Predictors and Outcomes Associated with Rescue Therapy in SWIFT

Area of Science:

• Endovascular therapy
• Acute ischemic stroke
• Neurointerventional procedures

Background:

• Rescue therapy is employed in endovascular stroke treatment when initial devices fail to restore vessel patency.
• Predictors for rescue therapy in endovascular procedures are not well-established, unlike for intravenous thrombolysis.
• The Solitaire With the Intention For Thrombectomy (SWIFT) trial provides data to investigate these predictors.

Purpose of the Study:

• To identify predictors of rescue therapy use in the SWIFT trial.
• To determine outcomes associated with rescue therapy in endovascular stroke treatment.
• To evaluate factors influencing the need for rescue interventions during thrombectomy.

Main Methods:

• Analysis of clinical, angiographic, and demographic data from 144 patients in the SWIFT trial.
• Rescue therapy defined as alternative device, agent, or maneuver after three failed retrieval attempts.
• Multivariate analysis to identify significant predictors of rescue therapy.

Main Results:

• Nearly 30% (43/144) of patients required rescue therapy.
• Rescue therapy was more frequent in the Merci group (43%) vs. Solitaire group (21%).
• Patients receiving rescue therapy had longer recanalization times, lower successful recanalization rates, and poorer outcomes.

Conclusions:

• Randomization to the Merci device group and age over 80 were significant predictors of rescue therapy.
• Hypertension and proximal clot location showed a trend towards increased rescue therapy need.
• Rescue therapy is associated with diminished favorable outcomes, suggesting areas for therapeutic improvement.