Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes

Abbasi, Mehdi; Liu, Yang; Fitzgerald, Seán; Mereuta, Oana Madalina; Larco, Jorge Arturo; Rizvi, Asim; Kadirvel, Ramanathan; Savastano, Luis; Brinjikji, Waleed; Kallmes, David F.

doi:10.1136/neurintsurg-2020-016869

Cited by 53 publications

(57 citation statements)

References 69 publications

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“…Potential reasons may be a lack of the use of balloon guide catheters, which has been proven to contribute to a greater first-pass effect. Our trial indicates a similar rate of modified first-pass effect to that of previous studies (13,14,(24)(25)(26).…”

Section: Discussionsupporting

confidence: 89%

“…These indicators were first described by Zaidat et al (13) and have subsequently been shown to be independent factors of favorable outcomes (14,24,25). In this trial, a firstpass effect was achieved in one-fifth of all patients, which was slightly lower than that reported by Zaidat as well as a recently published systematic review (13,26). Potential reasons may be a lack of the use of balloon guide catheters, which has been proven to contribute to a greater first-pass effect.…”

Section: Discussionmentioning

confidence: 61%

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Efficacy and Safety of a Novel Thrombectomy Device in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial

Zhang

Hua

et al. 2021

Front. Neurol.

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Purpose: The Tonbridge stent is a novel retriever with several design improvements which aim to achieve promising flow reperfusion in the treatment of acute ischemic stroke (AIS). We conducted a randomized controlled, multicenter, non-inferiority trial to compare the safety and efficacy of the Tonbridge stent with the Solitaire FR.Methods: AIS patients aged 18–85 years with large vessel occlusion in anterior circulation who could undergo puncture within 6 h of symptom onset were included. Randomization was performed on a 1:1 ratio to thrombectomy with either the Tonbridge stent or the Solitaire FR. The primary efficacy endpoint was successful reperfusion using a modified thrombolysis in cerebral infarction score (mTICI) of 2b/3. Safety outcomes were symptomatic intracranial hemorrhage (sICH) within 24 ± 6 h and all-cause mortality within 90 days. A clinically relevant non-inferiority margin of 12% was chosen as the acceptable difference between groups. Secondary endpoints included time from groin puncture to reperfusion, National Institutes of Health Stroke Scale (NIHSS) score at 24 h and at 7 days, and a modified Rankin Scale (mRS) score of 0–2 at 90 days.Results: A total of 220 patients were enrolled; 104 patients underwent thrombectomy with the Tonbridge stent and 104 were treated with the Solitaire FR. In all test group patients, the Tonbridge was used as a single retriever without rescuing by other thrombectomy devices. Angioplasty with balloon and/or stent was performed in 26 patients in the Tonbridge group and 16 patients in the Solitaire group (p = 0.084). Before angioplasty, 86.5% of those in the Tonbridge group and 81.7% of those in the Solitaire group reached successful reperfusion (p = 0.343). Finally, more patients in the Tonbridge group achieved successful reperfusion (92.3 vs. 84.6%, 95% CI of difference value 0.9–16.7%, p < 0.0001). There were no significant differences on sICH within 24 ± 6 h between the two groups. All-cause mortality within 90 days was 13.5% in the Tonbridge group and 16.3% in the Solitaire group (p = 0.559). We noted no significant differences between groups on the NIHSS at either 24 h or 7 days and the mRS of 0–2 at 90 days.Conclusion: The trial indicated that the Tonbridge stent was non-inferior to the Solitaire FR within 6 h of symptom onset in cases of large vessel occlusion stroke.Clinical Trial Registration:ClinicalTrials.gov, number: NCT03210623.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 61%

Efficacy and Safety of a Novel Thrombectomy Device in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial

Zhang

Hua

et al. 2021

Front. Neurol.

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“…Early and complete arterial recanalization is the most important factor in achieving favorable clinical outcome after ischemic stroke due to LVO (10,11). Mechanical thrombectomy is the standard of care for LVO and gaining momentum for medium vessel occlusions as well, as multiple randomized trials have demonstrated improved patient outcomes in the interventional arm (1,12).…”

Section: Discussionmentioning

confidence: 99%

“…Mean age was 74 ± 14 years, and 39 patients (49%) were female. The median NIHSS at admission was 15(IQR,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

mentioning

confidence: 99%

Initial Experience With the Trevo NXT Stent Retriever

et al. 2021

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Background: The application of a new coating to the delivery wire of the Trevo retriever has the potential to improve its handling. We therefore report our initial experience with this new stent retriever for mechanical thrombectomy of large and medium vessel occlusions.Methods: We pooled data of four high-volume European stroke centers over the time period from October 2020 to February 2021. Patients were included in our study if the Trevo NXT stent retriever was used as a first-line device. Primary endpoints were first-pass near-complete or complete reperfusion, defined as mTICI score of ≥2c. Secondary endpoints were final reperfusion, National Institutes of Health Stroke Scale (NIHSS) at 24 h and discharge, device malfunctions, complications during the procedure, and subjective ratings of the interventionalists regarding device functionality.Results: Eighty patients (39 women, mean age 74 ± 14 years) were eligible for our study. Median NIHSS at admission was 15 (IQR, 8–19), and median Alberta Stroke Program Early CT Score at baseline was 9 (IQR, 8–10). In 74 (93%) patients a primary combined approach was used as first-line technique. First-pass near-complete reperfusion was achieved in 43 (54%) and first-pass complete reperfusion in 34 (43%) patients. Final near-complete reperfusion was achieved in 66 (83%) patients after a median of 1.5 (1–3) passes, while final successful reperfusion was observed in 96% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR, 0–5), and 3 patients (4%) suffered a symptomatic intracranial hemorrhage.Conclusions: Based on our initial data, we conclude that the Trevo NXT is an effective and safe tool for mechanical thrombectomy especially when used for combined approaches.

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“…25 Improving a TICI 2b to a TICI 2c/3 reperfusion inherently comes with interventional risk or possible excess risk of sICH in the case of IAF. 26 While the earlier a good reperfusion status is achieved, the better the clinical outcomes 27 ; recent evidence suggests that reperfusion status is also important beyond the first maneuvers. 28,29 Hence, also delayed reperfusion improvements may be clinical important.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy

Kaesmacher

Peschi

Abdullayev

et al. 2021

Clinical and Translational Neuroscience

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Objective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms. Results: A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095). Conclusion: Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT.

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Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes

Cited by 53 publications

References 69 publications

Efficacy and Safety of a Novel Thrombectomy Device in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial

Efficacy and Safety of a Novel Thrombectomy Device in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial

Initial Experience With the Trevo NXT Stent Retriever

Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy

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