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 revascularization, 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:
Frontline thrombectomy strategy and outcome in acute basilar artery occlusion
Abstract
Background Novel thrombectomy strategies emanate expeditiously day-by-day counting on access system, clot retriever device, proximity to and integration with the thrombus, and microcatheter disengagement. Nonetheless, the relationship between native thrombectomy strategies and revascularization success remains to be evaluated in basilar artery occlusion (BAO).
Purpose To compare the safety and efficacy profile of key frontline thrombectomy strategies in BAO.
Methods Retrospective analyses of prospectively maintained stroke registries at two comprehensive stroke centers were performed between January 2015 and December 2019. Patients with BAO selected after MR imaging were categorized into three groups based on the frontline thrombectomy strategy (contact aspiration (CA), stent retriever (SR), or combined (SR+CA)). Patients who experienced failure of clot retrieval followed by an interchanging strategy were categorized as a fourth (switch) group. Clinicoradiological features and procedural variables were compared. The primary outcome measure was the rate of complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c–3). Favorable outcome was defined as a 90 day modified Rankin Scale score of 0–2.
Results Of 1823 patients, we included 128 (33 underwent CA, 35 SR, 35 SR +CA, and 25 switch techniques). Complete revascularization was achieved in 83/140 (59%) primarily analyzed patients. SR +CA was associated with higher odds of complete revascularization (adjusted OR 3.04, 95% CI 1.077 to 8.593, p=0.04) which was an independent predictor of favorable outcome (adjusted OR 2.73. 95% CI 1.152 to 6.458, p=0.02). No significant differences were observed for symptomatic intracranial hemorrhage, functional outcome, or mortality rate.
Conclusion Among BAO patients, the combined technique effectively(What you have described is not effective, NO 100% RECOVERY!) contributed to complete revascularization that showed a 90 day favorable outcome with an equivalent complication rate after thrombectomy.
Data availability statement
Data are available upon reasonable request.
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Introduction
Following the results of recent landmark randomized trials, endovascular thrombectomy (EVT) has been validated as the standard of care for anterior circulation stroke (ACS).1 Stent retriever (SR) thrombectomy, which was employed in more than 80% of patients within the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands), EXTEND-IA (Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial), ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke), and SWIFT PRIME (Solitaire With the Intention For Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke) trials achieved a significantly greater rate (58–88%) of successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b/3) and a proportionate higher rate of functional independence (modified Rankin Scale (mRS) score of 0–2) in 53–71% of patients compared with those treated with intravenous thrombolysis only.2
The introduction of soft tipped, atraumatic, highly trackable large bore intermediate catheters prompted the evolution of contact aspiration (CA) as frontline therapy in ACS.3 Similar angiographic results, analogous outcome, and comparable safety endpoints between CA and SR thrombectomy that were demonstrated in the ASTER (Contact Aspiration vs Stent Retriever for Successful Revascularization) and COMPASS (Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion) trials empowered incorporation of aspiration thrombectomy in the therapeutic armamentarium of stroke.4 5
As shown by Kang et al, the switching strategy between CA and SR resulted in a higher overall rate of successful recanalization compared with patients without the switching strategy (85.1% vs 73.8%, respectively).6 Currently, simultaneous distal aspiration with SR thrombectomy (combined SR +CA) has been broadly adopted with variable terminology to enhance the technical outcome and reduce potential clot fragmentation and distal embolization.7–10
To our knowledge, there are no current comparative studies regarding the safety and efficacy of foregoing revascularization techniques, particularly in the setting of basilar artery occlusion (BAO). Furthermore, swapping between techniques was customarily deemed as a failure with no separate exploration of those patients. We, therefore, investigated the influence of the frontline EVT technique on complete revascularization and outcome in MRI selected patients with BAO.
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