Publication details

Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy Results from the ESCAPE-NA1 Trial

Authors	CIMFLOVÁ Petra SINGH Nishita OSPEL Johanna M MARKO Martha KASHANI Nima MAYANK Arnuv HANEL Ricardo HAUSSEN Diogo C BHARATHA Aditya VOLDERS David HERAN Manraj K S POPPE Alexandre Y BRIAN van Adel MENON Bijoy K JOSHI Manish DEMCHUK Andrew MCTAGGART Ryan NOGUEIRA Raul G REMPEL Jeremy L ZERNA Charlotte TYMIANSKI Michael HILL Michael D GOYAL Mayank ALMEKHLAFI Mohammed A
Year of publication	2022
Type	Article in Periodical
Magazine / Source	CLINICAL NEURORADIOLOGY
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://link.springer.com/article/10.1007/s00062-021-01123-0
Doi	http://dx.doi.org/10.1007/s00062-021-01123-0
Keywords	Ischemic stroke; Endovascular treatment; Bypass effect; Device-thrombus interaction; Thrombus position within the stent-retriever
Description	Background Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial. Methods Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b-3 per attempt. The secondary outcome was successful reperfusion eTICI 2b-3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built. Results Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24-3.40 and OR 1.92; 95% CI: 1.16-3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07-2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47-5.35 and OR 2.05; 95% CI: 1.09-3.84, respectively) was associated with first-pass eTICI 2b-3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b-3 reperfusion (OR 1.95; 95% CI: 1.10-3.46). Conclusion The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.