One-year single-center experience with the Aperio thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome

Kaschner, Marius; Rubbert, Christian; Lee, John-Ih; Gliem, Michael; Jander, Sebastian; Ivan, Vivien Lorena; Kraus, Bastian; Turowski, Bernd; Caspers, Julian

doi:10.1007/s10072-019-03861-z

Cited by 9 publications

(11 citation statements)

References 29 publications

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“…Furthermore, overall complications are comparable to other studies. 6,21 The number of patients with M1-occlusion ( n = 10, 7.1%) and proximal M2-occlusion ( n = 1, 9.1%) developing symptomatic intracerebral hemorrhage (sICH) within 24 h in our study is slightly lower compared to previous reports, most likely to be caused by different sample sizes. 22…”

Section: Discussioncontrasting

confidence: 72%

“…[1][2][3][4][5] Especially, for the treatment of occlusions of the M1segment of the middle cerebral artery (MCA), ET is feasible and safe and has become the standard of care. 6,7 Evidence for ET in more distal parts of MCA is sparser. In this regard, it has to be considered that, if the occlusion is located in the distal M2-branches or beyond, ET may result in difficult revascularization maneuvers.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical thrombectomy in stroke patients with acute occlusion of the M1- compared to the M2-segment: Safety, efficacy, and clinical outcome

Weiss¹,

Rubbert²,

Ivan³

et al. 2022

Neuroradiol J

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Purpose Endovascular treatment (ET) in occlusions of the M1- and proximal M2-segment of the middle cerebral artery (MCA) is an established procedure. In contrast, ET in distal M2-occlusions has not been sufficiently evaluated yet. The purpose of this study was to assess relevant parameters for clinical outcome, efficacy and safety of patients undergoing ET in M1-, proximal M2- and distal M2-occlusions. Methods One-hundred-seventy-four patients undergoing ET in acute ischemic stroke with an occlusion of the M1- or M2-segment of the MCA were enrolled prospectively. Non-parametric analysis of variance in three months mRS, TICI scale and complication rates were performed with Kruskal-Wallis-test between M1-, proximal and distal M2-occlusions. Subsequent pairwise group comparisons were calculated using Mann-Whitney-U-tests. Binary logistic regression (BLR) models were calculated for each occlusion site. Results There were no significant group differences in three-months mRS, mTICI scale or complication rates between M1- and M2-occlusions nor between proximal and distal M2-occlusions. BLR in patients with M1-occlusions showed a substantial explanation of variance (NR2=0.35). NIHSS (p=0.009) and Maas Score as parameter for collateralization (p=0.01) appeared as significant contributing parameters. BLR in M2-occlusions showed a high explanation of variance (NR2=0.50) of mRS but no significant factors. Conclusions Clinical outcome and procedural safety of patients with M2-occlusions undergoing ET are comparable to those of patients with M1-occlusions. Clinical outcome of patients with M1-occlusions undergoing ET is primarily influenced by the initial neurological deficit and the collateralization of the occlusions. By contrast, clinical outcome in patients with M2-occlusions undergoing ET is more multifactorial.

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Mechanical thrombectomy in stroke patients with acute occlusion of the M1- compared to the M2-segment: Safety, efficacy, and clinical outcome

Weiss¹,

Rubbert²,

Ivan³

et al. 2022

Neuroradiol J

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“…In this study, we first excluded 122 patients who underwent carotid stenting and carotid endarterectomy in case these artificially altered vascular stenosis from affecting the study results [4]. The cubic simulation curve analysis showed that the degrees of ICA and VA stenosis negatively correlated with BF; that is, as the degree of stenosis increases, cerebral BF decreases.…”

Section: Discussionmentioning

confidence: 99%

“…There is a general consensus that cerebral vascular stenosis leads to ischemic stroke since 1980s [1][2][3][4]. Previous reports had shown asymptomatic patients with carotid stenosis have an absolute stroke risk of over 3% in 1 year and a relative stroke risk of over 50% [5].…”

Section: Introductionmentioning

confidence: 99%

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

Tang

Wang

et al. 2020

Neurol Sci

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Introduction To improve the accuracy of ultrasound techniques for the assessment of carotid stenosis, we designed a novel carotid artery stenosis ultrasound scale (CASUS), and evaluated its accuracy, reliability, and its value in predicting the occurrence of cardiovascular and cerebrovascular diseases in a prospective study. Methods A total of 750 patients with first-time ischemic stroke and hospitalized within 24 h were enrolled in the study. Using color Doppler ultrasound (CDUS), the degree of stenosis and blood flow (BF) in bilateral internal carotid arteries (ICA) and the V1-V3 segment of vertebral arteries (VA) was assessed. Cubic simulation curves for BF and global blood flow (GBF) over the stenosis score (SS), total stenosis score (TSS), and radiological imaging-total stenosis score (RI-TSS) were fitted and compared. The receiver operating characteristic (ROC) curves using TSS, RI-TSS, or GBF to predict various ischemic stroke endpoints were also analyzed and compared. Results There was a linear relationship between SS and BF both ICA and VA (R2 were 0.734 and 0.783, respectively, both P < 0.05). Both TSS and RI-TSS with GBF showed an inverse "S" curve relationship (R2 was 0.839 and 0.843, all P < 0.05). The AUC values of TSS-based and RI-TSS-based predictions of each endpoint were all greater than 0.7 (all P < 0.05), but the differences of the AUC values between TSS, RI-TSS, and GBF were not statistically significant (all P > 0.05). Conclusions The novel CASUS can better reflect the level of cerebral reperfusion in patients with ischemic stroke and can better predict the occurrence of cardiovascular and cerebrovascular diseases. Keywords Brain ischemic. Carotid stenosis. Ultrasound. Neuroimaging. Cerebral blood flow Yi Tang and Ming-yu Wang contributed equally to this work.

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“…Several new stent retrievers have come to market, though to date none have been compared directly to one another in a head-to-head RCT. Similar to the early days of Merci and the Penumbra System, the safety and efficacy of these devices is based largely on uncontrolled single-arm studies (54)(55)(56)(57)(58)(59), with the exception of 3D Revascularization Device (Penumbra Inc., Alameda, CA), which underwent a successful noninferiority RCT using aspiration thrombectomy as the control group (60). Current interest in the field of stent retriever design has included the development of interlinked adjustable nitinol cages to allow thrombus capture, as well as the production of smaller stent retrievers that can safely be used in small distal vessels (61,62).…”

Section: Current Directionsmentioning

confidence: 99%

The Evolution of Devices and Techniques in Endovascular Stroke Therapy

Bageac

Gershon

Leacy

2021

Stroke

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This chapter discusses the evolution of devices and techniques in endovascular stroke therapy, beginning with the development of effective intra-arterial thrombolysis in the late 1990s. We discuss the subsequent rise of early mechanical devices such as the Merci Retriever and Penumbra System, which, despite culminating in a series of failed trials in 2013, set the stage for the modern thrombectomy era. These first-generation devices gave way to the stent retriever, which would change the standard of care for acute large vessel occlusion stroke following a series of landmark trials in 2015. Finally, we discuss the more recent establishment of aspiration thrombectomy as an alternative to stent retrievers, as well as current investigations into novel devices and techniques that might further improve patient outcomes. Throughout, attention is paid to the regulatory landscape and evidentiary standards that shaped the field during its development in order to better understand how lessons from this history can guide future studies.

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One-year single-center experience with the Aperio thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome

Cited by 9 publications

References 29 publications

Mechanical thrombectomy in stroke patients with acute occlusion of the M1- compared to the M2-segment: Safety, efficacy, and clinical outcome

Mechanical thrombectomy in stroke patients with acute occlusion of the M1- compared to the M2-segment: Safety, efficacy, and clinical outcome

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

The Evolution of Devices and Techniques in Endovascular Stroke Therapy

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