Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration

A Multicenter Experience

Kunakorn Atchaneeyasakul, Amer Malik, Dileep R Yavagal, Diogo C. Haussen, Ashutosh P. Jadhav, Mehdi Bouslama, Cynthia L. Kenmuir, Shashvat Desai, Jonathan A. Grossberg, Seemant Chaturvedi, Tudor G. Jovin, Raul G. Nogueira

Research output: Contribution to journalArticle

Abstract

Objective: To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined. Methods: A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH). Results: A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever (n = 120) or aspiration only (n = 77). The aspiration-only group utilized either manual (n = 38) or pump aspiration (n = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality. Conclusion: Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.

Original languageEnglish (US)
Pages (from-to)180-186
Number of pages7
JournalInterventional Neurology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Thrombectomy
Middle Cerebral Artery Infarction
Stents
Stroke
Cerebral Hemorrhage
Middle Cerebral Artery
Equipment and Supplies
Catheters
Cerebral Infarction
Reperfusion
Cohort Studies
Multivariate Analysis
Retrospective Studies
Mortality

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration : A Multicenter Experience. / Atchaneeyasakul, Kunakorn; Malik, Amer; Yavagal, Dileep R; Haussen, Diogo C.; Jadhav, Ashutosh P.; Bouslama, Mehdi; Kenmuir, Cynthia L.; Desai, Shashvat; Grossberg, Jonathan A.; Chaturvedi, Seemant; Jovin, Tudor G.; Nogueira, Raul G.

In: Interventional Neurology, 01.01.2019, p. 180-186.

Research output: Contribution to journalArticle

Atchaneeyasakul, Kunakorn ; Malik, Amer ; Yavagal, Dileep R ; Haussen, Diogo C. ; Jadhav, Ashutosh P. ; Bouslama, Mehdi ; Kenmuir, Cynthia L. ; Desai, Shashvat ; Grossberg, Jonathan A. ; Chaturvedi, Seemant ; Jovin, Tudor G. ; Nogueira, Raul G. / Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration : A Multicenter Experience. In: Interventional Neurology. 2019 ; pp. 180-186.
@article{b2e3cf449a7c4a259effe1e3b42fb278,
title = "Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration: A Multicenter Experience",
abstract = "Objective: To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined. Methods: A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH). Results: A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever (n = 120) or aspiration only (n = 77). The aspiration-only group utilized either manual (n = 38) or pump aspiration (n = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95{\%} CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95{\%} CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95{\%} CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality. Conclusion: Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.",
author = "Kunakorn Atchaneeyasakul and Amer Malik and Yavagal, {Dileep R} and Haussen, {Diogo C.} and Jadhav, {Ashutosh P.} and Mehdi Bouslama and Kenmuir, {Cynthia L.} and Shashvat Desai and Grossberg, {Jonathan A.} and Seemant Chaturvedi and Jovin, {Tudor G.} and Nogueira, {Raul G.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1159/000500198",
language = "English (US)",
pages = "180--186",
journal = "Interventional Neurology",
issn = "1664-9737",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration

T2 - A Multicenter Experience

AU - Atchaneeyasakul, Kunakorn

AU - Malik, Amer

AU - Yavagal, Dileep R

AU - Haussen, Diogo C.

AU - Jadhav, Ashutosh P.

AU - Bouslama, Mehdi

AU - Kenmuir, Cynthia L.

AU - Desai, Shashvat

AU - Grossberg, Jonathan A.

AU - Chaturvedi, Seemant

AU - Jovin, Tudor G.

AU - Nogueira, Raul G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined. Methods: A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH). Results: A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever (n = 120) or aspiration only (n = 77). The aspiration-only group utilized either manual (n = 38) or pump aspiration (n = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality. Conclusion: Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.

AB - Objective: To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined. Methods: A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH). Results: A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever (n = 120) or aspiration only (n = 77). The aspiration-only group utilized either manual (n = 38) or pump aspiration (n = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality. Conclusion: Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.

UR - http://www.scopus.com/inward/record.url?scp=85067830695&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067830695&partnerID=8YFLogxK

U2 - 10.1159/000500198

DO - 10.1159/000500198

M3 - Article

SP - 180

EP - 186

JO - Interventional Neurology

JF - Interventional Neurology

SN - 1664-9737

ER -