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  • Redefining ‘success’: a systematic review and meta-analysis comparing outcomes between incomplete and complete revascularization

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Ischemic Stroke
Original research
Redefining ‘success’: a systematic review and meta-analysis comparing outcomes between incomplete and complete revascularization
  1. Asim Rizvi1,
  2. Seyed Mohammad Seyedsaadat1,
  3. Mohammad Hassan Murad2,
  4. Waleed Brinjikji1,3,
  5. Sean T Fitzgerald1,
  6. Ramanathan Kadirvel1,
  7. Alejandro A Rabinstein4,
  8. David F Kallmes1
  1. 1 Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
  4. 4 Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Asim Rizvi, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; drasimrizvi{at}gmail.com; rizvi.asim{at}mayo.edu

Abstract

Background Conventionally, ‘successful’ endovascular thrombectomy (EVT) had been defined as achieving revascularization of thrombolysis in cerebral infarction (TICI)−2B or greater, rather than as ‘complete’ (TICI-3) versus ‘incomplete’ (TICI-2B) revascularization.

Purpose We performed a systematic review and meta-analysis of studies comparing clinical outcomes between patients with TICI-2B and TICI-3 revascularization.

Methods Multiple databases were searched for relevant publications between January 2003 and March 2018. Studies comparing outcomes between the TICI-2B and the TICI-3 group of acute ischemic stroke (AIS) patients treated with EVT were included. Random effects meta-analysis was performed to evaluate outcomes among TICI-2B and TICI-3 groups. The following outcomes were assessed: good neurologic outcome (modified Rankin Scale (mRS)≤2 at day 90), mortality, and intracerebral hemorrhage (ICH).

Results Twenty-one studies comprising 2747 patients were identified. Patients with TICI-2B revascularization had mRS≤2 at day 90 rates of 46% (391/847) compared with 66% (522/791) for TICI-3 patients (OR 0.46, 95% CI 0.37 to 0.57). Mortality rates were significantly higher in the TICI-2B group (78/570, 14%) than in the TICI-3 group (55/709, 8%) (OR 2.00, 95% CI 1.38 to 2.91). The ICH rates were also significantly higher in the TICI-2B group as compared with the TICI-3 group (31% [134/439] vs. 22% [108/490]; OR 2.20, 95% CI 1.47 to 3.30).

Conclusions Differences in all major outcome measures were markedly better in patients with complete versus incomplete but still ‘successful’ revascularization using prior thresholds, with ORs in the order of those seen in recent definitive trials comparing EVT to an intravenous tissue plasminogen activator.

  • stroke
  • thrombectomy
  • thrombolysis

https://doi.org/10.1136/neurintsurg-2018-013950

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    Footnotes

    • Contributors AR, MHM, WB, AAR, and DFK have made substantial contributions to the: conception or design of the work or the acquisition, analysis, or interpretation of data for the work; and drafting of the work or revising it critically for important intellectual content. AR and SMS made substantial contributions to data collection. All authors have provided final approval of the version to be published. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data can be made available by contacting the corresponding author via email.