Publication details

Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial

Authors

CIMFLOVÁ Petra SINGH Nishita KAPPELHOF Manon OSPEL Johanna M SEHGAL Arshia KASHANI Nima ALMEKHLAFI Mohammed A DEMCHUK Andrew M BERROUSCHOT Joerg DORN Franziska KELLY Michael E BUCK Brian H FIELD Thalia S DOWLATSHAHI Dariush TYMIANSKI Michael HILL Michael D GOYAL Mayank

Year of publication 2024
Type Article in Periodical
Magazine / Source Journal of NeuroInterventional Surgery
MU Faculty or unit

Faculty of Medicine

Citation
Web https://jnis.bmj.com/content/early/2023/07/25/jnis-2023-020553
Doi http://dx.doi.org/10.1136/jnis-2023-020553
Keywords Thrombectomy; Stroke; Angiography
Description BackgroundIncomplete 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. MethodsPatients 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. ResultsOf 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%). ConclusionIR 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.

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