A survey of neurointerventionalists on thrombectomy practices for emergent large vessel occlusions

Fargen, Kyle M; Arthur, Adam S; Spiotta, Alejandro M; Lena, Jonathan; Chaudry, Imran; Turner, Raymond D; Turk, Aquilla S

doi:10.1136/neurintsurg-2015-012235

Cited by 41 publications

(26 citation statements)

References 22 publications

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“…As mentioned above, another common approach is to perform stent-retriever thrombectomy through an IMC using added local aspiration (“pinning technique”) [30,40]. By combining these two methods, this technique increases the retrieval force that can be generated on the thrombus as well as diminishes the line-of-force challenge of an S-configuration that may be formed by the upper carotid siphon and M1 segment (Figure 7).…”

Section: Challenges To Procedural Successmentioning

confidence: 99%

Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success

Yoo¹,

2017

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The overwhelming clinical benefit of intra-arterial stroke therapy owes to the major advance in revascularization brought on by the current generation of thrombectomy devices. Nevertheless, there remains a sizeable proportion of patients for whom substantial reperfusion cannot be achieved or is achieved too late. This article addresses the persistent challenges that face neurointerventionists and reviews technical refinements that may help to mitigate these obstacles to procedural success. Insights from in vitro modeling and clinical research are organized around a conceptual framework that examines the interaction between the device, the thrombus and the vessel wall.

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Section: Challenges To Procedural Successmentioning

confidence: 99%

Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success

Yoo¹,

2017

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“…Currently, there is no consensus whether this procedure should be performed under a specific form of anaesthesia, as previous studies have provided conflicting evidence whether general anaesthesia (GA), conscious sedation or local anaesthesia lead to better functional neurological outcome [2][3][4]. Therefore, all three methods are frequently used in clinical routine [5].…”

Section: Introductionmentioning

confidence: 99%

Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!

Fandler‐Höfler

Heschl

Kneihsl

et al. 2020

Euro J of Neurology

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Background and purpose The aim was to investigate the clinical impact of the duration of artificial ventilation in stroke patients receiving mechanical thrombectomy (MT) under general anaesthesia. Methods All consecutive ischaemic stroke patients who had been treated at our centre with MT for anterior circulation large vessel occlusion under general anaesthesia were identified over an 8‐year period. Ventilation time was analysed as a continuous variable and patients were grouped into extubation within 6 h (‘early’), 6–24 h (‘delayed’) and >24 h (‘late’). Favourable outcome was defined as modified Rankin Scale scores of 0–2 at 3 months post‐stroke. Pneumonia rate and reasons for prolonged ventilation were also assessed. Results Amongst 447 MT patients (mean age 69.1 ± 13.3 years, 50.1% female), the median ventilation time was 3 h. 188 (42.6%) patients had a favourable 3‐month outcome, which correlated with shorter ventilation time (Spearman’s rho 0.39, P < 0.001). In patients extubated within 24 h, early compared to delayed extubation was associated with improved outcome (odds ratio 2.40, 95% confidence interval 1.53–3.76, P < 0.001). This was confirmed in multivariable analysis (P = 0.01). A longer ventilation time was associated with a higher rate of pneumonia during neurointensive care unit/stroke unit stay (early/delayed/late extubation: 9.6%/20.6%/27.7%, P < 0.01). Whilst stroke‐associated complications represented the most common reasons for late extubation (>24 h), delayed extubation (6–24 h) was associated with admission outside of core working hours (P < 0.001). Conclusions Prolonged ventilation time after stroke thrombectomy independently predicts unfavourable outcome at 3 months and is associated with increased pneumonia rates. Therefore, extubation should be performed as early as safely possible.

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“…The positive results from these trials led the American Heart Association/American Stroke Association to update societal guidelines and provide a Class 1, level of evidence A recommendation that thrombectomy be pursued in patients with ELVO who meet the appropriate criteria 8. Subsequently, a recent national survey of physicians who perform thrombectomy reported increasing procedural volumes with many reporting increased aggressiveness in patient selection since the publication of these trials 9. The proven benefit of mechanical thrombectomy for patients with ELVO has led to renewed efforts to optimize logistics to improve patient outcomes, but also debate regarding who should be performing these procedures and in what hospital settings.…”

Section: Introductionmentioning

confidence: 99%