Endovascular thrombectomy first-pass reperfusion and ancillary device placement.

BACKGROUND: Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT). METHODS: Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device. RESULTS: From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0-2). CONCLUSIONS: Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.

Thrombectomy aspiration post-market study in acute stroke with the Q aspiration catheter: the TAPAS study.

BACKGROUND: The Q Aspiration Catheter (MIVI Neuro) has demonstrated greater aspiration flow rates and ingestion forces compared with conventional catheters in vitro. The safety and performance of the Q Catheter was assessed using a direct aspiration first pass technique in patients with acute ischemic stroke at four neurointerventional centers in Spain. METHODS: We included adult patients who underwent mechanical thrombectomy between March 2019 and March 2020 using the Q Catheter as first-line therapy. Performance endpoints included final successful revascularization of the target vessel (defined as modified thrombolysis in cerebral infarction (mTICI) grade 2B/3), first pass revascularization, and overall Q Catheter revascularization. Safety endpoints were symptomatic intracranial hemorrhage (sICH), embolization to new territory (ENT), and procedural complications. Modified Rankin Scale (mRS) score and all-cause mortality were also assessed. RESULTS: Forty-five subjects were enrolled. The Q Catheter successfully navigated to the lesion in 95.5% (43/45) of patients. Final successful mTICI 2B/3 revascularization was achieved in 93.3% (42/45), first pass mTICI 2B/3 revascularization with the Q Catheter was 55.3% (21/38), and overall with Q Catheter mTICI 2B/3 revascularization was 65.8% (25/38). Favorable clinical outcome of mRS 0-2 was achieved in 55.6% (25/45). There were no cases of ENT. sICH and mortality rates were 2.2% (1/45) and 13.3% (6/45), respectively. CONCLUSION: In this multicenter, observational study, the Q Aspiration Catheter used as first-line therapy demonstrated a good and safe profile in terms of navigation, revascularization, and safety in patients with acute ischemic stroke.

Prognosis of Tandem Occlusions versus Isolated Intracranial Occlusions.

BACKGROUND: Both acute single intracranial and tandem occlusions are managed with intravascular thrombectomy with success, but little evidence exists about the differences in their mid-term outcome. We aim to compare the outcome at 3 months after tandem (extracranial internal carotid and/or middle cerebral artery) and single intracranial (M1 division) occlusions, and to identify the factors, which determine such prognosis. METHODS: A total of 66 patients (33 with tandem and 33 with singleM1 occlusions) who underwent emergent intravascular therapy in our center between November of 2013 and November of 2016 were collected. Patients' medical histories were reviewed for clinical and radiological variables. A modified Rankin Scale of 3 or more was considered as bad outcome. An interobserver concordance analysis evaluated the quality of collaterals in the initial computed tomography through the Maas, Miteff, and CGS (collateral grading scale) scales. RESULTS: No differences were found in theprognosis of tandem versus single M1 occlusions (P = .30). The kappa index for the Maas scale was .77 (95% confidence interval [CI] .59-.94) and bad collaterals were defined by a score of 1 or 2. The factors independently associated with a worse prognosis were the presence of bad collaterals (adjusted odds ratio [OR] 6.03, 95% CI 1.01-35.9, P = .048) and an incomplete revascularization (adjusted OR 6.01, 95% CI 1.01-35.7, p = .049). CONCLUSIONS: The outcome of patients with acute stroke secondary to tandem or M1 occlusions has not been found to depend on their localization. The bad quality of collaterals is the main factor related to an unfavorable prognosis.

Aracnoiditis osificante: una causa infrecuente de compresión medular / Arachnoiditis ossificans: an uncommon cause of medular compression

Aportamos un nuevo caso de aracnoiditis osificante, sugerido a partir de los hallazgos en resonancia magnética y confirmado histopatológicamente después de la cirugía descompresiva. Revisamos la bibliografía sobre esta patología, haciendo hincapié en su diagnóstico radiológico por resonancia magnética, así como en los aspectos clínicos y en la actitud terapéutica.