More Retrieval Attempts are Associated with Poorer Functional Outcome After Unsuccessful Thrombectomy

Area of Science:

• Neurology
• Interventional Neuroradiology

Background:

• Mechanical thrombectomy is a key treatment for acute ischemic stroke.
• The impact of multiple retrieval attempts on patient outcomes, particularly in cases of failed reperfusion, requires further investigation.

Purpose of the Study:

• To assess the potential harmful effect of multiple mechanical thrombectomy retrieval attempts on patient outcomes.
• To analyze the association between the number of retrieval attempts and functional independence in patients with TICI score 0.

Main Methods:

• Retrospective analysis of 6635 patients undergoing endovascular thrombectomy (EVT) for acute large vessel occlusion (LVO) from the German Stroke Registry.
• Focus on 377 patients with a final Thrombolysis in Cerebral Infarction (TICI) score of 0 (no reperfusion).
• Propensity score matching and multivariable logistic regression were used to adjust for confounders and analyze outcomes (modified Rankin Scale at 90 days).

Main Results:

• Patients with no reperfusion (TICI 0) undergoing more than two retrieval attempts had significantly lower rates of functional independence (modified Rankin Scale 0-2) at 90 days (3.9% vs. 14%).
• After adjusting for confounders, >2 retrieval attempts remained significantly associated with lower odds of functional independence (OR 0.2, 95% CI 0.07-0.52).

Conclusions:

• In patients with mechanical thrombectomy failure (TICI 0), exceeding two retrieval attempts is associated with worse clinical outcomes.
• Multiple retrieval attempts may have a detrimental effect on functional independence after stroke treatment.