Introduction One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)).
Objective To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT.
Methods Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated.
Results A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11–20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005).
Conclusions IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.
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Contributors NG: study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. GT, AHK: analysis and interpretation, critical revision of the manuscript for important intellectual content. JJC, KM, DH, CN, VI-A, LE, AA: critical revision of the manuscript for important intellectual content. JG, AP, RK, MFI: acquisition of data, critical revision of the manuscript for important intellectual content. ASA: study supervision, critical revision of the manuscript for important intellectual content.
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.
Ethics approval The study was approved by the university of Tennessee institutional review board (15-04168-XP). Considering the retrospective nature, the board waived the need for the patient’s consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.