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Recanalization Rates Decrease with Increasing Thrombectomy Attempts

Recanalization Rates Decrease with Increasing Thrombectomy Attempts This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1958v1 31/5/935 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Loh, Y. Articles by Viñuela, F. PubMed PubMed Citation Articles by Loh, Y. Articles by Viñuela, F. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:935-939, May 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Recanalization Rates Decrease with Increasing Thrombectomy Attempts Y. Loh a ,c ,d , R. Jahan c , D.L. McArthur a , Z.-S. Shi c , N.R. Gonzalez a ,c , G.R. Duckwiler c , P.M. Vespa a , S. Starkman b , J.L. Saver b , S. Tateshima c , D.S. Liebeskind b and F. Viñuela c a Division of Neurosurgery (Y.L., D.L.M., N.R.G., P.M.V.) b Department of Neurology (S.S., J.L.S., D.S.L.), David Geffen School of Medicine at UCLA, Los Angeles, California c Division of Interventional Neuroradiology (Y.L., R.J., Z.-S.S., N.R.G., G.R.D., S.T., F.V.), Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, California d Neurovascular Service (Y.L.), Department of Medicine, Madigan Army Medical Center, Tacoma, Washington. Please address correspondence to Yince Loh, MD, Neurovascular Service, Department of Medicine, Madigan Army Medical Center, Building 9040, Fitzsimmons Dr, Tacoma, WA 98431; e-mail: [email protected] BACKGROUND AND PURPOSE: Use of the Merci retriever is increasing as a means to reopen large intracranial arterial occlusions. We sought to determine whether there is an optimum number of retrieval attempts that yields the highest recanalization rates and after which the probability of success decreases. MATERIALS AND METHODS: All consecutive patients undergoing Merci retrieval for large cerebral artery occlusions were prospectively tracked at a comprehensive stroke center. We analyzed ICA, M1 segment of the MCA, and vertebrobasilar occlusions. We compared the revascularization of the primary AOL with the number of documented retrieval attempts used to achieve that AOL score. For tandem lesions, each target lesion was compared separately on the basis of where the device was deployed. RESULTS: We identified a total of 97 patients with 115 arterial occlusions. The median number of attempts per target vessel was 3, while the median final AOL score was 2. Up to 3 retrieval attempts correlated with good revascularization (AOL 2 or 3). When 4 attempts were performed, the end result was more often failed revascularization (AOL 0 or 1) and procedural complications ( P = .006). CONCLUSIONS: In our experience, 3 may be the optimum number of Merci retrieval attempts per target vessel occlusion. Four or more attempts may not improve the chances of recanalization, while increasing the risk of complications. Abbreviations: AOL, arterial occlusive lesion • CI, confidence interval • HT, hemorrhagic transformation • ICA, internal carotid artery • IQR, interquartile range • MCA, middle cerebral artery • OR, odds ratio • UCLA, University of California, Los Angeles Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Recanalization Rates Decrease with Increasing Thrombectomy Attempts

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1958
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1958v1 31/5/935 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Loh, Y. Articles by Viñuela, F. PubMed PubMed Citation Articles by Loh, Y. Articles by Viñuela, F. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:935-939, May 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Recanalization Rates Decrease with Increasing Thrombectomy Attempts Y. Loh a ,c ,d , R. Jahan c , D.L. McArthur a , Z.-S. Shi c , N.R. Gonzalez a ,c , G.R. Duckwiler c , P.M. Vespa a , S. Starkman b , J.L. Saver b , S. Tateshima c , D.S. Liebeskind b and F. Viñuela c a Division of Neurosurgery (Y.L., D.L.M., N.R.G., P.M.V.) b Department of Neurology (S.S., J.L.S., D.S.L.), David Geffen School of Medicine at UCLA, Los Angeles, California c Division of Interventional Neuroradiology (Y.L., R.J., Z.-S.S., N.R.G., G.R.D., S.T., F.V.), Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, California d Neurovascular Service (Y.L.), Department of Medicine, Madigan Army Medical Center, Tacoma, Washington. Please address correspondence to Yince Loh, MD, Neurovascular Service, Department of Medicine, Madigan Army Medical Center, Building 9040, Fitzsimmons Dr, Tacoma, WA 98431; e-mail: [email protected] BACKGROUND AND PURPOSE: Use of the Merci retriever is increasing as a means to reopen large intracranial arterial occlusions. We sought to determine whether there is an optimum number of retrieval attempts that yields the highest recanalization rates and after which the probability of success decreases. MATERIALS AND METHODS: All consecutive patients undergoing Merci retrieval for large cerebral artery occlusions were prospectively tracked at a comprehensive stroke center. We analyzed ICA, M1 segment of the MCA, and vertebrobasilar occlusions. We compared the revascularization of the primary AOL with the number of documented retrieval attempts used to achieve that AOL score. For tandem lesions, each target lesion was compared separately on the basis of where the device was deployed. RESULTS: We identified a total of 97 patients with 115 arterial occlusions. The median number of attempts per target vessel was 3, while the median final AOL score was 2. Up to 3 retrieval attempts correlated with good revascularization (AOL 2 or 3). When 4 attempts were performed, the end result was more often failed revascularization (AOL 0 or 1) and procedural complications ( P = .006). CONCLUSIONS: In our experience, 3 may be the optimum number of Merci retrieval attempts per target vessel occlusion. Four or more attempts may not improve the chances of recanalization, while increasing the risk of complications. Abbreviations: AOL, arterial occlusive lesion • CI, confidence interval • HT, hemorrhagic transformation • ICA, internal carotid artery • IQR, interquartile range • MCA, middle cerebral artery • OR, odds ratio • UCLA, University of California, Los Angeles Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: May 1, 2010

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