The Stream Device-A Retrospective Review of 51 Cases

Publisher Copyright: © 2023 by the authors.Mechanical thrombectomy is the gold-standard treatment for patients that have suffered large-vessel occlusion (LVO) stroke. Various different stent-retrievers, aspiration catheters, and techniques have been developed to perform this procedure. We present our initial results regarding the Stream device. Materials and Methods: We performed a retrospective review of a prospectively maintained database at our high-volume centre to identify all patients treated with the Stream device between February 2021 and January 2023. We recorded baseline demographics, NIHSS, ASPECT scores, eTICI scores, complications, and 90-day mRS. Results: We identified 51 patients, 49.0% of whom were male (n = 25), with a median age of 73 (range: 51–89) and a median NIHSS score of 17 (range 4–22), and 68.6% received IV tPA. The median ASPECT score was 10 (range 6–10). Hyperdense clots were seen in 34 cases (66.7%), with a mean clot length of 12 ± 6.2 mm (range 2–26 mm). Clots were located in the anterior circulation in 49 patients. The standard Stream device was used in 78.4% of cases, with Stream 17 being used in 19.6% of cases. The FPE was observed in 25.5% of cases (n = 13), with the mFPE being seen in 31.4% of cases (n = 16). A final eTICI score of ≥2b was achieved in 90.2% of cases (n = 46), and eTICI 2c/3 was seen in 84.3% of cases (n = 43). Furthermore, 24 h CT scans showed that the median ASPECT score was 8 (range 0–10). Good functional outcomes at 90 days (mRS ≤ 2) were achieved in 21.6% of cases (n = 11). Conclusions: The Stream device shows acceptable rates of FPE and mFPE compared to existing devices. Further larger studies are required alongside an understanding of the optimal technique for this device’s use.Peer reviewe

Endovascular treatment of acute ischemic stroke using a dynamic thrombectomy system.

MedicīnaVeselības aprūpeMedicineHealth CareAtslēgas vārdi: akūts išēmisks insults, endovaskulāra ārstēšana, mehāniskā trombektomija, dinamiskā trombektomijas sistēma. Ievads. Akūts išēmisks insults (AII) mūsdienās ir viens no biežākajiem nāves cēloņiem gan Latvijā, gan pasaulē. Pēdējās desmitgadēs ir būtiski attīstījušās un uzlabojušās terapijas iespējas AII pacientiem, tomēr joprojām lielai daļai pacientu šis kardiovaskulārais notikums izraisa invaliditāti un ievērojamu funkcionālo spēju zudumu. Terapija galvenokārt sastāv no intravenozas trombolīzes un/vai mehāniskās trombektomijas. Mehāniskās trombektomijas sistēmas laika gaitā ir ievērojami attīstījušās, taču joprojām tiek meklēti jauni veidi, kā uzlabot to efektivitāti. Viena no jaunākajām ir dinamiskā trombektomijas sistēma, kas trombektomijas veicējam nodrošina pilnu kontroli pār ierīces vadību un ir labi vizualizējama attēldiagnostikas metodēs. Mērķi: izvērtēt endovaskulārās ārstēšanas efektivitāti, pielietojot dinamiskās trombektomijas sistēmu. Materiāli un metodes. Šis pētījums tika veikts kā retrospektīvs pētījums, kurā tika izvērtēti to 46 pacientu dati, kuri atbilda pētījuma iekļaušanas un izslēgšanas kritērijiem. Iegūtie dati tika analizēti, pielietojot statistiskās analīzes metodes. Rezultāti: 36 pacientiem (78%) rekanalizāciju izdevās nodrošināt ar dinamiskās trombektomijas sistēmu, 15 no tiem (33%) to izdevās veikt ar pirmo mēģinājumu. Lielākajai daļai jeb 39 pacientiem (85%) procedūra noritēja bez komplikācijām. Trīs pacientiem (7%) attīstījās maznozīmīga subarahnoidāla hemorāģija, diviem pacientiem (4%) tika konstatēta sekundāra intracerebrāla hemorāģija. Manipulācijas ilguma mediāna, pielietojot šo sistēmu, bija 45 (P25 39 - P75 90) minūtes. Pēc mehāniskās trombektomijas ievērojami mazinājās pacientu neiroloģiskais deficīts, pastāvēja statistiski nozīmīga atšķirība starp iestāšanās, 24h un izrakstīšanās NIHSS skalas mediānas vērtībām (p=0,000). Labs funkcionālais iznākums (90d mRS 0 – 2) bija vērojams septiņiem pacientiem (18%), mirstība - 18 (47%). Secinājumi. Dinamiskā trombektomijas sistēma ir droša un efektīva terapijas metode akūta išēmiska insulta ārstēšanā. Veiksmīga asinsvadu rekanalizācija ar šo sistēmu tiek sasniegta gandrīz astoņiem no desmit pacientiem, kamēr labs funkcionālais iznākums ir vērojams apmēram diviem no desmit. Lai varētu labāk un precīzāk izvērtēt rezultātus, ko sniedz šī sistēma, būtu nepieciešami pētījumi ar lielāku pacientu skaitu.Keywords: acute ischemic stroke, endovascular treatment, mechanical thrombectomy, dynamic thrombectomy system. Introduction: Acute ischemic stroke is one of the leading causes of deaths both in Latvia and worldwide. Treatment options for it have significantly developed and improved in the last decade, however for many patients this cardiovascular event still leads to disability and reduced functional abilities. Treatment mainly consists of intravenous thrombolysis and/or mechanical thrombectomy. Recently mechanical thrombectomy systems have significantly developed, however new ways are being researched to improve their efficiency. One of the newest is dynamic thrombectomy system, which allows physicians to have full device control and provides with very good visibility to make real-time adjustments during a thrombectomy procedure. Goals: Evaluate endovascular treatment effectiveness using dynamic thrombectomy system. Materials and methods: This research was done as a retrospective study by evaluating 46 patients’ data, which met inclusion and exclusion criteria of the research. Obtained data were analysed using statistical analysis methods. Results: For 36 (78%) patients recanalization was achieved with this system, of which for 15 (33%) it was achieved on first attempt. Complications did not develop for majority of patients 39 (85%). Insignificant subarachnoidal haemorrhage developed for three (7%) patients and intracerebral haemorrhage for two (4%). Median for manipulation duration was 45 (P25 39 - P75 90) minutes. Neurological deficit significantly decreased after mechanical thrombectomy. There was statistically significant difference between onset, 24h and discharge NIHSS values (p=0,000). Good functional outcome (90d mRS 0 – 2) was achieved for seven (18%) patients while mortality for 18 (47%) patients. Conclusions: Dynamic thrombectomy system is safe and effective treatment method for acute ischemic stroke patients. Successful vascular recanalization with this system is achieved in almost eight out of ten patients, while good functional outcomes are seen in about two out of ten patients. Studies with larger number of patients would be needed to better and more accurately evaluate the results of this system