Neurothrombectomy in acute ischaemic stroke: a prospective single‐centre study and comparison with randomized controlled trials

Nikoubashman, Omid; Jungbluth, M.; Schürmann, Kolja; Müller, Markus; Falkenburger, Björn H.; Tauber, Simone C.; Wiesmann, Martin; Schulz, Jörg B.; Reich, Arno

doi:10.1111/ene.12944

Cited by 32 publications

(24 citation statements)

References 35 publications

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“…Results from clinical trials favoring mechanical endovascular reperfusion treatment (ERT) versus best medical treatment alone [1][2][3][4][5] have substantially changed the acute treatment in patients with ischaemic stroke and large-vessel occlusion (LVO). The positive trial-result data from a few relatively small study populations have suggested that 'real-life' data may provide results similar to or even better than those reported from the trials [6][7][8]. The present study is the first to present national results on outcome after acute endovascular reperfusion treatment (aERT).…”

Section: Introductionsupporting

confidence: 55%

“…In a single‐center study from Portugal including 77 patients, 65% achieved a 3‐month mRS score of 0–2, whereas 12% of treated patients had died . In a German study of 97 patients treated with mechanical intervention, 40 (41.2%) had a 3‐month mRS score of 0–2, whereas 24.7% died . A Belgium register of 85 patients reported a 3‐month mRS score of 0–2 in 42% of patients but with a mortality of 26%, with a higher mortality in patients with occlusions in the posterior circulation .…”

Section: Discussionmentioning

confidence: 99%

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Acute endovascular reperfusion treatment in patients with ischaemic stroke and large‐vessel occlusion (Denmark 2011–2017)

Truelsen

Hansen

Andersen

et al. 2019

Euro J of Neurology

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Background and purpose Acute endovascular reperfusion treatment (aERT) of stroke patients with large‐vessel occlusions is efficacious and safe according to several clinical trials. Data on outcome and safety of aERT in daily clinical routine are warranted and, in this study, we present national data from Denmark during 2011–2017. Methods National data for Denmark from 2011 to 2017 on all aERT procedures in patients with acute ischaemic stroke and computed tomography angiography/magnetic resonance angiography‐verified large‐vessel occlusion were derived from the Danish Stroke Registry, a national clinical quality registry to which reporting is mandatory for all hospitals treating stroke patients. Outcome (modified Rankin Scale score) after 3 months, including time of death, was assessed prospectively based on clinical examination or the Danish Civil Registration System. Results During the 7 years of observation, a total of 1720 patients were treated with aERT. The annual number of procedures increased from 128 in 2011 to 409 in 2017. The median age was 70 years, 58% were males and median National Institutes of Health Stroke Scale score at baseline was 16. Median time from symptom onset to groin puncture was 238 min with a decreasing trend during the years. Successful recanalization was reported in 1306 (76%) patients. At 3‐month follow‐up, an modified Rankin Scale score of 0–2 was reported in 46% of patients, whereas 14% of patients had died. Conclusion Routine data on aERT in acute ischaemic stroke in Denmark from 2011 to 2017 suggest that the procedure is safe and efficacious.

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Section: Introductionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Acute endovascular reperfusion treatment in patients with ischaemic stroke and large‐vessel occlusion (Denmark 2011–2017)

Truelsen

Hansen

Andersen

et al. 2019

Euro J of Neurology

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“…The reported rate of SAH in the RCTs was 0.6%-4.9% 2,1,4, 5 and 1%-5.5% for the non-RCTs. 9,11,47,54 The proposed mechanisms for SAH include: intra-procedural vessel perforation or dissections, occult rupture resulting from stretching of the arterioles and venules in the subarachnoid spaces during the process of withdrawing the stent retriever and disruption of the cerebral microvascular barriers. 12,35,55 McCuster and colleagues reported a case of SAH due to rupture of the MCA with resultant diffuse SAH.…”

Section: Subarachnoid Hemorrhagementioning

confidence: 99%

Complications of endovascular treatment for acute ischemic stroke: Prevention and management

Balami

White

McMeekin³

et al. 2017

International Journal of Stroke

232

142

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Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory. Other complications include: anesthetic/contrast-related, post-operative hemorrhage, extra-cranial hemorrhage and pseudoaneurysm. Some complications are life-threatening and many lead to increased length of stay in intensive care and stroke units. Complications increase costs and delay the commencement of rehabilitation. Some may be preventable; the impact of others can be minimized with early detection and appropriate management. Both neurointerventionists and stroke specialists need to be aware of the risk factors, strategies for prevention, and management of these complications. With the increasing use of mechanical thrombectomy for the treatment of acute ischemic stroke, incidence and outcome of complications will need to be carefully monitored by stroke teams. In this narrative review, we examine the frequency of complications of MT in the treatment of acute ischemic stroke with an emphasis on periprocedural complications. Overall, from recent randomized controlled trials, the risk of complications with sequelae for patient from mechanical thrombectomy is ∼15%. We discuss the management of complications and identify areas with limited evidence, which need further research. Search strategy and selection criteria Relevant evidence was found by searches of Medline and Cochrane Library, reference list, cross-referencing and main journal content pages. Search terms included "brain ischemia", "acute ischemic stroke", "cerebral infarction" AND "mechanical thrombectomy", "endovascular therapy", "endovascular treatment", "endovascular embolectomy", "intra-arterial" AND "randomized controlled trial", "non-randomised trials", "observational studies" AND "complications", "procedural complications", "peri-procedural complications", "device-related complications", "management", "treatment", "outcome". The search included only human studies, and was limited to studies published in English between January 2014 and November 2016. The final reference list was selected on the basis of relevance to the topics covered in the Review. Guidelines for management of acute ischaemic stroke by the American Heart Association, the European Stroke Organisation, multi-disciplinary guidelines and the National Institute for Health and Care Excellence (NICE) wer...

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“…Neurological improvement was defined as decrease of >4 points on the NIHSS on discharge as compared to stroke onset [19]. Disability on discharge was measured with the modified Rankin Scale, mRS [16].…”

Section: Methodsmentioning

confidence: 99%

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Słowik

Wnuk

Brzegowy

et al. 2017

Neurologia i Neurochirurgia Polska

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Neurothrombectomy in acute ischaemic stroke: a prospective single‐centre study and comparison with randomized controlled trials

Abstract: By choosing pragmatic inclusion criteria state-of-the-art IA therapy of a specialized tertiary stroke centre can be safely applied under real-world conditions to a higher percentage of patients with similar success to the recently published RCTs.

Cited by 32 publications

References 35 publications

Acute endovascular reperfusion treatment in patients with ischaemic stroke and large‐vessel occlusion (Denmark 2011–2017)

Acute endovascular reperfusion treatment in patients with ischaemic stroke and large‐vessel occlusion (Denmark 2011–2017)

Complications of endovascular treatment for acute ischemic stroke: Prevention and management

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

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