Fabian Flottmann1, Gabriel Broocks2, Tobias Djamsched Faizy2, Rosalie McDonough2, Lucas Watermann2, Milani Deb-Chatterji3, Götz Thomalla3, Moriz Herzberg4, Christian H Nolte5,6, Jens Fiehler2, Hannes Leischner2, Caspar Brekenfeld2. 1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Haus Ost 22 (O 22), Martinistr. 52, 20246, Hamburg, Germany. f.flottmann@uke.de. 2. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Haus Ost 22 (O 22), Martinistr. 52, 20246, Hamburg, Germany. 3. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany. 5. Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany. 6. Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Abstract
AIM: In acute large vessel occlusions, endovascular therapy (EVT) achieves flow restoration in the majority of cases; however, EVT fails to achieve sufficient reperfusion in a substantial minority of patients. This study aimed to identify predictors of failed reperfusion. METHODS: In this study 2211 patients from the German Stroke Registry who received EVT for anterior circulation stroke were retrospectively analyzed. Failure of reperfusion was defined as thrombolysis in cerebral infarction (TICI) grades 0/1/2a, and sufficient reperfusion as TICI 2b/3. In 1629 patients with complete datasets, associations between failure of reperfusion and baseline clinical data, comorbidities, location of occlusion, and procedural data were assessed with multiple logistic regression. RESULTS: Failure of reperfusion occurred in 371 patients (16.8%) and was associated with the following locations of occlusion: cervical internal carotid artery (ICA, adjusted odds ratio, OR 2.01, 95% confidence interval, CI 1.08-3.69), intracranial ICA without carotid T occlusion (adjusted OR 1.79, 95% CI 1.05-2.98), and M2 segment (adjusted OR 1.86, 95% CI 1.21-2.84). Failed reperfusion was also associated with cervical ICA stenosis (>70% stenosis, adjusted OR 2.90, 95% CI 1.69-4.97), stroke of other determined etiology by TOAST (Trial of ORG 10172 in acute stroke treatment) criteria (e.g. nonatherosclerotic vasculopathies, adjusted OR 2.73, 95% CI 1.36-5.39), and treatment given outside the usual working hours (adjusted OR 1.41, 95% CI 1.07-1.86). Successful reperfusion was associated with higher Alberta stroke program early CT score (ASPECTS) on initial imaging (adjusted OR 0.85, 95% CI 0.79-0.92), treatment with the patient under general anesthesia (adjusted OR 0.72, 95% CI 0.54-0.96), and concomitant ICA stenting in patients with ICA stenosis (adjusted OR 0.20, 95% CI 0.11-0.38). CONCLUSION: Several factors are associated with failure of reperfusion, most notably occlusions of the proximal ICA and low ASPECTS on admission. Conversely, stent placement in the proximal ICA was associated with reperfusion success.
AIM: In acute large vessel occlusions, endovascular therapy (EVT) achieves flow restoration in the majority of cases; however, EVT fails to achieve sufficient reperfusion in a substantial minority of patients. This study aimed to identify predictors of failed reperfusion. METHODS: In this study 2211 patients from the German Stroke Registry who received EVT for anterior circulation stroke were retrospectively analyzed. Failure of reperfusion was defined as thrombolysis in cerebral infarction (TICI) grades 0/1/2a, and sufficient reperfusion as TICI 2b/3. In 1629 patients with complete datasets, associations between failure of reperfusion and baseline clinical data, comorbidities, location of occlusion, and procedural data were assessed with multiple logistic regression. RESULTS:Failure of reperfusion occurred in 371 patients (16.8%) and was associated with the following locations of occlusion: cervical internal carotid artery (ICA, adjusted odds ratio, OR 2.01, 95% confidence interval, CI 1.08-3.69), intracranial ICA without carotid T occlusion (adjusted OR 1.79, 95% CI 1.05-2.98), and M2 segment (adjusted OR 1.86, 95% CI 1.21-2.84). Failed reperfusion was also associated with cervical ICA stenosis (>70% stenosis, adjusted OR 2.90, 95% CI 1.69-4.97), stroke of other determined etiology by TOAST (Trial of ORG 10172 in acute stroke treatment) criteria (e.g. nonatherosclerotic vasculopathies, adjusted OR 2.73, 95% CI 1.36-5.39), and treatment given outside the usual working hours (adjusted OR 1.41, 95% CI 1.07-1.86). Successful reperfusion was associated with higher Alberta stroke program early CT score (ASPECTS) on initial imaging (adjusted OR 0.85, 95% CI 0.79-0.92), treatment with the patient under general anesthesia (adjusted OR 0.72, 95% CI 0.54-0.96), and concomitant ICA stenting in patients with ICA stenosis (adjusted OR 0.20, 95% CI 0.11-0.38). CONCLUSION: Several factors are associated with failure of reperfusion, most notably occlusions of the proximal ICA and low ASPECTS on admission. Conversely, stent placement in the proximal ICA was associated with reperfusion success.
Authors: Robert W Regenhardt; Ashby C Turner; Joshua A Hirsch; Michael J Young; Naif M Alotaibi; Christopher J Stapleton; Aman B Patel; Thabele M Leslie-Mazwi; Natalia S Rost; Mark R Etherton Journal: J Neurol Date: 2021-05-29 Impact factor: 4.849
Authors: Ludwig Schlemm; Regina von Rennenberg; Eberhard Siebert; Georg Bohner; Fabian Flottmann; Gabor C Petzold; Götz Thomalla; Matthias Endres; Christian H Nolte Journal: Neurol Res Pract Date: 2021-05-03
Authors: F Flottmann; N van Horn; M E Maros; H Leischner; M Bechstein; L Meyer; M Sauer; M Deb-Chatterji; A Alegiani; G Thomalla; J Fiehler; C Brekenfeld Journal: Clin Neuroradiol Date: 2021-07-08 Impact factor: 3.156
Authors: F Flottmann; N van Horn; M E Maros; R McDonough; M Deb-Chatterji; A Alegiani; G Thomalla; U Hanning; J Fiehler; C Brekenfeld Journal: Clin Neuroradiol Date: 2021-06-30 Impact factor: 3.156