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Possible Contribution of the Aspiration Catheter in Preventing Post-stent Retriever Thrombectomy Subarachnoid Hemorrhage

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Abstract

Purpose

This study aimed to identify factors related to the incidence of post-thrombectomy subarachnoid hemorrhage (PTSAH).

Methods

This retrospective, observational cohort study enrolled consecutive patients with acute ischemic stroke (AIS) due to the internal carotid artery (IC) top or middle cerebral artery (MCA) M1 or M2 segment occlusion who underwent single-pass stent retriever (SR) treatment between January 2015 and May 2022 at two acute care hospitals.

Results

Of the 54 included patients, 10 were in the PTSAH group (18.5%). The occlusion sites were IC top (31.5%), M1 segment (48.1%), and M2 segment (20.4%). Aspiration catheters (ACs) were used in 32 (59.3%) patients; however, the combined technique (AC advancement at least to the most proximal marker of SR) was actually used in 26 (48.1%) patients because a ledge effect at the ophthalmic artery origin from the IC interfered with distal navigation of the ACs. The baseline patient characteristics did not differ between the groups. M2 segment occlusion in the PTSAH and non-PTSAH groups were 40.0% and 15.9%, respectively (p = 0.19). More ACs were used in the non-PTSAH group (65.9% vs. 30.0%, p = 0.07). Significantly fewer combined techniques were performed in the PTSAH group (10.0% vs. 56.8%, p = 0.01). In multivariate analysis adjusted by variables with M2 segment occlusion and the combined technique, the combined technique (odds ratio 0.098; 95% confidence interval, 0.011–0.887; p = 0.039) was identified as a significantly associated factor for PTSAH. There was one PTSAH case (1.9%) with symptom worsening.

Conclusion

The combined technique significantly influenced PTSAH occurrence as a preventive factor.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Neurosurgery, Kamagaya General Hospital, 929-6 Hatsutomi, 273-0121, Kamagaya-shi, Chiba, Japan

    Yasuhiko Nariai & Akio Hyodo

  2. Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan

    Tomoji Takigawa, Yosuke Kawamura & Kensuke Suzuki

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  1. Yasuhiko Nariai
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  2. Tomoji Takigawa
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  3. Yosuke Kawamura
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  4. Akio Hyodo
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Contributions

Yasuhiko Nariai: conceptualization, data curation, formal analysis, and project administration. writing, original draft. Yasuhiko Nariai, Tomoji Takigawa, Yosuke Kawamura, and Akio Hyodo: investigation and methodology. Tomoji Takigawa, Yosuke Kawamura, Akio Hyodo, and Kensuke Suzuki: validation, supervision, writing, reviewing, and editing.

Corresponding author

Correspondence to Yasuhiko Nariai.

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Conflict of interest

Y. Nariai, T. Takigawa, Y. Kawamura, A. Hyodo and K. Suzuki declare that they have no competing interests.

Ethical standards

This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by our institutional review board. The requirement for informed consent from patients was waived owing to the retrospective study design.

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Data availability statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Nariai, Y., Takigawa, T., Kawamura, Y. et al. Possible Contribution of the Aspiration Catheter in Preventing Post-stent Retriever Thrombectomy Subarachnoid Hemorrhage. Clin Neuroradiol 33, 509–518 (2023). https://doi.org/10.1007/s00062-022-01240-4

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