Stent Thrombectomy Research Articles

Analysis of gradual diameter thrombectomy stent in vitro

Abstract Objective To analyze the effect of gradient thrombectomy stent in vitro. Methods The cerebrovascular fluid circulation model was made and fixed on the test table. About 0.9% sodium chloride injection was injected to the vascular model through a miniature water pump to circulate it. Four kinds of thrombus products containing different red blood cell (RBC) volumes of 0, 5, 40, and 80% were placed at the target location as thrombus. Each type of thrombus was removed five times using SOLITAIRE stent and gradient thrombectomy stent. The thrombectomy effects were observed by comparison of the two types of stents. Results Thrombus containing 80% volume of RBC escaped thrombus fragments during thrombectomy with both stents. Thrombus containing 0% volume of RBC (rich in fibrin) had poor chimerism with stents. In the thrombus containing 0% RBC volume, there was no statistically significant difference between the two stents (p = 1). Thrombus removal was successful in all cases. Conclusion The gradient thrombectomy stent is as effective as the currently used thrombectomy stent in vitro studies, and there is much room for improvement.

Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke.

This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS). Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment. A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference (P>0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group. Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.

Abstract 335: National Patterns Of Carotid Artery Stenting Utilization In Mechanical Thrombectomy Stroke Patients in the US

Background Patients with large vessel occlusion due to high‐grade extracranial carotid stenosis may requireadjunctive carotid artery stenting (CAS) plus mechanical thrombectomy (MT) to prevent acuteischemic stroke (AIS) recurrence. Population‐level data on contemporary CAS utilization in MTare lacking. This study describes CAS utilization trends in MT patients in the United States (US)over the last decade. Methods We conducted a serial cross‐sectional study utilizing the 2010‐2021 National Inpatient Sample.All adult (>=18 years) primary MT admissions with and without CAS were identified usingInternational Classification of Diseases codes. Age and sex‐ specific prevalence of CAS in MTwere computed. Multivariable‐adjusted negative binomial regression models were used tocompare prevalence of CAS between various demographic subgroups and to compare in‐hospitalmortality or good outcome (routine home discharge) rates between CAS versus non‐CAS MTadmissions. Results Of 5,927,384 weighted AIS admissions from 2010‐2021, 195,677 (3.3%) underwent MT. 6.4%of these MT admissions underwent CAS but this proportion deferred significantly by age and sex(Figure 1a). Highest frequency of utilization was in men 60‐79 years (10.1%) and lowest use inwomen >=80 years (1.9%). (Figure 1a). Annual CAS volume in MT increased from 186 casesannually in 2010 to 2,340 cases in 2021, but the overall utilization rate of all MTs did notincrease significantly over time (Figure 1b). 85.4% of these procedures were performed on thesame day as MT and only 14.6% were performed on different days. 12.7% of CAS admissionshad carotid dissection vs 2.5% in the non‐CAS group. Only 0.4% of MT had carotidendarterectomy. After multivariable adjustment for clinical and hospital‐level factors, womenhad ≈50% lower prevalence of CAS vs men (adjusted prevalence ratio (APR) 0.51, 95%CI 0.46‐0.55) and Black admissions had 43% lower prevalence of CAS vs White admissions (APR 0.57,95%CI 0.49‐0.66). In multivariable models that included the National Institute of Health StrokeScale and other clinical factors CAS utilization was not associated with in‐hospital mortality(APR 0.86, 95%CI 0.72‐1.03) or good outcome (APR 0.93, 95%CI 0.85‐1.02) Conclusion Just over 6% of MT admissions across the period 2010‐2021 in the US underwent CAS. CASutilization rate did not change over time, but volume of utilization has increased by over 10‐fold,accompanying the increase in MT that has occurred over time. CAS is more frequently utilized in men and in White admissions in the US compared to women and Black admissions,respectively.

Single-Center Experience With Endovascular Therapy in Acute Occlusion of ICAS: Preferred Stent Thrombectomy Versus Preferred Angioplasty.

The preferred endovascular therapy (EVT) for large-vessel occlusion in intracranial atherosclerosis (ICAS) is unknown. We compared the efficacy of preferred stent thrombectomy and preferred angioplasty in patients with acute large-vessel occlusion in ICAS. Data from consecutive EVT patients (May 2020 to September 2023) with acute middle cerebral artery occlusion in ICAS were retrospectively analyzed. Preferred angioplasty was performed if there was a preoperative "microcatheter first-pass effect;" otherwise, preferred stent thrombectomy was performed. Analyses were grouped according to the two EVT treatments. Clinical data of all patients, including the time from puncture to recanalization, rate of successful reperfusion, early neurological improvement, intracranial hemorrhage, and modified Rankin Scale score at 90 days, were recorded and analyzed. Six-two patients were enrolled in this study (mean age was 60.66±13.21y, 22.6% female). The preferred angioplasty group had a higher first-pass recanalization rate than the preferred stent thrombectomy group (61.3% vs. 21.9%, P <0.001) and a higher proportion of patients who were functionally independent (defined as a modified Rankin Scale score of 0 to 3) at 90 days [odds ratio,3.681; 95% confidence interval (CI):1.009 to 13.428; P =0.048]. There was no significant difference between the groups in the time from puncture to recanalization, the frequency of successful reperfusion, and early neurological improvement, or intracranial hemorrhage ( P >0.05). This study suggests that for acute middle cerebral artery occlusion in ICAS, preferred angioplasty may be a safe and effective procedure.

Extracorporeal membrane oxygenation states basilar artery thrombectomy and left posterior cerebral artery stent thrombectomy: A case report

BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a new type of extracorporeal respiratory and circulatory assistance device. It can drain venous blood out of the body and inject it into veins or arteries after being oxygenated by an oxygenator (membrane lung) to replace lung and heart functions in a short time. ECMO can provide tissue blood perfusion and gas exchange almost equivalent to cardiac output and extend the effective treatment time window for patients with acute circulatory failure to restore cardiopulmonary function. CASE SUMMARY We report a case of an 81-year-old woman who underwent whole cerebral angiography, basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain after implantation of ECMO. The patient was admitted to the hospital due to myocardial infarction. Considering that the cause of the patient’s disturbance of consciousness was unknown and cerebrovascular accident could not be ruled out after the implantation of ECMO, the department of Radioactive Intervention performed cerebral angiography. And the result of the angiography indicated vascular occlusion. After the basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain, the patency of the occlusive vessel was achieved. CONCLUSION Although the patient eventually died of circulatory failure, the result of this case verifies the feasibility of cerebral angiography and thrombectomy in patients with implanted ECMO in the intubated state.

Clinical and safety outcomes of acute stenting plus thrombectomy for carotid tandem lesions with large ischemic core

BackgroundWe evaluated the clinical and safety outcomes of emergent carotid artery stenting (eCAS) plus endovascular thrombectomy (EVT) among patients with anterior tandem lesion (TL) and large ischemic core (LIC).MethodsThis retrospective...

An Institutional Perspective on the Number of Stent Retriever Pass and Rate of Recanalization in Mechanical Thrombectomy for Acute Ischemic Stroke: When to Stop?

Mechanical thrombectomy is the standard treatment modality for flow restoration in acute ischemic stroke. In cases of persistent occlusion, the optimal number of retrieval attempts before considering procedure termination is currently undetermined and is a topic for research. Therefore in this study, we studied the impact of the number of stent retrieval maneuvers on the recanalization of vessels. In this retrospective single-center observational study we included 52 patients with large vessel occlusion who underwent stent retriever mechanical thrombectomy. Successful recanalization rate was defined as modified TICI (Thrombolysis in Cerebral Infarction) 2b or 3. The overall successful recanalization rate was 44.24%. The recanalization rate per stent retrieval attempt was the highest in 1st attempt (28.84%) and no recanalization was observed with the 3rd, 5th, and 6th attempts (p<0.001). At most 6 retrieval attempts were used. After two retrieval attempts, 91% of the patients were successfully recanalized and other after the 5th attempt could not result in recanalization.

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.

Fubuki XF Long Sheath guide catheter use in neuroendovascular procedures: Institutional experience in 60 cases.

Endovascular treatment devices require compatible guide catheters to navigate complex vessels and anatomy. The Fubuki XF Long Sheath guide catheter (Fubuki XF) was developed with a 0.090-inch internal diameter with hydrophilic coating, an atraumatic rounded tip, and enhanced trackability and support with gradual shaft transition zones. We retrospectively analyzed a prospectively maintained database of neuroendovascular patients treated using Fubuki XF at our center (July 2022─May 2023). Baseline/procedural characteristics were collected. Outcomes of interest included technical success (procedure completion with Fubuki XF without alternative guide catheter use) and peri-procedural complications. This study included 60 patients (43.3% [26/60] female; mean age: 69.6 ± 9.7) presenting with stenosis (45.0% [27/60]), unruptured aneurysms (31.7% [19/60]), ruptured aneurysm (1.7% [1/60]), arteriovenous fistula (5.0% [3/60]), arteriovenous malformation (3.3% [2/60]), chronic subdural hematoma (3.3% [2/60]), stroke/emboli (6.7% [4/60]), vasospasm (1.7% [1/60]), or carotid web (5.0% [1/60]). Fubuki XF was used to deliver endovascular treatment devices for stenting (43.3% [26/60]), flow diversion (23.3% [14/60]), embolization (11.7% [7/60]), coiling (10.0% [6/60]), balloon angioplasty (10.0% [6/60]), and mechanical thrombectomy (1.7% [1/60]). The Fubuki XF tip was placed in the internal carotid artery in 38.3% (23/60) of cases. Technical success was achieved in all cases. One V1 non-flow-limiting dissection (not related to Fubuki XF) and one failed closure occurred (1.7% [1/60] each). No iatrogenic strokes or intraprocedural ruptures occurred. We used Fubuki XF to safely and effectively deliver a variety of compatible neuroendovascular devices. Fubuki XF was stable in all cases and locations, and there were no device-related complications or dissections.

705 Urgent or Emergent Endovascular Intervention for Neurological Deficits Post-carotid Endarterectomy: A Single-institutional Case Series and Systematic Review of the Literature

INTRODUCTION: Historically the management of acute neurological deficit following carotid endarterectomy (CEA) has been operative re-exploration; however, given the proliferation of endovascular techniques, and utilization of CT angiography, endovascular intervention is an alternative to redo-CEA. METHODS: All patients undergoing CEA in the Department of Neurosurgery at Rhode Island Hospital (Providence, RI) were reviewed. A systematic literature review was conducted in PubMed according to PRISMA guidelines to identify papers relevant to endovascular procedures addressing acute neurological deficits following CEA, which yielded 2499 unique articles. Review by 2 investigators revealed 12 relevant articles. RESULTS: Four patients from our institutional cohort met inclusion criteria. Among these, stenting was technically successful in 3 patients, 2 of which achieved near-full recovery. One patient underwent successful carotid stenting and ipsilateral M2 thrombectomy for tandem occlusion. Stent placement was unsuccessful in the remaining patient due to mechanical constriction. Articles obtained through the literature review revealed 57 further relevant cases. Of those with sufficiently complete data, 30/39 (76.9%) were male with an age range of 43 - 78 years old. Twenty-eight of 32 (87.5%) patients underwent CEA for symptomatic carotid stenosis. Post-CEA angiographic evaluation was most commonly conducted for routine completion imaging (21/57, 36.8%), non-specific stroke symptoms (15/57, 26.3%), and extremity weakness (7/57, 12.3%). Thrombotic stenosis (23/43, 53.4%) and arterial dissection (15/43, 34.9%) were the most common angiography findings. Two (3.5%) stent procedures were unsuccessful, and in the immediate postoperative period 8 patients (14.0%) had significant neurological deficits and only 3 deaths (5.3%) were reported. CONCLUSIONS: Endovascular intervention may be considered in situations where patients have neurological deficit after CEA. Direct comparison of outcomes in patients who have endovascular intervention vs. redo CEA may help identify the optimal management strategy.

Importance of cerebral angiography in the evaluation of delayed carotid stent thrombosis: a case report

BackgroundWhile noninvasive imaging is typically used during the initial assessment of carotid artery disease, digital subtraction angiography remains the gold standard for evaluating carotid stent thrombosis and stenosis (Krawisz in Cardiol Clin 39:539–549, 2021). This case highlights the importance of digital subtraction angiography for assessing carotid artery stent patency in place of non-invasive imaging.Case presentationWe present a 61-year-old African American male patient with a history of right cervical internal carotid artery dissection that was treated with carotid artery stenting and endovascular thrombectomy, who developed recurrent right hemispheric infarcts related to delayed carotid stent thrombosis. Digital subtraction angiography found multiple filling defects consistent with extensive in-stent thrombosis not clearly observed with magnetic resonance angiography. Etiology was likely secondary to chronic antiplatelet noncompliance. Therefore, the patient was treated medically with a heparin drip, and dual antiplatelet therapy (dAPT) was restarted. At 1-month follow-up the patient did not report new motor or sensory deficits.ConclusionIn the setting of delayed carotid stent thrombosis secondary to antiplatelet noncompliance, digital subtraction angiography may play an essential diagnostic role for early identification and determination of the most appropriate treatment.

Effects of Solitaire AB stent thrombectomy with tirofiban and butylphthalide on neurological function and inflammatory factors in acute cerebral infarction patients

Background Acute cerebral infarction profoundly affects patients’ neurological function and quality of life. This study explores the impact of Solitaire AB stent thrombectomy, combined with tirofiban and butylphthalide, on neurological function and inflammatory factors in patients with acute cerebral infarction. Methods Seventy-three eligible patients treated between 2021 and 2023 were divided into a control group (Solitaire AB stent thrombectomy) and a treatment group (Solitaire AB stent thrombectomy with tirofiban and butylphthalide). Postoperative neurological function scores and inflammatory factor levels were analyzed. Results The treatment group demonstrated a higher clinical effective rate, lower National Institutes of Health Stroke Scale scores at one day and seven days and higher Mini-Mental State Examination and Montreal Cognitive Assessment scores post-treatment. Inflammatory factor levels (Neuron Specific Enolase (NSE), S100-β, TNF-α and IL-6) were lower in the treatment group. No significant differences in adverse outcomes were observed. Conclusion Solitaire AB stent thrombectomy with tirofiban and butylphthalide shows superior efficacy, improving neurological function and inflammatory factors without increasing adverse outcomes. This offers valuable insights for clinical treatment of acute cerebral infarction.

Relationship between blood glucose variation, collateral circulation and Batman score and prognosis after mechanical thrombectomy with Solitaire stent in acute posterior vascular occlusive stroke

Objective: To explore the relationship between blood glucose variability, collateral circulation and basilar artery computed scan angiography score (Batman) and prognosis of mechanical thrombectomy with Solitaire stent in patients with large vascular occlusive APCI. Methods: A retrospective study was conducted on 113 patients with large vessel occlusive APCI who underwent Solitaire stent mechanical thrombectomy in the Department of Neurology of Nanyang Central Hospital from March 2021 to July 2022. According to the prognosis, they were divided into outcome group (46 cases) and adverse group (67 cases). Evaluate the prognosis based on the Modified Rankin Scale three months after the surgery. The differences in collateral circulation, GV and Batman score between the two groups were compared, and the related factors affecting the prognosis of large vessel occlusive APCI patients treated with Solitaire stent mechanical thrombectomy were analyzed by multivariate logistic regression model. Results: The age of 113 patients with acute large vessel occlusive APCI was (65.3±8.9) years old. The proportion of female was 34.5% (39 cases). Compared with the outcome group, the adverse group had a lower proportion of collateral circulation [40 cases (87.0%) vs 47 cases (70.2%)], higher GV score [(25.19±3.54) vs (30.36±4.11) points], lower Batman score [(7.49±1.52) vs (6.65±1.33) points], higher proportion of atrial fibrillation history [16 cases (23.9%) vs 4 cases (8.7%)], higher National Institutes of Health Stroke Scale (NIHSS) score at admission [(8.33±0.74) vs (7.25±0.92) points], larger core infarct volume [(32.57±4.87) vs (29.54±5.14) ml], and longer time from admission to vascular recanalization [(123.52±31.17) vs (102.47±29.54) min] (all P<0.05). Atrial fibrillation history, core infarct volume, NIHSS score at admission, time from admission to vascular recanalization, glycemic variability, collateral circulation, and Batman score were related factors for the prognosis of large vessel occlusive APCI patients treated with Solitaire stent mechanical thrombectomy, with ORvalues (95%CI) of 1.383 (1.124-1.641), 1.166 (1.007-1.350), 4.777 (1.856-12.297), 3.068 (2.379-3.757), 1.477 (1.209-1.806), 0.742 (0.654-0.831), and 0.717 (0.214-1.221), respectively (all P<0.05). Conclusion: Blood glucose variation is a risk factor for prognosis of mechanical thrombectomy with Solitaire stent in patients with large vascular occlusive APCI, and collateral circulation and Batman score are protective factors.

Mechanical thrombectomy for acute left middle cerebral artery occlusion in a patient with mirror- image dextrocardia

Mirror-image dextrocardia is a physiological variant in which the heart is located in a mirror position to the right of the position of the normal human heart. Mirror-image dextrocardia combined with acute large-artery occlusive stroke is extremely rare in clinical practice. We present here a 67-year- old woman with complete blockage in her left middle cerebral artery. The patient also had a mirror- image dextrocardia. In this report, we share our experience in treating the patient using mechanical thrombectomy. During her visit to the emergency department, we performed various tests to understand the patient’s anatomy. Based on the findings, we decided to approach the femoral artery. Using a combination of stent thrombectomy and intermediate catheter aspiration, we successfully restored blood flow to the patient’s left middle cerebral artery.

Abstract 234: Antithrombotic use in Emergent Cervical Carotid Artery Stenting in Thrombectomy

Introduction Current literature suggests a benefit in functional outcomes and reperfusion rates when carotid artery stenting (CAS) and mechanical thrombectomy (MT) are performed emergently. However, rates of symptomatic intracranial hemorrhages have been inconclusive. Antithrombotic protocols used in CAS and MT tend to be heterogenous among physicians. There is no standardized data on antithrombotic therapy use during CAS and MT procedures with less associated rates of symptomatic hemorrhagic transformation. We aimed to compare the efficacy and safety of antithrombotic use in patients requiring CAS and MT. Additionally, we sought to analyze clinical and mortality outcomes in CAS and MT retrospectively at our institution. Methods We searched for patients who underwent emergency cervical ICA stent placement and intracranial thrombectomy with stent‐retriever and/or aspiration devices in our institution between 2019‐2023. Clinicoangiographic and antithrombotic data were analyzed. Good clinical outcomes were a &lt; 4 points of NIHSS at 24 hours, mRS (0‐3) at 90 days, and disposition to home or inpatient rehabilitation. Characteristics of hemorrhagic transformation (HT) according to the European Cooperative Acute Stroke Study (ECASS). Clinical, radiographic, and mortality outcomes were described. Results Twenty‐seven patients were treated. The mean age was 64 years, nine females: mean occlusion time 400 minutes, mean fluoro time 32 minutes. Fourteen patients received IV tissue‐type plasminogen (tPA) activator. The admission NIHSS score mean was 16. Stent placement was feasible in all cases. Thrombolysis in Cerebral Infarction score of 2B was achieved in 18 patients (66.7%); the rest had a TICI 3 score. Twelve patients had improved 4 NIHSS points between admission and 24 hours. Dual antiplatelet therapy with aspirin and clopidogrel was used in 15 patients before stenting. While six patients received aspirin and ticagrelor, and the rest received eptifibatide drip. Seven (26%) patients had symptomatic intracranial hemorrhages. Antithrombotic type of treatment had no significant association with bad outcomes (p‐value: 0.872), neither did IV tPA use (p‐value: 0.853). Fourteen patients had good clinical outcomes (mRS 0‐3) at discharge, while eight died. At 90 days follow‐up, the median mRS was 3. Conclusion Our analysis suggests no significant association between symptomatic hemorrhagic transformation with IV tPA or heterogenous antithrombotic use. Our retrospective study has several limitations, including sample size and heterogeneous pathology. Larger studies are needed to stratify symptomatic hemorrhages' high‐risk profile in CAS and MT.

Expansion and Subsequent Rupture of Carotid Pseudoaneurysm After Tandem Carotid and Middle Cerebral Artery Occlusion Treated With Mechanical Thrombectomy and Carotid Stenting.

Extracranial carotid artery pseudoaneurysm is a rare entity with potential etiologies including infection, blunt trauma, postsurgical atherosclerotic disease, and invasive neoplasia. Although the natural history of carotid pseudoaneurysm is difficult to determine because of its rarity, complications such as stroke, rupture, and local mass effect may occur at staggering rates. In this case, a middle-aged man presented with a tandem carotid, middle cerebral artery occlusion that was treated with a carotid stent and mechanical thrombectomy. He returned 3 weeks later with a ruptured carotid pseudoaneurysm that was then treated with a covered stent. He made a full recovery and was neurologically intact on follow-up. This case illustrates a rare potential complication of carotid occlusion and stenting with possible catastrophic consequences. The goal of this report was to educate other clinicians in remaining vigilant in awareness of this complication and provide a framework for potential treatment if and when it occurs.

Stent thrombectomy for acute upper limb ischemia associated with thrombosis or thromboembolism: a case series

Objective: To evaluate the effectiveness of endovascular stent thrombectomy for acute upper limb ischemia caused by thrombosis or thromboembolism of the major arteries of the upper limb.Methods: We evaluated the effectiveness and safety of this technique in 18 patients with acute upper limb ischemia. The mean age was 72 (38‐93) years; 66.7% of the patients were women. Arterial hypertension was observed in 94.4% of the patients, and 38.9% of the patients had confirmed atrial fibrillation.Results: The primary success rate (complete revascularization according to angiography findings) was 83.3% (15 of 18 cases). We used this technique as a stand-alone procedure in 15 cases. Two patients received self-expanding stents, and 1 patient had selective thrombolytic therapy. In 3 cases we did not relieve symptoms of acute ischemia and perform any upper limb amputations during hospitalization, nor did we have any conversions to open surgery. Two patients died during hospitalization: one patient died of acute myocardial infarction, and another died of multiple organ dysfunction syndrome in the postoperative period.Conclusion: This endovascular thrombectomy technique in combination with other endovascular techniques is highly effective and has a number of benefits, such as low trauma, no need for general anesthesia, accurate intra- and postoperative patency control, timely detection of emboli with the possibility of their removal from arteries comparable in diameter to a stent delivery system (up to 1.8 mm). Received 15 February 2023. Revised 29 March 2023. Accepted 6 April 2023. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsLiterature review: A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. KiselevDrafting the article: A.N. Kazantsev, A.N. Ivanenko, G.A. SobolevCritical revision of the article: I.S. SeminSurgical treatment: A.N. Ivanenko, G.A. SobolevFinal approval of the version to be published: I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.D. Kiselev, A.N. Kazantsev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan

Endovascular Stent Thrombectomy in Patients With Acute Lower Limb Arterial Thrombosis on the Background of COVID-19

AIM Analysis of the outcomes of endovascular stent thrombectomy in patients with acute arterial thrombosis of the lower extremities on the background of COVID-19.MATERIAL AND METHODS This retrospective study for the period from January 1, 2020 to March 1, 2022 included 34 patients with acute lower limb ischemia who were diagnosed with the novel coronavirus infection SARS-COV-2. Endovascular stent thrombectomy was performed according to the standard technique using a Destination 8F guiding sheath (Terumo), an Advantage 0.014`` guidewire (Terumo), and a Casper stent (Microvention, Terumo) as a stent retriever. In case of fragmentation of thrombotic masses in the guide sheath, manual aspiration of thrombi was performed using a standard 50,0 ml syringe. Self-expanding nitinol stents were implanted in 11 clinical cases.RESULTS Intraoperative bleeding from the puncture site of the artery developed in 14.7% of cases, which required additional manipulation to achieve hemostasis. Every tenth (11.8%) patient developed myocardial infarction, in 2.9% of cases — ischemic stroke. In the hospital postoperative period during the first hours after surgery, 26.5% of patients developed rethrombosis which required re-intervention. In 8.8% of cases, retrombectomy was unsuccessful, and limb amputation was performed. A fatal outcome occurred in 67.6% of cases, which was due to an increase in multiple organ failure and the development of sepsis.CONCLUSION Endovascular stent thrombectomy is characterized by a low risk of rethrombosis and amputation in the context of COVID-19.

Dual-energy Computed Tomography (DECT) predicts the efficacy of contrast medium extravasation and secondary cerebral hemorrhage after stent thrombectomy in acute ischemic cerebral infarction

ABSTRACT To prospective research the efficacy of dual-energy computed tomography (DECT) in predicting contrast medium extravasation and secondary cerebral hemorrhage after stent thrombectomy in acute ischemic cerebral infarction. Ninety-two patients with acute ischemic stroke who underwent intra-arterial thrombolysis in our hospital from December 2019 to January 2022 have opted as the study subjects. DECT was performed immediately after stent thrombectomy. Images were generated through the image workstation and routine diagnosis was performed 24 hours after the operation. To analyze the diagnostic value of To analyze the diagnostic value of DECT, and to explore the diagnostic status of lesions with hemorrhagic transformation or increased hemorrhage and their correlation with iodine concentration. (1) 68 situations were confirmed, 56 positive and 12 negative with detection rates of 10.71% for hemorrhage, 75.00% for contrast agent extravasation, and 14.29% for extravasation combined with hemorrhage; (2) DECT diagnosed 8 cases of postoperative bleeding and 44 cases of extravasation of contrast media and 4 cases of extravasation of contrast media with hemorrhage ; The accuracy of DECT in diagnosing postoperative hemorrhage was 96.43%. The accuracy of diagnosis of extravasation was 96.43%. (3) The mean iodine concentration of lesions with increased hemorrhage or hemorrhagic transformation was higher compared to those without; (4) There was a correlation between hemorrhagic transformation or increased hemorrhage and iodine concentration. Dual-energy CT (DECT) can accurately distinguish the extravasation of contrast agent and secondary cerebral hemorrhage, and can predict the increased bleeding and bleeding transformation, with good diagnostic value and good predictive efficacy.

Rationale and Design of a Randomized Controlled Pilot Trial to Assess Stent Retriever Thrombectomy for Thrombus Burden Reduction in Patients with Acute Myocardial Infarction: The RETRIEVE-AMI Study

BackgroundST-elevation myocardial infarction (STEMI) is typically caused by thrombotic occlusion of a coronary artery with subsequent hypoperfusion and myocardial necrosis. In approximately half of patients with STEMI, despite successful restoration of epicardial coronary patency, downstream myocardium perfusion remains impeded. Coronary microvascular injury is one of the key mechanisms behind suboptimal myocardial perfusion and it is primarily, yet not exclusively, related to distal embolization of atherothrombotic material following recanalization of the culprit artery. Routine manual thrombus-aspiration has failed to show clinical efficacy in this scenario. This could be related with limitations in technology adopted as well as patients' selection. To this end, we set out to explore the efficacy and safety of stent retriever-assisted thrombectomy based on clot-removal device routinely used in stroke intervention. Study design and objectivesThe stent RETRIEVEr thrombectomy for thrombus burden reduction in patients with Acute Myocardial Infarction (RETRIEVE-AMI) study has been designed to establish whether stent retriever-based thrombectomy is safe and more efficacious in thrombus modification than the current standard of care: manual thrombus aspiration or stenting. The RETRIEVE-AMI trial will enrol 81 participants admitted for primary PCI for inferior STEMI. Participants will be 1:1:1 randomised to receive either standalone PCI, thrombus aspiration and PCI, or retriever-based thrombectomy and PCI. Change in thrombus burden will be assessed via optical coherence tomography imaging. A telephone follow-up at 6 months will be arranged. ConclusionsIt is anticipated by the investigators that stent retriever thrombectomy will more effectively reduce the thrombotic burden compared to current standard of care whilst being clinically safe.