July 17, 2024

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Stroke: The number of bolt removals will be discussed again

Stroke: The number of bolt removals will be discussed again

 

Stroke: The number of bolt removals will be discussed again.  Studies have shown that patients who can achieve TICI 3 after the first thrombus removal have the best clinical prognosis.

Endovascular therapy (EVT) is the standard treatment for large vessel occlusive stroke, and successful reperfusion is the most important modifiable predictor of good clinical prognosis.

Usually, multiple embolus removals are required to achieve successful reperfusion. In the case of persistent occlusion, it is currently unknown how many thrombectomy should be performed before terminating the operation.


Studies have shown that patients who can achieve TICI 3 after the first thrombus removal have the best clinical prognosis. Through multiple thrombus removal, the success rate of reperfusion can be improved, but its impact on the clinical prognosis is not completely clear, and the results in the literature are conflicting.

In some studies, multiple thrombus removal is negatively correlated with good clinical prognosis. In contrast, a recent study showed that the number of thrombectomy required for successful reperfusion does not predict a good clinical prognosis.

Most studies are single-center analysis, and the results are based on the dichotomy of the number of thrombectomy. Therefore, the impact of each subsequent thrombus removal on the clinical prognosis is unclear.


Fabian Flottmann and others from Germany published their research results on Stroke in February 2021. This research provides a detailed analysis describing the impact of thrombectomy times on functional results.

 

In this observational cohort study, 2,611 patients from a prospective German stroke registry between June 2015 and April 2018 were analyzed. Patients with acute anterior circulation stroke who underwent endovascular treatment were included. Successful reperfusion is defined as a TICI score of 2b or 3. The main outcome was defined as functional independence at 90 days (mRS score 0-2).

1225 patients met the inclusion criteria. The chance of a good clinical outcome decreases as the number of thrombus removals (the number of times required for successful reperfusion) increases:

  • The first thrombectomy has the highest probability of good clinical outcome (aOR, 6.45 [95%CI, 4.0–10.4]),
  • The second embolectomy (aOR, 4.56[95%CI, 2.7–7.7]),
  • The third thrombus was taken (aOR, 3.16 [95% confidence interval, 1.8-5.6]).

Stroke: The number of bolt removals will be discussed again.  Studies have shown that patients who can achieve TICI 3 after the first thrombus removal have the best clinical prognosis.

 


In the end, the author believes that the successful reperfusion of the first 3 thrombectomy is related to improved clinical outcome (vs no reperfusion). They concluded that at least 3 thrombectomy should be performed for circulatory stroke before endovascular treatment.

 

(source:internet, reference only)


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