| 1. |
- Douglas, Andrew, et al.
(författare)
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Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes.
- 2020
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 12:6
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Tidskriftsartikel (refereegranskat)abstract
- Platelets and von Willebrand factor (vWF) are key factors in thrombosis and thus are likely key components of acute ischemic stroke (AIS) emboli. We aimed to characterize platelet and vWF levels in AIS emboli and to assess associations between their expression levels and clinical and procedural information.Histopathological and immunohistochemical analysis of emboli collected as part of the multi-institutional RESTORE registry was performed. The composition of the emboli was quantified using Orbit Image Analysis machine learning software. Correlations between clot components and clinical and procedural information were assessed using the χ2 test.Ninety-one emboli samples retrieved from 63 patients were analyzed in the study. The mean platelet (CD42b) content of the clots was 33.9% and the mean vWF content of the clots was 29.8%. There was a positive correlation between platelet and vWF levels (ρ=0.564, p<0.001*, n=91). There was an inverse correlation between both platelets and vWF levels and percentage of red blood cells (RBCs) in the emboli (CD42b vs RBC: ρ=-0.535, p<0.001*, n=91; vWF vs RBC: ρ=-0.366, p<0.001*, n=91). Eighty-one percent of patients in the low platelet group had a good revascularization outcome (Thrombolysis in Cerebral Infarction 2c/3) compared with 58% in the high platelet group (χ2=5.856, p=0.016).Platelet and vWF levels in AIS emboli correlate with each other and both have an inverse relationship with RBC composition. Patients with platelet-rich clots have poorer revascularization outcomes.
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| 2. |
- Fletcher-Sandersjoo, A, et al.
(författare)
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Long-term pain relief following percutaneous steroid treatment of spinal synovial cysts: a population-based cohort study
- 2020
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 12:9, s. 874-878
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Tidskriftsartikel (refereegranskat)abstract
- Spinal synovial cysts are fluid-filled sacs that develop after facet joint degeneration and can give rise to radicular pain. If resistant to conservative management, surgical decompression or percutaneous steroid treatment is usually recommended. Percutaneous treatment minimizes the risk of spinal instability, but it has been uncertain whether it provides any long-term symptom relief. Moreover, it is unclear whether cyst rupture provides any added benefit.ObjectiveTo assess long-term pain relief in patients with spinal synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture.MethodsA population-based cohort-study was conducted of all patients with symptomatic synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture between 1995 and 2014.ResultsThirty-eight patients were included. All patients had variations of lower back and radicular pain. Intra-articular access was achieved in 35 (92%) patients, and there were no treatment-related complications. At short-term assessment, 30 (79%) had pain relief. During the median follow-up of 11 years, 12 (32%) patients showed sustained pain relief without the need for decompressive surgery.ConclusionsPercutaneous intra-articular steroid treatment without cyst rupture is a safe treatment for symptomatic spinal synovial cysts and eliminates the need for surgery in a substantial number of patients. It can be suggested as a first line of treatment.
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| 3. |
- Sanchez, S, et al.
(författare)
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ANCD thrombectomy device: in vitro evaluation
- 2020
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 12:1, s. 77-81
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Tidskriftsartikel (refereegranskat)abstract
- Endovascular treatment of stroke, although highly effective, may fail to reach complete recanalization in around 20% of cases. The Advanced Thrombectomy System (ANCD) is a novel stroke thrombectomy device designed to reduce clot fragmentation and facilitate retrieval by inducing local flow arrest and allowing distal aspiration in combination with a stent retriever. We aimed to assess the preclinical efficacy of ANCD.MethodsSoft red blood cell (RBC)-rich (n=20/group) and sticky fibrin-rich (n=30/group) clots were used to create middle cerebral artery (MCA) occlusions in two vascular phantoms. Three different treatment strategies were tested: (1) balloon guide catheter + Solitaire (BGC+SR); (2) distal access catheter + SR (DAC+SR); and (3) ANCD+SR, until complete recanalization was achieved or to a maximum of three passes. The recanalization rate was determined after each pass.ResultsAfter one pass, ANCD+SR resulted in an increased recanalization rate (94%) for all clots together compared with BGC+SR (66%; p<0.01) or DAC+SR (80%; p=0.04). After the final pass the recanalization rate increased in all three groups but remained higher with ANCD+SR (100%) than with BGC+SR (74%; p<0.01) or DAC+SR (90%; p=0.02). The mean number of passes was lower with ANCD+SR (1.06) than with BGC+SR (1.46) or DAC+SR (1.25) (p=0.01). A logistic regression model adjusted for treatment arm, clot type, and model used showed that both RBC-rich clots (OR 8.1, 95% CI 1.6 to 13.5) and ANCD+SR (OR 3.9, 95% CI 1.01 to 15.8) were independent predictors of first-pass recanalization.ConclusionIn in vitro three-dimensional models replicating MCA-M1 occlusion, ANCD+SR showed significantly better recanalization rates in fewer passes than other commonly used combinations of devices.
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| 4. |
- Sanchez, S, et al.
(författare)
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Preclinical evaluation of the ANCD thrombectomy device: safety and efficacy in a swine clot model
- 2020
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 12:10, s. 1008-1013
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Tidskriftsartikel (refereegranskat)abstract
- The Advanced Thrombectomy System (ANCD) provides a new funnel component designed to reduce clot fragmentation and facilitate retrieval in patients with stroke by locally restricting flow, allowing distal aspiration in combination with a stent retriever (SR).ObjectiveTo evaluate the preclinical efficacy and safety of the ANCD in a swine clot model.MethodsSoft and firm clots were implanted in the lingual and cervical arteries of 11 swine to obtain Thrombolysis in Cerebral Infarction (TICI) 0 blood flow. Mechanical thrombectomy was performed with either a balloon guide catheter+Solitaire 2 stent retriever (BGC+SR, n=13) or ANCD+SR (n=13). TICI flow was evaluated and successful revascularization was defined as TICI 3 (normal perfusion). To characterize safety, a total of 3 passes were performed in each vessel independent of recanalization. Tissues were explanted for histopathological analysis after 3 and 30 days, respectively.ResultsFirst pass reperfusion rates were ANCD+SR: 69% and BGC+SR: 46%. Reperfusion increased after the third pass in both groups (ANCD+SR: 100%, vs BGC+SR: 77%). Recanalization was achieved after an average of 1.4 and 1.9 passes in ANCD+SR and BGC+SR (p=0.095), respectively. Vessel injury was comparable in both groups; endothelial loss at 3 days was the most common injury seen (ANCD+SR: 1.78±1.22; BGC+SR: 2.03±1.20; p=0.73), while other histopathological markers were absent or minimal. Tissues downstream from targeted vessels also showed absence or minimal lesions across both groups.ConclusionsResults in a swine clot model support the high efficacy of the ANCD+SR without causing clinically significant vessel injury potentially related to the new funnel component.
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