O-068 Direct mechanical thrombectomy with or without bridging thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trials

Abstract

outcomes. However, without complete ingestion of the clot, much of it remains outside of the catheter and can be a source of distal emboli. Super Large Bore Aspiration (SLBA) has shown high rates of complete clot ingestion. We report the initial clinical feasibility, safety, and efficacy of this novel SLBA-insert combination-Super Large-bore Ingestion of Clot (SLIC technique) for stroke. SLIC entails a triaxial assembly of an 8 Fr 0.106' Base Camp catheter, 0.088' catheter extender (HiPoint) and an insert catheter (Tenzing 8), that completely consumes the inner diameter of the 0.088' SLBA catheter. The HiPoint catheter is delivered over the Tenzing 8 to the face of the embolus, which is withdrawn, while aspirating through the Base Camp and HiPoint catheters as a single assembly. Materials and Methods Retrospective review of three comprehensive stroke center databases between February 2021 and January 2022 and identification of patients treated using the SLIC technique. Data collection and analysis was performed under an Institutional Review Board approved protocol. Patient selection for endovascular treatment was based on advanced imaging with non-contrast head CT, CT angiography and/or CT perfusion. Patients included in this series were found to have a large cerebral vessel occlusion with viable ischemic penumbra (6-24 hours) in the vascular territory supplied by the occluded target artery. Clinical and procedural data of the group of patients undergoing SLIC thrombectomy were extracted. Results Thirty-three patients with large vessel occlusion were treated with SLIC. Mean patient age was 70 years (range 30-91 years) and 17 patients were male (51.5%). The median presenting NIHSS was 21 (range 1-34) and median ASPECTS score was 8 (range 5-10). Successful delivery of the 0.088' catheter to the site of the occlusion was achieved in all cases. Successful revascularization defined as mTICI2B was seen in 100% using a single pass in most of the cases (82%). Final mTICI2C was achieved in 94.1% of patients, with 73.5% mTICI3 recanalization. The rate of first-pass effect in achieving excellent reperfusion defined as mTICI2C was seen in 70.5% of cases. There were no adverse events or post-procedural symptomatic intracranial hemorrhages. Conclusion Our initial experience with the SLIC technique resulted in achieving first-pass effect (mTICI2C) in 70.5%. Navigation of the SLBA catheter extender over the Tenzing insert was successful and safe in this early experience.

Endovascular Thrombectomy with or without Bridging Thrombolysis in Acute Ischemic Stroke: A Cost-Effectiveness Analysis

“…This was because of the small increase in probability of functional independence and decrease in the risk of death, which would further translate to increased QALYs over a longer time horizon. The interpretation of cost-effectiveness results should be cautious because only short-term evidence was derived from RCTs included in our systematic review to support the model, but there were more uncertainties around the estimates for clinical outcomes, especially on the long-term mortality and disability, and their impact [20].…”

“…material, see https://doi.org/10.1159/000535796). The clinical outcome inputs on the treatment effects of EVT alone and EVT plus IVT in the short run (0–90 days after the first stroke incident) were derived from the results of our systematic review [20]. We assumed that the functional independence, disability, and death were exclusive health states at 90 days, and the sum of their probabilities was 1.…”

“…We estimated the probabilities in patients receiving EVT plus IVT treatment based on relative risks and assumed control group (EVT alone group) probabilities. Our meta-analysis reported the relative risks were 0.83 (95% confidence interval (CI) 0.59–1.18), 0.96 (95% CI: 0.88–1.04), and 1.06 (95% CI: 0.88–1.28) for sICH, functional independence, and death [20]. We estimated the probability of disability by subtracting the probabilities of functional independence and death from 1.…”

“…While there remains limited evidence supporting added clinical benefit of IVT when added to EVT, which remains corroborated by meta-analyses of randomized trials [20], there is also the concern of cost of IVT [21]. The economic value of functional gains with the addition of IVT is unclear and could shape decision making in clinical practice and health policy.…”

“…The economic value of functional gains with the addition of IVT is unclear and could shape decision making in clinical practice and health policy. To this end, we performed a model-based economic evaluation to assess the short-term and long-term effectiveness of the two strategies based on results from our systematic review and meta-analysis of RCTs [20].…”