PMID- 30776994 OWN - NLM STAT- MEDLINE DCOM- 20191125 LR - 20191125 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 50 IP - 3 DP - 2019 Mar TI - Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry. PG - 697-704 LID - 10.1161/STROKEAHA.118.021126 [doi] AB - Background and Purpose- Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established. Methods- STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy. In this study, an independent core laboratory, blinded to the clinical outcomes, reviewed all procedures and angiographic data to classify procedural technique, target clot location, recanalization after each pass, and determine the number of stent retriever passes. The primary clinical end point was functional independence (modified Rankin Scale, 0-2) at 3 months as determined on-site, and the angiographic end point was first-pass effect (FPE) success rate from a single device attempt (modified Thrombolysis in Cerebral Infarction, ≥2c) as determined by a core laboratory. Achieving modified FPE (modified Thrombolysis in Cerebral Infarction, ≥2b) was also assessed. Comparisons of clinical outcomes were made between groups and adjusted for baseline and procedural characteristics. All participating centers received institutional review board approval from their respective institutions. Results- Adjunctive technique groups included BGC (n=445), distal access catheter (n=238), and conventional guide catheter (n=62). The BGC group had a higher rate of FPE following first pass (212/443 [48%]) versus conventional guide catheter (16/62 [26%]; P=0.001) and distal access catheter (83/235 [35%]; P=0.002). Similarly, the BGC group had a higher rate of modified FPE (294/443 [66%]) versus conventional guide catheter (26/62 [42%]; P<0.001) and distal access catheter (129/234 [55%]; P=0.003). The BGC group achieved the highest rate of functional independence (253/415 [61%]) versus conventional guide catheter (23/55 [42%]; P=0.007) and distal access catheter (113/218 [52%]; P=0.027). Final revascularization and mortality rates did not differ across the groups. Conclusions- BGC use was an independent predictor of FPE, modified FPE, and functional independence, suggesting that its routine use may improve the rates of early revascularization success and good clinical outcomes. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02239640. FAU - Zaidat, Osama O AU - Zaidat OO AD - From the Mercy Health St. Vincent Mercy Hospital, Toledo, OH (O.O.Z.). FAU - Mueller-Kronast, Nils H AU - Mueller-Kronast NH AD - Advanced Neuroscience Network/Tenet South Florida, Coral Springs (N.H.M.-K., R.K.). FAU - Hassan, Ameer E AU - Hassan AE AD - Valley Baptist Medical Center, Harlingen, TX (A.E.H.). FAU - Haussen, Diogo C AU - Haussen DC AD - Emory University School of Medicine, Atlanta, GA (D.C.H.). AD - Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.). FAU - Jadhav, Ashutosh P AU - Jadhav AP AD - University of Pittsburgh Medical Center, PA (A.P.J.). FAU - Froehler, Michael T AU - Froehler MT AD - Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.). FAU - Jahan, Reza AU - Jahan R AD - University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.). FAU - Ali Aziz-Sultan, Mohammad AU - Ali Aziz-Sultan M AD - Brigham and Women's Hospital, Boston, MA (M.A.A-S.). FAU - Klucznik, Richard P AU - Klucznik RP AD - Methodist Hospital, Houston, TX (R.P.K.). FAU - Saver, Jeffrey L AU - Saver JL AD - University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.). FAU - Hellinger, Frank R Jr AU - Hellinger FR Jr AD - Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.). FAU - Yavagal, Dileep R AU - Yavagal DR AD - University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.). FAU - Yao, Tom L AU - Yao TL AD - Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.D.). FAU - Gupta, Rishi AU - Gupta R AD - WellStar Neurosciences Network, WellStar Kennestone Regional Medical Center, Marietta, GA (R.G.). FAU - Martin, Coleman O AU - Martin CO AD - St. Luke's Hospital of Kansas City, MO (C.O.M.). FAU - Bozorgchami, Hormozd AU - Bozorgchami H AD - Oregon Health and Science University Hospital, Portland (H.B.). FAU - Kaushal, Ritesh AU - Kaushal R AD - Advanced Neuroscience Network/Tenet South Florida, Coral Springs (N.H.M.-K., R.K.). FAU - Nogueira, Raul G AU - Nogueira RG AD - Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.). FAU - Gandhi, Ravi H AU - Gandhi RH AD - Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.). FAU - Peterson, Eric C AU - Peterson EC AD - University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.). FAU - Dashti, Shervin AU - Dashti S AD - Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.D.). FAU - Given, Curtis A 2nd AU - Given CA 2nd AD - Baptist Health Lexington/Central Baptist, KY (C.A.G.). FAU - Mehta, Brijesh P AU - Mehta BP AD - South Broward Hospital, Hollywood, FL (B.P.M.). FAU - Deshmukh, Vivek AU - Deshmukh V AD - Providence St. Vincent Medical Center, Portland, OR (V.D.). FAU - Starkman, Sidney AU - Starkman S AD - University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.). FAU - Linfante, Italo AU - Linfante I AD - Baptist Hospital of Miami, FL (I.L.). FAU - McPherson, Scott H AU - McPherson SH AD - St. Dominic's-Jackson Memorial Hospital, MS (S.H.M.). FAU - Kvamme, Peter AU - Kvamme P AD - University of Tennessee Medical Center, Knoxville (P.K.). FAU - Grobelny, Thomas J AU - Grobelny TJ AD - Advocate Christ Medical Center, Oak Lawn, IL (T.J.G.). FAU - Hussain, Muhammad Shazam AU - Hussain MS AD - Cleveland Clinic, OH (M.S.H.). FAU - Thacker, Ike AU - Thacker I AD - Baylor University Medical Center, Dallas, TX (I.T.). FAU - Vora, Nirav AU - Vora N AD - OhioHealth Riverside Methodist Hospital, Columbus (N.V.). FAU - Chen, Peng Roc AU - Chen PR AD - Memorial Hermann Texas Medical Center, Houston (P.R.C.). FAU - Monteith, Stephen J AU - Monteith SJ AD - Swedish Medical Center First Hill Campus, Seattle, WA (S.J.M.). FAU - Ecker, Robert D AU - Ecker RD AD - Maine Medical Center, Portland, ME (R.D.E.). FAU - Schirmer, Clemens M AU - Schirmer CM AD - Geisinger Clinic, Danville, PA (C.M.S.). FAU - Sauvageau, Eric AU - Sauvageau E AD - Baptist Medical Center Jacksonville, FL (E.S.). FAU - Chebl, Alex Bou AU - Chebl AB AD - Baptist Hospital Louisville, KY (A.B.C.). FAU - Derdeyn, Colin P AU - Derdeyn CP AD - Barnes Jewish Hospital, St. Louis, MO (C.P.D.). FAU - Maidan, Lucian AU - Maidan L AD - Mercy San Juan Medical Center and Mercy General, Carmichael, CA (L.M.). FAU - Badruddin, Aamir AU - Badruddin A AD - Presence St. Joseph Medical Center, Joliet, IL (A.B.). FAU - Siddiqui, Adnan H AU - Siddiqui AH AD - Buffalo General Medical Center, NY (A.H.S.). FAU - Dumont, Travis M AU - Dumont TM AD - University of Arizona Medical Center, Tucson (T.M.D.). FAU - Alhajeri, Abdulnasser AU - Alhajeri A AD - University of Kentucky Hospital, Lexington (A.A.). FAU - Taqi, Muhammad A AU - Taqi MA AD - Los Robles Medical Center, Thousand Oaks, CA (M.A.T.). FAU - Asi, Khaled AU - Asi K AD - Aurora Hospital, Milwaukee, WI (K.A.). FAU - Carpenter, Jeffrey AU - Carpenter J AD - West Virginia University/Ruby Memorial Hospital, Morgantown (J.C.). FAU - Boulos, Alan AU - Boulos A AD - Albany Medical Center, NY (A.B.). FAU - Jindal, Gaurav AU - Jindal G AD - University of Maryland Medical Center, Baltimore (G.J.). FAU - Puri, Ajit S AU - Puri AS AD - University of Massachusetts Memorial Medical Center, Worcester (A.S.P.). FAU - Chitale, Rohan AU - Chitale R AD - Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.). FAU - Deshaies, Eric M AU - Deshaies EM AD - Crouse Hospital, Syracuse, NY (E.M.D.). FAU - Robinson, David AU - Robinson D AD - Virginia Mason Medical Center, Seattle, WA (D.R.). FAU - Kallmes, David F AU - Kallmes DF AD - Mayo Clinic, Rochester, MN (D.F.K.). FAU - Baxter, Blaise W AU - Baxter BW AD - Erlanger Medical Center, Chattanooga, TN (B.W.B.). FAU - Jumaa, Mouhammed AU - Jumaa M AD - ProMedica Toledo Hospital, OH (M.J.). FAU - Sunenshine, Peter AU - Sunenshine P AD - Banner University Medical Center, Phoenix, AZ (P.S.). FAU - Majjhoo, Aniel AU - Majjhoo A AD - McLaren Flint, MI (A.M.). FAU - English, Joey D AU - English JD AD - California Pacific Medical Center, San Francisco (J.D.E.). FAU - Suzuki, Shuichi AU - Suzuki S AD - University of California, Irvine (S.S.). FAU - Fessler, Richard D AU - Fessler RD AD - St. John Providence Hospital, Detroit, MI (R.D.F.). FAU - Delgado-Almandoz, Josser AU - Delgado-Almandoz J AD - Abbott Northwestern Hospital, Minneapolis, MN (J.D-A.). FAU - Martin, Jerry C AU - Martin JC AD - and Carolinas Medical Center, Charlotte, NC (J.C.M.). FAU - Liebeskind, David S AU - Liebeskind DS AD - University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.). CN - STRATIS Investigators LA - eng SI - ClinicalTrials.gov/NCT02239640 PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM MH - Aged MH - Aged, 80 and over MH - Brain Ischemia/diagnostic imaging/therapy MH - Catheterization/*methods MH - Cerebral Angiography MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Registries MH - Stents MH - Stroke/*diagnostic imaging/*surgery MH - Thrombectomy/*statistics & numerical data MH - Treatment Outcome OTO - NOTNLM OT - *animals OT - *brain ischemia OT - *humans OT - *stroke OT - *thrombectomy EDAT- 2019/02/20 06:00 MHDA- 2019/11/26 06:00 CRDT- 2019/02/20 06:00 PHST- 2019/02/20 06:00 [pubmed] PHST- 2019/11/26 06:00 [medline] PHST- 2019/02/20 06:00 [entrez] AID - 10.1161/STROKEAHA.118.021126 [doi] PST - ppublish SO - Stroke. 2019 Mar;50(3):697-704. doi: 10.1161/STROKEAHA.118.021126. PMID- 28754806 OWN - NLM STAT- MEDLINE DCOM- 20180731 LR - 20181202 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 10 IP - 4 DP - 2018 Apr TI - Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis. PG - 335-339 LID - 10.1136/neurintsurg-2017-013179 [doi] AB - BACKGROUND AND PURPOSE: Flow arrest with balloon guide catheters (BGCs) is becoming increasingly recognized as critical to optimizing patient outcomes for mechanical thrombectomy. We performed a systematic review and meta-analysis of the literature for studies that compared angiographic and clinical outcomes for patients who underwent mechanical thrombectomy with and without BGCs. MATERIALS AND METHODS: In April 2017 a literature search on BGC and mechanical thrombectomy for stroke was performed. All studies included patients treated with and without BGCs using modern techniques (ie, stent retrievers). Using random effects meta-analysis, we evaluated the following outcomes: first-pass recanalization, Thrombolysis In Cerebral Infarction (TICI) 3 recanalization, TICI 2b/3 recanalization, favorable outcome (modified Rankin Scale (mRS) 0-2), mortality, and mean number of passes and procedure time. RESULTS: Five non-randomized studies of 2022 patients were included (1083 BGC group and 939 non-BGC group). Compared with the non-BGC group, patients treated with BGCs had higher odds of first-pass recanalization (OR 2.05, 95% CI 1.65 to 2.55), TICI 3 (OR 2.13, 95% CI 1.43 to 3.17), TICI 2b/3 (OR 1.54, 95% CI 1.21 to 1.97), and mRS 0-2 (OR 1.84, 95% CI 1.52 to 2.22). BGC-treated patients also had lower odds of mortality (OR 0.52, 95% CI 0.37 to 0.73) compared with non-BGC patients. The mean number of passes was significantly lower for BGC-treated patients (weighted mean difference -0.34, 95% CI-0.47 to -0.22). Mean procedure time was also significantly shorter for BGC-treated patients (weighted mean difference -7.7 min, 95% CI-9.0to -6.4). CONCLUSIONS: Non-randomized studies suggest that BGC use during mechanical thrombectomy for acute ischemic stroke is associated with superior clinical and angiographic outcomes. Further randomized trials are needed to confirm the results of this study. CI - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. FAU - Brinjikji, Waleed AU - Brinjikji W AD - Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. AD - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA. AD - Department of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. FAU - Starke, Robert M AU - Starke RM AD - Department of Neurological Surgery, Miami Miller School of Medicine, University of Miami Hospital, Miami, Florida, USA. AD - Department of Radiology, University of Miami Hospital, Miami Miller School of Medicine, Miami, Florida, USA. FAU - Murad, M Hassan AU - Murad MH AD - Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA. FAU - Fiorella, David AU - Fiorella D AD - Department of Neurosurgery, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, New York, USA. FAU - Pereira, Vitor M AU - Pereira VM AD - Department of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. FAU - Goyal, Mayank AU - Goyal M AD - Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada. FAU - Kallmes, David F AU - Kallmes DF AD - Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. AD - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20170728 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Aged MH - Brain Ischemia/diagnostic imaging/*surgery MH - Catheterization/instrumentation/*methods MH - Clinical Trials as Topic/methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Stents MH - Stroke/diagnostic imaging/*surgery MH - Thrombectomy/instrumentation/*methods MH - Treatment Outcome OTO - NOTNLM OT - mechanical thrombectomy OT - stroke EDAT- 2017/07/30 06:00 MHDA- 2018/08/01 06:00 CRDT- 2017/07/30 06:00 PHST- 2017/05/05 00:00 [received] PHST- 2017/06/02 00:00 [revised] PHST- 2017/06/09 00:00 [accepted] PHST- 2017/07/30 06:00 [pubmed] PHST- 2018/08/01 06:00 [medline] PHST- 2017/07/30 06:00 [entrez] AID - neurintsurg-2017-013179 [pii] AID - 10.1136/neurintsurg-2017-013179 [doi] PST - ppublish SO - J Neurointerv Surg. 2018 Apr;10(4):335-339. doi: 10.1136/neurintsurg-2017-013179. Epub 2017 Jul 28. PMID- 26789499 OWN - NLM STAT- MEDLINE DCOM- 20170713 LR - 20180412 IS - 1527-1315 (Electronic) IS - 0033-8419 (Linking) VI - 280 IP - 1 DP - 2016 Jul TI - Comparison of a Balloon Guide Catheter and a Non-Balloon Guide Catheter for Mechanical Thrombectomy. PG - 169-76 LID - 10.1148/radiol.2015150575 [doi] AB - Purpose To evaluate the effectiveness of mechanical thrombectomy with the use of a stent retriever in acute ischemic stroke, performed by using a balloon guide catheter or non-balloon guide catheter. Materials and Methods In accordance with the institutional review board approval obtained at the two participating institutions, retrospective analysis was performed in 183 consecutive patients treated between 2013 and 2014 for occlusions in the middle cerebral artery or carotid terminus by using a stent retriever with a balloon guide catheter (n = 102) at one center and a non-balloon guide catheter (n = 81) at the other center. Data on procedure duration, number of passes, angiographic findings, type of stent retriever used, and expertise of the operators were collected. Successful recanalization was defined as grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization accomplished in up to three passes. Univariate and multivariate subgroup analyses were conducted to control for the confounding variables of prior thrombolysis, location of occlusion, and operator expertise. Results Successful recanalization with the balloon guide catheter was achieved in 89.2% of thrombectomies (91 of 102) versus 67.9% (55 of 81) achieved with the non-balloon guide catheter (P = .0004). The one-pass thrombectomy rate with the balloon guide catheter was significantly higher than for that with the non-balloon guide catheter (63.7% [65 of 102] vs 35.8% [29 of 81], respectively; P = .001). The procedure duration was significantly shorter by using the balloon guide catheter than the non-balloon guide catheter (median, 20.5 minutes vs 41.0 minutes, respectively; P < .0001). Conclusion The effectiveness of mechanical thrombectomy with stent retrievers in acute ischemic stroke in the anterior circulation in terms of angiographic results and procedure duration was improved when performed in combination with the balloon guide catheter. (©) RSNA, 2016. FAU - Velasco, Aglaé AU - Velasco A AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Buerke, Boris AU - Buerke B AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Stracke, Christian P AU - Stracke CP AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Berkemeyer, Shoma AU - Berkemeyer S AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Mosimann, Pascal J AU - Mosimann PJ AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Schwindt, Wolfram AU - Schwindt W AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Alcázar, Pedro AU - Alcázar P AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Cnyrim, Christian AU - Cnyrim C AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Niederstadt, Thomas AU - Niederstadt T AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Chapot, René AU - Chapot R AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). FAU - Heindel, Walter AU - Heindel W AD - From the Department of Clinical Radiology-Neuroradiology (A.V., B.B., S.B., W.S., C.C., T.N., W.H.), University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany; Department of Intracranial Endovascular Therapy and Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (C.P.S., R.C.); Department of Neuroradiology and Interventional Neuroradiology, University Hospital Virgen de las Nieves, Granada, Spain (P.A.); and Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland (P.J.M.). LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20160120 PL - United States TA - Radiology JT - Radiology JID - 0401260 SB - AIM SB - IM CIN - Radiology. 2017 Aug;284(2):607-608. PMID: 28723284 MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Catheters MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - *Stents MH - Stroke/*surgery MH - Thrombectomy/*instrumentation/*methods MH - Young Adult EDAT- 2016/01/21 06:00 MHDA- 2017/07/14 06:00 CRDT- 2016/01/21 06:00 PHST- 2016/01/21 06:00 [entrez] PHST- 2016/01/21 06:00 [pubmed] PHST- 2017/07/14 06:00 [medline] AID - 10.1148/radiol.2015150575 [doi] PST - ppublish SO - Radiology. 2016 Jul;280(1):169-76. doi: 10.1148/radiol.2015150575. Epub 2016 Jan 20. PMID- 30712011 OWN - NLM STAT- MEDLINE DCOM- 20191126 LR - 20191126 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 11 IP - 9 DP - 2019 Sep TI - Effect of balloon guide catheter on clinical outcomes and reperfusion in Trevo thrombectomy. PG - 861-865 LID - 10.1136/neurintsurg-2018-014452 [doi] AB - INTRODUCTION: The Solitaire stent retriever registry showed improved reperfusion, faster procedure times, and better outcome in acute stroke patients with large vessel occlusion treated with a balloon guide catheter (BGC) and Solitaire stent retriever compared with a conventional guide catheter. The goal of this study was to evaluate whether use of a BGC with the Trevo stent retriever improves outcomes compared with a conventional guide catheter. METHODS: The TRACK registry recruited 23 sites to submit demographic, clinical, and site adjudicated angiographic and outcome data on consecutive patients treated with the Trevo stent retriever. BGC use was at the discretion of the physician. RESULTS: 536 anterior circulation patients (of whom 279 (52.1%) had BGC placement) were included in this analysis. Baseline characteristics were notable for younger patients in the BGC group (65.4±15.3 vs 68.1±13.6, P=0.03) and lower rate of hypertension (72% vs 79%, P=0.06). Mean time from symptom onset to groin puncture was longer in the BGC group (357 vs 319 min, P=0.06).Thrombolysis in Cerebral Infarction 2b/3 scores were higher in the BGC cohort (84% vs 75.5%, P=0.01). There was no difference in reperfusion time, first pass effect, number of passes, or rescue therapy. Good clinical outcome at 3 months was superior in patients with BGC (57% vs 40%; P=0.0004) with a lower mortality rate (13% vs 23%, P=0.008). Multivariate analysis demonstrated that BGC use was an independent predictor of good clinical outcome (OR 2; 95% CI 1.3 to 3.1, P=0.001). CONCLUSIONS: In acute stroke patients presenting with anterior circulation large vessel occlusion, use of a BGC with the Trevo stent retriever resulted in improved reperfusion, improved clinical outcome, and lower mortality. CI - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Nguyen, Thanh N AU - Nguyen TN AD - Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA. AD - Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA. AD - Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA. FAU - Castonguay, Alicia C AU - Castonguay AC AD - Neurology, University of Toledo, Toledo, OH, US. FAU - Nogueira, Raul G AU - Nogueira RG AD - Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Haussen, Diogo C AU - Haussen DC AD - Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - English, Joey D AU - English JD AD - California Pacific Medical Center, San Francisco, California, USA. FAU - Satti, Sudhakar R AU - Satti SR AD - Department of Neurointerventional Surgery, Christiana Care Health System, Newark, Delaware, USA. FAU - Chen, Jennifer AU - Chen J AD - Sidney Kimmel Medical School, Philadelphia, Pennsylvania, USA. FAU - Farid, Hamed AU - Farid H AD - Department of Neurointerventional Radiology, St Jude Medical Center, Fullerton, USA. FAU - Borders, Candace AU - Borders C AD - UC Irvine Health School of Medicine, Irvine, California, USA. FAU - Veznedaroglu, Erol AU - Veznedaroglu E AD - Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA. FAU - Binning, Mandy J AU - Binning MJ AD - Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA. FAU - Puri, Ajit S AU - Puri AS AD - University of Massachusetts, Radiology, Worcester, Massachusetts, USA. FAU - Vora, Nirav A AU - Vora NA AD - Department of Radiology, Riverside Radiology and Interventional Associates Inc, Columbus, Ohio, USA. FAU - Budzik, Ron F AU - Budzik RF AD - Department of Radiology, Riverside Radiology and Interventional Associates Inc, Columbus, Ohio, USA. FAU - Dabus, Guilherme AU - Dabus G AD - Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida, USA. FAU - Linfante, Italo AU - Linfante I AD - Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida, USA. FAU - Janardhan, Vallabh AU - Janardhan V AD - Texas Stroke Institute, Plano, Texas, USA. FAU - Alshekhlee, Amer AU - Alshekhlee A AD - Department of Vascular and Interventional Neurology, DePaul Stroke Center-SSM Neuroscience Institutes, St Louis University, St Louis, Missouri, USA. FAU - Abraham, Michael G AU - Abraham MG AD - Departments of Neurology and Interventional Radiology, University of Kansas Medical Center, Kansas, USA. FAU - Edgell, Randall C AU - Edgell RC AD - Department of Neurology, St Louis University, St Louis, Missouri, USA. FAU - Taqi, M Asif AU - Taqi MA AD - Department of Neurology and Neurosurgery, Los Robles Hospital and Medical Center, Thousand Oaks, California, USA. FAU - El Khoury, Ramy AU - El Khoury R AD - Department of Neurology, Tulane University, New Orleans, Louisiana, USA. FAU - Mokin, Maxim AU - Mokin M AD - Department of Neurosurgery and Brain Repair, University of South Florida, South Florida, Florida, USA. FAU - Majjhoo, Aniel Q AU - Majjhoo AQ AD - Department of Neurology, Wayne State School of Medicine, Detroit, Michigan, USA. FAU - Kabbani, Mouhammed R AU - Kabbani MR AD - Department of Neurosurgery, Gundersen Health System, La Crosse, Wisconsin, USA. FAU - Froehler, Michael T AU - Froehler MT AD - Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. FAU - Finch, Ira AU - Finch I AD - John Muir Health, California, Walnut Creek, USA. FAU - Ansari, Sameer A AU - Ansari SA AD - Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Novakovic, Roberta AU - Novakovic R AD - Departments of Radiology, Neurology, and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas, USA. FAU - Abdalkader, Mohamad AU - Abdalkader M AD - Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA. AD - Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA. AD - Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA. FAU - Zaidat, Osama O AU - Zaidat OO AUID- ORCID: 0000-0003-4881-4698 AD - Departments of Endovascular Neurosurgery and Stroke, St Vincent Mercy Medical Center, Toledo, Ohio, USA. LA - eng PT - Journal Article DEP - 20190202 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Aged MH - Aged, 80 and over MH - Catheterization/instrumentation/*methods MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Registries MH - Reperfusion/instrumentation/*methods MH - Retrospective Studies MH - Stroke/diagnostic imaging/*surgery MH - Thrombectomy/instrumentation/*methods MH - Treatment Outcome OTO - NOTNLM OT - balloon OT - catheter OT - stroke OT - technique OT - thrombectomy COIS- Competing interests: TNN is a consultant for Medtronic. OOZ is a consultant/advisory board member for Stryker Neurovascular and Covidien. OOZ is overall principal investigator for TRACK–no compensation and Arise II–modest. RGN is a consultant/advisory board member for Stryker Neurovascular and Covidien. Stryker Neurovascular (Trevo-2 trial principal investigator–modest; DAWN trial principal investigator–no compensation, TREVO registry steering committee–no compensation), Medtronic (SWIFT trial steering committee–modest; SWIFT-Prime trial steering committee–no compensation; STAR Trial Angiographic Core Lab–significant), Penumbra (3D Separator trial executive committee–no compensation), Neuravi (ARISE-2 steering committee–no compensation), Genentech (physician advisory board–modest), Allm Inc (physician advisory board–no compensation), editor- in-chief Interventional Neurology journal (no compensation). SRS is a consultant for Stryker Neurovascular. JDE is a consultant for Stryker Neurovascular.
 IL is a consultant for Medtronic, Stryker, Penumbra, and Cordis. EDAT- 2019/02/04 06:00 MHDA- 2019/11/27 06:00 CRDT- 2019/02/04 06:00 PHST- 2018/09/28 00:00 [received] PHST- 2018/12/19 00:00 [revised] PHST- 2018/12/26 00:00 [accepted] PHST- 2019/02/04 06:00 [pubmed] PHST- 2019/11/27 06:00 [medline] PHST- 2019/02/04 06:00 [entrez] AID - neurintsurg-2018-014452 [pii] AID - 10.1136/neurintsurg-2018-014452 [doi] PST - ppublish SO - J Neurointerv Surg. 2019 Sep;11(9):861-865. doi: 10.1136/neurintsurg-2018-014452. Epub 2019 Feb 2. PMID- 28723284 OWN - NLM STAT- MEDLINE DCOM- 20180413 LR - 20181202 IS - 1527-1315 (Electronic) IS - 0033-8419 (Linking) VI - 284 IP - 2 DP - 2017 Aug TI - Balloon Guide Catheter in Large-Vessel Occlusion Stroke Therapy. PG - 607-608 LID - 10.1148/radiol.2017170375 [doi] FAU - Nguyen, Thanh N AU - Nguyen TN AD - Departments of Neurology, Neurosurgery, and Radiology, 72 E Concord St, C-3, Boston Medical Center, Boston, MA 02118. FAU - Zaidat, Osama O AU - Zaidat OO AD - Departments of Neurology, Neurosurgery, and Radiology, 72 E Concord St, C-3, Boston Medical Center, Boston, MA 02118. LA - eng PT - Comment PT - Journal Article PL - United States TA - Radiology JT - Radiology JID - 0401260 SB - AIM SB - IM CON - Radiology. 2016 Jul;280(1):169-76. PMID: 26789499 MH - *Balloon Occlusion MH - Humans MH - *Stroke EDAT- 2017/07/21 06:00 MHDA- 2018/04/14 06:00 CRDT- 2017/07/21 06:00 PHST- 2017/07/21 06:00 [entrez] PHST- 2017/07/21 06:00 [pubmed] PHST- 2018/04/14 06:00 [medline] AID - 10.1148/radiol.2017170375 [doi] PST - ppublish SO - Radiology. 2017 Aug;284(2):607-608. doi: 10.1148/radiol.2017170375. PMID- 30497154 OWN - NLM STAT- Publisher LR - 20191120 IS - 1933-0693 (Electronic) IS - 0022-3085 (Linking) DP - 2018 Nov 1 TI - Effect of balloon guide catheter utilization on contact aspiration thrombectomy. PG - 1-7 LID - 2018.6.JNS181045 [pii] LID - 10.3171/2018.6.JNS181045 [doi] AB - OBJECTIVEThe role of the balloon guide catheter (BGC) has not been evaluated in contact aspiration thrombectomy (CAT) for acute stroke. Here, the authors aimed to test whether the BGC was associated with recanalization success and good functional outcome in CAT.METHODSAll patients who had undergone CAT as the first-line treatment for anterior circulation intracranial large vessel occlusion were retrospectively identified from prospectively maintained registries for six stroke centers. The patients were dichotomized into BGC utilization and nonutilization groups. Clinical findings, procedural details, and recanalization success rates were compared between the two groups. Whether the BGC was associated with recanalization success and functional outcome was assessed.RESULTSA total of 429 patients (mean age 68.4 ± 11.4 years; M/F ratio 215:214) fulfilled the inclusion criteria. A BGC was used in 45.2% of patients. The overall recanalization and good outcome rates were 80.2% and 52.0%, respectively. Compared to the non-BGC group, the BGC group had a significantly reduced number of CAT passes (2.6 ± 1.6 vs 3.4 ± 1.5), shorter puncture-to-recanalization time (56 ± 27 vs 64 ± 35 minutes), lower need for the additional use of thrombolytics (1.0% vs 8.1%), and less embolization to a distal or different site (0.5% vs 3.4%). The BGC group showed significantly higher final (89.2% vs 72.8%) and first-pass (24.2% vs 8.1%) recanalization success rates. After adjustment for potentially associated factors, BGC utilization remained independently associated with recanalization (OR 4.171, 95% CI 1.523-11.420) and good functional outcome (OR 2.103, 95% CI 1.225-3.612).CONCLUSIONSBGC utilization significantly increased the final and first-pass recanalization rates and remained independently associated with recanalization success and good functional outcome. FAU - Kang, Dong-Hun AU - Kang DH AD - Departments of1Neurosurgery and Radiology. FAU - Kim, Byung Moon AU - Kim BM AD - Departments of2Radiology and. FAU - Heo, Ji Hoe AU - Heo JH AD - 3Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul. FAU - Nam, Hyo Suk AU - Nam HS AD - 3Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul. FAU - Kim, Young Dae AU - Kim YD AD - 3Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul. FAU - Hwang, Yang-Ha AU - Hwang YH AD - 4Neurology, and. FAU - Kim, Yong-Won AU - Kim YW AD - 4Neurology, and. FAU - Kim, Yong-Sun AU - Kim YS AD - 5Radiology, School of Medicine, Kyungpook National University, Daegu. FAU - Kim, Dong Joon AU - Kim DJ AD - Departments of2Radiology and. FAU - Kwak, Hyo Sung AU - Kwak HS AD - 6Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju. FAU - Roh, Hong Gee AU - Roh HG AD - 7Department of Radiology, Konkuk University Medical Center, Seoul. FAU - Lee, Young-Jun AU - Lee YJ AD - 8Department of Radiology, Hanyang University Medical School and Hospital, Seoul; and. FAU - Kim, Sang Heum AU - Kim SH AD - 9Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. LA - eng PT - Journal Article DEP - 20181101 PL - United States TA - J Neurosurg JT - Journal of neurosurgery JID - 0253357 OTO - NOTNLM OT - ASPECTS = Alberta Stroke Program Early CT Score OT - BGC = balloon guide catheter OT - CAT = contact aspiration thrombectomy OT - CRF = case report form OT - EVT = endovascular thrombectomy OT - ICA = internal carotid artery OT - LVO = large vessel occlusion OT - MCA = middle cerebral artery OT - NIHSS = National Institutes of Health Stroke Scale OT - OPT = onset-to-puncture time OT - PRT = puncture-to-recanalization time OT - RCT = randomized controlled trial OT - acute stroke OT - aspiration catheter OT - balloon guide catheter OT - interventional neurosurgery OT - mRS = modified Rankin Scale OT - mTICI modified Thrombolysis in Cerebral Infarction OT - tPA = tissue plasminogen activator OT - thrombectomy OT - vascular disorders EDAT- 2018/12/01 06:00 MHDA- 2018/12/01 06:00 CRDT- 2018/12/01 06:00 PHST- 2018/04/17 00:00 [received] PHST- 2018/06/11 00:00 [accepted] PHST- 2018/12/01 06:00 [pubmed] PHST- 2018/12/01 06:00 [medline] PHST- 2018/12/01 06:00 [entrez] AID - 2018.6.JNS181045 [pii] AID - 10.3171/2018.6.JNS181045 [doi] PST - aheadofprint SO - J Neurosurg. 2018 Nov 1:1-7. doi: 10.3171/2018.6.JNS181045. PMID- 31043149 OWN - NLM STAT- MEDLINE DCOM- 20200122 LR - 20200122 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 50 IP - 6 DP - 2019 Jun TI - Balloon Guide Catheter Is Beneficial in Endovascular Treatment Regardless of Mechanical Recanalization Modality. PG - 1490-1496 LID - 10.1161/STROKEAHA.118.024723 [doi] AB - Background and Purpose- Based on its mechanism, the use of balloon guide catheters (BGCs) may be beneficial during endovascular treatment, regardless of the type of mechanical recanalization modality used-stent retriever thrombectomy or thrombaspiration. We evaluated whether the use of BGCs can be beneficial regardless of the first-line mechanical endovascular modality used. Methods- We retrospectively reviewed consecutive acute stroke patients who underwent stent retriever thrombectomy or thrombaspiration from the prospectively maintained registries of 17 stroke centers nationwide. Patients were assigned to the BGC or non-BGC group based on the use of BGCs during procedures. Endovascular and clinical outcomes were compared between the BGC and non-BGC groups. To adjust the influence of the type of first-line endovascular modality on successful recanalization and favorable outcome, multivariable analyses were also performed. Results- This study included a total of 955 patients. Stent retriever thrombectomy was used as the first-line modality in 526 patients (55.1%) and thrombaspiration in 429 (44.9%). BGC was used in 516 patients (54.0%; 61.2% of stent retriever thrombectomy patients; 45.2% of thrombaspiration patients). The successful recanalization rate was significantly higher in the BGC group compared with the non-BGC group (86.8% versus 74.7%, respectively; P<0.001). Furthermore, the first-pass recanalization rate was more frequent (37.0% versus 14.1%; P<0.001), and the number of device passes was fewer in the BGC group (2.5±1.9 versus 3.3±2.1; P<0.001). The procedural time was also shorter in the BGC group (54.3±27.4 versus 67.6±38.2; P<0.001). The use of BGC was an independent factor for successful recanalization (odds ratio, 2.18; 95% CI, 1.54-3.10; P<0.001) irrespective of the type of first-line endovascular modality used. The use of BGC was also an independent factor for a favorable outcome (odds ratio, 1.40; 95% CI, 1.02-1.92; P=0.038) irrespective of the type of first-line endovascular modality used. Conclusions- Regardless of the first-line mechanical endovascular modality used, the use of BGC in endovascular treatment was beneficial in terms of both recanalization success and functional outcome. FAU - Baek, Jang-Hyun AU - Baek JH AD - From the Department of Neurology, Kangbuk Samsung Hospital (J.-H.B.), Sungkyunkwan University School of Medicine, Seoul, Korea. AD - Departments of Neurology (J.-H.B., J.H.H., H.S.N., Y.D.K.), Yonsei University College of Medicine, Seoul, Korea. FAU - Kim, Byung Moon AU - Kim BM AD - Radiology (B.M.K., D.J.K.), Yonsei University College of Medicine, Seoul, Korea. FAU - Kang, Dong-Hun AU - Kang DH AD - Departments of Neurosurgery (D.-H.K.), Kyungpook National University Hospital, Daegu, Korea. AD - Radiology (D.-H.K., Y.-S.K.), Kyungpook National University Hospital, Daegu, Korea. FAU - Heo, Ji Hoe AU - Heo JH AD - Departments of Neurology (J.-H.B., J.H.H., H.S.N., Y.D.K.), Yonsei University College of Medicine, Seoul, Korea. FAU - Nam, Hyo Suk AU - Nam HS AD - Departments of Neurology (J.-H.B., J.H.H., H.S.N., Y.D.K.), Yonsei University College of Medicine, Seoul, Korea. FAU - Kim, Young Dae AU - Kim YD AD - Departments of Neurology (J.-H.B., J.H.H., H.S.N., Y.D.K.), Yonsei University College of Medicine, Seoul, Korea. FAU - Hwang, Yang-Ha AU - Hwang YH AD - Neurology (Y.-H.H., Y.-W.K.), Kyungpook National University Hospital, Daegu, Korea. FAU - Kim, Yong-Won AU - Kim YW AD - Neurology (Y.-H.H., Y.-W.K.), Kyungpook National University Hospital, Daegu, Korea. FAU - Kim, Yong-Sun AU - Kim YS AD - Radiology (D.-H.K., Y.-S.K.), Kyungpook National University Hospital, Daegu, Korea. FAU - Kim, Dong Joon AU - Kim DJ AD - Radiology (B.M.K., D.J.K.), Yonsei University College of Medicine, Seoul, Korea. FAU - Kwak, Hyo Sung AU - Kwak HS AD - Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea (H.S.K.). FAU - Roh, Hong Gee AU - Roh HG AD - Department of Radiology, Konkuk University Hospital, Seoul, Korea (H.G.R.). FAU - Lee, Young-Jun AU - Lee YJ AD - Department of Radiology, Hanyang University Hospital, Seoul, Korea (Y.-J.L.). FAU - Kim, Sang Heum AU - Kim SH AD - Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (S.H.K.). FAU - Baik, Seung Kug AU - Baik SK AD - Department of Radiology, Pusan National University Yangsan Hospital, Korea (S.K.B.). FAU - Jeon, Pyoung AU - Jeon P AD - Department of Radiology, Samsung Medical Center (P.J.), Sungkyunkwan University School of Medicine, Seoul, Korea. FAU - Yoo, Joonsang AU - Yoo J AD - Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (J.Y.). FAU - Suh, Sang Hyun AU - Suh SH AD - Severance Hospital Stroke Center, and Department of Radiology, Gangnam Severance Hospital (S.H.S.), Yonsei University College of Medicine, Seoul, Korea. FAU - Kim, Byungjun AU - Kim B AD - Department of Radiology, Korea University Anam Hospital, Seoul (B.K.). FAU - Kim, Jin Woo AU - Kim JW AD - Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Korea (J.W.K.). FAU - Suh, Sangil AU - Suh S AD - Department of Radiology, Korea University Guro Hospital, Seoul (S.S.). FAU - Jeon, Hong-Jun AU - Jeon HJ AD - Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea (H.-J.J.). LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20190502 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM MH - Aged MH - *Angioplasty, Balloon MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Registries MH - Retrospective Studies MH - Stroke/epidemiology/*surgery MH - *Thrombectomy OTO - NOTNLM OT - *balloon occlusion OT - *endovascular treatment OT - *stroke OT - *thrombectomy EDAT- 2019/05/03 06:00 MHDA- 2020/01/23 06:00 CRDT- 2019/05/03 06:00 PHST- 2019/05/03 06:00 [pubmed] PHST- 2020/01/23 06:00 [medline] PHST- 2019/05/03 06:00 [entrez] AID - 10.1161/STROKEAHA.118.024723 [doi] PST - ppublish SO - Stroke. 2019 Jun;50(6):1490-1496. doi: 10.1161/STROKEAHA.118.024723. Epub 2019 May 2. PMID- 31648562 OWN - NLM STAT- MEDLINE DCOM- 20200110 LR - 20200110 IS - 1745-2422 (Electronic) IS - 1743-4440 (Linking) VI - 16 IP - 11 DP - 2019 Nov TI - Optimizing fast first pass complete reperfusion in acute ischemic stroke - the BADDASS approach (BAlloon guiDe with large bore Distal Access catheter with dual aspiration with Stent-retriever as Standard approach). PG - 955-963 LID - 10.1080/17434440.2019.1684263 [doi] AB - Introduction: Endovascular therapy is the standard of care for acute ischemic stroke due to large vessel occlusions. The ultimate goal is to achieve fast first pass complete reperfusion, since delayed and/or incomplete reperfusion increases complication rates and costs and deteriorates patient outcome. Achieving optimal results can sometimes be challenging, particularly in patients with tortuous vessels. Several techniques have been described lately to optimize recanalization, including first line aspiration and various stent-retriever assisted techniques. In our experience, mechanical thrombectomy with a BAlloon guide catheter, large bore Distal access catheter, Dual Aspiration and Stent-retriever as Standard approach (BADDASS) is the most efficient technique to succeed, since it combines the advantages of stent-retrievers and distal aspiration.Areas covered: The purpose of this review is to enable neurointerventionalists to achieve fast first pass complete reperfusion by outlining the BADDASS approach step-by-step and sharing additional tips for navigating through challenging internal carotid artery segments.Expert opinion: In our experience, the BADDASS approach is the safest and most effective way to achieve fast first pass complete reperfusion. FAU - Ospel, J M AU - Ospel JM AD - Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland. AD - Department of Radiology, University of Calgary, Calgary, Canada. FAU - Volny, O AU - Volny O AD - Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. AD - International Clinical Research Centre, Stroke Research Program, St. Anne´s University Hospital, Brno, Czech Republic. AD - Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic. FAU - Jayaraman, M AU - Jayaraman M AD - Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. AD - Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. AD - Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. AD - The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI, USA. FAU - McTaggart, R AU - McTaggart R AD - Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. AD - Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. AD - Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. AD - The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI, USA. FAU - Goyal, M AU - Goyal M AD - Department of Radiology, University of Calgary, Calgary, Canada. AD - Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. LA - eng PT - Journal Article PT - Review DEP - 20191031 PL - England TA - Expert Rev Med Devices JT - Expert review of medical devices JID - 101230445 SB - IM MH - Brain Ischemia/*complications/*therapy MH - *Cardiac Catheterization MH - Humans MH - *Reperfusion MH - *Stents/adverse effects MH - Stroke/*complications/*therapy MH - Suction OTO - NOTNLM OT - Aspiration OT - balloon guide catheter OT - endovascular therapy OT - ischemic stroke OT - reperfusion OT - thrombectomy EDAT- 2019/10/28 06:00 MHDA- 2020/01/11 06:00 CRDT- 2019/10/26 06:00 PHST- 2019/10/28 06:00 [pubmed] PHST- 2020/01/11 06:00 [medline] PHST- 2019/10/26 06:00 [entrez] AID - 10.1080/17434440.2019.1684263 [doi] PST - ppublish SO - Expert Rev Med Devices. 2019 Nov;16(11):955-963. doi: 10.1080/17434440.2019.1684263. Epub 2019 Oct 31. PMID- 31542275 OWN - NLM STAT- MEDLINE DCOM- 20200302 LR - 20200302 IS - 1535-7732 (Electronic) IS - 1051-0443 (Linking) VI - 30 IP - 11 DP - 2019 Nov TI - Balloon Guide Catheter in Endovascular Treatment for Acute Ischemic Stroke: Results from the MR CLEAN Registry. PG - 1759-1764.e6 LID - S1051-0443(19)30544-5 [pii] LID - 10.1016/j.jvir.2019.05.032 [doi] AB - PURPOSE: To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with and without the use of a balloon guide catheter (BGC) in clinical practice. MATERIALS AND METHODS: Data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry were used, in which all patients who underwent EVT for anterior-circulation stroke in The Netherlands between 2014 and 2016 were enrolled. Primary outcome was modified Rankin scale (mRS) score at 90 days. Secondary outcomes included reperfusion grade (extended Thrombolysis In Cerebral Infarction [eTICI] score) and National Institutes of Health Stroke Scale (NIHSS) score 24-48 hours after intervention. The association between the use of a BGC and outcomes was estimated with logistic regression adjusted for age, sex, prestroke mRS score, NIHSS score, collateral grade, and time from onset to EVT. RESULTS: A total of 887 patients were included. Thrombectomy was performed with the use of a BGC in 528 patients (60%) and without in 359 patients (40%). There was no significant association between use of a BGC and a shift on the mRS toward better outcome (adjusted common odds ratio, 1.17; 95% confidence interval [CI], 0.91-1.52). Use of a BGC was associated with higher eTICI score (adjusted common OR, 1.33; 95% CI, 1.04-1.70) and improvement of ≥ 4 points on the NIHSS (adjusted OR, 1.40; 95% CI, 1.04-1.88). CONCLUSIONS: In clinical practice, use of a BGC was associated with higher reperfusion grade and early improvement of neurologic deficits, but had no positive effect on long-term functional outcome. CI - Copyright © 2019 SIR. All rights reserved. FAU - Goldhoorn, Robert-Jan B AU - Goldhoorn RB AD - Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. Electronic address: robertjan.goldhoorn@mumc.nl. FAU - Duijsters, Nele AU - Duijsters N AD - Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. FAU - Majoie, Charles B L M AU - Majoie CBLM AD - Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands. FAU - Roos, Yvo B W E M AU - Roos YBWEM AD - Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands. FAU - Dippel, Diederik W J AU - Dippel DWJ AD - Department of Neurology, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands. FAU - van Es, Adriaan C G M AU - van Es ACGM AD - Department of Radiology, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands. FAU - Vos, Jan Albert AU - Vos JA AD - Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands. FAU - Boiten, Jelis AU - Boiten J AD - Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands. FAU - van Oostenbrugge, Robert J AU - van Oostenbrugge RJ AD - Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. FAU - van Zwam, Wim H AU - van Zwam WH AD - Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. CN - MR CLEAN Registry Investigators LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20190918 PL - United States TA - J Vasc Interv Radiol JT - Journal of vascular and interventional radiology : JVIR JID - 9203369 SB - IM MH - Aged MH - Aged, 80 and over MH - Brain Ischemia/diagnostic imaging/physiopathology/*therapy MH - Cerebrovascular Circulation MH - Disability Evaluation MH - Endovascular Procedures/adverse effects/*instrumentation MH - Female MH - Humans MH - Male MH - Middle Aged MH - Netherlands MH - Randomized Controlled Trials as Topic MH - Recovery of Function MH - Registries MH - Stents MH - Stroke/diagnostic imaging/physiopathology/*therapy MH - Thrombectomy/adverse effects/*instrumentation MH - Time Factors MH - Treatment Outcome MH - *Vascular Access Devices EDAT- 2019/09/23 06:00 MHDA- 2020/03/03 06:00 CRDT- 2019/09/23 06:00 PHST- 2019/02/27 00:00 [received] PHST- 2019/05/27 00:00 [revised] PHST- 2019/05/31 00:00 [accepted] PHST- 2019/09/23 06:00 [pubmed] PHST- 2020/03/03 06:00 [medline] PHST- 2019/09/23 06:00 [entrez] AID - S1051-0443(19)30544-5 [pii] AID - 10.1016/j.jvir.2019.05.032 [doi] PST - ppublish SO - J Vasc Interv Radiol. 2019 Nov;30(11):1759-1764.e6. doi: 10.1016/j.jvir.2019.05.032. Epub 2019 Sep 18. PMID- 30410509 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 1664-9737 (Print) IS - 1664-5545 (Electronic) IS - 1664-5545 (Linking) VI - 7 IP - 6 DP - 2018 Oct TI - Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use. PG - 327-333 LID - 10.1159/000488601 [doi] AB - BACKGROUND: Treatment of large vessel occlusion acute ischemic stroke with mechanical thrombectomy has become the standard of care after recent clinical trials. However, the degree of recanalization with stent retrievers remains very important in overall outcomes. We sought to review the utility of a new balloon guide catheter (BGC) in improving the degree of recanalization in conjunction with mechanical thrombectomy. METHODS: The medical records of a prospectively collected endovascular ischemic stroke database were reviewed. All consecutive strokes when a FlowGate BGC was used with a thrombectomy stent retriever were identified. Use of a FlowGate BGC, number of passes, final Thrombolysis in Cerebral Infarction (TICI) score, trackability, and use of adjunct devices were all collected and analyzed. RESULTS: Use of a FlowGate BGC resulted in 64% (33/52) first-pass effect (FPE) of TICI 2b/3, and specifically 46% (24/52) TICI 3 FPE (true FPE). A total of 52/62 (84%) of thrombectomy cases were treated with BGCs. In the remaining 10, the BGC was not inflated or used due to the clot not being visualized or the lesions being distal and BGC use thus not deemed appropriate. Adjunct use of an aspiration catheter was seen in 12% (6/52) of cases. The overall success with FlowGate BGCs with one or more passes of TICI 2b/3 was 94% (49/52). Trackability was achieved in 92% (57/62) of cases. CONCLUSIONS: Use of the FlowGate BGC as an adjunct to mechanical thrombectomy was associated with good FPE and an overall recanalization of TICI 2b/3 of 94%. FAU - Teleb, Mohamed S AU - Teleb MS AD - Neurointerventional Surgery, Stroke, and Neurocritical Care, Banner Health, Mesa, Arizona, USA. LA - eng PT - Journal Article DEP - 20180516 TA - Interv Neurol JT - Interventional neurology JID - 101606828 PMC - PMC6216708 OTO - NOTNLM OT - Acute stroke OT - Balloon guide catheter OT - First pass OT - Stent OT - Thrombectomy EDAT- 2018/11/10 06:00 MHDA- 2018/11/10 06:01 CRDT- 2018/11/10 06:00 PHST- 2017/09/03 00:00 [received] PHST- 2018/03/19 00:00 [accepted] PHST- 2018/11/10 06:00 [entrez] PHST- 2018/11/10 06:00 [pubmed] PHST- 2018/11/10 06:01 [medline] AID - ine-0007-0327 [pii] AID - 10.1159/000488601 [doi] PST - ppublish SO - Interv Neurol. 2018 Oct;7(6):327-333. doi: 10.1159/000488601. Epub 2018 May 16. PMID- 30309845 OWN - NLM STAT- MEDLINE DCOM- 20191104 LR - 20191104 IS - 1936-959X (Electronic) IS - 0195-6108 (Linking) VI - 39 IP - 11 DP - 2018 Nov TI - Balloon-Guide Catheters Are Needed for Effective Flow Reversal during Mechanical Thrombectomy. PG - 2077-2081 LID - 10.3174/ajnr.A5829 [doi] AB - BACKGROUND AND PURPOSE: Blood flow management in the carotid artery during mechanical thrombectomy is crucial for safety and effectiveness. There is an ongoing discussion about whether balloon-guide catheters or large-bore sheaths are needed for effective flow management. We compared general flow characteristics of proximal aspiration through a large-bore sheath and a balloon-guide catheter in a porcine in vivo model. MATERIALS AND METHODS: We investigated blood flow in a porcine common carotid artery with and without aspiration (VacLok syringe and Penumbra pump, Pump MAX) through an 8F-long sheath and an 8F balloon-guide catheter. Blood hemodynamics were assessed via continuous duplex sonography. RESULTS: Average vessel diameter and baseline blood flow were 4.4 ± 0.2 mm and 244 ± 20 mL/min, respectively. For the 8F sheath, pump aspiration resulted in a significant flow reduction (225 ± 25 mL/min, P < .001), but with a persisting antegrade stream. Manual aspiration resulted in collapse of the vessel in 2 of 7 measurements and oscillatory flow with antegrade systolic and retrograde diastolic components in the remaining 5 measurements. Net flow was antegrade (52 ± 44 mL/min) in 3 and retrograde (-95 ± 52 mL/min) in the remaining 2 measurements. For balloon-guide catheters, balloon inflation always resulted in flow arrest. Additional pump or manual aspiration resulted in significant flow reversal of -1100 ± 230 and -468 ± 46 mL/min, respectively (both, P < .001). CONCLUSIONS: Only balloon-guide catheters allow reliable blood flow arrest and flow reversal in combination with aspiration via syringes or high-flow pump systems. Aspiration through an 8F sheath results in either collapse of the vessel or oscillatory flow, which can result in a net antegrade or retrograde stream. CI - © 2018 by American Journal of Neuroradiology. FAU - Nikoubashman, O AU - Nikoubashman O AUID- ORCID: 0000-0002-2055-4217 AD - From the Departments of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., J.S., T.S., F.S.M., M.W.) onikoubashman@ukaachen.de. FAU - Wischer, D AU - Wischer D AUID- ORCID: 0000-0002-7787-2101 AD - From the Departments of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., J.S., T.S., F.S.M., M.W.). FAU - Hennemann, H M AU - Hennemann HM AUID- ORCID: 0000-0002-9175-972X AD - From the Departments of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., J.S., T.S., F.S.M., M.W.). FAU - Sandmann, J AU - Sandmann J AUID- ORCID: 0000-0001-6652-7655 AD - From the Departments of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., J.S., T.S., F.S.M., M.W.). FAU - Sichtermann, T AU - Sichtermann T AUID- ORCID: 0000-0002-9115-9548 AD - From the Departments of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., J.S., T.S., F.S.M., M.W.). FAU - Müschenich, F S AU - Müschenich FS AUID- ORCID: 0000-0001-7582-060X AD - From the Departments of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., J.S., T.S., F.S.M., M.W.). FAU - Reich, A AU - Reich A AUID- ORCID: 0000-0002-9439-7963 AD - Neurology (A.R.), RWTH Aachen University Hospital, Aachen, Germany. FAU - Wiesmann, M AU - Wiesmann M AUID- ORCID: 0000-0002-8261-5513 AD - From the Departments of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., J.S., T.S., F.S.M., M.W.). LA - eng PT - Journal Article DEP - 20181011 PL - United States TA - AJNR Am J Neuroradiol JT - AJNR. American journal of neuroradiology JID - 8003708 SB - IM MH - Animals MH - Carotid Artery, Common/surgery MH - *Catheters MH - *Cerebrovascular Circulation MH - Female MH - Stents MH - Stroke/surgery MH - Swine MH - Thrombectomy/*instrumentation/methods EDAT- 2018/10/13 06:00 MHDA- 2019/11/05 06:00 CRDT- 2018/10/13 06:00 PHST- 2018/04/30 00:00 [received] PHST- 2018/08/13 00:00 [accepted] PHST- 2018/10/13 06:00 [pubmed] PHST- 2019/11/05 06:00 [medline] PHST- 2018/10/13 06:00 [entrez] AID - ajnr.A5829 [pii] AID - 10.3174/ajnr.A5829 [doi] PST - ppublish SO - AJNR Am J Neuroradiol. 2018 Nov;39(11):2077-2081. doi: 10.3174/ajnr.A5829. Epub 2018 Oct 11. PMID- 31602354 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200108 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 11 IP - 8 DP - 2019 Aug 8 TI - Predictors of Balloon Guide Catheter Assistance Success in Stent-retrieval Thrombectomy for an Anterior Circulation Acute Ischemic Stroke. PG - e5350 LID - 10.7759/cureus.5350 [doi] LID - e5350 AB - Introduction Mechanical thrombectomy has become the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS) in well-selected patients. Although many devices and strategies exist, the use of a balloon-tip guide catheter (BGC) with stent-retriever (SR) may hold several advantages. We aim to assess the efficacy and identify predictors of technical success of this unique approach. Methods From our prospectively maintained database, we identified consecutive cases in which a BGC was used for stent-retriever thrombectomy in anterior circulation LVO between 2015 and 2016. Baseline and procedural characteristics were captured and analyzed. Predictors of technical and clinical outcomes were identified by multivariable logistic regression analysis. Results Ninety-three patients with AIS-LVO were treated with BGC-assisted mechanical thrombectomy. The mean age was 71 years old (SD 14), with 49.5% male (n=46). Pre-operative IV-tPA was administered in 55.9% (n=52) of cases. The most common location of occlusive thrombus was M1 (64.5%, n=60). Successful recanalization (mTICI=2b-3) was achieved in 86.0% (n=80) of cases while complete revascularization (mTICI-3) was achieved in 56.5% (n=52). There was a first-pass success rate of 52.7% (n=49). At discharge, 38.7% of the patients were functionally independent (mRS≤2). Multivariate analysis revealed that the middle cerebral artery location was strongly predictive of first-pass success, resulting in mTICI =2b revascularization (OR 7.10, p=0.018). Additionally, female gender (OR 2.85, p=0.042) and decreasing mTICI were associated with a poor clinical outcome (mRS≥4; OR 1.76, p=0.008). Conclusions BGC assistance in stent retrieval thrombectomy is safe and effective for AIS due to anterior circulation LVO. Further investigation is required to elucidate the optimal treatment strategy based on patient and disease characteristics. CI - Copyright © 2019, McCarthy et al. FAU - McCarthy, David J AU - McCarthy DJ AD - Neurosurgery, University of Miami Miller School of Medicine, Miami, USA. FAU - Sur, Samir AU - Sur S AD - Neurosurgery, University of Miami Miller School of Medicine, Miami, USA. FAU - Fortunel, Adisson AU - Fortunel A AD - Neurosurgery, University of Miami Miller School of Medicine, Miami, USA. FAU - Snelling, Brian AU - Snelling B AD - Neurosurgery, Boca Raton Regional Hospital, Boca Raton, USA. FAU - Luther, Evan AU - Luther E AD - Neurosurgery, University of Miami Miller School of Medicine, Miami, USA. FAU - Yavagal, Dileep AU - Yavagal D AD - Neuroendovascular Surgery, University of Miami Miller School of Medicine, Miami, USA. FAU - Peterson, Eric AU - Peterson E AD - Neurosurgery, University of Miami Miller School of Medicine, Miami, USA. FAU - Starke, Robert M AU - Starke RM AD - Neurosurgery, University of Miami Miller School of Medicine, Miami, USA. LA - eng PT - Journal Article DEP - 20190808 TA - Cureus JT - Cureus JID - 101596737 PMC - PMC6779151 OTO - NOTNLM OT - balloon guide OT - ischemia OT - large vessel occlusion OT - mechanical thrombectomy OT - outcomes OT - stent retriever OT - stroke COIS- The authors have declared that no competing interests exist. EDAT- 2019/10/12 06:00 MHDA- 2019/10/12 06:01 CRDT- 2019/10/12 06:00 PHST- 2019/10/12 06:00 [entrez] PHST- 2019/10/12 06:00 [pubmed] PHST- 2019/10/12 06:01 [medline] AID - 10.7759/cureus.5350 [doi] PST - epublish SO - Cureus. 2019 Aug 8;11(8):e5350. doi: 10.7759/cureus.5350. PMID- 29238099 OWN - NLM STAT- MEDLINE DCOM- 20181211 LR - 20181211 IS - 0027-7622 (Print) IS - 2186-3326 (Electronic) IS - 0027-7622 (Linking) VI - 79 IP - 4 DP - 2017 Nov TI - 8-F balloon guide catheter for embolization of anterior circulation aneurysms: an institutional experience in 152 patients. PG - 435-441 LID - 10.18999/nagjms.79.4.435 [doi] AB - The use of 8-F balloon guide catheter (BGC) for proximal flow control was previously shown to prevent distal embolic complications during mechanical clot retrieval in patients with acute ischemic stroke. In this retrospective study, the utility of 8-F BGCs for proximal flow control during endovascular coiling of anterior circulation aneurysms was investigated. Patients who underwent endovascular coiling for anterior circulation aneurysms between August 2013 and December 2016 were retrospectively analyzed. Among a total of 152 patients included in this series, 64 patients presented with aneurysmal rupture, whereas the aneurysms were detected incidentally or due to mass effects in the remaining patients. 8-F BGCs were successfully navigated in all patients. The balloon was inflated during navigation in 19 patients. Inflation of the catheter balloon during coil embolization was required in 34 patients; this was performed as an emergency maneuver in six of these patients. Thromboembolic complications occurred in one patient. 8-F BGC can be effectively used for proximal flow control during endovascular treatment of anterior circulation aneurysms. The other advantages included improved navigation of tortuous arterial anatomy, coil stabilization during aneurysmal coiling, and freedom to utilize aneurysmal neck-remodeling balloons for additional adjunctive techniques or to deploy rescue stents. This novel approach might be safely and effectively used in patients undergoing endovascular treatment for anterior circulation aneurysms. FAU - Ohshima, Tomotaka AU - Ohshima T AD - Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. FAU - Dash, Chinmaya AU - Dash C AD - Department of Neurosurgery, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan. FAU - Belayev, Andrey AU - Belayev A AD - Department of Neurosurgery, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan. FAU - Yamamoto, Taiki AU - Yamamoto T AD - Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. FAU - Goto, Shunsaku AU - Goto S AD - Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. FAU - Kato, Yoko AU - Kato Y AD - Department of Neurosurgery, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan. LA - eng PT - Journal Article TA - Nagoya J Med Sci JT - Nagoya journal of medical science JID - 0412011 SB - IM MH - Aged MH - Aneurysm, Ruptured/*therapy MH - Balloon Occlusion MH - Cerebral Angiography MH - Embolization, Therapeutic/adverse effects/*methods MH - Female MH - Humans MH - Intracranial Aneurysm/*therapy MH - Male MH - Middle Aged MH - Retrospective Studies MH - Treatment Outcome PMC - PMC5719202 OTO - NOTNLM OT - *balloon guide catheter OT - *coil embolization OT - *intracranial aneurysms EDAT- 2017/12/15 06:00 MHDA- 2018/12/12 06:00 CRDT- 2017/12/15 06:00 PHST- 2017/12/15 06:00 [entrez] PHST- 2017/12/15 06:00 [pubmed] PHST- 2018/12/12 06:00 [medline] AID - 10.18999/nagjms.79.4.435 [doi] PST - ppublish SO - Nagoya J Med Sci. 2017 Nov;79(4):435-441. doi: 10.18999/nagjms.79.4.435. PMID- 31591997 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200122 IS - 2005-3711 (Print) IS - 1598-7876 (Electronic) IS - 1225-8245 (Linking) VI - 63 IP - 1 DP - 2020 Jan TI - Role of Balloon Guide Catheter in Modern Endovascular Thrombectomy. PG - 14-25 LID - 10.3340/jkns.2019.0114 [doi] AB - Proximal flow control achieved with a balloon guide catheter (BGC) during endovascular treatment of acute ischemic stroke is reviewed in this article. In clinical practice, BGCs offer a multi-faceted approach for clot retrieval by creating proximal flow arrest, reducing embolic burden, and shortening procedure time. Evaluation of frontline thrombectomy procedures with BGCs revealed advantages of combined use over the conventional guide catheter (CGC), notably in the significant reduction of distal emboli to both the affected and previously unaffected territories. Recently, new measures of early and complete reperfusion at first thrombectomy pass have been identified as independent predictors of improved outcomes, which were consistently demonstrated with use of BGC as a safe and effective option to minimize number of passes during intervention. Prior randomized controlled trials reported the positive correlation between BGC-treated patients and a lower risk of mortality as well as shortened procedure time. While BGC use is more common in stent retriever-mediated mechanical thrombectomy, preliminary data has shown the potential benefit of device application during contact aspiration thrombectomy to achieve successful recanalization. However, the question of which major endovascular strategy reigns superior as a frontline remains to be answered. Along with clinical case assessments, BGC performance during in-vitro simulation was analyzed to further understand mechanisms for optimization of thrombectomy technique. FAU - Chueh, Ju-Yu AU - Chueh JY AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, MA, USA. FAU - Kang, Dong-Hun AU - Kang DH AD - Department of Neurosurgery and Radiology, School of Medicine, Kyungpook National University, Daegu, Korea. FAU - Kim, Byung Moon AU - Kim BM AD - Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. FAU - Gounis, Matthew J AU - Gounis MJ AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, MA, USA. LA - eng PT - Journal Article DEP - 20191008 TA - J Korean Neurosurg Soc JT - Journal of Korean Neurosurgical Society JID - 101467054 PMC - PMC6952736 OTO - NOTNLM OT - Acute stroke OT - Balloon occlusion OT - Endovascular thrombectomy OT - Thrombectomy COIS- JYC: Consultant for InNeuroCo and Stryker Neurovascular. MJG: Has been a consultant on a fee-per-hour basis for Cerenovus, Imperative Care, Medtronic Neurovascular, Mivi Neurosciences, Phenox, Route 92 Medical, Stryker Neurovascular; holds stock in Imperative Care and Neurogami; and has received research support from the Research support from the National Institutes of Health (NIH), the United States – Israel Binational Science Foundation, Anaconda, Cerenovus, Cook Medical, Gentuity, Imperative Care, InNeuroCo, Insera Therapeutics, Magneto, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Neuravi, Neurogami, Philips Healthcare, Rapid Medical, Route 92 Medical, Stryker Neurovascular, Syntheon, and the Wyss Institute. EDAT- 2019/10/09 06:00 MHDA- 2019/10/09 06:01 CRDT- 2019/10/09 06:00 PHST- 2019/05/09 00:00 [received] PHST- 2019/06/21 00:00 [accepted] PHST- 2019/10/09 06:00 [pubmed] PHST- 2019/10/09 06:01 [medline] PHST- 2019/10/09 06:00 [entrez] AID - jkns.2019.0114 [pii] AID - jkns-2019-0114 [pii] AID - 10.3340/jkns.2019.0114 [doi] PST - ppublish SO - J Korean Neurosurg Soc. 2020 Jan;63(1):14-25. doi: 10.3340/jkns.2019.0114. Epub 2019 Oct 8. PMID- 30611184 OWN - NLM STAT- In-Process LR - 20200226 IS - 1092-0684 (Electronic) IS - 1092-0684 (Linking) VI - 46 IP - Suppl_1 DP - 2019 Jan 1 TI - Nuances of carotid artery stenting under flow arrest with dual-balloon guide catheter. PG - V4 LID - 2019.1.FocusVid.18417 [pii] LID - 10.3171/2019.1.FocusVid.18417 [doi] AB - Cerebral protection device utilization during carotid artery stenting (CAS) has been demonstrated to decrease the risk of perioperative stroke. The ProximAl Protection with the MO.MA Device During CaRotid Stenting (ARMOUR) Trial had the lowest event rates of any independently adjudicated study. In this video of two cases of severe carotid artery stenosis, the authors present the nuances of the CAS procedure utilizing a dual-balloon guide catheter device (MO.MA). This device has the benefit of being in place before the lesion is crossed with any device, being able to arrest flow while the atherosclerotic lesion is crossed, and aiding in protection from distal emboli and stroke.The video can be found here: https://youtu.be/0o8DlC1n6_M. FAU - Vercelli, Giovanni AU - Vercelli G AD - Departments of1Neurologic Surgery and. FAU - Sorenson, Thomas J AU - Sorenson TJ AD - Departments of1Neurologic Surgery and. AD - 2School of Medicine, University of Minnesota, Minneapolis, Minnesota. FAU - Giordan, Enrico AU - Giordan E AD - Departments of1Neurologic Surgery and. FAU - Lanzino, Giuseppe AU - Lanzino G AD - Departments of1Neurologic Surgery and. AD - 3Radiology, Mayo Clinic, Rochester; and. FAU - Rangel-Castilla, Leonardo AU - Rangel-Castilla L AD - Departments of1Neurologic Surgery and. AD - 3Radiology, Mayo Clinic, Rochester; and. LA - eng PT - Journal Article PL - United States TA - Neurosurg Focus JT - Neurosurgical focus JID - 100896471 SB - IM OTO - NOTNLM OT - *carotid angioplasty OT - *carotid artery stenosis OT - *carotid artery stenting OT - *flow arrest OT - *stroke OT - *video EDAT- 2019/01/06 06:00 MHDA- 2019/01/06 06:00 CRDT- 2019/01/06 06:00 PHST- 2018/09/03 00:00 [received] PHST- 2018/11/14 00:00 [accepted] PHST- 2019/01/06 06:00 [entrez] PHST- 2019/01/06 06:00 [pubmed] PHST- 2019/01/06 06:00 [medline] AID - 2019.1.FocusVid.18417 [pii] AID - 10.3171/2019.1.FocusVid.18417 [doi] PST - ppublish SO - Neurosurg Focus. 2019 Jan 1;46(Suppl_1):V4. doi: 10.3171/2019.1.FocusVid.18417. PMID- 31409062 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200225 IS - 2093-9043 (Print) IS - 2233-6273 (Electronic) IS - 2093-9043 (Linking) VI - 14 IP - 2 DP - 2019 Sep TI - Recent Trend for Endovascular Treatment in Patients with Acute Ischemic Stroke: Balloon Guide Catheter. PG - 142-143 LID - 10.5469/neuroint.2019.00136 [doi] FAU - Suh, Chong Hyun AU - Suh CH AD - Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. FAU - Lee, Young-Jun AU - Lee YJ AD - Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea. LA - eng PT - Journal Article DEP - 20190816 TA - Neurointervention JT - Neurointervention JID - 101561462 PMC - PMC6736498 EDAT- 2019/08/15 06:00 MHDA- 2019/08/15 06:01 CRDT- 2019/08/15 06:00 PHST- 2019/06/20 00:00 [received] PHST- 2019/08/12 00:00 [accepted] PHST- 2019/08/15 06:00 [pubmed] PHST- 2019/08/15 06:01 [medline] PHST- 2019/08/15 06:00 [entrez] AID - neuroint.2019.00136 [pii] AID - neuroint-2019-00136 [pii] AID - 10.5469/neuroint.2019.00136 [doi] PST - ppublish SO - Neurointervention. 2019 Sep;14(2):142-143. doi: 10.5469/neuroint.2019.00136. Epub 2019 Aug 16. PMID- 30997860 OWN - NLM STAT- MEDLINE DCOM- 20200227 LR - 20200227 IS - 2385-2011 (Electronic) IS - 1591-0199 (Print) IS - 1591-0199 (Linking) VI - 25 IP - 5 DP - 2019 Oct TI - Intracranial mechanical thrombectomy using a proximal balloon guide catheter via a transradial access. PG - 508-510 LID - 10.1177/1591019919844850 [doi] AB - We present a description of a successful recanalization of an intracranial vessel occlusion by stent retriever-based mechanical thrombectomy with a proximal balloon guide catheter introduced via a transradial access. Therefore, we used the radial artery itself as a natural sheath, as the introduction of a balloon guide catheter would not have been possible through a common radial sheath. FAU - Maus, Volker AU - Maus V AUID- ORCID: 0000-0001-5097-2631 AD - Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany. FAU - Styczen, Hanna AU - Styczen H AUID- ORCID: 0000-0002-9623-4156 AD - Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany. FAU - Psychogios, Marios-Nikos AU - Psychogios MN AD - Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany. AD - Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland. LA - eng PT - Case Reports PT - Journal Article DEP - 20190418 TA - Interv Neuroradiol JT - Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences JID - 9602695 SB - IM MH - Aged MH - Brain Ischemia/diagnostic imaging/surgery MH - Catheterization, Peripheral/*methods MH - Computed Tomography Angiography MH - Humans MH - Male MH - *Radial Artery MH - Stents MH - Stroke/diagnostic imaging/surgery MH - Thrombectomy/*methods MH - Treatment Outcome PMC - PMC6777110 OTO - NOTNLM OT - Ischaemic stroke OT - balloon guide catheter OT - mechanical thrombectomy OT - transradial EDAT- 2019/04/19 06:00 MHDA- 2020/02/28 06:00 PMCR- 2020/10/01 CRDT- 2019/04/19 06:00 PHST- 2020/10/01 00:00 [pmc-release] PHST- 2019/04/19 06:00 [pubmed] PHST- 2020/02/28 06:00 [medline] PHST- 2019/04/19 06:00 [entrez] AID - 10.1177_1591019919844850 [pii] AID - 10.1177/1591019919844850 [doi] PST - ppublish SO - Interv Neuroradiol. 2019 Oct;25(5):508-510. doi: 10.1177/1591019919844850. Epub 2019 Apr 18. PMID- 30851472 OWN - NLM STAT- MEDLINE DCOM- 20200116 LR - 20200116 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 126 DP - 2019 Jun TI - Experience of the New FlowGate(2) Device as a Balloon Guide Catheter for Ischemic Stroke Intervention. PG - e736-e742 LID - S1878-8750(19)30563-7 [pii] LID - 10.1016/j.wneu.2019.02.140 [doi] AB - BACKGROUND: We report the experience of the FlowGate(2) (FG2) as a new balloon guide catheter in endovascular stroke intervention. METHODS: We evaluated the various outcomes and complications of patients with intracranial large artery occlusion undergoing endovascular stroke intervention with FG2 at our center. Baseline characteristics (failure rate of device application, sex, age, risk factors, arterial occlusion sites, and time intervals) were reviewed. Outcomes were evaluated according to National Institutes of Health Stroke Scale score, modified Rankin Scale (mRS) score, number of stent passages required, and Thrombolysis in Cerebral Infarction score. The incidence of hemorrhage, vessel damage, distal emboli, and mortality rate were evaluated as indicators of complications. RESULTS: Overall, 70 patients were enrolled, except the 2 patients with application failure of FG2. Seventy patients with a median age of 69 years were treated with FG2. Arterial occlusion involved the M1 (50%) and M2 (14.3%) segments, internal carotid artery (25.7%), and posterior circulation (10%). Median value of mRS at 90 days was 2.8, and 37 patients (52.8%) had a mRS score ≤2. The recanalization rate in patients with a Thrombolysis in Cerebral Infarction score of 2b or 3 was 91.4%. The hemorrhage rate was 5.7%, but none were symptomatic. In terms of complications, distal emboli occurred in 4.3% of cases. CONCLUSIONS: Endovascular stroke intervention with the FG2 is safe and effective with good accessibility and less occurrence of distal emboli. Its trackability, stability, and luminal size make the FG2 suitable for stroke intervention. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Yi, Ho Jun AU - Yi HJ AD - Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. FAU - Sung, Jae Hoon AU - Sung JH AD - Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: jaehoonsung@gmail.com. FAU - Lee, Min Hyung AU - Lee MH AD - Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. FAU - Lee, Dong Hoon AU - Lee DH AD - Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. LA - eng PT - Journal Article DEP - 20190306 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Brain Ischemia/*surgery MH - *Catheters MH - Endovascular Procedures/*instrumentation MH - Female MH - Humans MH - Male MH - Middle Aged MH - Stroke/*surgery MH - Thrombectomy/*instrumentation MH - Treatment Outcome OTO - NOTNLM OT - Balloon guide catheter OT - Intervention OT - Stents OT - Stroke OT - Thrombectomy EDAT- 2019/03/10 06:00 MHDA- 2020/01/17 06:00 CRDT- 2019/03/10 06:00 PHST- 2018/12/28 00:00 [received] PHST- 2019/02/12 00:00 [revised] PHST- 2019/02/13 00:00 [accepted] PHST- 2019/03/10 06:00 [pubmed] PHST- 2020/01/17 06:00 [medline] PHST- 2019/03/10 06:00 [entrez] AID - S1878-8750(19)30563-7 [pii] AID - 10.1016/j.wneu.2019.02.140 [doi] PST - ppublish SO - World Neurosurg. 2019 Jun;126:e736-e742. doi: 10.1016/j.wneu.2019.02.140. Epub 2019 Mar 6. PMID- 29378450 OWN - NLM STAT- MEDLINE DCOM- 20181001 LR - 20190610 IS - 2385-2011 (Electronic) IS - 1591-0199 (Print) IS - 1591-0199 (Linking) VI - 24 IP - 3 DP - 2018 Jun TI - Simple aspiration with balloon catheter technique (simple ABC technique) against proximal internal carotid artery occlusion in cases of cardiogenic cerebral embolism. PG - 317-321 LID - 10.1177/1591019917753823 [doi] AB - Background In cases of acute ischemic stroke, manual aspiration of the thrombus is commonly performed with a balloon guiding catheter placed in the cervical segment of the internal carotid artery (ICA). However, most manual aspirations using a balloon guiding catheter are combined with inner catheters, as in the direct aspiration first pass technique (ADAPT). We experienced some cases of acute ischemic stroke with proximal ICA occlusion due to cardiogenic thrombus where we obtained sufficient recanalization by simple manual aspiration from inflated Optimo 9F balloon catheters (Tokai Medical Products, Japan) placed in the origin of the cervical segment of the ICA without any inner catheter or stent retriever. We perform by preference this procedure, named the simple Aspiration with Balloon Catheter (simple ABC) technique. Herein, we report two recent cases and discuss this procedure. Case presentation Case 1: An 80-year-old man with paroxysmal atrial fibrillation developed left ICA occlusion. We performed the simple ABC technique and obtained a large amount of dark red and white thrombus. Puncture-to-reperfusion time was 14 minutes with Thrombolysis in Cerebral Infarction (TICI) grade 3. Case 2: A 69-year-old man with chronic atrial fibrillation developed left internal carotid occlusion. We performed the simple ABC technique and obtained a large amount of dark red thrombus. Puncture-to-reperfusion time was 15 minutes with TICI grade 2b. Conclusion The simple ABC technique is useful to deal with a large amount of thrombus, shortens procedure time, enables less invasive thrombectomy, and can shift immediately to subsequent procedures such as delivering a stent retriever or ADAPT. FAU - Okamura, Akitake AU - Okamura A AD - Department of Neurosurgery, Hiroshima General Hospital, Hiroshima, Japan. FAU - Kuroki, Kazuhiko AU - Kuroki K AD - Department of Neurosurgery, Hiroshima General Hospital, Hiroshima, Japan. FAU - Shinagawa, Katsuhiro AU - Shinagawa K AD - Department of Neurosurgery, Hiroshima General Hospital, Hiroshima, Japan. FAU - Yamada, Naoto AU - Yamada N AD - Department of Neurosurgery, Hiroshima General Hospital, Hiroshima, Japan. LA - eng PT - Case Reports PT - Journal Article DEP - 20180129 TA - Interv Neuroradiol JT - Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences JID - 9602695 SB - IM MH - Aged MH - Aged, 80 and over MH - Atrial Fibrillation/*complications MH - Brain Ischemia/*etiology/*surgery MH - *Carotid Artery, Internal MH - Endovascular Procedures/*methods MH - Humans MH - Intracranial Embolism/*etiology/*surgery MH - Male MH - Neuroimaging MH - Stroke/*etiology/*surgery MH - Suction/methods PMC - PMC5967180 OTO - NOTNLM OT - Acute ischemic stroke OT - balloon guide catheter OT - cardiogenic cerebral embolism OT - manual aspiration OT - simple ABC technique EDAT- 2018/01/31 06:00 MHDA- 2018/10/03 06:00 CRDT- 2018/01/31 06:00 PHST- 2018/01/31 06:00 [pubmed] PHST- 2018/10/03 06:00 [medline] PHST- 2018/01/31 06:00 [entrez] AID - 10.1177_1591019917753823 [pii] AID - 10.1177/1591019917753823 [doi] PST - ppublish SO - Interv Neuroradiol. 2018 Jun;24(3):317-321. doi: 10.1177/1591019917753823. Epub 2018 Jan 29. PMID- 31514211 OWN - NLM STAT- In-Data-Review LR - 20200220 IS - 1438-9010 (Electronic) IS - 1438-9010 (Linking) VI - 192 IP - 3 DP - 2020 Mar TI - Influence of Thrombus Composition on Thrombectomy: ADAPT vs. Balloon Guide Catheter and Stent Retriever in a Flow Model. PG - 257-263 LID - 10.1055/a-0998-4246 [doi] AB - PURPOSE:  A first-pass, direct aspiration technique and stent retrieval with a balloon guide catheter represent advanced thrombectomy techniques that are increasingly being used in the clinical routine. The purpose of this experimental study was to evaluate whether the techniques' effectiveness depended on the clot composition and to visualize the interaction between the devices and the clot. MATERIALS AND METHODS:  Erythrocyte-rich (red) and fibrin-rich (white) clots were placed into the M1-segment of the middle cerebral artery in a transparent vascular phantom with physiological architecture. Physiological hemodynamic conditions were maintained with a programmable pump. On the one hand direct aspiration with a 5F aspiration catheter (ADAPT) and on the other hand stent retrieval with a balloon guide catheter (flow arrest/reversal) was performed. The experiments were made under direct visual control to observe the interaction between the devices and the clot. The primary end points were the number of passes/maneuvers and the occurrence of distal emboli and emboli in a new territory (anterior cerebral artery), until full recanalization was achieved. The experiment was filmed with a full high-definition camera identifying emboli. RESULTS:  Six experiments were conducted for each technique and clot model. Red clots were retrieved by ADAPT with fewer passes and distal emboli, and could usually be aspirated directly at the occlusion site. White clots clogged the tip of the 5F aspiration catheter in every experiment. The catheter had to be pulled back into the long sheath in the cervical internal carotid artery, producing distal emboli. White clots were retrieved by the stent retriever and balloon guide catheter with fewer distal emboli. There was no difference in the number of passes. The stent-thrombus interaction was superficial in both clot models. Successful retrieval was granted by the flow arrest and proximal aspiration/flow reversal. One embolus in a new territory developed when using each technique in white clots. CONCLUSION:  This experimental study showed that the efficacy of advanced thrombectomy techniques might depend on clot composition. Identifying the right technique for the right clot might improve the results of thrombectomy. In a clinical setting the thrombus morphology in non-enhanced CT could be used as a marker for patient selection. KEY POINTS:   · The efficacy of thrombectomy seems to depend on thrombus composition.. · ADAPT might be more effective for rbc-rich clots.. · Thrombectomy with BGC might be more effective for fibrin-rich clots.. CITATION FORMAT: · Madjidyar J, Pineda Vidal L, Larsen N et al. Influence of Thrombus Composition on Thrombectomy: ADAPT vs. Balloon Guide Catheter and Stent Retriever in a Flow Model. Fortschr Röntgenstr 2020; 192: 257 - 263. CI - © Georg Thieme Verlag KG Stuttgart · New York. FAU - Madjidyar, Jawid AU - Madjidyar J AD - Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany. FAU - Pineda Vidal, Lorena AU - Pineda Vidal L AD - Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany. FAU - Larsen, Naomi AU - Larsen N AD - Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany. FAU - Jansen, Olav AU - Jansen O AD - Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany. LA - eng PT - Journal Article TT - Einfluss der Thrombus-Zusammensetzung auf die Thrombektomie: ADAPT gegen Balloon-Guide-Catheter und Stent-Retriever in einem Flussmodell. DEP - 20190912 PL - Germany TA - Rofo JT - RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin JID - 7507497 SB - IM COIS- The authors declare that they have no conflict of interest. EDAT- 2019/09/13 06:00 MHDA- 2019/09/13 06:00 CRDT- 2019/09/13 06:00 PHST- 2019/09/13 06:00 [pubmed] PHST- 2019/09/13 06:00 [medline] PHST- 2019/09/13 06:00 [entrez] AID - 10.1055/a-0998-4246 [doi] PST - ppublish SO - Rofo. 2020 Mar;192(3):257-263. doi: 10.1055/a-0998-4246. Epub 2019 Sep 12. PMID- 26801392 OWN - NLM STAT- MEDLINE DCOM- 20170516 LR - 20181113 IS - 1869-1447 (Electronic) IS - 1869-1439 (Linking) VI - 26 IP - 3 DP - 2016 Sep TI - Balloon Guide Catheter in Complex Anterior Circulation Mechanical Thrombectomy: Beyond Proximal Occlusion and Flow Reversal. PG - 369-73 LID - 10.1007/s00062-016-0498-z [doi] FAU - Demerath, T AU - Demerath T AD - Department of Neuroradiology, Neurocenter, University Hospital Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. FAU - Reinhard, M AU - Reinhard M AD - Department of Neurology, Neurocenter, University Hospital Freiburg, Freiburg, Germany. FAU - Elsheikh, S AU - Elsheikh S AD - Department of Neuroradiology, Neurocenter, University Hospital Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. FAU - Keuler, A AU - Keuler A AD - Department of Radiology, University Hospital of Cologne, Cologne, Germany. FAU - Urbach, H AU - Urbach H AD - Department of Neuroradiology, Neurocenter, University Hospital Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. FAU - Meckel, S AU - Meckel S AD - Department of Neuroradiology, Neurocenter, University Hospital Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. stephanmeckel@gmail.com. LA - eng PT - Case Reports PT - Journal Article DEP - 20160122 PL - Germany TA - Clin Neuroradiol JT - Clinical neuroradiology JID - 101526693 SB - IM MH - Aged MH - Balloon Occlusion/*instrumentation/*methods MH - Brain Infarction/*diagnostic imaging/*surgery MH - Cerebral Angiography/methods MH - Equipment Design MH - Equipment Failure Analysis MH - Female MH - Humans MH - Mechanical Thrombolysis/*instrumentation/*methods MH - Treatment Outcome EDAT- 2016/01/24 06:00 MHDA- 2017/05/17 06:00 CRDT- 2016/01/24 06:00 PHST- 2015/10/28 00:00 [received] PHST- 2016/01/08 00:00 [accepted] PHST- 2016/01/24 06:00 [entrez] PHST- 2016/01/24 06:00 [pubmed] PHST- 2017/05/17 06:00 [medline] AID - 10.1007/s00062-016-0498-z [pii] AID - 10.1007/s00062-016-0498-z [doi] PST - ppublish SO - Clin Neuroradiol. 2016 Sep;26(3):369-73. doi: 10.1007/s00062-016-0498-z. Epub 2016 Jan 22. PMID- 28712895 OWN - NLM STAT- MEDLINE DCOM- 20171226 LR - 20171226 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 106 DP - 2017 Oct TI - Parent and Child Balloon Technique for Navigating Guide Catheters During Neurointerventions. PG - 409-412 LID - S1878-8750(17)31130-0 [pii] LID - 10.1016/j.wneu.2017.07.030 [doi] AB - BACKGROUND: The stabilization of a guide catheter is an important factor for performing successful neurointerventional procedures. We present our technique for navigating guide catheters using parent and child balloons. METHODS: In 9 patients with severe atherosclerosis or anatomic variations such as a bovine arch, 8-9-F balloon-mounted guide catheters were navigated using balloon-attached guidewires. Both balloons were used complementarily for flow navigation and vessel fixation at the appropriate positions and times. RESULTS: In all cases, the balloon guide catheter could be inserted up to the required positions, and the procedures were completed without any complications. CONCLUSIONS: The parent and child balloon technique is useful for inserting guide catheters in hostile vascular anatomies. CI - Copyright © 2017 Elsevier Inc. All rights reserved. FAU - Ohshima, Tomotaka AU - Ohshima T AD - Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. Electronic address: tmtkoh@gmail.com. FAU - Ishikawa, Kojiro AU - Ishikawa K AD - Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. FAU - Goto, Shunsaku AU - Goto S AD - Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. FAU - Yamamoto, Taiki AU - Yamamoto T AD - Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. LA - eng PT - Journal Article DEP - 20170713 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 SB - IM MH - Balloon Occlusion/*methods MH - Carotid Arteries/*diagnostic imaging/surgery MH - Catheterization/*methods MH - Female MH - Femoral Artery/*diagnostic imaging/surgery MH - Humans MH - Male MH - Neuronavigation/*methods OTO - NOTNLM OT - Balloon OT - Endovascular treatment OT - Guide catheter OT - Navigation EDAT- 2017/07/18 06:00 MHDA- 2017/12/27 06:00 CRDT- 2017/07/18 06:00 PHST- 2017/05/18 00:00 [received] PHST- 2017/07/03 00:00 [revised] PHST- 2017/07/06 00:00 [accepted] PHST- 2017/07/18 06:00 [pubmed] PHST- 2017/12/27 06:00 [medline] PHST- 2017/07/18 06:00 [entrez] AID - S1878-8750(17)31130-0 [pii] AID - 10.1016/j.wneu.2017.07.030 [doi] PST - ppublish SO - World Neurosurg. 2017 Oct;106:409-412. doi: 10.1016/j.wneu.2017.07.030. Epub 2017 Jul 13. PMID- 27987034 OWN - NLM STAT- MEDLINE DCOM- 20170620 LR - 20181113 IS - 1437-2320 (Electronic) IS - 0344-5607 (Linking) VI - 40 IP - 2 DP - 2017 Apr TI - Retrograde suction decompression of a large internal carotid aneurysm using a balloon guide catheter combined with a blood-returning circuit and STA-MCA bypass: a technical note. PG - 351-355 LID - 10.1007/s10143-016-0808-6 [doi] AB - It is difficult to treat large internal carotid aneurysms with simple surgical clipping. Here, we present a retrograde suction decompression (RSD) procedure for large internal carotid aneurysms using a balloon guide catheter combined with a blood-returning circuit and a superficial temporal artery to middle cerebral artery (STA-MCA) bypass.All patients underwent an STA-MCA bypass before the temporary occlusion of the internal carotid artery (ICA). A 6-French sheath was inserted into the common carotid artery (CCA), and a 6-French Patrive balloon catheter was placed into the ICA 5 cm past the bifurcation. Aneurysm exposure was obtained; temporary clips were placed on the proximal M1, A1, and posterior communicating (Pcom) segments; and an extension tube was then connected to the balloon catheter. A three-way stopcock was placed, and aspiration was performed through the device to collapse the aneurysm. The aspirated blood was returned to a venous line with an added heparin to prevent anemia after aspiration. During the decompression, the blood flow to the cortical area was supplied through the STA-MCA bypass. After the aneurysm collapse, the surgeon carefully dissected the perforating artery from the aneurysm dome or neck, and permanent clips were then placed on the aneurysm neck. Our procedure has several advantages, such as STA-MCA bypass without external carotid artery occlusion for preventing ischemic complications of the cortical area, anemia may be avoided because of the return of the aspirated blood, and a hybrid operation room is not required to perform this method. FAU - Matano, Fumihiro AU - Matano F AD - Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. s00-078@nms.ac.jp. FAU - Mizunari, Takayuki AU - Mizunari T AD - Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. FAU - Kominami, Shushi AU - Kominami S AD - Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. FAU - Suzuki, Masanori AU - Suzuki M AD - Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. FAU - Fujiki, Yu AU - Fujiki Y AD - Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. FAU - Kubota, Asami AU - Kubota A AD - Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. FAU - Kobayashi, Shiro AU - Kobayashi S AD - Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. FAU - Murai, Yasuo AU - Murai Y AD - Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan. FAU - Morita, Akio AU - Morita A AD - Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan. LA - eng PT - Journal Article DEP - 20161216 PL - Germany TA - Neurosurg Rev JT - Neurosurgical review JID - 7908181 SB - IM MH - Anastomosis, Surgical/instrumentation/methods MH - Aneurysm/diagnostic imaging/surgery MH - Aneurysm, Ruptured/diagnostic imaging/*surgery MH - Carotid Artery, Internal/diagnostic imaging/*surgery MH - Cerebral Revascularization/instrumentation/methods MH - Decompression, Surgical/instrumentation/*methods MH - Female MH - Humans MH - Middle Aged MH - Middle Cerebral Artery/diagnostic imaging/*surgery MH - Suction MH - Surgical Stapling MH - Temporal Arteries/diagnostic imaging/*surgery OTO - NOTNLM OT - Aneurysm OT - Balloon catheter OT - Suction decompression EDAT- 2016/12/18 06:00 MHDA- 2017/06/21 06:00 CRDT- 2016/12/18 06:00 PHST- 2016/10/17 00:00 [received] PHST- 2016/12/09 00:00 [accepted] PHST- 2016/11/19 00:00 [revised] PHST- 2016/12/18 06:00 [pubmed] PHST- 2017/06/21 06:00 [medline] PHST- 2016/12/18 06:00 [entrez] AID - 10.1007/s10143-016-0808-6 [pii] AID - 10.1007/s10143-016-0808-6 [doi] PST - ppublish SO - Neurosurg Rev. 2017 Apr;40(2):351-355. doi: 10.1007/s10143-016-0808-6. Epub 2016 Dec 16. PMID- 30711506 OWN - NLM STAT- MEDLINE DCOM- 20190805 LR - 20190805 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 58 DP - 2019 Jul TI - Endovascular Treatment with Two Overlapping Micromesh-Covered Stents and Balloon Guide Catheter for Symptomatic Carotid Pseudoaneurysm Ten Years after Eversion Endarterectomy. PG - 379.e9-379.e13 LID - S0890-5096(19)30048-2 [pii] LID - 10.1016/j.avsg.2018.10.026 [doi] AB - Pseudoaneurysm is a rare complication after carotid endarterectomy. Herein, we report a successful endovascular exclusion of a symptomatic carotid pseudoaneurysm occurred ten years after an eversion carotid endarterectomy by means of 2 overlapping micromesh stents (InspireMD C-Guard™) and balloon guide catheter (FlowGate(2) Balloon Guide Catheter) used as a proximal protection device. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Siani, Andrea AU - Siani A AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. Electronic address: andreasiani@yahoo.it. FAU - Castrucci, Tommaso AU - Castrucci T AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. FAU - Accrocca, Federico AU - Accrocca F AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. FAU - Ianni, Giulia AU - Ianni G AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. FAU - Corona, Stefano AU - Corona S AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. FAU - De Vivo, Gennaro AU - De Vivo G AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. FAU - Smedile, Gianluca AU - Smedile G AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. FAU - Bartoli, Stefano AU - Bartoli S AD - Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, ASL-RM 2 Rome, Italy. LA - eng PT - Case Reports PT - Journal Article DEP - 20190131 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 MH - Aged MH - Aneurysm, False/diagnostic imaging/etiology/*therapy MH - Angioplasty, Balloon/*instrumentation MH - Carotid Artery Diseases/*surgery MH - Computed Tomography Angiography MH - *Embolic Protection Devices MH - Endarterectomy, Carotid/*adverse effects MH - Humans MH - Male MH - Prosthesis Design MH - *Stents MH - *Surgical Mesh MH - Treatment Outcome EDAT- 2019/02/04 06:00 MHDA- 2019/08/06 06:00 CRDT- 2019/02/04 06:00 PHST- 2018/08/20 00:00 [received] PHST- 2018/10/09 00:00 [revised] PHST- 2018/10/10 00:00 [accepted] PHST- 2019/02/04 06:00 [pubmed] PHST- 2019/08/06 06:00 [medline] PHST- 2019/02/04 06:00 [entrez] AID - S0890-5096(19)30048-2 [pii] AID - 10.1016/j.avsg.2018.10.026 [doi] PST - ppublish SO - Ann Vasc Surg. 2019 Jul;58:379.e9-379.e13. doi: 10.1016/j.avsg.2018.10.026. Epub 2019 Jan 31. PMID- 24302483 OWN - NLM STAT- MEDLINE DCOM- 20140220 LR - 20161122 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 45 IP - 1 DP - 2014 Jan TI - Balloon guide catheter improves revascularization and clinical outcomes with the Solitaire device: analysis of the North American Solitaire Acute Stroke Registry. PG - 141-5 LID - 10.1161/STROKEAHA.113.002407 [doi] AB - BACKGROUND AND PURPOSE: Efficient and timely recanalization is an important goal in acute stroke endovascular therapy. Several studies demonstrated improved recanalization and clinical outcomes with the stent retriever devices compared with the Merci device. The goal of this study was to evaluate the role of the balloon guide catheter (BGC) and recanalization success in a substudy of the North American Solitaire Acute Stroke (NASA) registry. METHODS: The investigator-initiated NASA registry recruited 24 clinical sites within North America to submit demographic, clinical, site-adjudicated angiographic, and clinical outcome data on consecutive patients treated with the Solitaire Flow Restoration device. BGC use was at the discretion of the treating physicians. RESULTS: There were 354 patients included in the NASA registry. BGC data were reported in 338 of 354 patients in this subanalysis, of which 149 (44%) had placement of a BGC. Mean age was 67.3±15.2 years, and median National Institutes of Health Stroke Scale score was 18. Patients with BGC had more hypertension (82.4% versus 72.5%; P=0.05), atrial fibrillation (50.3% versus 32.8%; P=0.001), and were more commonly administered tissue plasminogen activator (51.6% versus 38.8%; P=0.02) compared with patients without BGC. Time from symptom onset to groin puncture and number of passes were similar between the 2 groups. Procedure time was shorter in patients with BGC (120±28.5 versus 161±35.6 minutes; P=0.02), and less adjunctive therapy was used in patients with BGC (20% versus 28.6%; P=0.05). Thrombolysis in cerebral infarction 3 reperfusion scores were higher in patients with BGC (53.7% versus 32.5%; P<0.001). Distal emboli and emboli in new territory were similar between the 2 groups. Discharge National Institutes of Health Stroke Scale score (mean, 12±14.5 versus 17.5±16; P=0.002) and good clinical outcome at 3 months were superior in patients with BGC compared with patients without (51.6% versus 35.8%; P=0.02). Multivariate analysis demonstrated that the use of BGC was an independent predictor of good clinical outcome (odds ratio, 2.5; 95% confidence interval, 1.2-4.9). CONCLUSIONS: Use of a BGC with the Solitaire Flow Restoration device resulted in superior revascularization results, faster procedure times, decreased need for adjunctive therapy, and improved clinical outcome. FAU - Nguyen, Thanh N AU - Nguyen TN AD - From the Departments of Neurology (T.N.N., H.M.), Neurosurgery (T.N.N.), and Radiology (T.N.N., H.M., A.M.N.), Boston University School of Medicine, MA; Alexian Brothers Medical Center, Elk Grove Village, IL (T.M., F.A.M.); Departments of Neurosurgery (O.O.Z.), Neurology (A.C.C., M.A.I., O.O.Z.), and Radiology (O.O.Z.), Medical College of Wisconsin, Milwaukee; Department of Neurology, Emory University School of Medicine, Atlanta, GA (R.G., C.-H.J.S., R.G.N.); St. Luke's Neuroscience Institute, Kansas City, MO (C.O.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco (J.D.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Oregon Health and Sciences, Portland (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown (A.T.R.); Department of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Department of Neurosurgery, Presence Saint Joseph Medical Center, Joliet, IL (A.B.); Desert Regional Medical Center, Palm Springs, CA (M.T.); University of Kansas Medical Center, Kansas City (M.G.A.); Texas Stroke Institute, Dallas Fort-Worth Metroplex (V.J.); Baylor College of Medicine, Houston, TX (H.S.); Departments of Radiology and Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston (A.J.Y.); Department of Neurology, University of Louisville Medical School, KY (A.-A.C.); University of Texas, Houston (P.R.C.); Department of Neurosurgery, Methodist Neurological Institute, Houston, TX (G.W.B.); Tenet Health Florida, Hialeah (R.K.); and University of Missouri, Columbia (A.N.). FAU - Malisch, Timothy AU - Malisch T FAU - Castonguay, Alicia C AU - Castonguay AC FAU - Gupta, Rishi AU - Gupta R FAU - Sun, Chung-Huan J AU - Sun CH FAU - Martin, Coleman O AU - Martin CO FAU - Holloway, William E AU - Holloway WE FAU - Mueller-Kronast, Nils AU - Mueller-Kronast N FAU - English, Joey D AU - English JD FAU - Linfante, Italo AU - Linfante I FAU - Dabus, Guilherme AU - Dabus G FAU - Marden, Franklin A AU - Marden FA FAU - Bozorgchami, Hormozd AU - Bozorgchami H FAU - Xavier, Andrew AU - Xavier A FAU - Rai, Ansaar T AU - Rai AT FAU - Froehler, Michael T AU - Froehler MT FAU - Badruddin, Aamir AU - Badruddin A FAU - Taqi, Muhammad AU - Taqi M FAU - Abraham, Michael G AU - Abraham MG FAU - Janardhan, Vallabh AU - Janardhan V FAU - Shaltoni, Hashem AU - Shaltoni H FAU - Novakovic, Roberta AU - Novakovic R FAU - Yoo, Albert J AU - Yoo AJ FAU - Abou-Chebl, Alex AU - Abou-Chebl A FAU - Chen, Peng R AU - Chen PR FAU - Britz, Gavin W AU - Britz GW FAU - Kaushal, Ritesh AU - Kaushal R FAU - Nanda, Ashish AU - Nanda A FAU - Issa, Mohammad A AU - Issa MA FAU - Masoud, Hesham AU - Masoud H FAU - Nogueira, Raul G AU - Nogueira RG FAU - Norbash, Alexander M AU - Norbash AM FAU - Zaidat, Osama O AU - Zaidat OO LA - eng PT - Journal Article DEP - 20131203 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM CIN - Stroke. 2014 May;45(5):e86. PMID: 24627111 CIN - Stroke. 2014 May;45(5):e85. PMID: 24627115 MH - Aged MH - Catheterization, Central Venous/*methods MH - Cerebral Angiography MH - Cerebral Revascularization/*methods MH - Cerebrovascular Circulation/physiology MH - Endovascular Procedures/*methods MH - Female MH - Humans MH - Intracranial Thrombosis/complications MH - Male MH - Registries MH - Risk Factors MH - *Stents MH - Stroke/*surgery MH - Treatment Outcome OTO - NOTNLM OT - stroke OT - thrombectomy EDAT- 2013/12/05 06:00 MHDA- 2014/02/22 06:00 CRDT- 2013/12/05 06:00 PHST- 2013/12/05 06:00 [entrez] PHST- 2013/12/05 06:00 [pubmed] PHST- 2014/02/22 06:00 [medline] AID - STROKEAHA.113.002407 [pii] AID - 10.1161/STROKEAHA.113.002407 [doi] PST - ppublish SO - Stroke. 2014 Jan;45(1):141-5. doi: 10.1161/STROKEAHA.113.002407. Epub 2013 Dec 3. PMID- 25676149 OWN - NLM STAT- MEDLINE DCOM- 20161216 LR - 20161217 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 8 IP - 4 DP - 2016 Apr TI - Stent retriever thrombectomy with the Cover accessory device versus proximal protection with a balloon guide catheter: in vitro stroke model comparison. PG - 413-7 LID - 10.1136/neurintsurg-2014-011617 [doi] AB - BACKGROUND: Recently, an in vitro cerebrovascular occlusion model of the intracranial circulation was developed for testing thrombectomy devices. The Cover accessory (Lazarus Effect; Campbell, California, USA) is a novel nitinol braided mesh device that surrounds the stent retrieval device and thrombus during the retrieval process to help prevent clot fragmentation and embolization. METHODS: Using the in vitro model, after introducing fresh clot into the middle cerebral artery, we compared rates of target vessel recanalization and embolization in new territories (areas in which clot had not been introduced) achieved with the Solitaire Flow Restoration (FR) stent retriever (Covidien, Irvine, California) in conjunction with the use of a conventional guide catheter (control group), a balloon guide catheter (BGC group), and the Cover device (Cover group). RESULTS: In a total of 51 thrombectomy experiments (20 in the control group, 20 in the BGC group, and 11 in the Cover group), successful recanalization (Thrombolysis in Cerebral Infarction 2b-3) was achieved more frequently in the Cover group than in the control group or in the BGC group (p=0.047 and p=0.020, respectively). Embolization of new (previously unaffected) territories occurred in five (25%) experiments from the control group and in three (15%) experiments from the BGC group, whereas no embolization of new territories was seen with Cover device assisted thrombectomy. CONCLUSIONS: Application of the Cover device in this experimental model resulted in higher successful recanalization rates, no embolic events, and was more effective than use of the conventional guide catheter or BGC. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ FAU - Mokin, Maxim AU - Mokin M AD - Department of Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA Department of Neurology, University of South Florida College of Medicine, Tampa, Florida, USA. FAU - Setlur Nagesh, Swetadri Vasan AU - Setlur Nagesh SV AD - Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Electrical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA. FAU - Ionita, Ciprian N AU - Ionita CN AD - Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA. FAU - Mocco, J AU - Mocco J AD - Departments of Neurological Surgery and Radiology and Radiological Sciences, Mount Sinai Health System, New York, New York, USA. FAU - Siddiqui, Adnan H AU - Siddiqui AH AD - Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Departments of Neurosurgery and Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA. LA - eng GR - 1R01NS064592-01A1/NS/NINDS NIH HHS/United States GR - 2R01EB002873/EB/NIBIB NIH HHS/United States GR - 5R01EB002873-07/EB/NIBIB NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20150212 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Angiography, Digital Subtraction MH - Balloon Occlusion/instrumentation/*methods MH - Cerebral Revascularization/instrumentation/*methods MH - Humans MH - Stroke/diagnostic imaging/*surgery MH - Thrombectomy/instrumentation/*methods MH - *Vascular Closure Devices OTO - NOTNLM OT - Stent OT - Stroke OT - Thrombectomy EDAT- 2015/02/14 06:00 MHDA- 2016/12/17 06:00 CRDT- 2015/02/14 06:00 PHST- 2014/12/16 00:00 [received] PHST- 2015/01/23 00:00 [accepted] PHST- 2015/02/14 06:00 [entrez] PHST- 2015/02/14 06:00 [pubmed] PHST- 2016/12/17 06:00 [medline] AID - neurintsurg-2014-011617 [pii] AID - 10.1136/neurintsurg-2014-011617 [doi] PST - ppublish SO - J Neurointerv Surg. 2016 Apr;8(4):413-7. doi: 10.1136/neurintsurg-2014-011617. Epub 2015 Feb 12. PMID- 22552837 OWN - NLM STAT- MEDLINE DCOM- 20130723 LR - 20181113 IS - 1432-1920 (Electronic) IS - 0028-3940 (Linking) VI - 54 IP - 11 DP - 2012 Nov TI - Manual aspiration thrombectomy through balloon-tipped guide catheter for rapid clot burden reduction in endovascular therapy for ICA L/T occlusion. PG - 1261-5 LID - 10.1007/s00234-012-1039-3 [doi] AB - INTRODUCTION: Timely recanalization during endovascular procedures for acute ischemic stroke can be challenging in cases with large clot burden, such as those encountered in the terminal internal carotid T- or L-type occlusion. METHODS: A novel but simple technique to achieve fast reduction in clot burden in stroke patients with occlusion of the internal carotid artery termination is described where manual suction using a 60-ml syringe applied through an 8-F balloon guide catheter positioned in the cervical carotid vasculature with proximal flow arrest allows subsequent revascularization of the residual middle cerebral artery clot. RESULTS: The use of manual suction through a balloon-tipped guide catheter in internal carotid artery L- or T-type occlusion is illustrated. This resulted in a significant reduction of the clot burden and facilitated further interventions leading to full recanalization. CONCLUSION: Manual suction using a 60-ml syringe through a balloon guide catheter is a useful and feasible technique that facilitates thrombectomy of large burden cerebral clots. FAU - Eesa, Muneer AU - Eesa M AD - Department of Radiology, University of Calgary, Calgary, Alberta, Canada. FAU - Almekhlafi, Mohammed A AU - Almekhlafi MA FAU - Mitha, Alim P AU - Mitha AP FAU - Wong, John H AU - Wong JH FAU - Goyal, Mayank AU - Goyal M LA - eng PT - Journal Article DEP - 20120428 PL - Germany TA - Neuroradiology JT - Neuroradiology JID - 1302751 SB - IM CIN - Neuroradiology. 2012 Nov;54(11):1287. PMID: 22836714 MH - Carotid Artery Thrombosis/classification/*surgery MH - *Carotid Artery, Internal MH - Catheters MH - Equipment Design MH - Humans MH - Suction/methods MH - Thrombectomy/*instrumentation/*methods MH - Time Factors EDAT- 2012/05/04 06:00 MHDA- 2013/07/24 06:00 CRDT- 2012/05/04 06:00 PHST- 2012/01/16 00:00 [received] PHST- 2012/04/04 00:00 [accepted] PHST- 2012/05/04 06:00 [entrez] PHST- 2012/05/04 06:00 [pubmed] PHST- 2013/07/24 06:00 [medline] AID - 10.1007/s00234-012-1039-3 [doi] PST - ppublish SO - Neuroradiology. 2012 Nov;54(11):1261-5. doi: 10.1007/s00234-012-1039-3. Epub 2012 Apr 28. PMID- 28691137 OWN - NLM STAT- MEDLINE DCOM- 20181218 LR - 20191210 IS - 0942-0940 (Electronic) IS - 0001-6268 (Linking) VI - 159 IP - 9 DP - 2017 Sep TI - Effective use of balloon guide catheters in reducing incidence of mechanical thrombectomy related distal embolization. PG - 1671-1677 LID - 10.1007/s00701-017-3256-3 [doi] AB - BACKGROUND AND PURPOSE: The clinical benefit of endovascular stroke therapy has been demonstrated in several prospective randomized trials. However, in a relevant percentage of patients, mechanical thrombectomy bears the risk of causing new infarction in initially unaffected vascular territories through thrombus fragmentation and migration of clot debris. The goal of this study was to evaluate the use of the balloon guide catheter (BGC) to effectively achieve flow arrest and thrombus aspiration during the intervention to avoid distal embolization. METHODS: A retrospective study was performed in 139 patients between October 2010 and May 2016 to analyze occlusions in the middle cerebral artery (MCA) or internal carotid artery (ICA) by using a stent retriever with a BGC (n = 73) or a non-BGC (n = 66). The following data were collected: patient age and gender, along with history of diabetes mellitus, hypertension, atrial fibrillation, smoking, obesity, dyslipidemia, and previous ischemic stroke. Data on procedure time, number of passes, and angiographic findings were also collected. The final reperfusion score was rated based on the Thrombolysis in Cerebral Infarction (TICI) grading scale. Successful recanalization was defined as TICI 3 or 2b. RESULTS: A total of 139 patients underwent mechanical thrombectomy with the stent retriever. Of the 139 patients, 73 (52.5%) underwent placement of a BGC. The mean age was 65.8 ± 13.5 years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 11. The average initial NIHSS score was lower in the BGC group compared with the non-BGC group (mean, 11.2 ± 5.6 vs. 13.2 ± 5.6; P = 0.03). Patients with BGC had fewer incidences of previous ischemic stroke (12.3% vs. 28.8%; P = 0.01). The numbers of passes were similar between the two groups. The procedure time (99 ± 49.4 min vs. 124 ± 72.2 min; P = 0.02) and the time from onset of symptoms to procedure end (302 ± 102 min vs. 357.2 ± 136.1 min; P = 0.009) were shorter in the BGC group. TICI 3 or 2b recanalization scores were higher in the BGC group compared to the non-BGC group [63/73, 86.3% vs. 48/66, 72.7%; odds ratio (OR), 0.6; 95% confidence interval (CI), 0.2-1.4; P = 0.04]. Importantly, distal embolization was less frequent in the BGC group (5/73, 6.8% vs. 21/66, 31.8%; OR, 6.3; 95% CI, 2.2-18.0; P < 0.001). CONCLUSIONS: The risk of distal embolization was significantly decreased with the use of a BGC. FAU - Lee, Dong Hoon AU - Lee DH AD - Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero Paldal-gu, Suwon, 16247, South Korea. FAU - Sung, Jae Hoon AU - Sung JH AD - Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero Paldal-gu, Suwon, 16247, South Korea. jaehoonsung@gmail.com. FAU - Kim, Sang Uk AU - Kim SU AD - Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero Paldal-gu, Suwon, 16247, South Korea. FAU - Yi, Ho Jun AU - Yi HJ AD - Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero Paldal-gu, Suwon, 16247, South Korea. FAU - Hong, Jae Taek AU - Hong JT AD - Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero Paldal-gu, Suwon, 16247, South Korea. FAU - Lee, Sang Won AU - Lee SW AD - Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero Paldal-gu, Suwon, 16247, South Korea. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20170709 PL - Austria TA - Acta Neurochir (Wien) JT - Acta neurochirurgica JID - 0151000 SB - IM MH - Aged MH - Aged, 80 and over MH - Embolization, Therapeutic/adverse effects/*methods MH - Female MH - Humans MH - Infarction, Middle Cerebral Artery/surgery/*therapy MH - Male MH - Middle Aged MH - Postoperative Complications/epidemiology/prevention & control MH - Thrombectomy/*adverse effects/methods OTO - NOTNLM OT - Balloon-guided catheter OT - Distal embolization OT - Mechanical thrombectomy EDAT- 2017/07/12 06:00 MHDA- 2018/12/19 06:00 CRDT- 2017/07/11 06:00 PHST- 2017/04/04 00:00 [received] PHST- 2017/06/19 00:00 [accepted] PHST- 2017/07/12 06:00 [pubmed] PHST- 2018/12/19 06:00 [medline] PHST- 2017/07/11 06:00 [entrez] AID - 10.1007/s00701-017-3256-3 [pii] AID - 10.1007/s00701-017-3256-3 [doi] PST - ppublish SO - Acta Neurochir (Wien). 2017 Sep;159(9):1671-1677. doi: 10.1007/s00701-017-3256-3. Epub 2017 Jul 9. PMID- 32457694 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200529 IS - 1664-2295 (Print) IS - 1664-2295 (Electronic) IS - 1664-2295 (Linking) VI - 11 DP - 2020 TI - Effect of Balloon Guide Catheter Utilization on the Incidence of Sub-angiographic Peripheral Emboli on High-Resolution DWI After Thrombectomy: A Prospective Observational Study. PG - 386 LID - 10.3389/fneur.2020.00386 [doi] LID - 386 AB - Background: Thrombus fragmentation causing distal emboli is a feared complication during mechanical thrombectomy (MT). We aimed to investigate the impact of procedural parameters and thrombus properties on the incidence of peripheral emboli after MT for large vessel occlusions (LVO). Methods: We performed a prospective analysis of patients with LVO stroke successfully treated with MT, defined as a score of 2b, 2c, or 3 on the thrombolysis in cerebral infarction (TICI) scale. A follow-up MRI including high-resolution diffusion-weighted imaging (DWI) was performed within 24 h following MT. The primary endpoint was the number and volume of peripheral emboli, classified as punctuate DWI lesions distant to the diffusion-restricted core lesion. Further analysis included the influence of baseline characteristics, procedural and outcome parameters, and thrombus properties on peripheral emboli. Results: Thirty-seven patients with successful MT met the inclusion criteria. Use of a balloon guide catheter (BGC) and TICI were the only independent predictors for a reduced number of peripheral emboli. The use of a BGC led to a significant reduction in the number and volume of peripheral emboli, with a median number/volume of peripheral emboli of 4.5/287 μl (IQR 1.25-8.25/76-569 μl) vs. 12/938 μl (IQR 4-19/242-1,836 μl). In cases where BGC was not employed, the number of peripheral emboli increased with decreasing TICI scores. Conclusions: BGC-aided MT reduces the number of peripheral emboli in successful but incomplete reperfusion (TICI 2b and 2c). The effectiveness of this strategy therefore goes above and beyond that which can be demonstrated by the TICI score alone. CI - Copyright © 2020 Schönfeld, Kabiri, Kniep, Meyer, McDonough, Sedlacik, Ernst, Broocks, Faizy, Schön, Cheng, Thomalla, Fiehler and Hanning. FAU - Schönfeld, Michael H AU - Schönfeld MH AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Kabiri, Reza AU - Kabiri R AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Kniep, Helge C AU - Kniep HC AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Meyer, Lukas AU - Meyer L AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - McDonough, Rosalie AU - McDonough R AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Sedlacik, Jan AU - Sedlacik J AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. AD - Biomedical Engineering Department, Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom. FAU - Ernst, Marielle AU - Ernst M AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Broocks, Gabriel AU - Broocks G AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Faizy, Tobias AU - Faizy T AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Schön, Gerhard AU - Schön G AD - Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Cheng, Bastian AU - Cheng B AD - Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Thomalla, Götz AU - Thomalla G AD - Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Fiehler, Jens AU - Fiehler J AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Hanning, Uta AU - Hanning U AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. LA - eng PT - Journal Article DEP - 20200507 TA - Front Neurol JT - Frontiers in neurology JID - 101546899 PMC - PMC7221024 OTO - NOTNLM OT - cerebrovascular disease/stroke OT - embolism OT - ischemic stroke OT - magnetic resonance imaging (MRI) OT - revascularization EDAT- 2020/05/28 06:00 MHDA- 2020/05/28 06:01 CRDT- 2020/05/28 06:00 PHST- 2020/01/31 00:00 [received] PHST- 2020/04/17 00:00 [accepted] PHST- 2020/05/28 06:00 [entrez] PHST- 2020/05/28 06:00 [pubmed] PHST- 2020/05/28 06:01 [medline] AID - 10.3389/fneur.2020.00386 [doi] PST - epublish SO - Front Neurol. 2020 May 7;11:386. doi: 10.3389/fneur.2020.00386. eCollection 2020. PMID- 24627111 OWN - NLM STAT- MEDLINE DCOM- 20140703 LR - 20181202 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 45 IP - 5 DP - 2014 May TI - Response to letter regarding article, "Balloon guide catheter improves revascularization and clinical outcomes with the solitaire device: analysis of the North American Solitaire Acute Stroke Registry". PG - e86 LID - 10.1161/STROKEAHA.114.004828 [doi] FAU - Nguyen, Thanh N AU - Nguyen TN AD - Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, MA. FAU - Malisch, Timothy W AU - Malisch TW FAU - Zaidat, Osama O AU - Zaidat OO CN - North American Solitaire Acute Stroke Registry LA - eng PT - Comment PT - Letter DEP - 20140313 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM CON - Stroke. 2014 Jan;45(1):141-5. PMID: 24302483 CON - Stroke. 2014 May;45(5):e85. PMID: 24627115 MH - Catheterization, Central Venous/*methods MH - Cerebral Revascularization/*methods MH - Endovascular Procedures/*methods MH - Female MH - Humans MH - Male MH - *Stents MH - Stroke/*surgery EDAT- 2014/03/15 06:00 MHDA- 2014/07/06 06:00 CRDT- 2014/03/15 06:00 PHST- 2014/03/15 06:00 [entrez] PHST- 2014/03/15 06:00 [pubmed] PHST- 2014/07/06 06:00 [medline] AID - STROKEAHA.114.004828 [pii] AID - 10.1161/STROKEAHA.114.004828 [doi] PST - ppublish SO - Stroke. 2014 May;45(5):e86. doi: 10.1161/STROKEAHA.114.004828. Epub 2014 Mar 13. PMID- 28963367 OWN - NLM STAT- MEDLINE DCOM- 20180903 LR - 20181202 IS - 1759-8486 (Electronic) IS - 1759-8478 (Print) IS - 1759-8478 (Linking) VI - 10 IP - 6 DP - 2018 Jun TI - TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. PG - 516-524 LID - 10.1136/neurintsurg-2017-013328 [doi] AB - BACKGROUND: Recent randomized clinical trials (RCTs) demonstrated the efficacy of mechanical thrombectomy using stent-retrievers in patients with acute ischemic stroke (AIS) with large vessel occlusions; however, it remains unclear if these results translate to a real-world setting. The TREVO Stent-Retriever Acute Stroke (TRACK) multicenter Registry aimed to evaluate the use of the Trevo device in everyday clinical practice. METHODS: Twenty-three centers enrolled consecutive AIS patients treated from March 2013 through August 2015 with the Trevo device. The primary outcome was defined as achieving a Thrombolysis in Cerebral Infarction (TICI) score of ≥2b. Secondary outcomes included 90-day modified Rankin Scale (mRS), mortality, and symptomatic intracranial hemorrhage (sICH). RESULTS: A total of 634patients were included. Mean age was 66.1±14.8 years and mean baseline NIH Stroke Scale (NIHSS) score was 17.4±6.7; 86.7% had an anterior circulation occlusion. Mean time from symptom onset to puncture and time to revascularization were 363.1±264.5 min and 78.8±49.6 min, respectively. 80.3% achieved TICI ≥2b. 90-day mRS ≤2 was achieved in 47.9%, compared with 51.4% when restricting the analysis to the anterior circulation and within 6 hours (similar to recent AHA/ASA guidelines), and 54.3% for those who achieved complete revascularization. The 90-day mortality rate was 19.8%. Independent predictors of clinical outcome included age, baseline NIHSS, use of balloon guide catheter, revascularization, and sICH. CONCLUSION: The TRACK Registry results demonstrate the generalizability of the recent thrombectomy RCTs in real-world clinical practice. No differences in clinical and angiographic outcomes were shown between patients treated within the AHA/ASA guidelines and those treated outside the recommendations. CI - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. FAU - Zaidat, Osama O AU - Zaidat OO AD - Departments of Endovascular Neurosurgery and Stroke, St Vincent Mercy Medical Center, Toledo, Ohio, USA. AD - Neuroscience & Stroke Center, Mercy Health St Vincent Hospital, Toledo, OH, USA. FAU - Castonguay, Alicia C AU - Castonguay AC AD - Department of Biostatistics, University of Texas, Houston, Texas, USA. FAU - Nogueira, Raul G AU - Nogueira RG AD - Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Haussen, Diogo C AU - Haussen DC AD - Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - English, Joey D AU - English JD AD - California Pacific Medical Center, Atlanta, Florida, USA. FAU - Satti, Sudhakar R AU - Satti SR AD - Department of Neurointerventional Surgery, Christiana Care Health System, Newark, Delaware, USA. FAU - Chen, Jennifer AU - Chen J AD - Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA. FAU - Farid, Hamed AU - Farid H AD - Department of Neurointerventional Radiology, St Jude Medical Center, Fullerton, USA. FAU - Borders, Candace AU - Borders C AD - University of California, Irvine School of Medicine, Irvine, California, USA. FAU - Veznedaroglu, Erol AU - Veznedaroglu E AD - Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA. FAU - Binning, Mandy J AU - Binning MJ AD - Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA. FAU - Puri, Ajit AU - Puri A AD - Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Vora, Nirav A AU - Vora NA AD - Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, Ohio, USA. FAU - Budzik, Ron F AU - Budzik RF AD - Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, Ohio, USA. FAU - Dabus, Guilherme AU - Dabus G AD - Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida, USA. FAU - Linfante, Italo AU - Linfante I AD - Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida, USA. FAU - Janardhan, Vallabh AU - Janardhan V AD - Texas Stroke Institute, Plano, Texas, USA. FAU - Alshekhlee, Amer AU - Alshekhlee A AD - Department of Vascular and Interventional Neurology, DePaul Stroke Center-SSM Neuroscience Institutes, St Louis University, St Louis, Missouri, USA. FAU - Abraham, Michael G AU - Abraham MG AD - Departments of Neurology and Interventional Radiology, University of Kansas Medical Center, Kansas, USA. FAU - Edgell, Randall AU - Edgell R AD - Department of Neurology, St Louis University, St Louis, Missouri, USA. FAU - Taqi, Muhammad Asif AU - Taqi MA AD - Department of Neurology and Neurosurgery, Los Robles Hospital and Medical Center, Thousand Oaks, California, USA. FAU - Khoury, Ramy El AU - Khoury RE AD - Department of Neurology, Tulane University, New Orleans, Louisiana, USA. FAU - Mokin, Maxim AU - Mokin M AD - Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA. FAU - Majjhoo, Aniel Q AU - Majjhoo AQ AD - Department of Neurology, Wayne State School of Medicine, Detroit, Michigan, USA. FAU - Kabbani, Mouhammed R AU - Kabbani MR AD - Department of Neurosurgery, Gundersen Health System, La Crosse, Wisconsin, USA. FAU - Froehler, Michael T AU - Froehler MT AD - Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. FAU - Finch, Ira AU - Finch I AD - John Muir Health, Walnut Creek, California, USA. FAU - Ansari, Sameer A AU - Ansari SA AD - Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Novakovic, Roberta AU - Novakovic R AD - Departments of Radiology, Neurology, and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas, USA. FAU - Nguyen, Thanh N AU - Nguyen TN AD - Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, Massachusetts, USA. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20170929 TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Aged MH - Aged, 80 and over MH - Brain Ischemia/diagnostic imaging/*surgery MH - Cerebrovascular Disorders/diagnostic imaging/*surgery MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - *Registries MH - Retrospective Studies MH - *Stents MH - Stroke/diagnostic imaging/*surgery MH - Thrombectomy/instrumentation/*methods MH - Treatment Outcome PMC - PMC5969387 OTO - NOTNLM OT - mechanical OT - revascularization OT - stent-retriever OT - stroke OT - thrombectomy OT - trevo COIS- Competing interests: IL is consultant for Metronic, Stryker, Penumbra, and Cordis. MM is consultant for Claret Medical, Nogueira-Stryker Neurovascular (Trevo-2 Trial Principal Investigator – modest; DAWN Trial Principal Investigator – no compensation, TREVO Registry Steering Committee – no compensation), Medtronic (SWIFT Trial Steering Committee – modest; SWIFT-Prime Trial Steering Committee – no compensation; STAR Trial Angiographic Core Lab – significant), Penumbra (3D Separator Trial Executive Committee – no compensation), Neuravi (ARISE-2 Steering Committee – no compensation), Genentech (Physician Advisory Board – modest), Allm Inc (Physician Advisory Board – no compensation), Editor-In-Chief Interventional Neurology Journal (no compensation). SRS is a consultant for Stryker Neurovascular. OOZ is overall PI for TRACK – no compensation, Arise II – modest, Co-PI Therapy Trial – modest, Steering committee STRATIS registry – modest. EDAT- 2017/10/01 06:00 MHDA- 2018/09/04 06:00 CRDT- 2017/10/01 06:00 PHST- 2017/07/17 00:00 [received] PHST- 2017/08/17 00:00 [revised] PHST- 2017/08/24 00:00 [accepted] PHST- 2017/10/01 06:00 [pubmed] PHST- 2018/09/04 06:00 [medline] PHST- 2017/10/01 06:00 [entrez] AID - neurintsurg-2017-013328 [pii] AID - 10.1136/neurintsurg-2017-013328 [doi] PST - ppublish SO - J Neurointerv Surg. 2018 Jun;10(6):516-524. doi: 10.1136/neurintsurg-2017-013328. Epub 2017 Sep 29. PMID- 24627115 OWN - NLM STAT- MEDLINE DCOM- 20140703 LR - 20181202 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 45 IP - 5 DP - 2014 May TI - Letter by Simonsen et al regarding article, "Balloon guide catheter improves revascularization and clinical outcomes with the solitaire device: analysis of the North American Solitaire Acute Stroke Registry". PG - e85 LID - 10.1161/STROKEAHA.114.004789 [doi] FAU - Simonsen, Claus Z AU - Simonsen CZ AD - Department of Neurology. FAU - Sørensen, Leif H AU - Sørensen LH FAU - Andersen, Grethe AU - Andersen G LA - eng PT - Comment PT - Letter DEP - 20140313 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM CON - Stroke. 2014 Jan;45(1):141-5. PMID: 24302483 CIN - Stroke. 2014 May;45(5):e86. PMID: 24627111 MH - Catheterization, Central Venous/*methods MH - Cerebral Revascularization/*methods MH - Endovascular Procedures/*methods MH - Female MH - Humans MH - Male MH - *Stents MH - Stroke/*surgery EDAT- 2014/03/15 06:00 MHDA- 2014/07/06 06:00 CRDT- 2014/03/15 06:00 PHST- 2014/03/15 06:00 [entrez] PHST- 2014/03/15 06:00 [pubmed] PHST- 2014/07/06 06:00 [medline] AID - STROKEAHA.114.004789 [pii] AID - 10.1161/STROKEAHA.114.004789 [doi] PST - ppublish SO - Stroke. 2014 May;45(5):e85. doi: 10.1161/STROKEAHA.114.004789. Epub 2014 Mar 13. PMID- 30612534 OWN - NLM STAT- MEDLINE DCOM- 20191016 LR - 20191016 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 50 IP - 2 DP - 2019 Feb TI - Vertebral Artery Patency and Thrombectomy in Basilar Artery Occlusions. PG - 389-395 LID - 10.1161/STROKEAHA.118.022466 [doi] AB - Background and Purpose- Factors influencing recanalization success in basilar artery occlusions are largely unknown. Preliminary evidence has suggested that flow arrest in the vertebral artery contralateral to the catheter bearing vertebral artery may facilitate recanalization. The aim of this analysis was to assess the impact of anatomic variations and flow conditions on recanalization success in basilar artery occlusion treated with mechanical thrombectomy. Methods- Consecutive basilar artery occlusions treated with second-generation thrombectomy devices at a single-center were retrospectively analyzed. Baseline patients' characteristics, occlusion length, collateral circulation, underlying stenosis, incomplete occlusions, and patency of the vertebral arteries were analyzed with regards to recanalization success. Aplastic or hypoplastic vertebral artery contralateral to the catheter position was defined as contralateral low flow condition. Logistic regression analysis was used to examine the association between anatomic variations and flow conditions in relation to complete recanalization and the modified Rankin Scale score while controlling for several potentially confounding variables. Clinical impact was evaluated using the modified Rankin Scale score of ≤3. Results- One hundred fifteen patients were included (mean age 71.5±12.8, m:f=2:1, median National Institutes of Health Stroke Scale =15, interquartile range =10-22). Complete recanalization was more often observed in patients with contralateral low flow conditions (80.6% versus 50.0%), which remained an independent predictor of complete recanalization in multivariable analysis (adjusted odds ratio, 5.81; 95% CI, 1.97-17.19). Patients with complete posterior recanalization had lower in-hospital mortality (16.4% versus 41.7%) and more often achieved modified Rankin Scale score of ≤3 (49.4% versus 8.3%), even after adjusting for potential confounders (adjusted odds ratio, 15.93; 95% CI, 1.42-179.00). Conclusions- Contralateral low flow condition (vertebral artery aplasia or hypoplasia) seems to be an independent factor for fewer distal emboli and complete recanalization in basilar artery occlusion patients treated by modern endovascular devices. Complete recanalization reflecting the absence of peri-interventional clot fragmentation brings clear clinical benefit. Further studies are warranted to evaluate the need for contralateral flow modulation or ipsilateral balloon guide catheter during posterior circulation thrombectomy in patients with bilaterally patent vertebral arteries. FAU - Boeckh-Behrens, Tobias AU - Boeckh-Behrens T AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Pree, David AU - Pree D AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Lummel, Nina AU - Lummel N AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Friedrich, Benjamin AU - Friedrich B AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Maegerlein, Christian AU - Maegerlein C AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Kreiser, Kornelia AU - Kreiser K AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Kirschke, Jan AU - Kirschke J AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Berndt, Maria AU - Berndt M AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Lehm, Manuel AU - Lehm M AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Wunderlich, Silke AU - Wunderlich S FAU - Mosimann, Pascal J AU - Mosimann PJ AD - Department of Neurology (P.J.M., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. AD - Institute of Diagnostic and Interventional Neuroradiology (P.J.M., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland. FAU - Fischer, Urs AU - Fischer U AD - Department of Neurology (U.F., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland. FAU - Zimmer, Claus AU - Zimmer C AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. FAU - Kaesmacher, Johannes AU - Kaesmacher J AD - From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. AD - Department of Neurology (P.J.M., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany. AD - Institute of Diagnostic and Interventional Neuroradiology (P.J.M., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland. AD - Department of Neurology (U.F., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM MH - Aged MH - Aged, 80 and over MH - Blood Flow Velocity MH - Disease-Free Survival MH - Female MH - *Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Survival Rate MH - *Thrombectomy MH - *Vascular Patency MH - *Vertebral Artery/diagnostic imaging/physiopathology MH - *Vertebrobasilar Insufficiency/diagnostic imaging/mortality/physiopathology/surgery OTO - NOTNLM OT - *anatomy OT - *catheter OT - *stroke OT - *thrombectomy OT - *vertebral artery EDAT- 2019/01/08 06:00 MHDA- 2019/10/17 06:00 CRDT- 2019/01/08 06:00 PHST- 2019/01/08 06:00 [pubmed] PHST- 2019/10/17 06:00 [medline] PHST- 2019/01/08 06:00 [entrez] AID - 10.1161/STROKEAHA.118.022466 [doi] PST - ppublish SO - Stroke. 2019 Feb;50(2):389-395. doi: 10.1161/STROKEAHA.118.022466. PMID- 31318624 OWN - NLM STAT- MEDLINE DCOM- 20200312 LR - 20200312 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 50 IP - 9 DP - 2019 Sep TI - Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry. PG - 2455-2460 LID - 10.1161/STROKEAHA.118.024639 [doi] AB - Background and Purpose- It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry. Methods- The 24 sites that enrolled patients in the Trevo Acute Ischemic Stroke registry were trichotomized into low-volume (<2 cases/month), medium-volume (2-4 cases/month), and high-volume centers (>4 cases/month). Baseline features, imaging, and clinical outcomes were compared across the 3 volume strata. A multivariable analysis was performed to assess whether outcomes were influenced by site volumes. Results- A total of 624 patients were included and distributed as low- (n=188 patients, 30.1%), medium- (n=175, 28.1%), and high-volume (n=261, 41.8%) centers. There were no significant differences in terms of age (mean, 66±16 versus 67±14 versus 65±15; P=0.2), baseline National Institutes of Health Stroke Scale (mean, 17.6±6.5 versus 16.8±6.5 versus 17.6±6.9; P=0.43), or occlusion site across the 3 groups. Median (interquartile range) times from stroke onset to groin puncture were 266 (181.8-442.5), 239 (175-389), and 336.5 (221.3-466.5) minutes in low-, medium-, and high-volume centers, respectively (P=0.004). Higher efficiency and better outcomes were seen in higher volume sites as demonstrated by shorter procedural times (median, 97 versus 67 versus 69 minutes; P<0.001), higher balloon guide catheter use (40% versus 36% versus 59%; P≤0.0001), and higher rates of good outcome (90-day modified Rankin Scale [mRS], ≤2; 39% versus 50% versus 53.4%; P=0.02). There were no appreciable differences in symptomatic intracranial hemorrhage or 90-day mortality. After adjustments in the multivariable analysis, there were significantly higher chances of achieving a good outcome in high- versus low-volume (odds ratio, 1.67; 95% CI, 1.03-2.7; P=0.04) and medium- versus low-volume (odds ratio, 1.75; 95% CI, 1.1-2.9; P=0.03) centers, but there were no significant differences between high- and medium-volume centers (P=0.86). Conclusions- Stroke center volumes significantly influence efficiency and outcomes in mechanical thrombectomy. FAU - Nogueira, Raul G AU - Nogueira RG AD - From the Department of Neurology, Emory University School of Medicine, Atlanta, GA (R.G.N., D.C.H., L.C.R., M.R.F.). FAU - Haussen, Diogo C AU - Haussen DC AD - From the Department of Neurology, Emory University School of Medicine, Atlanta, GA (R.G.N., D.C.H., L.C.R., M.R.F.). FAU - Castonguay, Alicia AU - Castonguay A AD - Department of Neurology, University of Toledo, OH (A.C.). FAU - Rebello, Leticia C AU - Rebello LC AD - From the Department of Neurology, Emory University School of Medicine, Atlanta, GA (R.G.N., D.C.H., L.C.R., M.R.F.). FAU - Abraham, Michael AU - Abraham M AD - Department of Neurology, University of Kansas Medical Center, University of Massachusetts Medical School, Worcester (M.A.). FAU - Puri, Ajit AU - Puri A AD - Department of Neurosurgery, University of Massachusetts Medical School, Worcester (A.P.). AD - Department of Radiology, University of Massachusetts Medical School, Worcester (A.P.). FAU - Alshekhlee, Amer AU - Alshekhlee A AD - Department of Neurology, SSM Neuroscience Institutes, DePaul Health, Bridgeton, MO (A.A.). FAU - Majjhoo, Aniel AU - Majjhoo A AD - Department of Neurology, McLaren Flint Neuroscience Institute, Flint, MI (A.M.). AD - Department of Neurology, McLaren Flint Neuroscience Institute, Flint, MI (A.M.). FAU - Farid, Hamed AU - Farid H AD - Neurointerventional Radiology, St. Jude Medical Center, Chicago, IL (H.F.). FAU - Finch, Ira AU - Finch I AD - Department of Interventional Radiology, John Muir Medical Center, Walnut Creek, CA (I.F.). FAU - English, Joey AU - English J AD - Department of Neurology, California Pacific Medical Center, San Francisco (J.E.). FAU - Mokin, Maxim AU - Mokin M AD - Department of Neurosurgery and Brain Repair, University of South Florida, Tampa (M.M.). FAU - Froehler, Michael T AU - Froehler MT AD - Cerebrovascular Program, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.). FAU - Kabbani, Mo AU - Kabbani M AD - Department of Neurointervention, Gundersen Lutheran Medical Foundation, Inc, La Crosse, WI (M.K.). FAU - Taqi, Muhammad A AU - Taqi MA AD - Department of Neurology, Desert Regional Medical Center, Palm Springs, CA (M.A.T.). FAU - Vora, Nirav AU - Vora N AD - Department of Neuroradiology, Riverside Radiology, Columbus, OH (N.V., R.B.). FAU - Khoury, Ramy El AU - Khoury RE AD - Department of Neurology, Tulane University School of Medicine, New Orleans, LA (R.E.K.). FAU - Edgell, Randall C AU - Edgell RC AD - Department of Surgery, Saint Louis University Hospital, St. Louis, MO (R.C.E.). AD - Department of Neurology, Saint Louis University Hospital, St. Louis, MO (R.C.E.). FAU - Novakovic, Roberta AU - Novakovic R AD - Department of Radiology, University of Texas Southwestern, Dallas (R.N.). AD - Department of Neurology, University of Texas Southwestern, Dallas (R.N.). FAU - Nguyen, Thanh AU - Nguyen T AD - Department of and Neurotherapeutics, University of Texas Southwestern, Dallas (R.N.). AD - Department of Neurology, Boston Medical Center, MA (T.N.). AD - Department of Neurosurgery, Boston Medical Center, MA (T.N.). FAU - Janardhan, Vallabh AU - Janardhan V AD - Department of Radiology, Boston Medical Center, MA (T.N.). FAU - Veznedaroglu, Enrol AU - Veznedaroglu E AD - Department of Neurology, Texas Stroke Institute, Plano (V.J.). FAU - Prabhakaran, Shyam AU - Prabhakaran S AD - Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA (E.V.). FAU - Budzik, Ron AU - Budzik R AD - Department of Neuroradiology, Riverside Radiology, Columbus, OH (N.V., R.B.). FAU - Frankel, Michael R AU - Frankel MR AD - From the Department of Neurology, Emory University School of Medicine, Atlanta, GA (R.G.N., D.C.H., L.C.R., M.R.F.). FAU - Nordhaus, Brittany L AU - Nordhaus BL AD - Department of Neurology, Northwestern University, Chicago, IL (S.P.). FAU - Zaidat, Osama O AU - Zaidat OO AD - Department of Neurosciences, Mercy Health-St. Vincent Medical Center, Toledo, OH (B.L.N., O.O.Z.). LA - eng PT - Journal Article DEP - 20190718 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM MH - Aged MH - Aged, 80 and over MH - Brain Ischemia/*mortality/therapy MH - Female MH - Humans MH - Intracranial Hemorrhages/*mortality/therapy MH - Ischemia/therapy MH - Male MH - Middle Aged MH - Registries MH - Stents/adverse effects MH - Stroke/*mortality/therapy MH - *Thrombectomy/adverse effects/methods MH - Treatment Outcome OTO - NOTNLM OT - *brain ischemia OT - *groin OT - *humans OT - *stents OT - *thrombectomy EDAT- 2019/07/19 06:00 MHDA- 2020/03/13 06:00 CRDT- 2019/07/19 06:00 PHST- 2019/07/19 06:00 [pubmed] PHST- 2020/03/13 06:00 [medline] PHST- 2019/07/19 06:00 [entrez] AID - 10.1161/STROKEAHA.118.024639 [doi] PST - ppublish SO - Stroke. 2019 Sep;50(9):2455-2460. doi: 10.1161/STROKEAHA.118.024639. Epub 2019 Jul 18. PMID- 31072248 OWN - NLM STAT- MEDLINE DCOM- 20200227 LR - 20200227 IS - 2385-2011 (Electronic) IS - 1591-0199 (Print) IS - 1591-0199 (Linking) VI - 25 IP - 5 DP - 2019 Oct TI - Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke. PG - 491-496 LID - 10.1177/1591019919847623 [doi] AB - BACKGROUND: First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE. METHODS: We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus 'Push and Fluff' technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c-3. Associations were sought between cFPE and procedural approaches and angiographic signs. RESULTS: A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28-9.29, p = 0.010), PBGC (OR 3.81, 95% CI: 1.41-10.22, p = 0.008) and ACPS (OR 4.71, 95% CI: 1.78-12.44, p = 0.002) were independently associated with cFPE. Concurrence of these three variables led to cFPE in 82 vs 35% of the remaining cases (p = 0.002). CONCLUSIONS: The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials. FAU - Tomasello, Alejandro AU - Tomasello A AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Ribò, Marc AU - Ribò M AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Gramegna, Laura Ludovica AU - Gramegna LL AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy. FAU - Melendez, Fernando AU - Melendez F AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Rosati, Santiago AU - Rosati S AD - Department of Radiology, Clinical San Carlos Hospital, Madrid, Spain. FAU - Moreu, Manuel AU - Moreu M AD - Department of Radiology, Clinical San Carlos Hospital, Madrid, Spain. FAU - Aixut, Sonia AU - Aixut S AD - Department of Radiology, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Lüttich, Alexandre AU - Lüttich A AD - Department of Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain. FAU - Werner, Mariano AU - Werner M AD - Department of Radiology, Hospital Clinic I Provincial de Barcelona, Barcelona, Spain. FAU - Remollo, Sebastian AU - Remollo S AD - Department of Neurosciences, Universitat Autònoma de Barcelona, Badalona, Spain. FAU - Quintana, Manuel AU - Quintana M AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Coscojuela, Pilar AU - Coscojuela P AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Hernandez, David AU - Hernandez D AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Dinia, Lavinia AU - Dinia L AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Lopez-Rueda, Antonio AU - Lopez-Rueda A AD - Department of Radiology, Hospital Clinic I Provincial de Barcelona, Barcelona, Spain. FAU - Rubiera, Marta AU - Rubiera M AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain. FAU - Rovira, Àlex AU - Rovira À AD - Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. AD - Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20190509 TA - Interv Neuroradiol JT - Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences JID - 9602695 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Angiography, Digital Subtraction/*methods MH - Brain Ischemia/*diagnostic imaging/*surgery MH - Catheterization MH - Cerebral Angiography MH - Female MH - Humans MH - Male MH - Middle Aged MH - Neurosurgical Procedures/*methods MH - Predictive Value of Tests MH - Prospective Studies MH - Stents MH - Stroke/*diagnostic imaging/*surgery MH - Thrombectomy/*methods MH - Thrombolytic Therapy MH - Treatment Outcome MH - Young Adult PMC - PMC6777112 OTO - NOTNLM OT - Stroke OT - angiography OT - aspiration catheter OT - mechanical thrombectomy OT - stent retriever EDAT- 2019/05/11 06:00 MHDA- 2020/02/28 06:00 PMCR- 2020/10/01 CRDT- 2019/05/11 06:00 PHST- 2020/10/01 00:00 [pmc-release] PHST- 2019/05/11 06:00 [pubmed] PHST- 2020/02/28 06:00 [medline] PHST- 2019/05/11 06:00 [entrez] AID - 10.1177_1591019919847623 [pii] AID - 10.1177/1591019919847623 [doi] PST - ppublish SO - Interv Neuroradiol. 2019 Oct;25(5):491-496. doi: 10.1177/1591019919847623. Epub 2019 May 9. PMID- 29650784 OWN - NLM STAT- MEDLINE DCOM- 20190729 LR - 20190729 IS - 1936-959X (Electronic) IS - 0195-6108 (Linking) VI - 39 IP - 5 DP - 2018 May TI - Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy. PG - 905-909 LID - 10.3174/ajnr.A5605 [doi] AB - BACKGROUND AND PURPOSE: Blood flow should be interrupted during mechanical thrombectomy to prevent embolization of clot fragments. The purpose of our study was to provide a handy overview of the most common aspiration devices and to quantify their flow characteristics. MATERIALS AND METHODS: We assessed volumetric flow rates generated by a 60-mL VacLok vacuum pressure syringe, a Pump MAX aspiration pump, and a Dominant Flex suction pump connected to the following: 1) an 8F long sheath, 2) an 8F balloon-guide catheter, 3) an ACE 64 distal aspiration catheter, and 4) an AXS Catalyst 6 Distal Access Catheter. We used a water/glycerol solution, which was kept at a constant temperature of 20°C (viscosity, 3.7 mPa · s). RESULTS: Aspiration with the syringe and the Dominant Flex suction pump achieved the highest flows, whereas aspiration with the Pump MAX was significantly lower (P < .001). Resistors in the aspiration system (tubing, connectors, and so forth) restricted flows, especially when the resistance of the catheter was small (due to its large diameter) and the connected resistors became the predominant resistance (P < .001). The syringe achieved an average vacuum pressure of -90 kPa, and the resulting flow was constant during almost the entire procedure of filling the syringe. CONCLUSIONS: Sixty-milliliter VacLok vacuum pressure syringes and the Dominant Flex suction pump achieved high and constant flows likely sufficient to reverse blood flow during thrombectomy with an 8F sheath or balloon-guide catheter in the ICA and modern distal aspiration catheters in the MCA. The Pump MAX aspiration pump is dedicated for use with distal aspiration catheters and is unlikely to reverse blood flow in the ICA and MCA without balloon protection. CI - © 2018 by American Journal of Neuroradiology. FAU - Nikoubashman, O AU - Nikoubashman O AUID- ORCID: 0000-0002-2055-4217 AD - From the Department of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., M.W.), RWTH Aachen University Hospital, Aachen, Germany onikoubashman@ukaachen.de. FAU - Wischer, D AU - Wischer D AUID- ORCID: 0000-0002-7787-2101 AD - From the Department of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., M.W.), RWTH Aachen University Hospital, Aachen, Germany. FAU - Hennemann, H M AU - Hennemann HM AUID- ORCID: 0000-0002-9175-972X AD - From the Department of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., M.W.), RWTH Aachen University Hospital, Aachen, Germany. FAU - Büsen, M AU - Büsen M AUID- ORCID: 0000-0001-9758-2892 AD - Institute of Applied Medical Engineering (M.B.), RWTH Aachen University, Aachen, Germany. FAU - Brockmann, C AU - Brockmann C AUID- ORCID: 0000-0002-8405-1889 AD - Department of Neuroradiology (C.B.), University Medical Centre, Johannes Gutenberg University, Mainz, Germany. FAU - Wiesmann, M AU - Wiesmann M AUID- ORCID: 0000-0002-8261-5513 AD - From the Department of Diagnostic and Interventional Neuroradiology (O.N., D.W., H.M.H., M.W.), RWTH Aachen University Hospital, Aachen, Germany. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180412 PL - United States TA - AJNR Am J Neuroradiol JT - AJNR. American journal of neuroradiology JID - 8003708 MH - Catheters MH - Endovascular Procedures MH - Humans MH - Models, Biological MH - Suction/*instrumentation/*methods MH - Syringes MH - Thrombectomy/*instrumentation/*methods EDAT- 2018/04/14 06:00 MHDA- 2019/07/30 06:00 CRDT- 2018/04/14 06:00 PHST- 2017/09/20 00:00 [received] PHST- 2018/01/31 00:00 [accepted] PHST- 2018/04/14 06:00 [pubmed] PHST- 2019/07/30 06:00 [medline] PHST- 2018/04/14 06:00 [entrez] AID - ajnr.A5605 [pii] AID - 10.3174/ajnr.A5605 [doi] PST - ppublish SO - AJNR Am J Neuroradiol. 2018 May;39(5):905-909. doi: 10.3174/ajnr.A5605. Epub 2018 Apr 12. PMID- 30579014 OWN - NLM STAT- MEDLINE DCOM- 20190401 LR - 20191210 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 123 DP - 2019 Mar TI - Increased Success of Single-Pass Large Vessel Recanalization Using a Combined Stentriever and Aspiration Technique: A Single Institution Study. PG - e747-e752 LID - S1878-8750(18)32845-6 [pii] LID - 10.1016/j.wneu.2018.12.023 [doi] AB - BACKGROUND: Extensive evidence supports mechanical thrombectomy using stentrievers (SR) for acute large vessel occlusion (aLVO). Aspiration is also used as a first pass or adjunct technique during clot removal. Here we report technical results from mechanical thrombectomy cases using SR alone, aspiration alone (AD), or a combination of SR and aspiration (SA) as a first pass for aLVO. METHODS: An institutional stroke database was reviewed for patients presenting to a single academic institution with anterior circulation aLVO and who were treated with mechanical thrombectomy from 2011 to 2017. Patients managed with SR alone, AD, or a combination of these 2 techniques (SA) were identified. The rate of successful recanalization after the first thrombectomy attempt was compared between the 3 groups. RESULTS: A total of 353 patients were analyzed, including 215 in SR, 32 in AD, and 106 in SA groups. There was no significant difference for age and admission National Institutes of Health Stroke Scale between the groups. Successful recanalization rates after the first pass were 35.8% in the SR group, 34.4% in aspiration as a first pass technique, and 55.7% in SA, with a statistically significant higher rate of first pass success in the SA group (P = 0.002). Using balloon-guide catheter doubled the rate of successful first pass recanalization from 21.3% to 41.6% in the SR group (P = 0.005); however, the SA technique was more effective for first pass recanalization when compared with an SR and balloon-guide catheter combination (55.7% vs. 41.6%, P = 0.025). CONCLUSIONS: The combination of SR and catheter aspiration can increase the rate of single pass successful recanalization compared with these techniques individually. CI - Copyright © 2018 Elsevier Inc. All rights reserved. FAU - Colby, Geoffrey P AU - Colby GP AD - Department of Neurosurgery, University of California, Los Angeles, California, USA; Department of Radiology, University of California, Los Angeles, California, USA. Electronic address: gcolby@mednet.ucla.edu. FAU - Baharvahdat, Humain AU - Baharvahdat H AD - Department of Neurosurgery, University of California, Los Angeles, California, USA. FAU - Mowla, Ashkan AU - Mowla A AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Young, Richard AU - Young R AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Shwe, Yamin AU - Shwe Y AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Jahan, Reza AU - Jahan R AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Tateshima, Satoshi AU - Tateshima S AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Szeder, Viktor AU - Szeder V AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Nour, May AU - Nour M AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Vinuela, Fernando AU - Vinuela F AD - Department of Radiology, University of California, Los Angeles, California, USA. FAU - Duckwiler, Gary AU - Duckwiler G AD - Department of Radiology, University of California, Los Angeles, California, USA. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20181219 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 SB - IM MH - Brain Ischemia/therapy MH - Cerebral Arteries MH - Cerebral Revascularization/*instrumentation/methods MH - Female MH - Humans MH - Intracranial Thrombosis/*therapy MH - Male MH - Mechanical Thrombolysis/*instrumentation/methods MH - Retrospective Studies MH - Stroke/*therapy MH - Surgical Instruments MH - Treatment Outcome OTO - NOTNLM OT - Aspiration OT - Large vessel occlusion OT - Mechanical thrombectomy OT - Recanalization OT - Solumbra OT - Stent retriever OT - Stentrieval EDAT- 2018/12/24 06:00 MHDA- 2019/04/02 06:00 CRDT- 2018/12/23 06:00 PHST- 2018/10/01 00:00 [received] PHST- 2018/12/05 00:00 [revised] PHST- 2018/12/07 00:00 [accepted] PHST- 2018/12/24 06:00 [pubmed] PHST- 2019/04/02 06:00 [medline] PHST- 2018/12/23 06:00 [entrez] AID - S1878-8750(18)32845-6 [pii] AID - 10.1016/j.wneu.2018.12.023 [doi] PST - ppublish SO - World Neurosurg. 2019 Mar;123:e747-e752. doi: 10.1016/j.wneu.2018.12.023. Epub 2018 Dec 19. PMID- 32447614 OWN - NLM STAT- Publisher LR - 20200524 IS - 1868-601X (Electronic) IS - 1868-4483 (Linking) DP - 2020 May 23 TI - Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis. LID - 10.1007/s12975-020-00784-2 [doi] AB - Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient's anatomy to enhance effectivity. FAU - Velasco Gonzalez, Aglaé AU - Velasco Gonzalez A AUID- ORCID: 0000-0001-6865-6864 AD - Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. Aglae.VelascoGonzalez@ukmuenster.de. FAU - Görlich, Dennis AU - Görlich D AD - Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany. FAU - Buerke, Boris AU - Buerke B AD - Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. FAU - Münnich, Nico AU - Münnich N AD - Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. FAU - Sauerland, Cristina AU - Sauerland C AD - Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany. FAU - Rusche, Thilo AU - Rusche T AD - Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. FAU - Faldum, Andreas AU - Faldum A AD - Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany. FAU - Heindel, Walter AU - Heindel W AD - Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. LA - eng PT - Journal Article DEP - 20200523 PL - United States TA - Transl Stroke Res JT - Translational stroke research JID - 101517297 SB - IM OTO - NOTNLM OT - Carotid arteries OT - Circle of Willis OT - Stroke OT - Suction OT - Thrombectomy EDAT- 2020/05/25 06:00 MHDA- 2020/05/25 06:00 CRDT- 2020/05/25 06:00 PHST- 2019/10/09 00:00 [received] PHST- 2020/01/28 00:00 [accepted] PHST- 2020/01/13 00:00 [revised] PHST- 2020/05/25 06:00 [entrez] PHST- 2020/05/25 06:00 [pubmed] PHST- 2020/05/25 06:00 [medline] AID - 10.1007/s12975-020-00784-2 [pii] AID - 10.1007/s12975-020-00784-2 [doi] PST - aheadofprint SO - Transl Stroke Res. 2020 May 23. doi: 10.1007/s12975-020-00784-2. PMID- 16961148 OWN - NLM STAT- MEDLINE DCOM- 20060926 LR - 20121115 IS - 0022-3085 (Print) IS - 0022-3085 (Linking) VI - 105 IP - 3 DP - 2006 Sep TI - Retrograde suction decompression of giant paraclinoid aneurysms using a No. 7 French balloon-containing guide catheter. Technical note. PG - 479-81 AB - The treatment of large and giant paraclinoid carotid artery (CA) aneurysms often requires the use of suction decompression for safe and effective occlusion. Both open and endovascular suction decompression techniques have been described previously. In this article the authors describe a revised endovascular suction decompression technique that provides several advantages in the treatment of large and giant paraclinoid and CA aneurysms. A 51-year-old woman presented with a relatively brief history of progressive visual loss in the right eye, nonspecific headache, and an afferent pupillary defect. After angiography studies had been obtained, it was determined that she had a giant right paraclinoid internal CA aneurysm with a dome size of approximately 26 mm on the right and a neck diameter of 10 mm. A modified technique was performed in which suction decompression was used. With the aid of a No. 7 French Concentric balloon guide catheter (Concentric Medical, Inc., Mountain View, CA) and application of a temporary clip distal to the aneurysm, the aneurysm was trapped and decompressed using retrograde suction through the guide catheter when the balloon was inflated. After satisfactory placement of three permanent clips, an intraoperative angiogram obtained through the same guide catheter confirmed CA patency. The aneurysm was then punctured and aspirated, ensuring complete occlusion of the aneurysm sac and reconstruction of the parent vessel. The patient made an excellent recovery and did not suffer any complications. She did not experience worsening in her vision. This technical modification to endovascular suction decompression allows several potential advantages, including higher volume decompression and the ability to deliver endovascular devices to distal arterial locations. FAU - Parkinson, Richard J AU - Parkinson RJ AD - Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. FAU - Bendok, Bernard R AU - Bendok BR FAU - Getch, Christopher C AU - Getch CC FAU - Yashar, Parham AU - Yashar P FAU - Shaibani, Ali AU - Shaibani A FAU - Ankenbrandt, William AU - Ankenbrandt W FAU - Awad, Issam A AU - Awad IA FAU - Batjer, H Hunt AU - Batjer HH LA - eng PT - Case Reports PT - Journal Article PL - United States TA - J Neurosurg JT - Journal of neurosurgery JID - 0253357 SB - AIM SB - IM MH - Carotid Artery Diseases/*surgery MH - Carotid Artery, Internal MH - Catheterization/*instrumentation/methods MH - Decompression, Surgical/*instrumentation/methods MH - Female MH - Humans MH - Intracranial Aneurysm/*surgery MH - Middle Aged MH - Suction/instrumentation EDAT- 2006/09/12 09:00 MHDA- 2006/09/27 09:00 CRDT- 2006/09/12 09:00 PHST- 2006/09/12 09:00 [pubmed] PHST- 2006/09/27 09:00 [medline] PHST- 2006/09/12 09:00 [entrez] AID - 10.3171/jns.2006.105.3.479 [doi] PST - ppublish SO - J Neurosurg. 2006 Sep;105(3):479-81. doi: 10.3171/jns.2006.105.3.479. PMID- 31239220 OWN - NLM STAT- MEDLINE DCOM- 20190902 LR - 20190902 IS - 1532-8511 (Electronic) IS - 1052-3057 (Linking) VI - 28 IP - 9 DP - 2019 Sep TI - Evaluation of the Intracranial Flow Alteration during Manual Syringe and Continuous Pump Aspiration. PG - 2574-2579 LID - S1052-3057(19)30235-6 [pii] LID - 10.1016/j.jstrokecerebrovasdis.2019.05.015 [doi] AB - GOALS: While mechanical thrombectomy (MT) has been shown to be effective in the treatment of acute large vessel occlusions, adjunctive measures, such as balloon guide catheters (BGC) and aspiration techniques, are utilized heterogeneously. Clarifying the effects of aspiration applied to the anterior cerebral circulation with proximal flow arrest can shed light on embolic protection during MT. MATERIALS AND METHODS: Manual and pump aspiration were applied through a BGC in a synthetic cerebrovascular model with a 60 ml syringe and a Penumbra pump, respectively. Flow direction was observed during the procedure with fluorescent particles and ultraviolet light. Flow rates were monitored at the simulated internal carotid artery and middle cerebral artery (MCA). FINDINGS: Both aspiration methods produced retrograde flow in all the modeled cerebrovascular segments. In the syringe aspiration methods, an interval phase occurred during the experimental trial in which suction forces paused and MCA flow became anterograde through posterior communication artery collateral circulation. CONCLUSION: Flow patterns vary with different methods of aspiration. With proximal flow arrest, continuous aspiration methods induce constant retrograde flow in all vessels, whereas manual aspiration demonstrates various flow changes, including periods of anterograde flow during the procedure, which may be less effective at distal re-embolization prevention. CI - Copyright © 2019. Published by Elsevier Inc. FAU - Okada, Hideo AU - Okada H AD - Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan. Electronic address: hide829@me.com. FAU - Matsuda, Yoshikazu AU - Matsuda Y AD - Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan. Electronic address: ymatsuda0517@yahoo.co.jp. FAU - Malisch, Alex AU - Malisch A AD - Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois. Electronic address: amalisch@luc.edu. FAU - Chung, Joonho AU - Chung J AD - Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ns.joonho.chung@gmail.com. FAU - Heiferman, Daniel M AU - Heiferman DM AD - Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois. Electronic address: dheiferman@lumc.edu. FAU - Lopes, Demetrius K AU - Lopes DK AD - Department of Neurological Surgery, Advocate Health, Park Ridge, Illinois. Electronic address: brainaneurysm@me.com. LA - eng PT - Comparative Study PT - Journal Article DEP - 20190622 PL - United States TA - J Stroke Cerebrovasc Dis JT - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JID - 9111633 SB - IM MH - Blood Flow Velocity MH - Carotid Artery, Internal/*physiopathology MH - *Cerebrovascular Circulation MH - Cerebrovascular Disorders/physiopathology/*therapy MH - Humans MH - Intracranial Embolism/etiology/physiopathology/prevention & control MH - Middle Cerebral Artery/*physiopathology MH - Models, Anatomic MH - Risk Factors MH - Suction MH - Syringes MH - Thrombectomy/adverse effects/instrumentation/*methods MH - Time Factors MH - Vascular Access Devices OTO - NOTNLM OT - Balloon guide catheter OT - aspiration OT - mechanical thrombectomy OT - stroke EDAT- 2019/06/27 06:00 MHDA- 2019/09/03 06:00 CRDT- 2019/06/27 06:00 PHST- 2018/11/20 00:00 [received] PHST- 2019/04/14 00:00 [revised] PHST- 2019/05/14 00:00 [accepted] PHST- 2019/06/27 06:00 [pubmed] PHST- 2019/09/03 06:00 [medline] PHST- 2019/06/27 06:00 [entrez] AID - S1052-3057(19)30235-6 [pii] AID - 10.1016/j.jstrokecerebrovasdis.2019.05.015 [doi] PST - ppublish SO - J Stroke Cerebrovasc Dis. 2019 Sep;28(9):2574-2579. doi: 10.1016/j.jstrokecerebrovasdis.2019.05.015. Epub 2019 Jun 22. PMID- 28366058 OWN - NLM STAT- MEDLINE DCOM- 20170424 LR - 20170424 IS - 1092-0684 (Electronic) IS - 1092-0684 (Linking) VI - 42 IP - 4 DP - 2017 Apr TI - Novel and emerging technologies for endovascular thrombectomy. PG - E12 LID - 10.3171/2017.1.FOCUS16518 [doi] AB - Endovascular thrombectomy device improvements in recent years have served a pivotal role in improving the success and safety of the thrombectomy procedure. As the intervention gains widespread use, developers have focused on maximizing the reperfusion rates and reducing procedural complications associated with these devices. This has led to a boom in device development. This review will cover novel and emerging technologies developed for endovascular thrombectomy. FAU - Chartrain, Alexander G AU - Chartrain AG AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Awad, Ahmed J AU - Awad AJ AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Mascitelli, Justin R AU - Mascitelli JR AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Shoirah, Hazem AU - Shoirah H AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Oxley, Thomas J AU - Oxley TJ AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Feng, Rui AU - Feng R AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Gallitto, Matthew AU - Gallitto M AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - De Leacy, Reade AU - De Leacy R AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Fifi, Johanna T AU - Fifi JT AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Kellner, Christopher P AU - Kellner CP AD - Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. LA - eng PT - Journal Article PT - Review PL - United States TA - Neurosurg Focus JT - Neurosurgical focus JID - 100896471 SB - IM MH - Brain Ischemia/complications MH - Endovascular Procedures/*methods MH - Humans MH - *Medical Laboratory Personnel MH - Stroke/etiology/*therapy MH - Thrombectomy/*instrumentation/*methods OTO - NOTNLM OT - *ADAPT = A Direct Aspiration First Pass Technique OT - *BGC = balloon guide catheter OT - *ERIC = Embolus Retriever with Interlinked Cages OT - *ICH = intracerebral hemorrhage OT - *ID = inner diameter OT - *LVO = large vessel occlusion OT - *OD = outer diameter OT - *TICI = Thrombolysis in Cerebral Infarction OT - *acute ischemic stroke OT - *aspiration catheter OT - *endovascular thrombectomy OT - *large vessel occlusion OT - *mRS = modified Rankin Scale OT - *stent retriever EDAT- 2017/04/04 06:00 MHDA- 2017/04/25 06:00 CRDT- 2017/04/04 06:00 PHST- 2017/04/04 06:00 [entrez] PHST- 2017/04/04 06:00 [pubmed] PHST- 2017/04/25 06:00 [medline] AID - 10.3171/2017.1.FOCUS16518 [doi] PST - ppublish SO - Neurosurg Focus. 2017 Apr;42(4):E12. doi: 10.3171/2017.1.FOCUS16518. PMID- 23493730 OWN - NLM STAT- MEDLINE DCOM- 20130625 LR - 20161122 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 44 IP - 5 DP - 2013 May TI - Reduction in distal emboli with proximal flow control during mechanical thrombectomy: a quantitative in vitro study. PG - 1396-401 LID - 10.1161/STROKEAHA.111.670463 [doi] AB - BACKGROUND AND PURPOSE: To evaluate the impact of proximal flow control on efficacy and safety of mechanical thrombectomy in an in vitro middle cerebral artery occlusion. METHODS: Three independent variables, including clot type, device (Merci Retriever, Solitaire FR, and Trevo devices), and use of a balloon guide catheter, were used to ascertain the impact of proximal flow control on the size and number of distal emboli generated during thrombectomy. Secondary end points were the recanalization rate and amount of flow restored. RESULTS: Use of the balloon guide catheter during thrombectomy of the fragile, hard clot significantly reduced the formation of large distal emboli with a diameter >1 mm, regardless of the device used (P<0.01). Applying aspiration via the balloon guide catheter in place of the conventional guide catheter resulted in a significant increase of flow reversal (P<0.0001). Prior to thrombectomy, deployment of the stent-trievers produced immediate flow restoration through the soft and hard clot occlusions, 69.2 ± 27.3 and 45.5 ± 22.8 mL/min, respectively, that was preserved after the balloon inflation because of collateral flow via the posterior communication artery. After deployment but before thrombectomy, no flow was restored when using the Merci Retriever. After thrombectomy, complete flow restoration was achieved in a majority of cases. The Merci Retriever required more thrombectomy attempts to achieve hard clot removal compared with the stent-trievers when the conventional guide catheter was used (1.5 versus 1.1). CONCLUSIONS: The risk of distal embolization was significantly reduced with the use of the balloon guide catheter. FAU - Chueh, Ju-Yu AU - Chueh JY AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA. FAU - Kühn, Anna Luisa AU - Kühn AL FAU - Puri, Ajit S AU - Puri AS FAU - Wilson, Scott D AU - Wilson SD FAU - Wakhloo, Ajay K AU - Wakhloo AK FAU - Gounis, Matthew J AU - Gounis MJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130314 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM MH - Catheterization MH - Humans MH - Infarction, Middle Cerebral Artery/*surgery MH - *Models, Anatomic MH - Stents MH - Stroke/*surgery MH - Thrombectomy/instrumentation/*methods MH - Treatment Outcome EDAT- 2013/03/16 06:00 MHDA- 2013/06/26 06:00 CRDT- 2013/03/16 06:00 PHST- 2013/03/16 06:00 [entrez] PHST- 2013/03/16 06:00 [pubmed] PHST- 2013/06/26 06:00 [medline] AID - STROKEAHA.111.670463 [pii] AID - 10.1161/STROKEAHA.111.670463 [doi] PST - ppublish SO - Stroke. 2013 May;44(5):1396-401. doi: 10.1161/STROKEAHA.111.670463. Epub 2013 Mar 14. PMID- 25376809 OWN - NLM STAT- MEDLINE DCOM- 20151201 LR - 20181202 IS - 1936-959X (Electronic) IS - 0195-6108 (Linking) VI - 36 IP - 3 DP - 2015 Mar TI - Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. PG - 547-51 LID - 10.3174/ajnr.A4149 [doi] AB - BACKGROUND AND PURPOSE: A new in vitro cerebrovascular occlusion model of the intracranial circulation was developed recently for testing thrombectomy devices. Using this model, we compared recanalization success associated with different modern endovascular thrombectomy approaches. MATERIALS AND METHODS: Model experiments were performed in 4 thrombectomy test groups: 1) primary or direct Stentriever thrombectomy with a conventional guide catheter (control group), 2) primary Stentriever thrombectomy with a balloon-guide catheter, 3) combined Stentriever-continuous aspiration approach, and 4) direct aspiration alone. Successful recanalization was defined as a TICI score of 2b or 3. RESULTS: Seventy-one thrombectomy experiments were conducted. Similar rates of TICI 2b-3 scores were achieved with balloon-guide and conventional guide catheters (P = .34). The combined Stentriever plus aspiration approach and the primary aspiration thrombectomy resulted in significantly higher rates of TICI 2b or 3 than the conventional guide-catheter approach in the control group (P = .008 and P = .0001, respectively). The primary Stentriever thrombectomy with the conventional guide catheter showed the highest rate of embolization to new territories (53%). CONCLUSIONS: Data from our in vitro model experiments show that the Stentriever thrombectomy under continuous aspiration and primary aspiration thrombectomy approaches led to the highest degree of recanalization. CI - © 2015 by American Journal of Neuroradiology. FAU - Mokin, M AU - Mokin M AD - From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.). FAU - Setlur Nagesh, S V AU - Setlur Nagesh SV AD - Biomedical Engineering (S.V.S.N., C.N.I.) Electrical Engineering (S.V.S.N.) Mechanical and Aerospace Engineering (S.V.S.N.). FAU - Ionita, C N AU - Ionita CN AD - Biomedical Engineering (S.V.S.N., C.N.I.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York. FAU - Levy, E I AU - Levy EI AD - From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York. FAU - Siddiqui, A H AU - Siddiqui AH AD - From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York Jacobs Institute (A.H.S.), Buffalo, New York. asiddiqui@ubns.com. LA - eng PT - Comparative Study PT - Journal Article DEP - 20141106 PL - United States TA - AJNR Am J Neuroradiol JT - AJNR. American journal of neuroradiology JID - 8003708 SB - IM MH - Female MH - Humans MH - Intracranial Thrombosis/*surgery MH - Stroke/*surgery MH - Thrombectomy/instrumentation/*methods MH - Treatment Outcome EDAT- 2014/11/08 06:00 MHDA- 2015/12/15 06:00 CRDT- 2014/11/08 06:00 PHST- 2014/11/08 06:00 [entrez] PHST- 2014/11/08 06:00 [pubmed] PHST- 2015/12/15 06:00 [medline] AID - ajnr.A4149 [pii] AID - 10.3174/ajnr.A4149 [doi] PST - ppublish SO - AJNR Am J Neuroradiol. 2015 Mar;36(3):547-51. doi: 10.3174/ajnr.A4149. Epub 2014 Nov 6. PMID- 29578080 OWN - NLM STAT- MEDLINE DCOM- 20180607 LR - 20181202 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 114 DP - 2018 Jun TI - Endovascular Retrograde Suction Decompression-Assisted Clipping of Large Paraclinoid Aneurysm in Hybrid Operating Room: 2-Dimensional Operative Video. PG - 178 LID - S1878-8750(18)30591-6 [pii] LID - 10.1016/j.wneu.2018.03.109 [doi] AB - Surgical treatment of large paraclinoid aneurysms remains technically challenging due to the adjacent bony anatomy and neurovascular structures. Endovascular retrograde suction decompression using a double-lumen balloon catheter facilitates clip ligation of the aneurysm. Video 1 demonstrates a large paraclinoid aneurysm that was treated with endovascular balloon occlusion and retrograde suction decompression in a hybrid operating room. A 49-year-old woman presented with progressively worsening headache. Computed tomography angiography demonstrated a large 16-mm left paraclinoid aneurysm. Neurologic examination showed no deficits. Angiography with compression of the left carotid artery showed the collateral blood flow through the posterior communicating artery. The aneurysm was exposed via the pterional transsylvian approach. A double-lumen balloon guide catheter was placed in the left internal carotid artery. Considering the risk of ischemic complications, the "trapping-evacuation" technique was not used. After balloon inflation, a temporary clip was placed on the posterior communicating artery. Retrograde suction through the guide catheter decreased the intra-aneurysmal pressure. Tandem clipping with fenestrated clips was used to occlude the aneurysm and reconstruct the parent artery. Postoperative angiography confirmed complete obliteration of the aneurysm, and the patient recovered without any neurologic deficits. Endovascular balloon occlusion obviated the need for cervical dissection of the internal carotid artery. Retrograde suction decompression and intraoperative angiography facilitated surgical clipping for large and giant paraclinoid aneurysms. CI - Copyright © 2018 Elsevier Inc. All rights reserved. FAU - Xu, Feng AU - Xu F AD - Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: fengxu.dr@gmail.com. FAU - Huang, Lei AU - Huang L AD - Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. FAU - Xu, Bin AU - Xu B AD - Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. FAU - Gu, Yuxiang AU - Gu Y AD - Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. FAU - Leng, Bing AU - Leng B AD - Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. LA - eng PT - Case Reports PT - Journal Article PT - Video-Audio Media DEP - 20180323 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 SB - IM MH - Decompression, Surgical/*methods MH - Endovascular Procedures/*methods MH - Female MH - Humans MH - Intracranial Aneurysm/diagnostic imaging/*surgery MH - Middle Aged MH - Neurosurgical Procedures/*methods MH - Operating Rooms/*methods MH - Suction/methods MH - Surgical Instruments/statistics & numerical data MH - Video-Assisted Surgery/*methods OTO - NOTNLM OT - Clipping OT - Endovascular OT - Hybrid OT - Paraclinoid aneurysm OT - Retrograde suction decompression EDAT- 2018/03/27 06:00 MHDA- 2018/06/08 06:00 CRDT- 2018/03/27 06:00 PHST- 2017/12/22 00:00 [received] PHST- 2018/03/14 00:00 [revised] PHST- 2018/03/15 00:00 [accepted] PHST- 2018/03/27 06:00 [pubmed] PHST- 2018/06/08 06:00 [medline] PHST- 2018/03/27 06:00 [entrez] AID - S1878-8750(18)30591-6 [pii] AID - 10.1016/j.wneu.2018.03.109 [doi] PST - ppublish SO - World Neurosurg. 2018 Jun;114:178. doi: 10.1016/j.wneu.2018.03.109. Epub 2018 Mar 23. PMID- 30069103 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 0976-3147 (Print) IS - 0976-3155 (Electronic) IS - 0976-3155 (Linking) VI - 9 IP - 3 DP - 2018 Jul-Sep TI - Arterial Dissection Following the Use of Remote Aspiration Thrombectomy. PG - 417-419 LID - 10.4103/jnrp.jnrp_519_17 [doi] AB - Remote aspiration thrombectomy using a balloon guide catheter for acute carotid artery occlusion has been proposed as a safe and effective technique. We present a case of iatrogenic arterial dissection of the distal cervical segment in a patient with proximal vessel occlusion who underwent attempted revascularization using this strategy. A 57-year-old male patient presented with computed tomography (CT) angiogram evidence of a left carotid terminus and M1 segment occlusion. The patient was taken emergently for mechanical thrombectomy. Remote aspiration thrombectomy was attempted twice using manual aspiration through a balloon guide catheter in the common carotid artery; however, this resulted in minimal recanalization of the carotid terminus and a new iatrogenic dissection within the internal carotid artery (ICA) just proximal to the skull base. Despite multiple additional attempts at mechanical thrombectomy, only limited recanalization of the ICA terminus and anterior cerebral artery distribution was achieved, with no significant flow past the M1 segment. After the procedure, a large ischemic territory within the left middle cerebral artery distribution consistent with the continued M1 segment occlusion was apparent on CT. The patient died on the poststroke day 6. Although remote aspiration thrombectomy for thromboemboli in this location has potential benefits, it should be used cautiously given the potential risk of injury to the proximal vasculature. FAU - Kilburg, Craig AU - Kilburg C AD - Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. FAU - Kalani, M Yashar S AU - Kalani MYS AD - Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. FAU - Park, Min S AU - Park MS AD - Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. LA - eng PT - Case Reports TA - J Neurosci Rural Pract JT - Journal of neurosciences in rural practice JID - 101533710 PMC - PMC6050781 OTO - NOTNLM OT - *Arterial dissection OT - *balloon guide catheter OT - *carotid artery occlusion OT - *remote aspiration thrombectomy OT - *thromboembolus COIS- There are no conflicts of interest. EDAT- 2018/08/03 06:00 MHDA- 2018/08/03 06:01 CRDT- 2018/08/03 06:00 PHST- 2018/08/03 06:00 [entrez] PHST- 2018/08/03 06:00 [pubmed] PHST- 2018/08/03 06:01 [medline] AID - JNRP-9-417 [pii] AID - 10.4103/jnrp.jnrp_519_17 [doi] PST - ppublish SO - J Neurosci Rural Pract. 2018 Jul-Sep;9(3):417-419. doi: 10.4103/jnrp.jnrp_519_17. PMID- 25540180 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20181113 IS - 1759-8486 (Electronic) IS - 1759-8478 (Print) IS - 1759-8478 (Linking) VI - 8 IP - 2 DP - 2016 Feb TI - Risk of distal embolization with stent retriever thrombectomy and ADAPT. PG - 197-202 LID - 10.1136/neurintsurg-2014-011491 [doi] AB - BACKGROUND: There is a discrepancy in clinical outcomes and the achieved recanalization rates with stent retrievers in the endovascular treatment of ischemic stroke. It is our hypothesis that procedural release of embolic particulate may be one contributor to poor outcomes and is a modifiable risk. The goal of this study is to assess various treatment strategies that reduce the risk of distal emboli. METHODS: Mechanical thrombectomy was simulated in a vascular phantom with collateral circulation. Hard fragment-prone clots (HFC) and soft elastic clots (SECs) were used to generate middle cerebral artery (MCA) occlusions that were retrieved by the Solitaire FR devices through (1) an 8 Fr balloon guide catheter (BGC), (2) a 5 Fr distal access catheter at the proximal aspect of the clot in the MCA (Solumbra), or (3) a 6 Fr guide catheter with the tip at the cervical internal carotid artery (guide catheter, GC). Results from mechanical thrombectomy were compared with those from direct aspiration using the Penumbra 5MAX catheter. The primary endpoint was the size distribution of emboli to the distribution of the middle and anterior cerebral arteries. RESULTS: Solumbra was the most efficient method for reducing HFC fragments (p<0.05) while BGC was the best method for preventing SEC fragmentation (p<0.05). The risk of forming HFC distal emboli (>1000 µm) was significantly increased using GC. A non-statistically significant benefit of direct aspiration was observed in several subgroups of emboli with size 50-1000 µm. However, compared with the stent-retriever mechanical thrombectomy techniques, direct aspiration significantly increased the risk of SEC fragmentation (<50 µm) by at least twofold. CONCLUSIONS: The risk of distal embolization is affected by the catheterization technique and clot mechanics. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ FAU - Chueh, Ju-Yu AU - Chueh JY AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Puri, Ajit S AU - Puri AS AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Wakhloo, Ajay K AU - Wakhloo AK AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Gounis, Matthew J AU - Gounis MJ AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141224 TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Device Removal/adverse effects/*methods MH - Embolization, Therapeutic/*adverse effects/methods MH - Humans MH - Risk Factors MH - *Stents MH - Thrombectomy/*adverse effects/methods PMC - PMC4752657 OTO - NOTNLM OT - Device OT - Intervention OT - Stroke OT - Thrombectomy EDAT- 2014/12/30 06:00 MHDA- 2016/12/15 06:00 CRDT- 2014/12/26 06:00 PHST- 2014/09/26 00:00 [received] PHST- 2014/12/01 00:00 [accepted] PHST- 2014/12/26 06:00 [entrez] PHST- 2014/12/30 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - neurintsurg-2014-011491 [pii] AID - 10.1136/neurintsurg-2014-011491 [doi] PST - ppublish SO - J Neurointerv Surg. 2016 Feb;8(2):197-202. doi: 10.1136/neurintsurg-2014-011491. Epub 2014 Dec 24. PMID- 30177546 OWN - NLM STAT- MEDLINE DCOM- 20190409 LR - 20190409 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 11 IP - 3 DP - 2019 Mar TI - Microcatheter navigation through the clot: does size matter? PG - 271-274 LID - 10.1136/neurintsurg-2018-014105 [doi] AB - BACKGROUND: Despite high recanalization rates achieved with endovascular treatment of acute ischemic strokes, around 50% of eligible patients will not achieve a good outcome. Parameters that may determine patient outcomes include: time from puncture to recanalization, the collateral status, the anesthesia regimen, blood pressure management, and distal emboli. Characterization of distal emboli generated during mechanical thrombectomy has been performed in previous studies. OBJECTIVE: To further investigate the risk of distal embolization associated with microcatheter navigation across the clot. METHODS: A contrast-enhanced clot analog was used in an in vitro model that mimicked a middle cerebral artery occlusion within a complete circle of Willis vascular replica. The clot was crossed with one of the following microcatheters: Pro18, XT-27 or 3MAX. The emboli generated during the procedure were collected and measured. RESULTS: The use of Pro18 and XT-27 resulted in a significant reduction of visible particles (size ≥500 µm) as compared with the 3MAX catheter (P<0.003). For the size range between 8 and 200 µm, there was a trend for Pro18 to generate fewer particles (-18%) than XT-27 but without statistical significance (P>0.05). In comparison with previously published data, acquired under the same conditions, it was found that the clot crossing maneuver accounts approximately for 12% of the total number of small emboli (<200 µm) induced during a stent retriever-mediated mechanical thrombectomy procedure via a balloon guide catheter. CONCLUSIONS: The clot crossing maneuver has a significant effect on the total number of small particles induced during mechanical thrombectomy. Smaller microcatheter sizes should be favored when possible. CI - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Caroff, Jildaz AU - Caroff J AUID- ORCID: 0000-0002-0029-1835 AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. AD - Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Clichy, France. FAU - King, Robert M AU - King RM AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Arslanian, Rose AU - Arslanian R AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Marosfoi, Miklos AU - Marosfoi M AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Langan, Erin T AU - Langan ET AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Gounis, Matthew J AU - Gounis MJ AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. FAU - Chueh, Ju-Yu AU - Chueh JY AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. LA - eng PT - Journal Article DEP - 20180903 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Catheterization/instrumentation/methods MH - *Catheters MH - Embolization, Therapeutic/instrumentation/methods MH - Humans MH - Infarction, Middle Cerebral Artery/*surgery MH - *Models, Anatomic MH - Neuronavigation/instrumentation/*methods MH - Thrombectomy/instrumentation/methods MH - Thrombosis/*surgery OTO - NOTNLM OT - catheter OT - device OT - stroke COIS- Competing interests: JC has received educational grant from Microvention/Terumo and Medtronic. MM, J-YC: fee-for-service consulting for Stryker Neurovascular, ETL: fee-for-service consulting for Imperative Care, InNeuroCo, Route 92 Medical, StrykerNeurovascular. MJG: as been a consultant on a fee-per-hour basis for Cerenovus, Imperative Care, InNeuroCo, Medtronic Neurovascular, Phenox, Route 92 Medical, Stryker Neurovascular; holds stock in InNeuroCo, Imperative Care and Neurogami; and has received research support from the National Institutes of Health (NIH), Anaconda, Cerenovus, Cook Medical, Gentuity, Imperative Care, InNeuroCo, Magneto, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Neuravi, Neurogami, Philips Healthcare, Rapid Medical, Route 92M, Stryker Neurovascular, and the Wyss Institute. EDAT- 2018/09/05 06:00 MHDA- 2019/04/10 06:00 CRDT- 2018/09/05 06:00 PHST- 2018/05/18 00:00 [received] PHST- 2018/07/13 00:00 [revised] PHST- 2018/07/24 00:00 [accepted] PHST- 2018/09/05 06:00 [pubmed] PHST- 2019/04/10 06:00 [medline] PHST- 2018/09/05 06:00 [entrez] AID - neurintsurg-2018-014105 [pii] AID - 10.1136/neurintsurg-2018-014105 [doi] PST - ppublish SO - J Neurointerv Surg. 2019 Mar;11(3):271-274. doi: 10.1136/neurintsurg-2018-014105. Epub 2018 Sep 3. PMID- 30410514 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 1664-9737 (Print) IS - 1664-5545 (Electronic) IS - 1664-5545 (Linking) VI - 7 IP - 6 DP - 2018 Oct TI - Active Reperfusion Hemorrhage during Thrombectomy: Angiographic Findings and Real-Time Correlation with the CT "Spot Sign". PG - 370-377 LID - 10.1159/000488084 [doi] AB - INTRODUCTION: Symptomatic intracranial hemorrhage represents one of the most feared complications of endovascular reperfusion. We aim to describe a series of patients that experienced immediate reperfusion injury with active intraprocedural extravasation within the territory of the deep penetrating arteries and provide real-time correlation with CT "spot sign." METHODS: This was a retrospective analysis of patients that suffered reperfusion injury with active arterial extravasation during endovascular stroke treatment in two tertiary care centers. RESULTS: Five patients were identified. Median age was 63 (58-71) years, 66% were male. Median NIHSS was 13.5 (9.5-23.0), platelet level 212,000 (142,000-235,000), baseline systolic blood pressure 152 (133-201) mm Hg, and non-contrast CT ASPECTS 7.0 (6.5-9.0). Two patients were taking aspirin and one had received intravenous thrombolysis. There were three middle cerebral artery M1, one internal carotid artery terminus, and one vertebrobasilar junction occlusion. Three patients had anterior circulation tandem occlusions. Stroke etiology was extracranial atherosclerosis (n = 2), intracranial atherosclerosis (n = 2), and cervical dissection (n = 1). The median time from onset to puncture was 5.5 (3.9-8.6) h. Intravenous heparin was administered in all patients (median dose of 4,750 [3,250-6,000] units) and intravenous abciximab in four. All tandem cases had the cervical lesion addressed first. Four lenticulostriates and one paramedian pontine artery were involved. Intraprocedural flat-panel CT was performed in four (80%) cases and provided real-time correlation between the active contrast extravasation and the "spot sign." The bailout included use of protamine, blood pressure control, and balloon guide catheter or intracranial compliant balloon inflation plus coiling of targeted vessel. All patients had angiographic cessation of bleeding at the end of the procedure with parenchymal hemorrhage type 1 in one case and type 2 in four. Three patients had modified Rankin score of 4 and two were dead at 90 days. CONCLUSIONS: Active reperfusion hemorrhage involving perforator arteries was observed to correlate with the CT "spot sign" and to be associated with poor outcomes. FAU - Haussen, Diogo C AU - Haussen DC AD - Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA. FAU - Ferreira, Ivan M AU - Ferreira IM AD - Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA. FAU - Barreira, Clara AU - Barreira C AD - Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA. FAU - Grossberg, Jonathan A AU - Grossberg JA AD - Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA. FAU - Diana, Francesco AU - Diana F AD - Hospital Policlinico Umberto I/Sapienza University, Rome, Italy. FAU - Peschillo, Simone AU - Peschillo S AD - Hospital Policlinico Umberto I/Sapienza University, Rome, Italy. FAU - Nogueira, Raul G AU - Nogueira RG AD - Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA. LA - eng PT - Journal Article DEP - 20180608 TA - Interv Neurol JT - Interventional neurology JID - 101606828 PMC - PMC6216709 OTO - NOTNLM OT - Hemorrhage OT - Reperfusion injury OT - Stroke OT - Thrombectomy EDAT- 2018/11/10 06:00 MHDA- 2018/11/10 06:01 CRDT- 2018/11/10 06:00 PHST- 2018/01/08 00:00 [received] PHST- 2018/03/02 00:00 [accepted] PHST- 2018/11/10 06:00 [entrez] PHST- 2018/11/10 06:00 [pubmed] PHST- 2018/11/10 06:01 [medline] AID - ine-0007-0370 [pii] AID - 10.1159/000488084 [doi] PST - ppublish SO - Interv Neurol. 2018 Oct;7(6):370-377. doi: 10.1159/000488084. Epub 2018 Jun 8. PMID- 29628942 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 1664-9737 (Print) IS - 1664-5545 (Electronic) IS - 1664-5545 (Linking) VI - 7 IP - 1-2 DP - 2018 Feb TI - Clinical and Angiographic Outcomes with the Combined Local Aspiration and Retriever in the North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry. PG - 26-35 LID - 10.1159/000480353 [doi] AB - BACKGROUND: Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. SUMMARY: Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC, p = 0.04 and 26% in CGC, p = 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with CGC (54 vs. 91 min, p = 0.001) and was comparable to the BGC time (54 vs. 67, p = 0.11). Final degree of reperfusion was comparable among the groups (TICI [modified Thrombolysis in Cerebral Infarction] score 2b or higher was 72 vs. 70% for CGC vs. 78% for BGC). Procedural complications, mortality, and good clinical outcome at 90 days were similar between the groups. KEY MESSAGES: The ARTS mechanical thrombectomy in acute ischemic stroke patients appears to yield better results as compared to the use of CGCs with no significant difference when compared to BGC. This early ARTS technique NASA registry data are limited by the earlier generation distal large bore catheters and small sample size. Future studies should focus on the comparison of ARTS and BGC techniques. FAU - Malisch, Tim W AU - Malisch TW AD - Department of Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA. FAU - Zaidat, Osama O AU - Zaidat OO AD - St Vincent Mercy Hospital, Toledo, Ohio, USA. AD - Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA. FAU - Castonguay, Alicia C AU - Castonguay AC AD - St Vincent Mercy Hospital, Toledo, Ohio, USA. FAU - Marden, Franklin A AU - Marden FA AD - Department of Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA. FAU - Gupta, Rishi AU - Gupta R AD - St Vincent Mercy Hospital, Toledo, Ohio, USA. AD - Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA. FAU - Sun, Chung-Huan J AU - Sun CJ AD - St Vincent Mercy Hospital, Toledo, Ohio, USA. AD - Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA. FAU - Martin, Coleman O AU - Martin CO AD - Saint Luke's Kansas City, Kansas City, Missouri, USA. FAU - Holloway, William E AU - Holloway WE AD - Saint Luke's Kansas City, Kansas City, Missouri, USA. FAU - Mueller-Kronast, Nils AU - Mueller-Kronast N AD - Department of Neurology, Delray Medical Center, Delray Beach, Florida, USA. FAU - English, Joey AU - English J AD - California Pacific Medical Center, San Francisco, California, USA. FAU - Linfante, Italo AU - Linfante I AD - Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA. FAU - Dabus, Guilherme AU - Dabus G AD - Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA. FAU - Bozorgchami, Hormozd AU - Bozorgchami H AD - Oregon Health and Science University, Portland, Oregon, USA. FAU - Xavier, Andrew AU - Xavier A AD - Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA. FAU - Rai, Ansaar T AU - Rai AT AD - Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia, USA. FAU - Froehler, Michael AU - Froehler M AD - Department of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. FAU - Badruddin, Aamir AU - Badruddin A AD - Provena Saint Joseph Medical Center, Joliet, Illinois, USA. FAU - Nguyen, Thanh N AU - Nguyen TN AD - Department of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, Massachusetts, USA. FAU - Taqi, M Asif AU - Taqi MA AD - Desert Regional Medical Center, Palm Springs, California, USA. FAU - Abraham, Michael G AU - Abraham MG AD - University of Kansas Medical Center, Kansas City, Kansas, USA. FAU - Janardhan, Vallabh AU - Janardhan V AD - Texas Stroke Institute, Plano, Texas, USA. FAU - Shaltoni, Hashem AU - Shaltoni H AD - University of Texas Health Science Center, Houston, Texas, USA. FAU - Novakovic, Robin AU - Novakovic R AD - Department of Radiology, Neurology, UT Southwestern Medical Center, Dallas, Texas, USA. FAU - Yoo, Albert J AU - Yoo AJ AD - Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Abou-Chebl, Alex AU - Abou-Chebl A AD - Baptist Health System, Louisville, Kentucky, USA. FAU - Chen, Peng Roc AU - Chen PR AD - Department of Neurosurgery, University of Texas, Houston, Texas, USA. FAU - Britz, Gavin W AU - Britz GW AD - Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA. FAU - Kaushal, Ritesh AU - Kaushal R AD - Saint Louis University, St. Louis, Missouri, USA. FAU - Nanda, Ashish AU - Nanda A AD - University of Missouri, Columbia, Missouri, USA. FAU - Nogueira, Raul G AU - Nogueira RG AD - Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. LA - eng PT - Journal Article DEP - 20171011 TA - Interv Neurol JT - Interventional neurology JID - 101606828 PMC - PMC5881148 OTO - NOTNLM OT - Aspiration technique OT - Stent retriever OT - Stroke OT - Thrombectomy EDAT- 2018/04/10 06:00 MHDA- 2018/04/10 06:01 CRDT- 2018/04/10 06:00 PHST- 2018/04/10 06:00 [entrez] PHST- 2018/04/10 06:00 [pubmed] PHST- 2018/04/10 06:01 [medline] AID - ine-0007-0026 [pii] AID - 10.1159/000480353 [doi] PST - ppublish SO - Interv Neurol. 2018 Feb;7(1-2):26-35. doi: 10.1159/000480353. Epub 2017 Oct 11. PMID- 30847500 OWN - NLM STAT- Publisher LR - 20191120 IS - 1869-1447 (Electronic) IS - 1869-1439 (Linking) DP - 2019 Mar 7 TI - Angiographic Patterns and Outcomes Achieved by Proximal Balloon Occlusion in Symptomatic Carotid Artery Stenosis Stenting. LID - 10.1007/s00062-019-00770-8 [doi] AB - BACKGROUND AND PURPOSE: The best embolic protection strategy has not yet been established for carotid artery stenting (CAS). This article reports a new simplified approach using a balloon guide catheter inspired by stroke therapy, in patients harboring a symptomatic ICA atherosclerotic stenosis or web. In addition, the three angiographic patterns and clinical outcomes associated with this technique, called the simple flow blockage (SFB) technique are described. MATERIAL AND METHODS: This was a retrospective study with data extraction from a monocentric prospective clinical registry of consecutive patients admitted for symptomatic ICA stenosis or web. The primary study outcome (composite endpoint) was the rate of occurrence of death, symptomatic stroke or acute coronary syndrome within 30 days of the intervention. RESULTS: In this study 75 symptomatic patients with >50% carotid artery atherosclerotic stenosis or web were included. All procedures were successfully performed. The composite endpoint occurred in 3 patients (4.0%, 95% confidence interval, CI, 0.0-11.3): 1 had symptomatic ischemic stroke, 1 had reperfusion syndrome with symptomatic intracranial hemorrhage and 1 had acute coronary syndrome. After proximal balloon inflation three angiographic patterns were observed: complete contrast column stagnation in the ICA (38.7%), retrograde washout of the ICA from the intracranial circulation towards the external carotid artery (35.5%) and antegrade washout of contrast medium towards the intracranial circulation (25.8%). The median procedure length was 40 min. New asymptomatic ischemic lesions were observed in 22.5% on DWI-MRI. CONCLUSION: The SFB technique enables fast and safe procedures in CAS. A favorable angiographic pattern after proximal balloon inflation was observed in 74.2% of cases. FAU - Dargazanli, Cyril AU - Dargazanli C AUID- ORCID: 0000-0003-1891-9157 AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. c.dargazanli@gmail.com. AD - Laboratory of Cerebrovascular Mechanisms of Brain Disorders, Department of Neuroscience, Institute of Functional Genomics, UMR 5203 CNRS - U 1191 INSERM, University of Montpellier, Montpellier, France. c.dargazanli@gmail.com. FAU - Mahmoudi, Mehdi AU - Mahmoudi M AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Cappucci, Matteo AU - Cappucci M AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Collemiche, François-Louis AU - Collemiche FL AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Labreuche, Julien AU - Labreuche J AD - EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Univ. Lille, CHU Lille, 59000, Lille, France. FAU - Habza, Othmane AU - Habza O AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Gascou, Grégory AU - Gascou G AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Lefèvre, Pierre-Henri AU - Lefèvre PH AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Eker, Omer AU - Eker O AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Mourand, Isabelle AU - Mourand I AD - Neurology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Gaillard, Nicolas AU - Gaillard N AD - Neurology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Charif, Mahmoud AU - Charif M AD - Neurology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Derraz, Imad AU - Derraz I AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Arquizan, Caroline AU - Arquizan C AD - Neurology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. FAU - Costalat, Vincent AU - Costalat V AD - Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France. AD - Laboratory of Cerebrovascular Mechanisms of Brain Disorders, Department of Neuroscience, Institute of Functional Genomics, UMR 5203 CNRS - U 1191 INSERM, University of Montpellier, Montpellier, France. LA - eng PT - Journal Article DEP - 20190307 PL - Germany TA - Clin Neuroradiol JT - Clinical neuroradiology JID - 101526693 OTO - NOTNLM OT - Atherosclerosis OT - Endarterectomy OT - Endovascular OT - Intimal Dysplasia OT - Stroke EDAT- 2019/03/09 06:00 MHDA- 2019/03/09 06:00 CRDT- 2019/03/09 06:00 PHST- 2018/11/02 00:00 [received] PHST- 2019/02/15 00:00 [accepted] PHST- 2019/03/09 06:00 [entrez] PHST- 2019/03/09 06:00 [pubmed] PHST- 2019/03/09 06:00 [medline] AID - 10.1007/s00062-019-00770-8 [pii] AID - 10.1007/s00062-019-00770-8 [doi] PST - aheadofprint SO - Clin Neuroradiol. 2019 Mar 7. doi: 10.1007/s00062-019-00770-8. PMID- 29858398 OWN - NLM STAT- MEDLINE DCOM- 20190311 LR - 20190311 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 11 IP - 1 DP - 2019 Jan TI - Longer stent retrievers enhance thrombectomy performance in acute stroke. PG - 6-8 LID - 10.1136/neurintsurg-2018-013918 [doi] AB - BACKGROUND: Longer stent retrievers have recently become available and have theoretical advantages over their shorter counterparts. We aim to evaluate whether stent retriever length impacts reperfusion rates in stroke thrombectomy. METHODS: This was a retrospective analysis of a prospectively collected thrombectomy database in which equal diameter (4 mm) stent retrievers were used as the first-line strategy for intracranial internal carotid or middle cerebral artery M1 or M2 occlusions along with a balloon guide catheter from June 2011 to March 2017. The population was dichotomized into long (Trevo 4×30 mm/Solitaire 4×40 mm) or short (Trevo 4×20 mm/Solitaire 4×20 mm) retrievers. The primary outcome was first-pass modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 reperfusion. RESULTS: Of 1126 thrombectomies performed within the study period, 420 were included. Age, gender, National Institutes of Health Stroke Scale, ASPECTS, IV tissue plasminogen activator use, stroke etiology, occlusion site, time from last-known-normal to puncture, distribution of Trevo and Solitaire, and the use of newer generation local thromboaspiration devices were comparable between the long and short retrievers. The short retriever group had more frequent hypertension, dyslipidemia, and atrial fibrillation. First-pass mTICI 2b/3 reperfusion was more common in the long retriever group (62% vs 50%; P=0.01). Parenchymal hematomas type 2, subarachnoid hemorrhage, 90-day modified Rankin Scale score 0-2, and mortality were comparable. Multivariable analysis indicated that long retriever (OR 2.2; 95% CI 1.3 to 3.6; P=0.001), radiopaque device (OR 2.1; 95% CI 1.2 to 3.4; P=0.003), and adjuvant local aspiration (OR 2.4; 95% CI 1.3 to 4.3; P=0.003) were independently associated with first-pass reperfusion. CONCLUSIONS: The use of longer stent retrievers is an independent predictor of first-pass mTICI 2b/3 reperfusion. First-pass reperfusion was also associated with the use of radiopaque devices and adjuvant local aspiration. CI - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted. FAU - Haussen, Diogo C AU - Haussen DC AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. FAU - Al-Bayati, Alhamza R AU - Al-Bayati AR AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. FAU - Grossberg, Jonathan A AU - Grossberg JA AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. FAU - Bouslama, Mehdi AU - Bouslama M AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. FAU - Barreira, Clara AU - Barreira C AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. FAU - Bianchi, Nicolas AU - Bianchi N AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. FAU - Frankel, Michael R AU - Frankel MR AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. FAU - Nogueira, Raul G AU - Nogueira RG AD - Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Florida, USA. LA - eng PT - Journal Article DEP - 20180601 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 RN - EC 3.4.21.68 (PLAT protein, human) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Aged MH - Brain Ischemia/diagnosis/surgery MH - Cerebral Infarction/diagnosis/*surgery MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Reperfusion/*instrumentation/methods MH - Retrospective Studies MH - *Stents MH - Stroke/diagnosis/*surgery MH - Thrombectomy/*instrumentation/methods MH - Tissue Plasminogen Activator/administration & dosage MH - Treatment Outcome OTO - NOTNLM OT - stroke OT - thrombectomy COIS- Competing interests: RGN: Stryker-Neurovacular (Trevo-2 and DAWN/Trial PI), Covidien (SWIFT and SWIFT-PRIME/Steering- Committee, STAR Trial/Core-Lab), Penumbra (3-D Separator Trial/Executive-Committee). EDAT- 2018/06/03 06:00 MHDA- 2019/03/12 06:00 CRDT- 2018/06/03 06:00 PHST- 2018/03/08 00:00 [received] PHST- 2018/04/19 00:00 [revised] PHST- 2018/04/26 00:00 [accepted] PHST- 2018/06/03 06:00 [pubmed] PHST- 2019/03/12 06:00 [medline] PHST- 2018/06/03 06:00 [entrez] AID - neurintsurg-2018-013918 [pii] AID - 10.1136/neurintsurg-2018-013918 [doi] PST - ppublish SO - J Neurointerv Surg. 2019 Jan;11(1):6-8. doi: 10.1136/neurintsurg-2018-013918. Epub 2018 Jun 1. PMID- 31197024 OWN - NLM STAT- MEDLINE DCOM- 20200317 LR - 20200317 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 12 IP - 1 DP - 2020 Jan TI - ANCD thrombectomy device: in vitro evaluation. PG - 77-81 LID - 10.1136/neurintsurg-2019-014856 [doi] AB - INTRODUCTION: Endovascular treatment of stroke, although highly effective, may fail to reach complete recanalization in around 20% of cases. The Advanced Thrombectomy System (ANCD) is a novel stroke thrombectomy device designed to reduce clot fragmentation and facilitate retrieval by inducing local flow arrest and allowing distal aspiration in combination with a stent retriever. We aimed to assess the preclinical efficacy of ANCD. METHODS: Soft red blood cell (RBC)-rich (n=20/group) and sticky fibrin-rich (n=30/group) clots were used to create middle cerebral artery (MCA) occlusions in two vascular phantoms. Three different treatment strategies were tested: (1) balloon guide catheter + Solitaire (BGC+SR); (2) distal access catheter + SR (DAC+SR); and (3) ANCD+SR, until complete recanalization was achieved or to a maximum of three passes. The recanalization rate was determined after each pass. RESULTS: After one pass, ANCD+SR resulted in an increased recanalization rate (94%) for all clots together compared with BGC+SR (66%; p<0.01) or DAC+SR (80%; p=0.04). After the final pass the recanalization rate increased in all three groups but remained higher with ANCD+SR (100%) than with BGC+SR (74%; p<0.01) or DAC+SR (90%; p=0.02). The mean number of passes was lower with ANCD+SR (1.06) than with BGC+SR (1.46) or DAC+SR (1.25) (p=0.01). A logistic regression model adjusted for treatment arm, clot type, and model used showed that both RBC-rich clots (OR 8.1, 95% CI 1.6 to 13.5) and ANCD+SR (OR 3.9, 95% CI 1.01 to 15.8) were independent predictors of first-pass recanalization. CONCLUSION: In in vitro three-dimensional models replicating MCA-M1 occlusion, ANCD+SR showed significantly better recanalization rates in fewer passes than other commonly used combinations of devices. CI - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Sanchez, Sonia AU - Sanchez S AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. FAU - Cortiñas, Ignacio AU - Cortiñas I AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. FAU - Villanova, Helena AU - Villanova H AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. FAU - Rios, Anna AU - Rios A AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. FAU - Galve, Iñaki AU - Galve I AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. FAU - Andersson, Tommy AU - Andersson T AD - Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium. AD - Departments of Neuroradiology and Clinical Neuroscience, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. FAU - Nogueira, Raul AU - Nogueira R AD - Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Jovin, Tudor AU - Jovin T AD - Department of Neurology, UPMC, Pittsburgh, Pennsylvania, USA. FAU - Ribo, Marc AU - Ribo M AD - Stroke Unit. Neurology, Hospital Vall d'Hebron, Barcelona, Spain. AD - Universitat Autònoma de Barcelona, Barcelona, Spain. LA - eng PT - Journal Article DEP - 20190613 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 RN - 9001-31-4 (Fibrin) SB - IM MH - Fibrin MH - Humans MH - Infarction, Middle Cerebral Artery/surgery MH - *Models, Cardiovascular MH - *Stents MH - Stroke/surgery MH - Surgical Instruments MH - Thrombectomy/*instrumentation/*methods MH - Thrombosis/surgery MH - Treatment Outcome OTO - NOTNLM OT - device OT - stroke OT - thrombectomy COIS- Competing interests: SS, IC, HV, AR, and IG are employees of Anaconda Biomed. MR and TJ are shareholders in Anaconda Biomed. TA and RN are clinical consultants for Anaconda Biomed. RN is a consultant/advisory board member for Stryker Neurovascular and Covidien. Stryker Neurovascular (Trevo-2 trial principal investigator–modest; DAWN trial principal investigator–no compensation; TREVO registry steering committee–no compensation), Medtronic (SWIFT trial steering committee–modest; SWIFT-Prime trial steering committee–no compensation; STAR Trial Angiographic Core Lab–significant), Penumbra (3D Separator trial executive committee–no compensation), Neuravi (ARISE-2 steering committee–no compensation), Genentech (physician advisory board–modest), Allm Inc (physician advisory board–no compensation). TA is a consultant for Ablynx, Amnis Therapeutics, Anaconda,Cerenovus/Neuravi, Medtronic, Rapid Medical. MR is a consultant for Cerenovus, Medtronic, Stryker, Apta Targets and Vesalio. TJ is a consultant for Stryker Neurovascular (PI DAWN-unpaid); Ownership Interest: Anaconda; Advisory Board/Investor: FreeOx Biotech; Advisory Board/Investor: Route92; Advisory Board/Investor: Blockade Medical, Consultant; Honoraria: Cerenovus. EDAT- 2019/06/15 06:00 MHDA- 2020/03/18 06:00 CRDT- 2019/06/15 06:00 PHST- 2019/04/01 00:00 [received] PHST- 2019/05/14 00:00 [revised] PHST- 2019/05/14 00:00 [accepted] PHST- 2019/06/15 06:00 [pubmed] PHST- 2020/03/18 06:00 [medline] PHST- 2019/06/15 06:00 [entrez] AID - neurintsurg-2019-014856 [pii] AID - 10.1136/neurintsurg-2019-014856 [doi] PST - ppublish SO - J Neurointerv Surg. 2020 Jan;12(1):77-81. doi: 10.1136/neurintsurg-2019-014856. Epub 2019 Jun 13. PMID- 29904305 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 0899-8280 (Print) IS - 1525-3252 (Electronic) IS - 0899-8280 (Linking) VI - 31 IP - 3 DP - 2018 Jul TI - Successful reperfusion of bilateral middle cerebral artery embolic occlusions using stent retriever thrombectomy. PG - 339-341 LID - 10.1080/08998280.2018.1447182 [doi] AB - A 40-year-old woman presented to our stroke center for a left middle cerebral artery embolic occlusion. This was successfully treated with mechanical thrombectomy using a stent retriever and balloon guide catheter aspiration. The patient was discharged home in good condition on clopidogrel but returned 2 months later with a contralateral right middle cerebral artery embolic occlusion. This was also successfully treated, this time with a stent retriever and local aspiration (Sol-Arc technique). She was once again discharged in good condition but with warfarin and an implanted loop recorder. This case demonstrates the feasibility of short-term bilateral mechanical thrombectomy for embolic middle cerebral artery occlusions. FAU - Miller, Austin AU - Miller A AD - Department of Radiology, Baylor University Medical Center, Dallas, Texas. FAU - Onofrio, Anthony AU - Onofrio A AD - Department of Radiology, Baylor University Medical Center, Dallas, Texas. FAU - Graybeal, Dion AU - Graybeal D AD - Division of Neurology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas. FAU - Mir, Osman AU - Mir O AD - Division of Neurology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas. FAU - Linebarger, Megan B AU - Linebarger MB AD - Department of Radiology, Baylor University Medical Center, Dallas, Texas. FAU - Layton, Kennith F AU - Layton KF AD - Department of Radiology, Baylor University Medical Center, Dallas, Texas. LA - eng PT - Case Reports DEP - 20180425 TA - Proc (Bayl Univ Med Cent) JT - Proceedings (Baylor University. Medical Center) JID - 9302033 PMC - PMC5997098 OTO - NOTNLM OT - Embolus OT - ischemia OT - stent retriever OT - stroke OT - thrombectomy EDAT- 2018/06/16 06:00 MHDA- 2018/06/16 06:01 CRDT- 2018/06/16 06:00 PHST- 2017/10/16 00:00 [received] PHST- 2018/01/15 00:00 [revised] PHST- 2018/01/18 00:00 [accepted] PHST- 2018/06/16 06:00 [entrez] PHST- 2018/06/16 06:00 [pubmed] PHST- 2018/06/16 06:01 [medline] AID - 1447182 [pii] AID - 10.1080/08998280.2018.1447182 [doi] PST - epublish SO - Proc (Bayl Univ Med Cent). 2018 Apr 25;31(3):339-341. doi: 10.1080/08998280.2018.1447182. eCollection 2018 Jul. PMID- 26919972 OWN - NLM STAT- MEDLINE DCOM- 20170324 LR - 20181202 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 9 IP - 2 DP - 2017 Feb TI - An in vitro evaluation of distal emboli following Lazarus Cover-assisted stent retriever thrombectomy. PG - 183-187 LID - 10.1136/neurintsurg-2015-012256 [doi] AB - BACKGROUND: Formation of clot fragments during mechanical thrombectomy for acute ischemic stroke can occlude the distal vasculature, which may reduce the rate of good clinical outcome. OBJECTIVE: To examine the hypothesis that distal embolization can be reduced using stent retriever thrombectomy in combination with Lazarus Cover technology. METHODS: Hard, fragment-prone clots were used to create middle cerebral artery occlusions in a vascular phantom. Three different treatment strategies using Solitaire FR included: group 1-proximal flow control with an 8F balloon guide catheter (BGC), group 2-thrombectomy through a 6F conventional guide catheter (CGC), and group 3-a similar thrombectomy procedure to group 2 but including the Lazarus Cover device. The primary endpoint was distal emboli quantified by the number and size of the clot debris. RESULTS: The Cover-assisted stent retriever thrombectomy significantly reduced the generation of clot fragments >200 μm as compared with thrombectomy with a CGC, and was similar to the BGC group. Particle size distribution <200 μm was similar across the groups. All groups were associated with high rates of recanalization, with only one failed recanalization with partial clot retention after three passes in one experiment of stent retriever thrombectomy through a CGC. Use of the adjunctive Cover device did not prolong the procedure as compared with control groups. CONCLUSIONS: For a fragment-prone clot, Solitaire thrombectomy in conjunction with the Cover device may lower the risk of distal embolization and is comparable to BGC-protected embolectomy. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. FAU - Chueh, Ju-Yu AU - Chueh JY AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA. FAU - Puri, Ajit S AU - Puri AS AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA. FAU - Gounis, Matthew J AU - Gounis MJ AD - Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA. LA - eng PT - Journal Article DEP - 20160226 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Brain Ischemia/surgery MH - Cerebral Angiography MH - Device Removal/*adverse effects/methods MH - Embolization, Therapeutic/*methods MH - Infarction, Middle Cerebral Artery/surgery MH - Intracranial Embolism/diagnostic imaging/*etiology MH - Particle Size MH - *Stents MH - Stroke/surgery MH - Thrombectomy/*adverse effects/*methods MH - Treatment Outcome OTO - NOTNLM OT - *Device OT - *Stroke OT - *Thrombectomy EDAT- 2016/02/28 06:00 MHDA- 2017/03/25 06:00 CRDT- 2016/02/28 06:00 PHST- 2015/12/30 00:00 [received] PHST- 2016/01/28 00:00 [revised] PHST- 2016/01/30 00:00 [accepted] PHST- 2016/02/28 06:00 [pubmed] PHST- 2017/03/25 06:00 [medline] PHST- 2016/02/28 06:00 [entrez] AID - neurintsurg-2015-012256 [pii] AID - 10.1136/neurintsurg-2015-012256 [doi] PST - ppublish SO - J Neurointerv Surg. 2017 Feb;9(2):183-187. doi: 10.1136/neurintsurg-2015-012256. Epub 2016 Feb 26. PMID- 16908572 OWN - NLM STAT- MEDLINE DCOM- 20060929 LR - 20121115 IS - 0195-6108 (Print) IS - 0195-6108 (Linking) VI - 27 IP - 7 DP - 2006 Aug TI - Clot removal therapy by aspiration and extraction for acute embolic carotid occlusion. PG - 1521-7 AB - BACKGROUND AND PURPOSE: The purpose of our retrospective study was to investigate the feasibility, safety, and efficacy of clot removal therapy by aspiration and extraction for patients with acute stroke with embolic internal carotid artery (ICA) occlusion. METHODS: Of 814 consecutive patients with acute ischemic stroke admitted to our institution from March 2003 to April 2005, clot removal therapy was performed for 14. Inclusion criteria were patients (1) presenting within 6 hours of onset of cardioembolic stroke, (2) with serious neurologic symptoms defined by a National Institutes of Health Stroke Scale (NIHSS) score of at least 11, (3) without extensive high signal intensity on diffusion-weighted MR images but with decreased ipsilateral hemispheric cerebral blood flow on perfusion-weighted images (perfusion/diffusion mismatch), and (4) with total ICA occlusion on angiograms. We removed clots by aspiration and extraction with a microsnare through either a guiding or balloon guide catheter. Radiographic results, 7-day NIHSS, 3-month modified Rankin Scale, and procedure-related complications were evaluated. RESULTS: Of 10 patients treated with the balloon guide catheter to temporarily interrupt proximal flow, 7 obtained complete or partial recanalization. The 4 patients treated with the guiding catheter had no recanalization. Of the 7 patients with recanalization, 6 had favorable 7-day neurologic and 3-month functional outcome; all showed anatomic crossflow via the anterior communicating artery. A procedure-related complication, distal embolization into the ipsilateral anterior cerebral artery, occurred in 1 patient. CONCLUSION: Balloon guide catheter-assisted clot removal therapy for embolic ICA occlusion may provide a high recanalization rate and good clinical outcome in patients with anatomic crossflow. FAU - Imai, K AU - Imai K AD - Department of Stroke Treatment, Shonan Kamakura General Hospital, 1201-1 Yamazaki Kamakura, Kanagawa 247-8533, Japan. FAU - Mori, T AU - Mori T FAU - Izumoto, H AU - Izumoto H FAU - Takabatake, N AU - Takabatake N FAU - Kunieda, T AU - Kunieda T FAU - Shimizu, H AU - Shimizu H FAU - Watanabe, M AU - Watanabe M LA - eng PT - Journal Article PL - United States TA - AJNR Am J Neuroradiol JT - AJNR. American journal of neuroradiology JID - 8003708 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Volume/physiology MH - Brain Ischemia/therapy MH - Carotid Artery Thrombosis/*therapy MH - Carotid Artery, Internal/*pathology MH - Catheterization/instrumentation MH - Cerebral Angiography MH - Cerebrovascular Circulation/physiology MH - Diffusion Magnetic Resonance Imaging MH - Feasibility Studies MH - Female MH - Humans MH - Intracranial Embolism/*therapy MH - Male MH - *Micromanipulation/instrumentation MH - Middle Aged MH - Retrospective Studies MH - Stroke/therapy MH - *Suction/instrumentation MH - Tomography, X-Ray Computed MH - Treatment Outcome EDAT- 2006/08/16 09:00 MHDA- 2006/09/30 09:00 CRDT- 2006/08/16 09:00 PHST- 2006/08/16 09:00 [pubmed] PHST- 2006/09/30 09:00 [medline] PHST- 2006/08/16 09:00 [entrez] AID - 27/7/1521 [pii] PST - ppublish SO - AJNR Am J Neuroradiol. 2006 Aug;27(7):1521-7. PMID- 32015181 OWN - NLM STAT- Publisher LR - 20200213 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) DP - 2020 Feb 3 TI - Balloon anchoring technique for t hrombectomy in hostile craniocervical arterial anatomy. LID - neurintsurg-2019-015347 [pii] LID - 10.1136/neurintsurg-2019-015347 [doi] AB - BACKGROUND: Craniocervical catheter access in large vessel occlusion acute ischemic strokes can be challenging in cases of unfavorable aortic arch/cervical vascular anatomy, leading to lower recanalization rates, increased procedural time and worse clinical outcomes. We aim to demonstrate the feasibility of the balloon-anchoring technique (BAT) that can be attempted before switching to alternative access sites. METHODS: Retrospective review of prospectively collected information on 11 patients in which two variants of the BAT (proximal anchoring: balloon guide catheter (BGC) is inflated to provide support for distal access; distal anchoring: compliant balloon is inflated in an intracranial artery to allow advancement of the support system) were utilized to facilitate craniocervical access due to failure of conventional maneuvers. RESULTS: Ten patients had anterior and one patient had posterior circulation large vessel occlusions. Mean age was 81 years and 81% were females. Type 3 arches were found in 82% and a 9 French balloon guide catheter was used in 82%. Proximal anchoring with BGC was used in four cases while distal anchoring was used in seven patients to allow access to the target vessel, avoiding the need to puncture alternative access sites. Successful reperfusion (modified treatment in cerebral ischemia 2b-3) was achieved in all cases and no complications were observed. CONCLUSION: BAT is safe and feasible. It can be considered as a rescue maneuver in order to avoid switching to a different access during thrombectomy in individuals with unfavorable aortic arch/craniocervical anatomy. CI - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Sharashidze, Vera AU - Sharashidze V AD - Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. AD - Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Nogueira, Raul G AU - Nogueira RG AD - Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. AD - Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Al-Bayati, Alhamza R AU - Al-Bayati AR AD - Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. AD - Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Grossberg, Jonathan A AU - Grossberg JA AD - Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Haussen, Diogo C AU - Haussen DC AD - Neurology, Emory University School of Medicine, Atlanta, Georgia, USA diogo.haussen@emory.edu. AD - Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA. LA - eng PT - Journal Article DEP - 20200203 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM OTO - NOTNLM OT - CT angiography OT - CT perfusion OT - artery OT - balloon OT - catheter COIS- Competing interests: VS: None. AA: None. JG: None. DCH:Consultant for Stryker and Vesalio; Viz-Ai stock options. RGN: Principal Investigator, Stryker Neurovascular (DAWN trial[no compensation],Trevo-2 trial), Cerenovus/Neuravi (ENDOLOW trial, no compensation); consultant to Stryker Neurovascular; steering committee member, Stryker Neurovascular (no compensation), Medtronic (SWIFT trial, SWIFT Prime trial [no compensation]), Cerenovus/Neuravi (ARISE-2 trial, no compensation); angiographic core lab, Medtronic (STAR trial); executive committee member, Penumbra (no compensation); physician advisory board, Cerenovus/Neuravi, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Allm Inc. (no compensation), Viz-AI; stock options,Viz-AI. EDAT- 2020/02/06 06:00 MHDA- 2020/02/06 06:00 CRDT- 2020/02/05 06:00 PHST- 2019/09/29 00:00 [received] PHST- 2019/12/27 00:00 [revised] PHST- 2020/01/04 00:00 [accepted] PHST- 2020/02/06 06:00 [pubmed] PHST- 2020/02/06 06:00 [medline] PHST- 2020/02/05 06:00 [entrez] AID - neurintsurg-2019-015347 [pii] AID - 10.1136/neurintsurg-2019-015347 [doi] PST - aheadofprint SO - J Neurointerv Surg. 2020 Feb 3:neurintsurg-2019-015347. doi: 10.1136/neurintsurg-2019-015347. PMID- 30760625 OWN - NLM STAT- MEDLINE DCOM- 20191126 LR - 20191126 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 11 IP - 9 DP - 2019 Sep TI - Institutional and provider variations for mechanical thrombectomy in the treatment of acute ischemic stroke: a survey analysis. PG - 884-890 LID - 10.1136/neurintsurg-2018-014614 [doi] AB - INTRODUCTION: Stent retriever combined with aspiration, or the 'Solumbra technique', has recently emerged as one of the popular methods of mechanical thrombectomy (MT). However, the variations in understanding and implementation of the Solumbra technique have not been reported. METHODS: An 18 part anonymous survey questionnaire was designed to extract information regarding technical variations of MT with a focus on the Solumbra technique. The survey link was posted on the Society of Neurointerventional Surgery (SNIS) website in 'SNIS connect'. RESULTS: 80 responses were obtained over 4 weeks that were included in the final analysis. Direct aspiration without a balloon guide catheter (BGC) was the most favored technique among respondents (41.12%) followed by the Solumbra technique without a BGC (32.4%). Among those using the Solumbra technique, 77.6% reported that they wait between 2 and 5 min to allow clot engagement, 55.2% always remove the microcatheter before aspiration, and 69.1% commence aspiration through the intermediate catheter only when retrieving the stent retriever. Operators who infrequently used or did not use BGCs reported a higher incidence of >80% Thrombolysis in Cerebral Infarction 2b/3 annual recanalization rates (OR 8.85, 95% CI 2.03 to 38.55, P=0.004) compared with those who consistently used BGCs. CONCLUSION: Our study documents the variations in MT techniques, and more specifically, attempts to quantify variations in the Solumbra technique. The impact of these variations on recanalization rates and eventually patient outcomes are unclear, especially given the self-reported outcomes contained in this study. CI - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Mehta, Tapan AU - Mehta T AD - Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA. FAU - Male, Shailesh AU - Male S AUID- ORCID: 0000-0002-3217-7869 AD - Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA. FAU - Quinn, Coridon AU - Quinn C AD - Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA. FAU - Kallmes, David F AU - Kallmes DF AD - Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. FAU - Siddiqui, Adnan H AU - Siddiqui AH AUID- ORCID: 0000-0002-9519-0059 AD - Department of Neurosurgery and Radiology, University at Buffalo, Buffalo, New York, USA. FAU - Turk, Aquilla AU - Turk A AD - Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina, USA. FAU - Grande, Andrew Walker AU - Grande AW AD - Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA. FAU - Tummala, Ramachandra Prasad AU - Tummala RP AD - Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA. FAU - Jagadeesan, Bharathi Dasan AU - Jagadeesan BD AD - Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA. LA - eng PT - Journal Article DEP - 20190213 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Brain Ischemia/epidemiology/*surgery MH - Female MH - Health Personnel/standards MH - Humans MH - Male MH - Stents MH - Stroke/epidemiology/*surgery MH - *Surveys and Questionnaires MH - Thrombectomy/*methods/standards MH - Treatment Outcome OTO - NOTNLM OT - stroke OT - thrombectomy COIS- Competing interests: None declared. EDAT- 2019/02/15 06:00 MHDA- 2019/11/27 06:00 CRDT- 2019/02/15 06:00 PHST- 2018/12/05 00:00 [received] PHST- 2019/01/04 00:00 [revised] PHST- 2019/01/09 00:00 [accepted] PHST- 2019/02/15 06:00 [pubmed] PHST- 2019/11/27 06:00 [medline] PHST- 2019/02/15 06:00 [entrez] AID - neurintsurg-2018-014614 [pii] AID - 10.1136/neurintsurg-2018-014614 [doi] PST - ppublish SO - J Neurointerv Surg. 2019 Sep;11(9):884-890. doi: 10.1136/neurintsurg-2018-014614. Epub 2019 Feb 13. PMID- 29652229 OWN - NLM STAT- Publisher LR - 20191120 IS - 1933-0693 (Electronic) IS - 0022-3085 (Linking) DP - 2018 Apr 1 TI - A useful diagnostic method to reduce the in-hospital time delay for mechanical thrombectomy: volume perfusion computed tomography with added vessel reconstruction. PG - 1-8 LID - 2017.10.JNS171971 [pii] LID - 10.3171/2017.10.JNS171971 [doi] AB - OBJECTIVEVolume perfusion CT (VPCT) with added CT angiography (CTA)-like reconstruction from VPCT source data (VPCTA) can reveal multiple intracranial parameters. The authors examined the usefulness of VPCTA in terms of reducing the in-hospital time delay for mechanical thrombectomy.METHODSA total of 180 patients who underwent mechanical thrombectomy at the authors' institution between January 2014 and March 2017 were divided into 2 groups: a CTA-based thrombectomy decision group (group 1: CTA) and a VPCTA-based decision group (group 2: VPCTA). Multiple time interval categories (from symptom onset to groin puncture, from hospital arrival to groin puncture, procedure time, from symptom onset to reperfusion, and from hospital arrival to reperfusion) were reviewed. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale score and the modified Rankin Scale, and radiological results were evaluated by the Thrombolysis in Cerebral Infarction score.RESULTSIn all of the time interval categories except for procedure time, the VPCTA group showed a significantly shorter in-hospital time delay during the prethrombectomy period than did the CTA group. The 3-month modified Rankin Scale score was significantly lower in the VPCTA group (2.8) compared with the CTA group (3.5) (p = 0.003). However, there were no statistically significant differences between the 2 groups in the other clinical and radiological outcomes.CONCLUSIONSCompared with CTA, VPCTA significantly reduced the in-hospital time delay during the prethrombectomy period. FAU - Yi, Ho Jun AU - Yi HJ FAU - Sung, Jae Hoon AU - Sung JH FAU - Lee, Dong Hoon AU - Lee DH FAU - Yang, Seung Ho AU - Yang SH FAU - Hong, Jae Taek AU - Hong JT LA - eng PT - Journal Article DEP - 20180401 PL - United States TA - J Neurosurg JT - Journal of neurosurgery JID - 0253357 OTO - NOTNLM OT - BGC = balloon guide catheter OT - CBF = cerebral blood flow OT - CBV = cerebral blood volume OT - CTA = CT angiography OT - ER = emergency room OT - ICA = internal carotid artery OT - MCA = middle cerebral artery OT - MTT = mean transit time OT - NIHSS = National Institutes of Health Stroke Scale OT - TIA = transient ischemic attack OT - TICI = Thrombolysis in Cerebral Infarction OT - TTP = time to peak OT - VPCT = volume perfusion CT OT - VPCTA = VPCT with CTA-like reconstruction from VPCT source data OT - VRT = volume-rendering technique OT - angiography OT - computed tomography OT - mRS = modified Rankin Scale OT - perfusion OT - stroke OT - tPA = tissue plasminogen activator OT - thrombectomy OT - vascular disorders EDAT- 2018/04/14 06:00 MHDA- 2018/04/14 06:00 CRDT- 2018/04/14 06:00 PHST- 2017/08/09 00:00 [received] PHST- 2017/10/16 00:00 [accepted] PHST- 2018/04/14 06:00 [pubmed] PHST- 2018/04/14 06:00 [medline] PHST- 2018/04/14 06:00 [entrez] AID - 2017.10.JNS171971 [pii] AID - 10.3171/2017.10.JNS171971 [doi] PST - aheadofprint SO - J Neurosurg. 2018 Apr 1:1-8. doi: 10.3171/2017.10.JNS171971. PMID- 31563889 OWN - NLM STAT- In-Process LR - 20200416 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) VI - 12 IP - 5 DP - 2020 May TI - Effects of first pass recanalization on outcomes of contact aspiration thrombectomy. PG - 466-470 LID - 10.1136/neurintsurg-2019-015221 [doi] AB - BACKGROUND: First pass recanalization (FPR, defined as achieving a modified Thrombolysis in Cerebral Ischemia (mTICI) grade 2c/3 with a single pass of a thrombectomy device) effect has not yet been evaluated in contact aspiration thrombectomy (CAT). We evaluated FPR effect on clinical outcomes and FPR predictors in CAT. METHODS: All consecutive patients who underwent frontline CAT for anterior circulation large vessel occlusion with recanalization (mTICI 2b-3) were identified from registries at six stroke centers. The patients were dichotomized into FPR and non-FPR groups. Clinical features and outcomes were compared between the groups. Multivariate analyses were performed to determine whether FPR was independently associated with clinical outcomes and to identify predictors of FPR. RESULTS: Of the 429 patients who underwent frontline CAT, recanalization was successful in 344 patients (80.2%; mean age 68.7±11.0 years; M:F ratio 179:165). The FPR group had a higher rate of good outcome (modified Rankin Scale score 0-2) than the non-FPR group. Furthermore, the good outcome rate was higher in the FPR group than in patients who achieved mTICI 2c/3 with multiple passes or rescue treatment. FPR (OR 2.587; 95% CI 1.237 to 5.413) remained independently associated with good outcomes, in addition to age, baseline National Institute Health Stroke Scale, and coronary artery disease. The use of a balloon guide catheter (OR 3.071; 95% CI 1.699 to 5.550) was the only predictor of FPR. CONCLUSIONS: Patients in the FPR group had better clinical outcomes than the non-FPR group in CAT. FPR was independently associated with a good outcome. The use of a balloon guide catheter was the only predictor of FPR. CI - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Kang, Dong-Hun AU - Kang DH AD - Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. AD - Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. FAU - Kim, Byung Moon AU - Kim BM AUID- ORCID: 0000-0001-8593-6841 AD - Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. FAU - Heo, Ji Hoe AU - Heo JH AD - Department of Neurology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. FAU - Nam, Hyo Suk AU - Nam HS AD - Department of Neurology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. FAU - Kim, Young Dae AU - Kim YD AD - Department of Neurology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. FAU - Hwang, Yang Ha AU - Hwang YH AD - Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. FAU - Kim, Yong-Won AU - Kim YW AUID- ORCID: 0000-0003-0674-0352 AD - Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. FAU - Kim, Dong Joon AU - Kim DJ AUID- ORCID: 0000-0002-7035-087X AD - Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. FAU - Kim, Joon Whi AU - Kim JW AD - Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. FAU - Baek, Jang-Hyun AU - Baek JH AD - Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea. FAU - Kim, Yong-Sun AU - Kim YS AD - Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. LA - eng PT - Journal Article DEP - 20190928 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM OTO - NOTNLM OT - acute stroke OT - aspiration OT - first pass OT - outcome OT - thrombectomy COIS- Competing interests: None declared. EDAT- 2019/09/30 06:00 MHDA- 2019/09/30 06:00 CRDT- 2019/09/30 06:00 PHST- 2019/06/24 00:00 [received] PHST- 2019/08/27 00:00 [revised] PHST- 2019/09/06 00:00 [accepted] PHST- 2019/09/30 06:00 [pubmed] PHST- 2019/09/30 06:00 [medline] PHST- 2019/09/30 06:00 [entrez] AID - neurintsurg-2019-015221 [pii] AID - 10.1136/neurintsurg-2019-015221 [doi] PST - ppublish SO - J Neurointerv Surg. 2020 May;12(5):466-470. doi: 10.1136/neurintsurg-2019-015221. Epub 2019 Sep 28. PMID- 24668201 OWN - NLM STAT- MEDLINE DCOM- 20140703 LR - 20161122 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 45 IP - 5 DP - 2014 May TI - North American SOLITAIRE Stent-Retriever Acute Stroke Registry: choice of anesthesia and outcomes. PG - 1396-401 LID - 10.1161/STROKEAHA.113.003698 [doi] AB - BACKGROUND AND PURPOSE: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy. METHODS: We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage. RESULTS: A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ≥2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04). CONCLUSIONS: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes. FAU - Abou-Chebl, Alex AU - Abou-Chebl A AD - From the Texas Stroke Institute, Plano, TX (A.A.-C., V.J.); Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin/Froedtert Hospital, Atlanta, GA (O.O.Z., A.C.C., M.A.I.); Wellstar Neurosurgery Kennestone Hospital, Atlanta, GA (R.G.); Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.-H.J.S. R.G.N.); Saint Luke's Kansas City, Kansas City, MO (C.O.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.D.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland, OR (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown, WV (A.T.R.); Departments of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena Saint Joseph Medical Center, Joliet, IL (A.B.); Departments of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.T.); University of Kansas Medical Center, Kansas City, KS (M.G.A.); University of Texas Health Science Center, Houston, TX (H.S.); Departments of Radiology, Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.); University of Texas, Houston, TX (P.R.C.); Department of Neurosurgery, Houston Methodist, Methodist Neurological Institute, Houston, TX (G.W.B.); Saint Louis University, St. Louis, MO (R.K.); and University of Missouri, Columbia, MO (A.N.). FAU - Zaidat, Ossama O AU - Zaidat OO FAU - Castonguay, Alicia C AU - Castonguay AC FAU - Gupta, Rishi AU - Gupta R FAU - Sun, Chung-Huan J AU - Sun CH FAU - Martin, Coleman O AU - Martin CO FAU - Holloway, William E AU - Holloway WE FAU - Mueller-Kronast, Nils AU - Mueller-Kronast N FAU - English, Joey D AU - English JD FAU - Linfante, Italo AU - Linfante I FAU - Dabus, Guilherme AU - Dabus G FAU - Malisch, Timothy W AU - Malisch TW FAU - Marden, Franklin A AU - Marden FA FAU - Bozorgchami, Hormozd AU - Bozorgchami H FAU - Xavier, Andrew AU - Xavier A FAU - Rai, Ansaar T AU - Rai AT FAU - Froehler, Micahel T AU - Froehler MT FAU - Badruddin, Aamir AU - Badruddin A FAU - Nguyen, Thanh N AU - Nguyen TN FAU - Taqi, Muhammad AU - Taqi M FAU - Abraham, Michael G AU - Abraham MG FAU - Janardhan, Vallabh AU - Janardhan V FAU - Shaltoni, Hashem AU - Shaltoni H FAU - Novakovic, Roberta AU - Novakovic R FAU - Yoo, Albert J AU - Yoo AJ FAU - Chen, Peng R AU - Chen PR FAU - Britz, Gavin W AU - Britz GW FAU - Kaushal, Ritesh AU - Kaushal R FAU - Nanda, Ashish AU - Nanda A FAU - Issa, Mohammad A AU - Issa MA FAU - Nogueira, Raul G AU - Nogueira RG LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20140325 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM MH - Aged MH - Aged, 80 and over MH - Anesthesia, General/adverse effects/mortality/*statistics & numerical data MH - Anesthesia, Local/adverse effects/mortality/*statistics & numerical data MH - Brain Ischemia/mortality/*therapy MH - Endovascular Procedures/adverse effects/mortality/*statistics & numerical data MH - Female MH - Humans MH - Male MH - Middle Aged MH - North America MH - Registries/*statistics & numerical data MH - Retrospective Studies MH - Severity of Illness Index MH - Stents/*statistics & numerical data MH - Stroke/mortality/*therapy MH - Treatment Outcome OTO - NOTNLM OT - anesthesia OT - stroke EDAT- 2014/03/29 06:00 MHDA- 2014/07/06 06:00 CRDT- 2014/03/27 06:00 PHST- 2014/03/27 06:00 [entrez] PHST- 2014/03/29 06:00 [pubmed] PHST- 2014/07/06 06:00 [medline] AID - STROKEAHA.113.003698 [pii] AID - 10.1161/STROKEAHA.113.003698 [doi] PST - ppublish SO - Stroke. 2014 May;45(5):1396-401. doi: 10.1161/STROKEAHA.113.003698. Epub 2014 Mar 25. PMID- 28843759 OWN - NLM STAT- MEDLINE DCOM- 20171225 LR - 20171225 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 107 DP - 2017 Nov TI - Hybrid Technique for the Treatment of Refractory Vertebrobasilar Insufficiencies. PG - 1051.e13-1051.e17 LID - S1878-8750(17)31382-7 [pii] LID - 10.1016/j.wneu.2017.08.081 [doi] AB - BACKGROUND: Tortuous or occluded vertebral arteries (VAs) can make the endovascular treatment of vertebrobasilar insufficiency impractical. Bypass surgery is an option, but a craniotomy of the posterior fossa is complicated when physiologic vessels must be abandoned. We report 3 cases of refractory vertebrobasilar insufficiency with different presentations requiring problematic approaches in which the patients were treated by different hybrid strategies. CASE DESCRIPTION: Patient 1 had severe stenosis of right VA ostium with right V1 segment tortuosity and was treated by right VA ostium transposition during which the proximal subclavian artery was blocked by a balloon guide catheter. Patient 2 had severe stenosis of the basilar artery and bilateral VA tortuosity. The V1 segment was exposed and cut open so that an available approach for endovascular procedures was created. Patient 3 had bilateral VA occlusion. After exposure of the left V1 segment, recanalization of the left VA was performed by an interventional radiologist and surgeon working together. All patients had improved hemodynamics and symptoms alleviated without major complications. CONCLUSIONS: For refractory vertebrobasilar insufficiencies, hybrid operations that combine surgical manipulation of the V1 segment and endovascular techniques can be safe and effective. CI - Copyright © 2017. Published by Elsevier Inc. FAU - Lu, Xia AU - Lu X AD - Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China. FAU - Ma, Yan AU - Ma Y AD - Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China. FAU - Yang, Bin AU - Yang B AD - Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China. FAU - Gao, Peng AU - Gao P AD - Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China. FAU - Wang, Yabing AU - Wang Y AD - Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China. FAU - Jiao, Liqun AU - Jiao L AD - Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China. Electronic address: liqunjiao@sina.cn. LA - eng PT - Case Reports PT - Journal Article DEP - 20170823 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 SB - IM MH - Aged MH - Arterial Occlusive Diseases/diagnostic imaging/surgery MH - Endovascular Procedures/*methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Treatment Outcome MH - Vertebrobasilar Insufficiency/*diagnostic imaging/*surgery OTO - NOTNLM OT - Hybrid operation OT - Vertebral artery occlusion OT - Vertebral artery recanalization OT - Vertebral artery transposition OT - Vertebrobasilar insufficiency EDAT- 2017/08/28 06:00 MHDA- 2017/12/26 06:00 CRDT- 2017/08/28 06:00 PHST- 2017/05/29 00:00 [received] PHST- 2017/08/10 00:00 [revised] PHST- 2017/08/12 00:00 [accepted] PHST- 2017/08/28 06:00 [pubmed] PHST- 2017/12/26 06:00 [medline] PHST- 2017/08/28 06:00 [entrez] AID - S1878-8750(17)31382-7 [pii] AID - 10.1016/j.wneu.2017.08.081 [doi] PST - ppublish SO - World Neurosurg. 2017 Nov;107:1051.e13-1051.e17. doi: 10.1016/j.wneu.2017.08.081. Epub 2017 Aug 23. PMID- 17245008 OWN - NLM STAT- MEDLINE DCOM- 20070316 LR - 20190606 IS - 0470-8105 (Print) IS - 0470-8105 (Linking) VI - 47 IP - 1 DP - 2007 Jan TI - Experimental model evaluation of filter trapping after embolectomy using the Merci system: supplemental technique for Merci retrieval procedure. PG - 11-7 AB - Examination of embolectomy using the Merci Retrieval System using experimental stroke models demonstrated that aspiration is not adequate to remove larger clots. The effectiveness of filter trapping was examined using the same models. A silicone model of the carotid artery system with model blood clot was incorporated in a laboratory pulsatile flow system. Embolectomy was performed using the Merci Retrieval System. Any clot not evacuated through the balloon guide catheter was trapped with a distal protection filter device developed for cervical stenting. The clot could not be sucked into the guide catheter by the recommended procedures in nine of 15 trials. Trapping failed in only one trial, in which the clot passed through a gap between the edge of the filter orifice and the inner model lumen. A clot was withdrawn to the catheter tip trapped across the edge of the orifice frame in one trial, and a very large clot was trapped across the filter orifice in two trials. Even clots made by the same method showed variation in properties, especially hardness, which may affect the effectiveness of aspiration. The aspiration procedure recommended for the Merci Retrieval System did not remove the large clots formed by embolectomy. The trapping procedure using a filter device without an orifice frame was effective to solve this problem. FAU - Suzuki, Yasuhiro AU - Suzuki Y AD - Department of Radiology, Section of Interventional Neuroradiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. CQX05344@nifty.com FAU - Fujitsuka, Mitsuyuki AU - Fujitsuka M FAU - Chaloupka, John C AU - Chaloupka JC LA - eng PT - Journal Article PL - Japan TA - Neurol Med Chir (Tokyo) JT - Neurologia medico-chirurgica JID - 0400775 SB - IM MH - Embolectomy/*instrumentation/methods MH - Equipment Design MH - Filtration/instrumentation MH - Humans MH - Intracranial Embolism/*surgery MH - Models, Cardiovascular EDAT- 2007/01/25 09:00 MHDA- 2007/03/17 09:00 CRDT- 2007/01/25 09:00 PHST- 2007/01/25 09:00 [pubmed] PHST- 2007/03/17 09:00 [medline] PHST- 2007/01/25 09:00 [entrez] AID - JST.JSTAGE/nmc/47.11 [pii] AID - 10.2176/nmc.47.11 [doi] PST - ppublish SO - Neurol Med Chir (Tokyo). 2007 Jan;47(1):11-7. doi: 10.2176/nmc.47.11. PMID- 21479799 OWN - NLM STAT- MEDLINE DCOM- 20120810 LR - 20161125 IS - 0942-0940 (Electronic) IS - 0001-6268 (Linking) VI - 153 IP - 8 DP - 2011 Aug TI - A retrieval thrombectomy technique with the Solitaire stent in a large cerebral artery occlusion. PG - 1625-31 LID - 10.1007/s00701-011-0999-0 [doi] AB - BACKGROUND: To describe preliminary experiences and the procedural details of retrieval thrombectomy using a self-expanding and fully retrievable Solitaire stent (ev 3 Inc., CA, USA) in acute ischemic stroke (AIS) patients with large artery occlusions. METHODS: Eight patients with AIS were treated by mechanical thrombectomy using a self-expanding, fully retrievable stent (Solitaire, ev 3 Inc., CA, USA). The stent was deployed to cover the whole intra-arterial clot and then it was slowly retrieved while occluding the internal cerebral artery (ICA) with a balloon guiding catheter. Additionally, continuous negative pressure was applied through the balloon guiding catheter with a specially designed gun device. Occlusion sites were M1 in six cases including one combined supraclinoid ICA occlusion and the other combined M2 occlusion, M2 in 1 case and one basilar artery top. RESULTS: Complete recanalization was achieved in all patients. Procedure time was 45 min or less in seven cases and 70 min in one case. Distal emboli occurred in one case in which the balloon guide catheter was not used. Only in this case was intraarterial fibrinolytics infusion necessary. There was no post-operative intracranial hemorrhage. CONCLUSIONS: In our experience, retrieval thrombectomy with the Solitaire stent was a simple and effective method for reopening large cerebral arteries in AIS patients. FAU - Park, Hyun AU - Park H AD - Department of Neurosurgery, Jeju National University School of Medicine, Jeju National University Hospital, Ara-1-dong, Jeju-Si, Jeju Self-Governing Province 690-716, Korea. FAU - Hwang, Gyo Jun AU - Hwang GJ FAU - Jin, Sung-Chul AU - Jin SC FAU - Jung, Cheol-Kyu AU - Jung CK FAU - Bang, Jae Seung AU - Bang JS FAU - Han, Moon Ku AU - Han MK FAU - Bae, Hee Jun AU - Bae HJ FAU - Choe, Ghee Young AU - Choe GY FAU - Oh, Chang Wan AU - Oh CW FAU - Kwon, O-Ki AU - Kwon OK LA - eng PT - Case Reports PT - Journal Article DEP - 20110410 PL - Austria TA - Acta Neurochir (Wien) JT - Acta neurochirurgica JID - 0151000 SB - IM MH - Aged MH - Aged, 80 and over MH - Blood Vessel Prosthesis Implantation/instrumentation/methods MH - Catheterization/instrumentation/methods MH - Cerebral Revascularization/instrumentation/methods MH - Female MH - Humans MH - Intracranial Thrombosis/diagnostic imaging/pathology/*therapy MH - Male MH - Radiography MH - Stents/*standards MH - Thrombectomy/*instrumentation/*methods MH - Treatment Outcome EDAT- 2011/04/12 06:00 MHDA- 2012/08/11 06:00 CRDT- 2011/04/12 06:00 PHST- 2011/01/11 00:00 [received] PHST- 2011/03/14 00:00 [accepted] PHST- 2011/04/12 06:00 [entrez] PHST- 2011/04/12 06:00 [pubmed] PHST- 2012/08/11 06:00 [medline] AID - 10.1007/s00701-011-0999-0 [doi] PST - ppublish SO - Acta Neurochir (Wien). 2011 Aug;153(8):1625-31. doi: 10.1007/s00701-011-0999-0. Epub 2011 Apr 10. PMID- 31295596 OWN - NLM STAT- MEDLINE DCOM- 20200123 LR - 20200123 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 130 DP - 2019 Oct TI - Transarterial Embolization of Dural Arteriovenous Fistula in Superior Sagittal Sinus Under Bilateral External Carotid Artery Flow Control: Technical Note. PG - 227-230 LID - S1878-8750(19)31908-4 [pii] LID - 10.1016/j.wneu.2019.07.012 [doi] AB - BACKGROUND: Transarterial embolization (TAE) using liquid embolic material is a standard treatment for non-sinus-type dural arteriovenous fistula (DAVF). However, to reach embolic material over a shunt point for complete obliteration of DAVF is often difficult. We present a technical case report of the efficacy of bilateral external carotid artery (ECA) flow control for the TAE of superior sagittal sinus DAVF. CASE DESCRIPTION: A 64-year-old man presented with dizziness and left hemiparesis. Computed tomography imaging showed right parietal subcortical hemorrhage, and cerebral angiography revealed a DAVF in the superior sagittal sinus fed by bilateral occipital artery, bilateral superficial temporal artery and bilateral middle meningeal artery (MMA), with cortical venous reflux and without connection to the superior sagittal sinus. We therefore planned TAE using glue via MMA under bilateral ECA flow control. A 7-Fr balloon guide catheter was positioned in the bilateral ECA origins, and a microcatheter was introduced distal to the MMA. Heated 20% n-butyl-2-cyanoacrylate was slowly injected via the left MMA under bilateral ECA origin flow control. The n-butyl-2-cyanoacrylate reached the shunt point and obliterated the shunt in a single session. The patient was discharged without neurological symptoms. CONCLUSIONS: Bilateral ECA flow control using balloon guide catheter is safe and effective for a DAVF in the superior sagittal sinus with multiple and tortuous scalp feeders. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Kotsugi, Masashi AU - Kotsugi M AD - Department of Neurosurgery, Nara Medical University, Nara, Japan. FAU - Nakagawa, Ichiro AU - Nakagawa I AD - Department of Neurosurgery, Nara Medical University, Nara, Japan. Electronic address: nakagawa@naramed-u.ac.jp. FAU - Takamura, Yoshiaki AU - Takamura Y AD - Department of Neurosurgery, Nara Medical University, Nara, Japan. FAU - Wada, Takeshi AU - Wada T AD - Department of Radiology, Nara Medical University, Nara, Japan. FAU - Kichikawa, Kimihiko AU - Kichikawa K AD - Department of Radiology, Nara Medical University, Nara, Japan. FAU - Nakase, Hiroyuki AU - Nakase H AD - Department of Neurosurgery, Nara Medical University, Nara, Japan. LA - eng PT - Case Reports PT - Journal Article DEP - 20190708 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 SB - IM MH - Carotid Artery, External/*surgery MH - Central Nervous System Vascular Malformations/diagnosis/*surgery MH - Cerebral Angiography/methods MH - Dura Mater/blood supply/*surgery MH - Embolization, Therapeutic/methods MH - Humans MH - Male MH - Middle Aged MH - Superior Sagittal Sinus/*surgery MH - *Vascular Surgical Procedures OTO - NOTNLM OT - Balloon OT - Fistula OT - Liquid embolic material EDAT- 2019/07/12 06:00 MHDA- 2020/01/24 06:00 CRDT- 2019/07/12 06:00 PHST- 2019/06/03 00:00 [received] PHST- 2019/06/29 00:00 [revised] PHST- 2019/07/01 00:00 [accepted] PHST- 2019/07/12 06:00 [pubmed] PHST- 2020/01/24 06:00 [medline] PHST- 2019/07/12 06:00 [entrez] AID - S1878-8750(19)31908-4 [pii] AID - 10.1016/j.wneu.2019.07.012 [doi] PST - ppublish SO - World Neurosurg. 2019 Oct;130:227-230. doi: 10.1016/j.wneu.2019.07.012. Epub 2019 Jul 8. PMID- 23124642 OWN - NLM STAT- MEDLINE DCOM- 20131104 LR - 20161125 IS - 1936-959X (Electronic) IS - 0195-6108 (Linking) VI - 34 IP - 5 DP - 2013 May TI - Treatment of acute vertebrobasilar occlusion using thrombectomy with stent retrievers: initial experience with 18 patients. PG - 1044-8 LID - 10.3174/ajnr.A3329 [doi] AB - BACKGROUND AND PURPOSE: Acute vertebrobasilar occlusion is an ominous disease with few proved effective treatments. Experience with stent retrievers is scarce and limited to combined therapies (stent retrievers associated with previous intravenous fibrinolysis, intra-arterial thrombolysis, or other mechanical devices). We present our experience with 18 patients treated with direct thrombectomy by using stent retrievers. MATERIALS AND METHODS: Eighteen patients with vertebrobasilar occlusion were treated with direct thrombectomy by using stent retrievers at our hospital. The mean age was 67.5 years. Clinical presentation was sudden deterioration in consciousness level in 61.2% and progressive or fluctuating brain stem symptoms in 38.8%. Stroke subtype (TOAST) was atherothrombotic (33.3%), undetermined (33.3%), cardioembolic (27.7%), and of unusual etiology (5.5%). RESULTS: The occlusion site was the vertebral artery in 1 case, proximal basilar artery in 4, middle basilar artery in 6, distal basilar artery in 5, and unilateral posterior cerebral artery in 2 cases. SRs included the Solitaire AB in 8 cases, Solitaire FR in 5 cases, and Trevo Pro in 5 cases. An 8F Merci balloon guide catheter was used in 15 patients, and a Neuron 6F, in 3 patients. Post-clot retrieval definitive intracranial stents were used in 5 patients (27.7%). Postprocedural TICI ≥ 2b was achieved in 17 patients (94.4%). Clinically, 72.2% of patients experienced an improved NIHSS score at discharge, 22.2% died, and in 5.5% the NIHSS scores did not change. The mRS score at 3 months was 0-2 in 9 patients (50%) and 3-5 in 5 patients (27.7%). CONCLUSIONS: Thrombectomy with stent retrievers is feasible in the treatment of vertebrobasilar occlusion. These initial results must be confirmed by further prospective studies with a larger number of cases. FAU - Espinosa de Rueda, M AU - Espinosa de Rueda M AD - Department of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. mm.espinosa@gmail.com FAU - Parrilla, G AU - Parrilla G FAU - Zamarro, J AU - Zamarro J FAU - García-Villalba, B AU - García-Villalba B FAU - Hernández, F AU - Hernández F FAU - Moreno, A AU - Moreno A LA - eng PT - Clinical Trial PT - Journal Article DEP - 20121101 PL - United States TA - AJNR Am J Neuroradiol JT - AJNR. American journal of neuroradiology JID - 8003708 SB - IM MH - Acute Disease MH - Aged MH - *Blood Vessel Prosthesis MH - Device Removal/*instrumentation MH - Female MH - Humans MH - Male MH - Pilot Projects MH - *Stents MH - Thrombectomy/*instrumentation MH - Tomography, X-Ray Computed MH - Treatment Outcome MH - Vertebrobasilar Insufficiency/*diagnostic imaging/*surgery EDAT- 2012/11/06 06:00 MHDA- 2013/11/05 06:00 CRDT- 2012/11/06 06:00 PHST- 2012/11/06 06:00 [entrez] PHST- 2012/11/06 06:00 [pubmed] PHST- 2013/11/05 06:00 [medline] AID - ajnr.A3329 [pii] AID - 10.3174/ajnr.A3329 [doi] PST - ppublish SO - AJNR Am J Neuroradiol. 2013 May;34(5):1044-8. doi: 10.3174/ajnr.A3329. Epub 2012 Nov 1. PMID- 32419724 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200522 IS - 0739-9529 (Print) IS - 1098-8963 (Electronic) IS - 0739-9529 (Linking) VI - 37 IP - 2 DP - 2020 Jun TI - Evolution of Stroke Thrombectomy Techniques to Optimize First-Pass Complete Reperfusion. PG - 119-131 LID - 10.1055/s-0040-1709153 [doi] AB - Since 2015, endovascular therapy (EVT) has become the standard of care for acute ischemic stroke (AIS) due to large vessel occlusion. It is a safe and highly effective treatment, and its number needed to treat of 2.6 is one of the highest throughout medicine. The ultimate goal when performing EVT is to maximize chances of good outcome through achievement of fast first-pass complete reperfusion, as incomplete and delayed reperfusion increases complication rates and negatively affects outcome. Since EVT has been established as standard of care, new devices have been developed and treatment techniques have been refined. This review provides a brief overview about the rationale for and history of EVT, followed by a detailed step-by-step description of how to perform EVT using the BADDASS (BAlloon guide with large bore Distal access catheter with Dual Aspiration with Stent-retriever as Standard approach), a combined technique, which is in our opinion the safest and most effective way to achieve fast first-pass complete reperfusion. We also discuss treatment strategies for patients with simultaneous high-grade carotid stenosis/pseudoocclusion/occlusion and gaining carotid access in challenging arch anatomy, as these are commonly encountered situations in AIS, and conclude with an outlook on new technologies and future directions of EVT. CI - © Thieme Medical Publishers. FAU - Ospel, Johanna Maria AU - Ospel JM AD - Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland. AD - Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. FAU - McTaggart, Ryan AU - McTaggart R AD - Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. FAU - Kashani, Nima AU - Kashani N AD - Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. AD - Department of Radiology, University of Calgary, Calgary, Canada. FAU - Psychogios, Marios AU - Psychogios M AD - Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland. FAU - Almekhlafi, Mohammed AU - Almekhlafi M AD - Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. AD - Department of Radiology, University of Calgary, Calgary, Canada. FAU - Goyal, Mayank AU - Goyal M AD - Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. AD - Department of Radiology, University of Calgary, Calgary, Canada. LA - eng PT - Journal Article PT - Review DEP - 20200514 TA - Semin Intervent Radiol JT - Seminars in interventional radiology JID - 8510974 PMC - PMC7224978 OTO - NOTNLM OT - aspiration OT - balloon guide catheter OT - endovascular therapy OT - interventional radiology OT - ischemic stroke OT - mechanical thrombectomy OT - reperfusion COIS- Conflict of Interest None. EDAT- 2020/05/19 06:00 MHDA- 2020/05/19 06:01 PMCR- 2021/06/01 CRDT- 2020/05/19 06:00 PHST- 2021/06/01 00:00 [pmc-release] PHST- 2020/05/19 06:00 [entrez] PHST- 2020/05/19 06:00 [pubmed] PHST- 2020/05/19 06:01 [medline] AID - 001188 [pii] AID - 10.1055/s-0040-1709153 [doi] PST - ppublish SO - Semin Intervent Radiol. 2020 Jun;37(2):119-131. doi: 10.1055/s-0040-1709153. Epub 2020 May 14. PMID- 27076599 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20161230 IS - 1524-4539 (Electronic) IS - 0009-7322 (Linking) VI - 133 IP - 23 DP - 2016 Jun 7 TI - Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial. PG - 2279-86 LID - 10.1161/CIRCULATIONAHA.115.019983 [doi] AB - BACKGROUND: The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial used innovative imaging and aggressive target time metrics to demonstrate the benefit of endovascular treatment in patients with acute ischemic stroke. We analyze the impact of time on clinical outcome and the effect of patient, hospital, and health system characteristics on workflow within the trial. METHODS AND RESULTS: Relationship between outcome (modified Rankin Scale) and interval times was modeled by using logistic regression. Association between time intervals (stroke onset to arrival in endovascular-capable hospital, to qualifying computed tomography, to groin puncture, and to reperfusion) and patient, hospital, and health system characteristics were modeled by using negative binomial regression. Every 30-minute increase in computed tomography-to-reperfusion time reduced the probability of achieving a functionally independent outcome (90-day modified Rankin Scale 0-2) by 8.3% (P=0.006). Symptom onset-to-imaging time was not associated with outcome (P>0.05). Onset-to-endovascular hospital arrival time was 42% (34 minutes) longer among patients receiving intravenous alteplase at the referring hospital (drip and ship) versus direct transfer (mothership). Computed tomography-to-groin puncture time was 15% (8 minutes) shorter among patients presenting during work hours versus off hours, 41% (24 minutes) shorter in drip-ship patients versus mothership, and 43% (22 minutes) longer when general anesthesia was administered. The use of a balloon guide catheter during endovascular procedures shortened puncture-to-reperfusion time by 21% (8 minutes). CONCLUSIONS: Imaging-to-reperfusion time is a significant predictor of outcome in the ESCAPE trial. Inefficiencies in triaging, off-hour presentation, intravenous alteplase administration, use of general anesthesia, and endovascular techniques offer major opportunities for improvement in workflow. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335. CI - © 2016 American Heart Association, Inc. FAU - Menon, Bijoy K AU - Menon BK AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Sajobi, Tolulope T AU - Sajobi TT AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Zhang, Yukun AU - Zhang Y AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Rempel, Jeremy L AU - Rempel JL AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Shuaib, Ashfaq AU - Shuaib A AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Thornton, John AU - Thornton J AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Williams, David AU - Williams D AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Roy, Daniel AU - Roy D AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Poppe, Alexandre Y AU - Poppe AY AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Jovin, Tudor G AU - Jovin TG AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Sapkota, Biggya AU - Sapkota B AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Baxter, Blaise W AU - Baxter BW AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Krings, Timo AU - Krings T AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Silver, Frank L AU - Silver FL AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Frei, Donald F AU - Frei DF AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Fanale, Christopher AU - Fanale C AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Tampieri, Donatella AU - Tampieri D AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Teitelbaum, Jeanne AU - Teitelbaum J AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Lum, Cheemun AU - Lum C AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Dowlatshahi, Dar AU - Dowlatshahi D AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Eesa, Muneer AU - Eesa M AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Lowerison, Mark W AU - Lowerison MW AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Kamal, Noreen R AU - Kamal NR AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Demchuk, Andrew M AU - Demchuk AM AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Hill, Michael D AU - Hill MD AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). FAU - Goyal, Mayank AU - Goyal M AD - From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments of Radiology (D.R.) and Neurosciences (A.Y.P.), University of Montreal, Canada; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Acute Stroke Services, University of Tennessee, Chattanooga (B.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology (T.K.) andDivision of Neurology, Department of Medicine (F.L.S.), Toronto Western Hospital, Canada; Colorado Neurological Institute, Engelwood, CO (D.F.F., C.F.); Montreal Neurological Institute, Canada (D.T., J.T.); Departments of Radiology (C.L.) and Neurology (D.D.), University of Ottawa, Canada; Clinical Research Unit, University of Calgary, Canada (M.W.L.); and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., T.T.S., M.E., A.M.D., M.D.H., M.G.). mgoyal@ucalgary.ca. LA - eng SI - ClinicalTrials.gov/NCT01778335 GR - CIHR/Canada PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20160413 PL - United States TA - Circulation JT - Circulation JID - 0147763 RN - 0 (Fibrinolytic Agents) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - AIM SB - IM CIN - Circulation. 2016 Nov 8;134(19):e404-e405. PMID: 27821425 CIN - Circulation. 2016 Nov 8;134(19):e406-e407. PMID: 27821426 MH - Administration, Intravenous MH - After-Hours Care MH - Anesthesia, General MH - Brain Ischemia/diagnostic imaging/mortality/*therapy MH - Cerebral Angiography/methods MH - Computed Tomography Angiography MH - Disability Evaluation MH - *Endovascular Procedures/adverse effects/mortality MH - Fibrinolytic Agents/administration & dosage MH - Humans MH - Predictive Value of Tests MH - Punctures MH - Risk Factors MH - Stroke/diagnostic imaging/*mortality/*therapy MH - *Thrombectomy/adverse effects/mortality MH - *Thrombolytic Therapy/adverse effects/mortality MH - Time Factors MH - *Time and Motion Studies MH - *Time-to-Treatment MH - Tissue Plasminogen Activator/administration & dosage MH - Treatment Outcome MH - Triage MH - *Workflow OTO - NOTNLM OT - cerebrovascular disorders OT - emergency treatment OT - endovascular procedures OT - stroke OT - thrombolytic therapy EDAT- 2016/04/15 06:00 MHDA- 2016/12/15 06:00 CRDT- 2016/04/15 06:00 PHST- 2015/10/18 00:00 [received] PHST- 2016/04/08 00:00 [accepted] PHST- 2016/04/15 06:00 [entrez] PHST- 2016/04/15 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - CIRCULATIONAHA.115.019983 [pii] AID - 10.1161/CIRCULATIONAHA.115.019983 [doi] PST - ppublish SO - Circulation. 2016 Jun 7;133(23):2279-86. doi: 10.1161/CIRCULATIONAHA.115.019983. Epub 2016 Apr 13. PMID- 31900353 OWN - NLM STAT- Publisher LR - 20200104 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) DP - 2020 Jan 3 TI - Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation. LID - neurintsurg-2019-015595 [pii] LID - 10.1136/neurintsurg-2019-015595 [doi] AB - ​ BACKGROUND: Calcified cerebral emboli (CCEs) are a rare cause of acute ischemic stroke (AIS) and are frequently associated with poor outcomes. The presence of dense calcified material enables reliable identification of CCEs using non-contrast CT. However, recanalization rates with the available mechanical thrombectomy (MT) devices remain low. OBJECTIVE: To recreate a large vessel occlusion involving a CCE using an in vitro silicone model of the intracranial vessels and to demonstrate the feasability of this model to test different endovascular strategies to recanalize an occlusion of the M1 segment of the middle cerebral artery (MCA).​ METHODS: An in vitro model was developed to evaluate different endovascular treatment approaches using contemporary devices in the M1 segment of the MCA. The in vitro model consisted of a CCE analog placed in a silicone neurovascular model. Development of an appropriate CCE analog was based on characterization of human calcified tissues that represent likely sources of CCEs. Feasibility of the model was demonstrated in a small number of MT devices using four common procedural techniques.​ RESULTS: CCE analogs were developed with similar mechanical behavior to that of ex vivo calcified material. The in vitro model was evaluated with various MT techniques and devices to show feasibility of the model. In this limited evaluation, the most successful retrieval approach was performed with a stent retriever combined with local aspiration through a distal access catheter, and importantly, with flow arrest and dual aspiration using a balloon guide catheter.​ CONCLUSION: Characterization of calcified tissues, which are likely sources of CCEs, has shown that CCEs are considerably stiffer than thrombus. This highlights the need for a different in vitro AIS model for CCEs than those used for thromboemboli. Consequentially, an in vitro AIS model representative of a CCE occlusion in the M1 segment of the MCA has been developed. CI - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Johnson, Sarah AU - Johnson S AUID- ORCID: 0000-0002-2372-1236 AD - Biomedical Engineering, National University of Ireland Galway, Galway, Ireland. FAU - McCarthy, Ray AU - McCarthy R AD - Cerenovus, Galway Neuro Technology Centre, Galway, Ireland. FAU - Fahy, Brian AU - Fahy B AD - Cerenovus, Galway Neuro Technology Centre, Galway, Ireland. FAU - Mereuta, Oana Madalina AU - Mereuta OM AD - Department of Physiology, National University of Ireland Galway, Galway, Ireland. FAU - Fitzgerald, Seán AU - Fitzgerald S AUID- ORCID: 0000-0001-6634-092X AD - Department of Physiology, National University of Ireland Galway, Galway, Ireland. FAU - Gaudirc, Julien AU - Gaudirc J AD - Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Paris, France. FAU - Remadi, Jean-Paul AU - Remadi JP AD - Department of Cardiac Surgery, Amiens University Hospital, Amiens, France. FAU - Shotar, Eimad AU - Shotar E AD - Department of Neuroradiology, Pitie-Salpetriere Hospital, Paris, France. FAU - Sourour, Nader-Antoine AU - Sourour NA AD - Department of Neuroradiology, Pitie-Salpetriere Hospital, Paris, France. FAU - Doyle, Karen AU - Doyle K AD - Department of Physiology, National University of Ireland Galway, Galway, Ireland. FAU - Gilvarry, Michael AU - Gilvarry M AD - Cerenovus, Galway Neuro Technology Centre, Galway, Ireland. FAU - McGarry, Patrick AU - McGarry P AD - Biomedical Engineering, National University of Ireland Galway, Galway, Ireland. FAU - McHugh, Peter E AU - McHugh PE AD - Biomedical Engineering, National University of Ireland Galway, Galway, Ireland. FAU - Clarençon, Frédéric AU - Clarençon F AD - Department of Neuroradiology, Pitie-Salpetriere Hospital, Paris, France fredclare5@gmail.com. AD - Sorbonne University, Paris, France. LA - eng PT - Journal Article DEP - 20200103 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM OTO - NOTNLM OT - device OT - embolic OT - stroke OT - thrombectomy COIS- Competing interests: SJ reports grants from the Irish Research Council and the NUI Galway Hardiman Research Scholarship during the conduct of the study, and reports financial support from Cerenovus, outside the submitted work. RM and MG report a financial relationship with Cerenovus outside the submitted work. EDAT- 2020/01/05 06:00 MHDA- 2020/01/05 06:00 CRDT- 2020/01/05 06:00 PHST- 2019/11/04 00:00 [received] PHST- 2019/12/12 00:00 [revised] PHST- 2019/12/15 00:00 [accepted] PHST- 2020/01/05 06:00 [entrez] PHST- 2020/01/05 06:00 [pubmed] PHST- 2020/01/05 06:00 [medline] AID - neurintsurg-2019-015595 [pii] AID - 10.1136/neurintsurg-2019-015595 [doi] PST - aheadofprint SO - J Neurointerv Surg. 2020 Jan 3:neurintsurg-2019-015595. doi: 10.1136/neurintsurg-2019-015595. PMID- 32132966 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200308 IS - 1664-2295 (Print) IS - 1664-2295 (Electronic) IS - 1664-2295 (Linking) VI - 11 DP - 2020 TI - First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis. PG - 83 LID - 10.3389/fneur.2020.00083 [doi] LID - 83 AB - Background and Objective: The first pass effect (FPE; achieving complete recanalization with a single thrombectomy device pass) has been shown to be associated with higher rates of good clinical outcomes in patients with acute ischemic stroke. Here, we investigate clinical and radiographic factors associated with FPE in a large U.S. post-marketing registry (TRACK, Trevo Stent-Retriever Acute Stroke). Methods: We analyzed the TRACK database (multicenter registry of 634 patients from 23 centers from March 2013 through August 2015), which 609 patients were included in the final analysis. FPE was defined as a single pass/use of device, TICI 2c/3 recanalization, and no use of rescue therapy. Analysis of individual patient data from TRACK were performed to analyze clinical and radiographic characteristics associated with FPE as well-compared clinical outcomes defined as modified Rankin Scale (mRS) score at 30 and 90 days from hospital discharge to the non-FPE group. Results: The rate of FPE in TRACK was 23% (140/609). There was no association between patient demographics and FPE, including age (p = 0.36), sex (p = 0.50), race (p = 0.50), location of occlusion (p = 0.26), baseline NIHSS (p = 0.62), or past medical history. There was no difference in the use of a balloon-guide catheter or general anesthesia (49 and 57% with FPE vs. 47 and 64%, p = 0.63 and p = 0.14, respectively). Clinical outcomes were significantly associated with FPE; 63 vs. 44% in non-FPE patients achieved mRS 0-2 at 90 days (p = 0.0004). Conclusion: Our study showed that achieving complete recanalization with a single thrombectomy pass using the Trevo device was highly beneficial. The most common clinical factors that are used to determine eligibility for endovascular therapy, such as NIHSS severity, location of occlusion or patient age were not predictive of the ability to achieve FPE. CI - Copyright © 2020 Mokin, Primiani, Castonguay, Nogueira, Haussen, English, Satti, Chen, Farid, Borders, Veznedaroglu, Binning, Puri, Vora, Budzik, Dabus, Linfante, Janardhan, Alshekhlee, Abraham, Edgell, Taqi, Khoury, Majjhoo, Kabbani, Froehler, Finch, Ansari, Novakovic, Nguyen and Zaidat. FAU - Mokin, Maxim AU - Mokin M AD - Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States. FAU - Primiani, Christopher T AU - Primiani CT AD - Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States. FAU - Castonguay, Alicia C AU - Castonguay AC AD - Department of Neurology, University of Toledo, Toledo, OH, United States. FAU - Nogueira, Raul G AU - Nogueira RG AD - Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States. FAU - Haussen, Diogo C AU - Haussen DC AD - Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States. FAU - English, Joey D AU - English JD AD - Department of Neurology, California Pacific Medical Center, San Francisco, CA, United States. FAU - Satti, Sudhakar R AU - Satti SR AD - Department of Neurointerventional Surgery, Christiana Care Health Center, Newark, DE, United States. FAU - Chen, Jennifer AU - Chen J AD - Department of Radiology, Sidney Kimmel Medical College, Philadelphia, PA, United States. FAU - Farid, Hamed AU - Farid H AD - Department of Neurointerventional Radiology, St. Jude Medical Center, Fullerton, CA, United States. FAU - Borders, Candace AU - Borders C AD - Department of Neurosurgery, Irvine School of Medicine, University of California, Irvine, Irvine, CA, United States. FAU - Veznedaroglu, Erol AU - Veznedaroglu E AD - Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, United States. FAU - Binning, Mandy J AU - Binning MJ AD - Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, United States. FAU - Puri, Ajit AU - Puri A AD - Department of Radiology, University of Massachusetts Medical School, Worcester, MA, United States. FAU - Vora, Nirav A AU - Vora NA AD - Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, OH, United States. FAU - Budzik, Ron F AU - Budzik RF AD - Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, OH, United States. FAU - Dabus, Guilherme AU - Dabus G AD - Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL, United States. FAU - Linfante, Italo AU - Linfante I AD - Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL, United States. FAU - Janardhan, Vallabh AU - Janardhan V AD - Comprehensive Stroke Program and Neurointerventional, Texas Stroke Institute, Plano, TX, United States. FAU - Alshekhlee, Amer AU - Alshekhlee A AD - Department of Vascular and Interventional Neurology, DePaul Stroke Center-SSM Neuroscience Institutes, St. Louis, MO, United States. FAU - Abraham, Michael G AU - Abraham MG AD - Neurology and Interventional Radiology, University of Kansas Medical Center, Kansas City, KS, United States. FAU - Edgell, Randall AU - Edgell R AD - Department of Neurology, St. Louis University, St. Louis, MO, United States. FAU - Taqi, Muhammad Asif AU - Taqi MA AD - Department of Neurology and Neurosurgery, Los Robles Hospital and Medical Center, Thousand Oaks, CA, United States. FAU - Khoury, Ramy El AU - Khoury RE AD - Department of Neurology, Tulane University, New Orleans, LA, United States. FAU - Majjhoo, Aniel Q AU - Majjhoo AQ AD - Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States. FAU - Kabbani, Mouhammed R AU - Kabbani MR AD - Department of Neurosurgery, Gundersen Health System, La Crosse, WI, United States. FAU - Froehler, Michael T AU - Froehler MT AD - Department of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN, United States. FAU - Finch, Ira AU - Finch I AD - Interventional Radiology, John Muir Health, Walnut Creek, CA, United States. FAU - Ansari, Sameer A AU - Ansari SA AD - Department of Radiology, Neurology, and Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. FAU - Novakovic, Roberta AU - Novakovic R AD - Department of Radiology, Neurology, and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, United States. FAU - Nguyen, Thanh N AU - Nguyen TN AD - Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, United States. FAU - Zaidat, Osama O AU - Zaidat OO AD - Department of Endovascular Neurosurgery and Stroke, St. Vincent Mercy Medical Center, Toledo, OH, United States. LA - eng PT - Journal Article DEP - 20200218 TA - Front Neurol JT - Frontiers in neurology JID - 101546899 PMC - PMC7040359 OTO - NOTNLM OT - Ischemia—reperfusion OT - brain OT - endovascualar treatment OT - stroke OT - thrombectomy EDAT- 2020/03/07 06:00 MHDA- 2020/03/07 06:01 CRDT- 2020/03/06 06:00 PHST- 2019/11/26 00:00 [received] PHST- 2020/01/23 00:00 [accepted] PHST- 2020/03/06 06:00 [entrez] PHST- 2020/03/07 06:00 [pubmed] PHST- 2020/03/07 06:01 [medline] AID - 10.3389/fneur.2020.00083 [doi] PST - epublish SO - Front Neurol. 2020 Feb 18;11:83. doi: 10.3389/fneur.2020.00083. eCollection 2020. PMID- 17621010 OWN - NLM STAT- MEDLINE DCOM- 20070807 LR - 20070710 IS - 1524-4040 (Electronic) IS - 0148-396X (Linking) VI - 61 IP - 1 DP - 2007 Jul TI - Recanalization of a symptomatic extracranial internal carotid artery near occlusion with proximal and distal protection: technical case report. PG - E174; discussion E174 AB - OBJECTIVE: To describe a novel approach to recanalizing symptomatic extracranial internal carotid artery near occlusion using proximal and distal emboli protection devices. METHODS: Patients presenting with symptomatic extracranial internal carotid artery near occlusion who underwent endovascular recanalization between October 2004 and July 2005 were included in this study. During these procedures, a 9-French Concentric Balloon Guide Catheter (Concentric Medical, Mountain View, CA) was advanced into the common carotid artery proximal to the site of occlusion. During the prestent angioplasty of the lesion, the proximal balloon was inflated and aspiration was performed. After initial angioplasty and before stent placement, a distal filter protection device was placed in the distal internal carotid artery. Stent placement and repeat angioplasty were performed with both protection devices active. All patients were placed on dual antiplatelet therapy. RESULTS: There were four patients treated with a mean age of 74 years; three of these four patients were men. All patients had signs of ischemia and carotid occlusion or near occlusion on noninvasive imaging. Three right internal carotid arteries were treated. All patients were successfully recanalized. No procedurally related complications or deaths occurred. CONCLUSION: This series demonstrates the feasibility of recanalization of symptomatic carotid artery occlusion or near occlusion using proximal and distal emboli protection devices. Such an approach may provide an added level of safety during carotid recanalization procedures. FAU - Edgell, Randall C AU - Edgell RC AD - Division of Neurosurgery, Neuroendovascular Section, Albany Medical Center, Albany, New York 12208, USA. FAU - Yavagal, Dileep R AU - Yavagal DR FAU - Agner, Celso AU - Agner C FAU - Adamo, Matthew AU - Adamo M FAU - Boulos, Alan S AU - Boulos AS LA - eng PT - Journal Article PL - United States TA - Neurosurgery JT - Neurosurgery JID - 7802914 SB - IM MH - Aged MH - Aged, 80 and over MH - Carotid Artery, Internal/*surgery MH - Carotid Stenosis/*surgery MH - Cerebral Revascularization/*methods MH - Humans MH - Male MH - Treatment Outcome EDAT- 2007/07/11 09:00 MHDA- 2007/08/08 09:00 CRDT- 2007/07/11 09:00 PHST- 2007/07/11 09:00 [pubmed] PHST- 2007/08/08 09:00 [medline] PHST- 2007/07/11 09:00 [entrez] AID - 00006123-200707000-00024 [pii] AID - 10.1227/01.neu.0000279742.38178.f6 [doi] PST - ppublish SO - Neurosurgery. 2007 Jul;61(1):E174; discussion E174. doi: 10.1227/01.neu.0000279742.38178.f6. PMID- 23835465 OWN - NLM STAT- MEDLINE DCOM- 20140408 LR - 20161125 IS - 1532-2653 (Electronic) IS - 0967-5868 (Linking) VI - 20 IP - 9 DP - 2013 Sep TI - Tri-axial system using the Solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy. PG - 1303-5 LID - S0967-5868(13)00060-X [pii] LID - 10.1016/j.jocn.2012.10.037 [doi] AB - The Solitaire-FR (eV3/Covidien, Irvine, CA, USA) retrievable stent (SFR), designed for mechanical thrombectomy in acute ischemic stroke, recently received Food and Drug Administration approval in the USA. Clot retrieval is performed by deploying the SFR through a microcatheter directly into the thrombus, to capture the clot and restore perfusion. In order to perform this maneuver, a balloon guide catheter must be used to apply negative suction and reverse flow within the cervical arteries, thus minimizing the chance of antegrade blood flow dislodging the thrombus from the stent. This technique requires at least an 8-French system that can increase the risk of arterial injury at the access site particularly in older patients with smaller or highly atherosclerotic peripheral arteries, and may provide inadequate aspiration in the vertebrobasilar system where only one vertebral artery is accessed and aspirated. The author describes a technique whereby a 6-French tri-axial system is used to deliver the SFR through a Penumbra Aspiration Microcatheter (Penumbra, Inc., Alameda, CA, USA) to provide intracranial aspiration in close proximity to the stent. CI - Copyright © 2013 Elsevier Ltd. All rights reserved. FAU - Deshaies, Eric M AU - Deshaies EM AD - Department of Neurosurgery, State University of New York Upstate Medical University, 750 E Adams Street, Syracuse, NY 13210, USA. deshaiee@upstate.edu LA - eng PT - Case Reports PT - Journal Article DEP - 20130705 PL - Scotland TA - J Clin Neurosci JT - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JID - 9433352 SB - IM MH - Aged, 80 and over MH - Catheterization/instrumentation/*methods MH - Female MH - Humans MH - Mechanical Thrombolysis/instrumentation/*methods MH - Radiography MH - Stroke/*diagnostic imaging/*surgery OTO - NOTNLM OT - Brain OT - Mechanical thrombectomy OT - Penumbra OT - Solitaire-FR OT - Stroke EDAT- 2013/07/10 06:00 MHDA- 2014/04/09 06:00 CRDT- 2013/07/10 06:00 PHST- 2012/09/27 00:00 [received] PHST- 2012/10/08 00:00 [accepted] PHST- 2013/07/10 06:00 [entrez] PHST- 2013/07/10 06:00 [pubmed] PHST- 2014/04/09 06:00 [medline] AID - S0967-5868(13)00060-X [pii] AID - 10.1016/j.jocn.2012.10.037 [doi] PST - ppublish SO - J Clin Neurosci. 2013 Sep;20(9):1303-5. doi: 10.1016/j.jocn.2012.10.037. Epub 2013 Jul 5. PMID- 30413831 OWN - NLM STAT- In-Process LR - 20200328 IS - 1869-1447 (Electronic) IS - 1869-1439 (Linking) VI - 30 IP - 1 DP - 2020 Mar TI - Further Development of Combined Techniques Using Stent Retrievers, Aspiration Catheters and BGC : The PROTECT(PLUS) Technique. PG - 59-65 LID - 10.1007/s00062-018-0742-9 [doi] AB - PURPOSE: First pass complete (mTICI 3) reperfusion must be regarded as the ultimate goal in mechanical thrombectomy (MT) in patients suffering from an emergent large vessel occlusion (ELVO). With this in mind a technical modification of the previously published PROTECT (PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy) approach, the PROTECT(PLUS) technique was evaluated. Under proximal flow arrest using a balloon guide catheter (BGC), a stent retriever was only partially inserted into a large-bore aspiration catheter. This construction was subsequently retracted as a unit into the BGC with aspiration both at the aspiration catheter and at the BGC. METHODS: A case-control study was performed comparing the PROTECT technique with the PROTECT(PLUS) technique with respect to the technical and procedural parameters. Patients n = 165 (101 PROTECT, 64 PROTECT(PLUS)) with ELVO of either the terminus of the internal carotid artery or the proximal middle cerebral artery were included. RESULTS: Using the PROTECT(PLUS) resulted in a higher rate of first pass complete reperfusions (59.4% vs. 27.7%, p < 0.001) as compared with PROTECT. The PROTECT(PLUS) also led to shorter procedure times (21 min vs. 37 min, p = 0.001) and higher rates of overall complete reperfusion (73.5% vs. 49.5%, p = 0.014) compared to PROTECT. CONCLUSION: The PROTECT(PLUS) technique is a promising technical modification to further optimize endovascular stroke treatment. FAU - Maegerlein, Christian AU - Maegerlein C AUID- ORCID: 0000-0003-4885-7671 AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. christian.maegerlein@tum.de. FAU - Berndt, Maria Teresa AU - Berndt MT AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Mönch, Sebastian AU - Mönch S AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Kreiser, Kornelia AU - Kreiser K AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Boeckh-Behrens, Tobias AU - Boeckh-Behrens T AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Lehm, Manuel AU - Lehm M AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Wunderlich, Silke AU - Wunderlich S AD - Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. FAU - Zimmer, Claus AU - Zimmer C AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Friedrich, Benjamin AU - Friedrich B AD - Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. LA - eng PT - Journal Article DEP - 20181109 PL - Germany TA - Clin Neuroradiol JT - Clinical neuroradiology JID - 101526693 SB - IM OTO - NOTNLM OT - Balloon guide catheter OT - First-pass OT - Mechanical thrombectomy OT - Stroke OT - TICI 3 EDAT- 2018/11/11 06:00 MHDA- 2018/11/11 06:00 CRDT- 2018/11/11 06:00 PHST- 2018/10/10 00:00 [received] PHST- 2018/10/25 00:00 [accepted] PHST- 2018/11/11 06:00 [pubmed] PHST- 2018/11/11 06:00 [medline] PHST- 2018/11/11 06:00 [entrez] AID - 10.1007/s00062-018-0742-9 [pii] AID - 10.1007/s00062-018-0742-9 [doi] PST - ppublish SO - Clin Neuroradiol. 2020 Mar;30(1):59-65. doi: 10.1007/s00062-018-0742-9. Epub 2018 Nov 9. PMID- 32221623 OWN - NLM STAT- Publisher LR - 20200329 IS - 1869-1447 (Electronic) IS - 1869-1439 (Linking) DP - 2020 Mar 27 TI - Carotid Stenting as Definitive Treatment for Free Floating Thrombus-Review of 7 Cases. LID - 10.1007/s00062-020-00898-y [doi] AB - BACKGROUND AND PURPOSE: Free floating thrombus (FFT) is a rare condition. The optimal treatment strategy is yet to be determined although medical management with anticoagulation is the mainstay. This article reports experience of treating FFT with carotid stenting. METHODS: A retrospective analysis of a prospectively maintained database was performed to identify all patients with FFT treated with carotid stenting. For each patient the demographic data, clinical presentation, location of the thrombus, type of stent and use of adjunctive devices, e.g. balloon guide catheters, clinical and radiological follow-up information as well as complications were recorded. RESULTS: A total of 7 patients, 4 female, with mean age of 55.6 ± 14.5 years were identified. The median National Institutes of Health Stroke Scale (NIHSS) was 7 (range 0-13) at presentation. Free floating thrombus was seen on the left in the majority of cases (n = 6, 85.7%). None of the patients had intracranial large vessel occlusion. The FFT was located in the CCA in 2 cases (28.6%) and the proximal ICA in the remaining 5 cases (71.4%). The Wallstent was used in 5 patients and a cGuard stent used in 2 patients. In 1 patient 2 overlapping stents were used but a single stent was used in the remaining patients. In 6 cases a distal filter wire was used and in 2 cases a balloon guide catheter was used as embolic protection. There were no intraoperative complications and no cases of distal clot migration or intracranial large vessel occlusion during the procedure. At last follow-up (n = 7) 6 patients were recorded as modified Rankin Scale (mRS) ≤2 and 1 patient was mRS 3. CONCLUSION: Free floating thrombus of the carotid arteries can be managed with stenting. FAU - Bhogal, P AU - Bhogal P AD - Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK. bhogalweb@aol.com. AD - Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany. bhogalweb@aol.com. FAU - AlMatter, M AU - AlMatter M AD - Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany. FAU - Aguilar Pérez, M AU - Aguilar Pérez M AD - Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany. FAU - Bäzner, H AU - Bäzner H AD - Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany. FAU - Henkes, H AU - Henkes H AD - Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany. AD - Medical Faculty, University Duisburg-Essen, Essen, Germany. FAU - Hellstern, V AU - Hellstern V AD - Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany. LA - eng PT - Journal Article DEP - 20200327 PL - Germany TA - Clin Neuroradiol JT - Clinical neuroradiology JID - 101526693 SB - IM OTO - NOTNLM OT - Atherosclerosis OT - Carotid OT - Carotid stenting OT - Free floating thrombus EDAT- 2020/03/30 06:00 MHDA- 2020/03/30 06:00 CRDT- 2020/03/30 06:00 PHST- 2019/11/25 00:00 [received] PHST- 2020/03/04 00:00 [accepted] PHST- 2020/03/30 06:00 [entrez] PHST- 2020/03/30 06:00 [pubmed] PHST- 2020/03/30 06:00 [medline] AID - 10.1007/s00062-020-00898-y [pii] AID - 10.1007/s00062-020-00898-y [doi] PST - aheadofprint SO - Clin Neuroradiol. 2020 Mar 27. doi: 10.1007/s00062-020-00898-y. PMID- 31959631 OWN - NLM STAT- Publisher LR - 20200121 IS - 1759-8486 (Electronic) IS - 1759-8478 (Linking) DP - 2020 Jan 20 TI - Preclinical evaluation of the ANCD thrombectomy device: safety and efficacy in a swine clot model. LID - neurintsurg-2019-015548 [pii] LID - 10.1136/neurintsurg-2019-015548 [doi] AB - BACKGROUND: The Advanced Thrombectomy System (ANCD) provides a new funnel component designed to reduce clot fragmentation and facilitate retrieval in patients with stroke by locally restricting flow, allowing distal aspiration in combination with a stent retriever (SR). OBJECTIVE: To evaluate the preclinical efficacy and safety of the ANCD in a swine clot model. METHODS: Soft and firm clots were implanted in the lingual and cervical arteries of 11 swine to obtain Thrombolysis in Cerebral Infarction (TICI) 0 blood flow. Mechanical thrombectomy was performed with either a balloon guide catheter+Solitaire 2 stent retriever (BGC+SR, n=13) or ANCD+SR (n=13). TICI flow was evaluated and successful revascularization was defined as TICI 3 (normal perfusion). To characterize safety, a total of 3 passes were performed in each vessel independent of recanalization. Tissues were explanted for histopathological analysis after 3 and 30 days, respectively. RESULTS: First pass reperfusion rates were ANCD+SR: 69% and BGC+SR: 46%. Reperfusion increased after the third pass in both groups (ANCD+SR: 100%, vs BGC+SR: 77%). Recanalization was achieved after an average of 1.4 and 1.9 passes in ANCD+SR and BGC+SR (p=0.095), respectively. Vessel injury was comparable in both groups; endothelial loss at 3 days was the most common injury seen (ANCD+SR: 1.78±1.22; BGC+SR: 2.03±1.20; p=0.73), while other histopathological markers were absent or minimal. Tissues downstream from targeted vessels also showed absence or minimal lesions across both groups. CONCLUSIONS: Results in a swine clot model support the high efficacy of the ANCD+SR without causing clinically significant vessel injury potentially related to the new funnel component. CI - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Sanchez, Sonia AU - Sanchez S AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. FAU - Bailey, Lynn AU - Bailey L AD - CBSET Inc, Lexington, Massachusetts, USA. FAU - Ducore, Rebecca AU - Ducore R AD - CBSET Inc, Lexington, Massachusetts, USA. FAU - Andersson, Tommy AU - Andersson T AD - Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium. AD - Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden. FAU - Nogueira, Raul AU - Nogueira R AD - Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. FAU - Cognard, Christophe AU - Cognard C AD - Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France. FAU - Ribo, Marc AU - Ribo M AD - Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain marcriboj@hotmail.com. AD - Universitat Autònoma de Barcelona. FAU - Villanova, Helena AU - Villanova H AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. AD - Escola Tècnica Superior de Enginyeria Industrial de Barcelona (ETSEIB), Universidad Politécnica de Cataluña, Barcelona, Spain. FAU - Rios, Anna AU - Rios A AD - R&D, Anaconda Biomed, Barcelona, St Cugat del Valles, Spain. FAU - Galve, Iñaki AU - Galve I AD - Anaconda Biomed, Barcelona, Spain. LA - eng PT - Journal Article DEP - 20200120 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM OTO - NOTNLM OT - stroke OT - thrombectomy OT - vessel wall COIS- Competing interests: SS, HV, AR, and IG are employees of Anaconda Biomed. LB and RD are employees of CBSET, a not-for-profit research organization, which received research funding from Anaconda Biomed for the reported work. MR is a shareholder in Anaconda Biomed, consultant for Cerenovus, Medtronic, Stryker, Apta Targets, and Vesalio. TA is clinical consultant for Anaconda, Ablynx, Amnis Therapeutics, Cerenovus/Neuravi, Medtronic, and Rapid Medical. RN: Stryker Neurovascular (DAWN trial principal investigator- no compensation, TREVO Registry Steering Committee – no compensation, Trevo-2 trial principal investigator- modest; consultant - significant); Medtronic (SWIFT Trial Steering Committee - modest; SWIFT-Prime Trial Steering Committee – no compensation; STAR Trial Angiographic Core Lab - significant); Penumbra (3D Separator Trial Executive Committee – no compensation); Cerenovus/ Neuravi (ENDOLOW Trial Principal Investigator, EXCELLENT Registry Principal Investigator, ARISE-2 trial Steering Committee – no compensation, Physician Advisory Board, modest); Phenox (PROST Trial Principal Investigator, Physician Advisory Board, modest); Anaconda (Physician Advisory Board, modest); Genentech (Physician Advisory Board – modest); Biogen (CHARM Trial Steering Committee; Physician Advisory Board – modest). Pharmaceuticals (Physician Advisory Board – modest); Allm Inc. (Physician Advisory Board – no compensation); IschemaView (Speaker, modest); Brainomix (Physician Advisory Board, stock options); Sensome (Research Device Use – no compensation); Viz-AI (Physician Advisory Board, stock options); Philips (Research Software Use – no compensation, Speaker - modest); Corindus Vascular Robotics (Physician Advisory Board, stock options); Vesalio (Physician Advisory Board, stock options); Ceretrieve (Physician Advisory Board, stock options); Astrocyte (Physician Advisory Board, stock options). CC is consultant for Sequent Medical, MicroVention, Stryker and Codman. EDAT- 2020/01/22 06:00 MHDA- 2020/01/22 06:00 CRDT- 2020/01/22 06:00 PHST- 2019/10/26 00:00 [received] PHST- 2019/12/14 00:00 [revised] PHST- 2019/12/22 00:00 [accepted] PHST- 2020/01/22 06:00 [entrez] PHST- 2020/01/22 06:00 [pubmed] PHST- 2020/01/22 06:00 [medline] AID - neurintsurg-2019-015548 [pii] AID - 10.1136/neurintsurg-2019-015548 [doi] PST - aheadofprint SO - J Neurointerv Surg. 2020 Jan 20:neurintsurg-2019-015548. doi: 10.1136/neurintsurg-2019-015548. PMID- 32054612 OWN - NLM STAT- In-Data-Review LR - 20200320 IS - 1936-959X (Electronic) IS - 0195-6108 (Print) IS - 0195-6108 (Linking) VI - 41 IP - 3 DP - 2020 Mar TI - Comparison of Aspiration versus Stent Retriever Thrombectomy as the Preferred Strategy for Patients with Acute Terminal Internal Carotid Artery Occlusion: A Propensity Score Matching Analysis. PG - 469-476 LID - 10.3174/ajnr.A6414 [doi] AB - BACKGROUND AND PURPOSE: There is no consensus on endovascular treatment for terminal ICA. The purpose of this study was to evaluate the comparative safety and efficacy of preferred aspiration thrombectomy and stent retriever thrombectomy for revascularization in patients with isolated terminal ICA occlusion. MATERIALS AND METHODS: We conducted a retrospective analysis of patients with terminal ICA occlusion treated with aspiration thrombectomy or stent retriever thrombectomy in our center, from September 2013 to November 2018. To minimize the case bias, propensity score matching was performed. The primary outcomes were successful reperfusion defined by expanded TICI grades 2b-3 at the end of all endovascular procedures and puncture-to-reperfusion time. RESULTS: A total of 109 consecutive patients with terminal ICA occlusion were divided into the aspiration thrombectomy group (40 patients) and the stent retriever thrombectomy group (69 patients), and 30 patients were included in each group after propensity score matching. The proportion of complete reperfusion was significantly higher in the aspiration thrombectomy group (OR 4.75 [95% CI, 1.10-1.38]; P = .002). The median puncture-to-reperfusion time in the aspiration thrombectomy group was shorter than that in the stent retriever thrombectomy group (38  versus 69 minutes; P = .001). Fewer intracerebral hemorrhage events were recorded in the aspiration thrombectomy group (OR 0.29 [95% CI, 0.09-0.90]; P = .028). No significant differences were observed for good outcomes (OR 1.92 [95% CI, 0.86-4.25]) and mortality (OR 0.84 [95% CI, 0.29-2.44]) at 90 days. CONCLUSIONS: For the treatment of terminal ICA occlusion, aspiration thrombectomy was technically superior to stent retriever thrombectomy in the absence of a balloon guide catheter in achieving successful reperfusion with shorter puncture-to-reperfusion time and procedure-related adverse events. CI - © 2020 by American Journal of Neuroradiology. FAU - Xing, P F AU - Xing PF AUID- ORCID: 0000-0002-2663-1092 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. FAU - Yang, P F AU - Yang PF AUID- ORCID: 0000-0002-6154-3602 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. FAU - Li, Z F AU - Li ZF AUID- ORCID: 0000-0002-9332-3786 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. FAU - Zhang, L AU - Zhang L AUID- ORCID: 0000-0001-5559-6292 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. FAU - Shen, H J AU - Shen HJ AUID- ORCID: 0000-0002-4439-9506 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. FAU - Zhang, Y X AU - Zhang YX AUID- ORCID: 0000-0003-1525-5893 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. FAU - Zhang, Y W AU - Zhang YW AUID- ORCID: 0000-0001-9958-3098 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. FAU - Liu, J M AU - Liu JM AUID- ORCID: 0000-0003-2768-7298 AD - From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China. Liu118@vip.163.com. LA - eng PT - Journal Article DEP - 20200213 TA - AJNR Am J Neuroradiol JT - AJNR. American journal of neuroradiology JID - 8003708 SB - IM PMC - PMC7077898 EDAT- 2020/02/15 06:00 MHDA- 2020/02/15 06:00 PMCR- 2021/03/01 CRDT- 2020/02/15 06:00 PHST- 2019/10/29 00:00 [received] PHST- 2019/12/23 00:00 [accepted] PHST- 2021/03/01 00:00 [pmc-release] PHST- 2020/02/15 06:00 [pubmed] PHST- 2020/02/15 06:00 [medline] PHST- 2020/02/15 06:00 [entrez] AID - ajnr.A6414 [pii] AID - 19-01120 [pii] AID - 10.3174/ajnr.A6414 [doi] PST - ppublish SO - AJNR Am J Neuroradiol. 2020 Mar;41(3):469-476. doi: 10.3174/ajnr.A6414. Epub 2020 Feb 13.