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Ischemic stroke
Original research
Comparing different thrombectomy techniques in five large-volume centers: a ‘real world’ observational study
  1. Amélie Carolina Hesse1,
  2. Daniel Behme1,
  3. André Kemmling2,
  4. Antonia Zapf3,
  5. Nils Große Hokamp4,
  6. Isabelle Frischmuth5,
  7. Ilko Maier6,
  8. Jan Liman6,
  9. Ioannis Tsogkas1,
  10. Jan-Hendrik Buhk5,
  11. Julia Tran1,
  12. Jens Fiehler5,
  13. Anastasios Mpotsaris4,
  14. Peter Schramm2,
  15. Ansgar Berlis7,
  16. Michael Knauth1,
  17. Marios-Nikos Psychogios1
  1. 1Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
  2. 2Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
  3. 3Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
  4. 4Institute of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
  5. 5Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
  6. 6Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
  7. 7Department of Neuroradiology, Hospital Augsburg, Augsburg, Germany
  1. Correspondence to Dr Marios-Nikos Psychogios, Department of Neuroradiology, University Medical Center Goettingen, Goettingen, NS 37077, Germany; m.psychogios{at}med.uni-goettingen.de

Abstract

Background and purpose Thrombectomy has become the standard of care for acute ischaemic stroke due to large vessel occlusion. Aim of this study was to compare the radiological outcomes and time metrics of the various thrombectomy techniques.

Methods In this retrospective, multicenter study we analysed the data of 450 patients with occlusion of the anterior circulation, treated in five high-volume center from 2013 to 2016. The treatment techniques were divided in three categories: first-pass use of a large-bore aspiration-catheter; first-pass use of a stent-retriever; and primary combined approach (PCA) of an aspiration-catheter and stent-retriever. Primary endpoints were successful reperfusion and groin to reperfusion time. Secondary endpoints were the number of attempts and occurrence of emboli in new territory (ENT). The primary analysis was based on the intention to treat groups (ITT).

Results The ITT-analysis showed significantly higher reperfusion rates, with 86% of successful reperfusion in the PCA-group compared with 73% in the aspiration group and 65% in the stent-retriever group. There was no significant difference in groin to reperfusion time regarding the used technique. The secondary analysis showed an impact of the technique on the number of attempts and the occurrence of ENTs. Lowest ENT rates and attempts were reported with the combined approach.

Conclusions The combined first-pass deployment of a stent-retriever and an aspiration-catheter was the most effective technique for reperfusion of anterior circulation large vessel occlusion. Our results correlate with the latest single-centrere studies, reporting very high reperfusion rates with PCA variations.

  • stroke

https://doi.org/10.1136/neurintsurg-2017-013394

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    Footnotes

    • Contributors Conception and design: ACH, M-NP. Analysis and interpretation of data: ACH, M-NP, DB, AK, AZ, NGH, IF, IM, JL, IT. Drafting of the manuscript: ACH, M-NP, J-HB, JT, JF, AM, PS, AB. Statistics: ACH, M-NP, AZ. Critically revising and approval of the manuscript: all authors.

    • Competing interests Jens Fiehler has received fees as consultant or lecturer from Acandis, Bayer, Boehringer-Ingelheim, Codman, Covidien,Medtronic, MicroVention, Penumbra, Philips, Sequent, Siemens and Stryker. Lectures for Boehringer-Ingelheim, Covidien, and Penumbra. Funding to institution: Medtronic, MicroVention. Funding to Institution: DFG, EU, BMBF,BMWi. Jan-Hendrik Buhk has received fees as consultant orlecturer from Acandis, Bayer, Codman, Medtronic, MicroVention, Philips and Stryker.Michael Knauth has received fees as consultant or lecturer from Siemens, Penumbra, Stryker, Acandis, Bayer.Marios-Nikos Psychogios has received fees as consultant or lecturer from Siemens, Penumbra, Stryker.

    • Ethics approval Ethics committee University Medical Centre Goettingen.

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

    • Data sharing statement Yes, we are willing to provide additional data upon request.