Yongjie Bai1,2, Jie Pu3, Huaiming Wang4,5, Dong Yang4, Yonggang Hao6, Haowen Xu7, Meng Zhang8, Yu Geng9, Yue Wan10, Wei Wang11, Hao Zhang12, Wenjie Zi13, Xinfeng Liu1,4, Gelin Xu14,15. 1. Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China. 2. Department of Neurology, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 471003, China. 3. Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China. 4. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China. 5. Department of Neurology, 89th Hospital of People's Liberation Army, Weifang, Shandong, China. 6. Department of Emergency Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. 7. Department of Intervention Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 8. Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China. 9. Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China. 10. Department of Neurology, Hubei Zhongshan Hospital, Wuhan, Hubei, China. 11. Department of Radiology, First People's Hospital of Yangzhou, Yangzhou University, Yangzhou, Jiangsu, China. 12. Department of Neurology, First People's Hospital of Hangzhou, Nanjing Medical University, Hangzhou, 310006, Zhejiang, China. 13. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China. ziwenjie1981@163.com. 14. Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China. gelinxu@nju.edu.cn. 15. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China. gelinxu@nju.edu.cn.
Abstract
BACKGROUND AND PURPOSE: In patients with acute ischemic stroke treated with thrombectomy, additional retriever passes may increase the likelihood of recanalization, but also the risk of intracranial hemorrhage. This multicenter retrospective register study aimed to evaluate the impact of retriever passes on treatment efficacy and safety outcomes in patients treated with mechanical thrombectomy. MATERIALS AND METHODS: Patients with ischemic stroke due to large artery occlusion in anterior circulation and treated with mechanical thrombectomy were enrolled. The primary efficacy outcome was a favorable functional outcome defined as modified Rankin Scale score of 0-2 at 90 days. Major safety outcome was symptomatic intracranial hemorrhage (SICH) and mortality. Multivariate logistic regression was used to analyze the impact of retriever passes on efficacy and safety outcomes. RESULTS: Of the 472 enrolled patients, the likelihood of favorable outcome declined in patients with more than three retriever passes (44.4% in patients with three passes, 26.3% with four passes, 14.8% with five or more passes). Multivariate logistic regression analysis identified three or less passes as an independent predictor for favorable functional outcomes (OR 2.44, 95% CI 1.10-5.45, P = 0.029). More than three passes was associated with an increased risk of SICH (OR 2.24, 95% CI 1.16-4.33, P = 0.016). CONCLUSIONS: More than three retriever passes may increase the rate of recanalization, but not the likelihood of favorable functional outcomes in ischemic stroke patients treated with mechanical thrombectomy. Notably, multiple retriever passes may also increase the risk of intracranial hemorrhage. EVIDENCE-BASED MEDICINE: Level of Evidence: Level 4, Case Series.
BACKGROUND AND PURPOSE: In patients with acute ischemic stroke treated with thrombectomy, additional retriever passes may increase the likelihood of recanalization, but also the risk of intracranial hemorrhage. This multicenter retrospective register study aimed to evaluate the impact of retriever passes on treatment efficacy and safety outcomes in patients treated with mechanical thrombectomy. MATERIALS AND METHODS:Patients with ischemic stroke due to large artery occlusion in anterior circulation and treated with mechanical thrombectomy were enrolled. The primary efficacy outcome was a favorable functional outcome defined as modified Rankin Scale score of 0-2 at 90 days. Major safety outcome was symptomatic intracranial hemorrhage (SICH) and mortality. Multivariate logistic regression was used to analyze the impact of retriever passes on efficacy and safety outcomes. RESULTS: Of the 472 enrolled patients, the likelihood of favorable outcome declined in patients with more than three retriever passes (44.4% in patients with three passes, 26.3% with four passes, 14.8% with five or more passes). Multivariate logistic regression analysis identified three or less passes as an independent predictor for favorable functional outcomes (OR 2.44, 95% CI 1.10-5.45, P = 0.029). More than three passes was associated with an increased risk of SICH (OR 2.24, 95% CI 1.16-4.33, P = 0.016). CONCLUSIONS: More than three retriever passes may increase the rate of recanalization, but not the likelihood of favorable functional outcomes in ischemic strokepatients treated with mechanical thrombectomy. Notably, multiple retriever passes may also increase the risk of intracranial hemorrhage. EVIDENCE-BASED MEDICINE: Level of Evidence: Level 4, Case Series.
Authors: Mehdi Abbasi; Peter Kvamme; Kennith F Layton; Ricardo A Hanel; Mohammed A Almekhlafi; Josser E Delgado; Vitor M Pereira; Biraj M Patel; Babak S Jahromi; Albert J Yoo; Raul G Nogueira; Matthew J Gounis; Seán Fitzgerald; Oana M Mereuta; Daying Dai; Ramanathan Kadirvel; David F Kallmes; Karen M Doyle; Luis E Savastano; Harry J Cloft; Yang Liu; Ike C Thacker; Amin Aghaebrahim; Eric Sauvageau; Andrew M Demchuk; Yasha Kayan; Alexander Z Copelan; John Entwistle; Pouya Nazari; Donald Robert Cantrell; Parita Bhuva; Jazba Soomro; Diogo C Haussen; Alhamza Al-Bayati; Mahmoud Mohammaden; Leonardo Pisani; Gabriel Rodrigues; Ajit S Puri; Waleed Brinjikji Journal: Interv Neuroradiol Date: 2021-04-07 Impact factor: 1.610
Authors: Fabian Flottmann; Caspar Brekenfeld; Gabriel Broocks; Hannes Leischner; Rosalie McDonough; Tobias D Faizy; Milani Deb-Chatterji; Anna Alegiani; Götz Thomalla; Anastasios Mpotsaris; Christian H Nolte; Jens Fiehler; Máté E Maros Journal: Stroke Date: 2021-01-20 Impact factor: 7.914
Authors: Eva González Diaz; Carlos Rodríguez-Paz; Andres Fernandez-Prieto; Mario Martínez-Galdámez; Rosa Martínez-Moreno; Joaquín Ortega Quintanilla; Alejandro Tomasello; Joaquín Zamarro; David Liebeskind; Osama O Zaidat; Nils H Mueller-Kronast Journal: BMJ Open Date: 2022-09-01 Impact factor: 3.006
Authors: F Flottmann; N van Horn; M E Maros; H Leischner; M Bechstein; L Meyer; M Sauer; M Deb-Chatterji; A Alegiani; G Thomalla; J Fiehler; C Brekenfeld Journal: Clin Neuroradiol Date: 2021-07-08 Impact factor: 3.156
Authors: F Flottmann; N van Horn; M E Maros; R McDonough; M Deb-Chatterji; A Alegiani; G Thomalla; U Hanning; J Fiehler; C Brekenfeld Journal: Clin Neuroradiol Date: 2021-06-30 Impact factor: 3.156