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Diaz ML, Carmona T, Requena M, Piñana C, Hernández D, Diana F, De Dios M, Farrero J, Ribo M, Fredes Araya A, Gramegna LL, Purroy F, Fernandez L, Villalba J, Quintana M, Tomasello A. Remote Teleproctoring with the TEGUS System for Mechanical Thrombectomy in a Non-Comprehensive Stroke Center: Initial Preliminary Data On Clinical Experience. Clin Neuroradiol 2024:10.1007/s00062-024-01440-0. [PMID: 39179879 DOI: 10.1007/s00062-024-01440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/08/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE Mechanical thrombectomy (MT) is typically performed by experienced neurointerventional radiologists. However, logistical and geographic limitations often hinder access to rapid MT. This study reports the first clinical experience using TEGUS teleproctoring to support MT conducted by general interventional radiologists (IR) at non-comprehensive stroke centers, compared to on-site proctoring outcomes. METHODS The Arnau de Vilanova Hospital in Spain used to transfer stroke patients requiring MT to a comprehensive Stroke Center 160 km away. To overcome COVID-19 mobility restrictions, the Tegus Teleproctoring System was installed. Before teleproctoring, the general interventional radiologist underwent six months of neurointerventional training at a primary stroke center. From April 2021 to May 2023, general IR conducted MT either with on-site proctor supervision or teleproctoring support. We aim to compare clinical outcome of patients receiving MT according to proctoring method. RESULTS During the study, 49 MTs were performed: 15 with TEGUS teleproctoring and 34 with on-site proctoring. Both groups had similar baseline characteristics, except for NIHSS scores (Tegus 9 [IQR 6-20] vs 18 [IQR 12-22], p = 0.034). No significant differences were found in door-to-revascularization time (82 ± 28.2 vs 84 ± 26.4) min, p = (0.895). The final mTICI distribution and 90-day mRS scores were comparable after adjusting by stroke severity. There were no reports of symptomatic intracranial hemorrhage in either group. CONCLUSION This study shows the feasibility of Tegus remote teleproctoring during emergent cases of MT in a remote hospital. It could improve the learning curve of interventional radiologists with limited experience in MT, and lower the territorial inequity associated to MT.
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Affiliation(s)
- Maria Lourdes Diaz
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
| | - Tomás Carmona
- Neurosurgey unit, Hospital San Pablo, Coquimbo, Chile
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Manuel Requena
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Stroke unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carlos Piñana
- Interventional radiology unit, Hospital clínico Universitario, Valencia, Spain
| | - David Hernández
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesco Diana
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta De Dios
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Farrero
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
| | - Marc Ribo
- Stroke unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Arturo Fredes Araya
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
| | - Laura Ludovica Gramegna
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Leandro Fernandez
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
- Radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
| | - Jordi Villalba
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain
- Vascular interventional radiology unit, Santa Creu I Sant Pau Hospital, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain.
- Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
- Departamento de Medicina (A.T.), Universitat Autònoma de Barcelona, Barcelona, Spain.
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2
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Tomasello A, Gramegna LL, Vega P, Castaño C, Moreu M, Dominguez C, Macho J. Mechanical thrombectomy with a new intermediate balloon catheter combining the BGC and DAC features: Initial clinical experience with the iNedit device. Interv Neuroradiol 2023:15910199231207407. [PMID: 37847747 DOI: 10.1177/15910199231207407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION The iNedit balloon distal access catheter is a novel thrombectomy device. It has an inner diameter of 0.058″, proximal outer diameter of 2.13 mm, and distal outer diameter of 1.67mm. It is compatible with a 0.088″ guide catheter and includes a balloon located 5 cm from the catheter tip, enabling proximal flow restriction and combined therapy with stent retrievers. We investigate the appraisal of the use, safety, and efficacy of the iNedit catheter in the first-in-human study. METHODS In the preliminary cases that demanded training on the product previous to a multicentric study, prospective data were collected on 22 consecutive patients treated with the iNedit catheter to perform thrombectomy for acute ischemic stroke due to large vessel occlusion within 24 h. The outcome measures consisted of several evaluations of user experience rated on a 5-point scale ranging from 1 (bad) to 5 (excellent), as well as assessments of procedural safety outcomes such as artery perforation and arterial occlusion, procedural efficacy outcomes including first-pass effect (Thrombolysis In Cerebral Infarction [TICI] 2c/3) and final recanalization (TICI 2b/3), and clinical efficacy outcomes such as a 3-month 0-2 modified Rankin Scale (mRS). RESULTS The mean age was 72 ± 12 years old; median National Institute Health Stroke Scale was 17 (11-19). Sites of primary occlusion were: 2 internal carotid artery, 12 M1-MCA, 7 M2-MCA, and one P1. Median score evaluation of the appraisal of use was 4- IQR [4-5]. The median number of passes was 1 [IQR 1-2]. First pass complete recanalization rate was 50% and the final recanalization rate was 94.45%. No artery perforation and arterial occlusion. Good functional outcome mRS 0-2 was achieved in 50% of patients. CONCLUSIONS In this initial clinical experience, iNedit device achieved a high rate of first-pass effect and final recanalization rate with no safety concerns, thus favoring a high percentage of good clinical outcomes.
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Affiliation(s)
- Alejandro Tomasello
- Interventional Neuroradiology Section, Vall d Hebron University Hospital, Barcelona, Spain
| | | | - Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Castaño
- Interventional Neuroradiology Unit, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Manuel Moreu
- Interventional Neuroradiology, Radiology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Carlos Dominguez
- Interventional Neuroradiology, Hospital General Universitario Alicante, Alicante, Spain
| | - Juan Macho
- Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Spain
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3
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Requena M, Piñana C, Olive-Gadea M, Hernández D, Boned S, De Dios M, Rodrigo M, Rivera E, Muchada M, Cuevas JL, Rubiera M, García-Tornel Á, Gramegna LL, Molina C, Ribo M, Tomasello A. Combined technique as first approach in mechanical thrombectomy: Efficacy and safety of REACT catheter combined with stent retriever. Interv Neuroradiol 2023; 29:504-509. [PMID: 35491662 PMCID: PMC10549706 DOI: 10.1177/15910199221095798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mechanical thrombectomy (MT) with combined treatment including both a stent retriever and distal aspiration catheter may improve recanalization rates in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Here, we evaluated the effectiveness and safety of the REACT aspiration catheter used with a stent retriever. METHODS This prospective study included consecutive adult patients who underwent MT with a combined technique using REACT 68 and/or 71 between June 2020 and July 2021. The primary endpoints were final and first pass mTICI 2b-3 and mTICI 2c-3 recanalization. Analysis was performed after first pass and after each attempt. Secondary safety outcomes included procedural complications, symptomatic intracranial hemorrhage (sICH) at 24 h, in-hospital mortality, and 90-day functional independence (modified Rankin Scale [mRS] 0-2). RESULTS A total of 102 patients were included (median age 78; IQR: 73-87; 50.0% female). At baseline, median NIHSS score was 19 (IQR: 11-21), and ASPECTS was 9 (IQR: 8-10). Final mTICI 2b-3 recanalization was achieved in 91 (89.2%) patients and mTICI 2c-3 was achieved in 66 (64.7%). At first pass, mTICI 2b-3 was achieved in 55 (53.9%) patients, and mTICI 2c-3 in 37 (36.3%). The rate of procedural complications was 3.9% (4/102), sICH was 6.8% (7/102), in-hospital mortality was 12.7% (13/102), and 90-day functional independence was 35.6% (36/102). CONCLUSION A combined MT technique using a stent retriever and REACT catheter resulted in a high rate of successful recanalization and first pass recanalization in a sample of consecutive patients with AIS due to LVO in clinical use.
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Affiliation(s)
- Manuel Requena
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Carlos Piñana
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Marta Olive-Gadea
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - David Hernández
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Sandra Boned
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Marta De Dios
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Marc Rodrigo
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Eila Rivera
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Marián Muchada
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - José Luis Cuevas
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
- Servicio Neurocirugía, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Marta Rubiera
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Álvaro García-Tornel
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Laura Ludovica Gramegna
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Molina
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Marc Ribo
- Unitat d’Ictus, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Alejandro Tomasello
- Neurorradiologia Intervencionista, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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Baek JH, Kim BM, Suh SH, Jeon HJ, Ihm EH, Park H, Kim CH, Cha SH, Choi CH, Yi KS, Kim JH, Suh S, Kim B, Chang Y, Kim SY, Oh JS, Heo JH, Kim DJ, Nam HS, Kim YD. First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study. Korean J Radiol 2023; 24:145-154. [PMID: 36725355 PMCID: PMC9892223 DOI: 10.3348/kjr.2022.0618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/18/2022] [Accepted: 12/11/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. MATERIALS AND METHODS In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b-3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b-3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0-2 at 3 months. RESULTS Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0-35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0-2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0-2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59-10.8; p = 0.004). CONCLUSION Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0-2, even in patients with successful recanalization.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong-Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Hyun Ihm
- Department of Neurosurgery, Andong Hospital, Andong, Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Hoon Cha
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Chi-Hoon Choi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Kyung Sik Yi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Jun-Hwee Kim
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byungjun Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Jae Sang Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zhang Y, Liu P, Li Z, Peng Y, Chen W, Zhang L, Chu J, Kuai D, Chen Z, Wu W, Xu Y, Zhang Y, Zhou B, Geng Y, Yin C, Li J, Wang M, Zhai N, Peng X, Ji Z, Xiao Y, Zhu X, Cai X, Zhang L, Hong B, Xing P, Shen H, Zhang Y, Li M, Shang M, Liu J, Yang P. Endovascular treatment of acute ischemic stroke with a fully radiopaque retriever: A randomized controlled trial. Front Neurol 2022; 13:962987. [PMID: 36588884 PMCID: PMC9796564 DOI: 10.3389/fneur.2022.962987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The Neurohawk retriever is a new fully radiopaque retriever. A randomized controlled non-inferiority trial was conducted to compare the Neurohawk and the Solitaire FR in terms of safety and efficacy. In order to evaluate the efficacy and safety of endovascular treatment in acute ischemic stroke (AIS) caused by intracranial atherosclerotic disease (ICAD) larger vessel occlusion (LVO), a sub-analysis was performed. Methods Acute ischemic stroke patients aged 18-80 years with LVO in the anterior circulation were randomly assigned to undergo thrombectomy with either the Neurohawk or the Solitaire FR. The primary efficacy endpoint was successful reperfusion (mTICI 2b-3) rate by the allocated retriever. A relevant non-inferiority margin was 12.5%. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and all-cause mortality within 90 days. Secondary endpoints included first-pass effect (FPE), modified FPE, and favorable outcomes at 90 days. In subgroup analysis, the patients were divided into the ICAD group and non-ICAD group according to etiology, and baseline characteristics, angiographic, and clinical outcomes were compared. Results A total of 232 patients were involved in this analysis (115 patients in the Neurohawk group and 117 in the Solitaire group). The rates of successful reperfusion with the allocated retriever were 88.70% in the Neurohawk group and 90.60% in the Solitaire group (95%CI of the difference, -9.74% to 5.94%; p = 0.867). There were similar results in FPE and mFPE in both groups. The rate of sICH seemed higher in the Solitaire group (13.16% vs. 7.02%, p = 0.124). All-cause mortality and favorable outcome rates were comparable as well. In subgroup analysis, 58 patients were assigned to the ICAD group and the remaining 174 to the non-ICAD group. The final successful reperfusion and favorable outcome rates showed no statistically significant differences in two groups. Mortality within 90 days was relatively lower in the ICAD group (6.90% vs. 17.24%; p = 0.054). Conclusion The Neurohawk retriever is non-inferior to the Solitaire FR in the mechanical thrombectomy of large vessel occlusion-acute ischemic stroke (LVO-AIS). The sub-analysis suggested that endovascular treatment including thrombectomy with the retriever and essential rescue angioplasty is effective and safe in AIS patients with intracranial atherosclerotic disease-larger vessel occlusion (ICAD-LVO). Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04995757, number: NCT04995757.
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Affiliation(s)
- Yongxin Zhang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Pei Liu
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Zifu Li
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Ya Peng
- Department of Neurosurgery, Changzhou First People's Hospital, Changzhou, China
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital Brain Hospital, Liaocheng, China
| | - Jianfeng Chu
- Department of Neurology, The First People's Hospital of Jining City, Jining, China
| | - Dong Kuai
- Department of Neurosurgery, Shanxi Provincial Cardiovascular Hospital, Taiyuan, China
| | - Zhen Chen
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Yun Xu
- Department of Neurology, Nanjing Gulou Hospital, Nanjing, China
| | - Yong Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Zhou
- Department of Neurointervention, Cerebrovascular Disease Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yu Geng
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Congguo Yin
- Department of Neurology, Hangzhou First People's Hospital, Hangzhou, China
| | - Jiang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Ming Wang
- Department of Neurointervention, Nanyang Second People's Hospital, Nanyang, China
| | - Naichi Zhai
- Department of Neurosurgery, Zibo Central Hospital, Zibo, China
| | - Xiaoxiang Peng
- Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Zhong Ji
- Department of Neurology, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Yaping Xiao
- Department of Neurology, Shanghai Oriental Hospital, Shanghai, China
| | - Xingen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xueli Cai
- Department of Neurology, Lishui Municipal Central Hospital, Lishui, China
| | - Lei Zhang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Bo Hong
- Neurovascular Center, Shanghai General Hospital, Shanghai, China
| | - Pengfei Xing
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Hongjian Shen
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Yongwei Zhang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Minghua Li
- Institute of Diagnostic and Interventional Neuroradiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Meixia Shang
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China,*Correspondence: Jianmin Liu
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China,Pengfei Yang
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6
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Gilbert A, Detraz L, Alexandre PL, Serfaty JM, Desal H, Toquet C, Bourcier R. Magnetic resonance imaging quantitative T2* mapping to predict the red blood cell content of in vivo thrombi retrieved from patients with large vessel occlusions in acute ischemic stroke. Interv Neuroradiol 2022; 28:523-530. [PMID: 34559000 PMCID: PMC9511618 DOI: 10.1177/15910199211042473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance imaging quantitative T2* mapping has shown reliable identification of thrombus red blood cell content in vitro. The thrombus composition has been in vivo, associated with outcomes after endovascular therapy for acute ischemic stroke. We aim to analyze the red blood cell content of thrombi retrieved from patients with large vessel occlusions in relation to the thrombus-T2* relaxation time in magnetic resonance imaging. MATERIAL AND METHODS Consecutive acute ischemic stroke patients treated by endovascular therapy were scanned with an magnetic resonance imaging quantitative T2* mapping sequence. Quantitative histologic evaluations of red blood cell content were performed. A linear regression assessed the association between vascular risk factors, comorbidities, antithrombotic drugs intake, baseline National Institutes of Health Stroke Scale (NIHSS), intravenous thrombolysis before endovascular therapy, time between onset and groin puncture, patient's outcome at 3 months, magnetic resonance imaging quantitative T2* mapping results, and the red blood cell content of thrombi. The correlation between the mean thrombus-T2* relaxation time and red blood cell content was assessed by calculating the Pearson correlation coefficient. RESULTS Among 31 thrombi, 16 were "Fibrin rich" and 15 "red blood cell dominant." The median red blood cell content was 39 (range, 0-90; interquartile range, 37). The median (interquartile range) thrombus-T2* relaxation time was shorter in "red blood cell dominant" thrombi (21, interquartile range 6) than in "Fibrin rich" thrombi (24, interquartile range 7), without significant difference (p = 0.15), as shown in the Box plot. An inverse correlation between thrombus-T2* relaxation time and red blood cell content was found, with a correlation coefficient of -0.41 (95% CI, -0.67 to -0.08, p = 0.02). CONCLUSION Our study shows that a shorter thrombus-T2* relaxation time is related to a higher red blood cell content within in vivo thrombi.
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Affiliation(s)
- Alize Gilbert
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Lili Detraz
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Pierre-Louis Alexandre
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Jean-Michel Serfaty
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Hubert Desal
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Claire Toquet
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Romain Bourcier
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
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7
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Yamamoto Y, Yamamoto N, Kanematsu Y, Yamaguchi I, Ishihara M, Miyamoto T, Sogabe S, Shimada K, Takagi Y, Izumi Y. The claw sign predicts first-pass effect in mechanical thrombectomy for cerebral large vessel occlusion in the anterior circulation. Surg Neurol Int 2022; 13:72. [PMID: 35242438 PMCID: PMC8888293 DOI: 10.25259/sni_1160_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/09/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Mechanical thrombectomy (MT) is an effective treatment for acute cerebral large vessel occlusion (LVO). Complete recanalization of vessels in a single procedure is defined as the first-pass effect (FPE) and is associated with good prognosis. In this study, angiographic clot protruding sign termed the “claw sign,” was examined as candidate preoperative imaging factor for predicting the FPE.
Methods:
We retrospectively analyzed data from 91 consecutive patients treated for acute LVO in the anterior circulation by MT between January 2014 and December 2019. The claw sign was defined as a thrombus that protruded proximally by more than half of the diameter of the parent artery. Radiological findings such as claw sign, clinical and etiological features, and outcomes were compared between groups with and without successful FPE. Multivariate analysis was conducted to evaluate perioperative factors associated with FPE.
Results:
FPE was achieved in 26 of 91 (28.6%) patients and the claw sign was observed in 34 of 91 (37.4%) patients. The claw sign was significantly more frequent in the successful FPE group than in the failed FPE group (53.8% vs. 30.8%; P = 0.040). After the multivariate analysis, the claw sign was the only pretreatment parameter that could predict FPE (odds ratio, 2.67; 95% confidence interval, 1.01–7.06; P = 0.047).
Conclusion:
The claw sign is an angiographic imaging factor that might predict FPE after MT for anterior circulation acute ischemic stroke.
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Affiliation(s)
- Yuki Yamamoto
- Departments of Clinical Neuroscience, Tokushima University, Tokushima, Japan,
| | - Nobuaki Yamamoto
- Departments of Clinical Neuroscience, Tokushima University, Tokushima, Japan,
| | | | | | | | | | - Shu Sogabe
- Neurosurgery, Tokushima University, Tokushima, Japan
| | - Kenji Shimada
- Neurosurgery, Tokushima University, Tokushima, Japan
| | | | - Yuishin Izumi
- Departments of Clinical Neuroscience, Tokushima University, Tokushima, Japan,
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8
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Shigeta K, Suzuki K, Matsumaru Y, Takeuchi M, Morimoto M, Kanazawa R, Takayama Y, Kamiya Y, Okubo S, Hayakawa M, Ishii N, Koguchi Y, Ota T, Takigawa T, Inoue M, Naito H, Hirano T, Kato N, Ueda T, Akaji K, Iguchi Y, Miki K, Tsuruta W, Fujimoto S, Enomoto M, Aoyama J, Nakano T, Kimura K. Intravenous Alteplase is Associated with First Pass Effect in Stent-retriever but not ADAPT Thrombectomy : Post Hoc Analysis of the SKIP Study. Clin Neuroradiol 2021; 32:153-162. [PMID: 34498093 DOI: 10.1007/s00062-021-01085-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the effect of alteplase, either combined with stent-retriever thrombectomy or a direct aspiration first pass technique (ADAPT), in patients with large-vessel occlusion stroke. METHODS This was a retrospective post hoc analysis of data from The Direct Mechanical Thrombectomy in Acute LVO Stroke (SKIP) study. Patients were divided into two groups according to the first-line thrombectomy technique: stent-retriever and ADAPT. Each group was further divided into two subgroups, namely MT and MT + alteplase. The procedural outcomes, such as first pass effect (FPE) ratio and number of passes, were evaluated. The clinical outcomes included mRS score at 3 months. RESULTS A total of 180 patients were included (116 in the stent-retriever group and 64 in the ADAPT group). No interaction was detected between the first-line technique and alteplase administration. In the stent-retriever group, after adjusting for factors associated with FPE, the adjusted odds ratio (95% confidence interval) of FPE of the MT + alteplase subgroup versus the MT subgroup was 3.57 (1.5-8.48) and in the ADAPT group it was 1.35 (0.37-4.91). With alteplase, the number of passes decreased with adjusted odds ratios of 0.59 (0.37-0.93) in the stent-retriever group but not in the ADAPT group. In both first-line technique groups, clinical outcomes did not differ between subgroups. CONCLUSION In the SKIP study, alteplase administration was associated with increased FPE when combined with stent-retriever thrombectomy, but not with ADAPT. We found no differences in the clinical outcomes.
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Affiliation(s)
- Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Masafumi Morimoto
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgery Hospital, Kanagawa, Japan
| | | | - Yohei Takayama
- Department of Neurology, Akiyama Neurosurgical Hospital, Kanagawa, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Seiji Okubo
- Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Norihiro Ishii
- Department of Neurosurgery, New Tokyo Hospital, Chiba, Japan
| | - Yorio Koguchi
- Department of Neurology and Neurosurgery, Chiba Emergency Medical Center, Chiba, Japan
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Masato Inoue
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiromichi Naito
- Department of Neurosurgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center, Ibaraki, Japan
| | - Toshihiro Ueda
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kanagawa, Japan
| | - Kazunori Akaji
- Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Kazunori Miki
- Department of Endovascular surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masaya Enomoto
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Jiro Aoyama
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tomoyuki Nakano
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
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9
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Hassan AE, Dibas M, Sarraj A, Ghozy S, El-Qushayri AE, Dmytriw AA, Tekle WG. First pass effect vs multiple passes complete reperfusion: A retrospective study. Neuroradiol J 2021; 35:306-312. [PMID: 34464222 DOI: 10.1177/19714009211042886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE First pass effect (FPE) is defined as achieving modified treatment in cerebral infarction (mTICI) grade 2c/3 reperfusion from the first pass and is associated with more favorable outcomes. We aimed to compare FPE and non-FPE using a large database and further compare first-pass mTICI 2b with multiple passes mTICI 3. METHODS A retrospective cohort study of acute ischemic stroke patients who received mechanical thrombectomy at a high-volume center was performed. Baseline characteristics and outcomes including rates of discharge and 90-day functional independence (modified Rankin Scale ≤2), mortality, symptomatic, and asymptomatic intracerebral hemorrhage were compared. RESULTS Of the 637 patients included, 294 achieved FPE; 161 patients had multiple passes mTICI 3 and 36 had first pass mTICI 2b. Propensity-score matching resulted in 211 matched pairs for FPE vs non-FPE, and 30 matched pairs for multiple passes mTICI 3 vs first pass mTICI 2b. The FPE group had significantly more instances of discharge (33.6% vs 19.4%, p = 0.001) and 90-day functional independence (51.7% vs 40.8%, p = 0.032), and lower rates of mortality (18.0% vs 27.5%, p = 0.027) compared to non-FPE. There was no significant difference between first pass mTICI 2b and multiple passes mTICI 3 concerning any studied outcomes. CONCLUSIONS First pass mTICI 2c/3 is safer and is associated with higher rates of functional independence. We did not observe a significant difference between first pass mTICI 2b and multiple passes mTICI 3. The limitations of this study prevent us from drawing conclusions related to the difference between them and calls for future large-scale studies to explore that further.
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Affiliation(s)
- Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
| | - Mahmoud Dibas
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA.,Sulaiman Al Rajhi University, College of Medicine, Saudi Arabia
| | - Amrou Sarraj
- Department of Neurology, University of Texas at Houston Stroke Center, Houston, TX, USA
| | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | | | - Adam A Dmytriw
- Neuroradiology and Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wondwossen G Tekle
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
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10
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Delgado Acosta F, Jiménez Gómez E, Bravo Rey I, Bravo-Rodríguez FDA, Valverde Moyano R, Oteros Fernández R. Influence of the number of passes of Stent-Retriever on the occurrence of parenchymal hematomas in stroke patients undergoing thrombectomy. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Bai X, Zhang X, Wang J, Zhang Y, Dmytriw AA, Wang T, Xu R, Ma Y, Li L, Feng Y, Mena CS, Yang K, Wang X, Song H, Ma Q, Jiao L. Factors Influencing Recanalization After Mechanical Thrombectomy With First-Pass Effect for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:628523. [PMID: 33897591 PMCID: PMC8062801 DOI: 10.3389/fneur.2021.628523] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background: First-pass effect (FPE) is increasingly recognized as a predictor of good outcome in large vessel occlusion (LVO). This systematic review and meta-analysis aimed to elucidate the factors influencing recanalization after mechanical thrombectomy (MT) with FPE in treating acute ischemic stroke (AIS). Methods: Main databases were searched for relevant randomized controlled trials (RCTs) and observational studies reporting influencing factors of MT with FPE in AIS. Recanalization was assessed by the modified thrombolysis in cerebral ischemia (mTICI) score. Both successful (mTICI 2b-3) and complete recanalization (mTICI 2c-3) were observed. Risk of bias was assessed through different scales according to study design. The I2 statistic was used to evaluate the heterogeneity, while subgroup analysis, meta-regression, and sensitivity analysis were performed to investigate the source of heterogeneity. Visual measurement of funnel plots was used to evaluate publication bias. Results: A total of 17 studies and 6,186 patients were included. Among them, 2,068 patients achieved recanalization with FPE. The results of meta-analyses showed that age [mean deviation (MD):1.21,95% confidence interval (CI): 0.26–2.16; p = 0.012], female gender [odds ratio (OR):1.12,95% CI: 1.00–1.26; p = 0.046], diabetes mellitus (DM) (OR:1.17,95% CI: 1.01–1.35; p = 0.032), occlusion of internal carotid artery (ICA) (OR:0.71,95% CI: 0.52–0.97; p = 0.033), occlusion of M2 segment of middle cerebral artery (OR:1.36,95% CI: 1.05–1.77; p = 0.019), duration of intervention (MD: −27.85, 95% CI: −42.11–13.58; p < 0.001), time of onset to recanalization (MD: −34.63, 95% CI: −58.45–10.81; p = 0.004), general anesthesia (OR: 0.63,95% CI: 0.52–0.77; p < 0.001), and use of balloon guide catheter (BGC) (OR:1.60,95% CI: 1.17–2.18; p = 0.003) were significantly associated with successful recanalization with FPE. At the same time, age, female gender, duration of intervention, general anesthesia, use of BGC, and occlusion of ICA were associated with complete reperfusion with FPE, but M2 occlusion and DM were not. Conclusion: Age, gender, occlusion site, anesthesia type, and use of BGC were influencing factors for both successful and complete recanalization after first-pass thrombectomy. Further studies with more comprehensive observations indexes are need in the future.
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Affiliation(s)
- Xuesong Bai
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao Zhang
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Wang
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yinhang Zhang
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Tao Wang
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Xu
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Long Li
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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12
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den Hartog SJ, Zaidat O, Roozenbeek B, van Es ACGM, Bruggeman AAE, Emmer BJ, Majoie CBLM, van Zwam WH, van den Wijngaard IR, van Doormaal PJ, Lingsma HF, Burke JF, Dippel DWJ. Effect of First-Pass Reperfusion on Outcome After Endovascular Treatment for Ischemic Stroke. J Am Heart Assoc 2021; 10:e019988. [PMID: 33739141 PMCID: PMC8174317 DOI: 10.1161/jaha.120.019988] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background First‐pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C‐3) after multiple‐passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. Methods and Results FPR was defined as eTICI 2C‐3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01–1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06–1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03–1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01–1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24‐hour National Institutes of Health Stroke Scale (NIHSS) score (−37%; 95% CI, −43% to −31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83–2.54) compared with no FPR (multiple‐passes reperfusion+no excellent reperfusion), and compared with multiple‐passes reperfusion alone (24‐hour NIHSS score, (−23%; 95% CI, −31% to −14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19–1.78)). Conclusions FPR compared with multiple‐passes reperfusion is associated with favorable outcome, independently of patient, imaging, and treatment characteristics. Factors associated with FPR were the experience of the interventionist, history of hyperlipidemia, location of occluded artery, and use of an aspiration device compared with stent thrombectomy.
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Affiliation(s)
- Sanne J den Hartog
- Department of Neurology Erasmus MC, University Medical Center Rotterdam the Netherlands.,Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam the Netherlands.,Department of Public Health Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Osama Zaidat
- Department of Neurology Mercy St. Vincent Medical Center Toledo OH United States of America
| | - Bob Roozenbeek
- Department of Neurology Erasmus MC, University Medical Center Rotterdam the Netherlands.,Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Adriaan C G M van Es
- Department of Radiology and Nuclear Medicine Leiden University Medical Center Leiden the Netherlands
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine Amsterdam University Medical Centers, location AMC Amsterdam the Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine Amsterdam University Medical Centers, location AMC Amsterdam the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine Amsterdam University Medical Centers, location AMC Amsterdam the Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine Cardiovascular Research Institute MaastrichtMaastricht University Medical Center Maastricht the Netherlands
| | | | - Pieter Jan van Doormaal
- Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Hester F Lingsma
- Department of Public Health Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - James F Burke
- Department of Neurology University of Michigan Ann Arbor MI United States of America
| | - Diederik W J Dippel
- Department of Neurology Erasmus MC, University Medical Center Rotterdam the Netherlands
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13
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YAMAGAMI H, HAYAKAWA M, INOUE M, IIHARA K, OGASAWARA K, TOYODA K, HASEGAWA Y, OHATA K, SHIOKAWA Y, NOZAKI K, EZURA M, IWAMA T. Guidelines for Mechanical Thrombectomy in Japan, the Fourth Edition, March 2020: A Guideline from the Japan Stroke Society, the Japan Neurosurgical Society, and the Japanese Society for Neuroendovascular Therapy. Neurol Med Chir (Tokyo) 2021. [PMID: 33583863 PMCID: PMC7966209 DOI: 10.2176/nmc.st.2020-0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hiroshi YAMAGAMI
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
,Corresponding author: Hiroshi Yamagami, MD, PhD Department of Stroke Neurology, National Hospital Organizat ion Osaka Nat ional Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan e-mail:;
| | - Mikito HAYAKAWA
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Manabu INOUE
- Division of Stroke Care Unit/Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji IIHARA
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kuniaki OGASAWARA
- Department of Neurosurgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Kazunori TOYODA
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhiro HASEGAWA
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Stroke Center and Department of Neurology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kenji OHATA
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | | | - Kazuhiko NOZAKI
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayuki EZURA
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Toru IWAMA
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
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14
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Yamagami H, Hayakawa M, Inoue M, Iihara K, Ogasawara K, Toyoda K, Hasegawa Y, Ohata K, Shiokawa Y, Nozaki K, Ezura M, Iwama T. Guidelines for Mechanical Thrombectomy in Japan, the Fourth Edition, March 2020: A Guideline from the Japan Stroke Society, the Japan Neurosurgical Society, and the Japanese Society for Neuroendovascular Therapy. Neurol Med Chir (Tokyo) 2021; 61:163-192. [PMID: 33583863 DOI: 10.2176/nmc.nmc.st.2020-0357] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Manabu Inoue
- Division of Stroke Care Unit/Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.,Stroke Center and Department of Neurology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | | | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
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15
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Abbasi M, Liu Y, Fitzgerald S, Mereuta OM, Arturo Larco JL, Rizvi A, Kadirvel R, Savastano L, Brinjikji W, Kallmes DF. Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes. J Neurointerv Surg 2021; 13:212-216. [PMID: 33441394 DOI: 10.1136/neurintsurg-2020-016869] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND First pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes. OBJECTIVE To determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE. METHODS In July 2020, a literature search on FPE (defined as modified Thrombolysis in Cerebral Infarction (TICI) 2c-3 after a single pass) and modified FPE (mFPE, defined as TICI 2b-3 after a single pass) and mechanical thrombectomy for stroke was performed. Using a random-effects meta-analysis, we evaluated the following outcomes for both FPE and mFPE: overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale score ≤2 at day 90), mortality, and symptomatic intracerebral hemorrhage (sICH) rate. RESULTS Sixty-seven studies comprising 16 870 patients were included. Overall rates of FPE and mFPE were 28% and 45%, respectively. Thrombectomy techniques shared similar FPE (p=0.17) and mFPE (p=0.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR=1.78) and mFPE with non-mFPE (57% vs 44%, OR=1.73). FPE had a lower mortality rate (17% vs 25%, OR=0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared with non-FPE and non-mFPE (4% vs 18%, OR=0.41 for FPE; 5% vs 7%, OR=0.98 for mFPE). CONCLUSIONS Our findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques. FPE and mFPE are associated with better clinical outcomes.
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Affiliation(s)
- Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | - Oana Madalina Mereuta
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | | | - Asim Rizvi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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16
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Bai X, Zhang X, Yang W, Zhang Y, Wang T, Xu R, Wang Y, Li L, Feng Y, Yang K, Wang X, Song H, Ma Q, Jiao L. Influence of first-pass effect on recanalization outcomes in the era of mechanical thrombectomy: a systemic review and meta-analysis. Neuroradiology 2020; 63:795-807. [PMID: 33084936 DOI: 10.1007/s00234-020-02586-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE This systematic review and meta-analysis summarized the current literature to compare the safety and efficacy between first-pass effect (FPE) and multiple-pass effect (MPE) for thrombectomy in treatment of acute ischemic stroke (AIS). METHODS Major databases were searched for studies which reported clinical outcomes regarding successful or complete recanalization after first pass of mechanical thrombectomy in AIS. The assessment of bias was performed using different scales. I2 statistic was used to evaluate heterogeneity between reviewers. Subgroup, meta-regression, and sensitivity analyses were conducted to explore the source of heterogeneity. Visualization of funnel plots was used to evaluate publication bias. RESULTS A total of 9 studies were eligible for final analysis. For successful recanalization (mTICI 2b-3), favorable outcomes were seen in 49.7% (95% confidence interval (CI): 40.5-58.9%) and 34.7% (95% CI: 26.8-42.7%) of FPE and MPE patients, respectively. Mortality at 3 months was 13.8% (95% CI: 10.8-16.9%) and 26.0% (95% CI: 17.7-34.2%), respectively. For complete recanalization (mTICI 2c-3), proportion of favorable outcomes were 62.7% (95% CI: 51.2-74.2%) and 47.7% (95% CI: 37.4-58.0%) in FPE and MPE; mortality was seen in 11.5% (95% CI: 4.9-18.2%) and 17.0% (95% CI: 5.2-28.7%), respectively. For AIS with successful recanalization, FPE had more favorable outcome (odds ratio (OR): 1.85, 95% CI: 1.48-2.30; p < 0.01; I2 = 0%) and lower mortality than MPE (OR: 0.58, 95% CI: 0.42-0.79; p = 0.001; I2 = 61.9%). Similar results were seen in a subgroup analysis of patients with complete recanalization, with FPE having better outcome (OR: 1.79, 95% CI: 1.40-2.28; p < 0.01; I2 = 0%) and lower mortality risk (OR: 0.61, 95% CI: 0.44-0.86; p = 0.005; I2 = 0%) compared to MPE. CONCLUSION FPE is associated with better outcomes than MPE after achieving successful or complete recanalization.
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Affiliation(s)
- Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yinhang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China
| | - Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. .,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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17
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Hafeez MU, Kan P, Srivatsan A, Moore S, Jafari M, DeLaGarza C, Hafeez K, Nascimento FA, Srinivasan VM, Burkhardt JK, Chen S, Johnson J, Saleem Y. Comparison of First-Pass Efficacy Among Four Mechanical Thrombectomy Techniques: A Single-Center Experience. World Neurosurg 2020; 144:e533-e540. [PMID: 32891839 DOI: 10.1016/j.wneu.2020.08.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/29/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND First-pass efficacy (FPE) is an established marker of technical and clinical efficacy among mechanical thrombectomy (MT) techniques. It is unclear what the optimal approach is in achieving FPE. We present a single-center experience comparing rates of FPE among 2 MT techniques and evaluate the potential predictors of FPE among other outcomes. METHODS A single-center retrospective analysis was carried out of patients with consecutive large-vessel occlusion strokes (LVOS) of anterior circulation from September 2015 to April 2019 who underwent MT and for whom data were available on the status of FPE. Four MT techniques were identified: ADAPT (a direct first-pass aspiration), SrADAPT (stent retriever with aspiration), SRBG (stent retriever with balloon guide catheter), and STRAP (stent retriever-aspiration and proximal flow arrest). The primary outcome was FPE and secondary outcomes included the rate of successful reperfusion. RESULTS Among 226 patients with LVOS of the anterior circulation who underwent MT, data were available for 164 on FPE for the 4 MT techniques. SRBG was the most prevalent technique. No significant difference was found in rates of FPE among the 4 MT techniques (P = 0.332). No independent predictors of FPE were identified on multivariable analysis. STRAP had the highest rate of successful reperfusion compared with the other techniques (P = 0.049) and was the only independent predictor of that outcome (P = 0.027). CONCLUSIONS Among patients with LVOS of the anterior circulation, the rate of FPE did not differ among the 4 MT techniques. There were no predictors of FPE among the studied variables. STRAP was the only predictor of successful reperfusion.
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Affiliation(s)
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aditya Srivatsan
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Shawn Moore
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Mostafa Jafari
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Carlos DeLaGarza
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Komal Hafeez
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Fabio A Nascimento
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jan-Karl Burkhardt
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen Chen
- Department of Interventional Neuroradiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Yasir Saleem
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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18
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Velasco Gonzalez A, Görlich D, Buerke B, Münnich N, Sauerland C, Rusche T, Faldum A, Heindel W. Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis. Transl Stroke Res 2020; 11:900-909. [PMID: 32447614 PMCID: PMC7496051 DOI: 10.1007/s12975-020-00784-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient’s anatomy to enhance effectivity.
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Affiliation(s)
- Aglaé Velasco Gonzalez
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Boris Buerke
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Nico Münnich
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Thilo Rusche
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
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19
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Mokin M, Primiani CT, Castonguay AC, Nogueira RG, Haussen DC, English JD, Satti SR, Chen J, Farid H, Borders C, Veznedaroglu E, Binning MJ, Puri A, Vora NA, Budzik RF, Dabus G, Linfante I, Janardhan V, Alshekhlee A, Abraham MG, Edgell R, Taqi MA, Khoury RE, Majjhoo AQ, Kabbani MR, Froehler MT, Finch I, Ansari SA, Novakovic R, Nguyen TN, Zaidat OO. First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis. Front Neurol 2020; 11:83. [PMID: 32132966 PMCID: PMC7040359 DOI: 10.3389/fneur.2020.00083] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objective: The first pass effect (FPE; achieving complete recanalization with a single thrombectomy device pass) has been shown to be associated with higher rates of good clinical outcomes in patients with acute ischemic stroke. Here, we investigate clinical and radiographic factors associated with FPE in a large U.S. post-marketing registry (TRACK, Trevo Stent-Retriever Acute Stroke). Methods: We analyzed the TRACK database (multicenter registry of 634 patients from 23 centers from March 2013 through August 2015), which 609 patients were included in the final analysis. FPE was defined as a single pass/use of device, TICI 2c/3 recanalization, and no use of rescue therapy. Analysis of individual patient data from TRACK were performed to analyze clinical and radiographic characteristics associated with FPE as well-compared clinical outcomes defined as modified Rankin Scale (mRS) score at 30 and 90 days from hospital discharge to the non-FPE group. Results: The rate of FPE in TRACK was 23% (140/609). There was no association between patient demographics and FPE, including age (p = 0.36), sex (p = 0.50), race (p = 0.50), location of occlusion (p = 0.26), baseline NIHSS (p = 0.62), or past medical history. There was no difference in the use of a balloon-guide catheter or general anesthesia (49 and 57% with FPE vs. 47 and 64%, p = 0.63 and p = 0.14, respectively). Clinical outcomes were significantly associated with FPE; 63 vs. 44% in non-FPE patients achieved mRS 0–2 at 90 days (p = 0.0004). Conclusion: Our study showed that achieving complete recanalization with a single thrombectomy pass using the Trevo device was highly beneficial. The most common clinical factors that are used to determine eligibility for endovascular therapy, such as NIHSS severity, location of occlusion or patient age were not predictive of the ability to achieve FPE.
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Affiliation(s)
- Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Christopher T Primiani
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | | | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Joey D English
- Department of Neurology, California Pacific Medical Center, San Francisco, CA, United States
| | - Sudhakar R Satti
- Department of Neurointerventional Surgery, Christiana Care Health Center, Newark, DE, United States
| | - Jennifer Chen
- Department of Radiology, Sidney Kimmel Medical College, Philadelphia, PA, United States
| | - Hamed Farid
- Department of Neurointerventional Radiology, St. Jude Medical Center, Fullerton, CA, United States
| | - Candace Borders
- Department of Neurosurgery, Irvine School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Erol Veznedaroglu
- Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, United States
| | - Mandy J Binning
- Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, United States
| | - Ajit Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nirav A Vora
- Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, OH, United States
| | - Ron F Budzik
- Department of Radiology, Riverside Radiology and Interventional Associates, Columbus, OH, United States
| | - Guilherme Dabus
- Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL, United States
| | - Italo Linfante
- Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL, United States
| | - Vallabh Janardhan
- Comprehensive Stroke Program and Neurointerventional, Texas Stroke Institute, Plano, TX, United States
| | - Amer Alshekhlee
- Department of Vascular and Interventional Neurology, DePaul Stroke Center-SSM Neuroscience Institutes, St. Louis, MO, United States
| | - Michael G Abraham
- Neurology and Interventional Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Randall Edgell
- Department of Neurology, St. Louis University, St. Louis, MO, United States
| | - Muhammad Asif Taqi
- Department of Neurology and Neurosurgery, Los Robles Hospital and Medical Center, Thousand Oaks, CA, United States
| | - Ramy El Khoury
- Department of Neurology, Tulane University, New Orleans, LA, United States
| | - Aniel Q Majjhoo
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States
| | - Mouhammed R Kabbani
- Department of Neurosurgery, Gundersen Health System, La Crosse, WI, United States
| | - Michael T Froehler
- Department of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ira Finch
- Interventional Radiology, John Muir Health, Walnut Creek, CA, United States
| | - Sameer A Ansari
- Department of Radiology, Neurology, and Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Roberta Novakovic
- Department of Radiology, Neurology, and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, United States
| | - Osama O Zaidat
- Department of Endovascular Neurosurgery and Stroke, St. Vincent Mercy Medical Center, Toledo, OH, United States
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