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Original research
Institutional and provider variations for mechanical thrombectomy in the treatment of acute ischemic stroke: a survey analysis
  1. Tapan Mehta1,
  2. Shailesh Male1,
  3. Coridon Quinn1,
  4. David F Kallmes2,
  5. Adnan H Siddiqui3,
  6. Aquilla Turk4,
  7. Andrew Walker Grande1,
  8. Ramachandra Prasad Tummala1,
  9. Bharathi Dasan Jagadeesan1
  1. 1 Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA
  2. 2 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Neurosurgery and Radiology, University at Buffalo, Buffalo, New York, USA
  4. 4 Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Bharathi Dasan Jagadeesan, University of Minnesota, 420 Delaware StreetS.E., Minneapolis, MN 55455, USA; jagad002{at}umn.edu

Abstract

Introduction Stent retriever combined with aspiration, or the ‘Solumbra technique’, has recently emerged as one of the popular methods of mechanical thrombectomy (MT). However, the variations in understanding and implementation of the Solumbra technique have not been reported.

Methods An 18 part anonymous survey questionnaire was designed to extract information regarding technical variations of MT with a focus on the Solumbra technique. The survey link was posted on the Society of Neurointerventional Surgery (SNIS) website in ‘SNIS connect’.

Results 80 responses were obtained over 4 weeks that were included in the final analysis. Direct aspiration without a balloon guide catheter (BGC) was the most favored technique among respondents (41.12%) followed by the Solumbra technique without a BGC (32.4%). Among those using the Solumbra technique, 77.6% reported that they wait between 2 and 5 min to allow clot engagement, 55.2% always remove the microcatheter before aspiration, and 69.1% commence aspiration through the intermediate catheter only when retrieving the stent retriever. Operators who infrequently used or did not use BGCs reported a higher incidence of >80% Thrombolysis in Cerebral Infarction 2b/3 annual recanalization rates (OR 8.85, 95% CI 2.03 to 38.55, P=0.004) compared with those who consistently used BGCs.

Conclusion Our study documents the variations in MT techniques, and more specifically, attempts to quantify variations in the Solumbra technique. The impact of these variations on recanalization rates and eventually patient outcomes are unclear, especially given the self-reported outcomes contained in this study.

  • thrombectomy
  • stroke

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Footnotes

  • Contributors TM, SM, and BDJ: study design, data acquisition/analysis, and drafting and revising the article. CQ, DFK, AHS, AT, AWG, and RPT: study design, and review and revision of the article.

  • 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 None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the institutional review board.

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