BACKGROUND: We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial. METHODS: Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0-2], excellent outcome (90-day mRS0-1), isolated subarachnoid hemorrhage, symptomatic hemorrhage (sICH) on follow-up imaging, and death were compared across different levels of reperfusion defined by expanded Treatment in Cerebral Infarction (eTICI) Scale. Comparisons were also made between patients with (a) first-pass eTICI 2c3 reperfusion vs multiple-pass eTICI 2c3; (b) final eTICI 2b reperfusion vs eTICI 2b converted-to-eTICI 2c3; (c) sudden reperfusion vs gradual reperfusion if >1 pass was required. Multivariable logistic regression was used to test associations of reperfusion grade and clinical outcomes. RESULTS: Of 1037 included patients, final eTICI 0-1 was achieved in 46 (4.4%), eTICI 2a in 76 (7.3%), eTICI 2b in 424 (40.9%), eTICI 2c in 284 (27.4%), and eTICI 3 in 207 (20%) patients. The odds for good and excellent clinical outcome gradually increased with improved reperfusion grades (adjOR ranging from 5.7-29.3 and 4.3-17.6) and decreased for sICH and death. No differences in outcomes between first-pass versus multiple-pass eTICI 2c3, eTICI 2b converted-to-eTICI 2c3 versus unchanged eTICI 2b and between sudden versus gradual eTICI 2c3 reperfusion were observed. CONCLUSION: Better reperfusion degrees significantly improved clinical outcomes and reduced mortality, independent of the number of passes and whether eTICI 2c3 was achieved suddenly or gradually.

Centre Hospitalier de l'Université de Montréal Montreal Quebec Canada

Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada

Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada

Department of Diagnostic and Interventional Neuroradiology Inselspital University Hospital Bern Bern Switzerland

Department of Internal Medicine Neurology Division Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada

Department of Medical Imaging St Anne's University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Neurology Medical University of Vienna Vienna Austria

Department of Radiology Rady Faculty of Medicine University of Manitoba Winnipeg Manitoba Canada

Department of Radiology University of Calgary Calgary Alberta Canada

Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada

NoNO Toronto Ontario Canada

University of Alberta Hospital Edmonton Alberta Canada

UPMC Stroke Institute Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine Pittsburgh PA USA

Warren Alpert School of Medicine Brown University Providence RI USA

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