Effects of reperfusion grade and reperfusion strategy on the clinical outcome: Insights from ESCAPE-NA1 trial.

Autor:	Cimflova P; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Department of Radiology, University of Calgary, Calgary, Alberta, Canada.; Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.; Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland., Ospel JM; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Department of Radiology, University of Calgary, Calgary, Alberta, Canada., Singh N; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Department of Internal Medicine-Neurology Division, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada., Marko M; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Department of Neurology, Medical University of Vienna, Vienna, Austria., Kashani N; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Department of Radiology, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada., Mayank A; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada., Demchuk A; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Menon B; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Poppe AY; Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada., Nogueira R; UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., McTaggart R; Warren Alpert School of Medicine, Brown University, Providence, RI, USA., Rempel JL; University of Alberta Hospital, Edmonton, Alberta, Canada., Tymianski M; NoNO, Toronto, Ontario, Canada., Hill MD; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Almekhlafi MA; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Goyal M; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Jazyk:	angličtina
Zdroj:	Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2024 Oct 14, pp. 15910199241288874. Date of Electronic Publication: 2024 Oct 14.
DOI:	10.1177/15910199241288874
Abstrakt:	Background: We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial. Methods: Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0-2], excellent outcome (90-day mRS0-1), isolated subarachnoid hemorrhage, symptomatic hemorrhage (sICH) on follow-up imaging, and death were compared across different levels of reperfusion defined by expanded Treatment in Cerebral Infarction (eTICI) Scale. Comparisons were also made between patients with (a) first-pass eTICI 2c3 reperfusion vs multiple-pass eTICI 2c3; (b) final eTICI 2b reperfusion vs eTICI 2b converted-to-eTICI 2c3; (c) sudden reperfusion vs gradual reperfusion if >1 pass was required. Multivariable logistic regression was used to test associations of reperfusion grade and clinical outcomes. Results: Of 1037 included patients, final eTICI 0-1 was achieved in 46 (4.4%), eTICI 2a in 76 (7.3%), eTICI 2b in 424 (40.9%), eTICI 2c in 284 (27.4%), and eTICI 3 in 207 (20%) patients. The odds for good and excellent clinical outcome gradually increased with improved reperfusion grades (adjOR ranging from 5.7-29.3 and 4.3-17.6) and decreased for sICH and death. No differences in outcomes between first-pass versus multiple-pass eTICI 2c3, eTICI 2b converted-to-eTICI 2c3 versus unchanged eTICI 2b and between sudden versus gradual eTICI 2c3 reperfusion were observed. Conclusion: Better reperfusion degrees significantly improved clinical outcomes and reduced mortality, independent of the number of passes and whether eTICI 2c3 was achieved suddenly or gradually. Competing Interests: Declaration of conflicting interestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Financial interests: PC reports honoraria from ESMINT, outside the submitted work. JO reports consultancy fee from NicoLab. ADM received grants from NoNO; honoraria from Medtronic; patent Circle NVI. MT is CEO of NoNO; patents owned by NoNO. BKM has stock options in Circle NVI and has consulted for Biogen and Boehringer Ingelheim. AYP has received a project research grant from Stryker and honoraria from BMS-Pfizer. MDH has received consulting fees from Sun Pharma and Brainsgate and has stock options in Circle NVI. MG reports consultancy for Medtronic, Stryker, Microvention, GE Healthcare, Mentice, outside the submitted work. All other authors have nothing to disclose. Nonfinancial interests: ADM is a member of the editorial board at International Journal of Stroke (Editor). AYP is PI of EASI-TOC study. BKM is a member of the editorial board at Stroke (Assistant Editor). MDH is Director, Board of Circle Neurovascular, Director, Board of the Canadian Neuroscience Federation, and Director, Board of the Canadian Stroke Consortium. MG is a member of the editorial board at Stroke (Consulting Editor).
Databáze:	MEDLINE
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