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When to Stop.

Álvaro García-Tornel1, Manuel Requena1, Marta Rubiera1

  • 1From the Stroke Unit, Department of Neurology (A.G.-T., M. Requena, M. Rubiera, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., S.B., M.O.-G., C.A.M., M. Ribo), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.

Stroke
|June 11, 2019
PubMed
Summary
This summary is machine-generated.

Fewer thrombectomy device passes and higher recanalization rates in acute ischemic stroke patients predict better functional outcomes. More passes correlate with worse results, suggesting a need to optimize pass attempts for improved patient recovery.

Keywords:
National Institutes of Healthcerebral infarctionendovascular proceduresmultivariate analysisprognosisthrombectomy

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Stroke Medicine

Background:

  • A significant number of patients with acute ischemic stroke due to large vessel occlusion (LVO) do not achieve good functional outcomes despite successful recanalization.
  • The impact of mechanical thrombectomy procedural factors, specifically device pass count and recanalization degree, on patient outcomes requires further elucidation.

Purpose of the Study:

  • To investigate the association between the number of thrombectomy device passes and the degree of recanalization (using modified Thrombolysis in Cerebral Infarction scale) with clinical and functional outcomes in acute ischemic stroke patients with LVO.

Main Methods:

  • A retrospective analysis of 542 consecutive patients undergoing mechanical thrombectomy for anterior circulation LVO.
  • Data collected included baseline characteristics, number of device passes, recanalization degree (modified Thrombolysis in Cerebral Infarction), 24-hour clinical outcome (National Institutes of Health Stroke Scale), and 90-day functional outcome (modified Rankin Scale).
  • Multivariate analysis was employed to identify independent predictors of dramatic clinical recovery and good functional outcome.

Main Results:

  • Successful recanalization (modified Thrombolysis in Cerebral Infarction 2B-3) was achieved in 84% of patients, with 39% achieving it on the first pass.
  • First-pass recanalization and complete recanalization (modified Thrombolysis in Cerebral Infarction 3) were independent predictors of good functional outcome and dramatic clinical recovery.
  • Recanalization rates decreased with subsequent passes, and a linear association was observed between an increasing number of passes and worse functional outcomes in patients who achieved recanalization.

Conclusions:

  • A higher number of device passes and lower degrees of recanalization are significantly associated with poorer outcomes in acute ischemic stroke patients with LVO.
  • Further research is warranted to determine the optimal number of device passes to maximize recanalization success and improve functional outcomes, particularly in cases where initial recanalization is not achieved.