Advertisement

Neuroradiology

, Volume 49, Issue 4, pp 365–372 | Cite as

Mechanical thrombectomy with snare in patients with acute ischemic stroke

  • Alejandro González
  • Antonio Mayol
  • Eva Martínez
  • Jose Ramón González-Marcos
  • Alberto Gil-Peralta
Interventional Neuroradiology

Abstract

Introduction

We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS).

Methods

This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2–4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively.

Results

Nine patients (mean age 55 years, range 17–69 years) were included. Their basal mean NIHSS score was 16 (range 12–24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50–75 min). At 3 months, the mRSS score was 0 in two patients and 3–4 in three patients (two patients died).

Conclusion

According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS.

Keywords

Acute stroke Mechanical thrombectomy Snare 

Notes

Conflict of interest statement

We declare that we have no conflict of interest.

References

  1. 1.
    The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587CrossRefGoogle Scholar
  2. 2.
    Furlan A, Higashida R, Weshsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study – a randomized controlled trial. JAMA 282:2003–2011PubMedCrossRefGoogle Scholar
  3. 3.
    del Zoppo G, Higashida R, Furlan A et al (1998) PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 29:4–11PubMedGoogle Scholar
  4. 4.
    TIMI Study Group (1985) The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 312:932–936Google Scholar
  5. 5.
    Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP, MERCI Trial Investigators (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36:1432–1438PubMedCrossRefGoogle Scholar
  6. 6.
    Chopko BW, Kerber C, Wong W, Georgy B (2000) Transcatheter snare removal of acute middle cerebral artery thromboembolism: technical case report. Neurosurgery 46:1529–1531PubMedCrossRefGoogle Scholar
  7. 7.
    Kerber CW, Barr JD, Berger RM, Chopko BW (2002) Snare retrieval of intracranial thrombus in patients with acute stroke. J Vasc Interv Radiol 13:1269–1274PubMedGoogle Scholar
  8. 8.
    Wikholm G (2003) Transarterial embolectomy in acute stroke. AJNR Am J Neuroradiol 24:892–894PubMedGoogle Scholar
  9. 9.
    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607PubMedGoogle Scholar
  10. 10.
    Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, Roorick M, Moomaw CJ, Walker M (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:846–870Google Scholar
  11. 11.
    Barber PA, Demchuk AM, Zhang J, Buchan AM, for the ASPECTS Study Group (2000) Validity and reliability of a quantitative computed tomographic score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 355:1670–1674PubMedCrossRefGoogle Scholar
  12. 12.
    Berger C, Fiorelli M, Steiner T, Schabitz WR, Bozzao L, Bluhmki E, Hacke W, von Kummer R (2001) Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic? Stroke 32:1330–1335PubMedGoogle Scholar
  13. 13.
    Yoneyama T, Nakano S, Kawano H et al (2002) Combined direct percutaneous transluminal angioplasty and low-dose native tissue plasminogen activator therapy for acute embolic middle cerebral artery trunk. AJNR Am J Neuroradiol 23:277–281PubMedGoogle Scholar
  14. 14.
    Eckert B, Kucinski T, Pfeiffer G et al (2002) Endovascular therapy of acute vertebrobasilar occlusion: early treatment onset as the most important factor. Cerebrovasc Dis 14:42–50PubMedCrossRefGoogle Scholar
  15. 15.
    Bellon RJ, Putman CM, Budzik RF et al (2001) Rheolytic thrombectomy of the occluded internal carotid artery in the setting of acute ischemic stroke. AJNR Am J Neuroradiol 22:526–530PubMedGoogle Scholar
  16. 16.
    Berlis A, Lutsep H, Barnwell S et al (2004) Mechanical thrombolysis in acute ischemic stroke with endovascular photoacoustic recanalization. Stroke 35:1112–1116PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Alejandro González
    • 1
  • Antonio Mayol
    • 1
  • Eva Martínez
    • 2
  • Jose Ramón González-Marcos
    • 2
  • Alberto Gil-Peralta
    • 2
  1. 1.Interventional Neuroradiology, Department of RadiologyHospital Universitario Virgen del RocíoSevilleSpain
  2. 2.Department of NeurologyHospital Universitario Virgen del RocíoSevilleSpain

Personalised recommendations