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https://www.readbyqxmd.com/read/29152468/dual-mechanical-thrombectomy-for-recanalization-of-a-resistant-acute-posterior-circulation-stroke
#1
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/29147674/pediatric-otogenic-sigmoid-sinus-thrombosis-case-report-and-literature-reappraisal
#2
Andrea Scherer, Andrew Jea
The purpose of this study was to review our experience with a single case of mastoiditis associated with sigmoid sinus thrombosis and increased intracranial pressure, and to review the experience of others through prior publications. We reviewed a case of a 6-year-old boy with an acute otitis media and mastoiditis, with associated ipsilateral sigmoid sinus and contralateral distal transverse sinus thrombosis. Based on the literature and our own experience, we conclude that most children with dural sinus thrombosis from acute otitis media and mastoiditis, in the setting of increased intracranial pressure, attain a good neurological outcome with a conservative neurosurgical approach...
2017: Global Pediatric Health
https://www.readbyqxmd.com/read/29146873/mobile-interventional-stroke-teams-lead-to-faster-treatment-times-for-thrombectomy-in-large-vessel-occlusion
#3
Daniel Wei, Thomas J Oxley, Dominic A Nistal, Justin R Mascitelli, Natalie Wilson, Laura Stein, John Liang, Lena M Turkheimer, Jacob R Morey, Claire Schwegel, Ahmed J Awad, Hazem Shoirah, Christopher P Kellner, Reade A De Leacy, Stephan A Mayer, Stanley Tuhrim, Srinivasan Paramasivam, J Mocco, Johanna T Fifi
BACKGROUND AND PURPOSE: Endovascular recanalization treatment for acute ischemic stroke is a complex, time-sensitive intervention. Trip-and-treat is an interhospital service delivery model that has not previously been evaluated in the literature and consists of a shared mobile interventional stroke team that travels to primary stroke centers to provide on-site interventional capability. We compared treatment times between the trip-and-treat model and the traditional drip-and-ship model...
November 16, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29146829/is-bridging-therapy-still-required-in-stroke-due-to-carotid-artery-terminus-occlusions
#4
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/29146434/cerebral-hyperperfusion-syndrome-after-endovascular-reperfusion-therapy-in-a-patient-with-acute-internal-carotid-artery-and-middle-cerebral-artery-occlusions
#5
Tetsuya Hashimoto, Shoji Matsumoto, Mitsushige Ando, Hideo Chihara, Atsushi Tsujimoto, Taketo Hatano
BACKGROUND: Cerebral hyperperfusion syndrome (CHS) is known to be a rare but devastating complication of carotid artery revascularization. Because patients with acute ischemic stroke due to acute major cerebral and/or cervical artery occlusion treated with endovascular reperfusion therapy may have impaired autoregulation in the cerebral vasculature, these patients may also develop CHS. Despite the growing number of endovascular reperfusion procedures for acute ischemic stroke, this complication has only rarely been reported...
November 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29137863/results-and-functional-outcomes-of-acute-ischemic-stroke-patients-who-underwent-mechanical-thrombectomy-admitted-to-intensive-care-unit
#6
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/29134924/treatment-evaluation-of-acute-stroke-for-using-in-regenerative-cell-elements-treasure-trial-rationale-and-design
#7
Toshiya Osanai, Kiyohiro Houkin, Shinichiro Uchiyama, Kazuo Minematsu, Akihiko Taguchi, Shunsuke Terasaka
Rationale MultiStem® (HLM051) is one of the promising allogenic cell products for acute ischemic stroke with strong evidence. A previous phase 2 randomized, double-blind, placebo-controlled, multicenter dose-escalation trial showed the safety of MultiStem® for acute ischemic stroke, with a time window beyond that of rt-PA and endovascular thrombectomy. We aim to obtain stronger evidence and to show the efficacy of the MultiStem® for treatment of ischemic stroke. Sample size Estimated sample size is 220 (110 patients per group), which has 90% power at 5% significance level...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29132938/endovascular-management-of-extracranial-occlusions-at-the-hyperacute-phase-of-stroke-with-tandem-occlusions
#8
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/29129157/thrombectomy-6-to-24-hours-after-stroke-with-a-mismatch-between-deficit-and-infarct
#9
Raul G Nogueira, Ashutosh P Jadhav, Diogo C Haussen, Alain Bonafe, Ronald F Budzik, Parita Bhuva, Dileep R Yavagal, Marc Ribo, Christophe Cognard, Ricardo A Hanel, Cathy A Sila, Ameer E Hassan, Monica Millan, Elad I Levy, Peter Mitchell, Michael Chen, Joey D English, Qaisar A Shah, Frank L Silver, Vitor M Pereira, Brijesh P Mehta, Blaise W Baxter, Michael G Abraham, Pedro Cardona, Erol Veznedaroglu, Frank R Hellinger, Lei Feng, Jawad F Kirmani, Demetrius K Lopes, Brian T Jankowitz, Michael R Frankel, Vincent Costalat, Nirav A Vora, Albert J Yoo, Amer M Malik, Anthony J Furlan, Marta Rubiera, Amin Aghaebrahim, Jean-Marc Olivot, Wondwossen G Tekle, Ryan Shields, Todd Graves, Roger J Lewis, Wade S Smith, David S Liebeskind, Jeffrey L Saver, Tudor G Jovin
Background The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy. Methods We enrolled patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, with mismatch criteria defined according to age (<80 years or ≥80 years)...
November 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29127270/low-dose-tirofiban-improves-functional-outcome-in-acute-ischemic-stroke-patients-treated-with-endovascular-thrombectomy
#10
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
#11
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
https://www.readbyqxmd.com/read/29127195/microcatheter-contrast-injection-in-stent-retriever-neurothrombectomy-is-safe-and-useful-insights-from-swift-prime
#12
Radoslav Raychev, Reza Jahan, Jeffrey L Saver, Raul G Nogueira, Mayank Goyal, Vitor M Pereira, Elad Levy, Dileep R Yavagal, Christophe Cognard, David Liebeskind
Microcatheter contrast injection (MCI) prior to stent retriever deployment for the treatment of acute ischemic stroke may be useful for evaluation of distal anatomy and flow patterns beyond the occlusion. However, prior data from intra-arterialthrombolysis suggested that MCI increases the risk of intracranial hemorrhage (ICH). The safety and utility of MCI has not been investigated in the setting of thrombectomy. METHODS: We analyzed the Solitaire With the Intention For Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) trial to correlate pre-intervention MCI flow with collateral flow, and to investigate its impact on ICH and clinical outcome after thrombectomy with the Solitaire device...
November 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29120918/tissue-is-more-important-than-time-insights-into-acute-ischemic-stroke-from-modern-brain-imaging
#13
Andrew Bivard, Mark Parsons
PURPOSE OF REVIEW: The clinical practice of acute ischemic stroke treatment has undergone a major change over the last 5 years, as multimodal imaging becomes more accessible, and evidence mounts that individualized treatment is possible. Multimodal imaging performed before treatment provides invaluable information to treating clinicians, which includes confirmation of the diagnosis, and provides guidance on the appropriateness and the likely outcome of intravenous or endovascular treatment for individual patients (and their families)...
November 7, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29119876/endovascular-treatment-outcomes-using-the-stroke-triage-education-procedure-standardization-and-technology-steps-t-program
#14
Ameer E Hassan, Christina Sanchez, Angela N Johnson
Background "Door to treatment" time affects outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, the correlation between staff education and accessible technology with stroke outcomes has not been demonstrated. Objective The objective of this paper is to demonstrate the five-year impact of the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program on time-to-treat and clinical outcomes. Methods The study analyzed a prospectively maintained database of AIS patients who benefited from EVT through implementation of STEPS-T...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29118805/novel-distal-emboli-protection-technology-the-embotrap
#15
Ju-Yu Chueh, Miklos G Marosfoi, Olivia W Brooks, Robert M King, Ajit S Puri, Matthew J Gounis
Background: Over the course of the thrombectomy procedure, clot fragments may become dislodged and lead to downstream emboli due to manipulation of an endovascular device. The EmboTrap thrombectomy system features an inner stent channel with an outer stent trap design that may potentially reduce the risk of distal clot fragmentation during clot removal. We tested the hypothesis that distal emboli to both the same and new territory generated during mechanical thrombectomy are a function of device design...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29118797/comparison-of-vacuum-pressures-and-forces-generated-by-different-catheters-and-pumps-for-aspiration-thrombectomy-in-acute-ischemic-stroke
#16
Michael T Froehler
Background: Direct aspiration thrombectomy is an increasingly utilized technique in endovascular stroke treatment that relies on vacuum and suction force to remove the clot. This report assesses the pressures and forces generated by different catheters and pumps. Methods: Vacuum pressures were measured using a vacuum gauge for several catheters (Stryker Catalyst6, Penumbra Ace 064, Medtronic Arc 061, and Penumbra 041) and pumps (Penumbra pump, 60-mL syringe, and the ASPIRE device)...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29114095/direct-mechanical-intervention-versus-bridging-therapy-in-stroke-patients-eligible-for-intravenous-thrombolysis-a-pooled-analysis-of-2-registries
#17
Sebastian Bellwald, Ralph Weber, Tomas Dobrocky, Hannes Nordmeyer, Simon Jung, Jeffrie Hadisurya, Pasquale Mordasini, Marie-Luise Mono, Christian P Stracke, Hakan Sarikaya, Corrado Bernasconi, Klaus Berger, Marcel Arnold, René Chapot, Jan Gralla, Urs Fischer
BACKGROUND AND PURPOSE: Randomized controlled trials have shown that mechanical thrombectomy (MT) plus best medical treatment improves outcome in stroke patients with large-vessel occlusion in the anterior circulation. Whether direct MT is equally effective as bridging thrombolysis (intravenous thrombolysis plus MT) in intravenous thrombolysis eligible patients remains unclear. METHODS: We compared clinical and radiological outcomes at 3 months in 249 bridging patients with 111 patients receiving direct MT for large-vessel occlusion anterior circulation stroke from 2 prospective registries (study period Essen: June 2012 to August 2013, Bern February 2009 to August 2014)...
November 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29109882/successful-mechanical-thrombectomy-of-a-middle-cerebral-artery-occlusion-14-hours-after-stroke-onset
#18
Anelia Dietmann, Kety Wha-Vei Hsieh, Andrea M Humm, Claudio L Bassetti, Urs Fischer, Jan Gralla
A 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological deficits no IVT was performed. Nine hours after symptom onset the patient gradually deteriorated with a NIHSS fluctuating between 9 and 15. MRI showed a persistent occlusion of the MCA with a large diffusion-perfusion mismatch...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/29106687/aspects-large-vessel-occlusion-and-time-of-symptom-onset-estimation-of-eligibility-for-endovascular-therapy
#19
Maxim Mokin, Aparna Pendurthi, Vladimir Ljubimov, William S Burgin, Adnan H Siddiqui, Elad I Levy, Christopher T Primiani
BACKGROUND: Understanding how many patients are eligible for endovascular therapy can help develop more effective stroke systems of care. OBJECTIVE: To determine the proportion of patients eligible for endovascular therapy. METHODS: In this single center retrospective cohort study, we identified patients with acute ischemic stroke from large vessel occlusion (LVO) from January 2014 to December 2015. Selection criteria including LVO location, Alberta stroke program early computed tomography score (ASPECTS) range, hospital arrival time, and the use of intravenous thrombolysis were applied to calculate proportions of patients eligible for endovascular therapy...
July 6, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29103931/timely-thrombectomy-can-improve-patency-of-hemodialysis-arteriovenous-fistulas
#20
Mu-Yang Hsieh, Lin Lin, Tsung-Yan Chen, Dao-Ming Chen, Ming-Hsien Lee, Yung-Fang Shen, Chung-Wei Yang, Shao-Yuan Chuang, Chih-Cheng Wu, Kuan-Yu Hung
OBJECTIVE: The urgency with which salvage of thrombosed vascular accesses for dialysis should be attempted remains unknown. We examined the effect of a timely thrombectomy approach on vascular access outcomes for dialysis. METHODS: A before-and-after study was conducted with patients on hemodialysis who had undergone endovascular thrombectomy. A timely thrombectomy initiative (ie, salvage within 24 hours of thrombosis diagnosis) was started in July 2015 at our institution...
November 2, 2017: Journal of Vascular Surgery
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