nach oben

Neuroradiology

Erschienen in:

01.06.2015 | Interventional Neuroradiology

Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results

verfasst von: H. Lockau, T. Liebig, T. Henning, V. Neuschmelting, H. Stetefeld, C. Kabbasch, F. Dorn

Erschienen in: Neuroradiology | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Acute tandem occlusions of the cervical and distal internal carotid artery (ICA) or middle cerebral artery (MCA) are associated with major stroke with intravenous (i.v.) thrombolysis alone in approximately 90 % of patients. The data on endovascular management of tandem occlusions is still limited. The purpose of this study was to review technical aspects and the current state of the literature on acute ICA stenting in combination with stent retriever-based intracranial thrombectomy.

Methods

We retrospectively reviewed the data of 37 consecutive patients with tandem occlusions including clinical parameters, angiographic results, procedural aspects, complications, and hemorrhages.

Results

Median National Institutes of Health Stroke Scale (NIHSS) on admission was 17 (3–30). Intracranial thrombectomy was performed prior to ICA stenting in 25/37 (67.6 %) and after stenting in 12/37 (32.4 %) patients. ICA stenting was successful in all cases, and a thrombolysis in cerebral infarction (TICI) scale 2b/3 result was achieved in 27/37 (73 %) cases. The mean angiography time was significantly shorter in the “thrombectomy first” group (43.1 ± 30.8 vs. 110.8 ± 43.0 min, p < 0.001), and more patients had favorable outcomes after 3 months (13/25 = 52.0 vs. 4/12 = 33.3 %, p = 0.319). In this group, intermediate catheters were used and successfully prevented embolism to unaffected territories in all cases.

Conclusion

Acute stenting of the cervical ICA in combination with intracranial thrombectomy was technically feasible and safe in our series. Thrombectomy prior to proximal stenting was associated with shorter reperfusion times and a tendency towards better clinical outcome leading to a good outcome in about 50 % of the patients. Therefore, we recommend this approach in tandem occlusion requiring stent angioplasty.

Adams HP Jr, Bendixen BH, Leira E, Chang KC, Davis PH, Woolson RF, Clarke WR, Hansen MD (1999) Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology 53(1):122–125CrossRefPubMed

Linfante I, Llinas RH, Selim M, Chaves C, Kumar S, Parker RA, Caplan LR, Schlaug G (2002) Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator. Stroke 33(8):2066–2071CrossRefPubMed

Christou I, Felberg RA, Demchuk AM, Burgin WS, Malkoff M, Grotta JC, Alexandrov AV (2002) Intravenous tissue plasminogen activator and flow improvement in acute ischemic stroke patients with internal carotid artery occlusion. J Neuroimaging 12(2):119–123CrossRefPubMed

Kim YS, Garami Z, Mikulik R, Molina CA, Alexandrov AV, CLOTBUST Collaborators (2005) Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 36(4):869–871CrossRefPubMed

Rubiera M, Alvarez-Sabín J, Ribo M, Montaner J, Santamarina E, Arenillas JF, Huertas R, Delgado P, Purroy F, Molina CA (2005) Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke. Stroke 36(7):1452–1456CrossRefPubMed

Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, Akhtar N, Orouk FO, Salam A, Shuaib A, Alexandrov AV, CLOTBUST Investigators (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38(3):948–954CrossRefPubMed

Pérez MA, Miloslavski E, Fischer S, Bäzner H, Henkes H (2012) Intracranial thrombectomy using the Solitaire stent: a historical vignette. J Neurointerv Surg 4(6):e32CrossRefPubMedCentralPubMed

Nesbit GM, Clark WM, O'Neill OR, Barnwell SL (1996) Intracranial intraarterial thrombolysis facilitated by microcatheter navigation through an occluded cervical internal carotid artery. J Neurosurg 84(3):387–392CrossRefPubMed

Jovin TG, Gupta R, Uchino K, Jungreis CA, Wechsler LR, Hammer MD, Tayal A, Horowitz MB (2005) Emergent stenting of extracranial internal carotid artery occlusion in acute stroke has a high revascularization rate. Stroke 36(11):2426–2430CrossRefPubMed

10.

Hui FK, Hussain MS, Elgabaly MH, Sivapatham T, Katzan IL, Spiotta AM (2011) Embolic protection devices and the Penumbra 054 catheter: utility in tandem occlusions in acute ischemic stroke. J Neurointerv Surg 3(1):50–53CrossRefPubMed

11.

Papanagiotou P, Roth C, Walter S, Behnke S, Grunwald IQ, Viera J, Politi M, Körner H, Kostopoulos P, Haass A, Fassbender K, Reith W (2011) Carotid artery stenting in acute stroke. J Am Coll Cardiol 58(23):2363CrossRefPubMed

12.

Matsubara N, Miyachi S, Tsukamoto N, Kojima T, Izumi T, Haraguchi K, Asai T, Yamanouchi T, Ota K, Wakabayashi T (2013) Endovascular intervention for acute cervical carotid artery occlusion. Acta Neurochir (Wien) 155(6):1115–1123CrossRef

13.

Hauck EF, Natarajan SK, Ohta H, Ogilvy CS, Hopkins LN, Siddiqui AH, Levy EI (2011) Emergent endovascular recanalization for cervical internal carotid artery occlusion in patients presenting with acute stroke. Neurosurgery 69(4):899–907CrossRefPubMed

14.

Malik AM, Vora NA, Lin R, Zaidi SF, Aleu A, Jankowitz BT, Jumaa MA, Reddy VK, Hammer MD, Wechsler LR, Horowitz MB, Jovin TG (2011) Endovascular treatment of tandem extracranial/intracranial anterior circulation occlusions: preliminary single-center experience. Stroke 42(6):1653–1657CrossRefPubMed

15.

16.

Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D (2003) 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 34(8):e109–137CrossRefPubMed

17.

Dorn F, Stehle S, Lockau H, Zimmer C, Liebig T (2012) Endovascular treatment of acute intracerebral artery occlusions with the Solitaire stent: single-centre experience with 108 recanalization procedures. Cerebrovasc Dis 34:70–77CrossRefPubMed

18.

Davalos A, Pereira VM, Chapot R, Bonafe A, Andersson T, Gralla J (2012) Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke 43:2699–2705CrossRefPubMed

19.

Pereira VM, Gralla J, Davalos A, Bonafe A, Castano C, Chapot R et al (2013) Prospective, multicenter, single-arm study of mechanical thrombectomy using solitaire flow restoration in acute ischemic stroke [STAR]. Stroke 44(10):2802–2807CrossRefPubMedCentralPubMed

20.

Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO, SWIFT Trialists (2012) Solitaire flow restoration device versus the Merci retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380(9849):1241–1249CrossRefPubMed

21.

Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS, TREVO 2 Trialists (2012) Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380(9849):1231–1240CrossRefPubMedCentralPubMed

22.

Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, Glahn J, Brandt T, Hacke W, Diener HC (2001) Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 32(11):2559–2566CrossRefPubMed

23.

Kwak HS, Hwang SB, Jin GY, Hippe DS, Chung GH (2013) Predictors of functional outcome after emergency carotid artery stenting and intra-arterial thrombolysis for treatment of acute stroke associated with obstruction of the proximal internal carotid artery and tandem downstream occlusion. AJNR Am J Neuroradiol 34(4):841–846CrossRefPubMed

24.

Mpotsaris A, Bussmeyer M, Buchner H, Weber W (2013) Clinical outcome of neurointerventional emergency treatment of extra- or intracranial tandem occlusions in acute major stroke: antegrade approach with wallstent and solitaire stent retriever. Clin Neuroradiol 23(3):207–215CrossRefPubMed

25.

Son S, Choi DS, Oh MK, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH (2014) Emergency carotid artery stenting in patients with acute ischemic stroke due to occlusion or stenosis of the proximal internal carotid artery: a single-center experience. J Neurointerv Surg. 14

26.

Cohen JE, Gomori JM, Rajz G, Itshayek E, Eichel R, Leker RR (2014) Extracranial carotid artery stenting followed by intracranial stent-based thrombectomy for acute tandem occlusive disease. J Neurointerv Surg 12

27.

Stampfl S, Ringleb PA, Möhlenbruch M, Hametner C, Herweh C, Pham M, Bösel J, Haehnel S, Bendszus M, Rohde S (2014) Emergency cervical internal carotid artery stenting in combination with intracranial thrombectomy in acute stroke. AJNR Am J Neuroradiol 35(4):741–746CrossRefPubMed

28.

Fischer U, Mono ML, Schroth G, Jung S, Mordasini P, El-Koussy M, Weck A, Brekenfeld C, Findling O, Galimanis A, Heldner MR, Arnold M, Mattle HP, Gralla J (2013) Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. Eur J Neurol 20(7):1017–1024CrossRefPubMed

29.

Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38(3):967–973CrossRefPubMed

30.

Spiotta AM, Lena J, Vargas J, Hawk H, Turner RD, Chaudry MI, Turk AS (2014) Proximal to distal approach in the treatment of tandem occlusions causing an acute stroke. J Neurointerv Surg 21.

31.

Komiyama M, Nishio A, Nishijima Y (1994) Endovascular treatment of acute thrombotic occlusion of the cervical internal carotid artery associated with embolic occlusion of the middle cerebral artery: case report. Neurosurgery 34(2):359–363CrossRefPubMed

32.

Nesbit GM, Clark WM, O’Neill OR, Barnwell SL (1996) Intracranial intraarterial thrombolysis facilitated by microcatheter navigation through an occluded cervical internal carotid artery. J Neurosurg 84(3):387–392CrossRefPubMed

33.

Nedeltchev K, Brekenfeld C, Remonda L, Ozdoba C, Do DD, Arnold M, Mattle HP, Schroth G (2005) Internal carotid artery stent implantation in 25 patients with acute stroke: preliminary results. Radiology 237(3):1029–1037CrossRefPubMed

34.

Castano C, Dorado L, Guerrero C, Millan M, Gomis M, La Perez De Ossa N et al (2010) Mechanical thrombectomy with the solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke 41:1836–1840CrossRefPubMed

35.

Akins PT, Amar AP, Pakbaz RS, Fields JD (2014) Complications of endovascular treatment for acute stroke in the SWIFT trial with solitaire and Merci devices. AJNR Am J Neuroradiol 35:524–528CrossRefPubMed

36.

The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1588CrossRef

Titel: Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results
verfasst von: H. Lockau
T. Liebig
T. Henning
V. Neuschmelting
H. Stetefeld
C. Kabbasch
F. Dorn
Publikationsdatum: 01.06.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Neuroradiology / Ausgabe 6/2015
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-014-1465-5

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Thrombektomie auch bei großen Infarkten von Vorteil

16.05.2024 Ischämischer Schlaganfall Nachrichten

Auch ein sehr ausgedehnter ischämischer Schlaganfall scheint an sich kein Grund zu sein, von einer mechanischen Thrombektomie abzusehen. Dafür spricht die LASTE-Studie, an der Patienten und Patientinnen mit einem ASPECTS von maximal 5 beteiligt waren.

Schwindelursache: Massagepistole lässt Otholiten tanzen

14.05.2024 Benigner Lagerungsschwindel Nachrichten

Wenn jüngere Menschen über ständig rezidivierenden Lagerungsschwindel klagen, könnte eine Massagepistole der Auslöser sein. In JAMA Otolaryngology warnt ein Team vor der Anwendung hochpotenter Geräte im Bereich des Nackens.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2015

European Society of Neuroradiology (ESNR)

Evaluation of the use of automatic exposure control and automatic tube potential selection in low-dose cerebrospinal fluid shunt head CT

Objective and subjective image quality of primary and recurrent squamous cell carcinoma on head and neck low-tube-voltage 80-kVp computed tomography

Hidden spondylolisthesis: unrecognized cause of low back pain? Prospective study about the use of dynamic projections in standing and recumbent position for the individuation of lumbar instability

Delay-sensitive and delay-insensitive deconvolution perfusion-CT: similar ischemic core and penumbra volumes if appropriate threshold selected for each