INTRODUCTION: In acute ischemic stroke (AIS), extending mechanical thrombectomy procedural times beyond 60 min has previously been associated with an increased complication rate and poorer outcomes. OBJECTIVE: After improvements in thrombectomy methods, to reassess whether this relationship holds true with a more contemporary thrombectomy approach: a direct aspiration first pass technique (ADAPT). METHODS: We retrospectively studied a database of patients with AIS who underwent ADAPT thrombectomy for large vessel occlusions. Patients were dichotomized into two groups: 'early recan', in which recanalization (recan) was achieved in ≤35 min, and 'late recan', in which procedures extended beyond 35 min. RESULTS: 197 patients (47.7% women, mean age 66.3 years) were identified. We determined that after 35 min, a poor outcome was more likely than a good (modified Rankin Scale (mRS) score 0-2) outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score was similar between 'early recan' (n=122) (14.7±6.9) and 'late recan' patients (n=75) (15.9±7.2). Among 'early recan' patients, recanalization was achieved in 17.8±8.8 min compared with 70±39.8 min in 'late recan' patients. The likelihood of achieving a good outcome was higher in the 'early recan' group (65.2%) than in the 'late recan' group (38.2%; p<0.001). Patients in the 'late recan' group had a higher likelihood of postprocedural hemorrhage, specifically parenchymal hematoma type 2, than those in the 'early recan' group. Logistic regression analysis showed that baseline NIHSS, recanalization time, and atrial fibrillation had a significant impact on 90-day outcomes. CONCLUSIONS: Our findings suggest that extending ADAPT thrombectomy procedure times beyond 35 min increases the likelihood of complications such as intracerebral hemorrhage while reducing the likelihood of a good outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
INTRODUCTION: In acute ischemic stroke (AIS), extending mechanical thrombectomy procedural times beyond 60 min has previously been associated with an increased complication rate and poorer outcomes. OBJECTIVE: After improvements in thrombectomy methods, to reassess whether this relationship holds true with a more contemporary thrombectomy approach: a direct aspiration first pass technique (ADAPT). METHODS: We retrospectively studied a database of patients with AIS who underwent ADAPT thrombectomy for large vessel occlusions. Patients were dichotomized into two groups: 'early recan', in which recanalization (recan) was achieved in ≤35 min, and 'late recan', in which procedures extended beyond 35 min. RESULTS: 197 patients (47.7% women, mean age 66.3 years) were identified. We determined that after 35 min, a poor outcome was more likely than a good (modified Rankin Scale (mRS) score 0-2) outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score was similar between 'early recan' (n=122) (14.7±6.9) and 'late recan' patients (n=75) (15.9±7.2). Among 'early recan' patients, recanalization was achieved in 17.8±8.8 min compared with 70±39.8 min in 'late recan' patients. The likelihood of achieving a good outcome was higher in the 'early recan' group (65.2%) than in the 'late recan' group (38.2%; p<0.001). Patients in the 'late recan' group had a higher likelihood of postprocedural hemorrhage, specifically parenchymal hematoma type 2, than those in the 'early recan' group. Logistic regression analysis showed that baseline NIHSS, recanalization time, and atrial fibrillation had a significant impact on 90-day outcomes. CONCLUSIONS: Our findings suggest that extending ADAPT thrombectomy procedure times beyond 35 min increases the likelihood of complications such as intracerebral hemorrhage while reducing the likelihood of a good outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: A P Wessell; H D P Carvalho; E Le; G Cannarsa; M J Kole; J A Stokum; T Chryssikos; T R Miller; S Chaturvedi; D Gandhi; K Yarbrough; S R Satti; G Jindal Journal: AJNR Am J Neuroradiol Date: 2020-05 Impact factor: 3.825
Authors: Maxim Mokin; Muhammad Waqas; Felix Chin; Hamid Rai; Jillian Senko; Adam Sparks; Richard W Ducharme; Michael Springer; Cesario V Borlongan; Elad I Levy; Ciprian Ionita; Adnan H Siddiqui Journal: Neuroradiology Date: 2020-08-20 Impact factor: 2.804
Authors: Georgios Tsivgoulis; Maher Saqqur; Vijay K Sharma; Alejandro Brunser; Jürgen Eggers; Robert Mikulik; Aristeidis H Katsanos; Theodore N Sergentanis; Konstantinos Vadikolias; Fabienne Perren; Marta Rubiera; Reza Bavarsad Shahripour; Huy Thang Nguyen; Patricia Martínez-Sánchez; Apostolos Safouris; Ioannis Heliopoulos; Ashfaq Shuaib; Carol Derksen; Konstantinos Voumvourakis; Theodora Psaltopoulou; Anne W Alexandrov; Andrei V Alexandrov Journal: J Stroke Date: 2020-01-31 Impact factor: 6.967
Authors: Kamil Zeleňák; Antonín Krajina; Lukas Meyer; Jens Fiehler; Daniel Behme; Deniz Bulja; Jildaz Caroff; Amar Ajay Chotai; Valerio Da Ros; Jean-Christophe Gentric; Jeremy Hofmeister; Omar Kass-Hout; Özcan Kocatürk; Jeremy Lynch; Ernesto Pearson; Ivan Vukasinovic Journal: Life (Basel) Date: 2021-05-27