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First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study

 Jang-Hyun Baek  ;  Byung Moon Kim  ;  Sang Hyun Suh  ;  Hong-Jun Jeon  ;  Eun Hyun Ihm  ;  Hyungjong Park  ;  Chang-Hyun Kim  ;  Sang-Hoon Cha  ;  Chi-Hoon Choi  ;  Kyung Sik Yi  ;  Jun-Hwee Kim  ;  Sangil Suh  ;  Byungjun Kim  ;  Yoonkyung Chang  ;  So Yeon Kim  ;  Jae Sang Oh  ;  Ji Hoe Heo  ;  Dong Joon Kim  ;  Hyo Suk Nam  ;  Young Dae Kim 
 KOREAN JOURNAL OF RADIOLOGY, Vol.24(2) : 145-154, 2023-02 
Journal Title
Issue Date
Brain Ischemia* / diagnostic imaging ; Brain Ischemia* / surgery ; Cerebral Infarction ; Humans ; Ischemic Stroke* ; Male ; Prospective Studies ; Retrospective Studies ; Stents ; Stroke* / diagnostic imaging ; Stroke* / surgery ; Thrombectomy ; Treatment Outcome
First-pass recanalization ; Stent ; Stroke ; Thrombectomy
Objective: We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes.

Materials and methods: In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b-3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b-3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0-2 at 3 months.

Results: Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0-35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0-2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0-2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59-10.8; p = 0.004).

Conclusion: Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0-2, even in patients with successful recanalization.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 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
Kim, Jun-Hwee(김준휘)
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Baek, Jang Hyun(백장현)
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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