Impact of the Implementation of Thrombectomy with Stent Retrievers on the Frequency of Hemicraniectomy in Patients with Acute Ischemic Stroke
- 4 December 2015
- journal article
- Published by Springer Science and Business Media LLC in Clinical Neuroradiology
- Vol. 27 (2), 193-197
- https://doi.org/10.1007/s00062-015-0478-8
Abstract
The increasing use of endovascular treatments has led to higher recanalization rates and better clinical outcomes compared with intravenous thrombolysis alone. Stent retrievers represent the latest development for recanalization of large vessel occlusions. Decompressive hemicraniectomy has proved beneficial in patients suffering from rising intracranial pressure after malignant stroke. We investigated the effect of the implementation of stent retriever treatment on the frequency of hemicraniectomy as a surrogate marker for infarct size and thus for poor neurological outcome. Patients with acute ischemic stroke were retrospectively studied. We compared the frequency of hemicraniectomy following proximal artery occlusion of the internal carotid artery and middle cerebral artery main stem in the years before (2009 and 2010) and after (2012 and 2013) introducing stent retrievers. Overall, 497 patients with proximal arterial occlusion were included in the study. Of 253 patients admitted in the years 2009 and 2010 44 (17.4 %) and of 244 patients admitted in 2012 and 2013, 20 (8.2 %) received a hemicraniectomy. This decrease in the proportion of hemicraniectomies was statistically significant (p < 0.01). The findings in this study illustrate a significantly reduced rate of hemicraniectomies in patients with proximal artery occlusions after implementation of thrombectomy with stent retriever. Hereby, we could show a significant reduction of malignant infarctions after thrombectomy with stent retriever.Keywords
This publication has 18 references indexed in Scilit:
- Neurothrombectomy for the Treatment of Acute Ischemic Stroke: Results from the TREVO StudyCerebrovascular Diseases, 2013
- Endovascular Therapy after Intravenous t-PA versus t-PA Alone for StrokeThe New England Journal of Medicine, 2013
- Comparison of Stent-Retriever Devices versus the Merci Retriever for Endovascular Treatment of Acute StrokeAmerican Journal of Neuroradiology, 2012
- Mechanische Thrombektomie beim akuten SchlaganfallRöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2012
- Impact of Retrievable Stents on Acute Ischemic Stroke TreatmentAmerican Journal of Neuroradiology, 2011
- DESTINY II: Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery IIInternational Journal of Stroke, 2011
- Stent-Assisted Mechanical Recanalization for Treatment of Acute Intracerebral Artery OcclusionsStroke, 2010
- Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic StrokeThe New England Journal of Medicine, 2008
- The Impact of Recanalization on Ischemic Stroke OutcomeStroke, 2007
- American Heart Association Prevention Conference IV: Prevention and Rehabilitation of StrokeCirculation, 1997