Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis

Abstract

Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient’s anatomy to enhance effectivity.

Factors Influencing Recanalization After Mechanical Thrombectomy With First-Pass Effect for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…Thus, identifying factors influencing FPE could help clinicians and interventionalists maximize the benefit of MT through suitable patient selection and pre-interventional risk modification. There are many studies seeking to explore this phenomenon, but with inconsistent results (7,8,11,(13)(14)(15)(16)(17)(18)(19)(20). For example, balloon guide catheters (BGC) and non-internal carotid artery (ICA) terminus occlusion were correlated with FPE in the study of Zaidat et al (7), but factors such as older age, a lower systolic blood pressure, and conscious sedation were not (17).…”

Relationship between the first pass effect and the platelet-lymphocyte ratio in acute ischemic stroke

“…But, this finding was not an independent factor for FPE in their research. Contrary to this, Gonzalez et al 34 found that the success rate of FPE was lower in women in patients with anterior circulation stroke. These inconstant findings may be due to ethnical and genetic features, or unknown multifactorial variables, which require further investigation in the future.…”

Clot-based radiomics features predict first pass effect in acute ischemic stroke

“…Some authors reported similar results with us 5,10 while some studies found that FPE was lower in female patients. 7 Differences in ethnic features in these study cohorts or unidentified multiple variables may be the reasons for this inconsistency. A higher baseline ASPECT score was also noticed as a predictor of FPE in a large prospective study, similarly to us.…”

“…5,6 Since it is understood in these articles that the primary ambition in MT is to achieve FPE; clinical, demographic, laboratory, procedural, and anatomical factors associated with FPE have turned into an intriguing topic nowadays. [7][8][9][10] Nevertheless, predicting FPE by only evaluating the pretreatment imaging modalities is still impossible.…”