Outcomes Of Thrombectomy Research Articles

Effect of SARS-CoV2 Infection on Endovascular Thrombectomy Outcomes - Data from the Florida Stroke Registry.

Endovascular thrombectomy outcomes are impacted by changes in stroke systems of care. During the pandemic, SARS-CoV2 positive status had major implications on hospital arrival and treatment models of non-COVID related hospital admissions. Using the Florida Stroke Registry, we compared the rates of in-hospital death and discharge outcomes of patients treated with endovascular thrombectomy who tested positive for SARS-CoV2 infection during their hospitalization. Data from Get with the Guidelines-Stroke hospitals participating in the Florida Stroke Registry during the COVID pandemic from March 2020 to December 2022 were reviewed to identify endovascular thrombectomy patients with coding for SARS-CoV2 testing during their hospital stay. Associations between SARS-CoV2 status and favorable endovascular thrombectomy outcomes of mRS (0-2) at discharge, discharge to home or rehabilitation centre, symptomatic intracerebral hemorrhage, in-hospital mortality, and independent ambulation at discharge were examined using multivariate logistic regression modeling adjusting for demographics, vascular risk factors, and clinical characteristics. Temporal analyses were used to compare outcomes across the study period. A total of 8,184 patients underwent endovascular thrombectomy (median age 71.1 years, female 50%, mean NIHSS 14), of these, 180 (2.2%) were SARS-CoV2 positive. Compared to SARS-CoV2 negative endovascular thrombectomy patients, those who tested positive were younger, more frequently male, but with comparable stroke severity at presentation. In multivariable analysis, adjusting for baseline differences and confounding variables, there was a 33% lower likelihood of being discharged to home/inpatient rehab (OR=0.67, 95% CI=(0.49-0.93)), 65% higher odds of in-hospital death (OR=1.65, 95% CI=(1.06-2.58)), as well as a 85% less chance of having a high mRS (>2) at discharge (OR=0.15, 95% CI=(0.04-0.60)) for patients with positive SARS-CoV2 infection. However, a similar risk of symptomatic intracerebral hemorrhage was present compared to SARS-CoV2 negative patients (OR=0.97, 95% CI=(0.501.88)). Temporal analysis of SARS-CoV2 positive patients showed no significant differences. In this large multicenter stroke registry, despite comparable clinical presentation and in-hospital treatment timelines, SARS-CoV2 positive status negatively impacted thrombectomy outcomes. AIS = acute ischemic stroke; LVO = large vessel occlusion; EVT = endovascular thrombectomy; FSR = Florida Stroke Registry; sICH = symptomatic intracerebral hemorrhage.

Prediction of tissue and clinical thrombectomy outcome in acute ischaemic stroke using deep learning.

The advent of endovascular thrombectomy has significantly improved outcomes for stroke patients with intracranial large vessel occlusion, yet individual benefits can vary widely. As demand for thrombectomy rises and geographic disparities in stroke care access persist, there is a growing need for predictive models that quantify individual benefits. However, current imaging methods for estimating outcomes may not fully capture the dynamic nature of cerebral ischemia and lack a patient-specific assessment of thrombectomy benefits. Our study introduces a deep learning approach to predict individual responses to thrombectomy in acute ischemic stroke patients. The proposed models provide predictions for both tissue and clinical outcomes under two scenarios: one assuming successful reperfusion and another assuming unsuccessful reperfusion. The resulting simulations of penumbral salvage and difference in NIHSS at discharge quantify the potential individual benefits of the intervention. Our models were developed on an extensive dataset from routine stroke care, which included 405 ischemic stroke patients who underwent thrombectomy. We used acute data for training (n = 304), including multimodal CT imaging and clinical characteristics, along with post hoc markers like thrombectomy success, final infarct localization, and NIHSS at discharge. We benchmarked our tissue outcome predictions under the observed reperfusion scenario against a thresholding-based clinical method and a generalised linear model. Our deep-learning model showed significant superiority, with a mean Dice score of 0.48 on internal (n = 50) and 0.52 on external (n = 51) test data, versus 0.26/0.36 and 0.34/0.35 for the baselines, respectively. The NIHSS sum score prediction achieved median absolute errors of 1.5 NIHSS points on the internal test dataset and 3.0 NIHSS points on the external test dataset, outperforming other machine learning models. By predicting the patient-specific response to thrombectomy for both tissue and clinical outcomes, our approach offers an innovative biomarker that captures the dynamics of cerebral ischemia. We believe this method holds significant potential to enhance personalised therapeutic strategies and to facilitate efficient resource allocation in acute stroke care.

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.

Association of endovascular thrombectomy volume and outcomes in acute ischemic stroke: A National Inpatient Sample Study.

Previous studies suggest a positive relationship between higher hospital endovascular thrombectomy (EVT) volume and improved outcomes. We investigated this association using the National Inpatient Sample (NIS) database from 2016 to 2020. A cross-sectional analysis of the NIS examined the relationship between hospital EVT volume and outcomes. Data on clinical and demographic variables were collected. Outcomes included favorable functional outcome (discharge home without assistance), inpatient mortality, and intracerebral hemorrhage (ICH). Hospitals in the top quintile of annual EVT volume were classified as high-volume centers. We conducted univariate, multivariate, nearest neighbor matched analysis, and an exploratory analysis to identify annual EVT volume cutoffs. Among 114,640 patients with EVT, 24,415 (21.3%) were treated at high-volume centers. High-volume centers had higher rates of favorable functional outcomes in univariate (odds ratio (OR) 1.20, p < 0.001), multivariate (adjusted OR (aOR) 1.19, p = 0.003), and matched analysis (OR 1.14, p = 0.028). Before matching, inpatient mortality was lower in high-volume centers (OR 0.83, p < 0.001), but this difference was not significant in univariate and matched analyses. No differences in ICH were observed. Functional benefit was noted at ≥ 50 EVTs annually, with centers performing ≥ 175 EVTs showing significantly higher benefits (aOR 1.42, p = 0.002). Increased hospital EVT volume is associated with modestly improved functional outcomes in patients with acute ischemic stroke. Functional improvements are evident at ≥ 50 EVTs annually and increase with higher case volumes, without associated increases in inpatient mortality or ICH.

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.

A preliminary experience on the efficacy, safety and short-term results in the treatment of acute bilateral iliofemoral deep vein thrombosis with the Angiojet rheolytic thrombectomy.

This study aimed to examine the early clinical outcomes of AngioJet rheolytic thrombectomy (RT) in patients with acute bilateral iliofemoral deep vein thrombosis (IFDVT), with a specific focus on the incidence of post-thrombotic syndrome (PTS). From March 2021 to August 2023, sixteen consecutive patients with acute bilateral IFDVT treated with AngioJet RT at our center were evaluated. Primary outcomes include patency of the target veins, development of PTS, recurrent DVT, and procedure related death. Secondary outcomes included minor or major bleeding, acute kidney injury (AKI), documented haemoglobinuria, cardiac event, pulmonary embolism, limb loss, and death. The mean age of the patients was 69 ± 12 years (range, 53-87 years). Malignancy and recent major surgery were the most prevalent risk factors, each observed in 25% of patients (n=4). Technical success, complete clot removal, and alleviation of symptoms were achieved in all patients (n=16; 100%). In a quarter of the patients (n=4), transient hemoglobinuria was observed following the procedure. This complication resolved spontaneously after adequate fluid replenishment. Minor bleeding occurred in three patients (19%), while no patients had major bleeding complication. There was one postoperative AKI and transient bradycardia (6%). Three patients died after the procedures (19%). One patient (6%) developed postoperative massive PE. The mean follow-up was 11±6 months (range, 5-19 months). The primary patency rate was 92% and 91%, respectively, six and twelve months after procedures. One patient had reocclusion during the follow-up. AngioJet RT applied to patients with bilateral IFDVT provides a promising picture, providing a patent vein lumen with high procedural success and achieving convincing early symptomatic improvement in severely symptomatic patients with impaired quality of life. In this early case series, the feasibility of the AngioJet device in elderly cases appears to be a significant problem. Therefore, patient selection is essential.

Surgical Outcomes of Radical Nephrectomy and Inferior Vena Cava Thrombectomy Following Preoperative Systemic Immunotherapy: A Propensity Score Analysis

Surgical Outcomes of Radical Nephrectomy and Inferior Vena Cava Thrombectomy Following Preoperative Systemic Immunotherapy: A Propensity Score Analysis

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

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

Effect of prior use of statins on endovascular thrombectomy outcomes in acute ischemic stroke.

Acute large vessel occlusions (LVOs) account for up to one-third of acute ischemic strokes (AIS) and are associated with high mortality and severe functional deficits. Animal model research suggests that statins may have a protective effect on vessel wall injury during endovascular thrombectomy (EVT). We conducted a retrospective observational study to assess the impact of statin use on clinical outcomes post-EVT in AIS patients with LVOs. Using the Global Collaborative Network consisting of about 143 million patients in TriNetX database, we identified adult AIS patients who underwent EVT between 2018 and 2023. Patients were categorized based on any statin use (atorvastatin, simvastatin, rosuvastatin, pravastatin, lovastatin, or pitavastatin) in the 3 months before AIS admission. The primary outcome was all-cause mortality at one-week post-EVT. Secondary outcomes included intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), decompressive hemicraniectomy procedure (DHC), and aspiration pneumonia at one-week post-EVT. Propensity score matching balanced relevant medical history, stroke severity, medications, and demographics. Cox proportional hazard regression analysis compared outcomes between statin and non-statin cohorts. We identified 17,774 patients who received EVT for LVO ischemic stroke. A total of 10,678 patients were on statins during 3 months prior to EVT and 7096 patients were not on statins. After 1:1 propensity matching, 2148 patients were included in each group. AIS patients treated with EVT and on statins had lower risk of all-cause mortality [7 % vs. 17 %; HR 0.43, 95 % CI 0.35-0.51], ICH [10 % vs. 15 %; HR 0.64, 95 % CI 0.51-0.74], SAH [3 % vs. 6 %; HR 0.48, 95 % CI 0.35-0.64], and aspiration pneumonia [4 % vs 8 %; HR 0.53, 95 % CI 0.41-0.70] compared to AIS patients treated with EVT but not on statins. Rates of DHC were similar between groups [2 % vs 2 %; HR 0.81; 95 % CI (0.52,1.25)]. Statin use within 3 months prior to AIS was associated with better survival and lesser intracranial bleeding risks and complications following EVT. Future studies may help examine how the duration or dosages of statins or LDL levels on admission affect outcomes in LVO strokes treated with EVT.

Distal Access Catheter Improves Balloon Guide and Stent Retriever Thrombectomy Outcomes in Nonagenarians.

The safety and effectiveness of endovascular techniques in elderly patients with large vessel occlusion (LVO) remain controversial. We investigated the angiographic and clinical outcomes of nonagenarians treated with different endovascular techniques using a balloon guide catheter (BGC), distal aspiration catheter (DAC), and/or stent retriever (SR). We analyzed the data from the Registry of Combined versus Single Thrombectomy Techniques (ROSSETTI) of consecutive nonagenarian patients with anterior circulation LVO and compared the outcomes of those treated with BGC+noDAC+SR (101-group), BGC+DAC+SR (111-group), and noBGC+DAC+SR (011-group). Demographic, clinical, angiographic, and clinical outcome data (National Institute of Health Stroke Scale score at 24h [24h-NIHSS] and modified Rankin Scale score at 3months) were compared. Predictors of the first-pass effect (FPE), defining Modified Treatment In Cerebral Ischemia 2c-3 (mTICI 2c-3) after one pass, were explored. Of the 4111 patients from the ROSSETTI registry, 243 nonagenarians (68.7% female) were included in the analysis. The distribution of endovascular techniques was 101-group (61.4%), 111-group (15.6%), and 011-group (23%). The 101-group and 111-group had significantly shorter procedural times than the 011-group. The 111-group had a higher FPE rate, a lower number of passes, and a higher rate of final mTICI ≥2c than the other groups. The 24h-NIHSS score was significantly lower in the 111-group. In multivariate analysis, the only independent predictor for FPE was the BGC+DAC+SR endovascular technique (odds ratio 2.74 [confidence interval 1.16-6.47]; p=0.021). The addition of a DAC to a BGC increases the likelihood of FPE in nonagenarians with anterior circulation LVO SR-based thrombectomy for acute stroke.

Comparing Real-World Outcomes of Catheter-Directed Thrombolysis and Catheter-Based Thrombectomy in Acute Pulmonary Embolism: A Post PEERLESS Analysis.

The recently published PEERLESS trial compared catheter-directed thrombolysis (CDT) and catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE). However, it included a low proportion of patients with contraindications to thrombolytic therapy (4.4%), leaving uncertainty about how CDT would perform relative to CBT in a real-world cohort with higher bleeding risk. This study aims to address this gap by comparing real-world outcomes of CDT and CBT in patients with acute PE. This retrospective analysis included patients who underwent CDT and CBT at two tertiary care centers from January 2020 to January 2024. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, or hemodynamic decompensation. Secondary outcomes included major bleeding and intracranial hemorrhage (ICH). Inverse probability treatment weighting (IPTW) was used to adjust for baseline variables. A total of 162 (mean age 58 years, 45.7% women, 17.3% high-risk, 28% contraindication to lytics, 28% CDT, 72% CBT) patients were included, with 12.4% patients experiencing the primary outcome. There was no difference in the rates of the primary outcome between CBT versus CDT (11.2% vs. 15.2%, IPTW HR: 0.80; 95% CI: 0.27-2.38, p = 0.69). CBT was associated with a lower risk of hemodynamic decompensation (5% vs. 21.7%, p = 0.036), major bleeding (7.8% vs. 17.4%, IPTW HR 0.26; 95% CI: 0.07-0.95, p = 0.042) and ICH (0 vs. 4.3%, p = 0.024) compared to CDT. Among a real-world cohort of patients with acute PE with higher bleeding risk than PEERLESS undergoing catheter-based therapies, CBT was associated with a lower rate of hemodynamic deterioration, major bleeding, and ICH with similar rate of primary composite outcome when compared with CDT. Additional randomized controlled trials are needed to validate these findings.

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.

In-hospital outcomes of acute aortic occlusion treated by endovascular intervention: A single center study

Background Endovascular intervention by means of thrombolysis is emerging as a promising management of Acute Aortic Occlusion (AAO). This study aims to evaluate the outcomes of endovascular thrombectomy for AAO cases in a single-center tertiary hospital in Indonesia. Methods We review retrospectively AAO patients treated by Rheolytic thrombectomy ± stenting or TEVAR at our referral center from 2011 to 2024. Clinical characteristics and outcomes were analyzed independently and in correlation to one another. Result Out of 21 episodes in 19 patients, AAO was correlated with thromboembolism in 57.1 %, in situ thrombosis in 23.8%, and malperfusion syndrome in 19% of patients. Most prevalent comorbidities found were coronary arterial disease, hypertension, heart failure, and atrial fibrillation. Method of revascularization were Rheolytic thrombectomy (12), covered stent (5), catheter-directed thrombolysis (2), and TEVAR (4) with an average 90.9% success rate. In-hospital mortality was 21% and did not vary significantly according to etiology (thromboembolism 30% vs in situ thrombosis 20%) except for malperfusion syndrome 0% which comprised of four patients. All fatality occurred among patients with history of coronary artery disease and one failed revascularization case required urgent amputation (5.3%). Average length of stay was 8.67 ± 5.31 days. Conclusion Based on our data, thromboembolism remained highly associated with occurrence of AAO. Endovascular approach by Rheolytic thrombectomy is proven to be comparable or slightly superior in restoring occluded aorto-iliac connection compared to conventional management options. Compared to previous studies, this study establishes a wider representation of AAO cases treated by endovascular means considering the rarity of cases.

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

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

Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With vs Without Premorbid Disability in a National Registry.

Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability. We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) ≥3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared ΔmRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, ≥85 years) to explore outcome heterogeneity with vs without premorbid disability. Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS ≥ 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse ΔmRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality pinteraction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including ΔmRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04). Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patients fared better with EVT vs medical management and one-third with prestroke disability returned to their prestroke status.

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.

Outcomes of endovascular thrombectomy for acute ischaemic stroke in patients aged ≥80 years: A Hong Kong stroke center experience

BackgroundElderly patients contribute to the large proportion of ischaemic stroke worldwide. Currently, treatment for elderly stroke remains aggressive, as the exact age cutoff for endovascular thrombectomy (EVT) has not been well established due to a lack of large-scale randomized control trials. In this study we investigate the difference in outcome after EVT in the octogenarian and above, compared to their younger counterparts. MethodsEVT patients were divided into two groups, the octogenarian group and younger group (below age of 80). Primary outcome were the 90-days post-thrombectomy functional independence (modified Rankin scale), and Barthel index. Secondary and safety outcomes of post-thrombectomy were also analyzed, including reperfusion status (modified Thrombolysis in Cerebral Infarction (TICI) score), National Institutes of Health Stroke Scale (NIHSS), major complications and mortality rate. ResultsA total 340 patients were included from 2020 to 29 Feb 2024, and patients’ demographics were obtained. Poorer neurological outcome and functional independence were noted in octogenarian group compared with younger counterpart (OR 0.33; 95 % CI 0.14-0.51; p < 0.001). A slightly higher trend of overall post-procedural death was also identified in elder group compared with the younger group (OR 1.48; 95 % CI 0.85-2.60, p = 0.08). Subgroup analysis with more advanced age cutoff at 90 took a step further and proposed that advanced age resulting in more devastating neurological outcome. ConclusionOutcomes after endovascular thrombectomy in the elder group were significantly worse than their younger counterparts. More than 80 % of elder group who were treated with EVT required moderate functional dependence, and one in four were dead within 90-days post-EVT.

Prolonged intracranial catheter dwell time exacerbates penumbral stress and worsens stroke thrombectomy outcomes

BackgroundThe duration of mechanical thrombectomy (MT) is a negative predictor of outcomes in acute ischemic stroke (AIS), yet the precise mechanisms are unclear. We investigated whether the placement of large-bore...

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

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