Introduction: Revascularization rates continue to improve as technologiy improves in the treatment of acute ischemic stroke. While this is essential in improving the outcomes of endovascular treatment, focus must also be placed on the rapidity of the treatment. The faster revascularization takes place, the better chance of a good outcome. Since the development of a visible stent retriever we have noticed in curved vascular segments, when using the stent retriever as the primary treatment device, it is less successful.
Methods: We retrospectively analyzed all acute stroke interventions performed at our institution over the last 2 years in which a stent-retriever device was used. We divided the location of occlusion into 3 categories; ICA T-occlusion, straight M1 or M2 segment, or curved M1-M2 junction segment. We statistically analyzed TICI scores, time to vessel opening from groin puncture, and number of passes based on the category based on patient age, history of atrial fibrillation and clot length from each group.
Results: Of 27 patients, 12 had curved segment and 8 with straight segment MCA occlusion. The average time to vessel opening from groin puncture time was 127 minutes in curved segment (vs 89 minutes) , the average number of passes was 2.25vs 1.63, the % TICI 2B or 3 vessel opening was 16.7%vs 75%. There were 6 cases of T-occlusion with the average time to vessel opening from groin puncture time 120 minutes, the average number of passes was 2.67, the % TICI 2B or 3 vessel opening was 50%.
Conclusions: TICI recanalization rates were significantly better when using stent retrievers on a straight segment compared to a curved segment of MCA. The mixed results of ICA bifurcation occlusion is more likely to be explained by acute angulation and larger clot burden associated with these occlusions.
Patient Care: Deciding which treatment to use in the endovascular treatment of acute ischemic stroke can drastically effect the time it takes for vessel opening and therefore effect the outcomes of the intervention. Knowing when to use which device will improve revascularization times.
Learning Objectives: Configuration of the parent vessel correlates with the recanalization rates and time to vessel opening.