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Hesse AC, Behme D, Kemmling A, Zapf A, Große Hokamp N, Frischmuth I, Maier I, Liman J, Tsogkas I, Buhk JH, Tran J, Fiehler J, Mpotsaris A, Schramm P, Berlis A, Knauth M, Psychogios MN. Comparing different thrombectomy techniques in five large-volume centers: a 'real world' observational study. J Neurointerv Surg 2017; 10:525-529. [PMID: 28963362 DOI: 10.1136/neurintsurg-2017-013394] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Thrombectomy has become the standard of care for acute ischaemic stroke due to large vessel occlusion. Aim of this study was to compare the radiological outcomes and time metrics of the various thrombectomy techniques. METHODS In this retrospective, multicenter study we analysed the data of 450 patients with occlusion of the anterior circulation, treated in five high-volume center from 2013 to 2016. The treatment techniques were divided in three categories: first-pass use of a large-bore aspiration-catheter; first-pass use of a stent-retriever; and primary combined approach (PCA) of an aspiration-catheter and stent-retriever. Primary endpoints were successful reperfusion and groin to reperfusion time. Secondary endpoints were the number of attempts and occurrence of emboli in new territory (ENT). The primary analysis was based on the intention to treat groups (ITT). RESULTS The ITT-analysis showed significantly higher reperfusion rates, with 86% of successful reperfusion in the PCA-group compared with 73% in the aspiration group and 65% in the stent-retriever group. There was no significant difference in groin to reperfusion time regarding the used technique. The secondary analysis showed an impact of the technique on the number of attempts and the occurrence of ENTs. Lowest ENT rates and attempts were reported with the combined approach. CONCLUSIONS The combined first-pass deployment of a stent-retriever and an aspiration-catheter was the most effective technique for reperfusion of anterior circulation large vessel occlusion. Our results correlate with the latest single-centrere studies, reporting very high reperfusion rates with PCA variations.
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Affiliation(s)
- Amélie Carolina Hesse
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - André Kemmling
- Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Antonia Zapf
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Nils Große Hokamp
- Institute of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Isabelle Frischmuth
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Ilko Maier
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan Liman
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Ioannis Tsogkas
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Tran
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Anastasios Mpotsaris
- Institute of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Peter Schramm
- Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Ansgar Berlis
- Department of Neuroradiology, Hospital Augsburg, Augsburg, Germany
| | - Michael Knauth
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Marios-Nikos Psychogios
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
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