A Registry of Mechanical Recanalization Procedures in Acute Stroke – Pilot Results from a Multicentre Registry

Czech version

Authors: M. Roubec ¹; M. Kuliha ¹; D. Školoudík ¹; D. Šaňák ²; K. Langová ³; D. Krajíčková ⁴; E. Vítková ⁴; M. Kusyn ⁵; Z. Eichlová ⁶; R. Havlíček ⁷; P. Kešnerová ⁸; Širší Kolektiv Spolupracujících:; V. Procházka ⁹; T. Jonszta ⁹; J. Krajča ⁹; D. Czerný ⁹; R. Herzig ⁴; D. Václavík ⁵; J. Krátký ¹⁰; D. Kučera ¹¹; A. Tomek ⁸
Authors‘ workplace: Komplexní cerebrovaskulární centrum, Neurologická klinika LF OU a FN Ostrava ¹; Komplexní cerebrovaskulární centrum, Neurologická klinika LF UP a FN Olomouc ²; Ústav lékařské biofyziky, LF UP v Olomouci ³; Komplexní cerebrovaskulární centrum, Neurologická klinika, LF UK a FN Hradec Králové ⁴; Iktové centrum, Neurologické oddělení, Vítkovická nemocnice Ostrava a. s. ⁵; Komplexní cerebrovaskulární centrum, Neurologické oddělení, Krajská nemocnice Liberec, a. s. ⁶; Komplexní cerebrovaskulární centrum, Neurologické oddělení, ÚVN Praha ⁷; Komplexní cerebrovaskulární centrum, Neurologická klinika 2. LF UK a FN v Motole, Praha ⁸; Komplexní cerebrovaskulární centrum, Radiodiagnostický ústav LF OU a FN Ostrava ⁹; Iktové centrum, Radiologické oddělení, Vítkovická nemocnice Ostrava a. s. ¹⁰; Iktové centrum, Interní oddělení, Vaskulární centrum, Vítkovická nemocnice Ostrava a. s. ¹¹
Published in: Cesk Slov Neurol N 2015; 78/111(2): 205-208
Category: Short Communication
doi: https://doi.org/10.14735/amcsnn2015205

Overview

Background:
Acute cerebral artery occlusion is the most common cause of ischemic stroke. Early recanalization is associated with a significantly higher chance of achieving patient self‑ sufficiency and reducing mortality. Over the recent years, pharmacological recanalization methods were joined by mechanical methods. The aim of the registry is to map geographic availability and to assess safety and efficacy of mechanical recanalization techniques in routine clinical practice.

Methods:
All consecutive acute ischemic stroke patients treated with mechanical recanalization techniques in selected comprehensive cerebrovascular and stroke centers in the Czech Republic have been prospectively registered. Demographic data, stroke severity, grade of recanalization, patient clinical outcome and frequency of symptomatic intracranial hemorrhage (SICH) were analyzed in the pilot study and are presented.

Results:
A total of 353 patients (210 men, mean age 66.0 ± 13.1 years) with acute ischemic stroke and acute occlusion of the carotid or intracranial artery, treated using mechanical technique were consecutively registered to a multicentre registry between January 1, 2006 and September 21, 2014. The median of baseline NIHSS score was 16 points. Recanalization (TICI 2b‑ 3) was achieved in 58.6% and self‑ sufficiency after three months (modified Rankin Scale, mRS 0– 2) in 45.3% patients. SICH occurred in 4.2% patients and 3- month mortality was 26.1%.

Conclusion:
The organization of care for ischemic stroke patients in the Czech Republic is at a good level with availability of intravenous thrombolysis as well as mechanical recanalization methods. Endovascular procedures appear to be safe and highly effective with respect to arterial recanalization.

Key words:
stroke – registry – arterial occlusion – mechanical recanalization – therapy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population‑based studies of incidence, prevalence, and case‑ fatality in the late 20th century. Lancet Neurol 2003; 2(1): 43– 53.

2. Rosamond W, Flegal K, Furie K, Go A, Greenlund K,Haase N et al. Heart disease and stroke statistics – 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 117(4): e25– e146.

3. Fieschi C, Argentino C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L. Clinical and instrumentalevaluation of patients with ischemic stroke within the first six hours. J Neurol Sci 1989; 91(3): 311– 321.

4. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta‑analysis. Stroke 2007; 38(3): 967– 973.

5. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP et al. MERCI Trial Investigators. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 2005; 36(7): 1432– 1440.

6. Chopko BW, Kerber C, Wong W, Georgy B. Transcatheter snare removal of acute middle cerebral artery thromboembolism: technical case report. Neurosurgery 2000; 46(6): 1529– 1531.

7. Kerber CW, Barr JD, Berger RM, Chopko BW. Snare retrieval of intracranial thrombus in patients with acute stroke. J Vasc Interv Radiol 2002 13: 1269– 1274.

8. Fourie P, Duncan IC. Microsnare‑assisted mechanical removal of intraprocedural distal middle cerebral arterial thromboembolism. Am J Neuroradiol 2003; 24(4): 630– 632.

9. Schumacher HC, Meyers PM, Yavagal DR, Harel NY, Elkind MS, Mohr JP et al. Endovascular mechanical thrombectomy of an occluded superior division branch of the left MCA for acute cardioembolic stroke. Cardiovasc Intervent Radiol 2003; 26(3): 305– 308.

10. Charvát F, Lacman J, Mašková J. Mechanická embolektomie pomocí Merci katétru u nemocných s akutním uzávěrem mozkových tepen. Cesk Slov Neurol N 2008; 71/ 107(1): 69– 74.

11. Věstník Ministerstva zdravotnictví České republiky 2/ 2010. Praha: Ministerstvo zdravotnictví ČR 2010.

12. Věstník Ministerstva zdravotnictví České republiky 3/ 2012. Praha: Ministerstvo zdravotnictví ČR 2012.

13. Věstník Ministerstva zdravotnictví České republiky 4/ 2012. Praha: Ministerstvo zdravotnictví ČR 2012.

14. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13): 1317– 1329. doi: 10.1056/ NEJMoa0804656.

15. Školoudík D, Šaňák, D. Rekanalizační terapie akutní ischemické cévní mozkové příhody. 1. vyd. Praha: Maxdorf 2013.

16. Dmitrijevski B, Crome O, Foerschler A, Bock A, Nabavi D.Mechanical thrombectomy in stroke patients not eligible for systemic thrombolysis. Cerebrovasc Dis 2014; 37 (Suppl 1): 651.

17. Desfontaines PH, Brisbois D, Onclinx N, Daout C, Cornet O, Melin A et al. Rescue thrombectomy after failure of intravenous thrombolysis in acute ischemic stroke: a multicenter prospective observational study with retrospective case‑ control comparison. Cerebrovasc Dis 2014; 37 (Suppl 1): 658.

18. Unrath M, Eyding J, Weber R, Minnerup J, Stögbauer F,Berger K. Outcome after thrombectomy, i.v. thrombolysis, and their combination in patients with ischemic stroke – The REVASK register. Cerebrovasc Dis 2014; 37 (Suppl 1): 151.

19. Menon BK, Almekhlafi MA, Pereira VM, Gralla J, Bonafe A,Davalos A et al. Optimal workflow and process‑based performance measures for endovascular therapy in acute ischemic stroke: analysis of the Solitaire FR thrombectomy for acute revascularization study. Stroke 2014; 45(7): 2024– 2029. doi: 10.1161/ STROKEAHA.114.005050.

20. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA,Lingsma HF, Yoo AJ et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11– 20. doi: 10.1056/ NEJMoa1411587.

21. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD et al. Endovascular therapy after intravenous t‑ PA versus t‑ PA alone for stroke. N Engl J Med 2013; 368(10): 893– 903. doi: 10.1056/ NEJMoa1214300.

22. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M,Sterzi R et al. SYNTHESIS Expansion Investigators. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368: 904– 913. doi: 10.1056/ NEJMoa1213701.

23. Kidwell CS, Jahan R, Gornbein, J, Alger JR, Nenov V, Ajani Z et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368(10): 914– 923. doi: 10.1056/ NEJMoa1212793.

24. Roubec M, Kuliha M, Procházka V, Krajca J, Czerny D,Jonszta T et al. A controlled trial of revascularization in acute stroke. Radiology 2013; 266(3): 871– 878. doi: 10.1148/ radiol.12120798.

25. Kuliha M, Roubec M, Jonszta T, Krajca J, Czerny, D, Krajina A et al. Safety and efficacy of endovascular sonolysis using the EkoSonic endovascular system in patients with acute stroke. AJNR Am J Neuroradiol 2013; 34(7): 1401– 1406. doi: 10.3174/ ajnr.A3416.

26. Skoloudik D, Bar M, Skoda O, Vaclavik D, Hradilek P, Allendoerfer J et al. Safety and efficacy of the sonographic acceleration of the middle cerebral artery recanalization: results of the pilot thrombotripsy study. Ultrasound Med Biol 2008; 34(11): 1775– 1782. doi: 10.1016/ j.ultrasmedbio.2008.04.002.

27. Mendonça N, Flores A, Pagola J, Rubiera M, Rodríguez‑ Luna D, De Miquel MA et al. Trevo versus solitaire a head‑ to‑ head comparison between two heavy weights of clot retrieval. J Neuroimaging 2014; 24(2): 167– 170. doi: 10.1111/ j.1552‑ 6569.2012.00730.x.

28. Zaidat O, Castonguay A, Veznedaroglu E, Binning M, Alshekhlee A, Abraham M et al. P‑ 021 TREVO Stent‑ Retriever Acute Stroke (TRACK) Post‑marketing Registry: Interim Revascularization and Clinical Outcome Results Compared to TREVO‑ 2 and NASA Registry. J Neurointerv Surg 2014; 6 (Suppl 1): A31– A32. doi: 10.1136/ neurintsurg‑ 2014‑ 011343.57.

29. Zaidat OO, Castonguay AC, Gupta R, Sun CH, Martin C, Holloway WE et al. North American Solitaire Stent Retriever Acute Stroke registry: post‑marketing revascularization and clinical outcome results. J Neurointerv Surg 2014; 6(8): 584– 588. doi: 10.1136/ neurintsurg‑ 2013‑ 010895.

30. Ribo M, Molina CA, Jankowitz B, Tomasello A, Zaidi S,Jumaa M et al. Stentrievers versus other endovascular treatment methods for acute stroke: comparison of procedural results and their relationship to outcomes. J Neurointerv Surg 2014; 6(4): 265– 269. doi: 10.1136/ neurintsurg‑ 2013‑ 010748.

31. Neumann J, Tomek A, Školoudík D, Škoda O, Mikulík R, Herzig R et al. Doporučený postup pro intravenózní trombolýzu v léčbě akutního mozkového infarktu – verze 2014. Cesk Slov Neurol N 2014; 77/ 110(3): 381– 385.