Endovascular thrombectomy in the setting of aortic dissection

Reznik, Michael; Espinosa-Morales, Aixa Damaris; Jumaa, Mouhammad A.; Zaidi, Syed; Ducruet, Andrew F; Jadhav, Ashutosh P.

doi:10.1136/neurintsurg-2016-012397

Cited by 20 publications

(17 citation statements)

References 12 publications

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“…Complex vascular anatomy including aortic arch anatomy, vessel elongation, vessel tortuosity, aneurysmal disease, dissecting disease, peripheral vascular disease, previous vascular surgery and patient height make TFA time consuming and difficult, if not impossible [2][3][4]. Oftentimes, the delay in gaining access to attempt thrombectomy is due to arch tortuosity [17][18][19] or conditions that increase the risk of intra-/post-procedural morbidity such as existing aortic dissection [4].…”

Section: Discussionmentioning

confidence: 99%

“…As cerebral angiography has progressed over the past few decades, devices have become more pliable and smaller, and clinicians are no longer restricted to TFA. The trans-radial technique has been well validated in the cardiac literature, with trans-radial access (TRA) for both coronary artery diagnostic and interventional procedures and carotid artery stent procedures as a preferred method or equal alternative [4].…”

Section: Transradial Accessmentioning

confidence: 99%

See 1 more Smart Citation

Trans-Carotid and Trans-Radial Access for Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Scoco¹,

Addepalli²,

Zhu³

et al. 2020

Cureus

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We aim to demonstrate the safety and effectiveness of extra-femoral endovascular access for mechanical thrombectomy for acute ischemic stroke patients whose vascular anatomy precludes safe or maneuverable trans-femoral access. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct a systematic review and meta-analysis with articles published until March 2018. The search protocol, including research questions and inclusion and exclusion criteria, were developed a priori. Our own institutional retrospective data were included in the cohort of case series. Results Eleven studies including 51 patients were included. Age ranged from 4th to 10th decade of life (average: 9.3rd decade) and 40.1% received IV tissue plasminogen activator. Initial National Institutes of Health Stroke Scale (NIHSS) score ranged from 1 to 36, (average: 17.6). Of the 51 patients, 39 (76%) patients suffered from anterior circulation large vessel occlusions versus 12 (24%) from posterior circulation occlusions. Site of access included 26 (51%) radial artery punctures, 23 (45%) direct percutaneous cervical carotid punctures, 1 brachial artery puncture, and 1 direct extradural vertebral artery puncture. Technical success was achieved in 43/51 (84%) of patients. The average modified Rankin Scale at discharge was 2.93 (n=26). There were no complications in 25 patients who underwent radial arterial access. Two (7.4%) of 27 cervical access patients developed hematoma.

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Section: Discussionmentioning

confidence: 99%

Section: Transradial Accessmentioning

confidence: 99%

Trans-Carotid and Trans-Radial Access for Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Scoco¹,

Addepalli²,

Zhu³

et al. 2020

Cureus

View full text Add to dashboard Cite

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“…Observational data suggest that TRA offers more advantages in neuroendovascular procedures in patients with complex iliofemoral anatomy, pregnant patients, patients with aortic dissection, and when the target vessel is in the vertebrobasilar system 13–16. This was reflected in our study by the high success rate of interventional cases with the target vessel in the posterior circulation.…”

Section: Discussionmentioning

confidence: 54%

Fast-track incorporation of the transradial approach in endovascular neurointervention

Almallouhi

Leary

Wessell

et al. 2019

J NeuroIntervent Surg

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BackgroundThe transradial approach as a frontline approach is a novel technique in neuroendovascular procedures. In this study we aim to present our early experience with full transition to transradial access as the first-line approach for neuroendovascular procedures.MethodsWe prospectively collected data on the first 100 consecutive patients who underwent a diagnostic or interventional neuroendovascular procedure using the transradial approach at our institution between March 22 and April 30, 2019. Baseline characteristics were collected in addition to the type of procedure, access site, catheters and wires used, complications, and whether there was crossover to transfemoral access.ResultsTransradial access was attempted in 121 cases and 91 cases were completed successfully (72 diagnostic procedures and 19 interventional procedures). Mean (SD) age was 56.8 (14.7) years, 54.9% (50/91) underwent the procedure in the outpatient setting, and 60.4% (55/91) were women. Seven patients had minor immediate complications related to the radial access. Interventional procedures successfully performed included aneurysm embolization (ruptured (n=3) and unruptured (n=8)), tumor embolization (n=2), cervical internal carotid artery stenting (n=2), balloon occlusion test (n=1), vertebral artery sacrifice (n=1), and arteriovenous malformation embolization (n=2).ConclusionIn this early experience, full transition to the transradial approach as the frontline approach is feasible with a low complication rate for both diagnostic and interventional neuroendovascular procedures.

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“…However, there are limited data on endovascular therapy for LVO stroke in the setting of AD. One case series from 2017 identified three patients with proximal right MCA occlusions in the setting of AD, all of which underwent successful recanalization with endovascular therapy and experienced improved clinical neurologic status [16]. However, two of these patients were presenting with chronic ADs that were status-post graft repair and the other had an acute type B dissection.…”

Section: Discussionmentioning

confidence: 99%

Large Vessel Occlusion Stroke Secondary to Acute Aortic Dissection

Pawlukiewicz

Long

Mehta³

2020

Cureus

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Aortic dissection carries a high mortality of up to 40% at the time of initial dissection and an additional 1% per hour the dissection is untreated. Patients with acute aortic dissection most commonly present with chest or back pain. Less frequently, it manifests without pain with predominant neurologic symptoms secondary to an acute stroke. We present the case of a 53year-old male presenting with acute onset aphasia and right-sided weakness. Incidentally, CT angiography of his neck revealed a carotid artery dissection, which was found an extension of a Stanford type A acute aortic dissection resulting in a large vessel occlusion stroke. The patient's concomitant pathologies resulted in uncertainty as to the priority of management between the interventional neurology and cardiothoracic surgery services, ultimately resulting in the transfer of the patient to an aorta specialist at an outside facility. This case highlights several areas of difficulty in the management of patients with presenting with both large vessel occlusion stroke and acute aortic dissection and the need for consideration of acute aortic dissection in patients presenting with symptoms consistent with large vessel occlusion stroke. Optimal blood pressure control is unknown, as is the ideal timing of aortic repair and the potential for endovascular therapy for large vessel occlusion stroke in the setting of acute aortic dissection. Emergency physicians must rapidly engage with neurology, interventional neurology, and cardiothoracic surgery to determine appropriate interventions and timing of operative repair. The emergency physician must consider acute aortic dissection in patients presenting with signs and symptoms concerning for large vessel occlusion stroke, even if they have no complaint of chest pain, as administration of thrombolytics in these patients may be deadly.

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Endovascular thrombectomy in the setting of aortic dissection

Cited by 20 publications

References 12 publications

Trans-Carotid and Trans-Radial Access for Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Trans-Carotid and Trans-Radial Access for Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Fast-track incorporation of the transradial approach in endovascular neurointervention

Large Vessel Occlusion Stroke Secondary to Acute Aortic Dissection

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