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Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis

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Název: Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis
Autoři: Aglaé Velasco Gonzalez, Dennis Görlich, Boris Buerke, Nico Münnich, Cristina Sauerland, Thilo Rusche, Andreas Faldum, Walter Heindel
Zdroj: Transl Stroke Res
Informace o vydavateli: Springer Science and Business Media LLC, 2020.
Rok vydání: 2020
Témata: Aged, 80 and over, Male, 2. Zero hunger, Catheters, Decision Trees, Thrombosis, Brain Ischemia, Cerebral Angiography, Stroke, 03 medical and health sciences, 0302 clinical medicine, Humans, Female [MeSH], Stroke/therapy [MeSH], Circle of Willis, Aged, 80 and over [MeSH], Carotid arteries, Aged [MeSH], Thrombectomy/methods [MeSH], Humans [MeSH], Suction, Catheters/adverse effects [MeSH], Original Article, Decision Trees [MeSH], Male [MeSH], Thrombosis/therapy [MeSH], Cerebral Angiography/methods [MeSH], Thrombectomy, Thrombectomy/adverse effects [MeSH], Brain Ischemia/therapy [MeSH], Female, Aged
Popis: 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.
Druh dokumentu: Article
Other literature type
Jazyk: English
ISSN: 1868-601X
1868-4483
DOI: 10.1007/s12975-020-00784-2
Přístupová URL adresa: https://link.springer.com/content/pdf/10.1007/s12975-020-00784-2.pdf
https://pubmed.ncbi.nlm.nih.gov/32447614
https://paperity.org/p/250560518/predictors-of-successful-first-pass-thrombectomy-with-a-balloon-guide-catheter-results-of
https://pubmed.ncbi.nlm.nih.gov/32447614/
https://www.scilit.net/article/2196d00edef03028f233ec0948ea6351
https://link.springer.com/article/10.1007/s12975-020-00784-2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496051
https://link.springer.com/content/pdf/10.1007%2Fs12975-020-00784-2.pdf
https://repository.publisso.de/resource/frl:6471946
Rights: CC BY
Přístupové číslo: edsair.doi.dedup.....6b15721d25e14c5942cdf2f7ad891cf5
Databáze: OpenAIRE
Popis
Abstrakt: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.
ISSN:1868601X
18684483
DOI:10.1007/s12975-020-00784-2