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01-06-2015 | Editorial

Thrombectomy in patients with tandem stenoses

Authors: Gerhard Schroth, Rüdiger von Kummer

Published in: Neuroradiology | Issue 6/2015

Excerpt

In this issue, Lockau et al. retrospectively analyze different approaches for endovascular recanalization of tandem occlusions in acute stroke [1]. Starting with stent angioplasty of the carotid occlusion as the first step (stent-first group), they reversed the order of their techniques and performed intracranial thrombectomy prior to stenting of the carotid occlusion (thrombectomy-first group, the so-called upside-down approach). They found advantages and disadvantages with both techniques; however, time of intervention was shorter for the thrombectomy-first group. A higher percentage of thrombectomy-first patients had favorable outcomes after 3 months but the difference was not statistically significant. As discussed in this paper, one of the reasons may be that the thrombectomy-first technique allows mobilization and removal of the intracranial thrombus during flow arrest, whereas the thrombus becomes more compressed due to increased perfusion pressure following stenting of the carotid artery. …

Lockau H, Liebig T, Henning T, Neuschmelting V, Stetefeld H, Kabbasch C et al (2015) Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology 215:xxx-xxx. doi:10.1007/s00234-014-1465-5

Mokin M, Kass-Hout T, Kass-Hout O, Dumont TM, Kan P, Snyder KV et al (2012) Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. Stroke 43:2362–2368. doi:10.1161/STROKEAHA.112.655621 CrossRefPubMed

Kappelhof M, Marquering H, Berkhemer O, CBLM M (2015) Intra-arterial treatment of patients with acute ischemic stroke and internal carotid occlusion: a literature review. J Neurointerv Surg 7:8–15. doi:10.1136/neurintsurg-2013-011004 CrossRefPubMed

Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282:2003–2011CrossRefPubMed

Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD et al (2013) Interventional management of stroke IIII. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. New Engl J Med 368:893–903. doi:10.1056/NEJMoa1214300 CrossRefPubMedCentralPubMed

Ciccone A, Valvassori L, Investigators SE (2013) Endovascular treatment for acute ischemic stroke. New Engl J Med 368:2433–2434CrossRefPubMed

Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z et al (2013) Investigators MR. A trial of imaging selection and endovascular treatment for ischemic stroke. The New Engl J Med 368:914–923. doi:10.1056/NEJMoa1212793 CrossRef

Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira R et al (2014) SOLITAIRE with the intention for thrombectomy (SWIFT) trial: design of a randomized, controlled, multicenter study comparing the SOLITAIRE flow restoration device and the MERCI retriever in acute ischaemic stroke. Int J Stroke 9:658–668. doi:10.1111/j.1747-4949.2012.00856.x CrossRefPubMed

Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA et al (2012) Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380:1231–1240. doi:10.1016/S0140-6736(12)61299-9 CrossRefPubMedCentralPubMed

10.

Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. New Engl J Med 372:11–20. doi:10.1056/NEJMoa1411587 CrossRefPubMed

11.

Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. New Engl J Med 372:1009–1018. doi:10.1056/NEJMoa1414792 CrossRefPubMed

12.

Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J et al (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. New Engl J Med 372:1019–1030. doi:10.1056/NEJMoa1414905 CrossRefPubMed

13.

Pereira VM, Gralla J, Davalos A, Bonafe A, Castano C, Chapot R et al (2013) Prospective, multicenter, single-arm study of mechanical thrombectomy using Solitaire Flow Restoration in acute ischemic stroke. Stroke 44:2802–2807. doi:10.1161/STROKEAHA.113.001232 CrossRefPubMedCentralPubMed

Title: Thrombectomy in patients with tandem stenoses
Authors: Gerhard Schroth
Rüdiger von Kummer
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 6/2015
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-015-1525-5

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