Successful reperfusion, rather than number of passes, predicts clinical outcome after mechanical thrombectomy

Abstract

IntroductionFor patients undergoing mechanical thrombectomy, numerous (>3) thrombectomy passes may be harmful. However, non-recanalization leads to poor outcomes. For patients requiring multiple thrombectomy passes to achieve reperfusion, it remains unclear if the risk/benefit ratio favors recanalization.ObjectiveTo test the hypothesis that the benefits afforded by successful reperfusion outweigh the risk conveyed by the numerous passes required.MethodsWe retrospectively reviewed prospectively collected data for patients presenting to a comprehensive stroke center with anterior circulation large vessel occlusion (ACLVO) and undergoing thrombectomy requiring more than one pass over 24 months. We stratified patients into three groups: group 1 (successful reperfusion in 2–3 passes), group 2 (successful reperfusion in ≥4 passes), and group 3 (unsuccessful reperfusion).Results250 patients with ACLVO constituted the study cohort. Despite similar demographics, group 2 patients had better clinical outcomes than those in group 3 at 24 hours (National Institutes of Health Stroke Scale (NIHSS) score 13.5 vs 19.1, p<0.001) and at 90 days (modified Rankin Scale score 0–2 rates of 31.1% vs 0.0%, p=0.006) On multivariate logistic regression analysis, age (p=0.034), Alberta Stroke Program Early CT Score (p<0.01), NIHSS score (p=0.02), and parenchymal hematoma type 2 (p=0.015) were significant predictors of functional independence among those who achieved successful reperfusion, but the number of passes required did not predict outcome for these patients (p=0.74).ConclusionPatients who achieve successful reperfusion after many passes have better clinical outcomes than those who do not, despite the number of passes and procedural time required. The number of passes required to achieve successful reperfusion beyond the first pass is not a predictor of functional independence.

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

“…Similar results were reported by Tonetti et al [10], who showed, that patients who achieve successful reperfusion after ≥4 passes have significantly better rates of functional outcomes than those who do not achieve reperfusion. Furthermore, no patient with TICI 2a or worse reperfusion achieved favorable outcome.…”

Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: a systematic review and meta-analysis of observational data

“…[1][2][3] Although the chances for a clinical benefit are optimal if complete reperfusion is attained after the first pass, 4 5 there is a growing body of evidence suggesting that an effect of improved reperfusion is still tangible after multiple attempts and prolonged procedure time. [6][7][8] Despite recent technical advances, failed reperfusion (Thrombolysis in Cerebral Infarction (TICI) 0/1) is the final result of MT in every 10th patient, [9][10][11] and most patients treated successfully do not reach complete reperfusion (TICI 3). 12 13 Treatment options in these scenarios are distal MT of thrombus fragments, 7 14 bailout stenting 15 or administration of intra-arterial (IA) fibrinolytics.…”

Akut İskemik İnme İçin Mekanik Trombektomi Sonrası Klinik Sonuçlarla Tam Kan Viskozitesinin İlişkisi

“…In the study of Nogueira et al, Despite successful recanalization rates, good clinical results evaluated with the mRS score ≤ 2 were obtained in only half of the patients (21). Some authors have identified a lot of clinic factors that influence poor outcomes in patients with AIS treated with MT (22,23). In some studies, the association of laboratory parameters with poor functional results was evaluated (24, 265).…”