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endovascular thrombectomy

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https://www.readbyqxmd.com/read/29352059/increased-blood-pressure-variability-after-endovascular-thrombectomy-for-acute-stroke-is-associated-with-worse-clinical-outcome
#1
Alicia E Bennett, Michael J Wilder, J Scott McNally, Jana J Wold, Gregory J Stoddard, Jennifer J Majersik, Safdar Ansari, Adam de Havenon
BACKGROUND AND PURPOSE: Blood pressure variability has been found to contribute to worse outcomes after intravenous tissue plasminogen activator, but the association has not been established after intra-arterial therapies. METHODS: We retrospectively reviewed patients with an ischemic stroke treated with intra-arterial therapies from 2005 to 2015. Blood pressure variability was measured as standard deviation (SD), coefficient of variation (CV), and successive variation (SV)...
January 19, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29340574/effect-of-general-anesthesia-and-conscious-sedation-during-endovascular-therapy-on-infarct-growth-and-clinical-outcomes-in-acute-ischemic-stroke-a-randomized-clinical-trial
#2
Claus Z Simonsen, Albert J Yoo, Leif H Sørensen, Niels Juul, Søren P Johnsen, Grethe Andersen, Mads Rasmussen
Importance: Endovascular therapy (EVT) is the standard of care for select patients who had a stroke caused by a large vessel occlusion in the anterior circulation, but there is uncertainty regarding the optimal anesthetic approach during EVT. Observational studies suggest that general anesthesia (GA) is associated with worse outcomes compared with conscious sedation (CS). Objective: To examine the effect of type of anesthesia during EVT on infarct growth and clinical outcome...
January 16, 2018: JAMA Neurology
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
#3
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
#4
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
#5
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/29311286/endovascular-thrombectomy-in-acute-ischemic-stroke
#6
REVIEW
Panagiotis Papanagiotou, George Ntaios
Despite several effective strategies of stroke prevention, the stroke epidemic still constitutes the leading cause of permanent disability. The recent series of well-designed, convincingly-positive randomized controlled trials of endovascular thrombectomy in stroke patients with large vessel occlusion launched a paradigm shift and a new era in acute stroke management. The present review provides an overview of the technical aspects of the procedure, discusses patient selection criteria, summarizes the current evidence from randomized trials about its efficacy and safety, and explores its implications in the organization of acute stroke care...
January 2018: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29303110/-role-of-thrombectomy-in-acute-ischemic-stroke
#7
Albert Pall Sigurdsson
This article discusses endovascular thrombectomy in acute ischemic stroke. This treatment is vascular medicine's most significant leap in years. This treatment is complicated, and various technical aspects are discussed. Close cooperation is required between different specialties since patient selection for treatment is complex. Interventionists need close collaboration with stroke neurologists. Government needs to be involved as this treatment mandates structural changes which will incur more manpower and financial resources...
January 2018: Læknablađiđ
https://www.readbyqxmd.com/read/29298860/pre-hospital-detection-of-acute-ischemic-stroke-secondary-to-emergent-large-vessel-occlusion-lessons-learned-from-electrocardiogram-and-acute-myocardial-infarction
#8
REVIEW
Alexander G Chartrain, Christopher Paul Kellner, J Mocco
Currently, there is no device capable of detecting acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO) in the pre-hospital setting. The inability to reliably identify patients that would benefit from primary treatment with endovascular thrombectomy remains an important limitation to optimizing emergency medical services (EMS) triage models and time-to-treatment. Several clinical grading scales that rely solely on clinical examination have been proposed and have demonstrated only moderate predictive ability for ELVO...
January 3, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29297717/cincinnati-prehospital-stroke-scale-can-identify-large-vessel-occlusion-stroke
#9
Christopher T Richards, Ryan Huebinger, Katie L Tataris, Joseph M Weber, Laura Eggers, Eddie Markul, Leslee Stein-Spencer, Kenneth S Pearlman, Jane L Holl, Shyam Prabhakaran
OBJECTIVE: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), a simple assessment tool currently used by emergency medical services (EMS) providers, can be used to identify LVO. METHODS: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29297102/endovascular-stroke-treatment-on-single-plane-vs-bi-plane-angiography-suites-technical-considerations-and-evaluation-of-treatment-success
#10
Benjamin Friedrich, Christian Maegerlein, Donald Lobsien, Sebastian Mönch, Maria Berndt, Dennis Hedderich, Silke Wunderlich, Dominik Michalski, Manuel Lehm, Tobias Boeckh-Behrens, Claus Zimmer, Kornelia Kreiser
INTRODUCTION: Endovascular stroke therapy is mostly available in comprehensive stroke centers with state of the art bi-plane angiography suites. The aim of the present study was to analyze if it is justifiable to treat patients with alternative x‑ray machines in the case of capacity constraints, or if it is mandatory to refer patients in such cases. Secondly, we wanted to draw conclusions for the feasibility of different logistic approaches in stroke treatment, such as a "helistroke" concept...
January 2, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29296623/clarion-call-for-histopathological-clot-analysis-in-cryptogenic-ischemic-stroke-implications-for-diagnosis-and-treatment
#11
Sonu Bhaskar, Dennis Cordato, Cecilia Cappelen-Smith, Andrew Cheung, David Ledingham, David Celermajer, Christopher Levi
Diagnosis, treatment, and secondary management of cryptogenic stroke patients pose a formidable challenge. The scenario is further complicated in patients with native and prosthetic valvular heart disease. We present a case study of a 36-year-old man who received intravenous thrombolysis (IV-tPA) and endovascular thrombectomy (EVT) for presumed "cryptogenic" complete middle cerebral artery infarction who made a surprisingly excellent clinical recovery despite poor baseline and postintervention neuroimaging...
December 2017: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/29288212/cerebral-arterial-gas-embolism-from-attempted-mechanical-thrombectomy-recovery-following-hyperbaric-oxygen-therapy
#12
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
#13
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
#14
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/29273282/hemodialysis-access-maintenance-in-the-medicare-population-an-analysis-over-a-decade-of-trends-by-provider-specialty-and-site-of-service
#15
Osman Ahmed, Ketan Patel, Rana Rabei, Mikin V Patel, Michael Ginsburg, Bishir Clayton, Bulent Arslan
PURPOSE: To evaluate annual national trends in hemodialysis access maintenance procedures in the Medicare population by specialty and setting. METHODS: Medicare Physician Supplier Procedure Summary Master Files between 2005 and 2015 were analyzed for procedure codes of hemodialysis access angiography and percutaneous thrombectomy. Using physician specialty codes, component procedure volume for endovascular services were queried for radiology, medicine, and surgery...
December 19, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29262429/blood-pressure-management-for-acute-ischemic-and-hemorrhagic-stroke-the-evidence
#16
Sang-Bae Ko, Byung-Woo Yoon
Hypertension is the most common modifiable risk factor for stroke (both ischemic and hemorrhagic types). In the hyperacute phase, a majority of patients shows an elevated blood pressure (BP) at the time of presentation because of sympathetic hyperactivity or a physiological response to tissue ischemia. Therefore, BP may decrease spontaneously in a few hours and may drop further when complete recanalization is achieved. In stroke guidelines, an elevated BP is usually left untreated up to a systolic BP (SBP) of 220 mm Hg and a diastolic BP of 120 mm Hg...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29259124/referral-facility-ct-perfusion-prior-to-inter-facility-transfer-in-patients-undergoing-mechanical-thrombectomy
#17
Amin Aghaebrahim, Eric Sauvageau, Pedro Aguilar-Salinas, Gustavo Cortez, Roberta Santos, Ricardo A Hanel
BACKGROUND AND PURPOSE: The use of CT perfusion (CTP) imaging at a referring hospital is feasible and may shorten the door to puncture time for patients with acute ischemic stroke. METHODS: We conducted a single center retrospective review of a prospectively maintained database of consecutive ischemic stroke patients transferred to our center for consideration of endovascular therapy. Patients were divided into two groups. Group 1 consisted of patients transferred from facilities where CTP (using automated RAPID software) was routinely performed and group 2 consisted of patients transferred from facilities that did not perform perfusion imaging...
December 19, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29251337/-analysis-of-the-direct-costs-associated-with-mechanical-thrombectomy-and-intravenous-fibrinolysis-in-the-hospital-universitario-central-de-asturias
#18
P Vega-Valdes, E Murias-Quintana, E Morales-Santos, H Cigarran-Sexto, D Larrosa-Campo, L Benavente-Fernandez, M Gonzalez-Delgado, S Calleja-Puerta, F Garcia-Arias
INTRODUCTION: The increase in the indications for mechanical thrombectomy and its implementation in Spanish hospitals makes it necessary to determine the costs related to this treatment so as to be able to streamline economic resources and allow them to be distributed in an appropriate manner. AIMS: To analyse the direct costs associated with patients with acute ischaemic stroke who are treated with intravenous fibrinolysis and with mechanical thrombectomy, and to assess the effectiveness and safety of both treatments during the first 90 days of progression in the Hospital Universitario Central de Asturias...
January 1, 2018: Revista de Neurologia
https://www.readbyqxmd.com/read/29250029/ischemic-strokes-due-to-large-vessel-occlusions-contribute-disproportionately-to-stroke-related-dependence-and-death-a-review
#19
REVIEW
Konark Malhotra, Jeffrey Gornbein, Jeffrey L Saver
Background: Since large-vessel occlusion (LVO)-related acute ischemic strokes (AIS) are associated with more severe deficits, we hypothesize that the endovascular thrombectomy (ET) may disproportionately benefit stroke-related dependence and death. Methods: To delineate LVO-AIS impact, systematic search identified studies measuring dependence or death [modified Rankin Scale (mRS) 3-6] or mortality following ischemic stroke among consecutive patients presenting with both LVO and non-LVO events within 24 h of symptom onset...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29240054/-endovascular-interventions-in-treatment-of-patients-with-acute-impairment-of-mesenteric-blood-circulation
#20
A I Khripun, A V Salikov, A B Mironkov, A D Priamikov
The authors share herein their experience of treating a total of eight patients with acute impairment of mesenteric blood circulation, describing both technical and instrumental peculiarities of interventions on the superior mesenteric artery. Technical success defined as restoration of the main blood flow through the superior mesenteric artery was achieved in seven (87.5%) patients. Of these, two (25%) patients required laparotomy and intestinal resection, with the scope of resection being significantly reduced in one case after endovascular thrombectomy...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
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