TY - JOUR T1 - Fast Stent Retrieval during Mechanical Thrombectomy Improves Recanalization in Patients with the Negative Susceptibility Vessel Sign JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 726 LP - 731 DO - 10.3174/ajnr.A6989 VL - 42 IS - 4 AU - S. Soize AU - J.-B. Eymard AU - S. Cheikh-Rouhou AU - P.-F. Manceau AU - C. Gelmini AU - M. Sahnoun AU - M. Gawlitza AU - M. Zuber AU - L. Pierot AU - E. Touzé Y1 - 2021/04/01 UR - http://www.ajnr.org/content/42/4/726.abstract N2 - BACKGROUND AND PURPOSE: In acute ischemic stroke, the negative susceptibility vessel sign on T2*-weighted images traditionally highlights fibrin-rich clots, which are particularly challenging to remove. In vitro, fast stent retrieval improves fibrin-rich clot extraction. We aimed to evaluate whether the speed of stent retrieval influences the recanalization and clinical outcome of patients presenting with the negative susceptibility vessel sign.MATERIALS AND METHODS: Patients were identified from a registry of patients with ischemic stroke receiving mechanical thrombectomy between January 2016 and January 2020. Inclusion criteria were the following: 1) acute ischemic stroke caused by an isolated occlusion of the anterior circulation involving the MCA (Internal Carotid Artery-L, M1, M2) within 8 hours of symptom onset; 2) a negative susceptibility vessel sign on prethrombectomy T2*-weighted images; and 3) treatment with a combined technique (stent retriever + contact aspiration). Patients were dichotomized according to retrieval speed (fast versus slow). The primary outcome was the first-pass recanalization rate.RESULTS: Of 68 patients who met inclusion criteria, 31 (45.6%) were treated with fast retrieval. Patients receiving a fast retrieval had greater odds of first-pass complete (relative risk and 95% confidence interval [RR 95% CI], 4.30 [1.80–10.24]), near-complete (RR 95% CI, 3.24 [1.57–6.68]), and successful (RR 95% CI, 2.60 [1.53–4.43]) recanalization as well as greater odds of final complete (RR 95% CI, 4.18 [1.93–9.04]), near-complete (RR 95% CI, 2.75 [1.55–4.85]), and successful (RR 95% CI, 1.52 [1.14–2.03]) recanalization. No significant statistical differences in procedure-related serious adverse events, distal embolization, or symptomatic intracranial hemorrhage were reported. No differences were noted in terms of functional independence (RR 95% CI, 1.01 [0.53–1.93]) and all-cause mortality (RR 95% CI, 0.90 [0.35–2.30]) at 90 days.CONCLUSIONS: A fast stent retrieval during mechanical thrombectomy is safe and improves the retrieval of clots with the negative susceptibility vessel sign.eTICIextended TICIICA-L occlusioninternal carotid artery distal L-type occlusionRRrelative riskSVSsusceptibility vessel sign ER -