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Ischemic stroke
Original research
Device size selection can enhance Y-stentrieving efficacy and safety as a rescue strategy in stroke thrombectomy
  1. Lucas Scotta Cabral1,
  2. Francisco Mont’Alverne2,
  3. Henrique Coelho Silva2,
  4. Paulo Eloy Passos Filho3,
  5. Pedro S C Magalhães4,
  6. Marino Muxfeldt Bianchin5,6,
  7. Raul G Nogueira7
  1. 1 Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
  2. 2 Department of Interventional Neuroradiology, Hospital Geral de Fortaleza, Fortaleza, Brazil
  3. 3 Endovascular Therapy Service, Hospital Mãe de Deus, Porto Alegre, Brazil
  4. 4 Joinvasc Stroke Program, Joinville, Brazil
  5. 5 Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
  6. 6 B.R.A.I.N., Division of Neurology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
  7. 7 Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Lucas Scotta Cabral, Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre 900035-903, Rio Grande do Sul, Brazil; lscabral{at}hcpa.edu.br

Abstract

Background Despite advancements in stroke treatment, refractory clots are relatively common, prompting the exploration of alternative techniques. Bifurcation occlusions pose specific intraprocedural challenges, occasionally dealt with by two stentrievers deployed in Y-configuration. Previous studies have portrayed this strategy as feasible, yet little is known about its safety and efficacy, and how to best select retrievers.

Objective To determine whether device selection influences the efficacy and safety of Y-stentrieving.

Methods We performed a multicentric, retrospective analysis of patients undergoing Y-stentrieving rescue for bifurcation occlusions. Demographics, devices, procedural metrics, neurological severity, reperfusion, disability, and safety were assessed.

Results Y-configuration stents were used as a rescue maneuver after 2.16±1.5 failed attempts with other techniques in 20 patients. Successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b–3) was achieved in 70% of patients after the first Y-stentrieving attempt. The first stentriever more often had a larger diameter (5.15±0.92 vs 3.67±0.57 mm, p=0.017) and longer length (33.12±5.78 vs 20.67±1.15 mm, p=0.002) in successfully reperfused cases. Also, the diameter of the first device was associated with both any parenchymal (6.0 vs 4.71±0.99 mm, p=0.045) and symptomatic (6.0 vs 4.86±1.02 mm, p<0.001) hemorrhages. Exact logistic regression demonstrated that a longer length first stentriever independently predicted better angiographic outcomes (OR=1.26, p=0.036), and a 6 mm diameter first stentriever independently predicted more intracranial hemorrhages (OR=15.28, p=0.044). No periprocedural mortality was recorded.

Conclusion Y-stentrieving is an effective and safe bail-out strategy for refractory bifurcation clots. Longer stents may promote better angiographic outcomes, whereas avoidance of disproportionately large retrievers may mitigate intracranial hemorrhage. Future studies should account for these factors when evaluating alternative stentriever techniques.

  • stroke
  • thrombectomy
  • device

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017751

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @lscabral226

    • Contributors Study conception and design: LSC, RGN. Thrombectomy procedures and local database management: LSC, FMA, HCS, PEPF, PSCM, RGN. Statistical analysis: LSC, MMB. Graphical design: LSC. Draft of the manuscript: LSC. Draft revision: LSC, FMA, HCS, PEPF, MMB, RGN. Final approval and accountability for questions related to the accuracy or integrity of any part of the work: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests LSC reports presentation honoraria from Penumbra Inc. MMB is supported by National Council for Scientific and Technological Development (CNPq). RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Imperative Care, Hybernia, Medtronic, Phenox, Prolong Pharmaceuticals, Stryker Neurovascular, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, and Perfuze. The other authors have not reported any competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.