Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service

McCusker, Mark W; Robinson, Scott T.; Looby, Seamus; Power, Sarah; Ti, Joanna; Grech, Reuben; Galvin, Leanne; O’Hare, Alan; Brennan, Paul; O’Kelly, Patrick; O'Brien, Páraig; Collins, Rónán; Williams, David; Thornton, John

doi:10.1016/j.crad.2015.08.007

Cited by 13 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neck hematoma can cause more significant morbidity and mortality than groin hematoma with the potential for rapid airway compromise and possible need for emergent surgical evacuation. Hematoma at access sites in thrombectomy patients is of particular concern, as the majority of patients undergoing treatment for acute ischemic stroke receive thrombolysis with intravenous tissue plasminogen activator (Alteplase) prior to mechanical thrombectomy 9. Hemostasis at the femoral access site is generally successfully achieved using closure devices such as Angioseal (St. Jude Medical, Minnetonka, MN, USA), Exoseal (Cordis Corporation, Bridgewater, NJ, USA) and StarClose (Abbott, Chicago, IL, USA).…”

Section: Discussionmentioning

confidence: 99%

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Roche

Griffin

Looby

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundMechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access.Methods and materialsA review of a prospectively maintained thrombectomy database over a 2-year period (August 2016 – August 2018) was undertaken to identify cases where direct carotid access was performed. CT and angiographic imaging were reviewed. Indications for carotid access, techniques used, technical success of procedure, recanalization rates, procedure-related complications, and patient outcomes were assessed.ResultsEleven patients out of 498 overall thrombectomy procedures (2.2% thrombectomies) underwent direct carotid access. Median National Institutes of Health Stroke Scale was 20. Seventy three percent of patients received intravenous thrombolysis. The direct carotid approach was performed following the failed femoral approach due to unfavorable aortic arch anatomy, vessel tortuosity, and severe atherosclerotic disease. Direct carotid puncture was successful in 10 patients, and unsuccessful in one. Successful recanalization (TICI 2b–3) was achieved in eight patients. One patient had spontaneously recanalized on angiography. There was failed recanalization in one patient with tandem ICA and M1 occlusion. Carotid access complications included one patient with both neck hematoma and asymptomatic ICA dissection, and one of delayed central retinal artery occlusion.ConclusionThis case series highlights direct carotid puncture as a successful alternative when the femoral approach is not possible, allowing thrombectomy in patients who would otherwise be unsuitable.

show abstract

Section: Discussionmentioning

confidence: 99%

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Roche

Griffin

Looby

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…This finding could be explained by a selection bias as secondary transported patients (‘drip and ship concept’) were younger and had lower NIHSS scores. Nevertheless, this is practically important for national stroke care and indicates that patient transport and selection was safe and appropriate and efficient treatment can be applied also to those distant from an interventional centre who are likely to respond . In contrast, a retrospective single centre study showed significantly worse outcomes in 132 transferred as opposed to 61 locally admitted patients .…”

Section: Discussionmentioning

confidence: 99%

Endovascular stroke therapy in Austria: a nationwide 1‐year experience

Serles

Gattringer

Mutzenbach

et al. 2016

Euro J of Neurology

View full text Add to dashboard Cite

show abstract

“…9 Likewise in the case series by McCuster et al, 2015, two of the 14 patients who developed sICH were caused by rupture and perforation of the right MCA, presumably by a microguide wire. 12 Symptomatic ICH can be suspected clinically through deteriorating neurological status and confirmed radiologically with an emergency brain imaging. 32 Alternatively, compression of the major cerebral arteries (anterior or middle cerebral arteries) on angiogram could aid with the detection of significant bleed in the basal ganglia region.…”

Section: Intracerebral Hemorrhagementioning

confidence: 99%

“…9,11,47,54 The proposed mechanisms for SAH include: intra-procedural vessel perforation or dissections, occult rupture resulting from stretching of the arterioles and venules in the subarachnoid spaces during the process of withdrawing the stent retriever and disruption of the cerebral microvascular barriers. 12,35,55 McCuster and colleagues reported a case of SAH due to rupture of the MCA with resultant diffuse SAH. 12 In the case series by Yoon and colleagues, the reported 16% of SAH was claimed not to relate to vessel dissection or perforation but to occult bleed detected angiographically.…”

Section: Subarachnoid Hemorrhagementioning

confidence: 99%

“…12,35,55 McCuster and colleagues reported a case of SAH due to rupture of the MCA with resultant diffuse SAH. 12 In the case series by Yoon and colleagues, the reported 16% of SAH was claimed not to relate to vessel dissection or perforation but to occult bleed detected angiographically. 55 Clinical management Careful surveillance is appropriate in asymptomatic cases of SAH as there are still risks of delayed hydrocephalus and/or vasospasm with delayed cerebral ischemia (DCI) may occur.…”

Section: Subarachnoid Hemorrhagementioning

confidence: 99%

See 1 more Smart Citation

Complications of endovascular treatment for acute ischemic stroke: Prevention and management

Balami

White

McMeekin³

et al. 2017

International Journal of Stroke

206

142

View full text Add to dashboard Cite

Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory. Other complications include: anesthetic/contrast-related, post-operative hemorrhage, extra-cranial hemorrhage and pseudoaneurysm. Some complications are life-threatening and many lead to increased length of stay in intensive care and stroke units. Complications increase costs and delay the commencement of rehabilitation. Some may be preventable; the impact of others can be minimized with early detection and appropriate management. Both neurointerventionists and stroke specialists need to be aware of the risk factors, strategies for prevention, and management of these complications. With the increasing use of mechanical thrombectomy for the treatment of acute ischemic stroke, incidence and outcome of complications will need to be carefully monitored by stroke teams. In this narrative review, we examine the frequency of complications of MT in the treatment of acute ischemic stroke with an emphasis on periprocedural complications. Overall, from recent randomized controlled trials, the risk of complications with sequelae for patient from mechanical thrombectomy is ∼15%. We discuss the management of complications and identify areas with limited evidence, which need further research. Search strategy and selection criteria Relevant evidence was found by searches of Medline and Cochrane Library, reference list, cross-referencing and main journal content pages. Search terms included "brain ischemia", "acute ischemic stroke", "cerebral infarction" AND "mechanical thrombectomy", "endovascular therapy", "endovascular treatment", "endovascular embolectomy", "intra-arterial" AND "randomized controlled trial", "non-randomised trials", "observational studies" AND "complications", "procedural complications", "peri-procedural complications", "device-related complications", "management", "treatment", "outcome". The search included only human studies, and was limited to studies published in English between January 2014 and November 2016. The final reference list was selected on the basis of relevance to the topics covered in the Review. Guidelines for management of acute ischaemic stroke by the American Heart Association, the European Stroke Organisation, multi-disciplinary guidelines and the National Institute for Health and Care Excellence (NICE) wer...

show abstract

Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service

Cited by 13 publications

References 27 publications

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Endovascular stroke therapy in Austria: a nationwide 1‐year experience

Complications of endovascular treatment for acute ischemic stroke: Prevention and management

Contact Info

Product

Resources

About