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?

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

1. 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.

Data availability statement

Data are available upon reasonable request. Data will be shared upon reasonable request to the corresponding author.

https://doi.org/10.1136/jnis-2024-021545

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