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Thrombectomy

Thrombectomy is a medical procedure used to remove blood clots from blood vessels, particularly in the brain, to restore blood flow and prevent or treat ischemic stroke.
This minimally invasive technique involves the use of catheters and specialized devices to physically extract or dissolve the clot.
Thrombectomy is an important treatment option for eligible patients experiencing acute ischemic stroke, often in combination with other therapies like thrombolytic drugs.
Effectiev thrombectomy can significantly improve outcomes and reduce disability for those suffering from life-threatening clots.
Researchers can use PubCompare.ai's AI-driven platform to optimize thrombectomy research protocols, locate the best published methods, and enhance the reproducubility and accuracy of their work.

Most cited protocols related to «Thrombectomy»

We planned for this trial to use an adaptive enrichment design.12 (link) The maximal sample size was calculated to be 476, with two planned interim analyses after 200 and 350 patients had data on 90-day outcomes that could be evaluated. The plan was modified in June 2017 to accommodate the results of the DAWN trial, which involved patients and treatments similar to those in our trial and which showed clinical benefit of endovascular thrombectomy over medical therapy when treatment was initiated 6 to 24 hours after the onset of stroke symptoms. Enrollment in the DEFUSE 3 trial was placed on hold, and an early interim analysis, including subgroup analysis of the primary and secondary efficacy outcomes in patients who would have been eligible for the DAWN trial, was requested by the sponsor (the NIH).
As a result of that interim analysis, the trial was halted because the prespecified efficacy boundary (P<0.0025) had been exceeded. The statistical analysis plan specified one-sided hypothesis testing for the Wilcoxon rank-sum test and a P value of less than 0.025 as a measure of statistical significance, but we report two-sided results and use a P value of less than 0.05 as a measure of statistical significance. Adjusted treatment effects and P values for the primary efficacy outcome were calculated with the use of ordinal regression on the full modified Rankin scale and stratified Cochran–Mantel–Haenszel tests, with the randomization stratification variables split at their medians as the covariates. For patients lost to follow-up at 90 days, the missing 90-day score on the modified Rankin scale was imputed from the 30-day score by the last-observation-carried-forward method.
Publication 2018
Acclimatization Cerebrovascular Accident Patients Thrombectomy
Consenting patients recruited from April 2002 to March 2014 and surviving for 3 months after their first stroke in the study period (index stroke) were included in the analysis, to focus on the period beyond 90‐days poststroke that is not conventionally captured in stroke trials. Analyses were censored at 31 July 2015.
The proportions of patients who were (1) disabled, (2) dead/disabled, (3) dead from all causes, and (4) dead from index‐stroke‐related causes at 1, 2, 3, 4, and 5 years were calculated and categorized according to the 3‐month mRS (or the mRS between 1 and 3 months if the 3‐month mRS was missing). Logistic regression was used to adjust the associations of 3‐month mRS and long‐term outcomes for age and sex. Survival to 5 years after index stroke was assessed using Kaplan‐Meier techniques categorized according to 3‐month mRS. Differences in survival in relation to 3‐month mRS scores were assessed using age‐ and sex‐adjusted Cox proportional hazards models.23The above analyses were repeated for the subgroups defined below:

Treatable major strokes or nonhyperacute/minor strokes: The former were defined as patients seeking medical attention within 6 hours of symptom onset, presenting either to hospital or emergency services with National Institutes of Health Stroke Scale ≥5. These were “minimal criteria” to capture the subset that have been the focus of hyperacute stroke trials and would potentially be eligible for thrombolysis/thrombectomy.24, 25 The remaining patients were classified as nonhyperacute/minor strokes, to facilitate direct comparison.

Atrial fibrillation (AF)‐related or non‐AF‐related strokes: The former were defined as patients with a prestroke diagnosis of AF or AF at presentation, meeting criteria for cardioembolic etiology per the TOAST trial (Trial of Org 10172 in Acute Stroke Treatment) classification system.26

Lacunar or nonlacunar strokes: Classified by TOAST criteria for small‐vessel occlusion.26

We were specifically interested in examining the long‐term death and/or disability outcomes of AF‐related and lacunar strokes because they have been the focus of several recent stroke trials, particularly of secondary prevention strategies.27, 28We also plotted changes in mRS between 3 months and 1 year and between 1 and 5 years after the index stroke for all patients, categorized according to their 3‐month mRS.
Statistical analyses were performed using STATA 13.1 (Statacorp, College Station, TX).
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Publication 2017
Acute Cerebrovascular Accidents Atrial Fibrillation Attention Blood Vessel Cerebrovascular Accident Dental Occlusion Diagnosis Disabled Persons Fibrinolytic Agents Org 10172 Patients Secondary Prevention Service, Emergency Medical Stroke, Lacunar Thrombectomy
The etiology of target large vessel occlusion (i.e., embolic or ICAS-related occlusion) was determined by core laboratory imaging analyses based on angiographic diagnosis according to previous reports (Y.H.H. & J.S.L.) [12 (link),14 (link),16 (link)]. In brief, after confirmation of arterial occlusion, uncommon cerebral arterial diseases such as dissection, moyamoya disease, and vasculitis were evaluated. If the occluded vessel was completely recanalized after primary thrombectomy, the etiology was classified as embolic occlusion (Embolic group). A remnant stenosis of >70%, or a lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during the procedure, was classified as ICAS-related occlusion (ICAS group). If grading was difficult to determine or discordant, consensus was reached by the two graders (Y.H.H and J.S.L). In addition, this mechanism was further evaluated and could be amended by repeat angiography following EVT during admission (J.S.Y.). Consequently, Embolic and ICAS groups were included in the analyses.
Publication 2018
Angiography Arterial Occlusion Blood Vessel Cerebral Arterial Diseases Dental Occlusion Diagnosis Dissection Moyamoya disease 1 Splenic Hypoplasia Stenosis Thrombectomy Vasculitis
Medline bibliographic database including PubMed, Embase, and the Cochrane Central Register of Controlled trials in Cochrane Library published between January 2004 and January 2017 were searched using the following key words : “ischemic stroke”, “endovascular therapy”, “cerebral infarct”, “intra-venous”, “intra-arterial”, “fibrinolysis”[5 (link)], “thrombolysis”, “thrombectomy”, “bridging thrombolysis”, “IV Tpa”, “hemorrhage”, “embolus”, “eath”, “peri-operative complications”, and “mortality”.
Publication 2018
Arteries cDNA Library Cerebral Infarction Fibrinolysis Fibrinolytic Agents Hemorrhage Stroke, Ischemic Therapeutics Thrombectomy Veins
A series of polygons was calculated for the zones covered (isochrones) representing the distance that can be attained from each stroke treatment facility in a particular length of time. The first stage thus consists of listing and geolocalising each stroke treatment infrastructure. Thus, public hospital emergency departments, Primary Stroke Center (PSC) and Comprehensive Stroke Center (CSC) [35 (link)] in the Rhône and neighbouring counties were geolocalised using their precise postal addresses (Table 2).

Distribution of patient admission infrastructure

InfrastructureCountyStaff
Emergency departmentRhône (69)7
Ain (01)3
Saône-et-Loire (71)6
Isère (38)7
Loire (42)6
PSCRhône (69)2
Ain (01)1
Saône-et-Loire (71)1
Isère (38)2
Loire (42)2
CSCRhône (69)1
Ain (01)0
Saône-et-Loire (71)0
Isère (38)1
Loire (42)1
Preliminary measurement of accessibility to facilities from all points in the network with 10, 20, 30, 45 and 60-min access time was thus calculated. These time steps were chosen after bibliographic analysis [7 (link), 16 (link)–19 (link), 36 (link), 37 (link)]. Each scenario was applied to this modelling.
Although it is pertinent to characterise the area according to the time required for travel from any point in the network to the treatment facility, it is even more interesting to model overall admission time. Treatment of stroke requires the best possible upstream taking in hand of the patient [4 (link), 38 (link)]. This means that it is necessary to know the pattern of the territory according to the type of transport and also the positions of stroke treatment facilities. In our case, the development of thrombectomy and recent studies have shown its advantages for patients [39 (link)–41 (link)] and modelling overall patient reception was performed using the location of the CSC. With this model it is possible to characterize the territory by care delays from the emergency call to the admission in nearest CSC. It is a global approach of care because all the times of pre-hospital emergency care for stroke patients are taken into account. The second phase of our study was therefore aimed at georeferencing each fire station in the Rhône and neighbouring counties, together with each SMUR team, using their precise addresses. After this georeferencing, supply zones were calculated for these facilities and then for each CSC to finally show total admission time—i.e. the estimated times from SMUR centres or fire stations to all the points in the network and then from any point to the CSC (Fig. 2). In this model, private car is not considered because it is not possible for patient to go directly to the CSC by his own. It was interesting to take intervention and triage times into account to better estimate the time. Thus, after a review of the literature, average time for ambulance dispatch, time spent at the scene and transport to a Comprehensive Stroke Center and intervention at the site of occurrence determined by Adeoye [19 (link)] were chosen (Fig. 2). The final times were calculated using the United States EMS (Emergency Medical Service) register for stroke cases alone.

Diagrammatic representation of overall journey time modelled according to the type of transport (SMUR and fire brigade)

This overall approach was represented on the basis of IRIS area units (Ilots Regroupés pour l’Information Statistique, small zones grouped for statistical information), the smallest administrative division of Insee (Institut National de la Statistique et des Etudes Economiques) and that respect demographic (populations of 2000) and geographic criteria [42 ]. This representation gives an accurate view and characterisation of areas according to access time to an CSC. For thrombectomy, discussions are in progress with regard to direct admission to CSC (Mothership) or a first stop at PSC (‘Drip ‘n Ship’) [35 (link)]. In this study accessibility has been modelled using the Mothership pattern.
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Publication 2018
Ambulances Cerebrovascular Accident Emergencies Iris Patient Admission Patients Population Group Service, Emergency Medical Thrombectomy

Most recents protocols related to «Thrombectomy»

The Mount Sinai Health System (MSHS) consists of 3 comprehensive stroke centers (CSCs) and 7 PSCs. Patients with suspected or confirmed (by CTA) LVO stroke are transferred from PSCs to CSCs within our system. In addition, PSCs outside of the MSHS may transfer these cases to our CSCs. Each spoke center within or outside of MSHS acts independently and has the same availability and access to EMS transfer services. They are all geographically located within the NYC metropolitan area and follow the same transfer protocols.
Since September 2019, Viz LVO has been implemented in all MSHS facilities (PCSs and CSCs); however, PSCs outside our system lack this AI-driven tool. Viz LVO is an FDA-cleared AI-powered software that provides computer-assisted triage of suspected LVOs on CTA scans. Viz LVO is trained to identify LVOs in the supraclinoid internal carotid artery (ophthalmic, choroidal, and communicating segments) and the M1 (horizontal part) of the MCA. However, it does not assess the extracranial circulation, the posterior circulation, or the infraclinoid internal carotid artery [7] . In instances where a partial or complete occlusion is suspected, or when a vessel's caliber is less than the reference threshold, an LVO is suspected, and an alert is automatically sent to the stroke team [8] (link). For every CTA scan that is processed by Viz, a positive or negative LVO notification is provided, rather than the exact location of the occlusion.
For the purposes of this study, our institutional stroke database was reviewed in order to identify all suspected/confirmed LVO patients transferred from PSCs within and outside of our healthcare system from January 2020 to December 2021. Data collected included age, gender, ethnicity, race, rates of intravenous thrombolysis and mechanical thrombectomy, baseline modified Rankin Scale (mRS) score, presenting National Institutes of Health Stroke Scale (NIHSS), and initial Alberta Stroke Program Early CT Score (ASPECTS). Primary outcomes included peripheral arrival to peripheral CTA, transfer time, and all available time metrics from peripheral CTA.
The “Viz-transfers” group includes all LVO transfers from PSCs within our system (3 spoke hospitals), while the “Non-Viz-transfers” group (control group) is comprised of all LVO transfers from PSCs that are MSHS-affiliated but belong outside of our system (4 spoke hospitals). Spokes within MSHS are empowered with Viz, while spokes outside MSHS are not Viz-empowered. For non-MSHS spokes, interventional neuroradiology (INR) team notification time after CTA depends on how fast radiology and stroke teams diagnose the LVO. For MSHS spokes, post-CTA INR team notification is instantaneous when an LVO is suspected by Viz. To minimize confounding, contemporaneous LVO transfers within and outside the MSHS were compared. Patients that were placed on an “LVO watch” due to mild symptoms were excluded. Patients with missing time metrics were also excluded. This study was approved by our local IRB with waiver of informed consent.
Publication 2023
Cerebrovascular Accident Choroid Dental Occlusion Diagnosis Ethnicity Fibrinolytic Agents Gender Internal Carotid Arteries Pancreatic Stellate Cells Patients Radionuclide Imaging SERPINA3 protein, human Thrombectomy X-Rays, Diagnostic
The patient baseline characteristics, the anatomical structure of vascular access, medical history, procedure-related time points, stroke severity, recanalization devices, number of mechanical thrombectomy attempts, need for rescue therapy and 3-month follow-up data were collected. The degree of vessel occlusion before and after treatment was defined by the extended Thrombolysis in Cerebral Infarction (eTICI) classification, and a postoperative eTICI score 2c/3 was defined as successful recanalization of the vessel. The NIHSS score was used to determine the level of neurological severity (ranges from 0 to 42, with higher scores indicating a greater degree of severity), and improvements of at least 4 points on the NIHSS score within 24 h or at discharge than that of admission were considered short-term neurological improvement. The modified Rankin Scale (mRS) was used to assess neurological recovery at 90 days postoperative, and mRS score of 0 to 2 was defined as favorable neurological recovery. All patients were reexamined by head CT or MRI scan within 24 h after the operation to determine whether intracranial hemorrhage occurred, and symptomatic intracerebral hemorrhage (sICH) was defined as the presence of hemorrhage after the procedure, with worsening of clinical examination by ≥4 points on the NIHSS.
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Publication 2023
Aftercare Blood Vessel Cerebral Hemorrhage Cerebral Infarction Cerebrovascular Accident Dental Occlusion Fibrinolytic Agents Head Hemorrhage Intracranial Hemorrhage Medical Devices MRI Scans Patient Discharge Patients Physical Examination Therapeutics Thrombectomy
This study involved patients who underwent mechanical thrombectomy (MT) for acute ischemic stroke at Guangzhou Red Cross Hospital from January 2019 to June 2022. These individuals had an AF diagnosis before admission or an ECG examination proving AF prior discharge and fulfilled the following criteria: (1) age >18 years, (2) symptom onset < 6 h, (3) an Alberta Stroke Program Early CT Score (ASPECTS) >6, 4) a National Institute of Health Stroke Scale (NIHSS) score ≥5, (5) independent daily living (mRS < 3) before the index stroke, (6) DSA confirmed large vessel occlusion in anterior circulation.
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Publication 2023
Acute Ischemic Stroke Angle Class III Blood Vessel Cerebrovascular Accident Diagnosis Patient Discharge Patients Thrombectomy
If patients were eligible for intravenous thrombolysis, 0.9 mg/kg recombinant tissue-type fibrinogen activator (rt-PA) was administered before mechanical thrombectomy according to Chinese guidelines for the endovascular treatment of acute ischemic stroke (15 (link)). The mechanical thrombectomy procedure was performed by two interventional neuroradiologists with 10 years of practice in neurointerventions. The choice of STR or ADAPT was left to the discretion of the operator, usually based on the anatomical location of the thrombus obstruction, preoperative judgment of the etiology and pathogenesis, and the size of the thrombus. All patients were treated with local anesthesia, preferably through the right femoral artery, to establish access. A balloon guide catheter (BGC) was not used in all procedures due to limitations in available device conditions. The ADAPT and SRT techniques have been described previously (16 (link), 17 (link)). Patients received ADAPT using AXS Catalyst-6 (Stryker, USA) as front-line therapy. All stent retriever procedures were performed using the Solitaire FR (Covidien, USA). Meanwhile, intermediate catheters (AXS Catalyst-6) were routinely used. The operator could choose any necessary thrombectomy device and method to obtain an acceptable therapeutic effect if a successful recanalization could not be accomplished after three attempts using SRT or ADAPT.
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Publication 2023
Acute Ischemic Stroke Alteplase Catheters Chinese Femoral Artery Fibrinogen Fibrinolytic Agents Histocompatibility Testing Local Anesthesia Medical Devices pathogenesis Patients Stents Therapeutic Effect Therapeutics Thrombectomy Thrombus
The “ResISSSTE Cerebro” program includes seven urban healthcare facilities located in Mexico City and one in each of the neighboring states of Morelos and Hidalgo. According to the World Stroke Organization global stroke services guidelines and action plan (9 (link)), seven facilities are cataloged as essential stroke centers (ESC). Thus they offer access to non-contrast computed tomography (NCCT), clinical evaluation, and potentially IVT (according to IVT criteria cited below). At ESC, there is no personnel with expertise in AS treatment. The eighth facility is an advanced stroke center (ASC) capable of providing advanced stroke services on a 24/7 basis, including multidisciplinary stroke expertise, multimodal imaging, and acute reperfusion therapies for ischemic stroke.
Since its approval in 2019, the program has operated as a modified hub-and-spoke model. It receives funding from the Mexican government through the ISSSTE healthcare system and has access to ambulance services available 24/7. It also includes a stroke telemedicine network to facilitate the evaluation and care of potential patients.
As mentioned above, the program's functioning is mainly based on the hub-and-spoke model but with certain adequations to the Mexican Healthcare system. For example, most hub-and-spoke models function by offering daytime AS treatment at local centers, and the patients in need of treatment out-of-hours and on weekends are treated at hub hospitals. But, in the “ResISSSTE Cerebro” program, all centers provide AS treatment regardless of time or day, with the only difference being that advanced modalities of treatment (EVT and IVT guided by perfusion imaging up to 9 h after the onset of symptoms) are available only at the ASC. Similarly, the drip-and-ship model, as initially conceived, assumes that all centers within a network can diagnose LVO, thus allowing emergency medical services (EMS) to move patients to the closest hospital and only transfer to a thrombectomy-ready hospital for those patients with confirmed LVO. The drip-and-ship model was only partially implemented in our program due to constrained access to ambulances and human and technological infrastructure to perform advanced imaging in stroke patients at the ESC. Our model also accommodates that most of the patients in Mexico arrive at a hospital by their means (for example, the family car or public transportation), with few coming by EMS; therefore, prenotification is uncommon. Consequently, by concentrating the human and technological resources in a single center, the “ResISSSTE Cerebro” program can deliver advanced AS treatment 24/7 while preserving the capability of ESC to provide telemedicine supervised IVT also 24/7.
The stroke telemedicine network utilizes an instant messaging app that includes all the emergency room staff of all shifts grouped by each ESC. Each group, in turn, has all the stroke team members located at the ASC. Emergency room physicians are in charge of all initial evaluations and are responsible for alerting the stroke team and carrying out their instructions regarding treatment. At the same time, they order the NCCT and arrange for a possible transfer to the ASC. The ESC prenotifies all transfers to ASC. The protocol is known by all the staff at the emergency rooms of the ESC, and a print or electronic copy is available for consultation at the office of the head of the emergency department. Figure 1 depicts the pathway for patients initially arriving at ESC, and Figure 2 is that of patients coming directly to the ASC. All the ESCs are staffed 24/7 with emergency physicians, residents (emergency medicine is a 3-year residency program in Mexico), and radiologists. At the ASC, the staff comprises emergency physicians and emergency medicine residents, radiologists, neuroradiologists, clinical neurologists and clinical neurology residents, neurosurgeons and neurosurgery residents, and interventional neurologists and interventional neurology residents.
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Publication 2023
Acute Ischemic Stroke Ambulances Cerebrovascular Accident Diagnosis Emergencies Enhanced S-Cone Syndrome Head Homo sapiens Inpatient Neurologists Neurosurgeon Neurosurgical Procedures Patients Physicians Radiologist Reperfusion Residency Service, Emergency Medical Telemedicine Thrombectomy X-Ray Computed Tomography

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More about "Thrombectomy"

Thrombectomy is a minimally invasive medical procedure used to remove blood clots (thrombi) from blood vessels, particularly in the brain, to restore blood flow and prevent or treat ischemic stroke.
This procedure involves the use of catheters and specialized devices, such as the Trevo Retriever, Solitaire stent retriever, and Wallstent, to physically extract or dissolve the clot.
Thrombectomy is an important treatment option for eligible patients experiencing acute ischemic stroke, often in combination with other therapies like thrombolytic drugs (e.g., tPA).
Effective thrombectomy can significantly improve outcomes and reduce disability for those suffering from life-threatening clots.
Researchers can use PubCompare.ai's AI-driven platform to optimize thrombectomy research protocols, locate the best published methods (including pre-prints and patents), and enhance the reproducibility and accuracy of their work using tools like SPSS software version 25.0.
PubCompare.ai's cutting-edge technology can help researchers discover the latest advancements in thrombectomy procedures, such as the Trevo ProVue and Solitaire AB/FR devices, to improve patient care and outcomes.