Safety and Efficacy of Aspiration Catheter CAT6 and 5 Fr Navien in the Endovascular Treatment of Acute Ischemic Stroke.

BACKGROUND: Mechanical thrombectomy has become a key treatment option for acute ischemic stroke. This study compared the safety and efficacy of aspiration catheter CAT6 and 5 Fr Navien. METHODS: Thrombectomy was performed in103 patients with the acute internal carotid artery, middle cerebral artery M1 or M2 occlusions, including the CAT6 group (n=53 with stent retriever and CAT6 aspiration) and the 5 Fr Navien group (n=50 with stent retriever and 5 Fr Navien aspiration) at the Advanced Stroke Center. RESULTS: Overall, an aspiration catheter placement success rate was achieved in 93.2% of cases, 52 (98.11%) for CAT6, and 44 (88.00%) for 5 Fr Navien ( P =0.042). Overall, 17 cases (16.51%) required additional guidewire rates, 5.66% for CAT6, and 13.592% for 5 Fr Navien ( P =0.002). First-pass success rate (FPSR) was achieved in 38.84% of cases overall, a rate that did not differ significantly between catheters: 45.28% for CAT6; 32.00% for 5 Fr Navien ( P =0.167). Final thrombolysis in cerebral infarction 2b or 3 reperfusion was achieved in 91.26% of cases overall, 51 (96.23%) for CAT6, and 43 (86%) for 5 Fr Navien ( P =0.066). The participants had a mean number of passes for the index thrombus of 1.956 and a median procedure time of 65.82±21.8 minutes. There was no significant difference found in 90-day good outcome (mean 42.7%, modified Rankin Score 0 to 2) and 90-day mortality (17%) between CAT6 and 5 Fr Navien. CONCLUSION: Aspiration catheter placement success rate and first-pass success rate seemed to be higher for CAT6 and, moreover, the rate of additional guidewires was lower.

Simplified classification of cavernous internal carotid artery tortuosity: a predictor of procedural complexity and clinical outcomes in mechanical thrombectomy.

OBJECTIVES: Thromboaspiration catheters are increasingly used for the endovascular treatment of large vessel stroke (LVS), while tortuous vascular anatomy still remains one major challenge in mechanical thrombectomy. Prompt assessing and understanding cavernous internal carotid artery (cICA) tortuosity may help to predict procedural complexities of mechanical thrombectomy and thus improve the clinical outcomes. METHODS: A retrospective review was performed on a cohort of LVS patients with thromboaspiration catheter. Simplified classification of cICA tortuosity was applied by measurement of the angle of the posterior genus (P) and the height from the peak of the posterior genu to the trough of the anterior genu (D). Statistical analyses were performed to analyze differences among the obtained types of cICA tortuosity regarding procedural characteristics and clinical outcomes. RESULTS: A total of 150 patients with LVS proximal to the internal ICA terminus and middle cerebral artery (MCA) were included in this study, and three types of cICA tortuosity were defined by the simplified classification. The index, such as patients ages and hypertension, procedural fluoroscopy time, the degree of cICA tortuosity, first-pass success, final reperfusion, and 90-day mortality showed significant differences among the three types (P < 0.05), while 90-day good outcome (mRS 0-2) only presented significant difference between Type I and Type III (P < 0.05). CONCLUSIONS: The study indicated that the grading of cICA tortuosity is highly correlated with procedural complexity and clinical outcome in mechanical thrombectomy. The proposed classification system may be helpful in pre-procedure prognostication complexity and clinical outcomes.Abbreviations:LVS: large vessel stroke; cICA: cavernous internal carotid artery; mRS: modified Rankin Scale; AIS: acute ischemic stroke; MCA: middle cerebral artery; M1: first division of middle cerebral artery; M2: second division of middle cerebral artery; M3: third division of middle cerebral artery; TICI: Thrombolysis In Cerebral Infarction; TICI 2b: two-thirds of occluded territory reperfusion; DSA: digital subtraction angiography; FT: fluoroscopy time.

Glycine Improves Ischemic Stroke Through miR-19a-3p/AMPK/GSK-3ß/HO-1 Pathway.

PURPOSE: To explore the molecular mechanism of glycine in improving ischemic stroke. PATIENTS AND METHODS: The serum samples of patients with ischemic stroke and healthy people were compared. The ischemic stroke model of PC12 cells was established by oxygen-glucose deprivation (OGD). qPCR quantified miR-19a-3p and AMPK mRNA, and protein expression was detected by Western blot. MTT was used to detect cell activity. Flow cytometry was used to detect cells. Glucose metabolism kit was used to detect glucose intake and formation amount of lactic acid. RESULTS: Compared with the control group, OGD group (OGDG) showed lower cell activity and increased cell apoptosis. TNF-α, IL-1ßI, L-6, Caspase 3, Caspase 9 and Bax were up-regulated, and Glut1, HK2, LDHA, PDK1, PKM2 and Bcl2 were down-regulated. At the same time, glucose intake, formation amount of lactic acid and cell apoptosis rate were reduced, and AMPK/GSK-3ß/HO-1 pathway activity was down-regulated. Glycine could counteract the above phenomena in OGDG. miR-19a-3p and AMPK decreased and increased, respectively, during glycine therapy. AMPK was the target gene of miR-19a-3p. Rescue experiments demonstrated that glycine improved cell apoptosis, inflammatory response and glucose metabolism disorder of ischemic stroke through miR-19a-3p/AMPK/GSK-3ß/HO-1 pathway. CONCLUSION: Glycine improves ischemic stroke through miR-19a-3p/AMPK/GSK-3ß/HO-1 pathway.