Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices

Yeo, Leonard Ll; Jing, Mingxue; Bhogal, Pervinder; Tu, Tian Ming; Gopinathan, Anil; Yang, Chao; Tan, Benjamin Yong‐Qiang; Arnberg, Fabian; Sia, Ching‐Hui; Holmin, Staffan; Andersson, Tommy

doi:10.3389/fneur.2021.712527

Cited by 21 publications

(22 citation statements)

References 113 publications

(115 reference statements)

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“…We found that the combined aspiration stentriever in EVT may be associated with mFPE; however, our study might be underpowered, and larger studies are needed. The choice of the initial technique remains uncertain for DMVOs; however, specific devices are being developed 27 for these DMVO, and the rate of FPE will be a critical criteria to assess their efficacy and their complication rate. We did not find an association between the etiology of the clot and the probability of FPE, requiring further study as well.…”

Section: Discussionmentioning

confidence: 99%

First-Pass Effect Predicts Clinical Outcome and Infarct Growth After Thrombectomy for Distal Medium Vessel Occlusions

et al. 2022

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BACKGROUND:The first-pass effect in endovascular thrombectomy (EVT) has been associated with better clinical outcomes and decreased stroke progression in large vessel occlusion but has not been evaluated in distal, medium vessel occlusions (DMVOs). OBJECTIVE: To assess the impact on clinical outcome and stroke progression of the modified first-pass effect (defined as a successful first-pass [modified Thrombolysis In Cerebral Infarction 2b/2c/3] revascularization) in patients who underwent EVT for a primary DMVOs. METHODS: We collected data from consecutive patients who underwent EVT for a primary DMVO at a single large academic center. We compared the rate of good clinical outcome (modified Rankin Scale of 0-2 at 3 months) and stroke progression between patients who demonstrated modified first-pass effect (mFPE) vs those who did not (no-mFPE). RESULTS: Between January 2018 and January 2021, we included 60 patients who underwent EVT for an acute ischemic stroke with a primary DMVO. Overall, mFPE was achieved in 32% (19/60) of EVTs. The mFPE was associated with a higher rate of good clinical outcome compared with no-mFPE (89% vs 46%, odds ratio = 16. 04 [2.23-115.39], P = .006 in multivariate analysis). Final stroke volume was less among mFPE patients (6.9 mL [4.7-13.6] vs 23 mL [14.6-47], P = .001) as was stroke progression (6.8 mL [4-12.1] vs 17.8 mL [8.1-34.9], P = .016). The mFPE was still associated with higher rates of good clinical outcome when compared with patients reaching an modified Thrombolysis In Cerebral Infarction score ≥2b in more than 1 pass (89% vs 53%; odds ratio = 7.37 [1.43-38.08], P = .017). CONCLUSION: The mFPE may be associated with better clinical outcomes and lower stroke progression in DMVO.

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Section: Discussionmentioning

confidence: 99%

First-Pass Effect Predicts Clinical Outcome and Infarct Growth After Thrombectomy for Distal Medium Vessel Occlusions

et al. 2022

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“…The advantages of endovascular treatment are beyond doubt, as MTB improves recanalization rates in AIS patients and decreases associated morbidity and mortality 29 , 30 . It is becoming recognized that the use of stent retrievers is associated with vascular injury 31 – 34 .…”

Section: Discussionmentioning

confidence: 99%

A high resolution scanning electron microscopy analysis of intracranial thrombi embedded along the stent retrievers

LaGrange

Bernava²,

Reymond

et al. 2022

Sci Rep

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Endovascular treatment with stent retriever thrombectomy is a major advancement in the standard of care in acute ischemic stroke (AIS). The modalities through which thrombi embed along stent retriever following mechanical thrombectomy (MTB) have not yet been elucidated. Using scanning electron microscopy (SEM), we analyzed the appearance of thrombi retrieved by MTB from AIS patients, when embedded into the stent retriever. We observed that the organization and structural compactness vary for compositionally different thrombi. The modalities of attachment onto the stent vary according to thrombus composition and organization.

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“…To treat AIS caused by intracranial artery obstruction, multimodal treatments, including IV tissue plasminogen activator (t-PA) injection and endovascular treatment techniques, have been developed 10. Among several methods of endovascular treatment, MT using aspiration or a stent retriever has been validated in several randomized controlled trials for its effectiveness in treating AIS.…”

Section: Discussionmentioning

confidence: 99%

“…Not only is it ineffective, but there is also a concern that it may affect the patient’s functional outcome by taking time while performing MT. Recently, there has been a move to nominate a single pass reperfusion standard as the target to achieve during MT 10 19. Furthermore, fewer thrombectomy attempts before rescue stenting were associated with better functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

Angiographic tapering sign as a surrogate marker for large vessel occlusion due to intracranial atherosclerotic stenosis and its clinical implication: a retrospective matched case–control study

Cho

Son

Choi

et al. 2022

J NeuroIntervent Surg

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BackgroundThe purpose of this study was to investigate whether the initial DSA appearance of the occlusion during mechanical thrombectomy (MT) can help distinguish the nature of the underlying lesion and predict radiological and clinical outcomes.MethodsWe retrospectively reviewed cases of patients with acute ischemic stroke who underwent MT for anterior circulation occlusion between March 2017 and February 2020. Underlying intracranial atherosclerotic stenosis (ICAS) was determined based on the presence of fixed stenosis after endovascular treatment. Patients were categorized based on the appearance of the occlusion observed in the initial DSA as tapering sign (+) or (−) groups. We performed 1:2 propensity score matching to establish a proper control group among the tapering sign (−) group. We analyzed and compared baseline characteristics and clinical outcomes between the two groups.ResultsA total of 293 patients (tapering sign (+), n=47; tapering sign (−), n=246) were included in the analysis. The procedure time of MT was significantly longer for the tapering sign (+) group, and the successful recanalization rate after MT was significantly lower in the tapering sign (+) group than in the tapering sign (−) group. Logistic regression showed that ICAS-related occlusion was strongly associated with a positive angiographic tapering sign, and the angiographic tapering sign was a negative factor for the first-pass effect during MT. However, a 3-month good functional outcome was not significantly associated with the angiographic tapering sign.ConclusionsThe tapering sign on the initial DSA could be a surrogate marker for ICAS-related occlusion and procedural difficulty. However, its clinical significance remains unclear.

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Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices

Cited by 21 publications

References 113 publications

First-Pass Effect Predicts Clinical Outcome and Infarct Growth After Thrombectomy for Distal Medium Vessel Occlusions

First-Pass Effect Predicts Clinical Outcome and Infarct Growth After Thrombectomy for Distal Medium Vessel Occlusions

A high resolution scanning electron microscopy analysis of intracranial thrombi embedded along the stent retrievers

Angiographic tapering sign as a surrogate marker for large vessel occlusion due to intracranial atherosclerotic stenosis and its clinical implication: a retrospective matched case–control study

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