Stent-Based Retrieval Techniques in Acute Ischemic Stroke Patients with and Without Susceptibility Vessel Sign

Abstract

Background and Purpose Randomized controlled trials have challenged the assumption that reperfusion success after mechanical thrombectomy varies depending on the retrieval techniques applied; however, recent analyses have suggested that acute ischemic stroke (AIS) patients showing susceptibility vessel sign (SVS) may respond differently. We aimed to compare different stent retriever (SR)-based thrombectomy techniques with respect to interventional outcome parameters depending on SVS status. Methods We retrospectively reviewed 497 patients treated with SR-based thrombectomy for anterior circulation AIS. Imaging was conducted using a 1.5 T or 3 T magnetic resonance imaging (MRI) scanner. Logistic regression analyses were performed to test for the interaction of SVS status and first-line retrieval technique. Results are shown as percentages, total values or adjusted odds ratio (aOR) with 95% confidence intervals (CI). Results An SVS was present in 87.9% (n = 437) of patients. First-line SR thrombectomy was used to treat 293 patients, whereas 204 patients were treated with a combined approach (COA) of SR and distal aspiration. An additional balloon-guide catheter (BGC) was used in 273 SR-treated (93.2%) and 89 COA-treated (43.6%) patients. On logistic regression analysis, the interaction variable of SVS status and first-line retrieval technique was not associated with first-pass reperfusion (aOR 1.736, 95% CI 0.491–6.136; p = 0.392), overall reperfusion (aOR 3.173, 95% CI 0.752–13.387; p = 0.116), periinterventional complications, embolization into new territories, or symptomatic intracerebral hemorrhage. The use of BGC did not affect the results. Conclusion While previous analyses indicated that first-line SR thrombectomy may promise higher rates of reperfusion than contact aspiration in AIS patients with SVS, our data show no superiority of any particular SR-based retrieval technique regardless of SVS status.

Susceptibility Vessel Sign as a Predictor of Intracranial Large Vessel Occlusion

“…13 Multiple studies have also attempted to individually demonstrate the role of SVS in MCA territory or posterior circulation infarcts. 9, 14, 15 Our study showed that SVS was observed in 73 (68.9%) patients with LVO, in line with the study by Bourcier et al, which showed 76% of patients were SVS positive with anterior circulation ischemic stroke, and indeed higher than the observed value of 47.4% SVS positivity in the 2004 study by Cho et al 11…”

“…13 Multiple studies have also attempted to individually demonstrate the role of SVS in MCA territory or posterior circulation infarcts. 9,14,15 Our study showed that SVS was observed in 73 (68.9%) patients with LVO, in line with the study by Bourcier et al, which showed 76% of patients were SVS positive with anterior circulation ischemic stroke, and indeed higher than the observed value of 47.4% SVS positivity in the 2004 study by Cho et al 11 In examining studies that evaluated the sensitivity and specificity of SVS for detecting major intracranial occlusions across various vascular territories, it is noteworthy to mention the study conducted by Lingegowda et al 4 In their study involving 48 patients, they reported that the sensitivity and specificity of the "susceptibility sign" for detecting MCA occlusion were 77% and 100%, respectively (10 out of 13 cases). This suggests that SVS demonstrated high specificity in identifying MCA occlusion, accurately differentiating it from non-occluded cases.…”

Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis

“…After removing duplicates and screening for the titles and abstracts, 63 papers remained for full text review from which we excluded 58 papers (overlapping population, n=2; wrong outcome or no outcome reported, n=41; review, n=4; combined technique only used as salvage, n=2; unable to extract data, n=2; other endpoints, n=4; other, n=1). Finally, we included five studies in our meta-analysis,17 18 26–28 which included four cohort studies and one randomized trial. The quality of all of the included articles was high.…”

Deep Learning-based Assessment of Internal Carotid Artery Anatomy to Predict Difficult Intracranial Access in Endovascular Recanalization of Acute Ischemic Stroke

“…Prediction of and clinical outcome for EVT is an active field of research showing promising results [ 4 – 10 ]. Specifically, multiple studies have investigated the influence of the vascular access to the occlusion site.…”