Impact of Mechanical Thrombectomy Device on Thrombus Histology in Acute Embolic Stroke

2019 ◽  
Vol 132 ◽  
pp. e418-e422 ◽  
Author(s):  
Nobutaka Horie ◽  
Kazuya Shobayashi ◽  
Yoichi Morofuji ◽  
Eisaku Sadakata ◽  
Yusuke Iki ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Embolic Stroke ◽  
Thrombectomy Device

Abstract TP27: Impact of Mechanical Thrombectomy Device on the Thrombus Histology in Acute Embolic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nobutaka Horie ◽  
Yoichi Morofuji ◽  
Eisaku Sadakata ◽  
Yohei Tateishi ◽  
Tsuyoshi Izumo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Embolic Stroke ◽  
Stent Group ◽  
Distal Migration ◽  
Thrombectomy Device ◽  
The Impact

Background and Purpose: Thrombus composition has been suggested to have a decisive impact on the outcome of patients treated by mechanical thrombectomy because of embolic stroke. The aim of this prospective study was to assess the impact of a mechanical thrombectomy device (Penumbra aspiration catheter vs. Stent retriever) on thrombus composition, which could affect flow impairment after reperfusion. Methods: Thrombi of consecutive stroke patients with large vessel occlusion were collected during intracranial mechanical recanalization. Mechanical thrombectomy device was used either Penumbra aspiration catheter or Stent retriever. The hematoxylin and eosin-stained specimens were quantitatively analyzed in terms of the relative fractions of the main constituents (red blood cells and fibrin/platelets). Results: Of 65 cardio-embolic patients, Penumbra aspiration catheter was used in 27 patients, and Stent retriever was used in 38 patients. There was no significance in age, sex, occlusion vessel, NIH stroke scale, and onset to reperfusion time. The volume of thrombi was significantly larger in Penumbra group compared with that in Stent group (3.68 cm3 vs. 0.95 cm3, P<0.01). On the other hand, The percentage of fibrin component was significantly higher in Stent group (36.2% vs. 62.4%, P<0.01). Preoperative IV-tPA reduced the size of thrombi in Stent group, which was not seen in Penumbra group (0.46 cm3 vs. 1.26 cm3, P<0.01). Interestingly, preoperative susceptibility vessel sign on MR imaging correlated with the percentage of red blood cells in not Stent group but Penumbra group. Finally, new infarction on MR imaging was not different between two groups 24 hours after the treatment. Conclusions: Stent retriever could crush thrombus and reduce its size, which induce distal migration of the red blood cell component. However, it did not affect the final infarct lesion and outcome.

scholarly journals Initial Experience with the Flowtriever Mechanical Thrombectomy Device for Pulmonary Embolism

2021 ◽  
Vol 73 (3) ◽  
pp. 46-47
Author(s):  
Hunter M. Ray ◽  
Alejandro Pizano ◽  
Naveed U. Saqib ◽  
Stuart A. Harlin
Keyword(s):  
Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Initial Experience ◽  
Thrombectomy Device

Influence of Thrombus Age on the Mechanical Thrombectomy Efficacy of the Amplatz Thrombectomy Device In Vitro

2003 ◽  
Vol 26 (3) ◽  
pp. 265-268 ◽  
Author(s):  
Jan Grimm ◽  
Thomas Jahnke ◽  
Claus Muhle ◽  
Martin Heller ◽  
Stefan M�ller-H�lsbeck
Keyword(s):  
Mechanical Thrombectomy ◽  
Thrombectomy Device

Abstract TP12: The Trend of Successful First Pass in M2 Segment Stroke Thrombectomy- Insights From the STAR Collaboration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eyad Almallouhi ◽  
Sami Al kasab ◽  
Ali Alawieh ◽  
Reda M Chalhoub ◽  
Marios Psychogios ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Independent Predictor ◽  
Star Collaboration ◽  
Stroke Patients ◽  
First Pass ◽  
Thrombectomy Device ◽  
Intravenous Alteplase ◽  
Multicenter Registry ◽  
Over Time ◽  
Iv Tpa

Introduction: Stroke thrombectomy devices and the experience of neurointerventionists have improved significantly over the last few years making targeting distal occlusions such as of the M2 segment of the middle cerebral artery more feasible. We aimed to study the trend in the successful first pass (SFP) of M2 occlusions over time using the data from a contemporary multicenter registry. Methods: We reviewed the data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which included data from 11 thrombectomy-capable stroke centers to identify stroke patients who underwent mechanical thrombectomy of M2 segment occlusion. SFP was defined by achieving modified Thrombolysis in Cerebral Infarction (mTICI) score≥2b with a single thrombectomy device pass. We analyzed the linear trendline of the rate of SFP over time. Then, we used a logistic regression model to assess predictors of SFP of M2 segment occlusion. Results: We included 401 patients who underwent stroke thrombectomy of M2 occlusion; median age was 71 (IQR 60-80), 212 (52.9%) were females, 174 (43.4%) were white, National Institute of Health stroke scale (NIHSS) was 14 (IQR 8-19), Alberta Stroke Program Early CT (ASPECT) score on presentation was 9 (IQR 7-10) and onset wot groin time was 287 (IQR 181-454). SFP was achieved in 118 (29.4%) patients (linear trendline over time is in Figure 1). Presenting after 2014 was an independent predictor of SFP (OR 1.9, 95% CI 1.1-3.2, P=0.019) after controlling for age, sex, NIHSS on presentation, intravenous alteplase (IV-tPA), and onset to groin time. Conclusion: SFP rate of M2 segment occlusion has increased after 2014 likely secondary the improvement in stroke thrombectomy devices and neurointerventionists experience.

Abstract WP502: Predictors Of First Pass Reperfusion In Anterior Circulation Large Vessel Occlusion Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mahmoud Mohammaden ◽  
Leonardo Pisani ◽  
Catarina Perry da Camara ◽  
Mehdi Bousalma ◽  
Alhamza Al bayati ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Performance Metric ◽  
First Pass ◽  
Thrombectomy Device

Introduction: The speed and completeness of endovascular reperfusion strongly correlate with functional outcomes. First-Pass Reperfusion (FPR) has been recently established as a critical procedural performance metric for mechanical thrombectomy (MT). We aimed to study the predictors of FPR and its effect on the outcome Methods: Review of a prospectively collected database of MT patients with large vessel occlusion strokes (LVOS) from 05/2012-11/2018. Patients were included in the analysis if they had an anterior circulation LVOS that was successfully reperfused (mTICI 2b-3). FPR was defined as the achievement of mTICI 2c-3 after a single pass with any thrombectomy device. Uni- and multivariate analyses were performed to identify the independent predictors of FPR. Results: A total of 563 patients qualified for the analysis (mean age, 64.4±12.3 years, baseline NIHSS 16.2). FPR was achieved in 202 (35.9%) patients. On univariate analysis, FPR was significantly associated with higher ASPECTS (8.1 vs. 7.8, p=0.008), higher usage of balloon guide catheters (BGC) (88.1% vs. 75.3%, p<0.001), lower use of general anesthesia (9.5% vs. 18.2%, p= 0.006), and shorter procedure duration (mean, 45.5 vs. 79.9 min, p <0.001 and 90.5%). Both BGC (OR, 2.26; 95%CI [1.32-3.87], p=0.003) and ASPECTS (OR, 1.15; 95% CI [1.03-1.28], p= 0.01) were independent predictors of FPE on multivariate regression analysis. Conclusion: Higher baseline ASPECTS score and the use of BGC are strong predictors of First-Pass Reperfusion in mechanical thrombectomy.

The “GP” Mechanical Thrombectomy Device

2009 ◽  
Vol 18 (4) ◽  
pp. 288-293 ◽  
Author(s):  
Gillian Pearce ◽  
Neil D. Perkinson ◽  
Julian Wong ◽  
Matthew Burley ◽  
Julian Spence ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Thrombectomy Device

scholarly journals Penumbra System: A Novel Mechanical Thrombectomy Device for Large-Vessel Occlusions in Acute Stroke

2009 ◽  
Vol 31 (4) ◽  
pp. 628-633 ◽  
Author(s):  
Z. Kulcsár ◽  
C. Bonvin ◽  
V.M. Pereira ◽  
S. Altrichter ◽  
H. Yilmaz ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
System A ◽  
Thrombectomy Device

Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: Results from a multicentric prospective registry

2020 ◽  
pp. 174749302092305 ◽  
Author(s):  
Federico Di Maria ◽  
Maéva Kyheng ◽  
Arturo Consoli ◽  
Jean-Philippe Desilles ◽  
Benjamin Gory ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Lower Systolic Blood Pressure ◽  
Excellent Outcome ◽  
First Pass Effect ◽  
First Pass ◽  
Thrombectomy Device

Background The first-pass effect, defined as a complete or near-complete recanalization after one pass (first-pass effect) of a mechanical thrombectomy device, has been related to better clinical outcome than good recanalization after more than one pass in acute ischemic stroke. We searched for predictors of first-pass effect by analyzing the results within a large prospective multicentric registry. Methods We included patients treated by mechanical thrombectomy for isolated anterior intracranial occlusions. A multi-variate logistic regression analysis was carried out to search for predictors of first-pass effect. We also analyzed the percentage of patients with 90-day modified Rankin Scale score 0 to 2, excellent outcome (90-day modified Rankin Scale 0 to 1), 24-h NIHSS change, and 90-day all-cause mortality. Results Among the 1832 patients included, clinical outcome at 90 days was significantly better in first-pass effect patients (50.6% vs. 38.9% in patients without first-pass effect), with a center-adjusted OR associated with first-pass effect of 1.74 (95%CI, 1.24 to 1.77). Older age, a lower systolic blood pressure, an MCA-M1 occlusion, higher DWI-ASPECTS at admission, mechanical thrombectomy under local anesthesia, and combined first-line device strategy were independent predictors of first-pass effect. Conclusions In this study, a strategy combining thrombectomy and thrombo-aspiration was more effective than other strategies in achieving first-pass effect. In addition, we confirm that clinical outcome was better in patients with first-pass effect compared to non-first-pass effect patients.

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