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Suresh Giragani, Ankit Balani, Vikas Agrawal
We report the clinical details, imaging findings and management of a 45-year-old man who presented with recurrent transient ischemic attacks due to carotid free floating thrombus. Free floating thrombus of the carotid artery is a very rare condition with a high risk of distal embolic shower. The optimal treatment options are debatable and include medical management, surgical thrombectomy and endovascular thrombectomy. We describe the use of a stentriever with filter protection in the management of carotid free floating thrombus as a novel treatment option...
January 18, 2017: BMJ Case Reports
Jang-Hyun Baek, Byung Moon Kim, Dong Joon Kim, Ji Hoe Heo, Hyo Suk Nam, Dongbeom Song, Oh Young Bang
OBJECTIVE: To investigate whether angiographically defined occlusion type could predict of the etiology of acute intracranial large artery occlusion and the stentriever response. METHODS: We reviewed consecutive patients with acute intracranial large artery occlusion who underwent endovascular treatment and examined their workups for embolic sources. Patient demographics, laboratory findings, hyperdense artery sign, and angiographic occlusion type (truncal-type or branching-site occlusion) were compared between embolic sources (+) and (-) groups...
October 11, 2016: Neurology
José E Cohen, Ronen R Leker, J Moshe Gomori, Roni Eichel, Gustavo Rajz, Samuel Moscovici, Eyal Itshayek
Patients suffering from acute atherothrombotic occlusion of the proximal vertebral artery (VA) and concomitant basilar artery (BA) occlusion present a grim prognosis. We describe our experience in the endovascular recanalization of tandem vertebrobasilar occlusions using endovascular techniques. The BA was accessed through the normal VA (clean-road) or the occluded, thrombotic VA (dirty-road), and stentriever-based thrombectomy was performed using antegrade or reverse revascularization variants. Seven patients underwent successful stentriever-assisted mechanical thrombectomy of the BA and five sustained concomitant VA revascularization...
December 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Jang-Hyun Baek, Byung Moon Kim, Dong Joon Kim, Ji Hoe Heo, Hyo Suk Nam, Joonsang Yoo
BACKGROUND AND PURPOSE: We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure. METHODS: We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74...
September 2016: Stroke; a Journal of Cerebral Circulation
Thabele Leslie-Mazwi, James Rabinov, Joshua A Hirsch
Endovascular thrombectomy is an effective treatment for major acute ischemic stroke syndromes caused by major anterior circulation artery occlusions (commonly referred to as large vessel occlusion) and is superior to intravenous thrombolysis and medical management. Treatment should occur as quickly as is reasonably possible. All patients with moderate to severe symptoms (National Institutes of Health stroke scale >8) and a treatable occlusion should be considered. The use of neuroimaging is critical to exclude hemorrhage and large ischemic cores...
2016: Handbook of Clinical Neurology
Thomas L Merrill, Jennifer E Mitchell, Denise R Merrill
Recent revascularization success for ischemic stroke patients using stentrievers has created a new opportunity for therapeutic hypothermia. By using short term localized tissue cooling interventional catheters can be used to reduce reperfusion injury and improve neurological outcomes. Using experimental testing and a well-established heat exchanger design approach, the ɛ-NTU method, this paper examines the cooling performance of commercially available catheters as function of four practical parameters: (1) infusion flow rate, (2) catheter location in the body, (3) catheter configuration and design, and (4) cooling approach...
August 2016: Medical Engineering & Physics
Robert Fahed, Federico Di Maria, Charlotte Rosso, Nader Sourour, Vincent Degos, Sandrine Deltour, Flore Baronnet-Chauvet, Anne Léger, Sophie Crozier, Joseph Gabrieli, Yves Samson, Jacques Chiras, Frédéric Clarençon
OBJECTIVE Contrary to acute ischemic stroke involving the anterior circulation, no randomized trial has yet demonstrated the safety and effectiveness of endovascular management in acute basilar artery occlusion (BAO). Recently developed thrombectomy devices, such as stentrievers and aspiration systems, have helped in improving the endovascular management of acute ischemic stroke. The authors sought to assess the impact of these devices in the endovascular treatment of acute BAO. METHODS A retrospective analysis of 34 consecutive patients treated in Pitié-Salpêtrière Hospital for acute BAO was carried out...
June 3, 2016: Journal of Neurosurgery
Hélène Raoult, Hocine Redjem, Romain Bourcier, Alina Gaultier-Lintia, Benjamin Daumas-Duport, Jean-Christophe Ferré, François Eugène, Robert Fahed, Bruno Bartolini, Michel Piotin, Hubert Desal, Jean-Yves Gauvrit, Raphaël Blanc
OBJECTIVE: To report our experience with the Embolus Retriever with Interlinked Cage (ERIC) stentriever for use in mechanical endovascular thrombectomy (MET). METHODS: Thirty-four consecutive patients with acute stroke (21 men and 13 women; median age 66 years) determined appropriate for MET were treated with ERIC and prospectively included over a 6-month period at three different centers. The ERIC device differs from typical stentrievers in that it is designed with a series of interlinked adjustable nitinol cages that allow for fast thrombus capture, integration, and withdrawal...
May 17, 2016: Journal of Neurointerventional Surgery
Feras Akbik, Joshua A Hirsch, Pedro Telles Cougo-Pinto, Ronil V Chandra, Claus Z Simonsen, Thabele Leslie-Mazwi
The natural history of an acute ischemic stroke from a large vessel occlusion (LVO) is poor and has long challenged stroke therapy. Recently, endovascular therapy has demonstrated superiority to medical management in appropriately selected patients. This advance has revolutionized acute care for LVO and mandates a reevaluation of the entire chain of stroke care delivery, including patient selection, intervention, and post-procedural care. Since endovascular therapy is a therapy specifically targeting LVO, its application should be restricted to those patients only...
May 2016: Current Treatment Options in Cardiovascular Medicine
Calvin Hoi-Kwan Mak, Joanna Wing-Kiu Ho, Kwong-Yau Chan, Wai-Sang Poon, George Kwok-Chu Wong
Acute basilar artery occlusion has been managed aggressively with various modalities due to its potentially debilitating outcome. While intra-arterial mechanical thrombectomy with stentriever has established clear evidence for anterior circulation stroke with large vessel occlusion as an adjunct to intravenous thrombolysis or the sole modality in intravenous thrombolysis ineligible patients, similar high-level evidence was not available for intra-arterial mechanical thrombectomy of posterior circulation stroke with acute basilar artery occlusion...
October 2016: Neurosurgical Review
Diogo C Haussen, Leticia C Rebello, Raul G Nogueira
No abstract text is available yet for this article.
February 2016: Stroke; a Journal of Cerebral Circulation
Alfred P See, Priyank Khandelwal, Nirav J Patel
No abstract text is available yet for this article.
February 2016: Stroke; a Journal of Cerebral Circulation
R Grech, R Pullicino, J Thornton, J Downer
AIM: To assess the recanalisation rates and long-term functional outcomes of the Solitaire and Trevo devices; to compare these results to those from the Solitaire With the Intention For Thrombectomy (SWIFT) trial and TREVO 2 studies; and to assess for statistical differences in the outcomes between the two devices. MATERIALS AND METHODS: A systematic review and meta-analysis of studies that utilised stentrievers in the treatment of acute ischaemic stroke was conducted...
January 2016: Clinical Radiology
Russell Cerejo, Seby John, Andrew Bauer, Muhammad S Hussain, Mark Bain, Peter Rasmussen, Ferdinand Hui, Thomas Masaryk, Gabor Toth
BACKGROUND: Mechanical thrombectomy using stentrievers is the standard of care for emergent large vessel occlusion stroke. Data on the use of stentrievers in smaller caliber vessels are sparse. OBJECTIVE: To present our initial experience with the Mindframe Capture LP device, which was designed for mechanical thrombectomy in small cerebral arteries. METHODS: A retrospective chart review was conducted of patients who underwent Mindframe device assisted emergent thrombectomy...
November 2016: Journal of Neurointerventional Surgery
Reuben Grech, Mark Schembri, John Thornton
PURPOSE: To date only a few studies have compared the effectiveness and functional outcomes of stent retrievers versus intravenous thrombolysis in acute ischaemic stoke. Our aim was to identify and collate all the available data and to assess for statistical differences in patient outcomes between the two treatments. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of studies with a randomised controlled design which utilised stentrievers and intravenous thrombolysis in acute ischaemic stroke...
December 2015: Interventional Neuroradiology
Diogo C Haussen, Leticia C Rebello, Raul G Nogueira
BACKGROUND AND PURPOSE: We aimed to investigate the safety and efficacy of the Push and Fluff technique (PFT) as compared with the standard unsheathing technique for closed-cell stent retrievers in acute ischemic stroke. METHODS: Acute ischemic stroke thrombectomy database was analyzed (September 2010 to January 2015) with the Trevo Retriever as a primary strategy. The PFT was compared with our internal standard unsheathing technique and with the Trevo Versus Merci Retrievers for Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke 2 (TREVO2) trial...
October 2015: Stroke; a Journal of Cerebral Circulation
N C Beadell, T Bazan, Helmi Lutsep
Embolectomy with stentriever devices is the newest treatment for acute stroke. Since 1995, treatment of acute stroke has been limited to a 4.5-h window with the use of intravenous tissue plasminogen activator (tPA). Five articles have been published in 2015 with the results supporting the paired treatment of tPA and embolectomy. This has also expanded the treatment window to greater than 4.5 h and produced evidence which will guide selection of patients that will benefit most from this therapy. This article will compare and contrast this most recent evidence...
November 2015: Current Cardiology Reports
Yonca Ozkan Arat, Anil Arat, Kubilay Aydin
AIM: Knowledge of cerebrovascular morphology is integral in planning neuroendovascular interventions, especially for procedures involving placement of stents, flow diverters or stentrievers. There is insufficient data on angiographic normative values of cerebral circulation in the pediatric age group since angiograms are uncommonly performed in children except for arteriovenous malformations in which arterial dimensions are larger than normal. We aimed to measure the diameters of internal carotid circulation (ICC) arteries on digital subtraction angiograms of pediatric patients and determine the growth trends...
2015: Turkish Neurosurgery
Ethan A Benardete, Anil K Nair
BACKGROUND: The requirements for a comprehensive stroke center (CSC) include the capability to perform endovascular stroke therapy (EST). EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved...
September 2014: Cerebrovascular Diseases Extra
Pedro Telles Cougo-Pinto, Ronil V Chandra, Claus Z Simonsen, Joshua A Hirsch, Thabele Leslie-Mazwi
With the recent publication of multiple trials demonstrating the superiority of the endovascular treatment of patients presenting with stroke from large vessel occlusion (LVO) over medical management, the emergent care of these patients is entering a new era. This realization justifies an aggressive treatment approach with these stroke patients, given the poor natural history of the disease. In general, treatment should occur as quickly as is reasonably possible. Patients with NIHSS >8 should be considered, and if <6 h from onset imaging selection achieved with CT and CTA...
July 2015: Current Treatment Options in Neurology
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