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  • Number of passes and outcome of endovascular treatment of anterior circulation large core ischemic stroke: insights from the Endovascular Treatment in Ischemic Stroke (ETIS) registry

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Ischemic stroke
Original research
Number of passes and outcome of endovascular treatment of anterior circulation large core ischemic stroke: insights from the Endovascular Treatment in Ischemic Stroke (ETIS) registry
  1. Victoria Lambrou1,
  2. Benjamin Gory2,
  3. Bertrand Lapergue3,
  4. Gaultier Marnat4,
  5. Raoul Pop5,6,
  6. Lionel Calviere7,
  7. Mohammad Anadani8,
  8. Raphael Blanc9,
  9. Stephanos Nikolaos Finitsis1
  10. ETIS Study Group
      1. 1Neuroradiology, Aristotle University of Thessaloniki, Thessalonike, Kentrikḗ Makedonía, Greece
      2. 2Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
      3. 3Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Suresnes, France
      4. 4Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
      5. 5Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
      6. 6Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
      7. 7CHU Toulouse, Toulouse, France
      8. 8Medical University of South Carolina, Charleston, South Carolina, USA
      9. 9Interventional Neuroradiology, Fondation Rothschild, Paris, France
      1. Correspondence to Dr Stephanos Nikolaos Finitsis, Neuroradiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, St Kyriakidi, Greece; stefanosfin{at}yahoo.com

      Abstract

      Background The effect of multiple attempts on the outcome of endovascular treatment (EVT) of anterior circulation large ischemic core (LIC) stroke has not been fully explored.

      Methods We analyzed data from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective, observational, multicenter study of acute ischemic stroke patients treated with EVT at 21 centers in France between January 1, 2015 and June 31, 2023. We included patients with proximal intracranial occlusion and LIC defined as Alberta Stroke Program Early CT Score (ASPECTS) of 0–5 up to 24 hours after last being seen well. We divided patients according to the number of passes with successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) into seven groups, according to the corresponding number of passes. We compared them to the group of patients with unsuccessful reperfusion.

      Results A total of 1235 patients with LIC constituted the study cohort. The rate of a modified Rankin Scale (mRS) score of 0 to 3 at 90 days was significantly higher for the one-pass successful recanalization category compared to no recanalization (48.1% vs 17.2%; adjusted OR (aOR) 7.99, 95% CI 4.30 to 14.8, P<0.001) and remained so even after six or more attempts (27.7% vs 17.2%; aOR 3.59, 95% CI 1.37 to 9.39, P=0.009). The rate of symptomatic intracranial hemorrhage was lower for successful recanalization up to two passes (11.1% vs 18.8%; aOR 0.36, 95% CI 0.18 to 0.69, P=0.002) without any significant differences for a higher number of passes.

      Conclusion In anterior circulation LIC patients, successful reperfusion, even after six passes, is associated with favorable clinical outcomes with no increased hemorrhagic risk when compared to unsuccessful reperfusion.

      • Thrombectomy
      • Stroke
      • Technique

      Data availability statement

      Data are available upon reasonable request.

      https://doi.org/10.1136/jnis-2024-021857

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        Data availability statement

        Data are available upon reasonable request.

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        Footnotes

        • X @RaoulPop25

        • Collaborators ETIS Study Group: Foch Hospital, Paris, France: Adrien Wang, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Silvia Pizzuto, Alessandro Sgreccia, Charline Benoit, Lucas Gorza, David Weisenburger-Lile, Waliyde Jabeur, Tchikviladze Maia, Serge Evrard, Georges Rodesch. Fondation Rothschild, Paris, France: Raphaël Blanc, Michel Obadia, Jean-Philippe Desilles, Michel Piotin, Pierre Seners, Stanislas Smajda, Simon Escalard, Benjamin Maier, Candice Sabben, Hocine Redjem, Mikael Mazhigi, Grace Adwane, François Delvoye, Amira Al Raaisi, William Boisseau, Altayeb Adnan, Malayer Thomas, Robichon Erwan. Lyon Hospital, France: Omer Eker, Tae-Hee Cho, Laurent Derex, Julia Fontaine, Laura Mechtouff, Norbert Nighoghossian, Elodie Ong, Lucie Rascle, Roberto Riva, Françis Turjman, Morgane Laubacher, Mehdi Beyragued, Yves Berthezene, Marc Hermier, Ameli Roxanna, Alexandre Bani-Sadr, Andrea Filip, Matteo Cappucci, Laurent Derex, Pernot Pierre, Clottes Paul. Nantes Hospital, France: Romain Bourcier, Benjamin Daumas Duport, Pierre Louis Alexandre, Cédric Lenoble, Hubert Desal, Solene De Gaalon, Benoît Guillon, Cécile Preterre, Guillaume Tessier, Arthur Lionnet. Nancy Hospital, France: Lisa Humbertjean-Selton, René Anxionnat, Anne-Laure Derelle, Liang Liao, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Gioia Mione, Jean-Christophe Lacour, Marian Douarinou, Emilien Micard, Bailiang Chen, Gérard Audibert, Agnès Masson, Lionel Alb, Marine Beaumont, Adriana Tabarna, Marcela Voicu, Grégoire Barthel, Iona Podar, Madalina Brezeanu, Marie Reitter, François Zhu, Anxionnat René. Bordeaux Hospital, France: Jean-Sébastien Liegey, Pierre Briau, Lisa Papillon, Igor Sibon, Xavier Barreau, Jean Papaxanthos, Jérome Berge, Sabrina Debruxelles, Stéphane Olindo, Mathilde Poli, Pauline Renou, Sharmila Sagnier, Thomas Tourdias, Thomas Courret, Ludovic Lucas, Malgorzata Milnerowicz. Montpellier Hospital, France: Cyril Dargazanli, Vincent Costalat, Isabelle Mourand, Caroline Arquizan, Lucas Corti, Adrien Ter Schiphorst, Cagnazzo Federico, Imad Derraz, Mehdi Mahmoudi, Pierre-Henri Lefevre, Grégory Gascou, Quentin Varnier. Kremlin Bicêtre Hospital, Paris, France: Laurent Spelle, Jildaz Caroff, Christian Denier, Vanessa Chalumeau, Cristian Mihalea, Nicolas Legris, Augustin Ozanne, Leon Ikka, Olivier Chassin, Sophie Gallas, Laura Venditti, Mariana Sarov, Jonathan Cortese. Rennes Hospital, France: Jean-Christophe Ferre, Stephane Vannier, Thomas Ronziere, Maria Veronica Lassalle, Jean-Yves Gauvrit, Clément Tracol, Abdelghani Fakhreddine Boustia, Cécile Malrain, Edouard Beaufreton, Thibault Lapotre, Quentin Alias, Julien Hissier, Maud Guillen, François Eugene, Boucherit Julien. Amiens Hospital, France: Cyril Chivot, Audrey Courselle, Elisa Ouin, Chantal Lamy, Kevin Delaforge, Manuel Fernandez, Jérémie Vial, Quentin Laferte, Xavier Desdoit. Brest Hospital, France: Serge Timsit, Aurore Jourdain, Jean-Christophe Gentric, Julien Ognard, Irina Viakhireva, Jordan Coris, Sabine Prud'hon, François-Mathias Merrien, Denis Marechal, Marie Bruguet, Pierre Yves Rousseau, Philippe Goas, Elise Retho, Caroline Lavenant, Rozenn Le Gal, Leblanc Amélie. Caen Hospital, France: Marion Boulanger, Emmanuel Touze, Denis Vivien, Charlotte Barbier, Romain Schneckenburger, Fabrizio Salaris, Julien Cogez, Sophie Guettier, Estelle La Porte, Jean Bouchart. Limoges Hospital, France: Charbel Mounayer, Aymeric Rouchaud, Suzana Saleme, Géraud Forestier. Pitié-Salpêtrière Hospital, Paris, France: Frédéric Clarencon, Charlotte Rosso, Sara Leder, Flore Baronnet, Sophie Crozier, Anne Leger, Kevin Premat, Shotar Eimad, Stéphanie Lenck, Nader Sourour, Laure Bottin, Sam Ghazanfari, Marion Yger, Sonia Alamowitch, Stephen Delorme, Aymeric Wittwer, Christine Vassilev, Allard Julien. Ste Anne Hospital, Paris, France: Olivier Naggara, Guillaume Turc, Wagih Ben Hassen, Basile Kerleroux, Denis Trystram, Christine Rodriguez-Regent, Finoana Laza-Nomenjanahary. Rouen Hospital, France: Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Evelyne Massardier, Aude Triquenot, Margaux Lefebvre, Julien Burel, Basille Florient. Toulouse Hospital, France: Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-François Albucher, Lionel Calviere, Jean-Marc Olivot, Jean Darcourt, Nicolas Raposo, Fabrice Bonneville, Guillaume Bellanger, Louis Fontaine, Philippe Tall. Bayonne Hospital, France: Frédéric Bourdain, Patricia Bernady, Guillaume Ballan, Stephanie Bannier, Emmanuel Ellie, Olivier Flabeau, Julia Potenza, Antoine Soulages, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue. Vannes Hospital, France: Anthony Lebras, Sarah Adam, Benoit Pegat, Arnaud Le Guen, François Chedeville, Jérémy Jouan. Allibert Rémi, Alexanre Courtois, Sarah Evain, Lescot Lucile. Pau Hospital, France Stéphanie Demasles, Johann Sebastian Richter, Bruno Thierry Barroso, Camille Dahan, Alexis Gonnet, Régis Hubrecht, Zoé Lepine, Hélène Castagnet, Raluca Marasescu. Grenoble Hospital, France: Olivier Heck, Pauline Cuisenier, Olivier Detante, Isabelle Favre Wiki, Clémentine Bonaz, Garambois Katia, Loic Legris, Adrian Kastler, Kamel Boubagra, Corentin Berthet, Stéphane Charara. Poitiers Hospital, France: Victor Dumas, Neau Jean Philippe, Velasco Stéphane. Strasbourg Hospital, France: Valérie Wolff, Véronique Quenardelle, Valérie Lauer, Irène Pierre-Paul, Roxana Gheoca, Malwina Trzeciak, Bindila Perisse Daniella,Bonnart Camille. Reims Hospital, France: Solène Moulin, Hua Vi Tuan, Paolo Pagano, Alexandre Doucet, Christophe Gelmini, Pierre-François Manceau, Laurentiu Paiusan, Isabelle Serre, Sébastien Soize, Thi Ngoc Phuong Nguyen, Maher Sahnoun, Nathalie Caucheteux. Colmar Hospital, France: Pablo Lebindsky, Nader Vanessa, Federico Bolignini, Francis Vuillemet, Rodregues José. Clermont-Ferrand Hospital, France: Anna Ferrier, Abderrahim Zerroug, Ricardo Moreno, Emmanuel Chabert, Elie Lteif, Pauline Paris, Nathalie Bourgois, Marie Raquin. Angers Hospital, France: Anne Pasco-Papon, Jean Baptiste Girot, Alderic Lecluse, Sophie Godard, Vincent L'allinec, Corfu Alice. Tours Hospital, France: Kevin Janot, Richard Bibi, Marie Gaudron, Arnaud Bretonniere, Mariam Annan, Héloïse Ifergan, Grégoire Boulouis, Marco Pasi, Séverine Debiais, Elisabeth Molinier, Denis Herbreteau, Romain Doung, Fouzi Bala, Clemencie Hoche. Bar le Duc Hospital, France: Anthony Wietrich, Valérie Ruche, Karine Lavandier. Dijon Hospital, France: Yannick Bejot, Brivale Lemogne, Federic Ricolfi, Laura Baptiste, Pierre Thouant, Gaulthier Duloquin, Pierre Olivier Comby. Besançon Hospital, France: Guillaume Charbonnier, Louise Bonnet, Nicolas Raybaud, Benjamin Bouamra, Thierry Moulin, Alessandra Biondi. Versailles Hospital, France: Pico Fernando, Dano Benjamin, Patcas Carmen, Chaari Dhouha, Stanciu Daniela, Duang Duc Long, Hmida Intissar, Marie-Laure Chadenat. Marseille Hospital, France: Suissa Laurent, Doche Emilie, Hak Jean-François, Reyre Anthony, Carle Xavier, Laksiri Nadia, Osman Ophélie, Peres Roxane, Robinet-Borgomano Emmanuelle, Dulau Cécile, Kerleroux Basile, Rey Caroline. BASTIA Hospital, France: Basile Kerleroux, Jérôme Berge. ANNECY Hospital, France: Fabrice Bing, Mathieu Bonnerot.

        • Contributors All authors contributed to the collection of data. VL, BG, and SNF contributed to the conception, analysis, and drafting of the manuscript. MA contributed to the drafting of the manuscript. SNF is the guarantor of the manuscript.

        • 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.

        • 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.