Mechanical thrombectomy with stent retriever in acute ischemic stroke: first results.

Transcription

1 Mechanical thrombectomy with stent retriever in acute ischemic stroke: first results. Poster No.: C-0829 Congress: ECR 2014 Type: Scientific Exhibit Authors: M. H. J. Voormolen, T. Van der Zijden, I. Baar, P. Cras, O. d'archambeau, P. M. Parizel; Antwerp (Edegem)/BE Keywords: Neuroradiology brain, Interventional vascular, Catheter arteriography, Thrombolysis, Ischemia / Infarction, Embolism / Thrombosis DOI: /ecr2014/C-0829 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Aims and objectives Evaluation of endovascular mechanical thrombectomy stent retriever results in patients with acute ischemic stroke. Methods and materials Thrombo-embolic acute ischemic events are the most frequent neurological incidents. If applicable, intra-venous thrombolysis (IVT) can be administered to try to dissolve the clot. Only a small proportion of patients are suitable for IVT and results are poor. Beyond the time window for IVT or when IVT is contra-indicated, intra-arterial thrombolysis or mechanical thrombectomy (MT) have been tried with relatively poor outcomes and serious complications. Nowadays, the latest generation of stent retrievers look promising as MT device to recanalise the intra-arterial obstruction in case of cerebral thrombo-embolic acute ischemic events. Indications for MT in our hospital: Patients <60yr with deterioration or remaining severe stroke symptoms despite i.v. thrombolysis treatment (decision made within 30 min after i.v. thrombolysis start) Patients <60yr with presentation 4,5-8 hr after onset of symptoms and remaining area at risk on CT Perfusion or MRI Patients of any age with contra-indication for iv r-tpa Patients of any age with apparent (cardiac) embolic source with remaining severe stroke symptoms despite i.v. r-tpa Basilar artery thrombosis <24 hr after presentation if CT or MRI shows no infarction with high risk of secundary intracerebral hemorrhage (cerebellum/thalamus en occipital lobes) We retrospectively evaluated the results of MT in our hospital. Results Page 2 of 12

3 From September 2010 until November 2013, MT was performed in 26 patients (14 male, 12 female; mean age 57 years, range 23-81). There were no procedure related complications. In 10 cases bridging with IVT was used. Overall, complete recananalisation rate (TICI 2b and 3) was 85%, good clinical outcome (mrs 0-2) was 46%, 9 patients died (35%) and 4 had significant intracranial haemorrhages (15%). In patients younger than 60 years, 57% had good clinical outcome, 14% died and 7% had intracranial haemorrhages. In patients older than 60 years, 70% died and 25% had intracranial haemorrhages. In patients receiving IVT bridging, 70% had good clinical outcome, 10% died and none had haemorrhages. UZA Recanalization Good clinical Death (TICI 2B+3) outcome (mrs 0-2) Signif. ICH Male (n=14) 86% (n=12) 43% (n=6) 36% (n=5) 21% (n=3) Female (n=12) 83% (n=10) 50% (n=6) 33% (n=4) 8% (n=1) <60yrs (n=14) 79% (n=11) 57% (n=8) 14% (n=2) 7% (n=1) >60yrs (n=12) 92% (n=11) 29% (n=4) 58% (n=7) 25% (n=3) iv r-tpa (n=10) 80% (n=8) 70% (n=7) 10% (n=1) 0% 38% (n=5) 54% (n=7) 23% (n=3) 46% (n=12) 35% (n=9) no iv (n=13) r-tpa 92% (n=12) Total (n=26) 85% (n=22) 15% (n=4) Literature Recanalization Good clinical Death (TICI 2B+3) outcome (mrs 0-2) Signif. ICH MERCI 43-78% 21-36% 29-44% 0-10% 40-47% 11-28% 7-12% 50-55% 5-10% (1st gen) MT (2nd gen) 73-90% iv r-tpa 17-40% 2,5% ICH= intracranial haemorrhage TICI=thrombolysis in cerebral infarction mrs=modified Rankin Score Page 3 of 12

4 iv r-tpa= intravenous recombinant tissue plasminogen activator MERCI= MERCI stent retriever gen= generation MT= mechanical thrombectomy Images for this section: Fig. 1: Case 1: imaging before mechanical thrombectomy Page 4 of 12

5 Fig. 2: Case 1: mechanical thrombectomy procedure Page 5 of 12

6 Fig. 3: Case 1: imaging and clinical follow-up Page 6 of 12

7 Fig. 4: Case 2: imaging before mechanical thrombectomy Page 7 of 12

8 Fig. 5: Case 2: mechanical thrombectomy procedure: first stent passage Page 8 of 12

9 Fig. 6: Case 2: mechanical thrombectomy procedure: second stent passage Page 9 of 12

10 Fig. 7: Case 2: imaging and clinical follow-up Page 10 of 12

11 Conclusion Stent retriever mechanical thrombectomy (MT) in acute ischemic stroke patients provides excellent recanalisation rates. The procedure is safer than previous intra-arterial recanalisation methods. The clinical outcome is better in patients receiving intravenous thrombolysis bridging before MT and patients younger than 60 years of age. Personal information prof dr Maurits HJ Voormolen Interventional Neuroradiology Antwerp University Hospital department of Radiology Wilrijkstraat Edegem Belgium References Pérez MA, Miloslavski E, Fischer S, Bäzner H, Henkes H. Intracranial thrombectomy using the Solitaire stent: a historical vignette. J Neurointerv Surg Nov;4(6):e32 Pereira VM, Gralla J, Davalos A, Bonafé A, Castaño C, Chapot R, Liebeskind DS, et al. Prospective, multicenter, single-arm study of mechanical thrombectomy using Solitaire Flow Restoration in acute ischemic stroke. Stroke Oct;44(10): Castaño C, Serena J, Dávalos A. Use of the New Solitaire (TM) AB Device for Mechanical Thrombectomy when Merci Clot Retriever Has Failed to Remove the Clot. A Case Report. Interv Neuroradiol Jul 29;15(2): Castaño C, Dorado L, Guerrero C, Millán M, Gomis M, Perez de la Ossa N, Castellanos M, et al. Mechanical thrombectomy with the Solitaire AB device Page 11 of 12

12 in large artery occlusions of the anterior circulation: a pilot study. Stroke Aug;41(8): Mazighi M, Meseguer E, Labreuche J, Amarenco P. Bridging therapy in acute ischemic stroke: a systematic review and meta-analysis. Stroke May;43(5): Mazighi M, Serfaty JM, Labreuche J, Laissy JP, Meseguer E, Lavallée PC, et al; RECANALISE investigators. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurol Sep;8(9):802-7 Page 12 of 12