Journal article
Importance of First Pass Reperfusion in Endovascular Stroke Care ‐ Insights From Thrombectomy and Aneurysm Registry (STAR)
Stroke: Vascular and Interventional Neurology, Vol.2(6), e000427
11/2022
DOI: 10.1161/SVIN.122.000346
Abstract
Background Mechanical thrombectomy has become the first‐line treatment strategy for patients with large‐vessel occlusion strokes. Often >1 thrombectomy maneuver is necessary to achieve reperfusion. A first‐pass (FP) effect with improved functional outcomes after mechanical thrombectomy has been described. Aim of the present study is to investigate the FP effect in a large, international, multicenter stroke database. Methods Patients who underwent mechanical thrombectomy for large‐vessel occlusion stroke in the anterior cerebral circulation between January 2014 and January 2021 and achieved complete reperfusion were identified from the STAR (Stroke Thrombectomy and Aneurysm Registry). We compared functional outcomes of patients with FP (defined as modified treatment in cerebral ischemia score 3 after a single thrombectomy maneuver) versus multiple‐pass complete reperfusion (defined as modified treatment in cerebral ischemia 3 after ≥1 thrombectomy maneuver). Results A total of 1481 patients with anterior circulation large‐vessel occlusion stroke and successful recanalization were included in the analysis. FP complete recanalization was achieved in 778 patients versus 703 patients with multiple‐pass complete reperfusion. Patients with FP complete recanalization had higher Alberta Stroke Programme Early CT [Computed Tomography] Score at baseline (9 [7–10] versus 8 [7–10]; P =0.002), were less likely to be men (47% versus 51%; P =0.078) and to have intracranial internal carotid artery occlusions (14% versus 27%), as well as more likely to have M1/M2 occlusions (86% versus 73%; P <0.001), diabetes (28% versus 24%; P =0.076), and atrial fibrillation (37% versus 32%; P =0.064). FP complete recanalization (odds ratio [OR], 1.49; P =0.026), lower age (OR, 0.966; P <0.010), lower prestroke modified Rankin scale score (OR, 0.601; P <0.001), diabetes (OR, 0.612; P =0.014), and higher Alberta Stroke Programme Early CT Score (OR, 1.183; P <0.001) were independent predictors of favorable functional outcome (defined as modified Rankin scale score ≤2). In a subgroup analysis, the effect of FP complete reperfusion on favorable outcome was only detectable in patients with M1 occlusions (OR, 1.667; P =0.045). Predictors for FP reperfusion success were lower National Institutes of Health Stroke Scale score at baseline (OR, 0.980; P =0.020) and M1 occlusions (OR, 1.990; P <0.001). Conclusions This analysis of a large, multicenter stroke database confirms the importance of FP reperfusion in endovascular stroke care.
Details
- Title: Subtitle
- Importance of First Pass Reperfusion in Endovascular Stroke Care ‐ Insights From Thrombectomy and Aneurysm Registry (STAR)
- Creators
- Ilko L. Maier - University of GöttingenEyad Almallouhi - Medical University of South CarolinaMarios‐Nikos Psychogios - University Hospital of BaselJan Liman - University of GöttingenSami Al Kasab - Medical University of South CarolinaAli Alawieh - Emory University School of MedicineReda Chalhoub - Medical University of South CarolinaStacey Wolfe - Department of Neurosurgery Wake Forest School of Medicine Winston Salem SCAdam Arthur - University of Tennessee Health Science CenterAmir Shaban - University of IowaTravis Dumont - University of ArizonaPeter Kan - Baylor SchoolJoon‐Tae Kim - Chonnam National University HospitalReade De Leacy - Mount Sinai Health SystemJoshua Osbun - Washington University in St. LouisAnsaar Rai - West Virginia UniversityPascal Jabbour - Thomas Jefferson UniversityBrian M. Howard - Emory University School of MedicineMin Park - University of VirginiaRobert M. Starke - University of Miami Health SystemRoberto Crosa - Department of Neurosurgery Endovascular Neurological Center Montevideo UruguayJustin Mascitelli - The University of Texas Health Science Center at San AntonioMichael R. Levitt - University of WashingtonAdam Polifka - University of FloridaWalter Casagrande - Hospital FernándezShinichi Yoshimura - Hyogo Medical UniversityCharles Matouk - Yale School of MedicineRichard W. Williamson - Allegheny Health NetworkBenjamin Gory - Centre Hospitalier Universitaire de NancyMaxim Mokin - University of South FloridaIsabel Fragata - Hospital de São JoséDaniele G. Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaShakeel Chowdry - Department of Neurosurgery NorthShore University Health System Evanstone ILMark Moss - Washington Regional Medical CenterAlejandro M. Spiotta - Medical University of South CarolinaDaniel Behme - University Hospital MagdeburgStroke Care ‐ Insights From Thrombectomy and Aneurysm Registry (STAR) nvestigators
- Resource Type
- Journal article
- Publication Details
- Stroke: Vascular and Interventional Neurology, Vol.2(6), e000427
- DOI
- 10.1161/SVIN.122.000346
- ISSN
- 2694-5746
- eISSN
- 2694-5746
- Language
- English
- Date published
- 11/2022
- Academic Unit
- Neurology
- Record Identifier
- 9984353496002771
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