Andreia Carvalho1, Telma Santos1, André Cunha2, Tiago Gregório3, Ludovina Paredes3, Henrique Costa4, Sérgio Castro2, Manuel Ribeiro2, Miguel Veloso4, Pedro Barros5. 1. Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal. 2. Imagiology Department, Neuroradiology Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal. 3. Stroke Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal; Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal. 4. Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal; Stroke Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal. 5. Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal; Stroke Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: pedrojgbarros@gmail.com.
Abstract
INTRODUCTION: Modified TICI (mTICI) score≥2b has been largely used as a definition of successful revascularization in acute stroke endovascular treatment (EVT). However, mTICI 2b encompasses a broad range of different revascularization states and its clinical relevance, comparing to mTICI 3, has been questioned. We aimed to compare clinical outcomes between these two reperfusion groups, in patients submitted to EVT for anterior circulation large-vessel occlusion, in a real-world setting. MATERIALS AND METHODS: Retrospective statistical analysis of our database of consecutive EVTs. RESULTS: Our study population of 178 patients has a mean age of 71years, 46.6% males, median baseline NIHSS of 17 and ASPECTS of 8. There were no statistically significant differences in baseline characteristics and interventional procedure data between groups. A significantly higher rate of mRS≤1 at 3months (OR=2.33, 95%CI 1.03-5.25) and lower rate of total (OR=0.18, 95%CI 0.06-0.53) and symptomatic intracranial hemorrhage (OR=0.08, 95%CI 0.01-0.74) was seen in mTICI 3 group. This group also showed non-significant trend (adjusted p=0.071) toward higher percentages of mRS≤2 (71.8% versus 51.5%) and lower mortality at 3months (6.4% versus 19.1%). CONCLUSIONS: In accordance with previous reports from clinical trials, these real-world data suggest that is probably time to refine the definition of successful revascularization in acute stroke EVT.
INTRODUCTION: Modified TICI (mTICI) score≥2b has been largely used as a definition of successful revascularization in acute stroke endovascular treatment (EVT). However, mTICI 2b encompasses a broad range of different revascularization states and its clinical relevance, comparing to mTICI 3, has been questioned. We aimed to compare clinical outcomes between these two reperfusion groups, in patients submitted to EVT for anterior circulation large-vessel occlusion, in a real-world setting. MATERIALS AND METHODS: Retrospective statistical analysis of our database of consecutive EVTs. RESULTS: Our study population of 178 patients has a mean age of 71years, 46.6% males, median baseline NIHSS of 17 and ASPECTS of 8. There were no statistically significant differences in baseline characteristics and interventional procedure data between groups. A significantly higher rate of mRS≤1 at 3months (OR=2.33, 95%CI 1.03-5.25) and lower rate of total (OR=0.18, 95%CI 0.06-0.53) and symptomatic intracranial hemorrhage (OR=0.08, 95%CI 0.01-0.74) was seen in mTICI 3 group. This group also showed non-significant trend (adjusted p=0.071) toward higher percentages of mRS≤2 (71.8% versus 51.5%) and lower mortality at 3months (6.4% versus 19.1%). CONCLUSIONS: In accordance with previous reports from clinical trials, these real-world data suggest that is probably time to refine the definition of successful revascularization in acute stroke EVT.
Authors: Gautam Adusumilli; John M Pederson; Nicole Hardy; Kevin M Kallmes; Kristen Hutchison; Hassan Kobeissi; Daniel M Heiferman; Jeremy J Heit Journal: Front Neurol Date: 2021-12-17 Impact factor: 4.003