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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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| Published in: | Clinical neurology and neurosurgery 2021-09, Vol.208, p.106780-106780, Article 106780 |
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| container_title | Clinical neurology and neurosurgery |
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| creator | Kosty, Jennifer A. Carroll, Christopher P. Kandregula, Sandeep Plummer, Zachary Grossman, Aaron W. Abruzzo, Todd A. Dossani, Rimal H. Ringer, Andrew J. |
| description | 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 |
| doi_str_mv | 10.1016/j.clineuro.2021.106780 |
| format | article |
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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 < 0.001). Using multiple cut-off points, higher post-procedural NIHSS scores, mortality rates, and unfavorable 90-day outcomes were associated with a greater number of passes. Multivariate analysis revealed ICA thrombus (comparison: M2, OR: 25, 95% CI 2–275, p = 0.01) and failed revascularization (OR: 68, 95% CI 3.12–1489, p = 0.01) as the only significant predictors of unfavorable clinical outcome. Nonetheless, the likelihood of favorable clinical outcome was higher in patients with an ICA occlusion who were revascularized in < 2 vs. ≥ 2 (44 vs 4%, p = 0.01) or < 3 vs. ≥ 3 (32 vs. 0%, p = 0.02) passes.
The likelihood of angiographic improvement in patients with ELVO significantly decreases after the second pass. A greater number of passes is associated with worsened clinical outcomes.
•We characterized the cumulative efficacy and safety of repetitive device passes in patients undergoing thrombectomy for ELVO.•The likelihood of angiographic improvement is the greatest in the first two device passes.•Multiple passes were not an independent risk factor for poor 30 day functional outcome.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2021.106780</identifier><identifier>PMID: 34365239</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>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</subject><ispartof>Clinical neurology and neurosurgery, 2021-09, Vol.208, p.106780-106780, Article 106780</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><rights>2021. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-2a94ce9ad518cbe70d5c9deb51dffa04104e9067d6ca39797af5d70f9a716003</citedby><cites>FETCH-LOGICAL-c396t-2a94ce9ad518cbe70d5c9deb51dffa04104e9067d6ca39797af5d70f9a716003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34365239$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kosty, Jennifer A.</creatorcontrib><creatorcontrib>Carroll, Christopher P.</creatorcontrib><creatorcontrib>Kandregula, Sandeep</creatorcontrib><creatorcontrib>Plummer, Zachary</creatorcontrib><creatorcontrib>Grossman, Aaron W.</creatorcontrib><creatorcontrib>Abruzzo, Todd A.</creatorcontrib><creatorcontrib>Dossani, Rimal H.</creatorcontrib><creatorcontrib>Ringer, Andrew J.</creatorcontrib><title>Diminishing returns with successive device passes in mechanical thrombectomy for stroke</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>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 < 0.001). Using multiple cut-off points, higher post-procedural NIHSS scores, mortality rates, and unfavorable 90-day outcomes were associated with a greater number of passes. Multivariate analysis revealed ICA thrombus (comparison: M2, OR: 25, 95% CI 2–275, p = 0.01) and failed revascularization (OR: 68, 95% CI 3.12–1489, p = 0.01) as the only significant predictors of unfavorable clinical outcome. Nonetheless, the likelihood of favorable clinical outcome was higher in patients with an ICA occlusion who were revascularized in < 2 vs. ≥ 2 (44 vs 4%, p = 0.01) or < 3 vs. ≥ 3 (32 vs. 0%, p = 0.02) passes.
The likelihood of angiographic improvement in patients with ELVO significantly decreases after the second pass. A greater number of passes is associated with worsened clinical outcomes.
•We characterized the cumulative efficacy and safety of repetitive device passes in patients undergoing thrombectomy for ELVO.•The likelihood of angiographic improvement is the greatest in the first two device passes.•Multiple passes were not an independent risk factor for poor 30 day functional outcome.</description><subject>Acute ischemic stroke</subject><subject>ADAPT</subject><subject>Aged</subject><subject>Angioplasty</subject><subject>Brain - diagnostic imaging</subject><subject>Cardiovascular disease</subject><subject>Cerebral blood flow</subject><subject>Cerebral infarction</subject><subject>Clinical outcomes</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Large vessel occlusion</subject><subject>Male</subject><subject>Mechanical thrombectomy</subject><subject>Medical imaging</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Neurology</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Revascularization</subject><subject>Risk factors</subject><subject>Stroke</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - surgery</subject><subject>Thrombectomy</subject><subject>Thrombolysis</subject><subject>Thrombolysis in cerebral infarction</subject><subject>Thrombosis</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkE1P4zAQhi3ECgrLX0CWuHBJ144TO76BYBdWQtpLpT1arj2hLklcPEkR_x5XBQ5cOI00eubjfQg552zOGZe_1nPXhQGmFOclK3luStWwAzLjjSoLqWVzSGZMMFE0lVTH5ARxzRgTQjZH5FhUQtal0DPy_zb0YQi4CsMjTTBOaUD6EsYVxck5QAxboB62wQHdWERAGgbag1vZITjb0XGVYr8EN8b-lbYxURxTfIKf5EdrO4Sz93pKFn9-L27ui4d_d39vrh8KJ7Qci9LqyoG2vuaNW4Jivnbaw7Lmvm0tqzirQOdoXjortNLKtrVXrNVWcZnjnJLL_dpNis8T4Gj6gA66zg4QJzRlXWupWFXzjF58Qdcxp83PZSojoim1yJTcUy5FxASt2aTQ2_RqODM782ZtPsybnXmzN58Hz9_XT8se_OfYh-oMXO0ByDq2AZJBF2Bw4EPK-oyP4bsbb7uEmTg</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Kosty, Jennifer A.</creator><creator>Carroll, Christopher P.</creator><creator>Kandregula, Sandeep</creator><creator>Plummer, Zachary</creator><creator>Grossman, Aaron W.</creator><creator>Abruzzo, Todd A.</creator><creator>Dossani, Rimal H.</creator><creator>Ringer, Andrew J.</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202109</creationdate><title>Diminishing returns with successive device passes in mechanical thrombectomy for stroke</title><author>Kosty, Jennifer A. ; 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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 < 0.001). Using multiple cut-off points, higher post-procedural NIHSS scores, mortality rates, and unfavorable 90-day outcomes were associated with a greater number of passes. Multivariate analysis revealed ICA thrombus (comparison: M2, OR: 25, 95% CI 2–275, p = 0.01) and failed revascularization (OR: 68, 95% CI 3.12–1489, p = 0.01) as the only significant predictors of unfavorable clinical outcome. Nonetheless, the likelihood of favorable clinical outcome was higher in patients with an ICA occlusion who were revascularized in < 2 vs. ≥ 2 (44 vs 4%, p = 0.01) or < 3 vs. ≥ 3 (32 vs. 0%, p = 0.02) passes.
The likelihood of angiographic improvement in patients with ELVO significantly decreases after the second pass. A greater number of passes is associated with worsened clinical outcomes.
•We characterized the cumulative efficacy and safety of repetitive device passes in patients undergoing thrombectomy for ELVO.•The likelihood of angiographic improvement is the greatest in the first two device passes.•Multiple passes were not an independent risk factor for poor 30 day functional outcome.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>34365239</pmid><doi>10.1016/j.clineuro.2021.106780</doi><tpages>1</tpages></addata></record> |
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| source | ScienceDirect Freedom Collection 2022-2024 |
| 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 |
| title | Diminishing returns with successive device passes in mechanical thrombectomy for stroke |
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