Correlation of Thrombectomy Maneuver Count with Recanalization Success and Clinical Outcome in Patients with Ischemic Stroke

In the treatment of acute thromboembolic stroke, the effectiveness and success of thrombus removal when using stent retrievers is variable. In this study, we analyzed the correlation of thrombectomy maneuver count with a good clinical outcome and recanalization success. One hundred and four patients...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2017-07, Vol.38 (7), p.1368-1371
Main Authors: Seker, F, Pfaff, J, Wolf, M, Ringleb, P A, Nagel, S, Schönenberger, S, Herweh, C, Möhlenbruch, M A, Bendszus, M, Pham, M
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arterial Occlusive Diseases - diagnostic imaging
Arterial Occlusive Diseases - surgery
Brain Ischemia - diagnostic imaging
Brain Ischemia - surgery
Carotid artery
Carotid Artery, Internal - surgery
Carotid Stenosis - surgery
Cerebral blood flow
Clinical outcomes
Correlation analysis
Device Removal
Diffusion Magnetic Resonance Imaging
Female
Humans
Image Processing, Computer-Assisted
Implants
Infarction, Middle Cerebral Artery - diagnostic imaging
Infarction, Middle Cerebral Artery - surgery
Interventional
Ischemia
Male
Maneuvers
Middle Aged
Occlusion
Patients
Regression analysis
Retrospective Studies
Statistical analysis
Stents
Stroke
Stroke - diagnostic imaging
Stroke - surgery
Success
Surgical implants
Thrombectomy - methods
Thromboembolism
Thrombosis
Treatment Outcome
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Summary:In the treatment of acute thromboembolic stroke, the effectiveness and success of thrombus removal when using stent retrievers is variable. In this study, we analyzed the correlation of thrombectomy maneuver count with a good clinical outcome and recanalization success. One hundred and four patients with acute occlusion of the middle cerebral artery or the terminal internal carotid artery who were treated with thrombectomy were included in this retrospective study. A good clinical outcome was defined as a 90-day mRS of ≤2, and successful recanalization was defined as TICI 2b-3. The maneuver count ranged between 1-10, with a median of 2. Multivariate logistic regression analyses identified an increasing number of thrombectomy maneuvers as an independent predictor of poor outcome (adjusted OR, 0.59; 95% CI, 0.38-0.87; = .011) and unsuccessful recanalization (adjusted OR, 0.48; 95% CI, 0.32-0.66; < .001). A good outcome was significantly more likely if finished within 2 maneuvers compared with 3 or 4 maneuvers, or even more than 4 maneuvers ( < .001). An increasing maneuver count correlates strongly with a decreasing probability of both good outcome and recanalization. The probability of successful recanalization decreases below 50% if not achieved within 5 thrombectomy maneuvers. Patients who are recanalized within 2 maneuvers have the best chance of achieving a good clinical outcome.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A5212