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Prehospital Thrombolysis: A Manual from Berlin

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization.

Hidetoshi Matsukawa¹, Charles Matouk², Kazutaka Uchida¹

¹Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.

Journal of Neurointerventional Surgery

|September 20, 2024

Summary

Switching endovascular thrombectomy techniques after a failed first attempt improves recanalization success and patient outcomes in acute ischemic stroke. This strategy enhances technical success without increasing hemorrhage risk.

Keywords:

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Area of Science:

Neurology
Interventional Radiology
Vascular Surgery

Background:

Endovascular thrombectomy (EVT) efficacy decreases with more recanalization attempts for acute ischemic stroke (AIS) due to large vessel occlusion (LVO).
Assessing the impact of switching EVT techniques after initial failed attempts is crucial for optimizing patient outcomes.

Purpose of the Study:

To evaluate the effect of changing EVT techniques following a failed first pass on procedural success and clinical outcomes in patients with anterior circulation LVO.
To compare outcomes between patients who had their EVT technique switched versus those who had the same technique repeated after an initial failed attempt.

Main Methods:

Multicenter international study (2013-2022) including patients with anterior circulation LVO and failed first pass recanalization.
Propensity score matching created a 1:1 cohort comparing technique conversion versus technique repetition.
Primary outcome: successful recanalization (TICI 2B or higher) at second attempt. Secondary outcomes: 90-day mRS and postprocedural hemorrhage.

Main Results:

Technique conversion after failed first pass was associated with higher odds of successful recanalization (aOR=1.5) and improved 90-day mRS 0-2 (aOR=1.6) in the overall cohort.
In the matched cohort (n=490), technique conversion significantly increased odds of successful recanalization (aOR=1.32) and favorable 90-day mRS (aOR=1.38).
No significant increase in symptomatic postprocedural hemorrhage was observed with technique conversion (p=0.379).

Conclusions:

Early conversion to an alternative EVT technique after a failed first pass improves technical success in AIS patients.
Switching EVT techniques leads to better clinical outcomes, indicated by improved 90-day functional status.
This strategy offers a viable approach to enhance EVT effectiveness without compromising safety regarding hemorrhage.