P86 Complete Sudden Recanalization: there is hope beyond the first pass effect

Introduction

Achieving complete recanalization in a minimum number of attempts is the main procedural objective of mechanical thrombectomy. We aimed to explore the effect of the recanalization pattern in patients with final complete recanalization.

Methods

We performed a retrospective analysis of patients with terminal carotid internal artery or M1-middle cerebral artery occlusion and complete recanalization (eTICI 2c-3) from 2014 in our center. Complete Sudden Recanalization (cSR) was considered when eTICI varied from 0–1 to 2c-3 without an interim partial recanalization step (2a or 2b) (progressive recanalization, PR). We explored the effect of cSR on clinical outcome compared with progressive complete recanalization.

Results

Among four hundred patients with complete recanalization, in 301 was achieved with a cSR pattern. There were no differences between groups in terms demographic or clinical data and use of intravenous rtPA (42.2% vs 44.4%, p=0.69). The rate of terminal carotid artery occlusion (28.6% vs 44.4%, p=0.003), median number of passes (1 (IQR 1–2) vs 2 (2–3), p<0.001) and time from puncture to recanalization (27 (IQR 18–43) vs 46 (34–66) minutes; p<0.001) were lower in cSR group. At 90 days cSR was an independent predictor of good functional outcome (57.8% vs 44.4%, p=0.038). Compared with first pass effect, cSR after the first pass didn´t worsen the rate of good functional outcome (57.6% vs 58.6%, p=0.889).

Conclusion

Among patients with a large vessel occlusion, the complete sudden recanalization pattern was a predictor of functional independence even when it did not occur in the first attempt.

References

Zaidat OO, Castonguay AC, Linfante I, et al. First pass effect: a new measure for stroke thrombectomy devices. Stroke 2018 Mar;49(3):660–666. DOI: 10.1161/Stroke AHA.117.020315. EPUB 2018 Feb 19. PMID: 29459390. García-Tornel Á, Rubiera M, Requena M, et al. Sudden recanalization: a game-changing factor in endovascular treatment of large vessel occlusion strokes. Stroke 2020 Apr;51(4):1313–1316. DOI: 10.1161/Stroke AHA.119.028787. EPUB 2020 Feb 14. PMID: 32078495.

Do you have any conflict of interest to declare?: No