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Abstract:

Aim: was to assess efficiency of mechanical thrombectomy using stent-retriever pREset in patients with acute ischemic stroke (AIS).

Materials and methods: study included 27 patients with AIS. The average age of patients was 66 years, female - 12(44,4%). The average NIHSS was 20. Occlusion of middle cerebral artery (MCA) was observed in 21(77,8%) patients, internal carotid artery (ICA) - 4 patients, basilar artery - 2 patients.

Results: effective recovery of cerebral blood flow (TICI2b-3) was achieved in 22 patients (81,5%). The frequency of distal embolisms was 11,1%. The frequency of symptom hemorrhagic transformation was 7,4%. A favorable neurological outcome (mRs 0-2) was observed in 29,6% of patients, mortality was 25,9%.

Conclusions: the use of stent-retriever pREset allows to efficiently restore blood flow during occlusion of large cerebral arteries.

 

References

1.      Powers W., Rabinstein A., Ackerson T., et al. 2018 Guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2018; (49): DOI 10.1161/ STR.0000000000000158.

2.      Savello A.V., Voznyuk I.A., Svistov D.V. Vnutrisosudistoe lechenie ishemicheskogo insul'ta v ostrejshem periode (klinicheskie rekomendacii) [Intravascular treatment of ischemic stroke in the acute period (clinical recommendations)]. Sankt-Peterburg. 2015; [In Russ].

3.      Volodyuhin M.YU., Hasanova D.R., Dyomin T.V., i dr. Vnutriarterial'naya reperfuzionnaya terapiya u pacientov s ostrym ishemicheskim insul'tom [Intraarterial reperfusion therapy in patients with acute ischemic stroke.]. Medicinskij sovet. 2015; (10): 6-11 [In Russ].

4.      Krylov V.V., Savello A.V., Volodyuhin M.YU. Rentgenehdovaskulyarnoe lechenie ostrogo ishemicheskogo insul'ta [Endovascular treatment of acute ischemic stroke.]. Rukovodstvo. Moskva. 2017; 120 s [In Russ].

5.      Schwaiger B., Kober F., Gersing A., et al. The pREset stent retriever for endovascular treatment of stroke caused by MCA occlusion: safety and clinical outcome. Clin Neuroradiol. 2016; (26): 47-55.

6.      Machi P., Jourdan F., Ambard D., et. al. Experimental evaluation of stent retrievers mechanical properties and effectiveness. J. Neurolntervent. Surg. 2016; (0): 1-7.

7.      Prothmann S., Schwaiger B., Gersing A., et al. Recanalization of Thrombo-Embolic Ischemic Stroke with pREset (ARTESp): the impact of occlusion time on clinical outcome of directly admitted and transferred patients. J. Neuro. Intervent. Surg. 2017; (9): 817-822.

8.      Shams T., Zaidat O., Yavagal D., et al. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) criteria: A 7M management approach to developing a stroke interventional laboratory in the era of stroke thrombectomy for large vessel occlusions. Intervent. Neurol. 2016; (5): 1-28.

9.      Seker F., Pfaff J., Wolf M., et al. Correlation of thrombectomy maneuver count with recanalization success and clinical outcome in patients with ischemic stroke. Am. J. Neuroradiol. 2017; (38): 1368-1371.

10.    Mokin M., Nagesh S., Ionita C., et al. Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. Am. J. Neuroradiol. 2016; (36): 547-551.

11.    Raymond J., Ghostine J., Khoury N., et al. Endovascular interventions for acute stroke: past practice and current research. J. Neurolntervent.Surg. 2017; (9): 1-4.

 

Abstract:

Aim. Was to demonstrate our experience of using the stent-assistant technology for treatment of thromboembolic complication during endovascular procedures in extra- and intracranial arteries.

Materials and methods. Five patients with thromboembolic complication were successfully treated using stent-assistant technology In one case thromboembolic complication appeared during stenting of ICA, another - during performing of diagnostic cerebral angiography In 3 cases thromboembolic complications appeared during endovascular occlusion of intracranial artery. In four cases we used stent Solitaire (Covidien) in one case - Enterprise (Codman).

Results. In all cases we achieved full restoration of blood flow in intracranial vessels. Three patients were discharged without any neurological deficit. Two patients were discharged with minimal neurological deficit (mRS 1).

Conclusion. Stent-assistant technology can be successfully used in treatment of thromboembolic complications during endovascular procedures in extra- and intracranial arteries.

 

References

1.     Connors J., Sacks D., Furlan A., et al. Training, competency, and credentialing standards for diagnostic сervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American academy of neurology, American association of neurological surgeons1, American society of interventional and therapeutic radiology, American society of neuroradiology, congress of neurological surgeons, AANS/CNS cerebrovascular section, and society of interventional radiology. Radiology. 2005; 234: 26-34.

2.     Qureshi I., Luft R., Sharna M., et al. Prevention and treatment of tromboembolic and ischemic complications associated with endovascular procedures: Part I. Pathophysiological and pharmacological features. Neurosurgery. 2000; 46: 1344-1359.

3.     Bracard S., Abdel-Kerim A., Thuillier L., et all. Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results. J. Neurosurg. 2010; 112: 703-708.

4.     Fujii Y., Takeuchi S., Sasaki O., et al. Hemostasisin spontaneous subarachnoid hemorrhage. Neurosurgery. 1995; 37: 226-234.

5.     Blackham A., Meyers P., Abruzzo T., et al. Endovascular therapy of acute ischemic stroke: report of the standards of practice committee of the society of neurointerventional. J. NeturoIntevent. Surg. 2012; 4: 87-93.

6.     Costalat V., Machi P., Lobotesis K., et al. Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study: timing, safety, and efficacy. Stroke. 2011; 42:1929-1935.

7.     Gonzalez F., Jabbour P., TJoumakaris S., et all. Temporary endovascular bypass: rescue technique during mechanical thrombolysis. Neurosurgery. 2012; 70: 245-252.

8.     Saver J., Jahan R., Levy E.I., et all. Primary results of the Solitaire With Intention for Thrombectomy (SWIFT) multicenter, randomised trial. Presented at the international stroke ranference 2012. 

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