Complete Recanalization May Exert The Most Important Effect on Outcomes of Endovascular Treatment in Acute Ischemic Stroke With Small Infarct Core Beyond 6 Hours.
World Neurosurg. 2019 Feb 01;:
Authors: Yang D, Geng Y, Zhang M, Lin M, Shi Z, Zi W, Hao Y, Wang H, Liu W, Wang W, Xu G, Xiong Y, Liu X, ACTUAL Investigators
Abstract
OBJECTIVE: To explore the differences among grades of recanalization on outcomes of endovascular treatment for acute anterior large vessel occlusion with small infarct core beyond 6 hours time window.
METHODS: Patients beyond 6 hours time window with ASPECTS>7 were retrospectively enrolled from the endovascular treatment for acute anterior circulation ischemic stroke (ACTUAL) registry. They were divided into three groups according to the degree of recanalization: modified treatment in cerebral infarction (mTICI) 0-2a, 2b, and 3. We compared the differences of outcomes among groups on modified Rankin Scale (mRS) score at 90 days, symptomatic intracerebral hemorrhage (sICH) within 72 hours, and mortality.
RESULTS: One hundred and one patients were enrolled. Median of time from onset to groin puncture was 415 minutes (interquartile range [IQR]: 387-497 minutes). Favorable functional outcomes were significantly better in patients with successful recanalization than patients with failed recanalization (mTICI 0-2a, 22.7% [5/22], mTICI 2b, 48.0% [12/25], and mTICI 3, 61.1% [33/54], trend P=0.01). Complete recanalization (mTICI 3) (odds ratio [OR]: 5.34; 95% confidence interval [CI]: 1.71-16.66; P=0.004) was associated with good functional outcome. Mortality was different among groups at 90 days (mTICI 0-2a, 36.4% [8/22], mTICI 2b, 0, [0/25], P=0.001; mTICI 0-2a, 36.4% [8/22], mTICI 3, 9.3% [5/54], P=0.008; and mTICI 2b, 0, [0/25], mTICI 3, 9.3% [5/54], P=0.173). There was no significant differences of sICH among groups (mTICI 0-2a, 22.7% [5/22], mTICI 2b, 12.0% [3/25], and mTICI 3, 9.3% [5/54], P=0.28).
CONCLUSIONS: For acute anterior circulation stroke patients, who were beyond 6h time window yet with small ischemic core, complete recanalization following endovascular treatment may play the most important role on clinical outcome.
PMID: 30716496 [PubMed - as supplied by publisher]
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,