Combined Approach to Stroke Thrombectomy Using a Novel Short Flexible Aspiration Catheter with a Stent Retriever

Brain ischemia; Mechanical thrombectomy; DeviceIsquemia cerebral; Trombectomía mecánica; DispositivoIsquèmia cerebral; Trombectomia mecànica; DispositiuBackground Large-bore aspiration catheters enabling greater flow rates and suction force for mechanical thrombectomy might improve outcomes in patients with stroke secondary to large-vessel occlusion. Complete or near-complete reperfusion after a single thrombectomy pass (first-pass effect) is associated with improved clinical outcomes. We assessed the efficacy and safety of novel MIVI Q™ aspiration catheters in combination with stent-retriever devices. Methods We retrospectively analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute anterior large-vessel occlusion treated with a combined approach using MIVI Q™ aspiration catheters and stent retrievers. Reperfusion was defined according to the modified thrombolysis in cerebral infarction (mTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores. Results We included 52 patients (median age, 75 y IQR: 64–83); 31 (59.6%) women; 14 (26.9%) with terminal internal carotid artery occlusions, 26 (50%) middle cerebral artery (MCA) segment M1 occlusions, and 12 (23.1%) MCA segment M2 occlusions; median NIHSS score at admission was 19 (IQR: 13–22). After the first pass, 25 (48%) patients had mTICI ≥ 2c. At the end of the procedure, 47 (90.4%) had mTICI ≥ 2b and 35 (67.3%) had mTICI ≥ 2c. No serious device-related adverse events were observed. Symptomatic intracranial hemorrhage developed in 1 patient. Mean NIHSS score was 13 at 24 h and 5 at discharge. At 90 days, 24 (46.2%) patients were functionally independent (mRS 0–2). Conclusion This preliminary study found good efficacy and safety for MIVI Q™ aspiration catheters used in combination with stent-retriever devices

Mechanical thrombectomy with 'ADAPT' technique by transcervical access in acute ischemic stroke

The mechanical thrombectomy (MT) for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected acute stroke patients. MT is typically performed via a transfemoral approach, but catheterization of the occluded vessel can be problematic in cases of extensive vessel tortuosity. We describe a case of MT with the 'ADAPT' technique by direct carotid access due to an inability to catheterize the ICA by a transfemoral approach for acute cerebral ischemia in the setting of left MCA occlusion. Excellent angiographic and good clinical results were obtained without any complications. An 80-year-old woman was admitted with a stroke by occlusion of the left MCA, with an NIHSS: 11, and an ASPECT: 7 in the CT. Under sedation a transfemoral angiography was performed, but after multiple attempts, it was impossible to make a stable catheterization of the left CCA. A transcervical approach was pursued. With ultrasound guidance the CCA was catheterized. Using the 'ADAPT' technique, we performed a successful MT. Post-procedure angiography (at 14 minutes) demonstrated recanalization of the entire left MCA (TICI: 3), without complications. The carotid access point was closed with a percutaneous closure. Control TC at 24 h showed a slight hypodensity in the left lenticular nucleus, and loss of gray-white matter differentiation in the adjacent cortex. Neurologically, the patient presented with progressive improvement. At discharge, she had an NIHSS: 0, mRS: 0 and Barthel: 100. MT by direct carotid access is an effective alternative technique in those cases where it is not accessible by a transfemoral approach

Combined Approach to Stroke Thrombectomy Using a Novel Short Flexible Aspiration Catheter with a Stent Retriever

Background: Large-bore aspiration catheters enabling greater flow rates and suction force for mechanical thrombectomy might improve outcomes in patients with stroke secondary to large-vessel occlusion. Complete or near-complete reperfusion after a single thrombectomy pass (first-pass effect) is associated with improved clinical outcomes. We assessed the efficacy and safety of novel MIVI Q™ aspiration catheters in combination with stent-retriever devices. Methods: We retrospectively analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute anterior large-vessel occlusion treated with a combined approach using MIVI Q™ aspiration catheters and stent retrievers. Reperfusion was defined according to the modified thrombolysis in cerebral infarction (mTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores. Results: We included 52 patients (median age, 75 y IQR: 64-83); 31 (59.6%) women; 14 (26.9%) with terminal internal carotid artery occlusions, 26 (50%) middle cerebral artery (MCA) segment M1 occlusions, and 12 (23.1%) MCA segment M2 occlusions; median NIHSS score at admission was 19 (IQR: 13-22). After the first pass, 25 (48%) patients had mTICI ≥ 2c. At the end of the procedure, 47 (90.4%) had mTICI ≥ 2b and 35 (67.3%) had mTICI ≥ 2c. No serious device-related adverse events were observed. Symptomatic intracranial hemorrhage developed in 1 patient. Mean NIHSS score was 13 at 24 h and 5 at discharge. At 90 days, 24 (46.2%) patients were functionally independent (mRS 0-2). Conclusion: This preliminary study found good efficacy and safety for MIVI Q™ aspiration catheters used in combination with stent-retriever devices

Effect of combined acetylsalicylic acid and statins treatment on intracranial aneurysm rupture.

BackgroundAcetylsalicylic acid (ASA) and statins have been identified as potentially reducing the risk of intracranial aneurysms (IA) rupture. We aim to determine the effect of this drugs on the risk of rupture of IA.Patients and methodsWe performed a retrospective cohort study from a prospective database of patients with IA treated in our institution between January 2013 and December 2018. Demographics, previous oral treatments, presence of multiple aneurysms, size of aneurysm, lobulation, location and morphology of the aneurysms were recorded. Patients were dichotomized as ruptured and unruptured IA.ResultsA total of 408 IA were treated, of which 283 (68.6%) were in women. The median age was 53, 194 (47.5%) were ruptured IA. 38 patients (9.3%) were receiving ASA and 84 (20.6%) were receiving statins at the moment of the IA diagnosis. In the multivariable regression analysis, ASA plus statin use and multiple aneurysms were independently associated with unruptured IA (OR 5.01, 95% CI, 1.37-18.33, P = 0.015 and OR 2.72, 95% CI 1.68-4.27, PConclusionsIn our study population ASA plus statins treatment is independently associated with unruptured IA. Larger and prospective studies are required to explore this potential protective effect against IA rupture

Mechanical thrombectomy with 'ADAPT' technique by transcervical access in acute ischemic stroke

The mechanical thrombectomy (MT) for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected acute stroke patients. MT is typically performed via a transfemoral approach, but catheterization of the occluded vessel can be problematic in cases of extensive vessel tortuosity. We describe a case of MT with the 'ADAPT' technique by direct carotid access due to an inability to catheterize the ICA by a transfemoral approach for acute cerebral ischemia in the setting of left MCA occlusion. Excellent angiographic and good clinical results were obtained without any complications. An 80-year-old woman was admitted with a stroke by occlusion of the left MCA, with an NIHSS: 11, and an ASPECT: 7 in the CT. Under sedation a transfemoral angiography was performed, but after multiple attempts, it was impossible to make a stable catheterization of the left CCA. A transcervical approach was pursued. With ultrasound guidance the CCA was catheterized. Using the 'ADAPT' technique, we performed a successful MT. Post-procedure angiography (at 14 minutes) demonstrated recanalization of the entire left MCA (TICI: 3), without complications. The carotid access point was closed with a percutaneous closure. Control TC at 24 h showed a slight hypodensity in the left lenticular nucleus, and loss of gray-white matter differentiation in the adjacent cortex. Neurologically, the patient presented with progressive improvement. At discharge, she had an NIHSS: 0, mRS: 0 and Barthel: 100. MT by direct carotid access is an effective alternative technique in those cases where it is not accessible by a transfemoral approach

Cerebral aneurysm occlusion at 12-month follow-up after flow-diverter treatment: statistical modeling for V&V with real-world data

Background: Flow-Diverter (FD) porosity has been pointed as a critical factor in theocclusion of cerebral aneurysms after treatment.Objective: Verification and Validation of computational models in terms of predictivecapacity, relating FD porosity and occlusion after cerebral aneurysms treatment.Methods: Sixty-four aneurysms, with pre-treatment and follow-up images, wereconsidered. Patient demographics and aneurysm morphological information werecollected. The computational simulation provided by ANKYRAS provided FD porosity,expansion, and mesh angle. FD occlusion was assessed and recorded from follow-upimages. Multiple regression Logit and analysis of covariance (ANCOVA) models wereused to model the data with both categorical and continuous models.Results: Occlusion of the aneurysm after 12 months was affected by aneurysmmorphology but not by FD mesh morphology. A Time-To-Occlusion (TTO) of 6.92 monthson average was observed with an SE of 0.24 months in the aneurysm populationsurveyed. TTO was estimated with statistical significance from the resulting model forthe data examined and was capable of explaining 92% of the data variation.Conclusions: Porosity was found to have the most correction power when assessingTTO, proving its importance in the process of aneurysm occlusion. Still, further Verificationand Validation (V&V) of treatment simulation in more extensive, multi-center, andrandomized databases is required.Fil: Narata, Ana Paula. Hôpitaux de Tours; FranciaFil: Obradó, Laura. Galgo Medical S. L.; EspañaFil: Moyano, Raquel Kalé. Galgo Medical S. L.; EspañaFil: Macho, Juan M.. Hospital Clinic of Barcelona; EspañaFil: Blasco, Jordi. Hospital Clinic of Barcelona; EspañaFil: Rueda, Antonio López. Hospital Clinic of Barcelona; EspañaFil: Roman, Luis San. Hospital Clinic of Barcelona; EspañaFil: Remollo, Sebastian. Hospital Universitari Germans Trias i Pujol; EspañaFil: Marinelli, Claudia Beatriz. Universidad Nacional del Centro de la Provincia de Buenos Aires; ArgentinaFil: Cepeda, Rosana. Universidad Nacional del Centro de la Provincia de Buenos Aires; ArgentinaFil: Fernández, Héctor. Galgo Medical S. L.; EspañaFil: Larrabide, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Galgo Medical S. L.; Españ