Τίτλος:
Comparative Safety and Efficacy of Modified TICI 2b and TICI 3 Reperfusion in Acute Ischemic Strokes Treated with Mechanical Thrombectomy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
BACKGROUND: Mechanical thrombectomy (MT) is the current standard of care for acute ischemic stroke (AIS) patients with emergent large-vessel occlusions (ELVO). Successful reperfusion of ELVOis traditionally defined by modified Thrombolysis in Cerebral Infarction (mTICI) grades of 2b or 3. OBJECTIVE: To evaluate the comparative safety and efficacy ofmTICI 2b andmTICI 3 reperfusion in AIS patients treated with MT. METHODS: Consecutive ELVO patients who underwent MT at 6 high-volume centers were included in this analysis. Standard safety (3-mo mortality, symptomatic intracranial hemorrhage [sICH]) and efficacy (absolute and relative reduction in NIHSS-scores during hospitalization, functional-improvement [shift analysis in mRS-scores], and functional-independence [mRS-scores of 0-2] at 3-mo) were compared between patients who had mTICI 2b and mTICI 3 reperfusion post MT. RESULTS: A total of 416 ELVO patients achieved successful reperfusion with mTICI 2b (n = 216) and mTICI 3 (n = 200) following MT. The mTICI 3 group had significantly (P < .05) greater absolute (11 vs 9 points) and relative (77% vs 63%) reduction in NIHSS-scores during hospitalization, lower sICH (6% vs 12%), and higher 3-mo functional-independence (55% vs 44%) rates. Successful reperfusion with mTICI 3 was independently (P < .05) associated with greater absolute and relative reduction in NIHSS-scores during hospitalization as well as higher odds of 3-mo functional improvement (commonodds ratios: 1.67;95%confidence interval: 1.10-2.56) and functional independence (odds ratio: 2.08; 95% confidence interval: 1.22-3.53) in multivariable regression models adjusting for confounders. CONCLUSION: Successful reperfusion with mTICI 3 was associated with greater neurological improvement during hospitalization and better 3-mo functional outcomes in comparison to mTICI 2b reperfusion. © 2018 by the Congress of Neurological Surgeons.
Συγγραφείς:
Goyal, N.
Tsivgoulis, G.
Frei, D.
Turk, A.
Baxter, B.
Froehler, M.T.
Mocco, J.
Ishfaq, M.F.
Malhotra, K.
Chang, J.J.
Hoit, D.
Elijovich, L.
Loy, D.
Turner, R.D.
Mascitelli, J.
Espaillat, K.
Alexandrov, A.V.
Arthur, A.S.
Περιοδικό:
Clinical Neurology and Neurosurgery
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
tissue plasminogen activator, adult; aged; Article; brain hemorrhage; brain ischemia; clinical effectiveness; controlled study; female; hospitalization; human; major clinical study; male; mechanical thrombectomy; middle aged; modified thrombolysis in cerebral infarction grade; National Institutes of Health Stroke Scale; occlusive cerebrovascular disease; patient safety; priority journal; prospective study; recanalization; reperfusion; scoring system; treatment outcome; brain infarction; brain ischemia; cerebrovascular accident; clinical trial; comparative study; mechanical thrombectomy; multicenter study; odds ratio; procedures; treatment outcome; very elderly, Aged; Aged, 80 and over; Brain Ischemia; Cerebral Infarction; Female; Humans; Male; Mechanical Thrombolysis; Middle Aged; Odds Ratio; Reperfusion; Stroke; Treatment Outcome
DOI:
10.1093/neuros/nyy097
