Abstract 1122‐000219: Thrombectomy Treatment Strategies for Refractory Occlusions

Introduction : We sought to compare endovascular strategies in patients with intracranial occlusions refractory to stentriever thrombectomy. Methods : With approval, we retrospectively reviewed all acute stroke endovascular interventions from our center from July 2013 to September 2016. Of 294 interventions, we reviewed 151 patients with an intracranial internal carotid artery occlusion or middle cerebral artery M1 occlusion. Of these, 107 were treated initially with a stentriever, and had a completed procedure with < 2 device passes. Forty‐three had > 2 passes and were grouped as continued intervention with the same device (Group 1), switch to a different stentriever design (Group 2), switch to aspiration (Group 3), or alternating therapy with continued mechanical and aspiration thrombectomy (3 patients). Our endpoint was procedural time from ground puncture to end of intervention. We used a t test to compare mean procedural times of Groups 2 and 3 against Group 1 to assess for meaningful differences in treatment duration. Results : We identified 15 patients in Group 1 with a mean procedural time of 95 minutes (sd 21 minutes); 13 patients in Group 2 with a mean procedural time 89 minutes (sd 1 minute); and 12 patients in Group 3 with a mean procedural time of 81 minutes (sd 9 minutes). We observed a trend toward shorter procedure times when switching to a different stentriever design after two failed attempts with an original device (t score 1.0, 95% CI ‐18‐6, p = 0.31). A statistically lower difference procedural time was noted with a transition to aspiration (t score 2.2, 95% CI ‐27–0.6, p = 0.04). Conclusions : When dealing with refractory occlusions to mechanical embolectomy, switching therapy to direct aspiration may benefit over continued use of the same or different stentriever design. The possibility of shorter procedural times suggests the value of a prospective design to study this clinical question.