Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

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.

• Authors: Ching-Jen Chen, Reda Chalhoub, Dale Ding, Jeyan S Kumar, Natasha Ironside, Ryan T Kellogg, Bradford B Worrall, Andrew M Southerland, Pascal Jabbour, Stacey Q Wolfe, Adam S Arthur, Nitin Goyal, Isabel Fragata, Ilko Maier, Charles Matouk, Jonathan A Grossberg, Peter Kan, Clemens M Schirmer, R Webster Crowley, William J Ares, Christopher S Ogilvy, Ansaar T Rai, Michael R Levitt, Maxim Mokin, Waldo R Guerrero, Justin R Mascitelli, Albert J Yoo, Richard Williamson, Andrew Walker Grande, Roberto Javier Crosa, Sharon Webb, Marios N Psychogios, Robert M Starke, Alejandro M Spiotta, Min S Park, STAR collaborators
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 14 Issue 2 Pg. 111-116 (Feb 2022) ISSN: 1759-8486 [Electronic] England
• PMID: 33593800 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Brain Ischemia (diagnostic imaging, surgery)
• Humans
• Ischemic Stroke
• Retrospective Studies
• Stroke (diagnostic imaging, surgery)
• Thrombectomy
• Treatment Outcome