Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis
Por:
Perez-Garcia, C, Rosati, S, Gomez-Escalonilla, C, Arrazola, J, Lopez-Frias, A, Gonzalez, E, Fondevila, J, Vega, P, Murias, E, Jimenez-Gomez, E, Rey, IB, Macho, J, San Roman, L, Caamano, IR, Paipa, AJ, Remollo, S, Tejedor, YA, Bermudez-Coronel, I, Moliner, S, Pumar, JM, Bashir, S, Puig, J, Lopez-Rueda, A, Blasco, J, Nogueira, RG and Moreu, M
Publicada:
1 nov 2022
Ahead of Print:
1 nov 2021
Resumen:
Background The optimal endovascular treatment (EVT) technique for middle cerebral artery (MCA) M2 segment occlusions remains unknown. We aim to analyze whether reperfusion rate, procedure times, procedure-related complications, and clinical outcome differed between patients with isolated M2 occlusions who underwent stent-retriever (SR) alone versus combined SR and contact aspiration (CA) as a front-line EVT. Methods Patients who underwent EVT for isolated MCA-M2 occlusion were recruited from the prospectively ongoing ROSSETTI registry. Patients were divided regarding the EVT approach into SR alone versus SR+CA and propensity score matching was used to achieve baseline balance. Demographic, procedural, safety, and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of first-pass effect (FPE) and 90-day modified Rankin scale (mRS) 0-2. Results 214 patients underwent EVT for M2 occlusion, 125 treated with SR alone and 89 with SR+CA. Propensity score matchnig analysis selected 134 matched patients. The rates of FPE (42% vs 40%, p=1.000) and 90-day mRS 0-2 (60% vs 51%, p=0.281) were comparable between groups. Patients treated with SR alone had lower need of rescue therapy (p=0.006), faster times to reperfusion (p<0.001), and lower procedure-related complications (p=0.031). Higher initial Alberta Stroke Program Early CT Score was an independent predictor of FPE. Age, baseline National Institutes of Health Stroke Scale score, and procedure duration were significant predictors of good clinical outcome at 3 months. Conclusions As front-line modality in M2 occlusions, the SR alone approach results in similar rates of reperfusion and good clinical outcomes to combined SR+CA and might be advantageous due to faster reperfusion times and fewer adverse events.
Filiaciones:
Perez-Garcia, C:
Hosp Clin San Carlos, Intervent Neuroradiol, Madrid, Spain
Rosati, S:
Hosp Clin San Carlos, Intervent Neuroradiol, Madrid, Spain
Gomez-Escalonilla, C:
Hosp Clin San Carlos, Neurol, Madrid, Spain
Arrazola, J:
Hosp Clin San Carlos, Radiol, Madrid, Spain
Lopez-Frias, A:
Hosp Clin San Carlos, Intervent Neuroradiol, Madrid, Spain
Gonzalez, E:
Hosp Univ Cruces, Intervent Neuroradiol, Bilbao, Spain
Fondevila, J:
Hosp Univ Cruces, Intervent Neuroradiol, Bilbao, Spain
Vega, P:
Hosp Univ Cent Asturias, Intervent Neuroradiol, Oviedo, Spain
Murias, E:
Hosp Univ Cent Asturias, Intervent Neuroradiol, Oviedo, Spain
Jimenez-Gomez, E:
Hosp Univ Reina Sofia, Intervent Neuroradiol, Cordoba, Spain
Rey, IB:
Hosp Univ Reina Sofia, Intervent Neuroradiol, Cordoba, Spain
Macho, J:
Hosp Clin Barcelona, Intervent Neuroradiol, Barcelona, Spain
San Roman, L:
Hosp Clin Barcelona, Intervent Neuroradiol, Barcelona, Spain
Caamano, IR:
Hosp Univ Bellvitge, Intervent Neuroradiol, Lhospitalet De Llobregat, Spain
Paipa, AJ:
Hosp Univ Bellvitge, Neurol, Lhospitalet De Llobregat, Spain
:
Hosp Univ Germans Trias I Pujol, Intervent Neuroradiol, Badalona, Spain
Tejedor, YA:
Hosp Univ Insular Gran Canaria, Intervent Radiol, Las Palmas Gran Canaria, Spain
Bermudez-Coronel, I:
Hosp Ramon & Cajal, Intervent Neuroradiol, Madrid, Spain
Moliner, S:
Hosp Gen Univ Alicante, Intervent Neuroradiol, Alicante, Spain
Pumar, JM:
Complejo Hosp Univ Santiago de Compostela, Intervent Neuroradiol, Santiago De Compostela, Spain
Bashir, S:
Univ Hosp Dr Josep Trueta, Neurol, Girona, Spain
Puig, J:
Univ Hosp Dr Josep Trueta, Radiol, Girona, Spain
Lopez-Rueda, A:
Hosp Clin Barcelona, Intervent Neuroradiol, Barcelona, Spain
Blasco, J:
Hosp Clin Barcelona, Intervent Neuroradiol, Barcelona, Spain
Nogueira, RG:
Grady Mem Hosp, Neurol & Intervent Radiol, Chickasha, OK USA
Moreu, M:
Hosp Clin San Carlos, Intervent Neuroradiol, Madrid, Spain
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