{
  "abstract": "Background A higher number of recanalization attempts reduces the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke secondary to large vessel occlusion (LVO). We assessed the impact of switching EVT techniques after a failed first pass on procedural and clinical outcomes.Methods This multicenter international study, conducted between January 2013 and December 2022, included patients undergoing EVT for anterior circulation LVO (internal carotid artery or M1 segments) with failed first pass recanalization. Propensity score matching identified a 1:1 matched cohort of patients in whom EVT technique was changed after a failed first pass and those with the same technique repeated. The primary outcome was successful recanalization at second attempt defined as Thrombolysis in Cerebral Ischemia (TICI) score of 2B or higher. Secondary outcomes were 90-day modified Rankin Score (mRS) and postprocedural hemorrhage.Results Among 2167 patients, converting to an alternative technique after a failed first pass was associated with higher odds of successful recanalization (adjusted OR (aOR)=1.5, p=0.041), and higher odds of mRS 0–2 at 90 days (aOR=1.6, p=0.005) without additional risk of symptomatic hemorrhage (p=0.379). Using a propensity score matched cohort of 490 patients, technique conversion at second attempt increased odds of successful recanalization at second attempt (aOR=1.32, p=0.006) and 90-day mRS 0–2 (aOR=1.38, p=0.008).Conclusions Early conversion to an alternative EVT technique after a failed first pass recanalization in patients with AIS is associated with better technical success and clinical outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan"
      ],
      "name": "Hidetoshi Matsukawa"
    },
    {
      "affiliations": [
        "Neurosurgery, Yale University, New Haven, Connecticut, USA"
      ],
      "name": "Charles Matouk"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan"
      ],
      "name": "Kazutaka Uchida"
    },
    {
      "affiliations": [
        "Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Sami Al Kasab"
    },
    {
      "affiliations": [
        "Neurology, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Mohammad-Mahdi Sowlat"
    },
    {
      "affiliations": [
        "Neuroendovascular Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Sameh Samir Elawady"
    },
    {
      "affiliations": [
        "Neurology, University Medicine Goettingen, Goettingen, Germany"
      ],
      "name": "Ilko Maier"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Pascal Jabbour"
    },
    {
      "affiliations": [
        "Neurology, University Medicine Goettingen, Goettingen, Germany"
      ],
      "name": "Joon-tae Kim"
    },
    {
      "affiliations": [
        "Wake Forest University, Winston-Salem, North Carolina, USA"
      ],
      "name": "Stacey Q Wolfe"
    },
    {
      "affiliations": [
        "Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA"
      ],
      "name": "Ansaar T Rai"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA"
      ],
      "name": "Robert M Starke"
    },
    {
      "affiliations": [
        "Universität Basel, Basel, BS, Switzerland"
      ],
      "name": "Marios-Nikos Psychogios"
    },
    {
      "affiliations": [
        "Neurology and Neurointerventional Radiology, University of Iowa, Iowa City, Iowa, USA"
      ],
      "name": "Edgar A Samaniego"
    },
    {
      "affiliations": [
        "Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA"
      ],
      "name": "Adam S Arthur"
    },
    {
      "affiliations": [
        "Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Hugo Cuellar"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Brain M Howard"
    },
    {
      "affiliations": [
        "Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d’Aragona', Salerno, Italy"
      ],
      "name": "Daniele G Romano"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Omar Tanweer"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Justin R Mascitelli"
    },
    {
      "affiliations": [
        "Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal"
      ],
      "name": "Isabel Fragata"
    },
    {
      "affiliations": [
        "University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Adam Polifka"
    },
    {
      "affiliations": [
        "Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA"
      ],
      "name": "Joshua W Osbun"
    },
    {
      "affiliations": [
        "Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay"
      ],
      "name": "Roberto Javier Crosa"
    },
    {
      "affiliations": [
        "University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Min S Park"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA"
      ],
      "name": "Michael R Levitt"
    },
    {
      "affiliations": [
        "Radiology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Waleed Brinjikji"
    },
    {
      "affiliations": [
        "Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, Arkansas, USA"
      ],
      "name": "Mark Moss"
    },
    {
      "affiliations": [
        "Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Richard Williamson"
    },
    {
      "affiliations": [
        "Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain"
      ],
      "name": "Pedro Navia"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA"
      ],
      "name": "Peter Kan"
    },
    {
      "affiliations": [
        "Neurosurgery, Mount Sinai Health System, New York, New York, USA"
      ],
      "name": "Reade Andrew De Leacy"
    },
    {
      "affiliations": [
        "Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA"
      ],
      "name": "Shakeel A Chowdhry"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, College of Medicine, University of Houston, Houston, Texas, USA"
      ],
      "name": "Mohamad Ezzeldin"
    },
    {
      "affiliations": [
        "Neuroendovascular Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Alejandro M Spiotta"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan"
      ],
      "name": "Shinichi Yoshimura"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Ali M Alawieh"
    }
  ],
  "title": "Improved technical outcomes with converting thrombectomy techniques after failed first pass recanalization",
  "uid": "f658eac3-5ed0-5ba4-a2f1-e0a646bd4640"
}