Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis
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ORIGINAL ARTICLE
Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis Aglaé Velasco Gonzalez 1 & Dennis Görlich 2 & Boris Buerke 1 & Nico Münnich 1 & Cristina Sauerland 2 & Thilo Rusche 1 & Andreas Faldum 2 & Walter Heindel 1 Received: 9 October 2019 / Revised: 13 January 2020 / Accepted: 28 January 2020 # The Author(s) 2020
Abstract Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient’s anatomy to enhance effectivity. Keywords Stroke . Thrombectomy . Suction . Carotid arteries . Circle of Willis
Abbreviations ACA Anterior cerebral artery ACoA Anterior communicating artery BGC Balloon guide catheter
CCA CI CoW CTA
Common carotid artery Confidence interval Circle of Willis Computed tomography angiography
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12975-020-00784-2) contains supplementary material, which is available to authorized users. * Aglaé Velasco Gonzalez [email protected]
Andreas Faldum [email protected]
Dennis Görlich [email protected]
Walter Heindel [email protected]
Boris Buerke [email protected] 1
Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
2
Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
Nico Münnich [email protected]; [email protected] Cristina Sauerland [email protected] Thilo Rusche [email protected]
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