• Shota Yoshida, Motoaki Fujimoto, Kampei Shimizu, Hideki Ogata, Hokuto Yamashita, Yoshinori Akiyama, and Shoichi Tani.
• Department of Neurosurgery and Stroke Center, Tenri Hospital, Nara, Japan. Electronic address: zbsheu48@gmail.com.
• World Neurosurg. 2024 Jul 1; 187: e485e493e485-e493.

Background And PurposeSuccessful first-pass reperfusion is associated with better functional outcomes after mechanical thrombectomy (MT) for acute ischemic stroke, but its treatment strategies remain unclear.Materials And MethodsWe retrospectively recruited patients who underwent MT for M1 occlusion between December 2020 and May 2023 at our institution. The locations of susceptibility vessel sign (SVS) on magnetic resonance imaging were classified into M1 only, M1 to single M2 branch, or M1 to both M2 branches. Patients were included in the SVS tracing group when the stent retriever of the first pass covered the entire SVS length. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction scale 2b-3. Any intracranial hemorrhage detected at 24-hour postoperatively was included as a hemorrhagic complication.ResultsThe SVS was detected in M1 only, M1 to single M2 branch, and M1 to both M2 branches in 8, 22, and 4 patients, respectively. Among the 34 patients, 27 were included in the SVS-tracing group. Successful first-pass reperfusion was significantly more frequent in the SVS-tracing group compared with the non-SVS tracing group (odds ratio, 14.4; 95% confidence interval, 2.0 - 101; P = 0.007). The procedural time was significantly reduced in the SVS tracing group (median, 29 [interquartile range, 22 - 49] minute vs. 63 [43 - 106] minute; P = 0.043). There was a trend toward less frequent hemorrhagic complications in the SVS tracing group (odds ratio, 0.17; 95% confidence interval, 0.029 - 1.0; P = 0.052).ConclusionsThis study provides a thrombus imaging-based MT strategy to efficiently achieve first-pass reperfusion in M1 occlusion.Copyright © 2024 Elsevier Inc. All rights reserved.

25 keywords...

hide…