Mechanical thrombolysis in acute ischemic Stroke with endovascular photoacoustic recanalization

• Published in: Stroke (1970) Vol. 35; no. 5; pp. 1112 - 1116
• Main Authors: BERLIS, Ansgar, LUTSEP, Helmi, BARNWELL, Stan, NORBASH, Alexander, WECHSLER, Lawrence, JUNGREIS, Charles A, WOOLFENDEN, Andrew, REDEKOP, Gary, HARTMANN, Marius, SCHUMACHER, Martin
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-05-2004
• Subjects: Adult; Aged; Angioplasty, Balloon, Laser-Assisted - methods; Biological and medical sciences; Brain Ischemia - diagnostic imaging; Brain Ischemia - drug therapy; Brain Ischemia - therapy; Catheterization - adverse effects; Catheterization - instrumentation; Catheterization - methods; Cerebral Angiography; Female; Fibrinolytic Agents - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Neurology; Recombinant Proteins - therapeutic use; Stroke - diagnostic imaging; Stroke - drug therapy; Stroke - therapy; Suction - adverse effects; Suction - instrumentation; Suction - methods; Thrombolytic Therapy - adverse effects; Thrombolytic Therapy - instrumentation; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Stroke; Nervous system diseases; Cardiovascular disease; endovascular therapy; Cerebral disorder; Vascular disease; stroke, ischemic; Treatment; Ischemia; stroke, acute; Central nervous system disease; Laser; thrombolysis; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000124126.17508.d3

We present the results of endovascular photoacoustic recanalization (EPAR) treatment for acute ischemic stroke from the Safety and Performance Study at 6 centers in Europe and North America. The objectives of mechanical thrombolysis are rapid vessel recanalization and minimal use of chemical thrombolysis.
This study was a prospective, nonrandomized study. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score were recorded before treatment. The presence of recanalization was assessed by angiography. To measure outcome, follow-up examinations were performed at 24 hours, 7 days, and 30 days after stroke onset.
Thirty-four patients (median NIHSS 19) were enrolled. Ten patients had internal carotid artery occlusion, 12 patients had middle cerebral artery occlusion, 11 patients had vertebrobasilar occlusion, and 1 patient had posterior cerebral artery occlusion. The overall recanalization rate was 41.1% (14/34). Complete EPAR treatment was possible in 18 patients (median NIHSS 18), with vessel recanalization in 11 patients (61.1%) after EPAR. The average lasing time was 9.65 minutes. Incomplete EPAR treatment (16/34, median NIHSS 19) was defined as intention to treat with EPAR and that the EPAR microcatheter entered the patient. Additional treatment with intraarterial application of rTPA occurred in 13 patients. An adverse event associated with use of the device occurred in 1 patient. Symptomatic hemorrhages occurred in 2 patients (5.9%). The mortality rate was 38.2%.
This study demonstrates the safety and technical feasibility of EPAR. This new technique may provide another treatment option in the therapeutic armamentarium for patients with acute ischemic stroke.