Number of passes and outcome of endovascular treatment of anterior circulation large core ischemic stroke: insights from the Endovascular Treatment in Ischemic Stroke (ETIS) registry

Victoria Lambrou; Benjamin Gory; Bertrand Lapergue; Gaultier Marnat; Raoul Pop; Lionel Calviere; Mohammad Anadani; Raphael Blanc; Stephanos Nikolaos Finitsis; ETIS Study Group

doi:10.1136/jnis-2024-021857

Number of passes and outcome of endovascular treatment of anterior circulation large core ischemic stroke: insights from the Endovascular Treatment in Ischemic Stroke (ETIS) registry

J Neurointerv Surg. 2024 May 30:jnis-2024-021857. doi: 10.1136/jnis-2024-021857. Online ahead of print.

Authors

Collaborators

ETIS Study Group:
Adrien Wang, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Silvia Pizzuto, Alessandro Sgreccia, Charline Benoit, Lucas Gorza, David Weisenburger-Lile, Waliyde Jabeur, Tchikviladze Maia, Serge Evrard, Georges Rodesch, Raphaël Blanc, Michel Obadia, Jean-Philippe Desilles, Michel Piotin, Pierre Seners, Stanislas Smajda, Simon Escalard, Benjamin Maier, Candice Sabben, Hocine Redjem, Mikael Mazhigi, Grace Adwane, François Delvoye, Amira Al Raaisi, William Boisseau, Altayeb Adnan, Malayer Thomas, Robichon Erwan, Omer Eker, Tae-Hee Cho, Laurent Derex, Julia Fontaine, Laura Mechtouff, Norbert Nighoghossian, Elodie Ong, Lucie Rascle, Roberto Riva, Françis Turjman, Morgane Laubacher, Mehdi Beyragued, Yves Berthezene, Marc Hermier, Ameli Roxanna, Alexandre Bani-Sadr, Andrea Filip, Matteo Cappucci, Laurent Derex, Pernot Pierre, Clottes Paul, Romain Bourcier, Benjamin Daumas Duport, Pierre Louis Alexandre, Cédric Lenoble, Hubert Desal, Solene De Gaalon, Benoît Guillon, Cécile Preterre, Guillaume Tessier, Arthur Lionnet, Lisa Humbertjean-Selton, René Anxionnat, Anne-Laure Derelle, Liang Liao, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Gioia Mione, Jean-Christophe Lacour, Marian Douarinou, Emilien Micard, Bailiang Chen, Gérard Audibert, Agnès Masson, Lionel Alb, Marine Beaumont, Adriana Tabarna, Marcela Voicu, Grégoire Barthel, Iona Podar, Madalina Brezeanu, Marie Reitter, François Zhu, Anxionnat René, Jean-Sébastien Liegey, Pierre Briau, Lisa Papillon, Igor Sibon, Xavier Barreau, Jean Papaxanthos, Jérome Berge, Sabrina Debruxelles, Stéphane Olindo, Mathilde Poli, Pauline Renou, Sharmila Sagnier, Thomas Tourdias, Thomas Courret, Ludovic Lucas, Malgorzata Milnerowicz, Cyril Dargazanli, Vincent Costalat, Isabelle Mourand, Caroline Arquizan, Lucas Corti, Adrien Ter Schiphorst, Cagnazzo Federico, Imad Derraz, Mehdi Mahmoudi, Pierre-Henri Lefevre, Grégory Gascou, Quentin Varnier, Laurent Spelle, Jildaz Caroff, Christian Denier, Vanessa Chalumeau, Cristian Mihalea, Nicolas Legris, Augustin Ozanne, Leon Ikka, Olivier Chassin, Sophie Gallas, Laura Venditti, Mariana Sarov, Jonathan Cortese, Jean-Christophe Ferre, Stephane Vannier, Thomas Ronziere, Maria Veronica Lassalle, Jean-Yves Gauvrit, Clément Tracol, Abdelghani Fakhreddine Boustia, Cécile Malrain, Edouard Beaufreton, Thibault Lapotre, Quentin Alias, Julien Hissier, Maud Guillen, François Eugene, Boucherit Julien, Cyril Chivot, Audrey Courselle, Elisa Ouin, Chantal Lamy, Kevin Delaforge, Manuel Fernandez, Jérémie Vial, Quentin Laferte, Xavier Desdoit, Serge Timsit, Aurore Jourdain, Jean-Christophe Gentric, Julien Ognard, Irina Viakhireva, Jordan Coris, Sabine Prud'hon, François-Mathias Merrien, Denis Marechal, Marie Bruguet, Pierre Yves Rousseau, Philippe Goas, Elise Retho, Caroline Lavenant, Rozenn Le Gal, Leblanc Amélie, Marion Boulanger, Emmanuel Touze, Denis Vivien, Charlotte Barbier, Romain Schneckenburger, Fabrizio Salaris, Julien Cogez, Sophie Guettier, Estelle La Porte, Jean Bouchart, Charbel Mounayer, Aymeric Rouchaud, Suzana Saleme, Géraud Forestier, Frédéric Clarencon, Charlotte Rosso, Sara Leder, Flore Baronnet, Sophie Crozier, Anne Leger, Kevin Premat, Shotar Eimad, Stéphanie Lenck, Nader Sourour, Laure Bottin, Sam Ghazanfari, Marion Yger, Sonia Alamowitch, Stephen Delorme, Aymeric Wittwer, Christine Vassilev, Allard Julien, Olivier Naggara, Guillaume Turc, Wagih Ben Hassen, Basile Kerleroux, Denis Trystram, Christine Rodriguez-Regent, Finoana Laza-Nomenjanahary, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Evelyne Massardier, Aude Triquenot, Margaux Lefebvre, Julien Burel, Basille Florient, Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-François Albucher, Lionel Calviere, Jean-Marc Olivot, Jean Darcourt, Nicolas Raposo, Fabrice Bonneville, Guillaume Bellanger, Louis Fontaine, Philippe Tall, Frédéric Bourdain, Patricia Bernady, Guillaume Ballan, Stephanie Bannier, Emmanuel Ellie, Olivier Flabeau, Julia Potenza, Antoine Soulages, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue, Anthony Lebras, Sarah Adam, Benoit Pegat, Arnaud Le Guen, François Chedeville, Jérémy Jouan, Allibert Rémi, Alexanre Courtois, Sarah Evain, Lescot Lucile, Stéphanie Demasles, Johann Sebastian Richter, Bruno Thierry Barroso, Camille Dahan, Alexis Gonnet, Régis Hubrecht, Zoé Lepine, Hélène Castagnet, Raluca Marasescu, Olivier Heck, Pauline Cuisenier, Olivier Detante, Isabelle Favre Wiki, Clémentine Bonaz, Garambois Katia, Loic Legris, Adrian Kastler, Kamel Boubagra, Corentin Berthet, Stéphane Charara, Victor Dumas, Neau Jean Philippe, Velasco Stéphane, Valérie Wolff, Véronique Quenardelle, Valérie Lauer, Irène Pierre-Paul, Roxana Gheoca, Malwina Trzeciak, Bindila Perisse Daniella, Bonnart Camille, Solène Moulin, Hua Vi Tuan, Paolo Pagano, Alexandre Doucet, Christophe Gelmini, Pierre-François Manceau, Laurentiu Paiusan, Isabelle Serre, Sébastien Soize, Thi Ngoc PhuongNguyen, Maher Sahnoun, Nathalie Caucheteux, Pablo Lebindsky, Nader Vanessa, Federico Bolignini, Francis Vuillemet, Rodregues José, Anna Ferrier, Abderrahim Zerroug, Ricardo Moreno, Emmanuel Chabert, Elie Lteif, Pauline Paris, Nathalie Bourgois, Marie Raquin, Anne Pasco-Papon, Jean Baptiste Girot, Alderic Lecluse, Sophie Godard, Vincent L'allinec, Corfu Alice, Kevin Janot, Richard Bibi, Marie Gaudron, Arnaud Bretonniere, Mariam Annan, Héloïse Ifergan, Grégoire Boulouis, Marco Pasi, Séverine Debiais, Elisabeth Molinier, Denis Herbreteau, Romain Doung, Fouzi Bala, Clemencie Hoche, Anthony Wietrich, Valérie Ruche, Karine Lavandier, Yannick Bejot, Brivale Lemogne, Federic Ricolfi, Laura Baptiste, Pierre Thouant, Gaulthier Duloquin, Pierre Olivier Comby, Guillaume Charbonnier, Louise Bonnet, Nicolas Raybaud, Benjamin Bouamra, Thierry Moulin, Alessandra Biondi, Pico Fernando, Dano Benjamin, Patcas Carmen, Chaari Dhouha, Stanciu Daniela, Duang Duc Long, Hmida Intissar, Marie-Laure Chadenat, Suissa Laurent, Doche Emilie, Hak Jean-François, Reyre Anthony, Carle Xavier, Laksiri Nadia, Osman Ophélie, Peres Roxane, Robinet-Borgomano Emmanuelle, Dulau Cécile, Kerleroux Basile, Rey Caroline, Basile Kerleroux, Jérôme Berge, Fabrice Bing, Mathieu Bonnerot

Affiliations

¹ Neuroradiology, Aristotle University of Thessaloniki, Thessalonike, Kentrikḗ Makedonía, Greece.
² Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France.
³ Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Suresnes, France.
⁴ Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France.
⁵ Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.
⁶ Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France.
⁷ CHU Toulouse, Toulouse, France.
⁸ Medical University of South Carolina, Charleston, South Carolina, USA.
⁹ Interventional Neuroradiology, Fondation Rothschild, Paris, France.
¹⁰ Neuroradiology, Aristotle University of Thessaloniki, Thessalonike, Kentrikḗ Makedonía, Greece [email protected].

PMID: 38816202
DOI: 10.1136/jnis-2024-021857

Abstract

Background: The effect of multiple attempts on the outcome of endovascular treatment (EVT) of anterior circulation large ischemic core (LIC) stroke has not been fully explored.

Methods: We analyzed data from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective, observational, multicenter study of acute ischemic stroke patients treated with EVT at 21 centers in France between January 1, 2015 and June 31, 2023. We included patients with proximal intracranial occlusion and LIC defined as Alberta Stroke Program Early CT Score (ASPECTS) of 0-5 up to 24 hours after last being seen well. We divided patients according to the number of passes with successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) into seven groups, according to the corresponding number of passes. We compared them to the group of patients with unsuccessful reperfusion.

Results: A total of 1235 patients with LIC constituted the study cohort. The rate of a modified Rankin Scale (mRS) score of 0 to 3 at 90 days was significantly higher for the one-pass successful recanalization category compared to no recanalization (48.1% vs 17.2%; adjusted OR (aOR) 7.99, 95% CI 4.30 to 14.8, P<0.001) and remained so even after six or more attempts (27.7% vs 17.2%; aOR 3.59, 95% CI 1.37 to 9.39, P=0.009). The rate of symptomatic intracranial hemorrhage was lower for successful recanalization up to two passes (11.1% vs 18.8%; aOR 0.36, 95% CI 0.18 to 0.69, P=0.002) without any significant differences for a higher number of passes.

Conclusion: In anterior circulation LIC patients, successful reperfusion, even after six passes, is associated with favorable clinical outcomes with no increased hemorrhagic risk when compared to unsuccessful reperfusion.

Keywords: Stroke; Technique; Thrombectomy.