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https://www.readbyqxmd.com/read/28709707/endovascular-treatment-of-acute-ischemic-stroke-with-eric-device
#1
Laurent Pierot, Jean-Yves Gauvrit, Vincent Costalat, Michel Piotin, Charbel Mounayer, Denis Herbreteau, Sophie Gallas, René Anxionnat, Hubert Desal
BACKGROUND AND PURPOSE: After 6 positive randomized trials, mechanical thrombectomy with stent-retriever is now recommended as a first-line treatment for acute ischemic stroke (AIS). The ERIC device is a device with several interlinked cage-like spheres fixed on a pusher wire. Neurothrombectomy France (NTF) is a registry conducted in France to analyze the results of mechanical thrombectomy. In order to analyze its performances, the subgroup of patients treated with the ERIC device was analyzed...
July 11, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28702878/recent-trends-in-clot-retrieval-devices-a-review
#2
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/28691137/effective-use-of-balloon-guide-catheters-in-reducing-incidence-of-mechanical-thrombectomy-related-distal-embolization
#3
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/28673810/repeated-mechanical-thrombectomy-in-the-same-intracranial-artery-segment
#4
Herbert Tejada Meza, Maria Rosario Barrena Caballo, Santiago Guelbenzu Morte, Roberto Martínez García, Javier Marta Moreno
We report a patient with an important scenario that may arise in the management of an acute ischemic stroke: the need for a repeated mechanical thrombectomy in the same intracranial artery segment. The patient had a history of atrial fibrillation and a mechanical mitral valve replacement. In her first stroke, she had an occlusion of the proximal segment of the right middle cerebral artery; 58 days later, she presented with an occlusion in the same segment of that cerebral artery. In both instances, the thrombus was extracted by a stent retriever with good clinical and radiographic results...
June 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28646445/update-on-neurocritical-care-of-stroke
#5
Jason Siegel, Michael A Pizzi, J Brent Peel, David Alejos, Nnenne Mbabuike, Benjamin L Brown, David Hodge, W David Freeman
PURPOSE OF REVIEW: This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit. RECENT FINDINGS: New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations...
August 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28626055/ischemic-stroke-what-does-the-histological-composition-tell-us-about-the-origin-of-the-thrombus
#6
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/28611829/stent-retriever-mediated-manual-aspiration-thrombectomy-for-acute-ischemic-stroke
#7
Ashutosh P Jadhav, Amin Aghaebrahim, Anat Horev, Dan-Victor Giurgiutiu, Andrew F Ducruet, Brian Jankowitz, Tudor G Jovin
BACKGROUND AND PURPOSE: Stent retriever thrombectomy and manual aspiration thrombectomy (MAT) have each been shown to lead to high rates of recanalization as single-modality endovascular stroke therapy. We sought to describe the safety and efficacy of a multimodal approach combining these two techniques termed 'stent retriever-mediated manual aspiration thrombectomy' (SMAT) and compared them to MAT alone. METHODS: Retrospective review of a prospectively acquired acute endovascular stroke database...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28605743/incomplete-large-vessel-occlusions-in-mechanical-thrombectomy-an-independent-predictor-of-favorable-outcome-in-ischemic-stroke
#8
Volker Maus, Seunghwa You, Alev Kalkan, Jan Borggrefe, Christoph Kabbasch, Utako Birgit Barnikol, Henning Stetefeld, Christian Dohmen, Thomas Liebig, Gereon Rudolf Fink, Anastasios Mpotsaris
BACKGROUND AND PURPOSE: Cerebral large vessel occlusion (LVO) in acute ischemic stroke (AIS) may be complete (CLVO) or incomplete (ILVO). The influence of ILVO on clinical outcome after mechanical thrombectomy (MT) remains unclear. We investigated primarily the clinical outcome in patients with AIS due to ILVO or CLVO. METHODS: Five hundred three consecutive AIS patients with LVO treated with stent-retriever or direct aspiration-based MT between 2010 and 2016 were analyzed...
June 13, 2017: Cerebrovascular Diseases
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/28596196/effect-of-retrievable-stent-size-on-endovascular-treatment-of-acute-ischemic-stroke-a-multicenter-study
#10
D Yang, Y Hao, W Zi, H Wang, D Zheng, H Li, M Tu, Y Wan, P Jin, G Xiao, Y Xiong, G Xu, X Liu
BACKGROUND AND PURPOSE: In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes. MATERIALS AND METHODS: Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device...
June 8, 2017: AJNR. American Journal of Neuroradiology
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/28592218/first-line-use-of-contact-aspiration-for-thrombectomy-versus-a-stent-retriever-for-recanalization-in-acute-cerebral-infarction-the-randomized-aster-study-protocol
#12
Bertrand Lapergue, Julien Labreuche, Raphael Blanc, Xavier Barreau, Jérome Berge, Arturo Consoli, Georges Rodesch, Susanna Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Alain Duhamel, Sandrine Baffert, Mikael Mazighi, Benjamin Gory, Francis Turjman, Michel Piotin
Rationale Mechanical thrombectomy with a stent retriever is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion. New techniques for mechanical thrombectomy, such as contact aspiration, appear promising to increase reperfusion status and improve clinical outcome. Aim We aim at ascertaining whether contact aspiration is more efficient than the stent retriever as a first-line endovascular procedure. Sample size estimates With a two-sided test (alpha = 5%, power = 90%) and an anticipated rate of spontaneous recanalization and catheterization failures of 15%, we estimate that a sample size of 380 patients will be necessary to detect an absolute difference of 15% in primary outcome (superiority design)...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28589250/histopathological-and-bacteriological-analysis-of-thrombus-material-extracted-during-mechanical-thrombectomy-in-acute-stroke-patients
#13
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/28556351/thrive-score-predicts-clinical-and-radiological-outcome-after-endovascular-therapy-or-thrombolysis-in-patients-with-anterior-circulation-stroke-in-everyday-clinical-practice
#14
A Kastrup, F Brunner, H Hildebrandt, C Roth, M Winterhalter, C Gießing, P Papanagiotou
BACKGROUND AND PURPOSE: Based on the data of several trials the Totaled Health Risks in Vascular Events (THRIVE) score has been shown to predict outcome after either intravenous thrombolysis (IVT) or endovascular therapy (ET) in acute stroke patients. It is unknown whether the THRIVE score can also predict outcome in everyday clinical practice. Using our prospectively obtained stroke database the utility of the THRIVE score to predict clinical and radiological outcome in everyday clinical practice was analysed...
August 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28551292/clinical-outcomes-of-patients-with-acute-basilar-artery-occlusion-in-brazil-an-observational-study
#15
Francisco Antunes Dias, Frederico Fernandes Alessio-Alves, Luis Henrique Castro-Afonso, Pedro Telles Cougo, Clara Monteiro Antunes Barreira, Millene Rodrigues Camilo, Guilherme Seizem Nakiri, Daniel Giansante Abud, Octavio Marques Pontes-Neto
BACKGROUND: Intravenous thrombolysis (IVT) and endovascular therapy (EVT) were proven safe and effective for anterior circulation proximal occlusions. However, the most appropriate recanalization strategy in patients with acute basilar artery occlusion (BAO) is still controversial. This study aimed to assess outcomes of patients with BAO at an academic stroke center in Brazil. METHODS: This is a retrospective analysis of consecutive patients with BAO from a prospective stroke registry at Ribeirão Preto Medical School...
May 24, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28546252/acute-basilar-artery-occlusion-differences-in-characteristics-and-outcomes-after-endovascular-therapy-between-patients-with-and-without-underlying-severe-atherosclerotic-stenosis
#16
Y Y Lee, W Yoon, S K Kim, B H Baek, G S Kim, J T Kim, M S Park
BACKGROUND AND PURPOSE: Prediction of underlying intracranial atherosclerotic stenosis before endovascular therapy might be helpful for appropriate therapeutic planning in patients with acute ischemic stroke. This study aimed to compare the characteristics and treatment outcomes in patients with acute basilar artery occlusion relative to the existence or nonexistence of underlying intracranial atherosclerotic stenosis. MATERIALS AND METHODS: Sixty-two patients with acute basilar artery occlusion underwent multimodal endovascular therapy...
May 25, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28524799/-y-stent-retriever-a-new-rescue-technique-for-refractory-large-vessel-occlusions
#17
Roberto Crosa, Alejandro M Spiotta, Matías Negrotto, Alejandra Jaume, Walter Casagrande
Long-awaited positive trial data have shown the efficacy of endovascular treatment in patients with ischemic stroke who arrive at the hospital within the first 6 hours with large-vessel occlusion of the anterior circulation. With the introduction of stent retrievers (SRs) for mechanical thrombectomy, efficient and safe large-artery recanalization treatment can be achieved. However, sometimes there are patients who do not attain complete flow restoration following attempts with traditional maneuvers. The authors present the case of a 57-year-old man with acute ischemic stroke due to an M1 embolus that extended into both M2 trunks...
May 19, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28508117/single-center-experience-using-the-3max-reperfusion-catheter-for-the-treatment-of-acute-ischemic-stroke-with-distal-arterial-occlusions
#18
Kévin Premat, Bruno Bartolini, Flore Baronnet-Chauvet, Eimad Shotar, Vincent Degos, Paul Muresan, Federico Di Maria, Joseph Gabrieli, Charlotte Rosso, Silvia Pistocchi, Jacques Chiras, Nader Sourour, Sonia Alamowitch, Yves Samson, Frédéric Clarençon
PURPOSE: Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3...
May 15, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28502847/the-role-for-cardiologists-in-stroke-intervention
#19
REVIEW
Richard R Heuser
Even though cardiovascular disease (CVD) is still the leading cause of death in the United States, stroke is the second leading global cause of death behind CVD. In the 21st Century, less than 40% of overall stroke patients are discharged to home and almost 25% of Medicare beneficiaries do not survive 90 days. In spite of the fact that tissue plasminogen activator (TPA) has been approved for stroke care for 20 years, only .75% of annual strokes are actually treated with intravenous (IV) TPA. Similar to how interventional cardiologists evolved from IV to catheter mechanical treatment for acute myocardial infarctions (AMI) over 30 years ago, over the last few years, neurointerventionists now perform endovascular stroke therapy in many of these patients using stent retrievers...
May 2017: Progress in Cardiovascular Diseases
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
#20
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
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