First-pass effect after acute basilar artery occlusion: a comparison of mechanical thrombectomy techniques.
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Nicolini Ettore, Ciacciarelli Antonio, Saia Valentina, Pracucci Giovanni, Milonia Luca, Barrile Elena, De Michele Manuela, Casetta Ilaria, Fainardi Enrico, Sallustio Fabrizio, Nencini Patrizia, Vallone Stefano, Bigliardi Guido, Salsano Giancarlo, Benzi Markushi Tiziana, Gatti Francesca, Cordici Francesco, Saletti Andrea, De Vito Alessandro, Semeraro Vittorio, Prontera Maria Pia, Rustici Arianna, Zini Andrea, Camilli Arianna, Loizzo Nicola, Sanna Antioco, Coco Elena, Menozzi Roberto, Pezzini Alessandro, Zimatore Domenico Sergio, Petruzzellis Marco, Lazzarotti Guido A, Cosottini Mirco, Da Ros Valerio, Diomedi Marina, Bracco Sandra, Tassi Rossana, Besana Michele, Giossi Alessia, Bergui Mauro, Cappellari Manuel, Mangiafico Salvatore, Toni Danilo, Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) group
Аннотация
OBJECTIVE: We compared stent retriever (SR), contact aspiration (CA), and combined SR plus CA techniques as first-line approaches during MT for BAO.
METHODS: We emulated a hypothetical trial comparing CA, SR, and combined technique as first-line in BAO patients. The primary outcome was first-pass effect (FPE), defined as modified Thrombolysis in Cerebral Infarction (mTICI) 3 with one pass of MT. Secondary outcomes included modified FPE (mFPE), functional outcome at 90 days, successful recanalization, and safety outcomes. We used inverse probability weighting (IPW) adjusted for prespecified covariates.
RESULTS: The study included 960 BAO patients: 570 treated with CA, 268 with SR, and 122 with combined technique as the first approach. After applying IPW, SR was associated with lower odds of FPE (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.90) and of mFPE (aOR 0.48, 95% CI 0.33 to 0.70) compared with CA. No differences were found between the combined technique and either SR or CA. A 90-day modified Rankin Scale (mRS) 0-3 after mFPE was less frequent with SR (aOR 0.57, 95% CI 0.38 to 0.85) and with combined technique (aOR 0.50, 95% CI 0.28 to 0.89) compared with CA. Additionally, combined technique showed lower odds of mRS 0-1 at 90 days compared with CA (aOR 0.56, 95% CI 0.33 to 0.94).
CONCLUSIONS: In BAO patients, CA was more effective than SR for complete and successful recanalization after first pass and resulted in better outcomes after mFPE as compared with other techniques. Less traumatic approaches might be preferred as first-line in BAO.