{
  "abstract": "Introduction The optimal number of retrieval attempts during endovascular thrombectomy (EVT) for ischemic stroke remains uncertain. This study compares the expected functional outcomes of additional retrieval attempts with those of early termination after failed recanalization.Aim of Study To evaluate the expected clinical benefit of continuing EVT versus early termination following failed recanalization, aiming to improve treatment strategies.Method 10,573 patients with anterior circulation stroke undergoing EVT from a multicenter registry were included (GSR, 2015–2023). For each retrieval attempt, the rate of good functional outcome (modified Rankin Scale (mRS) score 0–2 at 90 days) was evaluated for successful (mTICI 2b-3) and unsuccessful (mTICI 0–2a) recanalization. Expected outcomes of subsequent attempts were adjusted for the probability of success.Results Up to six additional retrieval attempts were associated with significantly better expected outcomes compared to stopping after failed recanalization. The highest rate of good functional outcome (43.4%) was observed following first-pass recanalization. Terminating the procedure after a single failed attempt resulted in a mRS 0–2 rate of 21.5%, whereas the expected mRS 0–2 rate after a second attempt was 28.9% ( p=0.012). Even at the sixth attempt, the expected rate of good outcome following another retrieval (12.4%) remained significantly higher than the rate associated with stopping the procedure (5.5%; p=0.027) (figure 1, table 1).Abstract A50 Table 1Descriptive statistics of rate of good functional outcome mRS 0–2 at day 90 for successful recanalization, early stopping following failed recanalization and expected outcome for next attempt adjusted for probability of successful recanalization. P-values compare expected outcomes of next attempt with early stopping after failed recanalizationAbstract A50 Figure 1Rates of good functional outcomes mRS 0–2 per retrieval attempt, expected outcomes adjusted for probability of successful recanalizationConclusion The expected functional outcome of additional retrieval attempts adjusted for the probability of success is better than that of early termination for up to six attempts. These findings support continued pursuit of recanalization in eligible patients.Conflict of Interest Yes Helge Kniep and Fabian Flottmann are consultants for Eppdata GmbH. Helge Kniep is shareholder of Eppdata GmbH. Götz Thomalla received fees as consultant from Acandis, Boehringer Ingelheim, Bayer, and Portola, and fees as lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO. Jens Fiehler is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche and Tonbridge. He serves in the advisory board of Stryker and Phenox. He is stock holder of Tegus Medical, Eppdata and Vastrax.",
  "authors": [
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Helge Kniep"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Lukas Meyer"
    },
    {
      "affiliations": [
        "HELIOS Medical Center, Campus of MSH Medical School Hamburg, Department of Neuroradiology, Schwerin, Germany"
      ],
      "name": "Gabriel Broocks"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Matthias Bechstein"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Christian Heitkamp"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Laurens Winkelmeier"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Caspar Brekenfeld"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Maximilian Schell"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Uta Hanning"
    },
    {
      "affiliations": [
        "University Medical Center Mannheim, Neuroradiology, Mannheim, Germany"
      ],
      "name": "Mate Maros"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany"
      ],
      "name": "Götz Thomalla"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Jens Fiehler"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Susanne Gellißen"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany"
      ],
      "name": "Fabian Flottmann"
    }
  ],
  "title": "A50 Optimizing treatment strategy after failed recanalization: expected functional outcomes of next retrieval attempt vs. early termination – insights from a large multicenter registry",
  "uid": "c8e0b4f4-3765-55d4-bb2f-8ef30c66e22f"
}