Neurointervention.  2012 Sep;7(2):68-76. 10.5469/neuroint.2012.7.2.68.

Evidence-Based Changes in Devices and Methods of Endovascular Recanalization Therapy

• Jung C
• Kwon BJ
• Han MH

• KMID: 1841092
• DOI: http://doi.org/10.5469/neuroint.2012.7.2.68

Abstract

The devices and methods of endovascular recanalization therapy (ERT) have been rapidly developed and changed since PROACT II trial. Emerging as a treatment option in addition to intravenous or intra-arterial thrombolysis, mechanical thrombectomy is currently being further developed and investigated as a potential first-line and stand-alone treatment. This review highlights and summarizes the recent clinical series and trials of the available devices and methods of ERT focusing on the multimodal approach.

Keyword

Brain; Cerebrovascular disorders; Stroke; Thrombolytic therapy; Endovascular procedures

MeSH Terms

Brain
Cerebrovascular Disorders
Endovascular Procedures
Mechanical Thrombolysis
Stroke
Thrombectomy
Thrombolytic Therapy

Reference

1. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007; 38:967–973. PMID: 17272772.

2. Molina CA, Saver JL. Extending reperfusion therapy for acute ischemic stroke: emerging pharmacological, mechanical, and imaging strategies. Stroke. 2005; 36:2311–2320. PMID: 16179577.

3. NINDS. Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-PA stroke study group. N Engl J Med. 1995; 333:1581–1587. PMID: 7477192.

4. Goldemund D, Mikulik R. Reperfusion therapies for acute ischemic stroke. Curr Treat Options Neurol. 2010; 12:155–166. PMID: 20842578.

5. Nogueira RG, Schwamm LH, Hirsch JA. Endovascular approaches to acute stroke, part 1: Drugs, devices, and data. AJNR Am J Neuroradiol. 2009; 30:649–661. PMID: 19279271.

6. Rouchaud A, Mazighi M, Labreuche J, Meseguer E, Serfaty JM, Laissy JP, et al. Outcomes of mechanical endovascular therapy for acute ischemic stroke: a clinical registry study and systematic review. Stroke. 2011; 42:1289–1294. PMID: 21441143.

7. del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke. 1998; 29:4–11. PMID: 9445320.

8. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Prolyse in Acute Cerebral Thromboembolism. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA. 1999; 282:2003–2011. PMID: 10591382.

9. 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. 2005; 36:1432–1438. PMID: 15961709.

10. 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. 2008; 39:1205–1212. PMID: 18309168.

11. 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. 2009; 40:2761–2768. PMID: 19590057.

12. Lin DD, Gailloud P, Beauchamp NJ, Aldrich EM, Wityk RJ, Murphy KJ. Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke. AJNR Am J Neuroradiol. 2003; 24:1827–1833. PMID: 14561611.

13. Sauvageau E, Levy EI. Self-expanding stent-assisted middle cerebral artery recanalization: technical note. Neuroradiology. 2006; 48:405–408. PMID: 16622697.

14. Humpich M, Singer OC, du Mesnil de Rochemont R, Foerch C, Lanfermann H, Neumann-Haefelin T. Effect of early and delayed recanalization on infarct pattern in proximal middle cerebral artery occlusion. Cerebrovasc Dis. 2006; 22:51–56. PMID: 16567938.

15. Levy EI, Siddiqui AH, Crumlish A, Snyder KV, Hauck EF, Fiorella DJ, et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke). Stroke. 2009; 40:3552–3556. PMID: 19696415.

16. Levy EI, Siddiqui AH, Crumlish A, Snyder KV, Hauck EF, Fiorella DJ, et al. Midterm clinical and angiographic follow-up for the first Food and Drug Administration-approved prospective, Single-Arm Trial of Primary Stenting for Stroke: SARIS (Stent-Assisted Recanalization for Acute Ischemic Stroke). Neurosurgery. 2011; 69:915–920. PMID: 21552168.

17. Gupta R, Tayal AH, Levy EI, Cheng-Ching E, Rai A, Liebeskind DS, et al. Intra-arterial thrombolysis or stent placement during endovascular treatment for acute ischemic stroke leads to the highest recanalization rate: results of a multicenter retrospective study. Neurosurgery. 2011; 68:1618–1623. PMID: 21336221.

18. Castaño C, Dorado L, Guerrero C, Millán M, Gomis M, Perez de la Ossa N, et al. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010; 41:1836–1840. PMID: 20538693.

19. Bosel J, Hacke W, Bendszus M, Rohde S. Treatment of Acute Ischemic Stroke With Clot Retrieval Devices. Curr Treat Options Cardiovasc Med. 2012; 14:260–272. PMID: 22392611.

20. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007; 115:e478–e534. PMID: 17515473.

21. Lisboa RC, Jovanovic BD, Alberts MJ. Analysis of the safety and efficacy of intra-arterial thrombolytic therapy in ischemic stroke. Stroke. 2002; 33:2866–2871. PMID: 12468783.

22. Ogawa A, Mori E, Minematsu K, Taki W, Takahashi A, Nemoto S, et al. Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke. 2007; 38:2633–2639. PMID: 17702958.

23. Yoon W, Park MS, Cho KH. Low-dose intra-arterial urokinase and aggressive mechanical clot disruption for acute ischemic stroke after failure of intravenous thrombolysis. AJNR Am J Neuroradiol. 2010; 31:161–164. PMID: 19713319.

24. Kim DJ, Kim DI, Byun JS, Jung JY, Suh SH, Kim EY, et al. Simple microwire and microcatheter mechanical thrombolysis with adjuvant intraarterial urokinase for treatment of hyperacute ischemic stroke patients. Acta Radiol. 2008; 49:351–357. PMID: 18365826.

25. Sauvageau E, Samuelson RM, Levy EI, Jeziorski AM, Mehta RA, Hopkins LN. Middle cerebral artery stenting for acute ischemic stroke after unsuccessful Merci retrieval. Neurosurgery. 2007; 60:701–706. PMID: 17325617.

26. Gupta R, Vora NA, Horowitz MB, Tayal AH, Hammer MD, Uchino K, et al. Multimodal reperfusion therapy for acute ischemic stroke: factors predicting vessel recanalization. Stroke. 2006; 37:986–990. PMID: 16527997.

27. Roth C, Papanagiotou P, Behnke S, Walter S, Haass A, Becker C, et al. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke. 2010; 41:2559–2567. PMID: 20947848.

28. Kelly ME, Furlan AJ, Fiorella D. Recanalization of an acute middle cerebral artery occlusion using a self-expanding, reconstrainable, intracranial microstent as a temporary endovascular bypass. Stroke. 2008; 39:1770–1773. PMID: 18388338.

29. Suh SH, Lee KY, Hong CK, Kim BM, Kim CH, Chung TS, et al. Temporary stenting and retrieval of the self-expandable, intracranial stent in acute middle cerebral artery occlusion. Neuroradiology. 2009; 51:541–544. PMID: 19424689.

30. Gonzalez LF, Jabbour P, Tjoumakaris S, Teufack S, Gordon D, Dumont A, et al. Temporary endovascular bypass: rescue technique during mechanical thrombolysis. Neurosurgery. 2012; 70:245–252. PMID: 21788918.

31. Thomassen L, Bakke SJ. Endovascular reperfusion therapy in acute ischaemic stroke. Acta Neurol Scand Suppl. 2007; 187:22–29. PMID: 17419824.

32. Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A, et al. The Penumbra System: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol. 2008; 29:1409–1413. PMID: 18499798.

33. Kang DH, Hwang YH, Kim YS, Park J, Kwon O, Jung C. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol. 2011; 32:283–287. PMID: 21087940.

34. Costalat V, Machi P, Lobotesis K, Maldonado I, Vendrell JF, Riquelme C, et al. Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study: timing, safety, and efficacy. Stroke. 2011; 42:1929–1935. PMID: 21597019.

35. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira R, et al. Primary Resultus of the SOLITAIRE FR With the Intention for Thrombectomy (SWIFT) Multicenter, Randomized Clinical Trial. 2012. In : International Stroke Conference; Jan. 31-Feb. 3; New Orleans.

36. Mazighi M, Serfaty JM, Labreuche J, Laissy JP, Meseguer E, Lavallée PC, et al. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurol. 2009; 8:802–809. PMID: 19647488.

37. IMS II Trial Investigators. The Interventional Management of Stroke (IMS) II Study. Stroke. 2007; 38:2127–2135. PMID: 17525387.

38. Roth C, Mielke A, Siekmann R, Ferbert A. First experiences with a new device for mechanical thrombectomy in acute basilar artery occlusion. Cerebrovasc Dis. 2011; 32:28–34. PMID: 21576940.

39. Pfefferkorn T, Mayer TE, Opherk C, Peters N, Straube A, Pfister HW, et al. Staged escalation therapy in acute basilar artery occlusion: intravenous thrombolysis and on-demand consecutive endovascular mechanical thrombectomy: preliminary experience in 16 patients. Stroke. 2008; 39:1496–1500. PMID: 18323481.

40. Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141:e601S–e636S. PMID: 22315273.

41. Baker WL, Colby JA, Tongbram V, Talati R, Silverman IE, White CM, et al. Neurothrombectomy devices for the treatment of acute ischemic stroke: state of the evidence. Ann Intern Med. 2011; 154:243–252. PMID: 21242342.

42. Hussein HM, Georgiadis AL, Vazquez G, Miley JT, Memon MZ, Mohammad YM, et al. Occurrence and predictors of futile recanalization following endovascular treatment among patients with acute ischemic stroke: a multicenter study. AJNR Am J Neuroradiol. 2010; 31:454–458. PMID: 20075087.

43. Molina CA. Futile recanalization in mechanical embolectomy trials: a call to improve selection of patients for revascularization. Stroke. 2010; 41:842–843. PMID: 20378862.

44. Rai AT, Raghuram K, Domico J, Hobbs G, Carpenter J. Pre-intervention triage incorporating perfusion imaging improves outcomes in patients undergoing endovascular stroke therapy: a comparison with the device trials. J Neurointerv Surg. 2012.

45. Goyal M, Menon BK, Coutts SB, Hill MD, Demchuk AM. Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes. Stroke. 2011; 42:93–97. PMID: 21088240.

46. Lansberg MG, Albers GW, Wijman CA. Symptomatic intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke: a review of the risk factors. Cerebrovasc Dis. 2007; 24:1–10. PMID: 17519538.

47. Kidwell CS, Saver JL, Carneado J, Sayre J, Starkman S, Duckwiler G, et al. Predictors of hemorrhagic transformation in patients receiving intra-arterial thrombolysis. Stroke. 2002; 33:717–724. PMID: 11872894.

48. Kidwell CS, Latour L, Saver JL, Alger JR, Starkman S, Duckwiler G, et al. Thrombolytic toxicity: blood brain barrier disruption in human ischemic stroke. Cerebrovasc Dis. 2008; 25:338–343. PMID: 18303253.