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Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy

 Dong-Hun Kang  ;  Jin Woo Kim  ;  Byung Moon Kim  ;  Ji Hoe Heo  ;  Hyo Suk Nam  ;  Young Dae Kim  ;  Yang-Ha Hwang  ;  Yong-Won Kim  ;  Jang-Hyun Baek  ;  Joonsang Yoo  ;  Dong Joon Kim  ;  Pyoung Jeon  ;  Oh Young Bang  ;  Seung Kug Baik  ;  Sang Hyun Suh  ;  Kyung-Yul Lee  ;  Hyo Sung Kwak  ;  Hong Gee Roh  ;  Young-Jun Lee  ;  Sang Heum Kim  ;  Chang-Woo Ryu  ;  Yon-Kwon Ihn  ;  Byungjun Kim  ;  Hong Jun Jeon  ;  Jun Soo Byun  ;  Sangil Suh  ;  Jeong Jin Park  ;  Jieun Roh 
 Journal of Neurointerventional Surgery, Vol.11(10) : 979-983, 2019 
Journal Title
 Journal of Neurointerventional Surgery 
Issue Date
acute stroke ; rescue treatment ; thrombectomy
BACKGROUD: The need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT. METHODS: We identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome. RESULTS: A total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870). CONCLUSION: CA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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