Dorn, F., Prothmann, S., Patzig, M., Lockau, H., Kabbasch, C., Nikoubashman, O., Liebig, T., Zimmer, C., Brueckmann, H., Wiesmann, M., Stetefeld, H., Poppert, H., Reich, A., Kellert, L. and Fesl, G. (2016). Stent Retriever Thrombectomy in Patients Who Are Ineligible for Intravenous Thrombolysis: A Multicenter Retrospective Observational Study. Am. J. Neuroradiol., 37 (2). S. 305 - 311. DENVILLE: AMER SOC NEURORADIOLOGY. ISSN 1936-959X

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Abstract

BACKGROUND AND PURPOSE: Intravenous thrombolysis with rtPA is the standard of care for patients with acute ischemic stroke within 4.5 hours after symptom onset. However, a considerable number of patients are ineligible for IV thrombolysis due to various contraindications. Recent studies have proved the superiority of mechanical thrombectomy for patients with large-vessel occlusions in combination with IV rtPA compared with IV rtPA alone. We aimed to demonstrate the efficacy of mechanical thrombectomy for patients who are ineligible for IV rtPA. MATERIALS AND METHODS: Patients from the stroke registries of 4 dedicated centers who were treated with mechanical thrombectomy from January 2010 to October 2014 were retrospectively evaluated. Inclusion criteria were the following: acute stroke due to proved large-artery occlusion, ineligibility for IV thrombolysis, and a timeframe of 4.5 hours between stroke and the start of mechanical thrombectomy. Recanalization success, periprocedural complications, clinical outcome, and hemorrhages were evaluated. RESULTS: One hundred thirty endovascular recanalization procedures were identified. The locations were the following: proximal ICA in 17 (13.1%), terminus ICA in 25 (19.2%), M1 segment in 77 (59.2%), and M2 segment in 11 (8.5%). TICI 2b/3 results were achieved in 101 (77.7%), and an mRS score of 0-2 in 47 patients (37.9%). There was a significant correlation between TICI 2b/3 results and good clinical outcomes (87.2% versus 6.8%; P = .048). A good clinical result was most frequent when recanalization was achieved within 4.5 hours (37/74 = 50% versus 10/50 = 20.0%; P = .001). Symptomatic hemorrhage occurred in 13.1% of patients; mortality was 24.2%. Periprocedural complications were recorded in 10 patients (7.7%). CONCLUSIONS: Mechanical thrombectomy can achieve good clinical outcomes in patients with acute large-artery occlusion ineligible for IV thrombolysis, in particular when recanalization is reached early.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Dorn, F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Prothmann, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patzig, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lockau, H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kabbasch, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nikoubashman, O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Liebig, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zimmer, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brueckmann, H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wiesmann, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stetefeld, H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Poppert, H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reich, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kellert, L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fesl, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-285810
DOI: 10.3174/ajnr.A4520
Journal or Publication Title: Am. J. Neuroradiol.
Volume: 37
Number: 2
Page Range: S. 305 - 311
Date: 2016
Publisher: AMER SOC NEURORADIOLOGY
Place of Publication: DENVILLE
ISSN: 1936-959X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE ISCHEMIC-STROKE; INTRACEREBRAL ARTERY OCCLUSIONS; TISSUE-PLASMINOGEN-ACTIVATOR; MECHANICAL THROMBECTOMY; ENDOVASCULAR TREATMENT; RANDOMIZED-TRIAL; MERCI TRIAL; RECANALIZATION; INTRAARTERIAL; REVASCULARIZATIONMultiple languages
Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical ImagingMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/28581

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