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More than three passes of stent retriever is an independent predictor of parenchymal hematoma in acute ischemic stroke.
J Neurointerv Surg 2019; 11(7):625-629JN

Abstract

INTRODUCTION

Despite successful recanalization with mechanical thrombectomy (MT) for acute anterior ischemic stroke (AAIS), the number of passes may impact clinical outcome.We analyzed the impact of more than three MT passes (>3) in a trial that evaluated contact aspiration (CA) versus stent retriever (SR) as the first-line technique in AAIS.

METHODS

We included patients with mTICI 2b/3 recanalization after MT for isolated intracranial occlusions. The primary outcome was the percentage of patients with a 90-day modified Rankin Scale (mRS)≤2. Secondary outcomes included overall distribution of 90-day mRS, parenchymal hematoma on 24 hours' brain imaging (PH), and 90-day mortality.

RESULTS

Among the 281 patients included and even after adjustment on time to recanalization, significantly more patients with >3 passes had PH than patients with ≤3 passes in multivariate analysis (adjusted OR, 3.62; 95% CI, 1.55 to 8.44). When the analyses were stratified according to CA vs. SR, patients with >3 passes had a stronger risk of PH than patients with ≤3 passes, only in the SR first-line-treated group (adjusted OR, 9.24; 95% CI, 2.65 to 32.13) and not in the CA first-line-treated group (adjusted RR, 1.73; 95% CI, 0.57 to 5.19). A negative association of borderline significance (P=0.07) between >3 passes and favorable outcome was observed only in SR first-line-treated patients (adjusted OR, 0.33; 95% CI, 0.09 to 1.11).

CONCLUSIONS

After three passes of SR and unlike for three passes of CA, there is an increased risk of PH and a trend toward a worse clinical outcome.

Authors+Show Affiliations

Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France.Universite Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Lille, France.Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France.Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France.Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France.Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France.Universite Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Lille, France.Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France.Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.Hopital Foch, Suresnes, France.Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France.Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

30389897

Citation

Bourcier, Romain, et al. "More Than Three Passes of Stent Retriever Is an Independent Predictor of Parenchymal Hematoma in Acute Ischemic Stroke." Journal of Neurointerventional Surgery, vol. 11, no. 7, 2019, pp. 625-629.
Bourcier R, Saleme S, Labreuche J, et al. More than three passes of stent retriever is an independent predictor of parenchymal hematoma in acute ischemic stroke. J Neurointerv Surg. 2019;11(7):625-629.
Bourcier, R., Saleme, S., Labreuche, J., Mazighi, M., Fahed, R., Blanc, R., ... Lapergue, B. (2019). More than three passes of stent retriever is an independent predictor of parenchymal hematoma in acute ischemic stroke. Journal of Neurointerventional Surgery, 11(7), pp. 625-629. doi:10.1136/neurintsurg-2018-014380.
Bourcier R, et al. More Than Three Passes of Stent Retriever Is an Independent Predictor of Parenchymal Hematoma in Acute Ischemic Stroke. J Neurointerv Surg. 2019;11(7):625-629. PubMed PMID: 30389897.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - More than three passes of stent retriever is an independent predictor of parenchymal hematoma in acute ischemic stroke. AU - Bourcier,Romain, AU - Saleme,Suzana, AU - Labreuche,Julien, AU - Mazighi,Mikael, AU - Fahed,Robert, AU - Blanc,Raphael, AU - Gory,Benjamin, AU - Kyheng,Maeva, AU - Marnat,Gaultier, AU - Bracard,Serge, AU - Desal,Hubert, AU - Consoli,Arturo, AU - Piotin,Michel, AU - Lapergue,Bertrand, AU - ,, Y1 - 2018/11/02/ PY - 2018/08/27/received PY - 2018/10/15/revised PY - 2018/10/15/accepted PY - 2018/11/6/pubmed PY - 2019/8/20/medline PY - 2018/11/4/entrez KW - device KW - stroke KW - technique KW - thrombectomy SP - 625 EP - 629 JF - Journal of neurointerventional surgery JO - J Neurointerv Surg VL - 11 IS - 7 N2 - INTRODUCTION: Despite successful recanalization with mechanical thrombectomy (MT) for acute anterior ischemic stroke (AAIS), the number of passes may impact clinical outcome.We analyzed the impact of more than three MT passes (>3) in a trial that evaluated contact aspiration (CA) versus stent retriever (SR) as the first-line technique in AAIS. METHODS: We included patients with mTICI 2b/3 recanalization after MT for isolated intracranial occlusions. The primary outcome was the percentage of patients with a 90-day modified Rankin Scale (mRS)≤2. Secondary outcomes included overall distribution of 90-day mRS, parenchymal hematoma on 24 hours' brain imaging (PH), and 90-day mortality. RESULTS: Among the 281 patients included and even after adjustment on time to recanalization, significantly more patients with >3 passes had PH than patients with ≤3 passes in multivariate analysis (adjusted OR, 3.62; 95% CI, 1.55 to 8.44). When the analyses were stratified according to CA vs. SR, patients with >3 passes had a stronger risk of PH than patients with ≤3 passes, only in the SR first-line-treated group (adjusted OR, 9.24; 95% CI, 2.65 to 32.13) and not in the CA first-line-treated group (adjusted RR, 1.73; 95% CI, 0.57 to 5.19). A negative association of borderline significance (P=0.07) between >3 passes and favorable outcome was observed only in SR first-line-treated patients (adjusted OR, 0.33; 95% CI, 0.09 to 1.11). CONCLUSIONS: After three passes of SR and unlike for three passes of CA, there is an increased risk of PH and a trend toward a worse clinical outcome. SN - 1759-8486 UR - https://www.unboundmedicine.com/medline/citation/30389897/More_than_three_passes_of_stent_retriever_is_an_independent_predictor_of_parenchymal_hematoma_in_acute_ischemic_stroke L2 - http://jnis.bmj.com/cgi/pmidlookup?view=long&pmid=30389897 DB - PRIME DP - Unbound Medicine ER -