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Association Between Distal Stent Retriever Deployment Distance and First-Pass Effect and Hemorrhagic Complications in
Koji Yoshida1, Yosuke Akamatsu2, Hiromu Sasaki2
1From the Department of Neurosurgery (K.Y., H.S., K.D., M.Y., D.O., S.I., T.T., T.C., Y.O., T.M., H.K.), Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan and Department of Neurosurgery (Y.A., M.Y., S.I., T.T., Y.O., T.M., K.O.), Iwate Medical School of Medicine, Yahaba-cho, Iwate, Japan. koyoshi@iwate-med.ac.jp.
Background And Purpose:
Longer stent retrievers (SR) are associated with higher first-pass effect (FPE) rates, but the underlying mechanism remains unclear. We investigated whether stent retriever distance (SRD), defined as the distance between the distal thrombus end and the distal tip of the SR, is associated with modified FPE (mFPE) and post-thrombectomy SAH.
Materials And Methods:
This retrospective analysis included patients with MCA occlusion (distal M1 or M2 segments) treated using a combined thrombectomy technique with a Solitaire X 3 × 40 mm SR at a single center. The co-primary endpoints were mFPE and post-thrombectomy SAH. Multivariable logistic regression identified independent predictors of mFPE and post-thrombectomy SAH.
Results:
Forty-three patients were included, with a median age of 81 years. mFPE was achieved in 27 patients (62.8%), and post-thrombectomy SAH occurred in 14 patients (32.6%). SRD was significantly longer in patients achieving mFPE than in those without mFPE (16.4 ± 6.8 mm vs 9.4 ± 5.6 mm, P = .001). In multivariable analysis, longer SRD was independently associated with achieving mFPE (adjusted odds ratio [OR] per 1-mm increase, 1.27; 95% confidence interval [CI], 1.04-1.52; P = .02). Patients achieving mFPE required fewer device passes than those without mFPE (median 1 [IQR, 1-1] vs 2 [IQR, 2-3], P < .001). SRD was significantly shorter in patients with post-thrombectomy SAH than in those without SAH (10.5 ± 5.3 mm vs 15.4 ± 7.6 mm, P = .04). In multivariable analysis, a higher number of device passes was independently associated with post-thrombectomy SAH (adjusted OR, 4.9; 95% CI, 1.42-17.00; P = .01), whereas SRD was no longer significantly associated with post-thrombectomy SAH after adjustment. Post-thrombectomy SAH was not significantly associated with unfavorable functional outcome at 3 months (mRS 4-6).
Conclusions:
Longer SRD was independently associated with a higher likelihood of mFPE during combined thrombectomy for MCA occlusions, although these findings should be interpreted with caution given the limited sample size. Repeated device passes were independently associated with post-thrombectomy SAH.
