Predictors of Angiographic Outcome After Failed Thrombectomy for Large Vessel Occlusion: Insights from the Stroke Thrombectomy and Aneurysm Registry

Author:

Webb Matthew1,Essibayi Muhammed Amir2,Al Kasab Sami2,Maier Ilko L.3,Psychogios Marios-Nikos4,Grossberg Jonathan A.5,Alawieh Ali5,Wolfe Stacey Quintero6,Arthur Adam7,Dumont Travis8,Kan Peter9,Kim Joon-Tae10,De Leacy Reade11,Osbun Joshua12,Rai Ansaar13,Jabbour Pascal13,Park Min S.14,Crosa Roberto15,Levitt Michael R.16,Polifka Adam17,Yoshimura Shinichi18,Matouk Charles19,Williamson Richard W.20,Fragata Isabel21,Chowdhry Shakeel A.22,Starke Robert M.23,Samaniego Edgar A.24,Cuellar Hugo25,Spiotta Alejandro2,Mascitelli Justin1ORCID

Affiliation:

1. Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA;

2. Medical University of South Carolina, Charleston, South Carolina, USA;

3. University Medical Center Göttingen, Göttingen, Germany;

4. University Hospital Basel, Basel, Switzerland;

5. Emory University, Atlanta, Georgia, USA;

6. Wake Forest University, Winston-Salem, North Carolina, USA;

7. University of Tennessee Health Science Center, Memphis, Tennessee, USA;

8. Bannner University of Arizona Medical Center, Tucson, Arizona, USA;

9. University of Texas Medical Branch, Galveston, Texas, USA;

10. Chonnam National University Hospital, Gwangju, South Korea;

11. Mount Sinai Health System, New York, New York, USA;

12. Washington University in St. Louis, St. Louis, Missouri, USA;

13. Department of Neuroradiology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA;

14. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;

15. University of Virginia, Charlottesville, Virginia, USA;

16. Centro Endovascular Neurológico, Médica Uruguaya, Montevideo, Uruguay;

17. University of Washington, Seattle, Washington, USA;

18. University of Florida, Gainesville, Florida, USA;

19. Hyogo College of Medicine, Nishinomiya, Japan;

20. Yale School of Medicine, New Haven, Connecticut, USA;

21. Allegheny General Hospital, Pittsburgh, Pennsylvania, USA;

22. Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal;

23. NorthShore University Health System, Evanston, Illinois, USA;

24. University of Miami Health System, Miami, Florida, USA;

25. University of Iowa, Iowa City, Iowa, USA;

Abstract

BACKGROUND: Mechanical thrombectomy failure (MTF) occurs in approximately 15% of cases. OBJECTIVE: To investigate factors that predict MTF. METHODS: This was a retrospective review of prospectively collected data from the Stroke Thrombectomy and Aneurysm Registry. Patients who underwent mechanical thrombectomy (MT) for large vessel occlusion (LVO) were included. Patients were categorized by mechanical thrombectomy success (MTS) (≥mTICI 2b) or MTF (<mTICI 2b). Demographics, pretreatment, and treatment information were included in a univariate (UVA) and multivariate (MVA) analysis for prediction of MTF. RESULTS: A total of 6780 patients were included, and 1001 experienced anterior circulation MTF. Patients in the MTF group were older (73 vs 72, P = .044) and had higher poor premorbid modified Rankin Scale (mRS) (10.8% vs 8.4%, P = .017). Onset to puncture time was greater in the MTF group (273 vs 260 min, P = .08). No significant differences were found between the access site, use of balloon guide catheter, frontline technique, or first-pass devices between the MTF and MTS groups. More complications occurred in the MTF group (14% vs 5.8%), including symptomatic intracerebral hemorrhage (9.4% vs 6.1%) and craniectomies (10% vs 2.8%) (P < .001). On UVA, age, poor pretreatment mRS, increased number of passes, and increased procedure time were associated with MTF. Internal carotid artery, M1, and M2 occlusions had decreased odds of MTF. Poor preprocedure mRS, number of passes, and procedure time remained significant on MVA. A subgroup analysis of posterior circulation LVO revealed that number of passes and total procedure time correlated with increased odds of MTF (P < .001) while rescue stenting was associated with less odds of MTF (odds ratio 0.20, 95% CI 0.06-0.63). Number of passes remained significant on MVA of posterior circulation occlusion subgroup analysis. CONCLUSION: Anterior circulation MTF is associated with more complications and worse outcomes. No differences were found between techniques or devises used for the first pass during MT. Rescue intracranial stenting may decrease the likelihood of MTF for posterior circulation MT.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

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