uncertain. METHODS AND ANALYSIS: Patients with major trauma, defined by an estimated Injury Severity Score >15, who have contraindications to anticoagulant VTE prophylaxis within 72 hours of hospitalisation to the study centre will be eligible for this randomised multicentre controlled trial...
July 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28702878/recent-trends-in-clot-retrieval-devices-a-review
#4
REVIEW
Aamir Hameed, Haroon Zafar, Darren Mylotte, Faisal Sharif
Stroke is the second leading cause of death worldwide and in Europe. Even with gold standard medical management of acute ischemic stroke, which is intravenous (IV) thrombolysis by administration of recombinant tissue plasminogen activator (rt-PA), the mortality rate remains the same. Intra-arterial (IA) thrombolysis therapy also did not achieve significant results and was not approved by the US Food and Drug Administration (FDA) because of limited sample size. This encouraged scientists and engineers to develop endovascular clot retrieval devices for the mechanical recanalization of the occluded arteries in stroke patients...
July 12, 2017: Cardiology and Therapy
https://www.readbyqxmd.com/read/28694006/neurotoxicity-with-persistent-unilateral-ophthalmoplegia-from-envenoming-by-a-wild-inland-taipan-oxyuranus-microlepidotus-elapidae-in-remote-outback-south-australia
#5
Scott A Weinstein, Evan Everest, Jeremy Purdell-Lewis, Michael Harrison, Fiona Tavender, Sam Alfred, Liz Marrack, Chris Davenport-Klunder, Neralie Wearn, Julian White
INTRODUCTION: A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus, is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity. CASE REPORT: The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1...
July 8, 2017: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/28691137/effective-use-of-balloon-guide-catheters-in-reducing-incidence-of-mechanical-thrombectomy-related-distal-embolization
#6
Dong Hoon Lee, Jae Hoon Sung, Sang Uk Kim, Ho Jun Yi, Jae Taek Hong, Sang Won Lee
BACKGROUND AND PURPOSE: The clinical benefit of endovascular stroke therapy has been demonstrated in several prospective randomized trials. However, in a relevant percentage of patients, mechanical thrombectomy bears the risk of causing new infarction in initially unaffected vascular territories through thrombus fragmentation and migration of clot debris. The goal of this study was to evaluate the use of the balloon guide catheter (BGC) to effectively achieve flow arrest and thrombus aspiration during the intervention to avoid distal embolization...
July 9, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28674985/stroke-basic-and-clinical
#7
Tarvinder P Singh, Jonathan R Weinstein, Sean P Murphy
Tissue plasminogen activator (tPA) was first approved in the USA 25 years ago for those who had experienced a recent occlusion (<3 h) of a cerebral vessel. Now, advances in clot retrieval (stentriever), in concert with tPA, heralds new optimism for ischemic stroke victims, but adds more pressure to identify therapies that will minimize hypoxic damage, protect compromised cells, and promote rehabilitation. In the past preclinical investigations have been poor at predicting potential clinical therapy, but they have contributed enormously to understanding post-stroke pathology...
2017: Advances in Neurobiology
https://www.readbyqxmd.com/read/28626055/ischemic-stroke-what-does-the-histological-composition-tell-us-about-the-origin-of-the-thrombus
#8
Peter B Sporns, Uta Hanning, Wolfram Schwindt, Aglaé Velasco, Jens Minnerup, Tarek Zoubi, Walter Heindel, Astrid Jeibmann, Thomas Ulrich Niederstadt
BACKGROUND AND PURPOSE: The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke...
June 16, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28604188/correlation-between-clot-density-and-recanalization-success-or-stroke-etiology-in-acute-ischemic-stroke-patients
#9
Manoj Jagani, David F Kallmes, Waleed Brinjikji
Background Predicting recanalization success for patients undergoing endovascular treatment for acute ischemic stroke is of significant interest. Studies have previously correlated the success of recanalization with the density of the clot. We evaluated clot density and its relationship to revascularization success and stroke etiology. Methods We conducted a retrospective review of 118 patients undergoing intra-arterial therapy for acute ischemic stroke. Mean and maximum thrombus density was measured by drawing a circular region of interest on an axial slice of a non-contrast computed tomography scan...
June 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28593452/physical-therapy-in-the-management-of-stone-fragments-progress-status-and-needs
#10
REVIEW
Suoshi Jing, Qiongyan Gai, Xin Zhao, Juan Wang, Yuwen Gong, Yangyang Pang, Chen Peng, Yuejun Tian, Yuhan Wang, Zhiping Wang
With an increased risk of symptomatic events, the complications related to residual fragments are complex and intractable. The management of stone fragments is a challenge to urologists. This review focused on the progress, status, and needs of the newly developed physical therapies to remove fragments and improve the stone-free rate. Physical therapies, including mechanical percussion, diuresis, and inversion therapy, ultrasonic propulsion technology, glue-clot technology, and magnetization technology, will facilitate progress in endoscopic stone fragment retrieval...
June 7, 2017: Urolithiasis
https://www.readbyqxmd.com/read/28592777/causes-and-solutions-of-endovascular-treatment-failure
#11
REVIEW
Byung Moon Kim
In a meta-analysis of individual patient data from 5 randomized controlled trials, endovascular treatment (EVT) mainly using a stent retriever achieved successful recanalization in 71.1% of patients suffering from acute stroke due to anterior circulation large artery occlusion (LAO). However, EVT still failed in 28.9% of LAO cases in those 5 successful trials. Stent retriever failure may occur due to anatomical challenges (e.g., a tortuous arterial tree from the aortic arch to a target occlusion site), a large quantity of clots, tandem occlusion, clot characteristics (fresh versus organized clots), different pathomechanisms (embolic versus non-embolic occlusion), etc...
May 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28589250/histopathological-and-bacteriological-analysis-of-thrombus-material-extracted-during-mechanical-thrombectomy-in-acute-stroke-patients
#12
Francisco Hernández-Fernández, Laura Rojas-Bartolomé, Jorge García-García, Óscar Ayo-Martín, Juan David Molina-Nuevo, Rosa Angélica Barbella-Aponte, Gemma Serrano-Heras, Enrique Juliá-Molla, María José Pedrosa-Jiménez, Tomás Segura
PURPOSE: Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot. METHODS: All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin-eosin, Gram and Gomori trichrome staining...
June 6, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28584947/mechanical-recanalization-using-solitaire-ab-device-for-severe-thromboembolic-events-in-endovascular-treatment-of-intracranial-aneurysms
#13
Qiuji Shao, Liangfu Zhu, Tianxiao Li, Li Li, Yingkun He, Kaitao Chang, Xiaodong Liang
INTRODUCTION: Severe thromboembolism with complete occlusion of the proximal arteries during or after coil embolization can cause serious neurologic deficits. The study aimed to assess the effectiveness and safety of Solitaire AB device as a rescue therapy for severe thromboembolic complications in the endovascular treatment of intracranial aneurysms. MATERIALS AND METHODS: Between February 2013 and April 2016, 1047 intracranial aneurysms treated with endovascular procedures were retrospectively reviewed in our center...
June 5, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28573334/retrieval-of-migrated-volume-coils-using-different-clot-retrievers-in-a%C3%A2-porcine-model
#14
Andreas Simgen, Toshiki Tomori, Ruben Mühl-Benninghaus, Hagen Bomberg, Umut Yilmaz, Heiko Körner, Matthias W Laschke, Michael D Menger, Wolfgang Reith
PURPOSE: During endovascular treatment of intracranial aneurysms using coils, migration is a serious complication that increases neurological morbidity. The aim of this experimental study was to assess the effectiveness and complications of retrieving volume coils with different, currently available clot retrievers in a porcine model. METHODS: Volume coils of three-dimensional (3D) shape and different sizes were placed in the axillary artery of pigs. By means of 4 different clot retrievers (Trevo ProVue; Solitaire FR; 3D-Separator; ERIC) a total of 40 retrieval maneuvers (10 per retriever) were performed by deploying the retrievers within the migrated coils and trying to trap parts of the coils by advancing the microcatheter...
June 1, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28557368/strategic-framework-improves-access-to-stroke-reperfusion-across-the-state-of-victoria-australia
#15
Janet E Bray, Sonia Denisenko, Bruce C V Campbell, Michael Stephenson, Jason Muller, Grant Hocking, Peter J Hand, Christopher F Bladin
BACKGROUND: In 2010, rapid access to stroke thrombolysis centres was limited in some regional areas in the Australian state of Victoria. These results, and planning for endovascular clot retrieval (ECR), have led to the implementation of strategies by the Victorian Stroke Clinical Network, the Victorian Stroke Telemedicine Program and local health services to improve state-wide access. AIMS: To examine whether access to stroke reperfusion services (thrombolysis and ECR) in regional Victoria have subsequently improved...
August 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28534706/analyses-of-thrombi-in-acute-ischemic-stroke-a-consensus-statement-on-current-knowledge-and-future-directions
#16
Simon F De Meyer, Tommy Andersson, Blaise Baxter, Martin Bendszus, Patrick Brouwer, Waleed Brinjikji, Bruce Cv Campbell, Vincent Costalat, Antoni Dávalos, Andrew Demchuk, Diederik Dippel, Jens Fiehler, Urs Fischer, Michael Gilvarry, Matthew J Gounis, Jan Gralla, Olav Jansen, Tudor Jovin, David Kallmes, Pooja Khatri, Kennedy R Lees, Elena López-Cancio, Charles Majoie, Henk Marquering, Ana Paula Narata, Raul Nogueira, Peter Ringleb, Adnan Siddiqui, István Szikora, David Vale, Rüdiger von Kummer, Albert J Yoo, Werner Hacke, David S Liebeskind
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28503123/thromboelastometry-and-thrombelastography-analysis-under-normal-physiological-conditions-systematic-review
#17
Marcel Adler, Sandra Ivic, Nicolas S Bodmer, Hugo Ten Cate, Lucas M Bachmann, Walter A Wuillemin, Michael Nagler
BACKGROUND: Studies investigating thromboelastometry or thrombelastography analyses in a physiological context are scattered and not easy to access. OBJECTIVE: To systematically retrieve and describe published reports studying healthy subjects and targeting at the correlation of ROTEM® and TEG® measurements with conventional parameters of hemostasis. METHODS: Systematic Review: Papers were searched in Medline, Scopus and the Science Citation Index database...
April 2017: Transfusion Medicine and Hemotherapy
https://www.readbyqxmd.com/read/28495947/mechanical-thrombectomy-with-the-embolus-retriever-with-interlinked-cages-in-acute-ischemic-stroke-eric-the-new-boy-in-the-class
#18
H Steglich-Arnholm, D Kondziella, A Wagner, M E Cronqvist, K Hansen, T C Truelsen, L-H Krarup, J L S Højgaard, S Taudorf, H K Iversen, D W Krieger, M Holtmannspötter
BACKGROUND AND PURPOSE: The Embolus Retriever with Interlinked Cages (ERIC) device is a novel stent retriever for mechanical thrombectomy. It consists of interlinked cages and could improve procedural benchmarks and clinical outcome compared with classic stent retrievers. This study compares the rates of recanalization, favorable clinical outcome, procedural adverse events, and benchmarks between the ERIC device and classic stent retrievers. MATERIALS AND METHODS: From 545 patients treated with thrombectomy between 2012 and 2015, 316 patients were included...
July 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28490161/endovascular-stroke-therapy-focused-on-stent-retriever-thrombectomy-and-direct-clot-aspiration-historical-review-and-modern-application
#19
REVIEW
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
https://www.readbyqxmd.com/read/28480772/cross-circulation-thrombectomy-with-use-of-a-stent-retriever-a-case-report
#20
Ali Sultan-Qurraie, Gregory Rozansky, John Andrew Cox, Marc Lazzaro
Introduction The efficacy of the endovascular treatment of acute ischemic stroke has been substantiated by several recent randomized clinical trials. While intra-arterial therapy has significantly evolved in recent years, anatomic cerebrovascular variants and disease burden can present challenges to timely recanalization. We present the first reported case of anterior-to-posterior mechanical clot retrieval with use of a stent retriever. Case description A 53-year-old man presented with basilar artery thrombosis...
January 1, 2017: Interventional Neuroradiology
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