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Endovascular Thrombectomy Technique Optimization: A SVIN Registry Analysis
Joseph N Samaha1, Ritesh Bajaj1, Ngoc Mai Le1
1Department of Neurology McGovern Medical School at UTHealth Houston TX.
Stroke (Hoboken, N.J.)
|January 23, 2026
Summary
Switching endovascular techniques after a failed first pass improves reperfusion rates for M1 occlusions. Contact aspiration (CA) may offer better outcomes than stent retriever (SR) after multiple failed attempts.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Surgery
Background:
- Excellent recanalization (Modified Thrombolysis in Cerebral Infarction 2c/3) in fewer attempts improves clinical outcomes.
- Previous studies suggest technique switching may enhance reperfusion rates after failed first pass.
- This study evaluates technique switching's impact on reperfusion in a large multicenter registry.
Purpose of the Study:
- To evaluate whether switching endovascular techniques improves subsequent reperfusion rates.
- To analyze the likelihood of achieving TICI 2c/3 reperfusion with or without technique switching on the second pass.
- To stratify the likelihood of final TICI 2c/3 by technique and occlusion location.
Main Methods:
- Analysis of retrospective and prospective Society of Vascular and Interventional Neurology (SVIN) registry data from 12 US centers (October 2014-December 2021).
- Inclusion of patients undergoing endovascular therapy for M1 or internal carotid artery-terminus (ICA-T) occlusions with at least 2 recanalization attempts using stent retriever (SR), contact aspiration (CA), or combined technique (CT).
- Primary outcome: likelihood of achieving TICI 2c/3 reperfusion with or without technique switching on the second pass.
Main Results:
- Among 2893 treatments, 1089 (37.6%) achieved reperfusion after the first pass.
- For M1 occlusions, switching from combined technique (CT) to an alternative technique after a failed first pass significantly increased TICI 2c/3 odds on the second pass (aOR, 2.08).
- Patients with 2 failed contact aspiration (CA) attempts had higher odds of final TICI 2c/3 compared to those with 2 failed stent retriever (SR) passes (aOR, 1.65).
Conclusions:
- In M1-middle cerebral artery occlusions, switching from CT to SR or CA improved TICI 2c/3 rates on the second pass.
- After 2 failed CA passes, additional passes increased the odds of complete reperfusion compared to SR.
- Technique switching is a valuable strategy to improve reperfusion outcomes in complex stroke interventions.
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