Impact of Procedure Time on Outcomes of Thrombectomy for Stroke

Alawieh, Ali; Vargas, Jan; Fargen, Kyle M; Langley, E. Farris; Starke, Robert M.; Leacy, Reade De; Chatterjee, Arindam; Rai, Ansaar; Dumont, Travis M.; Kan, Peter; McCarthy, David; Nascimento, Fábio A.; Singh, Jasmeet; Vilella, Lukas; Turk, Aquilla S; Spiotta, Alejandro M

doi:10.1016/j.jacc.2018.11.052

Cited by 108 publications

(83 citation statements)

References 23 publications

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“…Finally, the heterogeneity in the effect of mTICI-3 reperfusion according to puncture-to-reperfusion time was not shown by the analysis where puncture-to-reperfusion time was included as a continuous variable. This may be because the relationship between clinical outcomes and puncture-to-reperfusion time is not linear, that is, the rate of favorable outcome decreases rapidly as time elapses in the early period of puncture-to-reperfusion time, and it reaches a plateau later 32 . The threshold of puncture-to-reperfusion time in this study is derived from our own registry, and its generalizability has not been confirmed.…”

Section: Discussionmentioning

confidence: 99%

Futile complete recanalization: patients characteristics and its time course

Kitano

Todo

Yoshimura

et al. 2020

Sci Rep

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As the goal of mechanical thrombectomy is shifting toward mTICI-3 rather than mTICI-2b, we sought to clarify the limitation of the effect of mTICI-3. A post-hoc analysis of a registry of large-vessel occlusion stroke from 46 centers was conducted. Among 2,420 registered patients, 725 patients with anterior circulation occlusion who achieved successful reperfusion were analyzed. We compared outcomes between patients with mTICI-3 and mTICI-2b, and investigated how the effect of mTICI-3 changed according to baseline characteristics and time course. The proportion of patients with favorable outcomes (mRS 0-2 at day 90) was higher among patients with mTICI-3 compared to those with mTICI-2b (adjusted OR, 2.10; 95% CI, 1.49-2.97). There was no heterogeneity in the effect of mTICI-3 with respect to age, neurological deficit, alteplase use, occluded vessels, or infarct size. mTICI-3 was associated with favorable outcomes when the puncture-to-reperfusion time was <80 minutes (adjusted OR, 2.28; 95% CI, 1.52-3.41), but not when the puncture-to-reperfusion time was ≥80 minutes. A significant heterogeneity was found in the effect of mTICI-3 reperfusion across the puncture-toreperfusion time subgroups (p for interaction = 0.025). Until when operators should continue the procedure after mTICI-2b has been achieved, needs to be studied.

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Section: Discussionmentioning

confidence: 99%

Futile complete recanalization: patients characteristics and its time course

Kitano

Todo

Yoshimura

et al. 2020

Sci Rep

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“…Although significant from a technical perspective, this reduction in procedure time was not associated with improvement in clinical outcomes using 90 day mRS scores. The likely rationale is that the average procedure duration was low in our cohort where 80% of patients were recanalized within 60 min of groin puncture; therefore, the reduction in procedure time within this first 60 min does not have a significant impact on clinical outcome as shown previously in larger cohort studies 11. Alawieh et al previously reported, using a large cohort of patients, that among patients recanalized within 30 or 60 min of procedure time, changes in procedure time did not independently predict outcome 11.…”

Section: Discussionmentioning

confidence: 67%

“…The likely rationale is that the average procedure duration was low in our cohort where 80% of patients were recanalized within 60 min of groin puncture; therefore, the reduction in procedure time within this first 60 min does not have a significant impact on clinical outcome as shown previously in larger cohort studies 11. Alawieh et al previously reported, using a large cohort of patients, that among patients recanalized within 30 or 60 min of procedure time, changes in procedure time did not independently predict outcome 11. In our cohort, the average procedure time was 24 min which falls within the 30 min window, thus explaining why the technical improvement did not translate into a clinical improvement when assessed by 90 day mRS scores.…”

Section: Discussionmentioning

confidence: 67%

“…Following the success of the major randomized controlled trials on MT for AIS using stent retrievers as the frontline device,1–8 frontline aspiration thrombectomy using ADAPT has been shown to be a faster and non-inferior alternative to stent retrievers 6 9. Faster thrombectomy procedures were associated with better clinical outcomes following MT in datasets derived from real-world reports and clinical trials 11 13 15. Based on studies comparing different thrombectomy aspiration catheters, higher aspiration forces are likely to increase the success rate of ADAPT thrombectomy leading to the current question of whether higher powered aspiration pumps can augment the efficacy of ADAPT thrombectomy without compromising safety.…”

Section: Discussionmentioning

confidence: 99%

“…Following its implementation, ongoing advances in the ADAPT technique and the devices used for aspiration have led to improved technical and clinical outcomes,10 11 leading to shortened procedure times and better safety profiles. Compared with smaller catheters, the use of higher caliber catheters (eg, 0.068 inch 5MAX 068ACE) with greater aspiration forces was associated with shorter procedure time, increased rate of first pass success and improved clinical outcomes compared with smaller caliber devices 10.…”

Section: Introductionmentioning

confidence: 99%

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Impact of reperfusion pump power on technical and clinical outcomes after direct aspiration thrombectomy (ADAPT)

Alawieh

Chalhoub

Korson

et al. 2019

J NeuroIntervent Surg

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IntroductionHigher aspiration forces using larger bore catheters in direct aspiration thrombectomy (ADAPT) have been associated with shorter procedure time and better outcomes in patients treated for acute ischemic stroke (AIS). However, the effect of using reperfusion pumps of higher aspiration power on outcomes of ADAPT has not been investigated. We evaluated the effect of using pumps with different aspiration powers on technical and clinical outcomes after ADAPT.MethodsWe reviewed a retrospective database of AIS cases between January 2018 and February 2019, while comparing technical and clinical outcomes between patients undergoing ADAPT using the MAX pump (28.5 inHg power) vs the ENGINE pump(29.2 inHg power).ResultsAmong 194 patients (48% females, age 69±15 years) included in the study, 73 patients undergoing ADAPT using the ENGINE pump were age-, gender-, comorbidities-, and operator-matched to 118 patients treated using the MAX pump. The ENGINE group had shorter procedure time (20±17 vs 27±21 mins, p=0.017), lower number of aspiration attempts (2.2±1.6 vs 2.8±1.9, p=0.047), and similar rates of favorable 90 day modified Rankin Scale. Using multivariate linear regression, the use of the ENGINE reperfusion pump with higher vacuum power was independently and inversely correlated with procedure time (coefficient −2.23, p=0.027). While controlling for confounders, there was a trend toward an inverse correlation between use of the ENGINE pump and the number of attempts on linear regression (coefficient −1.04, p=0.09) and lower odds of PH2/intracranial (ICH) hemorrhages on logistic regression (OR 0.227, p=0.075).ConclusionOur findings suggest that the use of the ENGINE reperfusion pump of higher aspiration power during ADAPT decreases procedure time, without increasing complications and post-procedural hemorrhage rates.

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Direct to Angiography—An Emerging Paradigm in Large Vessel Occlusion Stroke: Rationale, Feasibility, and Preliminary Results

Jovin

2021

12 Strokes

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Impact of Procedure Time on Outcomes of Thrombectomy for Stroke

Cited by 108 publications

References 23 publications

Futile complete recanalization: patients characteristics and its time course

Futile complete recanalization: patients characteristics and its time course

Impact of reperfusion pump power on technical and clinical outcomes after direct aspiration thrombectomy (ADAPT)

Direct to Angiography—An Emerging Paradigm in Large Vessel Occlusion Stroke: Rationale, Feasibility, and Preliminary Results

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