More Retrieval Attempts are Associated with Poorer Functional Outcome After Unsuccessful Thrombectomy

Abstract

Purpose In mechanical thrombectomy, it has been hypothesized that multiple retrieval attempts might the improve reperfusion rate but not the clinical outcome. In order to assess a potential harmful effect of a mechanical thrombectomy on patient outcome, the number of retrieval attempts was analyzed. Only patients with a thrombolysis in cerebral infarction (TICI) score of 0 were reviewed to exclude the impact of eventual successful reperfusion on the mechanical hazardousness of repeated retrievals. Methods In this study 6635 patients who underwent endovascular thrombectomy (EVT) for acute large vessel occlusion (LVO) from the prospectively administered multicenter German Stroke Registry were screened. Insufficient reperfusion was defined as no reperfusion (TICI score of 0), whereas a primary outcome was defined as functional independence (modified Rankin scale [mRS] 0–2 at day 90). Propensity score matching and multivariable logistic regressions were then performed to adjust for confounders. Results A total of 377 patients (7.8%) had a final TICI score of 0 and were included in the study. After propensity score matching functional independence was found to be significantly more frequent in patients who underwent ≤ 2 retrieval attempts (14%), compared to patients with > 2 retrieval attempts (3.9%, OR 0.29, 95% CI 0.07–0.73, p = 0.009). After adjusting for age, sex, admission NIHSS score, and location of occlusion, more than two retrieval attempts remained significantly associated with lower odds of functional independence at 90 days (OR 0.2, 95% CI 0.07–0.52, p = 0.002). Conclusion In patients with failure of reperfusion, more than two retrieval attempts were associated with a worse clinical outcome, therefore indicating a possible harmful effect of multiple retrieval attempts.

Clinical outcome after thrombectomy in patients with MeVO stroke: importance of clinical and technical factors

“…The number of passes is one of the main risk factors for poor outcome in LVO stroke [ 14 – 16 ]. Patients with one pass or distal aspiration alone obtained significant increased recanalization rate and better functional outcome.…”

“…We found no significant difference between patients who started EVT within 6 h after stroke onset and patients with unknown ictus or who started EVT after 6 h. This finding might be explained by a more restrictive selection of candidates for thrombectomy in the extended time window, as well as for patients with unknown ictus. First pass effect (FPE), defined as successful revascularization after a single stent-retriever pass (mTICI ≥ 2B), has been shown to be linked to better clinical outcome compared with non-FPE in patients with LVO [ 14 – 16 ]. This study showed the same impact of FPE in patients with pMeVO with a significantly increased probability of both mRS ≤ 1 and mRS ≤ 2.…”

Association of sepsis and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

“…The main research question, and explanatory variable of interest, was the effect of sepsis on the development of DCI. Therefore, we first performed propensity score matching (PSM) to adjust for potential confounders between subgroups of sepsis positive and negative patients 24 .…”

“…The main research question, and explanatory variable of interest, was the effect of sepsis on the development of DCI. Therefore, we first performed propensity score matching (PSM) to adjust for potential confounders between subgroups of sepsis positive and negative patients 24 . Matching weights for sepsis-3 (n yes_sepis-3 =55) subgroups were calculated using (the default settings of the matchit package) 1:1 nearest neighbor approach (N total =238; N matched =110) without replacement based on propensity score distance estimated with logistic regression including the following covariates: age, sex, WFNS grading scale, intraventricular hemorrhage (IVH), DCI protocol and smoking status as well as presence of arterial hypertension.…”

Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?

“…The role of thrombectomy attempts on procedural complications and outcome has been thoroughly assessed and reported in the literature. Several studies have demonstrated a negative impact on outcomes following multiple thrombectomy attempts with best outcomes occurring in patients requiring only one attempt [ 5 - 8 , 22 , 27 , 28 ]. Even among patients with failed recanalization (mTICI 0), more than two attempts were associated with a worse clinical outcome, demonstrating the harmful effect of multiple thrombectomy attempts [ 8 ].…”