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J Neurointerv Surg. 2018 Jun;10(6):525-529. doi: 10.1136/neurintsurg-2017-013394. Epub 2017 Sep 28.

Comparing different thrombectomy techniques in five large-volume centers: a 'real world' observational study.

Author information

1
Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
2
Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany.
3
Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany.
4
Institute of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.
5
Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
6
Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.
7
Department of Neuroradiology, Hospital Augsburg, Augsburg, Germany.

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.

KEYWORDS:

stroke

PMID:
28963362
DOI:
10.1136/neurintsurg-2017-013394
[Indexed for MEDLINE]

Conflict of interest statement

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.

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