Stroke thrombectomy complication management

Pilgram‐Pastor, Sara; Piechowiak, Eike Immo; Dobrocky, Tomas; Kaesmacher, Johannes; Hollander, J.; Gralla, Jan; Mordasini, Pasquale

doi:10.1136/neurintsurg-2021-017349

Cited by 53 publications

(40 citation statements)

References 56 publications

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“…Procedure-related SAH after mechanical thrombectomy has been reported as a benign clinical feature that does not require additional surgical procedures [ 1 , 3 , 5 , 7 ]. In one case, SAH after mechanical thrombectomy was suggested to be related to injury of the arterial wall during stent retrieval, but no definite offending lesion was usually observed [ 7 ], this was attributed to the spontaneous cessation of the SAH.…”

Section: Discussionmentioning

confidence: 99%

Salvage treatment with stenting and temporary balloon occlusion for subarachnoid hemorrhage after stent retrieval following acute proximal M3 occlusion treatment

Kim

Jin

Lee

2022

J Cerebrovasc Endovasc Neurosurg

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Procedure-related subarachnoid hemorrhage (SAH) after mechanical thrombectomy is known to be a clinically benign presentation. However, the treatment in the presence of definite contrast leakage without vessel rupture is controversial. Here, we report a case in which a salvage technique was performed for procedure-related SAH after mechanical thrombectomy for a proximal M3 occlusion.A 56-year-old female patient presented with global aphasia and right hemiparesis within 2 hours after symptom onset. The initial National Institute of Health Stroke Scale score of the patient was 18 points, and Computed tomography (CT) angiography showed that the superior division of the left middle cerebral artery (MCA) was occluded. We decided to treat the patient with mechanical thrombectomy. Control angiography showed a left proximal M3 occlusion. We performed mechanical thrombectomy with a partially deployed technique using a Trevo 3 mm stent (Stryker). Control angiography showed recanalization of the occluded vessel but contrast leakage after stent retrieval. We decided to treat the lesion presenting with contrast leakage with stenting using a Neuroform Atlas 3 mm stent (Stryker). Serial control angiography continued to show contrast leakage of the recanalized artery. We decided to treat the lesion with temporary balloon occlusion using a Scepter C balloon catheter (MicroVention). The patient recovered and had a modified Rankin scale score at discharge of 0.Given the results of our case, stenting and subsequent repeat temporary balloon occlusion should be considered for SAH with contrast leakage after mechanical thrombectomy, as spontaneous cessation of the arterial bleeding is unlikely.

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Section: Discussionmentioning

confidence: 99%

Salvage treatment with stenting and temporary balloon occlusion for subarachnoid hemorrhage after stent retrieval following acute proximal M3 occlusion treatment

Kim

Jin

Lee

2022

J Cerebrovasc Endovasc Neurosurg

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“…Pilgram-Pastor et al 2021 suggest a rate of 0.5 -1 mg nimodipine i.a. over several minutes and points out the risk of hypotension and steal phenomena [3]. Others suggest the use of 2 -5 mg nicardipine i.a.…”

Section: Discussionmentioning

confidence: 99%

“…Gupta et al described arterial vasospasms after stent-retriever thrombectomy in 2009 [1]. Since 2015, with the establishment of endovascular stroke treatment (EST) as a first-line therapy for acute ischemic stroke, more research emerges concerning the management of procedure failure and interventional complications [2,3]. In the early randomized multicenter studies of 2015, only REVASCAT and SWIFT PRIME reported on vasospasms with fourteen cases of vasospasms in the intervention group of REVASCAT (14/103, 13.6 %), four of which required treatment by application of vasodilating medication, and four reported cases of vasospasm (4/98, 4 %) in the intervention group of SWIFT PRIME [4,5].…”

Section: Introductionmentioning

confidence: 99%

Prediction of vasospasms as complication in ischemic stroke patients receiving anterior circulation endovascular stroke treatment

Jesser

Awounvo

Vey

et al. 2022

Preprint

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Background and Purpose: Vasospasms are a common and dreaded complication of endovascular stroke treatment (EST). There is a lack of understanding of risk factors for periprocedural vasospasms. Here, we aimed to identify prognostic factors for vasospasms in patients with acute ischemic stroke and EST. Methods: Retrospective single-center analysis of patients receiving EST for anterior circulation vessel occlusion between January 2015 and December 2021. Exclusion criteria were intracranial stenting and intraarterial (i.a.) thrombolysis. Study groups were defined as patients developing vasospasms during EST (V+) and patients, who did not (V-). The study groups were compared in univariate analysis. Further, multivariable regression models were developed to predict the patients' risk for developing vasospasms based on pre-identified potential prognostic factors. Secondary endpoint was clinical outcome as modified Rankin Scale (mRS) difference between pre-stroke mRS and discharge mRS (delta mRS). Results: In total, 132 of 1768 patients (7.5 %) developed vasospasms during EST in this study cohort. Patients with vasospasms were younger and had a lower pre-stroke disability (as per mRS). Vasospasms were more likely to occur in ESTs with multiple thrombectomy attempts in total and after several stent retriever maneuvers. Factors with predictive value for developing vasospasms were younger (OR = 0.967, 95%-CI = 0.96 - 0.98) and had a lower pre-stroke mRS (OR = 0.759, 95%-CI = 0.63 - 0.91). The prediction model incorporating patient age, pre-stroke mRS, stent retriever thrombectomy attempts, and total attempts as prognostic factors was found to predict vasospasms with decent accuracy (AUC = 0.714, 95%-CI = 0.709-0.720). V+ patients showed higher delta mRS (median (Q1 - Q3); V-: 2 (1-3) vs. V+: 2(1-4); p = 0.014). Conclusion: This study shows that vasospasms are a common complication in EST affecting younger and previously healthier patients and are more likely after multiple stent retriever thrombectomy attempts. As independent predictors patient age, pre-stroke mRS, thrombectomy maneuvers and stent-retriever attempts predict the occurrence of vasospasms during EST with decent accuracy.

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“…Thus far, no RCTs exist that include local anesthesia as a comparator arm and meta-analyses of observational studies have failed to show differences in functional outcomes with LA compared to CS and GA. Some of these studies show evidence of shorter door-to-needle time in patients and less intraprocedural hypotension, which are important considerations for functional outcomes [41].…”

Section: Anesthetic Strategiesmentioning

confidence: 99%

Updates in Neuroanesthesia

Schill¹,

Bates²,

Lovett³

et al. 2023

Updates in Anesthesia - The Operating Room and Beyond

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Providing anesthesia care to neurosurgical and neurocritical care patients presents unique challenges to the anesthesiologist. Over the last century, anesthetic care for such patients has become a robustly studied field, with tools and techniques to keep patients safe and comfortable in the perioperative period. A review of the major updates and considerations for perioperative care for awake craniotomies, thrombectomy for stroke, and endoscopic neurosurgery is critical for the anesthesiologist. Additionally, newly developed enhanced recovery after surgery procedures have improved patient experiences and outcomes after both cranial and spinal neurosurgery. Finally, post-operative delirium is a major neurologic complication in elderly patients undergoing all types of procedures which all anesthesiologists should be well versed in. Here, such topics are reviewed with a focus on recent updates to the literature which are important for clinical practice.

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Stroke thrombectomy complication management

Cited by 53 publications

References 56 publications

Salvage treatment with stenting and temporary balloon occlusion for subarachnoid hemorrhage after stent retrieval following acute proximal M3 occlusion treatment

Salvage treatment with stenting and temporary balloon occlusion for subarachnoid hemorrhage after stent retrieval following acute proximal M3 occlusion treatment

Prediction of vasospasms as complication in ischemic stroke patients receiving anterior circulation endovascular stroke treatment

Updates in Neuroanesthesia

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