D O'Neill1, E Griffin2,3, K M Doyle4, S Power1, P Brennan1, M Sheehan1, A O'Hare1, S Looby1, A M da Silva Santos4, R Rossi4, J Thornton1,3. 1. From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland. 2. From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland emma.griffin.2@ucdconnect.ie. 3. Royal College of Surgeons (E.G., J.T.), Dublin, Ireland. 4. Department of Physiology (K.M.D., A.M.d.S.S., R.R.), School of Medicine, National University of Ireland, Galway, Ireland.
Abstract
BACKGROUND AND PURPOSE: Direct aspiration is a recognized technique for revascularization in large-vessel ischemic strokes. There is ongoing debate regarding its efficacy compared with stent retrievers. Every delay in achieving revascularization and a decrease in reperfusion rates reduces the likelihood of patients achieving functional independence. We propose a standardized setup technique for aspiration-first for all anterior circulation thrombectomy procedures for increasing speed and recanalization rates. MATERIALS AND METHODS: We analyzed 127 consecutive patients treated by a standardized approach to thrombectomy with an intention to perform aspiration-first compared with 127 consecutive patients treated with a stent retriever-first approach. Key time metrics evaluated included groin to first angiogram, first angiogram to reperfusion, groin to first reperfusion, and length of the procedure. The degree of successful recanalization (TICI 2b-3) and the number of passes were compared between the 2 groups. RESULTS: In 127 patients who underwent the standardized technique, the median time from groin puncture to first reperfusion was 18 minutes compared with 26 minutes (P < .001). The duration of the procedure was shorter compared with the stent retriever group (26 minutes in the aspiration first group versus 47 minutes, P < .001) and required fewer passes (mean, 2.4 versus 3.1; P < .05). A higher proportion of patients had a TICI score of 2b-3 in the aspiration-first group compared with stent retriever group (96.1% versus 85.8%, P < .005). CONCLUSIONS: Our study highlights the increasing speed and recanalization rates achieved with fewer passes in a standardized approach to thrombectomy with an intention to attempt aspiration-first. Any attempt to reduce revascularization time and increase successful recanalization should be used.
BACKGROUND AND PURPOSE: Direct aspiration is a recognized technique for revascularization in large-vessel ischemic strokes. There is ongoing debate regarding its efficacy compared with stent retrievers. Every delay in achieving revascularization and a decrease in reperfusion rates reduces the likelihood of patients achieving functional independence. We propose a standardized setup technique for aspiration-first for all anterior circulation thrombectomy procedures for increasing speed and recanalization rates. MATERIALS AND METHODS: We analyzed 127 consecutive patients treated by a standardized approach to thrombectomy with an intention to perform aspiration-first compared with 127 consecutive patients treated with a stent retriever-first approach. Key time metrics evaluated included groin to first angiogram, first angiogram to reperfusion, groin to first reperfusion, and length of the procedure. The degree of successful recanalization (TICI 2b-3) and the number of passes were compared between the 2 groups. RESULTS: In 127 patients who underwent the standardized technique, the median time from groin puncture to first reperfusion was 18 minutes compared with 26 minutes (P < .001). The duration of the procedure was shorter compared with the stent retriever group (26 minutes in the aspiration first group versus 47 minutes, P < .001) and required fewer passes (mean, 2.4 versus 3.1; P < .05). A higher proportion of patients had a TICI score of 2b-3 in the aspiration-first group compared with stent retriever group (96.1% versus 85.8%, P < .005). CONCLUSIONS: Our study highlights the increasing speed and recanalization rates achieved with fewer passes in a standardized approach to thrombectomy with an intention to attempt aspiration-first. Any attempt to reduce revascularization time and increase successful recanalization should be used.
Authors: Volker Maus; Daniel Behme; Christoph Kabbasch; Jan Borggrefe; Ioannis Tsogkas; Omid Nikoubashman; Martin Wiesmann; Michael Knauth; Anastasios Mpotsaris; Marios Nikos Psychogios Journal: Clin Neuroradiol Date: 2017-02-13 Impact factor: 3.649
Authors: Aquilla S Turk; Raymond Turner; Alejandro Spiotta; Jan Vargas; Christine Holmstedt; Shelly Ozark; Julio Chalela; Tanya Turan; Robert Adams; Edward C Jauch; Holly Battenhouse; Brian Whitsitt; Matt Wain; M Imran Chaudry Journal: J Neurointerv Surg Date: 2014-07-15 Impact factor: 5.836
Authors: Christian Maegerlein; Maria Teresa Berndt; Sebastian Mönch; Kornelia Kreiser; Tobias Boeckh-Behrens; Manuel Lehm; Silke Wunderlich; Claus Zimmer; Benjamin Friedrich Journal: Clin Neuroradiol Date: 2018-11-09 Impact factor: 3.649
Authors: Mayank Goyal; Bijoy K Menon; Wim H van Zwam; Diederik W J Dippel; Peter J Mitchell; Andrew M Demchuk; Antoni Dávalos; Charles B L M Majoie; Aad van der Lugt; Maria A de Miquel; Geoffrey A Donnan; Yvo B W E M Roos; Alain Bonafe; Reza Jahan; Hans-Christoph Diener; Lucie A van den Berg; Elad I Levy; Olvert A Berkhemer; Vitor M Pereira; Jeremy Rempel; Mònica Millán; Stephen M Davis; Daniel Roy; John Thornton; Luis San Román; Marc Ribó; Debbie Beumer; Bruce Stouch; Scott Brown; Bruce C V Campbell; Robert J van Oostenbrugge; Jeffrey L Saver; Michael D Hill; Tudor G Jovin Journal: Lancet Date: 2016-02-18 Impact factor: 79.321
Authors: P F Xing; P F Yang; Z F Li; L Zhang; H J Shen; Y X Zhang; Y W Zhang; J M Liu Journal: AJNR Am J Neuroradiol Date: 2020-02-13 Impact factor: 3.825
Authors: Roisin M O'Cearbhaill; J Alderson; S Power; D B Herlihy; P Brennan; A O'Hare; J Thornton Journal: Interv Neuroradiol Date: 2021-06-14 Impact factor: 1.764
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