Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Endovascular Stroke Therapy Focused on Stent Retriever Thrombectomy and Direct Clot Aspiration : Historical Review and Modern Application

  • Kang, Dong-Hun (Department of Neurosurgery, Kyungpook National University Hospital, Daegu-Gyeongbuk Cardiocerebrovascular Center, School of Medicine, Kyungpook National University) ;
  • Park, Jaechan (Department of Neurosurgery, Kyungpook National University Hospital, Daegu-Gyeongbuk Cardiocerebrovascular Center, School of Medicine, Kyungpook National University)
  • Received : 2016.09.26
  • Accepted : 2017.01.11
  • Published : 2017.05.01
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Abstract

Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. Huge progress was made in 2015, as there were five randomized clinical trials which all demonstrated the safety and efficacy of endovascular stroke treatment. Despite differences in detail patient enrollment criteria, all 5 trials employed key factors for good functional recovery; (1) screening with non-invasive imaging to identify the proximal occlusion and exclude a large infarct core, (2) using highly effective modern thrombectomy devices mainly with stent retriever, and (3) establishment of a fast workflow to achieve effective reperfusion. The results of those trials indicate that modern thrombectomy devices can allow for faster and more effective reperfusion, which can lead to improved clinical outcomes compared to intravenous thrombolysis alone. These advances in mechanical thrombectomy are promising in the global fight against ischemic stroke-related disability and mortality. Two current mainstreams among such mechanical thrombectomy techniques, "stent retriever thrombectomy" and "direct clot aspiration", are the topic of this review. Stent retriever thrombectomy using Solitaire and Trevo retriever will be firstly discussed. And, the commonalities and the differences between two major clot aspiration thrombectomy techniques; a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be additionally explained. Finally, details regarding the combination of direct clot aspiration and stent retriever thrombectomy, the switching strategy and the Solumbra technique, will be described.

Keywords

References

  1. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al.; MR CLEAN Investigators : a randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372 : 11-20, 2015 https://doi.org/10.1056/NEJMoa1411587
  2. Berlis A, Lutsep H, Barnwell S, Norbash A, Wechsler L, Jungreis CA, et al. : Mechanical thrombolysis in acute ischemic stroke with endovascular photoacoustic recanalization. Stroke 35 : 1112-1116, 2004 https://doi.org/10.1161/01.STR.0000124126.17508.d3
  3. Brandt T, von Kummer R, Muller-Kuppers M, Hacke W : Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 27 : 875-881, 1996 https://doi.org/10.1161/01.STR.27.5.875
  4. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al.; Interventional Management of Stroke (IMS) III Investigators : Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368 : 893-903, 2013 https://doi.org/10.1056/NEJMoa1214300
  5. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al.; EXTEND-IA Investigators : Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372 : 1009-1018, 2015 https://doi.org/10.1056/NEJMoa1414792
  6. Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, et al. : New England Medical Center Posterior Circulation registry. Ann Neurol 56 : 389-398, 2004 https://doi.org/10.1002/ana.20204
  7. Chapot R, Houdart E, Rogopoulos A, Mounayer C, Saint-Maurice JP, Merland JJ : Thromboaspiration in the basilar artery: report of two cases. AJNR Am J Neuroradiol 23 : 282-284, 2002
  8. Chueh JY, Kuhn AL, Puri AS, Wilson SD, Wakhloo AK, Gounis MJ : Reduction in distal emboli with proximal flow control during mechanical thrombectomy: a quantitative in vitro study. Stroke 44 : 1396-1401, 2013 https://doi.org/10.1161/STROKEAHA.111.670463
  9. 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 368 : 904-913, 2013 https://doi.org/10.1056/NEJMoa1213701
  10. Delgado Almandoz JE, Kayan Y, Young ML, Fease JL, Scholz JM, Milner AM, et al. : Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg 8 : 1123-1128, 2016 https://doi.org/10.1136/neurintsurg-2015-012122
  11. Deshaies EM : Tri-axial system using the Solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy. J Clin Neurosci 20 : 1303-1305, 2013 https://doi.org/10.1016/j.jocn.2012.10.037
  12. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al.; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group : Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 383 : 245-254, 2014 https://doi.org/10.1016/S0140-6736(13)61953-4
  13. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al.; ESCAPE Trial Investigators : Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372 : 1019-1030, 2015 https://doi.org/10.1056/NEJMoa1414905
  14. Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ : Intraarterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19 : 1216-1222, 1988 https://doi.org/10.1161/01.STR.19.10.1216
  15. Holmstedt CA, Turan TN, Chimowitz MI : Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol 12 : 1106-1114, 2013 https://doi.org/10.1016/S1474-4422(13)70195-9
  16. Hu YC, Stiefel MF : Force and aspiration analysis of the ADAPT technique in acute ischemic stroke treatment. J Neurointerv Surg 8 : 244-246, 2016 https://doi.org/10.1136/neurintsurg-2014-011563
  17. Humphries W, Hoit D, Doss VT, Elijovich L, Frei D, Loy D, et al. : Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg 7 : 90-94, 2015 https://doi.org/10.1136/neurintsurg-2013-010986
  18. Hwang YH, Kang DH, Kim YW, Kim YS, Park SP, Suh CK : Outcome of forced-suction thrombectomy in acute intracranial internal carotid occlusion. J Neurointerv Surg 5 Suppl 1 : i81-i84, 2013 https://doi.org/10.1136/neurintsurg-2012-010277
  19. Imai K, Mori T, Izumoto H, Takabatake N, Kunieda T, Shimizu H, et al. : Clot removal therapy by aspiration and extraction for acute embolic carotid occlusion. AJNR Am J Neuroradiol 27 : 1521-1527, 2006
  20. IMS II Trial Investigators : The interventional management of stroke (IMS) II study. Stroke 38 : 2127-2135, 2007 https://doi.org/10.1161/STROKEAHA.107.483131
  21. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al.; REVASCAT Trial Investigators : Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372 : 2296-2306, 2015 https://doi.org/10.1056/NEJMoa1503780
  22. Kang DH, Kim YW, Hwang YH, Park J, Hwang JH, Kim YS : Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation. Stroke 44 : 3577-3579, 2013 https://doi.org/10.1161/STROKEAHA.113.002673
  23. Kang DH, Kim YW, Hwang YH, Park SP, Kim YS, Baik SK : Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis 37 : 350-355, 2014 https://doi.org/10.1159/000362435
  24. Kang DH, Hwang YH, Kim YS, Park J, Kwon O, Jung C : Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forcedsuction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol 32 : 283-287, 2011 https://doi.org/10.3174/ajnr.A2299
  25. Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, et al. : Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 113 : 555-563, 2006 https://doi.org/10.1161/CIRCULATIONAHA.105.578229
  26. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, et al.; MR RESCUE Investigators : A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368 : 914-923, 2013 https://doi.org/10.1056/NEJMoa1212793
  27. Lee JS, Hong JM, Lee SJ, Joo IS, Lim YC, Kim SY : The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion. Acta Neurochir (Wien) 155 : 635-641, 2013 https://doi.org/10.1007/s00701-013-1649-5
  28. Mahon BR, Nesbit GM, Barnwell SL, Clark W, Marotta TR, Weill A, et al. : North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 24 : 534-538, 2003
  29. Nakano S, Iseda T, Yoneyama T, Kawano H, Wakisaka S : Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombolysis. Stroke 33 : 2872-2876, 2002 https://doi.org/10.1161/01.STR.0000038985.26269.F2
  30. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group : Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333 : 1581-1587, 1995 https://doi.org/10.1056/NEJM199512143332401
  31. Nguyen TN, Malisch T, Castonguay AC, Gupta R, Sun CH, Martin CO, et al. : Balloon guide catheter improves revascularization and clinical outcomes with the Solitaire device: analysis of the North American Solitaire Acute Stroke Registry. Stroke 45 : 141-145, 2014 https://doi.org/10.1161/STROKEAHA.113.002407
  32. Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, et al.; TREVO 2 Trialists : Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial Lancet 380 : 1231-1240, 2012 https://doi.org/10.1016/S0140-6736(12)61299-9
  33. Noser EA, Shaltoni HM, Hall CE, Alexandrov AV, Garami Z, Cacayorin ED, et al. : Aggressive mechanical clot disruption: a safe adjunct to thrombolytic therapy in acute stroke? Stroke 36 : 292-296, 2005 https://doi.org/10.1161/01.STR.0000152331.93770.18
  34. Papanagiotou P, Roth C, Walter S, Behnke S, Grunwald IQ, Viera J, et al. : Carotid artery stenting in acute stroke. J Am Coll Cardiol 58 : 2363-2369, 2011 https://doi.org/10.1016/j.jacc.2011.08.044
  35. Penumbra Pivotal Stroke Trial Investigators : The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40 : 2761-2768, 2009 https://doi.org/10.1161/STROKEAHA.108.544957
  36. Qureshi AI, Abd-Allah F, Aleu A, Connors JJ, Hanel RA, Hassan AE, et al. : Endovascular treatment for acute ischemic stroke patients: implications and interpretation of IMS III, MR RESCUE, and SYNTHESIS EXPANSION trials: a report from the Working Group of International Congress of Interventional Neurology. J Vasc Interv Neurol 7 : 56-75, 2014
  37. Qureshi AI, Siddiqui AM, Suri MF, Kim SH, Ali Z, Yahia AM, et al. : Aggressive mechanical clot disruption and low-dose intra-arterial thirdgeneration thrombolytic agent for ischemic stroke: a prospective study. Neurosurgery 51 : 1319-1327; discussion 1327-1329, 2002 https://doi.org/10.1097/00006123-200211000-00040
  38. Ryu CW, Kwak HS, Jahng GH, Lee HN : High-resolution MRI of intracranial atherosclerotic disease. Neurointervention 9 : 9-20, 2014 https://doi.org/10.5469/neuroint.2014.9.1.9
  39. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al.; SWIFT PRIME Investigators : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372 : 2286-2295, 2015
  40. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, et al.; SWIFT Trialists : Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallelgroup, non-inferiority trial. Lancet 380 : 1241-1249, 2012 https://doi.org/10.1016/S0140-6736(12)61384-1
  41. Sivan-Hoffmann R, Gory B, Armoiry X, Goyal M, Riva R, Labeyrie PE, et al. : Stent-retriever thrombectomy for acute anterior ischemic stroke with tandem occlusion: a systematic review and meta-analysis. Eur Radiol 27 : 247-254, 2017 https://doi.org/10.1007/s00330-016-4338-y
  42. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. : Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39 : 1205-1212, 2008 https://doi.org/10.1161/STROKEAHA.107.497115
  43. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, et al. : Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36 : 1432-1438, 2005 https://doi.org/10.1161/01.STR.0000171066.25248.1d
  44. Stampfl S, Ringleb PA, Mohlenbruch M, Hametner C, Herweh C, Pham M, et al. : Emergency cervical internal carotid artery stenting in combination with intracranial thrombectomy in acute stroke. AJNR Am J Neuroradiol 35 : 741-746, 2014 https://doi.org/10.3174/ajnr.A3763
  45. Starck EE, McDermott JC, Crummy AB, Turnipseed WD, Acher CW, Burgess JH : Percutaneous aspiration thromboembolectomy. Radiology 156 : 61-66, 1985 https://doi.org/10.1148/radiology.156.1.3159042
  46. Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, et al. : Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 6 : 231-237, 2014 https://doi.org/10.1136/neurintsurg-2013-010713
  47. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. : Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 379 : 2364-2372, 2012 https://doi.org/10.1016/S0140-6736(12)60738-7
  48. Xu GF, Suh DC, Choi CG, Kim JK, Kim W, Kim SJ, et al. : Aspiration thrombectomy of acute complete carotid bulb occlusion. J Vasc Interv Radiol 16 : 539-542, 2005 https://doi.org/10.1097/01.RVI.0000150925.36365.8E
  49. Yoon W, Kim BM, Kim DJ, Kim DI, Kim SK : Outcomes and prognostic factors after emergent carotid artery stenting for hyperacute stroke within 6 hours of symptom onset. Neurosurgery 76 : 321-329, 2015 https://doi.org/10.1227/NEU.0000000000000610

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