Functional Outcome After Mechanical Thrombectomy with or without Previous Thrombolysis

Machado, Manuel; Alves, Marta; Fior, Alberto; Fragata, Isabel; Papoila, Ana Luísa; Reis, João Carlos R.; Nunes, Ana Paiva

doi:10.1016/j.jstrokecerebrovasdis.2020.105495

Cited by 5 publications

(2 citation statements)

References 45 publications

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“…There was no statistical difference as regard recanalization rate, FPE, and puncture-revascularization time between both groups despite significantly shorter OPT in BT group because most of the patients in the dMT group presented to the emergency room late (outside the 4.5 h window). Similar results from other retrospective and real practice studies were reported with shorter OPT in BT group and similar www.nature.com/scientificreports/ baseline characters in both groups 17,18 . This could represent a theoretical advantage for better outcomes in BT group, however, our analysis does not confirm the effect of OPT in early (at day seven) or late (90-day) favorable outcomes (Tables 2, 3).…”

Section: Discussionsupporting

confidence: 89%

Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study

Malky

Abdel-Hafiz

Abdelkhalek

2022

Sci Rep

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First pass effect (FPE) is a successful recanalization (mTICI ≥ 2b) after the first trial of thrombectomy. It is associated with good functional outcomes. Few studies discussed the effect of BT (bridging therapy: combined I.V. thrombolysis and mechanical thrombectomy) on FPE and clinical outcomes. In our study, we would like to report the effect of MT with or without preceding IVT on FPE and the functional outcome of AIS (Acute Ischemic Stroke) of anterior circulation in real practice. A dual-center retrospective cohort study enrolled 201 patients with AIS of anterior circulation and was divided into a bridging therapy (BT) group of 150 patients who received alteplase preceding thrombectomy, and a direct mechanical thrombectomy (dMT) group of 51 patients. Comparisons between both groups regarding the clinical and radiological outcome. Early better clinical outcome (mRS ≤ 2) at day seven with BT group (39.3%) rather than dMT (23.5%) with P value = 0.044. No significant differences as regard puncture to revascularization time, successful revascularization (mTICI) ≥ 2b and FPE between both groups (P value: 0.328, 0.538, and 0.708, respectively). No differences as regards hemorrhagic transformation, mortality rate, and 90-day favorable outcome between both groups (P value 0.091, 0.089, and 0.192, respectively). BT might have better early outcome than dMT but no difference as regards 90-day favorable outcomes, mortality, sICH, FPE, recanalization rate and procedure time. It might be reasonable to go directly to mechanical thrombectomy without IVT for AIS with large vessel occlusion.

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Section: Discussionsupporting

confidence: 89%

Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study

Malky

Abdel-Hafiz

Abdelkhalek

2022

Sci Rep

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“…However, the mechanical thrombectomy alone group failed to show a favorable functional outcome among patients with acute large vessel occlusion stroke compared with the combined group. Furthermore, a recent finding supported the hypothesis that intravenous therapy before mechanical thrombectomy does not influence the prognosis of patients with stroke (126).…”

Section: Clinical Managementmentioning

confidence: 71%

Neuronal injuries in cerebral infarction and ischemic stroke: From mechanisms to treatment (Review)

Zhao

Zhang²,

Chen³

et al. 2021

Int J Mol Med

234

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Stroke is the leading cause of disabilities and cognitive deficits, accounting for 5.2% of all mortalities worldwide. Transient or permanent occlusion of cerebral vessels leads to ischemic strokes, which constitutes the majority of strokes. Ischemic strokes induce brain infarcts, along with cerebral tissue death and focal neuronal damage. The infarct size and neurological severity after ischemic stroke episodes depends on the time period since occurrence, the severity of ischemia, systemic blood pressure, vein systems and location of infarcts, amongst others. Ischemic stroke is a complex disease, and neuronal injuries after ischemic strokes have been the focus of current studies. The present review will provide a basic pathological background of ischemic stroke and cerebral infarcts. Moreover, the major mechanisms underlying ischemic stroke and neuronal injuries are summarized. This review will also briefly summarize some representative clinical trials and up-to-date treatments that have been applied to stroke and brain infarcts. Contents 1. Introduction 2. Pathophysiological processes of ischemia 3. Clinical management 4. Conclusion and future perspectives

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Radiation Exposure in Interventional Stroke Treatment

2023

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Purpose To evaluate patient-related radiation exposure in interventional stroke treatment by analyzing data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) quality registry from 2019–2021. Methods The DeGIR/DGNR registry is the largest database of radiological interventions in Germany. Since the introduction of the registry in 2012, the participating hospitals have entered clinical and dose-related data on the procedures performed. To evaluate the current diagnostic reference level (DRL) for mechanical thrombectomy (MT) in stroke patients, we analyzed interventional data from 2019 to 2021 with respect to the reported dose area product (DAP) and factors that might contribute to the radiation dose, such as the localization of the occlusion, technical success using the modified treatment in cerebral ischemia (mTICI) score, number of passages, technical approach, additional intracranial/extracranial stenting, and case volume per center. Results A total of 41,538 performed MTs from 180 participating hospitals were analyzed. The median DAP for MT was 7337.5 cGy∙cm2 and the corresponding interquartile range (IQR) Q25 = 4064 cGy∙cm2 to Q75 = 12,263 cGy∙cm2. In addition, we discovered that the dose was significantly influenced by occlusion location, number of passages, case volume per center, recanalization score, and additional stenting. Conclusion We conducted a retrospective study on radiation exposure during MT in Germany. Based on the results of more than 41,000 procedures, we observed that the DRL of 14,000 cGy·cm2 is currently appropriate but may be lowered over the next years. Furthermore, we identified several factors that contribute to high radiation exposure. This can aid in detecting the cause of an exceeded DRL and optimize the treatment workflow.

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Functional Outcome After Mechanical Thrombectomy with or without Previous Thrombolysis

Cited by 5 publications

References 45 publications

Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study

Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study

Neuronal injuries in cerebral infarction and ischemic stroke: From mechanisms to treatment (Review)

Radiation Exposure in Interventional Stroke Treatment

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