133 Early Conversion of Thrombectomy Technique Improves Technical and Functional Outcomes
INTRODUCTION: Recanalization of occluded intracranial large vessels after endovascular thrombectomy (EVT) is often achieved following multiple attempts. Current literature does not offer any guidance regarding switching to alternative thrombectomy techniques (AT) after a futile first attempt. METHODS: We included patients with stroke secondary to large vessel occlusion (LVO) who failed their first attempt at recanalization of either ICA or M1 segments utilizing an international multicenter cohort. Propensity score matching was then used to match patients with similar versus AT used as a second attempt on a 1:1 basis. Successful recanalization at the second attempt was the primary outcome while secondary outcomes consisted of functional outcomes at 90 days and postprocedural hemorrhage. RESULTS: 10229 patients were included, 2167 of which failed first pass EVT. 1733(80%) patients were treated with the same technique while 434 (20%) patients were switched to an AT. Conversion to AT was associated with higher recanalization rate (aOR = 1.5, P=0.041), higher odds of mRS (0-2) at 90 days (aOR = 1.6, P=0.005), without increased post-procedural hemorrhage rate (P=0.379). CONCLUSIONS: Conversion to AT after futile first EVT attempt is associated with imporved technical and function outcomes at 90 days without additional complications.
Authors
- Stacey Q Wolfe (ORCID: https://orcid.org/0000-0001-7603-2728)
- Shakeel Chowdhry (ORCID: https://orcid.org/0000-0002-9752-3291)
- Roberto Crosa (ORCID: https://orcid.org/0000-0001-6924-2161)
- Hidetoshi Matsukawa (ORCID: https://orcid.org/0000-0001-8229-4935)
- Pedro Navía (ORCID: https://orcid.org/0000-0002-6516-6090)
- Reade De Leacy (ORCID: https://orcid.org/0000-0001-9447-5338)
- Joshua William Osbun (ORCID: https://orcid.org/0000-0003-4308-9669)
- Ilko Maier (ORCID: https://orcid.org/0000-0001-6988-8878)
- Brian M. Howard (ORCID: https://orcid.org/0000-0001-9134-0817)
- Alejandro M Spiotta (ORCID: https://orcid.org/0000-0002-7142-5538)
- Mohamad Ezzeldin (ORCID: https://orcid.org/0000-0001-7740-8774)
- Justin Robert Mascitelli (ORCID: https://orcid.org/0000-0001-9409-5810)
- Adam Polifka (ORCID: https://orcid.org/0000-0003-4807-5274)
- Waleed Brinjikji (ORCID: https://orcid.org/0000-0001-5271-5524)
- Edgar Andres Samaniego (ORCID: https://orcid.org/0000-0003-2764-2268)
- Mark B. Moss (ORCID: https://orcid.org/0000-0001-7330-3836)
- Sameh Samir Elawady (ORCID: https://orcid.org/0000-0002-6537-0251)
- Adam S Arthur (ORCID: https://orcid.org/0000-0002-1536-1613)
- Ali Mostafa Alawieh (ORCID: https://orcid.org/0000-0003-2601-8850)
- Shinichi Yoshimura (ORCID: https://orcid.org/0000-0002-3600-4842)
- Ansaar Rai
- R Williamson
- Sami Al Kasab (ORCID: https://orcid.org/0000-0003-0593-6281)
- Michael Robert Levitt
- Hugo Cuellar (ORCID: https://orcid.org/0000-0002-8348-4535)
- Isabel Fragata (ORCID: https://orcid.org/0000-0002-7037-7458)
- Charles Matouk (ORCID: https://orcid.org/0000-0003-3234-9541)
- Daniele Romano (ORCID: https://orcid.org/0000-0002-6366-8433)
- Min Park (ORCID: https://orcid.org/0000-0001-5204-5620)
- Kazutaka Uchida (ORCID: https://orcid.org/0000-0003-4780-9598)
- Hassan Saad (ORCID: https://orcid.org/0000-0001-7565-8307)
- Peter Kan (ORCID: https://orcid.org/0000-0002-6224-097X)
- Joon‐Tae Kim (ORCID: https://orcid.org/0000-0003-4028-8339)
- Omar Tanweer (ORCID: https://orcid.org/0000-0002-6544-5591)
- Robert M Starke
- Pascal Jabbour (ORCID: https://orcid.org/0000-0002-1544-4910)
- Mohamed Mahdi Sowlat
- Marios Psychogios
Publication Details
- Journal
- Neurosurgery
- Published
- 2025-03-14
- DOI
- https://doi.org/10.1227/neu.0000000000003360_133
- Primary Topic
- Clinical practice guidelines implementation
- Type
- article
- Field-Weighted Citation Impact
- 0.00