Is a picture-perfect thrombectomy necessary in acute ischemic stroke?
Document Type
Article
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; p
CONCLUSIONS: Complete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.
Medical Subject Headings
Brain Ischemia; Humans; Ischemic Stroke; Retrospective Studies; Stroke; Thrombectomy; Treatment Outcome
Publication Date
2-1-2022
Publication Title
J Neurointerv Surg
ISSN
1759-8486
Volume
14
Issue
2
First Page
111
Last Page
116
PubMed ID
33593800
Digital Object Identifier (DOI)
10.1136/neurintsurg-2020-017193
Recommended Citation
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; and Park, Min S, "Is a picture-perfect thrombectomy necessary in acute ischemic stroke?" (2022). Neurosurgery. 2099.
https://scholar.barrowneuro.org/neurosurgery/2099