Endovascular Treatment

Compagne, Kars C.J.; Sluijs, P Matthijs van der; Wijngaard, Ido R. van den; Roozenbeek, Bob; Mulder, Maxim J.H.L.; Zwam, Wim H. van; Emmer, Bart J.; Majoie, Charles B. L. M.; Yoo, Albert J.; Nijeholt, Geert J. Lycklama à; Lingsma, Hester F.; Dippel, Diederik W.J.; Lugt, Aad van der; Es, Adriaan C G M van; Jansen, Ivo G. H.; Goldhoorn, Robert‐Jan B.; Coutinho, Jonathan M.; Wermer, Marieke J.H.; Staals, Julie; Bruijn, Sebastiaan F. de; Dijk, Lukas C. van; Dijk, Ewoud J. van; Boogaarts, Hieronymus D.; Kort, Paul L.M. de; Peluso, Jo J.P.; Berg, Jan S.P. van den; Hasselt, Boudewijn A.A.M. van; Aerden, Leo A.M.; Dallinga, René J.; Uyttenboogaart, Maarten; Eshghi, Omid; Schreuder, Tobien H.C.M.L.; Heijboer, Roel J.J.; Keizer, Koos; Hertog, Heleen M. den; Sturm, Emiel J.C.; Walderveen, Marianne A.A. van; Sprengers, Marieke E.S.; Jenniskens, Sjoerd F.M.; Berg, René van den; Beenen, Ludo F. M.; Postma, Alida A.; Roosendaal, Stefan D.; Kallen, Bas F.W. van der; Yo, Lonneke S.F.; Bot, Joost; Doormaal, Pieter‐Jan van; Roos, Yvo B.W.E.M.; Boiten, Jelis; Vos, Jan Albert; Schonewille, Wouter J.; Martens, Jasper M.; Worp, H. Bart van der; Lo, Rob H.; Oostenbrugge, Robert J. van; Hofmeijer, Jeannette; Flach, H. Zwenneke; Ghannouti, Naziha el; Sterrenberg, Martin; Puppels, Corina; Pellikaan, Wilma; Sprengers, Rita; Meris, Joke de; Vermeulen, Tamara; Geerlings, Annet; Vemde, Gina van; Simons, Tiny; Rijswijk, Cathelijn van; Messchendorp, Gert; Bongenaar, Hester; Bodde, Karin; Kleijn, Sandra; Lodico, Jasmijn; Droste, Hanneke; Wollaert, Maureen; Jeurrissen, D.; Bos, Ernas; Drabbe, Yvonne; Elfrink, Marjan; Zweedijk, Berber; Khalilzada, Mostafa; Venema, Esmée; Chalos, Vicky; Geuskens, Ralph R.; Straaten, Tim van; Ergezen, Saliha; Harmsma, Roger R.M.; Muijres, Daan; Jong, Anouk de; Hinseveld, Wouter; Berkhemer, Olvert A.; Boers, Anna M. M.; Huguet, J F; Groot, Paul F. C.; Mens, Marieke A.; Kranendonk, Katinka R. van; Treurniet, Kilian M.; Kappelhof, Manon; Tolhuijsen, Manon L.; Alves, Heitor

doi:10.1161/strokeaha.118.023117

Cited by 27 publications

(5 citation statements)

References 26 publications

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“…Our study demonstrates that prehospital stroke scales are most sensitive in detecting ICA-T occlusions and least sensitive in detecting M2 occlusions. Since the treatment of isolated M2 occlusions is considered effective and safe, 22 , 23 it is important to realise that a considerable proportion of treatable LVO patients will be missed.…”

Section: Discussionmentioning

confidence: 99%

“… 21 Patients with a proximal occlusion usually present with high NIHSS scores, but more distal occlusion locations may be associated with lower NIHSS scores. 22 , 23 The sensitivity of prehospital stroke scales in detecting different occlusion locations in LVO is unknown. Because all patients treated with EVT in the Netherlands are registered, we had the opportunity to explore this in a large dataset of patients treated with EVT.…”

Section: Introductionmentioning

confidence: 99%

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Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

Duvekot

Venema

Lingsma

et al. 2021

European Stroke Journal

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Introduction Prehospital stroke scales have been proposed to identify stroke patients with a large vessel occlusion to allow direct transport to an intervention centre capable of endovascular treatment (EVT). It is unclear whether these scales are able to detect not only proximal, but also more distal treatable occlusions. Our aim was to assess the sensitivity of prehospital stroke scales for different EVT-eligible occlusion locations in the anterior circulation. Patients and methods The MR CLEAN Registry is a prospective, observational study in all centres that perform EVT in the Netherlands. We included adult patients with an anterior circulation stroke treated between March 2014 and November 2017. We used National Institutes of Health Stroke Scale scores at admission to reconstruct previously published prehospital stroke scales. We compared the sensitivity of each scale for different occlusion locations. Occlusions were assessed with CT angiography by an imaging core laboratory blinded to clinical findings. Results We included 3021 patients for the analysis of 14 scales. All scales had the highest sensitivity to detect internal carotid artery terminus occlusions (ranging from 0.21 to 0.97) and lowest for occlusions of the M2 segment (0.08 to 0.84, p-values < 0.001). Discussion and conclusion: Although prehospital stroke scales are generally sensitive for proximal large vessel occlusions, they are less sensitive to detect more distal occlusions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

Duvekot

Venema

Lingsma

et al. 2021

European Stroke Journal

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“…M2 caliber dominance was considered present if the M2 branch had a larger diameter than the other branches on digital subtraction angiography or if the perfusion defect associated with the occluded M2 branch was larger than 50% of the MCA territory. Only when the diameters of both the inferior and superior branches were equal and the associated perfusion defect was <50% of the MCA territory, were the branches considered co-dominant ( 22 ). M2 caliber dominance can be complicated to determine with initial angiograms, such as when the vessel is small but secondary to occlusion.…”

Section: Methodsmentioning

confidence: 99%

Blind Exchange With Mini-Pinning Technique Using the Tron Stent Retriever for Middle Cerebral Artery M2 Occlusion Thrombectomy in Acute Ischemic Stroke

et al. 2021

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Introduction: The usefulness of the blind exchange with mini-pinning (BEMP) technique has recently been reported for mechanical thrombectomy in patients with stroke owing to medium vessel occlusion (MeVO). The Tron stent retriever can be delivered and deployed through a 0.0165-inch microcatheter. This retriever has potential as an effective and safe treatment for acute ischemic stroke (AIS) due to occlusion of the M2 segment of the middle cerebral artery (MCA). Here, we report the outcomes of the BEMP technique using Tron stent retrievers for M2 occlusion thrombectomy.Methods: Consecutive patients with AIS owing to M2 occlusion who underwent the BEMP technique using 2 × 15-mm or 4 × 20-mm Tron stent retrievers were included. The technique involves deploying a Tron stent retriever through a 0.0165-inch microcatheter, followed by microcatheter removal and blind navigation of a 3MAX or 4MAX aspiration catheter over the bare Tron delivery wire until the aspiration catheter reaches the clot. A Tron stent retriever is inserted into the aspiration catheter like a cork and subsequently pulled as a unit. We assessed procedural outcomes [first-pass expanded thrombolysis in cerebral infarction (eTICI) score 2c/3 and 2b/2c/3], safety outcomes [symptomatic intracranial hemorrhage (sICH)], and clinical outcomes (good outcome rate defined as modified Rankin Scale score 0–2 at 90 days and mortality at 90 days).Results: Eighteen M2 vessels were treated in 15 patients (six female, median age: 80 years, and median National Institutes of Health Stroke Scale score: 18). The BEMP technique was performed successfully in all cases. Whether to use a 3MAX or 4MAX catheter was determined by considering one of the following target vessels: dominant, non-dominant, or co-dominant M2 (3MAX, n = 9; 4MAX, n = 9). The first-pass eTICI 2c/3 and 2b/2c/3 rates were 47 (7/15) and 60% (9/15), respectively; sICH was not observed. Seven patients (47%) achieved good outcomes, and one patient (7%) died within 90 days.Conclusions: The Tron stent retriever was safely and effectively used in the BEMP technique for acute MCA M2 occlusion and can be combined with a 0.0165-inch microcatheter, which may be useful for treating MeVO, in general.

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“…Crockett et al made an interesting attempt in this regard: in addition to the "regular" TICI, they used a modified TICI, which focused solely on the territory affected by the MeVO, with a scoring system identical to the standard TICI system (1, 2a, 2b, 2c, 3). 36 Figure 1 shows a proposed modified eTICI scoring system for 27 (+DWI if symptom onset unknown) Atchaneeyasakul et al 2020 46 Compagne et al 2019 23 Qureshi et al 2017 48 Sarraj et al 2016 49 Menon et al 2019 24 (CTP/MRI was available in some patients) Coutinho et al 2016 50 Bhogal et al 2017 52 (either NCCT+CTA or MRI) De Castro Afonso et al 2019 26 Grieb et al 2019 30 ► Wide availability ► Inexpensive ► Fast ► Robust against patient motion ► No post-processing needed ► Option to use multiphase CTA, including color-coded time-variant mCTA maps and mCTA-derived CTP-like maps 14 58 ► If single-phase CTA is used MeVOs may be missed 59 ► Little information about collateral status if single-phase CTA is used ► Current ASPECTS thresholds for LVO EVT are probably not optimal for MeVO EVT ► ASPECTS does not capture ischemic changes in ACA and PCA MeVO stroke NCCT+CTA + CTP Haussen et al 2020a 34 Jiang et al 2019 25 Vargas et al 2017 37 Navia et al 2016 29 Menon et al 2019 24 (CTP/MRI was available in some patients) Coutinho et al 2016 50 (CTP/MRI was available in some patients) Grossberg et al 2018 45 Altenbernd et al 2018 28 The key difference to the conventional eTICI score is hereby the "denominator", that is, only the affected territory downstream to the MeVO, rather than the entire middle cerebral artery territory, is used as a comparator.…”

Section: Angiographic Outcomesmentioning

confidence: 99%

A review of endovascular treatment for medium vessel occlusion stroke

Ospel

Goyal

2021

J NeuroIntervent Surg

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Medium-vessel occlusions (MeVOs), that is, occlusions of the M2/3 middle cerebral artery, A2/3 anterior cerebral artery, and P2/3 posterior cerebral artery segments, account for 25%–40% of all acute ischemic stroke cases. Clinical outcomes of MeVO stroke with intravenous thrombolysis, which is the current standard of care, are moderate at best. With improving imaging technologies and a growing literature, MeVOs are increasingly recognized as a target for endovascular treatment (EVT). For the time being, there is limited but promising evidence for the safety and efficacy of MeVO EVT, and many neurointerventionists are already routinely offering EVT for MeVO stroke, despite the lack of clear guideline recommendations. In this article, we review the evidence on endovascular treatment for MeVO stroke and summarize the available literature on current imaging strategies, commonly used EVT selection criteria, EVT techniques, and outcome assessment for MeVO stroke.

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Endovascular Treatment

Abstract: Supplemental Digital Content is available in the text.

Cited by 27 publications

References 26 publications

Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

Blind Exchange With Mini-Pinning Technique Using the Tron Stent Retriever for Middle Cerebral Artery M2 Occlusion Thrombectomy in Acute Ischemic Stroke

A review of endovascular treatment for medium vessel occlusion stroke

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