Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization

Hidetoshi Matsukawa; Charles Matouk; Kazutaka Uchida; Sami Al Kasab; Mohammad-Mahdi Sowlat; Sameh Samir Elawady; Ilko Maier; Pascal Jabbour; Joon-tae Kim; Stacey Q Wolfe; Ansaar T Rai; Robert M Starke; Marios-Nikos Psychogios; Edgar A Samaniego; Adam S Arthur; Hugo Cuellar; Brain M Howard; Daniele G Romano; Omar Tanweer; Justin R Mascitelli; Isabel Fragata; Adam Polifka; Joshua W Osbun; Roberto Javier Crosa; Min S Park; Michael R Levitt; Waleed Brinjikji; Mark Moss; Richard Williamson; Pedro Navia; Peter Kan; Reade Andrew De Leacy; Shakeel A Chowdhry; Mohamad Ezzeldin; Alejandro M Spiotta; Shinichi Yoshimura; Ali M Alawieh

doi:10.1136/jnis-2024-022071

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Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization

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Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization

Hidetoshi Matsukawa, Charles Matouk, Kazutaka Uchida, Sami Al Kasab, Mohammad-Mahdi Sowlat, Sameh Samir Elawady, Ilko Maier, Pascal Jabbour, Joon-tae Kim, Stacey Q Wolfe, …

Journal of neurointerventional surgery, Vol.17(12), pp.1333-1339

12/2025

DOI: 10.1136/jnis-2024-022071

PMCID: PMC12703258

PMID: 39304195

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Abstract

BackgroundA higher number of recanalization attempts reduces the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke secondary to large vessel occlusion (LVO). We assessed the impact of switching EVT techniques after a failed first pass on procedural and clinical outcomes.MethodsThis multicenter international study, conducted between January 2013 and December 2022, included patients undergoing EVT for anterior circulation LVO (internal carotid artery or M1 segments) with failed first pass recanalization. Propensity score matching identified a 1:1 matched cohort of patients in whom EVT technique was changed after a failed first pass and those with the same technique repeated. The primary outcome was successful recanalization at second attempt defined as Thrombolysis in Cerebral Ischemia (TICI) score of 2B or higher. Secondary outcomes were 90-day modified Rankin Score (mRS) and postprocedural hemorrhage.ResultsAmong 2167 patients, converting to an alternative technique after a failed first pass was associated with higher odds of successful recanalization (adjusted OR (aOR)=1.5, p=0.041), and higher odds of mRS 0–2 at 90 days (aOR=1.6, p=0.005) without additional risk of symptomatic hemorrhage (p=0.379). Using a propensity score matched cohort of 490 patients, technique conversion at second attempt increased odds of successful recanalization at second attempt (aOR=1.32, p=0.006) and 90-day mRS 0–2 (aOR=1.38, p=0.008).ConclusionsEarly conversion to an alternative EVT technique after a failed first pass recanalization in patients with AIS is associated with better technical success and clinical outcomes.

Stroke

Clinical neurology

Details

Title: Subtitle: Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization
Creators: Hidetoshi Matsukawa - Hyogo Medical University
Charles Matouk - University of New Haven
Kazutaka Uchida - Hyogo Medical University
Sami Al Kasab - Medical University of South Carolina
Mohammad-Mahdi Sowlat - Medical University of South Carolina
Sameh Samir Elawady - Medical University of South Carolina
Ilko Maier - Universitätsmedizin Göttingen
Pascal Jabbour - Thomas Jefferson University
Joon-tae Kim - Universitätsmedizin Göttingen
Stacey Q Wolfe - Wake Forest University
Ansaar T Rai - West Virginia University Hospitals
Robert M Starke - University of Miami
Marios-Nikos Psychogios - University of Basel
Edgar A Samaniego - University of Iowa
Adam S Arthur - The Spine Institute
Hugo Cuellar - Louisiana State University Health Sciences Center Shreveport
Brain M Howard - Emory University School of Medicine
Daniele G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona
Omar Tanweer - Baylor College of Medicine
Justin R Mascitelli - The University of Texas Health Science Center at San Antonio
Isabel Fragata - Unidade Local de Saúde de São José
Adam Polifka - University of Florida
Joshua W Osbun - Washington University in St. Louis School of Medicine
Roberto Javier Crosa - Universidad de Montevideo
Min S Park - University of Virginia
Michael R Levitt - University of Washington School of Medicine
Waleed Brinjikji - Mayo Clinic
Mark Moss - J. B. Hunt Transport Services (United States)
Richard Williamson - Allegheny Health Network
Pedro Navia - Hospital Universitario La Paz
Peter Kan - The University of Texas Medical Branch at Galveston
Reade Andrew De Leacy - Mount Sinai Health System
Shakeel A Chowdhry - NorthShore University HealthSystem
Mohamad Ezzeldin - University of Houston
Alejandro M Spiotta - Medical University of South Carolina
Shinichi Yoshimura - Hyogo Medical University
Ali M Alawieh - Emory University School of Medicine
Contributors: Katherine Woollway (Editor)
Resource Type: Journal article
Publication Details: Journal of neurointerventional surgery, Vol.17(12), pp.1333-1339
DOI: 10.1136/jnis-2024-022071
PMID: 39304195
PMCID: PMC12703258
NLM abbreviation: J Neurointerv Surg
ISSN: 1759-8478
eISSN: 1759-8486
Publisher: BMJ Publishing Group Ltd
Grant note: N/A / Medtronic N/A / Penumbra, Inc N/A / Stryker (http://dx.doi.org/10.13039/100008894)
Language: English
Electronic publication date: 09/20/2024
Date published: 12/2025
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984704832202771

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