Abstract
Background
Endovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization.
Methods
A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed.
Results
The mean age of the patients was 63.1 ± 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5–19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS ≤2) 30 days after stroke. Overall, significant neurological improvement (≥4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of ≥4 or death occurred in three (5 %) patients.
Conclusions
The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.
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References
Smith WS, Tsao JW, Billings ME et al (2006) Prognostic significance of angiographically confirmed large vessel intracranial occlusion in patients presenting with acute brain ischemia. Neurocrit Care 4:14–17
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 333:1581–1587
Hacke W, Kaste M, Bluhmki E et al (2008) Thrombolysis with Alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359(13):1317–1329
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 38:948–954
IMS Trial Investigators (2004) Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 35:904–911
Grunwald IQ, Wakhloo AK, Walter S et al (2011) Endovascular stroke treatment today. Am J Neuroradiol 32:238–243
Smith WS, Sung G, Saver J et al (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi-MERCI Trial. Stroke 39:1205–1212
Mazighi M, Serfaty JM, Labreuche J et al (2009) Comparison of intravenous Alteplase with a combined intravenous endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurol 8:802–809
Bose A, Henkes H, Alfke K et al (2008) The penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. Am J Neuroradiol 29:1409–1413
Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38(3):967–973
Lin K, Rapalino O, Law M et al (2008) Accuracy of the alberta stroke program early CT score during the first 3 hours of middle cerebral artery stroke: comparison of noncontrast CT, CT angiography source images, and CT perfusion. Am J Neuroradiol 29(5):931–936
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 40:2761–2768
Castano C, Dorado L, Guerrero C et al (2010) Mechanical thrombectomy with the solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke 41(8):1836–1840
Higashida RT, Furlan AJ, Roberts H et al (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34:109–137
Kulcsár Z, Bonvin C, Pereira VM et al (2010) Penumbra system: a novel mechanical thrombectomy device for large vessel occlusions in acute stroke. Am J Neuroradiol 31(4):628–633
Wahlgren N, Ahmed N, Dávalos A et al (2008) Thrombolysis with alteplase 3–4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. Lancet 372(9646):1303–1309
Brekenfeld C, Schroth G, Mordasini P et al (2011) Impact of retrievable stents on acute ischemic stroke treatment. Am J Neuroradiol 32(7):1269–1273
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):62–66
Eesa M, Schumacher HC, Higashida RT et al (2011) Advances in revascularization for acute ischemic stroke treatment: an update. Expert Rev Neurother 11(8):1125–1139
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Jeromel, M., Milosevic, Z.V., Kocijancic, I.J. et al. Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis. Cardiovasc Intervent Radiol 36, 338–345 (2013). https://doi.org/10.1007/s00270-012-0441-x
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DOI: https://doi.org/10.1007/s00270-012-0441-x