Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke

Mueller‐Kronast, Nils; Zaidat, Osama O.; Froehler, Michael T.; Jahan, Reza; Aziz-Sultan, Mohammad Ali; Klucznik, Richard P.; Saver, Jeffrey L.; Hellinger, Frank R; Yavagal, Dileep R.; Yao, Tom L; Liebeskind, David S; Jadhav, Ashutosh P.; Gupta, Rishi; Hassan, Ameer E.; Martin, Coleman; Bozorgchami, Hormozd; Kaushal, Ritesh; Nogueira, Raul G; Gandhi, Ravi H.; Peterson, Eric C.; Dashti, Shervin R.; Given, Curtis A.; Mehta, Brijesh; Deshmukh, Vivek R.; Starkman, Sidney; Linfante, Italo; McPherson, Scott H.; Kvamme, Peter; Grobelny, Thomas; Hussain, Muhammad Shazam; Thacker, Ike; Vora, Nirav; Chen, Peng R.; Monteith, Stephen J.; Ecker, Robert D.; Schirmer, Clemens M.; Sauvageau, Eric; Aböu-Chebl, Alex; Derdeyn, Colin P.; Maidan, Lucian; Badruddin, Aamir; Siddiqui, Adnan H.; Dumont, Travis M.; Alhajeri, Abdulnasser; Taqi, Muhammad; Asi, Khaled; Carpenter, Jeffrey; Boulos, Alan S.; Jindal, Gaurav; Puri, Ajit S; Chitale, Rohan; Deshaies, Eric M.; Robinson, David; Kallmes, David F.; Baxter, Blaise; Jumaa, Mouhammad; Sunenshine, Peter; Majjhoo, Aniel; English, Joey; Suzuki, Shinichi; Fessler, Richard D.; Almandoz, Josser E Delgado; Martin, Jorge R.; Haussen, Diogo C

doi:10.1161/strokeaha.117.016456

Cited by 158 publications

(148 citation statements)

References 18 publications

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“…The recent HERMES analysis [7] and STRATIS registry [16] included elderly patients aged ≥80 years without baseline disability and reported good outcomes (mRS score 0-2) in 29.8 and 43.2% of the patients, respectively (Table 2). Similarly, our rate of mRS scores of 0-2 among patients without baseline disability was 40.8%, thus supporting the findings of HERMES and STRATIS that patients aged ≥80 years achieve respectable rates of functional recovery when their premorbid disability is minimal.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

et al. 2018

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Background: The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Methods: Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0–2 or return to baseline. Results: Of the 96 patients, 50 had mild baseline disability (mRS score 0–1) and 46 had moderate disability (mRS score 2–4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, p = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, p = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, p = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability (p < 0.001 and p = 0.009, respectively). Conclusion: Advanced age, baseline disability, and delayed treatment are associated with suboptimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment.

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Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

et al. 2018

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“…The effects of OTR [5,19], age [6,8], and baseline NIHSS score [8] have been proven and widely accepted as major factors affecting patients' prognosis. Recently, patients achieving mTICI3 reperfusion were reported to have a better functional outcome [20,21].…”

Section: Discussionmentioning

confidence: 99%

“…However, several issues are yet to be clarified before applying these results to real-world clinical settings [6]. Among them, there still remains room for discussion about MT for elderly patients, for being elderly itself is a well-documented predictor of poor outcomes for patients with AIS [7].…”

Section: Introductionmentioning

confidence: 99%

Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo

Koizumi¹,

Ota²,

Shigeta³

et al. 2018

Cerebrovasc Dis

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Background: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke with large vessel occlusion; however, evidence remains insufficient for MT for elderly patients, especially with respect to factors affecting their outcomes. Methods: This study was a retrospective analysis of a multicenter registry of MT, called Tama Registry of Acute Endovascular Thrombectomy. Patients were divided by their age into 2 groups: Nonelderly (NE; < 80) and elderly (E; ≥80). Factors related to a good outcome (modified Rankin scale score ≤2) were examined in each group. Onset to reperfusion time (OTR) was stratified into 4 categories: category 1, 0 – ≤180 min; category 2, > 180 – ≤360 min; category 3, > 360 min or onset time not identified; and category 4, effective recanalization not achievable. Results: 143 NE patients and 78 E patients were included in this study. The E group had less chance of achieving a good outcome (NE group 51%, E group 35%; p = 0.024). In the NE group, lower OTR category was an independent prognostic factor for good outcome (p = 0.037, OR = 1.09). However, in the E group, OTR category was not a significant predictor on multivariate analysis. Instead, effective recanalization (p = 0.0081, OR 1.40) and lower National Institute of Health Stroke Scale score at presentation (p = 0.0032, OR 1.02) were the independent predictors. Conclusions: In MT for elderly patients, effective recanalization improved the patients’ outcome but OTR affected less. Further studies are warranted to establish the appropriate patient selection and treatment strategies.

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“…However, emergent stenting necessitates prophylactic antiplatelet medication, and also risks hyperperfusion syndrome and cerebral hemorrhage, issues that are further complicated in patients who have received intravenous tPA or in whom the cerebral infarct volume is unknown [23,24]. While recent large registries of AIS have shown no significant difference in symptomatic hemorrhage rates after acute stenting in AIS patients presenting with tandem occlusions, other reports suggest an intracerebral hemorrhage rate as high as 20% [25,26]. In our first case, after performing the critical intracranial thrombectomy, we were hopeful that balloon angioplasty would temporarily stabilize the ostial lesion until a time more suitable for prophylactic antiplatelet medication.…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting

2018

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Background: Acute ischemic stroke due to tandem occlusive lesions of the anterior circulation involves an intracranial large vessel occlusion as well as a concurrent occlusion or high-grade stenosis of the proximal carotid system. The vast majority of proximal lesions in tandem occlusive cases involve the extracranial internal carotid artery, although the lesion can theoretically exist anywhere along the carotid artery pathway, including the common carotid ostium. Summary: To the best of our knowledge, only 1 report describes common carotid artery ostial lesions in the setting of acute ischemic stroke due to tandem occlusions, in which the authors describe an anterograde treatment paradigm. We present the first 2 cases of acute ischemic stroke secondary to common carotid ostial disease with tandem intracranial occlusion, treated with intracranial thrombectomy followed by subsequent staged balloon-mounted stenting of the common carotid ostium. We review the pathophysiology of tandem occlusions, the controversy surrounding treatment techniques, and various approaches used in the treatment of ostial occlusive lesions. Key Message: In certain situations where acute carotid stenting is not safe or technically possible, immediate intracranial thrombectomy with a subsequent staged balloon-mounted stenting of the ostial lesion may be a reasonable and safe option.

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Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke

Abstract: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.

Cited by 158 publications

References 18 publications

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo

Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting

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