Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy

Title
Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy
Author
이영준
Keywords
acute stroke; thrombectomy; rescue treatment
Issue Date
2019-10
Publisher
BMJ PUBLISHING GROUP
Citation
JOURNAL OF NEUROINTERVENTIONAL SURGERY, v. 11, NO 10, Page. 979-983
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.
URI
https://jnis.bmj.com/content/11/10/979https://repository.hanyang.ac.kr/handle/20.500.11754/154676
ISSN
1759-8478; 1759-8486
DOI
10.1136/neurintsurg-2018-014696
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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