E-274 Impact of larger catheters on the effect of procedure time on thrombectomy outcomes
Notice bibliographique
Résumé
Introduction Endovascular thrombectomy (EVT) for acute ischemic stroke is the current standard of care. Previous investigations explored the impact of EVT total procedure time (PT) on clinical outcomes. Longer procedures correlated with worse outcomes. The underlying mechanisms explaining why minutes of PT have a more pronounced effect on outcomes than onset to puncture time remain unexplored. We hypothesized that the duration of aspiration catheters indwelling in the intracranial vasculature contributes to a further reduction in blood flow to the ischemic penumbra, thereby diminishing the efficacy of EVT. Methods We employ a combination of an in-vitro flow model and data from an international multicenter registry. Using a flow model of EVT, we tested the impact of placing different size endovascular catheter on the cerebral blood flow in the middle cerebral artery (MCA) and anterior cerebral (ACA) using 5 independent simulations. We then used a large multicenter retrospective cohort of patients to study the impact of time from catheter placement in the intracranial vasculature to revascularization (icPT) on EVT outcomes. Primary outcome included 90-day functional independence defined as modified Rankin Score (mRS) 0–2. Results Using an in-vitro flow model of cerebral vasculature, we first demonstrate that 6–8F catheters resulted in a size-dependent reduction of ipsilateral cerebral blood flow in the MCA (50%) and ACA (70%). Using a prospective registry-based study from 30 comprehensive stroke centers, we included 3318 EVT patients with recorded icPT. Using regression models controlling for covariates, icPT predicted lower rates of 90-day functional independence (aOR=0.87, p<0.01), higher odds of 90-day mortality (aOR=1.03, p<0.01), higher odds of decompressive craniectomy (aOR=1.07, p<0.01), and higher odds of post-procedural sICH (aOR=1.07,p<0.01). Every 10 min increase in icPT is associated with 13% lower odds of 90-day functional independence. The impact of icPT on outcomes was independent of successful recanalization but was potentiated by the use of larger bore catheters. In cases of complete internal carotid artery occlusion, large catheter placement did not impact outcomes. Techniques requiring distal placement of large catheters (contact aspiration) led to higher impact of icPT on outcomes compared to techniques not requiring distal catheter placement (stent retriever). Reduction in blood pressure (BP) intra-procedure amplifies the effect of icPT on outcomes. To identify the optimal cut-off if icPT for propensity score (PS) matching, we used the Youden’s index applied to the receiver operating characteristic. A cut-off at 30 min of icPT was deemed optimal. We performed PS-matched analysis of patients with successful recanalization that was achieved in <30 min versus ≥30 min of icPT. Comparing the two groups (N=1006/group), patients with icPT <30 min had better post-procedural NIHSS and more pronounced improvement in NIHSS between admission and post-procedure compared to those with ≥30 min (p<0.001). On logistic regression, icPT < 30 min was associated with 1.62 higher odds of good functional outcome at 90 days (p<0.001). Conclusions This study demonstrates the risks associated with duration of catheter use during EVT, and propose strategies to mitigate these risks including BP augmentation and limiting the duration of distal catheter placement in longer procedures. Disclosures A. Alawieh: 6; C; Penumbra. S. Elawady: None. R. Chalhoub: None. C. Cunningham: None. Y. Zohdy: None. B. Howard: None. C. Cawley: None. D. Barrow: None. F. Akbik: None. A. Pabaney: None. F. Tong: None. S. Alkasab: 1; C; Stryker. P. Jabbour: 2; C; Balt, Cerus endovascular, MicroVention, Medtronic. N. Goyal: None. A. Arthur: 1; C; Balt, Medtronic, Microvention, Penumbra, Siemens. 2; C; Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker. 4; C; Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. F. Siddiqui: None. S. Yoshimura: None. M. Park: 5; C; Medtronic. W. Brinjikji: None. C. Matouk: 2; C; Silk Road, Penumbra, Microvention, Stryker. 3; C; Silk Road, Penumbra. D. Romano: None. D. Altschul: None. R. Williamson: None. M. Moss: None. R. De Leacy: 1; C; Hyprevention, Kaneka Medical, Siemens Healthineers, SNIS foundation. 2; C; Stryker Neurovascular, Imperative Care, Cerenovus, Asahi Intec. 4; C; Synchron, Endostream, Q’Apel, Spartan Micro. 6; C; Editorial Board JNIS. M. Ezzeldin: None. P. Kan: 1; C; U18EB029353–01. 2; C; Stryker Neurovascular, Imperative Care, Microvention. 6; C; Editorial Board JNIS. M. Levitt: 1; C; Stryker, Medtronic. 2; C; Medtronic, Aeaean Advisers. 4; C; Hyperion Surgical, Proprio, Synchron, Cerebrotech, Fluid Biomed, Stereotaxis. 6; C; Travel support: Penumbra, Editorial board, Journal of NeuroInterventional Surgery, Metis Innovative: Adviser. R. Grandhi: None. J. Mascitelli: 2; C; Stryker. J. Grossberg: 1; C; Georgia Research Alliance, Emory Medical Care Foundation, Department of Defense, Neurosurgery Catalyst. 4; C; NTI, Cognition. A. Spiotta: 2; C; Stryker, Terumo, Penumbra, RapidAI.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,014 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».