Forced Arterial Suction Thrombectomy with the Penumbra Reperfusion Catheter in Acute Basilar Artery Occlusion: A Retrospective Comparison Study in 2 Korean University Hospitals

Eom, Yeseul; Hwang, Younghun; Hong, Ji Man; Choi, Jin Wook; Lim, Yong Cheol; Kang, Dong‐Hun; Kim, Y.-W.; Kim, S.Y.; Lee, J.S.

doi:10.3174/ajnr.a4045

Cited by 24 publications

(22 citation statements)

References 32 publications

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“…Procedural time is attributed to the reduction of the OTR. In our study, the mean procedural time was 39 (median 25) min, which is shorter than that in other studies [5,6,8,9,31,32.] This was also shorter than the mean procedural time of 48 min of BAO for anterior circulation at our facility.…”

Section: Discussioncontrasting

confidence: 50%

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Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Early Therapeutic Time Window

et al. 2017

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Background: The natural history of basilar artery occlusion (BAO) is devastating, with morbidity rates increasing up to 80%. However, the efficacy of recanalization therapy for BAO has not been established as yet. Objective: We analyzed consecutive cases of BAO treated with mechanical thrombectomy (MT) to evaluate its safety and efficacy and to determine factors associated with the prognosis. Methods: Between October 2011 and September 2016, MT was performed in 34 patients with BAO. MT was performed using the Penumbra system and stent retriever. CT perfusion was used for evaluating patients. Cerebral blood flow (CBF) maps and cerebral blood volume (CBV) maps were evaluated. CBF/CBV mismatch was defined as ≥50% penumbra. Clinical outcomes were correlated with demographic, clinical, and radiographic findings. Results: The median baseline National Institutes of Health Stroke Scale score was 29 (14-33). The recanalization rate (≥thrombolysis in cerebral infarction grades 2b) was 100%. The median onset to recanalization time (OTR) was 197 (160-256) min. Favorable outcomes (modified Rankin Scale ≤2) at 90 days occurred in 56% (n = 19 of 34). The mortality rate at 90 days was 12% (n = 4 of 34). In univariate analysis, intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) use, and OTR were significantly associated with favorable outcomes. In a multivariate logistic regression model, IV rt-PA use and lower National Institute of Health Stroke Scale score were significantly related to favorable outcomes. Conclusion and Relevance: Multimodal endovascular therapy using the Penumbra system and stent retriever demonstrated a high recanalization rate and favorable outcomes for BAO. Both devices were feasible and effective in the treatment of BAO. An approach combining MT with IV thrombolysis provided a better recanalization rate and more favorable clinical outcomes.

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Section: Discussioncontrasting

confidence: 50%

“…However, a higher recanalization rate and more favorable outcomes than IVT or intra-arterial thrombolysis (IAT) have been reported, suggesting that MT may be an innovative therapy for BAO [5,6,7]. Stent retrievers and the Penumbra system are mostly used as a device in MT [7,8,9]. …”

Section: Introductionmentioning

confidence: 99%

Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Early Therapeutic Time Window

et al. 2017

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“…[4][5][6][7][8] Evidence of endovascular treatment for posterior circulation occlusions is still lacking, though a few recent studies have shown better clinical outcomes compared with previous results. 9,10 Underlying stenosis due to intracranial atherosclerotic disease (IAD) is often encountered during endovascular treatment for acute intracranial large-artery occlusion. Regarding the pathomechanism of stroke, in situ thrombotic occlusions may occur in addition to hemodynamic compromise due to stenosis.…”

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confidence: 99%

Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion

Yw¹,

Hong²,

Park³

et al. 2016

AJNR Am J Neuroradiol

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“…Using this type of catheter has shown improvements in recanalization rates and favorable clinical outcomes as stent retriever thrombectomy 12)17)18). Although contrast leakage and subarachnoid hemorrhage (SAH) have been reported during and after MAT, pseudoaneurysm formation due to vessel wall injury has not been 2)6)7)8)9)10)11)12)13)14)15)17)18). We therefore report on a case of significant contrast leakage during MAT in which we found pseudoaneurysm formation at follow-up angiogram that was treated by detachable coil embolization.…”

Section: Introductionmentioning

confidence: 94%

Pseudoaneurysm Formation after Repetitive Suction Thrombectomy Using a Penumbra Suction Catheter

Jeong

Kwon

Choi

et al. 2016

J Cerebrovasc Endovasc Neurosurg

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With the recent advent of suction catheters, the use of manual aspiration thrombectomy (MAT) for patients with acute ischemic stroke with large vessel occlusion has increased. Although contrast leakage and subarachnoid hemorrhage have been reported during MAT procedures, pseudoaneurysm formation due to vessel injury by suction catheters has not been. We discuss the case of a 60-year-old woman who presented to our emergency room with dysarthria and left-sided weakness. She underwent suction thrombectomy 5 times for acute middle cerebral artery occlusion and significant contrast leakage occurred during the procedure. On follow-up angiogram on post-operative day 15, we noticed a pseudoaneurysm, which was treated with detachable coil embolization. Surgeons who perform suction thrombectomy should keep in mind the possibility of vessel injury that results in the formation of a pseudoaneurysm, especially at the branching site or tortuous segments.

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Forced Arterial Suction Thrombectomy with the Penumbra Reperfusion Catheter in Acute Basilar Artery Occlusion: A Retrospective Comparison Study in 2 Korean University Hospitals

Cited by 24 publications

References 32 publications

Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Early Therapeutic Time Window

Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Early Therapeutic Time Window

Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion

Pseudoaneurysm Formation after Repetitive Suction Thrombectomy Using a Penumbra Suction Catheter

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