Article Figures & Data
Figures
- Fig 1.
Lateral pre- (A) and post- (B) thrombectomy DSA images demonstrate complete TICI 3 reperfusion of a left ICA terminus (arrowhead) occlusion using the GUARD technique with distal guide sheath placement and combined stent retriever–distal access catheter aspiration thrombectomy. Fluoroscopic intraoperative images in the lateral (C) and antero-posterior (D) projections show stent retriever deployment across the supraclinoid ICA/M1 MCA occlusion with advancement of a large-bore ACE 68 distal access catheter (arrowheads) to the proximal aspect of the clot under vacuum aspiration, and triaxial advancement of the Neuron Max 088 guide sheath (arrows) distally into the posterior genu cavernous segment of the left ICA.
- Fig 2.
A, Comparison of recanalization results measured with a modified TICI score between the GUARD and standard techniques (P = .046). B, Comparison of functional clinical outcomes by an mRS at 90 days between the GUARD and standard techniques (P = .01).
Tables
- Table 1:
Comparison of baseline demographics, presentations, procedural efficacy, and safety between the GUARD and standard thrombectomy techniques
GUARD (n = 45) Standard (n = 45) P Value Sex (% male) 42 51 .53 Median age (range/yr) 69 (21–92) 74 (39–92) .09 Median NIHSS score (range) 17 (6–30) 17 (5–32) .68 Median CT ASPECTS (range) 9 (6–10) 9 (6–10) .89 CTP (%) 44 56 .40 IV rtPA (%) 36 49 .29 Vessel occlusion (%) .88 ICA terminus 25 22 Cervical ICA + MCA 4 7 MCA (M1–M2) 71 71 Risk factors (%) AF 44 53 .53 HTN 76 80 .80 DM 20 27 .62 Smoker 9 9 .99 HLD 49 49 .99 Previous stroke/TIA 7 11 .71 Median symptom onset-to-groin puncture time (range/min) 192 (78–1193) 219 (27–1097) .241 Median symptom onset to reperfusion time (range/min) 254 (107–1245) 279 (108–1226) .21 Median groin puncture to reperfusion time (range/min) 52 (29–225) 61 (23–184) .20 Mean No. of passes ± SD 2.3 ± 1.3 2.8 ± 1.5 .09 First-pass reperfusion (%) 39 23 .17 Final mTICI score (%) .046a 3 51 40 2c 16 7 2b 31 33 2a 2 16 1 0 2 0 0 2 Successful reperfusion mTICI ≥ 2b (%) 98 80 .015a Complete reperfusion mTICI 2c/3 (%) 67 47 .09 mTICI 3 (%) 51 40 .40 Adjunctive stenting/angioplasty (%) 20 11 .26 SICH (%) 2 9 .36 Neurovascular complications (%) 4 9 .68 Median mRS at 90 days (range) 2 (0–6) 4 (0–6) .01a mRS ≤ 2 at 90 days (%) 67 43 .04a Mortality at 90 days (%) 13 30 .10 Note:—AF indicates atrial fibrillation; HTN, hypertension; DM, diabetes mellitus; HLD, hyperlipidemia.
↵a Significant.
- Table 2:
Multivariable logistic regression analysis with dependent variables for successful reperfusion, complete reperfusion, and independent functional clinical outcomes
Successful Reperfusion TICI ≥2b Complete Reperfusion TICI 2c/3 Clinical Outcomes mRS ≤2 aOR P Value aOR P Value aOR P Value GUARD 13.7 (1.24–150.85) .03a 2.45 (0.93–6.42) .07 3.77 (1.15–12.34) .03a Age 1 .42 0.98 .25 1.03 .19 Sex (male) 4.2 .17 1.28 .6 2.68 .09 Onset to groin time 1.0 .49 1.0 .18 1.0 .11 IV rtPA 0.72 .75 0.72 .54 2.71 .15 Location MCA 9.0 .14 0.78 .80 8.82 .08 ICA terminus 4.7 .35 1.06 .96 4.71 .24 Cervical ICA + MCA 1 .286 1 .84 1 .15 CTP 1.5 .69 1.68 .32 2.82 .11 Note:—Data reported as adjusted odds ratio (aOR) including 95% confidence intervals (CI) for the GUARD technique.
↵a Significant.
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