Is a picture-perfect thrombectomy necessary in acute ischemic stroke?. (16th February 2021)

• Record Type: Journal Article
• Authors: Chen, Ching-Jen; Chalhoub, Reda; Ding, Dale; Kumar, Jeyan S; Ironside, Natasha; Kellogg, Ryan T; Worrall, Bradford B; Southerland, Andrew M; Jabbour, Pascal; Wolfe, Stacey Q; Arthur, Adam S; Goyal, Nitin; Fragata, Isabel; Maier, Ilko; Matouk, Charles; Grossberg, Jonathan A; Kan, Peter; Schirmer, Clemens M; Crowley, R Webster; Ares, William J; Ogilvy, Christopher S; Rai, Ansaar T; Levitt, Michael R; Mokin, Maxim; Guerrero, Waldo R; Mascitelli, Justin R; Yoo, Albert J; Williamson, Richard; Grande, Andrew Walker; Crosa, Roberto Javier; Webb, Sharon; Psychogios, Marios N; Starke, Robert M; Spiotta, Alejandro M; Park, Min S;
• Other Names: author non-byline.; Yavagal Dileep R author non-byline.; Peterson Eric C author non-byline.; Raper Daniel author non-byline.; Brown Patrick A author non-byline.; Reid Gooch M author non-byline.; Herial Nabeel author non-byline.; Thomas Ajith author non-byline.; Moore Justin author non-byline.; Albuquerque Felipe author non-byline.; Kim Louis J author non-byline.; Walker Melanie author non-byline.; Chen Michael author non-byline.; Munich Stephan author non-byline.; Hoit Daniel Alan author non-byline.; Inoa-Acosta Violiza author non-byline.; Lucas Christopher Nickele author non-byline.; Fernanda Elijovich author non-byline.; Rodriguez-Erazú Jan Liman author non-byline.; Cawley Michael author non-byline.; Pradilla Gustavo author non-byline.; Howard Brian author non-byline.; Walcott Brian author non-byline.; Ren Zeguang author non-byline.; Hebert Ryan author non-byline.; Reis João author non-byline.; Pamplona Jaime author non-byline.; Carvalho Rui author non-byline.; Baptista Mariana author non-byline.; Nunes Ana author non-byline.; Cerejo Russell author non-byline.; Tayal Ashis author non-byline.; Bhuva Parita author non-byline.; Hansen Paul author non-byline.; Ajiboye Norman author non-byline.; Brehm Alex author non-byline.; Kasab Sami Al author non-byline.; Lena Jonathan author non-byline.; Kicielinski Kimberly author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 14:Number 2(2022)
• Page Start: 111
• Page End: 116
• Publication Date: 2021-02-16
• Subjects: stroke -- thrombectomy; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2020-017193
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: The benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3. Methods: This is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage. Results: The unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction =0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction =0.041). Conclusions: Complete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.