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. 2025 Jan 26:jnis-2024-022071.
doi: 10.1136/jnis-2024-022071. Online ahead of print.

Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization

Hidetoshi Matsukawa  1 , Charles Matouk  2 , Kazutaka Uchida  1 , Sami Al Kasab  3 , Mohammad-Mahdi Sowlat  4 , Sameh Samir Elawady  5 , Ilko Maier  6 , Pascal Jabbour  7 , Joon-Tae Kim  6 , Stacey Q Wolfe  8 , Ansaar T Rai  9 , Robert M Starke  10 , Marios-Nikos Psychogios  11 , Edgar A Samaniego  12 , Adam S Arthur  13 , Hugo Cuellar  14 , Brain M Howard  15 , Daniele G Romano  16 , Omar Tanweer  17 , Justin R Mascitelli  18 , Isabel Fragata  19 , Adam Polifka  20 , Joshua W Osbun  21 , Roberto Javier Crosa  22 , Min S Park  23 , Michael R Levitt  24 , Waleed Brinjikji  25 , Mark Moss  26 , Richard Williamson  27 , Pedro Navia  28 , Peter Kan  29 , Reade Andrew De Leacy  30 , Shakeel A Chowdhry  31 , Mohamad Ezzeldin  32 , Alejandro M Spiotta  5 , Shinichi Yoshimura  1 , Ali M Alawieh  33
Affiliations

Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization

Hidetoshi Matsukawa et al. J Neurointerv Surg. .

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Stroke.

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Conflict of interest statement

Competing interests: Dr Hidetoshi Matsukawa received a lecture fee from Daiichi-Sankyo and Stryker and consulting services fee from B. Braun. Dr Kazutaka Uchida received a lecture fee from Daiichi-Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. Dr. Charles Matouk: Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. Speaker for Penumbra and Silk Road Medical. Contact PI for NIH Grant R21NS128641. Dr Sami Al Kasab: grant from Stryker for RESCUE-ICAS registry. Dr Ilko L Maier: speakers honoraria from Pfizer and Bristol-Myers Squibb. Dr Robert M Starke: RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant(21K02AWD-007000) and by National Institute of Health(R01NS111119-01A1) and(UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. RMS has an unrestricted research grant from Medtronic and Balt and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. Dr Marios-Nikos Psychogios: Grants from the Swiss National Science Foundation(SNF) for the DISTAL trial(33IC30_198783) and TECNO trial(32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial(Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. Dr Edgar Samaniego: Consultant for Medtronic, Microvention, Cerenovus, and Rapid Medical. Dr Adam S. Arthur: Consultant for Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Perfuze, Scientia, Siemens, Stryker. Research support from Balt, Medtronic, Microvention, Penumbra and Siemens, Shareholder Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Perfuze, Revbio, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. Dr Hugo Cuellar: Dr. Hugo Cuellar: Consultant for Medtronic, Penumbra and Microvention. Dr Daniele G. Romano: Consultant for Penumbra, Balt, Microvention, Phenox. Dr Omar Tanweer: Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. Proctor: Microvention Inc, Medtronic Inc.Educational/Research Grants: Q’apel Inc, Steinberg Foundation. Dr Adam Polifka: Consultant for Depuy Synthes and Stryker. Dr. Min S. Park: Consultant for Medtronic. Dr Michael R Levitt: Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Cerebrotech, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical; editorial boards of Journal of NeuroInterventional Surgery and Frontiers in Surgery. Dr Richard Williamson: Consultant for Medtronic, Stryker, and Synaptive Medical. Dr. Pedro Navia: Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. Dr Peter Kan: Grants from the NIH(1U18EB029353-01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. Stock ownership in Vena Medical. Dr Reade De Leacy: Research grants from Siemens Healthineers and Kaneka medical. Consultant for Cerenovus, Stryker Neurovascular and Scientia Vascular. Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular. Dr Shakeel A Chowdhry: Consultant and proctor for Medtronic and Microvention. Dr Shinichi Yoshimura received a lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. Dr Alejandro Spiotta: Research support from Penumbra, Stryker, Medtronic, RapidAI, Avail. Consultant for Penumbra, Stryker, Terumo, and RapidAI. Equity Avail.

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