Prevalence, Characteristics and Clinical Significance of Impaired Tissue Reperfusion Despite Complete Recanalization in Ischemic Stroke (No-Reflow): A Pooled Analysis of 3 Randomized Clinical Trials

Ng, Felix; Чурилов, Леонид; Yassi, Nawaf; Kleinig, Timothy; Thijs, Vincent; Wu, Teddy Y; Shah, DG; Dewey, Helen M; Sharma, Gagan; Desmond, Patricia; Yan, Bernard; Parsons, MW; Donnan, Geoffrey A; Davis, Stephen M.; Mitchell, Philip B.; Campbell, Bruce; Group, EXTEND-IA TNK Part 1 and 2 Investigators

doi:10.2139/ssrn.3786059

Cited by 2 publications

(1 citation statement)

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“…patients with successful reperfusion. 22 Although the exact time point of delayed reperfusion is unknown, 7,9,10,22,26 the clinical magnitude of this association was considerable across all eTICI scores and notably independent of the patients' collateral status. In our large series of patients with follow-up perfusion imaging, this effect was so pronounced that patients who had poor reperfusion grade on their last catheter angiographic control run, but presented with DR on follow-up, had better clinical outcomes than patients with higher final eTICI scores, but PPD on followup.…”

Section: Clinical and Population Sciencesmentioning

confidence: 97%

Importance of Delayed Reperfusions in Patients With Incomplete Thrombectomy

Mujanović

Jungi

Kurmann

et al. 2022

Stroke

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Background: There is paucity of data regarding the effects of delayed reperfusion (DR) on clinical outcomes in patients with incomplete reperfusion following mechanical thrombectomy. We hypothesized that DR has a strong association with clinical outcome in patients with incomplete reperfusion after mechanical thrombectomy (expanded Thrombolysis in Cerebral Infarction, 2a–2c). Methods: Single-institution’s stroke registry retrospective analysis of patients admitted from February 2015 to December 2020. DR was defined as the absence of any perfusion delay on ≈24-hour contrast-enhanced follow-up perfusion imaging, whereas persistent perfusion deficit denotes a perfusion delay corresponding to the catheter angiographic deficit directly after the intervention. The association of perfusion outcome (DR versus persistent perfusion deficit) with the occurrence of new infarcts and 90-day functional independence (modified Rankin Scale score 0–2) was evaluated using logistic regression analyses. Comparison of predictive accuracy was evaluated by calculating area under the curve for models with and without perfusion outcome. Results: In 566 patients (mean age 74, 49.6% female), new infarcts in the incomplete reperfusion areas were less common in DR versus persistent perfusion deficit patients (small punctiform: 17.1% versus 25%, large confluent: 7.9% versus 63.2%; P =0.001). After adjustment for confounders, DR was a strong predictor of functional independence (adjusted odds ratio, 2.37 [95% CI 1.34–4.23]). There was a significant improvement in predictive accuracy of functional independence when perfusion outcome was added to expanded Thrombolysis in Cerebral Infarction alone (area under the curve 0.57 versus 0.62, P =0.01). Conclusions: Occurrence of DR is closely associated with tissue outcome and functional independence. DR may be an independent prognostic parameter, suggesting it as a potential outcome surrogate for medical rescue therapies.

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Section: Clinical and Population Sciencesmentioning

confidence: 97%

Importance of Delayed Reperfusions in Patients With Incomplete Thrombectomy

Mujanović

Jungi

Kurmann

et al. 2022

Stroke

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Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy

et al. 2022

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Purpose Treatment of distal vessel occlusions causing incomplete reperfusion after mechanical thrombectomy (MT) is debated. We hypothesized that pretreatment with intravenous thrombolysis (IVT) may facilitate delayed reperfusion (DR) of residual vessel occlusions causing incomplete reperfusion after MT. Methods Retrospective analysis of patients with incomplete reperfusion after MT, defined as extended thrombolysis in cerebral infarction (eTICI) 2a–2c, and available perfusion follow-up imaging at 24 ± 12 h after MT. DR was defined as absence of any perfusion deficit on time-sensitive perfusion maps, indicating the absence of any residual occlusion. The association of IVT with the occurrence of DR was evaluated using a logistic regression analysis adjusted for confounders. Sensitivity analyses based on IVT timing (time between IVT start and the occurrence incomplete reperfusion following MT) were performed. Results In 368 included patients (median age 73.7 years, 51.1% female), DR occurred in 225 (61.1%). Atrial fibrillation, higher eTICI grade, better collateral status and longer intervention-to-follow-up time were all associated with DR. IVT did not show an association with the occurrence of DR (aOR 0.80, 95% CI 0.44–1.46, even in time-sensitive strata, aOR 2.28 [95% CI 0.65–9.23] and aOR 1.53 [95% CI 0.52–4.73] for IVT to incomplete reperfusion following MT timing <80 and <100 min, respectively). Conclusion A DR occurred in 60% of patients with incomplete MT at ~24 h and did not seem to occur more often in patients receiving pretreatment IVT. Further research on potential associations of IVT and DR after MT is required.

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Prevalence, Characteristics and Clinical Significance of Impaired Tissue Reperfusion Despite Complete Recanalization in Ischemic Stroke (No-Reflow): A Pooled Analysis of 3 Randomized Clinical Trials

Cited by 2 publications

References 0 publications

Importance of Delayed Reperfusions in Patients With Incomplete Thrombectomy

Importance of Delayed Reperfusions in Patients With Incomplete Thrombectomy

Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy

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