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Impact of Retriever Passes on Efficacy and Safety Outcomes of Acute Ischemic Stroke Treated with Mechanical Thrombectomy

  • Clinical Investigation
  • Stroke/Neurointerventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Background and Purpose

In patients with acute ischemic stroke treated with thrombectomy, additional retriever passes may increase the likelihood of recanalization, but also the risk of intracranial hemorrhage. This multicenter retrospective register study aimed to evaluate the impact of retriever passes on treatment efficacy and safety outcomes in patients treated with mechanical thrombectomy.

Materials and Methods

Patients with ischemic stroke due to large artery occlusion in anterior circulation and treated with mechanical thrombectomy were enrolled. The primary efficacy outcome was a favorable functional outcome defined as modified Rankin Scale score of 0–2 at 90 days. Major safety outcome was symptomatic intracranial hemorrhage (SICH) and mortality. Multivariate logistic regression was used to analyze the impact of retriever passes on efficacy and safety outcomes.

Results

Of the 472 enrolled patients, the likelihood of favorable outcome declined in patients with more than three retriever passes (44.4% in patients with three passes, 26.3% with four passes, 14.8% with five or more passes). Multivariate logistic regression analysis identified three or less passes as an independent predictor for favorable functional outcomes (OR 2.44, 95% CI 1.10–5.45, P = 0.029). More than three passes was associated with an increased risk of SICH (OR 2.24, 95% CI 1.16–4.33, P = 0.016).

Conclusions

More than three retriever passes may increase the rate of recanalization, but not the likelihood of favorable functional outcomes in ischemic stroke patients treated with mechanical thrombectomy. Notably, multiple retriever passes may also increase the risk of intracranial hemorrhage.

Evidence-Based Medicine

Level of Evidence: Level 4, Case Series.

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Abbreviations

SICH:

Symptomatic intracranial hemorrhage

mTICI:

Modified thrombolysis in cerebral infarction

mRS:

Modified Rankin Scale

ACTUAL:

Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry

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Acknowledgements

We acknowledge Shuyan Lu, Ph.D., for her statistical assistance.

Funding

This study was partly funded by National Natural Science Foundation of China (Nos. 81571143, 81400993 and 81530038), Jiangsu Provincial Special Program of Medical Science (No. BL2013025) and Chinese Postdoctoral Science Fund (No. 2015M572815).

Author information

Author notes

  1. Yongjie Bai and Jie Pu have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China

    Yongjie Bai, Xinfeng Liu & Gelin Xu

  2. Department of Neurology, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 471003, China

    Yongjie Bai

  3. Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China

    Jie Pu

  4. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China

    Huaiming Wang, Dong Yang, Wenjie Zi, Xinfeng Liu & Gelin Xu

  5. Department of Neurology, 89th Hospital of People’s Liberation Army, Weifang, Shandong, China

    Huaiming Wang

  6. Department of Emergency Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Yonggang Hao

  7. Department of Intervention Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Haowen Xu

  8. Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China

    Meng Zhang

  9. Department of Neurology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China

    Yu Geng

  10. Department of Neurology, Hubei Zhongshan Hospital, Wuhan, Hubei, China

    Yue Wan

  11. Department of Radiology, First People’s Hospital of Yangzhou, Yangzhou University, Yangzhou, Jiangsu, China

    Wei Wang

  12. Department of Neurology, First People’s Hospital of Hangzhou, Nanjing Medical University, Hangzhou, 310006, Zhejiang, China

    Hao Zhang

Authors
  1. Yongjie Bai
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  2. Jie Pu
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Corresponding authors

Correspondence to Wenjie Zi or Gelin Xu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Bai, Y., Pu, J., Wang, H. et al. Impact of Retriever Passes on Efficacy and Safety Outcomes of Acute Ischemic Stroke Treated with Mechanical Thrombectomy. Cardiovasc Intervent Radiol 41, 1909–1916 (2018). https://doi.org/10.1007/s00270-018-2022-0

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  • DOI: https://doi.org/10.1007/s00270-018-2022-0

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