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endovascular thrombectomy

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https://www.readbyqxmd.com/read/28935626/wide-variability-in-prethrombectomy-workflow-practices-in-the-united-states-a-multicenter-survey
#1
A P Kansagra, G C Meyers, M S Kruzich, D T Cross, C J Moran
BACKGROUND AND PURPOSE: Clinical outcomes in patients with acute ischemic stroke caused by large vessel occlusion depend on the speed and quality of workflows leading to mechanical thrombectomy. In the absence of universally accepted best practices for workflow, developing stroke hospitals can benefit from improved awareness of real-world workflows in effect at experienced centers. To this end, we surveyed prethrombectomy workflow practices at stroke centers throughout the United States...
September 21, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28923278/can-adjunctive-therapies-augment-the-efficacy-of-endovascular-thrombolysis-a-potential-role-for-activated-protein-c
#2
REVIEW
Arun Paul Amar, Abhay P Sagare, Zhen Zhao, Yaoming Wang, Amy R Nelson, John H Griffin, Berislav V Zlokovic
In the management of acute ischemic stroke, vessel recanalization correlates with functional status, mortality, cost, and other outcome measures. Thrombolysis with intravenous tissue plasminogen activator has many limitations that restrict its applicability, but recent advances in the development of mechanical thrombectomy devices as well as improved systems of stroke care have resulted in greater likelihood of vessel revascularization. Nonetheless, there remains substantial discrepancy between rates of recanalization and rates of favorable outcome...
September 15, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28923277/animal-models-of-ischaemic-stroke-and-characterisation-of-the-ischaemic-penumbra
#3
REVIEW
Christopher McCabe, Mariana M Arroja, Emma Reid, I Mhairi Macrae
Over the past forty years, animal models of focal cerebral ischaemia have allowed us to identify the critical cerebral blood flow thresholds responsible for irreversible cell death, electrical failure, inhibition of protein synthesis, energy depletion and thereby the lifespan of the potentially salvageable penumbra. They have allowed us to understand the intricate biochemical and molecular mechanisms within the 'ischaemic cascade' that initiate cell death in the first minutes, hours and days following stroke...
September 16, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28912883/tirofiban-facilitates-the-reperfusion-process-during-endovascular-thrombectomy-in-icas
#4
Hongchen Zhao, Jinhua Zhang, Danyan Gu, Zongjie Shi, Jie Pan, Yu Geng, Tianming Shi
The aim of the present study was to assess the use of tirofiban injections for rescue therapy following artery reocclusion due to intra-luminal thrombosis during endovascular thrombectomy in patients with acute ischemic stroke (AIS). A total of seven cases of patients treated with adjunctive tirofiban injections following failed endovascular thrombectomy due to instant intra-luminal thrombosis were retrospectively assessed. A Solitaire stent was used as the primary thrombectomy device in all patients. Tirofiban was injected intra-arterially via a temporarily deployed Solitaire stent with continuous intravenous infusion for the subsequent 24 h; half of the conventionally recommended dose was employed...
October 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28904820/successful-cerebral-thrombectomy-for-a-nonagenarian-with-stroke-in-the-subacute-phase-after-transcatheter-aortic-valve-implantation
#5
Kazuya Matsuo, Atsushi Fujita, Jun Tanaka, Tomoaki Nakai, Masaaki Kohta, Kohkichi Hosoda, Toshiro Shinke, Ken-Ichi Hirata, Eiji Kohmura
BACKGROUND: Thromboembolic events are infrequent but serious complications of transcatheter aortic valve implantation (TAVI), occurring in 2.3-10% of the patients. However, the cause of post-TAVI stroke is unclear. CASE DESCRIPTION: A 90-year-old female underwent transfemoral-TAVI for severe aortic stenosis. Ten days later, she presented with an ischemic stroke of the left middle cerebral artery territory due to new-onset atrial fibrillation (NOAF). She underwent emergent endovascular thrombectomy with good reperfusion approximately 6 hours after onset of symptoms...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28904228/anesthesia-related-outcomes-for-endovascular-stroke-revascularization-a-systematic-review-and-meta-analysis
#6
Waleed Brinjikji, Jeffrey Pasternak, Mohammad H Murad, Harry J Cloft, Tasha L Welch, David F Kallmes, Alejandro A Rabinstein
BACKGROUND AND PURPOSE: There is currently controversy on the ideal anesthesia strategy during mechanical thrombectomy for acute ischemic stroke. We performed a systematic review and meta-analysis of studies comparing clinical and angiographic outcomes of patients undergoing general anesthesia (GA group) and those receiving either local anesthesia or conscious sedation (non-GA group). METHODS: A literature search on anesthesia and endovascular treatment of acute ischemic stroke was performed...
September 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28899932/utility-of-perfusion-imaging-in-acute-stroke-treatment-a-systematic-review-and-meta-analysis
#7
REVIEW
Won Hyung A Ryu, Michael B Avery, Navjit Dharampal, Isabel E Allen, Steven W Hetts
BACKGROUND: Variability in imaging protocols and techniques has resulted in a lack of consensus regarding the incorporation of perfusion imaging into stroke triage and treatment. The objective of our study was to evaluate the available scientific evidence regarding the utility of perfusion imaging in determining treatment eligibility in patients with acute stroke and in predicting their clinical outcome. METHODS: We performed a systematic review of the literature using PubMed, Web of Science, and Cochrane Library focusing on themes of medical imaging, stroke, treatment, and outcome (CRD42016037817)...
October 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28894887/-endovascular-thrombectomy-for-ischemic-stroke
#8
REVIEW
B Kallmünzer, M Köhrmann
The standard of care for patients with acute stroke of the anterior circulation and large vessel occlusion is the combined treatment with intravenous rt-PA (recombinant tissue-type plasminogen activator) and endovascular thrombectomy. The therapy is highly effective while reducing functional deficits and long-term disability. International guidelines recommend thrombectomy during the first 6 h after symptom onset, but new evidence supports its use in selected patients within a time window of up to 24 h...
September 11, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28890041/successful-endovascular-thrombectomy-90h-after-stroke-onset
#9
Rusiru Gunawardena, Andrew Cheung, Paul Spira, Jianna He, Jason Wenderoth, Albert H Y Chiu
Endovascular thrombectomy (EVT) has extended the conventionally accepted time window of treatment, from 4.5h (ECASS III trial) for intravenous thrombolysis, to 7.3h for EVT (HERMES collaboration). More recent evidence suggests EVT times could be extended to 24h in carefully selected patients (DAWN trial). Some patients present after these time windows with large areas of ischemia but little established infarction on imaging. They represent a major dilemma with much to gain from EVT but at theoretically higher risk of a poor outcome...
September 7, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28887393/white-matter-hyperintensity-volume-and-outcome-of-mechanical-thrombectomy-with-stentriever-in-acute-ischemic-stroke
#10
Kunakorn Atchaneeyasakul, Thabele Leslie-Mazwi, Kathleen Donahue, Anne-Katrin Giese, Natalia S Rost
BACKGROUND AND PURPOSE: Finding of white matter hyperintensity (WMH) has been associated with an increased risk of parenchymal hematoma and poor clinical outcomes after mechanical thrombectomy using old-generation endovascular devices. Currently, no data exist with regard to the risk of mechanical thrombectomy using stentriever devices in patients with significant WMH. We hypothesized that WMH volume will not affect the hemorrhagic and clinical outcome in patients with acute ischemic stroke undergoing thrombectomy using new-generation devices...
September 8, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28878444/experimental-evaluation-and-training-of-stent-clot-retrieval-the-confront-clot-scrambling-method
#11
Tomotaka Ohshima, Shunsaku Goto, Taiki Yamamoto, Kojiro Ishikawa
The introduction of stent retrievers has changed the methods used for acute intracranial thrombectomy, but the training approach has not been discussed enough. We, therefore, aimed to establish a simple skill up method which can be used to train anytime and anywhere with low costs. Also, we introduce our experimental confront clot scrambling method (CCSM) which makes a profitable visualization in how the stent retriever works. The CCSM involved a sham clot set in the middle of a polyvinyl chloride tube, after which two stent retrievers were navigated from each side before being simultaneously withdrawn with the same force...
August 2017: Nagoya Journal of Medical Science
https://www.readbyqxmd.com/read/28877524/selection-paradigms-for-large-vessel-occlusion-acute-ischemic-stroke-endovascular-therapy
#12
Mehdi Bouslama, Meredith T Bowen, Diogo C Haussen, Seena Dehkharghani, Jonathan A Grossberg, Letícia C Rebello, Srikant Rangaraju, Michael R Frankel, Raul G Nogueira
BACKGROUND: Optimal patient selection methods for thrombectomy in large vessel occlusion stroke (LVOS) are yet to be established. We sought to evaluate the ability of different selection paradigms to predict favorable outcomes. METHODS: Review of a prospectively collected database of endovascular patients with anterior circulation LVOS, adequate CT perfusion (CTP), National Institutes of Health Stroke Scale (NIHSS) ≥10 from September 2010 to March 2016. Patients were retrospectively assessed for thrombectomy eligibility by 4 mismatch criteria: Perfusion-Imaging Mismatch (PIM): between CTP-derived perfusion defect and ischemic core volumes; Clinical-Core Mismatch (CCM): between age-adjusted NIHSS and CTP core; Clinical-ASPECTS Mismatch (CAM-1): between age-adjusted NIHSS and ASPECTS; Clinical-ASPECTS Mismatch (CAM-2): between NIHSS and ASPECTS...
September 7, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28875550/outcomes-of-endovascular-treatment-for-acute-large-vessel-ischemic-stroke-more-than-6-hours-after-symptom-onset
#13
Ronan Motyer, Hong Kuan Kok, Hamed Asadi, Alan O'Hare, Paul Brennan, Sarah Power, Seamus Looby, Patrick Nicholson, David Williams, Sean Murphy, Michael D Hill, Mayank Goyal, John McManus, Paul O'Brien, John Thornton
BACKGROUND AND OBJECTIVES: Benefit from endovascular thrombectomy (EVT) for large vessel occlusion (LVO) acute ischemic stroke (AIS) is well demonstrated. Furthermore, emerging evidence supports efficacy in appropriately selected patients treated beyond current recommendations of 6 hours. We evaluated clinical outcomes in patients undergoing late EVT at our institution. METHODS: Retrospective review of prospectively collected clinical database on 355 patients who underwent EVT for LVO AIS...
September 5, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/28864601/predictive-value-of-computed-tomography-angiography-determined-occlusion-type-in-stent-retriever-thrombectomy
#14
Jang-Hyun Baek, Byung Moon Kim, Joonsang Yoo, Hyo Suk Nam, Young Dae Kim, Dong Joon Kim, Ji Hoe Heo, Oh Young Bang
BACKGROUND AND PURPOSE: We investigated whether occlusion type identified with computed tomography angiography (CTA-determined occlusion type) could predict endovascular treatment success using stent retriever (SR) thrombectomy. METHODS: Consecutive patients with stroke who underwent CTA and then endovascular treatment for intracranial large artery occlusion were retrospectively reviewed. CTA-determined occlusion type was classified into truncal-type occlusion or branching-site occlusion and compared with digital subtraction angiography-determined occlusion type during endovascular treatment...
September 1, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28863285/endovascular-treatment-of-acute-ischemic-stroke-in-octogenarians-a-meta-analysis-of-observational-studies
#15
Jin Pyeong Jeon, Sung-Eun Kim, Chul Ho Kim
OBJECTIVES: The aim of this study is to compare procedural outcomes after endovascular treatment (EVT) according to age (≥80 years vs. <80 years) and to examine treatment outcomes after mechanical thrombectomy using a stent retriever between the different age groups. PATIENTS AND METHODS: A systemic literature review of an online database of articles published from January 2004 to February 2017 was conducted. The primary outcome was successful recanalization in the final angiogram and symptomatic intracranial hemorrhage (S-ICH) after EVT...
August 29, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28856327/percutaneous-mechanical-thrombectomy-treatment-of-acute-superior-mesenteric-artery-embolism
#16
Z Zhang, X Chen, R Zhu
OBJECTIVE/BACKGROUND: This report presents a superior mesenteric artery (SMA) embolism managed by percutaneous mechanical thrombectomy (PMT). METHODS: A 61 year old woman diagnosed with SMA embolism was admitted. Emboli were found in the middle and distal segments of the SMA on abdominal computed tomography angiography. Under local anaesthesia, a 6 F Rotarex system was used to remove the emboli via left brachial artery access. Emboli were successfully removed and patency was restored to the SMA and its branches...
2017: EJVES Short Rep
https://www.readbyqxmd.com/read/28855390/tissue-selective-salvage-of-the-white-matter-by-successful-endovascular-stroke-therapy
#17
Justus F Kleine, Mirjam Kaesmacher, Benedikt Wiestler, Johannes Kaesmacher
BACKGROUND AND PURPOSE: White matter (WM) is less vulnerable to ischemia than gray matter. In ischemic stroke caused by acute large-vessel occlusion, successful recanalization might therefore sometimes selectively salvage the WM, leading to infarct patterns confined to gray matter. This study examines occurrence, determinants, and clinical significance of such effects. METHODS: Three hundred twenty-two patients with acute middle cerebral artery occlusion subjected to mechanical thrombectomy were included...
August 30, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28851788/regional-transarterial-hypothermic-infusion-in-combination-with-endovascular-thrombectomy-in-acute-ischaemic-stroke-with-cerebral-main-arterial-occlusion-protocol-to-investigate-safety-of-the-clinical-trial
#18
Kikutaro Tokairin, Toshiya Osanai, Takeo Abumiya, Ken Kazumata, Kota Ono, Kiyohiro Houkin
INTRODUCTION: Acute cerebral ischaemia with main cerebral artery occlusion requires treatment with intravenous tissue plasminogen activator administration and/or endovascular thrombectomy. However, some patients fail to recover even after recanalisation because of ischaemia/reperfusion (I/R) injury. We hypothesised that regional transarterial hypothermic infusion would be effective for patients with I/R injury. The aim of this study is to validate the safety of this procedure. METHODS AND ANALYSIS: This is a clinical exploratory study to evaluate safety of regional transarterial hypothermic infusion in combination with endovascular thrombectomy...
August 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28845108/the-role-of-endovascular-therapy-in-acute-mesenteric-ischemia
#19
Anna Maria Ierardi, Dimitrios Tsetis, Sara Sbaraini, Salvatore Alessio Angileri, Nikolaos Galanakis, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Natalie Lucchina, Gianpaolo Carrafiello
BACKGROUND: Endovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, often associated with angioplasty and stent placement, has been described in the literature. The purpose of this study was to review case series of patients with acute mesenteric ischemia treated with endovascular therapy and evaluate their outcomes. METHODS: An online review using PubMed was carried out to identify all English articles about this topic in the time interval from 2005 to 2016...
2017: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/28844922/relationship-between-clot-quality-and-microguidewire-configuration-during-endovascular-thrombectomy-for-acute-ischemic-stroke
#20
Tomotaka Ohshima, Kojiro Ishikawa, Shunsaku Goto, Taiki Yamamoto
BACKGROUND: and Purpose: Although endovascular approaches for acute ischemic stroke have been developed, the appropriate selection and sequence of device application or other treatments is unclear. If information about the clot quality can be obtained before the selection of devices, fast recanalization with a suitable device and strategy can be achieved. We studied the relationship between clot quality and the configuration of a microguidewire during endovascular thrombectomy. MATERIALS AND METHODS: This prospective single-center study included all patients who were admitted for acute ischemic stroke between October 2015 and June 2017 and underwent emergency endovascular thrombectomy...
August 24, 2017: World Neurosurgery
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