Abstract
Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient’s anatomy to enhance effectivity.
Highlights
In acute ischemic stroke, clinical outcomes depend heavily on rapid and complete recanalization [1,2,3,4]
The logistic regression showed that inhospital mortality in the elderly was higher than that in younger patients, with the risk increasing by a factor of 1.034 (1.004–1.066) per year (p = 0.028)
Our study revealed an efficacy gradient depending on the location of the balloon guide catheter (BGC) in the carotid artery, consistent with the results of Jeong et al [13] (TICI 3 irrespective of passes in 67% of the distal BGC group versus 45% for the proximal BGC group)
Summary
Clinical outcomes depend heavily on rapid and complete recanalization [1,2,3,4]. The goal for interventional therapies is complete recanalization after a single retrieval maneuver, which is an independent factor for good clinical outcome [5]. Combining stent retrievers (SRs) and balloon guide catheters (BGCs) is a commonly used endovascular clot removal technique [6]. It is essential to analyze the anatomical and angiographic factors that could alter the effectiveness of clot removal on the first attempt using the combined SR-BGC technique. These biomarkers indicative of the difficulty of clot removal could be identified prior to therapy, thereby enabling the mechanical thrombectomy technique to be adapted to each patient’s anatomical conditions
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