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

Departement of Community Health Sciences Cumming School of Medicine University of Calgary Calgary 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 Marcus Stroke and Neuroscience Center Grady Memorial Hospital Emory University Atlanta GA USA

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

Departments of Clinical Neurosciences Radiology and Community Health Sciences Cumming School of Medicine University of Calgary 1403 29th St NW T2N2T9 Calgary AB Canada

Departments of Surgery and Medicine Division of Neurology Neurosurgery and Diagnostic Imaging McMaster University Hamilton Ontario 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

NoNO Toronto ON Canada

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

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