Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when?

IF 4.5 1区医学 Q1 NEUROIMAGING Journal of NeuroInterventional Surgery Pub Date : 2025-02-14 DOI:10.1136/jnis-2024-021545

Pedro N Martins, Raul G Nogueira, Mohamed A Tarek, Jaydevsinh N Dolia, Sunil A Sheth, Santiago Ortega-Gutierrez, Sergio Salazar-Marioni, Ananya Iyyangar, Milagros Galecio-Castillo, Aaron Rodriguez-Calienes, Aqueel Pabaney, Jonathan A Grossberg, Diogo C Haussen

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Abstract

Background: Fast and complete reperfusion in endovascular therapy (EVT) for ischemic stroke leads to superior clinical outcomes. The effect of changing the technical approach following initially unsuccessful passes remains undetermined.

Objective: To evaluate the association between early changes to the EVT approach and reperfusion.

Methods: Multicenter retrospective analysis of prospectively collected data for patients who underwent EVT for intracranial internal carotid artery, middle cerebral artery (M1/M2), or basilar artery occlusions. Changes in EVT technique after one or two failed passes with stent retriever (SR), contact aspiration (CA), or a combined technique (CT) were compared with repeating the previous strategy. The primary outcome was complete/near-complete reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) of 2c-3, following the second and third passes.

Results: Among 2968 included patients, median age was 66 years and 52% were men. Changing from SR to CA on the second or third pass was not observed to influence the rates of eTICI 2c-3, whereas changing from SR to CT after two failed passes was associated with higher chances of eTICI 2c-3 (OR=5.3, 95% CI 1.9 to 14.6). Changing from CA to CT was associated with higher eTICI 2c-3 chances after one (OR=2.9, 95% CI 1.6 to 5.5) or two (OR=2.7, 95% CI 1.0 to 7.4) failed CA passes, while switching to SR was not significantly associated with reperfusion. Following one or two failed CT passes, switching to SR was not associated with different reperfusion rates, but changing to CA after two failed CT passes was associated with lower chances of eTICI 2c-3 (OR=0.3, 95% CI 0.1 to 0.9). Rates of functional independence were similar.

Conclusions: Early changes in EVT strategies were associated with higher reperfusion and should be contemplated following failed attempts with stand-alone CA or SR.

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缺血性脑卒中机械血栓切除术失败后的早期技术转换：方法是否应该改变，何时改变？

背景：在缺血性脑卒中的血管内治疗（EVT）中，快速、完全的再灌注能带来更好的临床疗效。目标：评估EVT方法的早期改变与再灌注的关系：评估早期改变 EVT 方法与再灌注之间的关系：方法：对前瞻性收集的因颅内颈内动脉、大脑中动脉（M1/M2）或基底动脉闭塞而接受EVT的患者数据进行多中心回顾性分析。在使用支架回缩器（SR）、接触式抽吸器（CA）或联合技术（CT）进行一到两次EVT失败后，对EVT技术的改变与重复之前的策略进行了比较。主要结果是完全/近似完全再灌注，即第二次和第三次通过后脑梗塞溶栓扩展指数（eTICI）达到2c-3：在纳入的 2968 例患者中，中位年龄为 66 岁，52% 为男性。观察发现，在第二次或第三次检查时从 SR 改为 CA 不会影响 eTICI 2c-3 的发生率，而在两次检查失败后从 SR 改为 CT 则与 eTICI 2c-3 的发生率较高有关（OR=5.3，95% CI 1.9 至 14.6）。在一次（OR=2.9，95% CI 1.6 至 5.5）或两次（OR=2.7，95% CI 1.0 至 7.4）CA 通过失败后，从 CA 转为 CT 与更高的 eTICI 2c-3 机率有关，而在一次 CA 通过失败后转为 SR 与更高的 eTICI 2c-3 机率有关（OR=6.9，95% CI 1.6 至 30.0）。在一次或两次 CT 检查失败后，改用 SR 与不同的再灌注率无关，但在两次 CT 检查失败后改用 CA 与较低的 eTICI 2c-3 机会有关（OR=0.3，95% CI 0.1 至 0.9）。功能独立率相似：结论：EVT策略的早期改变与较高的再灌注率相关，在独立CA或SR尝试失败后应考虑进行EVT。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.