Journal article
Predictors of Angiographic Outcome After Failed Thrombectomy for Large Vessel Occlusion: Insights from the Stroke Thrombectomy and Aneurysm Registry
Neurosurgery, Vol.93(5), pp.1168-1179
11/2023
DOI: 10.1227/neu.0000000000002560
PMID: 37377425
Abstract
BACKGROUND:
Mechanical thrombectomy failure (MTF) occurs in approximately 15% of cases.
OBJECTIVE:
To investigate factors that predict MTF.
METHODS:
This was a retrospective review of prospectively collected data from the Stroke Thrombectomy and Aneurysm Registry. Patients who underwent mechanical thrombectomy (MT) for large vessel occlusion (LVO) were included. Patients were categorized by mechanical thrombectomy success (MTS) (≥mTICI 2b) or MTF (<mTICI 2b). Demographics, pretreatment, and treatment information were included in a univariate (UVA) and multivariate (MVA) analysis for prediction of MTF.
RESULTS:
A total of 6780 patients were included, and 1001 experienced anterior circulation MTF. Patients in the MTF group were older (73 vs 72, P = .044) and had higher poor premorbid modified Rankin Scale (mRS) (10.8% vs 8.4%, P = .017). Onset to puncture time was greater in the MTF group (273 vs 260 min, P = .08). No significant differences were found between the access site, use of balloon guide catheter, frontline technique, or first-pass devices between the MTF and MTS groups. More complications occurred in the MTF group (14% vs 5.8%), including symptomatic intracerebral hemorrhage (9.4% vs 6.1%) and craniectomies (10% vs 2.8%) (P < .001). On UVA, age, poor pretreatment mRS, increased number of passes, and increased procedure time were associated with MTF. Internal carotid artery, M1, and M2 occlusions had decreased odds of MTF. Poor preprocedure mRS, number of passes, and procedure time remained significant on MVA. A subgroup analysis of posterior circulation LVO revealed that number of passes and total procedure time correlated with increased odds of MTF (P < .001) while rescue stenting was associated with less odds of MTF (odds ratio 0.20, 95% CI 0.06-0.63). Number of passes remained significant on MVA of posterior circulation occlusion subgroup analysis.
CONCLUSION:
Anterior circulation MTF is associated with more complications and worse outcomes. No differences were found between techniques or devises used for the first pass during MT. Rescue intracranial stenting may decrease the likelihood of MTF for posterior circulation MT.
Details
- Title: Subtitle
- Predictors of Angiographic Outcome After Failed Thrombectomy for Large Vessel Occlusion: Insights from the Stroke Thrombectomy and Aneurysm Registry
- Creators
- Matthew Webb - The University of Texas Health Science Center at San AntonioMuhammed Amir Essibayi - Medical University of South CarolinaSami Al Kasab - Medical University of South CarolinaIlko L Maier - Universitätsmedizin GöttingenMarios-Nikos Psychogios - University Hospital of BaselJonathan A Grossberg - Emory UniversityAli Alawieh - Emory UniversityStacey Quintero Wolfe - Wake Forest UniversityAdam Arthur - University of Tennessee Health Science CenterTravis Dumont - Banner - University Medical Center TucsonPeter Kan - The University of Texas Medical Branch at GalvestonJoon-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 University HospitalMin S Park - University of VirginiaRoberto Crosa - CentroMichael R Levitt - University of WashingtonAdam Polifka - University of FloridaShinichi Yoshimura - Hyogo Medical UniversityCharles Matouk - Yale UniversityRichard W Williamson - Allegheny General HospitalIsabel Fragata - Unidade Local de Saúde de São JoséShakeel Chowdry - NorthShore University HealthSystemRobert M Starke - University of Miami Health SystemEdgar A Samaniego - University of IowaHugo Cuellar - Louisiana State UniversityAlejandro Spiotta - Medical University of South CarolinaJustin Mascitelli - The University of Texas Health Science Center at San Antonio
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.93(5), pp.1168-1179
- DOI
- 10.1227/neu.0000000000002560
- PMID
- 37377425
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Electronic publication date
- 06/28/2023
- Date published
- 11/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984438857502771
Metrics
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