Mechanical embolectomy for acute ischemic stroke in the anterior cerebral circulation: the Gothenburg experience during 2000-2011

Abstract

Background and purpose: Intra-arterial treatment of proximal occlusions in the cerebral circulation have become an important tool in the management of acute ischemic stroke. Our goal was to evaluate the safety and efficacy of intra-arterial acute ischemic stroke treatment performed in our institution in consecutive patients with anterior circulation occlusion during 2000-2011.

Materials and methods: We identified, in our data base, 156 consecutive cases with anterior acute ischemic stroke treated intra-arterially during 2000-2011. Stroke severity was defined according to the National Institutes of Health Stroke Scale, the results of the procedure were defined according to the modified Thrombolysis in Cerebral Infarction score, and clinical outcome was defined according to the modified Rankin scale, with favorable outcome ≤2 at 90 days.

Results: The mean admission NIHSS score was 19.4 (median, 20), with a mean time from stroke onset to groin puncture of 197 minutes (median, 171 minutes). The embolectomy tool of choice was the Amplatz GooseNeck snare (83%). Successful recanalization (modified TICI 2b +3) was seen in 74% of cases. A mRS ≤ 2 at 90 days was seen in 42% with a mortality rate of 17% and symptomatic intracerebral hemorrhage in 4%.

Conclusions: A high recanalization rate was obtained with the Amplatz GooseNeck snare without any device-related complications. Favorable outcome, mortality, and symptomatic intracerebral hemorrhage are comparable with results of newer embolectomy devices.

Fig 1.

A, Occlusion of the left M1 segment with a 4-mm snare pushed out of the microcatheter just enough to open fully and take its built-in shape perpendicular to the catheter and vessel. B, The snare with the microcatheter is pushed forward to engulf the embolus, with a slight deformation of the snare loop indicating that the loop is surrounding the embolus. C, Careful partial withdrawal of the snare into the microcatheter is seen, leaving a small eye outside the catheter tip. D, The microcatheter with the snare is carefully pulled back, and a careful control injection is performed showing the embolus hanging from the catheter tip in the distal ICA (arrow), while the M1 and M2 segments are open (slightly different projection angle than in A–C). The snare and the microcatheter are again pulled back as 1 unit, and aspiration via the guide catheter is performed simultaneously.