Futile complete recanalization: patients characteristics and its time course

Kitano, Takaya; Todo, Kenichi; Yoshimura, Shinichi; Yamagami, Hiroshi; Sakai, Nobuyuki; Sakaguchi, Manabu; Nakamura, Hajime; Kishima, Haruhiko; Mochizuki, Hideki; Ezura, Masayuki; Okada, Yasushi; Kitagawa, Kazuo; Kimura, Kazumi; Sasaki, Makoto; Tanahashi, Norio; Toyoda, Kazunori; Furui, Eisuke; Matsumaru, Yuji; Minematsu, Kazuo; Morimoto, Takeshi

doi:10.1038/s41598-020-61748-y

Cited by 15 publications

(16 citation statements)

References 32 publications

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“…Although the technical expertise of the operator is important, the increased number of passages may be due to some uncontrollable factors such as increased clot fragmentation with distal embolization or accumulated endothelial damage (27). In addition, the impact of the groin to recanalization and the number of passages on futile recanalization supports the conclusion of previous studies that an angiographic recanalization does not necessarily lead to functional independence if it was achieved at the expense of longer procedural times (28).…”

Section: Figurementioning

confidence: 58%

Machine learning to predict futile recanalization of large vessel occlusion before and after endovascular thrombectomy

Lin

Zheng²,

Zhang³

et al. 2022

Front. Neurol.

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Background and purposeFutile recanalization occurs when the endovascular thrombectomy (EVT) is a technical success but fails to achieve a favorable outcome. This study aimed to use machine learning (ML) algorithms to develop a pre-EVT model and a post-EVT model to predict the risk of futile recanalization and to provide meaningful insights to assess the prognostic factors associated with futile recanalization.MethodsConsecutive acute ischemic stroke patients with large vessel occlusion (LVO) undergoing EVT at the National Advanced Stroke Center of Nanjing First Hospital (China) between April 2017 and May 2021 were analyzed. The baseline characteristics and peri-interventional characteristics were assessed using four ML algorithms. The predictive performance was evaluated by the area under curve (AUC) of receiver operating characteristic and calibration curve. In addition, the SHapley Additive exPlanations (SHAP) approach and partial dependence plot were introduced to understand the relative importance and the influence of a single feature.ResultsA total of 312 patients were included in this study. Of the four ML models that include baseline characteristics, the “Early” XGBoost had a better performance {AUC, 0.790 [95% confidence intervals (CI), 0.677–0.903]; Brier, 0.191}. Subsequent inclusion of peri-interventional characteristics into the “Early” XGBoost showed that the “Late” XGBoost performed better [AUC, 0.910 (95% CI, 0.837–0.984); Brier, 0.123]. NIHSS after 24 h, age, groin to recanalization, and the number of passages were the critical prognostic factors associated with futile recanalization, and the SHAP approach shows that NIHSS after 24 h ranks first in relative importance.ConclusionsThe “Early” XGBoost and the “Late” XGBoost allowed us to predict futile recanalization before and after EVT accurately. Our study suggests that including peri-interventional characteristics may lead to superior predictive performance compared to a model based on baseline characteristics only. In addition, NIHSS after 24 h was the most important prognostic factor for futile recanalization.

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Section: Figurementioning

confidence: 58%

Machine learning to predict futile recanalization of large vessel occlusion before and after endovascular thrombectomy

Lin

Zheng²,

Zhang³

et al. 2022

Front. Neurol.

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“…28,29 On the other hand, recent analyses from the RESCUE-Japan 2 Registry suggested that mTICI 3 versus mTICI 2b was associated with favorable outcomes only when puncture to reperfusion time was <80 min. 30 In this analysis, the association of EARI with higher rates of functional independence was relatively homogenous across subgroups (including different time intervals from symptom onset to IAF) with one exception. Although not significant on interaction analyses, there was a tendency of the association being attenuated in patients with moderate to severe ischemia as opposed to those without or only minor ischemic changes on admission.…”

Section: Discussionmentioning

confidence: 72%

Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy

Kaesmacher

Peschi

Abdullayev

et al. 2021

Clinical and Translational Neuroscience

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Objective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms. Results: A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095). Conclusion: Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT.

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“…In general, increasing the number of passes and increasing the treatment time to achieve successful reperfusion were shown to lead to worse functional outcome 1 6–12. This trend to worse functional outcome was also seen when excellent or complete reperfusion (eTICI 2C/3) was reached 6 13. However, in patients with complete reperfusion a decline in the odds of post-stroke functional independence was only seen if more than three passes were necessary to achieve this result, while in patients with a final eTICI score of 2B this decline had already occurred if more than two passes were necessary 6.…”

Section: Discussionmentioning

confidence: 99%

“…However, in patients with complete reperfusion a decline in the odds of post-stroke functional independence was only seen if more than three passes were necessary to achieve this result, while in patients with a final eTICI score of 2B this decline had already occurred if more than two passes were necessary 6. Prolonged procedure time, greater infarct volumes, increased clot fragmentation with distal embolization, and accumulated endothelial damage after multiple passes are possible explanations for this negative effect of an increasing number of passes on functional outcome 13–16…”

Section: Discussionmentioning

confidence: 99%

“…As such, too many additional attempts could ultimately outweigh the benefit of an improved reperfusion grade. Previous studies have indeed found that the positive effect on functional outcome of reaching excellent/complete reperfusion over good reperfusion diminishes with an increasing number of passes and prolonged procedure time 6 13. Greater infarct volumes, increased clot fragmentation with distal embolization, and accumulated endothelial damage after multiple passes are possible explanations for this negative association between increasing number of passes and functional outcome 13–16…”

Section: Introductionmentioning

confidence: 98%

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Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3

Bruggeman

Kappelhof

Hartog

et al. 2022

J NeuroIntervent Surg

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BackgroundHigher expanded Treatment In Cerebral Ischemia (eTICI) reperfusion scores after endovascular treatment (EVT) are associated with better outcomes. However, the influence of the number of passes on this association is unclear. We aimed to compare outcomes of single-pass good reperfusion (eTICI 2B) with multiple-pass excellent/complete reperfusion (eTICI 2C/3) in daily clinical practice.MethodsWe compared outcomes of patients in the MR CLEAN Registry with good reperfusion (eTICI 2B) in a single pass to those with excellent/complete reperfusion (eTICI 2C/3) in multiple passes. Regression models were used to investigate the association of single-pass eTICI 2B versus multiple-pass eTICI 2C/3 reperfusion with 90-day functional outcome (modified Rankin Scale (mRS)), functional independence (mRS 0–2), per-procedural complications and safety outcomes.ResultsWe included 699 patients: 178 patients with single-pass eTICI 2B, and 242 and 279 patients with eTICI 2C/3 after 2 and ≥3 passes, respectively. Patients with eTICI 2C/3 after 2 or ≥3 passes did not achieve significantly better functional outcomes compared with patients with single-pass eTICI 2B (adjusted common OR (acOR) 1.06, 95% CI 0.75 to 1.50 and acOR 0.88, 95% CI 0.74 to 1.05 for 90-day mRS, and adjusted OR (aOR) 1.24, 95% CI 0.78 to 1.97 and aOR 0.79, 95% CI 0.52 to 1.22 for functional independence).ConclusionsOur results did not show better outcomes for patients who achieved eTICI 2C/3 in multiple, that is, two or more, passes when compared with patients with single-pass eTICI 2B. However, this concerns observational data. Further research is necessary to investigate the per-pass effect in relation to reperfusion and functional outcome.

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Futile complete recanalization: patients characteristics and its time course

Cited by 15 publications

References 32 publications

Machine learning to predict futile recanalization of large vessel occlusion before and after endovascular thrombectomy

Machine learning to predict futile recanalization of large vessel occlusion before and after endovascular thrombectomy

Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy

Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3

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