Background: There are little available data regarding the influence of intravenous thrombolysis (IVT) on the efficacy of different first line endovascular treatment (EVT) techniques.
Methods: We used the dataset of the SWIFT-DIRECT trial which randomized 408 patients to IVT + EVT or EVT alone at 48 international sites. The protocol required the use of a stent retriever (SR), but concomitant use of a balloon guide catheter (BGC) and/or distal aspiration (DA) catheter was left to the discretion of the operators. Four first line techniques were applied in the study population: SR, SR + BGC, SR + DA, SR + DA + BGC. To assess whether the effect of allocation to IVT + EVT versus EVT alone was modified by the first line technique, interaction models were fitted for predefined outcomes. The primary outcome was first pass mTICI 2c‑3 reperfusion (FPR).
Results: This study included 385 patients of whom 172 were treated with SR + DA, 121 with SR + DA + BGC, 57 with SR + BGC and 35 with SR. There was no evidence that the effect of IVT + EVT versus EVT alone would be modified by the choice of first line technique; however, allocation to IVT + EVT increased the odds of FPR by a factor of 1.68 (95% confidence interval, CI 1.11-2.54).
Conclusion: This post hoc analysis does not suggest treatment effect heterogeneity of IVT + EVT vs EVT alone in different stent retriever techniques but provides evidence for increased FPR if bridging IVT is administered before stent retriever thrombectomy.
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http://dx.doi.org/10.1007/s00062-023-01340-9 | DOI Listing |
J Neurointerv Surg
January 2025
Radiology, Auckland City Hospital, Auckland, New Zealand.
Background: Medium vessel occlusions (MeVOs) account for 25-40% of acute ischemic stroke. The Tenzing 5 (Route 92 Medical, San Mateo, California, USA) and FreeClimb 54 (Route 92 Medical, San Mateo, California, USA) catheter is a novel delivery-aspiration catheter combination designed to facilitate aspiration thrombectomy (AT) of MeVOs. We report our clinical experience using the Tenzing assisted delivery of aspiration (TADA) technique with FreeClimb 54 for first-line AT of MeVO.
View Article and Find Full Text PDFInterv Neuroradiol
January 2025
Department of Neurology, Emory University School of Medicine-Atlanta, GA, USA.
Introduction: We aimed to explore if anatomical and technical features could interact and favor the chances of reperfusion according to the treatment strategy: combined technique (CoT) of mechanical thrombectomy (MT) with contact aspiration and stent-retriever (SR) versus SR alone.
Methods: Retrospective analysis of a prospective MT database for carotid terminus or MCA-M1 occlusion, first-line SR alone or CoT, and angiographic run with SR deployed on the first pass. The primary analysis involved the interaction between clinical and angiographic characteristics and first-line MT modality on first-pass effect (FPE; first pass eTICI2c-3).
Radiologie (Heidelb)
January 2025
Klinik für Diagnostische und Interventionelle Radiologie, Städtisches Klinikum Lüneburg, Bögelstraße 1, 21339, Lüneburg, Deutschland.
Besides intravenous thrombolysis, endovascular therapy (EVT) is also a standard treatment option for acute ischemic stroke. The clinical efficacy and safety of this procedure was proven in 2015 by several randomized controlled trials. The aim of EVT is to achieve the fastest possible recanalization of an occluded artery supplying the brain and, thus, reperfusion of the brain tissue.
View Article and Find Full Text PDFJ Neuroimaging
January 2025
Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain.
Background And Purpose: The safety and effectiveness of endovascular techniques in elderly patients with large vessel occlusion (LVO) remain controversial. We investigated the angiographic and clinical outcomes of nonagenarians treated with different endovascular techniques using a balloon guide catheter (BGC), distal aspiration catheter (DAC), and/or stent retriever (SR).
Methods: We analyzed the data from the Registry of Combined versus Single Thrombectomy Techniques (ROSSETTI) of consecutive nonagenarian patients with anterior circulation LVO and compared the outcomes of those treated with BGC+noDAC+SR (101-group), BGC+DAC+SR (111-group), and noBGC+DAC+SR (011-group).
J Neuroimaging
January 2025
Vascular and Interventional Radiology Department, La Paz University Hospital, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.
Background And Purpose: Endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) with M2 segment occlusion of the middle cerebral artery (MCA) is debatable. This study assessed the efficacy, safety, and functional outcomes of EVT in M2 occlusion patients, examining differences in outcomes based on the dominance of the occluded segment (DomM2 vs. Non-DomM2).
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