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Breaking barriers in stroke care: the role of peripheral interventional radiologists in mechanical thrombectomy.

PURPOSE: To report the results of a Peripheral Interventional Radiology Unit in the endovascular treatment of acute ischemic stroke (AIS) and describe the training model previously adopted. METHODS: A retrospective analysis was conducted on all endovascular thrombectomy (EVT) procedures performed by the interventional radiology unit of a single center, after a dedicated training, between June 2022 and June 2024. Inclusion criteria included AIS patients treated with EVT for anterior circulation LVO with available pre- and post-procedural imaging. Good clinical outcomes (three-month modified Ra…

Mechanical thrombectomy as a safe alternative to catheter directed thrombolysis for upper extremity DVT.

BackgroundUpper extremity deep vein thrombosis (UEDVT) has been widely managed with anticoagulation and selectively with catheter directed thrombolysis (CDT) targeting prompt venous recanalization. CDT, however, comes with a bleeding risk and complex perioperative logistics. Percutaneous mechanical thrombectomy (MT) devices may simplify the procedure. However their safety and efficacy remain unknown.MethodsThe records of 14 consecutive patients with symptomatic UEDVT who underwent MT at two tertiary European centers were reviewed (2020-2025). Subclavian vein thrombosis was the principal anatom…

Distal thrombectomy for acute ischemic stroke: is a 0.008-inch wire a safer alternative?

Distal medium vessel occlusion (DMVO) thrombectomy remains challenging due to anatomical constraints and procedural risks. We evaluated the efficacy and safety of using a 0.008-inch J-shaped microguidewire in acute ischemic stroke (AIS) patients with DMVO. We retrospectively analyzed AIS patients who underwent DMVO thrombectomy using a 0.008-inch J-shaped microguidewire at a high-volume stroke center in 2024. Baseline characteristics, National Institutes of Health Stroke Scale (NIHSS), IV-tPA administration, occlusion location, and procedural complications were recorded. Successful recanalizat…

Reducing Door-to-Puncture Time with a Streamlined MRI-First Workflow for Endovascular Thrombectomy.

OBJECTIVE: Achieving door-to-puncture (D2P) times of less than 60 minutes remains challenging in endovascular thrombectomy (EVT), particularly within MRI-based triage systems. We evaluated whether implementation of an optimized workflow within an MRI-first triage strategy was associated with reduced D2P times. METHODS: We conducted a retrospective, single-center, before-and-after observational study of consecutive patients who underwent EVT for acute ischemic stroke between September 2023 and August 2025. The optimized workflow, implemented on February 1, 2025, incorporated prehospital emerge…

Safety and Efficacy of Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery.

PURPOSE: Mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs) in the middle cerebral artery (MCA) is less established than for large vessel occlusions. This study evaluates the safety and efficacy of MT in DMVOs, comparing it with M1-segment occlusions. MATERIALS AND METHODS: This retrospective study analyzed 218 patients who underwent MT for isolated M1 (n=123) or distal M2+M3 (n=35) occlusions between January 2020 and August 2023. Outcomes included procedural complications, hemorrhagic events, reperfusion rates, and clinical severity and disability at admission and disch…

Investigation of thrombectomy technique for M2 occlusion based on the M1-M2 bifurcation angle.

PurposeThe efficacy of mechanical thrombectomy (MT) for M2 occlusion remains uncertain, partly due to recanalization challenges owing to anatomical factors and hemorrhagic complications. This study investigated the best method for M2 occlusion based on the M1-M2 bifurcation angle.MethodsWe retrospectively evaluated the clinical data of 134 consecutive patients with M2 occlusion who underwent MT. The M1-M2 angle was measured between the conterminous (M2) and immediately proximal (M1) vessel segments with respect to the occlusion site. Patients were divided into the acute- and obtuse-angle group…

Thrombectomy and balloon angioplasty for a traumatic popliteal artery injury: A stent-free approach.

A 25-year-old morbidly obese female and heavy smoker sustained a traumatic right knee dislocation after falling down a stairwell. Initial radiography revealed posteromedial tibial displacement with valgus deformity with resultant vascular compromise. Despite closed reduction, sustained arterial compromise persisted, with weak pulses and cold extremity. CT angiography showed right popliteal artery filling defect, consistent with thrombosis or dissection, which was confirmed to be occluded by conventional angiography, prompting urgent thrombectomy using the Penumbra aspiration system followed by…

Эндоваскулярная тромбектомия у молодой пациентки с дефектом септальной системы: отчет по делу.

Крупноразмерный окклюз (LVO) у молодого пациента в возрасте до 30 лет является весьма редким явлением. При приближении к симптомам, похожим на инсульт, в молодом поколении, инсульт имитирует такие симптомы, как эпилепсия, хроническая субдуральная гематома, сжатие спинного мозга из-за грызуна диска или аутоиммунная нейропатия, как синдром Гильен-Барре или множественный склероз, безусловно, являются серьезным препятствием на пути быстрого диагностики. Такое состояние, вероятно, усугубит трудности с точным диагностикой и замедлит лечение инсульта в сочетании с редкостью инсультов у молодых людей.

Совпадение в аннотации оригинала
Large vessel occlusion (LVO) in a young patient aged less than 30 years of age is greatly rare. When approaching stroke-like symptoms in you … schemic stroke. We experienced a highly instructive case of a young LVO patient for whom mechanical thrombectomy was performed. A 26-year-old female patient with a past medical history of migraine or depression had been transferred to the hospital complaining of left upper and lower limb paralysis. Magnetic resonance imaging showed right middle cerebral artery …

Intraoperative decision-making in thrombectomy for bilateral cerebral embolism: a mimic of thrombus migration.

This study thoroughly examines the challenges in managing bilateral embolization, emphasizing intraoperative judgment. It aims to underscore the necessity of accurate etiological judgments and the limitations of cross-circulation thrombectomy. A 59-year-old male with hypertension and atrial fibrillation developed sudden limb twitching, progressing to limb paralysis and speech impairment. Neurological assessments identified multiple symptoms, while a head CT scan excluded intracranial hemorrhage. A mechanical thrombectomy revealed occlusions in the right internal cerebral artery (ICA) and left …

The differential proteomic response to ischemic stroke in appalachian subjects treated with mechanical thrombectomy.

INTRODUCTION: The Appalachia region of North America is known to have significant health disparities, specifically, worse risk factors and outcomes for stroke. Appalachians are more likely to have comorbidities related to stroke, such as diabetes, obesity, and tobacco use, and are often less likely to have stroke interventions, such as mechanical thrombectomy (MT), for emergent large vessel occlusion (ELVO). As our Comprehensive Stroke Center directly serves stroke subjects from both Appalachian and non-Appalachian areas, inflammatory proteomic biomarkers were identified associated with stroke…

Hybrid Thrombectomy and Central Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism in a Child.

We describe a hybrid thrombectomy and central extracorporeal membrane oxygenation for a child in cardiogenic shock due to a massive pulmonary embolism.

Aortic Valve Thrombus, Stroke, and Endovascular Thrombectomy in a Child With APML and Trisomy 21.

APML, a subtype of acute myeloid leukemia, is highly curable, with cure rates over 90%. Despite its therapeutic success, APML poses elevated bleeding risks due to frequent prior disseminated intravascular coagulation. Less commonly recognized but critical is the thrombotic risk. We document a unique pediatric case: a 13-year-old with trisomy 21 diagnosed with APML had an asymptomatic aortic valve thrombus leading to thromboembolic arterial ischemic stroke. Through endovascular thrombectomy, cerebral circulation was re-established, extracting a fibrin thrombus with APML cells. Neurological reco…

Pulmonary aspiration thrombectomy with Lightning Flash catheter in a young patient with fibrosing mediastinitis.

We present the case of a 33-year-old patient with atypical pulmonary anatomy secondary to fibrosing mediastinitis who underwent pulmonary thrombectomy with the Lightning Flash aspiration catheter following a pulmonary embolism triggered by tibial osteomyelitis. Despite an inconclusive computed tomography angiography report, the diagnosis was made through clinical evaluation associated with electrocardiographic and echocardiographic changes. Angiography was crucial for diagnosis. The procedure was technically successful, resulting in immediate improvement in pulmonary artery systolic pressure a…

Comparison of anticoagulation vs mechanical thrombectomy for the treatment of iliofemoral deep vein thrombosis.

OBJECTIVE: To compare the comparative effects of treatment with contemporary mechanical thrombectomy (MT) or anticoagulation (AC) on Villalta scores and post-thrombotic syndrome (PTS) incidence through 12 months in iliofemoral deep vein thrombosis (DVT). METHODS: Patients with DVT in the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) randomized trial and the ClotTriever Outcomes (CLOUT) registry were included in this analysis. Both studies evaluated the effects of thrombus removal on the incidence of PTS. Patients with bilateral DVT, isolate…

Successful Mechanical Thrombectomy for Basilar Artery Occlusion in a Pediatric Patient: A Case Report.

Studies have shown the benefits of endovascular treatment (EVT) in adult stroke cases, but its application in pediatric stroke remains controversial. Despite evidence of improved outcomes in adults, there are no established recommendations for EVT in children. Conducting individual case reports and case series is vital to understanding its potential advantages and disadvantages in this context. In this case report, a 9-year-old male initially diagnosed with gastroenteritis developed sudden left-sided weakness 1 day after admission. Comprehensive imaging revealed acute ischemia in the cerebellu

Transcatheter thrombectomy of acute pulmonary embolism in an adult Fontan patient: a case report.

BACKGROUND: The Fontan operation is a well-described palliative procedure for functional single-ventricle patients. This population has an increased risk of thrombo-embolic events. Adequate imaging, and therefore diagnosis, requires an understanding of the unique anatomy and physiology of a Fontan. Optimal strategies for the prevention and treatment of thrombo-embolic complications in the Fontan population are poorly defined. CASE SUMMARY: A 28-year-old female with a history of Ebstein anomaly of the tricuspid valve status post-Fontan presented with chest pain and acute hypoxia. Computed tomo

Safety and efficacy of mechanical aspiration thrombectomy for patients with acute lower extremity ischemia.

OBJECTIVE: Acute limb ischemia (ALI) is associated with high rates of amputation and consequent morbidity and mortality. The objective of this study is to report on the safety and efficacy of aspiration thrombectomy using the Indigo Aspiration System in patients with lower extremity (LE) ALI. METHODS: The STRIDE study was an international, multicenter, prospective, study that enrolled 119 participants presenting with LE-ALI. Patients were treated firstline with mechanical thrombectomy using the Indigo Aspiration System, before stenting or angioplasty, or other therapies as determined by treat…

Case report on the diagnosis of vascular thoracic outlet syndrome followed by mechanical thrombectomy.

INTRODUCTION AND IMPORTANCE: The thoracic outlet syndrome is characterized by compression of the brachial plexus or subclavian vessels due to anatomical alterations of the thoracic cavity. Vascular presentation is rare and includes thromboembolism and edema in the upper limb, and the diagnosis is often elusive due to its rarity. In this case, we describe a vascular thoracic outlet syndrome presentation whose diagnosis through angiography was achieved after a mechanical thrombectomy. CASE PRESENTATION: We report a 43-year-old female patient with pain in the right upper limb, accompanied by ede…

Impact of Number of Passes Before Rescue Therapy in Thrombectomy for Basilar Artery Strokes.

BACKGROUND: When standard endovascular thrombectomy techniques fail to achieve a successful recanalization, it is often necessary to use rescue therapies (RTs). RTs are more commonly used in basilar artery occlusions and conventionally thought to represent "a last resort option." We sought to study the outcomes of basilar artery occlusion patients who received RT, and further hypothesize that the number of instrumental passes before initiation of RT may be associated with increased risk for poor clinical outcomes. METHODS: We performed a retrospective analysis of the ETIS ("Endovascular Treat…