Mechanical thrombeсtomy and trombaspiration in stroke. Problem claims

  • O.A. Pastushyn SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine», Kyiv
  • D.V. Shchehlov SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine», Kyiv
  • S.V. Konotopchyk SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine», Kyiv
  • O.E. Sviridyuk SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine», Kyiv
Keywords: stroke; trombextraction; cеrebral angiography.

Abstract

Objective — to evaluate the effectiveness of endovascular mechanical recanalization methods in ischemic stroke and the analysis of problem cases.
Materials and methods. A retrospective analysis of the results of treatment of 33 patients with acute ischemic stroke due to occlusion of a large vessel was performed. There were 18 (54.5 %) men and 15 (45.5 %) women. Endovascular interventions were performed in all patients to restore cerebral arteries patency using various methods and techniques of mechanical thrombectomy. All patients underwent neuroimaging (CT of the brain and selective cerebral subtraction angiography). A topographical assessment of early CT-changes in ischemic stroke was performed using the ASPECTS scale. The severity of neurological symptoms in the acute period of ischemic stroke was assessed according to the NIHSS score. The severity of the condition – on the NIHSS score. The mTICI scale was used to assess the success of recanalization (reperfusion) after mechanical thrombectomy.
Results. Successful recanalization (mTICI 2b-3) with the use of stent retrievers and distal aspiration catheters was achieved in 22 (66.7 %) cases. The total number of intraoperative complications was 12.0 %. Mortality rate – 12.0 %.
Conclusions. Endovascular reperfusion methods using stent retrievers and distal aspiration catheters for acute ischemic stroke are effective. Endovascular reperfusion advisable to start with a mechanical thrombus aspiration. When performing endovascular recanalization, the use of stent retrievers in combination with guide balloon catheters only without distal aspiration catheters increases the risk of distal reembolism and embolism of other arterial basins.

Downloads

Download data is not yet available.

References

Malhotra K, Gornbey J, Saver JL. Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: A Review. Front Neurol. 2017;8:651. doi: 10.3389/fneur.2017.00651.

Kozhinova AB, Levin AS. Pharmacotherapy of patients with ischemic stroke during the rehabilitation period. Modern therapy in psychiatry and neurology. 2015;1:4-11.

Pizova NV. Thrombolytic therapy for ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2013;3:55-9.

Rha JH, Saver JL. The impact of recanalisation on ischemic stroke outcome – A meta-analysis. Stroke. 2007;38(3):967-73. doi: 10.1161/01.STR.0000258112.14918.24

Campbell BC, Donnan GA, Lees KR, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke Lancet Neurol. 2015;14(8):846-54. doi: 10.1016/S1474-4422(15)00140-4.

Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-31. doi: 10.1016/S0140-6736(16)00163-X.

Fink JN, Selim MH, Kumar S, et al. Insular cortex infarction in acute middle cerebral artery territory stroke: predictor of stroke severity and vascular lesion. Arch Neurol. 2005;62(7):1081-5.

Kodumuri N, Sebastian R, Davis C, et al. The association of insular stroke with lesion volume. Neuroimage Clin. 2016;11:41-5. doi: 10.1016/j.nicl.2016.01.007.

Heldner MR, Zubler C, Mattle HP, et al. National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke. Stroke. 2013;44(4):1153-7. doi: 10.1161/STROKEAHA.111.000604.

Cooray C, Fekete K, Mikulik R, et al. Threshold for NIH stroke scale in predicting vessel occlusion and functional outcome after stroke thrombolysis. Int J Stroke. 2015;10(6):822-9. doi: 10.1111/ijs.12451.

Smith WS, Tsao JW, Billings ME, et al. Prognostic significance of angiographically confirmed large vessel intracranial occlusion in patients presenting with acute brain ischemia. Neurocrit Care. 2009;40(12):3834-40. doi: 10.1161/STROKEAHA.109.561787.

Smith WS, Lev MH, English JD, et al. Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke. 2009;40(12):3834-40. doi: 10.1161/STROKEAHA.109.561787.

Warwick Pexman JH, Barber PA, Hill MD, et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT Scans in patients with acute stroke. American Journal of Neuroradiology. 2001;22(8):1534-42.

The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581-7.

Wong J, Telischak N, Heit J, et al. Neurosurgery, Stanford, Stanford, CA; 2 Radiology, Stanford, Stanford, CA. doi 10.1136/neurintsurg-2016-012589.155

Turk AS, Frei D, Fiorella D, et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg. 2014;6(4):260-4. PMID:24569575. DOI:10.1136/neurintsurg-2014-011125.

Kowoll A, Weber A, Mpotsaris A, Behme D, Weber W. Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg. 2016;8(3):230-4. PMID:25583533. DOI:10.1136/neurintsurg-2014-011520.

Balami JS, White PM, McMeekin PJ, Ford GA, Buchan AM.Complications of endovascular treatment for acute ischemic stroke: Prevention and management. doi: 10.1177/1747493017743051

Le Bouc R, Clarençon F, Meseguer E. Efficacy of endovascular therapy in acute ischemic stroke depends on age and clinical severity. Stroke. 2018;49(7):1686-94. doi: 10.1161/STROKEAHA.117.020511.

Gunning GM, McArdle K, Mirza M, et al. Clot friction variation with fibrin content; implications for resistance to thrombectomy. J Neurointerv Surg. 2018;10(1):34-8. doi: 10.1136/neurintsurg-2016-012721.

Hashimoto T, Hayakawa M, Funatsu N, et al. Histopathologic analysis of retrieved thrombi associated with successful reperfusion after acute stroke thrombectomy. Stroke 2016;47(12):3035-7. PMID:27780903. doi:10.1161/STROKEAHA.116.015228.

Saver JL. Time is brain–quantified. Stroke. 2006;37:263-6. doi: 10.1161/01.STR.0000196957.55928.ab

Tsivgoulis G, Alexandrov AV. Does «time is brain» also mean «time is clot»? Time dependency of tissue-type plasminogen activator-induced recanalization in acute ischemic stroke. Stroke. 2014;45(9):2555-6. doi: 10.1161/STROKEAHA.114.006579.

Crockett MT, Phillips TJ, Chiu AHY. Dual suction Headway27 microcatheter thrombectomy for the treatment of distal intracranial arterial occlusion strokes: initial experience with the micro-ADAPT technique. Journal of NeuroInterventional Surgery doi: 10.1136/neurintsurg-2018-014385


Abstract views: 118
PDF Downloads: 117
Published
2019-06-13
How to Cite
Pastushyn, O., Shchehlov, D., Konotopchyk, S., & Sviridyuk, O. (2019). Mechanical thrombeсtomy and trombaspiration in stroke. Problem claims. Endovascular Neuroradiology, 27(1), 58-66. https://doi.org/10.26683/2304-9359-2019-1(27)-58-66

Most read articles by the same author(s)

1 2 > >>