Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial
Language English Country England, Great Britain Media electronic
Document type Journal Article, Randomized Controlled Trial, Multicenter Study
PubMed
37491383
DOI
10.1136/jnis-2023-020553
PII: jnis-2023-020553
Knihovny.cz E-resources
- Keywords
- Angiography, Stroke, Thrombectomy,
- MeSH
- Cerebral Infarction diagnostic imaging therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Reperfusion * methods MeSH
- Aged MeSH
- Thrombectomy methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
BACKGROUND: Incomplete reperfusion (IR) after mechanical thrombectomy (MT) can be a consequence of residual occlusion, no-reflow phenomenon, or collateral counterpressure. Data on the impact of these phenomena on clinical outcome are limited. METHODS: Patients from the ESCAPE-NA1 trial with IR (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b) were compared with those with complete or near-complete reperfusion (eTICI 2c-3) on the final angiography run. Final runs were assessed for (a) an MT-accessible occlusion, or (b) a non-MT-accessible occlusion pattern. The primary clinical outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Our imaging outcome was infarction in IR territory on follow-up imaging. Unadjusted and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (95% CI) were obtained. RESULTS: Of 1105 patients, 443 (40.1%) with IR and 506 (46.1%) with complete or near-complete reperfusion were included. An MT-accessible occlusion was identified in 147/443 patients (33.2%) and a non-MT-accessible occlusion in 296/443 (66.8%). As compared with patients with near-complete/complete reperfusion, patients with IR had significantly lower chances of achieving mRS 0-2 at 90 days (aIRR 0.82, 95% CI 0.74 to 0.91). Rates of mRS 0-2 were lower in the MT-accessible occlusion group as compared with the non-MT-accessible occlusion pattern group (aIRR 0.71, 95% CI 0.60 to 0.83, and aIRR 0.89, 95% CI 0.81 to 0.98, respectively). More patients with MT-accessible occlusion patterns developed infarcts in the non-reperfused territory as compared with patients with non-MT occlusion patterns (68.7% vs 46.3%). CONCLUSION: IR was associated with worse clinical outcomes than near-complete/complete reperfusion. Two-thirds of our patients with IR had non-MT-accessible occlusion patterns which were associated with better clinical and imaging outcomes compared with those with MT-accessible occlusion patterns.
Clinic of Radiology and Nuclear Medicine Universitatsspital Basel Basel Switzerland
Community Health Sciences University of Calgary Cumming School of Medicine Calgary Alberta Canada
Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
Department of Radiology and Nuclear Medicine Amsterdam UMC Location AMC Amsterdam The Netherlands
Department of Radiology University of Calgary Calgary Alberta Canada
Division of Neurology University of Alberta Edmonton Alberta Canada
Division of Neurology University of Ottawa Faculty of Medicine Ottawa Ontario Canada
Hotchkis Brain Institute University of Calgary Cumming School of Medicine Calgary Alberta Canada
Klinik für Neuroradiologie Universitätsklinikum Bonn Bonn Germany
NoNO Inc Toronto Ontario Canada
University of Saskatchewan College of Medicine Saskatoon Saskatchewan Canada
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