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Clot retrieval

Matthew B Bevers, Thomas W K Battey, Ann-Christin Ostwaldt, Reza Jahan, Jeffrey L Saver, W Taylor Kimberly, Chelsea S Kidwell
BACKGROUND: Apparent diffusion coefficient (ADC) imaging is a biomarker of cytotoxic injury that predicts edema formation and outcome after ischemic stroke. It therefore has the potential to serve as a "tissue clock" to describe the extent of ischemic injury and potentially predict response to therapy. The goal of this study was to determine the relationship between baseline ADC signal intensity, revascularization, and edema formation. METHODS: We examined the ADC signal intensity ratio (ADCr) of the stroke lesion (defined as the baseline DWI hyperintense region) compared to the contralateral normal hemisphere in 65 subjects from the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy trial...
March 13, 2018: Cerebrovascular Diseases
Nobuyuki Sakai, Shinzo Ota, Yasushi Matsumoto, Rei Kondo, Tetsu Satow, Michiya Kubo, Tomoyuki Tsumoto, Yukiko Enomoto, Taketo Kataoka, Hirotoshi Imamura, Kenichi Todo, Mikito Hayakawa, Hiroshi Yamagami, Kazunori Toyoda, Yasushi Ito, Kenji Sugiu, Yuji Matsumaru, Shinichi Yoshimura
REVIVE SE (REVIVE) is a closed-ended, self-expanding stent retriever used in the RIVER JAPAN study. We present our early experience with REVIVE for revascularization of acute ischemic stroke (AIS) in patients who have failed or are ineligible for intravenous recombinant tissue plasminogen activator treatment. This prospective, single-arm, non-randomized, multicenter registry study followed up patients undergoing mechanical thrombectomy with REVIVE for 90 days. The primary endpoint was a post-procedure Thrombolysis in Cerebral Infarction (TICI) score ≥2a...
March 9, 2018: Neurologia Medico-chirurgica
Marc-Antoine Labeyrie, Vittorio Civelli, Peggy Reiner, Armand Aymard, Jean-Pierre Saint-Maurice, Akli Zetchi, Emmanuel Houdart
OBJECTIVE: To identify the prevalence and therapeutic consequences of spontaneous intracranial artery dissection (IAD) at the acute phase of ischemic stroke. METHODS: We reviewed clinical and imaging data of consecutive patients attending our center for mechanical thrombectomy (MT) between January 2012 and November 2017. IAD was defined according to published criteria and our own angiographic criteria (no clot following MT, and normalization of the vessel caliber after stenting)...
March 6, 2018: Journal of Neurointerventional Surgery
Anton A Khilchuk, Sergey V Vlasenko, Sergey G Scherbak, Andrey M Sarana, Vitaliy V Popov
Acute thrombotic occlusions of the large vessels, such as internal carotid artery, arms and legs arteries, and intracranial vessels, frequently require multiple techniques such as selective thrombolysis, manual aspiration, and stent retrievers for mechanical thrombectomy with combination of the mentioned techniques. Because of the massive thrombotic burden associated with these conditions, the response to systemic intravenous thrombolysis is poor. We present a case of a successful massive thrombi aspiration in a single attempt using an 8Fr guide catheter with aspiration syringe, subsequent ipsilateral middle cerebral artery mechanical thrombectomy, and axillary artery clot disruption attempt in a patient with acute ischemic stroke, right arm critical ischemia, and persistent atrial fibrillation...
February 2018: Radiology Case Reports
Muhammad Bilal Abid, Vijay Kumar Sharma
Urgent anticoagulation, despite the presence of acute cerebral hematoma, improves survival as well as the prognosis. Surgical decompression is a life-saving procedure and is required in a selected group of patients with considerable mass effect and elevated intracranial pressure (ICP). Endovascular thrombectomy is a novel approach to reduce the clot burden, achieve venous patency, and reduce ICP.
February 2018: Clinical Case Reports
Lei Liu, Yi-Song Liu, Guo-Hua Liu, Tian-Yin Cheng
BACKGROUND: Ticks and tick-borne diseases are of major public health concern. Currently, development of vaccines against ticks is considered crucial for their control. A critical step in this process is the screening of viable antigens. Faeces are byproducts of digestion and blood meal utilization, and partly reflect the vitality and vector potential of ticks. However, an integrated analysis of proteins in tick faeces is lacking. The present study explored the protein components in the faeces of the tick Haemaphysalis flava, by liquid chromatography-tandem mass spectrometry (LC/MS-MS) to identify potential protein antigens for vaccine development against ticks...
February 8, 2018: Parasites & Vectors
Mun Hee Choi, Geun Hwa Park, Jin Soo Lee, Sung Eun Lee, Seong-Joon Lee, Jang-Hee Kim, Ji Man Hong
BACKGROUND AND PURPOSE: Recent advent of endovascular thrombectomy (EVT) enables us to provide a new perspective on the use of tPA (tissue-type plasminogen activator) through histological analysis of retrieved thrombus. We investigated the responsiveness of intravenous thrombolysis (IVT) according to the thrombus composition in EVT-attempted patients with acute ischemic stroke. METHODS: We reviewed 92 consecutive patients with anterior circulation stroke who received combined IVT and EVT for 2 years...
March 2018: Stroke; a Journal of Cerebral Circulation
Vernard S Fennell, Swetadri Vasan Setlur Nagesh, Karen M Meess, Liza Gutierrez, Rhys H James, Michael E Springer, Adnan H Siddiqui
BACKGROUND: Despite advances in revascularization tools for large vessel occlusion presenting as acute ischemic stroke, a significant subset of clots remain recalcitrant to current strategies. We assessed the effectiveness of a novel thrombectomy device that was specifically designed to retrieve resistant fibrin rich clots, the geometric clot extractor (GCE; Neuravi, Galway, Ireland), in an in vitro cerebrovascular occlusion stroke model. METHODS: After introducing fibrin rich clot analogues into the middle cerebral artery of the model, we compared the rates of recanalization between GCE and Solitaire flow restoration stent retriever (SR; Medtronic, Minneapolis, Minnesota, USA; control group) cases...
January 19, 2018: Journal of Neurointerventional Surgery
Julian Maingard, Leonid Churilov, Peter Mitchell, Richard Dowling, Bernard Yan
INTRODUCTION: Endovascular clot retrieval (ECR) following intravenous thrombolysis is superior to intravenous thrombolysis alone for acute stroke with large vessel occlusion. However, trial selection criteria may exclude potentially salvageable patients. We investigated the impact of published selection criteria on the different proportions of patients excluded and clinical outcome. METHODS: We included patients with anterior circulation stroke treated with ECR from a single centre...
January 9, 2018: Journal of Medical Imaging and Radiation Oncology
Sonu Bhaskar, Dennis Cordato, Cecilia Cappelen-Smith, Andrew Cheung, David Ledingham, David Celermajer, Christopher Levi
Diagnosis, treatment, and secondary management of cryptogenic stroke patients pose a formidable challenge. The scenario is further complicated in patients with native and prosthetic valvular heart disease. We present a case study of a 36-year-old man who received intravenous thrombolysis (IV-tPA) and endovascular thrombectomy (EVT) for presumed "cryptogenic" complete middle cerebral artery infarction who made a surprisingly excellent clinical recovery despite poor baseline and postintervention neuroimaging...
December 2017: Annals of Clinical and Translational Neurology
Arthur Thevathasan, Jillian Naylor, Leonid Churilov, Peter J Mitchell, Richard J Dowling, Bernard Yan, Patrick Kwan
OBJECTIVE: Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between HT and occurrence of poststroke seizures in patients treated with endovascular therapy. METHODS: Consecutive patients treated with endovascular therapy for acute anterior circulation ischemic stroke were included. HT was assessed with computed tomography/magnetic resonance imaging (CT/MRI) at 24 h after stroke onset...
December 30, 2017: Epilepsia
Tomotaka Ohshima, Chinmaya Dash, Andrey Belayev, Taiki Yamamoto, Shunsaku Goto, Yoko Kato
The use of 8-F balloon guide catheter (BGC) for proximal flow control was previously shown to prevent distal embolic complications during mechanical clot retrieval in patients with acute ischemic stroke. In this retrospective study, the utility of 8-F BGCs for proximal flow control during endovascular coiling of anterior circulation aneurysms was investigated. Patients who underwent endovascular coiling for anterior circulation aneurysms between August 2013 and December 2016 were retrospectively analyzed. Among a total of 152 patients included in this series, 64 patients presented with aneurysmal rupture, whereas the aneurysms were detected incidentally or due to mass effects in the remaining patients...
November 2017: Nagoya Journal of Medical Science
Mads Nybo, Merete E Lund, Kjell Titlestad, Christian U Maegaard
BACKGROUND: Pneumatic transportation systems (PTSs) are increasingly used for transportation of blood samples to the core laboratory. Many studies have investigated the impact of these systems on different types of analyses, but to elucidate whether PTSs in general are safe for transportation of blood samples, existing literature on the subject was systematically assessed. METHODS: A systematic literature review was conducted following the preferred reporting items for systematic reviews and metaanalyses (PRISMA) Statement guidelines to gather studies investigating the impact of PTS on analyses in blood samples...
December 8, 2017: Clinical Chemistry
Jeremy N Pulvers, John D G Watson
Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times...
2017: Frontiers in Neurology
Dagmar Krajíčková, Antonín Krajina, Ivo Šteiner, Oldřich Vyšata, Roman Herzig, Miroslav Lojík, Vendelín Chovanec, Jan Raupach, Ondřej Renc, Jan Waishaupt, Eva Vítková, Petr Dulíček, Pavla Čabelková, Martin Vališ
BACKGROUND: The composition of intra-arterial clots might influence the efficacy of mechanical thrombectomy (MT) in ischemic stroke (IS) due to the acute occlusions within large cerebral arteries. The aims were to assess the factors associated with blood clot structure and the impact of thromboembolus structure on MT using stent-retrievers in patients with acute large artery IS in the anterior circulation.Methods and Results:In an observational cohort study, we studied the components of intra-arterial clots retrieved from large cerebral arteries in 80 patients with acute IS treated with MT with or without i...
February 23, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Ju-Yu Chueh, Miklos G Marosfoi, Olivia W Brooks, Robert M King, Ajit S Puri, Matthew J Gounis
Background: Over the course of the thrombectomy procedure, clot fragments may become dislodged and lead to downstream emboli due to manipulation of an endovascular device. The EmboTrap thrombectomy system features an inner stent channel with an outer stent trap design that may potentially reduce the risk of distal clot fragmentation during clot removal. We tested the hypothesis that distal emboli to both the same and new territory generated during mechanical thrombectomy are a function of device design...
October 2017: Interventional Neurology
Michael T Froehler
Background: Direct aspiration thrombectomy is an increasingly utilized technique in endovascular stroke treatment that relies on vacuum and suction force to remove the clot. This report assesses the pressures and forces generated by different catheters and pumps. Methods: Vacuum pressures were measured using a vacuum gauge for several catheters (Stryker Catalyst6, Penumbra Ace 064, Medtronic Arc 061, and Penumbra 041) and pumps (Penumbra pump, 60-mL syringe, and the ASPIRE device)...
October 2017: Interventional Neurology
Santhosh Kumar Kannath, Jayadevan Enakshy Rajan, Sylaja Padmavathy N, Sankara Sarma P, Sajith Sukumaran, Sapna Erat Sreedharan, Tirur Raman Kapilamoorthy
BACKGROUND AND OBJECTIVE: In acute ischemic stroke with large vessel occlusion, the interaction between the clot retriever and the stent is critical for achieving successful recanalization. The ideal time of stent deployment (dwell time, DT) to improve revascularization is currently unknown., We systematically analysed the effect of different DT on final angiographic and clinical outcome of of patients who underwent mechanical thrombectomy. METHODS: The DT was progressively increased from 3 minutes to 5 minutes and later, 8 minutes during the study period...
November 4, 2017: World Neurosurgery
Melanie J Winningham, Diogo C Haussen, Raul G Nogueira, David S Liebeskind, Wade S Smith, Helmi L Lutsep, Tudor G Jovin, Bin Xiang, Fadi Nahab
BACKGROUND: The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era. METHODS: A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP-) while undergoing MERCI or TREVO clot retrieval...
October 31, 2017: Journal of Neurointerventional Surgery
R Xu, X-K Zhao, M-L Wang, X Liu, D Xi
OBJECTIVE: Acute ischemic stroke (AIS) is an important global health problem. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the standard treatment. However, only a small number of patients benefit from it because of strict application restrictions. Increasing evidence has demonstrated that mechanical thrombectomy is an effective and safe therapy for AIS. PATIENTS AND METHODS: We present 14 cases of successful recanalization with Solitaire devices for AIS patients after stroke onset...
October 2017: European Review for Medical and Pharmacological Sciences
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