Risultati per: Utilizzo degli stent-retriever nell’ictus ischemico acuto

Amato A, Tarantino I, Facciorusso A On behalf of i-EUS Group, et al. Real-life multicentre study of lumen-apposing metal stent for EUS-guided drainage of pancreatic fluid collections. Gut 2022;71:1050-2. doi:10.1136/gutjnl-2022-326880.
There are errors in two of the affiliations.
The affiliations 6 and 13 should be as follows:
(6) Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
(13) Department of Biomedical Sciences, Humanitas University, Milan, Italy.

Stroke, Ahead of Print. Background:We aimed to assess whether the effect of intravenous alteplase treatment (IVT) before endovascular treatment (EVT) on outcome is modified by first-line technique during EVT in IVT eligible patients.Methods:This was a post hoc analysis from MR CLEAN-NO IV (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands – Intravenous Treatment Followed by Intra-Arterial Treatment Versus Direct Intra-Arterial Treatment for Acute Ischemic Stroke Caused by a Proximal Intracranial Occlusion), a randomized trial of IVT followed by EVT versus EVT alone in patients presenting directly to EVT-capable centers. We included data from all patients who underwent EVT with a thrombectomy attempt. We compared patients treated with stent retriever (with or without aspiration) to aspiration alone as first-line EVT technique and assessed the interaction of first-line EVT technique with IVT treatment. Primary outcome was the 90-day modified Rankin Scale score, analyzed with mixed model ordinal regression for a shift towards better outcome. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2b–3).Results:Of 473 included patients, 102 (21.6%) were treated with aspiration alone as first-line technique. In the full population, functional outcome was similar for patients treated with stent retriever versus aspiration only (adjusted common odds ratio [acOR]‚ 1.07 [95% CI, 0.69–1.66]). We observed a significant interaction between IVT and first-line EVT technique (P=0.03). In the aspiration-only group, patients treated with EVT alone had worse functional outcome compared to those treated with IVT and EVT (acOR, 0.44 [95% CI, 0.21–0.90]). In the stent retriever group, functional outcome did not differ between patients treated with or without IVT (acOR, 1.08 [95% CI, 0.74–1.57]). There was no statistically significant interaction for successful reperfusion.Conclusions:In MR CLEAN-NO IV, the treatment effect of IVT was modified by first-line EVT technique. Patients treated with aspiration only as first-line technique had worse clinical outcomes if they did not receive IVT. No such difference was observed in patients treated with stent retrievers. Confirmation by pooling with results from other trials is needed to confirm these findings.

Stroke, Volume 53, Issue 7, Page e362-e362, July 1, 2022.

Stroke, Ahead of Print. BACKGROUND:The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation.METHODS:TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events.RESULTS:A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62–81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44;P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%;P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0–1, aspiration: 60.5% versus stent retriever 68.6%;P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95–0.99];P

Stroke, Ahead of Print. Background:The Advanced Neurovascular Access (ANA) thrombectomy system is a novel stroke thrombectomy device comprising a self-expanding funnel designed to reduce clot fragmentation by locally restricting flow while becoming as wide as the lodging artery. Once deployed, the ANA device allows distal aspiration combined with a stent retriever to mobilize the clot into the funnel where it remains copped during extraction. We investigated the safety and efficacy of ANA catheter system.Methods:SOLONDA (Solitaire in Combination With the ANA Catheter System as Manufactured by Anaconda) was a prospective, open, single-arm, multicenter trial with blinded assessment of the primary outcome by an independent core lab. Patients with anterior circulation vessel occlusion admitted within 8 hours from symptom onset were eligible. The primary end point was successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b–3) with ≤3 passes of the ANA device in combination with stent retriever, before the use of rescue therapy in the intention to treat population. Primary predefined analysis was noninferiority as compared to the performance end point observed in HERMES (High Effective Reperfusion Using Multiple Endovascular Devices).Results:After enrollment of 74 patients, an interim analysis was conducted, and the trial Steering Committee decided to terminate recruitment due to safety and performance objectives were reached. Mean age was 71.6 (SD 8.9) years, 46.6% women and median National Institutes of Health Stroke Scale on admission 14 (interquartile range, 10–19). Successful reperfusion within 3 passes before rescue therapy was achieved in 60/72 (83.3% [95% CI, 74.7%–91.9%]) with a rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 2c–3) of 60% (95% CI, 48.4%–71.1%; 43/72 patients). After noninferiority was confirmed (P

Stroke, Volume 53, Issue Suppl_1, Page ATMP6-ATMP6, February 1, 2022. Introduction:Inflow blockage of aneurysms treated with flow diverter stents is dependent on the deployed braid angle (ϕ)—the angle between the yarns which comprise the stent braids and the longitudinal axis of the braid. We utilized computational fluid dynamic (CFD) analysis to examine the effects of braid angle on intra-aneurysmal hemodynamic parameters associated with long-term treatment success.Methods:Two flow diverter stents measuring 3.5 mm in diameter, each containing 88 strands with ϕ = 10° and ϕ = 35° were constructed and deployed into a patient model of an internal carotid artery saccular aneurysm containing pulsatile blood flow. Intra-aneurysmal flow velocity, pulsatility index (PI), turbulence, vorticity, and wall shear stress (WSS) parameters were obtained and compared for the two braid angles.Results:Reducing ϕ from 35° to 10° resulted in -2.59%, -1.92%, and -1.41% changes in systolic bulk velocity, and -1.79%, +0.57%, and -1.65% changes in PI at the aneurysm neck, body, and dome respectively. Vorticity changes were insignificant. High turbulence extending through the aneurysm neck peaked approximately 0.04 s later in systole, and was located closer to the parent vessel outlet when ϕ = 10°. Elevated intra-aneurysmal WSS was concentrated at the neck and body on the side of the parent vessel outlet for both ϕ = 10° and ϕ = 35°. Regions of WSS in excess of 10 Pa stretched higher into the aneurysm body when ϕ = 35°.Conclusion:Stenting at a lower ϕ resulted in higher blockage of flow and better reduction of WSS for initiating and facilitating long term intra-aneurysmal thrombosis. CFD analysis incorporating precise reconstruction of the stent deployment conformation into patient models can provide detailed visualization of flow parameters for assessing potential treatment efficacy throughout the diagnostic and treatment phases of patient care.

Stroke, Volume 53, Issue Suppl_1, Page ATP162-ATP162, February 1, 2022. Background and Purpose:Angioplasty and stenting is a therapeutic option for patients with medically refractory intracranial atherosclerotic disease (ICAD). We previously demonstrated the feasibility of using Resolute (R) Onyx Stent, a drug-eluting balloon mounted coronary stent (DES), for ICAD patients. WEAVE (Wingspan Stent System Post Market Surveillance) trial assessed the periprocedural safety of Wingspan Stents in ICAD patients. We present our on-going experience with R-Onyx in ICAD patients integrating WEAVE styled methodology to assess outcomes in our cohort.Methods:A prospectively maintained neuro-endovascular database was queried for intracranial angioplasty and stenting cases from October 2019 to June 2021. Patients with symptomatic ICAD despite maximum medical management with >70% stenosis who were treated with R-Onyx DES were included. Primary outcomes were assessed according to WEAVE trial criteria (ischemic or hemorrhagic stroke or death within 72 h of the procedure). Secondary outcomes were assessed by occurrence of stroke and/or in-stent restenosis evaluated 30 days post-procedure clinically or angiographically.Results:A total of 58 patients were eligible for analysis with a mean age of 63.66 years, and 63.8% (n=37) were males. A total of 42 patients had an indication for treatment consisting of recurrent stroke while 16 had recurrent transient ischemic attacks. A total of 62 R-onyx DES stents were used to treat 58 patients with symptomatic lesions with an average stenosis of 84.7%. All procedures were completed successfully with

Stroke, Volume 53, Issue Suppl_1, Page AWMP8-AWMP8, February 1, 2022. Background and Purpose:Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) using a stent retriever (SR) or contact aspiration (CA) has been established as standard therapy. The efficacy of combined use of an SR and aspiration catheter (combined technique: CBT) to achieve successful recanalization has not been fully elucidated. Here, we investigated the safety and efficacy of CBT compared with MT with the single use of an SR or CA.Methods:We analyzed 763 consecutive patients who underwent MT for AIS in the anterior circulation between January 2013 and January 2020 at six comprehensive stroke centers. The patients were divided into two groups based on the technique in the first attempt for thrombus removal: the CBT group and single device (SR/CA) group. The rate of successful recanalization with first pass (SRFP), the rate of final successful recanalization, and other procedural outcomes were compared between the groups.Results:A total of 571 patients (CBT group, 270; SR/CA group, 301 [SR: 128, CA: 173]), were analyzed. The rate of SRFP (mTICI 2c-3, 41.1 % vs. 27.9 %; p = 0.001; mTICI 3, 34.0 % vs. 25.5 %; p = 0.027) and final mTICI 2b-3 recanalization (88.8 % vs. 82.0 %; p = 0.024) was significantly higher, puncture to reperfusion time was shorter (median [IQR], 43 [31.2-69] vs. 55 (38-82.2) min; p = 0.004) and the number of passes were fewer (mean ± SD, 1.74 ± 0.93 vs. 1.99 ± 1.01; p = 0.002) in the CBT group compared with the SR/CA group. Procedural complications did not differ between the two groups. Subgroup analysis revealed that CBT was more effective for women, patients with cardioembolic stroke, internal carotid artery, and M2 occlusion.Conclusions:CBT could increase the rate of SRFP and shorten the puncture to reperfusion time without increasing procedural complications.

Stroke, Volume 53, Issue Suppl_1, Page A37-A37, February 1, 2022. Background:Clopidogrel bolus is an option used prior to carotid artery stent placement (CAS) when sustained clopidogrel pre-treatment is not used.Objective:To compare the effect of clopidogrel bolus (450 mg administered ≥4 hours) with sustained clopidogrel pre-treatment (48 hours or greater) prior to CAS in patients prospectively followed over 10 years in Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).Methods:The rates of primary endpoint (composite of any stroke, myocardial infarction (MI), or death during the periprocedural period or ipsilateral stroke within 4 years after randomization) were compared between patients who received clopidogrel bolus with those who received sustained clopidogrel pre-treatment after adjusting for age, gender, symptomatic status and initial severity of stenosis (≥70% versus

Stroke, Volume 53, Issue Suppl_1, Page A78-A78, February 1, 2022. Context:Transradial access has been increasingly utilized for neurointerventional procedures including carotid angioplasty and stent placement (CAS) over the past decade. At our center, we adopted transradial approach as the preferred approach in 2020.Objective:To compare the results of transradial approach with transfemoral approach for CAS as part of a quality assurance initiative.Methods:We analyzed data collected for all non-urgent CAS procedures performed at our institute in the last 24 months by same interventionalists to minimize inter-operator variability. We looked at the rates of technical failure; hemorrhagic complications classified as major (hemoglobin decrease >5 g/dL or intracranial hemorrhage with deficits), minor (hemoglobin decreases 3-5 g/dL or intracranial hemorrhage without residual deficits), or insignificant; and any stroke and/or death within 1-month post procedure.Results:A total of 182 non-urgent CAS procedures were performed at our institution; 116 (64%) were initiated using transfemoral approach and 66 (36%) were initiated using transradial approach. The median age was similar between the two group (66.5 years versus 66.7 years). There were 6 (3%) CAS procedures initiated using transradial approach but later converted to transfemoral due to anatomical and/or technical difficulties. One (0.6%) CAS procedure initiated using transfemoral approach was converted to transradial approach due to severe iliofemoral atherosclerosis. The rates of any stroke and/or death were 1.6% (n=1) and 3.3%% (n-=4) in patients undergoing CAS using transradial and transfemoral approaches, respectively. The rate of major hemorrhagic complications were 1.6% (n=1) and 5.7% (n-=7) in patients undergoing CAS using transradial and transfemoral approaches, respectively.Conclusions:The rates of major hemorrhagic complications were lower among patients who underwent CAS via transradial approach compared with CAS using transfemoral approach although the rates of technical failure remain relatively high with transradial approach.

Stroke, Ahead of Print. Background and Purpose:Whereas a clear benefit of endovascular treatment for anterior circulation stroke has been established, randomized trials assessing the posterior circulation have failed to show efficacy. Previous studies in anterior circulation stroke suggest that advanced thrombectomy devices were of great importance in achieving clinical benefit. Little is known about the effect of thrombectomy techniques on outcomes in posterior circulation stroke. In this study, we compare first-line strategy of direct aspiration to stent retriever thrombectomy for posterior circulation stroke.Methods:We analyzed data of patients with a posterior circulation stroke who were included in the Multicentre Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry between March 2014 and December 2018, a prospective, nationwide study, in which data were collected from consecutive patients who underwent endovascular treatment for ischemic stroke in the Netherlands. We compared patients who underwent first-line aspiration versus stent retriever thrombectomy. Primary outcome was functional outcome according to the modified Rankin Scale. Secondary outcomes were reperfusion grade, complication rate, and procedure duration. Associations between thrombectomy technique and outcome measures were estimated with multivariable ordinal logistic regression analyses.Results:Overall, 71 of 205 patients (35%) were treated with aspiration, and 134 (65%) with stent retriever thrombectomy. Patients in the aspiration group had a lower pc-ASPECTS on baseline computed tomography, and general anesthesia was more often applied in this group. First-line aspiration was associated with better functional outcome compared with stent retriever thrombectomy (adjusted common odds ratio for a 1-point improvement on the modified Rankin Scale 1.94 [95% CI, 1.03–3.65]). Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2B) was achieved more often with aspiration (87% versus 73%,P=0.03). Symptomatic hemorrhage rates were comparable (3% versus 4%). Procedure times were shorter in the aspiration group (49 versus 69 minutesP