Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Satoshi Namitome; Kazutaka Uchida; Seigo Shindo; Shinichi Yoshimura; Nobuyuki Sakai; Hiroshi Yamagami; Kazunori Toyoda; Yuji Matsumaru; Yasushi Matsumoto; Kazumi Kimura; Reiichi Ishikura; Manabu Inoue; Mikiya Beppu; Fumihiro Sakakibara; Manabu Shirakawa; Mitsuharu Ueda; Takeshi Morimoto; RESCUE-Japan LIMIT Investigators

doi:10.1161/STROKEAHA.123.042552

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT

Stroke. 2023 Aug;54(8):1985-1992. doi: 10.1161/STROKEAHA.123.042552. Epub 2023 Jul 7.

Authors

Satoshi Namitome¹, Kazutaka Uchida^{2

3}, Seigo Shindo⁴, Shinichi Yoshimura², Nobuyuki Sakai⁵, Hiroshi Yamagami⁶, Kazunori Toyoda⁷, Yuji Matsumaru⁸, Yasushi Matsumoto⁹, Kazumi Kimura¹⁰, Reiichi Ishikura¹¹, Manabu Inoue⁷, Mikiya Beppu², Fumihiro Sakakibara^{2

3}, Manabu Shirakawa², Mitsuharu Ueda⁴, Takeshi Morimoto³; RESCUE-Japan LIMIT Investigators

Affiliations

¹ Department of Neurology, Japanese Red Cross Kumamoto Hospital, Japan (S.N.).
² Department of Neurosurgery (K.U., S.Y., M.B., F.S., M.S.), Hyogo Medical University, Nishinomiya, Japan.
³ Department of Clinical Epidemiology (K.U., F.S., T.M.), Hyogo Medical University, Nishinomiya, Japan.
⁴ Department of Neurology, Kumamoto University, Japan (S.S., M.U.).
⁵ Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Japan.
⁶ Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Japan (H.Y.).
⁷ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., M.I.).
⁸ Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan (Y. Matsumaru).
⁹ Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y. Matsumoto).
¹⁰ Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (K.K.).
¹¹ Department of Diagnostic Radiology (R.I.), Kobe City Medical Center General Hospital, Japan.

PMID: 37417239
DOI: 10.1161/STROKEAHA.123.042552

Abstract

Background: The increased risk of intracranial hemorrhage with multiple passes in endovascular therapy (EVT) for large vessel occlusion with a large ischemic core is a concern. We explored the effect of the number of EVT passes on patients in a randomized clinical trial.

Methods: This post hoc study was the secondary analysis of RESCUE-Japan LIMIT, which was a randomized clinical trial comparing EVT and medical treatment alone for large vessel occlusion with large ischemic core. We grouped patients according to the number of passes with successful reperfusion (modified Thrombolysis in Cerebral Infarction score, ≥2b) in 1, 2, and 3 to 7 passes and failed reperfusion (modified Thrombolysis in Cerebral Infarction score, 0-2a) after any pass in the EVT group, and these groups were compared with medical treatment group. The primary outcome was modified Rankin Scale score of 0 to 3 at 90 days. Secondary outcomes were improvement in National Institutes of Health Stroke Scale score of ≥8 at 48 hours, mortality at 90 days, symptomatic intracranial hemorrhage, and any intracranial hemorrhage within 48 hours.

Results: The number of patients who received EVT with successful reperfusion after 1, 2, and 3 to 7 passes and failed reperfusion were 44, 23, 19, and 14, respectively, and 102 received medical treatment alone. The adjusted odds ratios (95% CIs) for the primary outcome relative to medical treatment were 5.52 (2.23-14.28) after 1 pass, 6.45 (2.22-19.30) after 2 passes, 1.03 (0.15-4.48) after 3 to 7 passes, and 1.17 (0.16-5.37) if reperfusion failed. The adjusted odds ratios (95% CIs) for any intracranial hemorrhage within 48 hours relative to medical treatment were 1.88 (0.90-3.93) after 1 pass, 5.14 (1.97-14.72) after 2 passes, 3.00 (1.09-8.58) after 3 to 7 passes, and 6.16 (1.87-24.27) if reperfusion failed.

Conclusions: The successful reperfusion within 2 passes was associated with better clinical outcomes.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT03702413.

Keywords: cerebral infarction; endovascular procedures; ischemic stroke; reperfusion.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia* / therapy
Cerebral Infarction / etiology
Endovascular Procedures* / adverse effects
Humans
Intracranial Hemorrhages / etiology
Japan
Stroke* / therapy
Thrombectomy
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03702413