Angiographic warning of hemorrhagic transformation after stent retriever thrombectomy procedure

Vollman, Andrew T; Bruno, Charles; Dumeer, Shifali; Malone, Hani; Meyers, Philip M.

doi:10.1136/neurintsurg-2012-010607.rep

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…Decompressive hemicraniectomy is a procedure in which a large bone flap is removed to allow the brain to expand extracranially, alleviating increased intracranial pressure, and has been shown to be a life-saving procedure in the setting of complete middle cerebral artery (MCA) infarction [13][14][15][16]. Following IAT, decompressive hemicraniectomy may be used as emergent management for malignant cerebral edema and/or hemorrhage associated with the infarction [17,18]. It has been suggested that innovations in endovascular techniques may now be decreasing the incidence of hemicraniectomy [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

An Observational Study Investigating the Need for Decompressive Hemicraniectomy after Thrombectomy in Acute Ischemic Stroke of the Middle Cerebral Artery Territory

Salehani

Tabibian

Self

et al. 2020

Cureus

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Objective: The frequency incidence of decompressive hemicraniectomy following intra-arterial thrombectomy (IAT) in acute ischemic stroke (AIS) involving the middle cerebral artery (MCA) territory was assessed as a surrogate for morbidity. Methods: A single-institution retrospective chart review was conducted involving 209 consecutive patients between September 2014 and May 2017 with infarctions affecting the MCA territory and who subsequently underwent IAT. The outcomes of interest included the frequency of hemicraniectomy following IAT and the effects of intravenous tissue plasminogen activator (IV tPA) use and primary occlusion site on the Thrombolysis in Cerebral Infarction (TICI) score. Results: Thirty-one patients were excluded for infarctions not involving the MCA territory. A total of 178 patients were included in the study. Sixty-eight patients (38.6%) had infarctions of less than one-third of the MCA territory, 50 (28.4%) had infarctions between one-third and two-thirds, and 58 (33%) had infarctions involving greater than two-thirds with 54.3% suffering infarctions of the left side. Only four patients (2.2%) required a hemicraniectomy with no statistically significant association found between TICI score and hemicraniectomy (p=0.41) or between administration of IV tPA and hemicraniectomy (p=0.36). The primary occlusion site was found to influence TICI score (p=0.045). Conclusion: A very small number of patients required hemicraniectomy after IAT as compared to previously published rates in the literature. However, several factors may prevent the patient from being an appropriate hemicraniectomy candidate in the first place and the small number of these patients in this study limits statistical analysis. The variables that determine a patient's candidacy for decompressive hemicraniectomy remains multi-factorial.

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Section: Introductionmentioning

confidence: 99%

An Observational Study Investigating the Need for Decompressive Hemicraniectomy after Thrombectomy in Acute Ischemic Stroke of the Middle Cerebral Artery Territory

Salehani

Tabibian

Self

et al. 2020

Cureus

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Cerebral Hyperperfusion Syndrome After Carotid Revascularization and Acute Ischemic Stroke

Kirchoff-Torres

Bakradze

2018

Curr Pain Headache Rep

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CHS was first described after carotid revascularization but is now also reported in patients with acute ischemic stroke. Proposed criteria involve a combination of new clinical symptoms, radiographic evidence of hyperperfusion, and/or presence of intracerebral hemorrhage occurring within 30 days after the carotid or intracranial vessel manipulation. Strongest risk factors include reduced cerebral vasoreactivity, contralateral stenosis of ≥ 70%, post-procedure hypertension, and recent ipsilateral stroke. Pathophysiology is incompletely understood but is likely due to increase in cerebral blood flow and impaired cerebral autoregulation, particularly in the areas of disrupted blood-brain barrier, as well as baroreceptor dysfunction during carotid surgery. Strict blood pressure control pre-, during, and post-procedure is recommended, depending on the recanalization status of the vessel. However, there is no randomized data regarding the goal blood pressure to prevent cerebral hyperperfusion syndrome. With technical advances, carotid or intracranial vessel manipulation is increasingly common. CHS is a likely under-recognized and serious complication of carotid revascularization and intracranial thrombectomy. Awareness of and surveillance for CHS is important to reduce morbidity and mortality. Future research should focus on validation of proposed diagnostic criteria and determining optimal post-procedure hemodynamic management to prevent CHS.

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Procedure-Related Complications

Hedayat¹,

Al-Khalili²,

Binning³

et al. 2019

Complications in Neurosurgery

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Angiographic warning of hemorrhagic transformation after stent retriever thrombectomy procedure

Cited by 3 publications

References 6 publications

An Observational Study Investigating the Need for Decompressive Hemicraniectomy after Thrombectomy in Acute Ischemic Stroke of the Middle Cerebral Artery Territory

An Observational Study Investigating the Need for Decompressive Hemicraniectomy after Thrombectomy in Acute Ischemic Stroke of the Middle Cerebral Artery Territory

Cerebral Hyperperfusion Syndrome After Carotid Revascularization and Acute Ischemic Stroke

Procedure-Related Complications

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