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Original research
Association of reperfusion success and emboli in new territories with long term mortality after mechanical thrombectomy

Abstract

Background The degree of reperfusion is the most important modifiable predictor of 3 month functional outcome and mortality in ischemic stroke patients treated with mechanical thrombectomy. Whether the beneficial effect of reperfusion also leads to a reduction in long term mortality is unknown.

Methods Patients undergoing mechanical thrombectomy between January 2010 and December 2018 were included. The post-thrombectomy degree of reperfusion and emboli in new territories were core laboratory adjudicated. Reperfusion was evaluated according to the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Vital status was obtained from the Swiss population register. Adjusted hazard ratios (aHRs) using time split Cox regression models were calculated. Subgroup analyses were performed in patients with borderline indications.

Results Our study included 1264 patients (median follow-up per patient 2.5 years). Patients with successful reperfusion had longer survival times, attributable to a lower hazard of death within 0–90 days and for >90 days to 2 years (aHR 0.34, 95% CI 0.26 to 0.46; aHR 0.37, 95% CI 0.22 to 0.62). This association was homogeneous across all predefined subgroups (p for interaction >0.05). Among patients with successful reperfusion, a significant difference in the hazard of death was observed between eTICI2b50 and eTICI3 (aHR 0.51, 95% CI 0.33 to 0.79). Emboli in new territories were present in 5% of patients, and were associated with increased mortality (aHR 2.3, 95% CI 1.11 to 4.86).

Conclusion Successful, and ideally complete, reperfusion without emboli in new territories is associated with a reduction in long term mortality in patients treated with mechanical thrombectomy, and this was evident across several subgroups.

  • stroke
  • thrombectomy

Data availability statement

Data are available upon reasonable request. The data from the present study are not stored in a repository. The database is stored on a secured share point at the local comprehensive stroke center. Data are available as de-identified data. Data regarding the index ischemic stroke are derived from the local clinical database and data regarding the long term mortality are extracted from the Swiss Population Registry, which is actualized quarterly. The data are available for further use upon reasonable request to the principal investigators of this study (Johannes.kaesmacher@insel.ch or Urs.fischer@insel.ch). The original ethics protocol is also available upon reasonable request. Approval by the local ethic committee for further use of the data is required, if applicable.

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