Neurothrombectomy for the treatment of acute ischemic stroke in 1530 patients

Department of Neurology, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China.
Journal of Clinical Neuroscience (Impact Factor: 1.38). 08/2012; 19(10):1363-8. DOI: 10.1016/j.jocn.2011.10.022
Source: PubMed


Neurothrombectomy is being used increasingly for the treatment of acute ischemic stroke. To assess the recanalization rates and clinical outcomes of patients treated with neurothrombectomy, we searched the CNKI (China National Knowledge Infrastructure), CBM (Chinese Biomedical Literature), MEDLINE and EMBASE databases to 2011 and summarized the outcome data of patients with acute ischemic stroke treated with neurothrombectomy. Forty-six studies (1530 patients) that reported recanalization rates were included in this analysis. Recanalization rates were recorded for the following neurothrombectomy techniques: endovascular thrombectomy (43-100%, median 86%), endovascular thromboaspiration (67-100%, median 83%), laser thrombolysis (41-50%, median 45.5%), and ultrasonification (62-71%, median 66.5%); the respective rates of symptomatic and asymptomatic intracranial hemorrhage were 20%, 22.5%, 12%, and 19% for each of the four types of neurothrombectomy. Clinical outcome data categorized by success or failure in achieving recanalization were available from 12 articles pertaining to 443 patients. At three months, patients in whom recanalization was achieved had better functional outcomes compared to non-recanalized patients (odds ratio [OR], 5.58; 95% confidence interval [CI], 2.98-10.45). In addition, the three-month mortality was lower in recanalized patients (OR, 0.37; 95% CI, 0.24-0.57). Among the various treatments for acute ischemic stroke, neurothrombectomy appears the most promising. Neurothrombectomy devices show great potential in improving functional outcomes and reducing mortality in patients with acute ischemic stroke, and meta-analysis confirms that successful recanalization was the most important indicator of predicting clinical benefit.

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    ABSTRACT: BACKGROUND: In order to avoid distal arterial embolism following mechanical thrombectomy, micro-balloon catheter temporary isolation is applied to prevent thrombus shedding. OBJECTIVE: To investigate the safety and feasibility of adopting the micro-balloon catheter technique in treatment of the hyperacute cerebral infarction. The micro-balloon catheter technique can temporarily block the artery blood flow and isolate the embolism location following mechanical thrombectomy and aspiration combined with thrombolysis. METHODS: Ten beagle dogs were included in this study. Under general anesthesia, the micro-balloon catheter was delivered to the dominant vertebral artery through the femoral artery in all the dogs and it was filled and temporarily blocked the blood flow. Then the autologous thrombus was injected through the micro-catheter into proximal vertebral artery to make a thrombosis model. All the dogs were equally divided into two groups according to the embolectomy method: control group (receiving pure stent embolectomy, n=5) and experimental group (n=5). The experiment group was disrupted and aspirated thrombus combined with the drug thrombolysis after temporarily blocking out the blood flow and isolating the target artery by micro-balloon catheter technique. After treatment, two groups underwent digital subtraction angiography to review the vertebral artery recanalization after different embolectomy methods. The hemodynamic status was evaluated through the thrombolysis in cerebral ischemia grade. All the dogs were scanned with magnetic resonance diffusion weighted imaging before modeling and at 12 hours after the thrombectomy. The animals were killed to perform pathological examination after magnetic resonance diffusion weighted imaging (12 hours after the thrombectomy). The vessel recanalization rates and complications were calculated in the two groups. RESULTS AND CONCLUSION: The thromboembolism model was successfully established in the dominant vertebral artery of all the 10 beagle dogs. In the control group, the vertebral arteries were completely successful recanalized in two dogs and were partly recanalized in three dogs, while the vertebral-basilar and intracranial arteries in one dog showed multiple small punctate filling defects with poor intracranial arterial development and contrast agent reflux. At 12 hours after embolectomy, the magnetic resonance diffusion weighted imaging showed slightly high signal intensity at the left temporoparietal lobe and the pathologic examination suggested thrombosis in the cerebral artery lumen of the left temporal lobe. In the experimental group, the vertebral arteries in five dogs were completely recanalized without infarction. The revascularization rate in the experimental group was significantly higher than that in the control group (P < 0.05). Experimental findings indicate that, the application of disruption and aspiration thrombus combined with the drug thrombolysis after temporarily blocking the blood flow and isolating the target artery by micro-balloon catheter technique in treatment of hyperacute cerebral infarction, can effectively prevent the small embolus exfoliating, which can cause distal embolization. Thus, the micro-balloon catheter technique is a safe, effective and relatively inexpensive interventional embolectomy. © 2015, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.