Retrieval of n-Butyl Cyanoacrylate Cast Migrated to the Dorsalis Pedis and Posterior Tibial Artery During Embolization of the Deep Circumflex Iliac Artery Using the Stent Retriever Device: A Case Report.

CLINICAL IMPACT: This case highlights the innovative application of stent retriever devices for retrieving migrated NBCA casts, traditionally used for stroke management in peripheral arterial occlusions. This adaptation offers clinicians a new, effective tool for managing embolization complications, such as unintended material migration that can cause severe ischemia. Implementing this technique could change clinical practice by providing a reliable method to swiftly address and resolve potentially limb-threatening situations, thereby improving patient outcomes and procedural safety. This advancement in interventional radiology enhances clinicians' ability to handle complex embolic events with greater confidence and efficacy.

Use of the pRESET LITE thrombectomy device in combined approach for medium vessel occlusions: A multicenter evaluation.

PURPOSE: Our purpose was to assess the efficacy and safety of the pRESET LITE stent retriever (Phenox, Bochum, Germany), designed for medium vessel occlusion (MeVO) in acute ischemic stroke (AIS) patients with a primary MeVO. METHODS: We performed a retrospective analysis of the MAD MT Consortium, an integration of prospectively maintained databases at 37 academic institutions in Europe, North America, and Asia, of AIS patients who underwent mechanical thrombectomy with the pRESET LITE stent retriever for a primary MeVO. We subcategorized occlusions into proximal MeVOs (segments A1, M2, and P1) vs. distal MeVOs/DMVO (segments A2, M3-M4, and P2). We reviewed patient and procedural characteristics, as well as angiographic and clinical outcomes. RESULTS: Between September 2016 and December 2021, 227 patients were included (50% female, median age 78 [65-84] years), of whom 161 (71%) suffered proximal MeVO and 66 (29%) distal MeVO. Using a combined approach in 96% of cases, successful reperfusion of the target vessel (mTICI 2b/2c/3) was attained in 85% of proximal MeVO and 97% of DMVO, with a median of 2 passes (IQR: 1-3) overall. Periprocedural complications rate was 7%. Control CT at day 1 post-MT revealed a hemorrhagic transformation in 63 (39%) patients with proximal MeVO and 24 (36%) patients with DMVO, with ECASS-PH type hemorrhagic transformations occurring in 3 (1%) patients. After 3 months, 58% of all MeVO and 63% of DMVO patients demonstrated a favorable outcome (mRS 0-2). CONCLUSION: Mechanical thrombectomy using the pRESET LITE in a combined approach with an aspiration catheter appears effective for primary medium vessel occlusions across several centers and physicians.

The effect of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke.

OBJECTIVE: To analyze the effectiveness of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke. METHODS: Markedly effective is defined as an SIS score of over 90, effective is indicated by an SIS score of between 50-90, and a score of below 50 suggests ineffective treatment results. RESULTS: ①The treatment's overall effectiveness in the observation group (91.30%) was significantly higher than that in the control group (75.56%) (p < 0.05). ②The vascular recanalization rate in the observation group (89.13%) was significantly higher than that in the control group (71.11%) (p < 0.05). ③The stent retrieval operation count (2.41 ± 0.23) was significantly lower in the observation group than in the control group (1.29 ± 0.16) (p < 0.05). ④ After treatment, the platelet aggregation rate (10.74 ± 3.95) and NIHSS scores (6.58 ± 1.04) were significantly lower, and the Barthel index (77.86 ± 7.21) was significantly higher in the observation group compared to the control group (26.47 ± 5.12, 7.75 ± 2.36, 68.12 ± 6.15) (p < 0.05). All platelet aggregation rate, NIHSS scores and Barthel Index showed significant improvement after treatment when compared to those before treatment (p < 0.05). CONCLUSION: The combined application of stent retriever mechanical thrombectomy and tirofiban in acute ischemic stroke treatment shows promising effectiveness. Compared to stent retriever alone, tirofiban adjunctive therapy enhances vascular recanalization, reduces retrieval procedures, shortens treatment duration, inhibits platelet aggregation, and improves neurological function recovery, daily living activities, and prognosis. Moreover, it doesn't significantly increase symptom-related risks.

Clinical comparison of aspiration to stentriever-mediated aspiration thrombectomy for M2 occlusions.

OBJECTIVE: While revascularization for M2 occlusions is generally recommended and considered beneficial, the optimal approach (aspiration vs stentriever/combined) is less well defined in the literature. We sought to compare outcomes after thrombectomy with manual aspiration thrombectomy alone (MAT) or stentriever-mediated aspiration thrombectomy (SMAT) MATERIALS AND METHODS: To circumvent inter-operator technical variability, patients underwent thrombectomy for M2 occlusions by a single operator and were stratified by first pass approach: manual aspiration thrombectomy (MAT/aspiration alone) and stentriever-mediated manual aspiration thrombectomy (SMAT/combination). Efficacy outcomes included good reperfusion (mTICI score ≥2b) and a favorable 90-day functional outcome (mRS score of ≤2). Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage. RESULTS: One hundred three patients were identified: 57 underwent MAT whereas 46 underwent SMAT. Good reperfusion (TICI 2b or greater) was comparable between groups (93.5 % vs. 87.7 %, P=0.33). The intracranial hemorrhage rate was higher with SMAT compared to MAT (13 % vs. 1.8 %, P=0.04). Puncture-to-recanalization time was longer in SMAT (34.4 vs. 19.9 minutes, P<0.001). In multivariable analysis, complete or good reperfusion was associated with shorter puncture-recanalization time (adjusted odds ratio [aOR], 0.85) or less total passes (aOR, 0.58), respectively. In a propensity score matched analysis of 66 patients with comparable baseline and technical efficiency, the safety outcomes were not different between SMAT and MAT groups. CONCLUSIONS: SMAT compared with MAT did not result in an improved revascularization rate or functional outcome, while it was related to more hemorrhagic complications and mortality. Given cost and time savings with manual aspiration alone, this approach may be optimal as first line for M2 occlusions.

Evaluation of effectiveness and safety of the multizone NeVaTM stent retriever for mechanical thrombectomy in ischemic stroke.

PURPOSE: This study aimed to evaluate the effectiveness and safety of the NeVaTM stent retriever as first- and second-line device for mechanical thrombectomy in acute ischemic stroke. METHODS: In this retrospective single-center study, all consecutive patients that underwent mechanical thrombectomy with NeVaTM stent retriever as first- or second-line device due to intracranial vessel occlusion with acute ischemic stroke between March and November 2022 were included. RESULTS: Thirty-nine patients (m=18, f=21) with a mean age of 69.9 ± 13.3 years were treated with the NeVaTM stent retriever. NeVaTM stent retriever was used as first-line device in 24 (61.5%) of patients and in 15 (38.5%) as second-line device. First-pass rate (≥mTICI 2c) of NeVaTM stent retriever was both 66.7% when used as first- or second-line device. Final recanalization rate including rescue strategies was 92.3% for ≥mTICI2c and 94.9% for ≥mTICI2b. No device-related minor or major adverse events were observed. A hemorrhage was detected in 33.3% of patients at 24h post-thrombectomy dual-energy CT, of which none was classified as symptomatic intracerebral hemorrhage. NIHSS and mRS improved significantly at discharge compared to admission (p<0.05). CONCLUSION: The NeVaTM stent retriever has a high effectivity and good safety profile as first- and second-line device for mechanical thrombectomy in acute ischemic stroke.

Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank.

PURPOSE: The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. METHODS: The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. RESULTS: The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00-1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00-1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. CONCLUSION: Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.

Comparison of mechanical thrombectomy techniques in an in vitro stroke model: How to obtain a first pass recanalization?

BACKGROUND: Since mechanical thrombectomy (MT) has proven to be effective in the treatment of acute ischemic stroke (AIS), significant research has been dedicated to establishing procedural techniques offering best rate of first pass effect (FPE). In this study, we compared the efficacy of different techniques in vitro to achieve the first pass recanalisation (FPR). METHODS: In vitro MT procedures were performed using a realistic silicone model of the human cerebral vasculature. The MT with stent retriever (SR) were performed with manual co-aspiration through the respective access catheter and intermediate catheter (IC), with Solumbra or partial retrieval techniques into the IC. Two SRs (Solitaire and EmboTrap) were selected to retrieve both red blood cells (RBC) rich and fibrin-rich clots. FPR rates were recorded for each case. RESULTS: Overall, 144 MT were performed. FPR rates using the partial retrieval and Solumbra technique were of 100% and 87%, respectively (p = 0.01). The rate of FPR was of 92% using the balloon-guide catheter (BGC) compared to 64% with the guide catheter (GC) (p = 0.0001). With an IC, no differences were found between using a BGC or a GC (87.9% vs 89,6%, p = 0.75). No significant difference was observed between the Embotrap and the Solitaire device for the rate of FPR (82% and 74%, respectively; p = 0.23). CONCLUSIONS: In this study, FPR rates were higher with the use of an IC associated with the partial retrieval technique, regardless the guide catheter, the SR, or the clot composition. The less effective technique was the association of GC and SR, without an IC.

Heavy lone coronary artery thrombosis treated by stent retriever, in the setting of COVID-19 infection.

We present a case of heavy lone coronary thrombosis in the setting of COVID-19 infection. We highlight the special angiographic, ultrasonographic, and histological features of this thrombus, and we describe the application of carotid stent retriever for its removal.

The Tigertriever 13 for mechanical thrombectomy in distal and medium intracranial vessel occlusions.

PURPOSE: To report our two-center initial experience using the Tigertriever 13 in the treatment of acute stroke of distal, medium vessel occlusions (DMVO). METHODS: We performed a retrospective analysis of all patients treated by mechanical thrombectomy using the Tigertriever 13 device (a manually expandable low profile stent retriever) due to an acute DMVO. Locations included the anterior, middle, and posterior cerebral artery in the A2 and A3, the M3 and M4, and the P2 or P3 segment and the superior cerebellar artery. RESULTS: Forty-three patients with 45 DMVOs underwent MTE using the Tigertriever 13 with the intention-to-treat approach between May 2019 and December 2020. After a median of two thrombectomy maneuvers, the successful recanalization rate (mTICI 2b-3) was 84.4% (38/45) with a first pass effect of 26.7% (12/45). The rate of symptomatic intracranial hemorrhages (sICH) and subarachnoid hemorrhages (SAH) was 7.0% (3/43) and 14.0% (6/43), respectively. At discharge, 53.5% (23/43) of the patients had a favorable clinical outcome (mRS 0-2). CONCLUSION: Mechanical thrombectomy in DMVOs using the Tigertriever 13 leads to high recanalization rates. The incidence of mostly asymptomatic hemorrhagic events appears higher compared to MTE procedures in LVOs. Further studies will help to identify anatomic and clinical criteria to define a guideline for MTE in DMVOs.

Aspiration versus Stent Retriever Thrombectomy in Posterior Circulation Stroke: A Systematic Review and Meta-Analysis.

INTRODUCTION: The management of posterior circulation stroke is primarily carried out by endovascular approaches including aspiration or stent retrevier thrombectomy. Existing reviews have attempted to comparatively evaluate their efficacy in terms of morbidity and mortality-related outcomes, however, with several limitations. Therefore, in this review, we attempt to address the gap in the existing literature by evaluating the comparative impact of stent retriever-based and aspiration-based thrombectomy interventions in posterior circulation stroke patients on the following parameters: overall procedure duration, recanalization time, rescue therapy usage, complication risk, and mortality risk. METHODS: A systematic search of the academic literature was performed according to PRISMA guidelines across five databases. We conducted a random-effect meta-analysis to evaluate comparative outcomes, including procedural duration, time to recanalization, risk of complications, use of rescue therapy, and risk of mortality in patients with posterior circulation stroke undergoing stent retriever- and aspiration-based thrombectomies. We also performed comparative subgroup analyses to evaluate differences in outcomes between contact and manual aspiration interventions. RESULTS: From 963 studies, we found nine eligible studies containing data on 840 patients. Meta-analysis revealed a large-to-medium size positive effect for stent retriever-based thrombectomy on overall procedure duration and recanalization compared to aspiration-based thrombectomy. Additional analysis revealed higher risk of complications and mortality in posterior circulation stroke patients undergoing stent retriever-based thrombectomy as compared to aspiration-based thrombectomy. We also observed that the use of rescue therapy was elevated in patients undergoing aspiration-based thrombectomy compared to stent retriever-based thrombectomy. CONCLUSION: This study provides preliminary evidence for improved morbidity and mortality outcomes in posterior circulation stroke patients undergoing aspiration-based thrombectomies as compared to stent retriever-based thrombectomy. The study also provides evidence for improved endovascular outcomes for patients undergoing aspiration-based thrombectomies. The findings from this study can have implications in developing awareness among neurosurgeons for stratifying patients to manage posterior circulation stroke according to the risks associated with aspiration and stent retriever-based thrombectomies.

Endovascular thrombectomy using a stent retriever catheter for massive pulmonary thromboembolism.

Acute massive pulmonary thromboembolism (PE) has a high mortality rate of 18%-65%. Along with anticoagulation and thrombolytic therapy, treatment may require a catheter-based thrombectomy or surgical thrombectomy. We report a case of pulmonary thromboembolism treated with a Stent Retriever (Trevo® NXT ProVue Retriever, Stryker, Kalamazoo, MI, USA), which is commonly used to treat stroke. An 81-year-old woman complained of back pain and was transported to our hospital after she became unconscious. Cardiopulmonary resuscitation was initiated before her arrival at the hospital; she returned to spontaneous circulation after arrival. After undergoing computed tomography (CT) scanning, she went into cardiac arrest again, and we established veno-arterial extracorporeal membrane oxygenation and performed catheter thrombectomy using a stent retriever. The left basilar pulmonary artery and the right middle pulmonary artery trunk were retrieved after the stent's deployment, and bilateral pulmonary arteries were confirmed to be reopened. A residual thrombus was present, and Monteplase was administered. A contrast-enhanced CT scan taken on day 15 following admission revealed that the thrombus had disappeared, and echocardiography revealed improved right ventricular dysfunction. The patient was transferred to another hospital on day 64 for rehabilitation. We report the first case of pulmonary artery thrombosis that was successfully recanalized by endovascular treatment with a stent retriever. The stent retriever may be useful as an endovascular treatment device for PE because it is easier to achieve recanalization using this method compared to conventional treatment methods.

Stent Opening Visualization During Mechanical Thrombectomy; Relationship with the Retrieved Clot and Procedural Success.

PURPOSE: The angiographic visualization of the stent during mechanical thrombectomy (MT) may provide information regarding the characteristics of the underlying occluding clot, device-clot interaction, and recanalization. The purpose of this study was to evaluate the open stent sign in relation to the retrieved clot and recanalization. METHODOLOGY: 78 patients treated with the stent retriever for acute stroke were retrospectively reviewed. The open stent sign was defined as full opening (>80% of normal vessel diameter) of the stent on DSA after deployment across the occlusion. The retrieved clot was visually classified as red or non-red clots. The relationship between the open stent sign and the patient characteristics, recanalization, retrieved clot, and clinical outcome were analyzed. RESULTS: Overall successful recanalization and good outcome was achieved in 68 (87.2%) and 35 (44.9%) patients, respectively. Open stent sign was seen in 52 patients (66.7%). Occlusions showing positive open stent sign was associated with significantly higher first pass effect (44.2% vs 19.2%, p=0.044) and successful recanalization rate (94.2% vs 73.1%, p=0.013) compared to negative open stent sign. The open stent sign was associated with higher incidence of red clot (75.0% vs 38.9%, p=0.008). On multivariate analysis, the open stent sign (OR 22.721, 95% CI 1.953-264.372, p=0.013) was a predictor of successful recanalization. CONCLUSIONS: The visualization of the open stent during MT of acute ischemic stroke may provide added information in terms of clot characteristics and procedural success. The open stent sign is associated with red clots, higher first pass effect and successful recanalization.

Histopathologic findings of vascular damage after mechanical thrombectomy using stent retriever in canine models.

Although mechanical thrombectomy is a powerful predictor of stroke outcome, it induces vessel wall injury in the acute phase. This study aimed to analyze the degree and the condition of recovery of wall injury after the acute phase via angiography and histopathological analysis of autopsied canine models. Digital subtraction angiography (DSA) and embolization with autologous thrombus were performed in six canines. The model of arterial occlusion was effective in all target vessels. Mechanical thrombectomy was performed in completely occluded vessels using stent retriever. Follow-up angiographic and histopathologic evaluations were performed 1 month later. Complete recanalization using stent retriever was achieved in four cases. Slight residual vessel narrowing after recanalization and moderate narrowing was observed in one case each. Histopathological analysis showed that inflammation, hemorrhage, and device-induced medial injury were not observed in any of the cases. Severe intimal proliferation (grade 4), marked diffuse thrombosis (grade 4), and weak vascular endothelial cell loss (grade 1) were observed in one case and weak endovascular proliferation was observed in one case. Although successful complete recanalization was achieved with a single mechanical thrombectomy attempt and no change was observed in the follow-up DSA, special attention should be paid to postoperative follow-up, as device-induced intimal proliferation, diffuse thrombosis, and endothelial cell loss may remain after 1 month.

Comparison of effectiveness and outcomes among different thrombectomy techniques in acute basilar artery occlusion: a dual-center experience.

OBJECTIVE: Acute basilar artery occlusion (BAO) is a rare large-vessel occlusion associated with high morbidity and mortality. Modern thrombectomy with stent retrievers and large-bore aspiration catheters is highly effective in achieving recanalization, but a direct comparison of different techniques for acute BAO has not been performed. Therefore, the authors sought to compare the technical effectiveness and clinical outcomes of stent retriever-assisted aspiration (SRA), aspiration alone (AA), and a stent retriever with or without manual aspiration (SR) for treatment of patients presenting with acute BAO and to evaluate predictors of clinical outcome in their cohort. METHODS: A retrospective analysis of databases of large-vessel occlusion treated with endovascular intervention at two US endovascular neurosurgery centers was conducted. Patients ≥ 18 years of age with acute BAO treated between January 2013 and December 2020 with stent retrievers or large-bore aspiration catheters were included in the study. Demographic information, procedural details, angiographic results, and clinical outcomes were extracted for analysis. RESULTS: Eighty-three patients (median age 67 years [IQR 58-76 years]) were included in the study; 33 patients (39.8%) were female. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 16 (IQR 10-21). Intravenous alteplase was administered to 26 patients (31.3%). The median time from symptom onset to groin or wrist puncture was 256 minutes (IQR 157.5-363.0 minutes). Overall, successful recanalization was achieved in 74 patients (89.2%). The SRA technique had a significantly higher rate of modified first-pass effect (mFPE; 55% vs 31.8%, p = 0.032) but not true first-pass effect (FPE; 45% vs 34.9%, p = 0.346) than non-SRA techniques. Good outcome (modified Rankin Scale [mRS] score 0-2) was not significantly different among the three techniques. Poor outcome (mRS score 3-6) was associated with a higher median admission NIHSS score (12.5 vs 19, p = 0.007), a higher rate of adjunctive therapy usage (9% vs 0%, p < 0.001), and a higher rate of intraprocedural complications (10.7% vs 14.5%, p = 0.006). The admission NIHSS score significantly predicted good outcome (OR 0.98, 95% CI 0.97-0.099; p = 0.032). Incomplete recanalization after thrombectomy significantly predicted mortality (OR 1.68, 95% CI 1.18-2.39; p = 0.005). CONCLUSIONS: The evaluated techniques resulted in high recanalization rates. The SRA technique was associated with a higher rate of mFPE than AA and SR, but the clinical outcomes were similar. A lower admission NIHSS score predicted a better prognosis for patients, whereas incomplete recanalization after thrombectomy predicted mortality.

Predictors of Reperfusion and 90-day Functional Outcome After Mechanical Thrombectomy for Large Vessel Occlusion Strokes.

OBJECTIVES: Whether elderly patients with adverse comorbidities or strong vascular meandering benefit from mechanical thrombectomy to the same degree as patients who participated in the pivotal randomized controlled trials on this procedure (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, DAWN, and DEFUSE 3) remains unknown. We aimed to investigate the predictors of reperfusion and 90-day functional outcome using real-world clinical data, without excluding elderly patients with adverse comorbidities or patients in whom vascular access could not be achieved. MATERIALS AND METHODS: We retrospectively reviewed consecutive patients with acute ischemic stroke who underwent or in whom mechanical thrombectomy was attempted at Japanese Red Cross Matsue Hospital from April 2015 to June 2020. RESULTS: Altogether, 111 mechanical thrombectomies in 111 patients (average age 77.2 years) were attempted for acute ischemic stroke. Vascular access was not achieved in 8 (7.2%) cases. In the multivariable analysis, age ≥85 years (odd ratio [OR] 0.191, 95% confidence interval [CI] 0.057-0.641, p = 0.007) and presence of adverse comorbidities (OR 0.265, 95% CI 0.090-0.659, p = 0.016) were associated with failed reperfusion. The diffusion-weighted imaging (DWI)-ASPECT score ≥6 (OR 4.650, 95% CI 1.610-13.40, p = 0.005) was associated with good 90-day functional outcomes. Presence of adverse comorbidities was not a predictor, but it had a relatively strong correlation with poor functional outcome. CONCLUSIONS: Mechanical thrombectomy in elderly patients should be considered very carefully if they are aged ≥85 years, have low DWI-ASPECT score and have clear evidence of pre-existing adverse comorbidities.

Clinical Trial of the New Stent Retriever Tron FX for both Proximal and Distal Intracranial Large Vessel Occlusions.

BACKGROUND: In all of randomized controlled trials of mechanical thrombectomy, the target vessels were proximal. Herein we report a clinical trial of the Tron FX stent retriever, including the smallest size of 2/15 mm for distal intracranial large vessel occlusion (LVO). OBJECTIVE: Eligible patients presented within 8 h of onset with proximal or distal LVOs, and the Tron FX 4/20 mm or 2/15 mm were used as the first-line device. METHODS: The primary endpoints were rate of modified Thrombolysis in Cerebral Infarction (mTICI) grade 2a-3 immediately after using Tron FX only, and mortality rate 90 d. We compared the outcomes between sizes 4/20 and 2/15 mm. RESULTS: The clinical trial was conducted in 50 cases, of which 44% presented with distal LVO and 15 cases were treated using only Tron FX 2/15 mm. The overall rate of mTICI grade 2a-3 was 80.0% (75.8% with Tron FX 4/20 mm, and 86.7% with 2/15 mm), and a 90-day modified Rankin Scale ≤ 2 or improvement of National Institute of Health Stroke Scale after thrombectomy ≥ 10 was achieved in 66.7% of cases (61.3% with Tron FX 4/20 mm, and 80.0% with 2/15 mm). The overall 90-day mortality rate was 8.0%, and symptomatic intracranial hemorrhage within 24 h occurred in 2.0% of cases. CONCLUSION: In this clinical trial using the Tron FX, which included the size of 2/15 mm for distal LVO, its efficacy was similar and its safety was superior compared with previous studies.

A Direct Aspiration First Pass Technique for Vertebra-Basilar Occlusion: A Retrospective Comparison to Stent Retriever.

OBJECTIVES: This study aimed to assess the clinical usefulness of a direct aspiration first pass technique as a first-line strategy for mechanical thrombectomy in posterior circulation. MATERIALS AND METHODS: We examined 34 consecutive patients treated with mechanical thrombectomy for acute vertebrobasilar artery occlusion. Procedural and clinical outcomes were assessed and compared between patients treated with a direct aspiration first pass technique first-line strategy (ADAPT group) and stent retriever system first-line strategy (stent retriever group). RESULTS: Overall, successful reperfusion, complete reperfusion, and first-pass effects were achieved in 94.1%, 61.8%, and 50% of patients with acute ischemic stroke in vertebra-basilar artery occlusion treated with mechanical thrombectomy, respectively. The ADAPT group required a significantly shorter procedural time (p=.015) and fewer attempts (p=.0498) to achieve successful recanalization than the stent retriever group. The ADAPT group also tended to show better recanalization rates and first-pass effects than the stent retriever group. The rates of favorable outcomes seemed to be better, although insignificant, in the ADAPT group than in the stent retriever group (52.2% vs. 27.3%, p=.217). However, a significant correlation between the time required for reperfusion and clinical outcome was detected, and this will serve as the rationale for encouraging a direct aspiration first pass technique as a first-line strategy in the acute vertebra-basilar artery. CONCLUSIONS: The a direct aspiration first pass technique first-line strategy for mechanical thrombectomy in posterior circulation may achieve successful recanalization with fewer attempts and shorter durations than the stent retriever first-line strategy.

Safety and effectiveness of CATCH+ as a first-line device for revascularization in the treatment of acute ischemic stroke.

PURPOSE: Mechanical thrombectomy devices and stent retrievers have recently been advocated for use as first-line therapy in acute ischemic stroke. Here we evaluate the safety and effectiveness of the CATCH+ stent retriever as a percutaneous thrombectomy device. METHODS: A retrospective analysis was performed on 101 consecutive patients who presented with anterior or posterior intracranial vessel occlusion and were treated with the CATCH+ intracranial system, either alone or in combination with intravenous tissue plasminogen activator, at a single treatment center. The primary outcome measure was successful post-procedural reperfusion as classified by the mTICI score. Secondary endpoints included mortality rate, incidence of adverse events, and functional outcomes evaluated at discharge using the mRS score. RESULTS: Sixty-nine (68.3%) patients received thrombolysis prior to mechanical thrombectomy. Successful reperfusion (mTICI≥2b) was achieved in 73.3% of patients at the end of the procedure, and good functional outcomes (mRS≤2) were observed in 32.7% of patients at discharge. Three patients developed asymptomatic subarachnoid hemorrhage, two developed asymptomatic dissections of the internal carotid artery, and one patient developed a symptomatic intracranial hemorrhage. Seventeen patients died (mortality rate 16.8%). CONCLUSIONS: The CATCH+ device is a safe and effective mechanical thrombectomy device for the first-line treatment of acute ischemic stroke.

Distal mechanical thrombectomy for very eloquent M3 branches with a new, adjustable diameter clot retriever: A technical note.

Distal thrombectomy may be considered in selected patients harboring acute occlusion of distal arterial branches, supplying very eloquent brain areas. In these cases navigation and deployment in tortuous, fragile and very small-caliber arteries is usually involved, potentially increasing the risk of per-procedural vessel wall perforation. We report a case of distal recanalization in a right-handed, fourty-year-old woman with left M3 occlusion, with the use of a novel device with manually adapted, gradual expansion, navigated through a 0.013-inch microcatheter, called the Tigertriever-13 [RapidMedical, Yokneam, Israel]. The device was deployed and retrieved with minimal alteration-straightening of the M3 vessels and complete recanalization was achieved. The patient achieved NIHSS 0 in less than 24 h.

Adjustment of Stent Retriever Length to Clot Extent Affects First-Pass Reperfusion in Endovascular Treatment of Acute Ischemic Stroke.

BACKGROUND: Stent retriever technology has evolved, and significantly longer devices have become available for mechanical thrombectomy (MT) of large cerebral vessel occlusions in ischemic stroke. We hypothesized that increased stent retriever length may improve the rate of complete angiographic reperfusion and decrease the respective number of attempts, resulting in a better clinical outcome. METHODS: Retrospective analysis of patients with large vessel occlusion in the anterior and posterior circulation treated with stent retriever MT. The study group was dichotomized into short (20 mm) and long (>20 mm) retrievers using propensity matching. In the anterior circulation, the clot burden score was evaluated. Primary end points were first-pass modified thrombolysis in cerebral infarction (mTICI) 3 reperfusion and first-pass mTICI ≥ 2b reperfusion, and the secondary end point was functional independence (defined as modified Rankin Scale score 0-2) at discharge and 90 days. RESULTS: Overall, 394 patients were included in the analysis. In the anterior circulation, short stent retrievers had a significantly higher rate of first-pass reperfusion in cases with low clot burden (mTICI 3: 27% vs. 17%; p = 0.009; mTICI ≥ 2b: 42 vs. 30%; p = 0.005) and in middle cerebral artery occlusions (mTICI ≥ 2b: 51 vs. 41%; p = 0.024). Higher rates of favorable outcome at discharge and 90 days were observed for the short stent retriever group (p < 0.001). CONCLUSION: Stent retriever length should be adjusted to clot burden score and vessel occlusion site.