Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke.
Adolescent
Adult
Aged
Aged, 80 and over
Angiography, Digital Subtraction
/ methods
Brain Ischemia
/ diagnostic imaging
Catheterization
Cerebral Angiography
Female
Humans
Male
Middle Aged
Neurosurgical Procedures
/ methods
Predictive Value of Tests
Prospective Studies
Stents
Stroke
/ diagnostic imaging
Thrombectomy
/ methods
Thrombolytic Therapy
Treatment Outcome
Young Adult
Stroke
angiography
aspiration catheter
mechanical thrombectomy
stent retriever
Journal
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
ISSN: 2385-2011
Titre abrégé: Interv Neuroradiol
Pays: United States
ID NLM: 9602695
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
pubmed:
11
5
2019
medline:
28
2
2020
entrez:
11
5
2019
Statut:
ppublish
Résumé
First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE. We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus 'Push and Fluff' technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c-3. Associations were sought between cFPE and procedural approaches and angiographic signs. A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28-9.29, The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials.
Sections du résumé
BACKGROUND
BACKGROUND
First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE.
METHODS
METHODS
We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus 'Push and Fluff' technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c-3. Associations were sought between cFPE and procedural approaches and angiographic signs.
RESULTS
RESULTS
A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28-9.29,
CONCLUSIONS
CONCLUSIONS
The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials.
Identifiants
pubmed: 31072248
doi: 10.1177/1591019919847623
pmc: PMC6777112
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
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