TY - JOUR
T1 - Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke
AU - Tomasello, Alejandro
AU - Ribò, Marc
AU - Gramegna, Laura Ludovica
AU - Melendez, Fernando
AU - Rosati, Santiago
AU - Moreu, Manuel
AU - Aixut, Sonia
AU - Lüttich, Alexandre
AU - Werner, Mariano
AU - Remollo, Sebastian
AU - Quintana, Manuel
AU - Coscojuela, Pilar
AU - Hernandez, David
AU - Dinia, Lavinia
AU - Lopez-Rueda, Antonio
AU - Rubiera, Marta
AU - Rovira, Àlex
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE. Methods: We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus ‘Push and Fluff’ technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c–3. Associations were sought between cFPE and procedural approaches and angiographic signs. Results: A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28–9.29, p = 0.010), PBGC (OR 3.81, 95% CI: 1.41–10.22, p = 0.008) and ACPS (OR 4.71, 95% CI: 1.78–12.44, p = 0.002) were independently associated with cFPE. Concurrence of these three variables led to cFPE in 82 vs 35% of the remaining cases (p = 0.002). Conclusions: The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials.
AB - Background: First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE. Methods: We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus ‘Push and Fluff’ technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c–3. Associations were sought between cFPE and procedural approaches and angiographic signs. Results: A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28–9.29, p = 0.010), PBGC (OR 3.81, 95% CI: 1.41–10.22, p = 0.008) and ACPS (OR 4.71, 95% CI: 1.78–12.44, p = 0.002) were independently associated with cFPE. Concurrence of these three variables led to cFPE in 82 vs 35% of the remaining cases (p = 0.002). Conclusions: The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials.
KW - angiography
KW - aspiration catheter
KW - mechanical thrombectomy
KW - stent retriever
KW - Stroke
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U2 - 10.1177/1591019919847623
DO - 10.1177/1591019919847623
M3 - Article
C2 - 31072248
AN - SCOPUS:85065763648
VL - 25
SP - 491
EP - 496
JO - Interventional Neuroradiology
JF - Interventional Neuroradiology
SN - 1591-0199
IS - 5
ER -