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Stent retrieval stroke

Jin Soo Lee, Seong-Joon Lee, Ji Man Hong, Jin Wook Choi, Jeong-Ho Hong, Hyuk-Won Chang, Chang-Hyun Kim, Yong-Won Kim, Dong-Hun Kang, Yong-Sun Kim, Bruce Ovbiagele, Andrew M Demchuk, Yang-Ha Hwang, Sung-Il Sohn
Background and Purpose: The purpose of the current study is to evaluate the influence of temporal patterns related to the availability of new endovascular treatment (EVT) devices on care processes and outcomes among patients with AIS. Materials and Methods: We enrolled 720 consecutive patients (January 2011 to May 2016) in a retrospective registry, ASIAN KR, from three Korean hospitals, who received EVT for acute ischemic stroke (AIS) caused by cervicocephalic arterial occlusions...
March 2018: Neurointervention
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
Ivo G H Jansen, Maxim J H L Mulder, Robert-Jan B Goldhoorn
OBJECTIVE: To determine outcomes and safety of endovascular treatment for acute ischaemic stroke, due to proximal intracranial vessel occlusion in the anterior circulation, in routine clinical practice. DESIGN: Ongoing, prospective, observational cohort study. SETTING: 16 centres that perform endovascular treatment in the Netherlands. PARTICIPANTS: 1488 patients included in the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry who had received endovascular treatment, including stent retriever thrombectomy, aspiration, and all alternative methods for acute ischaemic stroke within 6...
March 9, 2018: BMJ: British Medical Journal
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
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
S Kammerer, R du Mesnil de Rochemont, M Wagner, S -J You, S Tritt, M Mueller-Eschner, F C Keil, A Lauer, J Berkefeld
PURPOSE: Intra-arterial therapy of acute ischemic stroke has developed rapidly in recent years. Due to proven efficacy in randomized trials, stent retrievers were replacing first-generation thrombectomy devices and have been defined as method of choice. However, aspiration catheters or a combination of several techniques have shown promising rates of successful recanalizations. To create a basis for comparison of the new approaches according to real-world data, we determined the first pass recanalization rate of an evidence-based standard technique with the use of a stent retriever in combination with a balloon-guiding catheter...
February 21, 2018: Cardiovascular and Interventional Radiology
Aquilla S Turk, Adnan H Siddiqui, J Mocco
BACKGROUND AND OBJECTIVE: Acute ischemic stroke is a potentially devastating condition and leading cause of morbidity and mortality, affecting an estimated 800 000 people per year in the USA. The natural history of untreated or unrevascularized large vessel occlusions in acute stroke patients results in mortality rates approaching 30%, with only 25% achieving good neurologic outcomes at 90 days. Recently, data have demonstrated that early endovascular recanalization of large vessel occlusions results in better outcomes than medical therapy alone...
February 20, 2018: Journal of Neurointerventional Surgery
David Černík, Daniel Šaňák, Petra Divišová, Martin Köcher, Filip Cihlář, Jana Zapletalová, Tomáš Veverka, Andrea Prcúchová, Dušan Ospalík, Marie Černá, Petra Janoušová, Michal Král, Tomáš Dorňák, Vojtěch Prášil, David Franc, Petr Kaňovský
INTRODUCTION/PURPOSE: Mechanical thrombectomy (MT) for acute ischemic stroke (IS) can be performed also in patients on anticoagulation therapy (AT); however, sufficient and reliable data about safety and efficacy of MT are still missing. Thus, we aimed to compare these parameters between patients treated on AT and without AT. MATERIALS AND METHODS: All consecutive IS patients treated with MT using stent retrievers were included in the retrospective analysis. Neurological deficit was scored using National Institutes of Health Stroke Scale (NIHSS) and 90-day clinical outcome using modified Rankin scale with a score 0-2 for good outcome...
February 15, 2018: Cardiovascular and Interventional Radiology
Ossama Yassin Mansour, Abdulrahman Mostafa Ibrahim Ali, Mohamed Megahed
Background: Several mechanical thrombectomy (MT) devices have been designed with the goal of improving the recanalization rates of major intracranial artery occlusions. Objective: In this single-center experience, we analyzed the acute ischemic stroke (AIS) treatment with Primary MT; safety and efficacy and clinical results in our patients with large vessel occlusion (LVO). Methods: During a five-year period (from September 2011 to July 2016), out of 996 patients who presented to our center with a diagnosis of AIS, 113 (11...
December 2017: Journal of Vascular and Interventional Neurology
Geng Zhou, Ming-Hua Li, Hai-Tao Lu, Jiang-Shan Deng, Yu-Wu Zhao, Yi Xiang J Wang, Yue-Qi Zhu
INTRODUCTION: Mechanical thrombectomy (MT) has been widely accepted as a safe and effective treatment for acute ischemic stroke (AIS). Development of stent retriever devices has been intensively developed over the past two decades. In this study, we compared the effectiveness and safety of a new thrombectomy device with Solitaire FR for the treatment of AIS models. METHODS: Mechanical performance of stent retrievers was tested in vitro. Thrombin-induced thrombus was pre-injected into the right distal external carotid-maxillary artery in 18 dogs to create an acute thrombus occlusion model, and these animals were divided into a Tonbridge group (n=9, with Tonbridge stent Tonbridge Medical Technology) and a Solitaire group as control (n=9, with Solitaire stent, ev3 Neurovascular)...
February 14, 2018: Journal of Neurointerventional Surgery
Jeremy Hofmeister, Zsolt Kulcsar, Gianmarco Bernava, Alain Pellaton, Hasan Yilmaz, Gorislav Erceg, Maria Isabel Vargas, Karl-Olof Lovblad, Paolo Machi
OBJECTIVE: Mechanical thrombectomy (MTB) is a treatment of reference for acute ischemic stroke due to large brain vessel occlusion but some concerns remain about its use in small distal branches. In the present study, we assessed the efficacy and the safety of distal MTB using the Catch Mini (CM) stent retriever. METHODS: We retrospectively reviewed a prospectively maintained database of all consecutive patients who underwent MTB for a distal intracranial occlusion with the Catch Mini device at our hospital...
February 1, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Ting-Yu Yi, Wen-Huo Chen, Yan-Min Wu, Mei-Fang Zhang, Ding-Lai Lin, Xiao-Hui Lin
BACKGROUND: Both intra-arterial recombinant tissue plasminogen activator (rt-PA) and stent retrieval are effective for treating acute ischemic stroke. The goal of this study was to evaluate the effectiveness of stent retrieval combined with intra-arterial rt-PA administration via micro-catheter (called the complex technique) in acute ischemic stroke. MATERIAL AND METHODS: A retrospective analysis was performed of 93 consecutive patients treated between 2015 and 2017 for occlusions of the intracranial large artery using the complex technique (n=37) or stent retrieval alone (n=56) in our stroke center...
March 15, 2018: Journal of the Neurological Sciences
Kota Maekawa, Masunari Shibata, Hideki Nakajima, Akane Mizutani, Yotaro Kitano, Masaru Seguchi, Masayoshi Yamasaki, Kazuto Kobayashi, Takanori Sano, Genshin Mori, Tadashi Yabana, Yutaka Naito, Shigetoshi Shimizu, Fumitaka Miya
BACKGROUND: Only few studies have investigated the relationship between the histopathology of retrieved thrombi and clinical outcomes. This study aimed to evaluate thrombus composition and its association with clinical, laboratory, and neurointerventional findings in patients treated by mechanical thrombectomy due to acute large vessel occlusion. METHODS: At our institution, 79 patients were treated by mechanical thrombectomy using a stent retriever and/or aspiration catheter between August 2015 and August 2016...
January 15, 2018: Cerebrovascular Diseases Extra
Benjamin Gory, Mikael Mazighi, Julien Labreuche, Raphael Blanc, Michel Piotin, Francis Turjman, Bertrand Lapergue
BACKGROUND: Modern endovascular thrombectomy (MET), using stent retrievers or large-bore distal aspiration catheters in stroke patients with acute basilar artery occlusion (BAO), is routinely performed to date. However, more than 35% of BAO patients treated with MET die within 90 days despite high recanalization rates. The purpose of this study is to investigate the parameters associated with 90-day mortality in patients with BAO after MET. METHODS: We analyzed 117 consecutive BAO patients included in the Endovascular Treatment in Ischemic Stroke prospective clinical registry of consecutive acute ischemic stroke patients treated with MET (60 patients [51...
January 30, 2018: Cerebrovascular Diseases
Sofia Boudour, Marine Barral, Benjamin Gory, Caroline Giroudon, Gilles Aulagner, Anne-Marie Schott, Francis Turjman, Marie Viprey, Xavier Armoiry
BACKGROUND: Our objective was to review economic evaluations on stent-retriever thrombectomy (SRT) added/not added to intravenous (IV) tissue plasminogen activator (t-PA) in acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). METHODS: We conducted a systematic review using several electronic databases and searching for studies published from January 2009 to September 2017. INCLUSION CRITERIA: any publication type reporting the incremental cost-effectiveness ratio of SRT in people with AIS secondary to LVO...
February 1, 2018: Journal of Neurology
Young-Jin Kim, Kwang-Wook Cho, Seong-Rim Kim, Do-Sung Yoo, Hae-Kwan Park, Cheol Ji
Objective: Intraarterial thrombolysis (IA-Tx) with stent retriever is accepted as an additional treatment for selected patients and the clinical benefit is well reported. Each intravenous tissue plasminogen activator administration (IV-tPA) and perfusion diffusion mismatching (P/D-mismatching) is well known the beneficial effects for recanalization and clinical outcomes. In this report, authors analyzed the clinical outcomes of additional IA-Tx with retrieval stent device, according to the combined IV-tPA and P/D-mismatching or not...
December 2017: Journal of Cerebrovascular and Endovascular Neurosurgery
Akitake Okamura, Kazuhiko Kuroki, Katsuhiro Shinagawa, Naoto Yamada
Background In cases of acute ischemic stroke, manual aspiration of the thrombus is commonly performed with a balloon guiding catheter placed in the cervical segment of the internal carotid artery (ICA). However, most manual aspirations using a balloon guiding catheter are combined with inner catheters, as in the direct aspiration first pass technique (ADAPT). We experienced some cases of acute ischemic stroke with proximal ICA occlusion due to cardiogenic thrombus where we obtained sufficient recanalization by simple manual aspiration from inflated Optimo 9F balloon catheters (Tokai Medical Products, Japan) placed in the origin of the cervical segment of the ICA without any inner catheter or stent retriever...
January 1, 2018: Interventional Neuroradiology
Shih-Wei Meng, Ruei-Cheng Kuo, Hui-Jen Yang, Chao-Lun Lai, Chih-Cheng Wu, Mu-Yang Hsieh
Stroke treatment has entered a new era after the publication of multiple randomized trials involving the use of a stent retriever since 2015. In Taiwan, the demand for interventional neuroradiologists to perform mechanical thrombectomy is high. For this reason, providing this standard care requires reshaping of the care model. Here, we report our experience in recruiting an acute coronary care team to perform emergent mechanical thrombectomy, which is essential in a patient with acute ischemic stroke.
January 2018: Acta Cardiologica Sinica
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
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