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Research ArticleNeurointervention

A Standardized Aspiration-First Approach for Thrombectomy to Increase Speed and Improve Recanalization Rates

D. O'Neill, E. Griffin, K.M. Doyle, S. Power, P. Brennan, M. Sheehan, A. O'Hare, S. Looby, A.M. da Silva Santos, R. Rossi and J. Thornton
American Journal of Neuroradiology July 2019, DOI: https://doi.org/10.3174/ajnr.A6117
D. O'Neill
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
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E. Griffin
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
bRoyal College of Surgeons (E.G., J.T.), Dublin, Ireland
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K.M. Doyle
cDepartment of Physiology (K.M.D., A.M.d.S.S., R.R.), School of Medicine, National University of Ireland, Galway, Ireland.
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S. Power
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
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P. Brennan
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
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M. Sheehan
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
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A. O'Hare
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
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S. Looby
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
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A.M. da Silva Santos
cDepartment of Physiology (K.M.D., A.M.d.S.S., R.R.), School of Medicine, National University of Ireland, Galway, Ireland.
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R. Rossi
cDepartment of Physiology (K.M.D., A.M.d.S.S., R.R.), School of Medicine, National University of Ireland, Galway, Ireland.
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J. Thornton
aFrom the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
bRoyal College of Surgeons (E.G., J.T.), Dublin, Ireland
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    FIGURE.

    Type of device and the influence of total number of passes in percentages, P < .05

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    Table 1:

    Baseline characteristics

    Variable/StsAll (n = 254)Aspiration (n = 127)Stent Retriever (n = 127)P Value
    Age
        Mean69.1 ± 15.670.4 ± 14.867.9 ± 16.4.275
        Median (IQR 25%–75%)73.0 (62–80)74.0 (63–80)71.0 (58–79)
    NIHSS score
        Mean15.7 ± 6.315.6 ± 6.715.7 ± 5.9.844
        Median (IQR 25%–75%)16.0 (1–20)15.0 (10–20)16.0 (12–20)
    Thrombolysis (No.) (%)132 (52.2%)64 (50.4%)68 (53.5%).662
    Occlusion location (No.) (%)
        MCA, M1176 (69%)93 (73%)83 (65%).292
        MCA, M232 (12.6%)12 (9%)20 (15.7%)
        ICA, T/L46 (18%)22 (17%)24 (18.8%)
    mRS 0–2 at 90 days (No.) (%)121 (48%)63 (50%)58 (46%).53
    • Note:—Sts indicates statistics; T/L, carotid terminus.

    • View popup
    Table 2:

    Time variables—aspiration vs stent retriever

    Variable/StsAll (n = 254)Aspiration (n = 127)Stent Retriever (n = 127)P Value
    Length of procedure (min)
        Mean47.7 ± 38.933.2 ± 25.162.2 ± 44.6<.001
        Median (IQR 25%–75%)36.0 (22–62)26.0 (15–41)47.0 (32–80)
    Groin puncture to 1st angiogram (min)
        Mean7.3 ± 5.97.7 ± 5.97.0 ± 5.8.234
        Median (IQR 25%–75%) (min)6.0 (4–9)6.0 (4–10)5.0 (4–9)
    First angiogram to first 1st reperfusion (min)
        Mean23.0 ± 25.818.2 ± 22.927.9 ± 27.6<.001
        Median (IQR 25%–75%)15.0 (8–27)11.0 (7–20)19.5 (12–32)
    Groin puncture to 1st reperfusion (min)
        Mean30.2 ± 27.125.6 ± 23.834.9 ± 29.4<.001
        Median (IQR 25%–75%)22.0 (15–35)18.0 (13–31)26.0 (17–39)
    TICI (No.) (%)
        ¥ 2b–3231 (90.9%)122 (96.1%)109 (85.8%)<.005
        2c–3176 (69.3%)99 (78%)77 (60.6%)<.005
        3109 (43%)59 (46%)50 (39%).25
        First-pass 348 (19%)32 (25%)16 (13%).01
    • Note:—¥ indicates TICI as standing for Thrombolysis in Cerebral Infarction Score; Sts, statistics; TICI, Thrombolysis in Cerebral Infarction Score.

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D. O'Neill, E. Griffin, K.M. Doyle, S. Power, P. Brennan, M. Sheehan, A. O'Hare, S. Looby, A.M. da Silva Santos, R. Rossi, J. Thornton
A Standardized Aspiration-First Approach for Thrombectomy to Increase Speed and Improve Recanalization Rates
American Journal of Neuroradiology Jul 2019, DOI: 10.3174/ajnr.A6117

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A Standardized Aspiration-First Approach for Thrombectomy to Increase Speed and Improve Recanalization Rates
D. O'Neill, E. Griffin, K.M. Doyle, S. Power, P. Brennan, M. Sheehan, A. O'Hare, S. Looby, A.M. da Silva Santos, R. Rossi, J. Thornton
American Journal of Neuroradiology Jul 2019, DOI: 10.3174/ajnr.A6117
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