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Mechanical thrombectomy

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https://www.readbyqxmd.com/read/29331206/mechanical-thrombectomy-determining-the-proportion-of-eligible-acute-ischemic-stroke-patients-in-the-cohort-of-single-academic-stroke-center
#1
Marcin Wiącek, Rafał Kaczorowski, Bartosz Sieczkowski, Natalia Kanas, Halina Bartosik-Psujek
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is now well-established treatment method for selected patients with acute ischemic stroke (AIS) and efforts are being made to incorporate it into the systems of stroke care. Our objective is to assess the number of AIS individuals eligible for MT in the cohort of single academic stroke center. METHODS: We retrospectively reviewed initial non-invasive vascular imaging data of AIS patients presenting within 5h of symptom onset for the presence of large vessel occlusion (LVO) over 2-year period (2015-2016)...
December 26, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/29329730/mechanical-thrombectomy-in-acute-ischaemic-stroke-a-review-of-the-different-techniques
#2
REVIEW
V Leung, A Sastry, S Srivastava, D Wilcock, A Parrott, S Nayak
Endovascular mechanical thrombectomy (MT) is reserved for acute ischaemic stroke secondary to large vessel occlusion. The various MT techniques employed in the treatment of hyperacute strokes are constantly evolving with new devices and improvisation of existing technology (Wahlgren, et al 2016). In this review, we describe a variety of MT techniques gained from our experience of performing over 350 procedures in 7 years of providing a 24/7 service within the national framework of a hyperacute stroke centre...
January 9, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29327997/mechanical-thrombectomy-in-basilar-artery-occlusion-influence-of-reperfusion-on-clinical-outcome-and-impact-of-the-first-line-strategy-adapt-vs-stent-retriever
#3
Benjamin Gory, Mikael Mazighi, Raphael Blanc, Julien Labreuche, Michel Piotin, Francis Turjman, Bertrand Lapergue
OBJECTIVE Several randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with stent retriever devices...
January 12, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29326379/blood-pressure-levels-post-mechanical-thrombectomy-and-outcomes-in-non-recanalized-large-vessel-occlusion-patients
#4
Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Kira Dillard, Diana Alsbrook, Jason J Chang, Balaji Krishnaiah, Christopher Nickele, Daniel Hoit, Khalid Alsherbini, Andrei V Alexandrov, Adam S Arthur, Lucas Elijovich
OBJECTIVE: Permissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO. METHODS: Hourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24 hours following MT in consecutive nrLVO patients...
January 11, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29322481/influence-of-thrombolysis-on-the-safety-and-efficacy-of-blocking-platelet-adhesion-or-secretory-activity-in-acute-ischemic-stroke-in-mice
#5
Michael K Schuhmann, Peter Kraft, Michael Bieber, Axel Haarmann, György A Homola, Mirko Pham, Bernhard Nieswandt, Guido Stoll
In acute ischemic stroke (AIS), there is an alarming discrepancy between recanalization rates of up to 70% by combined recombinant tissue-type plasminogen activator (rt-PA) therapy and mechanical thrombectomy, and no clinical benefit in at least every second stroke patient. This is partly due to ischemia/reperfusion (I/R) injury. In a translational approach, we used mice lacking dense- (Unc13d -/- ) or α-granules (Nbeal2 -/- ) and mice after blocking of platelet glycoprotein receptor (GP) Ib conferring protection from I/R injury...
January 10, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29322232/mechanical-thrombectomy-using-the-new-solitaire%C3%A2-platinum-stent-retriever-reperfusion-results-complication-rates-and-early-neurological-outcome
#6
Johannes Pfaff, Stefan Rohde, Tobias Engelhorn, Arnd Doerfler, Martin Bendszus, Markus Alfred Möhlenbruch
BACKGROUND AND PURPOSE: The application of radiopaque markers to the Solitaire™ stent-retriever for better visibility during mechanical thrombectomy (MT) has the potential to alter the well-known characteristics of the device; however, it is uncertain whether this adjustment influences efficacy or safety of the enhanced stent-retriever. METHODS: Retrospective analysis of stroke databases of three comprehensive stroke centers. Our investigation was focused on technical and angiographic parameters, including procedure times, reperfusion results (thrombolysis in cerebral infarction, TICI), periprocedural complications and favorable early neurological recovery at discharge (modified Rankin scale ≤2 or National Institutes of Health Stroke Scale, NIHSS = 0 or ∆NIHSS ≥ 10), from consecutive patients with acute anterior circulation ischemic stroke treated with a Solitaire™ Platinum stent-retriever between October 2016 and March 2017...
January 10, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29319407/malpractice-litigation-in-acute-stroke-care-where-are-we-now
#7
Gilberto Kk Leung, Gerard Porter
Acute stroke care has undergone momentous changes in recent years with the introduction of intravenous thrombolysis, mechanical thrombectomy and integrated stroke services. While these are welcome developments, they also carry unique medico-legal challenges. In 2015, a patient from Greater Manchester was awarded over £1 million in compensation after ambulance paramedics failed to admit her to a specialist unit. This paper explores the medico-legal implications of this first but over looked thrombolysis-related claim in the United Kingdom...
January 1, 2018: Medico-legal Journal
https://www.readbyqxmd.com/read/29318351/correction-to-mechanical-thrombectomy-in-basilar-artery-occlusion-presence-of-bilateral-posterior-communicating-arteries-is-a-predictor-of-favorable-clinical-outcome
#8
Volker Maus, Alev Kalkan, Christoph Kabbasch, Nuran Abdullayev, Henning Stetefeld, Utako Birgit Barnikol, Thomas Liebig, Christian Dohmen, Gereon Rudolf Fink, Jan Borggrefe, Anastasios Mpotsaris
Correction to: Clin Neuroradiol 2017 https://doi.org/10.1007/s00062-017-0651-3 The original version of this article unfortunately contained a mistake. The presentation of Fig. 2 was incorrect. The corrected figure is given ….
January 9, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29314208/pretreatment-lesional-volume-impacts-clinical-outcome-and-thrombectomy-efficacy
#9
Yu Xie, Catherine Oppenheim, Francis Guillemin, Vincent Gautheron, Benjamin Gory, Hélène Raoult, Sébastien Soize, Jacques Felblinger, Gabriela Hossu, Serge Bracard
OBJECTIVE: We aimed to characterize the association between pretreatment lesional volume measured on diffusion-weighted images and functional outcome, and estimate the impact on thrombectomy efficacy for ischemic stroke with anterior proximal intracranial arterial occlusion. METHODS: Anterior circulation ischemic stroke patients who had pretreatment diffusion-weighted imaging in the THRACE study were included. Lesional volume was semi-automatically segmented. Logistic regression was applied to model clinical outcome as a function of lesional volume...
January 3, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29313944/regulatory-b-cells-in-experimental-stroke
#10
REVIEW
Hilary A Seifert, Arthur A Vandenbark, Halina Offner
Current treatment options for human stroke are limited mainly to the modestly effective infusion of tissue plasminogen activator (tPA), with additional improvement of functional independence and higher rates of angiographic revascularization observed after mechanical thrombectomy. However, new therapeutic strategies that address post-stroke immune-mediated inflammatory responses are urgently needed. Recent studies in experimental stroke have firmly implicated immune mechanisms in the propagation and partial resolution of CNS damage after the ischemic event...
January 3, 2018: Immunology
https://www.readbyqxmd.com/read/29313057/regional-differences-in-thrombectomy-rates-secondary-use-of-billing-codes-in-the-miracum-medical-informatics-for-research-and-care-in-university-medicine-consortium
#11
Christian Haverkamp, Thomas Ganslandt, Petar Horki, Martin Boeker, Arnd Dörfler, Stefan Schwab, Joachim Berkefeld, Waltraud Pfeilschifter, Wolf-Dirk Niesen, Karl Egger, Manfred Kaps, Marc A Brockmann, Eva Neumaier-Probst, Kristina Szabo, Martin Skalej, Siegfried Bien, Christoph Best, Hans-Ulrich Prokosch, Horst Urbach
BACKGROUND AND PURPOSE: Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine. METHODS: Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines...
January 8, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29311120/transradial-cerebral-angiography-techniques-and-outcomes
#12
Brian M Snelling, Samir Sur, Sumedh S Shah, Priyank Khandelwal, Justin Caplan, Rianna Haniff, Robert M Starke, Dileep R Yavagal, Eric C Peterson
BACKGROUND: Despite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for cerebral angiography, this transition for neurointerventional procedures has been gradual. Nonetheless, based on our positive initial institutional experience with TRA for mechanical thrombectomy in acute ischemic stroke patients, we have started transitioning more of our cerebral angiography cases to TRA. Here we present our single institution experience...
January 8, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29299753/factors-associated-with-the-outcome-of-very-elderly-patients-with-large-hemispheric-infarction-treated-with-medical-management-only
#13
Sudhir Datar, Christopher McLouth, Patrick Reynolds
BACKGROUND: Large ischemic stroke in the very elderly population is presumed to invariably carry a poor prognosis and clinicians may refrain from continuing intensive care. Many elderly patients are not surgical candidates, and there is a paucity of data outlining the real-world outcomes of continued medical management. Our objective is to identify the factors associated with the outcome of very elderly patients with large hemispheric infarction (LHI) treated with medical management alone...
January 3, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29298651/is-atherothromboaspiration-a-possible-solution-for-the-prevention-of-no-reflow-phenomenon-in-acute-coronary-syndromes-single-centre-experience-and-review-of-the-literature
#14
Antonis S Manolis
BACKGROUND: Intracoronary thrombus in acute myocardial infarction (MI) confers higher rates of no-reflow with attendant adverse consequences. Earlier randomized-controlled-trials (RCTs) of routine thromboaspiration during percutaneous coronary intervention (PCI) indicated a clinical benefit, but more recent RCTs were negative. However, data of selective use of this adjunctive approach remain scarce. OBJECTIVE: The aim of this single-centre prospective study was to report the results of selective thromboaspiration during PCI in patients with intracoronary thrombi, and also to provide an extensive literature review on current status of thromboaspiration...
January 1, 2018: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29296999/safety-and-efficacy-of-a-3-dimensional-stent-retriever-with-aspiration-based-thrombectomy-vs-aspiration-based-thrombectomy-alone-in-acute-ischemic-stroke-intervention-a-randomized-clinical-trial
#15
Raul G Nogueira, Donald Frei, Jawad F Kirmani, Osama Zaidat, Demetrius Lopes, Aquilla S Turk, Donald Heck, Brian Mason, Diogo C Haussen, Elad I Levy, Siddhart Mehta, Marc Lazzaro, Michael Chen, Arnd Dörfler, Albert J Yoo, Colin P Derdeyn, Lee Schwamm, David Langer, Adnan Siddiqui
Importance: The treatment effects of individual mechanical thrombectomy devices in large-vessel acute ischemic stroke (AIS) remain unclear. Objective: To determine whether the novel 3-dimensional (3-D) stent retriever used in conjunction with an aspiration-based mechanical thrombectomy device (Penumbra System; Penumbra) is noninferior to aspiration-based thrombectomy alone in AIS. Design, Setting, and Participants: This randomized, noninferiority clinical trial enrolled patients at 25 North American centers from May 19, 2012, through November 19, 2015, with follow-up for 90 days...
January 2, 2018: JAMA Neurology
https://www.readbyqxmd.com/read/29288212/cerebral-arterial-gas-embolism-from-attempted-mechanical-thrombectomy-recovery-following-hyperbaric-oxygen-therapy
#16
Louise Segan, Fiona Permezel, Wei Ch'ng, Ian Millar, Mark Brooks, Matt Lee-Archer, Geoffrey Cloud
Cerebral arterial gas embolism is a recognised complication of endovascular intervention with an estimated incidence of 0.08%. Its diagnosis is predominantly clinical, supported by neuroimaging. The treatment relies on alleviating mechanical obstruction and reversing the proinflammatory processes that contribute to tissue ischaemia. Hyperbaric oxygen therapy is an effective treatment and has multiple mechanisms to reverse the pathological processes involved in cerebral arterial gas embolism. Symptomatic cerebral arterial gas embolism is a rare complication of endovascular intervention for acute ischaemic stroke...
December 28, 2017: Practical Neurology
https://www.readbyqxmd.com/read/29288194/increased-middle-cerebral-artery-mean-blood-flow-velocity-index-after-stroke-thrombectomy-indicates-increased-risk-for-intracranial-hemorrhage
#17
Markus Kneihsl, Kurt Niederkorn, Hannes Deutschmann, Christian Enzinger, Birgit Poltrum, Renate Fischer, Daniela Thaler, Christina Hermetter, Gerit Wünsch, Franz Fazekas, Thomas Gattringer
BACKGROUND AND PURPOSE: Cerebral hyperperfusion has been related to the risk of intracranial hemorrhage (ICH) in stroke patients after vessel recanalization therapy. We hypothesized that after successful mechanical thrombectomy for acute anterior circulation stroke, hemodynamics detectable by transcranial Duplex (TCD) sonography would vary, and that increased blood flow velocities would be associated with ICH. METHODS: We retrospectively identified all ischemic stroke patients with successful endovascular recanalization for anterior circulation vessel occlusion (Thrombolysis in Cerebral Infarction 2b-3) between 2010 and 2017...
December 28, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29284735/contact-aspiration-versus-stent-retriever-in-patients-with-acute-ischemic-stroke-with-m2-occlusion-in-the-aster-randomized-trial-contact-aspiration-versus-stent-retriever-for-successful-revascularization
#18
Benjamin Gory, Bertrand Lapergue, Raphael Blanc, Julien Labreuche, Malek Ben Machaa, Alain Duhamel, Gautier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Mikael Mazighi, Arturo Consoli, Michel Piotin
BACKGROUND AND PURPOSE: Middle cerebral artery M2-segment occlusions represent an important subgroup of patients with acute stroke with large-vessel occlusion. The safety of mechanical thrombectomy, especially contact aspiration (CA), in such distal intracranial occlusions is still under debate. We compared reperfusion, adverse events, neurological recovery, and functional outcome of patients with isolated M2 occlusions according to the first-line strategy mechanical thrombectomy devices (CA versus stent retriever [SR])...
December 28, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29279529/optical-frequency-domain-imaging-of-very-late-stent-thrombosis-following-bare-metal-stent-implantation-for-acute-myocardial-infarction
#19
Shinichiro Masuda, Takashi Shibui, Ryuki Kawamura, Hitoshi Saiki, Akihiro Hata
A 43-year-old man was admitted to our hospital with ST-segment elevation acute coronary syndrome. He had experienced myocardial infarction 19 months previously, and a bare-metal stent (BMS) had been implanted in the culprit distal right coronary artery at another hospital. Emergency coronary angiography showed thrombotic in-stent occlusion of the BMS. Intravascular ultrasound revealed an undersized stent compared with the size of the vessel and late stent malapposition (LSM) with abundant thrombi. The lesion was successfully recanalized via thrombectomy and plain old balloon angioplasty...
December 27, 2017: International Heart Journal
https://www.readbyqxmd.com/read/29277912/a-hemorrhagic-transformation-model-of-mechanical-stroke-therapy-with-acute-hyperglycemia-in-mice
#20
David Couret, Steeve Bourane, Aurélie Catan, Brice Nativel, Cynthia Planesse, Anne-Claire Dorsemans, Imade Ait-Arsa, Maxime Cournot, Philippe Rondeau, Jessica Patche, Alexy Tran-Dinh, Gilles Lambert, Nicolas Diotel, Olivier Meilhac
Clinical benefit for mechanical thrombectomy (MT) in stroke was recently demonstrated in multiple large prospective studies. Acute hyperglycemia is an important risk factor of poor outcome in stroke patients, including those that underwent MT. The aim of this therapy is to achieve a complete reperfusion in a short time, given that reperfusion damage is dependent on the duration of ischemia. Here, we investigated the effects of acute hyperglycemia in a mouse model of ischemic stroke induced by middle cerebral artery occlusion (MCAO)...
December 26, 2017: Journal of Comparative Neurology
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