Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy.
Publication/Presentation Date
1-13-2026
Abstract
BACKGROUND: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA.
METHODS: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.
RESULTS: Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p< 0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03).
CONCLUSIONS: Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.
Volume
18
Issue
2
First Page
390
Last Page
398
ISSN
1759-8486
Published In/Presented At
Ezzeldin, M., Hukamdad, M., Abo Kasem, R., Ezzeldin, R., Maier, I., Rai, A. T., Jabbour, P., Kim, J. T., Howard, B. M., Alawieh, A., Wolfe, S. Q., Starke, R. M., Psychogios, M. N., Shaban, A., Goyal, N., Dye, J., Alaraj, A., Yoshimura, S., Fiorella, D., Tanweer, O., … Spiotta, A. M. (2026). Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy. Journal of neurointerventional surgery, 18(2), 390–398. https://doi.org/10.1136/jnis-2024-022781
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
39884851
Department(s)
Administration and Leadership
Document Type
Article