Need for rescue treatment and its implication: Stent retriever versus contact aspiration thrombectomy
- Authors
- Kang, D.-H.; Kim, J.W.; Kim, B.M.; Heo, J.H.; Nam, H.S.; Kim, Y.D.; Hwang, Y.-H.; Kim, Y.-W.; Baek, J.-H.; Yoo, J.S.; Kim, D.J.; Jeon, P.; Bang, O.Y.; Baik, S.K.; Suh, S.H.; Lee, K.-Y.; Kwak, H.S.; Roh, H.G.; Lee, Y.-J.; Kim, S.H.; Ryu, C.-W.; Ihn, Y.-K.; Kim, B.J.; Jeon, H.J.; Byun, J.S.; Suh, S.I.; Park, J.J.; Roh, J.E.
- Issue Date
- Oct-2019
- Publisher
- BMJ Publishing Group
- Keywords
- acute stroke; rescue treatment; thrombectomy
- Citation
- Journal of NeuroInterventional Surgery, v.11, no.10, pp 979 - 983
- Pages
- 5
- Journal Title
- Journal of NeuroInterventional Surgery
- Volume
- 11
- Number
- 10
- Start Page
- 979
- End Page
- 983
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/18430
- DOI
- 10.1136/neurintsurg-2018-014696
- ISSN
- 1759-8478
1759-8486
- Abstract
- Backgroud: The need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT. Methods: We identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome. Results: A total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870). Conclusion: CA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
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