Skip to main content

Advertisement

Log in

Periprocedural aspects in mechanical recanalization for acute stroke: data from the ENDOSTROKE registry

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

The ENDOSTROKE registry aims to accompany the spreading use of endovascular stroke treatment (EVT) in academic and non-academic hospitals. This analysis focuses on preprocedural imaging, patient handling and referral, as well as on different treatment modalities in mechanical recanalization.

Methods

Data for this study were from observational registry study in 12 stroke centers in Germany and Austria with online assessment of prespecified variables concerning endovascular stroke therapy.

Results

Data from 734 patients undergoing EVT were analyzed. Preferred imaging modality prior to EVT was CT (83 %) and CTA (78 %). In 95 %, EVT was performed under general anesthesia. In 55 % of patients, a combination of intravenous (IV) thrombolysis and EVT was used, followed by pure EVT (25 %), intra-arterial (IA) thrombolysis plus EVT (13 %) and IV + IA thrombolysis plus EVT (7 %). Intrahospital time delay until start of EVT was 91 and 99 min in anterior and vertebrobasilar circulation stroke, respectively. Average duration of EVT was 60 min. Overall thrombolysis in myocardial infarction grade 2/3 recanalization rate was 85 %. Stent retrievers were used in 75 %, being associated with higher recanalization rates than non-stent retrievers. Hemorrhagic complications (symptomatic and asymptomatic) occurred in 12 %. Overall vessel occlusion time was approximately 60 min longer in patients being referred from a primary care hospital for EVT.

Conclusion

This study gives an overview of procedure-related factors in current EVT practice. It gives estimates on preprocedural imaging modalities, periprocedural handling, and treatment combinations used for EVT. Patient referral for EVT from primary care hospitals is associated with longer vessel occlusion times.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Guzy J, Starkman S, Saver JL (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368(10):914–923

    Article  PubMed  CAS  Google Scholar 

  2. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R, Boccardi E (2013) Endovascular treatment for acute ischemic stroke. N Engl J Med 368(10):952–955

    Article  Google Scholar 

  3. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, Jauch EC, Jovin TG, Yan B, Silver FL, von Kummer R, Molina CA, Demaerschalk BM, Budzik R, Clark WM, Zaidat OO, Malisch TW, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson C, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Martin RH, Foster LD, Tomsick TA (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368:893–903

    Article  PubMed  CAS  Google Scholar 

  4. Molina CA (2010) Futile recanalization in mechanical embolectomy trials: a call to improve selection of patients for revascularization. Stroke 41(5):842–843

    Article  PubMed  Google Scholar 

  5. Hussein HM, Georgiadis AL, Vazquez G, Miley JT, Memon MZ, Mohammad YM, Christoforidis GA, Tariq N, Qureshi AI (2010) Occurrence and predictors of futile recanalization following endovascular treatment among patients with acute ischemic stroke: a multicenter study. AJNR Am J Neuroradiol 31(3):454–458

    Article  PubMed  CAS  Google Scholar 

  6. Abou-Chebl A, Lin R, Hussain MS, Jovin TG, Levy EI, Liebeskind DS, Yoo AJ, Hsu DP, Rymer MM, Tayal AH, Zaidat OO, Natarajan SK, Nogueira RG, Nanda A, Tian M, Hao Q, Kalia JS, Nguyen TN, Chen M, Gupta R (2010) Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: preliminary results from a retrospective, multicenter study. Stroke 41(6):1175–1179

    Article  PubMed  CAS  Google Scholar 

  7. Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, Dodge HT, Francis CK, Hillis D, Ludbrook P et al (1987) Thrombolysis in Myocardial Infarction (TIMI) Trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 76(1):142–154

    Article  PubMed  CAS  Google Scholar 

  8. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34(8):e109–e137

    Article  PubMed  Google Scholar 

  9. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352(9136):1245–1251

    Article  PubMed  CAS  Google Scholar 

  10. Singer OC, Sitzer M, du Mesnil de Rochemont R, Neumann-Haefelin T (2004) Practical limitations of acute stroke MRI due to patient-related problems. Neurology 62(10):1848–1849

    Article  PubMed  Google Scholar 

  11. Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, Wilder MJ, Lutsep HL, Czartoski TJ, Bernstein RA, Chang CW, Warach S, Fazekas F, Inoue M, Tipirneni A, Hamilton SA, Zaharchuk G, Marks MP, Bammer R, Albers GW (2012) MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11(10):860–867

    Article  PubMed  Google Scholar 

  12. Abou-Chebl A (2010) Endovascular treatment of acute ischemic stroke may be safely performed with no time window limit in appropriately selected patients. Stroke 41(9):1996–2000

    Article  PubMed  Google Scholar 

  13. Zangerle A, Kiechl S, Spiegel M, Furtner M, Knoflach M, Werner P, Mair A, Wille G, Schmidauer C, Gautsch K, Gotwald T, Felber S, Poewe W, Willeit J (2007) Recanalization after thrombolysis in stroke patients: predictors and prognostic implications. Neurology 68(1):39–44

    Article  PubMed  CAS  Google Scholar 

  14. Wunderlich MT, Stolz E, Seidel G, Postert T, Gahn G, Sliwka U, Goertler M (2005) Conservative medical treatment and intravenous thrombolysis in acute stroke from carotid T occlusion. Cerebrovasc Dis 20(5):355–361

    Article  PubMed  CAS  Google Scholar 

  15. Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375(9727):1695–1703

    Article  PubMed  CAS  Google Scholar 

  16. Sun CH, Nogueira RG, Glenn BA, Connelly KM, Zimmermann S, Anda K, Camp D, Frankel MR, Belagaje SR, Anderson AM, Isakov AP, Gupta R (2013) “Picture to puncture”: a novel time metric to enhance outcomes in patients transferred for endovascular reperfusion in acute ischemic stroke. Circulation 127(10):1139–1148

    Article  PubMed  CAS  Google Scholar 

  17. Galimanis A, Jung S, Mono ML, Fischer U, Findling O, Weck A, Meier N, Marco De Marchis G, Brekenfeld C, El-Koussy M, Mattle HP, Arnold M, Schroth G, Gralla J (2012) Endovascular therapy of 623 patients with anterior circulation stroke. Stroke 43(4):1052–1057

    Article  PubMed  Google Scholar 

  18. Jumaa MA, Zhang F, Ruiz-Ares G, Gelzinis T, Malik AM, Aleu A, Oakley JI, Jankowitz B, Lin R, Reddy V, Zaidi SF, Hammer MD, Wechsler LR, Horowitz M, Jovin TG (2010) Comparison of safety and clinical and radiographic outcomes in endovascular acute stroke therapy for proximal middle cerebral artery occlusion with intubation and general anesthesia versus the nonintubated state. Stroke 41(6):1180–1184

    Article  PubMed  Google Scholar 

  19. Froehler MT, Fifi JT, Majid A, Bhatt A, Ouyang M, McDonagh DL (2012) Anesthesia for endovascular treatment of acute ischemic stroke. Neurology 79(13 Suppl 1):S167–S173

    Article  PubMed  CAS  Google Scholar 

  20. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO (2012) Solitaire flow restoration device versus the merci retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380(9849):1241–1249

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to express their gratitude to Birgit Poltrum and Thomas Gattringer (Medical University of Graz, Austria); Christine Schneider and Felix J. Bode (University Hospital Bonn, Germany); Michael Gliem and John-Ih Lee (Heinrich-Heine University Hospital Duesseldorf, Germany); Johannes Brenck (University Hospital Essen, Germany); Dana Strenge and Se-Jong You (University Hospital Frankfurt, Germany); Serdar Tütüncü (Universitätsmedizin Berlin, Charite, Germany); and Karin Nußbaumer, Michael Sonnberger, and Jessica Meggeneder (Wagner-Jauregg Hospital, Linz, Austria).

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Oliver C. Singer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singer, O.C., Haring, HP., Trenkler, J. et al. Periprocedural aspects in mechanical recanalization for acute stroke: data from the ENDOSTROKE registry. Neuroradiology 55, 1143–1151 (2013). https://doi.org/10.1007/s00234-013-1219-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-013-1219-9

Keywords

Navigation