endovascular therapy: modena experience
TRANSCRIPT
Endovascular therapy:
Modena experience
Dott.S. Vallone
NEURORADIOLOGIA
AUSL MODENA
Stentriever
Responsabili del progetto
Salvatore Mangiafico, Danilo Toni
Comitato scientifico
Alfonso Ciccone, Domenico Inzitari, Patrizia Nencini, Andrea Zini
Francesco Causin, Roberto Gasparotti, Stefano Vallone
Coordinamento tecnico
Giovanni Pracucci, Valentina Saia
Organizzazione del Registro
30 active centers
Mappa SU I e II livello per Area Vasta
SU I Livello
SU II Livello = 500 casi/anno
TC
Hyperdensity ACM
dx
Hypodensity
Angio TC
Occlusion ICA dx - Occlusion ACM dx
TC PERFUSION
MTT
CBV
MTT Volume
MISMATCH. MTT-CBV
Angiografia
Subocclusione ICA dx dal tratto iniziale Flusso invertito sull’ACA dx visualizzata
attraverso la comunicante anteriore dopo
Iniezione dell’ICA sx
PTA con stent in ICA dx
Posizionamento di stent in ICA dx Ricanalizzazione ICA dx .
Non visualizzazione ACA e ACM dx
Superamento del trombo con
stent TrevoPro retriever
TROMBECTOMIA
Occlusione T carotidea dx
Ricanalizzazione del circolo intracranico carotideo dx
TC di controllo
ischemia caudato e capsula interna dx
TC a 24 ore TC post angiografia Volume TC perfusione in entrata
Ischemia del nucleo caudato e del braccio anteriore della capsula interna dx
NO MISMATCH
CORE ALLA TC PERFUSION
(ALGORITMO VOLUME)
ZONA DI IPOPERFUSIONE ALLA TC PERFUSION
(ALGORITMO FLUSSO)
ZONA DI IPOPERFUSIONE ALLA TC PERFUSION (ALGORITMO TEMPO DI TRANSITO MEDIO)
INFARCIMENTO DOPO DISOSTRUZIONE
TC perfusion (volume sanguigno) TC dopo fibrinolisi intra-arteriosa
2 ore e 40 minuti dall’ictus
NO TRATTAMENTO IA : craniotomia
TAC after 6 month
Emiplegia dx e afasia da 2 ore e 50 minuti
BASICS trial
RESCUE THERAPY
Modena - Karolinska Stoccolma
NIHSS >15
Popolazione 1.224.155 abitanti
535.869 ab 688.286 ab
Hub ASMN 491
AUSL RE 353
Tot. 844 AUSL 1.119
AOP 52
Tot. 1.171
MR CLEAN -‐ MULTICENTER RANDOMIZED CLINICAL TRIAL OF ENDOVASCULAR
TREATMENT FOR ACUTE ISCHEMIC STROKE IN THE NETHERLANDS
DESIGN
MR CLEAN is a pragmatic phase III multicenter randomized clinical trial with blinded
outcome assessment. The intervention contrast is Intra-arterial treatment vs. no intra-
arterial treatment. (PROBE)
POPULATION:
Patient with ischemic stroke, MRI or CT ruling out intracerebral hemorrhage, NISHH ≥2, a
relevant intracranial occlusion, demonstrated by neuro-imaging and the possibility to start
neurovascular treatment within 6 hours after Onset.
INTERVENTION
The exact choice of endovascular treatment modality for each patient is left to the
discretion of the local investigator and treating physicians
OUTCOMES
The primary outcome is the score on the modified Rankin scale (mRS) 90 days after inclusion
in the study. Secondary outcomes are the NIHSS score at 24 hours, vessel patency at 24
hours and infarct size at day 5--‐7 and the occurrence of major bleeding
Baseline was
500 patients were included randomized between both groups.k
Baselined characteristics really similar for both groups
NIHSS score ~17
IV tPA ~ 90% of the patients
Occlusion site: ~ 30% ICA-T, > 60% M1; < 10%M2
Interventions:
Time from Onset to groin puncture 260 min (mean)
97% patient were treated with Stentrievers. (COMMENT: Majority Trevo, really high MS in NL,
Minimal use of other techniques like aspiration, Adapt…)
Adverse effects
Both groups have similar adverse effect.
Stroke in a new territory was 5.6% for the endovascular group
Results.
Recanalization TICI 2b/3 59%
mRS score: Odds ratio 1.69 favorable outcome for Mechanical Thrombectomy. mRS 0-2 33%
vs19%
It shows that a patient treated with Mechanical
Thrombectomy has 1.69 more chance to have a
positive outcome than without
Conclusion:
The Intra-Arterial treatment in patient with acute
ischemic stroke caused by intracranial anterior
circulation occlusion IS EFFECTIVE and SAFE
within 6 hours from Stroke Onset.
Endovascular therapy:
Modena experience
Dott.S. Vallone
NEURORADIOLOGIA
AUSL MODENA