Background The benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3.
Methods This is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage.
Results The unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041).
Conclusions Complete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.
Statistics from Altmetric.com
Twitter @ChalhoubReda, @PascalJabbourMD, @AdamArthurMD, @brainvesseldoc, @DrMichaelLevitt, @WaldoGuerrero82, @Starke_neurosurgery
Collaborators on behalf of the STAR collaborators Dileep R Yavagal, Eric C Peterson, Daniel Raper, Patrick A Brown, M Reid Gooch, Nabeel Herial, Ajith Thomas, Justin Moore, Felipe Albuquerque, Louis J Kim, Melanie Walker, Michael Chen, Stephan Munich, Daniel Alan Hoit, Violiza Inoa-Acosta, Christopher Nickele Lucas, Elijovich Fernanda, Rodriguez-Erazú, Jan Liman, Michael Cawley, Gustavo Pradilla, Brian Howard, Brian Walcott, Zeguang Ren, Ryan Hebert, João Reis, Jaime Pamplona, Rui Carvalho, Mariana Baptista, Ana Nunes, Russell Cerejo, Ashis Tayal, Parita Bhuva, Paul Hansen, Norman Ajiboye, Alex Brehm, Sami Al Kasab, Jonathan Lena, Kimberly Kicielinski.
Contributors Design and conception: C-JC, MSP. Data collection: All authors. Statistical analysis: RC, C-JC. Interpretation of results: All authors. Drafting of manuscript: All authors. Revision of manuscript: All Authors. Approval of final manuscript: All authors. Study supervision: MSP, AMS.
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 MRL: Grants from the NIH (R01NS105692, R01NS088072, U24NS100654, UL1TR002319, R25NS079200) and the American Heart Association (18CDA34110295). Unrestricted educational grants from Medtronic, Stryker and Philips Volcano. Consultant for Medtronic. Minor equity/ownership interest in Proprio, Cerebrotech, Synchron. Adviser to Metis Innovative. JAG: Grants from the Georgia Research Alliance. Consultant for Cognition Medical. AJY: Grants from Medtronic, Cerenovus, Penumbra, and Stryker. Consultant for Penumbra and Cerenovus. Equity interest in Insera Therapeutics. RWC: Proctor for Medtronic and Cerenovus. AMS: Research support from Penumbra, Stryker, Medtronic, and Siemens. Consultant for Penumbra, Stryker, Terumo, and Arsenal. MM: Consultant for Medtronic and Cerenovus. Stock ownership in Serenity Medical, Synchron, and Endostream. RMS: Grants from the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, the NIH (R01NS111119-01A1, UL1TR002736, KL2TR002737), the National Center for Advancing Translational Sciences, the National Institute on Minority Health and Health Disparities, and Medtronic. Consultant for Penumbra, Abbott, Medtronic, InNeuroCo and Cerenovus. Others: None.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the principal investigator upon reasonable request.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.