Efficacy Of Thrombectomy Research Articles

Abstract TMP82: First line aspiration versus stent retriever for posterior circulation stroke; A meta-analysis

Introduction: Aspiration and stent retriever thrombectomy are the primary approaches for endovascular management of posterior circulation stroke. However, the optimal first-line choice of surgical technique remains unclear. This study aims to conduct a systematic review and meta-analysis comparing first-line aspiration with stent retriever thrombectomy in terms of recanalization rates, complications, and clinical outcomes. Methodology: This systematic review and meta-analysis followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Databases searched included PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov, focusing on studies comparing the efficacy and safety of first-line aspiration versus stent retriever thrombectomy for posterior circulation stroke. Data analysis was performed using RevMan version 5.4.1, with statistical significance set at p < 0.05. Result: A total of 21 studies, including 2,521 patients, were analyzed. First-line aspiration demonstrated a significant advantage in terms of successful recanalization (OR = 1.36; 95% CI: 1.04–1.76; p = 0.002) and complete recanalization (OR = 1.41; 95% CI: 0.91–2.20; p = 0.03), both favoring aspiration over the stent retriever technique. Additionally, first-line aspiration was associated with a significantly lower overall complication rate (OR = 0.58; 95% CI: 0.40–0.85; p = 0.005) and a shorter procedural time (SMD = -0.60; 95% CI: -0.81 to -0.40; p < 0.005). However, there were no statistically significant differences between the two techniques in the first pass effect (OR = 1.41; 95% CI: 0.95–2.09; p = 0.09), the need for rescue therapy (OR = 1.01; 95% CI: 0.71–1.44; p = 0.96), 90-day all-cause mortality (OR = 0.95; 95% CI: 0.71–1.27; p = 0.72), and 90-day favorable functional outcome (OR = 1.17; 95% CI: 0.97–1.41; p = 0.11). Conclusion: This meta-analysis suggests that first-line aspiration may offer advantages over stent retrievers for posterior circulation stroke, particularly in terms of recanalization success and procedural safety. However, no significant differences were observed in key clinical outcomes such as mortality and favorable recovery.

Meta-analysis on the primary approach: Aspiration versus stent retrieval for internal carotid artery occlusion.

Previous studies have not provided consistent findings regarding the efficacy of aspiration thrombectomy versus stent retriever thrombectomy in patients with acute internal carotid artery occlusion. This study aimed to evaluate the preferable endovascular technique (aspiration or stent retriever) and the impact of stent retriever utilization on both clinical and angiographic outcomes. We collected potential scholarly articles from a variety of databases including the PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov, and the World Health Organization, International Clinical Trials Registry Platform. The search spanned from the establishment of electronic databases up to March 2024. Additionally, gray literature was sourced from the references cited in the included literature reports. Statistical analysis of the combined data was performed using STATA version 11.0 (Stata Corporation, TX). Our analysis comprises a total of 4 studies, involving 759 participants in total. Among these individuals diagnosed with internal carotid artery occlusion, 435 were assigned to the aspiration group, while 324 were designated to the stent retriever group. The findings indicated a significant increase in the rate of successful reperfusion in the stent retriever group compared to the aspiration group. Furthermore, it was observed that the incidence of overall complications, intracerebral hemorrhage, embolization formation, puncture to reperfusion time, and onset to reperfusion time in the stent retriever group did not significantly exceed that in the aspiration group. In our review on intracranial internal carotid artery occlusion, stent retrievers outperformed direct aspiration in achieving successful reperfusion. However, further studies evaluating the effects of different approaches to internal carotid artery clot removal are required to confirm these results.

Safety and Efficacy of Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery.

Mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs) in the middle cerebral artery (MCA) is less established than for large vessel occlusions. This study evaluates the safety and efficacy of MT in DMVOs, comparing it with M1-segment occlusions. This retrospective study analyzed 218 patients who underwent MT for isolated M1 (n=123) or distal M2+M3 (n=35) occlusions between January 2020 and August 2023. Outcomes included procedural complications, hemorrhagic events, reperfusion rates, and clinical severity and disability at admission and discharge. Multivariate logistic regression identified predictors of favorable outcomes (modified Rankin Scale≤2) at discharge. Median admission National Institutes of Health Stroke Scale (NIHSS) scores were higher in the M1 group (13, interquartile range [IQR]: 8) compared to the distal M2+M3 group (8, IQR: 7; P<0.001), with significant improvements at discharge in both groups (6 [IQR: 8] for M1 and 2.5 [IQR: 5] for M2+M3; P=0.025). Favorable outcomes were more frequent in the M2+M3 group (50.0%) compared to M1 (28.1%; P=0.023). Recanalization rates (modified Thrombolysis in Cerebral Infarction≥2b) were excellent (>90% in both groups; P=0.300). Procedural complications were rare, with vessel perforations occurring infrequently (M1: 1.6%; M2+M3: 2.9%; P=0.531). Symptomatic intracranial hemorrhage rates were similarly low (2.4% vs. 2.9%; P=0.889). Multivariate analysis identified younger age (P=0.045) and lower NIHSS (P=0.061) as predictors of favorable outcomes in distal occlusions. MT is safe and effective for DMVOs of the MCA, demonstrating significant improvements in clinical outcomes and comparable complication rates to MT for M1-segment occlusions. Given the typically less severe presentations in DMVO and similar risk profiles, careful patient selection and individualized treatment remain critical.

Outcomes of mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke patients with ASPECTS 4-5 vs. 6-7: a retrospective, multicenter, and multinational study.

Mechanical thrombectomy (MT) efficacy in medium vessel occlusion (MeVO) stroke, particularly in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), remains less explored. This retrospective study analyzed data from 443 AIS patients treated with MT for MeVO and low ASPECTS (4-7) at 37 centers across North America, Asia, and Europe, from September 2017 to July 2021. Patients were categorized into ASPECTS of 4-5 and 6-7. Of 443 patients, 51 (12%) had ASPECTS of 4-5, and 392 (88%) had scores of 6-7. The median age was 65 years (IQR: 46-79), with a balanced sex distribution between the groups. The most common site of initial occlusion was M2 branch in both groups (92% in ASPECTS 4-5 and 85% in ASPECTS 6-7) (p = 0.68). The ASPECTS 4-5 group had lower TICI 2c-3 achievement (31% vs. 55%, p = 0.002) and poorer functional outcomes (mRS 0-1 at 90 days: 12% vs. 29%, p = 0.03) compared to the ASPECTS 6-7 group. Intracranial hemorrhagic complications were higher in the ASPECTS 4-5 group (69% vs. 47%, p = 0.007). Multivariable analysis revealed ASPECTS 6-7 to be associated with higher odds of TICI 2c-3 (OR: 2.5; CI: 1.28 to 4.89, p = 0.007) and lower odds of intracranial hemorrhagic complications (OR: 0.4; CI: 0.19 to 0.81, p = 0.012). MT may be associated with improved outcomes in patients with moderate-to-low ASPECTS (6-7), though the lack of a control group limits definitive conclusions about its effectiveness. In patients with very low ASPECTS (4-5), higher rates of hemorrhagic complications and poorer outcomes were observed, but this does not necessarily preclude the use of MT. These findings highlight the need for further research and careful patient selection.

Long-term outcome of endovascular thrombectomy in patients with acute ischemic stroke: a systematic review and meta-analysis.

Randomized controlled trials have demonstrated the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute large vessel occlusion stroke. However, its long-term benefits remain uncertain. Therefore, this study aimed to investigate the long-term clinical outcomes of EVT. We searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant literature pertaining to patients with acute ischemic stroke who were treated with EVT plus medical management (MM) compared with MM alone, until August, 31, 2024. The primary outcome was functional independence (defined as a score of 0 to 2 on the modified Rankin scale [mRS]) at 12months or beyond, while the safety outcome was mortality at 12months or longer. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. This study was registered on the International Prospective Register of Systematic Reviews on June 15, 2024 (PROSPERO, CRD42024554043). A total of 4546 articles were obtained through the search. After excluding those that did not meet the inclusion criteria, 9 randomized controlled trials with 3358 patients (1821 and 1537 assigned to EVT + MM and MM alone group, respectively) were included in this analysis. The EVT + MM group had a higher proportion of functional independence (32.9% vs 18.2%, risk ratio 2.07, 95% confidence interval 1.50-2.87, P < 0.001) and lower mortality (34.1% vs 39.7%, risk ratio 0.86, 95% confidence interval 0.78-0.94, P = 0.001) compared to the MM group. Endovascular thrombectomy was associated with improved functional outcomes and reduced mortality in acute large vessel occlusion stroke patients and presented a long-term favorable effect.

Intravenous thrombolysis and mechanical thrombectomy in acute stroke patients on direct oral anticoagulants

Intravenous thrombolysis and mechanical thrombectomy reduce morbidity and improve functional outcome in ischemic stroke. However, acute recanalization therapies may increase the risk of symptomatic intracranial hemorrhage due to its effects on the brain tissue. An increasing proportion of patients with ischemic stroke are using direct oral anticoagulants (DOACs). While current international guidelines recommend against intravenous thrombolysis in patients with intake of DOACs within the last 48 h, they also highlight lack of evidence in the area. Based on these guidelines, a significant proportion of patients are consequently disqualified from intravenous thrombolysis. Measuring anticoagulant activity before intravenous thrombolysis has been suggested as a way to select patients with low risk of symptomatic intracranial hemorrhage, but uncertainty exists about feasibility, validity, availability and costs. Reversal agents have demonstrated potential in facilitating safer intravenous thrombolysis administration, though their efficacy is not established in randomized controlled trials, and logistical and cost-related barriers limit their widespread use. During the last couple of years several large cohort studies reported no significant increase in symptomatic intracranial hemorrhage among selected patients on DOACs receiving intravenous thrombolysis compared to those not on anticoagulants, even without the use of DOAC plasma levels or reversal agents. Mechanical thrombectomy appears to be generally safe in patients with recent DOAC intake. The aim of this review is to discuss the uncertainty around the safety and efficacy of intravenous thrombolysis and thrombectomy in patients with a recent intake of DOAC, summarize existing knowledge, and outline potential approaches.

Enhancing thrombectomy outcomes with Adaptive Pulsatile Aspiration (APA): the role of complete clot ingestion in reducing thrombectomy time and distal embolization

BackgroundComplete clot ingestion (CCI) is defined as full ingestion of the clot into the catheter or pump canister without any external clot remnants at the catheter tip. The aim of...

Stroke thrombectomy in the elderly: A propensity score matched study on a nationwide real-world registry.

Data on safety and efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke in older patients are limited and controversial, and people aged 80 or older were under-represented in randomized trials. Our aim was to assess EVT effect for ischemic stroke patients aged ⩾80 at a nationwide level. The cohort included stroke patients undergoing EVT from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients were a priori divided into younger and older groups (<80 vs ⩾80). Primary outcome was good functional outcome (modified Rankin scale, mRS, 0-2 at 90 days). Secondary outcomes were symptomatic intracranial hemorrhage (sICH), successful reperfusion, EVT abortion. Propensity score matching (PSM) was performed between age groups for baseline features, functional status, stroke severity and neuroradiological features. Logistic regression was implemented to test the weight of age group on the predefined outcomes. Overall, 5872 individuals (1:1 matching, n = 2936 aged ⩾80 vs n = 2936 < 80) were matched from 13,922 records. In ⩾80 group 34.1% had good functional outcome, vs 51.2% in <80 group (absolute difference = -17.1%, p < 0.001), with a 4.4% excess in EVT abortion. Age ⩾80 was a negative independent predictor of good functional outcome (aOR = 0.4, 95% CI = 0.3-0.5), but had no impact on sICH. Age ⩾80 years represents a consistent predictor of worse functional outcome, independently from successful reperfusion and sICH. Cost-effectiveness studies are needed for tailored and implement sustainable care, and research should focus on strategies to improve functional outcome in older age patient groups.

Endovascular Treatment of Patients With Acute Ischemic Stroke With Tandem Lesions Presenting With Low Alberta Stroke Program Early Computed Tomography Score.

Recent trials confirmed the efficacy and safety of endovascular thrombectomy in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS); however, evidence in tandem lesions is limited. This study evaluates endovascular thrombectomy safety and efficacy in patients with acute large-vessel occlusion with tandem lesions, stratified by baseline ASPECTS. We conducted a retrospective analysis of data from 16 centers. Inclusion criteria included the following: age ≥18 years, anterior circulation tandem lesions, endovascular thrombectomy <24 hours of symptom onset, and ≥70% internal carotid artery stenosis/occlusion. Patients were categorized into low (0-5) and high (6-10) ASPECTS. Inverse probability of treatment weighting matching was used to balance the groups. Primary outcomes included the following: 90-day modified Rankin Scale (mRS) score 0 to 2 and symptomatic intracranial hemorrhage. Secondary outcomes included the following: ordinal mRS, mRS 0 to 3, modified Thrombolysis in Cerebral Infarction ≥2b and 2c-3, petechial hemorrhage, parenchymal hematoma (1/2), early neurologic improvement, and mortality. Of 691 patients, 44 had ASPECTS 0 to 5 and 505 had ASPECTS 6 to 10. Patients with low ASPECTS had lower odds of 90-day mRS 0 to 2 (adjusted odds ratio [OR], 0.48; P=0.036) and higher odds of symptomatic intracranial hemorrhage (adjusted OR, 3.78; P=0.014). Additional significant differences were found in mRS shift, mRS 0 to 3, parenchymal hematoma 2, and mortality. In interaction analysis, the association between low ASPECTS and functional outcome persisted only in the internal carotid artery occlusion subgroup, with no significant interaction indicating no reason to suppose a difference between the effect of both subgroups. Endovascular thrombectomy in patients with tandem lesions with low ASPECTS is associated with reduced odds of functional recovery and increased symptomatic intracranial hemorrhage risk, when compared with patients with high ASPECTS. However, 30% of patients with low ASPECTS achieved 90-day functional independence, suggesting potential benefit for a nonnegligible proportion of patients.

Endovascular Thrombectomy for Large Core Volume Acute Ischemic Stroke. Updated Systematic Review and Meta-Analysis: Thrombectomy for large core acute ischemic strokes

BackgroundSeveral recent studies assessed the efficacy and safety of endovascular thrombectomy (EVT) for patients with acute ischemic stroke caused by an anterior circulation large vessel occlusion (LVO) with large core infarct volumes. MethodsWe performed a systematic review and meta-analysis from inception until July 2024 of all randomized clinical trials (RCTs) and observational studies to date comparing the efficacy and safety of EVT plus best medical management (MM) for acute ischemic stroke due to anterior circulation LVO with large core, versus MM alone. Primary efficacy outcome was optimal functional outcome defined by a 90-day modified Rankin scale score (mRS) of 0-2. Safety outcomes were risk of symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Subgroup analyses were done by study design. Relative risk (RR) and 95 % CIs were calculated using random-effects models and heterogeneity was assessed by I2 statistics. ResultsA total of 16 studies with 3,717 participants met inclusion criteria (6 RCTs and 10 observational studies). The quality of the evidence was moderate to high. Compared with MM alone, EVT increased the outcome of mRS 0-2 (RR = 2.91, 95 % CI [2.12, 4.01], I2 = 63 %), decreased mortality (RR = 0.75 [0.63, 0.88], I2 = 60 %), but did not influence the risk of sICH (I2 = 14 %). When the analysis was restricted to data from RCTs (n = 1,887), EVT increased the outcome of mRS 0-2 (RR = 2.50 [1.89, 3.29], I2 = 8 %) and sICH (RR = 1.71 [1.09, 2.66], I2 = 0 %) but did not affect mortality (I2 = 45 %). In observational studies (n = 1,830), patients receiving EVT had a higher likelihood of achieving an mRS 0-2 (RR = 3.39 [1.98-5.79], I2 = 74 %), lower mortality (RR = 0.63 [1.49-0.82], I2 = 50 %), but equal risk of sICH (I2 = 29) than those receiving MM alone. ConclusionAmong patients with LVO with large core infarct, EVT was associated with improved functional outcome at 90 days. When the analysis was restricted to RCTs, EVT increased the risk of sICH, but did not affect 90-day mortality. However, in real-world (observational) studies, EVT did not modify the risk of sICH but reduced 90-day mortality.

Safety and Efficacy of Aspiration Thrombectomy With Intracoronary Tirofiban in Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

BACKGROUND: Primary percutaneous coronary intervention (PPCI) may be complicated by heavy intracoronary thrombus burden leading to decrease in myocardial perfusion and increase in infarct size. The current meta-analysis aims to investigate the clinical outcomes of aspiration thrombectomy (AT) with intracoronary tirofiban during PPCI. METHODS: A systematic search for randomized controlled trials that evaluate the safety and efficacy of AT with intracoronary tirofiban in ST-elevation myocardial infarction (STEMI) patients who underwent PPCI was done using PubMed, MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov., and Herdin PH. Studies included those published between 2010 and 2023 and involved human subjects. Search terms included “aspiration thrombectomy,” “intracoronary tirofiban,” “primary percutaneous coronary intervention,” and “STEMI patients.” RESULTS: Four randomized controlled trials (n = 490 participants) were included in this metaanalysis comparing AT with intracoronary tirofiban versus AT alone in STEMI patients undergoing PPCI. The results revealed no statistically significant difference in ST-segment resolution (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.97–1.08; P = 0.41, I2 = 0%), myocardial blush grade 2–3, (RR, 1.04; 95% CI, 0.97–1.12; P = 0.22, I2 = 62%), and Thrombolysis In Myocardial Infarction 3 flow (RR, &lt;1.0; 95% CI, 0.95–1.04; P = 0.87). The occurrence of major adverse cardiovascular events did not significantly differ between the two groups (RR, 0.46; 95% CI, 0.19–1.09; P = 0.08, I2 = 0%). There was no statistically significant difference in terms of bleeding when combining intracoronary tirofiban to standard medical therapy (RR, 1.35; 95% CI, 0.64–2.84; P = 0.78, four trials [490 patients]). CONCLUSION: In PPCI, major adverse cardiovascular event outcomes of AT with intracoronary tirofiban were similar to those for AT alone in terms of improving myocardial perfusion in STEMI patients without increasing the risk for bleeding. Our meta-analysis suggests that AT alone may be the more acceptable standard during PPCI when encountering heavy thrombus burden. Future validated studies may help further investigate the strategy of adding tirofiban during AT.

Safety and efficacy of catheter-directed thrombectomy without thrombolysis in acute pulmonary embolism: A systematic review and meta-analysis

BackgroundThis meta-analysis aims to investigate the safety and efficacy of catheter-directed thrombectomy (CDT) without using adjunct thrombolysis as reperfusion therapy to manage intermediate and high-risk pulmonary embolism (PE). MethodsA literature search of Ovid MEDLINE, Embase, CiNAHL, Cochrane Library, and Web of Science was conducted from inception to January 2024. Eligible studies reported more than 10 patients treated for acute PE with catheter-directed thrombectomy only, who were over 18 years of age. Primary endpoints were major bleeding, in-hospital mortality, and hemodynamic changes. ResultsEighteen studies (n = 803) were included for quantitative analysis. The pooled estimate of incidences of in-hospital mortality and major bleeding was 1.8 % (95 % CI 0.009, 0.027) and 2.1 % (95 % CI 0.011, 0.031) respectively. A pooled estimate reported a post-procedural increase in oxygen saturation and systolic blood pressure by 8.96 % (95 % CI: 3.54, 14.38) and 15.02 mmHg (95 % CI 6.35, 23.69) respectively. Post-procedural mean pulmonary artery pressure, right ventricle/left ventricle (RV/LV) ratio, and Miller score were reduced by 10.30 mmHg (95 % CI -14.94, −5.66), 0.29 (95 % CI -0.50, −0.08) and 8.09 (95 % CI -10.70, −5.47) respectively. ConclusionCDT without adjunctive thrombolysis may lead to improvements in hemodynamic outcomes and exhibits favorable safety profiles. This meta-analysis provides a rationale for lowering the threshold for considering this technique, and ongoing randomized trials will further advance the field to determine optimal managment strategies for intermediate and high-risk acute PE.

Anticoagulation Use and Endovascular Thrombectomy in Patients with Large Core Stroke: A Secondary Analysis of the SELECT2 Trial.

Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.89 [0.53-1.50]), but demonstrated significantly better outcomes in patients without OAC (EVT 4 [3-6] vs MM 5 [4-6], adjusted generalized odds ratio 1.87 [1.45-2.40], p = 0.02). The OAC group had higher comorbidities, including atrial fibrillation (70% vs 17%), congestive heart failure (28% vs 10%), and hypertension (87% vs 72%), suggesting increased frailty. However, the results were consistent after adjustment for these comorbidities, and was similar regardless of the type of OACs used. Whereas any hemorrhage rates were higher in the OAC group receiving EVT (86% in OAC vs 70% in no OAC), no parenchymal hemorrhage or symptomatic intracranial hemorrhage were observed with OAC use in both the EVT and MM arms. Although we did not find evidence that the effect was due to excess hemorrhage or confounded by underlying cardiac disease or older age, OAC use alone should not exclude patients from receiving EVT. Baseline comorbidities and ischemic injury extent should be considered while making individualized treatment decisions. ANN NEUROL 2024;96:887-894.

Safety and efficacy of aspiration thrombectomy with intracoronary tirofiban VS aspiration thrombectomy alone in patients undergoing primary PCI: a systematic review and meta-analysis

Abstract Background Primary percutaneous coronary intervention (PPCI) may be complicated by intracoronary thrombus accumulation in ST elevation myocardial infarction (STEMI) leading to decrease in myocardial perfusion and increase in infarct size. The utilization of aspiration thrombectomy and intracoronary tirofiban in STEMI patients undergoing PPCI hold clinical relevance by removal of thrombus burden, potentially reducing distal embolization and improving myocardial perfusion and by targeting platelet aggregation to mitigate thrombotic complications, respectively. Given the paramount importance of achieving rapid and effective reperfusion in STEMI, the evaluation of these interventions is warranted to assess overall impact on patient outcomes in terms of safety and efficacy. Purpose The current meta-analysis aims to investigate the clinical outcomes of aspiration thrombectomy (AT) with intracoronary tirofiban versus AT alone during PPCI. Methods A systematic search for randomized controlled trials that evaluate the safety and efficacy of aspiration thrombectomy with intracoronary tirofiban in STEMI patients who underwent PPCI was done using PubMed, MEDLINE, Embase, Cochrane, Clinicaltrials.gov. and Herdin PH. Studies included those between 2010 - 2023 and involved human subjects. Search terms included "Aspiration Thrombectomy", "Intracoronary Tirofiban", "Primary Percutaneous Coronary Intervention" and "STEMI patients". Results Four RCTs (n: 490 participants) were included in this meta-analysis comparing aspiration thrombectomy with intracoronary tirofiban versus aspiration thrombectomy alone in STEMI patients undergoing PPCI. The results revealed no statistically significant difference in ST segment resolution (RR 1.02, 95%, CI: 0.97 - 1.08, P = 0.41, I2 = 0%), myocardial blush grade 2-3, (risk ratio of 1.04, 95%, CI: 0.97 – 1.12, P = 0.22, I2 = 62%) and TIMI 3 flow (risk ratio of 1.0, 95% CI: 0.95 - 1.04, P = 0.87). The occurrence of major adverse cardiovascular events did not significantly differ between the two groups (RR 0.46, 95% CI: 0.19 – 1.09, P = 0.08, I2 = 0%). There was no statistically significant difference in terms of bleeding when combining intracoronary tirofiban to standard medical therapy (RR 1.35, 95% CI: 0.64 – 2.84, P= 0.78, 4 trials [490 patients]). Conclusion In primary percutaneous coronary intervention, MACE outcomes of aspiration thrombectomy with intracoronary tirofiban were similar to that for aspiration thrombectomy alone in terms of improving myocardial perfusion in STEMI patients without increasing the risk for bleeding. Our meta-analysis suggests that AT alone may be the more acceptable standard during PPCI when encountering heavy thrombus burden. Future validated studies may help further investigate the strategy of adding tirofiban during aspiration thrombectomy.1. Primary Outcomes2. Secondary Outcomes

Evaluation of efficacy of open thrombectomy for recently thrombosed arteriovenous fistulae and synthetic grafts for hemodialysis

Evaluation of efficacy of open thrombectomy for recently thrombosed arteriovenous fistulae and synthetic grafts for hemodialysis

Effect of thrombolysis type on the efficacy of aspiration versus stent retriever first line thrombectomy: results from the AcT trial

BackgroundIntravenous (IV) tenecteplase is increasingly being used in lieu of alteplase for acute ischemic stroke. We sought to study the influence of IV tenecteplase versus IV alteplase on the efficacy...

High Hypoperfusion Intensity Ratio Is Independently Associated with Very Poor Outcomes in Large Ischemic Core Stroke.

Recent advances have highlighted the efficacy of endovascular thrombectomy (EVT) in patients with large ischemic core stroke, yet asignificant portion still experience very poor outcomes, defined as a90-day modified Rankin Score (mRS) of 5-6. This study aims to investigate the hypoperfusion intensity ratio (HIR) as aprognostic imaging parameter for these outcomes. In amulticenter retrospective cohort study, data from consecutive patients undergoing EVT for acute ischemic stroke with large vessel occlusion (AIS-LVO) at two comprehensive stroke centers were analyzed. The study included patients with an Alberta Stroke Program Early CT Score (ASPECTS) of5 or less and utilized pretreatment perfusion imaging to calculate HIR. The primary outcome was very poor outcomes (90days mRS 5-6). Among 102 patients included, 59 (57.8%) had very poor outcome (90days mRS 5-6). Multivariable logistic regression analysis adjusting for multiple covariates including admission National Institutes of Health Stroke Scale (NIHSS) and EVT revealed that higher admission NIHSS (adjusted odds ratio [aOR] 1.224, 95% CI 1.089-1.374, p = 0.001) and HIR (aOR per 0.1 incremental change, 1.34, 95% CI 1.02-1.82, P = 0.042) were independently associated with very poor outcomes. This study demonstrates that admission NIHSS and HIR are independently associated with very poor outcome (90days mRS 5-6) in patients with large ischemic core strokes. These findings highlight the importance of collateral status and perfusion imaging in predicting outcomes in this patient population, suggesting apotential role for HIR in the triage and management of large core stroke patients.

Influence of Stroke-Onset Location on the Efficacy of Endovascular Thrombectomy: Comparison of Outcomes between In-Hospital versus Community-Onset Strokes.

Previous studies have suggested that patients experiencing an in-hospital stroke may face delays in treatment and worse outcomes compared with patients with community-onset strokes. However, most studies occurred when IV thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an in-hospital stroke in the endovascular thrombectomy era. This was a single-center retrospective cohort study of patients older than 18 years of age with acute ischemic stroke treated with endovascular thrombectomy within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into 2 groups: in-hospital strokes and community-onset strokes. We compared the time metrics of stroke care delivery, the rate of successful reperfusion, and functional outcome as scored using the mRS score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using the Fisher exact and χ2 tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney U tests. A total of 676 consecutive patients were included, with 69 (10%) comprising the in-hospital stroke group. Patients experiencing in-hospital stroke were more likely to have diabetes (36% versus 18%, P = .02) and less likely to receive thrombolysis (25% versus 68%, P < .001) than those in the community-onset stroke group, but they were otherwise similar. Patients with in-hospital stroke had significantly faster overall time metrics, most notably from stroke recognition to imaging (median, 70 [interquartile range, 38-141] minutes versus 121 [74-228] minutes, P < .001). Successful recanalization was achieved in >75% in both groups (P = .39), with a median NIHSS score at discharge of <4 (P = .18). The 90-day mRS was similar in both groups, with a trend toward higher in-hospital mortality in the in-hospital stroke group (P = .06). Patients with in-hospital stroke had shorter workflow delays to initiation of endovascular thrombectomy compared with their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Most important, 90-day mortality and mRS scores were equivalent between in-hospital stroke and community-onset stroke groups.

Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis

BackgroundThe safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.MethodsIn this nationwide analysis of...

Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization

BackgroundA higher number of recanalization attempts reduces the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke secondary to large vessel occlusion (LVO). We assessed the impact of switching EVT...