AJNR - American Journal of Neuroradiology

 

Acute Stroke Intervention

Collection Editors: Colin P. Derdeyn and Avi Mazumdar

AJNR is pleased to introduce its second special collection. The purpose of this biannual activity is to consolidate in one place some of the best articles published in AJNR and to make them available to all interested individuals. This endeavor takes full advantage of electronic publishing and of our large repository of articles by offering our readers topic-driven issues that are open access and available to subscribers, non-subscribers, and the general public, regardless of when the original articles were published, either electronically or in print. I hope that investigators looking for a comprehensive source of stroke therapy-related articles will find the ones chosen for this collection to be convenient, valuable, and quotable.

Drs. Derdeyn and Mazumdar from the Mallinckrodt Institute of Radiology at Washington University School of Medicine are well-known neurointerventionalists and have considerable experience in the treatment of stroke patients. They reviewed all stroke therapy-related articles published in the last 15 years in AJNR and selected the 33 they believe to be most important and interesting. They have nicely classified them into different headings for easier perusal and they also briefly annotated them. I think they have done an outstanding job and I hope our readers will share my opinion. AJNR continues to be the only imaging journal to offer these types of special issues, and I would be very interested to know what our readers’ opinions are. Please post your comments on our blogsite www.ajnrblog.org or send them to: Castillo{at}med.unc.edu.

A new feature available with this issue is our print on demand service (Brightdoc). By clicking on their link, interested individuals will be able from now on to order copies of our special collections. These printed copies are presented with specially designed covers and are only US $50.00 each plus shipping. Once ordered, they arrive at your address of choice in just a few days! I think they will nicely complement libraries, be useful to training programs, and can be distributed to your clinical colleagues.

M. Castillo
Editor-in-Chief

To see an article, click its [Full Text] link. To review many abstracts, check the boxes to the left of the titles you want, and click the 'Get All Checked Abstract(s)' button. To see one abstract at a time, click its [Abstract].

Introduction:

C.P. Derdeyn and A. Mazumdar
Acute Stroke Intervention
AJNR Am J Neuroradiol 2009;30:s1 [Full Text] [PDF]

IV Thrombolytics:

SM Wolpert, H Bruckmann, R Greenlee, L Wechsler, MS Pessin, and GJ del Zoppo
Neuroradiologic Evaluation of Patients with Acute Stroke Treated with Recombinant Tissue Plasminogen Activator. The rt-PA Acute Stroke Study Group
AJNR Am J Neuroradiol 1993;14:3-13 [Abstract] [PDF]
An important early study evaluating efficacy of IV tPA with pre- and postinfusion angiography, this established there were poor recanalization rates with large clot burdens in patients given IV tPA, and provided the basis for IA intervention in this population.

Mechanical Thrombectomy:

W.S. Smith, for the Multi MERCI Investigators
Safety of Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Results of the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) Trial, Part I
AJNR Am J Neuroradiol 2006;27:1177-82 [Abstract] [Full Text] [Figures Only] [PDF]
The most useful data in this large post–market approval, single-arm registry for the use of the MERCI retriever catheter in patients with stroke onset within 8 hours were the documentation of safety of the MERCI snare after IV-tPA administration.

A. Bose, H. Henkes, K. Alfke, W. Reith, T.E. Mayer, A. Berlis, V. Branca, S. Po Sit, for the Penumbra Phase 1 Stroke Trial Investigators
The Penumbra System: A Mechanical Device for the Treatment of Acute Stroke due to Thromboembolism
AJNR Am J Neuroradiol 2007;29:1409-13 Published ahead of print on May 22, 2008 doi: 10.3174/ajnr.A1110 [Abstract] [Full Text] [Figures Only] [PDF]
The original single-arm, industry-sponsored, Phase 1 trial established the safety of the Penumbra clot retrieval system.

Brian R. Mahon, Gary M. Nesbit, Stanley L. Barnwell, Wayne Clark, Thomas R. Marotta, Alain Weill, Phillip A. Teal, and Adnan I. Qureshi
North American Clinical Experience with the EKOS MicroLysUS Infusion Catheter for the Treatment of Embolic Stroke
AJNR Am J Neuroradiol 2003;24:534-38 [Abstract] [Full Text] [Figures Only] [PDF]
The safety and feasibility of using the EKOS MicroLysUS catheter in patients with acute ischemic stroke was established in this small multicenter series.

FY Tsai, B Berberian, V Matovich, M Lavin, and K Alfieri
Percutaneous Transluminal Angioplasty Adjunct to Thrombolysis for Acute Middle Cerebral Artery Rethrombosis
AJNR Am J Neuroradiol 1994;15:1823–29 [Abstract] [PDF]
This was the first report of the safety and feasibility of angioplasty after thrombolytic administration for treatment of rethrombosis.

S Nakano, K Yokogami, H Ohta, T Yano, and T Ohnishi
Direct Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Occlusion
AJNR Am J Neuroradiol 1997;19:767-72 [Abstract] [PDF]
A case series, this established balloon angioplasty as a safe and effective method for recanalization of acute middle cerebral artery occlusions.

E.I. Levy, R. Mehta, R. Gupta, R.A. Hanel, A.J. Chamczuk, D. Fiorella, H.H. Woo, F.C. Albuquerque, T.G. Jovin, M.B. Horowitz, and L.N. Hopkins
Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions
AJNR Am J Neuroradiol 2007;28:816-22 [Abstract] [Full Text] [Figures Only] [PDF] [Erratum]
The safety and feasibility of self-expanding stents for treatment of acute intracranial occlusions was established in this case series.

Helmi L. Lutsep, Wayne M. Clark, Gary M. Nesbit, Todd A. Kuether, and Stan L. Barnwell
Intraarterial Suction Thrombectomy in Acute Stroke
AJNR Am J Neuroradiol 2002;23:783-86 [Abstract] [Full Text] [Figures Only] [PDF]
This case series reported the feasibility, safety, and efficacy of suction aspiration through a guide catheter for the recanalization of patients with acute cervical internal carotid artery occlusion.

Richard J. Bellon, Christopher M. Putman, Ronald F. Budzik, Richard S. Pergolizzi, Gregory F. Reinking, and Alexander M. Norbash
Rheolytic Thrombectomy of the Occluded Internal Carotid Artery in the Setting of Acute Ischemic Stroke
AJNR Am J Neuroradiol 2001;22:526-30 [Abstract] [Full Text] [Figures Only] [PDF]
The feasibility of recanalization of an acutely occluded cervical internal carotid artery using a rheolytic thrombectomy catheter was described in this case series.

Hilario Martinez, Gregg H. Zoarski, Abraham M. Obuchowski, M. J. Bernadette Stallmayer, Alexander Papangelou, and Subha Airan-Javia
Mechanical Thrombectomy of the Internal Carotid Artery and Middle Cerebral Arteries for Acute Stroke by Using the Retriever Device
AJNR Am J Neuroradiol 2004;25:1812-15 [Abstract] [Full Text] [Figures Only] [PDF]
This was an early case report of the MERCI retriever device.

Eric J. Versnick, Huy M. Do, Greg W. Albers, David C. Tong, and Michael P. Marks
Mechanical Thrombectomy for Acute Stroke
AJNR Am J Neuroradiol 2005;26:875-79 [Abstract] [Full Text] [Figures Only] [PDF]
This was an early single-center, post–FDA approval MERCI series.

Gunnar Wikholm
Transarterial Embolectomy in Acute Stroke
AJNR Am J Neuroradiol 2003;24:892-94 [Abstract] [Full Text] [Figures Only] [PDF]
The feasibility of mechanical thrombectomy with a vascular snare was described in this single-center case series.

Combined IV/Endovascular Therapy:

T. Tomsick, J. Broderick, J. Carrozella, P. Khatri, M. Hill, Y. Palesch, J. Khoury, for the Interventional Management of Stroke II Investigators
Revascularization Results in the Interventional Management of Stroke II Trial
AJNR Am J Neuroradiol 2008;29:582-87 [Abstract] [Full Text] [Figures Only] [PDF]
These preliminary data suggested the benefit and safety of a combined IV/IA approach in 0-3 hour tPA candidates, provided preliminary evidence of the efficacy of the EKOS Primo sonography microcatheter, and established the basis for the ongoing IMS-III trial.

T.C. Burns, G.J. Rodriguez, S. Patel, H.M. Hussein, A.L. Georgiadis, K. Lakshminarayan, and A.I. Qureshi
Endovascular Interventions following Intravenous Thrombolysis May Improve Survival and Recovery in Patients with Acute Ischemic Stroke: A Case-Control Study
AJNR Am J Neuroradiol 2008;29:1918-24 Published ahead of print on September 10, 2008 doi: 10.3174/ajnr.A1236 [Abstract] [Full Text] [Figures Only] [PDF] [Supplemental Table]
Small case-control comparisons of outcomes between 2 centers using an endovascular approach in selected patients after IV tPA versus IV-only, suggested better outcomes with a combined approach. This study reinforced that endovascular therapy is safe after IV tPA.

IA Thrombolytics:

Executive Committee of the ASITN
Intraarterial Thrombolysis: Ready for Prime Time?
AJNR Am J Neuroradiol 2001;22:55-58 [Full Text] [PDF]
A very good review of the current state of the evidence for the IA approach, this is still relevant, unfortunately, with no randomized trial data since the publication of PRO-ACT II in 1998.

Osama O. Zaidat, Jose I. Suarez, Jeffrey L. Sunshine, Robert W. Tarr, Michael J. Alexander, Tony P. Smith, David S. Enterline, Warren R. Selman, and Dennis M. D. Landis
Thrombolytic Therapy of Acute Ischemic Stroke: Correlation of Angiographic Recanalization with Clinical Outcome
AJNR Am J Neuroradiol 2005;26:880-84 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective review of data from 2 centers correlated recanalization rates after IA or IV/IA thrombolytic administration with clinical outcomes and reinforced the concept that early recanalization is beneficial in patients with acute ischemic stroke.

N. Janjua, A. Alkawi, M.F.K. Suri, and A.I. Qureshi
Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic Stroke
AJNR Am J Neuroradiol 2008;29:253-58 Published ahead of print on November 16, 2007 doi: 10.3174/ajnr.A0825 [Abstract] [Full Text] [Figures Only] [PDF]
A retrospective analysis of 4 prospective acute stroke trials utlilizing mechanical thrombectomy or IA fibrinolysis evaluated frequency of distal emboli and arterial reocclusion and the effect of both on patient outcomes. Importantly, the presence of distal emboli did not correlate with worsening outcomes.

Adnan I. Qureshi, Amir M. Siddiqui, Stanley H. Kim, Ricardo A. Hanel, Andrew R. Xavier, Jawad F. Kirmani, M. Fareed K. Suri, Alan S. Boulos, and L. Nelson Hopkins
Reocclusion of Recanalized Arteries during Intra-arterial Thrombolysis for Acute Ischemic Stroke
AJNR Am J Neuroradiol 2004;25:322-28 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective case review described reocclusion after administration of IA tPA and poor prognosis in these patients and several potential methods to prevent reocclusion as well as rescue treatments.

DT Cross, 3rd, CJ Moran, PT Akins, EE Angtuaco, and MN Diringer
Relationship between Clot Location and Outcome after Basilar Artery Thrombolysis
AJNR Am J Neuroradiol 1997;18:1221-28 [Abstract] [PDF]
A case review series demonstrated better outcomes with smaller clot burden as well as improved outcomes with recanalization in basilar thrombosis.

DeWitte T. Cross III, Colin P. Derdeyn, and Christopher J. Moran
Bleeding Complications after Basilar Artery Fibrinolysis with Tissue Plasminogen Activator
AJNR Am J Neuroradiol 2001;22:521-25 [Abstract] [Full Text] [Figures Only] [PDF]
This case series helped establish current doses of IA tPA for acute stroke.

Reza Jahan, Gary R. Duckwiler, Chelsea S. Kidwell, James W. Sayre, Y. Pierre Gobin, J. PabloVillablanca, Jeffrey Saver, Sidney Starkman, Neil Martin, and Fernando Vinuela
Intraarterial Thrombolysis for Treatment of Acute Stroke: Experience in 26 Patients with Long-Term Follow-up
AJNR Am J Neuroradiol 1999;20:1291-99 [Abstract] [Full Text] [PDF]
An important early single-center case series, this described IA thrombolysis with urokinase and the correlation of recanalization with better outcomes.

Laurent Derex, Thomas A. Tomsick, Thomas G. Brott, Chistopher A. Lewandowski, Michael R. Frankel, Wayne Clark, Sid Starkman, Judith Spilker, Gavin J. Udsten, Jane Khoury, James C. Grotta, and Joseph P. Broderick
Outcome of Stroke Patients without Angiographically Revealed Arterial Occlusion within Four Hours of Symptom Onset
AJNR Am J Neuroradiol 2001;22:685-90 [Abstract] [Full Text] [Figures Only] [PDF]
This study reviewed data from a double-blind, placebo-controlled IV/IA fibrinolytic bridging trial, the Emergency Management of Stroke (EMS), to evaluate outcomes of symptomatic patients who did not have clot visible at angiography. It demonstrated that this subset of patients often have clinically significant strokes.

R.M. Sugg, E.A. Noser, H.M. Shaltoni, N.R. Gonzales, M.S. Campbell, R. Weir, E.D. Cacayorin, and J.C. Grotta
Intra-Arterial Reteplase Compared to Urokinase for Thrombolytic Recanalization in Acute Ischemic Stroke
AJNR Am J Neuroradiol 2006;27:769-73 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective case review series compared reteplase and urokinase for endovascular stroke treatment.

Emergent ICA Stenting with Distal Thrombolysis:

Rebecca M. Sugg, Marc D. Malkoff, Elizabeth A. Noser, Hashem M. Shaltoni, Raymond Weir, Edwin D. Cacayorin, and James C. Grotta
Endovascular Recanalization of Internal Carotid Artery Occlusion in Acute Ischemic Stroke
AJNR Am J Neuroradiol 2005;26:2591-94 [Abstract] [Full Text] [Figures Only] [PDF]
Treatment of acute internal carotid artery occlusions with endovascular therapy was reported in this single-center case series.

Keisuke Imai, Takahisa Mori, Hajime Izumoto, Masaki Watanabe, and Kenichiro Majima
Emergency Carotid Artery Stent Placement in Patients with Acute Ischemic Stroke
AJNR Am J Neuroradiol 2005;26:1249-58 [Abstract] [Full Text] [Figures Only] [PDF]
This single-center case series described emergent carotid stenting in patients with symptomatic occlusion or stenosis of the internal carotid artery.

Endovascular Procedure Complication Treatment:

Harry J. Cloft, Owen B. Samuels, Frank C. Tong, and Jacques E. Dion
Use of Abciximab for Mediation of Thromboembolic Complications of Endovascular Therapy
AJNR Am J Neuroradiol 2001;22:1764-67 [Abstract] [Full Text] [Figures Only] [PDF]
An important early case series, this described the use of an IV glycoprotein IIb/IIIa inhibitor to treat thromboembolic complications arising during neuroendovascular procedures.

Frank C. Tong, Harry J. Cloft, Gregory J. Joseph, Owen B. Samuels, and Jacques E. Dion
Abciximab Rescue in Acute Carotid Stent Thrombosis
AJNR Am J Neuroradiol 2000;21:1750-52 [Abstract] [Full Text] [Figures Only] [PDF]
This early case report described the use of an IV glycoprotein IIb/IIIa inhibitor to treat acute in-stent thrombosis.

M Cronqvist, L Pierot, A Boulin, C Cognard, L Castaings, and J Moret
Local Intraarterial Fibrinolysis of Thromboemboli Occurring during Endovascular Treatment of Intracerebral Aneurysm: A Comparison of Anatomic Results and Clinical Outcome
AJNR Am J Neuroradiol 1998;19:157-65 [Abstract] [PDF]
The use of IA thrombolytics to treat thromboembolic complications during coiling is reported in this early case series.

Charbel Mounayer, Michel Piotin, Sebastian Baldi, Laurent Spelle, and Jacques Moret
Intraarterial Administration of Abciximab for Thromboembolic Events Occurring during Aneurysm Coil Placement
AJNR Am J Neuroradiol 2003;24:2039-43 [Abstract] [Full Text] [Figures Only] [PDF]
An early case series, this described the successful use of IA glycoprotein IIb/IIIa inhibitors to treat coil-associated thrombus.

Joon K. Song, Yasunari Niimi, Patricia M. Fernandez, Jonathan L. Brisman, Razvan Buciuc, Mark J. Kupersmith, and Alejandro Berenstein
Thrombus Formation during Intracranial Aneurysm Coil Placement: Treatment with Intra-Arterial Abciximab
AJNR Am J Neuroradiol 2004;25:1147-53 [Abstract] [Full Text] [Figures Only] [PDF]
The use of IA abciximab to treat acute coil-associated thrombus is described in this early case series.

Venous Sinus Thrombosis:

FY Tsai, RT Higashida, V Matovich, and K Alfieri
Acute Thrombosis of the Intracranial Dural Sinus: Direct Thrombolytic Treatment
AJNR Am J Neuroradiol 1992;13:1137-41 [Abstract] [PDF]
This was the first report of the use of thrombolytics for the treatment of sinus thrombosis.

SY Kim and JH Suh
Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis: Infusion of Alteplase
AJNR Am J Neuroradiol1997;18:639-45 [Abstract] [PDF]
An important early case series, this described direct venous administration of thrombolytics for treatment of dural sinus thrombosis.

Christopher F. Dowd, Adel M. Malek, Constantine C. Phatouros, and J. Claude Hemphill III
Application of a Rheolytic Thrombectomy Device in the Treatment of Dural Sinus Thrombosis: A New Technique
AJNR Am J Neuroradiol 1999;20:568-70 [Abstract] [Full Text] [Figures Only] [PDF]
The use of a rheolytic thrombectomy catheter and directed lytic administration to treat venous sinus thrombosis are detailed in this early case report.