Influence of the number of passes of Stent-Retriever on the occurrence of parenchymal hematomas in stroke patients undergoing thrombectomy

Acosta, Fernando; Gómez, Elvira Jiménez; Rey, Isabel Bravo; Bravo-Rodríguez, Francisco de Asís; Moyano, Roberto Valverde; Fernández, R. Oteros

doi:10.1016/j.inat.2020.101041

Cited by 3 publications

(4 citation statements)

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“…We further found that the clinical benefit of recanalization in BAO patients was significant only when recanalization was achieved on the first two to three passes. This finding conflicts with some research conducted on anterior circulation LVO,18 but is consistent with the majority of studies which showed a relationship between the number of passes and functional outcome 2–7. We also found a significant and large effect of first pass recanalization on favorable outcome (mRS 0–3) in BAO patients, which is consistent with anterior circulation LVO studies and a prior analysis of the ETIS registry 5 16 23…”

Section: Discussionsupporting

confidence: 74%

“…Mechanical thrombectomy (MT) is the standard of care in patients with acute ischemic stroke with large vessel occlusions (LVO) of the anterior circulation 1. In anterior circulation LVO patients, there is a strong relationship between the number of MT passes and both successful reperfusion and functional outcome, with a detrimental effect of increasing passes on 3 month functional outcome 2–8. Whereas the benefit of MT in patients with basilar artery occlusion (BAO) has not yet been demonstrated in randomized trials,9–11 the trials faced substantial challenges including perceived lack of equipoise leading to cross-over or treatment outside the trial with subsequent slow enrollment and risk of inclusion bias.…”

Section: Introductionmentioning

confidence: 99%

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Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion

Havenon

Elhorany

Boulouis

et al. 2022

J NeuroIntervent Surg

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BackgroundThe number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes.MethodsWe used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0–3 at 90 days. We fit mixed multiple regression models, with center as a random effect.ResultsWe included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901).ConclusionsWe found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion

Havenon

Elhorany

Boulouis

et al. 2022

J NeuroIntervent Surg

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“…27 This relationship may explain the increased incidence of sICH in the young adult population despite high rates of good clinical outcomes, but this is far from certain and many other variables are in play. 29 A more recent and robust cohort, the ARISE II study, has shown good functional outcome in upwards of two-thirds of patients which was favorable when compared with older studies. The rates of good functional outcomes and mortality in the ARISE II study are similar to those seen in our study, though no direct comparison can be made.…”

Section: Discussionmentioning

confidence: 94%

Outcomes of young patients following mechanical thrombectomy for stroke: A systematic review and meta-analysis

et al. 2022

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Background Young patients experience acute ischemic stroke (AIS) at much lower rates than their older counterparts. We performed a systematic review and meta-analysis to assess the question regarding outcomes and clinical characteristics of young stroke patients who underwent mechanical thrombectomy for AIS. Methods Following PRISMA guidelines, a systematic review of the literature was conducted using the databases PubMed, MEDLINE, and Embase. The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0–2. Secondary outcome variables included rate of successful reperfusion (TICI 2b/3), symptomatic intracerebral hemorrhage (sICH), and mortality. Using R software version 4.1.2, we calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes. Results Our analysis included eight studies with a total of 1903 patients. Definitions of young patients included age ranges of 18–49/50 years, 18–54/55 years, and 18–64/65 years. Functional independence was achieved in 62.0% of the patients, with an overall mortality of 9.0%. Moreover, successful reperfusion was achieved in 82.0% of the patients with sICH rates of 5.7%. There was significant heterogeneity among different analyses, which could not be attributed to the differences of the definition of young patients. Conclusions Following mechanical thrombectomy for AIS, patients aged 18–65 years achieved relatively high rates of functional independence and successful reperfusion and low rates of mortality and sICH. Clinical Perspective In this systematic review and meta-analysis of eight studies, we examined outcomes in young stroke patients, aged 18–65 years old, following mechanical thrombectomy for acute ischemic stroke. We found that young patients achieved high rates of functional independence, high rates of successful reperfusion, and low rates of mortality and symptomatic intracerebral hemorrhage. While there have been several papers examining outcomes following mechanical thrombectomy for acute ischemic stroke in young patients, the results of these studies have yet to be pooled together in a meta-analysis. Our results indicate that young patients have good outcomes following mechanical thrombectomy. Further studies that examine these outcomes are warranted so that a higher-powered analysis can be performed to better informed clinicians regarding outcomes in this patient age-group cohort.

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“…Diabetes mellitus was defined as at least two fasting blood glucose levels above 126 mg / dl or the use of antidiabetic agents. CA-AKI was diagnosed 48-72 hours after intravascular contrast administration, with an increase in serum creatinine > 25% relative to basal creatinine, or an absolute increase in serum creatinine of at least 44 µmol / L (0.50 mg / dl) [8] [10].…”

Section: Methodsmentioning

confidence: 99%

The association between contrast associated acute kidney injury and direct bilirubin levels

Kaya

Ahmet

et al. 2021

Acta Medica Alanya

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Aim: In this study we aimed to association between bilirubin levels, which is known to have anti-oxidative, anti-inflammatory and anti-thrombotic effects, and contrast associated acute kidney injury (CA-AKI) in patients with acute coronary syndrome (ACS).Methods: Between 2017-2020, consecutive patients over 18 years of age who applied percutaneous angioplasty with the ACS diagnosis and met the exclusion and inclusion criteria (n:514) were retrospectively screened. Age, gender, chronic diseases and complete blood count parameters of the cases were recorded. Biochemical parameters, before applying contrast and 48 hours after applying contrast, were recorded. A 25% increase in creatinine level measured 48 hours after contrast application compared to basal creatinine was defined as CA-AKI.Results: CA-AKI rate was higher in females(p=0.011). In the CA-AKI positive patient group, the mean age was found significantly higher (p=0.04), hemoglobin (p=0.007), direct bilirubin (p=0.008) levels were found significantly lower. Direct bilirubin was found to be a predictor as a result of our statistical analysis to identify independent predictors of CA-AKI (Beta:0.051 OR 95% CI:0.007-0.392, p=0.004). It was found that the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity.Conclusion: It was observed that the direct bilirubin values were significantly lower in the CA-AKI positive patient group, and the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity.

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Influence of the number of passes of Stent-Retriever on the occurrence of parenchymal hematomas in stroke patients undergoing thrombectomy

Cited by 3 publications

References 20 publications

Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion

Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion

Outcomes of young patients following mechanical thrombectomy for stroke: A systematic review and meta-analysis

The association between contrast associated acute kidney injury and direct bilirubin levels

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