Recanalization Rate per Retrieval Attempt in Mechanical Thrombectomy for Acute Ischemic Stroke

BACKGROUND AND PURPOSE—In acute ischemic stroke, mechanical thrombectomy allows flow restoration in the majority of cases. In case of an unsuccessful retrieval, little is known about how many retrieval attempts should be performed before stopping the procedure. This study assessed the recanalization...

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Published in:Stroke (1970) 2018-10, Vol.49 (10), p.2523-2525
Main Authors: Flottmann, Fabian, Leischner, Hannes, Broocks, Gabriel, Nawabi, Jawed, Bernhardt, Martina, Faizy, Tobias Djamsched, Deb-Chatterji, Milani, Thomalla, Götz, Fiehler, Jens, Brekenfeld, Caspar
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Brain Ischemia - etiology
Brain Ischemia - surgery
Cerebral Infarction - etiology
Cerebral Infarction - surgery
Female
Humans
Ischemia - surgery
Male
Middle Aged
Stents - adverse effects
Stroke - surgery
Thrombectomy - methods
Treatment Outcome
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Summary:BACKGROUND AND PURPOSE—In acute ischemic stroke, mechanical thrombectomy allows flow restoration in the majority of cases. In case of an unsuccessful retrieval, little is known about how many retrieval attempts should be performed before stopping the procedure. This study assessed the recanalization rate and clinical outcome per retrieval maneuver. METHODS—In this analysis, 330 patients with acute large vessel occlusion treated exclusively with stentrieval devices were included. Successful recanalization was defined as Thrombolysis in Cerebral Infarction 2b-3, a good clinical outcome was defined as modified Rankin Scale at 90 days of ≤2. RESULTS—The median number of retrieval attempts was 1 (interquartile range, 1–2, maximum 8). Recanalization rates per retrieval attempt were highest for the first retrieval (46.8%) and lowest for the fifth retrieval (22.7%). After 3 retrieval attempts, 67.9% of patients were successfully recanalized. Patients with 1 to 3 retrieval attempts had higher rates of good clinical outcome (28.9% versus 7.4%; P=0.018). The number of passes was an independent negative predictor of good clinical outcome (adjusted odds ratio, 0.65; 95% CI, 0.435–0.970; P=0.035). CONCLUSIONS—Two-thirds of occlusions were successfully recanalized with up to 3 retrieval attempts. Further attempts had good recanalization rates, but the rate of favorable clinical outcome did not improve.
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.118.022737