Impact of Retriever Passes on Efficacy and Safety Outcomes of Acute Ischemic Stroke Treated with Mechanical Thrombectomy
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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.
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).
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.
Level of Evidence: Level 4, Case Series.
KeywordsIschemic stroke Mechanical thrombectomy Stent retriever Cerebral revascularization Intracranial hemorrhage
Symptomatic intracranial hemorrhage
Modified thrombolysis in cerebral infarction
Modified Rankin Scale
Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry
We acknowledge Shuyan Lu, Ph.D., for her statistical assistance.
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.
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.
For this type of study, formal consent is not required.
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