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Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy : Results from the ESCAPE-NA1 Trial
P. Cimflova, N. Singh, JM. Ospel, M. Marko, N. Kashani, A. Mayank, R. Hanel, DC. Haussen, A. Bharatha, D. Volders, MKS. Heran, AY. Poppe, B. van Adel, BK. Menon, M. Joshi, A. Demchuk, R. McTaggart, RG. Nogueira, JL. Rempel, C. Zerna, M....
Language English Country Germany
Document type Clinical Trial, Journal Article
NLK
ProQuest Central
from 2006-01-01 to 1 year ago
Health & Medicine (ProQuest)
from 2006-01-01 to 1 year ago
- MeSH
- Cerebral Infarction MeSH
- Stroke * MeSH
- Brain Ischemia * MeSH
- Humans MeSH
- Reperfusion MeSH
- Retrospective Studies MeSH
- Stents MeSH
- Thrombectomy MeSH
- Thrombosis * MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
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.
Centre Hospitalier de l'Université de Montréal Montreal Canada
Department of Clinical Neurosciences University of Calgary Calgary Canada
Department of Medical Imaging St Anne's University Hospital Brno Brno Czech Republic
Department of Medical Imaging University of Toronto Toronto Canada
Department of Neurology Medical University of Vienna Vienna Austria
Department of Radiology Cumming School of Medicine University of Calgary Calgary Canada
Department of Radiology Dalhousie University Halifax NS Canada
Department of Radiology University Hospital of Basel Basel Switzerland
Department of Radiology Vancouver General Hospital Vancouver British Columbia Canada
Divisions of Neuroradiology and Neurosurgery St Michael's Hospital Toronto Canada
Faculty of Medicine Masaryk University Brno Czech Republic
Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Canada
International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic
Stroke and Cerebrovascular Center Baptist Medical Center Jacksonville Jacksonville FL USA
University of Alberta Hospital Edmonton AB Canada
Warren Alpert School of Medicine Brown University Providence RI USA
References provided by Crossref.org
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- $a Cimflova, Petra $u Department of Clinical Neurosciences, University of Calgary, Calgary, Canada $u Department of Medical Imaging, St. Anne's University Hospital Brno, Brno, Czech Republic $u International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic $u Faculty of Medicine, Masaryk University, Brno, Czech Republic $1 https://orcid.org/http://orcid.org/000000018058383X
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- $a 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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