Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy

被引：0

作者：

Ezzeldin, Mohamad ^{[1
,2
]}

Hukamdad, Mishaal ^{[3
]}

Kasem, Rahim Abo ^{[4
]}

Ezzeldin, Rime ^{[5
]}

Maier, Ilko ^{[6
]}

Rai, Ansaar T. ^{[7
]}

Jabbour, Pascal ^{[8
]}

Kim, Joon-Tae ^{[9
]}

Howard, Brian M. ^{[10
,11
]}

Alawieh, Ali ^{[10
]}

Wolfe, Stacey Q. ^{[12
]}

Starke, Robert M. ^{[13
]}

Psychogios, Marios-Nikos ^{[14
]}

Shaban, Amir ^{[15
]}

Goyal, Nitin ^{[16
]}

Dye, Justin ^{[17
]}

Alaraj, Ali ^{[18
]}

Yoshimura, Shinichi ^{[19
]}

Fiorella, David ^{[20
]}

Tanweer, Omar ^{[21
]}

Romano, Daniele G. ^{[22
]}

Navia, Pedro ^{[23
]}

Cuellar, Hugo ^{[24
]}

Fragata, Isabel ^{[25
]}

Polifka, Adam ^{[26
]}

Mascitelli, Justin R. ^{[27
]}

Osbun, Joshua W. ^{[28
]}

Siddiqui, Fazeel ^{[29
]}

Moss, Mark ^{[30
]}

Limaye, Kaustubh ^{[31
]}

Mokin, Maxim ^{[32
]}

Matouk, Charles ^{[33
]}

Park, Min S. ^{[34
]}

Brinjikji, Waleed ^{[35
]}

Daglioglu, Ergun ^{[36
]}

Williamson, Richard ^{[37
]}

Altschul, David J. ^{[38
]}

Ogilvy, Christopher S. ^{[39
]}

Crosa, Roberto Javier ^{[40
]}

Levitt, Michael R. ^{[41
]}

Gory, Benjamin ^{[42
]}

Grandhi, Ramesh ^{[43
]}

Paul, Alexandra R. ^{[44
]}

Kan, Peter ^{[45
]}

Casagrande, Walter ^{[46
]}

Chowdhry, Shakeel A. ^{[47
]}

Stiefel, Michael F. ^{[48
]}

Chaubal, Varun ^{[49
]}

Spiotta, Alejandro M. ^{[4
]}

机构：

[1] Univ Houston, Coll Med, Dept Clin Sci, Houston, TX 77004 USA

[2] HCA Houston Healthcare, Neuroendovasc Surg, Houston, TX 77004 USA

[3] Univ Illinois, Med, Coll Med Chicago, Chicago, IL USA

[4] Med Univ South Carolina, Neurosurg, Charleston, SC USA

[5] Jordan Univ Sci & Technol, Fac Med, Med, Irbid, Jordan

[6] Univ Med Goettingen, Neurol, Gottingen, Germany

[7] West Virginia Univ, Neuroradiol, Morgantown, WV USA

[8] Thomas Jefferson Univ, Neurol Surg, Philadelphia, PA USA

[9] Chonnam Natl Univ Hosp, Neurol, Gwangju, South Korea

[10] Emory Univ, Sch Med, Neurosurg, Atlanta, GA USA

[11] Emory Univ, Sch Med, Radiol & Imaging Sci, Atlanta, GA USA

[12] Wake Forest Sch Med, Neurosurg, Winston Salem, NC USA

[13] Univ Miami, Miller Sch Med, Neurol Surg, Miami, FL USA

[14] Univ Hosp Basel, Dept Neuroradiol, Clin Radiol & Nucl Med, Basel, Switzerland

[15] Univ Iowa, Roy J & Lucille A Carver Coll Med, Neurol, Iowa City, IA USA

[16] Semmes Murphey Neurol & Spine Inst, Neurosurg, Memphis, TN USA

[17] Loma Linda Univ Hlth, Neurosurg, Loma Linda, CA USA

[18] Univ Illinois, Neurosurg, Chicago, IL USA

[19] Hyogo Coll Med, Dept Neurosurg, Nishinomiya, Japan

[20] SUNY Stony Brook SUNY SB, New York, NY USA

[21] Baylor Coll Med, Neurosurg, Houston, TX USA

[22] Univ Hosp San Giovanni di Dio & Ruggi Daragona, Neuroradiol, Salerno, Italy

[23] Hosp Univ La Paz, Intervent & Diag Neuroradiol, Madrid, Spain

[24] Louisiana State Univ Hlth Sci Ctr LSUHSC, Neurosurg, Shreveport, LA USA

[25] Ctr Hosp Lisboa Cent, Neuroradiol, Lisbon, Portugal

[26] Univ Florida, Neurosurg, Gainesville, FL USA

[27] Univ Texas Hlth & Sci Ctr San Antonio, Dept Neurosurg, San Antonio, TX USA

[28] Washington Univ St Louis, Sch Med, Neurosurg, St Louis, MO USA

[29] Univ Michigan Hlth West, Wyoming, MI USA

[30] Washington Reg Med Ctr, Intervent Neuroradiol, Fayetteville, AR USA

[31] Indiana Univ, Neurol, Bloomington, IN USA

[32] Univ S Florida, Coll Med, Neurosurg, Tampa, FL USA

[33] Yale Univ, Neurosurg, New Haven, CT USA

[34] Univ Virginia, Neurosurg, Charlottesville, VA USA

[35] Mayo Clin Minnesota, Neuroradiol, Rochester, MN USA

[36] Ankara Bilkent City Hosp, Neurosurg, Ankara, Turkiye

[37] Allegheny Hlth Network, Neurol, Pittsburgh, PA USA

[38] Montefiore Med Ctr, Dept Neurosurg, Bronx, NY USA

[39] Beth Israel Deaconess Med Ctr BIDMC, Neurosurg, Boston, MA USA

[40] Med Uruguaya, Endovasc Neurosurg, Montevideo, Uruguay

[41] Univ Washington, Sch Med, Neurol Surg, Seattle, WA USA

[42] CHRU Nancy, Dept Diag & Intervent Neuroradiol, Nancy, France

[43] Univ Utah Hlth, Dept Neurosurg, Salt Lake City, UT USA

[44] Albany Med Coll, Dept Neurosurg, Albany, NY USA

[45] Univ Texas Med Branch Galveston, Neurosurg, Galveston, TX USA

[46] HOSP JUAN A FERNANDEZ, Neurosurg, BUENOS AIRES, Argentina

[47] NorthShore Univ Hlth Syst, Neurosurg, Evanston, IL USA

[48] Piedmont Healthcare Inc, Vasc Neurosurg, Atlanta, GA USA

[49] HCA Houston Healthcare Kingwood, Neuroendovasc Surg, Kingwood, TX USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2025年

关键词：

Stent; Stroke; Thrombectomy; Technique; Reperfusion; ACUTE ISCHEMIC-STROKE; HEALTH-CARE PROFESSIONALS; ENDOVASCULAR TREATMENT; EARLY MANAGEMENT; 2018; GUIDELINES;

D O I：

10.1136/jnis-2024-022781

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA. Methods EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03). Conclusions Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.

引用

页数：9

共 29 条

[21] Improving the Reachability of Contact Aspiration for Acute Ischemic Stroke Using a New Delivery Assist Catheter [J].

Neki, Hiroaki ;

Mochizuki, Yuichi ;

Kamio, Yoshinobu ;

Kurozumi, Kazuhiko .

WORLD NEUROSURGERY, 2023, 179 :E510-E514

[22] Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [J].

Powers, William J. ;

Rabinstein, Alejandro A. ;

Ackerson, Teri ;

Adeoye, Opeolu M. ;

Bambakidis, Nicholas C. ;

Becker, Kyra ;

Biller, Jose ;

Brown, Michael ;

Demaerschalk, Bart M. ;

Hoh, Brian ;

Jauch, Edward C. ;

Kidwell, Chelsea S. ;

Leslie-Mazwi, Thabele M. ;

Ovbiagele, Bruce ;

Scott, Phillip A. ;

Sheth, Kevin N. ;

Southerland, Andrew M. ;

Summers, Deborah, V ;

Tirschwell, David L. .

STROKE, 2019, 50 (12) :E344-E418

[23] 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [J].

Powers, William J. ;

Rabinstein, Alejandro A. ;

Ackerson, Teri ;

Adeoye, Opeolu M. ;

Bambakidis, Nicholas C. ;

Becker, Kyra ;

Biller, Jose ;

Brown, Michael ;

Demaerschalk, Bart M. ;

Hoh, Brian ;

Jauch, Edward C. ;

Kidwell, Chelsea S. ;

Leslie-Mazwi, Thabele M. ;

Ovbiagele, Bruce ;

Scott, Phillip A. ;

Sheth, Kevin N. ;

Southerland, Andrew M. ;

Summers, Deborah V. ;

Tirschwell, David L. .

STROKE, 2018, 49 (03) :E46-E110

[24] Letter: Twinkle, Twinkle Little STAR, How I Wonder What You Are: The Case for High-Quality, Large-Scale, "Real-World" Databases [J].

Spiotta, Alejandro M. .

NEUROSURGERY, 2020, 87 (02) :E271-E272

[25] Impact of Periprocedural and Technical Factors and Patient Characteristics on Revascularization and Outcome in the DAWN Trial [J].

Tekle, Wondwossen G. ;

Hassan, Ameer E. ;

Jadhav, Ashutosh P. ;

Haussen, Diogo C. ;

Budzik, Ronald F. ;

Bonafe, Alain ;

Bhuva, Parita ;

Yavagal, Dileep R. ;

Hanel, Ricardo A. ;

Ribo, Marc ;

Cognard, Christophe ;

Sila, Cathy A. ;

Smith, Wade S. ;

Saver, Jeffrey L. ;

Liebeskind, David S. ;

Shields, Ryan ;

Nogueira, Raul G. ;

Jovin, Tudor G. .

STROKE, 2020, 51 (01) :247-253

[26] The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies [J].

von Elm, Erik ;

Altman, Douglas G. ;

Egger, Matthias ;

Pocock, Stuart J. ;

Gotzsche, Peter C. ;

Vandenbroucke, Jan P. .

BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2007, 85 (11) :867-872

[27] Association Between Thrombus Density and Reperfusion Outcomes Using Different Thrombectomy Strategies: A Single-Center Study and Meta-Analysis [J].

Ye, Gengfan ;

Cao, Ruoyao ;

Lu, Jun ;

Qi, Peng ;

Chen, Juan ;

Wang, Daming .

FRONTIERS IN NEUROLOGY, 2019, 10

[28] Effectiveness of Trevo stent retriever in acute ischemic stroke: Comparison with Solitaire stent [J].

Yi, Ho Jun ;

Lee, Dong Hoon ;

Kim, Sang Uk .

MEDICINE, 2018, 97 (20)

[29] MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke [J].

Zaidat, Osama ;

Ikeme, Shelly ;

Sheth, Sunil A. ;

Yoshimura, Shinichi ;

Yang, Xin-guang ;

Brinjikji, Waleed ;

Kallmes, David F. ;

Brouwer, Patrick ;

Pederson, John ;

Tarchand, Ranita ;

Steffenson, Annie ;

Kallmes, Kevin M. ;

Touchette, Jillienne ;

Andersson, Tommy .

JOURNAL OF COMPARATIVE EFFECTIVENESS RESEARCH, 2023, 12 (05)

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