ABSTRACT
Acute concomitant occlusions of the extracranial internal carotid artery and intracranial vessels frequently require multiple passes with stent-retrievers for mechanical thrombectomy. Due to the large clot burden associated with these occlusions, their response to intravenous thrombolysis is poor. We herein report a successful case of evacuating a massive clot (>14 cm) in a single-pass using a stent-retrieval device.
Subject(s)
Arterial Occlusive Diseases/therapy , Carotid Artery, Internal , Carotid Stenosis/therapy , Cerebral Arterial Diseases/therapy , Mechanical Thrombolysis/methods , Carotid Stenosis/surgery , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Humans , Male , Middle Aged , Stents , Stroke/therapy , Treatment OutcomeSubject(s)
Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Postoperative Complications/diagnostic imaging , Stents , Tomography, Optical Coherence , Brain Ischemia/diagnostic imaging , Brain Ischemia/surgery , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/surgery , Cerebral Angiography , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Stroke/diagnostic imaging , Stroke/surgeryABSTRACT
BACKGROUND: The metrics of imaging-to-puncture and imaging-to-reperfusion were recently found to be associated with the clinical outcomes of endovascular thrombectomy for acute ischemic stroke. However, measures for improving workflow within hospitals to achieve better timing results are largely unexplored for endovascular therapy. The aim of this study was to examine our experience with a novel smartphone application developed in house to improve our timing metrics for endovascular treatment. METHODS: We developed an encrypted smartphone application connecting all stroke team members to expedite conversations and to provide synchronized real-time updates on the time window from stroke onset to imaging and to puncture. The effects of the application on the timing of endovascular therapy were evaluated with a secondary analysis of our single-center cohort. Our primary outcome was imaging-to-puncture time. We assessed the outcomes with nonparametric tests of statistical significance. RESULTS: Forty-five patients met our criteria for analysis among 66 consecutive patients with acute ischemic stroke who received endovascular therapy at our institution. After the implementation of the smartphone application, imaging-to-puncture time was significantly reduced (preapplication median time, 127 minutes; postapplication time, 69 minutes; P < 0.001). Puncture-to-reperfusion time was not affected by the application use (42 minutes vs. 36 minutes). CONCLUSION: The use of smartphone applications may reduce treatment times for endovascular therapy in acute ischemic stroke. Further studies are needed to confirm our findings.
Subject(s)
Brain Ischemia/surgery , Endovascular Procedures/instrumentation , Mobile Applications , Smartphone , Stroke/surgery , Aged , Cerebral Infarction/surgery , Cerebral Revascularization/instrumentation , Female , Humans , Male , Middle Aged , Thrombectomy/instrumentation , Time-to-Treatment , Treatment OutcomeABSTRACT
BACKGROUND: Endovascular thrombectomy is an effective procedure to treat selected ischemic strokes, as shown in recent randomized controlled trials (RCTs). The generalizability of these trial data to real-world settings, however, is unknown. The aim of this study was to examine our single-center experience with endovascular thrombectomy for acute ischemic strokes and perform a comparative outcome analysis to the most recent RCTs. METHODS: We performed a 5-year retrospective analysis, from April 2011 to March 2016, on 66 consecutive patients with acute ischemic stroke who received endovascular thrombectomy at our institution. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale were used to assess preoperative status. Our primary outcomes were the modified Rankin Score (mRS) at 90 days and recanalization grade measured by the 6-point thrombolysis in cerebral infarction (TICI) grading system. RESULTS: Sixty-six patients received endovascular treatment during the study period. Among the patients examined, 35 (53%) had a favorable outcome (mRS 0-2 at 90 days), 23 (35%) a poor outcome (mRS 3-5), and 8 (12%) died. Successful recanalization (TICI score 3-5) was achieved in 68% of cases. In univariate analysis, patients with good outcome at 90 days had significantly greater ASPECTS, lower National Institutes of Health Stroke Scale, and higher TICI scores. In a multiple logistic regression model, higher ASPECTS and TICI scores were significantly and independently associated with favorable outcome. CONCLUSIONS: Excellent outcomes, as demonstrated by the recent RCTs, can be achieved in clinical practice and reproduced in dedicated tertiary centers.
