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. 2017 Feb;7(1):1-7.
doi: 10.21037/qims.2017.02.06.

Endovascular stroke treatment now and then-procedural and clinical effectiveness and safety of different mechanical thrombectomy techniques over time

Niels von Gadow  1 , Omid Nikoubashman  2 , Jessica Freiherr  2 , Frank Block  3 , Arno Reich  4 , Gunther Fesl  5 , Martin Wiesmann  2
Affiliations

Endovascular stroke treatment now and then-procedural and clinical effectiveness and safety of different mechanical thrombectomy techniques over time

Niels von Gadow et al. Quant Imaging Med Surg. 2017 Feb.

Abstract

Background: The most essential development in endovascular stroke treatment (EST) was the shift from intra-arterial thrombolysis to endovascular thrombectomy with dedicated thrombectomy devices, most notably the introduction of stent-retrievers. We evaluated procedural and clinical effectiveness and safety of different EST techniques over time.

Methods: We retrospectively analyzed EST cases that were treated by the same interventionalist before (n=36) and after (n=50) stent-retrievers were established as the treatment device of first choice. EST techniques in the first cohort comprised intra-arterial thrombolysis (n=24), manual thrombus aspiration (n=15), the use of the Penumbra thrombectomy system (n=13) and the Phenox clot retriever (n=3), intracranial stenting (n=10), and EST with stent-retrievers as a salvage procedure (n=11). In the second cohort, EST with stent-retrievers was the treatment option of first choice (n=47). Intra-arterial thrombolysis (n=15) and stenting of the occluded vessel (n=1) were performed, whenever EST with stent-retrievers failed.

Results: In both cohorts, revascularization rates (TICI ≥2b) were high (91.7% and 86.0%, respectively). A significantly lower number of interventional techniques per case were required in the second cohort (mean ± SD, 1.4±0.5 vs. 2.1±0.9, P<0.001). Recanalization was achieved almost twice as fast in the second cohort (85 vs. 163 minutes on average, P<0.001). The rate of patients achieving good functional outcome (mRS ≤2) was higher in the second cohort (40.0% vs. 22.2%, P=0.083).

Conclusions: Our findings imply that when stent-retrievers were established as first-line the treatment device a significantly lower number of interventional techniques per case were required and recanalization was achieved almost twice as fast.

Keywords: Endovascular stroke treatment (EST); interventional; revascularization; stent-retriever.

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Conflict of interest statement

Conflicts of Interest: Grants: Stryker Neurovascular, Siemens Healthcare; Personal fees: Stryker Neurovascular, Silkroad Medical, Siemens Healthcare, Bracco. And other authors have no conflicts of interest to declare.

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