Primary Thrombectomy Research Articles

Distal mechanical thrombectomy using beveled tip aspiration zoom catheters: A preliminary study.

Distal medium vessel occlusion (DVO) thrombectomy has been shown to be efficacious with safety profiles comparable to large vessel occlusion (LVO) thrombectomy. A novel, highly-trackable, bevel-tipped Zoom 35 catheter can be used as an aspiration catheter for DVO thrombectomy. This is a retrospective, single-arm, multi-institutional observational study evaluating the efficacy and safety of aspiration thrombectomy for DVO using the Zoom 35 catheter. Patient demographics, presenting and discharge NIHSS, primary and rescue thrombectomy, site of occlusion, TICI score, and intracranial hemorrhage were chart abstracted. Descriptive statistics were used to evaluate the efficacy and safety of thrombectomy. Fourteen patients (mean age 66.64 ± 13.75 years) were included. The mean NIHSS at presentation was 10.79 ± 5.48, and the mean ASPECTS was 9.00 ± 0.89. Nine patients (64.3%) received tPA. Primary occlusion location was M3 in nine cases (64.3%), M2/M3 junction in two cases (14.3%), A2 in one case (7.1%), A3 in one case (7.1%), and P1 in one case (7.1%). TICI scores were 3 in seven cases (50.0%), 2C in three cases (21.4%), and 2B in four cases (28.6%). There was one postoperative SAH (7.1%) and one asymptomatic ICH (7.1%). Mean discharge NIHSS was 3.38 ± 4.44, with a mean decrease of 7.31 from presentation (p < 0.0001, t-test). Zoom 35 beveled-tip aspiration microcatheters are highly trackable and associated with improved radiographic and clinical outcomes for the treatment of DVO with a good safety profile.

Outcome of Secondary Interval Rheolytic Thrombectomy after Localized Intra-Arterial Catheter-Directed Thrombolysis through Power-Pulse Spray Technique in Cases of Partially Successful or Failed Primary Rheolytic Thrombectomy

Abstract Objectives The aim of this study was to evaluate the safety and effectiveness of secondary interval AngioJet rheolytic thrombectomy after localized intra-arterial catheter-directed thrombolysis (CDT) through power-pulse spray (PPS) technique in partially successful or failed primary AngioJet rheolytic thrombectomy cases of acute and subacute peripheral artery thrombosis. Materials and Methods This retrospective study included 12 acute (&lt; 2 weeks) and subacute (2–4 weeks) peripheral arterial thrombosis patients who underwent primary thrombectomy alone without CDT and patients who received secondary thrombectomy after CDT through PPS at our institute between May 2022 and December 2022. Technical success, procedure-related complications (local and systemic), amputations, and 1-year patency were evaluated. Results The angiographic success after primary thrombectomy was evaluated in 12 patients (9 acute and 3 subacute), and the results were categorized into three groups. Of 12 patients, complete success, partial success, and failure were noted in three (25%), five (41.7%), and four (33.3%) patients, respectively, after primary thrombectomy alone. Complete luminal patency was restored in all nine cases of partial success and failure in postprimary thrombectomy through adjunctive PPS thrombolysis and secondary thrombectomy. Technical and clinical success was achieved in all patients (100%). Transient hemoglobinuria was seen in five (41.7%) patients, and all had long-segment occlusion. At 1 year follow-up, no reocclusion, limb loss, or death was noted. Conclusion Complete success after primary thrombectomy was more likely in the setting of short-segment occlusion and small-caliber arteries. In patients with partial success or failure after the primary thrombectomy alone, secondary thrombectomy may be performed after the adjuvant PPS thrombolysis to achieve complete recanalization.

Abstract 116: Reversal of Acute Ocular Ischemic Syndrome Following Rescue Carotid Revascularization: A Case Report

Introduction Ocular ischemic syndrome (OIS) is a rare, vision‐threatening condition resulting from severe carotid artery disease secondary to severe atherosclerosis or arteritis. Common clinical features include acute/subacute to gradual vision loss, ocular pain, amaurosis fugax, photophobia and diplopia. We are presenting a case of acute ocular ischemic syndrome secondary to acute re‐occlusion of the right internal carotid artery (RICA) post Carotid Endarterectomy (CEA), that reversed with carotid revascularization. Methods Case Summary: 59‐year‐old male with history of T2DM, hyperlipidemia, tobacco use presented to an outside hospital with complaints of dizziness, blurry vision, left upper extremity weakness and multiple falls with head trauma. Exam revealed left lower quadrantanopia, mild left arm weakness and left hemineglect. Computed Tomography (CT) Head showed scattered right middle cerebral artery (MCA) territory infarcts. CT Angiography (CTA) revealed ulcerated plaque with a small focus of thrombus intraluminally in the RICA. Subsequently, the patient was initiated on heparin infusion and underwent CEA. On postoperative day (POD) 2, the patient experienced severe stabbing right eye pain with reduced visual acuity and worsening of left arm weakness. Imaging revealed complete occlusion of the right common carotid artery (RCCA). Perfusion imaging did not reveal a core or a penumbra. Given acute loss of vision likely secondary to ocular ischemic syndrome, decision was taken to proceed with rescue stenting. Using a transfemoral approach, an 8‐French balloon guide catheter was advanced into the proximal RCCA. A primary suction thrombectomy was performed under proximal flow arrest. After achieving a complete recanalization in one pass, we started the patient on cangrelor 30 mcg/kg intravenous bolus followed by 4 mcg/kg/min infusion. Post bolus, we placed a tandem closed‐cell carotid stent measuring 8x36mm &amp; 10x37mm. The patient reported immediate relief of ocular pain, vision and weakness following the procedure. He transitioned from cangrelor infusion to ticagrelor 90 mg twice daily and aspirin 81 mg daily. On post‐stenting day 7, the patient experienced acute onset headache, and imaging revealed re‐occlusion of the entire carotid artery sparing only the ophthalmic segment of the RICA which now filled retrograde via anterior communicating artery (AcoA) from the contralateral carotid artery. However, his visual acuity remained unchanged and reported no ocular pain. At one month follow‐up the patient remains symptom‐free. Results Discussion: Incidence of OIS is estimated to be 7.5 cases per million every year. Carotid artery atherosclerosis is the most common etiology. Majority of OIS (∼90%) present with gradual vision loss and approximately 40% present with ocular pain. Gradual vision loss is predominantly related to chronic ocular hypoperfusion and resultant iris neovascularization and glaucoma. In this case, patient suffered acute vision loss secondary to acute ICA occlusion following CEA. Emergent carotid revascularization resulted in restoration of vision and resolution of ocular pain. Conclusion Our main goal is to emphasize the importance of rescue stenting to address symptoms of aOIS. Immediately post‐stenting, there was remarkable improvement in ocular pain and visual acuity. Although, the carotid re‐occluded within seven days post‐stenting, we hypothesize that gradual re‐occlusion while on DAPT provided enough time recruit and preserve collaterals into the right ophthalmic artery via retrograde flow into the ophthalmic segment of RICA from the contralateral carotid artery via the AcoA which was subsequently confirmed on imaging.

Primary Endovascular Thrombectomy in Acute Ischemic Stroke in Patients Ineligible for Intravenous Thrombolysis

Endovascular treatment (EVT) of acute ischemic stroke (AIS) is the main treatment of large vessel occlusion (LVO). Nonetheless, access to EVT is limited specially in developing countries. It is not uncommon in these regions to miss the time window for intravenous thrombolysis (IVT) or to arrive within the IVT window but with a contraindication for it. Hence, a lot of patients with LVO face a situation where either they receive EVT only or conservative management according to available logistics.&#x0D; Aim: To study the outcome of EVT vs best medical treatment (BMT) in two Egyptian stroke centres (Tanta and Alexandria) in AIS patients ineligible for IVT.&#x0D; Results: 390 patients with AIS and LVO were included in the study. 74 underwent EVT while 316 underwent BMT. There were no statistical differences in age, sex, time of onset, initial severity, or imaging scores in both groups. The EVT group had more diabetes mellitus (DM) patients, more smokers and more systolic and diastolic blood pressure (BP) while the BMT had more anticoagulated patients. The EVT group had better functional outcome but more symptomatic intracerebral haemorrhage with no difference in mortality.&#x0D; Conclusion: Endovascular treatment doubles the good functional outcome of AIS in LVO patients but ICH is more with no effect on mortality.

LACE+ is marginally predictive of 30-day readmission after stroke (P11-5.027)

<h3>Objective:</h3> We aimed to investigate predictors of 30-day same hospital readmission after stroke and incorporate these factors in a predictive model. <h3>Background:</h3> Hospital readmissions after stroke is costly and negatively impact outcomes. <h3>Design/Methods:</h3> Patients discharged with a primary diagnosis of ischemic stroke and intracerebral hemorrhage between 1/1/2018 and 12/31/2020 were included. Transient Ischemic Attack (TIA) patients were excluded from the analysis. LACE+ index, age, smoking status, primary care physician (PCP) status, type of stroke, admission National Institute of Health Stroke Scale (aNIHSS), thrombolysis and thrombectomy use were compared between patients with or without unplanned 30-day readmission. Logistic regression was used to generate readmission predictive models. <h3>Results:</h3> A total of 3319 patients were identified. Of these 196 TIA patients were excluded from the analysis. Mean age was 67.8 ± 15.27 years. Readmission rate was 9.5% for the whole cohort (ischemic stroke 7.7% and hemorrhagic stroke 14%). Readmitted patients had a high LACE+ score (≥ 60; 73%), low aNIHSS (0–5; 50%), were smokers (61%) and did not have an established PCP (94%) at the time of index admission. Readmitted patients were also less likely to have received thrombolysis (88%) or thrombectomy (80%) during index admission. Logistic regression incorporating LACE+, aNIHSS and stroke type (hemorrhage) were mildly predictive of 30-day unplanned readmission (Model A; c-stat 0.60). Addition of smoking status, alcohol status, primary care physician status, thrombolysis and thrombectomy use slightly improved the predictive ability of the model (Model B; c-stat 0.62). <h3>Conclusions:</h3> LACE+ is marginally predictive of 30-day unplanned readmission after stroke. Better scores incorporating socioeconomic, neurological and cerebrovascular variables are needed to predict readmission after stroke. <b>Disclosure:</b> The institution of Dr. Khan has received research support from NINDS. The institution of Dr. Khan has received research support from Genentech. The institution of Dr. Khan has received research support from Spectrum Health-MSU alliance. Dr. Khan has received research support from NIH. Mr. Hildreth has nothing to disclose. Dr. Haggerty has nothing to disclose. Dr. Knight has nothing to disclose. Dr. Miller has nothing to disclose. Dr. Tsai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Mrs. Scott has nothing to disclose. Tricia Tubergen has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Mrs. Evans has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Wees has nothing to disclose. Dr. Ahrar has nothing to disclose. Dr. Min has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott . Dr. Min has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic . Dr. DeJesus Brazitis has nothing to disclose. Laurel Packard has nothing to disclose.

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

BackgroundReducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy.MethodsThis is a retrospective review of the...

Complete Recanalization in Mechanical Thrombectomy Is Associated with Favorable Functional Outcome for M2 Occlusions.

There are insufficient coherent reports on mechanical thrombectomy (MT) for occlusion of the second segment of the middle cerebral artery (M2 occlusion) in a real-world clinical setting. We evaluated the efficacy and safety of MT for M2 occlusions and compared the primary thrombectomy strategies (stent retriever, aspiration catheter, and combined technique) to analyze factors predicting good functional outcomes. We evaluated background factors, preprocedural factors, procedural factors, and procedural time for patients who underwent MT for M2 occlusions from our retrospective cohort. According to the modified Rankin Scale (mRS) score three months after MT, patients were divided into good (mRS ≤2) and poor (mRS ≥3) prognosis groups. A total of 29 patients (median age, 78 years; 11 [37.9%] females) were included in the study. In this cohort, rates of successful reperfusion, thrombolysis in cerebral infarction (TICI) 3, postprocedural hemorrhage (PPH), and symptomatic PPH were 82.8, 34.5, 31.0, and 0%, respectively. Good prognoses were achieved in 13 (45%) cases. A prognostic factor of MT for M2 occlusions is TICI 3 from multivariate analysis (OR, 11.7; 95% CI, 1.003-136; p = 0.0497). There was no statistically significant difference in the functional outcome three months after MT based on the choice of the primary thrombectomy strategy. MT for M2 occlusions is a reliable and relatively safe procedure. The presence of TICI 3 was a prognostic factor in this cohort. Future studies are warranted to investigate the optimal thrombectomy strategy for medium vessel occlusion.

WHERE ARE YOU GOING: EMERGENCY MANAGEMENT OF A THROMBUS-IN-TRANSIT WITH PERCUTANEOUS MECHANICAL THROMBECTOMY AT A COMMUNITY HOSPITAL

WHERE ARE YOU GOING: EMERGENCY MANAGEMENT OF A THROMBUS-IN-TRANSIT WITH PERCUTANEOUS MECHANICAL THROMBECTOMY AT A COMMUNITY HOSPITAL

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

BackgroundDirect aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood.MethodsA...

Acute embolic stroke with large-vessel occlusion: does contact aspiration thrombectomy show superiority?

To compare the efficacy between contact aspiration thrombectomy and stent retriever thrombectomy in the treatment of acute embolic stroke patients with large vessel occlusion. Between January 2019 and June 2020, data from consecutive acute ischaemic stroke patients who underwent either endovascular contact aspiration or stent retriever thrombectomy were analysed at one institution. The primary outcome was the full 90-day modified Rankin Scale (mRS) score. Ordinal logistic regression analysis was used to assess the association between thrombectomy approach and functional outcomes. A total of 156 patients were analysed. Among them, 57 (36.5%) patients underwent primary aspiration thrombectomy, while 99 (63.5%) patients underwent primary stent retriever thrombectomy. The median procedure time was significantly shorter in patients treated with aspiration (37 versus 56 minutes; p<0.001). Compared with those of patients who underwent stent retriever thrombectomy, successful recanalisation rates and favourable functional outcome rates were higher in patients who underwent the aspiration approach (94.7% versus 77.8%, p=0.006; 49.1% versus 27.3%, p=0.006, respectively). Ordinal logistic regression analysis showed that aspiration thrombectomy was independently associated with a good functional outcome (adjusted common odds ratio, 0.30, 95% confidence interval: 0.16-0.60, p<0.001). Among the specific patients with large vessel occlusion in acute embolic stroke, the use of aspiration thrombectomy compared with stent retriever thrombectomy resulted in a greater likelihood of favourable neurological outcomes; however, because of study limitations, these findings should be interpreted as preliminary and require further study to confirm these results.

Abstract No. 155 Single-procedure, 8Fr rheolytic pharmacomechanical iliofemoral deep venous thrombectomy: a retrospective study of efficacy, safety and durability

A multicenter randomized controlled trial demonstrated reduction in severity of post-thrombotic syndrome in patients with symptomatic iliofemoral deep vein thrombosis (DVT) following pharmacomechanical thrombectomy/thrombolysis. However, patients in this trial were treated with variable lysis durations, including overnight lytic infusion. Further, the primary thrombectomy device used consisted of a 6Fr rheolytic thrombectomy catheter. Since then, an 8Fr rheolytic system has been developed specifically for deep venous disease, which may improve procedural efficiency and obviate the need for overnight lytic infusion.

Rescue stenting for acute ischemic stroke with refractory emergent large vessel occlusion in the modern thrombectomy era

Background and purposeRescue stenting is used as a bailout technique during mechanical thrombectomy for stroke. We performed a retrospective study analyzing outcomes of patients that received a stent as a bailout measure and compared results to a control group. MethodsWe identified all patients who underwent a mechanical thrombectomy for a large vessel occlusion between January 2010 and October 2019. Subjects with mTICI 0–2 A after at least three passes were defined as failed MT and constituted the control group (NSG-controls). Patients that received a rescue stent (RSG) formed the study group. ResultsComparative analysis of patient demographics between NSG-controls and SRG was performed. Baseline characteristics and comorbidities were not significantly different between both groups. NIHSS at admission and IV t-PA were not significantly different among both groups (16.5 vs. 14.2, p = 0.19) and (39.4% vs. 29.4%, p = 0.30), respectively. There was no significant difference in procedural and post-procedural complications between both the groups. In the RSG, 24 patients (82.4%) achieved favorable revascularization outcomes. NIHSS at discharge (p = 0.01) was higher in the NSG-controls, while favorable functional outcome at three months (12% vs. 39.2%, p = 0.01) was observed at a higher proportion in the RSG. There was also a significant mortality difference, with 15.2% mortality in the RSG compared to 35.1% mortality in the NSG-controls (p = 0.03). In multivariate analysis, stenting was an independent predictor of favorable outcome (OR: 10.0, p = 0.009). ConclusionHerein, we demonstrated that rescue stenting is a feasible, safe, and effective procedure to improve stroke outcomes and should be seriously considered if the primary mechanical thrombectomy is not successful.

Endovascular thrombectomy and repair of suprarenal inferior vena cava thrombosis: A case series.

The objective of this study is to document the combined use of catheter-based thrombectomy/thrombolysis with endovascular repair of high-risk segments of the inferior vena cava in the setting of iatrogenic and traumatic injuries. While the use of endovascular techniques to treat caval thrombosis is well documented and often preferred due to its minimally invasive nature, there is still little literature that focuses on the nuances related to injury of high mortality areas of the IVC as a result of major trauma, transplant, and other surgical interventions. An IRB-approved retrospective review of all patients undergoing IVC thrombectomy was performed at a single tertiary care academic center between January 2018 and July 2021. Cases were subsequently selected based on those who underwent primary mechanical thrombectomy followed by endovascular stenting (or angioplasty). Among this cohort, four patients who underwent this procedure in the context of iatrogenic and traumatic injuries were included. All four patients undergoing primary mechanical thrombectomy followed by endovascular stenting (or angioplasty) due to IVC thrombus and/or stenosis were technically successful with immediate positive clinical outcomes. Mechanical thrombectomy in conjunction with IVC recanalization via stenting may be a useful intervention with promising technical success and positive clinical outcomes for occlusive thrombosis and IVC stenosis.

Primary mechanical thrombectomy for anterior circulation stroke in children: Report of two cases and literature review.

Introduction and importancePediatric acute ischemic stroke is a rare but devastating condition with substantial rates of morbidity and mortality. Endovascular treatment is standard acute revascularization therapy for stroke in adults, but it is not well-studied in pediatrics. We report the successful treatment of two pediatric cases of anterior circulation stroke with primary mechanical thrombectomy.Case presentationTwo Asian children, aged 13 and 8 years, presented to Dr. Soetomo General Academic Hospital in September 2020 and April 2021, respectively, with hemiplegia and significant Pediatric National Institutes of Health Stroke Scale (Ped NIHSS) scores. Head CT scans demonstrated hyperdense middle cerebral artery signs, suggesting large-vessel occlusion stroke. Both patients underwent emergent thrombectomy within 5 and 10 h after initial onset, and successful recanalization was achieved within an hour. Both demonstrated good neurological recovery and there was no recurrent stroke during follow-up.Clinical discussionThrombectomy has appeal for childhood acute ischemic stroke (AIS) due to a longer post-stroke time window for intervention. As the short-term outcome, a significantly reduced Ped NIHSS score is achieved. Long-term outcomes are measured by modified Rankin Scale (mRS) scores. A literature review from 2016 to 2021 yielded 21 pediatric case reports of primary mechanical thrombectomy for anterior circulation stroke (including the present cases). We compare our cases with the published literature to discuss the short-term and long-term outcomes.ConclusionMechanical thrombectomy holds promise as a treatment modality in pediatric AIS. These case reports described successful primary mechanical thrombectomy for AIS treatment in children.

Trends and Outcomes of Uilization of Thrombectomy During Primary Percutaneous Coronary Intervention

BackgroundTo describe the national trends and outcomes of contemporary thrombectomy use for primary percutaneous coronary intervention (PCI) from 2016 to 2018. MethodsWe queried the Nationwide Readmission Database (NRD) from January 2016 to December 2018 to identify patients who underwent primary PCI and thrombectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality and stroke in patients undergoing primary PCI and those who underwent thrombectomy. ResultsWe identified 409,910 total hospitalizations who underwent primary PCI. Thrombectomy was used in 62,446 records (15.2%) with no change in the trend over the study period (p trend = 0.52). Thrombectomy was more utilized in patients who had more cardiogenic shock and use of mechanical circulatory devices. The overall incidence of in-hospital mortality and stroke were 5.6% and 1.1%, respectively. The incidence of in-hospital mortality (6.7% vs. 5.4%, p < 0.001) and strokes (1.3% vs. 1.0%, p < 0.001) were higher in the thrombectomy group. On multivariable regression analysis adjusting for high-risk features, thrombectomy was not independently associated with in-hospital mortality [1.036, 95% CI (0.993–1.080), p = 0.100], but was associated with a higher risk of stroke [OR 1.186, 95% CI (1.097–1.283), p < 0.001]. ConclusionDuring primary PCI, thrombectomy was used in 1 of 6 cases, and its use has been stable over 2016–2018. The use of thrombectomy was associated with a higher risk of stroke, but not in-hospital death.

Bridging Therapy and Occlusion Site Influence Symptomatic Hemorrhage Rate after Thrombectomy: A Daily Practice Study in 623 Stroke Patients

Background: Comparison of symptomatic intracranial hemorrhage (SICH) rates between stroke patients treated with bridging therapy (BT) and primary mechanical thrombectomy (PMT) are scarce and difficult to interpret due to baseline differences between both populations. Methods: Retrospective analysis of patients with acute ischemic stroke treated with endovascular therapy (BT or PMT) was performed at our center between January 2010 and June 2017. Results: Six hundred twenty-three patients were included. Global SICH rate was 9% overall: 6.8% in the PMT group and 12.6% in the BT group. The following factors significantly associated with SICH after multivariate analysis: MCA occlusion (p: 0.047), stroke of unknown origin (p: 0.025), BT (p: 0.024), and procedural time over 65 min (p: 0.027). The following variables presented a statistically significant higher frequency in patients treated with PMT: atrial fibrillation (p: 0.005), anticoagulant medication (p < 0.001), wake-up strokes (p < 0.001), atherothrombotic etiology (p < 0.05), combined thrombectomy technique (p: 0.008), longer procedural times (p: 0.025), and favorable outcome at 3 months (p: 0.011). The following variables presented a statistically significant higher frequency in patients treated with BT: antiplatelet medication (p: 0.048), MCA occlusions (p: 0.017), cardioembolic etiology (p < 0.05), stent retriever/aspiration technique (p: 0.008), and SICH (p: 0.013). Patients with MCA occlusions had twice the risk of SICH after BT than after PMT (16.4 and 8.6%, p: 0.038). Conclusions: In this clinical series, the SICH rate was higher in patients treated with BT than in those treated with PMT. Relevant differences in baseline (related to IVT contraindications) were found between both groups. Randomized studies of BT versus PMT in populations with similar baseline characteristics might be of interest.

MRS SOFIA: a multicenter retrospective study for use of Sofia for revascularization of acute ischemic stroke

BackgroundOver the past several years there has been increased interest in the use of the Sofia aspiration system (MicroVention, Tustin, California) as a primary aspiration catheter.ObjectiveTo perform a multicenter retrospective...

Retrospective Comparative Study for Effectiveness, Procedural Time and Radiation Exposure Between Primary Catheter Aspiration and Mechanical Thrombectomy with Stent Retriever in Ischemic Stroke

Mathkour, Mansour H MD; Gouveia, Edna; Scullen, Tyler MD; Huang, Brendan; Gulotta, Paul; Vidal, Gabriel; Milburn, James; Valle, Edison MD Author Information

Endovascular Thrombectomy for Large Vessel Occlusions in Covid-19 Patients

INTRODUCTIONCovid 19 infections has been shown to be associated with a range of thromboembolic disease that has implications for the neuro-endovascular management of large vessel occlusions.METHODSFive consecutive Covid-19 positive patients presented with large vessel occlusions to our institution. Covid-19 testing was performed using nasal swab. All thrombectomy cases was performed under general endotracheal anesthesia using a stent-aspiration combination as primary thrombectomy technique. The technical details of each case and the angiographic outcome are described. Routine labs including D-dimer, platelet count, coagulation panel (aPTT, INR), Interleukin 6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were evaluated in all patients. Rotational thrombelastography (ROTEM) was performed on the patients' blood samples to assess real-time clot formation/dissolution properties.RESULTSFour patients had anterior circulation large vessel occlusions and one patient had both anterior and posterior circulation occlusions. Mean age was 52.8 years and 80% were males. TICI 3 revascularization was achieved in one patient, TICI 2B achieved in two patients andTICI 2A in two patients. In our cohort, patients were on average 52.8 years old and presented with a median NIHSS of 27. All our patients had very proximal occlusions. Three patients presented with intra-cranial ICA occlusions. Two patients presented with a tandem carotid bulb thrombus in conjunction with an intracranial vessel occlusion. One patient had an ICA terminus occlusion with a concomitant basilar occlusion. Second, the intravascular clots in all our patients were prone to fragment and migrate into both new vascular territories and into distal downstream vasculature. Distal emboli into a different territory (anterior cerebral artery occlusion) was seen in two two of our five patients (40%) and distal emboli into a downstream territory was seen in all five patients (100%). An average of 2.7 pstent-retriever passes was needed to achieve a final TICI revascularization of IIb or better.CONCLUSIONCovid-19 patients are predisposed to a hypercoagulable state. When presenting with large vessel occlusions, these patients present unique challenges that make successful revascularization difficult.

Large Vessel Occlusion Strokes After the DIRECT-MT and SKIP Trials: Is the Alteplase Syringe Half Empty or Half Full?

Large Vessel Occlusion Strokes After the DIRECT-MT and SKIP Trials: Is the Alteplase Syringe Half Empty or Half Full?