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endovascular thrombectomy

Dong Yang, Min Lin, Shuiping Wang, Huaiming Wang, Yonggang Hao, Wenjie Zi, Penghua Lv, Dequan Zheng, Guodong Xiao, Gelin Xu, Yunyun Xiong, Xinfeng Liu
Objective The objective of this article is to compare the effectiveness of primary angioplasty and/or stenting with stent retriever thrombectomy in acute anterior large-vessel occlusion due to atherosclerotic disease. Methods Patients were retrospectively reviewed from the endovascular treatment for acute anterior circulation ischemic stroke registry. Patients with large-vessel occlusions due to atherosclerosis were selected. We evaluated modified Rankin Scale (mRS) score at 90 days, modified thrombolysis in cerebral infarction (mTICI) score immediately post-procedure, and symptomatic and asymptomatic intracranial hemorrhage within 72 hours...
January 1, 2018: Interventional Neuroradiology
Byung Hyun Baek, Hyung Seok Kim, Woong Yoon, Yun Young Lee, Jang Mi Baek, Eun Hee Kim, Seul Kee Kim
Objective: In this study we investigate the association between the expression of inflammatory mediators measured in clots retrieved by mechanical thrombectomy, stroke etiology, and the susceptibility vessel sign (SVS) on gradient-echo (GRE) MR imaging in acute ischemic stroke patients. Methods: We performed molecular analysis of intracranial clots retrieved by mechanical thrombectomy from 82 patients with acute stroke. Seventy-two of these patients underwent GRE imaging before endovascular therapy...
March 2018: Annals of Clinical and Translational Neurology
Dylan N Wolman, Michael Iv, Max Wintermark, Gregory Zaharchuk, Michael P Marks, Huy M Do, Robert L Dodd, Gregory W Albers, Maarten G Lansberg, Jeremy J Heit
BACKGROUND AND PURPOSE: Acute ischemic stroke (AIS) patients who benefit from endovascular treatment have a large vessel occlusion (LVO), small core infarction, and salvageable brain. We determined if diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) alone can correctly identify and localize anterior circulation LVO and accurately triage patients to endovascular thrombectomy (ET). MATERIALS AND METHODS: This retrospective cohort study included patients undergoing MRI for the evaluation of AIS symptoms...
March 19, 2018: Journal of Neurointerventional Surgery
Ali Yousif, Rajesh Samannan, Mazen Abu-Fadel
Acute renal artery embolism (RAE) is a rare condition associated with significant morbidity and mortality. The treatment strategy for RAE includes anticoagulation with or without thrombolysis or surgical or endovascular embolectomy. We describe here a case presentation of acute RAE secondary to atrial fibrillation treated successfully with Penumbra Indigo Aspiration System, a novel device in peripheral endovascular interventions. Our patient had ongoing symptoms and acute renal failure on presentation with contraindication to thrombolysis given hypertensive emergency...
January 1, 2018: Vascular and Endovascular Surgery
Tomoya Suzuki, Shogo Kaku, Kengo Nishimura, Akihiko Teshigawara, Yuichi Sasaki, Ken Aoki, Toshihide Tanaka, Kostadin Karagiozov, Yuichi Murayama
BACKGROUND: Surgical treatment of VA thrombosed giant aneurysms requires to achieve both obliteration of the parent artery to prevent bleeding and dome thrombectomy to relieve the brain stem from mass effect. To secure both proximal and distal control of complex VA aneurysms, contralateral approach to the aneurysm might be a useful alternative as previously described. We successfully treated a case of VA thrombosed giant aneurysm in a new original way by combining craniotomy (ipsilateral and contralateral) and endovascular technique...
March 15, 2018: World Neurosurgery
Jenq-Lin Yang, Sujira Mukda, Shang-Der Chen
Stroke is the leading cause of adult disability and mortality in most developing and developed countries. The current best practices for patients with acute ischemic stroke include intravenous tissue plasminogen activator and endovascular thrombectomy for large-vessel occlusion to improve clinical outcomes. However, only a limited portion of patients receive thrombolytic therapy or endovascular treatment because the therapeutic time window after ischemic stroke is narrow. To address the current shortage of stroke management approaches, it is critical to identify new potential therapeutic targets...
March 9, 2018: Redox Biology
Nitin Goyal, Georgios Tsivgoulis, Donald Frei, Aquilla Turk, Blaise Baxter, Michael T Froehler, J Mocco, Abhi Pandhi, Ramin Zand, Konark Malhotra, Daniel Hoit, Lucas Elijovich, David Loy, Raymond D Turner, Justin Mascitelli, Kiersten Espaillat, Aristeidis H Katsanos, Anne W Alexandrov, Andrei V Alexandrov, Adam S Arthur
OBJECTIVE: In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients. METHODS: Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0-2 at 3 months], favorable functional outcome [mRS of 0-1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone...
March 16, 2018: Neurology
Panagiotis M Kitrou, Konstantinos Katsanos, Panagiotis Papadimatos, Stavros Spiliopoulos, Dimitris Karnabatidis
Thrombosis is the most important access-related complication. Several declotting procedures have been suggested falling mainly into two categories; thrombolysis-dependent and thrombectomy-dependent. Areas covered: Seventeen studies after 2001 have been published on percutaneous treatment of thrombosed vascular access. Authors performed a systematic review of these studies together with a parametric meta-analysis of data available investigating clinical success, postintervention assisted primary patency (PAPP) and independent factors that could influence outcome measures...
March 21, 2018: Expert Review of Medical Devices
Up Huh, Chung Won Lee, Seon Hee Kim, Chan Ik Park, Sung Woon Chung, Seunghwan Song, Chang Won Kim
Blunt abdominal aortic injury (BAAI) is extremely rare. Three known treatments of BAAI exist: medical treatment, conventional surgical treatment, and endovascular treatment. Outcomes of medical and conventional surgical treatments, such as bypass graft, thrombectomy, and intimal suture, were not satisfactory. A 47-year-old man presented with multiple injuries after a high-speed vehicular accident. He was diagnosed with the traumatic aortic injury to be an intra-mural hematoma in the bifurcation of the terminal aorta...
March 15, 2018: Cardiovascular and Interventional Radiology
Henry Zhao, Lauren Pesavento, Skye Coote, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, Leonid Churilov, Nawaf Yassi, Stephen M Davis, Bruce C V Campbell
BACKGROUND AND PURPOSE: Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. METHODS: The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen...
March 14, 2018: Stroke; a Journal of Cerebral Circulation
Jin Soo Lee, Seong-Joon Lee, Ji Man Hong, Jin Wook Choi, Jeong-Ho Hong, Hyuk-Won Chang, Chang-Hyun Kim, Yong-Won Kim, Dong-Hun Kang, Yong-Sun Kim, Bruce Ovbiagele, Andrew M Demchuk, Yang-Ha Hwang, Sung-Il Sohn
Background and Purpose: The purpose of the current study is to evaluate the influence of temporal patterns related to the availability of new endovascular treatment (EVT) devices on care processes and outcomes among patients with AIS. Materials and Methods: We enrolled 720 consecutive patients (January 2011 to May 2016) in a retrospective registry, ASIAN KR, from three Korean hospitals, who received EVT for acute ischemic stroke (AIS) caused by cervicocephalic arterial occlusions...
March 2018: Neurointervention
Nobuyuki Sakai, Shinzo Ota, Yasushi Matsumoto, Rei Kondo, Tetsu Satow, Michiya Kubo, Tomoyuki Tsumoto, Yukiko Enomoto, Taketo Kataoka, Hirotoshi Imamura, Kenichi Todo, Mikito Hayakawa, Hiroshi Yamagami, Kazunori Toyoda, Yasushi Ito, Kenji Sugiu, Yuji Matsumaru, Shinichi Yoshimura
REVIVE SE (REVIVE) is a closed-ended, self-expanding stent retriever used in the RIVER JAPAN study. We present our early experience with REVIVE for revascularization of acute ischemic stroke (AIS) in patients who have failed or are ineligible for intravenous recombinant tissue plasminogen activator treatment. This prospective, single-arm, non-randomized, multicenter registry study followed up patients undergoing mechanical thrombectomy with REVIVE for 90 days. The primary endpoint was a post-procedure Thrombolysis in Cerebral Infarction (TICI) score ≥2a...
March 9, 2018: Neurologia Medico-chirurgica
Ali Abdul Jabaar, J Stephen Jenkins
BACKGROUND: Beyond medical therapy, the role of endovascular approach for the management of chronic Venous Thromboembolic (VTE) disease is yet to be defined. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage this chronic condition. This paper represents the first systematic review of published reports on the use of vacuum-assisted thrombectomy (AngioVac) in treating chronic VTE disease. METHODS: A systematic review of published case-series, individual case-reports, and review articles in MEDLINE, PubMed, and Google Scholar was conducted...
February 15, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Tomohide Yoshie, Toshihiro Ueda, Tatsuro Takada, Shinji Nogoshi, Fumio Miyashita, Satoshi Takaishi, Takayuki Fukano, Daiki Tokuura, Yasuhiro Hasegawa
BACKGROUND: Faster time to recanalization leads to better clinical outcomes in patients treated with endovascular thrombectomy. Whether the association between time to recanalization and clinical outcomes depends on cerebral blood volume (CBV) obtained from pretreatment computed tomography (CT) perfusion (CTP) imaging was investigated. METHODS: In consecutive patients with acute ischemic stroke who achieved recanalization by endovascular thrombectomy for intracranial internal carotid artery or M1 occlusion, the effects on clinical outcome of time to recanalization and the relative CBV value (rCBV) assessed by pretreatment CTP were evaluated...
March 7, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Ivo G H Jansen, Maxim J H L Mulder, Robert-Jan B Goldhoorn
OBJECTIVE: To determine outcomes and safety of endovascular treatment for acute ischaemic stroke, due to proximal intracranial vessel occlusion in the anterior circulation, in routine clinical practice. DESIGN: Ongoing, prospective, observational cohort study. SETTING: 16 centres that perform endovascular treatment in the Netherlands. PARTICIPANTS: 1488 patients included in the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry who had received endovascular treatment, including stent retriever thrombectomy, aspiration, and all alternative methods for acute ischaemic stroke within 6...
March 9, 2018: BMJ: British Medical Journal
Byung Moon Kim, Jang-Hyun Baek, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Seung Kug Baik, Sang Hyun Suh, Kyung Yol Lee, Hyo Sung Kwak, Hong Gee Roh, Young-Jun Lee, Sang Heum Kim, Chang-Woo Ryu, Yon-Kwon Ihn, Byungjoon Kim, Hong Jun Jeon, Jin Woo Kim, Jun Soo Byun, Sangil Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung-Soo Shin, Oh Young Bang
OBJECTIVE: To characterise the time window in which endovascular thrombectomy (EVT) is associated with good outcome, and to test the differential relationship between functional outcome and onset-to-reperfusion time (ORT), depending on collateral status. METHODS: This was a retrospective analysis of clinical and imaging data of 554 consecutive patients, who had recanalisation success by EVT for anterior circulation large artery occlusion, from the prospectively maintained registries of 16 comprehensive stroke centres between September 2010 and December 2015...
March 8, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
William J Yoon, Pegge Halandras, Bernadette Aulivola, Paul Crisostomo
INTRODUCTION & OBJECTIVES: Cancer patients demonstrate increased risk for venous thromboembolism (VTE), VTE recurrence, and anticoagulation-associated bleeding. Pharmacomechanical thrombolysis and thrombectomy (PMT) improves venous patency, venous valve function, and quality of life in patients with acute iliofemoral deep venous thrombosis (DVT). It remains unknown whether pharmacomechanical thrombolysis can be used safely in patients with active cancer. We hypothesized that perioperative and short-term outcomes of pharmacomechanical iliofemoral DVT thrombolysis would not differ between patients with cancer and those without cancer...
March 5, 2018: Annals of Vascular Surgery
Frank M Davis, Jeremy Albright, Katherine A Gallagher, Hitinder S Gurm, Gerald C Koenig, Theodore Schreiber, P Michael Grossman, Peter K Henke
OBJECTIVES: Acute limb ischemia (ALI) of the lower extremity is a potentially devastating condition that requires urgent and definitive management. This challenging scenario is often treated with endovascular, open surgical, or hybrid revascularization in an urgent basis, but the comparative effects of such therapies remain poorly defined. The purpose of this study was to compare outcomes of endovascular, open surgical, and hybrid revascularization for ALI in the contemporary era. METHODS: A large statewide cardiovascular consortium of 45 hospitals was queried for patients between January 2012 and June 2015 who underwent an endovascular, open surgical, or hybrid revascularization for ALI deemed at high risk of limb loss if not treated within 24 hours (Rutherford class IIA or IIB)...
March 5, 2018: Annals of Vascular Surgery
Omid Nikoubashman, Kolja Schürmann, Ahmed E Othman, Jan-Philipp Bach, Martin Wiesmann, Arno Reich
Background and Purpose: With the advent of endovascular stroke treatment (EST) with mechanical thrombectomy, stroke treatment has also become more challenging. Purpose of this study was to investigate whether a fulltime neuroradiological on-site service and workflow optimization with a structured documentation of the interdisciplinary stroke workflow resulted in improved procedural times. Material and Methods: Procedural times of 322 consecutive patients, who received EST (1) before ( n = 96) and (2) after ( n = 126) establishing a 24-hour neuroradiological on-site service as well as (3) after implementation of a structured interdisciplinary workflow documentation ("Stroke Check") ( n = 100), were analysed...
2018: BioMed Research International
Jonathan T Caranfa, Elaine Nguyen, Rafay Ali, Iregi Francis, Albert Zichichi, Elliott Bosco, Craig I Coleman, William L Baker, Christine G Kohn
BACKGROUND: Randomized controlled trials (RCTs) have compared mechanical endovascular therapy (MET) in addition to intravenous tissue plasminogen activator (IVtPA) to IVtPA alone for the management of acute ischemic stroke (AIS). Direct comparative studies between individual METs are not available. In lieu of head-to-head randomized control trials, we performed an adjusted indirect treatment comparison (ITC) meta-analysis to assess the comparative efficacy and safety of different METs, Solitaire+IVtPA and Penumbra+IVtPA in AIS patients...
2018: PloS One
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