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Zsolt Kulcsar, Emmanuel Carrera, Patrik Michel
The benefit of endovascular treatment (ET) after acute ischemic stroke has long been debated. Recent studies have demonstrated the clinical benefit of ET up to approximately 8 hours after stroke onset, mainly in association with intranenous thrombolysis. The positive effect is higher if ET is initiated early and performed by an experienced team. Current ET techniques include thrombectomy with clot removal using stentretriever technques or local thromboaspiration of the clot. ET seems to be so efficient that stroke care networks have to be organised to offer ET as quickly as possible in all patients who could benefit from this therapy...
April 26, 2017: Revue Médicale Suisse
Daniel Behme, Michael Knauth, Marios-Nikos Psychogios
After endovascular treatment became the standard of care procedure for acute ischaemic stroke with large artery occlusion in 2015 the number of performed interventions has increased dramatically. Especially because age is no exclusion criterion for endovascular treatment, a relevant number of patients with difficult to access carotid arteries has to be treated. In these patients a direct puncture of the carotid is a valuable tool but is associated with severe complications and an initial learning curve. We therefore developed the so called retriever first embolectomy (ReFirE) technique in which a stentretriever is deployed over a 5F diagnostic catheter and a microcatheter to establish a stable anchor prior to accessing the internal carotid artery/intracranial vasculature with an 8F guide catheter and a 5F/6F intermediate catheter...
August 2017: Interventional Neuroradiology
Franziska Dorn, Hannah Lockau, Henning Stetefeld, Christoph Kabbasch, Bastian Kraus, Christian Dohmen, Tobias Henning, Anastasios Mpotsaris, Thomas Liebig
BACKGROUND: There is growing evidence for the efficacy of mechanical thrombectomy in acute stroke patients with large-vessel occlusions in the anterior circulation. Although distal occlusions of the middle cerebral artery (MCA) can cause severe clinical symptoms, endovascular therapy is not considered here as the first choice. The aim of our study was to prove the efficacy and safety of mechanical thrombectomy for distal occlusion types in the anterior circulation (M2-segment). METHODS: Stentretriever-based thrombectomy was performed in 119 patients with acute MCA occlusions between October 2011 and April 2013: 104 (87...
July 2015: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Umut Yilmaz, Ruben Mühl-Benninghaus, Andreas Simgen, Wolfgang Reith, Heiko Körner
BACKGROUND AND PURPOSE: New techniques have substantially raised recanalization rates of mechanical thrombectomy in acute ischemic stroke in the last few years with initial prospective trials reporting good neurological outcome in up to 58 % of the cases. However some recent reports questioning the benefit of endovascular therapy have initiated a discussion about the importance of patient-selection. The purpose of this study was to investigate whether an elongation of the carotid artery affects the angiographic outcome of the recanalization procedure in middle cerebral artery (MCA)-occlusions...
June 2016: Clinical Neuroradiology
Daniela Frahm, Silke Wunderlich, Mirjam I Schubert, Holger Poppert, Justus F Kleine, Sascha Prothmann
BACKGROUND AND PURPOSE: Acute occlusion of the carotid-T is associated with large ischemic lesions, poor outcome and up to 53 % mortality with conservative therapy. Endovascular mechanical thrombectomy (EMT) is a promising alternative treatment of large vessel occlusion. Here, we examine feasibility, safety and efficiency of EMT in acute ischemic stroke due to carotid-T-occlusion. METHODS: Single centre, retrospective analysis of 51 consecutive patients with acute occlusion of the carotid-T, treated by EMT within 6 h after symptom onset...
March 2016: Clinical Neuroradiology
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