Mechanical Thrombectomy Research Articles

Acute pulmonary embolism treatment in lung transplant recipients: mechanical thrombectomy and catheter directed thrombolysis

PurposeAcute pulmonary embolism (PE) presents a significant challenge in lung transplant recipients (LTR), even with prophylactic anticoagulation. Due to the heightened risk of complications in this population, the optimal treatment approach for acute PE remains uncertain. This retrospective case series aims to elucidate the outcomes of percutaneous mechanical thrombectomy with the Inari device (MT) and catheter-directed thrombolysis (CDT) in managing acute PE in lung transplant patients.Materials and MethodsThis study examines the treatment outcomes of nine consecutive post-lung transplantation patients with acute PE confirmed with Computed Tomography Angiography (CTA). Treatment interventions included either MT or CDT. Follow-up assessments encompassed a minimum of one year and up to 3 years post-treatment, evaluating various parameters including ICU stay, ventricular pressures, pulmonary function, and laboratory tests.ResultsBoth MT and CDT achieved a 100% technical success rate, leading to the successful restoration of pulmonary blood flow and improvements in hemodynamic parameters, with a one-year survival rate of 100%.ConclusionPercutaneous treatments, including MT and CDT, demonstrate feasibility and efficacy in managing acute PE among lung transplant patients. These treatments lead to rapid thrombus resolution, post-treatment improvements, and enhanced overall survival.

Clot Composition and Pre-Interventional Radiological Characterization for Better Prognosis and Potential Choice of Treatment in Acute Ischemic Strokes

Acute ischemic stroke (AIS) remains a critical concern in clinical practice, with significant implications for patient outcomes and healthcare costs. This review highlights the role of clot composition in AIS, emphasizing the clinical relevance of radiological characterization. Variations in thrombus composition, such as red blood cell (RBC)-rich and white blood cell (WBC)-dominant clots, influence the success of thrombolytic therapies and mechanical thrombectomy. Advanced radiological techniques, including non-contrast CT, CT angiography, and MRI, are essential for pre-interventional clot characterization, guiding optimal treatment decisions. Integrating artificial intelligence (AI) in radiology can enhance the precision of clot composition assessment, facilitating personalized treatment approaches and improving predictive accuracy. By combining histopathological insights with imaging and AI technologies, this review underscores the importance of comprehensive radiological evaluation in the management of AIS, ultimately aiming to enhance clinical outcomes and reduce the burden on healthcare systems.

Mechanical Thrombectomy in Prestroke Disability: Data From the Italian Endovascular Stroke Registry.

The benefits and safety of mechanical thrombectomy (MT) in patients with prestroke disability, classified as modified Rankin Scale (mRS) score of 3 to 4, and anterior circulation stroke remain uncertain. This study aims to evaluate these factors using data from the Italian Registry of Endovascular Treatment in Acute Stroke. We analyzed data collected between 2015 and 2021, comparing functional outcomes (mRS), symptomatic intracerebral hemorrhage, and recanalization rates (Thrombolysis in Cerebral Infarction) at 90 days post-MT in patients with prestroke mRS score of 3 to 4 versus 0 to 2. A good outcome was defined as no change in the mRS score from baseline. Subgroup analysis was stratified by age. A total of 11.411 (96%) patients with prestroke mRS score of 0 to 2 and 477 (4%) patients with prestroke mRS score of 3 to 4 were included. Compared with patients with a baseline mRS score 0 to 2, those with mRS score 3 to 4 were older (82 versus 75 years; P<0.001) and predominantly female (71.7% versus 53%; P<0.001). The maintenance of the same mRS score after MT was observed in 100 (23.3%) patients with prestroke mRS score 3 to 4, compared with 2332 (22.1%) patients with mRS score 0 to 2 (P=0.556). Mortality was significantly higher in the mRS score 3 to 4 group (n=159 [37.1%] versus n=1939 [18.4%]; P<0.001). Successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) was lower in the mRS score 3 to 4 group (n=333 [71.6%] versus n=8706 [77.7%]; P=0.002), while no significant differences in symptomatic intracerebral hemorrhage were found. The benefit of MT was maintained in patients aged 80 to 85 and over 85 years with prestroke mRS score 3 to 4, although mortality remained higher. Our data suggest that prestroke disability does not imply less chance of returning to prestroke conditions after MT, even in octogenarians, despite higher mortality and lower recanalization rate. More data are warranted to better understand the benefit of MT in this subgroup of patients.

The role of first pass effect in mechanical thrombectomy for vertebrobasilar artery occlusion: a comprehensive meta-analysis of prevalence, outcomes, and predictive factors

BackgroundFirst-pass effect (FPE) is crucial for better outcomes in mechanical thrombectomy (MT) for acute large vessel occlusions. However, its frequency and predictors in vertebrobasilar artery occlusion (VBAO) remain unclear.ObjectiveTo conduct...

Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study

BackgroundMechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines...

Multicentre, real-world data of next-generation computer-assisted vacuum aspiration thrombectomy in acute pulmonary embolism

BackgroundData on interventional treatment of intermediate-high (and high-risk pulmonary embolism (PE) are limited. The authors sought to evaluate the safety and efficacy of catheter-directed mechanical aspiration thrombectomy (CDMT) in a real-world PE patient population.MethodsThis multicenter, prospective registry enrolled PE patients treated with CDMT using the Lightning 12 System. The primary safety endpoints included in-hospital all-cause mortality, procedure-related major bleeding, clinical deterioration, or bailout to another strategy. The primary efficacy outcomes included the reduction of pulmonary arterial pressures and change in the right-to-left ventricular (RV/LV) ratio 48 h after the CDMT. Multivariate regression analyzed characteristics associated with RV/LV improvement.ResultsOur analysis included 150 patients, 72% with intermediate-high PE and 28% with high-risk PE. Systemic thrombolysis was contraindicated in 33.3%, whereas in 4% it failed. There were 2% intraprocedural deaths (1.3% due to RV failure and 0.7% due to massive interstitial bleeding), with no more deaths during follow-up. In 0.7%, CDMT was converted to open surgery, and in 0.7%, bailout systemic thrombolysis and extracorporeal oxygenation support. Major bleedings occurred in 1.3% within 48 h post CDMT. Immediate hemodynamic improvements included a mean 11.3±10 mmHg (22.1%) drop in systolic pulmonary arterial pressure (p < 0.0001) and a median 0.33 (0.25–0.45), (25.2%) drop in RV/LV ratio (p < 0.0001 for paired values),ConclusionsAspiration thrombectomy with the Lightning 12 system characterizes an acceptable safety profile, substantial improvements in hemodynamic outcomes, and low mortality for patients with intermediate-high and high-risk PE.Trial registration NCT04879069 – date of registration 04.05.2021.

First prospective, single-arm, multicenter study to evaluate safety and efficacy of the overall thrombectomy system -iNedit, iNdeep, and iNtercept- for acute ischemic stroke. Rationale beyond the study

RationaleThe clinical impact of a novel mechanical thrombectomy strategy, which integrates distal access with flow reversal and flow arrest via a distal balloon, all within a single procedure [Safety and Efficacy of the overall throMbectomy system for sTroke (SEMTiC) strategy], has not been tested.AimThe SEMTiC-01 study is the first prospective, multicenter in vivo study evaluating the safety and efficacy of the combined thrombectomy system—iNedit, iNdeep, and iNtercept—in patients with acute ischemic stroke.Sample size estimatesThe study was designed with a sequential structure based on the efficacy endpoint (eTICI ≥2b) reported in the literature [71.1% with a 95% confidence interval of (68.5%, 73.8%)]. An interim analysis was set for 115 patients and a final analysis for 225 patients, ensuring 98% power at a one-sided 0.025 significance level, with a 2.6% non-inferiority margin and a 15% assumed withdrawal rate.DesignSEMTiC-01 is a prospective, multicenter, single-arm, open-label clinical safety and efficacy investigation.OutcomePrimary efficacy endpoint: expanded treatment in cerebral infarction score (eTICI) ≥2b revascularization within ≤ 3 stent retriever passes. Primary safety endpoint: monitoring serious adverse events within 24 h post-intervention and all-cause mortality at 90 days.

Clinical Results of the ANAIS Study: Mechanical Thrombectomy Using the ANA Device in Combination with a Stent Retriever in Subjects with Acute Ischemic Stroke.

The ANA thrombectomy system is a funnel catheter comprising a self-expanding coated funnel that works in conjunction with a standard stent retriever and is designed to locally restrict flow and reduce clot fragmentation. The ANAIS Study to Confirm the Safety and Performance of the ANA 5F Advanced Neurovascular Access investigated the performance of the ANA funnel catheter in patients with stroke. Mechanical thrombectomy using the ANA device in combination with a stent retriever in subjects with acute ischemic stroke. This is a prospective, single-arm, multicenter study with blinded outcome assessment by an independent imaging Core Lab. Patients with anterior circulation stroke undergoing mechanical thrombectomy were eligible. The primary end point was successful reperfusion (expanded TICI 2b50-3) within 3 passes without rescue therapy. The safety end point combined symptomatic intracranial hemorrhage and severe adverse device effect. Forty-three subjects were treated in 3 centers: mean age, 70.5 (SD, 13.1) years, 44.2% (19/43) women; median admission NIHSS score, 16.0 (range, 12.5-19.5). The primary end point was achieved in 70% (30/43) and 81% (26/32) in the intention-to-treat (ITT) and per-protocol (PP) populations, respectively. The rates of first pass expanded TICI 2c-3 were 44% (19/43) and 56% (18/32) in the ITT and PP populations, respectively. There were no severe adverse device effects/symptomatic ICH at 24 hours (0/43). When the funnel was deployed in the C1 segment of the internal carotid artery (Bouthillier Classification), the primary end point (ITT, 36%; PP, 57%) was lower than when deployed in the C2/C3 segments (ITT, 89%; PP, 100%; P < .01), or in the C4 or above segments (ITT, 71%; PP, 77%; P < .05). The primary end point was higher when continuous aspiration was applied from initiation of the retrieval maneuver (ITT, 81%; PP, 92%) compared with end-aspiration only (ITT, 36%; PP, 50%, P < .01). The ANA funnel catheter achieved high rates of reperfusion and first pass success, with a good safety profile. Successful reperfusion was superior when the funnel was deployed above the C1 segment of the ICA and clot retrieval was performed under continuous aspiration.

Improving Acute Stroke Care with an Implementation Science Guided Acute Stroke Nurse Pilot Project

Improving Acute Stroke Care with an Implementation Science Guided Acute Stroke Nurse Pilot Project

Simulation-Based Quality Improvement and Training to Improve Door to Puncture Time for Mechanical Thrombectomy.

Mechanical Thrombectomy (MT) exists as the gold standard for the management of acute ischaemic stroke secondary to large vessel occlusion. There is a direct correlation between reduced time to reperfusion and improved patient outcomes. Our study aimed to optimise processes and reduce the time from the patient's arrival at hospital to vascular puncture for MT (DTP time) through simulation-based quality improvement and staff training. This single-centre prospective study involved two simulation exercises completed over 3 months from March to May 2023. The multidisciplinary simulations involved staff following the MT patient's hyperacute journey from the time of arrival to the Emergency Department triage. Data from all patients at our centre who underwent MT in the 6-month period pre- and post-simulation training were included. The primary outcome measured was the DTP time. For statistical analysis, a paired t-test was used to compare values. In the period prior to the simulation exercises, our hospital recorded 19 direct-to-hospital presentations for patients requiring MT, where we recorded a mean DTP time of 132.38 min. Post the simulation training, we recorded 26 direct-to-hospital presentations, with a mean DTP time of 104.52 min (a reduction of 27.86 min, p = 0.02). Our study did not find any statistically significant difference in DTP time for patients who were inter-hospital transfer presentations. We validated simulation-based training as an effective intervention for reducing time to reperfusion for patients undergoing MT. Implementation of regular training for staff can improve patient outcomes.

Impact of body mass index on outcome of Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke in China：A post-hoc Analysis of DIRECT-MT Trial.

The impact of body mass index (BMI) on outcomes after mechanical thrombectomy (MT) for large vessel occlusion acute ischemic stroke (LVOS) has been a subject of controversy, mainly due to the so-called "obesity paradox". The obesity paradox refers to the phenomenon where, contrary to expectations, overweight or obese individuals seem to have better clinical outcomes in certain disease states. This study aimed to investigate the relationship between BMI and the clinical prognosis of patients with LVOS treated with endovascular thrombectomy (EVT) combined with or without intravenous alteplase in DIRECT-MT. This is a post-hoc analysis of the DIRECT-MT randomized trial. Patients were randomly allocated to undergo EVT after alteplase intravenous thrombolysis (IVT) (IVT+EVT group) or EVT alone (EVT group) at a 1:1 ratio. Among 656 randomized patients, 645 with baseline BMI information were included, The BMI was analyzed as a categorical variable, all patients were categorized according to their BMI into 3 groups: 18.5 ≤ BMI ＜ 24 kg/m2 (normal weight), 24 ≤ BMI＜28 kg/m2 (overweight), BMI ≥ 28 kg/m2 (obese). The primary outcome was the 90-day modified Rankin Scale (mRS) score analyzed as a continuous variable. Multivariable ordinal logistic regression with an interaction term was used to estimate treatment allocation and the BMI subgroups. A total of 645 patients were enrolled in this study, 373 (57.8%) were normal weight, 208 (32.2%) were overweight and 64 (10.0%) were obese. 175 (46.9%) normal weight patients, 114 (54.8%) overweight patients and 31 (48.4%) obese patients underwent direct EVT. Patients in the three groups were statistically different in age (71 versus 68, 66), time from randomization to groin puncture (31 versus 32, 39.5), time from randomization to revascularization (101.5 versus 92, 116), and time from admission to groin puncture (84 versus 83, 98.5). Other baseline and procedural characteristics were comparable. No significant difference for the ordinal mRS or 90 days mortality was observed by BMI [adjusted common odds ratio (acOR) was 0.92 (95% CI 0.64 to 1.32) for normal weight, 1.36 (95% CI 0.83 to 2.22) for overweight, and 1.09 (95% CI 0.45 to 2.64) for obese] and treatment allocation interaction [the adjusted P value for interaction was 0.335 (normal weight versus overweight), 0.761 (normal weight versus obese) and 0.733 (overweight versus obese)]. For the procedural complications and other clinical and imaging outcomes, no significant differences were observed between the BMI and treatment allocation. The results demonstrated that BMI had no association with final outcome whether the patient with LVOS underwent EVT alone or plus IVT for Chinese adults. Thus, the obesity paradox does not appear to pertain to EVT alone or plus IVT. Further studies are needed to confirm the finding.

Compliance Evaluation with ChatGPT for diagnosis and treatment in patients brought to the ED with a Preliminary Diagnosis of Stroke

Compliance Evaluation with ChatGPT for diagnosis and treatment in patients brought to the ED with a Preliminary Diagnosis of Stroke

Carotid Artery Stenosis in Head and Neck Cancer Patients Treated with Radiotherapy

Abstract Introduction Radiotherapy (RT) is a crucial treatment modality for 80% of head and neck cancer (HNC) patients, often combined with surgery or chemotherapy, leading to a significant reduction in cancer-related mortality. However, as cancer survival rates increase, therapy-related complications also increase, impacting both mortality and morbidity. One such late complication is radiation-induced carotid artery stenosis (CAS), a condition associated with an increased risk of cerebrovascular events. Radiation-induced CAS is rarely studied, especially in the Indian population. Despite its potential severity, there is no standardized screening or management protocol for radiation-induced CAS in HNC patients. Objectives This study aims to assess the prevalence, risk factors, complications, management, and outcomes of CAS in HNC patients who received RT, with or without chemotherapy and surgery at our institution. Materials and Methods This is a retrospective observational study of newly diagnosed primary HNC patients who received RT between January 2012 and December 2021. Patients with metastatic HNC and those treated elsewhere were excluded. Data on demographics, tumor characteristics, treatment, and imaging for vascular stenosis were collected. Statistical analysis was performed using R version 4.4.1, with categorical variables analyzed using the chi-square or Fisher's exact test and continuous variables using the Mann–Whitney's U test. Significance was set at p-value &lt;/= 0.05. Results Of 949 patients, 34 (3.6%) developed CAS. Preradiation vascular stenosis was rare (0.1%). Among the 34 patients categorized by time since treatment, CAS developed in 47.1% of patients after 5 years, 32.4% within 2 to 5 years, and 5.9% within 1 year. CAS severity included near-total occlusion in 23.5%, ≥70% stenosis in 20.6%, and neurological deficits in 8.8%. The median age was 62 years, and the majority were male (85.3%). Common risk factors were hypertension (29.4%), diabetes (20.6%), tobacco use (82.4%), and alcohol consumption (41.2%). Tumors of oral cavity and hypopharynx were more common. Most CAS patients (76.5%) received radical chemoradiation. Only 23.3% of CAS patients received anticoagulation therapy, with 14.3% undergoing mechanical thrombectomy. Conclusion This study highlights the prevalence of radiation-induced CAS in HNC patients, especially in the Indian population, and identifies associated risk factors. Hence, standardized screening and management protocols for CAS are crucial for improving long-term outcomes in HNC survivors.

Antiplatelets before or during endovascular therapy after intravenous thrombolysis for atherothrombotic large vessel occlusion.

Antiplatelets before or during endovascular therapy after intravenous thrombolysis for atherothrombotic large vessel occlusion.

Characteristics of Cerebral Autoregulation After Mechanical Thrombectomy and Its Relationship With Prognosis.

To investigate the characteristics of dynamic cerebral autoregulation (dCA) in patients after mechanical thrombectomy (MT) and the relationship between dCA and prognosis. In this prospective study, 89 and 158 patients were enrolled in the MT and non-MT groups, respectively. Both groups underwent dCA measurements within 3 days after stroke. The transfer function parameter, phase difference (PD), and gain were used to quantify dCA. A favorable outcome was defined as a modified Rankin Scale score ≤ 2 at 90 days. The collateral score was used to reflect the collateral reserve capacity. MT was associated with better PD in both the affected and unaffected sides. In the MT group, the PD of the affected side was an independent predictor of favorable outcomes (odds ratio [OR] 0.927, 95% confidence interval [CI] 0.885-0.970; p < 0.001). The area under the receiver operating characteristic curve for predicting favorable outcomes of the PD on the affected side was 0.759 (95% CI, 0.654-0.864; p < 0.001). Further, good collaterals were independently associated with better PD. MT has a positive effect on dCA during the acute phase of stroke. For patients undergoing MT, dCA is a reliable indicator for predicting prognosis and may be an intervention target to improve outcomes.

Racial and socioeconomic disparities in the utilization of mechanical thrombectomy: a meta-analysis and systematic review of over 11 million patients.

Understanding racial and socioeconomic disparities in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is crucial to addressing these critical healthcare challenges. The authors aimed to evaluate racial and socioeconomic disparities in MT usage for patients with AIS. The authors performed a comprehensive search of four electronic databases for studies assessing racial and socioeconomic disparity in MT utilization among Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Native American, and Other race groups. Outcomes were measured by calculating proportions and 95% CIs for each study using a random-effects model due to expected clinical and methodological heterogeneity. A total of 11,583,329 patients from 11 studies were included in this systematic review and meta-analysis. The racial breakdown involved 1,864,453 Asian, 2,260,026 NHB, 2,070,186 Hispanic, 5,239,707 NHW, 23,724 Native American, and 125,233 Other patients. Although MT utilization was highest in NHW (2.55%, 95% CI 1.0%-4.8%) and lowest in Native American (0.87%, 95% CI 0.0%-6.8%) patients, the subgroup analysis showed no statistically significantly difference (p = 0.71). Additionally, there was no significant difference in intravenous tissue-type plasminogen activator (IV-tPA) usage rate (p = 0.14) among the races. The MT utilization rate was significantly different in patients who were in the first (p < 0.00001), second (p < 0.0001), third (p < 0.0001), and fourth (p < 0.00001) income quartiles. Among insurance types, disparity in thrombectomy usage was not significantly different in patients with Medicaid (p = 0.99) and Medicare (p = 0.99), while it was significant in patients with private (p < 0.0001) or self-pay (p < 0.0001) insurance. Although our findings showed no disparity in thrombectomy and IV-tPA utilization, there is still a significant disparity in accessibility to thrombectomy based on insurance types and income quartiles. This study offers future directions for healthcare providers and state legislators to address racial and socioeconomic disparities.

Outcomes of Mechanical Thrombectomy in Patients With Ischemic Stroke and Heart Failure. A Systematic Review and Meta‐analysis

Background Patients with heart failure (HF) treated with mechanical thrombectomy (MT) for acute ischemic stroke were underrepresented in clinical trials on MT. Our systematic review and meta‐analysis aim to assess differences in outcomes between patients with HF and their counterparts without HF treated with MT for acute ischemic stroke. Methods A systematic review of the English language literature from inception up to March 7, 2024, was conducted using PubMed, Embase, Cochrane Library, and Web of Science databases. Studies focused on patients with and without HF who were treated with MT for acute ischemic stroke were included. The primary outcome of interest was the rate of modified Rankin Scale scores of 0–2 at 90 days. Secondary outcomes of interest included rates of 90‐day mortality, successful reperfusion, and symptomatic intracranial hemorrhage. Results Of 5394 initially retrieved studies, 5 studies were included in the systematic review with a final population of 44 385 patients with ischemic stroke with and without HF treated with MT. Four studies were combined for the primary outcome and showed comparable rates of 0–2 modified Rankin Scale scores between patients with HF and patients without HF (odds ratio, 0.86 [95% CIs, 0.70–1.06]; P = 0.15). Ninety‐day mortality was significantly higher in the HF group (odds ratio, 1.92 [95% CIs, 1.66–2.23]; P &lt;0.0001) although the sample size was small (n of study = 3) and only unadjusted estimates were used. Successful reperfusion and symptomatic intracranial hemorrhage rates were similar between the groups. Conclusion In this systematic review and meta‐analysis, patients with HF experienced worse 90‐day mortality post‐MT. Our data encourage further research on MT outcomes in patients with large vessel‐occlusion ischemic stroke and concomitant HF.

Stress Hyperglycemia Could Influence Futile Recanalization in Patients Who Undergo Mechanical Thrombectomy for Stroke Caused by Large Vessel Occlusion.

Stress Hyperglycemia Could Influence Futile Recanalization in Patients Who Undergo Mechanical Thrombectomy for Stroke Caused by Large Vessel Occlusion.

Extended Length of Stay After Mechanical Thrombectomy for Stroke: A Single-Center Analysis of 703 Patients.

Mechanical thrombectomy (MT) is crucial for improving functional outcomes for acute ischemic stroke. Length of stay (LOS) is a reimbursement metric implemented to incentivize value-based care. Our study aims to identify predictors of LOS in patients undergoing MT at a high-volume center in the United States. This was a retrospective study of patients who underwent MT at a single institution from 2017 to 2023. Patients who experienced mortality during their course of hospital stay were excluded from this study. Extended LOS (eLOS) was defined as the upper quartile (≥75th) of the median duration of hospital stay. Univariate and multivariate analyses were performed, with P values < .05 denoting statistical significance. Seven hundred three patients met criteria for inclusion. The median age of the cohort was 72 years (IQR: 61-82), and 57.2% was female. The median LOS was 6, IQR: 4-10. A total of 28.9% of the cohort (n = 203) patients experienced eLOS. The multivariate regression model identified age (odds ratio [OR]: 0.98, 95% CI: 0.97-0.99), diabetes mellitus (OR: 1.68, 95% CI: 1.15-2.44), and hemorrhagic transformation of stroke (OR: 2.89, 95% CI: 0.39-0.90) as predictors of eLOS, whereas antiplatelet use before admission (OR: 0.55, 95% CI: 0.34-0.89) and higher baseline modified Rankin Scale before stroke were associated with lower odds (OR: 0.59 [0.39-0.90]; P < .05) of eLOS. By identifying predictors of eLOS, we provide a foundation for targeted interventions aimed at optimizing post-thrombectomy care pathways and improving patient outcomes. The implications of our study extend beyond clinical practice, offering insights into healthcare resource utilization, reimbursement strategies, and value-based care initiatives.

Sickness absence and disability pension in patients treated with mechanical thrombectomy.

Sickness absence and disability pension in patients treated with mechanical thrombectomy.