Mechanical thrombectomy in acute ischaemic stroke: a review of the different techniques

Leung, V.J.; Sastry, Anand; Srivastava, Saurabh Kumar; Wilcock, Donna M.; Parrott, Ashley; Nayak, Sanjeev

doi:10.1016/j.crad.2017.10.022

Cited by 17 publications

(10 citation statements)

References 20 publications

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“…[13] Mechanical thrombectomy is usually applied for large artery occlusion, with an intra-arterial catheter-guided technique under fluoroscopy. [14] A systematic review and meta-analysis in 2015 of randomized trials concluded that endovascular therapy significantly improved the clinical prognosis in patients with AIS compared with conventional treatment. [15]…”

Section: Resultsmentioning

confidence: 99%

“…[2,3] Mechanical thrombectomy is preferred for large vessel occlusion, according to the current evidences. [4] However, radiation produced during the X-ray assisted procedure is an unwanted incidence, which would increase the risk of skin and malignant diseases. [5,6] And currently, limited studies are available to detect the radiation effects during mechanical thrombectomy for acute stroke patients.…”

Section: Introductionmentioning

confidence: 99%

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Radiation outcome in mechanical thrombectomy of acute ischemic stroke

Cai

Ding

Wang

et al. 2019

Translational Neuroscience

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Objective Mechanical thrombectomy is recommended for acute ischemic stroke (AIS) with large artery occlusion. Radiation during the endovascular procedure would increase the risk of skin diseases. We sought to identify radiation outcomes during mechanical thrombectomy. Methodology We prospectively collected and analyzed radiation parameters during mechanical thrombectomy in 41 patients affected with acute cerebral artery occlusion. Results There were 41 cases (68.73 ± 11.05 years) in this study, with a National Institute Health Stroke Scale (NIHSS) score of 15.66 ± 5.94. The time parameters were recorded as following: 84.45 ± 31.66 min (operation duration), 129.71 ± 81.14 s (angiographic run), 16.02 ± 11.03 min (fluoroscopy) and 18.19 ± 11.14 min (angiographic exposure). The doses produced in the procedure were: 1276.43 ± 1647.56 mGy (shot dose), 607.26 ± 412.34 mGy (fluoroscopy) and 1635.52 ± 593.65 mGy (angiographic exposure). Further analysis discovered no association between NIHSS and these time and radiation parameters (P > 0.05). Conclusion This study provided the description of radiation details during mechanical thrombectomy for acute cerebral artery occlusion. The stroke severity would not influence the procedure parameters.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiation outcome in mechanical thrombectomy of acute ischemic stroke

Cai

Ding

Wang

et al. 2019

Translational Neuroscience

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“…MT using modern devices has proved to be efficacious in re-establishing intracranial circulation and reduced procedural times. 16,18 Aspiration devices achieve consistently high recanalization rates (68-100%), but clinical outcomes with aspiration are variable with studies showing very poor recovery rates. 18 ASTER trial showed no difference and no inferiority was shown in COMPASS trial and post-hoc analysis of Mr CLEAN did not demonstrate any trends in outcome when comparing the two different approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Any potential risk of embolism in distal new territory by employing this technique can be mitigated by the use of a balloon guide catheter to cause flow arrest. 16,18 Figure 2A, presented below, illustrates our application of the distal access support technique to maximise retrieval force in an 85-year-old female with a right MCA occlusion, where access to a right MCA thrombus was challenged by significant vessel tortuosity. Figure 2B, presented below illustrates our application of distal access support technique to maximise retrieval force and provide distal support to minimise vessel damage when performing a stent-retriever thrombectomy in a M3 MCA occluded vessel.…”

Section: Technique (12)mentioning

confidence: 99%

Mechanical Thrombectomy using Distal Access Catheters: Current Status and Future Prospects

Nayak

2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: Mechanical Thrombectomy (MT) using modern devices has proved to be efficacious in reestablishing intracranial circulation and reduced procedural times. We outline a number of endovascular techniques utilizing the distal access catheter, the circumstances where they are applicable, and the outcomes achieved. METHODS: In this review, we describe a variety of endovascular techniques with distal access catheter, deployed with and without the stent retriever device gained from our experience of performing over 700 procedures in 10 years of providing a 24/7 service within the national framework of a hyperacute stroke centre. RESULTS: We used distal access catheter techniques for intracranial support during a stent-retriever thrombectomy or thrombosuction on its own. When used as a sole suction device, or combined with a stent-retriever, we have been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures. We can report distal access catheter techniques works well when access to thrombi involves navigation through tortuous vessel anatomy, notably when convoluted loops in the cervical internal carotid artery are encountered. We suggest use of the distal access catheter techniques in thrombectomy procedures for steep-angle Middle Cerebral Artery occlusions, M2/M3 occlusion, and for basilar occlusion, where thrombectomy via suction alone proved to be adequate. CONCLUSION: In this pictorial review, we have demonstrated techniques where distal access catheter when used as a sole suction device, or combined with a stent-retriever, has been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures.

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“…IVT is indicated for lysis of thrombus with the administration of intravenous recombinant tissue plasminogen activator (IV-rtPA). On the other hand, MT is an image guided minimally invasive procedure utilizing thrombectomy devices; such as stent retrievers and/or aspiration devices to trap and remove clots in the occluded artery 7 . Increasingly evidence shows greater recanalization rates with MT from 2015 onwards, especially cases with large vessel occlusions (LVOs) of the anterior circulation [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

Yaziz¹,

Muda²,

Zaidi³

et al. 2019

CVNS

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Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods: A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

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Mechanical thrombectomy in acute ischaemic stroke: a review of the different techniques

Cited by 17 publications

References 20 publications

Radiation outcome in mechanical thrombectomy of acute ischemic stroke

Radiation outcome in mechanical thrombectomy of acute ischemic stroke

Mechanical Thrombectomy using Distal Access Catheters: Current Status and Future Prospects

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

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