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Original research
Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy
  1. Dong-Hun Kang1,
  2. Jin Woo Kim2,
  3. Byung Moon Kim3,
  4. Ji Hoe Heo4,
  5. Hyo Suk Nam4,
  6. Young Dae Kim4,
  7. Yang-Ha Hwang5,
  8. Yong-Won Kim5,
  9. Jang-Hyun Baek6,
  10. Joonsang Yoo7,
  11. Dong Joon Kim3,
  12. Pyoung Jeon8,
  13. Oh Young Bang9,
  14. Seung Kug Baik10,
  15. Sang Hyun Suh11,
  16. Kyung-Yul Lee12,
  17. Hyo Sung Kwak13,
  18. Hong Gee Roh14,
  19. Young-Jun Lee15,
  20. Sang Heum Kim16,
  21. Chang-Woo Ryu17,
  22. Yon-Kwon Ihn18,
  23. Byungjun Kim19,
  24. Hong Jun Jeon20,
  25. Jun Soo Byun21,
  26. Sangil Suh22,
  27. Jeong Jin Park23,
  28. Jieun Roh10
  1. 1 Department of Neurosurgery and Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
  2. 2 Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
  3. 3 Department of Radiology, Severance stroke center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  4. 4 Department of Neurology, Severance stroke center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  5. 5 Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
  6. 6 Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
  7. 7 Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
  8. 8 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  9. 9 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  10. 10 Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
  11. 11 Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  12. 12 Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  13. 13 Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, South Korea
  14. 14 Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
  15. 15 Department of Radiology, Hanyang University College of Medicine and Hospital, Seoul, South Korea
  16. 16 Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
  17. 17 Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
  18. 18 Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
  19. 19 Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
  20. 20 Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
  21. 21 Department of Radiology, Chung-Ang University Hospital, Seoul, South Korea
  22. 22 Department of Radiology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea
  23. 23 Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
  1. Correspondence to Prof Byung Moon Kim, Department of Radiology, Severance stroke center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; bmoon21{at}hanmail.net

Abstract

Backgroud The need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT.

Methods We identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome.

Results A total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870).

Conclusion CA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.

  • acute stroke
  • thrombectomy
  • rescue treatment
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Footnotes

  • D-HK and JWK contributed equally.

  • Contributors BMK conceptualized the study, performed the analysis, and wrote the manuscript. DHK and JWK assisted in data collection, adjudication of imaging and clinical data, and wrote the manuscript. All authors acquired and analyzed data.

  • Funding This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1056).

  • Competing interests None declared.

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

  • Data sharing statement Additional data from this project can be acauired by contacting the corresponding author.

  • Patient consent for publication Not required.

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