More than five stentriever passes: real benefit or futile recanalization?
- PDF / 238,591 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 46 Downloads / 250 Views
INTERVENTIONAL NEURORADIOLOGY
More than five stentriever passes: real benefit or futile recanalization? A. Filioglo 1 & J. E. Cohen 2 & A. Honig 1 & N. Simaan 1 & J. M. Gomori 3 & Ronen R. Leker 1 Received: 4 March 2020 / Accepted: 31 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background and aims Clot extraction is associated with favorable outcome in patients with large vessel occlusions (LVO) undergoing endovascular thrombectomy (EVT). However, whether revascularization becomes futile or harmful with an increasing number of passes remains unknown. Methods We performed a retrospective analysis of 271 consecutive patients with LVO who underwent stentriever-based EVT as the primary recanalization strategy. Primary outcomes including favorable recanalization, survival, and favorable functional outcomes were compared according to a dichotomized number of stentriever passes utilized with a cutoff of 4. Results In the entire cohort, 234 (86%) patients reached favorable recanalization and 46 (17%) patients had ≥ 5 passes (range 5– 40). Patients that had ≤ 4 passes had significantly higher rates of favorable recanalization and favorable outcomes and a trend towards lower mortality rates compared with those that had ≥ 5 stentriever passes (92% vs. 61%; p < 0.001, 52% vs. 30%; p = 0.009 and 12% vs. 22%, p = 0.098). Among patients that received ≥ 5 stentriever passes, 30% reached favorable outcomes. Patients who achieved recanalization after ≥ 5 passes had higher rates of favorable outcome in comparison with those who did not (p = 0.009). Among patients that had ≥ 5 stentriever passes favorable recanalization (OR 97.3, 95%CI 2.8–3399.3) and admission NIHSS (OR 0.77, 95%CI 0.60–0.99) remained independent predictors of favorable outcome, whereas the number of passes did not. Conclusions A substantial proportion of patients reach favorable outcomes even when ≥ 5 stentriever passes are performed. Treatment choices should be individualized based on personal preferences and expertise as well as on patient and clot-specific characteristics. Keywords Stroke . Endovascular . Thrombectomy . Stentriever
Introduction Endovascular thrombectomy (EVT) is the standard of care in acute ischemic stroke caused by large vessel occlusion (LVO) Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00234-020-02469-x) contains supplementary material, which is available to authorized users. * Ronen R. Leker [email protected] 1
Departments of Neurology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel
2
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
3
Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
[1]. Previous studies showed that patients in whom target reperfusion was achieved after fewer passes reached better outcome than those who required higher number of passes [2, 3]. However, in some cases, recanalization is impossible even after multiple cl
Data Loading...
