RESUMO
BACKGROUND AND PURPOSE: In contrast to anterior circulation stroke (ACS), there is no evidence from randomized trials that mechanical thrombectomy (MT) with modern stent retrievers or thromboaspiration is safe and effective in posterior circulation stroke (PCS). METHODS: The present analysis was based on the prospective multicentre Registry on Revascularization in Ischemic Stroke Patients (REVASK) in Germany. Demographic data, periprocedural times and complications, recanalization rates, and functional outcome at discharge and after 3 months were compared between 139 consecutive patients with PCS (84.9% basilar artery, 16.5% vertebral artery and 4.3% posterior cerebral artery occlusion) and 961 patients with ACS treated with MT. RESULTS: Compared to ACS, PCS patients were significantly younger (65 vs. 69 years, P = 0.021) and had a lower median National Institutes of Health Stroke Scale (NIHSS) score at baseline (12 vs. 15, P = 0.024). Patients with PCS had a significantly longer time delay between symptom onset and both start and end of the MT procedure. Successful recanalization and thrombectomy passes did not significantly differ between the two groups. No symptomatic intracranial haemorrhage occurred in PCS compared to 3% in ACS (P = 0.010). The median NIHSS score at discharge was 3 in PCS and 4 in ACS. Favourable functional outcome at 3 months (modified Rankin Scale 0-2 38.0% vs. 42.6%, P = 0.392) and mortality (33.7% vs. 30.8%, P = 0.539) did not differ significantly between PCS and ACS. CONCLUSIONS: The study suggests that MT in PCS shows a lower risk of symptomatic intracranial haemorrhage and similar effectiveness compared to ACS. PCS patients also seem to benefit from MT started beyond 6 h after symptom onset.
Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/cirurgia , Artéria Cerebral Posterior/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Isquemia Encefálica/etiologia , Avaliação da Deficiência , Feminino , Alemanha , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Stents , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
PURPOSE: In the treatment of wide-necked aneurysms, stenting may be required after balloon-assisted coiling (BAC) for reconstructing the lumen/flow of the parent artery in cases of coil herniation. The potential benefits and complications of both techniques remain unclear when used together. Our aim was to assess the safety and long-term angiographic outcomes of stenting after BAC. METHODS: Retrospective review of 87 unruptured wide necked aneurysms (in 80 patients) treated with BAC and requiring stent placement at the final stage of the procedure due to coil prolapse. Aneurysm characteristics, technical issues, clinical records, and MR results were assessed. Post-treatment and follow-up angiograms were evaluated by two independent reviewers and categorized as "stable," "further thrombosis," or "recanalization." RESULTS: The mean maximum diameter was 9.1 ± 4.7 mm and aspect ratio 1.20 ± 0.47. Complete and near-complete initial occlusion were observed in 53 (60.9%) and 28 (32.2%) of all treated aneurysms, respectively. Angiographic follow-up (80 aneurysms; mean, 34.68 ± 25.26 months) revealed stability and further thrombosis in 92.4% (74/80). Recanalization was observed in six cases (7.5%, 6/83), four of which were retreated. No significantly different outcomes were found in terms of aneurysm size (p = 0.641). Transient and reversible procedure-related complications occurred in eight (9.2%), minor permanent deficits in 2.3%, and major deficits, including death, in four cases (4.6%). CONCLUSION: Our results suggest that treatment of wide-necked aneuryms with stent placement after BAC yields low recanalization rates and enhanced angiographic outcomes in long-term follow-up.
Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Angiografia Cerebral , Meios de Contraste , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva , Retratamento , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Mechanical thrombectomy predominantly using stent retrievers effectively restores cerebral blood flow and improves functional outcomes in patients with acute ischemic stroke. We sought to determine the safety and efficacy of mechanical thrombectomy using the EmboTrap device. MATERIALS AND METHODS: We identified 80 consecutive patients from 4 centers with acute ischemic stroke treated with EmboTrap from June 2015 to December 2016. All patients had confirmed large vessel occlusions in the anterior circulation using CT or MR angiography with salvageable tissue. We assessed baseline characteristics and treatment related parameters including onset-to-treatment time, recanalization success (mTICI 2b or greater), complications, and good clinical outcome (mRS 0 to 2). RESULTS: Successful recanalization was achieved in 72 patients (90%). When considering the use of a second thrombectomy device as failure, the EmboTrap successfully recanalized 65 patients (81%), with complete (mTICI 3) recanalization in 40 patients (50%) within 1 or 2 passes. Median procedure time (groin to recanalization) was 35 minutes (8-161 minutes). During the procedure, distal emboli in previously unaffected territories were found in 5 (6%) patients. There were 3 vasospasms (4%) and no vessel perforations. Intracranial hemorrhage on CT at day 1 was found in 18 17 (2321%) patients, none with subarachnoid hemorrhages, and 5 were symptomatic (6%). Good clinical outcome occurred in 4749/68 78 patients (6963%). CONCLUSIONS: In this multicenter retrospective study, the EmboTrap device achieved high recanalization rates, good clinical outcomes and was safe in treating acute stroke patients with large vessel occlusions.
Assuntos
Infarto da Artéria Cerebral Anterior/cirurgia , Trombólise Mecânica/instrumentação , Trombólise Mecânica/métodos , Acidente Vascular Cerebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
This article gives an overview about diagnostic imaging and treatment options of acute patients with ischemic and hemorrhagic stroke with emphasis on evidence from relevant studies published in the last 2 years. A computed tomography of the brain with CT-angiography should be the minimal standard imaging modality in acute ischemic stroke patients. Diffusion-weighted/imaging-fluid-attenuated inversion recovery (FLAIR)-mismatch magnetic resonance imaging can be useful in patients with wake-up stroke to select patients for recanalisation therapies. Systemic thrombolysis with rt-PA within 4.5 hours after symptom onset and mechanical thrombectomy with stent retrievers within 6 hours and proven occlusion of a large vessel in the anterior brain circulation are both evidence-based treatments. In contrast, there are no major therapeutic advances in patients with hemorrhagic stroke. The systolic blood pressure should be lowered <â140 âmm Hg in these patients within one hour. Both acute ischemic and hemorrhagic stroke and patients with a transient ischemic attack should be monitored and treated on a stroke unit due to an improved outcome. A prophylactic antibiotic treatment and very early mobilization during the first 24 hours is not recommended in acute stroke patients.
Assuntos
Acidente Vascular Cerebral/terapia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Imagem de Difusão por Ressonância Magnética , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/terapia , Procedimentos Neurocirúrgicos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Terapia TrombolíticaRESUMO
SUMMARY: Coil displacement during endovascular coiling procedures may require coil retrieval in the context of flow limitation or thromboembolic risk. No standard recommended method of coil retrieval exists. We present a consecutive series of 14 patients with displaced coil during aneurysm coiling in whom the complication was effectively managed with the use of a stent retriever system. Two illustrative cases from the 14 are described, and technical notes are detailed regarding use of the technique. The use of stent retrievers presents a simple, safe, and effective choice for removal of prolapsed coils during aneurysm coiling.
Assuntos
Aneurisma Roto/terapia , Remoção de Dispositivo/instrumentação , Embolização Terapêutica/efeitos adversos , Migração de Corpo Estranho/etiologia , Aneurisma Intracraniano/terapia , Stents/efeitos adversos , Adulto , Idoso , Bases de Dados Factuais , Remoção de Dispositivo/métodos , Embolização Terapêutica/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoAssuntos
Isquemia Encefálica/patologia , Isquemia Encefálica/cirurgia , Córtex Motor/patologia , Córtex Motor/cirurgia , Angiografia Digital , Isquemia Encefálica/fisiopatologia , Angiografia Cerebral , Revascularização Cerebral , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Córtex Motor/fisiopatologia , Stents , Resultado do Tratamento , Adulto JovemAssuntos
Angiografia/métodos , Aorta/anormalidades , Aortografia/métodos , Fístula Artério-Arterial/diagnóstico por imagem , Coluna Vertebral/anormalidades , Coluna Vertebral/irrigação sanguínea , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Coluna Vertebral/diagnóstico por imagemRESUMO
A total of 10 tubing materials (butyl-, rubber-, latex-, polyethylene-, Perbunan-, PVC-, silicone-, Teflon-, Tygon- and Vitontubes), which are sold for laboratory use, was tested for their sorption capacity. Different concentrations (0.03-8 micrograms active ingredients/ml H2O) of pesticides, lindane and atrazine, were used in three experiments to investigate the sorption on inner and/or outer surface of tubes and with continuous flow rate of pesticide solutions. In general the sorption of lindane was greater than atrazine. The extent of sorption was dependent on the concentration of pesticides. Teflon showed no sorption in any of the experiments, the same as quartz glass, which was used as a standard. Depending on the sorption behaviour, the use of some tubing materials (e.g. Tygon, Perbunan or silicone tubes) is not advisable for certain experiments.