Sistema de Salut de Catalunya
Institut Català de la Salut
[Yoo AJ, Soomro J] Department of Neurointervention, Texas Stroke Institute, Fort Worth, TX, United States. [Andersson T] Neuroradiology, Karolinska University Hospital, Clinical Neuroscience Karolinska Institutet, Stockholm, Sweden. Medical Imaging, Allgemeine Ziekenhuis Groeninge, Kortrijk, Belgium. [Saver JL] Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States. [Ribo M] Unitat d’Ictus, Servei de Neurologia, Vall d'Hebron Hospital Universitari, Barcelona, Spain. [Bozorgchami H] Department of Neurology, Oregon Health and Science University Hospital, Portland, OR, United States
Vall d'Hebron Barcelona Hospital Campus
2021-12-16T13:20:21Z
2021-12-16T13:20:21Z
2021-05-11
Isquèmia cerebral; Trombectomia mecànica; Reperfusió
Isquemia cerebral; Trombectomía mecánica; Reperfusión
Brain ischaemia; Mechanical thrombectomy; Reperfusion
Background and Purpose: End-of-procedure substantial reperfusion [modified Treatment in Cerebral Ischemia (mTICI) 2b-3], the leading endpoint for thrombectomy studies, has several limitations including a ceiling effect, with recent achieved rates of ~90%. We aimed to identify a more optimal definition of angiographic success along two dimensions: (1) the extent of tissue reperfusion, and (2) the speed of revascularization. Methods: Core-lab adjudicated TICI scores for the first three passes of EmboTrap and the final all-procedures result were analyzed in the ARISE II multicenter study. The clinical impact of extent of reperfusion and speed of reperfusion (first-pass vs. later-pass) were evaluated. Clinical outcomes included 90-day functional independence [modified Rankin Scale (mRS) 0–2], 90-day freedom-from-disability (mRS 0–1), and dramatic early improvement [24-h National Institutes of Health Stroke Scale (NIHSS) improvement ≥ 8 points]. Results: Among 161 ARISE II subjects with ICA or MCA M1 occlusions, reperfusion results at procedure end showed substantial reperfusion in 149 (92.5%), excellent reperfusion in 121 (75.2%), and complete reperfusion in 79 (49.1%). Reperfusion rates on first pass were substantial in 81 (50.3%), excellent reperfusion in 62 (38.5%), and complete reperfusion in 44 (27.3%). First-pass excellent reperfusion (first-pass TICI 2c-3) had the greatest nominal predictive value for 90-day mRS 0–2 (sensitivity 58.5%, specificity 68.6%). There was a progressive worsening of outcomes with each additional pass required to achieve TICI 2c-3. Conclusions: First-pass excellent reperfusion (TICI 2c-3), reflecting rapid achievement of extensive reperfusion, is the technical revascularization endpoint that best predicted functional independence in this international multicenter trial and is an attractive candidate for a lead angiographic endpoint for future trials.
Cerenovus sponsored the ARISE II study, and provided support for open access to this article.
Article
Published version
English
Isquèmia cerebral - Tractament; Reperfusió (Fisiologia); DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia; Other subheadings::Other subheadings::/therapy; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Perfusion::Reperfusion; Other subheadings::Other subheadings::/methods; ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::isquemia cerebral; Otros calificadores::Otros calificadores::/terapia; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::perfusión::reperfusión; Otros calificadores::Otros calificadores::/métodos
Frontiers Media
Frontiers in Neurology;12
https://doi.org/10.3389/fneur.2021.669934
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
Articles científics - HVH [3439]
