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Title: Stroke thrombectomy : new devices, imaging, scoring system and outcomes in the older population
Authors: Cora, Elena Adela
Issue Date: 2020
Publisher: Newcastle University
Abstract: In the past several years there have been major developments in the interventional treatment of acute ischaemic stroke. This thesis consists of four projects that I developed throughout my graduate studies. I started by working on setting up a phase 2 multicentre, randomised, controlled trial to assess the technical safety and efficacy of two new devices to be used in endovascular treatment: the ERIC retriever and the SOFIA distal access catheter. The trial has not yet finished, but partial results are presented. I went on to investigate the role of imaging in hyperacute stroke management. I developed a validated case archive of computed tomography angiography scans which was used for a radiological course. Assessing trainees reports pre- and post-training showed that there was a significant improvement in rates of major errors and this study concluded that an intensive hands-on radiological course was effective. While the trial was running, I developed a new technical index of thrombectomy difficulty. This score uses computed tomography angiographic images to evaluate key factors for predicting the expected procedural difficulty. The results demonstrated an excellent inter-rater reliability making this potentially a powerful tool to help with decision making and procedural planning. Due to limited evidence for mechanical thrombectomy in the older population, I worked on a study to assess the safety and efficacy of this treatment. Patients had more comorbidities, more tandem occlusions, but still good reperfusion rates with a similar safety profile to the younger population. Clinical results at 3 months were poorer than in the younger population, but milder presenting clinical deficits and good reperfusion rates were predictors of good outcomes. This thesis will first discuss stroke with a review of the evidence for performing mechanical thrombectomy. The projects undertaken during my studies will be discussed and I will finish with a succinct conclusion.
Description: Ph. D.
Appears in Collections:Institute of Neuroscience

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