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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical Thrombectomy in Medium Vessel Occlusions: Blind Exchange With Mini-Pinning Technique Versus Mini Stent
Carlos Pérez-García1, Manuel Moreu1, Santiago Rosati1
1Department of Interventional Neuroradiology (C.P.-G., M.M., S.R.), Hospital Clínico San Carlos, Madrid, Spain.
Background And Purpose:
Mechanical thrombectomy techniques for intracranial medium vessel occlusions (MeVOs) have evolved in recent years, although the optimal approach is still unclear. The aim of this study was to investigate the effectiveness and safety of mechanical thrombectomy in MeVOs using mini (0.017 inches microcatheter compatible) stent retrievers combined with low-profile (0.035 inches distal inner diameter) distal aspiration catheters through the blind exchange/mini-pinning (BEMP) technique compared with mini stent retrievers alone.
Methods:
Retrospective review of a prospectively maintained database of patients treated with the BEMP technique or mini stent retriever alone for intracranial MeVOs from 2017 to 2020 in a comprehensive stroke center. Both groups were compared about baseline characteristics, occlusion site, clinical presentation, clot cause, procedural outcomes (MeVO first-pass and final expanded Thrombolysis in Cerebral Ischemia score, the mini stent retriever used, number of passes with the front-line approach, and need of rescue therapy), safety outcomes (emboli to unwanted territories and hemorrhagic complications), and clinical outcomes at 90 days. Multivariable logistic regression analysis was performed with potential predictors of vessel recanalization to find independent variables associated with MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization.
Results:
We reviewed 102 patients/106 MeVOs treated with the BEMP technique (n=56) or mini stent retriever (n=50). There was a higher rate of MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization (57% versus 34%, P=0.017), lower need of rescue therapy (7.1% versus 22%, P=0.028), and lower rate of emboli to new territory (1.8% versus 12%, P=0.035) and symptomatic intracranial hemorrhage (1.9% versus 12.8%, P=0.038) with the BEMP technique. After multivariable analysis, the sole independent factor associated to MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization was the BEMP technique (odds ratio, 2.72 [95% CI, 1.19-6.22]; P=0.018).
Conclusions:
In the setting of MeVOs, the BEMP technique may lead to higher rates of the first-pass recanalization and a lower incidence of symptomatic intracranial hemorrhage than mini stent retrievers alone.
Insights
The blind exchange/mini-pinning (BEMP) technique for mechanical thrombectomy in medium vessel occlusions (MeVOs) improved first-pass recanalization and reduced new emboli and hemorrhage compared to mini stent retrievers alone.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Mechanical thrombectomy is crucial for treating intracranial medium vessel occlusions (MeVOs).
- Optimal thrombectomy techniques for MeVOs remain under investigation.
- Advancements in devices and techniques are continuously evolving.
Purpose of the Study:
- To compare the effectiveness and safety of the blind exchange/mini-pinning (BEMP) technique with mini stent retrievers alone for MeVOs.
- To evaluate procedural and clinical outcomes of the BEMP technique.
- To identify predictors of successful recanalization in MeVOs.
Main Methods:
- Retrospective review of a prospectively maintained database (2017-2020).
- Comparison of 102 patients treated with BEMP (n=56) versus mini stent retriever alone (n=50).
- Analysis of procedural outcomes, safety events, and 90-day clinical outcomes, including multivariable logistic regression.
Main Results:
- The BEMP technique showed higher first-pass expanded Thrombolysis in Cerebral Infarction (TICI) 2c/3 recanalization rates (57% vs. 34%, P=0.017).
- BEMP resulted in lower need for rescue therapy (7.1% vs. 22%, P=0.028).
- Emboli to new territory (1.8% vs. 12%, P=0.035) and symptomatic intracranial hemorrhage (1.9% vs. 12.8%, P=0.038) were significantly lower with BEMP.
Conclusions:
- The BEMP technique is associated with superior first-pass recanalization rates in MeVOs.
- BEMP demonstrates a reduced incidence of complications, including emboli to new territories and symptomatic intracranial hemorrhage.
- The BEMP technique represents a promising advancement in the endovascular treatment of MeVOs.
