Dwell Time of Stentriever Influences Complete Revascularization and First-Pass TICI 3 Revascularization in Acute Large Vessel Occlusive Stroke

World Neurosurg. 2018 Feb;110:169-173. doi: 10.1016/j.wneu.2017.10.155. Epub 2017 Nov 4.

Abstract

Objective: In acute ischemic stroke with large vessel occlusion, the interaction between the clot retriever and the stent is critical for achieving successful recanalization. The ideal time of stent deployment (dwell time [DT]) to improve revascularization is currently unknown. We systematically analyzed the effect of different DT on final angiographic and clinical outcomes of patients who underwent mechanical thrombectomy.

Methods: The DT was progressively increased from 3 minutes to 5 minutes and then 8 minutes during the study period. The effect of DT on recanalization attempts, successful angiographic outcome (thrombolysis in cerebral ischemia [TICI] 2b or TICI 3), total revascularization time, and immediate and 3-month clinical outcomes were evaluated. The DT of 3 minutes and 5 minutes (DT3-5) was compared against DT of 8 minutes (DT8).

Results: Forty patients were included in the analysis. Good angiographic outcome was observed in 94.1% of patients in the DT8 cohort with an average attempt of 1.2 compared with 78.3% with average attempts of 2.0 in other group. Single-pass good recanalization (TICI 2b or 3) and single-pass complete revascularization (TICI3) was significantly higher in the DT group compared with the DT3-5 group (82.4% vs. 43.5% [P = 0.013] and 42.9% vs. 8.7% [P = 0.003], respectively). A favorable trend toward a reduced overall procedural time (34.59 vs. 55.59 minutes) was observed, but was not statistically significant (P = 0.15).

Conclusions: Mild prolongation of DT to 8 minutes improves revascularization outcome with fewer attempts, possibly because of better clot-stent interaction.

Keywords: Acute large vessel stroke; Dwell time; Revascularization; Stentriever.

MeSH terms

  • Adult
  • Aged
  • Brain Ischemia / complications*
  • Brain Ischemia / diagnostic imaging
  • Cerebral Revascularization / methods*
  • Computed Tomography Angiography
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Mechanical Thrombolysis / methods*
  • Middle Aged
  • Stents*
  • Stroke / diagnostic imaging
  • Stroke / etiology*
  • Stroke / surgery*
  • Time Factors