Clinical impact of EVT with failed reperfusion in patients with acute ischemic stroke: results from the ESCAPE and ESCAPE-NA1 trials

Ospel, Johanna M.; Hill, Michael D; Demchuk, Andrew M.; Menon, Bijoy K; Thornton, John; Rempel, Jeremy; Almekhlafi, Mohammed; Ganesh, Aravind; Kappelhof, Manon; Singh, Nishita; Cimflová, Petra; Kashani, Nima; Bala, Fouzi; Kim, Beom Joon; McTaggart, Ryan; Poppe, Alexandre Y; Nogueira, Raul G; Tymianski, Michael; Goyal, Mayank

doi:10.1007/s00234-021-02723-w

Cited by 9 publications

(10 citation statements)

References 11 publications

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“…The literature available about outcomes in this population experiencing unsuccessful revascularization is scarce [4–8]. In these patients with failed MT, the endovascular procedure itself might be the source of impaired outcome.…”

Section: Introductionmentioning

confidence: 99%

Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome

Marnat¹,

Gory

Sibon³

et al. 2022

Euro J of Neurology

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Background and purpose Despite continuous improvement and growing knowledge in the endovascular therapy of large vessel occlusion stroke (LVOS), mechanical thrombectomy (MT) still fails to obtain satisfying intracranial recanalization in 10% to 15% of cases. However, little is known regarding clinical and radiological outcomes among this singularly underexplored subpopulation undergoing failed MT. We aimed to investigate the outcome after failed MT and identify predictive factors of favorable outcome despite recanalization failure. Methods We conducted a retrospective analysis of consecutive patients prospectively included in the ongoing observational multicenter Endovascular Treatment in Ischemic Stroke registry from January 2015 to September 2020. Patients presenting with anterior circulation LVOS treated with MT but experiencing failed intracranial recanalization defined as final modified Thrombolysis In Cerebral Infarction (mTICI) score of 0, 1 and 2a were included. Clinical and radiological outcomes were assessed along with the exploration of predictive factors of Day‐90 favorable outcome. Results The study population comprised 533 patients. Mean age was 68.8 ± 16 years, and median admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were 17 (IQR 12–21) and 7 (IQR 5–8), respectively. Favorable outcomes were observed in 85 patients (18.2%) and 186 died (39.0%). The rate of symptomatic intracranial hemorrhage was 14.1%. In multivariable analysis, younger age (odds ratio [OR] 0.96, 95% CI 0.94–0.98, p < 0.001), a lower admission NIHSS (OR 0.87, 95% CI 0.83–0.91, p < 0.001), a lower number of MT passes (OR 0.77, 95% CI 0.77–0.87, p < 0.001), a lower delta ASPECTS between initial and Day‐1 imaging (OR 0.83, 95% CI 0.71–0.98, p = 0.026) and stroke etiology [significant difference among etiological subtypes (p = 0.024) with a tendency toward more favorable outcomes for dissection (OR 2.01, 95% CI 0.71–5.67)] were significantly associated with a 90‐day favorable outcome. Conclusions In this large retrospective analysis of a multicenter registry, we quantified the poor outcome after MT failure. We also identified factors associated with favorable outcome despite recanalization failure that might influence therapeutic management.

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Section: Introductionmentioning

confidence: 99%

Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome

Marnat¹,

Gory

Sibon³

et al. 2022

Euro J of Neurology

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“…The mortality of AIS patients which suffered an EVT was around 10% 16/154 compared to the AIS which only received medical treatment12.8% 19/148 p<0.05 Thrombectomy eligibility was previously estimated to be 6%-7% of AIS patients at a comprehensive hospital [6].With the increasing number of AIS patients receiving EVT, the bene ts of receiving EVT for patients are also increasing. Previous study showed clinical outcomes of EVT patients with failed reperfusion did not differ signi cantly from patients treated with best medical management,further, not all patients with large vessel cerebral infarction can bene t from endovascular treatment [7]. In this study, we retrospectively analyzed the data of patients who had undergone EVT which is now indicated in patients up to 24 h from their last known normal, provided that the patient meets speci c clinical and imaging criteria (Acute ischemic stroke endovascular therapy and meets the criteria of relative no differences in baseline) in our center to analyze the factors associated with a good or a poor prognosis.This study aims to nd the main factors that in uence the poor prognosis of AIS patients after EVT by analyzing the clinical data of AIS patients.…”

Section: Introductionmentioning

confidence: 92%

Clinical predictors of stroke prognosis after endovascular therapy

Wang¹,

Yuan²,

Kang³

et al. 2023

Preprint

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Background and Aims Endovascular therapy (EVT) has been shown to be effective in the treatment of large vascular occlusive stroke, but many factors are correlated with the outcome for acute ischemic stroke (AIS) patients after EVT[1]. There are so many factors such as baseline admitting NIHSS score, smoking, last known normal (LKN) time to puncture and so on impacted functional outcome of AIS[2]. This study aims to find the main factors that influence the poor prognosis of AIS patients after EVT by analyzing the clinical data of AIS patients. Methods We analyzed the clinical data of AIS patients in the First People’s Hospital of Xian Yang city in Sha’anXi province from June 2017 to August 2021 following treatment with EVT. The data included the patient blood pressure upon admission, blood glucose, National Institutes of Health Stroke Scale (NIHSS) score, and 90-day modified Rankin scale (mRs) score follow-up data, last known normal (LKN) time to puncture, LKN time to puncture was defined as the time from the patient's last normal time to the successful groin puncture (GP), calculated in minutes. A good outcome was defined as a 90-day mRs score of 0 to 3, and a poor outcome was defined as a 90-day mRs score of 4 to 6. Results A total of 144 patients were included in the study, baseline admitting NIHSS score, smoking, and LKN time to puncture, After NIHSS stratification, an NIHSS score of 6–12 was found to be relevant to the prognosis from the results of the univariate analysis. The baseline NIHSS were (odds ratio = 3.02; 95% confidence interval, 2.878–4.252; P < 0.001), LKN time to GP (odds ratio = 2.17; 95% confidence interval, 1.341–2.625; P < 0.01), and time stratification (6–12h) (odds ratio = 4.22; 95% confidence interval, 2.519–5.561; P < 0.001).The result showed higher baseline NIHSS, LKN time to puncture, and time were associated with poorer prognosis of stroke patients after EVT in a multivariate analysis. Conclusions Our study indicated that smoking, the baseline NIHSS score, and LKN time to puncture were the risk factors for a poor outcome of stroke patients following an EVT. Quitting smoking, shortening LKN time to puncture should improve the outcome of AIS after EVT.

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“…We know from major trials that adverse events arising after EVT are relevant to the clinical outcomes among those who have had a good technical result. 54 Elevated systolic blood pressure (SBP) after successful EVT for AIS is associated with a higher rate of intraparenchymal hemorrhage. 55 Blood pressure management after EVT is complicated.…”

Section: Postprocedural Management and Imaging Workupmentioning

confidence: 99%

“…We know from major trials that adverse events arising after EVT are relevant to the clinical outcomes among those who have had a good technical result. 54…”

Section: Potential Causes and Mechanisms Of Cir After Evtmentioning

confidence: 99%

Clinically Ineffective Reperfusion After Endovascular Therapy in Acute Ischemic Stroke

Nie

Leng

Miao

et al. 2023

Stroke

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Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion. However, in clinical practice, nearly half of the patients do not have favorable outcomes despite successful recanalization of the occluded artery. This unfavorable outcome can be defined as having clinically ineffective reperfusion. The objective of the review is to describe clinically ineffective reperfusion after endovascular therapy and its underlying risk factors and mechanisms, including initial tissue damage, cerebral edema, the no-reflow phenomenon, reperfusion injury, procedural features, and variations in postprocedural management. Further research is needed to more accurately identify patients at a high risk of clinically ineffective reperfusion after endovascular therapy and to improve individualized periprocedural management strategies, to increase the chance of achieving favorable clinical outcomes.

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Clinical impact of EVT with failed reperfusion in patients with acute ischemic stroke: results from the ESCAPE and ESCAPE-NA1 trials

Cited by 9 publications

References 11 publications

Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome

Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome

Clinical predictors of stroke prognosis after endovascular therapy

Clinically Ineffective Reperfusion After Endovascular Therapy in Acute Ischemic Stroke

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