Limits...
Endovascular thrombectomy following acute ischemic stroke: a single-center case series and critical review of the literature.

Sussman E, Kellner C, McDowell M, Yang P, Nelson E, Greenberg S, Sahlein D, Lavine S, Meyers P, Connolly ES - Brain Sci (2013)

Bottom Line: Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world.Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease.In order to demonstrate the progression of this treatment strategy over the past decade, we will also present a single-center case series of AIS patients treated with endovascular thrombectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Columbia University Medical Center, 710 West 168th Street, New York, NY 10032, USA. esuss11@gmail.com.

ABSTRACT
Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world. Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease. Here, we review the treatment options for cerebrovascular thromboembolic occlusion with a focus on the evolution of strategies and devices that are utilized for achieving endovascular clot extraction. In order to demonstrate the progression of this treatment strategy over the past decade, we will also present a single-center case series of AIS patients treated with endovascular thrombectomy.

No MeSH data available.


Related in: MedlinePlus

Solitaire flow restoration device.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4061858&req=5

brainsci-03-00521-f003: Solitaire flow restoration device.

Mentions: As described previously, cerebrovascular stenting leads to a high rate of recanalization in patients with AIS, but more widespread implementation of this technique has been limited by concerns about the need for dual anti-platelet therapy, the increased risk of hemorrhage and possible in-stent stenosis. In order to circumvent some of these limitations, a novel technique has been utilized in which stents are partially deployed and subsequently removed with the clot embedded within the struts of the stent. This technique of using reversible stents (RS), or stentrievers, combines the advantages of angioplasty and stenting with those of mechanical clot extraction. The two most commonly used stentrievers are the Solitaire Flow Restoration Device (ev3, Plymouth, MN) (Figure 3) and the Trevo Retriever (Concentric Medical, Mountain View, CA). The safety and efficacy of the Solitaire stentriever was compared with that of the Merci device in a randomized, parallel-group non-inferiority study—the Solitaire with intention for thrombectomy (SWIFT) trial. Due to overwhelming superiority (p = 0.0001) of the Solitaire device at the interim analysis, the SWIFT Trial was terminated early in 2011, after only 126 of the anticipated 250 patients were enrolled [57], and the Solitaire device has since been FDA approved with an indication for clot retrieval in AIS. The efficacy of the Trevo Retriever was also assessed in The Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO-2) Trial [58], an open-label randomized controlled trial that compared the Trevo Retriever to the Merci device. Similar to the results of the SWIFT trial, the TREVO-2 Trial found that the Trevo Retriever had superior efficacy as compared with the Merci device. In a 2012 prospective trial comparing the Trevo Retriever and the Solitaire device, the Trevo Retriever was associated with a higher rate of recanalization [59]; however, this trial was small (n = 33) and not randomized. Without an adequately powered randomized controlled trial, it is impossible to draw a definitive conclusion regarding the relative efficacy of the Trevo and Solitaire devices.


Endovascular thrombectomy following acute ischemic stroke: a single-center case series and critical review of the literature.

Sussman E, Kellner C, McDowell M, Yang P, Nelson E, Greenberg S, Sahlein D, Lavine S, Meyers P, Connolly ES - Brain Sci (2013)

Solitaire flow restoration device.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061858&req=5

brainsci-03-00521-f003: Solitaire flow restoration device.
Mentions: As described previously, cerebrovascular stenting leads to a high rate of recanalization in patients with AIS, but more widespread implementation of this technique has been limited by concerns about the need for dual anti-platelet therapy, the increased risk of hemorrhage and possible in-stent stenosis. In order to circumvent some of these limitations, a novel technique has been utilized in which stents are partially deployed and subsequently removed with the clot embedded within the struts of the stent. This technique of using reversible stents (RS), or stentrievers, combines the advantages of angioplasty and stenting with those of mechanical clot extraction. The two most commonly used stentrievers are the Solitaire Flow Restoration Device (ev3, Plymouth, MN) (Figure 3) and the Trevo Retriever (Concentric Medical, Mountain View, CA). The safety and efficacy of the Solitaire stentriever was compared with that of the Merci device in a randomized, parallel-group non-inferiority study—the Solitaire with intention for thrombectomy (SWIFT) trial. Due to overwhelming superiority (p = 0.0001) of the Solitaire device at the interim analysis, the SWIFT Trial was terminated early in 2011, after only 126 of the anticipated 250 patients were enrolled [57], and the Solitaire device has since been FDA approved with an indication for clot retrieval in AIS. The efficacy of the Trevo Retriever was also assessed in The Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO-2) Trial [58], an open-label randomized controlled trial that compared the Trevo Retriever to the Merci device. Similar to the results of the SWIFT trial, the TREVO-2 Trial found that the Trevo Retriever had superior efficacy as compared with the Merci device. In a 2012 prospective trial comparing the Trevo Retriever and the Solitaire device, the Trevo Retriever was associated with a higher rate of recanalization [59]; however, this trial was small (n = 33) and not randomized. Without an adequately powered randomized controlled trial, it is impossible to draw a definitive conclusion regarding the relative efficacy of the Trevo and Solitaire devices.

Bottom Line: Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world.Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease.In order to demonstrate the progression of this treatment strategy over the past decade, we will also present a single-center case series of AIS patients treated with endovascular thrombectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Columbia University Medical Center, 710 West 168th Street, New York, NY 10032, USA. esuss11@gmail.com.

ABSTRACT
Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world. Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease. Here, we review the treatment options for cerebrovascular thromboembolic occlusion with a focus on the evolution of strategies and devices that are utilized for achieving endovascular clot extraction. In order to demonstrate the progression of this treatment strategy over the past decade, we will also present a single-center case series of AIS patients treated with endovascular thrombectomy.

No MeSH data available.


Related in: MedlinePlus