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31 results on '"Bernava, Gianmarco"'

1. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

Author

Nguyen, Thanh N, Haussen, Diogo C, Qureshi, Muhammad M, Yamagami, Hiroshi, Fujinaka, Toshiyuki, Mansour, Ossama Y, Abdalkader, Mohamad, Frankel, Michael, Qiu, Zhongming, Taylor, Allan, Lylyk, Pedro, Eker, Omer F, Mechtouff, Laura, Piotin, Michel, Lima, Fabricio Oliveira, Mont'Alverne, Francisco, Izzath, Wazim, Sakai, Nobuyuki, Mohammaden, Mahmoud, Al-Bayati, Alhamza R, Renieri, Leonardo, Mangiafico, Salvatore, Ozretic, David, Chalumeau, Vanessa, Ahmad, Saima, Rashid, Umair, Hussain, Syed Irteza, John, Seby, Griffin, Emma, Thornton, John, Fiorot, Jose Antonio, Rivera, Rodrigo, Hammami, Nadia, Cervantes-Arslanian, Anna M, Dasenbrock, Hormuzdiyar H, Vu, Huynh Le, Nguyen, Viet Quy, Hetts, Steven, Bourcier, Romain, Guile, Romain, Walker, Melanie, Sharma, Malveeka, Frei, Don, Jabbour, Pascal, Herial, Nabeel, Al-Mufti, Fawaz, Ozdemir, Atilla Ozcan, Aykac, Ozlem, Gandhi, Dheeraj, Chugh, Chandril, Matouk, Charles, Lavoie, Pascale, Edgell, Randall, Beer-Furlan, Andre, Chen, Michael, Killer-Oberpfalzer, Monika, Pereira, Vitor Mendes, Nicholson, Patrick, Huded, Vikram, Ohara, Nobuyuki, Watanabe, Daisuke, Shin, Dong Hun, Magalhaes, Pedro SC, Kikano, Raghid, Ortega-Gutierrez, Santiago, Farooqui, Mudassir, Abou-Hamden, Amal, Amano, Tatsuo, Yamamoto, Ryoo, Weeks, Adrienne, Cora, Elena A, Sivan-Hoffmann, Rotem, Crosa, Roberto, Möhlenbruch, Markus, Nagel, Simon, Al-Jehani, Hosam, Sheth, Sunil A, Lopez Rivera, Victor S, Siegler, James E, Sani, Achmad Fidaus, Puri, Ajit S, Kuhn, Anna Luisa, Bernava, Gianmarco, Machi, Paolo, Abud, Daniel G, Pontes-Neto, Octavio M, Wakhloo, Ajay K, Voetsch, Barbara, Raz, Eytan, Yaghi, Shadi, Mehta, Brijesh P, Kimura, Naoto, Murakami, Mamoru, Lee, Jin Soo, Hong, Ji Man, Fahed, Robert, Walker, Gregory, Hagashi, Eiji, Cordina, Steve M, and Roh, Hong Gee

Subjects
Brain Disorders, Stroke, Clinical Research, Neurosciences, COVID-19, Cross-Sectional Studies, Humans, Intracranial Aneurysm, Pandemics, Prospective Studies, Retrospective Studies, SARS-CoV-2, Subarachnoid Hemorrhage, Treatment Outcome, aneurysm, coil, haemorrhage, infection, subarachnoid, SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization, Japanese Society of Vascular and Interventional Neurology Society
Abstract

BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p

Published
2021

3. In vitro evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter.

Author

Bernava, Gianmarco, Brina, Olivier, Reymond, Philippe, Rosi, Andrea, Hofmeister, Jeremy, Yilmaz, Hasan, Muster, Michel, Kulcsar, Zsolt, Lovblad, Karl-Olof, and Machi, Paolo

Subjects
*ISCHEMIC stroke, *LEVEL of aspiration, *THROMBECTOMY, *ASPIRATORS, *CATHETERS
Abstract

Background: Several variations of the combined thrombectomy technique for acute ischemic stroke using a stent retriever and aspiration catheter have been described. The aim of our study was to assess how the presence of the microcatheter and stent retriever affect the basic aspiration parameters, namely, flow rate and aspiration force, depending on their position within the aspiration catheter. Methods: Two experimental set-ups were designed to assess changes in flow rate and aspiration force according to the position of the stent retriever and microcatheter within the aspiration catheter. Results: The transition of the stent retriever and microcatheter from the distal to proximal position resulted in a progressive increase in the flow rate, but with no impact on aspiration force. Additionally, the size of the stent retriever had no significant effect on flow rate changes and the reduction in flow rate was related to the microcatheter diameter. Negative pressure generated inside the aspiration catheter impacted on its distal segment located beyond the radiopaque marker, thus leading to its partial collapse. As a consequence, the measured aspiration force was lower than the theoretical aspiration force level for all tested aspiration catheters. Conclusions: In our experimental model, the position of the stent retriever and microcatheter within the aspirator catheter affected the flow rate, but not the aspiration force. Negative pressure generated within the aspiration catheter appeared to determine a partial collapse of the distal segment that resulted in a less effective aspiration force than the theoretical aspiration force level. [ABSTRACT FROM AUTHOR]

Published
2024
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5. In vitroevaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter

Author

Bernava, Gianmarco, Brina, Olivier, Reymond, Philippe, Rosi, Andrea, Hofmeister, Jeremy, Yilmaz, Hasan, Muster, Michel, Kulcsar, Zsolt, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

Background Several variations of the combined thrombectomy technique for acute ischemic stroke using a stent retriever and aspiration catheter have been described. The aim of our study was to assess how the presence of the microcatheter and stent retriever affect the basic aspiration parameters, namely, flow rate and aspiration force, depending on their position within the aspiration catheter.Methods Two experimental set-ups were designed to assess changes in flow rate and aspiration force according to the position of the stent retriever and microcatheter within the aspiration catheter.Results The transition of the stent retriever and microcatheter from the distal to proximal position resulted in a progressive increase in the flow rate, but with no impact on aspiration force. Additionally, the size of the stent retriever had no significant effect on flow rate changes and the reduction in flow rate was related to the microcatheter diameter. Negative pressure generated inside the aspiration catheter impacted on its distal segment located beyond the radiopaque marker, thus leading to its partial collapse. As a consequence, the measured aspiration force was lower than the theoretical aspiration force level for all tested aspiration catheters.Conclusions In our experimental model, the position of the stent retriever and microcatheter within the aspirator catheter affected the flow rate, but not the aspiration force. Negative pressure generated within the aspiration catheter appeared to determine a partial collapse of the distal segment that resulted in a less effective aspiration force than the theoretical aspiration force level.

Published
2024
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6. Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures

Author

Bernava, Gianmarco, primary, Tesoro, Rosa, additional, Boto, José, additional, Challita, Myriam, additional, Rosi, Andrea, additional, Hofmeister, Jeremy, additional, Yilmaz, Hasan, additional, Carrera, Emmanuel, additional, Brina, Olivier, additional, Reymond, Philippe, additional, Muster, Michel, additional, Kulcsar, Zsolt, additional, Lovblad, Karl-Olof, additional, and Machi, Paolo, additional

Published
2023
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10. Endovascular treatment strategies for simultaneous bilateral anterior circulation occlusions in acute ischemic stroke: A single-center experience and systematic review of the literature

Author

Bernava, Gianmarco, primary, Botti, Paul, additional, Rosi, Andrea, additional, Hofmeister, Jeremy, additional, Yilmaz, Hasan, additional, Carrera, Emmanuel, additional, Brina, Olivier, additional, Reymond, Philippe, additional, Muster, Michel, additional, Kulcsar, Zsolt, additional, Lovblad, Karl-Olof, additional, and Machi, Paolo, additional

Published
2023
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11. Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up

Author

Society of Vascular and Interventional Neurology (US), Nguyen, Thanh N., Qureshi, Muhammad M., Klein, Piers, Yamagami, Hiroshi, Mikulik, Robert, Czlonkowska, Anna, Abdalkader, Mohamad, Sedova, Petra, Sathya, Anvitha, Lo, Hannah C., Mansour, Ossama Yassin, Vanguru, Husitha Reddy, Lesaine, Emilie, Tsivgoulis, Georgios, Loochtan, Aaron I., Demeestere, Jelle, Uchino, Ken, Inoa, Violiza, Goyal, Nitin, Charidimou, Andreas, Siegler, James E., Yaghi, Shadi, Aguiar de Sousa, Diana, Mohammaden, Mahmoud H., Haussen, Diogo C., Kristoffersen, Espen Saxhaug, Lereis, Virginia Pujol, Scollo, Sergio Daniel, Campbell, Bruce C. V., Ma, Alice, Thomas, James Orton, Parsons, Mark W., Singhal, Shaloo, Slater, Lee-Anne, Tomazini Martins, Rodrigo, Enzinger, Chris, Gattringer, Thomas, Rahman, Aminur, Bonnet, Thomas, Ligot, Noemie, De Raedt, Sylvie, Lemmens, Robin, Vanacker, Peter, Vandervorst, Fenne, Conforto, Adriana Bastos, Hidalgo, Raquel C. T., Neves, Luciana de Oliveira, Martins, Rodrigo Targa, Mora Cuervo, Daissy Liliana, Rebello, Leticia C., Santiago, Igor Bessa, Silva, Isabelle Lameirinhas da, Sakelarova, Teodora, Kalpachki, Rosen, Alexiev, Filip, Catanese, Luciana, Cora, Elena Adela, Goyal, Mayank, Hill, Michael D., Kelly, Michael E., Khosravani, Houman, Lavoie, Pascale, Peeling, Lissa, Pikula, Aleksandra, Rivera, Rodrigo, Chen, Hui-Sheng, Chen, Yimin, Huo, Xiaochuan, Miao, Zhongrong, Yang, Shuiquan, Bedekovic, Marina Roje, Bralic, Marina, Budincevic, Hrvoje, Corredor-Quintero, Ángel Basilio, Lara-Sarabia, Osvaldo E., Cabal, Martin, Tenora, Dusan, Fibrich, Petr, Herzig, Roman, Hlaváčová, Helena, Hrabanovska, Emanuela, Hlinovsky, David, Jurak, Lubomir, Kadlcikova, Jana, Karpowicz, Igor, Klecka, Lukas, Kovar, Martin, Lauer, David, Neumann, Jiri, Palouskova, Hana, Reiser, Martin, Rekova, Petra, Rohan, Vladimir, Skoda, Ondrej, Škorňa, Miroslav, Sobotková, Lenka, Sramek, Martin, Zakova, Lenka, Christensen, Hanne, Drenck, Nicolas, Iversen, Helle Klingenberg, Truelsen, Thomas Clement, Wienecke, Troels, Sobh, Khalid, Ylikotila, Pauli, Alpay, Kemal, Strbian, Daniel, Bernady, Patricia, Casenave, Philippe, Dan, Maria, Faucheux, Jean-Marc, Gentric, Jean-Christophe, Magro, Elsa, Sabben, Candice, Reiner, Peggy, Rouanet, Francois, Bohmann, Ferdinand O., Boskamp, Stefan, Mbroh, Joshua, Nagel, Simon, Nolte, Christian H, Ringleb, Peter A., Rosenkranz, Michael, Poli, Sven, Thomalla, Götz, Karapanayiotides, Theodoros, Koutroulou, Ioanna, Kargiotis, Odysseas, Palaiodimou, Lina, Barrientos Guerra, José Domingo, Huded, Vikram, Menon, Bindu, Nagendra, Shashank, Prajapati, Chintan, Sylaja, P. N., Krishna Pramana, Nyoman Angga, Sani, Achmad Firdaus, Ghoreishi, Abdoreza, Farhoudi, Mehdi, Hokmabadi, Elyar Sadeghi, Raya, Tariq Abu, Kalmanovich, Shani Avnery, Ronen, Levite, Sabetay, Sergiu Ionut, Acampa, Maurizio, Adami, Alessandro, Castellan, Lucio, Longoni, Marco, Ornello, Raffaele, Renieri, Leonardo, Bigliani, Claudia Rolla, Romoli, Michele, Sacco, Simona, Salmaggi, Andrea, Sangalli, Davide, Zini, Andrea, Doijiri, Ryosuke, Fukuda, Hiroki, Fujinaka, Toshiyuki, Fujita, Kyohei, Imamura, Hirotoshi, Sakai, Nobuyuki, Kanamaru, Takuya, Kimura, Naoto, Kono, Ryuhei, Miyake, Kosuke, Sakaguchi, Manabu, Sakai, Kenichiro, Sonoda, Kazutaka, Todo, Kenichi, Miyashita, Fumio, Tokuda, Naoki, Matsumaru, Yuji, Matsumoto, Shoji, Ohara, Nobuyuki, Shindo, Seigo, Takenobu, Yohei, Yoshimoto, Takeshi, Toyoda, Kazunori, Uwatoko, Takeshi, Yagita, Yoshiki, Yamada, Takehiro, Yamamoto, Nobuaki, Yamamoto, Ryoo, Yazawa, Yukako, Sugiura, Yuri, Waweru, Peter Kuria, Baek, Jang-Hyun, Lee, Si Baek, Seo, Kwon-Duk, Sohn, Sung-Il, Arsovska, Anita Ante, Chan, Yong Chieh, Wan Zaidi, Wan Asyraf, Jaafar, Ainul Syahrilfazli, Gongora-Rivera, Fernando, Martinez-Marino, Manuel, Infante-Valenzuela, Adrian, Groppa, Stanislav, Leahu, Pavel, Coutinho, Jonathan M, Rinkel, Leon A., Dippel, Diederik W. J., Dam-Nolen, Dianne H. K. van, Ranta, Annemarei, Wu, Teddy Y., Adebayo, Tajudeen Temitayo, Bello, Abiodun H., Nwazor, Ernest Okwundu, Sunmonu, Taofiki Ajao, Wahab, Kolawole Wasiu, Ronning, Ole Morten, Sandset, Else Charlotte, Al Hashmi, Amal M., Ahmad, Saima, Rashid, Umair, Rodriguez-Kadota, Liliana, Vences, Miguel Ángel, Yalung, Patrick Matic, Hao Dy, Jon Stewart, Pineda-Franks, Maria Carissa, Co, Christian Oliver, Brola, Waldemar, Debiec, Aleksander, Dorobek, Malgorzata, Karlinski, Michal Adam, Labuz-Roszak, Beata M., Lasek-Bal, Anetta, Sienkiewicz-Jarosz, Halina, Staszewski, Jacek, Sobolewski, Piotr, Wiacek, Marcin, Zielinska-Turek, Justyna, Araujo, Andre Pinho, Rocha, Mariana, Castro, Pedro, Cruz, Vitor Tedim, Ferreira, Paulo Venancio, Ferreira, Patricia, Nunes, Ana Paiva, Fonseca, Luisa, Marto, João Pedro, Pinho E Melo, Teresa, Rodrigues, Miguel, Silva, M. Luis, Dimitriade, Adela, Falup-Pecurariu, Cristian, Hamid, May Adel, Venketasubramanian, Narayanaswamy, Krastev, Georgi, Mako, Miroslav, Ayo-Martin, Oscar, Hernández-Fernández, Francisco, Blasco, Jordi, Rodríguez-Vázquez, Alejandro, Cruz-Culebras, Antonio, Moniche, Francisco, Montaner, Joan, Pérez-Sánchez, Soledad, García Sánchez, María Jesús, Guillán Rodríguez, Marta, Jood, Katarina, Nordanstig, Annika, Mazya, Michael V., Moreira, Tiago T. P., Bernava, Gianmarco, Beyeler, Morin, Bolognese, Manuel, Carrera, Emmanuel, Dobrocky, Tomas, Karwacki, Grzegorz Marek, Keller, Emanuela, Hsieh, Chang Yang, Boonyakarnkul, Surawan, Churojana, Anchalee, Aykac, Ozlem, Ozdemir, Atilla Ã-Zcan, Bajrami, Arsida, Senadim, Songul, Hussain, Syed Irteza, John, Seby, Banerjee, Soma, Kwan, Joseph, Krishnan, Kailash, Lenthall, Robert, Matthews, Ashok, Wong, Ken, Zhang, Liqun, Altschul, Dorothea, Asif, Kaiz S., Bahiru, Zeelalem, Below, Kristine, Biller, José, Ruland, Sean, Chaudry, Saqib A., Chen, Michael, Chebl, Alex, Cibulka, Jackie, Cistrunk, Leon, Clark, Judith, Colasurdo, Marco, Czap, Alexandra, de Havenon, Adam, D'Amato, Salvatore, Dharmadhikari, Sushrut, Grimmett, Kasey B., Dmytriw, Adam A., Etherton, Mark R., Ezepue, Chizoba, Farooqui, Mudassir, Feske, Steven K., Fink, Lauren, Gasimova, Ulviyya, Guzik, Amy K., Hakemi, Maryam, Hovingh, Majesta, Khan, Muhib, Jillela, Dinesh, Kan, Peter T., Khatri, Rakesh, Khawaja, Ayaz M., Khoury, Naim N., Kiley, Nicole L., Kim, Benny S., Kolikonda, Murali K., Kuhn, Anna Luisa, Lara, Stephanie, Linares, Guillermo, Linfante, Italo, Lukovits, Timothy G., Lycan, Sarah, Male, Shailesh S., Maali, Laith, Mancin, John, Masoud, Hesham, Mohamed, Ghada A., Monteiro, Andre, Nahab, Fadi, Nalleballe, Krishna, Ortega-Gutiérrez, Santiago, Puri, Ajit S, Radaideh, Yazan, Rahangdale, Rahul H., Rai, Ansaar, Ramakrishnan, Pankajavalli, Reddy, Aravind B., Rojas-Soto, Diana M., Romero, José Rafael, Rost, Natalia S., Rothstein, Aaron, Omran, Setareh Salehi, Sheth, Sunil A., Siddiqui, Adnan H., Starosciak, Amy K., Tarlov, Nicholas E., Taylor, Robert A., Wang, Michael J., Wolfe, Jared, Wong, Ka-Ho, Le, Huynh Vu, Nguyen, Quy Viet, Pham, Thong Nhu, Nguyen, Trung Thanh, Phan, Hoang Thi, Ton, Mai Duy, Fischer, Urs, Michel, Patrik, Strambo, Davide, Martins, Sheila O., Zaidat, Osama O., Nogueira, Raul G., Society of Vascular and Interventional Neurology (US), Nguyen, Thanh N., Qureshi, Muhammad M., Klein, Piers, Yamagami, Hiroshi, Mikulik, Robert, Czlonkowska, Anna, Abdalkader, Mohamad, Sedova, Petra, Sathya, Anvitha, Lo, Hannah C., Mansour, Ossama Yassin, Vanguru, Husitha Reddy, Lesaine, Emilie, Tsivgoulis, Georgios, Loochtan, Aaron I., Demeestere, Jelle, Uchino, Ken, Inoa, Violiza, Goyal, Nitin, Charidimou, Andreas, Siegler, James E., Yaghi, Shadi, Aguiar de Sousa, Diana, Mohammaden, Mahmoud H., Haussen, Diogo C., Kristoffersen, Espen Saxhaug, Lereis, Virginia Pujol, Scollo, Sergio Daniel, Campbell, Bruce C. V., Ma, Alice, Thomas, James Orton, Parsons, Mark W., Singhal, Shaloo, Slater, Lee-Anne, Tomazini Martins, Rodrigo, Enzinger, Chris, Gattringer, Thomas, Rahman, Aminur, Bonnet, Thomas, Ligot, Noemie, De Raedt, Sylvie, Lemmens, Robin, Vanacker, Peter, Vandervorst, Fenne, Conforto, Adriana Bastos, Hidalgo, Raquel C. T., Neves, Luciana de Oliveira, Martins, Rodrigo Targa, Mora Cuervo, Daissy Liliana, Rebello, Leticia C., Santiago, Igor Bessa, Silva, Isabelle Lameirinhas da, Sakelarova, Teodora, Kalpachki, Rosen, Alexiev, Filip, Catanese, Luciana, Cora, Elena Adela, Goyal, Mayank, Hill, Michael D., Kelly, Michael E., Khosravani, Houman, Lavoie, Pascale, Peeling, Lissa, Pikula, Aleksandra, Rivera, Rodrigo, Chen, Hui-Sheng, Chen, Yimin, Huo, Xiaochuan, Miao, Zhongrong, Yang, Shuiquan, Bedekovic, Marina Roje, Bralic, Marina, Budincevic, Hrvoje, Corredor-Quintero, Ángel Basilio, Lara-Sarabia, Osvaldo E., Cabal, Martin, Tenora, Dusan, Fibrich, Petr, Herzig, Roman, Hlaváčová, Helena, Hrabanovska, Emanuela, Hlinovsky, David, Jurak, Lubomir, Kadlcikova, Jana, Karpowicz, Igor, Klecka, Lukas, Kovar, Martin, Lauer, David, Neumann, Jiri, Palouskova, Hana, Reiser, Martin, Rekova, Petra, Rohan, Vladimir, Skoda, Ondrej, Škorňa, Miroslav, Sobotková, Lenka, Sramek, Martin, Zakova, Lenka, Christensen, Hanne, Drenck, Nicolas, Iversen, Helle Klingenberg, Truelsen, Thomas Clement, Wienecke, Troels, Sobh, Khalid, Ylikotila, Pauli, Alpay, Kemal, Strbian, Daniel, Bernady, Patricia, Casenave, Philippe, Dan, Maria, Faucheux, Jean-Marc, Gentric, Jean-Christophe, Magro, Elsa, Sabben, Candice, Reiner, Peggy, Rouanet, Francois, Bohmann, Ferdinand O., Boskamp, Stefan, Mbroh, Joshua, Nagel, Simon, Nolte, Christian H, Ringleb, Peter A., Rosenkranz, Michael, Poli, Sven, Thomalla, Götz, Karapanayiotides, Theodoros, Koutroulou, Ioanna, Kargiotis, Odysseas, Palaiodimou, Lina, Barrientos Guerra, José Domingo, Huded, Vikram, Menon, Bindu, Nagendra, Shashank, Prajapati, Chintan, Sylaja, P. N., Krishna Pramana, Nyoman Angga, Sani, Achmad Firdaus, Ghoreishi, Abdoreza, Farhoudi, Mehdi, Hokmabadi, Elyar Sadeghi, Raya, Tariq Abu, Kalmanovich, Shani Avnery, Ronen, Levite, Sabetay, Sergiu Ionut, Acampa, Maurizio, Adami, Alessandro, Castellan, Lucio, Longoni, Marco, Ornello, Raffaele, Renieri, Leonardo, Bigliani, Claudia Rolla, Romoli, Michele, Sacco, Simona, Salmaggi, Andrea, Sangalli, Davide, Zini, Andrea, Doijiri, Ryosuke, Fukuda, Hiroki, Fujinaka, Toshiyuki, Fujita, Kyohei, Imamura, Hirotoshi, Sakai, Nobuyuki, Kanamaru, Takuya, Kimura, Naoto, Kono, Ryuhei, Miyake, Kosuke, Sakaguchi, Manabu, Sakai, Kenichiro, Sonoda, Kazutaka, Todo, Kenichi, Miyashita, Fumio, Tokuda, Naoki, Matsumaru, Yuji, Matsumoto, Shoji, Ohara, Nobuyuki, Shindo, Seigo, Takenobu, Yohei, Yoshimoto, Takeshi, Toyoda, Kazunori, Uwatoko, Takeshi, Yagita, Yoshiki, Yamada, Takehiro, Yamamoto, Nobuaki, Yamamoto, Ryoo, Yazawa, Yukako, Sugiura, Yuri, Waweru, Peter Kuria, Baek, Jang-Hyun, Lee, Si Baek, Seo, Kwon-Duk, Sohn, Sung-Il, Arsovska, Anita Ante, Chan, Yong Chieh, Wan Zaidi, Wan Asyraf, Jaafar, Ainul Syahrilfazli, Gongora-Rivera, Fernando, Martinez-Marino, Manuel, Infante-Valenzuela, Adrian, Groppa, Stanislav, Leahu, Pavel, Coutinho, Jonathan M, Rinkel, Leon A., Dippel, Diederik W. J., Dam-Nolen, Dianne H. K. van, Ranta, Annemarei, Wu, Teddy Y., Adebayo, Tajudeen Temitayo, Bello, Abiodun H., Nwazor, Ernest Okwundu, Sunmonu, Taofiki Ajao, Wahab, Kolawole Wasiu, Ronning, Ole Morten, Sandset, Else Charlotte, Al Hashmi, Amal M., Ahmad, Saima, Rashid, Umair, Rodriguez-Kadota, Liliana, Vences, Miguel Ángel, Yalung, Patrick Matic, Hao Dy, Jon Stewart, Pineda-Franks, Maria Carissa, Co, Christian Oliver, Brola, Waldemar, Debiec, Aleksander, Dorobek, Malgorzata, Karlinski, Michal Adam, Labuz-Roszak, Beata M., Lasek-Bal, Anetta, Sienkiewicz-Jarosz, Halina, Staszewski, Jacek, Sobolewski, Piotr, Wiacek, Marcin, Zielinska-Turek, Justyna, Araujo, Andre Pinho, Rocha, Mariana, Castro, Pedro, Cruz, Vitor Tedim, Ferreira, Paulo Venancio, Ferreira, Patricia, Nunes, Ana Paiva, Fonseca, Luisa, Marto, João Pedro, Pinho E Melo, Teresa, Rodrigues, Miguel, Silva, M. Luis, Dimitriade, Adela, Falup-Pecurariu, Cristian, Hamid, May Adel, Venketasubramanian, Narayanaswamy, Krastev, Georgi, Mako, Miroslav, Ayo-Martin, Oscar, Hernández-Fernández, Francisco, Blasco, Jordi, Rodríguez-Vázquez, Alejandro, Cruz-Culebras, Antonio, Moniche, Francisco, Montaner, Joan, Pérez-Sánchez, Soledad, García Sánchez, María Jesús, Guillán Rodríguez, Marta, Jood, Katarina, Nordanstig, Annika, Mazya, Michael V., Moreira, Tiago T. P., Bernava, Gianmarco, Beyeler, Morin, Bolognese, Manuel, Carrera, Emmanuel, Dobrocky, Tomas, Karwacki, Grzegorz Marek, Keller, Emanuela, Hsieh, Chang Yang, Boonyakarnkul, Surawan, Churojana, Anchalee, Aykac, Ozlem, Ozdemir, Atilla Ã-Zcan, Bajrami, Arsida, Senadim, Songul, Hussain, Syed Irteza, John, Seby, Banerjee, Soma, Kwan, Joseph, Krishnan, Kailash, Lenthall, Robert, Matthews, Ashok, Wong, Ken, Zhang, Liqun, Altschul, Dorothea, Asif, Kaiz S., Bahiru, Zeelalem, Below, Kristine, Biller, José, Ruland, Sean, Chaudry, Saqib A., Chen, Michael, Chebl, Alex, Cibulka, Jackie, Cistrunk, Leon, Clark, Judith, Colasurdo, Marco, Czap, Alexandra, de Havenon, Adam, D'Amato, Salvatore, Dharmadhikari, Sushrut, Grimmett, Kasey B., Dmytriw, Adam A., Etherton, Mark R., Ezepue, Chizoba, Farooqui, Mudassir, Feske, Steven K., Fink, Lauren, Gasimova, Ulviyya, Guzik, Amy K., Hakemi, Maryam, Hovingh, Majesta, Khan, Muhib, Jillela, Dinesh, Kan, Peter T., Khatri, Rakesh, Khawaja, Ayaz M., Khoury, Naim N., Kiley, Nicole L., Kim, Benny S., Kolikonda, Murali K., Kuhn, Anna Luisa, Lara, Stephanie, Linares, Guillermo, Linfante, Italo, Lukovits, Timothy G., Lycan, Sarah, Male, Shailesh S., Maali, Laith, Mancin, John, Masoud, Hesham, Mohamed, Ghada A., Monteiro, Andre, Nahab, Fadi, Nalleballe, Krishna, Ortega-Gutiérrez, Santiago, Puri, Ajit S, Radaideh, Yazan, Rahangdale, Rahul H., Rai, Ansaar, Ramakrishnan, Pankajavalli, Reddy, Aravind B., Rojas-Soto, Diana M., Romero, José Rafael, Rost, Natalia S., Rothstein, Aaron, Omran, Setareh Salehi, Sheth, Sunil A., Siddiqui, Adnan H., Starosciak, Amy K., Tarlov, Nicholas E., Taylor, Robert A., Wang, Michael J., Wolfe, Jared, Wong, Ka-Ho, Le, Huynh Vu, Nguyen, Quy Viet, Pham, Thong Nhu, Nguyen, Trung Thanh, Phan, Hoang Thi, Ton, Mai Duy, Fischer, Urs, Michel, Patrik, Strambo, Davide, Martins, Sheila O., Zaidat, Osama O., and Nogueira, Raul G.

Abstract

Background and Objectives: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020)., Methods: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases., Results: There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations., Discussion: There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year., Trial Registration Information: This study is registered under NCT04934020.

Published
2023

12. Endovascular treatment strategies for simultaneous bilateral anterior circulation occlusions in acute ischemic stroke: A single-center experience and systematic review of the literature

Author

Bernava, Gianmarco; https://orcid.org/0000-0003-2037-5558, Botti, Paul; https://orcid.org/0000-0002-2268-1121, Rosi, Andrea; https://orcid.org/0000-0003-0286-2889, Hofmeister, Jeremy; https://orcid.org/0000-0002-0071-8499, Yilmaz, Hasan, Carrera, Emmanuel, Brina, Olivier, Reymond, Philippe, Muster, Michel, Kulcsar, Zsolt; https://orcid.org/0000-0002-6805-5150, Lovblad, Karl-Olof, Machi, Paolo, Bernava, Gianmarco; https://orcid.org/0000-0003-2037-5558, Botti, Paul; https://orcid.org/0000-0002-2268-1121, Rosi, Andrea; https://orcid.org/0000-0003-0286-2889, Hofmeister, Jeremy; https://orcid.org/0000-0002-0071-8499, Yilmaz, Hasan, Carrera, Emmanuel, Brina, Olivier, Reymond, Philippe, Muster, Michel, Kulcsar, Zsolt; https://orcid.org/0000-0002-6805-5150, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

BACKGROUND Bilateral and simultaneous occlusion of the anterior circulation is a rare event in patients with acute ischemic stroke. Although endovascular treatment is feasible and safe, the endovascular strategy to be used remains a subject of debate. OBJECTIVE To assess the different endovascular strategies proposed for the treatment of a bilateral, simultaneous anterior circulation occlusion following acute ischemic stroke. METHODS We present a retrospective study of the clinical and radiological records of all patients with a bilateral, simultaneous anterior circulation occlusion treated at our center between January 2019 and December 2022. Following the PRISMA guidelines, we also conducted a systematic review of the literature. RESULTS Two patients with a bilateral and simultaneous middle cerebral artery occlusion were treated at our center during the study period. A TICI score ≥2b was obtained in 4 out of 4 occlusions. Modified Rankin Scale (mRS) at 90 days was 0 and 4, respectively. The literature review retrieved reports on 22 patients. The most frequent bilateral occlusion sites were internal carotid artery-middle cerebral artery. The clinical presentation was severe in most patients. A combined thrombectomy technique proved to have the highest number of first-pass recanalization. A TICI ≥2b was obtained in 95% of patients and an mRS ≤2 was found in 31.8% of patients. CONCLUSIONS In patients with bilateral and simultaneous occlusion of the anterior circulation, endovascular treatment using a combined technique appears to be rapid and effective. The clinical evolution of this patient population strongly depends on the severity of the onset symptoms.

Published
2023

13. Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures

Author

Bernava, Gianmarco; https://orcid.org/0000-0003-2037-5558, Tesoro, Rosa, Boto, José, Challita, Myriam, Rosi, Andrea, Hofmeister, Jeremy; https://orcid.org/0000-0002-0071-8499, Yilmaz, Hasan, Carrera, Emmanuel, Brina, Olivier, Reymond, Philippe, Muster, Michel, Kulcsar, Zsolt, Lovblad, Karl-Olof, Machi, Paolo, Bernava, Gianmarco; https://orcid.org/0000-0003-2037-5558, Tesoro, Rosa, Boto, José, Challita, Myriam, Rosi, Andrea, Hofmeister, Jeremy; https://orcid.org/0000-0002-0071-8499, Yilmaz, Hasan, Carrera, Emmanuel, Brina, Olivier, Reymond, Philippe, Muster, Michel, Kulcsar, Zsolt, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

BACKGROUND Focal vasospasm (FV) of the occluded vessel can occur during the endovascular treatment of acute ischemic stroke (AIS). Nimodipine is commonly used to treat vasospasm and can play a role in distinguishing it from artery narrowing due to iatrogenic dissection or residual clot. However, nimodipine administration can result in arterial hypotension and subsequent enlargement of the ischemic core. OBJECTIVE To assess the efficacy of preventive and continuous vasoactive amine infusion to counterbalance nimodipine-induced hypotension. METHODS We reviewed data from a prospective registry of patients treated for AIS between January 2019 and January 2022 who were administered nimodipine. All patients were equipped with an arterial cannula for invasive blood pressure measurement and given vasoactive amines preemptively before general anesthesia and throughout the procedure. Data obtained from invasive monitoring of mean arterial blood pressure (MABP) in a time-lapse of 25 min before and after nimodipine administration were analyzed. RESULTS MABP significantly decreased after nimodipine administration but remained within the recommended range (81.79 ± 0.49 mmHg). Nimodipine was effective in reducing FV caused by stent retriever passage in 76.3% of cases. Furthermore, it proved valuable in diagnosing iatrogenic dissection (9.2%), residual clot (10.5%), or intracranial stenosis (4%). CONCLUSIONS Infusion of vasoactive amines effectively counteracted the intraarterial nimodipine effect, thus avoiding frank arterial hypotension during endovascular treatment. Nimodipine has been useful in differentiating the diagnosis of FV resulting from mechanical thrombectomy and other potential causes, such as iatrogenic dissection or residual clot.

Published
2023

14. Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Author

Nguyen, Thanh N, Qureshi, Muhammad M, Klein, Piers, Yamagami, Hiroshi, Abdalkader, Mohamad, Mikulik, Robert, Sathya, Anvitha, Mansour, Ossama Yassin, Czlonkowska, Anna, Hannah, Lo, Field, Thalia S, Charidimou, Andreas, Banerjee, Soma, Yaghi, Shadi, Siegler, James E, Sedova, Petra, Kwan, Joseph, de Sousa, Diana Aguiar, Demeestere, Jelle, Inoa, Violiza, Omran, Setareh Salehi, Zhang, Liqun, Michel, Patrik, Strambo, Davide, Marto, João Pedro, Nogueira, Raul G, Kristoffersen, Espen Saxhaug, Tsivgoulis, Georgios, Lereis, Virginia Pujol, Alice, Ma, Enzinger, Christian, Gattringer, Thomas, Rahman, Aminur, Bonnet, Thomas, Ligot, Noémie, De Raedt, Sylvie, Lemmens, Robin, Vanacker, Peter, Vandervorst, Fenne, Conforto, Adriana Bastos, Hidalgo, Raquel C T, Mora Cuervo, Daissy Liliana, de Oliveira Neves, Luciana, Lameirinhas da Silva, Isabelle, Martíns, Rodrigo Targa, Rebello, Letícia C, Santiago, Igor Bessa, Sadelarova, Teodora, Kalpachki, Rosen, Alexiev, Filip, Cora, Elena Adela, Kelly, Michael E, Peeling, Lissa, Pikula, Aleksandra, Chen, Hui-Sheng, Chen, Yimin, Yang, Shuiquan, Roje Bedekovic, Marina, Čabal, Martin, Tenora, Dusan, Fibrich, Petr, Dušek, Pavel, Hlaváčová, Helena, Hrabanovska, Emanuela, Jurák, Lubomír, Kadlčíková, Jana, Karpowicz, Igor, Klečka, Lukáš, Kovář, Martin, Neumann, Jiří, Paloušková, Hana, Reiser, Martin, Rohan, Vladimir, Šimůnek, Libor, Skoda, Ondreij, Škorňa, Miroslav, Šrámek, Martin, Drenck, Nicolas, Sobh, Khalid, Lesaine, Emilie, Sabben, Candice, Reiner, Peggy, Rouanet, Francois, Strbian, Daniel, Boskamp, Stefan, Mbroh, Joshua, Nagel, Simon, Rosenkranz, Michael, Poli, Sven, Thomalla, Götz, Karapanayiotides, Theodoros, Koutroulou, Ioanna, Kargiotis, Odysseas, Palaiodimou, Lina, Barrientos Guerra, José Dominguo, Huded, Vikram, Nagendra, Shashank, Prajapati, Chintan, Sylaja, P N, Sani, Achmad Firdaus, Ghoreishi, Abdoreza, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Hashemilar, Mazyar, Sabetay, Sergiu Ionut, Rahal, Fadi, Acampa, Maurizio, Adami, Alessandro, Longoni, Marco, Ornello, Raffaele, Renieri, Leonardo, Romoli, Michele, Sacco, Simona, Salmaggi, Andrea, Sangalli, Davide, Zini, Andrea, Sakai, Kenichiro, Fukuda, Hiroki, Fujita, Kyohei, Imamura, Hirotoshi, Kosuke, Miyake, Sakaguchi, Manabu, Sonoda, Kazutaka, Matsumaru, Yuji, Ohara, Nobuyuki, Shindo, Seigo, Takenobu, Yohei, Yoshimoto, Takeshi, Toyoda, Kazunori, Uwatoko, Takeshi, Sakai, Nobuyuki, Yamamoto, Nobuaki, Yamamoto, Ryoo, Yazawa, Yukako, Sugiura, Yuri, Baek, Jang-Hyun, Lee, Si Baek, Seo, Kwon-Duk, Sohn, Sung-Il, Lee, Jin Soo, Arsovska, Anita Ante, Chieh, Chan Yong, Wan Zaidi, Wan Asyraf, Wan Yahya, Wan Nur Nafisah, Gongora-Rivera, Fernando, Martinez-Marino, Manuel, Infante-Valenzuela, Adrian, Dippel, Diederik, van Dam-Nolen, Dianne H K, Teddy Y, Wu, Punter, Martin, Adebayo, Tajudeen Temitayo, Bello, Abiodun H, Sunmonu, Taofiki Ajao, Wahab, Kolawole Wasiu, Sundseth, Antje, Al Hashmi, Amal M, Ahmad, Saima, Rashid, Umair, Rodriguez-Kadota, Liliana, Vences, Miguel Ángel, Yalung, Patrick Matic, Jon Stewart Hao, Dy, Brola, Waldemar, Dębiec, Aleksander, Dorobek, Malgorzata, Karlinski, Michal Adam, Labuz-Roszak, Beata M, Lasek-Bal, Anetta, Sienkiewicz-Jarosz, Halina, Staszewski, Jacek, Sobolewski, Piotr, Wiącek, Marcin, Zielinska-Turek, Justyna, Araújo, André Pinho, Rocha, Mariana, Castro, Pedro, Ferreira, Patricia, Nunes, Ana Paiva, Fonseca, Luísa, Pinho E Melo, Teresa, Rodrigues, Miguel, Silva, M Luis, Ciopleias, Bogdan, Dimitriade, Adela, Falup-Pecurariu, Cristian, Hamid, May Adel, Venketasubramanian, Narayanaswamy, Krastev, Georgi, Haring, Jozef, Ayo-Martin, Oscar, Hernandez-Fernandez, Francisco, Blasco, Jordi, Rodríguez-Vázquez, Alejandro, Cruz-Culebras, Antonio, Moniche, Francisco, Montaner, Joan, Perez-Sanchez, Soledad, García Sánchez, María Jesús, Guillán Rodríguez, Marta, Bernava, Gianmarco, Bolognese, Manuel, Carrera, Emmanuel, Churojana, Anchalee, Aykac, Ozlem, Özdemir, Atilla Özcan, Bajrami, Arsida, Senadim, Songul, Hussain, Syed I, John, Seby, Krishnan, Kailash, Lenthall, Robert, Asif, Kaiz S, Below, Kristine, Biller, Jose, Chen, Michael, Chebl, Alex, Colasurdo, Marco, Czap, Alexandra, de Havenon, Adam H, Dharmadhikari, Sushrut, Eskey, Clifford J, Farooqui, Mudassir, Feske, Steven K, Goyal, Nitin, Grimmett, Kasey B, Guzik, Amy K, Haussen, Diogo C, Hovingh, Majesta, Jillela, Dinesh, Kan, Peter T, Khatri, Rakesh, Khoury, Naim N, Kiley, Nicole L, Kolikonda, Murali K, Lara, Stephanie, Grace, Li, Linfante, Italo, Loochtan, Aaron I, Lopez, Carlos D, Lycan, Sarah, Male, Shailesh S, Nahab, Fadi, Maali, Laith, Masoud, Hesham E, Min, Jiangyong, Orgeta-Gutierrez, Santiago, Mohamed, Ghada A, Mohammaden, Mahmoud, Nalleballe, Krishna, Radaideh, Yazan, Ramakrishnan, Pankajavalli, Rayo-Taranto, Bliss, Rojas-Soto, Diana M, Ruland, Sean, Simpkins, Alexis N, Sheth, Sunil A, Starosciak, Amy K, Tarlov, Nicholas E, Taylor, Robert A, Voetsch, Barbara, Zhang, Linda, Duong, Hai Quang, Dao, Viet-Phuong, Huynh Vu, Le, Pham, Thong Nhu, Ton, Mai Duy, Tran, Anh Duc, Zaidat, Osama O, Machi, Paolo, Dirren, Elisabeth, Rodríguez Fernández, Claudio, Escartín López, Jorge, Fernández Ferro, Jose Carlos, Mohammadzadeh, Niloofar, Suryadevara, Neil C, de la Cruz Fernández, Beatriz, Bessa, Filipe, Jancar, Nina, Brady, Megan, Scozzari, Dawn, SVIN COVID-19 Global COVID Stroke Registry, Neurology, Radiology & Nuclear Medicine, Society of Vascular and Interventional Neurology, Nguyen, Thanh N., Nogueira, Raul G., Clinical sciences, Neuroprotection & Neuromodulation, Biology, Neurologian yksikkö, HUS Neurocenter, and Helsinki University Hospital Area

Subjects
Stroke, Vaccine-induced immune thrombotic thrombocytopenia, SDG 3 - Good Health and Well-being, Cerebral venous thrombosis, SARS-CoV-2, 3112 Neurosciences, COVID-19, Mortality, Neurology (clinical), Cardiology and Cardiovascular Medicine, 3124 Neurology and psychiatry
Abstract

[Background and Purpose] Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year., [Methods] We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020)., [Results] There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P, [Conclusions] During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT., The study was funded by the Society of Vascular and Interventional Neurology research pilot grant.

Published
2022
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15. Global impact of the COVID-19 pandemic on stroke volumes and cerebrovascular events

Author

Nguyen, Thanh N., Qureshi, Muhammad M., Klein, Piers, Yamagami, Hiroshi, Mikulik, Robert, Czlonkowska, Anna, Abdalkader, Mohamad, Sedova, Petra, Sathya, Anvitha, Lo, Hannah C., Mansour, Ossama Yassin, Iversen, Helle Klingenberg, Truelsen, Thomas Clement, Wienecke, Troels, Sobh, Khalid, Ylikotila, Pauli, Alpay, Kemal, Strbian, Daniel, Bernady, Patricia, Casenave, Philippe, Dan, Maria, Vanguru, Husitha Reddy, Faucheux, Jean-Marc, Gentric, Jean-Christophe, Magro, Elsa, Sabben, Candice, Reiner, Peggy, Rouanet, Francois, Bohmann, Ferdinand O., Boskamp, Stefan, Mbroh, Joshua, Nagel, Simon, Lesaine, Emilie, Nolte, Christian H., Ringleb, Peter A., Rosenkranz, Michael, Poli, Sven, Thomalla, Götz, Karapanayiotides, Theodoros, Koutroulou, Ioanna, Kargiotis, Odysseas, Palaiodimou, Lina, Barrientos Guerra, Jose Dominguo, Tsivgoulis, Georgios, Huded, Vikram, Menon, Bindu, Nagendra, Shashank, Prajapati, Chintan, Sylaja, P.N., Krishna Pramana, Nyoman Angga, Sani, Achmad Firdaus, Ghoreishi, Abdoreza, Farhoudi, Mehdi, Hokmabadi, Elyar Sadeghi, Loochtan, Aaron I., Raya, Tariq Abu, Kalmanovich, Shani Avnery, Ronen, Levite, Sabetay, Sergiu Ionut, Acampa, Maurizio, Adami, Alessandro, Castellan, Lucio, Longoni, Marco, Ornello, Raffaele, Renieri, Leonardo, Demeestere, Jelle, Bigliani, Claudia Rolla, Romoli, Michele, Sacco, Simona, Salmaggi, Andrea, Sangalli, Davide, Zini, Andrea, Doijiri, Ryosuke, Fukuda, Hiroki, Fujinaka, Toshiyuki, Fujita, Kyohei, Uchino, Ken, Imamura, Hirotoshi, Sakai, Nobuyuki, Kanamaru, Takuya, Kimura, Naoto, Kono, Ryuhei, Miyake, Kosuke, Sakaguchi, Manabu, Sakai, Kenichiro, Sonoda, Kazutaka, Todo, Kenichi, Inoa, Violiza, Miyashita, Fumio, Tokuda, Naoki, Matsumaru, Yuji, Matsumoto, Shoji, Ohara, Nobuyuki, Shindo, Seigo, Takenobu, Yohei, Yoshimoto, Takeshi, Toyoda, Kazunori, Uwatoko, Takeshi, Goyal, Nitin, Yagita, Yoshiki, Yamada, Takehiro, Yamamoto, Nobuaki, Yamamoto, Ryoo, Yazawa, Yukako, Sugiura, Yuri, Waweru, Peter Kuria, Baek, Jang-Hyun, Lee, Si Baek, Seo, Kwon-Duk, Charidimou, Andreas, Sohn, Sung-Il, Arsovska, Anita Ante, Chan, Yong Chieh, Wan Zaidi, Wan Asyraf, Jaafar, Ainul Syahrilfazli, Gongora-Rivera, Fernando, Martinez-Marino, Manuel, Infante-Valenzuela, Adrian, Groppa, Stanislav, Leahu, Pavel, Siegler, James E., Coutinho, Jonathan M., Rinkel, Leon A., Dippel, Diederik W.J., van Dam-Nolen, Dianne H.K., Ranta, Annemarei, Wu, Teddy Y., Adebayo, Tajudeen Temitayo, Bello, Abiodun H., Nwazor, Ernest Okwundu, Sunmonu, Taofiki Ajao, Yaghi, Shadi, Wahab, Kolawole Wasiu, Ronning, Ole Morten, Sandset, Else Charlotte, Al Hashmi, Amal M., Ahmad, Saima, Rashid, Umair, Rodriguez-Kadota, Liliana, Vences, Miguel Ángel, Yalung, Patrick Matic, Hao Dy, Jon Stewart, de Sousa, Diana Aguiar, Pineda-Franks, Maria Carissa, Co, Christian Oliver, Brola, Waldemar, Debiec, Aleksander, Dorobek, Malgorzata, Karlinski, Michal Adam, Labuz-Roszak, Beata M., Lasek-Bal, Anetta, Sienkiewicz-Jarosz, Halina, Staszewski, Jacek, Mohammaden, Mahmoud H., Sobolewski, Piotr, Wiacek, Marcin, Zielinska-Turek, Justyna, Araujo, Andre Pinho, Rocha, Mariana, Castro, Pedro, Cruz, Vitor Tedim, Ferreira, Paulo Venancio, Ferreira, Patricia, Nunes, Ana Paiva, Haussen, Diogo C., Fonseca, Luisa, Marto, João Pedro, Melo, Teresa Pinho e, Rodrigues, Miguel, Silva, M. Luis, Dimitriade, Adela, Falup-Pecurariu, Cristian, Hamid, May Adel, Venketasubramanian, Narayanaswamy, Krastev, Georgi, Kristoffersen, Espen Saxhaug, Mako, Miroslav, Ayo-Martin, Oscar, Hernández-Fernández, Francisco, Blasco, Jordi, Rodríguez-Vázquez, Alejandro, Cruz-Culebras, Antonio, Moniche, Francisco, Montaner, Joan, Perez-Sanchez, Soledad, García Sánchez, María Jesús, Lereis, Virginia Pujol, Guillán Rodríguez, Marta, Jood, Katarina, Nordanstig, Annika, Mazya, Michael V., Moreira, Tiago T.P., Bernava, Gianmarco, Beyeler, Morin, Bolognese, Manuel, Carrera, Emmanuel, Dobrocky, Tomas, Scollo, Sergio Daniel, Karwacki, Grzegorz Marek, Keller, Emanuela, Hsieh, Chang Yang, Boonyakarnkul, Surawan, Churojana, Anchalee, Aykac, Ozlem, Ozdemir, Atilla Özcan, Bajrami, Arsida, Senadim, Songul, Hussain, Syed Irteza, Campbell, Bruce C. V., John, Seby, Banerjee, Soma, Kwan, Joseph, Krishnan, Kailash, Lenthall, Robert, Matthews, Ashok, Wong, Ken, Zhang, Liqun, Altschul, Dorothea, Asif, Kaiz S., Ma, Alice, Bahiru, Zeelalem, Below, Kristine, Biller, José, Ruland, Sean, Chaudry, Saqib A., Chen, Michael, Chebl, Alex, Cibulka, Jackie, Cistrunk, Leon, Clark, Judith, Thomas, James Orton, Colasurdo, Marco, Czap, Alexandra, de Havenon, Adam, D'Amato, Salvatore, Dharmadhikari, Sushrut, Grimmett, Kasey B., Dmytriw, Adam A., Etherton, Mark R., Ezepue, Chizoba, Farooqui, Mudassir, Parsons, Mark W., Feske, Steven K., Fink, Lauren, Gasimova, Ulviyya, Guzik, Amy K., Hakemi, Maryam, Hovingh, Majesta, Khan, Muhib, Jillela, Dinesh, Kan, Peter T., Khatri, Rakesh, Singhal, Shaloo, Khawaja, Ayaz M., Khoury, Naim N., Kiley, Nicole L., Kim, Benny S., Kolikonda, Murali K., Kuhn, Anna Luisa, Lara, Stephanie, Linares, Guillermo, Linfante, Italo, Lukovits, Timothy G., Slater, Lee-Anne, Lycan, Sarah, Male, Shailesh S., Maali, Laith, Mancin, John, Masoud, Hesham, Mohamed, Ghada A., Monteiro, Andre, Nahab, Fadi, Nalleballe, Krishna, Ortega-Gutierrez, Santiago, Tomazini Martins, Rodrigo, Puri, Ajit S., Radaideh, Yazan, Rahangdale, Rahul H., Rai, Ansaar, Ramakrishnan, Pankajavalli, Reddy, Aravind B., Rojas-Soto, Diana M., Romero, Jose Rafael, Rost, Natalia S., Rothstein, Aaron, Enzinger, Chris, Omran, Setareh Salehi, Sheth, Sunil A., Siddiqui, Adnan H., Starosciak, Amy K., Tarlov, Nicholas E., Taylor, Robert A., Wang, Michael J., Wolfe, Jared, Wong, Ka-Ho, Le, Huynh Vu, Gattringer, Thomas, Nguyen, Quy Viet, Pham, Thong Nhu, Nguyen, Trung Thanh, Phan, Hoang Thi, Ton, Mai Duy, Fischer, Urs, Michel, Patrik, Strambo, Davide, Martins, Sheila O., Zaidat, Osama O., Rahman, Aminur, Nogueira, Raul G., Bonnet, Thomas, Ligot, Noemie, De Raedt, Sylvie, Lemmens, Robin, Vanacker, Peter, Vandervorst, Fenne, Conforto, Adriana Bastos, Hidalgo, Raquel C.T., de Oliveira Neves, Luciana, Martins, Rodrigo Targa, Mora Cuervo, Daissy Liliana, Rebello, Leticia C., Santiago, Igor Bessa, Lameirinhas da Silva, Isabelle, Sakelarova, Teodora, Kalpachki, Rosen, Alexiev, Filip, Catanese, Luciana, Cora, Elena Adela, Goyal, Mayank, Hill, Michael D., Kelly, Michael E., Khosravani, Houman, Lavoie, Pascale, Peeling, Lissa, Pikula, Aleksandra, Rivera, Rodrigo, Chen, Hui-Sheng, Chen, Yimin, Huo, Xiaochuan, Miao, Zhongrong, Yang, Shuiquan, Bedekovic, Marina Roje, Bralic, Marina, Budincevic, Hrvoje, Corredor-Quintero, Angel Basilio, Lara-Sarabia, Osvaldo E., Cabal, Martin, Tenora, Dusan, Fibrich, Petr, Herzig, Roman, Hlaváčová, Helena, Hrabanovska, Emanuela, Hlinovsky, David, Jurak, Lubomir, Kadlcikova, Jana, Karpowicz, Igor, Klecka, Lukas, Kovar, Martin, Lauer, David, Neumann, Jiri, Palouskova, Hana, Reiser, Martin, Rekova, Petra, Rohan, Vladimir, Skoda, Ondrej, Škorňa, Miroslav, Sobotková, Lenka, Sramek, Martin, Zakova, Lenka, Christensen, Hanne, Drenck, Nicolas, and Repositório da Universidade de Lisboa

Abstract

© 2022 American Academy of Neurology, Background and objectives: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). Methods: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations. Discussion: There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.

Published
2023

16. Three-dimensional rotational angiography improves mechanical thrombectomy recanalization rate for acute ischaemic stroke due to middle cerebral artery M2 segment occlusions

Author

Rosi, Andrea, primary, Bernava, Gianmarco, additional, Hofmeister, Jeremy, additional, Nicolò, Madruzzato, additional, Boto, José, additional, Yilmaz, Hasan, additional, Reymond, Philippe, additional, Brina, Olivier, additional, Muster, Michel, additional, Carrera, Emmanuel, additional, Lövblad, Karl-Olof, additional, and Machi, Paolo, additional

Published
2022
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17. In vitro evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter

Author

Bernava, Gianmarco, primary, Brina, Olivier, additional, Reymond, Philippe, additional, Rosi, Andrea, additional, Hofmeister, Jeremy, additional, Yilmaz, Hasan, additional, Muster, Michel, additional, Kulcsar, Zsolt, additional, Lovblad, Karl-Olof, additional, and Machi, Paolo, additional

Published
2022
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19. In vitro evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter

Author

Bernava, Gianmarco, Brina, Olivier, Reymond, Philippe, Rosi, Andrea, Hofmeister, Jeremy, Yilmaz, Hasan, Muster, Michel, Kulcsar, Zsolt, Lovblad, Karl-Olof, Machi, Paolo, University of Zurich, and Bernava, Gianmarco

Subjects
2728 Neurology (clinical), 10043 Clinic for Neuroradiology, 2741 Radiology, Nuclear Medicine and Imaging, 610 Medicine & health, 2705 Cardiology and Cardiovascular Medicine
Published
2022
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20. In vitro evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter

Author

Bernava, Gianmarco; https://orcid.org/0000-0003-2037-5558, Brina, Olivier, Reymond, Philippe, Rosi, Andrea; https://orcid.org/0000-0003-0286-2889, Hofmeister, Jeremy, Yilmaz, Hasan, Muster, Michel, Kulcsar, Zsolt; https://orcid.org/0000-0002-6805-5150, Lovblad, Karl-Olof, Machi, Paolo, Bernava, Gianmarco; https://orcid.org/0000-0003-2037-5558, Brina, Olivier, Reymond, Philippe, Rosi, Andrea; https://orcid.org/0000-0003-0286-2889, Hofmeister, Jeremy, Yilmaz, Hasan, Muster, Michel, Kulcsar, Zsolt; https://orcid.org/0000-0002-6805-5150, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

BACKGROUND Several variations of the combined thrombectomy technique for acute ischemic stroke using a stent retriever and aspiration catheter have been described. The aim of our study was to assess how the presence of the microcatheter and stent retriever affect the basic aspiration parameters, namely, flow rate and aspiration force, depending on their position within the aspiration catheter. METHODS Two experimental set-ups were designed to assess changes in flow rate and aspiration force according to the position of the stent retriever and microcatheter within the aspiration catheter. RESULTS The transition of the stent retriever and microcatheter from the distal to proximal position resulted in a progressive increase in the flow rate, but with no impact on aspiration force. Additionally, the size of the stent retriever had no significant effect on flow rate changes and the reduction in flow rate was related to the microcatheter diameter. Negative pressure generated inside the aspiration catheter impacted on its distal segment located beyond the radiopaque marker, thus leading to its partial collapse. As a consequence, the measured aspiration force was lower than the theoretical aspiration force level for all tested aspiration catheters. CONCLUSIONS In our experimental model, the position of the stent retriever and microcatheter within the aspirator catheter affected the flow rate, but not the aspiration force. Negative pressure generated within the aspiration catheter appeared to determine a partial collapse of the distal segment that resulted in a less effective aspiration force than the theoretical aspiration force level.

Published
2022

21. Multimodality Characterization of the Clot in Acute Stroke

Author

LaGrange, Daniela Dumitriu, primary, Wanke, Isabel, additional, Machi, Paolo, additional, Bernava, Gianmarco, additional, Vargas, Maria, additional, Botta, Daniele, additional, Berberat, Jatta, additional, Muster, Michel, additional, Platon, Alexandra, additional, Poletti, Pierre-Alexandre, additional, and Lövblad, Karl-Olof, additional

Published
2021
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22. Experimental evaluation of direct thromboaspiration efficacy according to the angle of interaction between the aspiration catheter and the clot.

Author

Bernava, Gianmarco, Rosi, Andrea, Boto, José, Hofmeister, Jeremy, Brina, Olivier, Reymond, Philippe, Muster, Michel, Yilmaz, Hasan, Kulcsar, Zsolt, Carrera, Emmanuel, Bouri, Mohamed, Lovblad, Karl- Olof, and Machi, Paolo

Subjects
THROMBOSIS, IN vitro studies, MEDICAL equipment reliability, CONFIDENCE intervals, MEDICAL suction, SURGICAL stents, FISHER exact test, VEIN surgery, TREATMENT effectiveness, THROMBECTOMY, LOGISTIC regression analysis, DATA analysis software, CATHETERS, KINEMATICS
Abstract

Background Successful direct thromboaspiration (DTA) is related to several factors such as clot consistency, size, and location. It has also been demonstrated recently that the angle of interaction (AOI) formed by the aspiration catheter and the clot is related to DTA efficacy. The aims of this study were three- fold: (a) to confirm the clinical finding that the AOI formed by the aspiration catheter and the clot influence DTA efficacy; (b) to evaluate to what extent this influence varies according to differences in clot consistency and size; and (c) to validate stent retriever thrombectomy as an effective rescue treatment after DTA failure in the presence of an unfavorable AOI. Methods A rigid vascular phantom designed to reproduce a middle cerebral artery trifurcation anatomy with three M2 segments forming different angles with M1 and thrombus analog of different consistencies and sizes was used. Results DTA was highly effective for AOIs >125.5°, irrespective of thrombus analog features. However, its efficacy decreased for acute AOIs. Rescue stent retriever thrombectomy was effective in 92.6% of cases of DTA failure. Conclusions This in vitro study confirmed that the AOI formed by the aspiration catheter and the thrombus analog influenced DTA efficacy, with an AOI >125.5° related to an effective DTA. Stent retriever thrombectomy was an effective rescue treatment after DTA failure, even in the presence of an unfavorable AOI. [ABSTRACT FROM AUTHOR]

Published
2021
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23. Experimental comparison of first-pass effect between direct thromboaspiration and combined thrombectomy in the setting of distal basilar occlusion

Author

Seiffert, Reza, Brina, Olivier, Reymond, Philippe, Hofmeister, Jeremy, Bernava, Gianmarco, Rosi, Andrea, Michels, Lars, Kulcsar, Zsolt, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

Background Studies investigating endovascular therapy in vertebro-basilar stroke have led to controversial results in the past, but recent randomized trials seem to show an effectiveness superiority of endovascular therapy versus best medical treatment. However, uncertainty remains concerning many aspects of thrombectomy in acute basilar artery occlusion, notably technical considerations. This study compared the first-pass effect of direct thromboaspiration and combined thrombectomy in the setting of distal basilar occlusion.Methods An in-vitro experimental set-up was used, consisting of a vascular phantom model and thrombus analogs of different consistencies to mimic human clots. Thrombus analogs were injected into the model through the vertebral artery and flowed to the basilar distal third to mimic a distal basilar occlusion. Ten procedures were performed for each thrombus analog stiffness and technique (direct thromboaspiration versus combined thrombectomy).Results Direct thromboaspiration showed an overall first-pass effect rate of 83.3% (25/30) and was particularly effective for ultra-soft and soft clot analogs, but decreased for hard clot analogs. Combined thrombectomy had an overall first-pass effect rate of 56.7% (17/30). The effect rate for ultra-soft and soft clot analogs was 60% and 50% for hard clot analogs. In the softer clot analogs, the stent-retriever device used for the combined thrombectomies tended to deviate the clot analog from a co-axial trajectory with the aspiration catheter.Conclusions In the context of distal basilar occlusion, our in-vitro results showed that higher first-pass effect rates were achieved with direct thromboaspiration compared to combined thrombectomy in all types of thrombus analogs.

Published
2024
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24. Endovascular treatment strategies for simultaneous bilateral anterior circulation occlusions in acute ischemic stroke: A single-center experience and systematic review of the literature

Author

Bernava, Gianmarco, Botti, Paul, Rosi, Andrea, Hofmeister, Jeremy, Yilmaz, Hasan, Carrera, Emmanuel, Brina, Olivier, Reymond, Philippe, Muster, Michel, Kulcsar, Zsolt, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

Background Bilateral and simultaneous occlusion of the anterior circulation is a rare event in patients with acute ischemic stroke. Although endovascular treatment is feasible and safe, the endovascular strategy to be used remains a subject of debate.Objective To assess the different endovascular strategies proposed for the treatment of a bilateral, simultaneous anterior circulation occlusion following acute ischemic stroke.Methods We present a retrospective study of the clinical and radiological records of all patients with a bilateral, simultaneous anterior circulation occlusion treated at our center between January 2019 and December 2022. Following the PRISMA guidelines, we also conducted a systematic review of the literature.Results Two patients with a bilateral and simultaneous middle cerebral artery occlusion were treated at our center during the study period. A TICI score ≥2b was obtained in 4 out of 4 occlusions. Modified Rankin Scale (mRS) at 90 days was 0 and 4, respectively. The literature review retrieved reports on 22 patients. The most frequent bilateral occlusion sites were internal carotid artery-middle cerebral artery. The clinical presentation was severe in most patients. A combined thrombectomy technique proved to have the highest number of first-pass recanalization. A TICI ≥2b was obtained in 95% of patients and an mRS ≤2 was found in 31.8% of patients.Conclusions In patients with bilateral and simultaneous occlusion of the anterior circulation, endovascular treatment using a combined technique appears to be rapid and effective. The clinical evolution of this patient population strongly depends on the severity of the onset symptoms.

Published
2024
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25. Three-dimensional rotational angiography improves mechanical thrombectomy recanalization rate for acute ischaemic stroke due to middle cerebral artery M2 segment occlusions

Author

Rosi, Andrea, Bernava, Gianmarco, Hofmeister, Jeremy, Nicolò, Madruzzato, Boto, José, Yilmaz, Hasan, Reymond, Philippe, Brina, Olivier, Muster, Michel, Carrera, Emmanuel, Lövblad, Karl-Olof, and Machi, Paolo

Abstract

Background Occlusions of the middle cerebral artery (MCA) M2 segments can be difficult to address with mechanical thrombectomy (MTB) using standard projections and this can affect the final recanalization. Three-dimensional rotational angiography (3D-RA) allows to obtain a 3D model of cerebral vessels in a few seconds and to determine the best two-dimensional (2D) projections to be selected to evaluate and treat cerebrovascular diseases, such as aneurysms or vascular malformations. We aimed to determine if 3D-RA could be applied also in MTB.Methods A retrospective review of two patient cohorts treated during two time periods of 12 months before and after the introduction of 3D-RA use at our institution for MTB in M2 occlusions. Analyses were conducted to compare the two groups for procedural characteristics, such as timing, recanalization rate and complications and clinical outcome.Results One hundred acute ischaemic stroke (AIS) patients (3D-RA group = 57; controls = 43) underwent MTB for an M2 occlusion during the two study periods. Recanalization rates were significantly higher in cases treated with 3D-RA. The mean 3D technique thrombectomy time was compared to that of non-3D cases (47 vs. 49 min, respectively).Conclusions Our findings showed that 3D-RA is a useful tool to select specific working projections to AIS patients presenting an M2 occlusion by improving final recanalization compared to standard projections, without increasing the overall procedural time.

Published
2024
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26. Benchtop evaluation of a double stent retriever thrombectomy technique for acute ischemic stroke treatment

Author

Hofmeister, Jeremy, Bernava, Gianmarco, Rosi, Andrea, Reymond, Philippe, Brina, Olivier, Muster, Michel, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

Background and purpose A mechanical thrombectomy technique using a double stent retriever approach has been reported for the treatment of patients with acute ischemic stroke. The purpose of this study was to perform a benchtop evaluation of the mechanism of action and efficacy of a double-stent retriever approach compared to a single-stent retriever approach.Materials and methods In vitro, mechanical thrombectomy procedures were performed in a vascular phantom reproducing an M1-M2 occlusion with two different clot analog consistencies (soft and hard). We compared the double stent retriever approach to the single stent retriever approach and recorded the recanalization rate, distal embolization, and retrieval forces of each mechanical thrombectomy procedure.Results The double stent retriever approach achieved a higher recanalization rate and lower embolic complications compared to the single stent retriever approach. This seems to stem from two facts: the greater probability of targeting the correct artery with two stents in the case of bifurcation occlusion, and an improved clot capture mechanism using the double stent retriever approach. However, the double stent retriever was associated with an increased initial retrieval force.Conclusions In vitro evaluation of the mechanism of action of the double stent retriever provided explanations that appear to support the high efficacy of such an approach in patient cohorts and could help operators when selecting the optimal mechanical thrombectomy strategy in cases of arterial occlusions difficult to treat with a single stent retriever.

Published
2024
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27. Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures

Author

Bernava, Gianmarco, Tesoro, Rosa, Boto, José, Challita, Myriam, Rosi, Andrea, Hofmeister, Jeremy, Yilmaz, Hasan, Carrera, Emmanuel, Brina, Olivier, Reymond, Philippe, Muster, Michel, Kulcsar, Zsolt, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

Background Focal vasospasm (FV) of the occluded vessel can occur during the endovascular treatment of acute ischemic stroke (AIS). Nimodipine is commonly used to treat vasospasm and can play a role in distinguishing it from artery narrowing due to iatrogenic dissection or residual clot. However, nimodipine administration can result in arterial hypotension and subsequent enlargement of the ischemic core.Objective To assess the efficacy of preventive and continuous vasoactive amine infusion to counterbalance nimodipine-induced hypotension.Methods We reviewed data from a prospective registry of patients treated for AIS between January 2019 and January 2022 who were administered nimodipine. All patients were equipped with an arterial cannula for invasive blood pressure measurement and given vasoactive amines preemptively before general anesthesia and throughout the procedure. Data obtained from invasive monitoring of mean arterial blood pressure (MABP) in a time-lapse of 25 min before and after nimodipine administration were analyzed.Results MABP significantly decreased after nimodipine administration but remained within the recommended range (81.79 ± 0.49 mmHg). Nimodipine was effective in reducing FV caused by stent retriever passage in 76.3% of cases. Furthermore, it proved valuable in diagnosing iatrogenic dissection (9.2%), residual clot (10.5%), or intracranial stenosis (4%).Conclusions Infusion of vasoactive amines effectively counteracted the intraarterial nimodipine effect, thus avoiding frank arterial hypotension during endovascular treatment. Nimodipine has been useful in differentiating the diagnosis of FV resulting from mechanical thrombectomy and other potential causes, such as iatrogenic dissection or residual clot.

Published
2024
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28. Benchtop evaluation of a double stent retriever thrombectomy technique for acute ischemic stroke treatment.

Author

Hofmeister, Jeremy, Bernava, Gianmarco, Rosi, Andrea, Reymond, Philippe, Brina, Olivier, Muster, Michel, Lovblad, Karl-Olof, and Machi, Paolo

Abstract

A mechanical thrombectomy technique using a double stent retriever approach has been reported for the treatment of patients with acute ischemic stroke. The purpose of this study was to perform a benchtop evaluation of the mechanism of action and efficacy of a double-stent retriever approach compared to a single-stent retriever approach.In vitro, mechanical thrombectomy procedures were performed in a vascular phantom reproducing an M1-M2 occlusion with two different clot analog consistencies (soft and hard). We compared the double stent retriever approach to the single stent retriever approach and recorded the recanalization rate, distal embolization, and retrieval forces of each mechanical thrombectomy procedure.The double stent retriever approach achieved a higher recanalization rate and lower embolic complications compared to the single stent retriever approach. This seems to stem from two facts: the greater probability of targeting the correct artery with two stents in the case of bifurcation occlusion, and an improved clot capture mechanism using the double stent retriever approach. However, the double stent retriever was associated with an increased initial retrieval force.In vitro evaluation of the mechanism of action of the double stent retriever provided explanations that appear to support the high efficacy of such an approach in patient cohorts and could help operators when selecting the optimal mechanical thrombectomy strategy in cases of arterial occlusions difficult to treat with a single stent retriever. [ABSTRACT FROM AUTHOR]

Published
2023
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29. Intraoperative contrast-enhanced cone beam CT allows visualization of the 'dark side' of the clot and improves mechanical thrombectomy performance.

Author

Hofmeister J, Rosi A, Bernava G, Reymond P, Brina O, Yilmaz H, Carrera E, Lovblad KO, and Machi P

Abstract

Background: Visualization of the clot is key to the endovascular treatment of ischemic stroke, but identification of the distal part of the clot and distal arteries during mechanical thrombectomy (MT) remains challenging with conventional intraoperative imaging. We aimed to leverage the potential of contrast-enhanced cone beam CT (CE-CBCT) to better visualize the distality ('dark side') of the clot., Methods: We retrospectively analyzed all patients treated with MT for medium vessel occlusion (MeVO) guided by three-dimensional (3D) imaging to identify those who underwent either CE-CBCT or 3D rotational angiography (3DRA). Our primary outcome was the visualization of the proximal and distal edges of the clot and the arteries beyond the occlusion on the different types of intraoperative imaging: digital subtraction angiography (DSA), 3DRA, and CE-CBCT. Secondary outcomes included the efficacy, safety, and timing of MT between CE-CBCT versus 3DRA groups., Results: The proximal edge of the clot was well visualized by DSA, 3DRA, and CE-CBCT. However, the distal edge of the clot and distal arteries were significantly better visualized with CE-CBCT (60.0%) than 3DRA (2.7%) and DSA (11.4-13.5%). Moreover, MT efficacy was better with CE-CBCT than 3DRA, with higher first-pass effect (65.7% vs 37.8%) and final recanalization grade (expanded Treatment In Cerebral Infarction (eTICI) 3: 71.4% vs 43.2%). Finally, the visualization of the distal edge of the clot and distal arteries correlated with better collateralization grade., Conclusion: CE-CBCT localizes the clot and reveals the underlying vascular anatomy better than 3DRA or DSA, thereby enhancing the efficacy of MT. The improved filling of collaterals with CE-CBCT may explain this better visualization of the 'dark side' of the clot., Competing Interests: Competing interests: JH has been awarded a speaking compensation by Philips and Nicolab. GB has been awarded a speaking compensation by Penumbra. PM has been awarded a speaking compensation by Medtronic, Stryker and Penumbra., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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30. Double Stent Retriever Technique for Mechanical Thrombectomy: A Systematic Review and Meta-Analysis.

Author

Hofmeister J, Brina O, Bernava G, Rosi A, Reymond P, Lovblad KO, and Machi P

Subjects
Humans, Treatment Outcome, Endovascular Procedures instrumentation, Endovascular Procedures methods, Ischemic Stroke surgery, Ischemic Stroke diagnostic imaging, Stents, Thrombectomy instrumentation, Thrombectomy methods
Abstract

Background: Mechanical thrombectomy using a double stent retriever technique has recently been described for the treatment of acute ischemic stroke, but its efficacy and safety are not well-established., Purpose: The aim of this systematic review and meta-analysis was to evaluate reports of the use of a double stent retriever technique during the endovascular treatment of patients with ischemic stroke., Data Sources: The PubMed, EMBASE, Web of Science, and Scopus databases were searched to identify all studies (clinical trials, cohort series, and case reports) investigating the utility of a double stent retriever technique for the treatment of stroke. The study is reported in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42023482691)., Study Selection: Seventeen studies involving a total of 128 patients with large-vessel occlusions predominantly in the anterior circulation (93.0%) were identified., Data Analysis: Outcomes of interest were the prevalence of successful recanalization (modified TICI ≥2b) and a first-pass effect following the double stent retriever technique as well as complications such as iatrogenic dissections and SAH. Data were pooled using a random effects model., Data Synthesis: The double stent retriever technique was used as a rescue strategy in occlusions refractory to conventional endovascular treatment in 68.7% (88/128) of patients and as a first-line strategy in 31.3% (40/128) of patients. The double stent retriever technique achieved an overall final modified TICI ≥2b in 92.6% cases, with a first-pass effect of 76.6%. The complication rate remained low, with 0.37% dissection and 1.56% SAH., Limitations: Limitations of the study include the following: 1) a large number of case reports or small series, 2) a meta-analysis of proportions with no statistical comparison with a control group, and 3) the lack of access to patient-level data., Conclusions: Our findings suggest that double stent retriever thrombectomy may be safe and associated with good recanalization outcomes, but prospective comparative studies are needed to determine which patients may benefit from this endovascular procedure., (© 2024 by American Journal of Neuroradiology.)

Published
2024
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31. Can micro-guidewire advancement forces predict clot consistency and location to assist the first-line technique for mechanical thrombectomy?

Author

Reymond P, Roussinova E, Brina O, Hofmeister J, Bernava G, Rosi A, Galand W, Lovblad KO, Pereira VM, Bouri M, and Machi P

Abstract

Background: The identification of specific clot characteristics before mechanical thrombectomy (MTB) might allow the selection of the most effective first-line technique, thus potentially improving the procedural outcome. We aimed to evaluate if the microwire push forces could extrapolate information on clot consistency and extension before MTB, based on clot mechanical properties., Methods: We measured in vitro the forces exerted on the proximal extremity of the guidewire during the advancement and retrieval of the guidewire through clot analogs of different compositions. In addition, we analyzed the forces exerted on the guidewire to extrapolate information about the location of the proximal and distal extremities of the clot analogs., Results: The maximum forces recorded during the whole penetration phase were significantly different for hard and soft clots (median values, 55.6 mN vs 15.4 mN, respectively; P<0.0001). The maximum slope of the force curves recorded during the advancement of the guidewire for the first 3 s of penetration also significantly differentiated soft from hard clot analogs (7.6 mN/s vs 23.9 mN/s, respectively; P<0.0001). In addition, the qualitative analysis of the shape of the force curves obtained during the advancement and retrieval of the guidewire showed a good potential for the identification of the proximal and distal edges of the clot analogs., Conclusion: Our results demonstrated that it was possible to differentiate between soft and hard clot analogs. Furthermore, force measurements could give important information about the location of the clot extremities. Such an approach might support the selection of the first-line MTB technique, with the potential to improve the outcome., Competing Interests: Competing interests: PM is consultant for Medtronic, Stryker, MIVI Neuroscience and Penumbra. VMP is consultant for Stryker, Medtronic, Cerenovus, Microvention, Siemens Healthineers, Imperative Care, Infinity Neuro and Philips Healthcare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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