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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.