Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy

Mohamad Ezzeldin; Mishaal Hukamdad; Rahim Abo Kasem; Rime Ezzeldin; Ilko Maier; Ansaar T. Rai; Pascal Jabbour; Joon Tae Kim; Brian M. Howard; Ali Alawieh; Stacey Q. Wolfe; Robert M. Starke; Marios Nikos Psychogios; Amir Shaban; Nitin Goyal; Justin Dye; Ali Alaraj; Shinichi Yoshimura; David Fiorella; Omar Tanweer; Daniele G. Romano; Pedro Navia; Hugo Cuellar; Isabel Fragata; Adam Polifka; Justin R. Mascitelli; Joshua W. Osbun; Fazeel Siddiqui; Mark Moss; Kaustubh Limaye; Maxim Mokin; Charles Matouk; Min S. Park; Waleed Brinjikji; Ergun Daglioglu; Richard Williamson; David J. Altschul; Christopher S. Ogilvy; Roberto Javier Crosa; Michael R. Levitt; Benjamin Gory; Ramesh Grandhi; Alexandra R. Paul; Peter Kan; Walter Casagrande; Shakeel A. Chowdhry; Michael F. Stiefel; Varun Chaubal; Alejandro M. Spiotta

doi:10.1136/jnis-2024-022781

Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy

Mohamad Ezzeldin, Mishaal Hukamdad, Rahim Abo Kasem, Rime Ezzeldin, Ilko Maier, Ansaar T. Rai, Pascal Jabbour, Joon Tae Kim, Brian M. Howard, Ali Alawieh, Stacey Q. Wolfe, Robert M. Starke, Marios Nikos Psychogios, Amir Shaban, Nitin Goyal, Justin Dye, Ali Alaraj, Shinichi Yoshimura, David Fiorella, Omar TanweerDaniele G. Romano, Pedro Navia, Hugo Cuellar, Isabel Fragata, Adam Polifka, Justin R. Mascitelli, Joshua W. Osbun, Fazeel Siddiqui, Mark Moss, Kaustubh Limaye, Maxim Mokin, Charles Matouk, Min S. Park, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David J. Altschul, Christopher S. Ogilvy, Roberto Javier Crosa, Michael R. Levitt, Benjamin Gory, Ramesh Grandhi, Alexandra R. Paul, Peter Kan, Walter Casagrande, Shakeel A. Chowdhry, Michael F. Stiefel, Varun Chaubal, Alejandro M. Spiotta

Neurosurgery

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA. Methods: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results: Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03). Conclusions: Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.

Original language	English (US)
Journal	Journal of neurointerventional surgery
DOIs	https://doi.org/10.1136/jnis-2024-022781
State	Accepted/In press - 2025

Keywords

Reperfusion
Stent
Stroke
Technique
Thrombectomy

ASJC Scopus subject areas

Surgery
Clinical Neurology

Access to Document

10.1136/jnis-2024-022781

Cite this

Ezzeldin, M., Hukamdad, M., Abo Kasem, R., Ezzeldin, R., Maier, I., Rai, A. T., Jabbour, P., Kim, J. T., Howard, B. M., Alawieh, A., Wolfe, S. Q., Starke, R. M., Psychogios, M. N., Shaban, A., Goyal, N., Dye, J., Alaraj, A., Yoshimura, S., Fiorella, D., ... Spiotta, A. M. (Accepted/In press). Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy. Journal of neurointerventional surgery. https://doi.org/10.1136/jnis-2024-022781

Ezzeldin, M, Hukamdad, M, Abo Kasem, R, Ezzeldin, R, Maier, I, Rai, AT, Jabbour, P, Kim, JT, Howard, BM, Alawieh, A, Wolfe, SQ, Starke, RM, Psychogios, MN, Shaban, A, Goyal, N, Dye, J, Alaraj, A, Yoshimura, S, Fiorella, D, Tanweer, O, Romano, DG, Navia, P, Cuellar, H, Fragata, I, Polifka, A, Mascitelli, JR, Osbun, JW, Siddiqui, F, Moss, M, Limaye, K, Mokin, M, Matouk, C, Park, MS, Brinjikji, W, Daglioglu, E, Williamson, R, Altschul, DJ, Ogilvy, CS, Crosa, RJ, Levitt, MR, Gory, B, Grandhi, R, Paul, AR, Kan, P, Casagrande, W, Chowdhry, SA, Stiefel, MF, Chaubal, V & Spiotta, AM 2025, 'Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy', Journal of neurointerventional surgery. https://doi.org/10.1136/jnis-2024-022781

@article{e7cdacd2242a40d8a99bc310de020c71,

title = "Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy",

abstract = "Background: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA. Methods: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results: Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03). Conclusions: Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.",

keywords = "Reperfusion, Stent, Stroke, Technique, Thrombectomy",

author = "Mohamad Ezzeldin and Mishaal Hukamdad and {Abo Kasem}, Rahim and Rime Ezzeldin and Ilko Maier and Rai, {Ansaar T.} and Pascal Jabbour and Kim, {Joon Tae} and Howard, {Brian M.} and Ali Alawieh and Wolfe, {Stacey Q.} and Starke, {Robert M.} and Psychogios, {Marios Nikos} and Amir Shaban and Nitin Goyal and Justin Dye and Ali Alaraj and Shinichi Yoshimura and David Fiorella and Omar Tanweer and Romano, {Daniele G.} and Pedro Navia and Hugo Cuellar and Isabel Fragata and Adam Polifka and Mascitelli, {Justin R.} and Osbun, {Joshua W.} and Fazeel Siddiqui and Mark Moss and Kaustubh Limaye and Maxim Mokin and Charles Matouk and Park, {Min S.} and Waleed Brinjikji and Ergun Daglioglu and Richard Williamson and Altschul, {David J.} and Ogilvy, {Christopher S.} and Crosa, {Roberto Javier} and Levitt, {Michael R.} and Benjamin Gory and Ramesh Grandhi and Paul, {Alexandra R.} and Peter Kan and Walter Casagrande and Chowdhry, {Shakeel A.} and Stiefel, {Michael F.} and Varun Chaubal and Spiotta, {Alejandro M.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025.",

year = "2025",

doi = "10.1136/jnis-2024-022781",

language = "English (US)",

journal = "Journal of neurointerventional surgery",

issn = "1759-8478",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy

AU - Ezzeldin, Mohamad

AU - Hukamdad, Mishaal

AU - Abo Kasem, Rahim

AU - Ezzeldin, Rime

AU - Maier, Ilko

AU - Rai, Ansaar T.

AU - Jabbour, Pascal

AU - Kim, Joon Tae

AU - Howard, Brian M.

AU - Alawieh, Ali

AU - Wolfe, Stacey Q.

AU - Starke, Robert M.

AU - Psychogios, Marios Nikos

AU - Shaban, Amir

AU - Goyal, Nitin

AU - Dye, Justin

AU - Alaraj, Ali

AU - Yoshimura, Shinichi

AU - Fiorella, David

AU - Tanweer, Omar

AU - Romano, Daniele G.

AU - Navia, Pedro

AU - Cuellar, Hugo

AU - Fragata, Isabel

AU - Polifka, Adam

AU - Mascitelli, Justin R.

AU - Osbun, Joshua W.

AU - Siddiqui, Fazeel

AU - Moss, Mark

AU - Limaye, Kaustubh

AU - Mokin, Maxim

AU - Matouk, Charles

AU - Park, Min S.

AU - Brinjikji, Waleed

AU - Daglioglu, Ergun

AU - Williamson, Richard

AU - Altschul, David J.

AU - Ogilvy, Christopher S.

AU - Crosa, Roberto Javier

AU - Levitt, Michael R.

AU - Gory, Benjamin

AU - Grandhi, Ramesh

AU - Paul, Alexandra R.

AU - Kan, Peter

AU - Casagrande, Walter

AU - Chowdhry, Shakeel A.

AU - Stiefel, Michael F.

AU - Chaubal, Varun

AU - Spiotta, Alejandro M.

PY - 2025

Y1 - 2025

N2 - Background: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA. Methods: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results: Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03). Conclusions: Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.

AB - Background: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA. Methods: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results: Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03). Conclusions: Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.

KW - Reperfusion

KW - Stent

KW - Stroke

KW - Technique

KW - Thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=85217661367&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85217661367&partnerID=8YFLogxK

U2 - 10.1136/jnis-2024-022781

DO - 10.1136/jnis-2024-022781

M3 - Article

C2 - 39884851

AN - SCOPUS:85217661367

SN - 1759-8478

JO - Journal of neurointerventional surgery

JF - Journal of neurointerventional surgery

ER -

Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this