TY - JOUR
T1 - Endovascular Thrombectomy Technique Optimization
T2 - A SVIN Registry Analysis
AU - Samaha, Joseph N
AU - Bajaj, Ritesh
AU - Le, Ngoc Mai
AU - Azeem, Hussain
AU - Iyyangar, Ananya S
AU - Haussen, Diogo C
AU - Dolia, Jay
AU - Grossberg, Jonathan A
AU - Mohammaden, Mahmoud
AU - Hassan, Ameer E
AU - Tekle, Wondwossen G
AU - Miller, Samantha E
AU - Saei, Hamzah M
AU - Ortega-Gutierrez, Santiago
AU - Galecio-Castillo, Milagros
AU - Cespedes, Jorge
AU - Abdelhakim, Nashwa
AU - Reddi, Preethi
AU - Fifi, Johanna T
AU - Majidi, Shahram
AU - Koneru, Manisha
AU - Zhang, Linda
AU - Khalife, Jane
AU - Abdalkader, Mohamad
AU - Nguyen, Thanh N
AU - Dabus, Guilherme
AU - Linfante, Italo
AU - Mehta, Brijesh P
AU - Sessa, Joy
AU - Jumaa, Mohammad A
AU - Sugg, Rebecca M
AU - Linares, Guillermo
AU - Al-Bayati, Alhamza R
AU - Liebeskind, David S
AU - Nogueira, Raul G
AU - Sheth, Sunil A
N1 - © 2025 The Author(s). Published on behalf of the American Heart Association, Inc., and the Society of Vascular and Interventional Neurology by Wiley Periodicals LLC.
PY - 2025/9
Y1 - 2025/9
N2 - BACKGROUND: Achieving excellent recanalization (Modified Thrombolysis in Cerebral Infarction 2c/3) in fewer attempts improves clinical outcomes. Previous studies suggest that switching techniques after a failed first pass may enhance reperfusion rates. This study evaluates whether technique switching improves subsequent reperfusion in a large multicenter registry.METHODS: We analyzed retrospective and prospective SVIN (Society of Vascular and Interventional Neurology) registry data from 12 US centers (October 2014-December 2021) involving endovascular therapy for M1 or internal carotid artery-terminus (ICA-T) occlusions. Patients with at least 2 recanalization attempts using stent retriever (SR), contact aspiration (CA), or combined technique (CT) were included. Primary outcome was the likelihood of achieving TICI 2c/3 reperfusion with or without technique switching on the second pass. Secondary outcomes included the likelihood of final TICI 2c/3 stratified by the technique and occlusion location.RESULTS: Among 2893 endovascular therapy treatments, 1089 patients (37.6%) had successful reperfusion after the first pass. First-pass TICI 2c/3 rates for ICA-T occlusions were 36.0% with SR, 23.6% with CA, and 35.8% with CT; for M1 occlusions, the rates were 38.8% with SR, 39.3% with CA, and 38.6% with CT. A total of 1420 treatments included at least 2 passes. ICA-T occlusions occurred in 20.4% and M1 occlusions in 79.6%. In multivariable analysis, in M1 occlusions, switching from CT to alternative technique after a failed first pass significantly increased the odds of achieving TICI 2c/3 after the second pass (adjusted odds ratio, 2.08 [95% CI, 1.18-3.67]). Patients who had 2 failed attempts using CA had significantly higher odds of achieving final TICI 2c/3 compared with those with 2 failed passes using the SR technique (adjusted odds ratio 1.65, [95% CI, 1.09-2.51]).CONCLUSION: In M1-middle cerebral artery occlusion, switching from CT to SR or CA was associated with an improvement in TICI2c/3 rates on the second pass. In addition, after 2 failed passes with CA, additional passes increased the odds of achieving complete reperfusion compared with SR.
AB - BACKGROUND: Achieving excellent recanalization (Modified Thrombolysis in Cerebral Infarction 2c/3) in fewer attempts improves clinical outcomes. Previous studies suggest that switching techniques after a failed first pass may enhance reperfusion rates. This study evaluates whether technique switching improves subsequent reperfusion in a large multicenter registry.METHODS: We analyzed retrospective and prospective SVIN (Society of Vascular and Interventional Neurology) registry data from 12 US centers (October 2014-December 2021) involving endovascular therapy for M1 or internal carotid artery-terminus (ICA-T) occlusions. Patients with at least 2 recanalization attempts using stent retriever (SR), contact aspiration (CA), or combined technique (CT) were included. Primary outcome was the likelihood of achieving TICI 2c/3 reperfusion with or without technique switching on the second pass. Secondary outcomes included the likelihood of final TICI 2c/3 stratified by the technique and occlusion location.RESULTS: Among 2893 endovascular therapy treatments, 1089 patients (37.6%) had successful reperfusion after the first pass. First-pass TICI 2c/3 rates for ICA-T occlusions were 36.0% with SR, 23.6% with CA, and 35.8% with CT; for M1 occlusions, the rates were 38.8% with SR, 39.3% with CA, and 38.6% with CT. A total of 1420 treatments included at least 2 passes. ICA-T occlusions occurred in 20.4% and M1 occlusions in 79.6%. In multivariable analysis, in M1 occlusions, switching from CT to alternative technique after a failed first pass significantly increased the odds of achieving TICI 2c/3 after the second pass (adjusted odds ratio, 2.08 [95% CI, 1.18-3.67]). Patients who had 2 failed attempts using CA had significantly higher odds of achieving final TICI 2c/3 compared with those with 2 failed passes using the SR technique (adjusted odds ratio 1.65, [95% CI, 1.09-2.51]).CONCLUSION: In M1-middle cerebral artery occlusion, switching from CT to SR or CA was associated with an improvement in TICI2c/3 rates on the second pass. In addition, after 2 failed passes with CA, additional passes increased the odds of achieving complete reperfusion compared with SR.
U2 - 10.1161/SVIN.125.001797
DO - 10.1161/SVIN.125.001797
M3 - Article
C2 - 41573331
SN - 2694-5746
VL - 5
SP - e001797
JO - Stroke (Hoboken, N.J.)
JF - Stroke (Hoboken, N.J.)
IS - 5
ER -