First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy.

Autor: Remollo S; Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain., Werner M; Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain., Blasco J; Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain., López-Rueda A; Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain., San Roman L; Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain., Jimenez-Gomez E; Diagnostic and Therapeutical Neuroradiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain., Bravo Rey I; Neuroradiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain., Vega P; Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain., Murias E; Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain., Rosati S; Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain., Pérez-García C; Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain., González E; Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain., Manso X; Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain., Aixut S; Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain., Chirife Chaparro O; Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain., Terceño M; Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain., Bashir S; Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain., Pumar JM; Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Ruiz-González E; Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain., Méndez JC; Interventional Neuroradiology, Hospital Universitario Ramon y Cajal, Madrid, Spain., Aguilar Tejedor Y; Radiology Department, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain., Zamarro J; Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain., Castaño M; Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario de Salamanca, Salamanca, Spain., Daunis-I-Estadella P; Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain., Puig J; Department of Radiology (IDI) and Institut d'Investigació Biomèdica de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain. jpuigmd@gmail.com.
Jazyk: angličtina
Zdroj: Clinical neuroradiology [Clin Neuroradiol] 2023 Sep; Vol. 33 (3), pp. 701-708. Date of Electronic Publication: 2023 Mar 01.
DOI: 10.1007/s00062-023-01264-4
Abstrakt: Introduction: Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers.
Methods: We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device.
Results: We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004).
Conclusion: Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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