Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke.
stent
stroke
thrombectomy
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
07
05
2021
accepted:
08
08
2021
pubmed:
29
8
2021
medline:
17
8
2022
entrez:
28
8
2021
Statut:
ppublish
Résumé
Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS. Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after single device pass. We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68-85) vs 73.5 (65-82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14-46) vs 37 (24.5-63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0-2) at 3 months across these techniques. Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS.
METHODS
METHODS
Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after single device pass.
RESULTS
RESULTS
We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68-85) vs 73.5 (65-82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14-46) vs 37 (24.5-63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0-2) at 3 months across these techniques.
CONCLUSIONS
CONCLUSIONS
Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.
Identifiants
pubmed: 34452989
pii: neurintsurg-2021-017760
doi: 10.1136/neurintsurg-2021-017760
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
863-867Investigateurs
E González Díaz
(E)
Labayen Azparren
(L)
E González Díaz
(E)
Labayen Azparren
(L)
J Fondevila Monsó
(J)
Manso Del Caño
(MD)
P Vega
(P)
E Murias
(E)
J M Jiménez Pérez
(JM)
J Chaviano Grajera
(J)
M Castañon Apilanez
(M)
E Lopez Cancio
(E)
R Oteros Fernández
(R)
E Jiménez-Gómez
(E)
Bravo Rey
(B)
Romero Saucedo
(R)
F Delgado Acosta
(F)
L San Román
(L)
A López-Rueda
(A)
J Macho
(J)
N Macías
(N)
F Zarco
(F)
A Renú Jornet
(A)
J Blasco
(J)
M Moreu
(M)
C Perez-García
(C)
S Rosati
(S)
A López-Frias
(A)
O Chirife Chaparro
(O)
S Aixut
(S)
Rodríguez Caamaño
(R)
de Miquel Miquel Ma
(M)
R Barranco Pons
(R)
L Aja Rodríguez
(L)
Cuba Camasca
(C)
M Terceño
(M)
S Bashir
(S)
L Paul
(L)
M Werner
(M)
C Castaño
(C)
S Remollo
(S)
J M Pumar
(JM)
A Mosqueira
(A)
Y Aguilar Tejedor
(Y)
D Cubillo Prieto
(D)
Bravo de Laguna Toboada A
(BL)
J C Méndez
(JC)
I Bermúdez-Coronel
(I)
E Fandiño
(E)
J I Gallego Leon
(JI)
N López Hernandez
(N)
S Moliner
(S)
J C Rayon
(JC)
Informations de copyright
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Imperative Care, Medtronic, Phenox, Prolong Pharmaceuticals, and Stryker Neurovascular, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, and Perfuze.