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Mechanical Thrombectomy for Acute Common Carotid Artery Occlusion
Neurol Med Chir (Tokyo). 2023 Jan 5. doi: 10.2176/jns-nmc.2022-0183. Online ahead of print.ABSTRACTMechanical thrombectomy (MT) is the standard treatment for acute large occlusion of the cerebral artery. Evidence for the success of this procedure was based on the treatment of patients with internal carotid artery and middle cerebral artery thrombi. There are a few reports on thrombi extending to the common carotid artery (CCA). We document our endovascular procedure and the clinical outcome in seven consecutive patients who underwent MT for CCA thrombi between September 2016 and April 2021. Their mean National Institutes o...
Source: Neurologia Medico-Chirurgica - January 4, 2023 Category: Neurosurgery Authors: Minoru Ideguchi Kyongsong Kim Masanori Suzuki Junya Kaneko Shin Sato Kazutaka Shirokane Akio Morita Source Type: research

P74 Keep it simple: MAC (Manual Aspiration with Contrast) technique for the endovascular management of acute ischemic stroke (LVO & MVO)
We report a prospectively collected clinical experience with a simple technique: MAC (Manual Aspiration Contrast Enhancement) as the primary method for vessel recanalization.Gently contrast injection while the aspiration catheter is advancedto the thrombus and subsequentlycreating a closed-loop system with the contrast column within the cathetercan result in better visualization during the aspiration, thus improving the FPEavoiding clot fragmentation, multiple passes and blind movements of catheter by a single operator.Methods47 prospectively patients with ELVO and 3 cases of middle vessel occlusion (MVO) at four instituti...
Source: Journal of NeuroInterventional Surgery - August 29, 2022 Category: Neurosurgery Authors: Pabon, B., Torres, V., Patino, M., Pelaez, F., Mutis, J. Tags: 14th Congress of the European Society of Minimally Invasive Neurological Therapy 2022 Meeting Abstracts Source Type: research

Risk factors for decompressive craniectomy after endovascular treatment in acute ischemic stroke
This study aimed to evaluate the risk factors for subsequent DC after EVT. This retrospective cohort study comprised 138 patients who received EVT between April 2015 and June 2019 at our center. The need for subsequent DC was defined as cerebral edema or/and hemorrhagic transformation caused by large ischemic infarction, with a ≥ 5-mm midline shift and clinical deterioration after EVT. The relationship between risk factors and DC after EVT was assessed via univariate and multivariable logistic regression. Thirty (21.7%) patients required DC. These patients tended to have atrial fibrillation (P = 0.037), sedation (P...
Source: Neurosurgical Review - September 3, 2019 Category: Neurosurgery Source Type: research

O-011 Symptomatic Intracranial Hemorrhage After Reperfusion Therapy - Impact of Definition on its Frequency
ConclusionUnder the trial definition, any apparent extravascular blood in the brain or cranium with an increase of 4 or more on the NIHSS, associated or not, is considered a sICH; as a result, the inclusion of hemorrhagic infarctions (HI1 and HI2) in this definition resulted in an apparent relative increase in sICH rates. Subjecting the THERAPY cohort to other definitions yielded notable variance in complication rates. As there is no current standardization for the quantification of sICH, further analysis and data are needed to identify and standardize a succinct and relevant definition.DisclosuresR. von Kummer: 2; C; Penu...
Source: Journal of NeuroInterventional Surgery - July 28, 2016 Category: Neurosurgery Authors: von Kummer, R., Frei, D., Yoo, A., Zaidat, O., Khatri, P., Gupta, R., Lopes, D., Shownkeen, H., Meyer, D., Buell, H., Bach, V., Kuo, S., Bose, A., Sit, S., Mocco, J. Tags: Oral abstracts Source Type: research

O-025 The Superiority of Thrombectomy over IV rtPA Monotherapy May be Associated with Thrombus Length - Results of the THERAPY Trial
ConclusionExtensive thrombus burden presents a challenge for stroke intervention, posing greater risk of complications and poor clinical outcome. However, this effect is dampened when IAT is the interventional modality, leading to a more favorable prognosis over IV-rtPA alone. This study finding supports the use of aspiration thrombectomy in treatment of extended thrombi, demonstrating relative advantages over thrombolytic monotherapy, and enables better clinical outcomes.DisclosuresR. von Kummer: 2; C; Penumbra, Inc. J. Mocco: 1; C; Penumbra, Inc. O. Zaidat: 6; C; Penumbra, Inc. P. Khatri: 1; C; Penumbra, Inc. R. Gupta: 6...
Source: Journal of NeuroInterventional Surgery - July 28, 2016 Category: Neurosurgery Authors: von Kummer, R., Mocco, J., Zaidat, O., Khatri, P., Gupta, R., Frei, D., Lopes, D., Shownkeen, H., Berkhemer, O., Meyer, D., Chauke, M., Hak, S., Kuo, S., Buell, H., Bose, A., Sit, S., Yoo, A. Tags: Oral abstracts Source Type: research

Complex decision-making in stroke: preoperative mechanical thrombectomy of septic embolus for emergency cardiac valve surgery
We report a case of cardioembolic stroke in a patient with enterococcal endocarditis, with National Institutes of Health Stroke Scale score of 3. A middle-aged patient with bacterial endocarditis exhibited mild intermittent left hemiparesis and dysarthria in the setting of severe aortic insufficiency requiring urgent aortic valve replacement. Cerebrovascular imaging revealed a partially occlusive thrombus in the M1 segment of the right middle cerebral artery, which became symptomatic during relative hypotension. Given the expected hypotension during the urgently needed aortic valve replacement, there was a significant risk...
Source: Journal of NeuroInterventional Surgery - November 13, 2015 Category: Neurosurgery Authors: Ladner, T. R., Davis, B. J., He, L., Kirshner, H. S., Froehler, M. T., Mocco, J. Tags: Electronic pages Source Type: research

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture.
Abstract Acute internal carotid artery (ICA) terminus occlusion is associated with extremely poor functional outcomes or mortality, especially when it is caused by plaque rupture of the cervical ICA with engrafted thrombus that elongates and extends into the ICA terminus. The goal of this study was to evaluate the efficacy and safety of surgical embolectomy in conjunction with carotid endarterectomy (CEA) for acute ICA terminus occlusion associated with cervical plaque rupture resulting in tandem occlusion. A retrospective review of medical records was performed. Clinical and radiographic characteristics were eval...
Source: Journal of Neurosurgery - January 9, 2015 Category: Neurosurgery Authors: Hasegawa H, Inoue T, Tamura A, Saito I Tags: J Neurosurg Source Type: research