@article {Soize726, author = {S. Soize and J.-B. Eymard and S. Cheikh-Rouhou and P.-F. Manceau and C. Gelmini and M. Sahnoun and M. Gawlitza and M. Zuber and L. Pierot and E. Touz{\'e}}, title = {Fast Stent Retrieval during Mechanical Thrombectomy Improves Recanalization in Patients with the Negative Susceptibility Vessel Sign}, volume = {42}, number = {4}, pages = {726--731}, year = {2021}, doi = {10.3174/ajnr.A6989}, publisher = {American Journal of Neuroradiology}, abstract = {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{\textendash}10.24]), near-complete (RR 95\% CI, 3.24 [1.57{\textendash}6.68]), and successful (RR 95\% CI, 2.60 [1.53{\textendash}4.43]) recanalization as well as greater odds of final complete (RR 95\% CI, 4.18 [1.93{\textendash}9.04]), near-complete (RR 95\% CI, 2.75 [1.55{\textendash}4.85]), and successful (RR 95\% CI, 1.52 [1.14{\textendash}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{\textendash}1.93]) and all-cause mortality (RR 95\% CI, 0.90 [0.35{\textendash}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}, issn = {0195-6108}, URL = {https://www.ajnr.org/content/42/4/726}, eprint = {https://www.ajnr.org/content/42/4/726.full.pdf}, journal = {American Journal of Neuroradiology} }