scholarly journals Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique

2021 ◽  
pp. svn-2020-000833
Author(s):  
Carlos Pérez-García ◽  
Christian Maegerlein ◽  
Santiago Rosati ◽  
Charlotte Rüther ◽  
Carlos Gómez-Escalonilla ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Multivariable Analysis ◽  
Balloon Occlusion ◽  
Stent Retriever ◽  
Multivariable Logistic Regression Analysis ◽  
Complication Rates ◽  
First Pass Effect ◽  
Guide Catheter ◽  
First Pass ◽  
Catheter Size

Background and purposeThe first-pass effect (FPE), defined as a first-pass Expanded Treatment in Cerebral Ischaemia (eTICI) 2c/3 reperfusion, has emerged as a key metric of efficacy in mechanical thrombectomy (MT) for acute ischaemic stroke. The proximal balloon occlusion together with direct thrombus aspiration during stent retriever thrombectomy (PROTECT)-PLUS technique consists in the use of a balloon guide catheter and a combined MT approach involving contact aspiration and a stent retriever. The aim of this study is to assess the effectiveness and safety of the PROTECT-PLUS technique using distal aspiration catheters (DACs) with different inner diameters by comparing the large-bore DAC Catalyst 7 versus the use of medium-bore DACs.MethodsRetrospective analysis of a prospectively maintained database of patients treated with PROTECT-PLUS using Catalyst 7, Catalyst 6 or Catalyst 5 with an occlusion of either the terminal carotid artery or the M1 or M2 segments of the middle cerebral artery from 2018 to 2020 in two comprehensive stroke centres. Baseline characteristics and procedural, safety and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed in order to find independent predictors of FPE.ResultsWe identified 238 consecutive patients treated with PROTECT-PLUS as front-line approach using Catalyst 7 (n=86), Catalyst 6 (n=78) and Catalyst 5 (n=76). The rate of FPE was higher with Catalyst 7 (54%) than Catalyst 6 (33%, p=0.009) and Catalyst 5 (32%, p=0.005), in addition to higher final eTICI 2c/3 reperfusion rates, shorter procedural times, lower need of rescue therapy and fewer procedure-related complications. After multivariable analysis the sole independent factor associated to FPE was the use of Catalyst 7 (OR 2.34; 95% CI 1.19 to 4.58; p=0.014).ConclusionFurther development of combined MT by incorporating larger-bore aspiration catheters is associated with higher reperfusion rates, shorter procedure times, and lower need of rescue therapy while reducing the complication rates.

scholarly journals Mechanical Thrombectomy in Medium Vessel Occlusions

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3224-3231 ◽  
Author(s):  
Carlos Pérez-García ◽  
Manuel Moreu ◽  
Santiago Rosati ◽  
Patricia Simal ◽  
Jose Antonio Egido ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Multivariable Analysis ◽  
Stent Retriever ◽  
Multivariable Logistic Regression Analysis ◽  
First Pass ◽  
Stent Retrievers ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Mechanical thrombectomy techniques for intracranial medium vessel occlusions (MeVOs) have evolved in recent years, although the optimal approach is still unclear. The aim of this study was to investigate the effectiveness and safety of mechanical thrombectomy in MeVOs using mini (0.017 inches microcatheter compatible) stent retrievers combined with low-profile (0.035 inches distal inner diameter) distal aspiration catheters through the blind exchange/mini-pinning (BEMP) technique compared with mini stent retrievers alone. Methods: Retrospective review of a prospectively maintained database of patients treated with the BEMP technique or mini stent retriever alone for intracranial MeVOs from 2017 to 2020 in a comprehensive stroke center. Both groups were compared about baseline characteristics, occlusion site, clinical presentation, clot cause, procedural outcomes (MeVO first-pass and final expanded Thrombolysis in Cerebral Ischemia score, the mini stent retriever used, number of passes with the front-line approach, and need of rescue therapy), safety outcomes (emboli to unwanted territories and hemorrhagic complications), and clinical outcomes at 90 days. Multivariable logistic regression analysis was performed with potential predictors of vessel recanalization to find independent variables associated with MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization. Results: We reviewed 102 patients/106 MeVOs treated with the BEMP technique (n=56) or mini stent retriever (n=50). There was a higher rate of MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization (57% versus 34%, P =0.017), lower need of rescue therapy (7.1% versus 22%, P =0.028), and lower rate of emboli to new territory (1.8% versus 12%, P =0.035) and symptomatic intracranial hemorrhage (1.9% versus 12.8%, P =0.038) with the BEMP technique. After multivariable analysis, the sole independent factor associated to MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization was the BEMP technique (odds ratio, 2.72 [95% CI, 1.19–6.22]; P =0.018). Conclusions: In the setting of MeVOs, the BEMP technique may lead to higher rates of the first-pass recanalization and a lower incidence of symptomatic intracranial hemorrhage than mini stent retrievers alone.

scholarly journals First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial

2019 ◽  
Vol 12 (4) ◽  
pp. 386-391 ◽  
Author(s):  
Célina Ducroux ◽  
Michel Piotin ◽  
Benjamin Gory ◽  
Julien Labreuche ◽  
Raphael Blanc ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Rescue Therapy ◽  
Hemorrhagic Transformation ◽  
Stent Retriever ◽  
Complete Revascularization ◽  
Unique Identifier ◽  
First Pass Effect ◽  
Significant Difference ◽  
First Pass ◽  
Stent Retrievers

BackgroundThe ‘first pass effect’ (FPE), which was originally described with stent retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality.ObjectiveWe report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial.Materials and methodsASTER is a randomized trial comparing angiographic revascularization with the stent retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients.ResultsFPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients.ConclusionIn the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted.Trial registration numberUnique identifier: NCT02523261.

EXPRESS: Stent Retriever Alone vs. Aspiration and Stent-Retriever Combination in Large Vessel Occlusion Stroke: A Matched Analysis

2021 ◽  
pp. 174749302110192
Author(s):  
Mahmoud H Mohammaden ◽  
Diogo C. Haussen ◽  
Leonardo Pisani ◽  
Alhamza Al-Bayati ◽  
Aaron Anderson ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Functional Independence ◽  
Stent Retriever ◽  
Sensitivity Analyses ◽  
First Line ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Guide Catheter ◽  
First Pass ◽  
Combined Technique

Background Three randomized clinical trials have reported similar safety and efficacy for contact aspiration (CA) and Stent-retriever (SR) thrombectomy. Aim We aimed to determine whether the Combined Technique (SR+CA) was superior to SR alone as first-line thrombectomy strategy in a patient cohort where balloon-guide catheter was universally used. Methods A prospectively maintained mechanical thrombectomy database from January 2018-December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent SR alone thrombectomy or SR+CA as first-line therapy. The primary outcome was the first-pass effect (FPE) (mTICI2c-3). Secondary outcomes included modified FPE (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS ≤2). Safety outcomes included rate of parenchymal hematoma (PH) type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. Results A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16[11-21]). As compared to first-line SR alone, first-line SR+CA resulted in similar rates of FPE (53% vs. 51%,aOR 1.122, 95%CI[0.745-1.691],p=0.58), mFPE (63% vs. 60.4%,aOR1.250, 95%CI[0.782-2.00],p=0.35), final successful reperfusion (97.6% vs. 98%,p=0.75) and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%,aOR 2.033, 95%CI[1.209-3.419],p=0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line SR+CA treatment (81.8% vs. 73.6%,aOR 1.881, 95%CI[1.039-3.405],p=0.037). Conclusions Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a Combined Technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, addition of contact aspiration after initial SR failure might be beneficial in achieving earlier reperfusion.

First-Pass Effect in Basilar Artery Occlusions: Insights From the Endovascular Treatment of Ischemic Stroke Registry

Stroke ◽  
2021 ◽  
Author(s):  
Mathilde Aubertin ◽  
David Weisenburger-Lile ◽  
Benjamin Gory ◽  
Sébastien Richard ◽  
Raphael Blanc ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Rescue Therapy ◽  
Strong Predictor ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Unique Identifier ◽  
First Pass Effect ◽  
Improved Outcomes ◽  
First Pass

Background and Purpose: In the settings of thrombectomy, the first-pass effect (FPE), defined by a complete recanalization after one pass with no rescue therapy, has been shown to be associated with an improved outcome. As this phenomenon has been predominantly described in anterior circulation strokes, we aimed to study the prevalence, outcomes, and predictors of FPE in patients with a basilar artery occlusion. Methods: From a prospective multicentric registry, we collected the data of all consecutive basilar artery occlusion patients who underwent thrombectomy and compared the outcomes of patients who achieved FPE and those who did not. We also compared FPE patients with those who achieved a complete recanalization with >1 pass. Finally, a multivariate analysis was performed to determine the predictors of FPE. Results: Data from 280 patients were analyzed in our study, including 84 of 280 patients (30%) with an atheromatous etiology. An FPE was achieved in 93 patients (33.2%), with a significantly higher proportion of good outcomes (modified Rankin Scale score 0-2 at 3 months) and lower mortality than non-FPE patients. An FPE was also associated with improved outcomes compared with patients who went on to have full recanalization with >1 pass. Contact aspiration as first-line strategy was a strong predictor of FPE, whereas baseline antiplatelets and atheromatous etiology were negative predictors. Conclusions: In our study, an FPE was achieved in approximately one-third of patients with a basilar artery occlusion and was associated with improved outcomes. More research is needed to improve devices and techniques to increase the incidence of FPE. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03776877.

Comparison of aspiration-first versus stentriever-first techniques in performing mechanical thrombectomy for large vessel occlusions

2020 ◽  
pp. neurintsurg-2020-016547
Author(s):  
Vance L Fredrickson ◽  
Phillip A Bonney ◽  
Shivani D Rangwala ◽  
Joshua S Catapano ◽  
Tyler S Cole ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Multivariable Analysis ◽  
Large Vessel ◽  
Aspiration Thrombectomy ◽  
Patient Demographics ◽  
Radiographic Outcomes ◽  
Operator Series ◽  
First Pass

BackgroundBoth stentriever and direct-aspiration thrombectomy effectively treat large-vessel occlusions. However, data are limited comparing clinical outcomes after aspiration-first versus stentriever-assisted aspiration for thrombectomy.MethodsA retrospective cohort study compared procedure times and radiographic outcomes after two mechanical thrombectomy techniques (aspiration first or stentriever). To minimize bias and variability inherent to multi-operator series, we assessed consecutive patients with cerebrovascular occlusions treated by a single surgeon during a 1 year period at two stroke centers. Expanded Thrombolysis in Cerebral Infarction (eTICI) grades were assessed by an investigator blinded to treatment.ResultsData from 93 patients (median age 70 years) were analyzed: 73 patients (78.5%) were treated with a strentriever-first strategy and 20 (21.5%) were treated with aspiration first, with stentriever rescue therapy required in only three of these cases following unsuccessful aspiration. There were no significant differences in patient demographics, sites of occlusion, or rates of tandem occlusions between aspiration-first and stentriever-assisted groups (p≥0.36). The rate of first-pass eTICI ≥2b was 75.0% (15/20) for aspiration-first and 52.1% (38/73) for strentriever-first groups (p=0.07), while the rate of final eTICI ≥2b was 100% (20/20) and 82.2% (60/72), respectively (p=0.04). The aspiration-first technique was associated with procedural times ≤25 min in a multivariable analysis (adjusted OR 4.77, 95% CI 1.15 to 18.39; p=0.03).ConclusionsIn this single-surgeon series, an aspiration-first technique was associated with a statistically significant improvement in eTICI outcomes and faster procedure times compared with stentriever-assisted aspiration. Further prospective studies are necessary to minimize selection bias inherent in this study design.

Hyperdense vessel sign as a potential guide for the choice of stent retriever versus contact aspiration as first-line thrombectomy strategy

2020 ◽  
pp. neurintsurg-2020-016005 ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Diogo C Haussen ◽  
Catarina Perry da Camara ◽  
Leonardo Pisani ◽  
Marta Olive Gadea ◽  
...  
Keyword(s):  
Stent Retriever ◽  
Imaging Biomarker ◽  
First Line ◽  
Primary Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
First Line Therapy ◽  
Guide Catheter ◽  
First Pass ◽  
Secondary Analyses

BackgroundThe first-pass effect (FPE) has emerged as a key metric for efficacy in mechanical thrombectomy (MT). The hyperdense vessel sign (HDVS) on non-contrast head CT (NCCT) indicates a higher clot content of red blood cells.ObjectiveTo assess whether the HDVS could serve as an imaging biomarker for guiding first-line device selection in MT.MethodsA prospective MT database was reviewed for consecutive patients with anterior circulation large vessel occlusion stroke who underwent thrombectomy with stent retriever (SR) or contact aspiration (CA) as first-line therapy between January 2012 and November 2018. Pretreatment NCCT scans were evaluated for the presence of HDVS. The primary outcome was FPE (modified Thrombolysis in Cerebral Infarction score 2c/3). The primary analysis was the interaction between HDVS and thrombectomy modality on FPE. Secondary analyses aimed to evaluate the predictors of FPE.ResultsA total of 779 patients qualified for the analysis. HDVS and FPE were reported in 473 (60.7%) and 286 (36.7%) patients, respectively. The presence of HDVS significantly modified the effect of thrombectomy modality on FPE (p=0.01), with patients with HDVS having a significantly higher rate of FPE with a SR (41.3% vs 22.2%, p=0.001; adjusted OR 2.11 (95% CI 1.20 to 3.70), p=0.009) and non-HDVS patients having a numerically better response to CA (41.4% vs 33.9%, p=0.28; adjusted OR 0.58 (95% CI 0.311 to 1.084), p=0.088). Age (OR 1.01 (95% CI 1.00 to 1.02), p=0.04) and balloon guide catheter (OR 2.08 (95% CI 1.24 to 3.47), p=0.005) were independent predictors of FPE in the overall population.ConclusionOur data suggest that patients with HDVS may have a better response to SRs than CA for the FPE. Larger confirmatory prospective studies are warranted.

Preclinical evaluation of the ANCD thrombectomy device: safety and efficacy in a swine clot model

2020 ◽  
Vol 12 (10) ◽  
pp. 1008-1013 ◽  
Author(s):  
Sonia Sanchez ◽  
Lynn Bailey ◽  
Rebecca Ducore ◽  
Tommy Andersson ◽  
Raul Nogueira ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Histopathological Analysis ◽  
Efficacy And Safety ◽  
Guide Catheter ◽  
Vessel Injury ◽  
First Pass ◽  
Thrombectomy Device ◽  
Clinically Significant ◽  
Model Support

BackgroundThe Advanced Thrombectomy System (ANCD) provides a new funnel component designed to reduce clot fragmentation and facilitate retrieval in patients with stroke by locally restricting flow, allowing distal aspiration in combination with a stent retriever (SR).ObjectiveTo evaluate the preclinical efficacy and safety of the ANCD in a swine clot model.MethodsSoft and firm clots were implanted in the lingual and cervical arteries of 11 swine to obtain Thrombolysis in Cerebral Infarction (TICI) 0 blood flow. Mechanical thrombectomy was performed with either a balloon guide catheter+Solitaire 2 stent retriever (BGC+SR, n=13) or ANCD+SR (n=13). TICI flow was evaluated and successful revascularization was defined as TICI 3 (normal perfusion). To characterize safety, a total of 3 passes were performed in each vessel independent of recanalization. Tissues were explanted for histopathological analysis after 3 and 30 days, respectively.ResultsFirst pass reperfusion rates were ANCD+SR: 69% and BGC+SR: 46%. Reperfusion increased after the third pass in both groups (ANCD+SR: 100%, vs BGC+SR: 77%). Recanalization was achieved after an average of 1.4 and 1.9 passes in ANCD+SR and BGC+SR (p=0.095), respectively. Vessel injury was comparable in both groups; endothelial loss at 3 days was the most common injury seen (ANCD+SR: 1.78±1.22; BGC+SR: 2.03±1.20; p=0.73), while other histopathological markers were absent or minimal. Tissues downstream from targeted vessels also showed absence or minimal lesions across both groups.ConclusionsResults in a swine clot model support the high efficacy of the ANCD+SR without causing clinically significant vessel injury potentially related to the new funnel component.

Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis

2021 ◽  
pp. neurintsurg-2021-017987
Author(s):  
Carlos Pérez-García ◽  
Santiago Rosati ◽  
Carlos Gómez-Escalonilla ◽  
Juan Arrazola ◽  
Alfonso López-Frías ◽  
...  
Keyword(s):  
Propensity Score ◽  
Clinical Outcome ◽  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Propensity Score Analysis ◽  
Rescue Therapy ◽  
Stent Retriever ◽  
Multivariable Logistic Regression Analysis ◽  
Front Line

BackgroundThe optimal endovascular treatment (EVT) technique for middle cerebral artery (MCA) M2 segment occlusions remains unknown. We aim to analyze whether reperfusion rate, procedure times, procedure-related complications, and clinical outcome differed between patients with isolated M2 occlusions who underwent stent-retriever (SR) alone versus combined SR and contact aspiration (CA) as a front-line EVT.MethodsPatients who underwent EVT for isolated MCA-M2 occlusion were recruited from the prospectively ongoing ROSSETTI registry. Patients were divided regarding the EVT approach into SR alone versus SR+CA and propensity score matching was used to achieve baseline balance. Demographic, procedural, safety, and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of first-pass effect (FPE) and 90-day modified Rankin scale (mRS) 0–2.Results214 patients underwent EVT for M2 occlusion, 125 treated with SR alone and 89 with SR+CA. Propensity score matchnig analysis selected 134 matched patients. The rates of FPE (42% vs 40%, p=1.000) and 90-day mRS 0–2 (60% vs 51%, p=0.281) were comparable between groups. Patients treated with SR alone had lower need of rescue therapy (p=0.006), faster times to reperfusion (p<0.001), and lower procedure-related complications (p=0.031). Higher initial Alberta Stroke Program Early CT Score was an independent predictor of FPE. Age, baseline National Institutes of Health Stroke Scale score, and procedure duration were significant predictors of good clinical outcome at 3 months.ConclusionsAs front-line modality in M2 occlusions, the SR alone approach results in similar rates of reperfusion and good clinical outcomes to combined SR+CA and might be advantageous due to faster reperfusion times and fewer adverse events.

scholarly journals Mechanical thrombectomy in acute ischemic stroke: a single-center experience

2020 ◽  
Vol 8 (4S) ◽  
pp. 95-103
Author(s):  
K. M. Vakkosov ◽  
D. Yu. Naumov ◽  
N. I. Vodop`yanova ◽  
I. V. Moldavskaya ◽  
V. I. Ganyukov
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Small Sample Size ◽  
Small Sample ◽  
Stent Retriever ◽  
Federal State ◽  
First Pass Effect ◽  
First Pass

Aim. Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. The objective of this study is to analyze the results of our own experience of endovascular treatment in Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” Kemerovo.Methods. 12 patients with AIS and underwent mechanical thrombectomy with «Trevo» stent-retriever were included in this analysis. Primary outcomes included 90-day modified Rankin scale (mRS) score, first pass effect (FPE) and recanalization rate (TICI score), the combined incidence of postintervention hemorrhages and mortality at 90 days.Results. Among 12 patients (66.7% male, age 59.5 [57.5; 66.5] years) hypertension were in 100%, 61.5% had an ischemic heart disease, 53.8% was current smoking and atrial fibrillation. Median of the NIHSS scale was 13 points, mRS≥4 was in 75% of patients. In 33.3% was a tandem lesion (internal carotid artery terminus and middle cerebral artery) and 25% required stenting of the carotid artery. Good clinical outcomes (mRS≤2 at 90 days) were achieved in 77.8% (7/9) among surviving patients. The 90-day NIHSS score – 4 [1; 5]. The first pass effect and recanalization rate (TICI Scores 2b-3/3) was achieved in 50% and 91.7% of patients. The combined incidence of postintervention hemorrhages and mortality at 90 days was 33.3% and 25% respectively.Conclusion. Despite the small sample size, stent retriever mechanical thrombectomy in AIS provides satisfactory clinical results.

Longer stent retrievers enhance thrombectomy performance in acute stroke

2018 ◽  
Vol 11 (1) ◽  
pp. 6-8 ◽  
Author(s):  
Diogo C Haussen ◽  
Alhamza R Al-Bayati ◽  
Jonathan A Grossberg ◽  
Mehdi Bouslama ◽  
Clara Barreira ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Internal Carotid ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
First Line ◽  
Guide Catheter ◽  
First Pass ◽  
Tissue Plasminogen ◽  
Stent Retrievers

BackgroundLonger stent retrievers have recently become available and have theoretical advantages over their shorter counterparts. We aim to evaluate whether stent retriever length impacts reperfusion rates in stroke thrombectomy.MethodsThis was a retrospective analysis of a prospectively collected thrombectomy database in which equal diameter (4 mm) stent retrievers were used as the first-line strategy for intracranial internal carotid or middle cerebral artery M1 or M2 occlusions along with a balloon guide catheter from June 2011 to March 2017. The population was dichotomized into long (Trevo 4×30 mm/Solitaire 4×40 mm) or short (Trevo 4×20 mm/Solitaire 4×20 mm) retrievers. The primary outcome was first-pass modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 reperfusion.ResultsOf 1126 thrombectomies performed within the study period, 420 were included. Age, gender, National Institutes of Health Stroke Scale, ASPECTS, IV tissue plasminogen activator use, stroke etiology, occlusion site, time from last-known-normal to puncture, distribution of Trevo and Solitaire, and the use of newer generation local thromboaspiration devices were comparable between the long and short retrievers. The short retriever group had more frequent hypertension, dyslipidemia, and atrial fibrillation. First-pass mTICI 2b/3 reperfusion was more common in the long retriever group (62% vs 50%; P=0.01). Parenchymal hematomas type 2, subarachnoid hemorrhage, 90-day modified Rankin Scale score 0–2, and mortality were comparable. Multivariable analysis indicated that long retriever (OR 2.2; 95% CI 1.3 to 3.6; P=0.001), radiopaque device (OR 2.1; 95% CI 1.2 to 3.4; P=0.003), and adjuvant local aspiration (OR 2.4; 95% CI 1.3 to 4.3; P=0.003) were independently associated with first-pass reperfusion.ConclusionsThe use of longer stent retrievers is an independent predictor of first-pass mTICI 2b/3 reperfusion. First-pass reperfusion was also associated with the use of radiopaque devices and adjuvant local aspiration.

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