Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy

Once again, the wrong definition of success; reperfusion.

You're not measuring 100% recovery which means  it's not important enough for you to solve. Maybe, just maybe you want to talk to your patients because you're forcing your tyranny of low expectations on them.  Survivors don't fucking care about reperfusion, that's just the first step to 100% recovery. 

Business 101: If you don't measure it, it is not important, so obviously 100% recovery is not important. 

“What's measured, improves.” So said management legend and author Peter F. Drucker 

The latest here:

Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy

Results from the ESCAPE-NA1 Trial

• Petra Cimflova,
• Nishita Singh,
• Johanna M. Ospel,
• Martha Marko,
• Nima Kashani,
• Arnuv Mayank,
• Ricardo Hanel,
• Diogo C. Haussen,
• Aditya Bharatha,
• David Volders,
• Manraj K. S. Heran,
• Alexandre Y. Poppe,
• Brian van Adel,
• Bijoy K. Menon,
• Manish Joshi,
• Andrew Demchuk,
• Ryan McTaggart,
• Raul G. Nogueira,
• Jeremy L. Rempel,
• Charlotte Zerna,
• Michael Tymianski,
• Michael D. Hill,
• Mayank Goyal &
• Mohammed A. Almekhlafi 

Clinical Neuroradiology (2022)Cite this article

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Abstract

Background

Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial.

Methods

Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b–3 per attempt. The secondary outcome was successful reperfusion eTICI 2b–3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built.

Results

Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24–3.40 and OR 1.92; 95% CI: 1.16–3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07–2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47–5.35 and OR 2.05; 95% CI: 1.09–3.84, respectively) was associated with first-pass eTICI 2b–3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b–3 reperfusion (OR 1.95; 95% CI: 1.10–3.46).

Conclusion

The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.

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