Stentriever salvage after failed manual aspiration thrombectomy

Area of Science:

• Neurology
• Interventional Neurology
• Vascular Neurology

Background:

• Manual aspiration thrombectomy (MAT) and stent retriever mediated aspiration thrombectomy (SMAT) are established reperfusion techniques for large vessel occlusions.
• Predictors for successful transition to SMAT after initial MAT failure are not well-defined.

Purpose of the Study:

• To identify predictors of successful crossover to SMAT following a failed first pass MAT in acute large vessel occlusions.

Main Methods:

• Prospective data from 433 large vessel thrombectomies were analyzed.
• Multivariate logistic regression identified predictors of successful reperfusion (TICI 2b or greater) after crossover from MAT to SMAT.

Main Results:

• Of 113 patients requiring repeat passes, 23% underwent SMAT on the second pass (73% success) and 55% on the third pass (77% success).
• Overall, 12% of patients crossed over to successful SMAT.
• Internal carotid artery (ICA) location and higher NIHSS scores predicted successful crossover.

Conclusions:

• SMAT demonstrates higher successful clot removal rates compared to repeat MAT passes.
• Patients with ICA occlusions and higher NIHSS scores may benefit from early crossover to SMAT or primary SMAT selection.