Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke

Jang Hyun Baek, Byungmoon Kim, Jihoe Heo, Hyo Suk Nam, Young Dae Kim, Hyungjong Park, Oh Young Bang, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Seung Kug Baik, Sang Hyun Suh, Kyung Yul Lee, Hyo Sung Kwak, Hong Gee Roh, Young Jun Lee, Sang Heum Kim, Chang Woo Ryu, Yon Kwon Ihn, Byungjun KimHong Jun Jeon, Jin Woo Kim, Jun Soo Byun, Sangil Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung Soo Shin

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background and Purpose- Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile recanalization can be determined. Methods- Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results- A total of 467 patients were included. Successful recanalization by SR alone was achieved in 82.2% of patients. Recanalization rates got sequentially lower as the number of passes increased, and the recanalization rate achievable by ≥5 passes of the SR was 5.5%. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without recanalization (OR 1.70 with 95% CI, 0.42-6.90 for 5 passes, P=0.455; OR 0.33 with 0.02-5.70, P=0.445 for ≥6 passes). Conclusions- The likelihood of successful recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the recanalization rate and functional outcomes.

Original languageEnglish
Pages (from-to)2088-2095
Number of pages8
JournalStroke
Volume49
Issue number9
DOIs
Publication statusPublished - 2018 Sep 1

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Stents
Stroke
Odds Ratio
Arteries
Thrombectomy

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Baek, Jang Hyun ; Kim, Byungmoon ; Heo, Jihoe ; Nam, Hyo Suk ; Kim, Young Dae ; Park, Hyungjong ; Bang, Oh Young ; Yoo, Joonsang ; Kim, Dong Joon ; Jeon, Pyoung ; Baik, Seung Kug ; Suh, Sang Hyun ; Lee, Kyung Yul ; Kwak, Hyo Sung ; Roh, Hong Gee ; Lee, Young Jun ; Kim, Sang Heum ; Ryu, Chang Woo ; Ihn, Yon Kwon ; Kim, Byungjun ; Jeon, Hong Jun ; Kim, Jin Woo ; Byun, Jun Soo ; Suh, Sangil ; Park, Jeong Jin ; Lee, Woong Jae ; Roh, Jieun ; Shin, Byoung Soo. / Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke. In: Stroke. 2018 ; Vol. 49, No. 9. pp. 2088-2095.
@article{809870e03421453db9d4788dca83bfe6,
title = "Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke",
abstract = "Background and Purpose- Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile recanalization can be determined. Methods- Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results- A total of 467 patients were included. Successful recanalization by SR alone was achieved in 82.2{\%} of patients. Recanalization rates got sequentially lower as the number of passes increased, and the recanalization rate achievable by ≥5 passes of the SR was 5.5{\%}. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without recanalization (OR 1.70 with 95{\%} CI, 0.42-6.90 for 5 passes, P=0.455; OR 0.33 with 0.02-5.70, P=0.445 for ≥6 passes). Conclusions- The likelihood of successful recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the recanalization rate and functional outcomes.",
author = "Baek, {Jang Hyun} and Byungmoon Kim and Jihoe Heo and Nam, {Hyo Suk} and Kim, {Young Dae} and Hyungjong Park and Bang, {Oh Young} and Joonsang Yoo and Kim, {Dong Joon} and Pyoung Jeon and Baik, {Seung Kug} and Suh, {Sang Hyun} and Lee, {Kyung Yul} and Kwak, {Hyo Sung} and Roh, {Hong Gee} and Lee, {Young Jun} and Kim, {Sang Heum} and Ryu, {Chang Woo} and Ihn, {Yon Kwon} and Byungjun Kim and Jeon, {Hong Jun} and Kim, {Jin Woo} and Byun, {Jun Soo} and Sangil Suh and Park, {Jeong Jin} and Lee, {Woong Jae} and Jieun Roh and Shin, {Byoung Soo}",
year = "2018",
month = "9",
day = "1",
doi = "10.1161/STROKEAHA.118.021320",
language = "English",
volume = "49",
pages = "2088--2095",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

Baek, JH, Kim, B, Heo, J, Nam, HS, Kim, YD, Park, H, Bang, OY, Yoo, J, Kim, DJ, Jeon, P, Baik, SK, Suh, SH, Lee, KY, Kwak, HS, Roh, HG, Lee, YJ, Kim, SH, Ryu, CW, Ihn, YK, Kim, B, Jeon, HJ, Kim, JW, Byun, JS, Suh, S, Park, JJ, Lee, WJ, Roh, J & Shin, BS 2018, 'Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke', Stroke, vol. 49, no. 9, pp. 2088-2095. https://doi.org/10.1161/STROKEAHA.118.021320

Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke. / Baek, Jang Hyun; Kim, Byungmoon; Heo, Jihoe; Nam, Hyo Suk; Kim, Young Dae; Park, Hyungjong; Bang, Oh Young; Yoo, Joonsang; Kim, Dong Joon; Jeon, Pyoung; Baik, Seung Kug; Suh, Sang Hyun; Lee, Kyung Yul; Kwak, Hyo Sung; Roh, Hong Gee; Lee, Young Jun; Kim, Sang Heum; Ryu, Chang Woo; Ihn, Yon Kwon; Kim, Byungjun; Jeon, Hong Jun; Kim, Jin Woo; Byun, Jun Soo; Suh, Sangil; Park, Jeong Jin; Lee, Woong Jae; Roh, Jieun; Shin, Byoung Soo.

In: Stroke, Vol. 49, No. 9, 01.09.2018, p. 2088-2095.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke

AU - Baek, Jang Hyun

AU - Kim, Byungmoon

AU - Heo, Jihoe

AU - Nam, Hyo Suk

AU - Kim, Young Dae

AU - Park, Hyungjong

AU - Bang, Oh Young

AU - Yoo, Joonsang

AU - Kim, Dong Joon

AU - Jeon, Pyoung

AU - Baik, Seung Kug

AU - Suh, Sang Hyun

AU - Lee, Kyung Yul

AU - Kwak, Hyo Sung

AU - Roh, Hong Gee

AU - Lee, Young Jun

AU - Kim, Sang Heum

AU - Ryu, Chang Woo

AU - Ihn, Yon Kwon

AU - Kim, Byungjun

AU - Jeon, Hong Jun

AU - Kim, Jin Woo

AU - Byun, Jun Soo

AU - Suh, Sangil

AU - Park, Jeong Jin

AU - Lee, Woong Jae

AU - Roh, Jieun

AU - Shin, Byoung Soo

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background and Purpose- Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile recanalization can be determined. Methods- Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results- A total of 467 patients were included. Successful recanalization by SR alone was achieved in 82.2% of patients. Recanalization rates got sequentially lower as the number of passes increased, and the recanalization rate achievable by ≥5 passes of the SR was 5.5%. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without recanalization (OR 1.70 with 95% CI, 0.42-6.90 for 5 passes, P=0.455; OR 0.33 with 0.02-5.70, P=0.445 for ≥6 passes). Conclusions- The likelihood of successful recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the recanalization rate and functional outcomes.

AB - Background and Purpose- Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile recanalization can be determined. Methods- Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results- A total of 467 patients were included. Successful recanalization by SR alone was achieved in 82.2% of patients. Recanalization rates got sequentially lower as the number of passes increased, and the recanalization rate achievable by ≥5 passes of the SR was 5.5%. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without recanalization (OR 1.70 with 95% CI, 0.42-6.90 for 5 passes, P=0.455; OR 0.33 with 0.02-5.70, P=0.445 for ≥6 passes). Conclusions- The likelihood of successful recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the recanalization rate and functional outcomes.

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U2 - 10.1161/STROKEAHA.118.021320

DO - 10.1161/STROKEAHA.118.021320

M3 - Article

C2 - 30354993

AN - SCOPUS:85055604216

VL - 49

SP - 2088

EP - 2095

JO - Stroke

JF - Stroke

SN - 0039-2499

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