Benchmarking the Extent and Speed of Reperfusion: First Pass TICI 2c-3 Is a Preferred Endovascular Reperfusion Endpoint

Yoo, Albert J.; Soomro, Jazba; Andersson, Tommy; Saver, Jeffrey L.; Ribó, Marc; Bozorgchami, Hormozd; Dabus, Guilherme; Liebeskind, David S; Jadhav, Ashutosh P.; Mattle, Heinrich; Zaidat, Osama O.

doi:10.3389/fneur.2021.669934

Cited by 24 publications

(24 citation statements)

References 19 publications

(29 reference statements)

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“…In patients presenting with AIS secondary to LVOs, timely MT is the mainstay treatment in achieving recanalization. While it is recognized that mTICI 2c/3 patients have improved outcomes over mTICI 2b patients [ 7 , 8 , 9 ], little is known about what factors drive this difference in recanalization. Our study aimed to shed light on this topic by examining whether any baseline characteristics or procedural parameters were predictive of patients achieving mTICI 2c/3 over 2b following endovascular treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, patients were considered to be successfully recanalized if they achieved a modified thrombolysis in cerebral infarction (mTICI) grade of 2b, 2c, or 3. However, more recent studies have shown that patients who achieve an mTICI grade of 2c/3—considered excellent recanalization—have better outcomes than those who achieve an mTICI grade of 2b [ 6 , 7 , 8 , 9 ]. Is it therefore of growing interest to better understand which factors separate patients who achieve excellent recanalization from those who only achieve mTICI 2b.…”

Section: Introductionmentioning

confidence: 99%

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Groin Puncture to Recanalization Time May Be a Strong Predictor of mTICI 2c/3 over mTICI 2b in Patients with Large Vessel Occlusions Successfully Recanalized with Mechanical Thrombectomy

et al. 2022

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Mechanical thrombectomy (MT) is an important therapeutic option in the management of acute ischemic stroke (AIS) caused by large vessel occlusions (LVO). While achieving a modified thrombolysis in cerebral infarction (mTICI), grades of 2b, 2c, and 3 are all considered successful recanalization; recent literature suggests that mTICI grades of 2c/3 are associated with superior outcomes than 2b. The aim of this preliminary study is to determine whether any baseline or procedural parameters can predict whether successfully recanalized patients achieve an mTICI grade of 2c/3 over 2b. Consecutive patients from 9/2019 to 10/2021 who were successfully recanalized following MT for confirmed LVO were included in the study. Baseline and procedural data were collected through manual chart review and analyzed to ascertain whether any variables of interest could predict mTICI 2c/3. A total of 47 patients were included in the preliminary study cohort, with 35 (74.5%) achieving an mTICI score of 2c/3 and 12 (25.5%) achieving an mTICI score of 2b. We found that a lower groin puncture to recanalization time was a strong, independent predictor of TICI 2c/3 (p = 0.015). These findings emphasize the importance of minimizing procedure time in achieving superior reperfusion but must be corroborated in larger scale studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Groin Puncture to Recanalization Time May Be a Strong Predictor of mTICI 2c/3 over mTICI 2b in Patients with Large Vessel Occlusions Successfully Recanalized with Mechanical Thrombectomy

et al. 2022

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“…Twelve studies comprising 3891 patients provided per pass successful recanalization rate, [5][6][7][8][9][10][11][12][13][14][15][16] while six studies including 1302 patients had data on per pass complete recanalization. 7,9,11,15,17,18 All studies were assessed as having a moderate risk of bias based on their non-randomized design. No studies were excluded for high-risk of bias.…”

Section: Literature Searchmentioning

confidence: 99%

Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis

et al. 2021

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Background and aim First pass effect (FPE) is defined as achieving a complete recanalization with a single thrombectomy device pass. Although clinically desired, FPE is reached in less than 30% of thrombectomy procedures. Multiple device passes are often necessary to achieve successful or complete recanalization. We performed a systematic review and meta-analysis to determine the recanalization rate after each pass of mechanical thrombectomy and its association with good neurological outcome. Methods A literature search was performed for studies reporting the number of device passes required for either successful (mTICI 2b or higher) or complete (mTICI 2c or higher) recanalization. Using random-effect meta-analysis, we evaluated the likelihood of recanalization and good neurological outcome (measured with the modified Rankin Score <2 at 90 days) after each device pass. Results Thirteen studies comprising 4197 patients were included. Among cases with failed first pass, 24% of them achieved final complete recanalization and 45% of them achieved final successful recanalization. Independently to the total number of previously failed attempts, the likelihood of achieving successful recanalization was 30% per pass, and the likelihood to achieve complete recanalization was about 20% per pass. The likelihood of good neurological outcome in patients with final successful recanalization decreased after each device pass: 55% after the first pass, 48% after the second pass, 42% after the third pass, 36% after the fourth pass, and 26% for 5 passes or more. Conclusion Each pass is associated with a stable likelihood of recanalization but a decreased likelihood of good neurological outcome.

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“…Over the last five years, the evidence for the efficacy and safety of endovascular therapy in patients with stroke related to large vessel occlusion (LVO) has been growing. Recanalisation resulting from mechanical thrombectomy has been observed in up to 92% of patients, although only 46% of those were fully independent three months later [1,2]. The main cause of failure is arterial reocclusion despite a previous successful angiographic result directly following an instrumental restoration of arterial patency.…”

Section: Introductionmentioning

confidence: 99%

Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients

Lasek–Bal

Żak

Binek

et al. 2022

Neurol Neurochir Pol.

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Introduction. The relevance of diabetes mellitus (DM) to the efficacy of mechanical thrombectomy (MT) has been the subject of few studies and with only inconclusive results.Objectives. This study aimed to evaluate the effect of DM and admission hyperglycaemia on the efficacy and safety of MT in stroke patients. Material and methods.This retrospective study analysis focused on the relevance of admission hyperglyacemia and DM to the functional status of patients treated with MT at the Upper Silesian Medical Centre of the Silesian Medical University in Katowice, Poland.Results. 417 stroke patients (median age 70 years) were qualified for the study. There were 103 patients (24.70%) with DM. Admission hyperglycaemia ≥ 140 mg% was found in 91 patients (21.82%), of whom 69 were diagnosed with DM before or during hospitalisation. The parameters with the strongest effect on the functional status on days 7, 90 and 365 were: age, and neurological status according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of ischaemic stroke before MT. The angiographic effect indirect after MT and patient functional status on days 7, 90 and 365 were comparable between the groups, regardless of the DM burden. The frequency of symptomatic intracranial bleeding 24 hours after MT was comparable between patients with and patients without DM (p = 0.092).Model based on parameters were age, NIHSS on the first day of ischaemic stroke, an when score in Thrombolysis In Cerebral Infarct (TICI) showed good predictive attributes for the functional status of patients in the acute period (day 7). Age, a lack of admission hyperglycaemia, and the neurological state on day 1 of ischaemic stroke (before MT) were the key parameters for a favourable outcome (≤ 2 points on the modified Rankin Scale, mRS) on day 90. Admission hyperglycaemia ≥ 140 mg/dL, regardless of the presence or absence of DM, had a negative effect on achieving a good functional status one week after stroke onset. Conclusions. Diabetes mellitus has a neutral effect on the angiographic and clinical outcomes of mechanical thrombectomy in stroke patients. It does not increase the risk of intracranial haemorrhage after instrumental therapy. It is admission hyperglycaemia, rather than diabetes mellitus, that is a predictor of poor functional status in patients treated with thrombectomy. According to our results, the patient's neurological status, age, and the outcome of thrombectomy are relevant to the functional status in the acute ischaemic stroke period.

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Benchmarking the Extent and Speed of Reperfusion: First Pass TICI 2c-3 Is a Preferred Endovascular Reperfusion Endpoint

Cited by 24 publications

References 19 publications

Groin Puncture to Recanalization Time May Be a Strong Predictor of mTICI 2c/3 over mTICI 2b in Patients with Large Vessel Occlusions Successfully Recanalized with Mechanical Thrombectomy

Groin Puncture to Recanalization Time May Be a Strong Predictor of mTICI 2c/3 over mTICI 2b in Patients with Large Vessel Occlusions Successfully Recanalized with Mechanical Thrombectomy

Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis

Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients

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