Médecine

Paramédical

Autres domaines


Suscribirse

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.

El texto completo de este artículo está disponible en PDF.

Graphical abstract




Image, graphical abstract

El texto completo de este artículo está 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.

El texto completo de este artículo está disponible en PDF.

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


Esquema


© 2022  Elsevier Masson SAS. Reservados todos los derechos.
Añadir a mi biblioteca Eliminar de mi biblioteca Imprimir
Exportación

    Exportación citas

  • Fichero

  • Contenido

Vol 49 - N° 4

P. 317-323 - juin 2022 Regresar al número
Artículo precedente Artículo precedente
  • 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
| Artículo siguiente Artículo siguiente
  • 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

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
El acceso al texto completo de este artículo requiere una suscripción.

¿Ya suscrito a @@106933@@ revista ?

Mi cuenta


Declaración CNIL

EM-CONSULTE.COM se declara a la CNIL, la declaración N º 1286925.

En virtud de la Ley N º 78-17 del 6 de enero de 1978, relativa a las computadoras, archivos y libertades, usted tiene el derecho de oposición (art.26 de la ley), el acceso (art.34 a 38 Ley), y correcta (artículo 36 de la ley) los datos que le conciernen. Por lo tanto, usted puede pedir que se corrija, complementado, clarificado, actualizado o suprimido información sobre usted que son inexactos, incompletos, engañosos, obsoletos o cuya recogida o de conservación o uso está prohibido.
La información personal sobre los visitantes de nuestro sitio, incluyendo su identidad, son confidenciales.
El jefe del sitio en el honor se compromete a respetar la confidencialidad de los requisitos legales aplicables en Francia y no de revelar dicha información a terceros.