Journal article
Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when?
Journal of neurointerventional surgery, Vol.17(3), pp.236-241
03/2025
DOI: 10.1136/jnis-2024-021545
PMID: 38479798
Abstract
BackgroundFast and complete reperfusion in endovascular therapy (EVT) for ischemic stroke leads to superior clinical outcomes. The effect of changing the technical approach following initially unsuccessful passes remains undetermined.ObjectiveTo evaluate the association between early changes to the EVT approach and reperfusion.MethodsMulticenter retrospective analysis of prospectively collected data for patients who underwent EVT for intracranial internal carotid artery, middle cerebral artery (M1/M2), or basilar artery occlusions. Changes in EVT technique after one or two failed passes with stent retriever (SR), contact aspiration (CA), or a combined technique (CT) were compared with repeating the previous strategy. The primary outcome was complete/near-complete reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) of 2c–3, following the second and third passes.ResultsAmong 2968 included patients, median age was 66 years and 52% were men. Changing from SR to CA on the second or third pass was not observed to influence the rates of eTICI 2c–3, whereas changing from SR to CT after two failed passes was associated with higher chances of eTICI 2c–3 (OR=5.3, 95% CI 1.9 to 14.6). Changing from CA to CT was associated with higher eTICI 2c–3 chances after one (OR=2.9, 95% CI 1.6 to 5.5) or two (OR=2.7, 95% CI 1.0 to 7.4) failed CA passes, whereas switching to SR after one failed CA pass was associated with greater chance of eTICI 2c–3 (OR=6.9, 95% CI 1.6 to 30.0). Following one or two failed CT passes, switching to SR was not associated with different reperfusion rates, but changing to CA after two failed CT passes was associated with lower chances of eTICI 2c–3 (OR=0.3, 95% CI 0.1 to 0.9). Rates of functional independence were similar.ConclusionsEarly changes in EVT strategies were associated with higher reperfusion and should be contemplated following failed attempts with stand-alone CA or SR.
Details
- Title: Subtitle
- Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when?
- Creators
- Pedro N Martins - Grady Memorial HospitalRaul G Nogueira - UPMC Health SystemMohamed A Tarek - Grady Memorial HospitalJaydevsinh N Dolia - Grady Memorial HospitalSunil A Sheth - The University of Texas Health Science Center at HoustonSantiago Ortega-Gutierrez - Department of Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASergio Salazar-Marioni - The University of Texas Health Science Center at HoustonAnanya Iyyangar - The University of Texas Health Science Center at HoustonMilagros Galecio-Castillo - University of IowaAaron Rodriguez-Calienes - University of Iowa Hospitals and ClinicsAqueel Pabaney - Grady Memorial HospitalJonathan A Grossberg - Grady Memorial HospitalDiogo C Haussen - Grady Memorial Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.17(3), pp.236-241
- DOI
- 10.1136/jnis-2024-021545
- PMID
- 38479798
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group Ltd
- Language
- English
- Electronic publication date
- 03/13/2024
- Date published
- 03/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984572459202771
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