title: Endovascular stroke treatment now and then-procedural and clinical effectiveness and safety of different mechanical thrombectomy techniques over time.
abstract: BACKGROUND
  The most essential development in endovascular stroke treatment (EST) was the shift from intra-arterial thrombolysis to endovascular thrombectomy with dedicated thrombectomy devices, most notably the introduction of stent-retrievers. We evaluated procedural and clinical effectiveness and safety of different EST techniques over time.
  
  
  METHODS
  We retrospectively analyzed EST cases that were treated by the same interventionalist before (n=36) and after (n=50) stent-retrievers were established as the treatment device of first choice. EST techniques in the first cohort comprised intra-arterial thrombolysis (n=24), manual thrombus aspiration (n=15), the use of the Penumbra thrombectomy system (n=13) and the Phenox clot retriever (n=3), intracranial stenting (n=10), and EST with stent-retrievers as a salvage procedure (n=11). In the second cohort, EST with stent-retrievers was the treatment option of first choice (n=47). Intra-arterial thrombolysis (n=15) and stenting of the occluded vessel (n=1) were performed, whenever EST with stent-retrievers failed.
  
  
  RESULTS
  In both cohorts, revascularization rates (TICI ≥2b) were high (91.7% and 86.0%, respectively). A significantly lower number of interventional techniques per case were required in the second cohort (mean ± SD, 1.4±0.5vs. 2.1±0.9, P<0.001). Recanalization was achieved almost twice as fast in the second cohort (85vs. 163 minutes on average, P<0.001). The rate of patients achieving good functional outcome (mRS ≤2) was higher in the second cohort (40.0%vs. 22.2%, P=0.083).
  
  
  CONCLUSIONS
  Our findings imply that when stent-retrievers were established as first-line the treatment device a significantly lower number of interventional techniques per case were required and recanalization was achieved almost twice as fast.
authors.affiliation: Department of Radiology and Neuroradiology, Helios Kliniken, Wismarsche Str. 393, 19049 Schwerin, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: von Gadow
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
authors.forename: Omid
authors.initials: O
authors.lastname: Nikoubashman
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Freiherr
authors.affiliation: Department of Neurology, Helios Kliniken, Wismarsche Str. 393, 19049 Schwerin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Block
authors.affiliation: Department of Neurology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
authors.forename: Arno
authors.initials: A
authors.lastname: Reich
authors.affiliation: Department of Neuroradiology, University of Munich, Klinikum Großhadern, Marchioninistr. 15, 81377 Munich, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Fesl
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
keywords: Endovascular stroke treatment (EST); interventional; revascularization; stent-retriever