Matsukawa Hidetoshi, Matouk Charles, Uchida Kazutaka, Al Kasab Sami, Sowlat Mohammad-Mahdi, Elawady Sameh Samir, Maier Ilko, Jabbour Pascal, Kim Joon-Tae, Wolfe Stacey Q, Rai Ansaar T, Starke Robert M, Psychogios Marios-Nikos, Samaniego Edgar A, Arthur Adam S, Cuellar Hugo, Howard Brain M, Romano Daniele G, Tanweer Omar, Mascitelli Justin R, Fragata Isabel, Polifka Adam, Osbun Joshua W, Crosa Roberto Javier, Park Min S, Levitt Michael R, Brinjikji Waleed, Moss Mark, Williamson Richard, Navia Pedro, Kan Peter, De Leacy Reade Andrew, Chowdhry Shakeel A, Ezzeldin Mohamad, Spiotta Alejandro M, Yoshimura Shinichi, Alawieh Ali M
Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Neurosurgery, Yale University, New Haven, Connecticut, USA.
J Neurointerv Surg. 2025 Jan 26. doi: 10.1136/jnis-2024-022071.
A higher number of recanalization attempts reduces the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke secondary to large vessel occlusion (LVO). We assessed the impact of switching EVT techniques after a failed first pass on procedural and clinical outcomes.
This multicenter international study, conducted between January 2013 and December 2022, included patients undergoing EVT for anterior circulation LVO (internal carotid artery or M1 segments) with failed first pass recanalization. Propensity score matching identified a 1:1 matched cohort of patients in whom EVT technique was changed after a failed first pass and those with the same technique repeated. The primary outcome was successful recanalization at second attempt defined as Thrombolysis in Cerebral Ischemia (TICI) score of 2B or higher. Secondary outcomes were 90-day modified Rankin Score (mRS) and postprocedural hemorrhage.
Among 2167 patients, converting to an alternative technique after a failed first pass was associated with higher odds of successful recanalization (adjusted OR (aOR)=1.5, p=0.041), and higher odds of mRS 0-2 at 90 days (aOR=1.6, p=0.005) without additional risk of symptomatic hemorrhage (p=0.379). Using a propensity score matched cohort of 490 patients, technique conversion at second attempt increased odds of successful recanalization at second attempt (aOR=1.32, p=0.006) and 90-day mRS 0-2 (aOR=1.38, p=0.008).
Early conversion to an alternative EVT technique after a failed first pass recanalization in patients with AIS is associated with better technical success and clinical outcomes.
