Cerebral vessel anatomy as a predictor of first-pass effect in mechanical thrombectomy for emergent large-vessel occlusion

Restricted access

OBJECTIVE

Mechanical thrombectomy is effective in acute ischemic stroke secondary to emergent large-vessel occlusion, but optimal efficacy is contingent on fast and complete recanalization. First-pass recanalization does not occur in the majority of patients. The authors undertook this study to determine if anatomical parameters of the intracranial vessels impact the likelihood of first-pass complete recanalization.

METHODS

The authors retrospectively evaluated data obtained in 230 patients who underwent mechanical thrombectomy for acute ischemic stroke secondary to large-vessel occlusion at their institution from 2016 to 2018. Eighty-six patients were identified as having pure M1 occlusions, and 76 were included in the final analysis. The authors recorded and measured clinical and anatomical parameters and evaluated their relationships to the first-pass effect.

RESULTS

The first-pass effect was achieved in 46% of the patients. When a single device was employed, aspiration thrombectomy was more effective than stent retriever thrombectomy. A larger M1 diameter (p = 0.001), decreased vessel diameter tapering between the petrous segment of the internal carotid artery (ICA) and M1 (p < 0.001), and distal collateral grading (p = 0.044) were associated with first-pass recanalization. LASSO (least absolute shrinkage and selection operator) was used to generate a predictive model for recanalization using anatomical variables.

CONCLUSIONS

The authors demonstrated that a larger M1 vessel diameter, low rate of vessel diameter tapering along the course of the intracranial ICA, and distal collateral status are associated with first-pass recanalization for patients with M1 occlusions.

ABBREVIATIONS ASPECTS = Alberta Stroke Program Early Computed Tomography Score; GLM = generalized linear model; ICA = internal carotid artery; LASSO = least absolute shrinkage and selection operator; MCA = middle cerebral artery; NIHSS = NIH Stroke Scale; ROC = receiver operating characteristic; TICI = thrombolysis in cerebral infarction.
Article Information

Contributor Notes

Correspondence Nicholas C. Bambakidis: University Hospitals Cleveland Medical Center, Cleveland, OH. nicholas.bambakidis2@uhhospitals.org.INCLUDE WHEN CITING Published online January 24, 2020; DOI: 10.3171/2019.11.JNS192673.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Agresti A: An Introduction to Categorical Data Analysised 1. New York: Wiley1996

  • 2

    Ducroux CPiotin MGory BLabreuche JBlanc RBen Maacha M: First pass effect with contact aspiration and stent retrievers in the aspiration versus stent retriever (ASTER) trial. J Neurointerv Surg [epub ahead of print]2019

    • Search Google Scholar
    • Export Citation
  • 3

    Friedman JHastie TTibshirani R: Regularization paths for generalized linear models via coordinate descent. J Stat Softw 33:1222010

    • Search Google Scholar
    • Export Citation
  • 4

    Goyal MMenon BKvan Zwam WHDippel DWMitchell PJDemchuk AM: Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387:172317312016

    • Search Google Scholar
    • Export Citation
  • 5

    Kono KFujimoto TTerada T: Proximal stenosis may induce initiation of cerebral aneurysms by increasing wall shear stress and wall shear stress gradient. Int J Numer Methods Biomed Eng 30:9429502014

    • Search Google Scholar
    • Export Citation
  • 6

    Lapergue BBlanc RGory BLabreuche JDuhamel AMarnat G: Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER Randomized Clinical Trial. JAMA 318:4434522017

    • Search Google Scholar
    • Export Citation
  • 7

    Lauric AGreim-Kuczewski KAntonov ADardik GMagida JKHippelheuser JE: Proximal parent vessel tapering is associated with aneurysm at the middle cerebral artery bifurcation. Neurosurgery 84:108210892019

    • Search Google Scholar
    • Export Citation
  • 8

    Melkumova LEShatskikh SY: Comparing ridge and LASSO estimators for data analysis. Procedia Eng 201:7467552017

  • 9

    Menard S: Applied Logistic Regression Analysis ed 1. Thousand Oaks, CA: Sage1995

  • 10

    Mocco JFiorella DFargen KMAlbuquerque FChen MGupta R: Endovascular therapy for acute ischemic stroke is indicated and evidence based: a position statement. J Neurointerv Surg 7:79812015

    • Search Google Scholar
    • Export Citation
  • 11

    Nikoubashman ONikoubashman ABüsen MWiesmann M: Necessary catheter diameters for mechanical thrombectomy with ADAPT. AJNR Am J Neuroradiol 38:227722812017

    • Search Google Scholar
    • Export Citation
  • 12

    Rai ATHogg JPCline BHobbs G: Cerebrovascular geometry in the anterior circulation: an analysis of diameter, length and the vessel taper. J Neurointerv Surg 5:3713752013

    • Search Google Scholar
    • Export Citation
  • 13

    Ruopp MDPerkins NJWhitcomb BWSchisterman EF: Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J 50:4194302008

    • Search Google Scholar
    • Export Citation
  • 14

    Sing TSander OBeerenwinkel NLengauer T: ROCR: visualizing classifier performance in R. Bioinformatics 21:394039412005

  • 15

    Tan IYDemchuk AMHopyan JZhang LGladstone DWong K: CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30:5255312009

    • Search Google Scholar
    • Export Citation
  • 16

    Turk AS IIISiddiqui AFifi JTDe Leacy RAFiorella DJGu E: Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet 393:99810082019

    • Search Google Scholar
    • Export Citation
  • 17

    Zaidat OOCastonguay ACLinfante IGupta RMartin COHolloway WE: First pass effect: a new measure for stroke thrombectomy devices. Stroke 49:6606662018

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 424 424 424
Full Text Views 80 80 80
PDF Downloads 63 63 63
EPUB Downloads 0 0 0
PubMed
Google Scholar