PT  - JOURNAL ARTICLE
AU  - Mahmoud H Mohammaden
AU  - Diogo C Haussen
AU  - Catarina Perry da Camara
AU  - Leonardo Pisani
AU  - Marta Olive Gadea
AU  - Alhamza R Al-Bayati
AU  - Bernardo Liberato
AU  - Srikant Rangaraju
AU  - Michael R Frankel
AU  - Raul G Nogueira
TI  - Hyperdense vessel sign as a potential guide for the choice of stent retriever versus contact aspiration as first-line thrombectomy strategy
AID  - 10.1136/neurintsurg-2020-016005
DP  - 2021 Jul 01
TA  - Journal of NeuroInterventional Surgery
PG  - 599--604
VI  - 13
IP  - 7
4099  - http://jnis.bmj.com/content/13/7/599.short
4100  - http://jnis.bmj.com/content/13/7/599.full
SO  - J NeuroIntervent Surg2021 Jul 01; 13
AB  - Background The first-pass effect (FPE) has emerged as a key metric for efficacy in mechanical thrombectomy (MT). The hyperdense vessel sign (HDVS) on non-contrast head CT (NCCT) indicates a higher clot content of red blood cells.Objective To assess whether the HDVS could serve as an imaging biomarker for guiding first-line device selection in MT.Methods A prospective MT database was reviewed for consecutive patients with anterior circulation large vessel occlusion stroke who underwent thrombectomy with stent retriever (SR) or contact aspiration (CA) as first-line therapy between January 2012 and November 2018. Pretreatment NCCT scans were evaluated for the presence of HDVS. The primary outcome was FPE (modified Thrombolysis in Cerebral Infarction score 2c/3). The primary analysis was the interaction between HDVS and thrombectomy modality on FPE. Secondary analyses aimed to evaluate the predictors of FPE.Results A total of 779 patients qualified for the analysis. HDVS and FPE were reported in 473 (60.7%) and 286 (36.7%) patients, respectively. The presence of HDVS significantly modified the effect of thrombectomy modality on FPE (p=0.01), with patients with HDVS having a significantly higher rate of FPE with a SR (41.3% vs 22.2%, p=0.001; adjusted OR 2.11 (95% CI 1.20 to 3.70), p=0.009) and non-HDVS patients having a numerically better response to CA (41.4% vs 33.9%, p=0.28; adjusted OR 0.58 (95% CI 0.311 to 1.084), p=0.088). Age (OR 1.01 (95% CI 1.00 to 1.02), p=0.04) and balloon guide catheter (OR 2.08 (95% CI 1.24 to 3.47), p=0.005) were independent predictors of FPE in the overall population.Conclusion Our data suggest that patients with HDVS may have a better response to SRs than CA for the FPE. Larger confirmatory prospective studies are warranted.The unpublished data from this dataset are held by Grady Memorial Hospital/Emory University and the corresponding author. Requests for data sharing would be required to be discussed with them directly.