Impact of vessel tortuosity and radiological thrombus
characteristics on the choice of first-line thrombectomy
strategy: Results from the ESCAPE-NA1 trial

J 2023

Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial

BALA, Fouzi, Petra CIMFLOVÁ, Nishita SINGH, Jianhai ZHANG, Manon KAPPELHOF et. al.

Basic information

Original name

Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial

Authors

BALA, Fouzi, Petra CIMFLOVÁ (203 Czech Republic, belonging to the institution), Nishita SINGH, Jianhai ZHANG, Manon KAPPELHOF, Beom Joon KIM, Mohamed NAJM, Rotem GOLAN, Ibukun ELEBUTE, Faysal BENALI, Nerea Arrarte TERREROS, Henk MARQUERING, Charles MAJOIE, Mohammed ALMEKHLAFI, Mayank GOYAL, Michael D HILL, Wu QIU and Bijoy K MENON

Edition

EUROPEAN STROKE JOURNAL, LONDON, SAGE PUBLICATIONS LTD, 2023, 2396-9873

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30224 Radiology, nuclear medicine and medical imaging

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 6.100 in 2022

RIV identification code

RIV/00216224:14110/23:00133405

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1177/23969873231183766

UT WoS

001011867200001

Keywords in English

Stroke; endovascular thrombectomy; ischemic; thrombus; reperfusion

Abstract

V originále

Introduction: Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. Patients and methods: Patients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms. Results: Among 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83-0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00-1.06]). Conclusion: Our study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.

Citovat

BALA, Fouzi, Petra CIMFLOVÁ, Nishita SINGH, Jianhai ZHANG, Manon KAPPELHOF, Beom Joon KIM, Mohamed NAJM, Rotem GOLAN, Ibukun ELEBUTE, Faysal BENALI, Nerea Arrarte TERREROS, Henk MARQUERING, Charles MAJOIE, Mohammed ALMEKHLAFI, Mayank GOYAL, Michael D HILL, Wu QIU and Bijoy K MENON. Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial. EUROPEAN STROKE JOURNAL. LONDON: SAGE PUBLICATIONS LTD, 2023, vol. 8, No 3, p. 675-683. ISSN 2396-9873. Available from: https://dx.doi.org/10.1177/23969873231183766.

@article{2368961,
   author = {Bala, Fouzi and Cimflová, Petra and Singh, Nishita and Zhang, Jianhai and Kappelhof, Manon and Kim, Beom Joon and Najm, Mohamed and Golan, Rotem and Elebute, Ibukun and Benali, Faysal and Terreros, Nerea Arrarte and Marquering, Henk and Majoie, Charles and Almekhlafi, Mohammed and Goyal, Mayank and Hill, Michael D and Qiu, Wu and Menon, Bijoy K},
   article_location = {LONDON},
   article_number = {3},
   doi = {http://dx.doi.org/10.1177/23969873231183766},
   keywords = {Stroke; endovascular thrombectomy; ischemic; thrombus; reperfusion},
   language = {eng},
   issn = {2396-9873},
   journal = {EUROPEAN STROKE JOURNAL},
   title = {Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial},
   url = {https://journals.sagepub.com/doi/10.1177/23969873231183766},
   volume = {8},
   year = {2023}
}

TY  - JOUR
ID  - 2368961
AU  - Bala, Fouzi - Cimflová, Petra - Singh, Nishita - Zhang, Jianhai - Kappelhof, Manon - Kim, Beom Joon - Najm, Mohamed - Golan, Rotem - Elebute, Ibukun - Benali, Faysal - Terreros, Nerea Arrarte - Marquering, Henk - Majoie, Charles - Almekhlafi, Mohammed - Goyal, Mayank - Hill, Michael D - Qiu, Wu - Menon, Bijoy K
PY  - 2023
TI  - Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial
JF  - EUROPEAN STROKE JOURNAL
VL  - 8
IS  - 3
SP  - 675-683
EP  - 675-683
PB  - SAGE PUBLICATIONS LTD
SN  - 23969873
KW  - Stroke
KW  - endovascular thrombectomy
KW  - ischemic
KW  - thrombus
KW  - reperfusion
UR  - https://journals.sagepub.com/doi/10.1177/23969873231183766
N2  - Introduction: Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. Patients and methods: Patients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms. Results: Among 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83-0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00-1.06]). Conclusion: Our study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.
ER  -

BALA, Fouzi, Petra CIMFLOVÁ, Nishita SINGH, Jianhai ZHANG, Manon KAPPELHOF, Beom Joon KIM, Mohamed NAJM, Rotem GOLAN, Ibukun ELEBUTE, Faysal BENALI, Nerea Arrarte TERREROS, Henk MARQUERING, Charles MAJOIE, Mohammed ALMEKHLAFI, Mayank GOYAL, Michael D HILL, Wu QIU and Bijoy K MENON. Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial. \textit{EUROPEAN STROKE JOURNAL}. LONDON: SAGE PUBLICATIONS LTD, 2023, vol.~8, No~3, p.~675-683. ISSN~2396-9873. Available from: https://dx.doi.org/10.1177/23969873231183766.

Detailed Information on Publication Record