Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial.

Autor: Hassan AE; Valley Baptist Medical Center, Harlingen, TX., Abraham MG; University of Kansas Medical Center, Kansas City, KS., Blackburn S; McGovern Medical School at UTHealth, Houston, TX., Hussain MS; Cleveland Clinic, Cleveland, OH., Ortega-Gutierrez S; University of Iowa Hospitals and Clinics, Iowa City, IA., Chen M; Rush University Medical Center., Hu YC; University Hospital Cleveland Medical Center - Case Western Reserve University., Pujara DK; University Hospital Cleveland Medical Center - Case Western Reserve University., Herial NA; Thomas Jefferson University Hospital., Tsai JP; Spectrum Health., Budzik RF; OhioHealth - Riverside Methodist Hospital., Manning NW; Liverpool Hospital, Liverpool, Australia., Kozak O; Abington Jefferson Health, Abington, PA., Hanel RA; Baptist Medical Center Jacksonville., Aghaebrahim AN; Baptist Medical Center Jacksonville., Gandhi CD; Westchester Medical Center - NY Medical College., Al-Mufti F; Westchester Medical Center - NY Medical College., Cheung A; Liverpool Hospital, Liverpool, Australia., Yan B; The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Australia., Mitchell P; The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Australia., Blasco J; Hospital Clínic de Barcelona, Spain., Manzanera LSR; Hospital Clínic de Barcelona, Spain., Vora N; OhioHealth - Riverside Methodist Hospital., Gibson D; Ascension Columbia St. Mary's Hospital., Wallace A; BayCare Clinic., Sahlein D; Goodman Campbell Brain and Spine., Elijovich L; Semmes Murphey Clinic., Arenillas JF; Hospital Clínico Universitario Valladolid - University of Valladolid., Wu TY; Christchurch Hospital, New Zealand., Portela PC; Hospital Universitari de Bellvitge, Spain., de la Ossa NP; Hospital Universitari Germans Trias i Pujol, Spain., Schaafsma JD; Toronto Western Hospital, Canada., Hicks WJ; OhioHealth - Riverside Methodist Hospital., Cordato DJ; Liverpool Hospital, Liverpool, Australia., Sangha N; Kaiser Permanente Southern California., Warach S; Dell Medical School at The University of Texas at Austin - Ascension Texas., Kleinig TJ; Royal Adelaide Hospital, Australia., Shaker F; McGovern Medical School at UTHealth, Houston, TX., Johns H; The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Australia., Tekle W; Valley Baptist Medical Center, Harlingen, TX., Dannenbaum MJ; McGovern Medical School at UTHealth, Houston, TX., Ebersole K; University of Kansas Medical Center, Kansas City, KS., Toth G; Cleveland Clinic, Cleveland, OH., Gooch M; Thomas Jefferson University Hospital., Alhajeri A; OhioHealth - Riverside Methodist Hospital., Amuluru K; Goodman Campbell Brain and Spine., Ray A; University Hospital Cleveland Medical Center - Case Western Reserve University., Burkhardt JK; University of Pennsylvania., Abdulrazzak MA; Cleveland Clinic, Cleveland, OH., Rosenbaum-Halevi DP; Munson Healthcare, Traverse City, MI., Kamal H; Memorial Healtcare System., Duncan KR; University Hospital Cleveland Medical Center - Case Western Reserve University., Sitton CW; McGovern Medical School at UTHealth, Houston, TX., Churilov L; The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Australia., Pereira VM; St. Michael's Hospital, Canada., Sunshine J; University Hospital Cleveland Medical Center - Case Western Reserve University., Nguyen TN; Boston Medical Center., Fifi JT; Icahn School of Medicine at Mount Sinai., Samaniego EA; University of Iowa Hospitals and Clinics, Iowa City, IA., Arthur A; Semmes Murphey Clinic., Tjoumakaris S; Thomas Jefferson University Hospital., Jabbour P; Thomas Jefferson University Hospital., Davis SM; The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Australia., Wechsler L; Hospitals of University of Pennsylvania., Bambakidis N; University Hospital Cleveland Medical Center - Case Western Reserve University., Kasner SE; University of Pennsylvania., Grotta JC; Memorial Hermann Hospital., Hill MD; University of Calgary., Campbell BC; The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Australia.; The Florey Institute for Neuroscience and Mental Health., Ribo M; Hospital Vall d'Hebrón, Spain., Sarraj A; University Hospital Cleveland Medical Center - Case Western Reserve University.
Jazyk: angličtina
Zdroj: Annals of neurology [Ann Neurol] 2024 Nov 07. Date of Electronic Publication: 2024 Nov 07.
DOI: 10.1002/ana.27104
Abstrakt: Endovascular thrombectomy (EVT) was shown to be safe and efficacious in patients with large core stroke in multiple randomized controlled trials. However, the impact of reperfusion and other procedural metrics on EVT outcomes in this population has not been well-characterized.
Methods: From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml).
Results: Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01-2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33-2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96-2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87-0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50-1.10) as compared with stent-retriever first.
Interpretation: Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2024.
(© 2024 American Neurological Association.)
Databáze: MEDLINE
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