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, 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.

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

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30224 Radiology, nuclear medicine and medical imaging
• Country of publisher: United Kingdom of Great Britain and Northern Ireland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: 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
• Tags: 14110119, rivok
• Tags: International impact, Reviewed

Abstract

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.