851 results match your criteria direct thrombectomy

Practical use and underlying physics of the BENCHMARK™ BMX™ 96 for large-bore aspiration thrombectomy: Case report of initial institutional experience.

Neuroradiol J 2021 Aug 3:19714009211036691. Epub 2021 Aug 3.

Division of Neuroradiology, Department of Diagnostic Radiology, 3688Dalhousie University, Dalhousie University, Canada.

Endovascular thrombectomy (EVT) is part of first-line intervention for acute ischemic stroke management. Recent technological advances have demonstrated that large-bore catheters are an attractive approach for EVT. A multitude of approaches such as A Direct Aspiration first Pass Technique (ADAPT) or in conjunction with stent retrieval (Solumbra technique) have been developed with increasingly large-bore catheters, demonstrating safety and efficacy. Read More

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Quality assurance data for regional drip-and-ship strategies- gearing up the transfer process.

Neurol Res Pract 2021 Aug 2;3(1):38. Epub 2021 Aug 2.

Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.

Background: Stroke patients with large vessel occlusion (LVO) require endovascular therapy (EVT) provided by comprehensive stroke centers (CSC). One strategy to achieve fast stroke symptom 'onset to treatment' times (OTT) is the preclinical selection of patients with severe stroke for direct transport to CSC. Another is the optimization of interhospital transfer workflow. Read More

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Mechanical Thrombectomy of Carotid Terminus Occlusion Using Direct Aspiration Technique-Video Illustration: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Jul 31. Epub 2021 Jul 31.

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

Acute carotid terminus occlusion (CTO) is responsible for up to 5% of acute ischemic strokes secondary to emergent large vessel occlusion (ELVO) and up to 20% of acute internal carotid artery (ICA) occlusions.1 The term "CTO" has also been used to describe occlusions in the supra-clinoid segment or at the bifurcation of the ICA. Compared to other ELVOs, patients with CTO present with higher stroke severity and larger infarct volume, likely to be a result of disruption of direct Circle of Willis collaterals across the anterior communicating artery (AComA) and posterior communicating artery (PComA). Read More

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Concomitant Acute Ischemic Stroke and Upper Extremity Arterial Occlusion: Feasibility of Mechanical Thrombectomy of the Upper Limb Using Neurointerventional Devices and Techniques.

J Clin Med 2021 Jul 20;10(14). Epub 2021 Jul 20.

Department of Radiology, Neuroradiology and Nuclear Medicine Ruhr-University Bochum, Knappschaftskrankenhaus, Bochum-Langendreer, 44892 Bochum, Germany.

Background: Concomitant acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and acute upper extremity arterial occlusion causing upper limb ischemia (ULI) is a rarely observed coincidence. The first-line treatment for AIS is mechanical thrombectomy (MT), with or without additional intravenous thrombolysis, while there are different pharmacological, surgical and endovascular treatment options for an acute occlusion of the UL arteries. Here, we describe the practicability, efficacy and safety of neurointerventional devices and techniques for MT of upper extremity arterial occlusions. Read More

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Direct aspiration thrombectomy as a first-pass approach for very elderly patients with ischemic stroke.

Clin Neurol Neurosurg 2021 Jul 6;207:106797. Epub 2021 Jul 6.

Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Objective: This study aimed to determine whether an age of ≥ 80 years would affect the radiological and clinical outcomes of the direct aspiration first pass strategy for large vessel occlusion.

Methods: This study analyzed single-center data of patients with stroke who were treated with mechanical thrombectomy between May 2018 and October 2020. Baseline characteristics, as well as radiological and clinical outcomes of patients were recorded, analyzed, and compared between the very elderly (≥80 years) and elderly patients (<80 years). Read More

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Direct versus Bridging Mechanical Thrombectomy in Elderly Patients with Acute Large Vessel Occlusion: A Multicenter Cohort Study.

Clin Interv Aging 2021 5;16:1265-1274. Epub 2021 Jul 5.

Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, People's Republic of China.

Purpose: Elderly people represent a growing stroke population with different pathophysiological states than younger. Whether intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is beneficial for elderly patients remains unclear. This study compared the efficacy and safety between elderly patients treated with MT alone and those treated with both IVT and MT. Read More

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Successful Use of Apixaban for Paget-Schroetter Syndrome in a Pediatric Patient.

J Pediatr Pharmacol Ther 2021 28;26(5):508-511. Epub 2021 Jun 28.

Paget-Schroetter syndrome (PSS) is a rare syndrome that typically develops in young, healthy males subjected to repetitive overhead motions resulting in compression and thrombosis of the subclavian vein. This "effort thrombosis" typically occurs acutely in patients with specific anatomic variations within the thoracic outlet and is treated by a combination of surgical and pharmacologic interventions. There is a paucity of literature regarding this syndrome, particularly surrounding pharmacotherapy, and in the treatment of pediatric patients. Read More

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Mechanical thrombectomy beyond the circle of Willis: efficacy and safety of different techniques for M2 occlusions.

J Neurointerv Surg 2021 Jul 5. Epub 2021 Jul 5.

Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Background: M2 segment occlusions represent approximately one-third of non-lacunar ischemic stroke and can lead to permanent neurological deficits. Various techniques are available for mechanical thrombectomy beyond the circle of Willis, but data evaluating their effectiveness and safety are lacking.

Methods: A retrospective review of patients with ischemic stroke undergoing mechanical thrombectomy for M2 occlusions from 13 centers in North American and Europe was performed. Read More

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Influence of Onset to Imaging Time on Radiological Thrombus Characteristics in Acute Ischemic Stroke.

Front Neurol 2021 18;12:693427. Epub 2021 Jun 18.

Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.

Radiological thrombus characteristics are associated with patient outcomes and treatment success after acute ischemic stroke. These characteristics could be expected to undergo time-dependent changes due to factors influencing thrombus architecture like blood stasis, clot contraction, and natural thrombolysis. We investigated whether stroke onset-to-imaging time was associated with thrombus length, perviousness, and density in the MR CLEAN Registry population. Read More

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Experimental Evaluation of the Risk of Distal Embolization during Endovascular Clot Retrieval Using Various Techniques.

Asian J Neurosurg 2021 Jan-Mar;16(1):84-88. Epub 2021 Feb 23.

Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.

Background: This study was conducted to evaluate various devices and techniques for endovascular thrombectomy that can reduce the risk of intraprocedural distal embolism in a preliminary in vitro setting with different types of thrombi.

Materials And Methods: Endovascular clot retrieval was performed in a vascular model with collateral circulation. White and red thrombi were prepared using whole blood collected from a pig. Read More

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February 2021

Direct thrombectomy versus bridging thrombolysis with mechanical thrombectomy in middle cerebral artery stroke: a real-world analysis through National Inpatient Sample data.

Neurosurg Focus 2021 Jul;51(1):E4

Departments of1Neurosurgery.

Objective: A paradigm shift in the management of acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) occurred after 2015 when 7 randomized controlled trials demonstrated better outcomes using second-generation thrombectomy devices combined with best medical management than did stand-alone intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA). All recently published landmark trials were designed to study the outcome of mechanical thrombectomy (MT); therefore, the majority of the patients enrolled in these trials received intravenous tPA. Currently, initiating IVT before MT is a matter of debate. Read More

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Comparison of effectiveness and outcomes among different thrombectomy techniques in acute basilar artery occlusion: a dual-center experience.

Neurosurg Focus 2021 Jul;51(1):E8

Departments of1Neurosurgery.

Objective: Acute basilar artery occlusion (BAO) is a rare large-vessel occlusion associated with high morbidity and mortality. Modern thrombectomy with stent retrievers and large-bore aspiration catheters is highly effective in achieving recanalization, but a direct comparison of different techniques for acute BAO has not been performed. Therefore, the authors sought to compare the technical effectiveness and clinical outcomes of stent retriever-assisted aspiration (SRA), aspiration alone (AA), and a stent retriever with or without manual aspiration (SR) for treatment of patients presenting with acute BAO and to evaluate predictors of clinical outcome in their cohort. Read More

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Is concurrent intravenous alteplase in patients undergoing endovascular treatment for large vessel occlusion stroke cost-effective even if the cost of alteplase is only US$1?

J Neurointerv Surg 2021 Jun 29. Epub 2021 Jun 29.

Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada

Background: The added value of intravenous (IV) alteplase in large vessel occlusion (LVO) stroke over and beyond endovascular treatment (EVT) is controversial. We compared the long-term costs and cost-effectiveness of a direct-to-EVT paradigm in LVO stroke patients presenting directly to the mothership hospital to concurrent EVT and IV alteplase.

Methods: We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes. Read More

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Mechanical thrombectomy for stroke patients anticoagulated with direct oral anticoagulants versus warfarin.

J Neurol Sci 2021 Aug 17;427:117545. Epub 2021 Jun 17.

Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.

Background Outcomes after mechanical thrombectomy (MT) for large vessel occlusion (LVO) were compared between stroke patients anticoagulated with direct oral anticoagulants (DOACs) and those anticoagulated with warfarin.

Materials And Methods: From data for 2399 LVO stroke patients in a prospective, multicenter registry, patients with prior oral anticoagulation who underwent MT were analyzed. Angiographic outcomes included successful recanalization (modified Thrombolysis in Cerebral Infarction 2b/3). Read More

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Acute Ischemic Stroke Revealing ChAdOx1 nCov-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia: Impact on Recanalization Strategy.

J Stroke Cerebrovasc Dis 2021 Jun 24;30(9):105942. Epub 2021 Jun 24.

Department of Neurology, Rouen University Hospital, Rouen F-76000, France.

Vaccine-induced immune thrombotic thrombocytopenia is a rare syndrome following the ChAdOx1 nCov-19 or Ad26.COV2.S vaccine. Read More

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Improving Door-To-Puncture Time in Mechanical Thrombectomy with Direct Care from a Neurointerventionalist in the Emergency Department.

World Neurosurg 2021 Aug 16;152:e455-e461. Epub 2021 Jun 16.

Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea. Electronic address:

Objective: A shorter door-to-puncture time is an independent predictor of good clinical outcomes in patients with acute ischemic stroke (AIS) who undergo mechanical thrombectomy (MT). We recently initiated a protocol for direct care from neurointerventionalists (NIs) in the emergency department (ED) rather than from non-NI neurologists for patients with AIS. Our aim was to investigate whether NIs, as the first point-of-care physicians for stroke in the ED, could shorten door-to-puncture time compared to non-NI neurologists. Read More

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The Quest to Reduce Stroke Treatment Delays at A Melbourne Metropolitan Primary Stroke Centre over the Last Two Decades.

Intern Med J 2021 Jun 18. Epub 2021 Jun 18.

Department of Neurosciences, Box Hill Hospital, Eastern Health, Victoria, Australia.

Background: Reducing door-to-needle time (DNT) for intravenous thrombolysis in acute ischaemic stroke can lead to improved patient outcomes. Long-term reports on DNT trends in Australia are lacking in the setting of extension of the thrombolysis time window, addition of mechanical thrombectomy and increasing presentations.

Aims: To examine 17-year trends of DNT and identify factors associated with improved DNT at a high-volume, metropolitan primary stroke centre. Read More

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Direct angiographic intervention for acute ischemic stroke with large vessel occlusion.

Neurol Res 2021 Jun 16:1-6. Epub 2021 Jun 16.

Department of Neurosurgery, University of South Florida, Tampa, FL, USA.

Rapid and effective revascularization is the cornerstone of acute ischemic stroke treatment. Endovascular thrombectomy reperfusion has dramatically changed patients' outcomes with large vessel occlusions. Results of randomized controlled trials have shown that the benefit of this treatment is highly time-sensitive. Read More

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Direct to Angiography vs Repeated Imaging Approaches in Transferred Patients Undergoing Endovascular Thrombectomy.

JAMA Neurol 2021 Jun 14. Epub 2021 Jun 14.

Department of Neurosurgery, The University of Texas McGovern Medical School, Houston.

Importance: A direct to angiography (DTA) treatment paradigm without repeated imaging for transferred patients with large vessel occlusion (LVO) may reduce time to endovascular thrombectomy (EVT). Whether DTA is safe and associated with better outcomes in the late (>6 hours) window is unknown. Also, DTA feasibility and effectiveness in reducing time to EVT during on-call vs regular-work hours and the association of interfacility transfer times with DTA outcomes have not been established. Read More

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Subarachnoid Hemorrhage in Mechanical Thrombectomy for Acute Ischemic Stroke: Analysis of the STRATIS Registry, Systematic Review, and Meta-Analysis.

Front Neurol 2021 25;12:663058. Epub 2021 May 25.

Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.

The indications for mechanical thrombectomy in acute ischemic stroke continue to broaden, leading neurointerventionalists to treat vessel occlusions at increasingly distal locations farther in time from stroke onset. Accessing these smaller vessels raises the concern of iatrogenic subarachnoid hemorrhage (SAH) owing to increasing complexity in device navigation and retrieval. This study aims to determine the prevalence of SAH following mechanical thrombectomy, associated predictors, and resulting functional outcomes using a multicenter registry and compare this with a systematic review and meta-analysis of the literature. Read More

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Direct to Thrombectomy.

Stroke 2021 Jul 11;52(7):2442-2444. Epub 2021 Jun 11.

Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (B.H.B.).

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Impact of Direct Admission Versus Interfacility Transfer on Endovascular Treatment Outcomes for Acute Ischemic Stroke: Systematic Review and Meta-Analysis.

World Neurosurg 2021 Aug 1;152:e387-e397. Epub 2021 Jun 1.

Department of Neurosurgery, George Washington University, Washington, DC, USA. Electronic address:

Background: Mechanical thrombectomy is a proven treatment for large-vessel ischemic stroke with improved functional outcomes compared with intravenous thrombolytics. Access to thrombectomy-capable sites varies greatly by geography, often necessitating interhospital transfer of patients who first present to hospitals unable to provide thrombectomy. The purpose of this meta-analysis was to examine the impact of interhospital transportation on patient outcomes to better inform recommendations for prehospital protocols. Read More

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Aspiration Thrombectomy in Patients with Large Vessel Occlusion and Mild Stroke: A Single-Center Experience.

Med Sci Monit 2021 May 21;27:e930014. Epub 2021 May 21.

Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia.

BACKGROUND The purpose of this study was to evaluate outcomes of patients with mild stroke, defined by National Institutes of Health Stroke Scale (NIHSS) score <6, caused by large vessel occlusion treated with aspiration thrombectomy. MATERIAL AND METHODS Data from the endovascular stroke registry of our center were retrospectively analyzed. Anterior or posterior circulation strokes with NIHSS score <6 upon admission were analyzed. Read More

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A Direct Aspiration First Pass Technique for Basilar Artery Occlusion Caused by Elastic-hard Tumor Embolus via the Pulmonary Vein by Metastatic Prostate Adenocarcinoma: A Case Report.

NMC Case Rep J 2021 Apr 2;8(1):95-100. Epub 2021 Apr 2.

Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

Basilar artery occlusion (BAO) accounts for only 1% of all strokes, and cerebral infarction resulting from tumor emboli has been infrequently demonstrated; therefore, few reports described BAO due to tumor embolus and its treatment experience. We report here an 83-year-old man with an acute BAO caused by embolized lung tumor invading right pulmonary vein that was revealed as metastasis of prostate adenocarcinoma. The patient underwent rapid recanalization through acute thrombectomy with a direct aspiration first pass technique (ADAPT) with Penumbra catheter. Read More

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Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke: A meta-analysis of randomized controlled trials.

Int J Stroke 2021 Jun 2:17474930211021353. Epub 2021 Jun 2.

Stroke, Division of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, UK.

Background: Direct mechanical thrombectomy may result in similar outcomes compared to a bridging approach with intravenous thrombolysis (IVT + MT) in acute ischemic stroke. Recent randomized controlled trials have varied in their design and noninferiority margin.

Aim: We sought to meta-analyze accumulated trial data to assess the difference and non-inferiority in clinical and procedural outcomes between direct mechanical thrombectomy and bridging therapy. Read More

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Comparison of Prior Bridging Intravenous Thrombolysis With Direct Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion: Systematic Review and Meta-Analysis.

Front Neurol 2021 30;12:602370. Epub 2021 Apr 30.

The Third ward of Neurology Department, Affiliated Hospital of Hebei University, Baoding, China.

Whether bridging treatment combining intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) is superior to direct EVT alone for emergent large vessel occlusion (LVO) in the anterior circulation is unknown. A systematic review and a meta-analysis were performed to investigate and assess the effect and safety of bridging treatment . direct EVT in patients with LVO in the anterior circulation. Read More

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Mechanical thrombectomy of acute distal posterior cerebral artery occlusions.

J Clin Neurosci 2021 Jun 1;88:57-62. Epub 2021 Apr 1.

Institute of Neuroradiology, Charité, Universitary Medicine Berlin.

To describe our experience with mechanical thrombectomy (MTE) of acute distal posterior cerebral artery (PCA) occlusions, either isolated or in combination with more proximal vessel occlusions regarding recanalization rates, MTE techniques, and procedural safety. From the prospectively maintained stroke thrombectomy databases of two institutions, all consecutive patients subjected to MTE of acute distal PCA occlusion (P2 and 3 segments) between July 2013 and May 2020 were retrospectively identified. Imaging data and angiographic features, as well as patients' demographic and clinical data were evaluated. Read More

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Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy.

Eur Radiol 2021 May 8. Epub 2021 May 8.

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

Objective: Thrombus microfragmentation causing peripheral emboli (PE) during mechanical thrombectomy (MT) may modulate treatment effects, even in cases with successful reperfusion. This study aims to investigate whether intravenous alteplase is of potential benefit in reducing PE after successful MT.

Methods: Patients from a prospective study treated at a tertiary care stroke center between 08/2017 and 12/2019 were analyzed. Read More

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Aspiration Thrombectomy with the Indigo System for Acute Lower Limb Ischemia: Preliminary experience and analysis of parameters affecting the outcome.

Ann Vasc Surg 2021 May 2. Epub 2021 May 2.

Department of Radiology and Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy.

Background: The purpose of our study is to assess the short-term technical success and the safety of the Indigo System in a series of patients undergoing vacuum-assisted catheter direct thrombus aspiration (IS-CDTA) for acute lower limb ischemia (ALLI) and to evaluate which parameters may affect the outcome.

Methods: All procedures using the IS-CDTA for ALLI, performed in a single-centre Interventional Radiology Unit from February 2016 to March 2020, were retrospectively analysed. Technical success was defined as the achievement of nearly-complete or complete revascularization (TIPI grade 2/3) and considered as a good outcome. Read More

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Thrombectomy and Clip Occlusion of a Giant, Stent-Coiled Basilar Bifurcation Aneurysm: 3-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 07;21(2):E117-E118

Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.

Giant basilar apex aneurysms are associated with significant therapeutic challenges.1-6 Multiple techniques exist to treat giant basilar apex aneurysms, including direct clipping, stent-assisted coil embolization, and proximal occlusion with bypass revascularization.7-9 Hypothermic circulatory arrest was a useful adjunct for surgical repair of these aneurysms but has been abandoned because of associated risks. Read More

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