Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus - 18/06/22

Doi : 10.1016/j.neurad.2022.02.006

Téodor Grand ^a, Cyril Dargazanli ^b, Chrysanthi Papagiannaki ^c, Agnetha Bruggeman ^d, Christoph Maurer ^e, Gregory Gascou ^b, Cédric Fauche ^f, Romain Bourcier ^g, Guillaume Tessier ^g, Raphaël Blanc ^h, Malek Ben Machaa ^h, Gaultier Marnat ⁱ, Xavier Barreau ⁱ, Julien Ognard ^j, Jean-Christophe Gentric ^j, Charlotte Barbier ^k, Benjamin Gory ^l, Christine Rodriguez ^m, Grégoire Boulouis ^m, François Eugène ⁿ, Pierre Thouant ^o, Frederic Ricolfi ^o, Kevin Janot ^p, Denis Herbreteau ^p, Omer Faruk Eker ^q, Matteo Cappucci ^q, Tomas Dobrocky ^r, Markus Möhlenbruch ^s, Theo Demerath ^t, Marios Psychogios ^u, Sebastian Fischer ^v, Alessandro Cianfoni ^w, Charles Majoie ^d, Bart Emmer ^d, Henk Marquering ^d, Rémi Valter ^x, Stéphanie Lenck ^a, Kévin Premat ^a, Jonathan Cortese ^a, Didier Dormont ^a,^y, Nader-Antoine Sourour ^a, Eimad Shotar ^a, Yves Samson ^z, Frédéric Clarençon ^a,^y,^aa,^⁎
^a Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
^b Department of Neuroradiology, CHU Montpellier, FRANCE
^c Department of Neuroradiology, CHU Rouen, FRANCE
^d Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
^e Department of Neuroradiology, Klinikum Augsburg, Augsburg, GERMANY
^f Department of Neuroradiology, CHU de Poitiers, FRANCE
^g Department of Neuroradiology, Hôpital Nord Laennec, Nantes, FRANCE
^h Department of Neuroradiology, Fondation Rothschild, Paris, FRANCE
ⁱ Department of Neuroradiology, CHU de Bordeaux, FRANCE
^j Department of Neuroradiology, CHU de Brest, FRANCE
^k Department of Neuroradiology, CHU de Caen, FRANCE
^l Department of Neuroradiology, Centre Hospitalier Régional et Universitaire, Nancy, FRANCE
^m Department of Neuroradiology, Hôpital Saint-Anne, Paris, FRANCE
ⁿ Department of Neuroradiology, CHU de Rennes, France
^o Department of Neuroradiology, CHU de Dijon, France
^p Department of Neuroradiology, CHU de Tours, France
^q Department of Neuroradiology, CHU de Lyon, FRANCE
^r Department of Neuroradiology, Universitätsspital Bern, Bern, SWITZERLAND
^s Department of Neurology, University Heidelberg Medical Center, Heidelberg, GERMANY
^t Department of Neurology, University Freiburg Medical Center, Freiburg, GERMANY
^u Department of Neurology, University Basel Medical Center, Basel, SWITZERLAND
^v Department of Neurology, University Bochum Medical Center, Bochum, GERMANY
^w Department of Neurology, University Lugano Medical Center, Lugano, SWITZERLAND
^x Department of Public Health, Hôpital Henri Mondor, Créteil, FRANCE
^y Sorbonne University, Paris, FRANCE
^z Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, FRANCE
^aa GRC Biofast, Paris, FRANCE

^⁎Corresponding author.

Abstract

Summary purpose

Mechanical thrombectomies (MT) in patients with large vessel occlusion (LVO) related to calcified cerebral embolus (CCE) have been reported, through small case series, being associated with low reperfusion rate and worse outcome, compared to regular MT. The purpose of the MASC (Mechanical Thrombectomy in Acute Ischemic Stroke Related to Calcified Cerebral Embolus) study was to evaluate the incidence of CCEs treated by MT and the effectiveness of MT in this indication.

Methods

The MASC study is a retrospective multicentric (n = 37) national study gathering the cases of adult patients who underwent MT for acute ischemic stroke with LVO related to a CCE in France from January 2015 to November 2019. Reperfusion rate (mTICI ≥ 2B), complication rate and 90-day mRS were systematically collected. We then conducted a systematic review by searching for articles in PubMed, Cochrane Library, Embase and Google Scholar from January 2015 to March 2020. A meta-analysis was performed to estimate clinical outcome at 90 days, reperfusion rate and complications.

Results

We gathered data from 35 patients. Reperfusion was obtained in 57% of the cases. Good clinical outcome was observed in 28% of the patients. The meta-analysis retrieved 136 patients. Reperfusion and good clinical outcome were obtained in 50% and 29% of the cases, respectively.

Conclusion

The MASC study found worse angiographic and clinical outcomes compared to regular thrombectomies. Individual patient-based meta-analysis including the MASC findings shows a 50% reperfusion rate and a 29% of good clinical outcome.

Le texte complet de cet article est disponible en PDF.

Graphical abstract

Image, graphical abstract

Le texte complet de cet article est disponible en PDF.

Highlights

•	Cerebral calcic emboli (CCEs) have been reported in 3% of the acute ischemic stroke.
•	CCEs’ prevalence is probably underestimated.
•	CCEs are associated with a poorer reperfusion rate and a worse clinical outcome than regular clots using the currently available thrombectomy techniques.

Le texte complet de cet article est disponible en PDF.

Keywords : Calcified cerebral embolus, Mechanical thrombectomy, Reperfusion, Clinical outcome

Plan

Patients’ demographics and CCE characteristics

Reperfusion/complication

Clinical follow-up

Systematic review of the literature and meta-analysis

Statistical analysis

Results

Study population

Pretreatment imaging/CCE characteristics

MT procedures

Reperfusion and clinical outcomes

Systematic review of the literature and meta-analysis

Discussion

Limitations of the study

Conclusion

Export

Vol 49 - N° 4

P. 317-323 - juin 2022 Retour au numéro

Article précédent

Safety and effectiveness of mechanical thrombectomy for primary isolated distal vessel occlusions: A monocentric retrospective comparative study
Mahmoud Elhorany, Charlotte Rosso, Eimad Shotar, Flore Baronnet-Chauvet, Kévin Premat, Stéphanie Lenck, Sophie Crozier, Céline Corcy, Laure Bottin, Ossama Yassin Mansour, Atika Talbi, El-Sayed Ali Tag El-din, Wael Ahmed Fadel, Nader-Antoine Sourour, Sonia Alamowitch, Yves Samson, Frédéric Clarençon

| Article suivant

Mechanical thrombectomy with a novel device: initial clinical experience with the ANA thrombectomy device
Alejandro Tomasello, David Hernandez, Carlos Piñana, Manuel Requena, David S. Liebeskind, Raul G. Nogueira, Tudor Jovin, Tommy Andersson, Christoph Cognard, Adnan Siddiqui, Marc Ribo

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus - 18/06/22

Abstract

Summary purpose

Methods

Results

Conclusion

Graphical abstract

Highlights

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL