CardioVascular and Interventional Radiology

, Volume 35, Issue 5, pp 1029–1035 | Cite as

Endovascular Acute Stroke Treatment Performed by Vascular Interventional Radiologists: Is It Safe and Efficacious?

  • Lars Fjetland
  • Sumit Roy
  • Kathinka D. Kurz
  • Jan Petter Larsen
  • Martin W. Kurz
Clinical Investigation

Abstract

Purpose

To evaluate the safety and efficacy of neurointerventional procedures in acute stroke patients performed by a team of vascular interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists and to compare the results with those of previous reports from centres with specialised interventional neuroradiologists.

Material and Methods

A total of 39 patients with acute ischemic stroke due to large-vessel occlusion not responding to or not eligible for intravenous thrombolysis were treated with either intra-arterial thrombolysis or mechanical thrombectomy (Penumbra System or solitaire FR thrombectomy system, respectively) and included in our prospective study. Outcomes were measured using the modified Rankin scale after 90 days, and recanalization was assessed by thrombolysis using the myocardial infarction score.

Results

Mean patient age was 68.3 ± 14.2 years; the average National Institutes of Health Stroke Scale score at hospital admission was 17.2 (SD = 6.2 [n = 38]). Successful recanalization was achieved in 74.4 % of patients. Median time from clinical onset to recanalization was 5 h 11 min. Procedure-related complications occurred in 5 % of patients, and 7.5 % had a symptomatic intracerebral hemorrhage. Of the patients, 22.5 % died within the first 90 postprocedural days, 5 % of these from cerebral causes. Patients who were successfully recanalized had a clinical better outcome at follow-up than those in whom treatment failed. Of the patients, 35.9 % had an mRS score ≤2 after 90 days.

Conclusion

Our results are in line with those in the published literature and show that a treatment strategy with general interventional radiologists performing neurointerventional procedures in acute stroke patients with large vessel occlusions can be achieved to the benefit of patients.

Keywords

Neurointerventions Endovascular treatment Thrombectomy Thrombolysis Stroke therapy 

References

  1. 1.
    Lopez AD, Mathers CD, Ezzati M et al (2006) Global and regional burden of disease and risk factors 2001: systematic analysis of population health data. Lancet 367:1747–1757PubMedCrossRefGoogle Scholar
  2. 2.
    Ellekjaer H, Holmen J, Indredavik B et al (1997) Epidemiology of stroke in Innherred, Norway, 1994 to 1996. Incidence and 30-day case-fatality rate. Stroke 28(11):2180–2184PubMedCrossRefGoogle Scholar
  3. 3.
    Lloyd-Jones D, Adams R, Carnethon M et al (2009) Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):e21–e181PubMedCrossRefGoogle Scholar
  4. 4.
    Hatano S (1976) Experience from a multicentre stroke register: a preliminary report. Bull World Health Org 54(5):541–553PubMedGoogle Scholar
  5. 5.
    Thrift AG, Dewey HM, Macdonell RA et al (2001) Incidence of the major stroke subtypes: initial findings from the North East Melbourne stroke incidence study (NEMESIS). Stroke 32(8):1732–1738PubMedCrossRefGoogle Scholar
  6. 6.
    Kolominsky-Rabas PL, Sarti C, Heuschmann PU et al (1998) A prospective community-based study of stroke in Germany—The Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke 29(12):2501–2506PubMedCrossRefGoogle Scholar
  7. 7.
    The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Medicine 333(24):1581–1587Google Scholar
  8. 8.
    Hacke W, Kaste M, Fieschi C et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 274(13):1017–1025PubMedCrossRefGoogle Scholar
  9. 9.
    Hacke W, Kaste M, Fieschi C et al (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352(9136):1245–1251PubMedCrossRefGoogle Scholar
  10. 10.
    Clark WM, Wissman S, Albers GW et al (1999) Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase thrombolysis for acute noninterventional therapy in ischemic stroke. JAMA 282(21):2019–2026PubMedCrossRefGoogle Scholar
  11. 11.
    Wahlgren N, Ahmed N, Davalos A et al (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study. Lancet 369(9558):275–282PubMedCrossRefGoogle Scholar
  12. 12.
    Wolpert SM, Bruckmann H, Greenlee R et al (1993) Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. AJNR Am J Neuroradiol 14:3–13PubMedGoogle Scholar
  13. 13.
    Saqqur M, Uchino K, Demchuk AM et al (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38(3):948–954PubMedCrossRefGoogle Scholar
  14. 14.
    Nogueira RG, Liebeskind DS, Sung G et al (2009) Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the mechanical embolus removal in cerebral ischemia (MERCI) and multi MERCI trials. Stroke 40(12):3777–3783PubMedCrossRefGoogle Scholar
  15. 15.
    Bose A, Henkes H, Alfke K et al (2008) The penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 29(7):1409–1413PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen JE, Gomori JM, Leker RR et al (2012) Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke. J Clin Neurosci 19(1):39–43PubMedCrossRefGoogle Scholar
  17. 17.
    IMS Study Investigators (2004) Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 35(4):904–911Google Scholar
  18. 18.
    Machi P, Costalat V, Lobotesis K et al (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 4(1):62–66PubMedCrossRefGoogle Scholar
  19. 19.
    Hirsch JA, Yoo AJ, Nogueira RG et al (2009) Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA. J Neurointerv Surg 1:27–31PubMedCrossRefGoogle Scholar
  20. 20.
    Penumbra Pivotal Stroke Trial Investigators (2009) The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40(8):2761–2768Google Scholar
  21. 21.
    Castano C, Dorado L, Guerrero C et al (2010) Mechanical thrombectomy with the solitaire AB device in large artery occlusions of the anterior circulation. Stroke 41:1836–1840PubMedCrossRefGoogle Scholar
  22. 22.
    The IMS Study Investigators (2004) Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 35:904–911CrossRefGoogle Scholar
  23. 23.
    Roth C, Papanagiotou P, Behnke S et al (2010) Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke 41(11):2559–2567PubMedCrossRefGoogle Scholar
  24. 24.
    TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med 312(14):932–936Google Scholar
  25. 25.
    Khatri P, Neff J, Broderick JP et al (2005) Revascularization end points in stroke interventional trials: recanalization versus reperfusion in IMS—I. Stroke 36:2400–2403PubMedCrossRefGoogle Scholar
  26. 26.
    Brott T, Adams HP, Olinger CP et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. 20:864–870Google Scholar
  27. 27.
    Van Swieten JC, Koudstaal PJ, Visser MC et al (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607PubMedCrossRefGoogle Scholar
  28. 28.
    Heck VH (2012) Do no harm: the rush to abbreviated training of stroke interventionalists is premature and ill advised. J Neurointerv Surg 4:3–6PubMedCrossRefGoogle Scholar
  29. 29.
    Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282(21):2003–2011PubMedCrossRefGoogle Scholar
  30. 30.
    Tarr R, Hsu D, Kulcsar Z et al (2010) The POST trial: initial post-market experience of the penumbra system: revascularization of large vessel occlusion in acute ischemic stroke in the United States and Europe. J Neurointerv Surg 2(4):341–344PubMedCrossRefGoogle Scholar
  31. 31.
    Möhlenbruch M, Seifert M, Okulla T, et al. (2011) Mechanical thrombectomy compared to local-intraarterial thrombolysis in carotid T and middle cerebral artery occlusions: a single center experience. Clin Neuroradiol 22(2):141–147Google Scholar
  32. 32.
    Kulcsár Z, Bonvin C, Pereira VM et al (2010) Penumbra system: a novel mechanical thrombectomy device for large-vessel occlusions in acute stroke. AJNR Am J Neuroradiol 31(4):628–633PubMedCrossRefGoogle Scholar
  33. 33.
    Smith WS, Sung G, Starkman S et al (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36:1432–1438PubMedCrossRefGoogle Scholar
  34. 34.
    Mpotsaris A, Bussmeyer M, Loehr C et al (2012) Mechanical thrombectomy in severe acute stroke: preliminary results of the solitaire stent. J Neurol Neurosurg Psychiatry 83(1):117–118PubMedCrossRefGoogle Scholar
  35. 35.
    Taschner CA, Treier M, Schumacher M et al (2011) Mechanical thrombectomy with the penumbra recanalization device in acute ischemic stroke. J Neuroradiol 38:47–52PubMedCrossRefGoogle Scholar
  36. 36.
    Belisle JG, McCollom VE, Tytle TL et al (2009) Intraarterial therapy for acute ischemic strokes. J Vasc Interv Radiol 20(3):327–333PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Lars Fjetland
    • 1
    • 2
  • Sumit Roy
    • 1
  • Kathinka D. Kurz
    • 1
  • Jan Petter Larsen
    • 2
    • 3
  • Martin W. Kurz
    • 2
    • 3
  1. 1.Department of RadiologyStavanger University HospitalStavangerNorway
  2. 2.The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
  3. 3.Department of NeurologyStavanger University HospitalStavangerNorway

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