More than five stentriever passes: real benefit or futile recanalization?

Filioglo, Andrei; Cohen, José E.; Honig, Asaf; Simaan, Naaem; Gomori, John M.; Leker, Ronen R.

doi:10.1007/s00234-020-02469-x

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…EVT patients undergoing more device passes. 11,12,[22][23][24] In line with this, our nomogram showed that baseline ASPECTS score and age were important predictors of the number of thrombectomy device passes during EVT.…”

supporting

confidence: 81%

“…9 Previously, numerous studies focused on the number of thrombectomy device passes during intravascular treatment procedures and reported that the number of thrombectomy device passes is closely related to the clinical outcome and prognosis of patients with ischemic stroke. [9][10][11][12][13][14] The most significant predictor of good prognosis was successful target-vessel recanalization. 11,15 With every additional thrombectomy device pass, the vascular recanalization rate for each individual receiving continuous thrombectomy decreases successively.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14] The most significant predictor of good prognosis was successful target-vessel recanalization. 11,15 With every additional thrombectomy device pass, the vascular recanalization rate for each individual receiving continuous thrombectomy decreases successively. Three passes may be the optimal number of attempts for target vessels; moreover, four or more attempts may not improve the probability of recanalization and may not be prognostic, while also increasing the risk of associated complications, such as hemorrhagic transformation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy

Yang¹,

Zhao²,

Xi³

et al. 2021

RMHP

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supporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy

Yang¹,

Zhao²,

Xi³

et al. 2021

RMHP

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“…However, a recently published study conducted by our group [9] showed different results. Our results indicate that 30 % of patients still reach favorable outcome even when ≥5 stentriever passes are performed.…”

mentioning

confidence: 72%

Number of passes in mechanical thrombectomy: where is your limit?

Filioglo

Cohen

Simaan

et al. 2020

Endovasc. Neurorad.

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Background and aims. Stent retriever based thrombectomy is the mainstay of treatment of acute ischemic stroke caused by large vessel occlusion. However, recanalization is sometimes not achieved even after multiple passes of the thrombectomy device. Whether revascularization becomes futile or harmful with an increasing number of passes as well as criteria for when to halt attempting recanalization remain unknown. The purpose of our work is to analyze literature data on this issue. Materials and methods. We performed a short review of the literature and summarized evidence on the impact of repeated stentriever attempts on outcome.Results. Despite some controversies, the published data indicate that up to 30 % of patients still reach favorable outcome even when ≥5 stentriever passes are performed. Probability of obtaining functional independence after multiple stentriever attempts is even higher in patients with lower baseline NIHSS score. Patients who achieve successful reperfusion after ≥5 passes have significantly higher rates of functional independence and significantly lower rates of hemorrhagic transformation compared with those who do not achieve reperfusion. Rate of target recanalization after ≥4 passes may reach 19 %. Number of passes alone is not an independent negative predictor of functional independence. The impact of multiple stentriever attempts on hemorrhagic transformation has not been well-established.Conclusions. Target vessel recanalization is an essential goal of mechanical thrombectomy, which should be pursued despite the additional number of passes and procedural time required. Number of stentriver attempts is not a game- changing factor in the decision to abort the procedure for technical futility. Treatment decisions need to be individualized for each patient based on operator’s experience and preferences, patient and clot-specific characteristics.

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“…Twelve studies comprising 3891 patients provided per pass successful recanalization rate, [5][6][7][8][9][10][11][12][13][14][15][16] while six studies including 1302 patients had data on per pass complete recanalization. 7,9,11,15,17,18 All studies were assessed as having a moderate risk of bias based on their non-randomized design.…”

Section: Literature Searchmentioning

confidence: 99%

Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis

et al. 2021

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Background and aim First pass effect (FPE) is defined as achieving a complete recanalization with a single thrombectomy device pass. Although clinically desired, FPE is reached in less than 30% of thrombectomy procedures. Multiple device passes are often necessary to achieve successful or complete recanalization. We performed a systematic review and meta-analysis to determine the recanalization rate after each pass of mechanical thrombectomy and its association with good neurological outcome. Methods A literature search was performed for studies reporting the number of device passes required for either successful (mTICI 2b or higher) or complete (mTICI 2c or higher) recanalization. Using random-effect meta-analysis, we evaluated the likelihood of recanalization and good neurological outcome (measured with the modified Rankin Score <2 at 90 days) after each device pass. Results Thirteen studies comprising 4197 patients were included. Among cases with failed first pass, 24% of them achieved final complete recanalization and 45% of them achieved final successful recanalization. Independently to the total number of previously failed attempts, the likelihood of achieving successful recanalization was 30% per pass, and the likelihood to achieve complete recanalization was about 20% per pass. The likelihood of good neurological outcome in patients with final successful recanalization decreased after each device pass: 55% after the first pass, 48% after the second pass, 42% after the third pass, 36% after the fourth pass, and 26% for 5 passes or more. Conclusion Each pass is associated with a stable likelihood of recanalization but a decreased likelihood of good neurological outcome.

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More than five stentriever passes: real benefit or futile recanalization?

Cited by 12 publications

References 16 publications

Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy

Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy

Number of passes in mechanical thrombectomy: where is your limit?

Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis

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