Pretreatment and interventional parameters predict excellent recanalization of large vessel occlusion in patients with acute ischemic stroke

Abstract

Background: In patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO), improved functional outcomes have been reported in patients who achieve Modified Thrombolysis In Cerebral Infarction (mTICI) 2c/3 (excellent recanalization) over mTICI 2b. We aimed to determine pretreatment and interventional variables that could predict achieving mTICI 2c/3 over 2b reperfusion in patients who underwent technically successful mechanical thrombectomy (MT). Methods: In this retrospective study, consecutive AIS patients with anterior circulation LVO who underwent MT and achieved recanalization with mTICI 2b/2c/3 were included. We evaluated the association between pretreatment clinical and imaging variables and interventional parameters in patients who achieved mTICI 2c/3 vs. 2b using logistic regression and ROC analyses. Results: From 5/11/2019 to 10/09/2022, 149 consecutive patients met our inclusion criteria (median 70 years old [IQR 65 - 78.5], 57.7% female). Adjusted multivariate regression analyses showed that patients with excellent recanalization had lower admission NIHSS (aOR 0.93, p = 0.036), were less likely to have a history of diabetes mellitus (DM) (aOR 0.42, p = 0.050) and prior stroke (aOR 0.27, p = 0.007), had a cerebral blood volume (CBV) index >= 0.7 (aOR 3.75, p = 0.007), and were more likely to achieve excellent recanalization with aspiration alone (aOR 2.89, p = 0.012). A multivariate logistic regression model comprising these independent factors predicted mTICI 2c/3 with an AUC 0.79 (95% CI: 0.68-0.86; p < 0.001), sensitivity of 94%; specificity of 41%. Conclusion: Robust collateral status (CS) defined by CBV index >= 0.7, absence of DM and prior stroke, lower initial stroke severity, and direct aspiration are all predictive of excellent recanalization in successfully recanalized AIS-LVO patients. Our findings highlight the prognostic implications of robust CS, DM and stroke prevention, as well as use of aspiration alone in maximizing the likelihood of excellent recanalization.