First Experience with the Nimbus Stentretriever

Lehnen, Nils Christian; Paech, Daniel; Zülow, Stefan; Bode, Felix J; Petzold, Gabor C.; Radbruch, Alexander; Dorn, Franziska

doi:10.1007/s00062-022-01237-z

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…To retrieve such hard clot, special measures such as the Nimbus stent retriever (Cerenovus, Johnson & Johnson, New Brunswick, NJ) could be used to remove the fibrin-rich clots. 25 In patients with LIC, there was no difference in mRS score 0 to 3 at 90 days between patients who achieved mTICI score 2c/3 and 2b in this study. It suggested that patients with LIC had a smaller residual functional parenchyma than those without, and therefore, even if an mTICI score of 2c/3 was not achieved, it could be sufficient to achieve an mTICI score of 2b, including artery that supplied the residual function territory.…”

Section: Discussioncontrasting

confidence: 52%

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Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Namitome

Uchida

Shindo

et al. 2023

Stroke

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BACKGROUND: The increased risk of intracranial hemorrhage with multiple passes in endovascular therapy (EVT) for large vessel occlusion with a large ischemic core is a concern. We explored the effect of the number of EVT passes on patients in a randomized clinical trial. METHODS: This post hoc study was the secondary analysis of RESCUE-Japan LIMIT, which was a randomized clinical trial comparing EVT and medical treatment alone for large vessel occlusion with large ischemic core. We grouped patients according to the number of passes with successful reperfusion (modified Thrombolysis in Cerebral Infarction score, ≥2b) in 1, 2, and 3 to 7 passes and failed reperfusion (modified Thrombolysis in Cerebral Infarction score, 0–2a) after any pass in the EVT group, and these groups were compared with medical treatment group. The primary outcome was modified Rankin Scale score of 0 to 3 at 90 days. Secondary outcomes were improvement in National Institutes of Health Stroke Scale score of ≥8 at 48 hours, mortality at 90 days, symptomatic intracranial hemorrhage, and any intracranial hemorrhage within 48 hours. RESULTS: The number of patients who received EVT with successful reperfusion after 1, 2, and 3 to 7 passes and failed reperfusion were 44, 23, 19, and 14, respectively, and 102 received medical treatment alone. The adjusted odds ratios (95% CIs) for the primary outcome relative to medical treatment were 5.52 (2.23–14.28) after 1 pass, 6.45 (2.22–19.30) after 2 passes, 1.03 (0.15–4.48) after 3 to 7 passes, and 1.17 (0.16–5.37) if reperfusion failed. The adjusted odds ratios (95% CIs) for any intracranial hemorrhage within 48 hours relative to medical treatment were 1.88 (0.90–3.93) after 1 pass, 5.14 (1.97–14.72) after 2 passes, 3.00 (1.09–8.58) after 3 to 7 passes, and 6.16 (1.87–24.27) if reperfusion failed. CONCLUSIONS: The successful reperfusion within 2 passes was associated with better clinical outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03702413.

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Section: Discussioncontrasting

confidence: 52%

“…To retrieve such hard clot, special measures such as the Nimbus stent retriever (Cerenovus, Johnson & Johnson, New Brunswick, NJ) could be used to remove the fibrin-rich clots. 25…”

Section: Discussionmentioning

confidence: 99%

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Namitome

Uchida

Shindo

et al. 2023

Stroke

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“…When it is impossible to reach the occlusion with the aspiration catheter, only a stent retriever technique is used [13]. The third, and all further attempts, usually involve a different ("rescue") method ("rescue"), either by combining a stent for direct aspiration only or by changing the type of stent [14,15] or the aspiration catheter used [16,17] (Figure 1). combining a stent for direct aspiration only or by changing the type of stent [14,15] or the aspiration catheter used [16,17] (Figure 1).…”

Section: Populationmentioning

confidence: 99%

Innovation in Acute Ischemic Stroke Patients over 80 y/o—A Retrospective Monocentric Study on Mechanical Thrombectomy of Consecutive Patients: Is Age an Adequate Selection Criterion?

Cernigliaro

Stanca

Galbiati

et al. 2023

JCM

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Background: Although it is clear that stroke is a time-dependent and age-associated disease, we still need more evidence regarding the efficacy and outcomes in elderly patients who were excluded from the first trials of mechanical thrombectomy. The aim of this study is to highlight patient characteristics, the timing of medical attention and therapy, successful recanalization, and functional outcomes in patients over 80 y/o who underwent mechanical thrombectomy at the Ospedale Maggiore della Carità di Novara (Hub) since endovascular stroke treatment was first started here. Methods: all 122 consecutive patients over 80 y/o at admission who underwent mechanical thrombectomy between 2017 and 2022 at our Hub center were retrospectively included in our database. A good functional outcome in these elderly patients was considered as the 90 days modified Rankin Scale (mRS) ≤ 3 and/or a decrease in functional status as ∆mRS ≤ 1 in order to interpret the results for patients with intact intellect and basal mRS > 3. Successful recanalization as a score of TICI ≥ 2b (Thrombolysis in Cerebral Infarction) was analyzed as a secondary outcome. Results: Good functional outcome (mRS ≤ 3 and/or ∆mRS ≤ 1) was observed in 45.90% (56/122). The rate of successful recanalization (TICI ≥ 2b) was 65.57% (80/122). Conclusion: Our data confirm that a good outcome in the elderly age group has a correlation with age; being younger, with a milder NIHSS (National Institutes of Health Stroke Scale) at the onset and with a lower pre-morbid mRS is statistically associated with a better outcome. However, age should not be a criterion to exclude older patients from mechanical thrombectomy. Decision-making should take into consideration the pre-morbid mRS and the severity of the stroke on the NIHSS scale, especially in the age group over 85 y/o.

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NIMBUS geometric clot extractor for challenging clots: Real-world clinical experience and clot composition

et al. 2023

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Purpose Revascularization rates following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remain suboptimal for patients with fibrin-rich, recalcitrant clots. The NIMBUS Geometric Clot Extractor has demonstrated promising in vitro revascularization rates using fibrin-rich clot analogs. This study assessed the retrieval rate and composition of clot using NIMBUS in a clinical setting. Methods This retrospective study included patients who underwent MT with NIMBUS at two high-volume stroke centers between December 2019 and May 2021. NIMBUS was used for clots deemed challenging to remove at the interventionalist's discretion. At one of the centers, per pass clot was collected for histological analysis by an independent lab. Results A total of 37 patients (mean age 76.87 ± 11.73 years; 18 female; mean time from stroke onset 11.70 ± 6.41 h) were included. NIMBUS was used as first and second-line device in 5 and 32 patients, respectively. The main reason for using NIMBUS (32/37) was the failure of standard MT techniques after a mean 2.86 ± 1.48 number of passes. Substantial reperfusion (mTICI ≥2b) was achieved in 29/37 patients (78.4%) with a mean of 1.81 ± 1.00 NIMBUS passes (mean 4.68 ± 1.68 passes with all devices), and NIMBUS was the final device used in 79.3% (23/29) of those cases. Clot specimens from 18 cases underwent composition analysis. Fibrin and platelets represented 31.4 ± 13.7% and 28.8 ± 18.8% of clot components; 34.4 ± 19.5% were red blood cells. Conclusions In this series, NIMBUS was effective in removing tough clots rich in fibrin and platelets in challenging real-world situations.

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First Experience with the Nimbus Stentretriever

Cited by 5 publications

References 25 publications

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Innovation in Acute Ischemic Stroke Patients over 80 y/o—A Retrospective Monocentric Study on Mechanical Thrombectomy of Consecutive Patients: Is Age an Adequate Selection Criterion?

NIMBUS geometric clot extractor for challenging clots: Real-world clinical experience and clot composition

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