Petra Cimflova1,2,3,4, Nishita Singh1, Johanna M Ospel1,5, Martha Marko1,6, Nima Kashani1,7, Arnuv Mayank1, Ricardo Hanel8, Diogo C Haussen9, Aditya Bharatha10,11, David Volders12, Manraj K S Heran13, Alexandre Y Poppe14, Brian van Adel15, Bijoy K Menon1,7,16,17, Manish Joshi7, Andrew Demchuk1,7,16, Ryan McTaggart18, Raul G Nogueira9, Jeremy L Rempel19, Charlotte Zerna1,17, Michael Tymianski20, Michael D Hill1,7,16,17, Mayank Goyal1,7,16, Mohammed A Almekhlafi21,22,23,24,25. 1. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. 2. Department of Medical Imaging, St. Anne's University Hospital Brno, Brno, Czech Republic. 3. International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic. 4. Faculty of Medicine, Masaryk University, Brno, Czech Republic. 5. Department of Radiology, University Hospital of Basel, Basel, Switzerland. 6. Department of Neurology, Medical University of Vienna, Vienna, Austria. 7. Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada. 8. Stroke and Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, FL, USA. 9. Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital/Emory University, Atlanta, GA, USA. 10. Divisions of Neuroradiology and Neurosurgery, St Michael's Hospital, Toronto, Canada. 11. Department of Medical Imaging, University of Toronto, Toronto, Canada. 12. Department of Radiology, Dalhousie University, Halifax, NS, Canada. 13. Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada. 14. Centre Hospitalier de l'Université de Montréal, Montreal, Canada. 15. Departments of Surgery and Medicine, Division of Neurology, Neurosurgery and Diagnostic Imaging, McMaster University, Hamilton, Ontario, Canada. 16. Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada. 17. Departement of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. 18. Warren Alpert School of Medicine, Brown University, Providence, RI, USA. 19. University of Alberta Hospital, Edmonton, AB, Canada. 20. NoNO, Toronto, ON, Canada. 21. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. mohammed.almekhlafi1@ucalgary.ca. 22. Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada. mohammed.almekhlafi1@ucalgary.ca. 23. Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada. mohammed.almekhlafi1@ucalgary.ca. 24. Departement of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. mohammed.almekhlafi1@ucalgary.ca. 25. Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada. mohammed.almekhlafi1@ucalgary.ca.
Abstract
BACKGROUND: Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial. METHODS: Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b-3 per attempt. The secondary outcome was successful reperfusion eTICI 2b-3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built. RESULTS: Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24-3.40 and OR 1.92; 95% CI: 1.16-3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07-2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47-5.35 and OR 2.05; 95% CI: 1.09-3.84, respectively) was associated with first-pass eTICI 2b-3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b-3 reperfusion (OR 1.95; 95% CI: 1.10-3.46). CONCLUSION: The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.
BACKGROUND: Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial. METHODS: Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b-3 per attempt. The secondary outcome was successful reperfusion eTICI 2b-3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built. RESULTS: Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24-3.40 and OR 1.92; 95% CI: 1.16-3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07-2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47-5.35 and OR 2.05; 95% CI: 1.09-3.84, respectively) was associated with first-pass eTICI 2b-3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b-3 reperfusion (OR 1.95; 95% CI: 1.10-3.46). CONCLUSION: The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.
Authors: N F Belachew; T Dobrocky; T R Meinel; A Hakim; J Vynckier; M Arnold; D J Seiffge; R Wiest; E I Piechowiak; U Fischer; J Gralla; P Mordasini; J Kaesmacher Journal: AJNR Am J Neuroradiol Date: 2021-10-14 Impact factor: 3.825
Authors: John M Pederson; Natalie L Reierson; Nicole Hardy; Jillienne C Touchette; Sammy Medam; Averi Barrett; Megan Schmidt; Waleed Brinjikji; David F Kallmes; Kevin M Kallmes Journal: World Neurosurg Date: 2021-07-16 Impact factor: 2.104