Endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (bridging therapy) for embolic stroke due to cardiac myxoma: a case report / 中华神经科杂志

Myxomas are the most frequent,cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli.The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge.A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple's Hospital of Huizhou.The initial National Institutes of Health Stroke Scale (NIHSS) score was 16.He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset.No intracranial hemorrhage developed.Pathological study of embolus showed a myxoma.A cardiac mass was found in the left atrium and removed surgically three weeks after stroke.Pathological study of the tumor showed a myxoma.At the one-month follow-up after excision of myxoma,the NIHSS score was 1 and the modified Rankin scale score was 0.No recurrence of embolism occurred after surgical resection.Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective,and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.

Endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (bridging therapy) for embolic stroke due to cardiac myxoma: a case report / 中华神经科杂志

Myxomas are the most frequent, cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli. The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge. A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple′s Hospital of Huizhou. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset. No intracranial hemorrhage developed. Pathological study of embolus showed a myxoma. A cardiac mass was found in the left atrium and removed surgically three weeks after stroke. Pathological study of the tumor showed a myxoma. At the one-month follow-up after excision of myxoma, the NIHSS score was 1 and the modified Rankin scale score was 0. No recurrence of embolism occurred after surgical resection. Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective, and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.

Endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (bridging therapy) for embolic stroke due to cardiac myxoma: a case report / 中华神经科杂志

Myxomas are the most frequent, cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli. The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge. A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple′s Hospital of Huizhou. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset. No intracranial hemorrhage developed. Pathological study of embolus showed a myxoma. A cardiac mass was found in the left atrium and removed surgically three weeks after stroke. Pathological study of the tumor showed a myxoma. At the one-month follow-up after excision of myxoma, the NIHSS score was 1 and the modified Rankin scale score was 0. No recurrence of embolism occurred after surgical resection. Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective, and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.

Clinical efficacy of tirofiban combined with a Solitaire stent in treating acute ischemic stroke

This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.

Clinical efficacy of enclovascular thrombectomy in patients with ischemic stroke beyond the time window / 中国脑血管病杂志

Objective To investigate the clinical efficacy of endovascular thrombectomy in patients with acute anterior circulation stroke with large vessel occlusion beyond the time window. Methods From January 2014 to September 2018,182 patients with acute anterior circulation stroke with large vessel occlusion and treated with endovascular thrombectomy in the Department of Neurology of Liuzhou People's Hospital were retrospectively included. Preoperative CT angiography or MR angiography confirmed the presence of internal carotid artery or middle cerebral artery occlusion. According to the symptom onset to puncture (OTP) time, patients were divided into the within time windov group(0TP

Effect analysis of solitaire stent combined with navien aspiration for large vessel occlusion of anterior circulation performed in county comprehensive stroke centers / 中国脑血管病杂志

Objective: To investigate the safety and efficacy of Solitaire stent combined with Navien aspiration for large vessel occlusion of anterior circulation performed in county comprehensive stroke centers. Methods: From March 2018 to December 2018, a total of 17 consecutive patients with large vessel occlusion of anterior circulation and treated with Solitaire stent combined with Navien catheter for mechanical thrombectory in Department of Stroke Center, the First People's Hospital of Taicang were retrospectively recruited. Among the 17 patients, 10 were males and 7 were females. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 8 to 22,with mean score 14 ±4. The occluded arteries included M1 segment of middle cerebral artery in 12 patients, bifurcation of middle cerebral artery in 1 patient and initial part of the internal carotid artery in 4 patients. Four patients were wake-up stroke and 1 patient was in-hospital stroke. The age, gender, onset-to-door time(ODT), door-toneedle time(DNT),door-to-puncture time(DPT), puncture-to-reperfusion time(PRT), changes of NIHSS score at 24 h after operation compared to preoperative baseline,successful recanalization of the Thrombolysis in Cerebral Infarction (TIG) classification 2b-3, operation-related complications and good prognosis of modified Rankin Scale (mRS) score ≤ 2 at day 90 after operation were all documented. Results: Among the 17patients,5 patients were treated with endovascular thrombectomy bridging with intravenous thrombolysis and 12 patients with endovascular thrombectomy alone. The ODT ranged 1. 0 -5. 5 h, with median 3.0 (2. 0,4. 7) h; the DNT ranged 26-35 min,with mean 30 ±4min; the DPT ranged 79-276 min,with mean 152 ±53 min; the PRT ranged 27-134 min, with mean 57 ±33 min. The thrombectomy ranged 1 - 3 times,with median 1(1,2) times. DSA examination was performed immediately after thrombectomy. Among 17 patients,2patients achieved TICI 2a,5 patients achieved TICI 2b and lOpatients achieved TICI 3. The rate of successful recanalization was 15/17. The rate of successful recanalization by one-time thrombectomy was 11/17. One patient showed distal occlusion and was recanalized after additional thrombectomy. No intracranial hemorrhage occurred. The postoperative NIHSS ranged 2-20points,with mean 9 ±5points and it was significantly different from that of preoperative NIHSS (t = 5. 759, P < 0. 05). Twelve patients had mRS score ≤ 2 at day 90 after operation, and the rate of good prognosis was 12/17. Conclusion: Solitaire stent thrombectomy combined with Navien catheter aspiration in county comprehensive stroke centers is safe and effective for large vessel occlusion of anterior circulation.

Causes and Solutions of Endovascular Treatment Failure / 대한뇌졸중학회지

In a meta-analysis of individual patient data from 5 randomized controlled trials, endovascular treatment (EVT) mainly using a stent retriever achieved successful recanalization in 71.1% of patients suffering from acute stroke due to anterior circulation large artery occlusion (LAO). However, EVT still failed in 28.9% of LAO cases in those 5 successful trials. Stent retriever failure may occur due to anatomical challenges (e.g., a tortuous arterial tree from the aortic arch to a target occlusion site), a large quantity of clots, tandem occlusion, clot characteristics (fresh versus organized clots), different pathomechanisms (embolic versus non-embolic occlusion), etc. Given that recanalization success is the most important factor in the neurological outcome of acute stroke patients, it is important to seek solutions for such difficult cases. In this review, the basic technique of EVT is briefly summarized and then various difficult cases with diverse conditions are discussed along with suggested solutions.