Number of stent retriever passes associated with futile recanalization in acute stroke

Jang Hyun Baek, Byung Moon Kim, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Hyungjong Park, Oh Young Bang, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Seung Kug Baik, Sang Hyun Suh, Kyung Yul Lee, Hyo Sung Kwak, Hong Gee Roh, Young Jun Lee, Sang Heum Kim, Chang Woo Ryu, Yon Kwon Ihn, Byungjun KimHong Jun Jeon, Jin Woo Kim, Jun Soo Byun, Sangil Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung Soo Shin

    Research output: Contribution to journalArticlepeer-review

    39 Citations (Scopus)

    Abstract

    Background and Purpose-Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile recanalization can be determined. Methods-Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results-A total of 467 patients were included. Successful recanalization by SR alone was achieved in 82.2% of patients. Recanalization rates got sequentially lower as the number of passes increased, and the recanalization rate achievable by ≥5 passes of the SR was 5.5%. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without recanalization (OR 1.70 with 95% CI, 0.42.6.90 for 5 passes, P=0.455; OR 0.33 with 0.02.5.70, P=0.445 for ≥6 passes). Conclusions-The likelihood of successful recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the recanalization rate and functional outcomes.

    Original languageEnglish
    Pages (from-to)2088-2095
    Number of pages8
    JournalStroke
    Volume49
    Issue number9
    DOIs
    Publication statusPublished - 2018

    Keywords

    • Stents
    • Stroke
    • Thrombectomy

    ASJC Scopus subject areas

    • Clinical Neurology
    • Cardiology and Cardiovascular Medicine
    • Advanced and Specialised Nursing

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