Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry
Background Mechanical thrombectomy has changed the landscape of acute ischemic stroke treatment, offering improved outcomes for patients with large vessel occlusions. The interplay between reperfusion techniques and occlusion sites remains a critical consideration in treatment decisions. This study...
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Wiley
2024-11-01
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| Series: | Stroke: Vascular and Interventional Neurology |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.124.001446 |
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| author | Ulf Neuberger Lori Lyn Price Salvador Miralbés Bharath Naravetla Alejandro Spiotta Christian Loehr Mario Martínez‐Galdámez Ryan A. McTaggart Luc Defreyne Pedro Vega Osama O. Zaidat David S. Liebeskind Rishi Gupta Markus Alfred Möhlenbruch the ASSIST Investigators |
| author_facet | Ulf Neuberger Lori Lyn Price Salvador Miralbés Bharath Naravetla Alejandro Spiotta Christian Loehr Mario Martínez‐Galdámez Ryan A. McTaggart Luc Defreyne Pedro Vega Osama O. Zaidat David S. Liebeskind Rishi Gupta Markus Alfred Möhlenbruch the ASSIST Investigators |
| author_sort | Ulf Neuberger |
| collection | DOAJ |
| description | Background Mechanical thrombectomy has changed the landscape of acute ischemic stroke treatment, offering improved outcomes for patients with large vessel occlusions. The interplay between reperfusion techniques and occlusion sites remains a critical consideration in treatment decisions. This study investigates the impact of primary reperfusion techniques—stent retriever classic, stent retriever combination with aspiration, and direct aspiration—on procedural and clinical outcomes at different occlusion sites. Methods Using data from the ASSIST registry, a prospective multinational initiative, patients with anterior circulation acute ischemic stroke with large vessel occlusions (n = 1477) were included. Three primary occlusion sites—M1 segment of the middle cerebral artery, M2 segment of the middle cerebral artery, and the internal carotid artery—were studied. Univariate tests and multivariable logistic regression models were used to assess associations between reperfusion techniques and procedural and clinical outcomes, including the expanded thrombolysis in cerebral infarction score and the modified Rankin Scale, stratified by occlusion site. Results Achieving expanded thrombolysis in cerebral infarction ≥2c after first pass was lower in internal carotid artery occlusions (18.2%, P<0.0001) with direct aspiration alone compared with stent retriever classic (38.2%) or stent retriever combination with aspiration (43.3%), while no differences were seen for M1 segment of the middle cerebral artery (P = 0.77) and M2 segment of the middle cerebral artery (P = 0.29) occlusions. Bailout maneuvers, which were more frequent in the direct aspiration group for all occlusion sites, did not result in longer procedure times or different final recanalization outcomes in direct aspiration compared with stent retriever classic or stent retriever combination with aspiration. Overall, there were no differences in the rate of patients with modified Rankin Scale scores of 0–2 at 90 days. No differences in safety outcomes were observed. Conclusions This study provides insight into the complex relationship between reperfusion techniques and occlusion sites in patients with acute ischemic stroke and shows that certain techniques have advantages in certain occlusion sites. As the field evolves, further research is warranted to refine our understanding of these dynamics and inform clinical practice. |
| format | Article |
| id | doaj-art-aea5c46319cb4dd8be9e1acea1c18ba0 |
| institution | Kabale University |
| issn | 2694-5746 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
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| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj-art-aea5c46319cb4dd8be9e1acea1c18ba02025-08-20T03:24:32ZengWileyStroke: Vascular and Interventional Neurology2694-57462024-11-014610.1161/SVIN.124.001446Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke RegistryUlf Neuberger0Lori Lyn Price1Salvador Miralbés2Bharath Naravetla3Alejandro Spiotta4Christian Loehr5Mario Martínez‐Galdámez6Ryan A. McTaggart7Luc Defreyne8Pedro Vega9Osama O. Zaidat10David S. Liebeskind11Rishi Gupta12Markus Alfred Möhlenbruch13the ASSIST Investigators14Department of Neuroradiology Heidelberg University Hospital Heidelberg DEStryker Neurovascular Fremont CAHospital Son Espases Mallorca SpainMcLaren Regional Medical Center Flint MIMedical University of South Carolina Charleston SCKlinikum Vest Recklinghausen Recklinghausen GermanyHospital Clínico Universitario de Valladolid Valladolid SpainRhode Island Hospital Providence RIGhent University Hospital Ghent BelgiumHospital Universitario Central de Asturias‐HUCA Oviedo SpainNeuroscience Department Bon Secours Mercy Health St. Vincent Medical Center Toledo OHDepartment of Neurology and Comprehensive Stroke Center David Geffen School of Medicine University of California Los Angeles CAWellstar Medical Group Neurosurgery WellStar Health System Marietta GADepartment of Neuroradiology Heidelberg University Hospital Heidelberg DEDepartment of Neuroradiology Heidelberg University Hospital Heidelberg DEBackground Mechanical thrombectomy has changed the landscape of acute ischemic stroke treatment, offering improved outcomes for patients with large vessel occlusions. The interplay between reperfusion techniques and occlusion sites remains a critical consideration in treatment decisions. This study investigates the impact of primary reperfusion techniques—stent retriever classic, stent retriever combination with aspiration, and direct aspiration—on procedural and clinical outcomes at different occlusion sites. Methods Using data from the ASSIST registry, a prospective multinational initiative, patients with anterior circulation acute ischemic stroke with large vessel occlusions (n = 1477) were included. Three primary occlusion sites—M1 segment of the middle cerebral artery, M2 segment of the middle cerebral artery, and the internal carotid artery—were studied. Univariate tests and multivariable logistic regression models were used to assess associations between reperfusion techniques and procedural and clinical outcomes, including the expanded thrombolysis in cerebral infarction score and the modified Rankin Scale, stratified by occlusion site. Results Achieving expanded thrombolysis in cerebral infarction ≥2c after first pass was lower in internal carotid artery occlusions (18.2%, P<0.0001) with direct aspiration alone compared with stent retriever classic (38.2%) or stent retriever combination with aspiration (43.3%), while no differences were seen for M1 segment of the middle cerebral artery (P = 0.77) and M2 segment of the middle cerebral artery (P = 0.29) occlusions. Bailout maneuvers, which were more frequent in the direct aspiration group for all occlusion sites, did not result in longer procedure times or different final recanalization outcomes in direct aspiration compared with stent retriever classic or stent retriever combination with aspiration. Overall, there were no differences in the rate of patients with modified Rankin Scale scores of 0–2 at 90 days. No differences in safety outcomes were observed. Conclusions This study provides insight into the complex relationship between reperfusion techniques and occlusion sites in patients with acute ischemic stroke and shows that certain techniques have advantages in certain occlusion sites. As the field evolves, further research is warranted to refine our understanding of these dynamics and inform clinical practice.https://www.ahajournals.org/doi/10.1161/SVIN.124.001446acute ischemic strokeclinical outcomesmechanical thrombectomyocclusion locationsreperfusion techniques |
| spellingShingle | Ulf Neuberger Lori Lyn Price Salvador Miralbés Bharath Naravetla Alejandro Spiotta Christian Loehr Mario Martínez‐Galdámez Ryan A. McTaggart Luc Defreyne Pedro Vega Osama O. Zaidat David S. Liebeskind Rishi Gupta Markus Alfred Möhlenbruch the ASSIST Investigators Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry Stroke: Vascular and Interventional Neurology acute ischemic stroke clinical outcomes mechanical thrombectomy occlusion locations reperfusion techniques |
| title | Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry |
| title_full | Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry |
| title_fullStr | Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry |
| title_full_unstemmed | Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry |
| title_short | Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry |
| title_sort | clinical impact of reperfusion techniques and occlusion sites in thrombectomy insights from the assist stroke registry |
| topic | acute ischemic stroke clinical outcomes mechanical thrombectomy occlusion locations reperfusion techniques |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.124.001446 |
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