Switching Strategy for Mechanical Thrombectomy of Acute Large Vessel Occlusion in the Anterior Circulation

Kang, Dong‐Hun; Kim, Yongwon; Hwang, Yang‐Ha; Park, Jaechan; Hwang, Jeong-In

doi:10.1161/strokeaha.113.002673

Cited by 47 publications

(59 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…26 A number of studies on suction-based approaches have been published recently, showing inconsistent results; however, none of these studies analyzed vessel anatomy as a factor influencing recanalization success. [27][28][29] Aortic and cervical vessel anatomy may influence recanalization results as well. Especially, older patients with a history of hypertension present with elongated arteries that may impede catheterization and lengthen the procedure duration.…”

Section: Discussionmentioning

confidence: 99%

The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke

Schwaiger

Gersing

Zimmer

et al. 2015

AJNR Am J Neuroradiol

101

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke

Schwaiger

Gersing

Zimmer

et al. 2015

AJNR Am J Neuroradiol

101

View full text Add to dashboard Cite

show abstract

“…We employed two MT techniques described previously [10,11,12]: forced arterial suction thrombectomy (FAST) and the Solitaire stent (Covidien/ev3, Dublin, Ireland). Recanalization was measured using the thrombolysis in cerebral infarction (TICI) scale (‘successful' was defined as a TICI score of 2b-3) [13].…”

Section: Methodsmentioning

confidence: 99%

Instant Reocclusion following Mechanical Thrombectomy of in situ Thromboocclusion and the Role of Low-Dose Intra-Arterial Tirofiban

et al. 2014

Self Cite

View full text Add to dashboard Cite

Background: An in situ thromboocclusion (IST) is defined as an infarct extensively involving all or most of a stenosed arterial territory, which is one major stroke mechanism related to intracranial atherosclerosis (ICAS). We focused on ISTs occurring in major cerebral arteries and analyzed their rate of instant reocclusion during mechanical thrombectomy (MT) compared with non-ISTs. Also, we introduced a treatment strategy of low-dose intra-arterial tirofiban administration to prevent such reocclusion following repeat recanalization, and evaluated its safety and efficacy. Methods: We analyzed 168 consecutive patients treated with MT over a 2-year period from May 2011 to April 2013. During MT, if angiography following a successful recanalization showed stenosis at the occlusion site, we performed additional angiographic runs every 10 min for 30 min after the recanalization. Then, if angiography revealed reocclusion, we performed a repeat recanalization, using the same MT technique but additionally followed by low-dose intra-arterial tirofiban infusion. Time-of-flight MR angiography or CT angiography was performed to confirm any underlying ICAS at the occlusion site 5-7 days after the procedure. The patients who had confirmed underlying ICAS were included in the IST cohort. Results: Of 168 enrolled patients, we excluded 36 who could not be checked for underlying ICAS at the occlusion site for one of the following reasons: recanalization failure (n = 11), rescue stenting after tirofiban failure (n = 5) and lack of follow-up vascular imaging (n = 20). The incidence of IST was 30.3% (40/132). All IST patients were confirmed to have underlying ICAS by follow-up vascular imaging. Instant reocclusion after successful recanalization was significantly more frequent in the IST cohort [26/40 (65%) vs. 3/92 (3.3%); p < 0.001]. Regarding the efficacy of low-dose intra-arterial tirofiban infusion, 85.7% of the reocclusion patients finally achieved a thrombolysis in cerebral infarction score 2/3 recanalization, but in the remaining 14.3% of the cases, the condition was refractory to the procedure and required rescue stenting. There were no cases of symptomatic intracranial hemorrhage following the procedure. Conclusions: In situ thromboocclusion was characterized by a significantly higher chance of instant reocclusion during MT. In such cases, low-dose intra-arterial tirofiban administration may be effective and safe. However, future confirmation by prospective multicenter trials seems necessary.

show abstract

“…Treatment strategies were selected on the basis of available therapies at the time of angiography, which included intra-arterial thrombolytic infusion (urokinase or rtPA), mechanical clot disruption, mechanical thrombectomy including forced arterial suction thrombectomy or Solitaire thrombectomy (Covidien, Irvine, California), rescue intra-/extracranial stent, or a combination. [16][17][18] Angiographic collateral-flow grade was evaluated with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral-flow grading system on pretreatment angiography. This angiographic scale assigns patients to grades 0 -4 according to the completeness and rapidity of collateral filling in a retrograde fashion.…”

Section: Methodsmentioning

confidence: 99%

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

Hwang

Kang²,

Kim³

et al. 2014

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE:The relationship between reperfusion and clinical outcome is time-dependent, and the effect of reperfusion on outcome can vary on the basis of the extent of collateral flow. We aimed to identify the impact of time-to-reperfusion on outcome relative to baseline angiographic collateral grade in patients successfully treated with endovascular revascularization for acute large-vessel anterior circulation stroke.

show abstract

Switching Strategy for Mechanical Thrombectomy of Acute Large Vessel Occlusion in the Anterior Circulation

Abstract: The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

Cited by 47 publications

References 5 publications

The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke

The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke

Instant Reocclusion following Mechanical Thrombectomy of in situ Thromboocclusion and the Role of Low-Dose Intra-Arterial Tirofiban

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

Contact Info

Product

Resources

About