1.Author Correction: Treatment of Intracranial Aneurysms with the Pipeline Embolization Device Only: a Single Center Experience.
Volker MAUS ; Anastasios MPOTSARIS ; Jan BORGGREFE ; Nuran ABDULLAYEV ; Thomas LIEBIG ; Franziska DORN ; Pantelis STAVRINOU ; De Hua CHANG ; Christoph KABBASCH
Neurointervention 2018;13(2):144-144
The originally published version of this Article contained an error in the author list: the last and first names of all authors are inverted.
2.Treatment of Intracranial Aneurysms with the Pipeline Embolization Device Only: a Single Center Experience.
Maus VOLKER ; Mpotsaris ANASTASIOS ; Borggrefe JAN ; Abdullayev NURAN ; Liebig THOMAS ; Dorn FRANZISKA ; Stavrinou PANTELIS ; Chang DE-HUA ; Kabbasch CHRISTOPH
Neurointervention 2018;13(1):32-40
PURPOSE: The aim of this study was to evaluate the technical feasibility and rate of mid-term occlusion in aneurysms treated solely with the Pipeline Embolization Device (PED) in a German tertiary care university hospital. MATERIALS AND METHODS: Forty-nine non-consecutive intracranial aneurysms underwent endovascular treatment using the PED exclusively between March 2011 and May 2017 at our institution. Primary endpoint was a favorable aneurysm occlusion defined as OKM C1-3 and D (O'Kelly Marotta Scale). Secondary endpoints were retreatment rate and delayed complications. Median follow-up was 200 days. RESULTS: The mean aneurysm size was 7.1 ± 5.3 mm. Forty-four aneurysms were located in the anterior circulation (90%). Ten aneurysms were ruptured (20%). Branching vessels from the sac were observed in 11 aneurysms (22%). Favorable obliteration immediately after PED placement was seen in 13/49 aneurysms (27%), of those nine aneurysms were completely occluded (18%). Angiographic and clinical follow-up was available for 45 cases (92%); 36/45 aneurysms (80%) were occluded completely and 40/45 aneurysms (89%) showed a favorable occlusion result. A branching vessel arising from the aneurysm sac was associated with incomplete occlusion (P < .05). All electively treated patients had good outcome (mRS 0). Three aneurysms (6%) required additional treatment due to aneurysm recurrence. CONCLUSION: In our series, treatment of intracranial aneurysms with the PED was associated with favorable occlusion rates and low complication rates at mid-term follow-up. The presence of branching vessels arising from the aneurysms sac was predictive for an incomplete occlusion.
Aneurysm
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Follow-Up Studies
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Humans
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Intracranial Aneurysm*
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Recurrence
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Retreatment
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Tertiary Healthcare
3.Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry
Johannes KAESMACHER ; Nuran ABDULLAYEV ; Basel MAAMARI ; Tomas DOBROCKY ; Jan VYNCKIER ; Eike I. PIECHOWIAK ; Raoul POP ; Daniel BEHME ; Peter B. SPORNS ; Hanna STYCZEN ; Pekka VIRTANEN ; Lukas MEYER ; Thomas R. MEINEL ; Daniel CANTRÉ ; Christoph KABBASCH ; Volker MAUS ; Johanna PEKKOLA ; Sebastian FISCHER ; Anca HASIU ; Alexander SCHWARZ ; Moritz WILDGRUBER ; David J. SEIFFGE ; Sönke LANGNER ; Nicolas MARTINEZ-MAJANDER ; Alexander RADBRUCH ; Marc SCHLAMANN ; Dan MIHOC ; Rémy BEAUJEUX ; Daniel STRBIAN ; Jens FIEHLER ; Pasquale MORDASINI ; Jan GRALLA ; Urs FISCHER
Journal of Stroke 2021;23(1):91-102
Background:
and Purpose Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse.
Methods:
INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months.
Results:
Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9).
Conclusions
Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.