October 2014

Introduction

Mechanical Thrombectomy in Acute Ischemic Stroke: How To Improve It?

Laurent Pierot

Laurent Pierot

The publication in 2013 of 3 negative randomized trials comparing endovascular treatment (EVT) with IV rtPA vs. IV rtPA alone was really disappointing for the neurointerventional community, even if these trials had several drawbacks restricting their clinical importance.1 One major drawback was the heterogeneity of endovascular techniques used, and recent studies have established the value … more »

Interventional

Emergency Cervical Internal Carotid Artery Stenting in Combination with Intracranial Thrombectomy in Acute Stroke

Sibylle Stampfl

Sibylle Stampfl

Tandem cervical internal carotid artery/middle cerebral artery occlusion is a relatively frequent finding (10–20%) in patients with acute stroke who undergo endovascular treatment.1 In the literature there were only reports about emergency cervical carotid artery stenting prior to intracranial stroke treatment, but no studies evaluating the combination with intracranial thrombectomy exclusively performed with stent retrievers.2–4 However, … more »

Interventional

Mechanical Thrombectomy in Acute Stroke: Prospective Pilot Trial of the Solitaire FR Device while Under Conscious Sedation

Sébastien Soize

Sébastien Soize

General anesthesia (GA), conscious sedation (CS), and local anesthesia (LA) are used in acute ischemic stroke interventions depending on several factors, including patient status, operator habits, and immediate availability of anesthetic support. In 2008, Mc Donagh et al showed that neurointerventionalists’ preferred modality was general anesthesia, citing elimination of patient’s movements, the perception of increased procedural safety … more »

Interventional

Mechanical Thrombectomy with Stent Retrievers in Acute Basilar Artery Occlusion

Markus Möhlenbruch

Markus Möhlenbruch

Self-expanding retrievable stents (stent retrievers) are the latest hot topic in the endovascular treatment of ischemic stroke. In April 2010, I performed my first thrombectomy with a stent retriever in a patient with an M1 occlusion. Recent data of our own have demonstrated that adding stent retrievers to a multimodal approach in acute ischemic stroke … more »

Interventional

Frequency and Relevance of Anterior Cerebral Artery Embolism Caused by Mechanical Thrombectomy of Middle Cerebral Artery Occlusion

Wiebke Kurre

Wiebke Kurre

Mechanical thrombectomy for the treatment of acute stroke is gaining importance in the portfolio of neuro-endovascular procedures. With proper patient selection, optimized workflow, and advanced technique, angiographic and—even more importantly, clinical—success is convincing. Triggered by the rapid evolution of endovascular stroke treatment, randomized trials comparing standard therapy and mechanical thrombectomy were initiated and are actively recruiting … more »

Interventional

Impact of Age and Baseline NIHSS Scores on Clinical Outcomes in the Mechanical Thrombectomy Using Solitaire FR in Acute Ischemic Stroke Study

Mayank Goyal

Mayank Goyal

As we move forward in the field of acute ischemic stroke, after the publication of 3 negative trials last year, it is critical that we have a better understanding of patient selection. This will not only help in the conduct and design of the newer trials, it will allow for more appropriate utilization of resources. As … more »

Interventional

Fate of the Penumbra after Mechanical Thrombectomy

Benjamin Friedrich

Benjamin Friedrich

Until recently, decisions on stroke therapy were based solely on clinical assessment. Only noncontrast CT was needed to rule out intracranial hemorrhage or large infarction to treat the patients with intravenous tPA. Founding the treatment decision using only the clinical evaluation and NCCT was sound practice at the time of the initial studies testing the safety and efficacy … more »