Acute Cerebral Artery Occlusion Research Articles

Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery

The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms, and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms, which often make early diagnosis difficult, thus losing the best treatment opportunity. Once cerebral infarction occurs, the consequences are difficult to recover. This is also an important reason for the high misdiagnosis rate and mortality of this disease. In this paper, the characteristics of the disease were analyzed to provide clinical reference.

Penumbral Imaging to Guide Endovascular Treatment for M2 Middle Cerebral Artery Stroke.

A potential benefit of mechanical thrombectomy for patients with distal medium vessel occlusions is currently being investigated in randomized trials. Computed tomography perfusion imaging has not yet been tested as a method to guide mechanical thrombectomy for distal medium vessel occlusions. The purpose of this study was to assess penumbral imaging as an imaging-based method for triaging patients with ischemic stroke and acute M2-middle cerebral artery occlusion. This observational retrospective study of M2-middle cerebral artery patients with ischemic stroke triaged by multimodal computed tomography undergoing mechanical thrombectomy at a high-volume stroke center between January 2015 and January 2023. The effect of recanalization was analyzed according to computed tomography perfusion-derived lesion volumes (defined using relative cerebral blood flow <30% and Tmax >6 seconds) using logistic regression analysis, and interaction terms between the independent variables and recanalization were tested. The primary end point was functional independence at day 90, defined using modified Rankin Scale scores of 0 to 2. A total of 140 patients with M2-middle cerebral artery occlusion were included. In multivariable logistic regression analysis, recanalization was not associated with better functional outcome (adjusted odds ratio, 1.85 [95% CI, 0.87-3.90]; P=0.11). After including interaction terms, a significant treatment effect between recanalization and computed tomography perfusion-derived lesion volumes was observed in patients with >150 mL hypoperfusion volume (adjusted odds ratio, 1.02 [95% CI, 1.00-1.03]; P=0.007) or >125 mL penumbral volumes (adjusted odds ratio, 1.02 [95% CI, 1.01-1.03]; P=0.005), as well as for baseline ischemic core volume within the range of 15 to 40 mL (adjusted odds ratio, 1.11 [95% CI, 1.01-1.22]; P=0.03). Penumbral imaging might serve as a useful tool for treatment decision-making in distal medium vessel occlusions, particularly in cases of suspected non- or codominant M2-middle cerebral artery vessel occlusions. A hypoperfusion volume threshold of >150 mL emphasizes the potential value of computed tomography perfusion as a standardized tool directly showing the volumetric relevance in distal medium vessel occlusion cases.

Long and Large Stentrievers Improve Reperfusion Outcomes in Acute Intracranial Terminal Internal Carotid Artery Occlusion: Interim Results of the Rossetti Registry.

Although stentrievers (SRs) are widely used for mechanical thrombectomy (MT), the impact of device dimensions on optimizing reperfusion outcomes in high clot burden cases is unclear. Our study aimed to investigate the effect of SR size on angiographic and clinical outcomes in patients with acute terminal internal cerebral artery (TICA) occlusion. We analyzed ROSSETTI registry data to compare technical and clinical outcomes of TICA occlusion patients treated with MT without rescue therapy, according to SR diameter and length: 6 × 41-50 mm, 6 × 20-40 mm, and <6 × 20-50 mm. The first-pass effect (FPE) was defined as achieving aTICI2c‑3 after asingle pass. We included 491 patients, 240 (41.5%) in 6 × 41-50 group, 117 (20.2%) in 6 × 20-40 group, and 134 (23.2%) in < 6 × 20-50 group. The MT procedure time for the 6 × 41-50 group was shorter, but the FPE rate was similar across all groups. The highest final mTICI2c‑3 rate was in 6 × 41-50 group (81.2%), compared to 6 × 20-40 group (68.4%) and 4-6 × 20-50 group (72.4%) (p = 0.016). Distal catheter use was associated with final mTICI0-2b (62% of patients). Clinical outcomes were similar between the groups. Larger diameter and longer length of the SR, as well as not using an intermediate catheter, were independent predictors of final mTICI2c‑3. The use of 6 × 41-50 SRs (OR 1.64, 95% CI 1.06-2.52; p = 0.024) and distal catheter use (OR 0.62, 95%CI 0.40-0.96; p = 0.034) were independent predictors of final mTICI2c‑3. Use of longer and larger SRs in acute intracranial TICA occlusion improves final reperfusion rate.

Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

BackgroundThe safety and efficacy of mechanical thrombectomy (MT) for the treatment of acute anterior cerebral artery (ACA) occlusions have not clearly been delineated. Outcomes may be impacted based on whether...

Feasibility and safety of ADAPT in acute distal posterior cerebral artery occlusions

PurposeThe direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVO) of the anterior circulation. Clinical experience with ADAPT in the distal posterior circulation, however, is still limited and published data is scarce. In this original work, feasibility, safety and efficacy of ADAPT with distal access catheters (DAC) for treatment of acute distal posterior cerebral artery occlusions (DPCAOs) is evaluated. MethodAll acute ischemic stroke patients between 2017 and 2022 with primary or secondary DPCAOs in the P2 or P3 segment, that underwent thrombectomy of the DPACO using ADAPT with DACs as frontline therapy, were identified. Demographic data, recanalization rates, procedural safety, and clinical outcome were assessed. ResultsTwenty-four patients with primary (n = 6) or secondary (n = 18) DPCAOs (P2: 21/24; P3: 3/24) were included. Median NIHSS score at admission was 14.5 (IQR 9.5). In all cases, the DPCAO could be reached with the DAC. Successful revascularization (DMVO-p-TICI ≥ 2b) with ADAPT was achieved in 79.2% (19/24), including a first pass effect of 62.5% (15/24), leading to complete recanalization (DMVO-p-TICI 3). Median number of passes was 1 (range 1–2). No complications related to distal PCA aspiration thrombectomy occurred. Median NIHSS and mRS scores at discharge were 4 (IQR 8) and 3 (IQR 2), respectively. ConclusionsADAPT appears to be feasible, safe and effective for the treatment of acute DPCAOs in the setting of different occlusion patterns. High revascularization rates without procedural complications can be achieved. Further studies are needed to consolidate these results.

Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion

PurposePatients with isolated posterior cerebral artery occlusion (iPCAO) represent up to 6% of all acute ischemic stroke patients. Acute revascularization therapies for these patients were not tested in randomized controlled trials. The aim of this study was to evaluate outcomes of iPCAO patients who undergo endovascular treatment (EVT).MethodsA systematic search of MEDLINE, Web of Science, CENTRAL, Scopus (inception—03/2022) was conducted for studies reporting 3‑month outcome, symptomatic intracranial hemorrhage (sICH) and/or successful recanalization in iPCAO patients who underwent EVT. Random effect meta-analyses for pooled proportions were calculated. Double-arm meta-analyses for comparison of outcomes of iPCAO patients treated with EVT with age-, sex- and NIHSS-matched iPCAO patients treated with best medical treatment only were performed.ResultsFifteen studies reporting a total of 461 iPCAO patients who underwent EVT were included. Excellent and favorable 3‑month outcome proportions were 36% (95% confidence interval, CI 20–51%) and 57% (95% CI 40–73%), respectively. The 3‑month mortality was 9% (95% CI 5–13), sICH occurred in 1% (95% CI 0–2%), successful recanalization was achieved in 79% (95% CI 71–86%). No significant differences in favorable and excellent 3‑month outcomes, 3‑month mortality and symptomatic intracerebral hemorrhage were found between the groups of patients who underwent EVT and the group of patients who received best medical treatment only.ConclusionThese results support the feasibility and safety of EVT in iPCAO, but do not show an outcome benefit with EVT compared to best medical treatment. Randomized trials are needed to evaluate treatment benefit of EVT in these patients.

Predictors for intracerebral hemorrhage after intravenous or intraarterial recanalization in acute major cerebral artery occlusion in Korean patients

Objective To evaluate predictors for intracerebral hemorrhage (ICH) and 1-month mortality after intravenous (IV) or intraarterial (IA) recanalization therapy for major cerebral artery occlusion in Korean patients. Methods From 2011 to 2015, we prospectively gathered data from consecutive patients treated with IV/IA recanalization within 8 h of symptoms in a single center. The effects of demographic, clinical, laboratory, and radiological factors on ICH within 2 weeks were assessed, as well as 1-month mortality. Results From a total of 183 patients, symptomatic intracerebral hemorrhage (SICH) occurred in 32 patients (17.5%), and asymptomatic ICH occurred in 37 patients (20.2%). The mortality rate at 1 month in ICH patients was 37.7%. The international normalized ratio (INR) (OR, 4.9; 95% CI, 1.03–23.4; p = 0.046), glucose (OR, 1.119 per mmol/L; 95% CI, 1.015–1.233; p = 0.023), medium-volume infarct (15–69.9 mL) (OR, 2.62; 95% CI, 1.1–6.26; p = 0.03), large-volume infarct (≥70 mL) (OR, 5.54; 95% CI, 2.1–14.6; p = 0.001), and angioplasty or stenting (OR, 6.29; 95% CI, 1.71–23.22; p = 0.006) were predictors of any ICH. Hyperlipidemia or statin medication (OR, 4.17; 95% CI, 1.38–12.59; p = 0.011), INR (OR, 7.13; 95% CI, 0.94–54.22 p = 0.058), and large-volume infarct (≥70 mL) (OR, 7.96; 95% CI, 2.31–27.39; p = 0.001) were predictors of SICH. Hypertension (OR, 5.77; 95% CI, 1.43-23.3; p = 0.014), initial NIHSS score (OR, 1.09; 95% CI, 1.01–1.18; p = 0.27), and SICH (OR, 15.7; 95% CI, 4.04–61.08; p < 0.001) were predictors of 1-month mortality. Conclusion INR and glucose may be strong modifiable predictors of critical ICH leading to death after IV/IA recanalization therapy in acute cerebral artery occlusion.

Comparative study on treatment of acute cerebral infarction between mechanical thrombectomy by micro catheter and thrombectomy by Solitaire AB stent.

Background:Acute cerebral artery occlusion is a common disease with high morbidity and mortality. At present, the commonly used mechanical thrombectomy schemes are mechanical thrombectomy and stent thrombectomy. However, the clinical differences between the two methods is not fully understood. The present study aimed to evaluate the clinical effectiveness of Solitaire AB stent thrombectomy for acute cerebral infarction (ACI).Methods:A retrospective study was carried out in 96 ACI patients admitted to our department from January 2017 to January 2020. According to the treatment they received, they were divided into group A (conventional microcatheter mechanical thrombectomy, n = 48) and group B (Solitaire AB stent thrombectomy, n = 48). All patients were followed up for 3 months. Their pre- and post-operative nerve function indices were compared between the 2 groups. The therapeutic effects were evaluated by thrombolysis in cerebral infarction scale system, Glasgow coma scale (GCS), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin scale statistics.Results:Two groups of patients with NIHSS scores postoperative 3 and 30 days decreased significantly compared with preoperation. NIHSS score of group A 3 and 30 days postoperation was significantly higher than group B (P < .05). Two groups of patients with GCS scores postoperative 3 and 30 days increased significantly compared with preoperation. GCS score of group A 3 and 30 days postoperation was significantly lower than group B (P < .05). Group B with vascular recanalization ratio postoperative 30 days was higher than group A, however with no significant differences (P > .05). Moreover, group B with outcomes (modified Rankin scale score ≤2 points) postoperative 3 months was better than group A, however with no significant differences (P > .05).Conclusion:Solitaire AB stent embolectomy shows similar efficacy as mechanical thrombectomy in the treatment of ACI patients.

Acute occlusion of the fetal posterior cerebral artery: diagnosis and management paradigms.

The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. We performed a retrospective review of consecutive patients presenting with acute large vessel occlusion who underwent cerebral angiogram and/or mechanical thrombectomy between January 2015 and January 2021. Patients diagnosed with fetal posterior cerebral artery occlusion were included. Demographic data, clinical presentation, imaging findings and management strategies were reviewed. Between January 2015 and January 2021, three patients with fetal posterior cerebral artery occlusion were identified from 400 patients who underwent angiogram and/or mechanical thrombectomy for acute stroke (0.75%). The first patient presented with concomitant fetal posterior cerebral artery and middle cerebral artery occlusions. Thrombectomy was performed with recanalisation of the fetal posterior cerebral artery but the patient died from malignant oedema. The second patient presented with isolated fetal posterior cerebral artery occlusion. No endovascular intervention was performed and the patient was disabled from malignant posterior cerebral artery infarct. The third patient presented with carotid occlusion and was found to have fetal posterior cerebral artery occlusion after internal carotid artery recanalisation. No further intervention was performed. The patient was left with residual contralateral homonymous hemianopia and mild left sided weakness. Fetal posterior cerebral artery occlusion is a rare, but potentially disabling, cause of ischaemic stroke. Endovascular treatment is feasible. Further investigation is needed to compare the efficacy of medical versus endovascular management strategies.

Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors

BackgroundThe procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi...

Teaching Video NeuroImage: ECG-Gated 4-D CT Angiography Can Detect Aortic Plaque Mobility in Cryptogenic Stroke.

An 80-year-old man developed an acute ischemic stroke and right posterior cerebral artery (PCA) occlusion (figure, A and B). Cardiac and carotid artery ultrasound examinations and 24-hour ECG monitoring did not identify any embolic sources. ECG-gated 4-D CT angiography (CTA) showed a noncalcified plaque with a superimposed mobile component on the ascending aorta (figure, C, and video 1). Virtual angioscopy using the datasets from ECG-gated 4-D CTA showed seaweed-like mobile component in the 3-D view (figure, D, and video 1). This was diagnosed as aortogenic embolism. The antithrombotic therapy was changed from clopidogrel to warfarin with an international normalized ratio of 2.0–3.0, and low-density lipoprotein cholesterol levels were controlled to less than 70 mg/dL by rosuvastatin.

Mechanical thrombectomy of acute distal posterior cerebral artery occlusions

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. 35 consecutive patients were included in the study. In 17 patients MTE of isolated acute distal PCA occlusion was performed. 9 patients had combined basilar artery (BA) and distal PCA occlusion on stroke imaging and 3 had embolic distal PCA occlusion following MTE for BA occlusion. 6 patients harbored distal PCA occlusions in combination with carotid-T occlusion and a dominant posterior communicating artery. The median NIHSS at presentation was 14 (IQR 8 – 27). 25 patients (71.4%) had occlusions of the P2 and 10 patients (28.6%) of the P3 segment. Successful recanalization (TICI 2b/3) was achieved in 31 patients (88.6%). 10 patients (28.6%) were treated with a direct contact aspiration technique, while a stent retriever was used in 25 patients (71.4%). No complication attributable to distal PCA MTE occurred. Good outcome (mRS ≤ 2) was achieved in 14 patients (46.7%) and mortality was 22.9%. MTE for acute distal PCA occlusion in the setting of different occlusion patterns appears both safe and angiographically effective. Yet, clinical effectiveness remains to be determined.

Acute Cerebral Artery Occlusion by Direct Tumor Embolus

In acute stroke, emboli are mostly composed of thrombi from artery, cardiac chamber, valve and vein. Non-thrombotic emboli are sometimes difficult to identify the origin. According to the increased number of cancer patients, now 10% of stroke patients have a cancer. However, the potential mechanisms of stroke in patients with cancer are various. We presented a case of serious acute arterial occlusion with a tumor embolus, which was revealed by histopathologic analysis of retrieved emboli during mechanical thrombectomy.

A Case of Mechanical Thrombectomy for Acute Occlusion of the Left Internal Carotid Artery Later than 24 Hours after Onset.

Mechanical thrombectomy is performed on ischemic stroke patients with acute major cerebral artery occlusion within 24 hours of symptom onset. We report a case of delayed mechanical thrombectomy for acute left internal carotid artery occlusion. A 76-year-old woman suddenly presented with dysarthria and right hemiparesis was admitted to her previous hospital. She was treated by conservative therapy. The next day, she was transferred to our hospital 26 hours after onset with a diagnosis of ischemic stroke due to left carotid artery acute occlusion. Contrast CT revealed left carotid artery occlusion. Arterial fibrillation was detected. Mechanical thrombectomy through the right brachial artery was immediately performed. Complete recanalization was achieved without hemorrhagic complication. Her postoperative course was uneventful. In this case, delayed mechanical thrombectomy for acute major cerebral artery occlusion was safely performed 24 hours after symptom onset.

Attempt to delineate occluded arteries with initial plain computed tomography in acute cerebral arterial occlusion

BackgroundWe used initial plain computed tomography to delineate acutely occluded internal carotid arteries or horizontal segments of middle cerebral arteries. If affected arteries could be delineated using initial plain computed tomography, useful information might be obtained that could support endovascular thrombectomies. MethodsIn 15 patients with occluded internal carotid arteries or horizontal segments of middle cerebral arteries, the affected middle cerebral artery was automatically traced using the extender function for blood vessel tracing with reference to the default value (window setting, 40; window width, 90) on Ziostation 2 (Ziosoft Inc., Tokyo, Japan) based on initial plain computed tomography data. ResultsThe horizontal and sylvian segments of the middle cerebral artery were delineated in 15 and nine patients, respectively, based on plain computed tomography volume data. Images of occluded vessels delineated by plain computed tomography closely correlated with digital subtraction angiography. ConclusionsInitial plain computed tomography combined with a new generation workstation enabled the rapid delineation of occluded segments of intracranial vessels and could provide useful information that might improve the safety of endovascular thrombectomy.

Double Stent Retriever (SR) Technique: A Novel Mechanical Thrombectomy Technique to Facilitate the Device-Clot Interaction for Refractory Acute Cerebral Large Vessel Occlusions

Mechanical thrombectomy has become the standard treatment for acute ischemic stroke caused by large vessel occlusion; however, refractory occlusions still occur despite various thrombectomy procedures. The double stent retriever (SR) technique, which employs 2 SRs simultaneously at the occlusion, can be useful for such refractory occlusions. We described 2 cases of refractory acute cerebral occlusion despite the use of conventional thrombectomy procedures that were both treated with the double SR technique. To discuss the technical aspects of how this easy-to-perform technique facilitates the device-clot interaction, we also evaluated radiographic findings of the SR strut during the procedure. In both cases, conventional thrombectomy procedures, including an SR alone, an aspiration catheter alone, and combined use of the SR and aspiration catheter, failed to recanalize the occlusion. The double SR technique was then performed with the stent-in-stent method in 1 patient and the parallel stent method in 1 patient. One pass of this technique retrieved hard clots and successfully recanalized the refractory occlusion in both cases. Intraprocedural radiographic images of these cases showed that the degree of stent expansion improved after deployment of the second SR compared with the first SR. Our radiographic findings suggested that adding a second SR facilitates the device-clot interaction at the occlusion site. The double SR technique may be an easy-to-perform thrombectomy technique to improve clot-capturing ability for the management of refractory acute cerebral artery occlusions.

Flat Panel Computed Tomography Pooled Blood Volume and Infarct Prediction in Endovascular Stroke Treatment.

Background and Purpose- Patients with large-vessel stroke frequently need to be transferred to comprehensive stroke centers for endovascular treatment. An update of physiological perfusion parameters and stroke progression on arrival is desirable. We examined the reliability of preinterventional pooled blood volume (PBV)-maps acquired by flat-panel detector computed tomography (CT) in the interventional angiography suite. Methods- The volumes of preinterventional perfusion deficit in flat-panel detector CT-PBV source images were compared with final infarct volume on follow-up multislice-CT after endovascular treatment of 29 consecutive patients with occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA). Results- Endovascular treatment was successful in 26 patients (Thrombolysis in Cerebral Infarction, 2b-3). Overall, the median preinterventional PBV-deficit was 9×larger than median final infarct volume on multislice-CT (86.4 mL [10.3; 111.6] versus 9.6 mL [3.6; 36.8]). This was especially evident in the subgroup of successful recanalization (PBV-deficit: 87.5 mL [10.6; 115.1], final infarct: 8.7 mL [3.6; 29]). In futile recanalization, the final infarct tended to be underestimated (PBV-deficit: 86.4 mL [5.9; -] and final infarct: 116.4 mL [3.5; -]). Conclusions- Flat panel detector CT-PBV is not reliable in predicting the final infarct volume and should not be used in clinical decision making for endovascular treatment of acute cerebral artery occlusions.

Effect of direct oral anticoagulant for acute major cerebral artery occlusion in cardioembolic stroke/transient ischemic attack patients with non-valvular atrial fibrillation

BackgroundDirect oral anticoagulants (DOACs) can reduce the frequency of cardioembolic stroke with non-valvular atrial fibrillation as well as or better compared to vitamin K antagonists (VKAs). However, whether taking DOACs prior to stroke can prevent acute major cerebral artery occlusion (MCAO) has not been fully elucidated. MethodsWe enrolled patients who underwent cardioembolic stroke or transient ischemic attack with non-valvular atrial fibrillation who were admitted to our hospital between April 2011 and February 2017. The patients were classified into four groups based on anticoagulant medications prior to stroke: no oral anticoagulant (No OAC), VKA below therapeutic range on admission, VKA within therapeutic range on admission, and the DOAC group. We compared clinical backgrounds, National Institutes of Health Stroke Scale (NIHSS) scores, and MCAO prevalence on admission. We identified those patients with MCAO and investigated factors related to MCAO. ResultsA total of 287 patients were enrolled in the study (200 No OAC; 49 VKA below therapeutic range; 21 VKA within therapeutic range; and 17 DOAC). Median and interquartile range of NIHSS scores for each group were 10.5 (4–22) for No OAC; 14 (4–22) for VKA below therapeutic range; 8 (6–17) for VKA within therapeutic range; and 3 (1–9) for DOAC (P = 0.041). The prevalence of MCAO in each group was 40% in No OAC; 35% in VKA below therapeutic range; 29% in VKA within therapeutic range; and 6% in DOAC (P = 0.040). In total, 103 patients were identified with MCAO on admission. Multivariate analysis revealed that taking DOACs prior to stroke was significantly associated with MCAO (OR, 0.09; 95% CI, 0.004–0.75; P = 0.023). ConclusionsDOACs were an independent factor negatively correlated with MCAO in acute cardioembolic stroke with non-valvular atrial fibrillation.

Radiation Outcome in Mechanical Thrombectomy of Acute Ischemic Stroke.

ObjectiveMechanical thrombectomy is recommended for acute ischemic stroke (AIS) with large artery occlusion. Radiation during the endovascular procedure would increase the risk of skin diseases. We sought to identify radiation outcomes during mechanical thrombectomy.MethodologyWe prospectively collected and analyzed radiation parameters during mechanical thrombectomy in 41 patients affected with acute cerebral artery occlusion.ResultsThere were 41 cases (68.73 ± 11.05 years) in this study, with a National Institute Health Stroke Scale (NIHSS) score of 15.66 ± 5.94. The time parameters were recorded as following: 84.45 ± 31.66 min (operation duration), 129.71 ± 81.14 s (angiographic run), 16.02 ± 11.03 min (fluoroscopy) and 18.19 ± 11.14 min (angiographic exposure). The doses produced in the procedure were: 1276.43 ± 1647.56 mGy (shot dose), 607.26 ± 412.34 mGy (fluoroscopy) and 1635.52 ± 593.65 mGy (angiographic exposure). Further analysis discovered no association between NIHSS and these time and radiation parameters (P > 0.05).ConclusionThis study provided the description of radiation details during mechanical thrombectomy for acute cerebral artery occlusion. The stroke severity would not influence the procedure parameters.

Mechanical thrombectomy treatment in patients with acute ischemic stroke: a single center study

OBJECTIVE To evaluate the effectiveness and safety of mechanical thrombectomy treatment in patients with acute ischemic stroke (AIS),and to explore influential factors of the clinical prognosis preliminarily. METHODS Clinical data of 26 patients with acute cerebral arterial occlusion treated with mechanical thrombectomy in Peking University Third Hospital from January 2014 to June 2017 were retrospectively collected. The immediate effects of the 26 patients in this group after mechanical thrombectomy treatment were analyzed,The national institutes of health stroke scale (NIHSS) scores between preoperative and at discharge of the 26 patients in this group were compared,and modified Rankin scale (mRS) scores of 90 days post operation were analyzed to assess the prognosis of the 26 patients in this group. RESULTS (1)In this group, 23 patients (88.5%) achieved vascular recanalization evaluated by thrombolysis in cerebral ischemia scale scores [thrombolysis in cerebral ischemia scale (TICI) scores, 3/2b grades were recognized as vascular recanalization], 19 patients of them reached TICI grade 3 and 4 atients reached TICI grade 2b. In this group 3 patients (11.5%) encountered symptomatic intracranial hemorrhage, 2 patients of them recovered after cerebral hemorrhage absorbed and 1 patient died of massive cerebral hemorrhage. In this group 4 patients (15.4%) died after mechanical thrombectomy treatment,2 patients died of hernia of the brain caused by severe cerebral edema, 1 patient died of symptomatic intracranial hemorrhage and 1 patient died of extensive subarachnoid hemorrhage. (2)The assessment of NIHSS scores at discharge(5.3±2.1)showed significantly lower than those preoperatively(12.6±4.2), P<0.01,and in this group 12 patients (46.2%) achieved favourable prognosis (defined as mRS scores 0-2), 6 patients of them reached mRS 0 score,4 patients reached mRS 1 score and 2 patients reached mRS 2 scores. CONCLUSION Mechanical thrombectomy with stent retriever contributed to a high rate of vascular recanalization and favourable prognosis,but some patients had poor prognosis, suggesting that we should screen the enrolled patients strictly.