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, Sang-Il Suh, Jeong Jin Park, Jieun Roh

Research output: Contribution to journalArticle

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
JournalJournal of NeuroInterventional Surgery
DOIs
Publication statusPublished - 2019 Jan 1

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Thrombectomy
Stents
Therapeutics
Equipment and Supplies
Platelet Glycoprotein GPIIb-IIIa Complex
Balloon Angioplasty
Punctures
Registries
Stroke

Keywords

  • acute stroke
  • rescue treatment
  • thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Need for rescue treatment and its implication : Stent retriever versus contact aspiration thrombectomy. / Kang, Dong Hun; Kim, Jin Woo; Kim, Byung Moon; Heo, Ji Hoe; Nam, Hyo Suk; Kim, Young Dae; Hwang, Yang Ha; Kim, Yong Won; Baek, Jang Hyun; Yoo, Joonsang; Kim, Dong Joon; Jeon, Pyoung; Bang, Oh Young; Baik, Seung Kug; Suh, Sang Hyun; Lee, Kyung Yul; Kwak, Hyo Sung; Roh, Hong Gee; Lee, Young Jun; Kim, Sang Heum; Ryu, Chang Woo; Ihn, Yon Kwon; Kim, Byungjun; Jeon, Hong Jun; Byun, Jun Soo; Suh, Sang-Il; Park, Jeong Jin; Roh, Jieun.

In: Journal of NeuroInterventional Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Kang, DH, Kim, JW, Kim, BM, Heo, JH, Nam, HS, Kim, YD, Hwang, YH, Kim, YW, Baek, JH, Yoo, J, Kim, DJ, Jeon, P, Bang, OY, Baik, SK, Suh, SH, Lee, KY, Kwak, HS, Roh, HG, Lee, YJ, Kim, SH, Ryu, CW, Ihn, YK, Kim, B, Jeon, HJ, Byun, JS, Suh, S-I, Park, JJ & Roh, J 2019, 'Need for rescue treatment and its implication: Stent retriever versus contact aspiration thrombectomy', Journal of NeuroInterventional Surgery. https://doi.org/10.1136/neurintsurg-2018-014696
Kang, Dong Hun ; Kim, Jin Woo ; Kim, Byung Moon ; Heo, Ji Hoe ; Nam, Hyo Suk ; Kim, Young Dae ; Hwang, Yang Ha ; Kim, Yong Won ; Baek, Jang Hyun ; Yoo, Joonsang ; Kim, Dong Joon ; Jeon, Pyoung ; Bang, Oh Young ; Baik, Seung Kug ; Suh, Sang Hyun ; Lee, Kyung Yul ; Kwak, Hyo Sung ; Roh, Hong Gee ; Lee, Young Jun ; Kim, Sang Heum ; Ryu, Chang Woo ; Ihn, Yon Kwon ; Kim, Byungjun ; Jeon, Hong Jun ; Byun, Jun Soo ; Suh, Sang-Il ; Park, Jeong Jin ; Roh, Jieun. / Need for rescue treatment and its implication : Stent retriever versus contact aspiration thrombectomy. In: Journal of NeuroInterventional Surgery. 2019.
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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.",
keywords = "acute stroke, rescue treatment, thrombectomy",
author = "Kang, {Dong Hun} and Kim, {Jin Woo} and Kim, {Byung Moon} and Heo, {Ji Hoe} and Nam, {Hyo Suk} and Kim, {Young Dae} and Hwang, {Yang Ha} and Kim, {Yong Won} and Baek, {Jang Hyun} and Joonsang Yoo and Kim, {Dong Joon} and Pyoung Jeon and Bang, {Oh Young} and Baik, {Seung Kug} and Suh, {Sang Hyun} and Lee, {Kyung Yul} and Kwak, {Hyo Sung} and Roh, {Hong Gee} and Lee, {Young Jun} and Kim, {Sang Heum} and Ryu, {Chang Woo} and Ihn, {Yon Kwon} and Byungjun Kim and Jeon, {Hong Jun} and Byun, {Jun Soo} and Sang-Il Suh and Park, {Jeong Jin} and Jieun Roh",
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TY - JOUR

T1 - Need for rescue treatment and its implication

T2 - Stent retriever versus contact aspiration thrombectomy

AU - Kang, Dong Hun

AU - Kim, Jin Woo

AU - Kim, Byung Moon

AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

AU - Kim, Young Dae

AU - Hwang, Yang Ha

AU - Kim, Yong Won

AU - Baek, Jang Hyun

AU - Yoo, Joonsang

AU - Kim, Dong Joon

AU - Jeon, Pyoung

AU - Bang, Oh Young

AU - Baik, Seung Kug

AU - Suh, Sang Hyun

AU - Lee, Kyung Yul

AU - Kwak, Hyo Sung

AU - Roh, Hong Gee

AU - Lee, Young Jun

AU - Kim, Sang Heum

AU - Ryu, Chang Woo

AU - Ihn, Yon Kwon

AU - Kim, Byungjun

AU - Jeon, Hong Jun

AU - Byun, Jun Soo

AU - Suh, Sang-Il

AU - Park, Jeong Jin

AU - Roh, Jieun

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - acute stroke

KW - rescue treatment

KW - thrombectomy

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U2 - 10.1136/neurintsurg-2018-014696

DO - 10.1136/neurintsurg-2018-014696

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