Difficult catheter access to the occluded vessel during endovascular treatment of acute ischemic stroke is associated with worse clinical outcome

Ribó, Marc; Flores, Alan; Rubiera, Marta; Pagola, Jorge; Mendonça, Nuno; Rodríguez‐Luna, David; Piñeiro, Soco; Meler, Pilar; Alvarez-Sabin, José; Molina, Carlos A.

doi:10.1136/neurintsurg-2012-010438

Cited by 126 publications

(147 citation statements)

References 22 publications

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“…11) While the lesions could be accessed in a median time of 20 minutes from femoral artery puncture in easily accessible cases, about 30 minutes was reportedly wasted in poorly accessible cases. 11) Difficult catheter access is considered an adverse prognostic factor, 11) and shortening of the access time is vital. At our hospital, change of the approach route is considered if more than 30 minutes is needed from puncture to the placement of the guiding catheter.…”

Section: Resultsmentioning

confidence: 99%

Thrombectomy in Octogenarians in the Era of Stent Retriever: Is an Age Limit Necessary?

Tajima

Hayasaka

Ebihara

et al. 2017

JNET

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Objective:The results of thrombectomy in people aged 80 years and above were reviewed, and the necessity of an age limit was evaluated.Methods: Seventy eight patients who underwent thrombectomy at our hospital between July 2014 and September 2016 were divided into those aged <80 years and those aged ≥80 years, and the therapeutic results and outcome were evaluated. Results:The patients consisted of 25 aged ≥80 years (≥80 years group) and 53 aged <80 years (<80 years group). The mean time from puncture to recanalization was 56 and 65 minutes, respectively, and thrombolysis in cerebral infarction score of 2b or better recanalization was observed in 96.0 and 88.7%, respectively, with no significant difference in either parameter. Change of the approach route was necessary in five patients aged ≥80 years (20.0%). A favorable outcome with a modified Rankin scale (mRS) score of ≤2 was observed 3 months after the onset in 44.0 and 64.2%, respectively, being slightly lower in the ≥80 years group (P = 0.151). In the ≥80 years group, the time from the onset to recanalization was a poor prognostic factor (P = 0.048). Conclusion:In the patients aged ≥80 years, the recanalization rate, procedural time, and complication rate in thrombectomy were comparable to those in the patients aged <80 years, and no significant difference was observed in the outcome.Therefore, aggressive intervention without an age limit is considered recommendable in preoperatively activities of daily living (ADL)-independent elderly patients expected to be good candidates for simple thrombectomy. However, with the possibility of change in the approach route in mind, it is necessary to achieve recanalization more promptly in older patients.

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Section: Resultsmentioning

confidence: 99%

Thrombectomy in Octogenarians in the Era of Stent Retriever: Is an Age Limit Necessary?

Tajima

Hayasaka

Ebihara

et al. 2017

JNET

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“…approach was chosen only for patients who switched from unsuccessful TFA. [4][5][6] Haussen et al 4) reported 15 patients who underwent endovascular treatment for acute ischemic stroke via the TRA. In 12 of these, the TFA was unsuccessful, requiring a switch to the TRA.…”

Section: Resultsmentioning

confidence: 99%

“…However, other factors, such as aortic tortuosity, prolong the access time in some patients. Ribo et al 6) reported that the recanalization rate was low in patients with an access time of ≥30 minutes, and that many patients showed an unfavorable outcome. According to several studies, the route was changed, or the use of devices was devised in such patients.…”

Section: Discussionmentioning

confidence: 99%

“…According to several studies, the route was changed, or the use of devices was devised in such patients. [3][4][5][6]11) Of patients with pc-LVO, the prognosis becomes unfavorable in approximately 90% when recanalization is not achieved. On the other hand, recent studies indicated that the endovascular treatment related effective recanalization rate was approximately 70%-80%, and that a favorable outcome was achieved in 30%-40%.…”

Section: Discussionmentioning

confidence: 99%

“…1,2) With respect to thrombectomy or the recanalization rate, favorable results have been consistently obtained, but we have often encountered patients in whom it was difficult to guide a guiding catheter into an occluded blood vessel, with an increase in the number of patients to be treated by this therapy. [3][4][5][6] Several studies reported that recanalization should be promptly performed to treat posterior circulation large vessel occlusion (pc-LVO), as indicated for the anterior circulation. 7,8) However, when selecting the transfemoral approach (TFA) for patients in whom an approach to the right vertebral artery (VA) is necessary, a specific interval is sometimes required until reaching due to the tortuosity of the aortic arch.…”

Section: Introductionmentioning

confidence: 99%

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Transradial Approach for Mechanical Thrombectomy of Posterior Circulation Stroke

Mizokami

Uwatoko

Furukawa

et al. 2018

JNET

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Objective: We report the mechanical thrombectomy (MT) of posterior circulation large vessel occlusion (pc-LVO) in which the transradial approach (TRA) was selected as an initial approach route to reduce the duration of treatment.Case Presentation: We performed MT using the TRA for four patients with pc-LVO between November 2015 and March 2017. The TRA was used as an initial approach route in patients in whom preoperative MRI showed that the right vertebral artery (VA) was predominant. In all patients, the procedure could be accomplished without changing the approach route. Thrombolysis in Cerebral Infarction (TICI) 2b or better recanalization was achieved in all patients (100%), and TICI 3 recanalization in three patients (75%). Mean time from radial artery puncture to initial intracranial angiography and to the effective recanalization was 7.3 ± 1.5 and 28.8 ± 6.2 minutes, respectively. There was no complication at the site of puncture. Conclusion:Recanalization was promptly and effectively achieved by the MT of pc-LVO using the TRA. The results suggest that TRA can be utilized as an initial access route in patients in whom an approach to the right VA is possible.

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Direct Carotid Artery Puncture for Endovascular Stroke Treatment

AlMatter

Kursumovic

Kimmig

2023

The Ischemic Stroke Casebook

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Difficult catheter access to the occluded vessel during endovascular treatment of acute ischemic stroke is associated with worse clinical outcome

Abstract: Difficult catheter access to target the carotid is common during acute endovascular treatment of stroke patients and is associated with a worse clinical outcome. If transfemoral access appears difficult, alternative access such as direct carotid puncture could be explored.

Cited by 126 publications

References 22 publications

Thrombectomy in Octogenarians in the Era of Stent Retriever: Is an Age Limit Necessary?

Thrombectomy in Octogenarians in the Era of Stent Retriever: Is an Age Limit Necessary?

Transradial Approach for Mechanical Thrombectomy of Posterior Circulation Stroke

Direct Carotid Artery Puncture for Endovascular Stroke Treatment

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