The ReWiSed CARe Technique

Maus, Volker; Behme, Daniel; Maurer, Christoph J.; Tropine, Andrei; Tritt, Stephanie; Berlis, Ansgar; Psychogios, Marios‐Nikos

doi:10.1007/s00062-019-00795-z

Cited by 11 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The debate regarding the order of stent placement relative to thrombectomy has recently been circumvented by some authors who have developed techniques using nearly simultaneous c-ICA revascularization and intracranial stent-retriever thrombectomy; however, adoption of this approach remains limited thus far. 29,30 What Type of Stent Should Be Used? Dual-layer stents contain a second micromesh layer to theoretically better cover the atherosclerotic plaque and more effectively prevent dislodgement of debris.…”

Section: Should the Intracranial Or Extracranial Lesions Be Treated Fmentioning

confidence: 99%

Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions

Poppe

Jacquin

Roy

et al. 2020

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

Approximately 15% of patients undergoing endovascular thrombectomy for anterior circulation acute ischemic stroke have a tandem lesion, defined as a severe stenosis or occlusion of the cervical internal carotid artery ipsilateral to its intracranial occlusion. Patients with tandem lesions have worse outcomes than patients with isolated intracranial occlusions, but the optimal management of their carotid lesions during endovascular thrombectomy remains controversial. The main options commonly used in current practice include acute stent placement in the carotid lesion versus thrombectomy alone without definitive revascularization of the carotid artery. While treatment decisions for these patients are often complex and strategies vary according to clinical, anatomic, and technical considerations, only results from randomized trials comparing these approaches are likely to strengthen current recommendations and optimize patient care.

show abstract

Section: Should the Intracranial Or Extracranial Lesions Be Treated Fmentioning

confidence: 99%

Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions

Poppe

Jacquin

Roy

et al. 2020

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Steno-occlusion of the cervical internal carotid artery (ICA) poses a technical challenge in the treatment of TO by endovascular means [ 6 ]. Emergent stenting of the extracranial carotid lesion is a predictor of successful reperfusion and favourable outcome in this complex patient population [ 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ideal endovascular treatment of acute cerebral large vessel occlusions and concomitant atherosclerotic lesions of the ipsilateral internal carotid artery (ICA) is still a matter of debate [ 5 ]. Recent retrospective multicentre studies have shown good results with simultaneous treatment of both occlusions with a good outcome (mRS 0–2) in up to 55% of patients [ 6 – 8 ]. Furthermore, a pooled analysis of the retrospective international TITAN trial and the prospective multicenter observational ETIS registry showed that acute cervical ICA stenting is associated with higher odds of favourable clinical outcome and successful reperfusion in patients with ischaemic strokes due to TO [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety Outcomes for Acute Ischemic Stroke Patients Treated with Intravenous Infusion of Tirofiban After Emergent Carotid Artery Stenting

Garayzade,

Berlis,

Schiele

et al. 2023

Clin Neuroradiol

Self Cite

View full text Add to dashboard Cite

Introduction Emergent stenting of the extracranial internal carotid artery (ICA) in stroke patients requires antiplatelet therapy to prevent in-stent thrombosis with a higher risk of intracranial haemorrhage. Aim of the Study Assess the efficacy and safety of emergent carotid stenting with intravenous tirofiban in acute ischemic stroke patients. Methods Primary endpoint: symptomatic hemorrhage. Secondary endpoints: 90-day functional outcome and mortality. Results Of the 62 patients, 21 (34%) received tirofiban as a single antiplatelet, and 41 (66%) received combined therapy. Premedication with anticoagulants and antiplatelets was significantly more frequent in the tirofiban-only group. The rate of symptomatic haemorrhage was significantly lower in the tirofiban-only group than in the combined group (4.8% vs. 27%, p = 0.046). The patients with tirofiban alone had a significantly better functional outcome at day 90 than the combined group (52% vs. 24%, p = 0.028). Mortality was equal (24%) in both groups. Pre-interventional NIHSS score (p = 0.003), significant blood pressure fluctuations (p = 0.012), tandem occlusion (p = 0.023), and thrombolysis (p = 0.044) showed relevant influence on the rate of symptomatic hemorrhage in the entire patient cohort. Conclusions A single antiplatelet therapy with tirofiban regardless of the premedication may improve the functional outcome in patients with stroke due to acute extracranial carotid lesion and emergent carotid stenting with lower rates of serious intracranial haemorrhage. For patients with high pre-interventional NIHSS score, tandem occlusion and after pre-interventional thrombolysis, caution is advised. Additionally, strict blood pressure monitoring should be conducted during the first 72 h after intervention.

show abstract

“…Previous reports of TL treatment utilizing the SR’s wire, as in our procedure, include the method by Yamamoto et al 8) and the retriever wire supported carotid artery revascularization (ReWiSed CARe) technique by Behme et al 9 , 10) Compared with these techniques, our procedure has two important characteristics. One is the use of the Solitaire 6 × 40 mm, which is the longest SR, and the second is completion of the procedure under continuous balloon occlusion of the CCA with concomitant manual aspiration.…”

Section: Discussionmentioning

confidence: 99%

Utility of Coaxial Angioplasty–thrombectomy for Acute Tandem Occlusion of Intracranial and Extracranial Arteries

Miyauchi

Kamiya

Kuriki

et al. 2020

JNET

View full text Add to dashboard Cite

We report a novel technique for acute occlusion of both intracranial and extracranial arteries (tandem lesions [TL]). Case Presentation: A 67-year-old male was transferred to our hospital because of right hemiparesis and aphasia. MRA revealed occlusion of the left cervical internal carotid artery (ICA) and middle cerebral artery (MCA). A balloon guide catheter (BGC) was advanced into the left common carotid artery (CCA). A microcatheter was advanced over a microwire through the intracranial thrombus. A stent retriever (SR) was deployed from the MCA to the ICA through the microcatheter. Next, with the SR anchored to the thrombus, the microcatheter was withdrawn. The extracranial percutaneous transluminal angioplasty (PTA) balloon was coaxially advanced over the SR's delivery wire and angioplasty was performed. Then, an aspiration catheter was coaxially advanced to the proximal aspect of the intracranial thrombus over the delivery wire by pump aspiration. We removed the SR and the aspiration catheter as a single unit into the BGC, resulting in sufficient recanalization. The puncture to recanalization time was 29 minutes. Conclusion: This technique can lead to faster recanalization in cases of TL.

show abstract

The ReWiSed CARe Technique

Cited by 11 publications

References 17 publications

Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions

Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions

Efficacy and Safety Outcomes for Acute Ischemic Stroke Patients Treated with Intravenous Infusion of Tirofiban After Emergent Carotid Artery Stenting

Utility of Coaxial Angioplasty–thrombectomy for Acute Tandem Occlusion of Intracranial and Extracranial Arteries

Contact Info

Product

Resources

About