• Title/Summary/Keyword: Thrombectomy

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Endovascular Treatment of Acute Ischemic Stroke (급성 허혈성 뇌졸중의 혈관 내 치료)

  • Jun Hwee Kim;Byung Moon Kim
    • Journal of the Korean Society of Radiology
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    • v.81 no.3
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    • pp.562-576
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    • 2020
  • Acute ischemic stroke is one of the leading causes of disability and death around the world, especially in developed countries. Since the introduction of the 2nd generation devices, endovascular treatment of acute ischemic stroke has rapidly developed and is now considered to be a standard treatment. Here, we summarize the results of recent randomized clinical trials that have compared endovascular thrombectomy with conventional treatment for acute stroke and review the indications, current devices, and endovascular thrombectomy methods used.

Treatment of Deep Thrombosis (심부정맥혈전증의 치료)

  • 왕옥보
    • Journal of Chest Surgery
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    • v.25 no.11
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    • pp.1358-1361
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    • 1992
  • During the past 4 years, 18 cases of deep vein thrombosis were treated. Diagnosis was based on clinical symptoms, phlebography and vascular Doppler examination. Etiologic factors were mainly trauma, operation and immobilization of the lower extremities. Seven patients were treated surgically and eleven patients medically. The indications for surgical thrombectomy included phlegmasia cerulea dolens [N=6], and phlemasia cerulea dolens with focal venous gangrene[N=1]. The comparative analysis of each treatment methods was done after a mean observation period of 6 months. Good clincal results were observation in 4 patents in surgically treated [57.1%], and 4 in conservative management group[36.3%]. There were no mortality in the both surgical and medically treated group but one patient with phlegmasia cerulea dolens and focal venous gangrene was dischared in moribund state at the third postoperation day due to sepsis and multiorgan failure. We believe that aggressive early surgical thrombectomy should be stronly considered for patients of phlegmasia cerulea dolena.

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Extent of Contrast Enhancement on Non-Enhanced Computed Tomography after Intra-Arterial Thrombectomy for Acute Infarction on Anterior Circulation : As a Predictive Value for Malignant Brain Edema

  • Song, Seung Yoon;Ahn, Seong Yeol;Rhee, Jong Ju;Lee, Jong Won;Hur, Jin Woo;Lee, Hyun Koo
    • Journal of Korean Neurosurgical Society
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    • v.58 no.4
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    • pp.321-327
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    • 2015
  • Objective : To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. Methods : We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. Results : A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR ${\geq}0.2$ and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p<0.001 and p=0.004), but on multivariate analysis, only CEAR ${\geq}0.2$ showed a statistically significant association (p=0.019). In the group with CEAR ${\geq}0.2$, the time to malignant brain edema was shorter (p=0.039) than in the group with CEAR <0.2. Clinical functional outcomes, based on the modified Rankin scale, were also significantly worse in patients with CEAR ${\geq}0.2$ (p=0.003) Conclusion : The extent of contrast enhancement as noted on NECT scans obtained immediately after IAT could be predictive of malignant brain edema and a poor clinical outcome.

Risk Factors and Clinical Outcomes of Brain Reperfusion Injury after Mechanical Thrombectomy for Ischemic Stroke (기계적 혈전제거술을 시행한 허혈성 뇌졸중 환자의 뇌재관류 손상 위험요인과 임상결과)

  • Moon, Ji Hyun;Choi, Hye-Ran
    • Journal of Korean Biological Nursing Science
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    • v.23 no.3
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    • pp.217-226
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    • 2021
  • Purpose: The aim of this study was to investigate the risk factors for brain reperfusion injury in ischemic stroke patients and to analyze the clinical outcomes. Methods: A retrospective study was conducted in 168 patients who underwent mechanical thrombectomy. The data were analyzed using descriptive statistics, t-test, Mann-Whitney U test, Chi-Square test, Fisher's exact test, and logistic regression with IBM SPSS/WIN 24.0. Results: Brain reperfusion injury occurred in 67 patients (39.9%) with a low favored outcome (𝛘2=6.01, p=.014). On multivariable analysis, blood urea nitrogen (Odds ratio [OR]=1.14, 95% Confidence interval [CI]=1.06-1.23), aphasia (OR=6.16, CI=1.62-23.40), anosognosia (OR=4.84, CI=1.13-20.79), presence of both aphasia and anosognosia (OR=7.33, CI=1.20-44.60), and time required to achieve targeted blood pressure (OR=1.00, CI=1.00-1.00) were identified as risk factors for brain reperfusion injury. A statistically significant difference was detected in clinical outcomes, including hemorrhagic transformation (𝛘2=6.32, p=.012), intensive care unit length of stay (Z=-2.08, p=.038), National Institute of Health Stroke scale score at discharge (Z=-3.14, p=.002), and modified Rankin Scale score at discharge (Z=-2.93, p=.003). Conclusion: This study identified the risk factors and presented the clinical outcomes of brain reperfusion injury. It is necessary to consider these risk factors for evaluating the patients and to establish nursing interventions and strategies.

Outcomes of Mechanical Thrombectomy in Patients with Large Diffusion-Weighted Imaging Lesions

  • Cho, Yong-Hwan;Choi, Jae Hyung
    • Journal of Korean Neurosurgical Society
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    • v.65 no.1
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    • pp.22-29
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    • 2022
  • Objective : Despite many advancements in endovascular treatment, the benefits of mechanical thrombectomy (MT) in patients with large infarctions remain uncertain due to hemorrhagic complications. Therefore, we aimed to investigate the efficacy and safety of recanalization via MT within 6 hours after stroke in patients with large cerebral infarction volumes (>70 mL). Methods : We retrospectively reviewed the medical data of 30 patients with large lesions on initial diffusion-weighted imaging (>70 mL) who underwent MT at our institution within 6 hours after stroke onset. Baseline data, recanalization rate, and 3-month clinical outcomes were analyzed. Successful recanalization was defined as a modified treatment in cerebral ischemia score of 2b or 3. Results : The recanalization rate was 63.3%, and symptomatic intracerebral hemorrhage occurred in six patients (20%). The proportion of patients with modified Rankin Scale (mRS) scores of 0-3 was significantly higher in the recanalization group than in the non-recanalization group (47.4% vs. 9.1%, p=0.049). The mortality rate was higher in the non-recanalization group, this difference was not significant (15.8% vs. 36.4%, p=0.372). In the analysis of 3-month clinical outcomes, only successful recanalization was significantly associated with mRS scores of 0-3 (90% vs. 50%, p=0.049). The odds ratio of recanalization for favorable outcomes (mRS 0-3) was 9.00 (95% confidence interval, 0.95-84.90; p=0.055). Conclusion : Despite the risk of symptomatic intracerebral hemorrhage, successful recanalization via MT 6 hours after stroke may improve clinical outcomes in patients with large vessel occlusion.

Mechanical Thrombectomy for Refractory Cerebral Venous Sinus Thrombosis in a Child with Nephrotic Syndrome : A Case Report

  • Jing Ye;Yuan Yang;Weifeng Wan;Xuntai Ma;Lei Liu;Yong Liu;Zhongchun He;Zhengzhou Yuan
    • Journal of Korean Neurosurgical Society
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    • v.66 no.6
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    • pp.735-742
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    • 2023
  • Nephrotic syndrome (NS) is associated with cerebral venous sinus thrombosis (CVST), which is a rare cerebrovascular disorder in children. Systemic anticoagulation with heparin is the standard therapy for CVST, and mechanical thrombectomy (MT) has been described as a salvage treatment for adult anticoagulant refractory CVST, However, it has never been reported in children. We describe a case of MT for refractory CVST in a child with NS. A 13-year-old boy with newly diagnosed NS presented to an emergency department with acute headache. A head computed tomography showed acute thrombus in the superior sagittal sinus, straight sinus and transverse sinus. The child was started on heparin therapy, but clinically deteriorated and became unresponsive. In view of the rapid deterioration of the condition after anticoagulation treatment, the patient received intravascular treatment. Several endovascular technologies, such as stent retriever and large bore suction catheter have been adopted. After endovascular treatment, the patient's neurological condition was improved within 24 hours, and magnetic resonance venography of the head demonstrated that the CVST was reduced. The child recovered with normal neurological function at discharge. This case highlights the importance of considering MT for refractory CVST, and we suggest that MT may be considered for refractory CVST with NS in children.

Predictive Factors of First-Pass Effect in Patients Who Underwent Successful Endovascular Thrombectomy for Emergent Large Vessel Occlusion

  • In-Hyoung Lee;Jong-Il Choi;Sung-Kon Ha;Dong-Jun Lim
    • Journal of Korean Neurosurgical Society
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    • v.67 no.1
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    • pp.14-21
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    • 2024
  • Objective : The primary treatment goal of current endovascular thrombectomy (EVT) for emergent large-vessel occlusion (ELVO) is complete recanalization after a single maneuver, referred to as the 'first-pass effect' (FPE). Hence, we aimed to identify the predictive factors of FPE and assess its effect on clinical outcomes in patients with ELVO of the anterior circulation. Methods : Among the 129 patients who participated, 110 eligible patients with proximal ELVO (intracranial internal carotid artery and proximal middle cerebral artery) who achieved successful recanalization after EVT were retrospectively reviewed. A comparative analysis between patients who achieved FPE and all others (defined as a non-FPE group) was performed regarding baseline characteristics, clinical variables, and clinical outcomes. Multivariate logistic regression analyses were subsequently conducted for potential predictive factors with p<0.10 in the univariate analysis to determine the independent predictive factors of FPE. Results : FPE was achieved in 31 of the 110 patients (28.2%). The FPE group had a significantly higher level of functional independence at 90 days than did the non-FPE group (80.6% vs. 50.6%, p=0.002). Pretreatment intravenous thrombolysis (IVT) (odds ratio [OR], 3.179; 95% confidence interval [CI], 1.025-9.861; p=0.045), door-to-puncture (DTP) interval (OR, 0.959; 95% CI, 0.932-0.987; p=0.004), and the use of balloon guiding catheter (BGC) (OR, 3.591; 95% CI, 1.231-10.469; p=0.019) were independent predictive factors of FPE. Conclusion : In conclusion, pretreatment IVT, use of BGC, and a shorter DTP interval were positively associated with FPE, increasing the chance of acquiring better clinical outcomes.

Comparative Analysis of Surgical Thrombectomy with Revision and Percutaneous Thrombectomy with Angioplasty for Treating Obstruction of a Dialysis Graft (인조혈관 동정맥루 폐쇄의 치료에서 수술적 혈전제거술 및 재건술과 경피적 혈전제거술 및 혈관성형술의 비교연구)

  • Lim, Jae-Woong;Won, Yong-Soon;Kim, Dong-Hyun;Shin, Hwa-Kyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.487-491
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    • 2009
  • Background: Salvaging prosthetic arteriovenous grafts can be performed using surgical or endovascular techniques. We conducted a retrospective analysis to compare the efficacy of these two methods for restoring dialysis graft function. Material and Method: We studied 41 patients who had received surgical thrombectomy with revision (Group A) or percutaneous thrombectomy with angioplasty (Group B) from January 2006 to December 2007. We compared them according to the patient characteristics and the location of stenotic lesions, and we analyzed the post-intervention primary patency rates. Result: 21 patients underwent surgery and 20 patients underwent percutaneous balloon angioplasty. There were no significant differences of the patients' characteristics between the two groups. Venous anastomotic stenosis was the most common cause of graft thrombosis in both groups. In Group A, 90.5% of the grafts remained functional at 6 months and 38.1% remained functional at 12 months. In Group B, 55.0% of the grafts were functional at 6 months and 20.0% of the grafts were functional at 12 months. The post-intervention primary patency rate was significantly better in Group A (p=0.034). Conclusion: Surgical treatment resulted in significantly longer post-intervention primary patency in this study, and this supports its use as the primary method of management for most patients in whom dialysis graft obstruction develops.

Efficacy of Combining Proximal Balloon Guiding Catheter and Distal Access Catheter in Thrombectomy with Stent Retriever for Anterior Circulation Ischemic Stroke

  • Kim, Sang Hwa;Choi, Jae Hyung;Kang, Myung Jin;Cha, Jae Kwan;Kim, Dae Hyun;Nah, Hyun Wook;Park, Hyun Seok;Kim, Sang Hyun;Huh, Jae Taeck
    • Journal of Korean Neurosurgical Society
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    • v.62 no.4
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    • pp.405-413
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    • 2019
  • Objective : We evaluated efficacy of combining proximal balloon guiding catheter (antegrade flow arrest) and distal access catheter (aspiration at the site of occlusion) in thrombectomy for anterior circulation ischemic stroke. Methods : We retrospectively analyzed 116 patients who underwent mechanical thrombectomy with stent retriever. The patients were divided by the techniques adopted, the combined technique (proximal balloon guiding catheter and large bore distal access catheter) group (n=57, 49.1%) and the conventional (guiding catheter with stent retriever) technique group (n=59, 50.9%). We evaluated baseline characteristics (epidemiologic data, clinical and imaging characteristics) and procedure details (the number of retrieval attempts, procedure time), as well as angiographic (thrombolysis in cerebral infarction (TICI) score, distal thrombus migration) and clinical outcome (National Institutes of Health Stroke Scale at discharge, modified Rankin Scale [mRS] at 3 months) of them. Results : The number of retrieval attempts was lower (p=0.002) and the first-pass successful reperfusion rate was higher (56.1% vs. 28.8%; p=0.003) in the combined technique group. And the rate of final result of TICI score 3 was higher (68.4% vs. 28.8%; p<0.01) and distal thrombus migration rate was also lower (15.8% vs. 40.7%; p=0.021) in the combined technique group. Early strong neurologic improvement (improvement of National Institutes of Health Stroke Scale ${\geq}11$ or National Institutes of Health Stroke Scale ${\leq}1$ at discharge) rate (57.9% vs. 36.2%; p=0.02) and favorable clinical outcome (mRS at 3 months ${\leq}2$) rate (59.6% vs. 33.9%; p=0.005) were also better in the combined technique group. Conclusion : The combined technique needs lesser attempts, decreases distal migration, increases TICI 3 reperfusion and achieves better clinical outcomes.

A Retrieved Sparganum of Spirometra erinaceieuropaei from a Korean Man during Mechanical Thrombectomy

  • Hwang, Yang-Ha;Son, Wonsoo;Kim, Yong-Won;Kang, Dong-Hun;Chang, Hyun-Ha;Goo, Youn-Kyoung;Hong, Yeonchul;Chung, Dong-Il
    • Parasites, Hosts and Diseases
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    • v.58 no.3
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    • pp.309-313
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    • 2020
  • Human sparganosis is a zoonotic disease caused by infection and migration of the plerocercoid of Spirometra spp. Although sparganosis were reported from most parts of the body, the sparganum parasitizing inside cerebral artery is remarkably uncommon. We report a case of cerebral intravascular sparganosis in an elderly patient with acute ischemic stroke who was diagnosed by retrieving sparganum during mechanical thrombectomy. Finally, the parasites were identified as Spirometra erinaceieuropaei using multiplex PCR and cox1 gene sequencing.