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Cost-effectiveness analysis of mechanical thrombectomy in acute ischemic stroke

Clinical article

Chirag G. Patil, Elisa F. Long, and Maarten G. Lansberg

E ndovascular mechanical thrombectomy for acute ischemic stroke is being increasingly performed by neurosurgeons and neurointerventionalists. Mechanical thrombectomy devices reopen large cerebral vessels and represent an alternative treatment to the standard medical therapy with antiplatelet agents in patients with large-vessel ischemic stroke who are not eligible for thrombolytic therapy, or in whom thrombolytic therapy has failed. The Merci retriever system (Concentric Medical) and more recently, the Penumbra system (Penumbra Inc.) have been granted 510

Open access

Favorable outcome of repeat mechanical thrombectomy in a geriatric patient: illustrative case

Ali A. Alsarah, Omar M. Hussein, and Andrew P. Carlson

From 2015 to 2018, seven trials (MR CLEAN, 1 REVA SCAT, 2 ESCAPE, 3 SWIFT PRIME, 4 EXTEND-1A, 5 DIFFUSE 3, 6 and DAWN 7 ) provided evidence of increased functional independence without increasing the risk of death after the early performance of mechanical thrombectomy. Intravenous chemical thrombolysis and mechanical thrombectomy have become the gold standards for treating patients who experience acute ischemic stroke. 8 Despite its rarity, recurrent mechanical thrombectomy has been considered a relatively safe procedure. Bouslama et al. 9 found no

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Mechanical thrombectomy for pediatric stroke arising from an atrial myxoma: case report

Rafael A. Vega, Julie L. Chan, Tony I. Anene-Maidoh, Margaret M. Grimes, and John F. Reavey-Cantwell

cardiovascular complications. 5 Cardiac myxoma is the most common primary heart tumor and is a benign neoplasm of endocardial origin. The location is usually in the left atrium. Atrial myxomas can be associated with a syncopal episode or sudden death as well as embolization resulting from tumor dislodgment or thrombus formation that can lead to AIS. 12 These lesions usually have an insidious presentation and the diagnosis is rarely known before or at the onset of stroke. We report an unusual case in which mechanical thrombectomy was used in the successful treatment of AIS

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Cerebral tumor embolism from thyroid cancer treated by mechanical thrombectomy: illustrative case

Yuta Fujiwara, Kentaro Hayashi, Yohei Shibata, Tatsuya Furuta, Tomohiro Yamasaki, Kazuhiro Yamamoto, Masahiro Uchimura, Fumio Nakagawa, Mizuki Kambara, Hidemasa Nagai, and Yasuhiko Akiyama

Cancer activates blood coagulation and results in cancer-associated cerebral infarction. In addition, cancer may invade the blood vessels and induce tumor embolism. It is reported that the rate of cerebral tumor embolism with a malignant tumor is as high as 4.7%. 1 Herein, we report a case of thyroid cancer embolism retrieved with mechanical thrombectomy and review the literature on tumor embolism recanalized with endovascular treatment. Illustrative Case A 57-year-old man was diagnosed with an advanced stage of thyroid cancer. Multiple lung

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Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke

Nikolaos Mouchtouris, Fadi Al Saiegh, Breanna Valcarcel, Carrie E. Andrews, Evan Fitchett, David Nauheim, David Moskal, Nabeel Herial, Pascal Jabbour, Stavropoula I. Tjoumakaris, Ashwini D. Sharan, Robert H. Rosenwasser, and M. Reid Gooch

, readmission prevention programs targeting ischemic stroke have the potential to substantially lower healthcare costs and improve patients’ quality of life. Several recently published studies have investigated the reasons for and predictors of hospital readmission following ischemic stroke. 3–6 However, the recent adoption of mechanical thrombectomy has radically altered the hospital course and functional outcome of patients with acute ischemic stroke. 7 This paradigm shift has also impacted the 30-day readmission rates and reasons for readmission. The present

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Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

Bing Zhou, Xiao-Chuan Wang, Jun-Yi Xiang, Ming-Zhao Zhang, Bo Li, Hai-Bo Jiang, and Xiao-Dong Lu

P ediatric acute ischemic stroke (AIS) is relatively rare compared to adult AIS, but it still plays an important role in pediatric death and disability. 6 , 11 With improvement in thrombectomy apparatus, the application of mechanical thrombectomy is increasingly used in adult AIS and shows good curative effect. However, because of the data scarcity and different pathogenesis in adults, it remains controversial whether mechanical thrombectomy can be used in pediatric AIS. 7 , 14 The purpose of this study was to analyze the safety and effectiveness of mechanical

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Takotsubo cardiomyopathy following mechanical thrombectomy for acute ischemic stroke: illustrative case

Tomohiro Yamasaki, Kentaro Hayashi, Yohei Shibata, Tatsuya Furuta, Kazuhiro Yamamoto, Masahiro Uchimura, Yuta Fujiwara, Fumio Nakagawa, Mizuki Kambara, Tsutomu Yoshikane, Hidemasa Nagai, Yasuhiko Akiyama, Kazuaki Tanabe, and Junya Tanabe

Takotsubo cardiomyopathy is characterized by transient left ventricular apical ballooning that resembles a Japanese octopus catcher pot (takotsubo) with a short narrow neck and round bottom. 1 Central nervous system disorders most frequently triggering takotsubo cardiomyopathy include subarachnoid hemorrhage (SAH), intracerebral bleeding, epilepsy, migraine, and ischemic stroke. Here, we report a case of takotsubo cardiomyopathy following mechanical thrombectomy for acute ischemic stroke. Illustrative Case A 73-year-old man was emergently brought to

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Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients

Carrie E. Andrews, Nikolaos Mouchtouris, Evan M. Fitchett, Fadi Al Saiegh, Michael J. Lang, Victor M. Romo, Nabeel Herial, Pascal Jabbour, Stavropoula I. Tjoumakaris, Robert H. Rosenwasser, and M. Reid Gooch

functional outcome at discharge (p = 0.078) ( Table 3 ). FIG. 1. Clinical outcomes after mechanical thrombectomy. HAC = hospital-acquired condition. Figure is available in color online only. TABLE 2. Patient outcomes Age Group <80 Yrs (n = 303) 80–89 Yrs (n = 86) ≥90 Yrs (n = 14) p Value TICI grade 2B–3 264 (87.1%) 73 (84.9%) 14 (100%) 0.627 Favorable outcome (mRS score 0–2) 105 (34.7%) 16 (18.6%) 4 (28.6%) 0.019 Hemorrhagic conversion (grade 4) 33 (10.9%) 6 (7.0%) 1 (7.7%) 0.31 Inpatient mortality 36 (11.8%) 7 (8.1%) 1 (7.1%) 0.292 HACs  PNA 50 (16.5%) 11 (12.8%) 2 (14

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Revascularization and functional outcomes after mechanical thrombectomy: an update to key metrics

Nikolaos Mouchtouris, Fadi Al Saiegh, Evan Fitchett, Carrie E. Andrews, Michael J. Lang, Ritam Ghosh, Richard F. Schmidt, Nohra Chalouhi, Guilherme Barros, Hekmat Zarzour, Victor Romo, Nabeel Herial, Pascal Jabbour, Stavropoula I. Tjoumakaris, Robert H. Rosenwasser, and M. Reid Gooch

Medical, Inc.), not only had improved neurological recovery compared with the medical therapy group, but also had a similar adverse event rate with a limited number of complications (symptomatic intracranial hemorrhage in 6% of patients and embolization in different territory in 4% of patients). 17 While these trials demonstrated the superiority and safety of MT, each trial included a different group of neurointerventionists, and only one device was used per trial. 5 , 20 Our study offers a unique insight into our real-life experience with mechanical thrombectomy by

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Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

Kartik Bhatia, Hans Kortman, Christopher Blair, Geoffrey Parker, David Brunacci, Timothy Ang, John Worthington, Prakash Muthusami, Hazem Shoirah, J Mocco, and Timo Krings

S ince 2015, the evidence demonstrating the benefit of mechanical thrombectomy (MT) in adults with acute ischemic stroke due to large vessel occlusion has been overwhelming. 21 , 44 In contrast, the role of MT in the pediatric stroke population is still unclear. There are no published randomized controlled trials, case-control studies, or prospective registries. There are multiple reasons for this limited evidence, including the purposeful exclusion of pediatric patients from the major trials as well as the paucity of pediatric acute stroke cases in which