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Update on Thrombectomy
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Update on Thrombectomy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (27 June 2024) | Viewed by 2630

Special Issue Editor

Prof. Dr. José Manuel Pumar

E-Mail Website
Guest Editor
Director of the Chair of Interventional Neuroradiology, University of Santiago de Compostela, Santiago de Compostela University, A Coruña, Spain
Interests: hemorrhagic stroke; ischemic stroke; brain aneurysms; thrombectomy; flow diverters

Special Issue Information

Dear Colleagues,

Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS). It is now the standard of care according to international guidelines (level 1 class A evidence).

Since 2015, there have been significant advances in establishing and widening the criteria for treatment. However, in about 20% of EVT procedures, recanalization is not achieved, and over 50% of patients who undergo EVT still do not have good functional outcomes.

This Special Issue aims to summarize the current evidence base and the latest advances with interest in recanalization treatments for acute ischemic stroke. It focuses on improving thrombectomy techniques, including the development of new technologies and new systems as well as the expansion of their indications to distal arteries and posterior territory.

Prof. Dr. José Manuel Pumar
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • first pass recanalization
  • thrombectomy distal arteries
  • thrombectomy posterior territory
  • direct aspiration vs. stent retriever
  • combined techniques
  • cyclical aspiration
  • rescue stenting

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Published Papers (2 papers)

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Research

12 pages, 1741 KiB  
Article
Rescue Stenting of Isolated Middle Cerebral Artery (MCA) Dissections (MCAD) with Antithrombogenic Coated Stents and Mono-Antiplatelet Therapy (MAPT)
by Piotr Pedowski, Jakub Fedorko, Stefan Pataky and Zuzana Gdovinova
J. Clin. Med. 2024, 13(15), 4329; https://doi.org/10.3390/jcm13154329 - 24 Jul 2024
Viewed by 962
Abstract
Objective: Acute ischemic stroke (AIS) is a leading cause of death, but isolated middle cerebral artery dissection (MCAD) is rarely reported. The aim of this article is to sum up the current information on this pathology and to explore the technical aspects of [...] Read more.
Objective: Acute ischemic stroke (AIS) is a leading cause of death, but isolated middle cerebral artery dissection (MCAD) is rarely reported. The aim of this article is to sum up the current information on this pathology and to explore the technical aspects of its endovascular treatment with emphasis on novel coated, antithrombogenic stents and antiplatelet management. Another part of this article offers our experience with the problematics represented by a small sample group of patients with an MCAD diagnosis who were treated in our center. Methods: We conducted literature research and a retrospective review of patients treated for anterior circulation AIS at our comprehensive stroke center from January 2022 to March 2024. The cohort included 16 patients diagnosed with isolated MCAD, 9 received antithrombogenic coated stents, while 7 received bare metal stents. Pharmacological management of coated stents involved the use of Cangrelor for acute antiplatelet therapy, transitioning to oral Ticagrelor. Results: Among the 16 patients treated, those with antithrombogenic coated stents showed no major complications and had a lower incidence of intracranial hemorrhage compared to the bare metal stent group. The average National Institutes of Health Stroke Scale (NIHSS) score at discharge improved in both groups. Functional outcomes and mortality rates were slightly better in the coated stent group, but no statistical significance was proven. Conclusions: Antithrombogenic coated stents, in conjunction with MAPT, demonstrated a safe and effective option for treating isolated MCAD. These stents offer promising potential for improved outcomes and reduced complications compared to traditional treatments. Further multicentric studies with larger cohorts are recommended to validate these findings. Full article
(This article belongs to the Special Issue Update on Thrombectomy)
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10 pages, 244 KiB  
Article
Enhancing the First-Pass Effect in Acute Stroke: The Impact of Stent Retriever Characteristics
by Eduardo Murias, Josep Puig, Carmen Serna-Candel, Eva María Gonzalez, Manuel Moreu, Elvira Jiménez-Gómez, Luis SanRoman, Fernando Aparici-Robles, Mikel Terceño, Antonio Mosqueira Martínez, Sonia Aixut, Veredas Romero, Jose Carlos Mendez, Antonio Sagredo-Barra, Yeray Aguilar, Mariano Espinosa de Rueda, Miguel Angel Castaño Blázquez, Saima Bashir, José Rodríguez Castro, Alfonso Lopez-Frías, Jose María Jiménez, Juan Chaviano, Victor Maestro, Javier Manso, Antonio Lopez-Rueda, Sebastià Remollo, Lluis Morales-Caba, Marc Comas-Cufí, Pedro Vega and on behalf of Rossetti Registry Investigatorsadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(11), 3123; https://doi.org/10.3390/jcm13113123 - 26 May 2024
Viewed by 1281
Abstract
Introduction: Although stentrievers (SRs) have been a mainstay of mechanical thrombectomy (MT), and current guidelines recommend the use of SRs in the treatment of large vessel occlusion stroke (LVO), there is a paucity of studies in the literature comparing SRs directly against each [...] Read more.
Introduction: Although stentrievers (SRs) have been a mainstay of mechanical thrombectomy (MT), and current guidelines recommend the use of SRs in the treatment of large vessel occlusion stroke (LVO), there is a paucity of studies in the literature comparing SRs directly against each other in terms of mechanical and functional properties. Timely access to endovascular therapy and the ability to restore intracranial flow in a safe, efficient, and efficacious manner have been critical to the success of MT. This study aimed to investigate the impact of contemporary SR characteristics, including model, brand, size, and length, on the first-pass effect (FPE) in patients with acute ischemic stroke. Methods: Consecutive patients with M1 occlusion treated with a single SR+BGC were recruited from the ROSSETTI registry. The primary outcome was the FPE that was defined as modified (mFPE) or true (tFPE) for the achievement of modified thrombolysis in cerebral infarction (mTICI) grades 2b-3 or 3 after a single device pass, respectively. We compared patients who achieved mFPE with those who achieved tFPE according to SR characteristics. Results: We included 610 patients (52.3% female and 47.7% male, mean age 75.1 ± 13.62 years). mFPE was achieved in 357 patients (58.5%), whereas tFPE was achieved in 264 (43.3%). There was no significant association between SR characteristics and mFPE or tFPE. Specifically, the SR size did not show a statistically significant relationship with improvement in FPE. Similarly, the length of the SR did not yield significant differences in the mFPE and tFPE, even when the data were grouped. Conclusions: Our data indicate that contemporary SR-mediated thrombectomy characteristics, including model, brand, size, and length, do not significantly affect the FPE. Full article
(This article belongs to the Special Issue Update on Thrombectomy)
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