Outcomes Of Mechanical Thrombectomy Research Articles

The effects of admission hyperglycemia and diabetes mellitus on mechanical thrombectomy outcomes: A systematic review and meta-analysis.

The impact of certain comorbidities on mechanical thrombectomy (MT) outcomes remains largely unexplored. Diabetes mellitus (DM) and admission hyperglycemia have been associated with poor clinical outcomes for patients treated with MT. In this study, we sought to investigate the effects of DM and admission hyperglycemia on MT outcomes. Following PRISMA guidelines, a systematic literature search was conducted in Medline, Embase, Scopus, and Web of Science databases. Data regarding successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b), functional independence (modified Rankin Scale [mRS] 0-2), excellent outcomes (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated using random effects model. Twenty-one studies comprising 9708 patients were included. A total of 2311 patients (24%) had a history of DM, and 2026 patients (21%) had admission hyperglycemia. Admission hyperglycemia was associated with significantly lower odds of mTICI ≥2b (OR = 0.7, 95% CI = 0.55-0.89), mRS 0-2 (OR = 0.47, 95% CI = 0.41-0.53), and mRS 0-1 (OR = 0.43, 95% CI = 0.34-0.55) as compared to normoglycemic state. Patients with hyperglycemia had significantly higher rates of sICH (OR = 2.05, 95% CI = 1.66-2.54) and mortality (OR = 1.99, 95% CI = 1.58-2.52) than normoglycemic patients. Diabetes mellitus was associated with significantly high rates of mortality (OR = 1.74, 95% CI = 1.31-2.3) and lower rates of mRS 0-2 (OR = 0.60, 95% CI = 0.48-0.76) in sensitivity analyses. Our results indicate that admission blood glucose levels and DM can negatively affect MT outcomes. Further research should focus on optimizing MT outcomes for these patients.

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.

The role of carotid elongation for intervention time and outcome in mechanical thrombectomy for anterior circulation acute ischemic stroke.

This study investigates the influence of carotid artery elongation on neurovascular intervention and outcome in acute stroke treatments proposing an easily assessable imaging marker for carotid elongation. 118 patients who underwent mechanical thrombectomy for middle cerebral artery occlusions were included. The carotid elongation ratio (CER), center-line artery length to scan's Z-axis, was measured on the affected side in CT-angiographies. Full and partial correlations of CER with periprocedural times, complications and outcome were computed. Multivariate logistic regression, including comorbidities, for prediction of dichotomized mRS outcome after 3 months was performed. CER showed no significant correlation with recanalization success. Weak, outlier-driven correlation was found with recanalization time (p = 0.021, cor = 0.2). Weak correlations were found with improvement of NIHSS score at discharge and mRS score after 3 months (p = 0.023 and p = 0.031, each rho=-0.2). There was moderate correlation with NIHSS score at discharge (p = 0.001, rho = 0.3). Patients with favorable outcomes (mRS 0-2) exhibited lower CER (p = 0.012). Partial correlations of CER with favorable outcomes were observed after correcting for age, sex and cardiovascular risk factors (cor = 0.2, p = 0.048). Multivariate analysis (Nagelkerke's R2 = 0.42) identified NIHSS score at admission, diabetes, hypertension and intervention time as significant factors for predicting outcome at 3 month, while CER showed the highest log Odd's (2.97). Correlations between CER and clinical improvement suggest that carotid elongation might be a risk factor for poorer outcome without relevant effect on endovascular treatment and should not guide treatment decisions. Further studies should consider carotid elongation as an individual neurovascular risk factor, independent of hypertension.

Outcomes of Mechanical Thrombectomy in Patients With Acute Basilar Artery Occlusion With Mild to Moderate Symptoms.

The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) with basilar artery occlusion (BAO) and a baseline National Institute of Health Stroke Scale (NIHSS) score <10 is unclear because this subpopulation has been substantially excluded from large clinical trials. The aim of our study was to determine whether MT ± IV thrombolysis (IVT) improves functional outcomes compared with IVT alone in patients with BAO and a NIHSS score <10. We emulated a hypothetical trial including adult patients with BAO, a baseline NIHSS score <10, and prestroke modified Rankin scale (mRS) scores 0-2, comparing MT (±IVT) with IVT alone. We acquired data from patients receiving MT (±IVT) within 24 hours of onset from the Italian Registry of Endovascular Treatment in Acute Stroke and data from patients treated only with IVT within 9 hours of symptom onset from the SITS International Stroke Thrombolysis Register, from 2011 until 2021. We used inverse probability weighting (IPW) adjusted for prespecified covariates to weight each individual's contribution to the outcome. The primary outcome was 90-day mRS scores 0-2. Secondary outcomes included 90-day mRS scores 0-1, 90-day mRS scores 4-5, mortality at 90 days, in-hospital death, and symptomatic intracerebral hemorrhage. Among the 764 patients recruited from the 2 databases (477 men [62.4%]; mean age [±SD] 67.88 [±13.9] years), 410 (53.7%) received MT±IVT and 354 (46.3%) only IVT. After applying IPW, our population was composed of 710 MT and 707 IVT patients. Of these, 454 MT-treated (63.9%) and 383 IVT-treated (54.2%) patients had a 90-day mRS score of 0-2 (adjusted odds ratio (aOR) 1.56 [95% CI 1.04-2.03]). MT was also associated with a higher rate of mRS scores 0-1 (aOR 2.01 [95% CI 1.37-2.95]) and a lower rate of in-hospital death (aOR 0.45 [95% CI 0.25-0.78]). Among the subgroups tested, MT had a larger effect on 90-day mRS scores 0-2 for patients with NIHSS scores 6-9 than for patients with a NIHSS score <6 (p for interaction 0.02). In a large-scale target trial emulation on patients with stroke from BAO and a NIHSS score <10, MT was associated with better functional outcomes compared with IVT alone. Further research is needed to confirm the benefit of MT in patients with a NIHSS score <6. This study provides Class III evidence that MT ± intravenous thrombolysis is associated with better 90-day functional outcomes in patients with BAO and a NIHSS score < 10 compared with intravenous thrombolysis alone.

Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke Following Cardiac Interventions: A Systematic Review and Meta-Analysis.

The purpose of this study isto pool the evidence on the safety and efficacy of mechanical thrombectomy (MT) in patients who develop acute ischemic stroke (AIS) due to large vessel occlusion (LVO) following recent cardiac interventions. PubMed, Embase and Scopus were searched from inception up to February 2024 using a combination of "cardiac interventions" and "mechanical thrombectomy" as keywords. Studies that evaluated AIS within 30days of a recent cardiac intervention who underwent MT were included. The proportion of mortality, favorable functional outcome (modified Rankin Scale (mRS) 0-2), successful reperfusion (TICI ≥ 2b or TIMI ≥ 2) and symptomatic intracranial hemorrhage (sICH) were pooled using generalized linear mixed model. Thirty-one case reports/series and 11 observational studies including 195 MT procedures were included. The patients' mean age was 72years. The most common cardiac intervention associated with AIS was transcatheter aortic valve replacement/implantation in 96/192 cases (50%). The median onset of stoke was 0 (IQR 0-3) days after cardiac intervention. Rate of successful reperfusion was 79.4% [95%confidence interval (CI) 66.7-88.1%], rate of mRS 0-2 after 90 days was 42.7% [95%CI 32.5-53.6%], and rate of mortality at 90 days was 30.3% [95%CI 21.7-40.6%]. The rate of sICH was 11.6% [95%CI 5.9-21.5%]. MT to treat AIS due to LVO after cardiac interventions may result in good rates of functional recovery, though mortality and sICH may be higher. Regular and repeated neurological examinations should be performed following cardiac interventions, with special attention to stroke. If stroke is detected, MT should be considered as a viable option.

Abstract 004: Early Feasibility Study of RapidPulse® Aspiration System as Frontline Approach for Patients with Acute Ischemic Stroke due to Large Vessel Occlusions (Pulse‐C Study)

Background and aims The first‐pass effect (FPE) is associated with improved clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS). However, current devices achieve FPE in only 30‐40% of patients. The RapidPulse® Aspiration System (RP) is designed to remove occlusive thrombus from the cerebral vasculature using precisely pulsed aspiration. The system aims to improve revascularization results during aspiration thrombectomy in patients with acute ischemic stroke. Initial clinical evaluation suggests that RapidPulse® can achieve FPE rates in the 70% range. Our goal is to evaluate this technology as a frontline approach in LVOS. Methods Prospective, multicenter, open‐label, early experience study of the RapidPulse® System. Patients with LVOS involving anterior and/or posterior circulations within 24 hours from stroke onset, without evidence of intracranial atherosclerotic disease and/or tandem occlusions, and amenable to treatment with the RapidPulse 071 aspiration catheter were eligible. The primary outcome was the rate of FPE (mTICI ≥2c after one pass). Secondary outcomes included frontline technical success (mTICI ≥2b after final pass with no rescue therapy), and incidence of vessel injury and/or device related SAEs. The study will enroll up to 50 participants at up to 5 centers in Europe and Latin America. Results As of August 2024, ten patients have been recruited and enrollment is expected to be completed in November 2024. The results of the study will be presented at the SVIN conference. Conclusions The RapidPulse® system is a novel cyclic aspiration technology designed to achieve faster and better reperfusion in LVOS while significantly improving FPE and frontline success rates which, in turn, may improve clinical outcomes and reduce overall procedure costs. Additional larger studies are underway.

Abstract 420: The Correlation of Whole Blood Viscosity and Outcome in Mechanical Thrombectomy for Acute Ischemic Stroke

Introduction Whole blood viscosity (WBV), reflecting the intrinsic resistance of blood flow, is an established predictor of stroke events in individuals. This study aims to correlate the WBV at different shear rates with the outcome of endovascular thrombectomy, known to be an effective treatment for large vessel occlusion (LVO) stroke. Methods This is a single‐center retrospective study conducted at our comprehensive stroke center. The charts of 317 patients who underwent endovascular thrombectomy within 6 hours of LVO stroke were reviewed. The modified Rankin score (mRS) at discharge was used as the outcome measure, with individuals categorized as low (0‐2) or high (3‐6). WBV at different shear rates was calculated using De Simone's Formula, dependent on hematocrit and total protein levels. The T‐test and Chi‐square test were used to compare baseline quantitative and categorical data, respectively, amongst the mRS study groups. We elaborated multivariable logistic regression analyses to identify the independent risk factors associated with the outcome of interest following mechanical thrombectomy. Finally, Spearman rank order correlation was used to assess for r between mRS and WBV at different shear rates. Results Baseline group characteristics, constituted by variables pertaining to demographics and medical history, were similar across the two study groups. However, our study found no significant differences in clinical outcomes between the two groups with WBV at high shear rate (OR 0.969, 95% CI 0.77‐1.204, p = 0.780) and low shear rate (OR 0.998, 95% CI 0.988‐1.008, p = 0.779) following mechanical thrombectomy. Spearman rank order correlation between WBV at high shear rate (r=0.058, p=0.123) and low shear rate (r=0.048, p=0.128) was non‐significant. Conclusion This is one of the few studies to evaluate the effect of WBV at high and low shear rates on the clinical outcome of endovascular thrombectomy in patients with LVO. Our results revealed that WBV at high and low shear rates did not affect the outcome of endovascular thrombectomy, as measured by mRS at discharge. We propose that different components of blood viscosity may uniquely affect blood flow, and our study provides a path for future research to further study the correlation.

Abstract 072: Antiplatelet Pre‐treatment and Outcomes of Mechanical Thrombectomy in Stroke Patients: A Meta‐analysis of 51,497 Patients

Abstract 072: Antiplatelet Pre‐treatment and Outcomes of Mechanical Thrombectomy in Stroke Patients: A Meta‐analysis of 51,497 Patients

Comparative analysis of single plane and biplane angiography systems for mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis

BackgroundThe choice of angiography system could influence the outcomes of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS), but its impact is not yet well understood. This...

Mechanical Thrombectomy for Pediatric Stroke: Focal Cerebral Arteriopathy Versus Cardioembolic Etiologies-Pooled Analysis of the Save ChildS and KidClot Cohort.

The study aimed to compare outcomes of mechanical thrombectomy (MT) in pediatric patients with acute ischemic stroke (AIS) caused by focal cerebral arteriopathy (FCA) versus cardioembolism (CE). Data from the Save ChildS and KidClot cohorts were merged. Children with AIS because of FCA or CE that underwent MT were included. The study used the Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation (CASCADE) for stroke cause assessment. Descriptive statistics and multivariable regression models were used to analyze final modified thrombolysis in cerebral infarction (mTICI) scores, periprocedural complications, and functional outcomes assessed by the modified Rankin scale (mRS) at 6 to 12 months. The analysis included 60 children with 14 FCA and 46 CE cases. CE etiology was associated with better revascularization (good to excellent thrombolysis in cerebral infarction scores) and shift toward better outcomes (common adjusted odds ratio of mRs for CE vs FCA: 0.27, 95% CI: [0.06-0.97], p = 0.039), with no difference in favorable outcome rates. FCA was associated with significantly lower rates of excellent revascularization (21% vs 65%, p < 0.001). No difference in complications' rates was observed between the groups (7.2% in FCA vs 5.5%, p = 0.69). We found that pediatric AIS because of CE etiology has more favorable procedural outcomes compared to FCA following MT. This translated to mixed functional outcomes that may be more favorable in the CE group. These findings highlight the need for further research to refine treatment protocols for pediatric stroke, particularly in understanding and managing FCA in children. ANN NEUROL 2024.

Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in Early and Late Time Windows.

This study aimed to compare outcomes of low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) patients with stroke who underwent mechanical thrombectomy (MT) within 6 hours or 6 to 24 hours after stroke onset. A retrospective cohort study was conducted using data from a large multicenter international registry from 2013 to 2023. Patients with low ASPECTS (2-5) who underwent MT for anterior circulation intracranial large vessel occlusion were included. A propensity matching analysis was conducted for patients presented in the early (<6 hours) vs late (6-24 hours) time window after symptom onset or last known normal. Among the 10 229 patients who underwent MT, 274 met the inclusion criteria. 122 (44.5%) patients were treated in the late window. Early window patients were older (median age, 74 years [IQR, 63-80] vs 66.5 years [IQR, 54-77]; P < .001), had lower proportion of female patients (40.1% vs 54.1%; P = .029), higher median admission National Institutes of Health Stroke Scale score (20 [IQR, 16-24] vs 19 [IQR, 14-22]; P = .004), and a higher prevalence of atrial fibrillation (46.1% vs 27.3; P = .002). Propensity matching yielded a well-matched cohort of 84 patients in each group. Comparing the matched cohorts showed there was no significant difference in acceptable outcomes at 90 days between the 2 groups (odds ratio = 0.90 [95% CI = 0.47-1.71]; P = .70). However, the rate of symptomatic ICH was significantly higher in the early window group compared with the late window group (odds ratio = 2.44 [95% CI = 1.06-6.02]; P = .04). Among patients with anterior circulation large vessel occlusion and low ASPECTS, MT seems to provide a similar benefit to functional outcome for patients presenting <6 hours or 6 to 24 hours after onset.

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.

Predictive value of white matter hyperintensity burden combined with collateral circulation in mechanical thrombectomy for acute anterior circulation large vessel occlusion

ObjectiveTo investigate the correlation and predictive value of white matter hyperintensity (WMH) burden in conjunction with collateral circulation during mechanical thrombectomy (MT) for acute anterior circulation occlusion. MethodsA database comprising consecutive registrations of patients who underwent mechanical thrombectomy for acute anterior circulation large vessel occlusive cerebral infarction at Nanjing Drum Tower Hospital from January 2018 to December 2021 was analyzed. Collateral circulation was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scoring criteria. The good collateral group included ASITN/SIR grades 3 and 4, while the poor collateral group included grades 1 and 2. Additionally, white matter hyperintensity burden was evaluated using white matter hyperintensity volume and the Fazekas scoring system. A favorable functional outcome was defined as a modified Rankin scale (mRS) of 0–2 at 90 days. Multivariable logistic regression analyses and Spearman correlation analysis were employed to assess the correlation between white matter hyperintensity burden and unfavorable outcomes in mechanical thrombectomy. ResultsA total of 123 patients who underwent mechanical thrombectomy for acute anterior circulation occlusion were included (56.9 % male). Favorable outcomes were observed in 45.5 % (56/123) of cases. Those with a low ASITN/SIR scale (r = -1.33, 95 % CI: 0.26 (0.09–0.78), P=0.01; cutoff value = 2.5), low low-density lipoprotein cholesterol (LDL-C) level (r = -1.00, 95 % CI: 0.37 (0.15–0.92), P=0.03; cutoff value = 2.26), and high white matter hyperintense volume (r = 0.28, 95 % CI: 1.33 (1.03–1.71), P=0.03; cutoff value = 10.03) were more likely to experience unfavorable outcomes. Moreover, when compared to ASITN/SIR scale (AUC=89.6, 95 % CI: 0.09–0.78) and LDL level (AUC=62.8, 95 % CI: 0.15–0.92), white matter hyperintense volume demonstrated greater accuracy in predicting poor outcomes (AUC=94.4, 95 % CI: 1.03–1.71). Importantly, white matter hyperintense volume showed a positive correlation with the modified Rankin Scale (mRS) Score (r = 0.8289, P<0.0001). In brief, the burden of white matter hyperintensity is negatively correlated with collateral circulation in mechanical thrombectomy for acute anterior circulation occlusion. ConclusionsThe higher the burden of white matter hyperintensity, the worse the collateral circulation in mechanical thrombectomy for acute anterior circulation occlusion. The combination of high white matter hyperintensity volume and poor collateral circulation enhances might predict a worse clinical outcome of mechanical thrombectomy with acute anterior circulation occlusion.

Treatment outcome of bridge mechanical thrombectomy with different IV-tPA dosages in the standard and extended time window in real-world practice.

Differences of treatment outcome between full or reduced dose of tissue plasminogen activator (tPA) for bridge mechanical thrombectomy (MT) in the extended time window have not been clearly established. We aimed to present real-world results of bridge MT with different tPA dosages in the standard and extended windows. Patients with anterior circulation stroke treated with MT between 2017 and 2021 at two stroke referral centers were retrospectively reviewed. Bridge MT with tPA were categorized as full (0.9mg/kg) or reduced (<0.9mg/kg) dose. Standard window (SW) cohort was defined as MT performed within 6h of acute ischemic stroke onset, while those beyond 6h as the extended window (EW) cohort. 90days Modified Rankin Scale (mRS) score, technical treatment success, in-hospital mortality, and post-treatment hemorrhage were analyzed. A total of 423 patients met the inclusion criteria, 218 of which treated in the SW, while 205 treated in the EW. Within the SW cohort, the full-dose tPA group demonstrated a higher proportion of good functional outcome (GFO) at 90days (mRS0-3) versus reduced (49% vs 21%, p = 0.0358). The overall GFO of SW was higher than that of the EW cohort (33% vs 20%, p = 0.0480). Within the EW cohort, GFO was similar between full and reduced dose groups. Successful reperfusion rate was lower in SW versus EW cohorts (39% vs 58%, p = 0.0199). In real-world practice, the GFO of bridge MT is better than MT alone. The tPA dosage is not a determining factor of GFO in EW MT.

Aspiration tubing diameter is a key determinant of vacuum pressure and is associated with procedural outcome in mechanical thrombectomy for large vessel occlusion: An experimental and cohort study.

We (1) evaluated the effect of aspiration tubing diameter on intraluminal pressure and (2) compared thrombectomy outcomes in patients treated using small diameter tubing versus those treated using large diameter vacuum tubing. Intraluminal negative pressure was measured in a validated benchtop set up where consistency of negative pressure (inHg) was measured between static and dynamic aspiration. Static aspiration refers to activation of vacuum once the catheter is engaged with the clot. Dynamic aspiration refers to activation of vacuum when the catheter is slightly proximal to the clot. Four different sizes of vacuum tubing were trialed. We performed a retrospective analysis of consecutive patients who underwent mechanical thrombectomy. Procedural and functional outcomes were compared. The large diameter aspiration tubing held a consistent high negative pressure in static and dynamic aspiration (p = 0.152). Tubing types I to III were associated with a significant fall off in negative pressure between static and dynamic technique (p < 0.05). Two-hundred and five patients were included in the retrospective analysis; 124 (60%) underwent thrombectomy using small diameter vacuum tubing, and 81 (40%) using the large tubing. Mean thrombectomy time was shorter with the larger tubing [25.9 (17.9) minutes] versus the small tubing [37.5 (28.5) minutes, p = 0.002]. A greater proportion of patients had a thrombolysis in cerebral infarction score ≥2b in the group treated using the large tubing (78, 99%) than those with the small tubing (96, 78%, p < 0.001). Vacuum tubing diameter is linearly associated with intraluminal aspiration pressure. These findings have clinical significance as shown by increased recanalization rates and decreased thrombectomy times when large-diameter aspiration tubing is used. Shifting the paradigm toward a flow-based technique using large-bore vacuum tubing ought to be considered.

Comparison of Mechanical Thrombectomy Outcomes Before and During COVID-19 Pandemic

Comparison of Mechanical Thrombectomy Outcomes Before and During COVID-19 Pandemic

Role of mechanical thrombectomy among large vessel stroke patients during the coronavirus disease (COVID-19) pandemic

PurposeThe aim of our study is to provide insights derived from experience at multiple centers regarding the outcomes of mechanical thrombectomy (MT) for large vessel occlusion (LVO) in COVID-19 patients and compare them with those in non-COVID-19 patients during the coronavirus disease (COVID-19) pandemic.ResultsCOVID‐19 positive patients were younger than COVID‐19 negative patients (62.1 ± 2.69 versus 69.5 ± 2.2, P < 0.001). There was a significant difference between COVID-19 and non-COVID-19 groups in the median D-dimer levels (6 vs. 4.5; P < 0.001), median ESR levels (63 vs. 38; P < 0.001) and median CRP levels (110 vs. 48.5; P < 0.001), respectively. Median time from stroke symptoms onset to hospital admission was significantly higher among COVID-19 positive patients (366 vs. 155 min; P < 0.001). COVID‐19 positive patients with LVO presented with a higher median NIH Stroke Scale score at presentation (16 versus 8, P < 0.001) and lower median Alberta Stroke Program Early CT Score (ASPECTS) on admission (6 versus 8, P < 0.001). Patients with COVID-19 had significantly higher percentages of poor functional outcomes as scored using the mRS grades 3–5 in comparison to non-COVID-19 patients (69.2% vs. 13.6%; P = 0.002), but there was no significant difference between both groups in complications such as early cerebral re-occlusion, intracerebral hemorrhage, or in-hospital mortality (P > 0.05).ConclusionMechanical thrombectomy has effectively managed patients with LVO stroke. LVO stroke in COVID-19 patients occur at a young age, and have multi-territory vascular involvement. Poor functional outcomes post thrombectomy in COVID-19 patients, irrespective of timely, successful angiographic recanalization.

Comparative Analysis of Mechanical Thrombectomy Outcomes of Middle Cerebral Artery M1, M2 Superior, and M2 Inferior Occlusion Strokes

BackgroundThe M1 middle cerebral artery (MCA) commonly bifurcates into an M2 superior and an M2 inferior segment. However, MCA anatomy is highly variable rendering classification for mechanical thrombectomy (MT) trials difficult. Safety and effectiveness of M2 MCA stroke thrombectomy stratified by M2 MCA anatomy remains to be explored. MethodsLarge vessel occlusion strokes undergoing MT between 02/2016-08/2022 were reviewed (n=784). M1 (n=431) and M2 MCA (n=118) occlusions were assessed. Among M2 MCA occlusions only prototypical MCA bifurcation anatomy cases were included (n=99). Dominance was assessed based on angiography. Procedural and outcome data was compared between M1, M2 superior and M2 inferior MCA occlusions. ResultsBaseline demographics and periprocedural criteria of M2 superior (n=56) and M2 inferior (n=43) occlusion MTs were comparable. Among M2 inferior cases, the occluded branch was dominant in 41/43 (95.3%) but only in 37/56 (66.1%) among M2 superior cases (p<0.001). The 90-day favorable functional outcome (mRS 0-2) and mortality (mRS 6) rates were 60.0% and 8.9% in the M2 superior, 42.9% and 32.6% in the M2 inferior, and 44.1% and 26.0% in the M1 group (n=431). Compared to M2 superior, M2 inferior favorable outcome rates were lower (p=0.094) and mortality rates were higher (p=0.003) and resembled M1 outcome rates (p=0.750 and p=0.355, respectively). ConclusionIn setting of prototypical MCA bifurcation anatomy, thrombectomy of dominant M2 inferior occlusions had outcome rates like M1 occlusions. In contrast, M2 superior occlusions had significantly lower mortality rates and a trend towards better favorable functional outcome rates.

Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: AScoping Review.

There is limited evidence on the outcomes and safety of mechanical thrombectomy (MT) among patients with acute ischemic stroke (AIS) in the context of cardiac diseases. Our study reviews MT in AIS within the context of cardiac diseases, aiming to identify existing and emerging needs and gaps. PubMed and Scopus were searched until December 31, 2023, using a combination of cardiological diseases and "mechanical thrombectomy" or "endovascular treatment" as keywords. Study design included case reports/series, observational studies, randomized clinical trials, and meta-analyses/systematic reviews. We identified 943 articles, of which 130 were included in the review. Results were categorized according to the cardiac conditions. MT shows significant benefits in patients with atrial fibrillation (n=139) but lacks data for stroke occurring after percutaneous coronary intervention (n=2) or transcatheter aortic valve implantation (n=5). MT is beneficial in AIS attributable to infective endocarditis (n=34), although functional benefit may be limited. Controversy surrounds the functional outcomes and mortality of patients with AIS with heart failure undergoing MT (n=11). Despite technical challenges, MT appears feasible in aortic dissection cases (n=4), and in patients with left ventricular assist device or total artificial heart (n=10). Data on AIS attributable to congenital heart disease (n=4) primarily focus on pediatric cases requiring technical modifications. Treatment outcomes of MT in patients with cardiac tumors (n=8) vary because of clot consistency differences. After cardiac surgery stroke, MT may improve outcomes with early intervention (n=13). Available data outline the feasibility of MT in patients with AIS attributable to large-vessel occlusion in the context of cardiac diseases.

Outcome and safety of mechanical thrombectomy in patients with acute ischemic stroke due to internal carotid artery dissection.

Mechanical thrombectomy (MT) in patients with symptoms of acute ischemic stroke (AIS) due to internal carotid artery dissection (ICAD) remains controversial. In this study, we present clinical outcome and safety of MT in acute ICAD compared to other acute carotid artery pathology. Patients with symptoms of AIS due to internal carotid artery pathology, treated with MT from 2017-2021, were categorized as ICAD or non-ICAD. Baseline and procedural characteristics, complications, and functional outcome at 90 days were compared between the two groups. Factors associated with a favorable outcome (modified Rankin Scale 0-2) were analyzed using multivariate logistic regression. Safety analyses included in-stent thrombosis, perforation, intracranial hemorrhage, and mortality. Sixty-seven ICAD patients (14.8%) and 387 non-ICAD patients (85.2%) were enrolled. ICAD patients were younger, median age 53 years (interquartile range (IQR) 47-61) vs. non-ICAD 72 years (IQR 64-79), p < 0.001. Favorable outcome was more common in ICAD patients, 49 ICAD patients (76.6%) vs. 158 non-ICAD patients (42.4%), p < 0.001. Post-procedural symptomatic intracranial hemorrhage occurred in 41 patients, 5 (7.5%) ICAD patients vs. 36 (9.3%) non-ICAD patients, p = 0.6. Mortality differed significantly, 6 (9%) ICAD patients vs. 94 (24.3%) non-ICAD patients, p = 0.01. ICAD was not associated with functional outcome in multivariate analysis, OR = 1.25 [95%confidence interval:0.55-2.86]. ICAD patients achieved a better 90-day functional outcome compared with non-ICAD patients. ICAD patients did not perform worse in safety measures than non-ICAD patients. Our data provide indirect evidence that MT is of clinical benefit in ICAD patients with symptoms of AIS.