1,500 results match your criteria Mechanical Thrombolysis in Acute Stroke


Thrombolysis management in thrombectomy patients: Real-life data from German stroke centres.

Eur Stroke J 2017 Dec 17;2(4):356-360. Epub 2017 Aug 17.

Department of Neuroradiology, Klinikum der Universität München, Ludwig-Maximilians University, Munich, Germany.

Introduction: In randomised clinical trials (RCTs), endovascular thrombectomy (ET) was combined with intravenous thrombolysis (IVT) in the vast majority of patients. We aimed to analyse how German stroke centres manage IVT in patients receiving ET in daily routine.

Patients And Methods: We performed an online survey among neurologists and neurointerventionalists that included all German University hospitals and a selection of German community hospitals known to perform ET. Read More

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http://dx.doi.org/10.1177/2396987317727229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453195PMC
December 2017

Intra-arterial mechanical thrombectomy stent retrievers and aspiration devices in the treatment of acute ischaemic stroke: A systematic review and meta-analysis with trial sequential analysis.

Eur Stroke J 2017 Dec 10;2(4):308-318. Epub 2017 Jul 10.

Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle Upon Tyne, UK.

Purpose: Intra-arterial mechanical thrombectomy combined with appropriate patient selection (image-based selection of acute ischaemic stroke patients with large artery occlusion) yields improved clinical outcomes. We conducted a systematic review and meta-analysis, with trial sequential analysis to understand the benefits, risks and impact of new trials reporting in 2016 on the magnitude/certainty of the estimates for clinical effectiveness and safety of mechanical thrombectomy.

Method: Random effects' models were conducted of randomised clinical trials comparing mechanical thrombectomy (stent retriever or aspiration devices) with/without adjuvant intravenous thrombolysis with intravenous thrombolysis and other forms of best medical/supportive care in the treatment of acute ischaemic stroke. Read More

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http://dx.doi.org/10.1177/2396987317719362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453187PMC
December 2017
1 Read

Recanalization treatments in basilar artery occlusion-Systematic analysis.

Eur Stroke J 2016 Mar 1;1(1):41-50. Epub 2016 Mar 1.

Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background And Aims: Basilar artery occlusion is a most devastating form of stroke, and the current practice is to reverse it with revascularization therapies. Pharmacological thrombolysis, intravenous or intraarterial, has been adjuncted or replaced with invasive, endovascular thrombectomy procedures. The preferred approach remains unknown and many recanalizations are futile with no clinical benefit. Read More

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http://dx.doi.org/10.1177/2396987316629889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301218PMC

ERASER.

Stroke 2019 May;50(5):1275-1278

From the Department of Neuroradiology (J.F., M.B., H.K., S.G.), University Hospital Hamburg-Eppendorf, Germany.

Background and Purpose- Using a novel study design with virtual comparators based on predictive modeling, we investigated whether next-generation mechanical thrombectomy devices improve outcomes in patients with ischemic stroke. We hypothesized that this new study design shows that a next-generation mechanical thrombectomy system is superior to intravenous tPA (tissue-type plasminogen activator) therapy (IVT) alone. Methods- ERASER (Eric Acute Stroke Recanalization) was an investigator-initiated, prospective, multicenter, single-arm (virtual 2-arm) study that evaluated the effectiveness of a new recanalization device together with a specific intermediate catheter (Embolus Retriever with Interlinked Cages/SOFIA, Microvention) in stroke patients with internal carotid artery or middle cerebral artery occlusions. Read More

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http://dx.doi.org/10.1161/STROKEAHA.119.024858DOI Listing

Acute Stroke With Large Ischemic Core Treated by Thrombectomy.

Stroke 2019 May;50(5):1164-1171

Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (B.L.).

Background and Purpose- Acute stroke patients with a large ischemic core may still benefit from mechanical thrombectomy (MT), but the predictors of clinical outcome are not well known after MT. We investigated the clinical and imaging factors associated with good outcome and mortality at 90 days in acute stroke patients with a large baseline ischemic core treated with MT. Methods- Data from the multicentric prospective ETIS (Endovascular Treatment in Ischemic Stroke) registry of consecutive acute ischemic stroke patients treated with MT from January 1, 2012, to August 31, 2016, were retrospectively analyzed. Read More

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http://dx.doi.org/10.1161/STROKEAHA.118.024295DOI Listing

Per-Pass Analysis of Thrombus Composition in Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy.

Stroke 2019 May;50(5):1156-1163

Cerenovus, Galway Neuro Technology Centre, Ireland (S.D., R.M., M.G.).

Background and Purpose- Mechanical thrombectomy may involve multiple attempts to retrieve the occluding thrombus. This study examined the composition of thrombus fragments retrieved with each pass of a device during the thrombectomy procedure. Second, the per-pass composition was compared with procedural and clinical data including angiographic outcome and stroke etiology. Read More

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https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023419
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http://dx.doi.org/10.1161/STROKEAHA.118.023419DOI Listing
May 2019
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Endovascular treatment of acute basilar artery occlusion: Tama-REgistry of Acute Thrombectomy (TREAT) study.

J Neurol Sci 2019 Apr 12;401:29-33. Epub 2019 Apr 12.

Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan. Electronic address:

Objective: The effectiveness of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) remains unknown. We evaluated the feasibility, safety, and efficacy of endovascular treatment for ABAO.

Methods: We retrospectively investigated patients with ABAO who underwent MT, using modern stent retrievers and an aspiration device, between January 2015 and December 2017 at 12 comprehensive stroke centers. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S0022510X193016
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http://dx.doi.org/10.1016/j.jns.2019.04.010DOI Listing
April 2019
1 Read

Endovascular Treatment of Acute Stroke Due to Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion.

Front Neurol 2019 2;10:308. Epub 2019 Apr 2.

Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Endovascular treatment (EVT) has become a standard treatment for acute ischemic stroke due to large vessel occlusion (LVO) in the anterior circulation. However, whether EVT tools used for intracranial atherosclerotic stenosis (ICAS)-related LVO are as safe and effective as for use in embolic LVO remains unclear. There have been only a few studies about EVT for ICAS-related LVO, and these studies revealed that mechanical thrombectomy with a stent retriever or contact aspiration was less effective and more time consuming in ICAS-related LVO than in embolic LVO. Read More

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http://dx.doi.org/10.3389/fneur.2019.00308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454085PMC

[Mechanical thrombectomy treatment in patients with acute ischemic stroke: a single center study].

Beijing Da Xue Xue Bao Yi Xue Ban 2019 Apr;51(2):256-259

Department of Interventional Radiologyand Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.

Objective: To evaluate the effectiveness and safety of mechanical thrombectomy treatment in patients with acute ischemic stroke (AIS),and to explore influential factors of the clinical prognosis preliminarily.

Methods: Clinical data of 26 patients with acute cerebral arterial occlusion treated with mechanical thrombectomy in Peking University Third Hospital from January 2014 to June 2017 were retrospectively collected. The immediate effects of the 26 patients in this group after mechanical thrombectomy treatment were analyzed,The national institutes of health stroke scale (NIHSS) scores between preoperative and at discharge of the 26 patients in this group were compared,and modified Rankin scale (mRS) scores of 90 days post operation were analyzed to assess the prognosis of the 26 patients in this group. Read More

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April 2019
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2019 Update of the Korean Clinical Practice Guidelines of Stroke for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke.

J Stroke 2019 Apr 17. Epub 2019 Apr 17.

Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

Endovascular recanalization therapy (ERT) has been a standard of care for patients with acute ischemic stroke due to large artery occlusion (LAO) within 6 hours after onset, since five landmark ERT trials conducted by 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window of up to 16 hours or 24 hours after last known normal time, improved the outcome of patients who had a target mismatch, defined as either clinical-core mismatch or perfusion-core mismatch, which prompted the update of national guidelines in several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT in patients with acute LAO in Korea, the Clinical Practice Guidelines Committee of the Korean Stroke Society decided to revise the previous Korean Clinical Practice Guidelines of Stroke for ERT. Read More

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http://dx.doi.org/10.5853/jos.2019.00024DOI Listing

Safety and Efficacy of Heparinization During Mechanical Thrombectomy in Acute Ischemic Stroke.

Front Neurol 2019 29;10:299. Epub 2019 Mar 29.

Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

The benefits of heparization during mechanical thrombectomy (MT) with newer generation thrombectomy devices, and if it is counterbalanced by the increased risk of intracranial hemorrhage (ICH) remain unknown. We included eligible patients who underwent MT from the ANGEL registry study (2015-2017) in China. Subjects in the current analysis were dichotomized into two groups according to whether adequate heparinization during MT was performed. Read More

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https://www.frontiersin.org/article/10.3389/fneur.2019.00299
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http://dx.doi.org/10.3389/fneur.2019.00299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450216PMC
March 2019
2 Reads

'Real-world' comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study.

J Neurointerv Surg 2019 Apr 11. Epub 2019 Apr 11.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA.

Background: Thrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to 'real-world' practice.

Objective: To compare revascularization rates and outcomes for direct aspiration (ADAPT) and stent retriever thrombectomy following anterior acute ischemic stroke (AIS) in a real-life setting. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014624DOI Listing
April 2019
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Time-dependence of NIHSS in predicting functional outcome of patients with acute ischemic stroke treated with intravenous thrombolysis.

Postgrad Med J 2019 Apr 11. Epub 2019 Apr 11.

Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China

Objectives: The National Institute of Health Stroke Scale (NIHSS) is a predictor for the prognosis of acute ischaemic stroke (AIS) and its prediction is time-dependent. We examined the performance of NIHSS at different timepoints in predicting functional outcome of patients with thrombolysed AIS.

Methods: This prospective study included 269 patients with AIS treated with recombinant tissue plasminogen activator (rt-PA). Read More

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http://dx.doi.org/10.1136/postgradmedj-2019-136398DOI Listing

Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy.

J Stroke Cerebrovasc Dis 2019 Apr 8. Epub 2019 Apr 8.

Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania.

Introduction: Mechanical thrombectomy is revolutionizing treatment of acute stroke due to large vessel occlusion (LVO). Unfortunately, use of the modified Thrombolysis in Cerebral Infarction score (mTICI) to characterize recanalization of the cerebral vasculature does not address microvascular perfusion of the distal parenchyma, nor provide more than a vascular "snapshot." Thus, little is known about tissue-level hemodynamic consequences of LVO recanalization. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.019DOI Listing

Pulmonary Embolism.

Med Clin North Am 2019 May;103(3):549-564

John Hopkins Hospital, 830 East Monument Street, 1830 Building 5th Floor Pulmonary, Baltimore, MD 21287, USA.

Venous thromboembolism (VTE) includes pulmonary embolism (PE) and deep vein thrombosis. PE is the third most common cause of cardiovascular death worldwide after stroke and heart attack. Management of PE has evolved recently with the availability of local thrombolysis; mechanical extraction devices; hemodynamic support devices, like extracorporeal membrane oxygenation; and surgical embolectomy. Read More

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http://dx.doi.org/10.1016/j.mcna.2018.12.013DOI Listing
May 2019
1 Read

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke.

J Neurointerv Surg 2019 Apr 6. Epub 2019 Apr 6.

Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland.

Background: Mechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014586DOI Listing
April 2019
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Endovascular Thrombolysis or Thrombectomy for Cerebral Venous Thrombosis: Study of Nationwide Inpatient Sample 2004-2014.

J Stroke Cerebrovasc Dis 2019 Apr 2. Epub 2019 Apr 2.

Department of Neurology, Academic Medical Center, Netherlands.

Background And Purpose: 15% of cerebral venous thrombosis (CVT) patients have poor outcomes despite anticoagulation. Uncontrolled studies suggest that endovascular approaches may benefit such patients. In this study, we analyze Nationwide Inpatient Sample (NIS) data to evaluate the safety and efficacy of endovascular therapy (ET) versus medical management in CVT. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10523057193012
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.025DOI Listing
April 2019
2 Reads

Acute ischemic stroke treated with mechanical thrombectomy and fungal endocarditis: A case report and systematic review of the literature.

J Neuroradiol 2019 Apr 2. Epub 2019 Apr 2.

Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France.

Fungal endocarditis is a rare clinical form of infective endocarditis. The main etiology of FE is Candida albicans but also Candida parapsilosis and the overall mortality is high. We report a case of an acute ischemic stroke treated by mechanical thrombectomy, with the histopathological analysis of the retrieved clot followed by the confirmation of fungal endocarditis. Read More

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http://dx.doi.org/10.1016/j.neurad.2019.03.003DOI Listing
April 2019
4 Reads

One-year single-center experience with the Aperio thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome.

Neurol Sci 2019 Apr 4. Epub 2019 Apr 4.

Medical Faculty, Department of Diagnostic and Interventional Radiology, University Duesseldorf, Moorenstr.5, 40225, Duesseldorf, Germany.

Background And Purpose: The Aperio thrombectomy device (Aperio) is a stent retriever designed to achieve rapid and substantial flow restoration in acute ischemic stroke due to large-vessel occlusions (LVOs). We evaluated the safety and efficacy of the Aperio device and compared it with published data of established stent retrievers.

Methods: We retrospectively analyzed institutional data of consecutive stroke procedures in patients with LVO in the anterior circulation that were treated between January 2017 and December 2017 with the Aperio. Read More

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http://dx.doi.org/10.1007/s10072-019-03861-zDOI Listing
April 2019
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Comparative efficacy and safety of bridging strategies with direct mechanical thrombectomy in large vessel occlusion: A systematic review and meta-analysis.

Medicine (Baltimore) 2019 Apr;98(14):e14956

Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China.

Background: Whether bridging strategies[intravenous thrombolysis (IVT) + mechanical thrombectomy (MT)] are superior to mechanical thrombectomy alone for large vessel occlusion(LVO) is still uncertain. A systematic review and meta-analysis was conducted to investigate and evaluate comparative efficacy and safety of bridging strategies vs direct MT in patients with LVO.

Methods: The PubMed, EMBASE and Cochrane library databases were searched to evaluate the efficacy and safety of bridging strategies with direct MT in LVO. Read More

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http://dx.doi.org/10.1097/MD.0000000000014956DOI Listing
April 2019
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5.723 Impact Factor

Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry.

Ther Adv Neurol Disord 2019 27;12:1756286419835708. Epub 2019 Mar 27.

Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, CH-3010, Switzerland.

Background And Purpose: In acute ischaemic stroke (AIS) of the anterior circulation (AC) treated with mechanical thrombectomy (MT), data point to a decline of treatment effect with increasing time from symptom onset to treatment. However, the magnitude of the decline will depend on the clinical setting and imaging selection used. The aims of this study were (1) to evaluate the clinical effect of time to reperfusion (TTR); and (2) to assess the safety and technical efficacy of MT according to strata of TTR. Read More

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http://dx.doi.org/10.1177/1756286419835708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437320PMC
March 2019
3 Reads

Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients.

J Neurosurg 2019 03 29:1-8. Epub 2019 Mar 29.

2Department of Neurological Surgery and.

OBJECTIVE Mechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients. METHODS The authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Read More

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http://dx.doi.org/10.3171/2018.12.JNS182399DOI Listing
March 2019
1 Read

Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence.

Neurol Res Int 2019 24;2019:9657073. Epub 2019 Feb 24.

Internal Medicine, Stroke Unit and Center of Thromboembolic Diseases, Santa Maria Nuova Hospital, Florence, Italy.

Introduction: The optimal timing for starting anticoagulation in the early phase of nonvalvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains a challenge, especially in patients undergoing urgent reperfusion by systemic thrombolysis or mechanical thrombectomy. The aim of our study was to review the literature evidence reporting on safety of direct oral anticoagulants (DOACs) starting in the early phase of NVAF-related AIS undergoing systemic thrombolysis and/or mechanical thrombectomy.

Materials And Methods: We reviewed the PubMed databases searching articles reporting on efficacy and safety of DOACs starting time within two weeks from AIS onset in patients undergoing systemic thrombolysis and/or mechanical thrombectomy. Read More

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http://dx.doi.org/10.1155/2019/9657073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409009PMC
February 2019

Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome.

Radiology 2019 Mar 26:181924. Epub 2019 Mar 26.

From the Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.

Background Acute stroke because of basilar artery occlusion (BAO) represents 1% of all ischemic strokes. However, recanalization rates and treatment outcome for the different pathologic subtypes of BAO stroke are not fully understood. Purpose To compare the recanalization rate and clinical outcomes of mechanical thrombectomy in different subtypes of BAO. Read More

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http://dx.doi.org/10.1148/radiol.2019181924DOI Listing
March 2019
2 Reads

[Acute stroke].

MMW Fortschr Med 2019 Mar;161(Suppl 1):22-31

Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland.

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http://dx.doi.org/10.1007/s15006-019-0008-8DOI Listing

Vasospasm as a major complication after acute mechanical thrombectomy with stent retrievers.

J Clin Neurosci 2019 Mar 20. Epub 2019 Mar 20.

Department of Neurosurgery, Hokuto Hospital, Obihiro, Japan. Electronic address:

Objective: Mechanical thrombectomy using a stent retriever for acute large vessel occlusion is indispensable in stroke treatment, however, vasospasm may occur. The objective of this retrospective study was to investigate which cases are more likely to experience vasospasm after thrombectomy with stent retrievers.

Methods: We included 29 patients diagnosed with acute cardiogenic cerebral embolism who were treated with stent retrievers at our facility from December 2014 to December 2017. Read More

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http://dx.doi.org/10.1016/j.jocn.2019.03.011DOI Listing
March 2019
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Benefit from revascularization after thrombectomy according to FLAIR vascular hyperintensities-DWI mismatch.

Eur Radiol 2019 Mar 22. Epub 2019 Mar 22.

Department of Neuroradiology, INSERM U1266, Sainte-Anne Hospital, Paris Descartes University, Paris, France.

Objectives: We tested whether FLAIR vascular hyperintensities (FVH)-DWI mismatch could identify candidates for thrombectomy most likely to benefit from revascularization.

Methods: We retrospectively reviewed 100 patients with proximal MCA occlusion from 18 stroke centers randomized in the IV-thrombolysis plus mechanical thrombectomy arm of the THRACE trial (2010-2015). We tested the associations between successful revascularization on digital subtraction angiography (modified Thrombolysis in Cerebral Infarction 2b/3) and 3-month favorable outcome (modified Rankin Scale score ≤ 2), stratified on FVH-DWI mismatch status, with secondary analyses adjusted on National Institutes of Health Stroke Scale (NIHSS) and DWI lesion volume. Read More

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http://dx.doi.org/10.1007/s00330-019-06094-yDOI Listing
March 2019
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Standards of Practice in Acute Ischemic Stroke Intervention International Recommendations.

Can J Neurol Sci 2019 Mar 20:1-6. Epub 2019 Mar 20.

University of Toronto, Toronto Western Hospital,Toronto,Canada.

After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). Read More

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http://dx.doi.org/10.1017/cjn.2019.1DOI Listing

Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units.

Front Neurol 2019 1;10:159. Epub 2019 Mar 1.

Department of Neurology, Saarland University Medical Centre, Homburg, Germany.

In acute stroke management, time is brain, as narrow therapeutic windows for both intravenous thrombolysis and mechanical thrombectomy depend on expedient and specialized treatment. In rural settings, patients are often far from specialized treatment centers. Concurrently, financial constraints, cutting of services and understaffing of specialists for many rural hospitals have resulted in many patients being underserved. Read More

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http://dx.doi.org/10.3389/fneur.2019.00159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407433PMC
March 2019
2 Reads

Initial Experience in Direct Aspiration Thrombectomy Utilizing a Novel 0.071-inch Aspiration Catheter.

World Neurosurg 2019 Mar 14. Epub 2019 Mar 14.

Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.

Introduction: ADAPT (A Direct Aspiration First Pass Technique) is one of the most widely used techniques in mechanical thrombectomy. Aspiration catheter size plays a major role in the success of this technique. The AXS Vecta (Stryker Neurovascular, Fremont, CA) aspiration catheter is the first approved 0. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.03.055DOI Listing
March 2019
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Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy.

J Stroke Cerebrovasc Dis 2019 Mar 13. Epub 2019 Mar 13.

The Department of Clinical Neurology, The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, United Kingdom.

Intravenous recombinant tissue-plasminogen-activator (rtPA) and mechanical-thrombectomy (MT) are currently the only approved treatments for acute ischemic stroke. Their effectiveness was demonstrated in several clinical trials, and is therefore standard of care. Pregnant women were not included in these studies and consequently the effectiveness and safety in this group are unclear. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.015DOI Listing
March 2019
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Point-of-care measurements reveal release of purines into venous blood of stroke patients.

Purinergic Signal 2019 Mar 12. Epub 2019 Mar 12.

University Hospital of North Midlands, Stoke-on-Trent, and Keele University, Keele, UK.

Stroke is a leading cause of death and disability. Here, we examine whether point-of-care measurement of the purines, adenosine, inosine and hypoxanthine, which are downstream metabolites of ATP, has potential to assist the diagnosis of stroke. In a prospective observational study, patients who were suspected of having had a stroke, within 4. Read More

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http://dx.doi.org/10.1007/s11302-019-09647-4DOI Listing

Stent-Retriever Thrombectomy and Rescue Treatment of M1 Occlusions Due to Underlying Intracranial Atherosclerotic Stenosis: Cohort Analysis and Review of the Literature.

Cardiovasc Intervent Radiol 2019 Mar 11. Epub 2019 Mar 11.

University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 8, 3010, Bern, Switzerland.

Background And Purpose: Data on the management of large vessel occlusion in patients with anterior circulation acute ischemic stroke (AIS) due to underlying intracranial stenosis are scarce. The aim of this retrospective study was to compare endovascular treatment and outcome in AIS patients with and without underlying stenosis of the M1 segment.

Materials And Methods: A total of 533 acute stroke patients with an isolated M1 occlusion who underwent mechanical thrombectomy between 02/2010 and 08/2017 were included. Read More

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http://dx.doi.org/10.1007/s00270-019-02187-9DOI Listing

Catheter-directed aspiration thrombectomy and low-dose thrombolysis for patients with acute unstable pulmonary embolism: Prospective outcomes from a PE registry.

Int J Cardiol 2019 Feb 28. Epub 2019 Feb 28.

Respiratory Department, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), Madrid, Spain. Electronic address:

Objectives: To evaluate the efficacy and safety of aspiration thrombectomy in combination with low-dose catheter-directed thrombolysis for acute unstable pulmonary embolism (PE).

Background: Acute unstable (PE) is a life-threatening condition requiring treatment escalation, but many patients cannot receive full-dose systemic thrombolysis due to contraindications.

Methods: Eligible patients had a PE with sustained hypotension. Read More

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http://dx.doi.org/10.1016/j.ijcard.2019.02.061DOI Listing
February 2019
2 Reads

Clinical Characteristics and Emergent Therapeutic Interventions in Patients Evaluated through the In-hospital Stroke Alert Protocol.

J Stroke Cerebrovasc Dis 2019 May 4;28(5):1362-1370. Epub 2019 Mar 4.

Department of Neurology, University of Chicago Medical Center, Chicago, Illinois.

Background And Purpose: Emergent evaluation of inpatients with suspected acute ischemic stroke faces difficulty of symptoms recognition, false alarms, and high rate of contraindications to reperfusion therapies. We aim to assess the clinical characteristics and therapeutic interventions implemented in patients evaluated though the in-hospital Stroke Alert Protocol.

Methods: We analyzed 4 years-worth of Stroke Alert cases at a university hospital. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.001DOI Listing
May 2019
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Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment.

J Neurointerv Surg 2019 Mar 6. Epub 2019 Mar 6.

Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA.

Background: Procedural time in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy may affect clinical outcomes. We performed a pooled analysis of the effect of procedural time on clinical outcomes using data from three prospective endovascular treatment trials.

Objective: To examine the relationship between endovascular procedural time and clinical outcomes of patients with AIS following endovascular treatment. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014576DOI Listing
March 2019
1 Read

The Large ARtery Intracranial Occlusion Stroke Scale: A New Tool With High Accuracy in Predicting Large Vessel Occlusion.

Front Neurol 2019 19;10:130. Epub 2019 Feb 19.

Department of Neurology and Stroke Unit, Niguarda Ca' Granda Hospital, Milan, Italy.

The combination of systemic thrombolysis and mechanical thrombectomy is indicated in patients with ischemic stroke due to a large vessel occlusion (LVO) and these treatments are time-dependent. Rapid identification of patients with suspected LVO also in a prehospital setting could influence the choice of the destination hospital. Aim of this pilot study was to evaluate the predictive role of a new stroke scale for LVO, comparing it to other scores. Read More

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http://dx.doi.org/10.3389/fneur.2019.00130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389631PMC
February 2019
5 Reads

Management of Acute Ischemic Stroke.

Am J Med 2019 Mar 26;132(3):286-291. Epub 2018 Oct 26.

Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Electronic address:

The treatment of acute ischemic stroke includes both intravenous (IV) thrombolysis and mechanical thrombectomy. Important advances regarding both treatment modalities have occurred recently that all physicians who see patients at risk for or who have had a stroke should be aware of. This review will focus on recent clinical trials of IV thrombolysis both positive and negative. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00029343183103
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http://dx.doi.org/10.1016/j.amjmed.2018.10.019DOI Listing
March 2019
6 Reads

Factors impacting on technical success in stroke thrombectomy: experience of a UK neuro-interventional unit.

Clin Radiol 2019 May 28;74(5):390-398. Epub 2019 Feb 28.

Department of Neuroradiology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK. Electronic address:

Aim: To investigate factors that could impact on recanalisation and reperfusion in patients undergoing mechanical thrombectomy and to assess the technical success over time.

Materials And Methods: Two hundred consecutive patients who underwent thrombectomy for a proximal anterior circulation occlusion were dichotomised into equal groups (groups 1 and 2) based on the date that immediate access to emergency general anaesthesia (GA) commenced.

Results: Recanalisation success using thrombolysis in cerebral infarction (TICI) 2b/3 or TICI 2c/3 significantly improved in group 2 (67% versus 93%, p<0. Read More

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http://dx.doi.org/10.1016/j.crad.2019.01.022DOI Listing

European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke.

J Neurointerv Surg 2019 Feb 26. Epub 2019 Feb 26.

Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.

Background: Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO).

Objective: To assist physicians in their clinical decisions with regard toMT.

Methods: These guidelines were developed based on the standard operating procedure of the European Stroke Organisation and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014569DOI Listing
February 2019

DWI-pc-ASPECT score in basilar artery occlusion: is 6 points or less always indicative of a bad outcome?

Interv Neuroradiol 2019 Feb 25:1591019919827505. Epub 2019 Feb 25.

2 Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background And Purpose: The prognosis of patients with acute basilar arterial occlusion after endovascular reperfusion therapy with diffusion-weighted imaging - posterior circulation-Alberta Stroke Program Early Computed Tomography Score (DWI-pc-ASPECTS) of 6 or less remains unclear. We aimed to assess the characteristics and prognosis of endovascular reperfusion therapy in patients with acute basilar arterial occlusion and DWI-pc-ASPECTS of 6 or less.

Methods: We analysed data collected from 1 January 2012 to 31 January 2018 in a prospective neuro-interventional registry of consecutive patients treated with endovascular reperfusion therapy. Read More

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http://dx.doi.org/10.1177/1591019919827505DOI Listing
February 2019

Comparison of 4 FDA-approved mechanical thrombectomy devices for acute ischemic stroke: a network meta-analysis.

World Neurosurg 2019 Feb 22. Epub 2019 Feb 22.

Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address:

Background: The use of mechanical thrombectomy for the treatment of acute ischemic stroke (AIS) is rapidly growing. However there are limited data on the comparative effects of the various devices approved by the FDA for the treatment of AIS. We aimed to perform a network meta-analysis to assess the relative efficacy and safety of 4 thrombectomy devices. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.02.011DOI Listing
February 2019

Thrombus Length Predicts Lack of Post-Thrombolysis Early Recanalization in Minor Stroke With Large Vessel Occlusion.

Stroke 2019 Mar;50(3):761-764

From the Department of Neurology, INSERM U894 (P.S., J.D., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, Paris, France.

Background and Purpose- Whether bridging therapy, that is, intravenous thrombolysis [IVT] followed by mechanical thrombectomy, is beneficial as compared with IVT alone in minor stroke (National Institutes of Health Stroke Scale ≤5) with large vessel occlusion is unknown and should be tested in randomized trials. To help select the most appropriate candidates for such trials, we aimed to identify strong predictors of lack of post-IVT early recanalization (ER)-a surrogate marker of poor outcome. Methods- From a large multicenter French registry of patients with large vessel occlusion referred for thrombectomy immediately after IVT start between 2015 and 2017, we extracted 97 minor strokes with ER evaluated on first angiographic run or noninvasive imaging ≤3 hours from IVT start. Read More

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https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023455
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http://dx.doi.org/10.1161/STROKEAHA.118.023455DOI Listing
March 2019
3 Reads

Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke.

J Neurointerv Surg 2019 Feb 23. Epub 2019 Feb 23.

Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China.

Background: Malignant brain edema (MBE) is a devastating complication in ischemic stroke. Data on MBE in patients who have had mechanical thrombectomy (MT) are relatively scarce.

Objective: To investigate the incidence, predictors, and clinical outcomes of MBE in patients after MT. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014650DOI Listing
February 2019

Dasatinib Re-initiation after Post-stroke Thrombolysis Associated with Symptomatic Intracerebral Hemorrhage.

World Neurosurg 2019 Feb 21. Epub 2019 Feb 21.

Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK. Electronic address:

Background: Dasatinib, a tyrosine kinase inhibitor commonly used in treatment of acute lymphoblastic leukemia and chronic myelogenous leukemia (CML), is often associated with hemorrhagic complications. Safety of Dasatinib after thrombolytic therapy in acute ischemic stroke (AIS) is unknown.

Case Description: 63-year-old man with multiple vascular risk factors and CML (in molecular remission) on Dasatinib presented with signs and symptoms of right hemispheric stroke due to acute intracranial internal carotid artery occlusion that was treated with intravenous thrombolysis and mechanical thrombectomy resulting in near complete resolution of stroke symptoms. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S18788750193043
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http://dx.doi.org/10.1016/j.wneu.2019.02.026DOI Listing
February 2019
6 Reads

Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions.

Stroke 2019 Apr;50(4):1003-1006

St. Vincent Mercy Hospital, Toledo, OH (O.O.Z.).

Background and Purpose- Mechanical thrombectomy (MT) devices have led to improved reperfusion and clinical outcomes in acute ischemic stroke patients with emergent large vessel occlusions; however, less than one-third of patients achieve complete reperfusion. Use of intraarterial thrombolysis in the context of MT may provide an opportunity to enhance these results. Here, we evaluate the use of intraarterial rtPA (recombinant tissue-type plasminogen activator) as rescue therapy (RT) after failed MT in the North American Solitaire Stent-Retriever Acute Stroke registry. Read More

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http://dx.doi.org/10.1161/STROKEAHA.118.024442DOI Listing
April 2019
5 Reads

Higher Annual Operator Volume Is Associated With Better Reperfusion Rates in Stroke Patients Treated by Mechanical Thrombectomy: The ETIS Registry.

JACC Cardiovasc Interv 2019 Feb;12(4):385-391

Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Versailles, France; Versailles Saint-Quentin en Yvelines and Paris Saclay University, Versailles, France; INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France. Electronic address:

Objectives: The aim of this study was to determine whether individual operator characteristics have an impact on reperfusion and procedural complication rates.

Background: Mechanical thrombectomy (MT) is a Level IA treatment in acute ischemic stroke (AIS) patients. The operator's effect has been found to be an independent predictor for clinical outcome and technical performance in interventional cardiology. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S19368798183243
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http://dx.doi.org/10.1016/j.jcin.2018.12.007DOI Listing
February 2019
6 Reads

Mechanical thrombectomy and the future of acute stroke treatment.

Eur J Radiol 2019 Mar 29;112:214-221. Epub 2019 Jan 29.

Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada.

After being staggered by numerous negative trials in 2013, the interventional stroke community saw four years of vindication for mechanical thrombectomy showing efficacy and safety, even beyond a hopeful 6-8 hour window out to 24 h. A landmark set of five trials in 2015 provided a foundation upon which years of incremental follow-ups, meta-analyses and new breakthroughs would be built. With optimized devices for thrombectomy and image analysis, the neurointerventional community has turned to workflow and systemization in this new era of acute ischemic stroke treatment. Read More

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http://dx.doi.org/10.1016/j.ejrad.2019.01.029DOI Listing
March 2019
2.369 Impact Factor

Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry.

Stroke 2019 Mar;50(3):697-704

University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.).

Background and Purpose- Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established. Methods- STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy. Read More

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http://dx.doi.org/10.1161/STROKEAHA.118.021126DOI Listing
March 2019
8 Reads
5.723 Impact Factor

Institutional and provider variations for mechanical thrombectomy in the treatment of acute ischemic stroke: a survey analysis.

J Neurointerv Surg 2019 Feb 13. Epub 2019 Feb 13.

Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA.

Introduction: Stent retriever combined with aspiration, or the 'Solumbra technique', has recently emerged as one of the popular methods of mechanical thrombectomy (MT). However, the variations in understanding and implementation of the Solumbra technique have not been reported.

Methods: An 18 part anonymous survey questionnaire was designed to extract information regarding technical variations of MT with a focus on the Solumbra technique. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014614DOI Listing
February 2019