title: Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation.
abstract: OBJECTIVE
  We introduce the concept of a switching strategy for mechanical thrombectomy with period-to-period analysis. In period 1, forced arterial suction thrombectomy with a Penumbra reperfusion catheter was performed, even in difficult cases; in period 2, forced arterial suction thrombectomy was initially performed, with switching to Solitaire in difficult cases.
  
  
  METHODS
  We analyzed 135 consecutive patients treated with mechanical thrombectomy with acute large vessel occlusion in the anterior circulation, 61 from period 1 and 74 from period 2. We defined difficult case for both periods as ≥3 failed attempts at recanalization.
  
  
  RESULTS
  Period 2 showed a trend for better angiographic outcome of Thrombolysis in Cerebral Infarction 2b-3 (73.8%, period 1 versus 85.1%, period 2; P=0.10). In interperiod subgroup analysis of difficult cases, switching significantly outperformed nonswitching in Thrombolysis in Cerebral Infarction 2b-3 recanalization (52.7% versus 82.9%; P=0.030). Differences in puncture-to-recanalization time, symptomatic intracranial hemorrhage incidence, and procedure-related complications were not statistically significant.
  
  
  CONCLUSIONS
  A switching strategy using 2 mechanical thrombectomy techniques (forced arterial suction thrombectomy to Solitaire) may harbor better angiographic outcomes than a 1 technique only strategy (forced arterial suction thrombectomy).
authors.affiliation: From the Department of Radiology (D.-H.K., Y.-W.K., Y.-S.K.), Department of Neurology (Y.-W.K., Y.-H.H.), and Department of Neurosurgery (D.-H.K., J.P., J.-H.H.), Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Kang
authors.forename: Yong-Won
authors.initials: YW
authors.lastname: Kim
authors.forename: Yang-Ha
authors.initials: YH
authors.lastname: Hwang
authors.forename: Jaechan
authors.initials: J
authors.lastname: Park
authors.forename: Jeong-Hyun
authors.initials: JH
authors.lastname: Hwang
authors.forename: Yong-Sun
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000601:surgery*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: acute stroke; mechanical thrombectomy; switching strategy