Browsing by Subject "Thrombectomy"

Now showing 1 - 6 of 6
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    DEEP MOVEMENT: Deep learning of movie files for management of endovascular thrombectomy
    (Springer, 2023) Kelly, Brendan; Martinez, Mesha; Do, Huy; Hayden, Joel; Huang, Yuhao; Yedavalli, Vivek; Ho, Chang; Keane, Pearse A.; Killeen, Ronan; Lawlor, Aonghus; Moseley, Michael E.; Yeom, Kristen W.; Lee, Edward H.; Radiology and Imaging Sciences, School of Medicine
    Objectives: Treatment and outcomes of acute stroke have been revolutionised by mechanical thrombectomy. Deep learning has shown great promise in diagnostics but applications in video and interventional radiology lag behind. We aimed to develop a model that takes as input digital subtraction angiography (DSA) videos and classifies the video according to (1) the presence of large vessel occlusion (LVO), (2) the location of the occlusion, and (3) the efficacy of reperfusion. Methods: All patients who underwent DSA for anterior circulation acute ischaemic stroke between 2012 and 2019 were included. Consecutive normal studies were included to balance classes. An external validation (EV) dataset was collected from another institution. The trained model was also used on DSA videos post mechanical thrombectomy to assess thrombectomy efficacy. Results: In total, 1024 videos comprising 287 patients were included (44 for EV). Occlusion identification was achieved with 100% sensitivity and 91.67% specificity (EV 91.30% and 81.82%). Accuracy of location classification was 71% for ICA, 84% for M1, and 78% for M2 occlusions (EV 73, 25, and 50%). For post-thrombectomy DSA (n = 194), the model identified successful reperfusion with 100%, 88%, and 35% for ICA, M1, and M2 occlusion (EV 89, 88, and 60%). The model could also perform classification of post-intervention videos as mTICI < 3 with an AUC of 0.71. Conclusions: Our model can successfully identify normal DSA studies from those with LVO and classify thrombectomy outcome and solve a clinical radiology problem with two temporal elements (dynamic video and pre and post intervention).
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    Endovascular approach to thrombosed limb of aortoiliac endoprosthetic stent graft following abdominal endovascular aneurysm repair
    (Elsevier, 2022-07-20) Willhite, Sydney R.; Warner, Adam C.; Hain, Julius S.; Nickerson, Margaret C.; Peterson, David A.; Cuddy, Duangnapa S.; Graduate Medical Education, School of Medicine
    The increasing use of endovascular aneurysm repair to treat abdominal aortic aneurysms has mandated solutions to the limitations of this operation, including the requirement for additional procedures. A 64-year-old man had presented with symptomatic thrombosis of the left iliac limb after endovascular aneurysm repair. We have reported the use of an innovative endovascular repair for our patient.
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    Large-bore aspiration thrombectomy for the treatment of pulmonary embolism in octogenarians
    (Springer, 2025-01-22) Masterson, Reid; Pebror, Travis; Gauger, Andrew; Schmitz, Adam William; Butty, Sabah David; Radiology and Imaging Sciences, School of Medicine
    Purpose: To evaluate outcomes in patients aged ≥ 80 years following large-bore aspiration thrombectomy (LBAT) for the treatment of pulmonary embolism (PE). Materials and methods: All patients ≥ 80 years of age with PE treated via LBAT at a single center were analyzed from September 2019 - August 2024. This included the octogenarian subgroup from a recently published retrospective analysis assessing all PE patients treated with LBAT at our center between September 2019 and January 2023. The following outcomes were evaluated: technical success, change in several hemodynamic measures including pulmonary artery pressure (PAP) and right ventricle to left ventricle ratio (RV to LV ratio), length of hospital and intensive-care-unit (ICU) stay, procedure-related complications, and 7- and 30-day mortality. Results: Forty-eight patients aged ≥ 80 years underwent LBAT procedures for PE. Technical success was achieved in 46 cases (95.8%). The mean reduction in mean PAP was 3.6 mmHg. The mean reduction in RV to LV ratio was -0.42. The mean length of postprocedural hospital and ICU stays were 5.7 ± 3.6 days and 1.0 ± 1.6 days, respectively. There were 2 procedural complications, 1 pulmonary vascular injury involving a pulmonary artery pseudoaneurysm and 1 decompensation involving hypotension requiring vasopressor support. There were no major bleeding complications or cardiac injuries. All-cause mortality was 2.1% (n = 1) at 7 days and 6.3% (n = 3) at 30 days post procedure. PE-related mortality was 2.1% (n = 1) at 30 days. Conclusion: LBAT is a technically feasible procedure for the treatment of PE in octogenarian patients and has a favorable preliminary safety and mortality profile.
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    Macrowire for Intracranial Thrombectomy: A Video Description
    (Sage, 2024-12-18) Kumar, Arjun B.; Khan, Usama; Limaye, Kaustubh; Neurology, School of Medicine
    Mechanical thrombectomy has become the cornerstone to achieve reperfusion in large vessel occlusion causing acute ischemic stroke. Since the advent of intracranial thrombectomy, the procedural setup has been to deliver aspiration catheter over microwire and microcatheter to the intracranial occlusion (ADAPT) or to deliver the stent-retriever through the microcatheter (SOLUMBRA) to perform thrombectomy.1 In both these techniques the quintessential aspect is crossing the clot/thrombus, which increases the chances of clot fragmentation or disruption.2 We demonstrate delivering an ultra-large bore (Sofia 0.088, Microvention, Aliso Viejo, CA, USA) to the intracranial occlusion over a macrowire (Aristotle Colossus OD: 0.035' × 200 cm, Scientia Vascular, UT, USA) alone with no use of microcatheter or microwire. The utilization of macrowire to perform thrombectomy provides enough support to guide the large or ultra large bore catheter to the clot interface without the need to cross the clot. As this technique involves no crossing of clot it prevents clot disruption and distal embolization. There are other possible benefits which are under study in MINT Registry3 and include making thrombectomy more time and cost efficient.
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    Macrowire for intracranial thrombectomy: An early experience of a new device and technique for anterior circulation large vessel occlusion stroke
    (Sage, 2024-12-18) Limaye, Kaustubh; Al Kasab, Sami; Dolia, Jaidevsinh; Ezzeldin, Mohamad; Vela Duarte, Daniel; Doss, Vinodh; Lahoti, Sourabh; Hasan, David; Spiotta, Alejandro; Asi, Khaled; Saini, Vasu; Mehta, Tapan; Hassan, Ameer; Haussen, Diogo; Yavagal, Dileep; Jones, Jesse; Tanweer, Omar; Brinjikji, Waleed; Neurology, School of Medicine
    Background and purpose: Mechanical thrombectomy (MT) has become the standard of care for treatment of acute ischemic stroke secondary to large vessel occlusion up to 24 h from the last known normal time. With ADAPT and SOLUMBRA techniques, classically, a large bore aspiration catheter is delivered over a microcatheter and microwire crossing the clot to perform thrombectomy. Recently, a novel macrowire (Colossus 035 in.) has been introduced as a potential alternative to the use of microwire-microcatheter to allow the delivery of the aspiration catheter (ID = 0.070 in. up to 0.088 in.) over a macrowire alone. Objective: To test the feasibility of delivering an aspiration catheter to clot interface over a macrowire alone. Materials and methods: A retrospective evaluation of prospectively maintained Macrowire for Intracranial Thrombectomy (MINT) Registry where this novel technique was utilized for thrombectomy. Consecutive patients undergoing MT using the MINT technique were included. We collected baseline demographics, imaging and clinical characteristics, rate of procedural success, conversion to traditional MT, and complications. Results: Fifty consecutive patients were recruited during the initial 4 months of the larger study duration. The aspiration catheter was able to be advanced to the clot interface successfully in 46/50 (92%) using the MINT technique. Median time from vascular access to the first pass was 11.30 min (IQR = 7.45-14.30 min) and successful thrombectomy was 14 min (IQR = 10-22.15). The modified first-pass effect with this procedure was 71%. One vasospasm was reported as a procedural complication. Conclusions: MINT is safe and feasible for large vessel occlusion recanalization based on our initial clinical experience in this multicenter study.
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    Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke
    (American Medical Association, 2023) Mac Grory, Brian; Holmes, DaJuanicia N.; Matsouaka, Roland A.; Shah, Shreyansh; Chang, Cherylee W. J.; Rison, Richard; Jindal, Jenelle; Holmstedt, Christine; Logan, William R.; Corral, Candy; Mackey, Jason S.; Gee, Joey R.; Bonovich, David; Walker, James; Gropen, Toby; Benesch, Curtis; Dissin, Jonathan; Pandey, Hemant; Wang, David; Unverdorben, Martin; Hernandez, Adrian F.; Reeves, Mathew; Smith, Eric E.; Schwamm, Lee H.; Bhatt, Deepak L.; Saver, Jeffrey L.; Fonarow, Gregg C.; Peterson, Eric D.; Xian, Ying; Neurology, School of Medicine
    Importance: Use of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications. Objective: To determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice. Design, setting, and participants: Retrospective, observational cohort study based on the American Heart Association's Get With the Guidelines-Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included. Exposure: VKA use within the 7 days prior to hospital arrival. Main outcome and measures: The primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion therapy, in-hospital mortality, and in-hospital mortality or discharge to hospice. Results: Of 32 715 patients (median age, 72 years; 50.7% female), 3087 (9.4%) had used a VKA (median international normalized ratio [INR], 1.5 [IQR, 1.2-1.9]) and 29 628 had not used a VKA prior to hospital presentation. Overall, prior VKA use was not significantly associated with an increased risk of sICH (211/3087 patients [6.8%] taking a VKA compared with 1904/29 628 patients [6.4%] not taking a VKA; adjusted odds ratio [OR], 1.12 [95% CI, 0.94-1.35]; adjusted risk difference, 0.69% [95% CI, -0.39% to 1.77%]). Among 830 patients taking a VKA with an INR greater than 1.7, sICH risk was significantly higher than in those not taking a VKA (8.3% vs 6.4%; adjusted OR, 1.88 [95% CI, 1.33-2.65]; adjusted risk difference, 4.03% [95% CI, 1.53%-6.53%]), while those with an INR of 1.7 or lower (n = 1585) had no significant difference in the risk of sICH (6.7% vs 6.4%; adjusted OR, 1.24 [95% CI, 0.87-1.76]; adjusted risk difference, 1.13% [95% CI, -0.79% to 3.04%]). Of 5 prespecified secondary end points, none showed a significant difference across VKA-exposed vs VKA-unexposed groups. Conclusions and relevance: Among patients with acute ischemic stroke selected to receive EVT, VKA use within the preceding 7 days was not associated with a significantly increased risk of sICH overall. However, recent VKA use with a presenting INR greater than 1.7 was associated with a significantly increased risk of sICH compared with no use of anticoagulants.