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Taichiro Imahori, Kazuhiro Tanaka, Junji Koyama, Atsushi Arai, Ryoji Shiomi, Hirofumi Iwahashi, Akiyoshi Yokote, Kazushi Matsushima, Daisaku Matsui, Makoto Kobayashi, Atsushi Fujita, Kohkichi Hosoda, Eiji Kohmura
Mechanical thrombectomy using the stent retriever has been proven to be effective for select patients with acute ischemic stroke. We evaluated our early experience using the device after its approval in 2014 in Japan, with a special emphasis on the occlusion site. Fifty consecutive endovascular revascularization procedures for treating anterior acute large vessel occlusion were performed using the Trevo ProVue as the first-line device at our institute between April 2015 and March 2016. Focusing on the involvement of the M1-M2 bifurcation with deployment or retrieval of the stent retriever, we regarded the middle cerebral artery M1 mid-portion as the boundary and divided the cases into proximal (n = 26) and distal (n = 24) groups...
December 27, 2016: Neurologia Medico-chirurgica
Syed Ali Raza, Bin Xiang, Tudor G Jovin, David S Liebeskind, Ryan Shields, Raul G Nogueira, Srikant Rangaraju
BACKGROUND: Optimal patient selection is needed to maximize the therapeutic benefit of endovascular therapy for large vessel occlusion stroke. AIMS: To validate the Pittsburgh response to endovascular therapy (PRE) score in a randomized controlled trial (Trevo2) comparing stent retriever (Trevo) to the Merci device. METHODS: Trevo2 participants with internal carotid, M1 and M2 middle cerebral artery occlusions with prospectively collected baseline stroke severity (NIHSS), degree of hypodensity (CT ASPECTS), and three-month modified Rankin Scale (mRS) were included...
November 3, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Maria Celeste Buompadre, Kathleen Andres, Lee-Anne Slater, Hadi Mohseni-Bod, Anne-Marie Guerguerian, Helen Branson, Suzanne Laughlin, Derek Armstrong, Mahendranath Moharir, Gabrielle deVeber, Tilman Humpl, Osami Honjo, Shaf Keshavjee, Rebecca Ichord, Vitor Pereira, Nomazulu Dlamini
The updated American Heart Association/American Stroke Association guidelines include recommendation for thrombectomy in certain adult stroke cases. The safety and efficacy of thrombectomy in children are unknown. An 8-year-old girl experienced acute stroke symptoms on two occasions while therapeutically anticoagulated on Novalung. Computed tomography scans showed proximal vessel thrombi, which were retrieved using a Trevo device without hemorrhagic complications. Postprocedural assessment found respective decreases in the National Institutes of Health Stroke Scale score from 10 to 4 and 12 to 7...
January 2017: Pediatric Neurology
Kouichi Misaki, Naoyuki Uchiyama, Masanao Mohri, Tomoya Kamide, Taishi Tsutsui, Naomi Kanamori, Keisuke Kurokawa, Mitsutoshi Nakada
This is the first report on the mechanism of pseudoaneurysm formation after withdrawal of a stent retriever. A 79-year-old woman developed cardiogenic embolization of the distal middle cerebral artery (M2). The deployed stent retriever bent because of vessel tortuosity. After withdrawal of the stent with strong resistance, complete revascularization was achieved, but an extravasation was detected at the site. Eight hours after disappearance of the extravasation, re-bleeding occurred with aneurysm-like pooling of contrast media...
November 2016: Acta Neurochirurgica
Diederik W Dippel, Charles B Majoie, Yvo B Roos, Aad van der Lugt, Robert J van Oostenbrugge, Wim H van Zwam, Hester F Lingsma, Peter J Koudstaal, Kilian M Treurniet, Lucie A van den Berg, Debbie Beumer, Puck S Fransen, Olvert A Berkhemer
BACKGROUND AND PURPOSE: Intra-arterial treatment by means of retrievable stents has been proven safe and effective. In MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the choice of the type of thrombectomy device was left to the discretion of the interventionist. The aim of this study was to explore the differences in functional outcome, neurological recovery, reperfusion, extent of infarction, and adverse events according to stent type and make...
October 2016: Stroke; a Journal of Cerebral Circulation
Kojiro Ishikawa, Tomotaka Ohshima, Masahiro Nishihori, Tasuku Imai, Shunsaku Goto, Taiki Yamamoto, Toshihisa Nishizawa, Shinji Shimato, Kyozo Kato
The optional endovascular approach for acute ischemic stroke is unclear. The Trevo stent retriever can be used as first-line treatment for fast mechanical recanalization. The authors developed a treatment protocol for acute ischemic stroke based on the assessment of clot quality during clot removal with the Trevo. This prospective single-center study included all patients admitted for acute ischemic stroke between July 2014 and February 2015, who underwent emergency endovascular treatment. According to the protocol, the Trevo was used for first-line treatment...
August 2016: Nagoya Journal of Medical Science
Sara Protto, Juha-Pekka Pienimäki, Janne Seppänen, Ira Matkaselkä, Jyrki Ollikainen, Heikki Numminen, Niko Sillanpää
PURPOSE: Mechanical thrombectomy (MT) is a proven method to treat large vessel occlusions in acute anterior circulation stroke. We compared the technical, imaging, and clinical outcomes of MT performed with either TREVO or Capture LP devices. METHODS: There were 42 and 43 patients in the TREVO and Capture LP groups, respectively. Baseline variables, technical outcome (Thrombolysis In Cerebral Infarction, TICI), 24 hours imaging outcome, and 3-month clinical outcome (modified Rankin Scale, mRS) were prospectively recorded...
June 17, 2016: Journal of Neurointerventional Surgery
Kate A Hentschel, Badih Daou, Nohra Chalouhi, Robert M Starke, Shannon Clark, Ashish Gandhe, Pascal Jabbour, Robert Rosenwasser, Stavropoula Tjoumakaris
OBJECTIVE Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. However, limited data are available from assessment of outcomes of FDA-approved devices. The objective of this study is to compare clinical outcomes, efficacy, and safety of non-stent retriever and stent retriever thrombectomy devices. METHODS Between January 2008 and June 2014, 166 patients treated at Jefferson Hospital for Neuroscience for acute ischemic stroke with mechanical thrombectomy using Merci, Penumbra, Solitaire, or Trevo devices were retrospectively reviewed...
April 29, 2016: Journal of Neurosurgery
Joe Senda, Tomohide Nishikawa, Hiroshi Iizuka, Naoki Kato, Hiroshi Ito, Ryosuke Ohshima, Takashi Yamamoto, Takenori Kato, Toshinori Hasegawa, Takashi Izumi, Toshihiko Wakabayashi
A 41-year-old woman was admitted due to a sudden-onset severe headache, left hemiparesis and dysarthria. Diffusion-weighted magnetic resonance imaging showed an acute infarct in the bilateral pons, and magnetic resonance angiography revealed basilar artery (BA) occlusion resulting from dissection of the right vertebral artery (VA). She was treated with intravenous recombinant tissue plasminogen activator (rt-PA) 110 minutes after symptom onset. Subsequently, brain angiography was performed along with mechanical thrombolysis using Trevo ProVue retriever devices...
2016: Internal Medicine
Omid Nikoubashman, Jan Patrick Alt, Arash Nikoubashman, Martin Büsen, Sarah Heringer, Carolin Brockmann, Marc-Alexander Brockmann, Marguerite Müller, Arno Reich, Martin Wiesmann
BACKGROUND: Flow control during endovascular stroke treatment with stent-retrievers is crucial for successful revascularization. The standard technique recommended by stent-retriever manufacturers implies obstruction of the respective access catheter by the microcatheter, through which the stent-retriever is delivered. This, in turn, results in reduced aspiration during thrombectomy. In order to maximize aspiration, we fully retract the microcatheter out of the access catheter before thrombectomy-an approach we term the 'bare wire thrombectomy' (BWT) technique...
April 15, 2016: Journal of Neurointerventional Surgery
Hesham Masoud, Thanh N Nguyen, Coleman O Martin, William E Holloway, Sudheer Ambekar, Dileep R Yavagal, Diogo C Haussen, Raul Nogueira, Diego J Lozano, Ajit Puri, Ayman Quateen, Daniela Iancu, Michael G Abraham, Michael Chen, Sonal Mehta, Tim Malisch, Franklin Marden, Robin Novakovic, Daniel Roy, Alain Weill, Alexander M Norbash
Mechanical thrombectomy using retrievable stents or stent retriever devices has become the mainstay of intra-arterial therapy for acute ischemic stroke. The recent publication of a series of positive trials supporting intra-arterial therapy as standard of care for the treatment of large vessel occlusion will likely further increase stent retriever use. Rarely, premature stent detachment during thrombectomy may be encountered. In our multicenter case series, we found a rate of detachment of less than 1% (n = 7/1,067), and all were first-generation Solitaire FR devices...
March 2016: Interventional Neurology
Martin Wiesmann, Marc-Alexander Brockmann, Sarah Heringer, Marguerite Müller, Arno Reich, Omid Nikoubashman
BACKGROUND: The optimal interaction between stent struts and thrombus is crucial for successful revascularization in endovascular stroke therapy with stent retrievers. Deploying the stent retriever by actively pushing it into the thrombus increases the radial force with which the stent struts expand into the thrombus. OBJECTIVE: To examine the active push deployment (APD) technique in an in vitro model and present our clinical experience with this technique. METHODS: In an in vitro experiment we investigated the configuration of a Solitaire and a Trevo ProVue device (both 4×20 mm), depending on whether the devices were deployed using the APD technique or simple unsheathing...
March 14, 2016: Journal of Neurointerventional Surgery
Seul Kee Kim, Byung Hyun Baek, Tae Wook Heo, Woong Yoon
Acute ischemic stroke due to embolic occlusion of the middle cerebral artery (MCA) in patients with chronic ipsilateral internal carotid artery (ICA) occlusion is quite rare. Several previous reports demonstrated that intra-arterial (IA) thrombolytic therapy or aspiration thrombectomy using the cross-circulation technique via an alternative collateral pathway is feasible in acute stroke patients with an unfavorable direct route to the occluded sites. However, stent-retriever embolectomy via the cross-circulation approach has not been reported in the literature...
March 2016: Neurointervention
Kajo van der Marel, Ju-Yu Chueh, Olivia W Brooks, Robert M King, Miklos G Marosfoi, Erin T Langan, Sarena L Carniato, Matthew J Gounis, Raul G Nogueira, Ajit S Puri
PURPOSE: Rapid revascularization in emergent large vessel occlusion with endovascular embolectomy has proven clinical benefit. We sought to measure device-clot interaction as a potential mechanism for efficient embolectomy. METHODS: Two different radiopaque clot models were injected to create a middle cerebral artery occlusion in a patient-specific vascular phantom. A radiopaque stent retriever was deployed within the clot by unsheathing the device or a combination of unsheathing followed by pushing the device (n=8/group)...
February 1, 2016: Journal of Neurointerventional Surgery
Lahoud Touma, Kristian B Filion, Lee H Sterling, Renée Atallah, Sarah B Windle, Mark J Eisenberg
IMPORTANCE: Stent retrievers are a promising alternative for the treatment of acute ischemic stroke (AIS). Several recently completed clinical trials have examined the use of stent retrievers with intravenous recombinant tissue plasminogen activator (rtPA) compared with rtPA alone. OBJECTIVE: To conduct a systematic review and meta-analysis of randomized clinical trials to quantify the benefits and risks of using stent retrievers in addition to rtPA for the treatment of AIS...
March 2016: JAMA Neurology
Bryan M Bishop
OBJECTIVE: To review recent endovascular intervention trials for acute ischemic stroke. DATA SOURCES: Recent, randomized controlled trials of endovascular interventions for acute ischemic stroke were identified. The search terms "endovascular" AND "stroke" were used and filter for "randomized controlled trial" was applied; the period searched was January 1, 2013, to October 31, 2015. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled trials of endovascular interventions in acute ischemic stroke published within the past 3 years (2013-2015)...
March 2016: Annals of Pharmacotherapy
J Höltje, F Bonk, A Anstadt, C Terborg, C Pohlmann, P P Urban, R Brüning
Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA) or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization...
2015: Radiology Research and Practice
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
Daisuke Arai, Akira Ishii, Hideo Chihara, Hiroyuki Ikeda, Susumu Miyamoto
BACKGROUND AND OBJECTIVES: Although the recently marketed stent retriever thrombectomy devices have demonstrated a high recanalization rate and favorable clinical outcomes, there is a concern about the risks of intimal injuries when pulling out the stent in the unfolded position. In this study, the Solitaire Flow Restoration System and the Trevo retriever were used in a histopathological comparison of vascular injuries caused by stent retriever thrombectomy devices. METHODS: Rabbit carotid arteries were used in the experiments with stent retriever thrombectomy devices...
October 2016: Journal of Neurointerventional Surgery
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
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