Intraprocedural Thrombus Fragmentation During Interventional Stroke Treatment: A Comparison of Direct Thrombus Aspiration and Stent Retriever Thrombectomy

CardioVascular and Interventional Radiology - The aim of this study was to compare the rates of intraprocedural thrombus fragmentation between the exclusive thrombus aspiration technique (ADAPT)...     

Endovascular Stroke Treatment of Nonagenarians

BACKGROUND AND PURPOSE:Although endovascular treatment has become a standard therapy in patients with acute stroke, the benefit for very old patients remains uncertain. The purpose of this study was the evaluation of procedural and outcome data of patients ≥90 years undergoing endovascular stroke treatment.MATERIALS AND METHODS:We retrospectively analyzed prospectively collected data of patients ≥90 years in whom endovascular stroke treatment was performed between January 2011 and January 2016. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS, prestroke mRS), at discharge (NIHSS), and after 3 months (mRS).RESULTS:Twenty-nine patients met the inclusion criteria for this analysis. The median prestroke mRS was 2. Successful recanalization (TICI ≥ 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement ≥ 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0–2 or exhibited prestroke mRS, and 24.1% achieved mRS 0–3. Mortality rate was 44.8%. There was only 1 minor procedure-related complication (small SAH without clinical sequelae).CONCLUSIONS:Despite high mortality rates and only moderate overall outcome, 17.2% of the patients achieved mRS 0–2 or prestroke mRS, and no serious procedure-related complications occurred. Therefore, very high age should not per se be an exclusion criterion for endovascular stroke treatment.

It is expected that the elderly population will grow substantially over the next few decades, with a doubling of the percentage of people over 80 years in the United States as well as in the European Union by 2050.^1,2 The risk of stroke, a leading cause of disability and death, increases with age,³ and patients older than 80 years have the highest incidence.⁴In studies assessing the outcomes of patients with stroke after endovascular treatment, patients are frequently separated into groups <80 years versus ≥80 years. Age greater than 80 years was found to be associated with a poorer clinical outcome and increased mortality,⁵ though revascularization success rates were comparable with those of younger patients.⁶ However, recent large prospective trials on endovascular stroke treatment had no upper age limit,^7,8 and the subgroup analysis in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial showed a treatment effect in all predefined subgroups, including the subgroup based on age (<80 years versus ≥80 years). Therefore, patients ≥80 years regularly undergo endovascular stroke treatment in our institution if they are eligible. Increasingly, we also treat nonagenarians (patients ≥ 90 years), though in the literature, most reports on the older age group include patients between 80 and 90 years, and only few data on patients older than 90 years exist. The oldest documented patient who underwent endovascular stroke treatment was a 103-year-old woman⁹ who recovered well.In this study, we summarize our experience of endovascular stroke treatment in patients ≥90 years of age between January 2011 and January 2016.     

Endovascular Stroke Treatment of Acute Tandem Occlusion: A Single-Center Experience

Purpose

To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment.

Conscious Sedation versus General Anesthesia during Endovascular Acute Ischemic Stroke Treatment: A Systematic Review and Meta-Analysis

BACKGROUND AND PURPOSE:A number of studies have suggested that anesthesia type (conscious sedation versus general anesthesia) during intra-arterial treatment for acute ischemic stroke has implications for patient outcomes. We performed a systematic review and meta-analysis of studies comparing the clinical and angiographic outcomes of the 2 anesthesia types.MATERIALS AND METHODS:In March 2014, we conducted a computerized search of MEDLINE and EMBASE for reports on anesthesia and endovascular treatment of acute ischemic stroke. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome (mRS ≤ 2), asymptomatic and symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, time to groin, and time from symptom onset to recanalization.RESULTS:Nine studies enrolling 1956 patients (814 with general anesthesia and 1142 with conscious sedation) were included. Compared with patients treated by using conscious sedation during stroke intervention, patients undergoing general anesthesia had higher odds of death (OR = 2.59; 95% CI, 1.87–3.58) and respiratory complications (OR = 2.09; 95% CI, 1.36–3.23) and lower odds of good functional outcome (OR = 0.43; 95% CI, 0.35–0.53) and successful angiographic outcome (OR = 0.54; 95% CI, 0.37–0.80). No difference in procedure time (P = .28) was seen between the groups. Preintervention NIHSS scores were available from 6 studies; in those, patients receiving general anesthesia had a higher average NIHSS score.CONCLUSIONS:Patients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with conscious sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies; thus, a randomized trial is necessary to confirm this association.

Intra-arterial recanalization for acute ischemic stroke is commonly used in patients with large-vessel occlusion.¹ Timely recanalization of the occluded vessel with either IV-tPA or intra-arterial therapy is essential in preventing neuronal death and improving patient outcome.² A number of factors affect patient outcomes following endovascular recanalization, possibly including choice of anesthetic agent during the procedure. Moderate conscious sedation and general anesthesia with intubation are the 2 most commonly used anesthesia techniques for patients with acute ischemic stroke undergoing endovascular recanalization.³ General anesthesia is often the preferred method due to the perceptions of improved procedural safety and efficacy.³ However, conscious sedation and local anesthesia allow operators to monitor neurologic status during the procedure and avoid delays in procedure initiation.⁴ Furthermore, conscious sedation may be associated with improved hemodynamic stability compared with general anesthesia. Due to the continuing debate regarding anesthesia choices during intra-arterial treatment of acute ischemic stroke, we performed a meta-analysis of studies comparing outcomes of patients with stroke receiving general anesthesia and conscious sedation during the procedures.^5,6     

Massive Pulmonary Embolism: Treatment with Thrombus Fragmentation and Local Fibrinolysis with Recombinant Human-Tissue Plasminogen Activator

Purpose: To report the results of thrombus fragmentation in combination with local fibrinolysis using recombinant human-tissue plasminogen activator (rtPA) in patients with massive pulmonary embolism. Methods: Five patients with massive pulmonary embolism were treated with thrombus fragmentation followed by intrapulmonary injection of rtPA. Clot fragmentation was performed with a guidewire, angiographic catheter, and balloon catheter. Three patients had undergone recent surgery; one of them received a reduced dosage of rtPA. Results: All patients survived and showed clinical improvement with a resultant significant (p < 0.05) decrease in the pulmonary blood pressure (mean systolic pulmonary blood pressure before treatment, 49 mmHg; 4 hr after treatment, 28 mmHg). Angiographic follow-up in three patients revealed a decrease in thrombus material and an increase in pulmonary perfusion. Two patients developed retroperitoneal hematomas requiring transfusion. Conclusion: Clot fragmentation and local fibrinolysis with rtPA was an effective therapy for massive pulmonary embolism. Bleeding at the puncture site was a frequent complication. Received: 0/00/00/Accepted: 0/00/00     

Effects of Antecedent Intravenous Thrombolysis on Endovascular Treatment of Acute Stroke Using Tirofiban

PurposeTo investigate whether preceding intravenous thrombolysis combined with tirofiban in patients with acute ischemic stroke undergoing endovascular treatment is safe and effective.Materials and MethodsConsecutive data were identified for patients who experienced acute ischemic stroke and were admitted to 2 comprehensive stroke centers from January 2015 to August 2021. All patients were divided into 2 groups—a thrombolytic with tirofiban group and a tirofiban-alone group—on the basis of whether intravenous thrombolysis before emergency endovascular angioplasty was used. Multivariate regression and propensity adjustment analyses were performed to characterize differences in safety and clinical outcomes between the 2 groups.ResultsOf 373 eligible patients, 111 (29.7%) were treated with thrombolysis with tirofiban. There was a significant difference in the rate of any intracerebral hemorrhage (35.1% vs 24.8%; P = .04) but not in the rates of symptomatic intracerebral hemorrhage (16.2% vs 11.5%; P = .23) and reocclusion at 24 hours (5.4% vs 7.6%; P = .51) between the 2 groups. Multivariate regression analysis revealed that intravenous thrombolysis was not associated with any or symptomatic intracerebral hemorrhage, artery occlusion, functional outcome, or death at the 3-month follow-up (all adjusted P > .05). After propensity adjustment, the thrombolytic with tirofiban group showed nonsignificant rates of clinical and safety outcomes compared with those of the tirofiban-alone group (all P > .05).ConclusionsTirofiban may be used without increasing the risk of adverse events in selected patients who experienced ischemic stroke and were treated with intravenous thrombolysis and endovascular therapy.     

A radiologist’s guide to the clinical scales used in the 2015 Endovascular Stroke Trials and the Revised American Heart Association/American Stroke Association Guidelines for Endovascular Stroke Treatment

In 2015, five trials demonstrated the efficacy of endovascular treatment for acute stroke, culminating in the revised American Heart Association/American Stroke Association (AHA/ASA) recommendations for stroke management. The different clinical scales used in these trials may be unfamiliar to emergency and on-call radiologists. The modified Rankin Scale was used to describe patient disability for prestroke assessment in three of the trials and for the 90-day follow up in all five trials. The Barthel index was used in one trial to score prestroke ability to perform activities of daily living. The NIH Stroke Scale was used as part of eligibility criteria in four of the stroke trials to assess pre-existing neurological deficits. Also, the modified Rankin Scale and the NIH Stroke Scale are used in the revised AHA/ASA recommendations. By understanding these scales, emergency and on-call radiologists will better appreciate the stroke patient’s condition and will be able to more actively collaborate in the care of acute stroke patients.     

Transcarotid Endovascular Thrombectomy for Acute Ischemic Stroke

Endovascular thrombectomy (EVT) via a transfemoral approach can be extremely time-consuming or even impossible. This brief review presents 7 transcarotid EVT procedures in which reperfusion graded as 2b or 3 on the Thrombolysis In Cerebral Infarction scale was achieved. Neck hematoma in need of treatment occurred in 1 patient. Two patients died. In the remaining patients, clinical outcome was graded as a modified Rankin scale score of 3 or less. The results suggest that transcarotid access may be a realistic option for EVT when transfemoral catheterization of the internal carotid artery is not feasible.     

Endovascular Treatment versus Best Medical Treatment in Patients with Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND AND PURPOSE:Endovascular treatment has emerged as a minimally invasive technique for patients with acute ischemic stroke to achieve recanalization. Our aim was to determine the effects of endovascular treatment on clinical and safety outcomes compared with best medical treatment.MATERIALS AND METHODS:Fifteen randomized trials that compared endovascular treatment with best medical treatment in patients with acute ischemic stroke met the inclusion criteria. We calculated pooled odds ratios and 95% CIs by using random-effects models. The primary end point was a favorable outcome defined by a modified Rankin Scale score of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability) at 90 days postrandomization.RESULTS:Of the 2980 subjects randomized, the proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to endovascular treatment compared with best medical treatment (2949 subjects analyzed; odds ratio, 1.82; 95% CI, 1.38–2.40; P < .001). Excellent outcome (modified Rankin Scale score of 0 or 1) was also significantly greater among those randomized to endovascular treatment (2791 subjects analyzed; odds ratio, 1.77; 95% CI, 1.29–2.43, P < .001). Risk of symptomatic intracranial hemorrhage was similar between endovascular treatment and best medical treatment (2906 subjects analyzed; odds ratio, 1.19; 95% CI, 0.84–1.68; P = .34).CONCLUSIONS:Compared with best medical treatment, the odds of achieving a favorable outcome or excellent outcome at 3 months postrandomization are approximately 80% higher with endovascular treatment among patients with acute ischemic stroke.

Endovascular treatment was introduced for patients with ischemic stroke in whom limited benefit with intravenous recombinant tissue plasminogen activator was expected or for those in whom IV thrombolytics was not indicated. There has been a 6-fold increase in the use of endovascular treatment among patients with acute ischemic stroke in the past few years,¹ and availability of endovascular treatment has been identified as a mandatory component of comprehensive stroke centers in the United States.^2,3 Several randomized trials have compared the efficacy of endovascular treatment with best medical treatment, which may include IV thrombolytic administration. Because of the small sample sizes or the limited representation of patients most likely to benefit from endovascular treatment within a study population, the results have been conflicting.^4–7 We performed this meta-analysis to combine the results of all existing trials to provide a comprehensive assessment of the benefit and risk associated with endovascular treatment in patients with acute ischemic stroke.     

Effect of Retrievable Stent Size on Endovascular Treatment of Acute Ischemic Stroke: A Multicenter Study

BACKGROUND AND PURPOSE:In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes.MATERIALS AND METHODS:Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device. We matched patients treated with the 2 stent sizes using propensity score analysis. The successful outcome was reperfusion as measured by the modified Thrombolysis in Cerebral Infarction score immediately postprocedure and the dichotomized modified Rankin Scale score at 90 days. Symptomatic intracerebral hemorrhage and in-hospital mortality were also recorded.RESULTS:After propensity score analysis, group outcomes did not differ. In addition, in patients with atherosclerosis-related occlusion, a higher reperfusion rate (P = .021) was observed in the Solitaire 4 group, as well as a shorter time interval (P = .002) and fewer passes (P = .025). Independent predictors of successful reperfusion in patients with atherosclerotic disease on logistic analysis were the small stent (OR, 3.217; 95% CI, 1.129–9.162; P = .029) and the propensity score acting as a covariate (OR, 52.84; 95% CI, 3.468–805.018; P = .004).CONCLUSIONS:We found no evidence of a differential effect of intra-arterial therapy based on the size of Solitaire retrievers. In patients with atherosclerotic disease, favorable reperfusion was associated with deployment of a small stent.

Large-vessel occlusion accounts for 28%–46% of all ischemic strokes and leads to poor prognosis and high mortality.¹ Since 2015, the results of several clinical randomized trials have suggested that intra-arterial treatment is safe and effective for anterior circulation large-vessel occlusion.^2–7 The success also demonstrated the benefit of newer stent devices in endovascular recanalization therapies because most patients were treated with retrievable stents in these trials.In these trials, most devices used for mechanical thrombectomy were retrievable stents such as the Solitaire FR (Covidien, Irvine, California)⁸ or the Trevo retriever (Stryker, Kalamazoo, Michigan).⁹ The Solitaire is a self-expanding and retrievable stentlike device that restores blood flow immediately by thrombus entrapment between the stent struts and the vessel wall,¹⁰ achieving substantially better safety and efficacy outcomes than former devices.¹¹ This device was at first designed for aneurysms, with a variety of diameters made available to meet the needs of different sizes of intracranial vessels.¹² For mechanical thrombectomy, stents with 4- and 6-mm diameters delivered through 0.021- and 0.027-inch microcatheters, respectively, optimize performance in intracranial large vessels in present day interventional therapy. The Trevo retriever is structurally similar to the Solitaire FR, with a stent cell geometry designed to integrate the clot into the stent for retrieval.^13,14It has been reported that a difference in stent size potentially influences stent properties, including radial force, flexibility, and deliverability.^15–17 The radial force represents the supporting action of the stent on the vessel wall to prevent elastic retraction, while flexibility and deliverability exemplify the ability to pass through the occluded site. Several studies have found that a stent with a large radial force is suitable for proximal vessels and atherosclerotic modified vessels with hardened or calcified plaque, while a more flexible stent should be used in a tortuous or distant vessel.^16,18In addition, extensive evidence shows that the stent diameter is associated with in-stent restenosis¹⁹ and change in blood flow after intracranial stent implantation,²⁰ as well as adverse events after percutaneous coronary intervention.^21,22 These results demonstrated the impact of stent size on vascular interventional therapy and also showed the importance and necessity of research on device size in mechanical thrombectomy. However, as yet there is no established guideline for stent selection, with the choice being been left entirely to the interventionist. Hence, uncertainties remain about the benefit and risk of endovascular intervention in relation to different sizes of stents. This study addresses the uncertainties regarding stent size for thrombectomy.     

Rescue Treatment of Thromboembolic Complications during Endovascular Treatment of Cerebral Aneurysms: A Meta-Analysis

BACKGROUND AND PURPOSE:Intraprocedural thrombus formation during endovascular treatment of intracranial aneurysms is often treated with glycoprotein IIb/IIIa inhibitors and, in some instances, fibrinolytic therapy. We performed a meta-analysis evaluating the safety and efficacy of GP IIb/IIIa inhibitors compared with fibrinolysis. We also evaluated the safety and efficacy of abciximab, an irreversible inhibitor, compared with tirofiban and eptifibatide, reversible inhibitors of platelet function.MATERIALS AND METHODS:We performed a comprehensive literature search for studies on rescue therapy for intraprocedural thromboembolic complications with glycoprotein IIb/IIIa inhibitors or fibrinolysis during endovascular treatment of intracranial aneurysms. We studied rates of periprocedural stroke/hemorrhage, procedure-related morbidity and mortality, immediate arterial recanalization, and long-term good clinical outcome. Event rates were pooled across studies by using random-effects meta-analysis.RESULTS:Twenty-three studies with 516 patients were included. Patients receiving GP IIb/IIIa inhibitors had significantly lower perioperative morbidity from stroke/hemorrhage compared with those treated with fibrinolytics (11.0%; 95% CI, 7.0%–16.0% versus 29.0%; 95% CI, 13.0%–55.0%; P = .04) and were significantly less likely to have long-term morbidity (16.0%; 95% CI, 11.0%–21.0% versus 35.0%; 95% CI, 17.0%–58.0%; P = .04). There was a trend toward higher recanalization rates among patients treated with glycoprotein IIb/IIIa inhibitors compared with those treated with fibrinolytics (72.0%; 95% CI, 64.0%–78.0% versus 50.0%; 95% CI, 28.0%–73.0%; P = .08). Patients receiving tirofiban or eptifibatide had significantly higher recanalization rates compared with those treated with abciximab (83.0%; 95% CI, 68.0%–91.0% versus 66.0%; 95% CI, 58.0%–74.0%; P = .05). No difference in recanalization was seen in patients receiving intra-arterial (77.0%; 95% CI, 66.0%–85.0%) or intravenous GP IIb/IIIa inhibitors (70.0%; 95% CI, 57.0%–80.0%, P = .36).CONCLUSIONS:Rescue therapy with thrombolytic agents resulted in significantly more morbidity than rescue therapy with glycoprotein IIb/IIIa inhibitors. Tirofiban/eptifibatide resulted in significantly higher recanalization rates compared with abciximab.

Periprocedural thromboembolic complications from endovascular treatment of intracranial aneurysms occur in 2%–15% of patients.¹ Intraprocedural thrombus formation is often treated with pharmacologic rescue, by using intra-arterial or intravenous administration of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors or fibrinolytics. The primary goal of rescue therapy is to recanalize the artery to avoid permanent neurologic deficits. Many studies have described intraprocedural administration of GP IIb/IIIa inhibitors and thrombolytic agents during endovascular treatment of intracranial aneurysms. Some studies have suggested that patients receiving GP IIb/IIIa inhibitors have better outcomes than those treated with fibrinolytic therapy. Studies have also examined the comparative efficacy of irreversible GP IIb/IIIa inhibitor agents (abciximab) and reversible agents (tirofiban/eptifibatide) and the comparative efficacy of intra-arterial and intravenous administration of GP IIb/IIIa inhibitors, but they have not demonstrated any significant differences in recanalization rates and outcomes.^2,3 Overall however, the evidence is limited to small case series. We performed a meta-analysis of the literature examining angiographic and clinical outcomes in patients treated with GP IIb/IIIa inhibitors and fibrinolytic therapy for intraprocedural thrombus formation during intracranial aneurysm treatment.⁴ We also performed subgroup analyses to compare outcomes of patients treated with abciximab versus tirofiban/eptifibatide and those treated with intra-arterial (IA) and intravenous GP IIb/IIIa rescue therapy.     

Stroke Secondary to Aseptic Meningitis After Endovascular Treatment of a Giant Aneurysm with Parent Artery Occlusion

Aseptic meningitis related to hydrogel-coated coils is a known complication, but it is extremely rare after platinum bare coil aseptic meningitis. Here we report the development of aseptic meningitis causing brain stem and cerebellar infarct in a patient with a giant aneurysm treated with bare platinum coils. We conclude that aneurysm size is an important factor affecting the occurrence of aseptic meningitis associated with stroke.     

Endovascular Treatment of Phlegmasia Cerulea Dolens with Impending Venous Gangrene: Manual Aspiration Thrombectomy as the First-Line Thrombus Removal Method

Purpose  

Our purpose was to report the outcome of endovascular treatment with manual aspiration thrombectomy as the first-line thromboablative method for phlegmasia cerulea dolens.     

Complications of Endovascular Treatment for Acute Stroke in the SWIFT Trial with Solitaire and Merci Devices

BACKGROUND AND PURPOSE:Treatment of patients with ischemic stroke after endovascular treatment requires in-depth knowledge of complications. The goal of this study was to make endovascular treatment for acute ischemic stroke safer through an in-depth review of the major periprocedural complications observed in the Solitaire FR With Intention for Thrombectomy (SWIFT) trial.MATERIALS AND METHODS:The SWIFT data base was searched for major peri-procedural complications defined as symptomatic intracranial hemorrhage within 36 hours, SAH, air emboli, vessel dissection, major groin complications, and emboli to new vascular territories.RESULTS:Major peri-procedural complications occurred in 18 of 144 patients (12.5%) as follows: symptomatic intracranial hemorrhage, 4.9%; air emboli, 1.4%; vessel dissection, 4.2%; major groin complications, 2.8%; and emboli to new vascular territories, 0.7%. Rates of symptomatic intracranial bleeding by subtype were PH1, 0.7%; PH2, 0.7% (PH1 indicates hematoma within ischemic field with some mild space-occupying effect but involving ≤30% of the infarcted area; PH2, hematoma within ischemic field with space-occupying effect involving >30% of the infarcted area); intracranial hemorrhage remote from ischemic zone, 0%; intraventricular hemorrhage, 0.7%; and SAH, 3.5%. We did not observe any statistically significant associations of peri-procedural complications with age; type of treatment center; duration of stroke symptoms; NIHSS score, IV thrombolytics, atrial fibrillation, site of vessel occlusion; rescue therapy administered after endovascular treatment; or device. Comparing the Merci with the Solitaire FR retrieval device, we observed symptomatic cerebral hemorrhage (10.9% versus 1.1%; P = .013); symptomatic SAH (7.3% versus 1.1%; P = .07), air emboli (1.8% versus 1.1%; P = 1.0), emboli to new vascular territories (1.8% versus 0%; P = .38), vessel dissection (1.8% versus 4.5%; P = .65), and major groin complications (3.6% versus 7.9%; P = .48). Angiographic vasospasm was common but without clinical sequelae.CONCLUSIONS:Understanding of procedural complications is important for treatment of patients with stroke after endovascular treatment. We observed fewer endovascular complications with the Solitaire FR device treatment compared with Merci device treatment, particularly symptomatic cerebral hemorrhage.

Intravenous tissue plasminogen activator has been proven to be efficacious in recanalization of occluded intracranial vessels and improvement of clinical outcome for acute ischemic stroke.¹ A meta-analysis of 53 studies including 2066 patients with acute stroke demonstrated a 46.2% overall recanalization rate with IV fibrinolysis.^1,2 However, IV tPA has limited ability to open occlusions of medium and large arteries such as the internal carotid artery, proximal middle cerebral artery, or basilar artery, with recanalization rates reported as low as 10%.^2,3 Because of these limitations, catheter-based approaches for acute ischemic stroke have been developed to directly infuse thrombolytics at the site of the thrombus or mechanically extract and disrupt the clot.^3–13 As with systemic thrombolytics, endovascular treatments for acute ischemic stroke carry the risk of intracranial bleeding. These treatments also carry additional risks related to vascular access, catheter placement, direct vessel injury, and the type of device deployed.The Solitaire FR With Intention for Thrombectomy (SWIFT) trial provides additional information about endovascular approaches for acute stroke and directly compares the Solitaire FR device (Covidien, Irvine, California) with the Merci retrieval device (Stryker Neurovascular, Fremont, California) in a prospective, randomized trial. Results of the primary end point for this study have been reported separately.¹³ Acute stroke trials have consistently highlighted the importance of achieving early reperfusion while keeping procedural complication risks as low as possible. The therapeutic time windows are tight, and gains achieved by flow restoration are easily erased by symptomatic intracranial bleeding caused by procedural complications. The SWIFT trial reports a significant technical advance for mechanical thrombectomy by use of the Solitaire device compared with current technology (Merci retriever); the focus of this report is an in-depth analysis of the major procedural complications of this trial.     

医源性假性动脉瘤的介入治疗

目的对33例医源性假性动脉瘤的诊断、治疗进行了总结、讨论,提高对本病的认识,提高治愈率,减少致残及死亡。资料与方法 33例均经股动脉穿刺插管行选择性血管造影,明确载瘤动脉后将导管超选择插入载瘤动脉内,19例用明胶海绵、9例用螺旋圈栓塞载瘤动脉,代替了动脉结扎手术;5例用带膜支架封闭动脉破口,代替了动脉修补术。结果均获得了明显的止血效果,无并发症,无致残、无死亡,住院天数明显缩短。结论对医源性假性动脉瘤的治疗,只要是有条件的医院应首选血管内介入治疗的方法,它具有创伤小,靶血管明确,止血快,疗效好的特点,能最大限度地降低或杜绝致残及死亡率,有很好的社会效益。