Deans' stroke musings: Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when?

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, March 21, 2024

Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when?

You do realize by not measuring the only goal in stroke; 100% recovery, you'll never get there? Survivors don't give a flying fuck about reperfusion, that's only the first step to 100% recovery!

You're not even measuring 100% recovery! I'd fire all of you!

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

Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when?

http://orcid.org/0000-0002-5760-6869Pedro N Martins1,2,
Raul G Nogueira1,2,3,
Mohamed A Tarek1,2,
Jaydevsinh N Dolia1,2,
Sunil A Sheth4,
http://orcid.org/0000-0002-3408-1297Santiago Ortega-Gutierrez5,
Sergio Salazar-Marioni4,
Ananya Iyyangar4,
http://orcid.org/0000-0002-8107-9632Milagros Galecio-Castillo5,
http://orcid.org/0000-0002-8413-6954Aaron Rodriguez-Calienes5,6,
Aqueel Pabaney1,2,
http://orcid.org/0000-0002-1152-8826Jonathan A Grossberg1,2,
Diogo C Haussen1,2

Correspondence to Dr Diogo C Haussen, Department of Neurology and Radiology, Emory University School of Medicine, Atlanta, GA 30303, USA; diogo.haussen@emory.edu

Abstract

Background Fast and complete reperfusion in endovascular therapy (EVT) for ischemic stroke leads to superior clinical outcomes(Superior is 100% recovery!). The effect of changing the technical approach following initially unsuccessful passes remains undetermined.

Objective To evaluate the association between early changes to the EVT approach and reperfusion.

Methods Multicenter retrospective analysis of prospectively collected data for patients who underwent EVT for intracranial internal carotid artery, middle cerebral artery (M1/M2), or basilar artery occlusions. Changes in EVT technique after one or two failed passes with stent retriever (SR), contact aspiration (CA), or a combined technique (CT) were compared with repeating the previous strategy. The primary outcome was complete/near-complete reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) of 2c–3, following the second and third passes.

Results Among 2968 included patients, median age was 66 years and 52% were men. Changing from SR to CA on the second or third pass was not observed to influence the rates of eTICI 2c–3, whereas changing from SR to CT after two failed passes was associated with higher chances of eTICI 2c–3 (OR=5.3, 95% CI 1.9 to 14.6). Changing from CA to CT was associated with higher eTICI 2c–3 chances after one (OR=2.9, 95% CI 1.6 to 5.5) or two (OR=2.7, 95% CI 1.0 to 7.4) failed CA passes, whereas switching to SR after one failed CA pass was associated with greater chance of eTICI 2c–3 (OR=6.9, 95% CI 1.6 to 30.0). Following one or two failed CT passes, switching to SR was not associated with different reperfusion rates, but changing to CA after two failed CT passes was associated with lower chances of eTICI 2c–3 (OR=0.3, 95% CI 0.1 to 0.9). Rates of functional independence were similar.

Conclusions Early changes in EVT strategies were associated with higher reperfusion and should be contemplated following failed attempts with stand-alone CA or SR.