Journal article
Impact of Successful Recanalization and Clinical Outcomes of Patients With Acute Ischemic Stroke with 5 or More Thrombectomy Passes
Stroke: vascular and interventional neurology, Vol.4(1), e001107
01/2024
DOI: 10.1161/SVIN.123.001107
Abstract
Background As the number of thrombectomy passes increases during endovascular therapy (EVT) for acute stroke, neurointerventionalists must weigh the risks of potential complications against the risk of failing to recanalize the affected vessel. Thus, we investigated the effectiveness and safety of EVT for patients with acute stroke in which ≥5 EVT passes were performed. Methods This retrospective cohort study from January 2013 to December 2022 included 31 thrombectomy‐capable centers. Patients in whom ≥5 EVT passes were made were included in the analysis. The patients with successful recanalization defined as modified Thrombolysis in Cerebral Infarction ≥2b at 5, 6, 7, or more passes were compared with unsuccessful recanalization. We also compared procedure time, separated by 30 minutes. Primary outcome was a favorable 90‐day outcome (modified Rankin scale score of 0–2). Secondary outcomes were intracranial hemorrhage and death. Results A total of 407 patients met the inclusion criteria, of which 175 were women (43.1%); the mean age was 67.3 years. In 265 (65.1%) patients, successful recanalization was achieved: 134 patients with 5 passes, 67 patients with 6 passes, and 64 with ≥7 passes. Intravenous recombinant tissue plasminogen activator administration was more common in the unsuccessful recanalization group (successful recanalization with 5, 6, and ≥7 EVT passes and unsuccessful recanalization: 35.3%, 30.3%, 18.8%, and 45.4%, respectively). Successful recanalization with 5, 6, and ≥7 EVT passes was associated with favorable outcome compared with unsuccessful recanalization group (adjusted odds ratio successful recanalization with 5, 6, and ≥7 EVT passes to unsuccessful recanalization [95% CIs]: 8.29 [2.13–32.3]; 14.0 [3.27–60.3]; and 5.26 [1.12–24.8], respectively). However, symptomatic intracranial hemorrhage was not significantly different between the groups. Regarding procedure time, favorable outcome was not significantly different in each group, while symptomatic intracranial hemorrhage occurred more frequently in the 60 to 89 minutes group compared with the <30 minutes group (adjusted odds ratio, 60–89 minutes group to <30 minutes group [95% CI]: 5.86 [1.09–31.6]). Conclusion These findings suggest that a benefit in outcome persists for recanalization, without significant increase in complications. In addition, there was no significant difference in favorable outcomes among procedure time.
Details
- Title: Subtitle
- Impact of Successful Recanalization and Clinical Outcomes of Patients With Acute Ischemic Stroke with 5 or More Thrombectomy Passes
- Creators
- Kazutaka Uchida - Medical University of South CarolinaMohammad‐Mahdi Sowlat - Medical University of South CarolinaHidetoshi Matsukawa - Medical University of South CarolinaSameh Samir Elawady - Medical University of South CarolinaAli Alawieh - Emory University School of MedicineConor Cunningham - Medical University of South CarolinaSami Al Kasab - Medical University of South CarolinaIlko Maier - Universitätsmedizin GöttingenPascal Jabbour - Thomas Jefferson UniversityJoon‐Tae Kim - Chonnam National University HospitalStacey Quintero Wolfe - Wake Forest UniversityAnsaar Rai - West Virginia UniversityRobert M Starke - University of Miami Health SystemMarios‐Nikos Psychogios - University of BaselAmir Shaban - University of IowaAdam Arthur - University of Tennessee Health Science CenterHugo Cuellar - Louisiana State UniversityJonathan A. Grossberg - Emory UniversityJustin Mascitelli - The University of Texas Health Science Center at San AntonioDaniele G. Romano - University of SalernoIsabel Fragata - Hospital de São JoséOmar Tanweer - Baylor College of MedicineAdam Polifka - University of FloridaJoshua Osbun - Washington University in St. LouisRoberto Crosa - Department of Neurosurgery Endovascular Neurological Center Montevideo UruguayCharles Matouk - Yale School of MedicineMin S. Park - University of VirginiaMichael R. Levitt - University of WashingtonWaleed Brinjikji - Mayo Clinic in ArizonaMark Moss - Washington Regional Medical CenterRichard Williamson - Allegheny Health NetworkPedro Navia - Hospital Universitario La PazPeter Kan - The University of Texas Medical Branch at GalvestonReade De Leacy - Mount Sinai Health SystemShakeel Chowdhry - NorthShore University HealthSystemMohamad Ezzeldin - University of HoustonShinichi Yoshimura - Hyogo Medical UniversityAlejandro M. Spiotta - Medical University of South CarolinaStroke Thrombectomy and Aneurysm Registry (STAR) Collaborators
- Resource Type
- Journal article
- Publication Details
- Stroke: vascular and interventional neurology, Vol.4(1), e001107
- DOI
- 10.1161/SVIN.123.001107
- ISSN
- 2694-5746
- eISSN
- 2694-5746
- Language
- English
- Date published
- 01/2024
- Academic Unit
- Neurology
- Record Identifier
- 9984539753202771
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