1.REACT Aspiration Catheters: Clinical Experience and Technical Considerations
Neurointervention 2022;17(2):70-77
Aspiration catheters are widely used in mechanical thrombectomy procedures to treat acute ischemic stroke due to large vessel occlusion. The key performance requirements for aspiration catheters are ease of navigation and effective aspiration. In this work, we review the clinical experience and in vitro studies of REACT aspiration catheters (Medtronic, Minneapolis, MN, USA). In vitro experiments showed that REACT catheters exhibit solid performance in navigation and aspiration. Previous studies reported that the recanalization capacity of the aspiration catheters can be influenced by the devices’ inner diameter and tip distensibility, the catheter-to-vessel diameter ratio, the negative pressure delivered by the vacuum generator, the cyclical aspiration mode, the proximal flow arrest, and the angle of interaction between catheter and clot. REACT catheters can be navigated through the vasculature without any support from a microcatheter/microwire in favorable anatomical configurations. In challenging situations, mostly encountered when crossing the ophthalmic segment of the internal carotid artery, the use of the stentriever anchoring technique or delivery assist catheter can facilitate the navigation. Three clinical studies reporting on 299 patients who underwent mechanical thrombectomy with REACT catheters were included in this review. Successful recanalization (modified treatment in cerebral ischemia score 2b–3) was achieved in 89–96% of cases, no procedural complications related to REACT catheters were reported, and functional independence (modified Rankin Scale 0–2) at 90-days was 24–36%. In vitro experimental evaluations and clinical studies support the safety and effectiveness of the REACT catheters.
2.Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions
Milagros GALECIO-CASTILLO ; Mudassir FAROOQUI ; Ameer E. HASSAN ; Mouhammad A. JUMAA ; Afshin A. DIVANI ; Marc RIBO ; Michael ABRAHAM ; Nils H. PETERSEN ; Johanna T. FIFI ; Waldo R. GUERRERO ; Amer M. MALIK ; James E. SIEGLER ; Thanh N. NGUYEN ; Sunil SHETH ; Albert J. YOO ; Guillermo LINARES ; Nazli JANJUA ; Darko QUISPE-OROZCO ; Wondwossen TEKLE ; Syed F. ZAIDI ; Sara Y. SABBAGH ; Marta OLIVÉ-GADEA ; Tiffany BARKLEY ; Reade De LEACY ; Kenyon W. SPRANKLE ; Mohamad ABDALKADER ; Sergio SALAZAR-MARIONI ; Jazba SOOMRO ; Weston GORDON ; Charoskhon TURABOVA ; Juan VIVANCO-SUAREZ ; Aaron RODRIGUEZ-CALIENES ; Maxim MOKIN ; Dileep R. YAVAGAL ; Tudor JOVIN ; Santiago ORTEGA-GUTIERREZ
Journal of Stroke 2023;25(3):378-387
Background:
and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours.
Methods:
This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality.
Results:
Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours.
Conclusion
EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.
3.Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability
Kanta TANAKA ; Hiroshi YAMAGAMI ; Muhammad M. QURESHI ; Kazutaka UCHIDA ; James E. SIEGLER ; Raul G. NOGUEIRA ; Shinichi YOSHIMURA ; Nobuyuki SAKAI ; Nicolas MARTINEZ-MAJANDER ; Simon NAGEL ; Jelle DEMEESTERE ; Volker PUETZ ; Diogo C. HAUSSEN ; Mohamad ABDALKADER ; Marta OLIVE-GADEA ; Mahmoud H. MOHAMMADEN ; João Pedro MARTO ; Anne DUSART ; Simon WINZER ; Liisa TOMPPO ; Francois CAPARROS ; Hilde HENON ; Flavio BELLANTE ; João Nuno RAMOS ; Santiago ORTEGA-GUTIERREZ ; Sunil A. SHETH ; Stefania NANNONI ; Johannes KAESMACHER ; Lieselotte VANDEWALLE ; Sergio SALAZAR-MARIONI ; Mudassir FAROOQUI ; Pekka VIRTANEN ; Rita VENTURA ; Syed ZAIDI ; Alicia C. CASTONGUAY ; Ajit S. PURI ; Behzad FARZIN ; Hesham E. MASOUD ; Piers KLEIN ; Jessica JESSER ; Manuel REQUENA ; Tomas DOBROCKY ; Daniel P.O. KAISER ; Erno PELTOLA ; Davide STRAMBO ; Markus A. MÖHLENBRUCH ; Eugene LIN ; Peter A. RINGLEB ; Osama O. ZAIDAT ; Charlotte CORDONNIER ; Daniel ROY ; Robin LEMMENS ; Marc RIBO ; Daniel STRBIAN ; Urs FISCHER ; Patrik MICHEL ; Jean RAYMOND ; Thanh N. NGUYEN
Journal of Stroke 2024;26(2):269-279
Background:
and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability.
Methods:
In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1).
Results:
A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995).
Conclusion
A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.
4.Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke
Silja RÄTY ; Thanh N. NGUYEN ; Simon NAGEL ; Davide STRAMBO ; Patrik MICHEL ; Christian HERWEH ; Muhammad M. QURESHI ; Mohamad ABDALKADER ; Pekka VIRTANEN ; Marta OLIVE-GADEA ; Marc RIBO ; Marios PSYCHOGIOS ; Anh NGUYEN ; Joji B. KURAMATSU ; David HAUPENTHAL ; Martin KÖHRMANN ; Cornelius DEUSCHL ; Jordi Kühne ESCOLÀ ; Jelle DEMEESTERE ; Robin LEMMENS ; Lieselotte VANDEWALLE ; Shadi YAGHI ; Liqi SHU ; Volker PUETZ ; Daniel P.O. KAISER ; Johannes KAESMACHER ; Adnan MUJANOVIC ; Dominique Cornelius MARTERSTOC ; Tobias ENGELHORN ; Anne BERBERICH ; Piers KLEIN ; Diogo C. HAUSSEN ; Mahmoud H. MOHAMMADEN ; Hend ABDELHAMID ; Isabel FRAGATA ; Bruno CUNHA ; Michele ROMOLI ; Wei HU ; Jianlon SONG ; Johanna T. FIFI ; Stavros MATSOUKAS ; Sunil A. SHETH ; Sergio A. SALAZAR-MARIONI ; João Pedro MARTO ; João Nuno RAMOS ; Milena MISZCZUK ; Christoph RIEGLER ; Sven POLI ; Khouloud POLI ; Ashutosh P. JADHAV ; Shashvat DESAI ; Volker MAUS ; Maximilian KAEDER ; Adnan H. SIDDIQUI ; Andre MONTEIRO ; Tatu KOKKONEN ; Francesco DIANA ; Hesham E. MASOUD ; Neil SURYADAREVA ; Maxim MOKIN ; Shail THANKI ; Pauli YLIKOTILA ; Kemal ALPAY ; James E. SIEGLER ; Italo LINFANTE ; Guilherme DABUS ; Dileep YAVAGHAL ; Vasu SAINI ; Christian H. NOLTE ; Eberhart SIEBERT ; Markus A. MÖHLENBRUCH ; Peter A. RINGLEB ; Raul G. NOGUEIRA ; Uta HANNING ; Lukas MEYER ; Urs FISCHER ; Daniel STRBIAN
Journal of Stroke 2024;26(2):290-299
Background:
and Purpose Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone.
Methods:
From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0–1) and independent outcome (mRS 0–2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment.
Results:
Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3–P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79–1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05–2.12), sICH (aOR 2.87, 95% CI 1.23–6.72), and mortality (aOR 1.77, 95% CI 1.07–2.95).
Conclusion
Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.