Mechanical thrombectomy in acute ischemic stroke: a single-center experience
https://doi.org/10.17802/2306-1278-2019-8-4S-95-103
Abstract
Aim. Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. The objective of this study is to analyze the results of our own experience of endovascular treatment in Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” Kemerovo.
Methods. 12 patients with AIS and underwent mechanical thrombectomy with «Trevo» stent-retriever were included in this analysis. Primary outcomes included 90-day modified Rankin scale (mRS) score, first pass effect (FPE) and recanalization rate (TICI score), the combined incidence of postintervention hemorrhages and mortality at 90 days.
Results. Among 12 patients (66.7% male, age 59.5 [57.5; 66.5] years) hypertension were in 100%, 61.5% had an ischemic heart disease, 53.8% was current smoking and atrial fibrillation. Median of the NIHSS scale was 13 points, mRS≥4 was in 75% of patients. In 33.3% was a tandem lesion (internal carotid artery terminus and middle cerebral artery) and 25% required stenting of the carotid artery. Good clinical outcomes (mRS≤2 at 90 days) were achieved in 77.8% (7/9) among surviving patients. The 90-day NIHSS score – 4 [1; 5]. The first pass effect and recanalization rate (TICI Scores 2b-3/3) was achieved in 50% and 91.7% of patients. The combined incidence of postintervention hemorrhages and mortality at 90 days was 33.3% and 25% respectively.
Conclusion. Despite the small sample size, stent retriever mechanical thrombectomy in AIS provides satisfactory clinical results.
About the Authors
K. M. Vakkosov
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”; State Budgetary Healthcare Institution of the Kemerovo Region “Kemerovo Regional Clinical Cardiology Dispensary named after academician L.S. Barbarash”
Russian Federation
Russian Federation
Vakkosov Kamoliddin M. - research assistant, Laboratory of Interventional Cardiology at the Multifocal atherosclerosis Department, Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”, interventional cardiologist at the State Budgetary Healthcare Institution of the Kemerovo Region “Kemerovo Regional Clinical Cardiology Dispensary n.a. academician L.S. Barbarash”.
650002, Kemerovo, 6, Sosnoviy Blvd.
D. Yu. Naumov
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”; State Budgetary Healthcare Institution of the Kemerovo Region “Kemerovo Regional Clinical Cardiology Dispensary named after academician L.S. Barbarash”
Russian Federation
Russian Federation
Naumov Danil Yu., interventional cardiology cabinet X-ray surgical method of diagnostic and treatment Kemerovo State Budgetary Healthcare Institution “Kemerovo Regional Clinical Cardiac Dispensary n.a. academician L.S. Barbarash”, research assistant at the laboratory of interventional method of diagnostic and treatment Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”.
6, Sosonoviy Blvd., Kemerovo, 650002
N. I. Vodop`yanova
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”; State Budgetary Healthcare Institution of the Kemerovo Region “Kemerovo Regional Clinical Cardiology Dispensary named after academician L.S. Barbarash”
Russian Federation
6, Sosonoviy Blvd., Kemerovo, 650002
Russian Federation
6, Sosonoviy Blvd., Kemerovo, 650002
I. V. Moldavskaya
State Budgetary Healthcare Institution of the Kemerovo Region “Kemerovo Regional Clinical Cardiology Dispensary named after academician L.S. Barbarash”
Russian Federation
Moldavskaya Irina V. - PhD, neurologist and Head of the Neurology Department.
Russian Federation
Moldavskaya Irina V. - PhD, neurologist and Head of the Neurology Department.
V. I. Ganyukov
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”
Russian Federation
Russian Federation
Ganyukov Vladimir I. - PhD, Head of the Laboratory of Interventional Cardiology.
6, Sosonoviy Blvd., Kemerovo, 650002
References
1. Berkhemer O., Fransen P., Beumer D., et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20. doi:10.1056/NEJMoa1411587.
2. Goyal M., Demchuk A., Menon B., et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30. doi:10.1056/NEJMoa1414905.
3. Saver J., Goyal M., Bonafe A., et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95. doi:10.1056/NEJMoa1415061.
4. Campbell B., Mitchell P., Kleinig T., et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18. doi:10.1056/NEJMoa1414792.
5. Jovin T., Chamorro A., Cobo E., et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306. doi:10.1056/NEJMoa1503780.
6. Shilov A.A., Ganyukov V.I., Moldavskaya I.V., Chromov A.A., Tokmakov E.V., Naumov D.Y. Clinical case of thrombus extraction in ischemic stroke in a patient with severe concomitant pathology. Complex Issues of Cardiovascular Diseases. 2018;7(4S):157-162. (In Russian) https://doi.org/10.17802/2306-1278-2018-7-4S-157-162
7. National Institute of Neurological, D. and P.A.S.S.G. Stroke rt. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7.
8. Hacke W., Kaste M., Bluhmki E., et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29. doi:10.1056/NEJMoa0804656.
9. Bhatia R., Hill M., Shobha N., et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254–8. doi: 10.1161/STROKEAHA.110.592535.
10. Bose A., Henkes H., Alfke K., et al. The penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol. 2008;29(7):1409–13. doi: 10.3174/ajnr.A1110.
11. Kang D., Hwang Y., Kim Y., et al. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol. 2011;32(2):283–7. doi: 10.3174/ajnr.A2299.
12. Turk A., Spiotta A., Frei D., et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2014;6(3):231–7. doi: 10.1136/neurintsurg-2013-010713.
13. Tarr R., Hsu D., Kulcsar Z., et al. The POST trial: initial post-market experience of the Penumbra system: revascularization of large vessel occlusion in acute ischemic stroke in the United States and Europe. Journal of neurointerventional surgery. 2010 Dec;2(4):341-344. doi:10.1136/jnis.2010.002600.
14. Saver J., Jahan R., Levy E., et al. Solitaire flow restoration device versus the Merci retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380(9849):1241–9. doi:10.1016/S0140-6736(12)61384-1.
15. Nogueira R., Lutsep H., Gupta R., et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012 Oct 6;380(9849):1231-1240. doi: 10.1016/S0140-6736(12)61299-9.
16. Walcott B., Boehm K., Stapleton C., et al. Retrievable stent thrombectomy in the treatment of acute ischemic stroke: analysis of a revolutionizing treatment technique. J Clin Neurosci. 2013 Oct;20(10):1346-9. doi: 10.1016/j.jocn.2013.03.015.
17. Agrawal A., Golovoy D., Nimjee S., et al. Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience. Asian J Neurosurg. 2012 Oct;7(4):166-70. doi: 10.4103/17935482.106647.
18. Adeoye O., Nyström K., Yavagal D., et al. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update. Stroke. 2019 Jul;50(7):e187-e210. doi:10.1161/STR.0000000000000173.
19. Jauch E., Saver J., Adams H. Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947. doi: 10.1161/STR.0b013e318284056a.
20. Bracard S., Ducrocq X., Mas J., et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomized controlled trial. Lancet Neurol. 2016;15(11):1138–47. doi: 10.1016/S14744422(16)30177-6.
21. Hentschel K., Daou B., Chalouhi N., et al. Comparison of non-stent retriever and stent retriever mechanical thrombectomy devices for the endovascular treatment of acute ischemic stroke. J Neurosurg. 2017 Apr;126(4):1123-1130. doi:10.3171/2016.2.JNS152086.
22. Haussen D., Eby B., Al-Bayati A., et al. A comparative analysis of 3MAX aspiration versus 3 mm Trevo Retriever for distal occlusion thrombectomy in acute stroke. J Neurointerv Surg. 2019 Jun 26. pii: neurintsurg-2019-014990. doi: 10.1136/neurintsurg-2019-014990.
23. Zaidat O., Castonguay A., Linfante I., et al. First Pass Effect: A New Measure for Stroke Thrombectomy Devices. Stroke. 2018 Mar;49(3):660-666. doi: 10.1161/STROKEAHA.117.020315.
24. Ducroux C., Piotin M., Gory B., et al. First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial. J Neurointerv Surg. 2019 Aug 30. pii: neurintsurg-2019-015215. doi: 10.1136/neurintsurg-2019-015215.
25. Kang D., Kim B., Heo J., et al. Effects of first pass recanalization on outcomes of contact aspiration thrombectomy. J Neurointerv Surg. 2019 Sep 28. pii: neurintsurg-2019-015221. doi: 10.1136/neurintsurg-2019-015221.
26. Balami J., White P., McMeekin P., et al. Complications of endovascular treatment for acute ischemic stroke: prevention and management. Int J Stroke. 2018;13(4):348–61. doi:10.1177/1747493017743051.
27. Hao Y., Yang D., Wang H., et al. Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke. Stroke. 2017;48(5):1203–9. doi: 10.1161/STROKEAHA.116.016368.
28. Hao Y., Zhang Z., Zhang H., et al. Risk of intracranial hemorrhage after endovascular treatment for acute ischemic stroke: systematic review and meta-analysis. Interv Neurol.2017;6(1–2):57–64. doi: 10.1159/000454721.
29. Nakiri G., Castro-Afonso L., Monsignore L., et al. Experience on mechanical thrombectomy for acute stroke treatment in a Brazilian University Hospital. J Stroke Cerebrovasc Dis.2017;26(3):532–7. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.128.
30. Mansour O.Y., Ali A.M., Megahed M. Primary endovascular treatment of acute ischemic stroke using stent retrievers: initial Egyptian experience. J Vasc Interv Neurol. 2017;9(6):20–5.
31. Wiącek M., Kaczorowski R., Homa J., et al. Singlecenter experience of stent retriever thrombectomy in acute ischemic stroke. Neurol Neurochir Pol. 2017;51(1):12–8. doi: 10.1016/j.pjnns.2016.09.001.
Review
For citations:
Vakkosov K.M., Naumov D.Yu., Vodop`yanova N.I., Moldavskaya I.V., Ganyukov V.I. Mechanical thrombectomy in acute ischemic stroke: a single-center experience. Complex Issues of Cardiovascular Diseases. 2019;8(4S):95-103. (In Russ.) https://doi.org/10.17802/2306-1278-2019-8-4S-95-103
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