Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

Abstract

Background: Reperfusion status after intra-arterial thrombectomy (IAT) is a critical predictor of functional outcome after acute ischemic stroke. However, most prognostic models have not included a detailed assessment of reperfusion status after IAT. Objective: The aim of this work was to assess the association between successful reperfusion and clinical outcome. Methods: Clinical, radiological, and procedural variables of patients treated with IAT were extracted from our prospective stroke registry. The association with functional outcome using the modified Rankin Scale (mRS) after 3 months was assessed using multivariable logistic regression. An extension of the modified TICI score, eTICI, was used to classify reperfusion status. The prognostic value of reperfusion status after IAT in addition to age, stroke severity, imaging characteristics, treatment with intravenous thrombolysis, and time from symptom onset to the end of IAT was assessed with logistic regression and summarized with receiver operating characteristic curves. Results: In total, 119 patients were included (mean age 66 years). In multivariable analysis, age >80 years (OR 6.8, 95% CI 1.2–39.8), NIHSS at presentation >15 (OR 7.3, 95% CI 2.3–23.5), and incomplete reperfusion status (eTICI score <2C; OR 10.3, 95% CI 3.5–30.6) were the strongest predictors of a poor outcome (mRS 3–6). Adding reperfusion status to the model improved the prognostic accuracy (AUC 0.88, 95% CI 0.91–0.94). Our results indicate a large difference between using an eTICI cutoff of ≥2C versus ≥2B: a cutoff ≥2C improved the predictive value for a good clinical outcome (2C: positive predictive value, PPV, 0.78; 2B: PPV 0.32). Conclusion: Our results promote using reperfusion status for assessing prognosis in ischemic stroke patients treated with IAT. A model using eTICI ≥2C had greater PPV than eTICI ≥2B and could improve prognostic accuracy.

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

“…Nevertheless, there is a strong correlation between successful reperfusion and patients' outcome, as shown in recent literature [9,10,19,40]. The study cohort is the same size as in other comparable studies.…”

Futile complete recanalization: patients characteristics and its time course

“…Our study demonstrated that the effect of mTICI-3 reperfusion was not significantly modified by patients' baseline characteristics such as age, sex, NIHSS score, ASPECTS, and target occlusion location among patients www.nature.com/scientificreports www.nature.com/scientificreports/ with anterior circulation occlusion. Previous studies have reported the effect of complete reperfusion on outcomes [4][5][6][7][8][9][10][11][12][22][23][24] , but the heterogeneity of this effect according to patients' characteristics has not been fully investigated. Although the superiority of mTICI-3 reperfusion did not reach statistical significance in some subgroups, presumably due to insufficient power, our findings provide further support for the importance of achieving mTICI-3 reperfusion regardless of the baseline characteristics.…”

2B, 2C, or 3

“…A few studies have previously investigated the relation between various eTICI scores and clinical outcome. [6][7][8][9][10] The results of these studies varied, which may be due to variations in definitions and the fact that some studies had a small sample size. [7][8][9][10] Moreover, some studies used clinical trial data, 6 which may not reflect daily clinical practice.…”