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<meta name="DC.Title" content="Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2221" />
<meta name="DC.Date" content="2010-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: High recanalization rates achieved with endovascular procedures are not always followed by the expected clinical improvement. These time-consuming procedures imply a delayed reperfusion despite the capacity of earlier intravascular microcatheter bypass to the ischemic tissue beyond the clot. We aimed to explore the safety and feasibility of MOB beyond the clot.

MATERIALS AND METHODS: We studied patients with stroke undergoing endovascular procedures. The timing of procedural steps was recorded. We then explored the safety and feasibility of repeated femoral artery MOB injections beyond the occlusion every time the clot was crossed in 17 patients. Pre- and postocclusion flow was continuously monitored with TCD.

RESULTS: We studied 60 patients (mean age, 70 ± 11 years; median NIHSS score, 20; IR, 18–21). Of them, 33 (55%) received IV-tPA before the endovascular procedure. The following arteries were occluded: the MCA (63.3%, n = 38) and the ICA (36.6%, n = 22). The TSO to arterial puncture was 193 ± 77 minutes. The occluding clot was successfully crossed with the microcatheter in 46 patients (76.6%; mean TSO, 228 ± 82 minutes). Recanalization was achieved in 44 patients (73.2%; mean TSO, 328 ± 144 minutes). Repeated MOB injections were performed in 17 patients. Patients with/without MOB presented with similar baseline characteristics. The median number of MOB injections was 2 (IR, 2–3), and the median injected blood volume was 40 mL (IR, 27.5–50). The mean time from first MOB to arterial recanalization was 136 ± 86 minutes. During MOB, a nonpulsatile flow appeared in previously nonvisible distal branches on TCD.

CONCLUSIONS: In this small series, oxygenated blood delivered through a microcatheter positioned distal to the site of occlusion was feasible and safe. Until final recanalization is achieved, MOB injections may generate intermittent reperfusion for up to 2 hours.

IA
:   intra-arterial
ICA
:   internal carotid artery
IR
:   interquartile range
IV
:   intravenous
MCA
:   middle cerebral artery
MOB
:   microcatheter oxygenated blood infusion
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
TCD
:   transcranial Doppler sonography
TIMI
:   Thrombolysis in Myocardial Infarction
tPA
:   tissue plasminogen activator
TSO
:   time from symptom onset" />
<meta name="DC.Contributor" content="M. Ribo" />
<meta name="DC.Contributor" content="M. Rubiera" />
<meta name="DC.Contributor" content="J. Pagola" />
<meta name="DC.Contributor" content="D. Rodriguez-Luna" />
<meta name="DC.Contributor" content="P. Meler" />
<meta name="DC.Contributor" content="A. Flores" />
<meta name="DC.Contributor" content="J. Alvarez-Sabin" />
<meta name="DC.Contributor" content="C.A. Molina" />
<meta name="article:published_time" content="2010-11-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;High recanalization rates achieved with endovascular procedures are not always followed by the expected clinical improvement. These time-consuming procedures imply a delayed reperfusion despite the capacity of earlier intravascular microcatheter bypass to the ischemic tissue beyond the clot. We aimed to explore the safety and feasibility of MOB beyond the clot.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We studied patients with stroke undergoing endovascular procedures. The timing of procedural steps was recorded. We then explored the safety and feasibility of repeated femoral artery MOB injections beyond the occlusion every time the clot was crossed in 17 patients. Pre- and postocclusion flow was continuously monitored with TCD.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;We studied 60 patients (mean age, 70 ± 11 years; median NIHSS score, 20; IR, 18–21). Of them, 33 (55%) received IV-tPA before the endovascular procedure. The following arteries were occluded: the MCA (63.3%, &lt;i&gt;n&lt;/i&gt; = 38) and the ICA (36.6%, &lt;i&gt;n&lt;/i&gt; = 22). The TSO to arterial puncture was 193 ± 77 minutes. The occluding clot was successfully crossed with the microcatheter in 46 patients (76.6%; mean TSO, 228 ± 82 minutes). Recanalization was achieved in 44 patients (73.2%; mean TSO, 328 ± 144 minutes). Repeated MOB injections were performed in 17 patients. Patients with/without MOB presented with similar baseline characteristics. The median number of MOB injections was 2 (IR, 2–3), and the median injected blood volume was 40 mL (IR, 27.5–50). The mean time from first MOB to arterial recanalization was 136 ± 86 minutes. During MOB, a nonpulsatile flow appeared in previously nonvisible distal branches on TCD.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In this small series, oxygenated blood delivered through a microcatheter positioned distal to the site of occlusion was feasible and safe. Until final recanalization is achieved, MOB injections may generate intermittent reperfusion for up to 2 hours.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2010/11/01" />
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<meta name="citation_volume" content="31" />
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<meta name="citation_section" content="Interventional" />
<meta name="citation_firstpage" content="1899" />
<meta name="citation_lastpage" content="1902" />
<meta name="citation_author" content="M. Ribo" />
<meta name="citation_author" content="M. Rubiera" />
<meta name="citation_author" content="J. Pagola" />
<meta name="citation_author" content="D. Rodriguez-Luna" />
<meta name="citation_author" content="P. Meler" />
<meta name="citation_author" content="A. Flores" />
<meta name="citation_author" content="J. Alvarez-Sabin" />
<meta name="citation_author" content="C.A. Molina" />
<meta name="twitter:title" content="Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/31/10.cover.gif" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: High recanalization rates achieved with endovascular procedures are not always followed by the expected clinical improvement. These time-consuming procedures imply a delayed reperfusion despite the capacity of earlier intravascular microcatheter bypass to the ischemic tissue beyond the clot. We aimed to explore the safety and feasibility of MOB beyond the clot.

MATERIALS AND METHODS: We studied patients with stroke undergoing endovascular procedures. The timing of procedural steps was recorded. We then explored the safety and feasibility of repeated femoral artery MOB injections beyond the occlusion every time the clot was crossed in 17 patients. Pre- and postocclusion flow was continuously monitored with TCD.

RESULTS: We studied 60 patients (mean age, 70 ± 11 years; median NIHSS score, 20; IR, 18–21). Of them, 33 (55%) received IV-tPA before the endovascular procedure. The following arteries were occluded: the MCA (63.3%, n = 38) and the ICA (36.6%, n = 22). The TSO to arterial puncture was 193 ± 77 minutes. The occluding clot was successfully crossed with the microcatheter in 46 patients (76.6%; mean TSO, 228 ± 82 minutes). Recanalization was achieved in 44 patients (73.2%; mean TSO, 328 ± 144 minutes). Repeated MOB injections were performed in 17 patients. Patients with/without MOB presented with similar baseline characteristics. The median number of MOB injections was 2 (IR, 2–3), and the median injected blood volume was 40 mL (IR, 27.5–50). The mean time from first MOB to arterial recanalization was 136 ± 86 minutes. During MOB, a nonpulsatile flow appeared in previously nonvisible distal branches on TCD.

CONCLUSIONS: In this small series, oxygenated blood delivered through a microcatheter positioned distal to the site of occlusion was feasible and safe. Until final recanalization is achieved, MOB injections may generate intermittent reperfusion for up to 2 hours.

IA
:   intra-arterial
ICA
:   internal carotid artery
IR
:   interquartile range
IV
:   intravenous
MCA
:   middle cerebral artery
MOB
:   microcatheter oxygenated blood infusion
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
TCD
:   transcranial Doppler sonography
TIMI
:   Thrombolysis in Myocardial Infarction
tPA
:   tissue plasminogen activator
TSO
:   time from symptom onset" />
<meta name="og-title" property="og:title" content="Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/10/1899" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: High recanalization rates achieved with endovascular procedures are not always followed by the expected clinical improvement. These time-consuming procedures imply a delayed reperfusion despite the capacity of earlier intravascular microcatheter bypass to the ischemic tissue beyond the clot. We aimed to explore the safety and feasibility of MOB beyond the clot.

MATERIALS AND METHODS: We studied patients with stroke undergoing endovascular procedures. The timing of procedural steps was recorded. We then explored the safety and feasibility of repeated femoral artery MOB injections beyond the occlusion every time the clot was crossed in 17 patients. Pre- and postocclusion flow was continuously monitored with TCD.

RESULTS: We studied 60 patients (mean age, 70 ± 11 years; median NIHSS score, 20; IR, 18–21). Of them, 33 (55%) received IV-tPA before the endovascular procedure. The following arteries were occluded: the MCA (63.3%, n = 38) and the ICA (36.6%, n = 22). The TSO to arterial puncture was 193 ± 77 minutes. The occluding clot was successfully crossed with the microcatheter in 46 patients (76.6%; mean TSO, 228 ± 82 minutes). Recanalization was achieved in 44 patients (73.2%; mean TSO, 328 ± 144 minutes). Repeated MOB injections were performed in 17 patients. Patients with/without MOB presented with similar baseline characteristics. The median number of MOB injections was 2 (IR, 2–3), and the median injected blood volume was 40 mL (IR, 27.5–50). The mean time from first MOB to arterial recanalization was 136 ± 86 minutes. During MOB, a nonpulsatile flow appeared in previously nonvisible distal branches on TCD.

CONCLUSIONS: In this small series, oxygenated blood delivered through a microcatheter positioned distal to the site of occlusion was feasible and safe. Until final recanalization is achieved, MOB injections may generate intermittent reperfusion for up to 2 hours.

IA
:   intra-arterial
ICA
:   internal carotid artery
IR
:   interquartile range
IV
:   intravenous
MCA
:   middle cerebral artery
MOB
:   microcatheter oxygenated blood infusion
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
TCD
:   transcranial Doppler sonography
TIMI
:   Thrombolysis in Myocardial Infarction
tPA
:   tissue plasminogen activator
TSO
:   time from symptom onset" />
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      <h1 class="highwire-cite-title" id="page-title">Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Ribo</span>, <span class="highwire-citation-author" data-delta="1">M. Rubiera</span>, <span class="highwire-citation-author" data-delta="2">J. Pagola</span>, <span class="highwire-citation-author" data-delta="3">D. Rodriguez-Luna</span>, <span class="highwire-citation-author" data-delta="4">P. Meler</span>, <span class="highwire-citation-author" data-delta="5">A. Flores</span>, <span class="highwire-citation-author" data-delta="6">J. Alvarez-Sabin</span> and <span class="highwire-citation-author" data-delta="7">C.A. Molina</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1899-1902; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2221 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9724--8464453955" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Ribo </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BRibo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ribo%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BRibo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. 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Pagola </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BPagola%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pagola%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.%2BPagola%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D. Rodriguez-Luna </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BRodriguez-Luna%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rodriguez-Luna%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.%2BRodriguez-Luna%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">P. Meler </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BMeler%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Meler%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BMeler%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">A. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">M. Ribo</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">M. Rubiera</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">J. Pagola</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-4"><span class="name">D. Rodriguez-Luna</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-5"><span class="name">P. Meler</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-6"><span class="name">A. Flores</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-7"><span class="name">J. Alvarez-Sabin</span><a id="xref-aff-1-7" class="xref-aff" href="#aff-1">a</a> and </li><li class="last" id="contrib-8"><span class="name">C.A. Molina</span><a id="xref-aff-1-8" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Unitat Neurovascular, Servei de Neurologia, Hospital Vall d'Hebron, Barcelona, Spain.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Marc Ribo, MD, <span class="addr-line">Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain</span>; e-mail: <span class="em-link"><span class="em-addr">marcriboj{at}hotmail.com</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/10/1899.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1899-1902; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2221 </span></div>
  
  
  
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