TY - JOUR
T1 - Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy
T2 - Results from the ESCAPE-NA1 trial
AU - Bala, Fouzi
AU - Cimflova, Petra
AU - Singh, Nishita
AU - Zhang, Jianhai
AU - Kappelhof, Manon
AU - Kim, Beom Joon
AU - Najm, Mohamed
AU - Golan, Rotem
AU - Elebute, Ibukun
AU - Benali, Faysal
AU - Terreros, Nerea Arrarte
AU - Marquering, Henk
AU - Majoie, Charles
AU - Almekhlafi, Mohammed
AU - Goyal, Mayank
AU - Hill, Michael D.
AU - Qiu, Wu
AU - Menon, Bijoy K.
N1 - Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Mohammed Almekhlafi reports grants from CIHR outside the submitted work, and serving on the scientific advisory board of Palmera Medical, Inc. Michael D Hill reports grants from CIHR during the conduct of the study, grants from Medtronic, and grants from NoNO Inc. outside the submitted work. In addition, he has a patent to US Patent office Number: 62/086,077 issued and licensed, and Director, Board of Circle Neurovascular, Director, Board of the Canadian Neuroscience Federation, and Director, Board of the Canadian Stroke Consortium. Mayank Goyal reports receiving fees from Medtronic, Stryker, Microvention, GE Healthcare, and Mentice. Charles Majoie reports grants from CVON/Dutch Heart Foundation, TWIN Foundation, European Commission, Healthcare Evaluation Netherlands, and Stryker outside the submitted work (all paid to institution); and is (minority interest) shareholder of Nicolab. Bijoy K Menon reports shares in Circle NVI; patent for systems of triage in acute stroke. Other authors report no conflict of interest. Fouzi Bala, Petra Cimflova, Nishita Singh, Jianhai Zhang, Manon Kappelhof, Beom Joon Kim, Mohamed Najm, Rotem Golan, Ibukun Elebute, Faysal Benali, Nerea Arrarte Terreros, Henk Marquering, and Wu Qiu report no relevant disclosures. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The ESCAPE-NA1 trial was supported by a grant from the Canadian Institutes of Health Research, by Alberta Innovates and NoNo. Publisher Copyright: © European Stroke Organisation 2023.
PY - 2023/9
Y1 - 2023/9
N2 - Introduction: Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. Patients and methods: Patients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms. Results: Among 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83–0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00–1.06]). Conclusion: Our study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.
AB - Introduction: Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. Patients and methods: Patients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms. Results: Among 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83–0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00–1.06]). Conclusion: Our study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.
KW - Stroke
KW - endovascular thrombectomy
KW - ischemic
KW - reperfusion
KW - thrombus
UR - http://www.scopus.com/inward/record.url?scp=85162631800&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/23969873231183766
DO - https://doi.org/10.1177/23969873231183766
M3 - Article
C2 - 37345551
SN - 2396-9873
VL - 8
SP - 675
EP - 683
JO - European Stroke Journal
JF - European Stroke Journal
IS - 3
ER -