TY - JOUR
T1 - 2B, 2C, or 3 What Should Be the Angiographic Target for Endovascular Treatment in Ischemic Stroke?
AU - LeCouffe, Natalie E.
AU - Kappelhof, Manon
AU - Treurniet, Kilian M.
AU - Lingsma, Hester F.
AU - Zhang, Guang
AU - van den Wijngaard, Ido R.
AU - van Es, Adriaan C. G. M.
AU - Emmer, Bart J.
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
AU - Coutinho, Jonathan M.
AU - van Zwam, Wim
AU - van Oostenbrugge, Robert Jan
AU - MR CLEAN Registry Investigators
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/6
Y1 - 2020/6
N2 - Background and Purpose-A score of >= 2B on the modified Thrombolysis in Cerebral Infarction scale is generally regarded as successful reperfusion after endovascular treatment for ischemic stroke. The extended Thrombolysis in Cerebral Infarction (eTICI) includes a 2C grade, which indicates near-perfect reperfusion. We investigated how well the respective eTICI scores of 2B, 2C, and 3 correlate with clinical outcome after endovascular treatment.Methods-We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, nationwide registry of endovascular treatment in the Netherlands. We included patients with a proximal intracranial occlusion of the anterior circulation for whom final antero-posterior and lateral digital subtraction angiography imaging was available. Our primary outcome was the distribution on the modified Rankin Scale at 90 days per eTICI grade. We performed (ordinal) logistic regression analyses, using eTICI 2B as reference group, and adjusted for potential confounders.Results-In total, 2807/3637 (77%) patients met the inclusion criteria. Of these, 17% achieved reperfusion grade eTICI 0 to 1, 14% eTICI 2A, 25% eTICI 2B, 12% eTICI 2C, and 32% eTICI 3. Groups differed in terms of age (PConclusions-Our results indicate a continuous relationship between reperfusion grade and functional outcome, with eTICI 3 leading to the best outcomes. Although this implies that interventionists should aim for the highest possible reperfusion grade, further research on the optimal strategy is necessary.
AB - Background and Purpose-A score of >= 2B on the modified Thrombolysis in Cerebral Infarction scale is generally regarded as successful reperfusion after endovascular treatment for ischemic stroke. The extended Thrombolysis in Cerebral Infarction (eTICI) includes a 2C grade, which indicates near-perfect reperfusion. We investigated how well the respective eTICI scores of 2B, 2C, and 3 correlate with clinical outcome after endovascular treatment.Methods-We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, nationwide registry of endovascular treatment in the Netherlands. We included patients with a proximal intracranial occlusion of the anterior circulation for whom final antero-posterior and lateral digital subtraction angiography imaging was available. Our primary outcome was the distribution on the modified Rankin Scale at 90 days per eTICI grade. We performed (ordinal) logistic regression analyses, using eTICI 2B as reference group, and adjusted for potential confounders.Results-In total, 2807/3637 (77%) patients met the inclusion criteria. Of these, 17% achieved reperfusion grade eTICI 0 to 1, 14% eTICI 2A, 25% eTICI 2B, 12% eTICI 2C, and 32% eTICI 3. Groups differed in terms of age (PConclusions-Our results indicate a continuous relationship between reperfusion grade and functional outcome, with eTICI 3 leading to the best outcomes. Although this implies that interventionists should aim for the highest possible reperfusion grade, further research on the optimal strategy is necessary.
KW - cerebral infarction
KW - digital subtraction angiography
KW - goals
KW - reperfusion
KW - thrombectomy
KW - THROMBECTOMY
KW - REVASCULARIZATION
KW - REPERFUSION
KW - RECANALIZATION
KW - METAANALYSIS
KW - OUTCOMES
KW - CARE
U2 - 10.1161/STROKEAHA.119.028891
DO - 10.1161/STROKEAHA.119.028891
M3 - Article
C2 - 32397926
SN - 0039-2499
VL - 51
SP - 1790
EP - 1796
JO - Stroke
JF - Stroke
IS - 6
ER -