Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Flottmann, Fabian; Broocks, Gabriel; Faizy, Tobias D.; McDonough, Rosalie; Watermann, Lucas; Deb‐Chatterji, Milani; Thomalla, Götz; Herzberg, Moriz; Nolte, Christian H.; Fiehler, Jens; Leischner, Hannes; Brekenfeld, Caspar; investigators, Gsr

doi:10.1007/s00062-020-00880-8

Cited by 24 publications

(21 citation statements)

References 35 publications

(68 reference statements)

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“…Successful endovascular recanalization has been described as the most important predictor of good clinical outcome following BAO stroke, while failed thrombectomy was associated with a significant increase of risk for poor outcome [7,9]. Therefore, the early identification of factors, in particular factors that can be adjusted in the acute situation, associated with successful recanalization might be of significant importance to improve functional outcome.…”

Section: Discussionmentioning

confidence: 99%

Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion

et al. 2022

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Purpose Evidence regarding the effect of mechanical thrombectomy (MT) of basilar artery occlusion (BAO) stroke is yet sparse. As successful recanalization has been suggested as major determinant of outcome, the early identification of modifiable factors associated with successful recanalization could be of importance to improve functional outcome. Hyperglycemia has been associated with enhanced thrombin generation and unfavorably altered clot features. Objective We hypothesized that serum baseline glucose is associated with likelihood of vessel recanalization mediated by collateral quality and clot burden in BAO stroke. Methods BAO stroke patients who received multimodal CT on admission were analyzed. The association of vessel recanalization defined using modified Thrombolysis in cerebral infarction scale (mTICI) scores 2b-3, and baseline imaging and clinical parameters were tested in logistic regression analyses. Collateral quality and clot burden were evaluated using the Basilar Artery on CT-Angiography (BATMAN) score. Results Out of 117 BAO patients, 91 patients (78%) underwent MT. In 70 patients (77%), successful recanalization could be achieved (mTICI 2b/3). In multivariable logistic regression analysis, only a higher BGL (aOR 0.97, 95% CI 0.96–0.99, p = 0.03) and higher BATMAN score (aOR 1.77, 95% CI 1.11–2.82, p = 0.02) were independently associated with vessel recanalization. Application of alteplase, or time from symptom onset-imaging revealed no independent association with recanalization status. Conclusion Higher BGL was significantly associated with reduced likelihood for recanalization success besides BATMAN score as a measure of collateral quality and clot burden. BGL could be tested as a modifiable parameter to increase likelihood for recanalization in BAO stroke, aiming to improve functional outcome.

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Section: Discussionmentioning

confidence: 99%

Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion

et al. 2022

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“…1). Of these, 808 patients K [11][12][13][14][15][16][17][18] and the median ASPECTS score on admission imaging was 9 [7][8][9][10]. The median number of device passes was 1 [1,2].…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Early TICI 2b or Late TICI 3—Is Perfect the Enemy of Good?

et al. 2021

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Background and Purpose A Thrombolysis in Cerebral Infarction (TICI) score of 3 has been established as therapeutic goal in endovascular therapy (EVT) for acute ischemic stroke; however, in the case of early TICI2b reperfusion, the question remains whether to stop the procedure or to continue in the pursuit of perfection (i.e., TICI 2c/3). Methods A total of 6635 patients were screened from the German Stroke Registry. Patients who underwent EVT for occlusion of the middle cerebral artery (M1 segment), with final TICI score of 2b/3 were included. Multivariable logistic regression was performed with functional independence (modified Rankin Scale, mRS at day 90 of 0–2) as the dependent variable. Results Of 1497 patients, 586 (39.1%) met inclusion criteria with a final TICI score of 2b and 911 (60.9%) with a TICI score of 3. Patients who achieved first-pass TICI3 showed highest odds of functional independence (Odds ratio [OR] 1.71, 95% confidence interval [95% CI] 1.18–2.47). Patients who achieved TICI2b with the second pass (OR 0.53, 95% CI 0.31–0.89) or with three or more passes (OR 0.44, 95% CI 0.27–0.70) had significantly worse clinical outcomes compared to first-pass TICI2b. TICI3 at the second pass was by trend better than first-pass TICI2b (OR 1.55, 95% CI 0.98–2.45), but TICI3 after 3 or more passes (OR 0.93, 95% CI 0.57–1.50) was not significantly different from first-pass TICI2b. Conclusion First-pass TICI2b was superior to TICI2b after ≥ 2 retrievals and comparable to TICI3 at ≥ 3 retrievals. The potential benefit in outcome after achieving TICI3 following further retrieval attempts after first-pass TICI2b need to be weighed against the risks.

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“…As factors for poor recanalization, anatomical vascular anomalies (bovine type, aortic arch type II/III, and ICA dolichoarteriopathy), sites of occlusion (cervical ICA, intracranial ICA other than T occlusion, and M2), marked stenosis of the cervical ICA, large-volume thrombi, tandem lesions, hard thrombi, non-embolic features, rare stroke type, overtime medical service, female sex, a history of hypertension, and treatment for many hours have been reported. [4][5][6][7] In the present case, the second pass led to recanalization at the site of M1 occlusion, but a hard, giant thrombus involved the area of dolichoarteriopathy with a round structure at the site of cervical ICA occlusion, making thrombectomy difficult. At the origin of the ICA, there was no arteriosclerotic or dissecting lesion, but dolichoarteriopathy of the ICA and the hard thrombus affected recanalization.…”

Section: Discussionmentioning

confidence: 52%

A Case Report Using Goose Neck Microsnare for Severe Cervical Internal Carotid Artery Occlusion with Dolichoarteriopathy

Kuwajima

Hirotaka

Nakajo

et al. 2021

JNET

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We report the use of a Goose Neck microsnare for cervical internal carotid artery (ICA) occlusion in a patient with dolichoarteriopathy in whom it was difficult to achieve recanalization.Case Presentation: A 65-year-old woman underwent thrombectomy for a tandem lesion of left M1 occlusion and left cervical ICA occlusion. Recanalization of left M1 occlusion was achieved. For left cervical ICA occlusion, we attempted multiple thrombectomy using an existing device, but a hard clot with mobility was caught due to dolichoarteriopathy, which made thrombectomy difficult. Using a Goose Neck microsnare, we were able to capture the thrombus and achieve recanalization. Conclusion:Thrombectomy by capturing the thrombus using a Goose Neck microsnare may be useful for capturing hard clots with mobility when it is difficult to achieve recanalization with existing devices.

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Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Cited by 24 publications

References 35 publications

Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion

Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion

Early TICI 2b or Late TICI 3—Is Perfect the Enemy of Good?

A Case Report Using Goose Neck Microsnare for Severe Cervical Internal Carotid Artery Occlusion with Dolichoarteriopathy

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