RT Journal Article
SR Electronic
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.
FD American Society of Neuroradiology
SP 726
OP 731
DO 10.3174/ajnr.A6989
VO 42
IS 4
A1 S. Soize
A1 J.-B. Eymard
A1 S. Cheikh-Rouhou
A1 P.-F. Manceau
A1 C. Gelmini
A1 M. Sahnoun
A1 M. Gawlitza
A1 M. Zuber
A1 L. Pierot
A1 E. Touzé
YR 2021
UL http://www.ajnr.org/content/42/4/726.abstract
AB 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