Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.
Abstract
Background and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.
참고문헌 (28)
- Powers WJ, "Guidelines for the early management of patients with acute ischemic stroke : 2019 update to the 2018 guidelines for the early management of acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2019, pp.50, e344~e418
- Powers WJ, "2018 Guidelines for the early management of patients with acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2018, pp.49, e46~e110
- Turc G, "European Stroke Organisation(ESO)-European Society for Minimally Invasive Neurological Therapy(ESMINT)guidelines on mechanical thrombectomy in acute ischemic stroke", J Neurointerv Surg, 11, pp.535~538 (2019)
- LeCouffe NE, "2B, 2C, or 3 : what should be the angiographic target for endovascular treatment in ischemic stroke?", Stroke, 51, pp.1790~1796 (2020)
- Zaidat OO, "First pass effect : a new measure for stroke thrombectomy devices", Stroke, 49, pp.660~666 (2018)
- Nikoubashman O, "True first-pass effect", Stroke, 50, pp.2140~2146 (2019)
- Flottmann F, "Good clinical outcome decreases with number of retrieval attempts in stroke thrombectomy : beyond the first-pass effect", Stroke, 52, pp.482~490 (2021)
- Flottmann F, "More retrieval attempts are associated with poorer functional outcome after unsuccessful thrombectomy", Clin Neuroradiol, 32, pp.361~368 (2022)
- Alawieh A, "Impact of procedure time on outcomes of thrombectomy for stroke", J Am Coll Cardiol, 73, pp.879~890 (2019)
- Almallouhi E, "Outcomes of mechanical thrombectomy for patients with stroke presenting with low Alberta Stroke Program Early Computed Tomography Score in the early and extended window", JAMA Netw Open, 4, pp.e2137708~ (2021)
- Hungerford JP, "Impact of ASPECT scores and infarct distribution on outcomes among patients undergoing thrombectomy for acute ischemic stroke with the ADAPT technique", J Neurointerv Surg, 9, pp.823~829 (2017)
- von Elm E, "The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)statement : guidelines for reporting observational studies", Lancet, 370, pp.1453~1457 (2007)
- Manning NW, "Endovascular stroke management : key elements of success", Cerebrovasc Dis, 42, pp.170~177 (2016)
- Badhiwala JH, "Endovascular thrombectomy for acute ischemic stroke : a meta-analysis", JAMA, 314, pp.1832~1843 (2015)
- Hacke W, "Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study(ECASS)", JAMA, 274, pp.1017~1025 (1995)
- Haley EC Jr, "Urgent therapy for stroke. Part II. Pilot study of tissue plasminogen activator administered 91-180 minutes from onset", Stroke, 23, pp.641~645 (1992)
- Brott TG, "Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes", Stroke, 23, pp.632~640 (1992)
- Huo X, "Trial of endovascular therapy for acute ischemic stroke with large infarct", N Engl J Med, 388, pp.1272~1283 (2023)
- Yoshimura S, "Endovascular therapy for acute stroke with a large ischemic region", N Engl J Med, 386, pp.1303~1313 (2022)
- Sarraj A, "Trial of endovascular thrombectomy for large ischemic strokes", N Engl J Med, 388, pp.1259~1271 (2023)
- Campbell BCV, "Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy : a meta-analysis of individual patient-level data", Lancet Neurol, 18, pp.46~55 (2019)
- Román LS, "Imaging features and safety and efficacy of endovascular stroke treatment : a meta-analysis of individual patient-level data", Lancet Neurol, 17, pp.895~904 (2018)
- Mourand I, "Favorable revascularization therapy in patients with ASPECTS ≤ 5 on DWI in anterior circulation stroke", J Neurointerv Surg, 10, pp.5~9 (2018)
- Kaesmacher J, "Mechanical thrombectomy in ischemic stroke patients With Alberta Stroke Program Early Computed Tomography Score 0-5", Stroke, 50, pp.880~888 (2019)
- Cagnazzo F, "Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6 : a meta-analysis", J Neurointerv Surg, 12, pp.350~355 (2020)
- Yoo AJ, "Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment : a subgroup analysis of a randomised phase 3 trial(MR CLEAN)", Lancet Neurol, 15, pp.685~694 (2016)
- Liebeskind DS, "eTICI reperfusion : defining success in endovascular stroke therapy", J Neurointerv Surg, 11, pp.433~438 (2019)
- Flottmann F, "Recanalization rate per retrieval attempt in mechanical thrombectomy for acute ischemic stroke", Stroke, 49, pp.2523~2525 (2018)