Recanalization Rate Research Articles

Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study.

Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support ageneral anesthesia (GA) strategy in these patients. We conducted an international retrospective study of MeVO cases. Apropensity score matching algorithm was used to mitigate potential differences across patients undergoing GA and conscious sedation (CS). Comparisons in clinical and safety outcomes were performed between the two study groups GA and CS. The favourable outcome was defined as amodified Rankin Scale (mRS) 0-2 at 90days. Safety outcomes were 90-days mortality and symptomatic intracranial hemorrhage (sICH). Predictors of afavourable outcome and sICH were evaluated with backward logistic regression. After propensity score matching 668 patients were included in the CS and 264 patients in the GA group. In the matched cohort, either strategy CS or GA resulted in similar rates of good functional outcomes (50.1% vs. 48.4%), and successful recanalization (89.4% vs. 90.2%). The GA group had higher rates of 90-day mortality (22.6% vs. 16.5%, p < 0.041) and sICH (4.2% vs. 0.9%, p = 0.001) compared to the CS group. Backward logistic regression did not identify GA vs CS as apredictor of good functional outcome (OR for GA vs CS = 0.95 (0.67-1.35)), but GA remained asignificant predictor of sICH (OR = 5.32, 95% CI 1.92-14.72). Anaesthetic strategy in MeVOs does not influence favorable outcomes or final successful recanalization rates, however, GA may be associated with an increased risk of sICH and mortality.

Three-year follow-up analysis of automated microfoam preparation system for great saphenous vein incompetence and varicose veins sclerotherapy treatment.

To describe the treatment of patients with great saphenous vein (GSV) incompetence and varicose veins (VVs), utilizing an Automated Microfoam Preparation System (AMPS, Varixio®, VB Devices, Barcelona, Spain). Adults between January and June 2021 were included. The AMPS system was used for foam preparation. Sclerotherapy treatment followed international recommendations. The primary endpoint was GSV closure rate after 36 months. 164 patients were enrolled. During the 7-day follow-up period, all GSVs showed complete closure, which was maintained at the 1-year mark. No major complications were reported. A cumulative complete GSV recanalization rate of 6.1% and a partial recanalization rate of 26.8% after 36 months were noted. Some patients (9.7%) required additional treatment. A higher BMI was associated with complete recanalization. The AMPS offers an easy-to-use and standardized procedure, potentially enhancing treatment outcomes if compared with manual preparation. Caution is advised when treating obese patients.

Modeling Robotic-Assisted Mechanical Thrombectomy Procedures with the CorPath GRX Robot: The Core-Flow Study.

Endovascular robotic devices may enable experienced neurointerventionalists to remotely perform endovascular thrombectomy. This study aimed to assess the feasibility, safety, and efficacy of robot-assisted endovascular thrombectomy compared with manual procedures by operators with varying levels of experience, using a 3D printed neurovascular model. M1 MCA occlusions were simulated in a 3D printed neurovascular model, linked to a CorPath GRX robot in a biplane angiography suite. Four interventionalists performed manual endovascular thrombectomy (n = 45) and robot-assisted endovascular thrombectomy (n = 37) procedures. The outcomes included first-pass recanalization (TICI 2c-3), the number and size of generated distal emboli, and procedural length. A total of 82 experimental endovascular thrombectomies were conducted. A nonsignificant trend favoring the robot-assisted endovascular thrombectomy was observed in terms of final recanalization (89.2% versus manual endovascular thrombectomy, 71.1%; P = .083). There were no differences in total mean emboli count (16.54 [SD, 15.15] versus 15.16 [SD, 16.43]; P = .303). However, a higher mean count of emboli of > 1 mm was observed in the robot-assisted endovascular thrombectomy group (1.08 [SD, 1.00] versus 0.49 [SD, 0.84]; P = .001) compared with manual endovascular thrombectomy. The mean procedural length was longer in robot-assisted endovascular thrombectomy (6.43 [SD, 1.71] minutes versus 3.98 [SD, 1.84] minutes; P < .001). Among established neurointerventionalists, previous experience with robotic procedures did not influence recanalization (95.8% were considered experienced; 76.9% were considered novices; P = .225). In a 3D printed neurovascular model, robot-assisted endovascular thrombectomy has the potential to achieve recanalization rates comparable with those of manual endovascular thrombectomy within competitive procedural times. Optimization of the procedural setup is still required before implementation in clinical practice.

Endovascular Coiling of Ruptured Tiny Saccular Intracranial Aneurysms: A Systematic Review and Meta-Analysis

BackgroundThe safety and efficacy of endovascular coiling of ruptured tiny saccular intracranial aneurysms (IAs) (≤ 3mm) remains unknown. MethodsA comprehensive search of PubMed, Embase, Web of Science, and Scorpus databases up to November 15, 2023 was performed. Pooled prevalence was calculated for occlusion rates, recanalization, retreatment, long-term favorable outcome, and procedure-related complications and mortality. Pooled odds ratios were calculated to compare these outcomes between coiling and stent-assisted coiling (SAC). Results42 studies with 2,174 ruptured tiny saccular IAs treated with coiling were included. The follow-up complete aneurysm occlusion rate was 83.9% (95% CI: 77.2–88.9%). The rates of recanalization and retreatment were 7.7% (95% CI: 5.7–10.2%) and 5.8% (95% CI: 4.5–7.5%). The range of median Hunt and Hess grades was 1.4–2.9 and the favorable outcome rate was 85.6% (95% CI: 81.1–89.2%). The rates of thromboembolism, intraprocedural rupture, and mortality were 4.6% (95% CI: 3.6–5.8%), 5.4% (95% CI: 4.1–7.0%), and 5.6% (95% CI: 4.4–7.2%), respectively. Comparison of coiling and SAC revealed no significant difference, except for a higher likelihood of follow-up complete aneurysm occlusion in SAC (odds ratio [OR] 0.37, 95% CI: 0.17–0.80) and recanalization in the coiling (OR, 3.21 [95% CI, 1.37–7.51]). ConclusionsOur meta-analysis demonstrates that coiling for ruptured tiny saccular IA is a feasible, effective, and safe approach that is associated with favorable clinical outcomes in both the short and long term for patients with mild to moderate Hunt and Hess grades.

Clot composition and recanalization outcomes in mechanical thrombectomy

BackgroundMechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to...

Large vessel occlusive stroke with milder baseline severity shows better collaterals and reduced harm from thrombectomy transfer delays.

Patients with large vessel occlusion (LVO) stroke presenting with milder baseline clinical severity are common and require endovascular thrombectomy. However, such patients are difficult to recognize using pre-hospital severity-based triage tools and therefore are likely to require a secondary inter-hospital transfer if transported to a non-thrombectomy center. Given the potential for milder severity to represent better underlying cerebrovascular collateral circulation, it is unknown whether transfer delays are still associated with poorer post-stroke outcomes in this patient group. We primarily aimed to examine whether the harmful effect of inter-hospital transfer delay for thrombectomy was different for LVO patients with mild or severe deficits. Secondarily, we also investigated whether imaging markers of collateral circulation were different between severity groups. Registry data from two large Australian thrombectomy centers were used to identify all directly presenting and secondarily transferred LVO patients undergoing thrombectomy, divided into those with lower (NIHSS < 10) and higher (NIHSS ⩾ 10) baseline deficits. The primary outcome was the functional independence or return to baseline defined as modified Rankin Scale 0-2 or baseline at 90 days. Patients with complete baseline CT-perfusion data were analyzed for imaging markers of collateral circulation by baseline severity group. A total of 1210 LVO patients undergoing thrombectomy were included, of which 273 (22.6%) had lower baseline severity. Despite similar thrombolysis and recanalization rates, transferred patients had lower odds of achieving the primary outcome compared to the primary presentation to a thrombectomy center, where baseline severity was higher (adjusted odds ratio (aOR) 0.759 (95% CI 0.576-0.999)), but not when severity was lower (aOR 1.357 (95% CI 0.764-2.409), p-interaction = 0.122). In the imaging analysis of 436 patients, those with milder severity showed smaller median ischemic core volumes (12.6 (IQR 0.0-17.9) vs 27.5 (IQR 6.5-37.1) mL, p < 0.001)), higher median perfusion mismatch ratio (10.8 (IQR 4.8-54.5) vs 6.6 (IQR 3.5-16.5), p < 0.001), and lower median hypoperfusion intensity ratio (0.25 (IQR 0.18-0.38) vs 0.40 (IQR 0.22-0.57), p < 0.001). Patients receiving secondary inter-hospital transfer for thrombectomy had poorer outcomes compared to those presenting directly to a thrombectomy center if baseline deficits were severe, but this difference was not observed when baseline deficits were milder. This result may potentially be due to our secondary findings of significantly improved collateral circulation markers in lower-severity LVO patients. As such, failure of pre-hospital screening tools to detect lower-severity LVO patients for pre-hospital bypass to a thrombectomy center may not necessarily deleteriously affect outcome. Anonymized data not published within this article will be made available on request from any qualified investigator.

The effect of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke

Objective To analyze the effectiveness of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke. Methods Markedly effective is defined as an SIS score of over 90, effective is indicated by an SIS score of between 50–90, and a score of below 50 suggests ineffective treatment results. Results ①The treatment’s overall effectiveness in the observation group (91.30%) was significantly higher than that in the control group (75.56%) (p < 0.05). ②The vascular recanalization rate in the observation group (89.13%) was significantly higher than that in the control group (71.11%) (p < 0.05). ③The stent retrieval operation count (2.41 ± 0.23) was significantly lower in the observation group than in the control group (1.29 ± 0.16) (p < 0.05). ④ After treatment, the platelet aggregation rate (10.74 ± 3.95) and NIHSS scores (6.58 ± 1.04) were significantly lower, and the Barthel index (77.86 ± 7.21) was significantly higher in the observation group compared to the control group (26.47 ± 5.12, 7.75 ± 2.36, 68.12 ± 6.15) (p < 0.05). All platelet aggregation rate, NIHSS scores and Barthel Index showed significant improvement after treatment when compared to those before treatment (p < 0.05). Conclusion The combined application of stent retriever mechanical thrombectomy and tirofiban in acute ischemic stroke treatment shows promising effectiveness. Compared to stent retriever alone, tirofiban adjunctive therapy enhances vascular recanalization, reduces retrieval procedures, shortens treatment duration, inhibits platelet aggregation, and improves neurological function recovery, daily living activities, and prognosis. Moreover, it doesn’t significantly increase symptom-related risks.

Timing of acute carotid artery stenting for tandem lesions in patients with acute ischemic stroke: A Maastricht Stroke Quality Registry (MaSQ-Registry) study.

To better understand the influence of treatment strategies on outcomes for patients with tandem lesions undergoing acute internal carotid artery (ICA) stenting during endovascular treatment (EVT), this study compared clinical, technical, and safety outcomes in patients with acute ischemic stroke due to a large vessel occlusion (LVO) who underwent ICA stenting before versus after intracranial thrombectomy. This single-center retrospective cohort study included patients who underwent EVT due to a LVO and periprocedural ICA stenting for significant ICA stenosis or occlusion between September 2020 and January 2023. Data were extracted from the Maastricht Stroke Quality Registry (MaSQ-Registry). Primary outcome was the modified Rankin Scale (mRS) at 3 months. Secondary outcomes included procedure times, number of total thrombectomy attempts, first-attempt excellent recanalization rates (extended Thrombolysis In Cerebral Infarction (eTICI) ≥ 2C after one thrombectomy attempt), and safety outcomes. This study included 50 patients. Thirty-one patients (62%) underwent ICA stenting before intracranial thrombectomy. No significant differences between both groups were found regarding mRS, total procedure time, number of total thrombectomy attempts, first-attempt excellent recanalization, or complications. Time between groin puncture and recanalization (reperfusion time) was significantly longer in patients who had ICA stenting before intracranial thrombectomy versus after intracranial thrombectomy (45 min versus 28 min, P = 0.004). ICA stenting after intracranial thrombectomy in patients with tandem lesions undergoing EVT did not lead to better patient outcomes compared to stenting before intracranial thrombectomy, despite shorter reperfusion times.

Endovascular revascularization of vertebrobasilar tandem occlusions in comparison to isolated basilar artery occlusions: A multi-center experience.

Acute basilar artery occlusion (BAO) is a severe disease that is associated with an 85% mortality rate if untreated. Several studies have analyzed the use of mechanical thrombectomy (MT) in the different scenarios of BAO. However, the results remain conflicting and the role of MT as standard of care for vertebrobasilar tandem occlusions (VBTO) has not been confirmed. Our goal was to assess technical feasibility, safety, and functional outcome of endovascular treatment of VBTO in comparison to isolated BAO (IBAO). We retrospectively reviewed all prospectively collected patients with acute BAO from six tertiary centers between September 2016 and November 2021. Patients were subsequently divided into two groups: VBTO and IBAO. Baseline data, procedural details, and outcomes were compared between groups. A total of 190 patients were included, 55 presenting with a VBTO and 135 with IBAO. Successful recanalization was equally common in both groups (89.1% and 86.0%). Rates of favorable functional outcome (modified Rankin Scale: 0-2) were higher in patients with VBTO compared to IBAO (36.4% vs. 25.2%, p = 0.048) and mortality was lower (29.1% vs. 33.3%). However, these associations faded after adjustment for confounders (adjusted odds ratio [aOR] 0.86, 95% CI 0.35-2.05; aOR 0.93, 95% CI 0.35-2.45). Rates of symptomatic intracranial hemorrhage did not differ between the groups (VBTO: 7.3% vs. IBAO: 4.2%; p = 0.496). Endovascular treatment of VBTO is technically feasible and safe with similar rates of successful recanalization, favorable functional outcome, and mortality to those in patients with IBAO.

Intracoronary microcatheter indwelling for continuous pumping of low-dose thrombolytic drugs: A new approach to reperfusion in acute myocardial infarction.

Reperfusion therapy of acute myocardial infarction (AMI) refers to physical or chemical recanalization and restoration of blood flow to an occluded coronary artery, and current techniques for reperfusion therapy include intravenous thrombolysis, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The number of patients receiving emergency CABG in the real world is decreasing due to the disadvantages of CABG and the improvement in PCI procedures. Thrombolytic therapy has some disadvantages such as low recanalization rate, high risk of reocclusion and bleeding, and short time window. On the other hand, intracoronary interventional therapy may meet the requirements of "early, complete and persistent" patency of coronary arteries at different time points. However, in the emergency PCI, although thrombus aspiration via a catheter or balloon dilation is performed, residual thrombus with heavy or low TIMI (thrombolysis in myocardial infarction) myocardial perfusion grading is still observed in some patients, suggesting disordered microcirculation. Currently, the treatment of microcirculatory disturbance in emergency PCI mainly employed injection of tirofiban, adenosine, thrombolytic agent or other drugs into the local area via a microcatheter in a short time, all of which can significantly reduce the thrombus load and improve TIMI perfusion. Herein, we report that a microcatheter was indwelled in the coronary artery for continuous pumping of low-dose thrombolytic drugs as reperfusion therapy in 12 patients with acute and subacute MI.

Endovascular Thrombectomy for Carotid Pseudo-Occlusion in the Setting of Acute Ischemic Stroke: A Comparative Systematic Review and Meta-analysis.

The effective treatment for patients with acute ischemic stroke (AIS) with cervical internal carotid pseudo-occlusion (cICA-PO) requires comprehensive research on the safety and outcomes of endovascular thrombectomy (EVT). However, there are limited data available, highlighting the need for further research to ensure better treatment strategies and improve the quality of care for these patients. This study aims to assess the management and outcomes in this population group compared with patients with true carotid occlusion. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive systematic review was conducted by using PubMed, Embase, Web of Science, and Scopus from database inception to November 2023. The size of the included studies ranged from 16 patients to 146 patients. Through the 4 full-text articles, a total of 259 patients were collected. We compared outcomes between patients with cICA-PO compared with patients with true carotid occlusions undergoing EVT due to AIS. We excluded studies with patients with carotid pseudo-occlusion without stroke, review articles, duplicate studies, overlapped data that included the same patients presented in another included study, case reports, case series with fewer than 5 patients, and meeting abstracts that did not contain the outcomes of interest. We did not pose any limitations regarding sample size or patient characteristics. We utilized the R statistical software (V.4.3.1; R package meta) to conduct the analysis of all the data obtained. We calculated the OR for binary variables, and the corresponding 95% CI. To synthesize the data, random-effect models, as well as forest plots were generated to visually represent the synthesis of the data. Additionally, we assessed heterogeneity by using Cochran Q and I 2 tests. A P value < .05 for the Q statistic or I 2 more than 50% suggests notable heterogeneity. Based on a small number of studies (<10), the assessment of publication bias could not be reliably performed. This meta-analysis encompassed data from 4 studies. Patients with cICA-PO and AIS who underwent EVT (n = 135) exhibited lower rates of functional independence (OR = 0.35; 95% CI, 0.20-0.61; P < .001) compared with patients with true occlusions (n = 103), as well as successful recanalization rates (OR = 0.39; 95% CI, 0.20-0.74; P = .004). In addition, the cICA-PO group experienced higher mortality and symptomatic intracranial hemorrhage (sICH) compared with the group with true carotid occlusions (OR = 2.62; 95% CI, 0.21-7.24; and OR = 2.23; 95% CI, 1.00-4.95; P = .049, respectively). Individual patient data were not available. Studies were a retrospective design and some of the studies had small sample sizes. The included studies in our meta-analysis did not exclude patients with tandem occlusions that might influence the results of the comparison. Compared with patients with true carotid occlusion, the cICA-PO group with AIS undergoing EVT presented poor outcomes with lower functional independence and successful recanalization, as well as higher sICH and mortality rates.

Flow diverters versus stent-assisted coiling in unruptured intracranial vertebral artery dissecting aneurysms.

Flow diverters (FDs) have been used in unruptured intracranial vertebral artery dissecting aneurysms (IVADAs) with seemingly more favorable outcomes compared with stent-assisted coiling (SAC). However, the benefits of FDs over SAC in unruptured IVADAs need further evaluation. This was a propensity score-matched, retrospective cohort study. Consecutive patients with unruptured IVADAs treated with FDs or SAC at the authors' hospital between January 2016 and December 2020 were reviewed. Propensity score matching at 1:1 was based on age, significant stenosis adjacent to aneurysmal dilatation, maximum diameter, and posterior inferior cerebellar artery involvement. Periprocedural cerebrovascular complications and angiographic and clinical outcomes were compared between the two matched groups. A total of 124 unruptured IVADAs in 123 patients (median age 53 [interquartile range 47-59] years; 101 men) were included. The FD and SAC groups included 65 and 59 IVADAs, respectively. Propensity score matching resulted in 47 matched pairs. The rates of immediate complete occlusion were significantly lower in the matched FD group than in the matched SAC group (6.4% vs 68.1%, p < 0.001). The rates of periprocedural cerebrovascular complications were comparable between the two matched groups (6.4% vs 6.4%, p > 0.99). At last follow-up, the rates of complete occlusion (89.4% vs 80.9%, p = 0.39) and favorable clinical outcomes (100.0% vs 97.9%, p > 0.99) were comparable, whereas the rate of recanalization was significantly lower in the matched FD group than in the matched SAC group (0.0% vs 12.8%, p = 0.03). Although the difference between the rates of in-stent stenosis was not statistically significant (17.0% vs 6.4%, p = 0.18), the difference in the effect measures was considerable. In unruptured IVADAs and compared with SAC, FDs provide comparable rates of periprocedural cerebrovascular complications, favorable clinical outcomes, and follow-up complete occlusion, lower rates of immediate complete occlusion and follow-up recanalization, and likely higher rates of in-stent stenosis.

Factors associated with recanalization and reintervention following below knee polidocanol endovenous microfoam ablation for great saphenous and small saphenous veins

BackgroundPolidocanol endovenous microfoam (PEM) has been used to treat lower extremity venous reflux for almost one decade with specific advantages for below knee (BK) truncal veins where thermal ablation poses a risk of injury to adjacent nerves. The current literature of the BK segment often examines short-term outcomes with modest sample sizes. We aim to identify factors associated with recanalization and reintervention in this subset of patients. MethodsWe performed a retrospective study of a prospectively maintained database of patients from a single institution who underwent 1% PEM ablation for BK great saphenous vein (GSV) and small saphenous vein (SSV) reflux. Patients underwent duplex ultrasound (DU) within 7 days after injection, every 3 to 6 months for 1 year, and every 6 to 12 months thereafter. Patients with symptomatic recanalization underwent reintervention. The 26 patients lost to follow-up without DU after ablation were excluded. The factors associated with recanalization and reintervention were examined by multivariate and nonparametric analyses. ResultsBetween March 2018 and July 2023, 411 patients (166 male, 245 female) with 573 treated limbs (284 right, 289 left) met the study criteria. Of the 573 included limbs, 457 (79.8%) had undergone prior above knee saphenous ablations. A total of 554 BK GSV and 42 SSV ablations were performed. The most recent DU was performed at a mean of 231 ± 329 days. The overall recanalization rate was 10.6% (55 GSVs and 8 SSVs) at a mean follow-up of 104 ± 180 days. Comparing the closed and recanalized veins, we found no significant difference in age (P = .90), treated laterality (P = .14), patient body mass index (P = .59), preprocedural CEAP (clinical-etiology-anatomy-pathophysiology) score (P = .79), recanalization rate in GSVs vs SSVs (P = .06), or administered PEM volume (P = .24). The recanalized veins had significantly larger preprocedural diameters than the veins that remained closed (recanalized, 4.9 mm; closed, 4.3 mm; P = .001). Men had higher incidence of recanalization than women (men, 14.2%; women, 8%; P = .015). Anticoagulation use was associated with recanalization (odds ratio, 1.96; 95% confidence interval, 1.1-3.6; P = .03). Early recanalization at the first DU accounted for 31 failures (49.2%) and had a significantly lower administered PEM volume compared with later recanalization (early, 4 mL; late, 5 mL; P = .025). There were no significant differences between the 33 recanalized patients requiring reintervention (52.4%) and the 30 who did not. Twenty-four reinterventions were performed with PEM, 100% of which remained closed at a median of 160 days (interquartile range, 257 days). ConclusionsPEM is successful for the treatment of BK GSV and SSV reflux with a closure rate of 89% at a mean of 231 days and shows promise as salvage therapy. Most cases of recanalization were noted in the early postprocedure period and were associated with a lower PEM volume. A larger vein diameter, male sex, and anticoagulation use are associated with higher rates of recanalization.

The impact of regular aspirin use on aneurysm recanalization rates after endovascular coiling.

Intracranial aneurysms (IAs) pose a significant health risk, often leading to subarachnoid hemorrhage and severe neurological outcomes. Endovascular coiling has been a principal treatment method, but it comes with the challenge of high recanalization rates. Aspirin has recently emerged as a potential agent to reduce these rates. In this study, the authors aimed to investigate the impact of regular aspirin use on aneurysm recanalization rates following endovascular coiling in a 10-year single-institution study. A retrospective analysis was conducted on a dataset of 2236 aneurysms treated by a single neurosurgeon over a period of 10 years. The primary outcome measure was aneurysm recanalization, defined by a change in the Raymond-Roy Occlusion Classification of at least one grade. A total of 525 aneurysms were coiled, 109 of which involved patients who reported regular use of aspirin. The recanalization rate was significantly lower in the aspirin group (9.2%) compared with the control group (23.6%) (OR 0.33, 95% CI 0.15-0.66; p = 0.001). On analysis of the specific mechanisms of recanalization, aneurysm sac growth was less frequent in the aspirin group (5.5%) compared with the control group (18%) (OR 0.265, 95% CI 0.09-0.63; p = 0.002). Additionally, patients in the control group had a higher retreatment rate (18%) than patients in the aspirin group (5.5%) (OR 0.265, 95% CI 0.09-0.63; p = 0.002). Regular use of aspirin appears to be associated with reduced rates of aneurysm recanalization after endovascular coiling. However, caution is advised in interpretation of these results given the retrospective nature of this study. Further randomized controlled trials are needed to confirm these findings.

Enterprise stents for the treatment of symptomatic non-acute intracranial artery stenosis disease: safety and efficiency evaluation

ABSTRACT Background Enterprise stent was approved for the treatment of wide-necked intracranial aneurysms. However, it has been widely used in the endovascular treatment of intracranial artery stenosis, which is still controversial. The purpose of this study was to evaluate the safety and efficiency of the Enterprise stent in the endovascular treatment of intracranial artery stenosis disease. Methods We conducted a retrospective case series of 107 patients with intracranial artery stenosis who received Enterprise stent implantation at Nanjing Drum Tower Hospital from January 2020 to December 2022. The rates of recanalization, perioperative complications, in-stent restenosis at 3–12 months and stroke recurrence were assessed for endovascular treatment. Results A total of 107 individuals were included in this study, 88 were followed up, and 19 (17.8%) patients were lost to follow-up. The operation success rate was 100%, During the procedure,4（3.7%）patients had vasospasm, and 2(1.9%) patients showed symptomatic bleeding. The overall perioperative complication rate was 5.6%, including 2.8% distal artery embolism, 0.9% in-stent thrombosis, and 1.9% symptomatic bleeding. 88 (82.2%) patients were followed up from 3 to 12 months, of whom 12 (13.6%) had in-stent restenosis, 4 (4.7%) recurrent strokes and 2 died of pulmonary infection caused by COVID-19. Patients were divided into 3 groups according to the cerebral artery, including the middle cerebral artery group, internal carotid artery group, and vertebrobasilar artery group. Conclusions In this study, the placement of the Enterprise stent in patients with symptomatic non-acute intracranial stenosis was successful. However, the occurrence of periprocedural and long-term complications after stenting remains of high concern.

214 Technical and Clinical Outcomes in Patients With Short-term Repeated Mechanical Thrombectomy: An International Multicenter Study

INTRODUCTION: Endovascular thrombectomy (EVT) remains the standard of care for acute large vessel occlusion (LVO) stroke. However, the safety and efficacy of repeat EVT (rEVT) in recurrent LVO remains unclear. METHODS: Data were included from the Stroke Thrombectomy and Aneurysm Registry (STAR) with 21 stroke centers for EVT performed to treat LVO stroke from 2013-2022. Patients undergoing single or rEVT within 30 days were included. Propensity score matching was used to compare patients undergoing single versus rEVT. The primary outcome was the modified Rankin score(mRS) at 90 days, and secondary outcomes were successful recanalization, postprocedural hemorrhage and mortality. RESULTS: Out of a total of 7387 patients who underwent EVT for LVO stroke, 90(1.2%) patients underwent rEVT for the same vascular territory within 30 days. The average time to re-occlusion was 5.3±7.3 days, and 41(45.6%) patients required rEVT within 24hrs. Patients undergoing rEVT had comparable rate of good functional outcome and mortality rate, but with but higher rate of symptomatic intracranial hemorrhage compared to a matched cohort of patients undergoing single procedure. There was a significant reduction in NIHSS before rEVT and at discharge (ΔNIHSS=(-)5 ± 1; p = 0.006). The rate of successful recanalization was similar in single and rEVT groups (78% versus 80%, p = 0.78) and between index and rEVT performed on the same patients (79% versus 80%; p = 0.78). CONCLUSIONS: Short-term rEVT is associated with comparable functional outcomes but with higher rate of hemorrhagic conversion compared to patients undergoing single EVT.

156 Stenting of Intracranial Stenosis With a Fibrin-heparin Coated Stent Multicentre Experience

INTRODUCTION: Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke due to large vessel occlusions (LVO). However, in up to 30% MT may not result in successful recanalization due to an underlying stenosis or clot recalcitrant to retrieval. Bail-out stenting has been reported to be a treatment option to achieve permanent recanalization. METHODS: We retrospectively analysed data from 16 stroke centres. Patients treated with the CREDO heal Stent were divided into two groups: symptomatic high-grade intracranial stenosis (sICAD group) and persisting LVO due to underlying stenosis after at least one mechanical thrombectomy attempt (Rescue Stenting group). Primary endpoints were the improvement of stenosis grade and the rate of successful recanalization after stenting defined as mTICI = 2b for the sICAD and the Rescue Stenting group respectively. Favourable neurological outcome was defined by modified Rankin Score (mRS) at 90 days. RESULTS: 121 patients were treated from 2021-2023 with the CREDO heal Stent. Rescue stenting and sICAD treatment was performed in 82 and 39 cases respectively. Overall, a final TICI = 2b score was achieved in 94.5%. In 14% periprocedural complications occurred were in-stent thrombosis accounted for 6.3% (rescue stenting group). The mean stenosis grade in the sICAD group was 90% before and 15% after PTA and stenting. On follow-up (n = 27) restenosis was observed in 2.8%. CONCLUSIONS: The CREDO® heal stent offers a new treatment option for patients with sICAD or with persistent occlusion during thrombectomy procedures. The final mTICI sore is in accordance with uncoated devices. The rate of restenosis is low compared to previous trials. Its effectiveness with regard to long-term ischemic complications has to be evaluated in the prospective ReCHRUT trial.

420 Decrease in Post-Coiling Aneurysm Recanalization With Regular Aspirin Use

INTRODUCTION: Endovascular coiling has remained an efficacious mechanism for aneurysm treatment. While continued biomechanical advancements in coil design have led to improved aneurysm embolization rates (1), aneurysm recanalization is estimated to remain between 21-33% (2, 3, 4). Post-occlusion, cerebral aneurysm sac growth has been identified as one of the driving components of aneurysm recurrence (2, 5). Recently, antiplatelet agents such as aspirin (ASA) have been shown to be significantly associated with decreased aneurysm growth and rupture (6, 7, 8). METHODS: All aneurysms treated by a single surgeon over 10 years (n = 2236) were screened for adherence to inclusion criteria. The primary endpoint was follow-up more than 12 months from the original intervention. Of 525 treated with coils only, 109 patients reported regular ASA use (defined as = 3x/ week, irrespective of dose). No significant demographic differences were identified between patients with regular ASA use and those without. While there were no significant differences in aneurysm size, location, or history of rupture, there was an increased presence of daughter sacs in patients without regular ASA. Rates of aneurysm recanalization, defined as a change of Raymond-Roy occlusion classification =1, were compared between ASA-treated and non-ASA-treated groups. RESULTS: Of the 109 coiled aneurysms with concomitant regular ASA use, only 9.2% underwent recanalization compared to 23.6% in patients without regular ASA use (P = 0.001, OR = 0.33, 95% CI = 0.15–0.66). Furthermore, when specifically considering cases of recanalization that only demonstrated sac growth, 5.5% occurred with regular ASA use compared to 18% without (P = 0.001, OR = 0.26, 95% CI = 0.09–0.63). CONCLUSIONS: ASA use significantly decreased the odds of post-coiling aneurysm sac growth and recanalization 12 months post-original intervention when compared to those without regular ASA use.

Co-relation of Portal Vein Tumour Thrombus Response With Survival Function Following Robotic Radiosurgery in Vascular Invasive Hepatocellular Carcinoma

Purpose or ObjectiveProspective evaluation of stereotactic body radiotherapy (SBRT) with Robotic Radiosurgery in hepatocellular carcinoma patients with macrovascular invasion (HCC-PVT). Materials and MethodsPatients with inoperable HCC-PVT, good performance score (PS0-1) and preserved liver function (up to Child Pugh B7) were accrued after ethical and scientific committee approval [CTRI: 2022/01/050234] for treatment on Robotic Radiosurgery (M6) and planned with Multiplan (iDMS V2.0). Triple-phase contrast computed tomography (CT) scan was done for contouring and gross tumor volume (GTV) included contrast enhancing mass within main portal vein and adjacent parenchymal disease. Dose prescription was as per risk stratification protocol (22- 50Gy in 5 fractions) while achieving the constraints of mean liver dose <15Gy, 800 cc liver <8Gy and the duodenum max of <24 Gy). Response assessment done at 2 months follow up for recanalization. Patient and treatment related factors evaluated for influence in survival function. ResultsBetween Jan 2017 till May 2022, 317 consecutive HCC with PVT patients were screened and 219 patients were accrued [male 92%, CP score 5-7 90%, mean age 63 years (38-85yrs), CLIP <3: 84 (40%), 3-6 117 (56%), infective etiology 9.5%, Performance status (PS) 0-37%; 1-56%]. Among 209 consecutive patients after accrual SBRT treatment done (10 patients were excluded after accrual due to ascites and decompensation), 139 were evaluable for response assessment (>2 mo follow up). At mean follow up of 10.2 months (SD 8.43), 88 (63%) patients expired and 51 (36%) were alive. 82 (59%) patients had recanalization of PVT (response), 57 (41%) pts did not recanalize, 28 (17%) had progressive disease had progressive/metastatic disease prior to response evaluation (<2 months). Mean overall survival in responders and non-responders were 18.4 (SE 2.52) and 9.34 month (SE 0.81) respectively (p<0.001). Mean survival in patients with PS0, PS1 and PS2 were 17, 11.7 and 9.7 months (p- 0.019) respectively. Overall survival (OS) in partial recanalization, bland thrombus and complete recanalization was 12.4, 14.1, 30.3 months respectively (p-0.002). Adjuvant sorafenib, Barcelona Clinic Liver Classification (BCLC) stage, gender, age, RT dose did not influence response to treatment. Recanalization rate was higher in good PS patients (p-0.019). OS in patients with response to treatment, no response to treatment, fit but not accrued and not suitable patients were 18.4, 9.34, 5.9, 2.6 months respectively (p-<0.001). 36/139 patients (24%) had RILD [10 (7.2%) had Classic Radiation induced liver disease (RILD) & 26 (19%) had non-classic RILD]. Derangement in Child Pugh Score (CP score change) by more than 2 was seen in 30 (24%) within 2-month period after Robotic Radiosurgery. 18 (13%) had unplanned admissions, two patients required embolization due to fiducial related bleeding, 20 (14%) had ascites of which 9 (6%) patients required abdominocentesis. ConclusionPVT response or recanalization after SBRT is a statistically significant prognostic factor for survival function in HCC-PVT.

Combined Aspiration and Stent Retriever Thrombectomy for Distal Carotid Artery Occlusion Using Balloon Guide versus Non-Balloon Guide Catheter.

Background: The introduction of endovascular thrombectomy dramatically changed acute stroke management and became the standard treatment. Balloon guide catheters provide flow arrest during the clot retrieval process and have several advantages.This study aimed to compare balloon guide catheters (BGCs) versus non-balloon guide catheters (NBGCs) as a part of a combined treatment modality in patients presenting with acute ischemic stroke. Methods: This retrospective study included n = 65 patients who underwent a combined endovascular stroke treatment for distal internal carotid artery (ICA) occlusion. Patients underwent aspiration and stent retriever thrombectomy with the use of BGCs (Group 1, n = 27) or NBGCs (Group 2, n = 38). Results: The groups were compared for outcomes: the National Institutes of Health Stroke Scale (NIHSSS) score change, successful recanalization, good functional outcome at three months, and in-hospital mortality. Conclusion: The two groups didn't differ in terms of the NIHSS score change compared to baseline (p > 0.05). Moreover, there were no significant differences between the two groups in terms of the successful recanalization rate, three-month favorable functional outcome rate, and in-hospital mortality (p = 0.292, p = 0.952, p = 0.178), respectively. Further prospective studies with a larger number of patients and better methodology are warranted.