Need for rescue treatment and its implication: Stent retriever versus contact aspiration thrombectomy

Dong Hun Kang, Jin Woo Kim, Byung Moon Kim, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Yang Ha Hwang, Yong Won Kim, Jang Hyun Baek, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Oh Young Bang, Seung Kug Baik, Sang Hyun Suh, Kyung Yul Lee, Hyo Sung Kwak, Hong Gee Roh, Young Jun Lee, Sang Heum KimChang Woo Ryu, Yon Kwon Ihn, Byungjun Kim, Hong Jun Jeon, Jun Soo Byun, Sangil Suh, Jeong Jin Park, Jieun Roh

    Research output: Contribution to journalArticlepeer-review

    11 Citations (Scopus)

    Abstract

    Backgroud The need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT. Methods We identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome. Results A total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870). Conclusion CA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.

    Original languageEnglish
    Pages (from-to)979-983
    Number of pages5
    JournalJournal of NeuroInterventional Surgery
    Volume11
    Issue number10
    DOIs
    Publication statusPublished - 2019 Oct 1

    Keywords

    • acute stroke
    • rescue treatment
    • thrombectomy

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology

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