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Mechanical thrombectomy

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https://www.readbyqxmd.com/read/29166463/physicians-are-not-well-informed-about-the-new-guidelines-for-the-treatment-of-acute-stroke
#1
Luana Antunes Maranha Gatto, Gelson Luis Koppe, Zeferino Demartini, Viviane de Hiroki Flumignan Zétola
OBJECTIVE: Treatment of cerebrovascular disease has advanced rapidly in the last two decades. Recent data has added challenges to the treatment of ischemic stroke in the acute phase. OBJECTIVE: To evaluate the knowledge of physicians about the treatment of ischemic stroke in the acute phase. METHODS: An online questionnaire was submitted to all physicians enrolled in the Regional Council of Medicine in Brazil. RESULTS: 456 physicians from different specialties answered the questions...
October 2017: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/29162028/endovascular-renal-artery-stent-retriever-embolectomy-in-a-young-patient-with-cardiac-myxoma-case-report-and-review-of-the-literature
#2
Michael A Silva, Alfred P See, Samir K Shah, Priyank Khandelwal, Nirav J Patel, Heather Lyu, Matthew T Menard, Mohammad Ali Aziz-Sultan
PURPOSE: Cardiac myxomas are common tumors of the heart with disproportionate impact on young patients, occasionally with dramatic systemic dissemination of tumor emboli with catastrophic multiorgan system ischemia. The coincident comorbidities can increase the risk of traditional treatments for tumor embolus in each region. CASE REPORT: A young patient with previously unknown cardiac myxoma presented with seizure and was found to have stress cardiomyopathy, multiple cerebral large vessel occlusions with acute ischemic stroke, bilateral lower extremity tumor emboli and rhabdomyolysis, and renal tumor embolus with acute tubular necrosis...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29159155/how-to-escape-stentriever-wedging-in-an-open-cell-carotid-stent-during-mechanical-thrombectomy-for-tandem-cervical-internal-carotid-artery-and-middle-cerebral-artery-occlusion
#3
Hae Won Rho, Won Ki Yoon, Jang Hun Kim, Jong Hyun Kim, Taek Hyun Kwon
We present 2 cases of complicated mechanical thrombectomy involving tandem cervical internal carotid artery and middle cerebral artery occlusion using the Solitaire FR stent and simultaneous carotid stent angioplasty. During the procedures, the Solitaire stents containing the thrombus were wedged into the open-cell carotid stents, which were already deployed for proximal flow restoration. We describe the methods used to avoid and overcome such complications.
September 2017: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/29157527/catheter-directed-therapy-for-pulmonary-embolism-patient-selection-and-technical-considerations
#4
REVIEW
Bedros Taslakian, Akhilesh K Sista
Acute pulmonary embolism (PE) is the third most common cause of death among hospitalized patients. Treatment escalation beyond anticoagulation therapy is necessary in patients with cardiogenic shock and may be of benefit in select normotensive patients with right heart strain. Percutaneous catheter-based techniques (catheter-directed mechanical thrombectomy, clot maceration, and/or pharmacologic thrombolysis) as an alternative or adjunct to systemic thrombolysis can rapidly debulk central clot in patients with shock...
January 2018: Interventional cardiology clinics
https://www.readbyqxmd.com/read/29153304/thrombectomy-using-clamping-embolus-with-semi-retrieval-technique-in-acute-ischemic-stroke
#5
Zhen-Sheng Liu, Long-Jiang Zhou, Yong Sun, Xiong-Wei Kuang, Jia-Xiang Wang, Xin-Jiang Zhang
BACKGROUND: Embolization of thrombus fragments in new or downstream vascular territories is a potential adverse event in neurothrombectomy, requiring additional repeated thrombectomy attempts. This study aims to describe technical results of the thrombectomy with clamping embolus technique (TCET) method in acute ischemic stroke. This study also aims to evaluate the efficiency of mechanical thrombectomy by TCET, and to compare it with conventional stent retriever thrombectomy (CSRT). MATERIALS AND METHODS: A retrospective analysis was performed in 52 consecutive patients treated between January 2015 and October 2016 for intracranial large vessel occlusion by stent retriever thrombectomy...
November 16, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29152468/dual-mechanical-thrombectomy-for-recanalization-of-a-resistant-acute-posterior-circulation-stroke
#6
Ahmet Peker, Ayça Akgoz, Ethem Murat Arsava, Mehmet Akif Topçuoglu, Anil Arat
A 71-year-old man with acute basilar artery occlusion was referred for endovascular treatment 6 hours after the onset of stroke with a Glasgow Coma Score of 3 and National Institutes of Health Stroke Scale of 27. A cerebral arteriogram revealed occlusion of the left vertebral artery proximally and thromboembolic occlusion of the basilar tip. Direct aspiration and mechanical thrombectomy with various stent retrievers failed to reconstitute arterial flow in the basilar artery. Thrombolysis in cerebral infarction 2b recanalization was achieved only after placement of double Catch Mini stent retrievers through 2 microcatheters, on both side branches of the basilar bifurcation in a kissing fashion and retrieving them simultaneously...
June 2017: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/29149357/recommendations-for-mechanical-thrombectomy-in-patients-with-acute-ischemic-stroke-a%C3%A2-clinical-guide-by-the-hellenic-stroke-organization
#7
REVIEW
Panagiotis Papanagiotou, George Ntaios, Vasileios Papavasileiou, Klearchos Psychogios, Marios Psychogios, Anastasios Mpotsaris, Timolaos Rizos, Konstantinos Spengos, Miltiadis Gravanis, Sofia Vassilopoulou, Christos Gkogkas, Petros Zampakis, Panagiotis Zis, Apostolos Karantanas, Michail Karygiannis, Georgios Karydas, Eleni Korompoki, Konstantinos Makaritsis, Konstantinos Marmagkiolis, Haralambos Milionis, Dimos Mitsikostas, Dimitrios Nikas, Androniki Plomaritoglou, Maria Politi, Nikolaos Ptochis, Christos Savopoulos, Konstantinos Takis, Nikolaos Tsamopoulos, Dimitrios Tsetis, Adam Hatzidakis, Achilleas Chatziioannou, Apostolos Hatzitolios, Konstantinos Vemmos
This document presents the consensus recommendations of the Hellenic Stroke Organization which can be of assistance to the treating stroke physicians.
November 17, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29148900/combined-interventional-and-surgical-treatment-of-tandem-middle-cerebral-artery-embolus-and-internal-carotid-artery-occlusion-case-report
#8
Mark B Frenkel, Jaclyn J Renfrow, Jasmeet Singh, Nitin Garg, Stacey Q Wolfe
Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thrombectomy was performed through percutaneous cervical ICA access due to the inability to cross the cervical carotid occlusion. Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasminogen activator (tPA) infusion...
November 17, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29146830/mechanical-thrombectomy-performs-similarly-in-real-world-practice-a-2016-nationwide-study-from-the-czech-republic
#9
Ondrej Volny, Antonin Krajina, Silvie Belaskova, Michal Bar, Petra Cimflova, Roman Herzig, Daniel Sanak, Ales Tomek, Martin Köcher, Miloslav Rocek, Radek Padr, Filip Cihlar, Miroslava Nevsimalova, Lubomir Jurak, Roman Havlicek, Martin Kovar, Petr Sevcik, Vladimir Rohan, Jan Fiksa, Bijoy K Menon, Robert Mikulik
BACKGROUND: Randomized clinical trials have proven mechanical thrombectomy (MT) to be a highly effective and safe treatment in acute stroke. The purpose of this study was to compare neurothrombectomy data from the Czech Republic (CR) with data from the HERMES meta-analysis. METHODS: Available nationwide data for the CR from 2016 from the Safe Implementation of Treatments in Stroke-Thrombectomy (SITS-TBY) registry for patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusions were compared with data from HERMES...
November 16, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29146829/is-bridging-therapy-still-required-in-stroke-due-to-carotid-artery-terminus-occlusions
#10
Romain Bourcier, Pierre-Louis Alexandre, François Eugène, Béatrice Delasalle-Guyomarch, Benoit Guillon, Basile Kerleroux, Suzana Saleme, Gaultier Marnat, Samy Boucebci, Mahmood Mirza, Jean-Christophe Ferré, Chrysanthi Papagiannaki, Hubert Desal
INTRODUCTION: Studies comparing endovascular stroke treatment using mechanical thrombectomy (MT) with or without prior IV tissue plasminogen activator (tPa) have included only 30% of internal carotid artery terminus occlusions (ICA-O), a known predictor of recanalization failure with IV tPa. OBJECTIVE: To carry out a retrospective multicenter analysis of prospectively collected data of consecutive patients to investigate the impact of intravenous thrombolysis on ICA-O by comparing patients treated with MT alone or bridging therapy (BT)...
November 16, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29145742/improving-mechanical-thrombectomy-time-metrics-in-the-angiography-suite-stroke-cart-parallel-workflows-and-conscious-sedation
#11
Fabio Settecase, David B McCoy, Robert Darflinger, Matthew D Alexander, Daniel L Cooke, Christopher F Dowd, Steven W Hetts, Randall T Higashida, Van V Halbach, Matthew R Amans
Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical thrombectomy time metrics. Methods We identified 47 consecutive LVO patients who underwent mechanical thrombectomy at our center, retrospectively and prospectively from implementation of these three workflow changes (19 pre- and 28 post-)...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29144166/imaging-assessment-of-acute-ischaemic-stroke-a-review-of-radiological-methods
#12
Aubrey Smith, Chris Rowland Hill
Acute ischaemic stroke is the second largest cause of death worldwide and a cause of major physical and psychological morbidity. Current evidence based treatment includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both requiring careful patient selection and to be administered as quickly as possible within a limited time window from symptom onset. Imaging plays a crucial role identifying patients who may benefit from MT or IVT whilst excluding those that maybe harmed. For IVT, imaging must as a minimum exclude haemorrhage, stroke mimics and provide an estimate of non-viable brain...
November 16, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29142624/significances-and-outcomes-of-mechanical-thrombectomy-for-acute-infarction-in-very-elderly-patients-a-single-center-experience
#13
Dong Hun Kim, Sang Uk Kim, Jae Hoon Sung, Dong Hoon Lee, Ho Jun Yi, Sang Won Lee
Objective: Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ≥80 years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods: Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy...
November 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29142622/effectiveness-and-safety-of-mechanical-thrombectomy-with-stent-retrievers-in-basilar-artery-occlusion-comparison-with-anterior-circulation-occlusions
#14
Soo Young Hu, Ho Jun Yi, Dong Hoon Lee, Jae Taek Hong, Jae Hoon Sung, Sang Won Lee
Objective: Acute basilar artery occlusion (BAO) is associated with severe neurological dysfunction and high mortality rates. The benefits of mechanical thrombectomy in BAO have not been explored in recent clinical trials. Therefore, we analyzed outcomes of stent retriever mechanical thrombectomy for BAO, and compared with anterior circulation occlusions (ACO). Methods: In total, 161 consecutive patients (24 BAO, 137 ACO) who underwent mechanical thrombectomy with the stent retriever between January 2013 and August 2016 enrolled in our study...
November 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29142621/mechanical-thrombectomy-with-solitaire-stent-retrieval-for-acute-cardioembolic-stroke
#15
Hokyun Han, Hyunho Choi, Keun-Tae Cho, Byong-Cheol Kim
Objective: Few studies have reported the outcome of mechanical thrombectomy with Solitaire stent retrival (MTSR) in subtypes of acute ischemic stroke. The purpose of this study was to evaluate the efficacy and result of MTSR in acute cardioembolic stroke. Methods: Twenty consecutive patients with acute cardioembolic stroke were treated by MTSR. The angiographic outcome was assessed by thrombolysis in cerebral infarction (TICI) grade. TICI grade 2a, 2b, or 3 with a measurable thrombus that was retrieved was considered as a success when MTSR was performed in the site of primary vessel occlusion, and TICI grade 2b or 3 was considered as a success when final result was reported...
November 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29137863/results-and-functional-outcomes-of-acute-ischemic-stroke-patients-who-underwent-mechanical-thrombectomy-admitted-to-intensive-care-unit
#16
L Viña Soria, L Martín Iglesias, L López Amor, I Astola Hidalgo, R Rodríguez García, L Forcelledo Espina, J A Gonzalo Guerra, S de Cima Iglesias, E Murias Quintana, P Vega Valdés, S Calleja Puerta, D Escudero Augusto
PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None...
November 11, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/29136121/mechanical-thrombectomy-for-acute-ischemic-stroke-secondary-to-infective-endocarditis
#17
Juan Ambrosioni, Xabier Urra, Marta Hernández-Meneses, Manel Almela, Carlos Falces, Adrian Tellez, Eduard Quintana, David Fuster, Elena Sandoval, Barbara Vidal, Jose M Tolosana, Asunción Moreno, Angel Chamorro, José M Miró
Intravenous thrombolysis is contraindicated in acute ischemic stroke secondary to infective endocarditis. We report our initial experience of six cases with proximal vessel occlusion treated with mechanical thrombectomy. It was safe (no bleeding) and effective (significant, early neurological improvement) and might therefore be useful in this clinical setting.
November 9, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29132938/endovascular-management-of-extracranial-occlusions-at-the-hyperacute-phase-of-stroke-with-tandem-occlusions
#18
M-A Labeyrie, V Civelli, P Reiner, E Cognat, A Aymard, A Bisdorff, J-P Saint-Maurice, E Houdart
BACKGROUND AND PURPOSE: The management of cervical artery occlusions in hyperacute stroke with tandem cervical/intracranial occlusions has not yet become standardized, especially when the circle of Willis is effective. METHODS: We retrospectively analyzed the safety and accuracy of current approaches to manage the cervical occlusion in consecutive patients with tandem occlusions addressed for intracranial mechanical thrombectomy (MT) in our department from January 2012 to May 2017...
November 11, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/29127270/low-dose-tirofiban-improves-functional-outcome-in-acute-ischemic-stroke-patients-treated-with-endovascular-thrombectomy
#19
Wenbo Zhao, Ruiwen Che, Shuyi Shang, Chuanjie Wu, Chuanhui Li, Longfei Wu, Jian Chen, Jiangang Duan, Haiqing Song, Hongqi Zhang, Feng Ling, Yuping Wang, David Liebeskind, Wuwei Feng, Xunming Ji
BACKGROUND AND PURPOSE: Chinese patients largely experience acute ischemic stroke (AIS) because of large artery atherosclerosis rather than cardioembolism, and whether tirofiban is safe and effective in these patients treated with endovascular thrombectomy (ET) is unknown. This study evaluated the safety and efficacy of tirofiban in Chinese patients with AIS treated with ET. METHODS: This observational study is based on a single-center prospective registry study...
November 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29127196/mechanical-thrombectomy-for-acute-ischemic-stroke-with-occlusion-of-the-m2-segment-of-the-middle-cerebral-artery-a-meta-analysis
#20
Hamidreza Saber, Sandra Narayanan, Mohan Palla, Jeffrey L Saver, Raul G Nogueira, Albert J Yoo, Sunil A Sheth
BACKGROUND: Endovascular thrombectomy has demonstrated benefit for patients with acute ischemic stroke from proximal large vessel occlusion. However, limited evidence is available from recent randomized trials on the role of thrombectomy for M2 segment occlusions of the middle cerebral artery (MCA). METHODS: We conducted a systematic review and meta-analysis to investigate clinical and radiographic outcomes, rates of hemorrhagic complications, and mortality after M2 occlusion thrombectomy using modern devices, and compared these outcomes against patients with M1 occlusions...
November 10, 2017: Journal of Neurointerventional Surgery
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