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CardioVascular and Interventional Radiology

, Volume 41, Issue 12, pp 1909–1916 | Cite as

Impact of Retriever Passes on Efficacy and Safety Outcomes of Acute Ischemic Stroke Treated with Mechanical Thrombectomy

  • Yongjie Bai
  • Jie Pu
  • Huaiming Wang
  • Dong Yang
  • Yonggang Hao
  • Haowen Xu
  • Meng Zhang
  • Yu Geng
  • Yue Wan
  • Wei Wang
  • Hao Zhang
  • Wenjie ZiEmail author
  • Xinfeng Liu
  • Gelin XuEmail author
  • for the ACTUAL Investigators
Clinical Investigation Stroke/Neurointerventions
Part of the following topical collections:
  1. Stroke/Neurointerventions

Abstract

Background and Purpose

In patients with acute ischemic stroke treated with thrombectomy, additional retriever passes may increase the likelihood of recanalization, but also the risk of intracranial hemorrhage. This multicenter retrospective register study aimed to evaluate the impact of retriever passes on treatment efficacy and safety outcomes in patients treated with mechanical thrombectomy.

Materials and Methods

Patients with ischemic stroke due to large artery occlusion in anterior circulation and treated with mechanical thrombectomy were enrolled. The primary efficacy outcome was a favorable functional outcome defined as modified Rankin Scale score of 0–2 at 90 days. Major safety outcome was symptomatic intracranial hemorrhage (SICH) and mortality. Multivariate logistic regression was used to analyze the impact of retriever passes on efficacy and safety outcomes.

Results

Of the 472 enrolled patients, the likelihood of favorable outcome declined in patients with more than three retriever passes (44.4% in patients with three passes, 26.3% with four passes, 14.8% with five or more passes). Multivariate logistic regression analysis identified three or less passes as an independent predictor for favorable functional outcomes (OR 2.44, 95% CI 1.10–5.45, P = 0.029). More than three passes was associated with an increased risk of SICH (OR 2.24, 95% CI 1.16–4.33, P = 0.016).

Conclusions

More than three retriever passes may increase the rate of recanalization, but not the likelihood of favorable functional outcomes in ischemic stroke patients treated with mechanical thrombectomy. Notably, multiple retriever passes may also increase the risk of intracranial hemorrhage.

Evidence-Based Medicine

Level of Evidence: Level 4, Case Series.

Keywords

Ischemic stroke Mechanical thrombectomy Stent retriever Cerebral revascularization Intracranial hemorrhage 

Abbreviations

SICH

Symptomatic intracranial hemorrhage

mTICI

Modified thrombolysis in cerebral infarction

mRS

Modified Rankin Scale

ACTUAL

Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry

Notes

Acknowledgements

We acknowledge Shuyan Lu, Ph.D., for her statistical assistance.

Funding

This study was partly funded by National Natural Science Foundation of China (Nos. 81571143, 81400993 and 81530038), Jiangsu Provincial Special Program of Medical Science (No. BL2013025) and Chinese Postdoctoral Science Fund (No. 2015M572815).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

270_2018_2022_MOESM1_ESM.doc (185 kb)
Supplementary material 1 (DOC 185 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of NeurologyJinling Clinical College of Nanjing Medical UniversityNanjingChina
  2. 2.Department of Neurology, First Affiliated Hospital, College of Clinical MedicineHenan University of Science and TechnologyLuoyangChina
  3. 3.Department of Neurology, Jinling HospitalSouthern Medical UniversityNanjingChina
  4. 4.Department of Neurology, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
  5. 5.Department of Neurology89th Hospital of People’s Liberation ArmyWeifangChina
  6. 6.Department of Emergency MedicineFirst Affiliated Hospital of Soochow UniversitySuzhouChina
  7. 7.Department of Intervention NeuroradiologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  8. 8.Department of Neurology, Research Institute of Surgery, Daping HospitalThird Military Medical UniversityChongqingChina
  9. 9.Department of NeurologyZhejiang Provincial People’s HospitalHangzhouChina
  10. 10.Department of NeurologyHubei Zhongshan HospitalWuhanChina
  11. 11.Department of Radiology, First People’s Hospital of YangzhouYangzhou UniversityYangzhouChina
  12. 12.Department of Neurology, First People’s Hospital of HangzhouNanjing Medical UniversityHangzhouChina

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