DOI: 10.1161/svin.125.001797 ISSN: 2694-5746

Endovascular Thrombectomy Technique Optimization: A SVIN Registry Analysis

Joseph N. Samaha, Ritesh Bajaj, Ngoc Mai Le, Hussain Azeem, Ananya S. Iyyangar, Diogo C. Haussen, Jay Dolia, Jonathan A. Grossberg, Mahmoud Mohammaden, Ameer E. Hassan, Wondwossen G. Tekle, Samantha E. Miller, Hamzah M. Saei, Santiago Ortega‐Gutierrez, Milagros Galecio‐Castillo, Jorge Cespedes, Nashwa Abdelhakim, Preethi Reddi, Johanna T. Fifi, Shahram Majidi, Manisha Koneru, Linda Zhang, Jane Khalife, Mohamad Abdalkader, Thanh N. Nguyen, Guilherme Dabus, Italo Linfante, Brijesh P. Mehta, Joy Sessa, Mohammad A. Jumaa, Rebecca M. Sugg, Guillermo Linares, Alhamza R Al‐Bayati, David S. Liebeskind, Raul G. Nogueira, Sunil A. Sheth
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BACKGROUND

Achieving excellent recanalization (Modified Thrombolysis in Cerebral Infarction 2c/3) in fewer attempts improves clinical outcomes. Previous studies suggest that switching techniques after a failed first pass may enhance reperfusion rates. This study evaluates whether technique switching improves subsequent reperfusion in a large multicenter registry.

METHODS

We analyzed retrospective and prospective SVIN (Society of Vascular and Interventional Neurology) registry data from 12 US centers (October 2014–December 2021) involving endovascular therapy for M1 or internal carotid artery‐terminus (ICA‐T) occlusions. Patients with at least 2 recanalization attempts using stent retriever (SR), contact aspiration (CA), or combined technique (CT) were included. Primary outcome was the likelihood of achieving TICI 2c/3 reperfusion with or without technique switching on the second pass. Secondary outcomes included the likelihood of final TICI 2c/3 stratified by the technique and occlusion location.

RESULTS

Among 2893 endovascular therapy treatments, 1089 patients (37.6%) had successful reperfusion after the first pass. First‐pass TICI 2c/3 rates for ICA‐T occlusions were 36.0% with SR, 23.6% with CA, and 35.8% with CT; for M1 occlusions, the rates were 38.8% with SR, 39.3% with CA, and 38.6% with CT. A total of 1420 treatments included at least 2 passes. ICA‐T occlusions occurred in 20.4% and M1 occlusions in 79.6%. In multivariable analysis, in M1 occlusions, switching from CT to alternative technique after a failed first pass significantly increased the odds of achieving TICI 2c/3 after the second pass (adjusted odds ratio, 2.08 [95% CI, 1.18–3.67]). Patients who had 2 failed attempts using CA had significantly higher odds of achieving final TICI 2c/3 compared with those with 2 failed passes using the SR technique (adjusted odds ratio 1.65, [95% CI, 1.09–2.51]).

CONCLUSION

In M1‐middle cerebral artery occlusion, switching from CT to SR or CA was associated with an improvement in TICI2c/3 rates on the second pass. In addition, after 2 failed passes with CA, additional passes increased the odds of achieving complete reperfusion compared with SR.

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