Mechanical Thrombectomy Research Articles

Anticoagulation plus antiplatelet therapy versus anticoagulation alone following iliac vein stent implantation in acute and subacute deep vein thrombosis: A multicenter study with propensity score matching

BackgroundIliac vein stenting is an effective treatment for iliac venous stenosis after percutaneous mechanical thrombectomy. Nevertheless, while some researchers have investigated medical therapy following iliac vein stenting, no consensus has been reached to date. ObjectivesTo evaluate the effectiveness and safety of anticoagulation plus antiplatelet therapy following iliac vein stent implantation in patients with acute and subacute iliofemoral deep vein thrombosis (DVT). Materials and methodsThis retrospective study comprised 234 patients: 167 patients in Group 1 with a mean age of 64.3 ± 13.5 years received anticoagulants alone, and 67 patients in Group 2 with a mean age of 60.7 ± 15.4 years received anticoagulation plus antiplatelet therapy. All patients received technically successful percutaneous pharmacomechanical thrombectomy and iliac vein stent implantation, and 61 patients underwent additional catheter-directed thrombolysis. The two groups exhibited comparable demographics, comorbidities, DVT burdens, and procedural details. Through propensity score matching (PSM) analysis, 62 pairs of patients from Group 1 and Group 2 were matched. ResultsDuring a follow-up period of 33.7 ± 16.5 months, the cumulative primary patency rates were 95.1 %, 89.7 % and 88.3 % at one, three and five years in Group 1 compared to 98.8 %, 98.5 % and 98.5 % in Group 2 for the entire cohort (p = 0.042); in the PSM analysis, the rates were 91.9 %, 87.3 % and 87.3 % at one, three and five years in Group 1 versus 98.4 % at one, three and five years in Group 2 (p = 0.039). The cumulative bleeding-free rate was 98.2 % at one, three and five years in Group 1 versus 95.5 %, 93.8 % and 93.8 % at one, three and five years in Group 2 for the entire cohort (p = 0.089), and it was 98.4 % at one, three and five years in Group 1 versus 95.2 %, 93.3 % and 93.3 % (p = 0.156) at one, three and five years in Group 2 in the PSM analysis. ConclusionAnticoagulation plus antiplatelet therapy significantly improved stent patency, with a non-significant increase in the bleeding rate.

The Long-Term Prognosis of Endovascular Thrombectomy in Patients with Acute Left Iliofemoral Vein Thrombosis Combined with Left Iliac Vein Compression

This study investigated the long-term outcomes of different thrombus removal methods in patients with acute left iliofemoral vein thrombosis (IFDVT) accompanied by left iliac vein compression (LIVC). This was a single-center cohort study. 240 patients with acute left-sided IFDVT complicated by LIVC were categorized based on their treatment approach into two groups: those receiving anticoagulation alone (No-PCDT group) and those undergoing anticoagulation combined with pharmacomechanical catheter-directed thrombolysis (PCDT group). The PCDT group was further divided into three subgroups: anticoagulation combined with percutaneous mechanical thrombectomy (PMT group), anticoagulation combined with catheter-directed thrombolysis (CDT group), and anticoagulation combined with both percutaneous mechanical thrombectomy and catheter-directed thrombolysis (PMT+CDT group). The incidence of post-thrombotic syndrome (PTS) was assessed using Villalta scores and Venous Clinical Severity Scores (VCSS). Patients were followed up for 24 months to compare long-term outcomes. The No-PCDT group consisted of 123 individuals, while the PCDT group comprised 117, with 36 in the CDT subgroup, 41 in the PMT subgroup, and 40 in the PMT+CDT subgroup. The follow-up period ranged from 3 to 24 months. The PCDT group was associated with a reduced incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or presence of ulcer: 22% PCDT vs. 39% No-PCDT; OR, 0.446; 95% CI, 0.253-0.787; P=0.005; and VCSS≥4: 22% PCDT vs. 34% No-PCDT; OR, 0.551; 95% CI, 0.311-0.978; P=0.042). Among the three subgroups of PCDT cohort, compared to the CDT group, the PMT group showed a decreased incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or ulcer: 12% PMT vs. 39% CDT; OR, 0.218; 95% CI, 0.069-0.690; P=0.010; and VCSS≥4: 12% PMT vs. 36% CDT; OR, 0.246; 95% CI, 0.077-0.781; P=0.017). The PMT+CDT group also demonstrated a reduced incidence of PTS (18% PMT+CDT vs. 39% CDT; OR, 0.333; 95% CI, 0.116-0.958; P=0.041) compared to the CDT group, but did not show a significant reduction in the risk of high VCSS (20% PMT+CDT vs. 36% CDT; P=0.121). Compared to the PMT group, the PMT+CDT group did not significantly reduce the incidence of PTS (12% PMT vs. 18% PMT+CDT; P=0.504) or the rate of high VCSS (12% PMT vs. 20% PMT+CDT; P=0.343). In patients with acute left IFDVT complicated by LIVC, PMT may serve as a more efficacious method for thrombus removal compared to CDT and combined PMT+CDT in reducing both the incidence of PTS and the risk of high VCSS.

174 Comparison of Large-Bore Mechanical Thrombectomy to Other Therapies for High-Risk Pulmonary Embolism Using Propensity-Score Matched Analysis of the FLAME Study

174 Comparison of Large-Bore Mechanical Thrombectomy to Other Therapies for High-Risk Pulmonary Embolism Using Propensity-Score Matched Analysis of the FLAME Study

Quality of life in acute ischaemic stroke patients treated with recanalisation

<p>Stroke is a serious health problem that has a significant impact on health-related quality of life. Despite the increasing popularity of measuring quality of life among patients, it is not routinely measured in clinical practice, and therefore little is known about how well clinical measures reflect quality of life after stroke. The aim of this study was to investigate the quality of life of patients with acute ischaemic stroke.</p>. <p>For the prospective study, patients diagnosed with acute ischemic stroke at the Neurology Clinic of the Clinical Center of the University of P&eacute;cs were selected through convenience sampling between June 2022 and May 2023. Based on the treatments, patients were divided into three groups: mechanical thrombectomy (MT), intravenous thrombolysis (IVT), and standard care (SC). Modified Rankin Scale (Pre-mRS, Follow-up mRS), NIH Stroke Scale (NIHSS), and European Quality of Life 5 Dimensions Scale (EQ-5D-5L) were used in the research. Descriptive statistics, paired T-tests, Wilcoxon tests, McNemar tests and Pearson correlation analysis were applied for the analysis (SPSS 25.0; p &lt;0.05).</p>. <p>A total of 198 participants (115 males, 83 females) took part in the study (MT: 50, IVT: 69, SC: 79). The Pre-mRS and follow-up mRS values indicate that the majority of patients in all three groups fell into the mild category (Pre-mRS: 176 participants; 88%, follow-up mRS: 158 participants; 80%). There was a significant improvement in NIHSS scores in all three groups (IVT: 4.36 vs. 1.57, p&lt;0.001; MT: 8.98 vs. 4.50, p&lt;0.001; SC: 4.38 vs. 2.84, p&lt;0.001). The EQ-5D-5L value also significantly increased for all groups (IVT: 0.82 vs. 0.88, p&lt;0.001; MT: 0.63 vs. 0.73, p&lt;0.001, SC: 0.76 vs. 0.80, p=0.014). Patients admitted with lower NIHSS values reported better quality of life at the end of our study (r: -0.43451).</p>. <p>At 30 days, significant improvement was observed in MT, IVT and SC groups when measured with EQ-5D-5L, but the extent of improvement was highest in the MT group.</p>.

Prevalence and Distribution of Intracranial Vessel Occlusion on Angiography and Its Association with Functional Outcome in Patients with Atrial Fibrillation Presenting with Ischemic Stroke.

To determine the prevalence and distribution of intracranial vessel occlusion identified on computed tomography (CT) or magnet resonance (MR) angiography and to explore its association with functional outcome in patients with atrial fibrillation (AF) and ischemic stroke. Multicenter cohort study enrolling consecutive patients with AF with imaging-confirmed ischemic stroke who underwent CT- or MR-angiography on admission (2014-2022). Multivariable regression was used to explore the association between intracranial vessel occlusion and poor functional outcome (modified Rankin Scale score 3-6) at 90 days. The analysis included 10,164 patients (median age 81.5 years, 47.8% female, median National Institutes of Health Stroke Scale score on admission 6; 14.7% on a vitamin K antagonist [VKA], 27.5% on a direct oral anticoagulant [DOAC], 57.8% not receiving oral anticoagulation). Angiography showed intracranial vessel occlusion in 5,190 patients (51.1%), affecting the anterior cerebral circulation in 87.4%. Overall, 29.2% and 29.4% of patients received thrombolysis and mechanical thrombectomy, respectively. The proportion of patients with poor functional outcome at 90 days was 60.6% and 42.7% in those with and without vessel occlusion, respectively. In multivariable analyses, vessel occlusion was associated with poor functional outcome (adjusted odds ratio [aOR]: 1.95, 95% confidence interval [CI]: 1.71-2.22) with consistent results in subgroups according to oral anticoagulation use (VKA, aOR: 1.98, 95% CI: 1.40-2.80; DOAC, aOR: 2.35, 95% CI: 1.83-3.03; none, aOR: 1.76, 95% CI: 1.49-2.09). Intracranial vessel occlusion is common in patients with AF with ischemic stroke, mainly affects the anterior circulation and is associated with poor functional outcome. ANN NEUROL 2024.

Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study.

The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone. This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage. The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0-1 and 0-2), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; P=0.35) and 1.00 (95% CI 0.66 to 1.51; P>0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; P=0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; P<0.001). The results of this study indicate that while MT-IVT and IVT alone show similar functional and mortality outcomes in DMVO patients, MT-IVT presents a higher risk of hemorrhagic complications, thus MT-IVT may not routinely offer additional benefits over IVT alone for all DMVO stroke patients. Further prospective randomized trials are needed to identify patient subgroups most likely to benefit from MT-IVT treatment in DMVO.

The Evolution of Mechanical Thrombectomy for Acute Ischaemic Stroke: A Decade In Dublin

Abstract Background The advent of mechanical thrombectomy (MT) has entirely transformed hyperacute care for patients with stroke. We studied changing trends in MT provision over a decade, spanning participation in pivotal randomised controlled trials, evolving neuro-interventional techniques, a global pandemic and expanding treatment indications in a comprehensive stroke centre in Dublin. Methods Consecutive patients treated with MT were prospectively recorded between January 2012 and December 2022. We compared baseline clinical and imaging data, treatment times and procedural and clinical outcomes both on an annual basis and across the totality of the epoch. Results 2211 MT patients were recorded. Total annual numbers were: 36 (2012), 53 (2013), 46 (2014), 122 (2015), 172 (2016), 248 (2017), 262 (2018), 306 (2019), 301 (2020), 326 (2021) and 338 (2022). Between 2012 and 2022 patients treated with MT became older (mean age: 65.6yrs (SD:13.8) vs 70.0yrs (SD: 14.6); p=0.017), had greater infarct volumes (median baseline ASPECTS: 10 (IQR:9-10) vs 9(IQR:8-10): p=0.045) and were treated faster (median door-to-recanalisation: 70mins vs 39 mins; p&amp;lt;0.0001). Patients were less likely to have witnessed stroke onset (100% vs 54%; p&amp;lt;0.0001), receive IV tPA (72% vs 38%; p&amp;lt;0.0001) or have thrombus located in the intracranial ICA or M1-MCA (95% vs 65%: P&amp;lt;0.0001). No significant variations in pre-stroke mRS, baseline NIHSS, onset-to-recanalisation times, rates of successful recanalisation (86% vs 91%: p0.29) or 90-day mRS (0-2: 44% vs 50%; p0.68) were observed. Conclusion As our service has evolved, patients presenting for MT have become more complex, are treated faster and continue to achieve excellent clinical and radiological outcomes.

Delayed door to puncture time during off-duty hours is associated with unfavorable outcomes after mechanical thrombectomy in the early window of acute ischemic stroke

BackgroundsThe impact of off-duty hours mechanical thrombectomy on outcomes remains a subject of controversy. The impacts of off-duty hours on procedures are influenced by various factors, but the most critical one is the time delay in initiating the procedure after the patient’s arrival at the emergency room. Recently, a report suggested that the impact of time delay on post-procedural outcomes is evident in patients who arrive at the emergency room within 6 h of symptom onset, referred to as the “early window.” We hypothesized that the impact of procedure delays on outcomes during off duty-hours would be most significant within this early window. This study aimed to investigate the impact of door-to-puncture time (DTPT) delays in patients who underwent mechanical thrombectomy for acute ischemic stroke (AIS) during off-duty hours in both the early and late time windows.MethodsWe investigated patients who presented to the emergency center between 2014 and 2022. Among a total of 6,496 AIS patients, we selected those who underwent mechanical thrombectomy within 24 h of the onset of acute anterior circulation occlusion. The eligible patients were divided into two groups: those who arrived within 6 h of symptom onset and received the procedure within 8 h (early window), and those who received the procedure between 8 h and 24 h after symptom onset (late window). The study assessed the association between the onset to puncture time in each group and poor outcomes, measured by the modified Rankin scores(mRs) at 90 days. Furthermore, the study analyzed the impact of receiving the procedure during off-hours in both the early and late windows on outcomes. Specifically, the analysis focused on the impact of delayed DTPT in patients during off-duty hours on outcomes measured by the 90-days mRS.ResultsAmong the eligible patients, a total of 501 AIS patients underwent mechanical thrombectomy for acute anterior circulation occlusion within 24 h. Of these, 395 patients (78.8%) fell into the early window category, and 320 patients (63.9%) underwent the procedure during off-duty hours. In the early window, for every 60-minute increase in OTPT, the probability of occurrence a poor outcome at 90 days significantly increased in the fully adjusted model (OR = 1.21; 95% CI, 1.02 to 1.43; p = 0.03). In the early window, delayed procedures during off-duty hours (exceeding 103 min of DTPT) were identified as an independent predictor of poor outcomes (OR = 1.85; 95% CI, 1.05 to 3.24; p = 0.03). However, in the late window, there was no association between DTPT and outcomes at 90 days, and the impact of DTPT delays during off-hours was not observed.ConclusionsThrough this study, it became evident that the impacts of off-duty hours in mechanical thrombectomy were most pronounced in the early window, where the impact of time delay was clear. Therefore, it is believed that improvements in the treatment system are necessary to address this issue.

Analysis of Factors Associated to Hemorrhagic Transformation After Recanalization of Acute Ischemic Stroke

Ischemic stroke is associated with high rates of mortality and disability, making it an urgent issue that requires immediate attention. However, patients with acute ischemic stroke (AIS) can open the occluded cerebral vessels timelier, restore cerebral perfusion, save the ischemic penumbra, and bring better prognosis. However, a considerable number of patients still have poor clinical outcome due to complications such as hemorrhagic transformation (HT) after vascular reopening. The specific mechanism of HT after recanalization treatment is currently not fully understood. Studies have shown that multiple factors are associated with bleeding transformation after mechanical thrombectomy in AIS patients. Some studies suggest that the damage of ischemia and reperfusion and vascular permeability may play a role. This paper summarizes the possible mechanisms and related influencing factors of HT after vascular recanalization treatment of AIS patients to further guide the treatment and management decisions of AIS patients.

Short- and long- term outcomes of mechanical thrombectomy in acute ischemic stroke patients with chronic kidney disease.

Chronic kidney disease (CKD) is a risk factor of acute ischemic stroke (AIS). Outcomes of treatment with mechanical thrombectomy (MT) in patients with CKD seem to be poorer than in the general population. Long‑term follow‑up studies are lacking. Our aim was to asses short- and long‑term outcomes (up to 365 days after stroke) in MT‑treated AIS patients with concomitant CKD. The study included all AIS patients treated with MT at the Comprehensive Stroke Center in Kraków, Poland, from 2019 to 2021. The patients were divided into the CKD group (best glomerular filtration rate [GFR] during hospitalization <60 ml/min/1.73 m2 or diagnosed CKD) and the controls. In‑hospital, 90‑day, and 365‑day mortality and rate of good functional outcomes (defined as modified Rankin Scale ≤2) were compared between the CKD patients and controls as well as between patients with CKD stages 1-3 (GFR ≥30 ml/min/1.73 m2) and 4-5 (GFR <30 ml/min/1.73 m2). Factors associated with the abovementioned outcomes were identified using univariable logistic regression analyses and then added to multivariable analyses. The CKD patients had higher 90- and 365‑day mortality and lower 90- and 365‑day good functional outcome rates than the controls. The patients with CKD stage 4-5 had significantly higher in‑hospital, 90‑day, and 365‑day mortality than the patients with CKD stage 1-3. Neither CKD nor its late stages (4-5) were independently associated with short- and long‑term mortality and functional outcomes of MT. MT outcomes in CKD patients are worse, especially in advanced stages of the disease, but CKD is not independently associated with poor prognosis. CKD alone should not be a contraindication for MT in otherwise eligible patients, although patients with impaired kidney function require more careful postprocedural monitoring.

Angioplasty and/or stenting following successful mechanical thrombectomy for intracranial atherosclerosis-related emergent large vessel occlusive stroke (ASSET): protocol of a multicentre randomised trial

RationaleThe management of residual stenosis after mechanical thrombectomy in patients with intracranial atherosclerotic stenosis-related emerge large vessel occlusive (ICAS-LVO) stroke is still unclear question in clinical practice.AimTo demonstrate the design...

Early stopping versus continued retrievals after failed recanalization: associated factors and implications for outcome

BackgroundSuccessful recanalization defined as modified Thrombolysis in Cerebral Infarction Score (mTICI) ≥2b is not achieved in 15%–20% of patients with acute ischemic stroke. This study aims to identify patient-specific factors...

Medical Management of Acute Stroke based on Japan Stroke Society Guidelines and the Japan Stroke Data Bank.

Stroke is a leading cause of death and disability in Japan, necessitating standardized treatment guidelines. The Japan Stroke Society (JSS) periodically revises its guidelines to incorporate new research. This review provides a short overview of acute stroke management based on JSS Guideline 2021 (revised 2023) and the Japan Stroke Data Bank (JSDB), and discusses future directions in stroke management. Acute stroke management emphasizes systemic support and complication management. Risk factor control during acute hospitalization is also crucial for preventing recurrent strokes in the chronic phase.In ischemic stroke, super-acute recanalization therapies, including intravenous thrombolysis and mechanical thrombectomy, are the most important and effective. Antiplatelet therapy, particularly aspirin and clopidogrel, is recommended for noncardiogenic stroke and high-risk transient ischemic attack. In cardioembolic stroke, early initiation of direct oral anticoagulants might be considered according to stroke severity.For brain hemorrhage, early blood pressure management is recommended. Specific reversal agents are advised for patients on anticoagulant therapy. Minimally invasive hematoma removal may improve outcomes for intracerebral hemorrhage.Subarachnoid hemorrhage treatments reported from Japan include intravenous drugs to prevent vasospasm.The JSDB revealed improvements in functional outcomes in patients with ischemic stroke over the past 20 years, although patients with hemorrhagic stroke showed no clear improvement. The evolving guidelines and research underscore the importance of stratified and timely intervention in stroke care.

PRESET thrombectomy device outcomes in patients with acute ischemic stroke: A systematic review and meta-analysis.

Many devices are used to perform mechanical thrombectomy in the setting of large vessel occlusion acute ischemic stroke. We sought to evaluate the efficacy and safety of pRESET stent-retriever systems. We conducted a comprehensive systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies up to March 2024 were retrieved from PubMed, Scopus, Web of Science, and Embase databases. A total of 8 papers met the inclusion/exclusion criteria comprising a total of 1140 participants (average age 72.4 ± 11.9, female percentage (50%). Preintervention intravenous thrombolysis was utilized in 46.5% (range 32.9-65.4) of patients, with a median National Institute of Health Stroke Scale at presentation of 15 (range 0-38). The middle cerebral artery was the most commonly affected artery, with a prevalence of 76.4% (range 62.8-100). The pRESET stent-retriever systems demonstrated a first-passing effect rate of 53.4% [95% confidence interval [CI] 44.8; 61.7] and a final thrombolysis in cerebral infarction 2b-3 grade rate of 90.41% [95% CI 82.13; 95.08]. Ninety-day modified Rankin Scale (0-2) rate was 42.2% [95% CI 27.6; 58.4], and 90-day mortality rate was 15.1% [95% CI 9.8; 22.6]. Postintervention hemorrhage occurred at a rate of 28.6% [CI 17.2; 43.6]. Our systematic review and meta-analysis describes the efficacy of the pRESET stent retriever system in managing acute ischemic stroke patients. The pRESET device was found to have a similar safety and efficacy profile to other mechanical thrombectomy devices currently in use.

Trans-Clot MAP gradient: A novel innovative technique during thrombectomy for acute ischemic stroke with potential applications for assessing collateral circulation, determining clot etiology, informing device selection, and predicting first-pass success.

Endovascular mechanical thrombectomy has significantly improved recovery in acute ischemic stroke (AIS). While traditional patient selection has relied on factors such as last known well and penumbra volume, emerging research highlights the importance of collateral circulation in influencing thrombectomy success. However, current methods to assess collateral circulation are often unreliable and lack standardization, limiting their integration into clinical decision-making and prompting the need for innovative approaches. This study introduces trans-clot manometry as a promising approach for quantitatively assessing collateral blood flow before thrombectomy. Two patients were included in this study: a 64-year-old female with a left M1 near-complete occlusion and an 81-year-old male with a left P1 occlusion. After receiving intravenous tenecteplase, each patient underwent emergent thrombectomy where intraoperative trans-clot manometry revealed significant trans-clot mean arterial pressure (MAP) gradients (66.7% for Patient 1 and 96.9% for Patient 2). Both patients had successful first-pass thrombectomy (Patient 1: TICI 3; Patient 2: TICI 3), with substantial clinical improvement (Patient 1: NIHSS 11 to 1; Patient 2: NIHSS 19 to 8). Intraoperative trans-clot manometry offers a simple yet powerful, objective, and generalizable measure of collateral circulation, applicable to a wide range of AIS cases regardless of clot location or vessel size. In addition, real-time correlations with heart-rate variability and radial artery pressures provide an intrinsic quality control, ensuring proper execution of the technique and accuracy of the resulting MAP gradient. Future research will focus on validating this approach, determining its generalizability, and establishing MAP gradient thresholds to enhance device selection and predict first-pass success.

Acute ischemic stroke with large vessel occlusion for mechanical thrombectomy: personalization is highly desired.

Acute ischemic stroke with large vessel occlusion for mechanical thrombectomy: personalization is highly desired.

Cyclic Aspiration in Mechanical Thrombectomy: Influencing Factors and Experimental Validation.

Mechanical thrombectomy is a fundamental intervention for acute ischemic stroke treatment. While conventional techniques are effective, cyclic aspiration (CyA) shows potential for better recanalization rates. We aim to investigate factors affecting CyA and compare them with static aspiration (StA). StA setup consisted of an aspiration pump connected to pressure transducer. CyA was tested with 5 subsequent iterations: single solenoid valve with air plus saline (i1) or saline alone (i2) as aspiration medium; 2 solenoid valves with air plus saline (i3) as aspiration medium; complete air removal and saline feeding (i4); and pressurized saline feeding (i5). To assess the efficacy of clot ingestion, the pressure transducer was replaced with a distal aspiration catheter. Moderately stiff clot analogs (15 mm) were used to investigate the ingestion quantified as clot relative weight loss. Additionally, the aspiration flow rate was assessed for each setup. With CyA i1, the amplitude of the achieved negative pressure waves declined with increasing frequencies but progressively increased with each subsequent iteration, achieving a maximum amplitude of 81 kPa for i5 at 1 Hz. Relative clot weight loss was significantly higher with i5 at 5 Hz than with StA (100% versus 37.8%; P = .05). Aspiration flow rate was lower with CyA than with StA (i5 at 5 Hz: 199.8 mL/min versus StA: 311 mL/min; P < .01). CyA with the appropriate setup may represent an encouraging innovation in mechanical thrombectomy, offering a promising pathway for improving efficacy in clot ingestion and recanalization. The observed benefits warrant confirmation in a clinical setting.

Performance of An Automated Algorithm in Large and Medium Vessel Occlusion Detection: A Real-World Experience.

Fast, accurate detection of large (LVO) and medium vessel occlusion (MeVO) is critical for triage and management of acute ischemic stroke. Multiple AIbased software products are commercially available. However, their strengths and limitations for detection of vessel occlusion in the context of expanding indications for mechanical thrombectomy are not entirely understood. We aimed to investigate the performance of a fully automated commercial detection algorithm to identify large and medium vessel occlusions in Code Stroke patients. We utilized a single-center, institutional, retrospective registry of all consecutive code stroke patients with CTA and automated processing using Viz.ai presenting at a comprehensive stroke center between March 2020 and February 2023. LVO was categorized as anterior LVO (aLVO), defined as occlusion of the intracranial internal cerebral artery or M1-middle cerebral artery (MCA), and posterior LVO (pLVO), defined as occlusion of the basilar artery or V4-vertebral artery. MeVO was defined as occlusion of the M2-MCA, A1/A2-anterior cerebral artery, or P1/P2-posterior cerebral artery. Reports from 12 board-certified radiologists were considered the gold standard. We analyzed the performance of the automated algorithm using STARD guidelines. Our primary outcome was accuracy of anterior LVO (aLVO) by the software. Secondary outcomes were accuracy of the software to detect three additional categories: all LVO (aLVO and pLVO), aLVO with M2-MCA, and aLVO with MeVO. Of 3,590 code stroke patients, 3,576 were technically sufficient for analysis by the automated software (median age 67 years; 51% female; 68% White), of which 616 (17.2%) had vessel occlusions. The respective sensitivity and specificity for all four pre-specified categories were: aLVO: 91% (87-94%), 93% (92-94%); all LVO: 73% (68-77%), 92% (91-93%); aLVO with M2-MCA:74% (70-78%), 93% (92-94%); aLVO with all MeVO: 65% (61-69%), and 93% (92-94%). The automated algorithm demonstrated high accuracy in identifying anterior LVO with lower performance for pLVO and MeVO. It is crucial for acute stroke teams to be aware of the discordance between automated algorithm results and true rates of LVO and MeVO for timely diagnosis and triage. LVO = large vessel occlusion; aLVO = anterior large vessel occlusion; pLVO = posterior large vessel occlusion; MeVO = medium vessel occlusion; EVT= endovascular thrombectomy; AI = artificial intelligence; ACA = anterior cerebral artery; PCA = posterior cerebral artery; BA = basilar artery; VA = vertebral artery.

Safety and effectiveness of SOFIA/SOFIA PLUS for direct aspiration as first line treatment in patients with acute anterior ischemic stroke: results from the prospective, multicentric SESAME study.

Mechanical thrombectomy is a cornerstone treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO), yet the optimal technique remains debated. The SOFIA/SOFIA PLUS catheter has emerged as a promising tool for direct aspiration thrombectomy. This prospective multi-center study, adhering Good-Clinical-Practice guidelines, aimed to evaluate the safety and efficacy of the SOFIA/SOFIA PLUS catheter for direct aspiration as a first-line treatment technique in patients with acute anterior circulation LVO. Between 10/2017 and 12/2021, 246 consecutive patients presenting with AIS due to anterior circulation LVO were enrolled from 14 European centers. Primary treatment with SOFIA catheters was performed within 6 h of symptom onset. Clinical and radiological data were collected, and statistical analyses were conducted. The mean age of the included patients was 71.6 ± 13.9 years, with 44.7% being male. Primary aspiration achieved complete recanalization in 72.8% of patients, with functional independence observed in 63.8% after 90 days. Secondary outcomes included a median NIHSS of 4 at 24 h post-procedure, median ASPECTS of 7 on follow-up imaging, and a mortality rate of 24.4% at 90 days. No device malfunctions were observed, and the rate of symptomatic intracranial hemorrhage was 4.4%. Primary aspiration with the SOFIA/SOFIA PLUS catheter demonstrates favorable safety and efficacy profiles in the treatment of anterior circulation LVO. These findings support the utilization of this technique as a first-line approach in mechanical thrombectomy for AIS, contributing to the growing body of evidence endorsing the effectiveness of direct aspiration thrombectomy in stroke management.

Anesthetic Management of Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: An Overview.

Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents-such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine-depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period.