TY - JOUR
T1 - Higher intracranial positioning of an 8 Fr guide catheter improves efficacy of aspiration thrombectomy in large vessel occlusion stroke
AU - Goldman, Daryl
AU - Al-Kawaz, Mais
AU - Reddi, Preethi
AU - Yaeger, Kurt A.
AU - Hardigan, Trevor
AU - Mehta, Amol
AU - Scaggiante, Jacopo
AU - Tomalty, Robert Dana
AU - Gulotta, Paul
AU - Fennell, Vernard
AU - Vidal, Gabriel A.
AU - Poongkunran, Mugilan
AU - Milburn, James M.
AU - Majidi, Shahram
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024
Y1 - 2024
N2 - Background: Higher positioning of a large bore guide catheter during endovascular thrombectomy (EVT) is hypothesized to potentially improve thrombectomy success. Objective: To evaluate the safety and efficacy of intracranial guide catheter placement during EVT using a multicenter database. Methods: We reviewed data on consecutive patients undergoing EVT for anterior circulation large vessel occlusion (LVO) at three comprehensive stroke centers between October 2019 and December 2022. Participants were allocated to one of two cohorts: intracranial (n=141) - guide catheter tip positioned in the petrous carotid or further distal; and control (n=285) - guide catheter tip below the petrous carotid. Primary outcome was excellent reperfusion (Thrombolysis in Cerebral Ischemia (TICI) 2c or better), first pass effect (TICI 2c or better after one pass), and arterial access to final reperfusion time. The unpaired t-test, Mann-Whitney U test, and Fisher's exact test were used to compare the means, medians and proportions of the two groups, respectively. P values & lt;0.05 were considered statistically significant two cohorts. Results: A total of 426 patients were included in the analysis. Patients with guide catheter location in the petrous segment or further distal had a significantly higher first-pass effect (111/284, 39.1% vs 37/141, 26.2%, P=0.009). There was no significant difference in final excellent recanalization rates between groups (202/285, 70.9% vs 92/141, 65.2%, P=0.266). Furthermore, intracranial positioning of the guide catheter was associated with significantly shorter time to final recanalization (median 21.0 (13.0-38.0) min vs 30.0 (17.0-48.0) min, P<0.001). Conclusion: Positioning a large bore guide catheter in the petrous segment or further distal resulted in a significantly higher rate of first pass effect, faster procedural times, and equivalent final excellent reperfusion rates compared with more proximal guide catheter placement for patients with anterior circulation LVO.
AB - Background: Higher positioning of a large bore guide catheter during endovascular thrombectomy (EVT) is hypothesized to potentially improve thrombectomy success. Objective: To evaluate the safety and efficacy of intracranial guide catheter placement during EVT using a multicenter database. Methods: We reviewed data on consecutive patients undergoing EVT for anterior circulation large vessel occlusion (LVO) at three comprehensive stroke centers between October 2019 and December 2022. Participants were allocated to one of two cohorts: intracranial (n=141) - guide catheter tip positioned in the petrous carotid or further distal; and control (n=285) - guide catheter tip below the petrous carotid. Primary outcome was excellent reperfusion (Thrombolysis in Cerebral Ischemia (TICI) 2c or better), first pass effect (TICI 2c or better after one pass), and arterial access to final reperfusion time. The unpaired t-test, Mann-Whitney U test, and Fisher's exact test were used to compare the means, medians and proportions of the two groups, respectively. P values & lt;0.05 were considered statistically significant two cohorts. Results: A total of 426 patients were included in the analysis. Patients with guide catheter location in the petrous segment or further distal had a significantly higher first-pass effect (111/284, 39.1% vs 37/141, 26.2%, P=0.009). There was no significant difference in final excellent recanalization rates between groups (202/285, 70.9% vs 92/141, 65.2%, P=0.266). Furthermore, intracranial positioning of the guide catheter was associated with significantly shorter time to final recanalization (median 21.0 (13.0-38.0) min vs 30.0 (17.0-48.0) min, P<0.001). Conclusion: Positioning a large bore guide catheter in the petrous segment or further distal resulted in a significantly higher rate of first pass effect, faster procedural times, and equivalent final excellent reperfusion rates compared with more proximal guide catheter placement for patients with anterior circulation LVO.
KW - Catheter
KW - Embolic
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85205029648&partnerID=8YFLogxK
U2 - 10.1136/jnis-2024-022026
DO - 10.1136/jnis-2024-022026
M3 - Article
C2 - 39299745
AN - SCOPUS:85205029648
SN - 1759-8478
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
M1 - jnis-2024-022026
ER -