CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(04): 213-216
DOI: 10.1055/s-0037-1607062
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Intra-arterial Thrombectomy with Stent Retriever for Acute Ischemic Stroke – a Retrospective, Single-centered Study from Brazil

Trombectomia intra-arterial com Stent Retriever para o acidente vascular encefálico isquêmico agudo - estudo retrospectivo em único centro no Brasil
Luana Antunes Maranha Gatto
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, Paraná, Brazil
,
Viviane de Hiroki F. Zétola
2   Department of Neurology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
,
Zeferino Demartini Junior
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, Paraná, Brazil
,
Fábio A. Nascimento
3   Department of Neurology, Baylor College of Medicine, Houston, Texas, United States
,
Gelson Luis Koppe
4   Department of Neuroradiology, Hospital Universita'rio Cajuru, Curitiba, Paraná, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

30. Juni 2017

04. September 2017

Publikationsdatum:
25. September 2017 (online)

Abstract

Objective To report our initial experience with intra-arterial thrombectomy (IAT) with stent retriever for acute ischemic stroke.

Methods We conducted a retrospective review of patients with acute ischemic stroke who underwent IAT from September 2010 to August 2016.

Results Forty-one patients were included; mean age was 57 years (range: 29–85), and 54% were women. There were 32 anterior circulation occlusions, and 11 posterior circulation occlusions. The mean value of the National Institutes of Health Stroke Scale (NIHSS) upon admission (available in 9/41 patients) was 14 (range: 6–20). Nineteen patients had favorable outcomes (modified Rankin Scale [mRS]: 0–2 at 6 months), and 22 had unfavorable outcomes (mRS: 3–6 at 6 months). The mortality rate was 37% (15/41). Favorable outcomes were associated with revascularization within the first 360 minutes of the onset of symptoms (p = 0.000001), and satisfactory revascularization (thrombolysis in cerebral infarction [TICI] scale: 2b or 3) (p = 0.0018).

Conclusion It is of paramount importance to educate stroke teams on the benefits of IAT for acute ischemic stroke and the population on identifying stroke and seeking immediate care following symptom onset.

Resumo

Objetivo Relatar nossa experiência inicial com trombectomia intra-arterial (TIA) com uso de stent retriever em acidente vascular encefálico isquêmico (Avei) agudo.

Métodos Análise retrospectiva de pacientes com Avei submetidos a TIA de setembro de 2010 a agosto de 2016.

Resultados Foram incluídos 41 pacientes; a idade média foi 57 anos (intervalo: 29–85), e 54% dos pacientes eram mulheres. Trombos ocluindo vasos da circulação anterior foram encontrados em 32 casos, e 11 na circulação posterior. A média do valor da Escala de Acidente Vascular Encefálico do National Institutes of Health (NIH) na admissão (disponível para 9 dos 41 pacientes) foi 14 (intervalo: 6–20). Um total de 19 pacientes teve resultados favoráveis (Escala de Rankin modificada [ERm]: 0–2 em 6 meses), e 22 tiveram resultados não favoráveis (ERm: 3–6 em 6 meses). A mortalidade foi de 37% (15/41). Resultados favoráveis foram associados com revascularização dentro dos primeiros 360 minutos de instalação dos sintomas (p = 0.000001) e revascularização satisfatória (escala de trombólise em infarto cerebral [TEIC]: 2b ou 3) (p = 0.0018).

Conclusão É de suma importância educar as equipes de acidente vascular encefálico sobre os benefícios da TIA para Avei agudo, e a população, na identificação do Avei, para que seja buscado atendimento imediato após o início dos sintomas.

Study Funding

The authors declare that this study did not receive any funding.


 
  • References

  • 1 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333 (24) 1581-1587
  • 2 Berkhemer OA, Fransen PS, Beumer D. , et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
  • 3 Goyal M, Demchuk AM, Menon BK. , et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372 (11) 1019-1030
  • 4 Campbell BC, Mitchell PJ, Kleinig TJ. , et al; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372 (11) 1009-1018
  • 5 Saver JL, Goyal M, Bonafe A. , et al; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372 (24) 2285-2295
  • 6 Jovin TG, Chamorro A, Cobo E. , et al; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372 (24) 2296-2306
  • 7 Higashida RT, Furlan AJ, Roberts H. , et al; Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology; Technology Assessment Committee of the Society of Interventional Radiology. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003; 34 (08) e109-e137
  • 8 IMS Study Investigators. Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 2004; 35 (04) 904-911
  • 9 Broderick JP, Palesch YY, Demchuk AM. , et al; Interventional Management of Stroke (IMS) III Investigators. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013; 368 (10) 893-903
  • 10 Ciccone A, Valvassori L, Nichelatti M. , et al; SYNTHESIS Expansion Investigators. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368 (10) 904-913
  • 11 Kidwell CS, Jahan R, Gornbein J. , et al; MR RESCUE Investigators. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368 (10) 914-923
  • 12 Powers WJ, Derdeyn CP, Biller J. , et al; 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46 (10) 3020-3035