Percutaneous rotational thrombectomy reduces acute reocclusion in an animal model of acute coronary thrombosis

Dewhurst, Timothy A.; Bruneau, Rodney; Titus, Bradley G.; Clement, T.J.; Auth, David A.; Ritchie, James L.

doi:10.1002/ccd.1810300207

Cited by 4 publications

(1 citation statement)

References 18 publications

(10 reference statements)

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“…The pooled results revealed that patients with reocclusion after MT displayed higher rates of early neurological deterioration and 90-day death and a lower rate of 90day mRS score ≤2 than patients without reocclusion. Repeated reperfusion and occlusion at the target site may aggravate ischemia-reperfusion injury and oxidative stress injury, leading to severe brain infarction (19). Because of the high risk of bias in the study conducted by Hernández-Fernández et al, we removed this study in our sensitive analysis (12).…”

Section: Discussionmentioning

confidence: 99%

The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis

Li¹,

GU²,

Ding³

et al. 2020

Ann Transl Med

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Background: Mechanical thrombectomy (MT) is the cornerstone for treating acute ischemic stroke (AIS) in emergency cases. However, 3-9% of patients display reocclusion in the recanalized vessels within 24 hours after performing MT. This meta-analysis aimed to further identify the predictors and prognosis of unexpected reocclusion after MT.Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched several literature databases, including PubMed, Embase, and Cochrane, for publications related to the subject term "thrombectomy" that were published prior to March 2020. Pooled analysis was performed with the fixed-effects model using the Mantel-Haenszel method if the heterogeneity was expected to be available (I 2 ≤50%). Otherwise, the random-effects model computed by the DerSimonian-Laird method was used (I 2 >50%). R software (http://www.r-project.org) was used for analysis in this study.Results: A total of five articles comprising 1,883 patients (126 patients with reocclusion, 1,757 patients without reocclusion) who were confirmed to have AIS and who underwent emergency MT were finally included in this study. The pooled analysis (reocclusion versus non-reocclusion) showed that atrial fibrillation [odds ratio (OR), 0.36; 95% confidence interval (CI), 0.20-0.63], cardiogenic embolism (OR, 0.35; 95% CI, 0.20-0.63), long-term statin use (OR, 0.39; 95% CI, 0.21-0.75), long-term antiplatelet use (OR, 0.53; 95% CI, 0.31-0.92), and target occlusion at middle cerebral artery-M1 (MCA-M1) (OR, 0.39; 95% CI, 0.19-0.77) might prevent reocclusion and longer onset-to-reperfusion time (mean difference, 66.51; 95% CI, 36.66-96.35) might promote reocclusion after MT performance. Furthermore, the clinical outcomes including early neurological deterioration (OR, 4.87; 95% CI,, 90-day modified Rankin Scale score ≤2 (OR, 0.28; 95% CI, 0.18-0.45), and 90-day death rate (OR, 1.85; 95% CI, 1.04-3.29) were also associated with reocclusion after MT performance.Conclusions: Atrial fibrillation, cardiogenic embolism, long-term statin use, long-term antiplatelet use, and target occlusion at MCA-M1 might prevent reocclusion, and longer onset-to-reperfusion time seemed to promote reocclusion after MT. Reocclusion after MT results in a high risk of poor prognosis.

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Section: Discussionmentioning

confidence: 99%

The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis

Li¹,

GU²,

Ding³

et al. 2020

Ann Transl Med

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Use of half (disarticulated) Palmaz‐Schatz stents for thrombus‐containing coronary lesions

Mehan

Kaufmann

Salzmann

et al. 1994

Cathet. Cardiovasc. Diagn.

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Coronary stenoses associated with thrombus can lead to poor angioplasty results and increased procedural complications. Stenting in the presence of thrombus is associated with an increased risk of stent thrombosis. We report eight patients in whom half a Palmaz-Schatz stent was implanted for inadequate angioplasty results owing to thrombus. Stenting resulted in improved angioplasty results; no stent thrombosis occurred.

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Management of intracoronary thrombosis complicating percutaneous transluminal coronary angioplasty

Boston¹,

Malouf²,

Barry³

1996

Clinical Cardiology

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Summary:With technological advances in equipment and increased experience of operators, the success rates of percutaneous transluminal coronary angioplasty (PTCA) now exceed 90%. However, acute periprocural occlusion continues to complicate approximately 6% of all procedures, and many of these occlusions are due to intracoronary (IC) thrombus.Patients at highest risk for this complication include those with acute ischemic syndromes or with angiographically apparent thrombus. These individuals may be candidates for the use of prolonged heparin infusions prior to dilatation, intracoronary thrombolytic therapy, or monoclonal antibody directed against the platelet glycoprotein IIbLIIa receptor. All patients undergoing PTCA should receive adequate antiplatelet therapy, including aspirin, and heparin with dosing monitored by activated clotting times (ACT). In addition, some recommend the use of ionic contrast material. When IC thrombus accumulates following intervention, initial therapy should include IC nitroglycerin followed by a combination of redilatation and IC urokinase infusion. Prolonged balloon inflations may be useful, particularly with the use of autoperfusion catheters. Platelet glycoprotein IIbmIa receptor antagonists may prove to be beneficial in this situation as well. If the patient's clinical status deteriorates in spite of these measures, emergency coronary artery bypass graft surgery may be required.

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Percutaneous rotational thrombectomy reduces acute reocclusion in an animal model of acute coronary thrombosis

Cited by 4 publications

References 18 publications

The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis

The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis

Use of half (disarticulated) Palmaz‐Schatz stents for thrombus‐containing coronary lesions

Management of intracoronary thrombosis complicating percutaneous transluminal coronary angioplasty

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