Diminishing returns with successive device passes in mechanical thrombectomy for stroke

Multiple device passes are associated with complications and poor functional outcomes following mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO). To characterize the relationship between number of device passes, complications, angiographic outcomes, and clinical outcomes in MT...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2021-09, Vol.208, p.106780-106780, Article 106780
Main Authors: Kosty, Jennifer A., Carroll, Christopher P., Kandregula, Sandeep, Plummer, Zachary, Grossman, Aaron W., Abruzzo, Todd A., Dossani, Rimal H., Ringer, Andrew J.
Format: Article
Language:English
Subjects:
Acute ischemic stroke
ADAPT
Aged
Angioplasty
Brain - diagnostic imaging
Cardiovascular disease
Cerebral blood flow
Cerebral infarction
Clinical outcomes
Female
Humans
Ischemia
Large vessel occlusion
Male
Mechanical thrombectomy
Medical imaging
Medical records
Middle Aged
Mortality
Multivariate analysis
Neurology
Patients
Regression analysis
Retrospective Studies
Revascularization
Risk factors
Stroke
Stroke - diagnostic imaging
Stroke - surgery
Thrombectomy
Thrombolysis
Thrombolysis in cerebral infarction
Thrombosis
Tomography, X-Ray Computed
Treatment Outcome
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Summary:Multiple device passes are associated with complications and poor functional outcomes following mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO). To characterize the relationship between number of device passes, complications, angiographic outcomes, and clinical outcomes in MT for ELVO. This is a single-center, retrospective cohort study. Individual device passes for MT were evaluated for any change in Thrombolysis in Cerebral Infarction (TICI) score, successful revascularization (TICI 2b or 3), and complications. Outcomes were compared among groups requiring multiple passes with various cut-off points. Risk factors for unfavorable clinical outcome [90 day modified Rankin Scale > 2] were assessed using multivariate analysis. Successful revascularization was achieved in 75% of 163 patients and 36% required only one device pass. After the second pass, the likelihood of angiographic improvement significantly decreased (p 
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2021.106780