Systematic Review on Endovascular Access to Intracranial Arteries for Mechanical Thrombectomy in Acute Ischemic Stroke

Penide, J.; Mirza, Mahmood; McCarthy, Ray; Fiehler, Jens; Mordasini, Pasquale; Delassus, Patrick; Morris, Liam; Gilvarry, Michael

doi:10.1007/s00062-021-01100-7

Cited by 10 publications

(5 citation statements)

References 48 publications

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“…The rate of intraprocedural complications was similar in both groups as well. Sufficient technical equipment is a requirement for adequate recanalization results and management of complications, because not every thrombectomy case can be handled with standard material ( 20 ). The TSC in the present study, for instance, has a fully equipped radiology department with various stent-retrievers, stents, wires, catheters, sheathes etc.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome, recanalization success, and time metrics in drip-and-ship vs. drive-the-doctor: A retrospective analysis of the HEI-LU-Stroke registry

et al. 2023

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PurposeThis study aimed at comparing clinical outcome, recanalization success and time metrics in the “drip and ship” (DS) vs. “drive the doctor” (DD) concept in a comparable setting.MethodsThis is a retrospective analysis of thrombectomy registries of a comprehensive stroke center (CSC) and a thrombectomy-capable stroke center (TSC). Patients, who were transferred from the TSC to the CSC, were classified as DS. Patients treated at the TSC by an interventionalist transferred from the CSC were classified as DD. Good outcome was defined as mRS 0–2 or equivalent to premorbid mRS at discharge. Recanalization (TICI 2b-3 or equivalent) and time metrics were compared in both groups.ResultsIn total, 295 patients were included, of which 116 (39.3%) were treated in the DS concept and 179 (60.7%) in the DD concept. Good clinical outcome was similarly achieved in DS and DD (DS 25.0% vs. DD 31.3%, P = 0.293). mRS on discharge (DS median 4, DD median 4, P = 0.686), NIHSS improvement (DS median 4, DD median 5, P = 0.582) and NIHSS on discharge (DS median 9, DD median 7, P = 0.231) were similar in both groups. Successful reperfusion was achieved similarly in DS (75.9%) and DD as well (81.0%, P = 0.375). Time from onset to reperfusion (median DS 379 vs. DD 286 min, P = 0.076) and time from initial imaging to reperfusion were longer in DS compared to DD (median DS 246 vs. DD 162 min, P < 0.001).ConclusionThe DD concept is time saving while achieving similar clinical outcome and recanalization results.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome, recanalization success, and time metrics in drip-and-ship vs. drive-the-doctor: A retrospective analysis of the HEI-LU-Stroke registry

et al. 2023

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“…In a recent systematic review, it was found that 4.4% of MTs failed to achieve intracranial access using a femoral approach, preventing a single thrombectomy attempt, and leading to revascularization failure. The supra-aortic vessels (2.7%) and aortic arch (1.32%) together account for 92% of the known TFA failure locations, with vessel tortuosity given as the primary reason (2.1%, i.e., 46.8% of all causes) ( 55 ).…”

Section: Characteristics Of Current In-vitro Modelsmentioning

confidence: 99%

“…Challenges associated with ICA tortuosity among patients has long been reported ( 55 , 56 ). Many categories of tortuosity have been described, including arterial elongation, coils, kinks, and loops.…”

Section: Characteristics Of Current In-vitro Modelsmentioning

confidence: 99%

“…Not only are the intra- and supra aortic extra-cranial vasculature important for modeling access challenges, but also tortuous aortic access can delay or prevent access to occlusions. Difficult arch anatomy is the second most common location of failure ( 55 ). Challenging arch access is often associated with sharper take-off angle of the innominate or common carotid arteries, or vascular variants such as a bovine arch ( 62 ).…”

Section: Characteristics Of Current In-vitro Modelsmentioning

confidence: 99%

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A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

Johnson

Dwivedi

Mirza

et al. 2022

Front. Med. Technol.

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In-vitro neurovascular models of large vessel occlusions (LVOs) causing acute ischemic stroke (AIS) are used extensively for pre-clinical testing of new treatment devices. They enable physicians and engineers to examine device performance and the response of the occlusion to further advance design solutions for current unmet clinical needs. These models also enable physicians to train on basic skills, to try out new devices and new procedural approaches, and for the stroke team to practice workflows together in the comfort of a controlled environment in a non-clinical setting. Removal of the occlusive clot in its entirety is the primary goal of the endovascular treatment of LVOs via mechanical thrombectomy (MT) and the medical treatment via thrombolysis. In MT, recanalization after just one pass is associated with better clinical outcomes than procedures that take multiple passes to achieve the same level of recanalization, commonly known as first pass effect (FPE). To achieve this, physicians and engineers are continually investigating new devices and treatment approaches. To distinguish between treatment devices in the pre-clinical setting, test models must also be optimized and expanded become more nuanced and to represent challenging patient cohorts that could be improved through new technology or better techniques. The aim of this paper is to provide a perspective review of the recent advancements in the in-vitro modeling of stroke and to outline how these models need to advance further in future. This review provides an overview of the various in-vitro models used for the modeling of AIS and compares the advantages and limitations of each. In-vitro models remain an extremely useful tool in the evaluation and design of treatment devices, and great strides have been made to improve replication of physiological conditions. However, further advancement is still required to represent the expanding indications for thrombectomy and thrombolysis, and the generation of new thrombectomy devices, to ensure that smaller treatment effects are captured.

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“…Impossibility to reach the LVO may account for up to one third of reperfusion failures (Kaesmacher et al, 2018). Nonetheless, the overall rate of failed MTs due to unreachability of the LVO remains low, at around 4.4% (Penide et al, 2021). Time delays related to DCA during MT procedures to reach the target LVO are far more prevalent.…”

Section: Introductionmentioning

confidence: 99%

A Fully Automatic Method for Vascular Tortuosity Feature Extraction in the Supra-Aortic Region: Unraveling Possibilities in Stroke Treatment Planning

et al. 2022

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Systematic Review on Endovascular Access to Intracranial Arteries for Mechanical Thrombectomy in Acute Ischemic Stroke

Cited by 10 publications

References 48 publications

Clinical outcome, recanalization success, and time metrics in drip-and-ship vs. drive-the-doctor: A retrospective analysis of the HEI-LU-Stroke registry

Clinical outcome, recanalization success, and time metrics in drip-and-ship vs. drive-the-doctor: A retrospective analysis of the HEI-LU-Stroke registry

A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

A Fully Automatic Method for Vascular Tortuosity Feature Extraction in the Supra-Aortic Region: Unraveling Possibilities in Stroke Treatment Planning

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