Redefining ‘success’: a systematic review and meta-analysis comparing outcomes between incomplete and complete revascularization

Rizvi, Asim; Seyedsaadat, Seyed Mohammad; Murad, M. Hassan; Brinjikji, Waleed; Fitzgerald, Seán; Kadirvel, Ramanathan; Rabinstein, Alejandro A.; Kallmes, David F.

doi:10.1136/neurintsurg-2018-013950

Cited by 58 publications

(39 citation statements)

References 36 publications

(3 reference statements)

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“…Our study demonstrated that the effect of mTICI-3 reperfusion was not significantly modified by patients' baseline characteristics such as age, sex, NIHSS score, ASPECTS, and target occlusion location among patients www.nature.com/scientificreports www.nature.com/scientificreports/ with anterior circulation occlusion. Previous studies have reported the effect of complete reperfusion on outcomes [4][5][6][7][8][9][10][11][12][22][23][24] , but the heterogeneity of this effect according to patients' characteristics has not been fully investigated. Although the superiority of mTICI-3 reperfusion did not reach statistical significance in some subgroups, presumably due to insufficient power, our findings provide further support for the importance of achieving mTICI-3 reperfusion regardless of the baseline characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Successful reperfusion in endovascular therapy (EVT) for acute ischemic stroke is commonly defined as modified thrombolysis in cerebral infarction (mTICI) scores of 2b or 3 [1][2][3] . It has been shown that outcomes of patients with complete reperfusion (mTICI-3) are superior to those with incomplete reperfusion (mTICI-2b) [4][5][6][7][8][9][10][11][12][13][14][15][16] , and the importance of achieving mTICI-3 reperfusion is remarked. However, whether the superiority of mTICI-3 is retained in any patient subgroups has not been fully investigated.…”

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confidence: 99%

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Futile complete recanalization: patients characteristics and its time course

Kitano

Todo

Yoshimura

et al. 2020

Sci Rep

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As the goal of mechanical thrombectomy is shifting toward mTICI-3 rather than mTICI-2b, we sought to clarify the limitation of the effect of mTICI-3. A post-hoc analysis of a registry of large-vessel occlusion stroke from 46 centers was conducted. Among 2,420 registered patients, 725 patients with anterior circulation occlusion who achieved successful reperfusion were analyzed. We compared outcomes between patients with mTICI-3 and mTICI-2b, and investigated how the effect of mTICI-3 changed according to baseline characteristics and time course. The proportion of patients with favorable outcomes (mRS 0-2 at day 90) was higher among patients with mTICI-3 compared to those with mTICI-2b (adjusted OR, 2.10; 95% CI, 1.49-2.97). There was no heterogeneity in the effect of mTICI-3 with respect to age, neurological deficit, alteplase use, occluded vessels, or infarct size. mTICI-3 was associated with favorable outcomes when the puncture-to-reperfusion time was <80 minutes (adjusted OR, 2.28; 95% CI, 1.52-3.41), but not when the puncture-to-reperfusion time was ≥80 minutes. A significant heterogeneity was found in the effect of mTICI-3 reperfusion across the puncture-toreperfusion time subgroups (p for interaction = 0.025). Until when operators should continue the procedure after mTICI-2b has been achieved, needs to be studied.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Futile complete recanalization: patients characteristics and its time course

Kitano

Todo

Yoshimura

et al. 2020

Sci Rep

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“…Clinical outcome after MT can be improved by an increasing degree of reperfusion evaluated by the expanded thrombolysis in cerebral infarction (eTICI) scale [3,4]. Accordingly, complete reperfusion (TICI 3) is leading to a markedly better outcome with the highest rate of excellent functional outcome (mRS ≤ 1) [5,6].…”

Section: Introductionmentioning

confidence: 99%

Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization

et al. 2020

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Background and aim To analyze the incidence of peripheral emboli after successful mechanical thrombectomy (MT) of intracranial large vessel occlusions (LVO). Methods We performed a prospective analysis of patients with intracranial LVO who underwent successful MT and received a 1.5 T MRI including diffusion-weighted imaging (DWI) in standard-and high-resolution as well as susceptibility-weighted imaging (SWI) on the day following the intervention. Reperfusion grade was assessed on post-thrombectomy digital subtraction angiography (DSA) using the expanded thrombolysis in cerebral infarction (eTICI) scale. Punctuate DWI lesions distal to the DWI core lesion were classified as peripheral emboli. DWI lesions outside the primary affected vascular territory were classified as emboli into new territories. Additionally, SWI and post-thrombectomy DSA were analyzed and correlated to findings on DWI. Results Twenty-eight patients undergoing successful MT met the inclusion criteria. In 26/28 patients (93%), a total of 324 embolic lesions were detected in DWI representing 2.1% of the cumulated ischemic core volume. 151 peripheral emboli were detected in standard-resolution DWI, 173 additional emboli were uncovered in high-resolution DWI. Eight out of nine patients with an eTICI 3 reperfusion had embolic lesions (29 DWI lesions). 9.6% (31/324) of peripheral emboli were observed in vascular territories not affected by the LVO. SWI lesions were observed in close proximity to 10.2% (33/324) of DWI lesions. Conclusions Peripheral emboli are frequent after MT even after complete reperfusion. These emboli occur rather in the vascular territory of the occluded vessel than in other territories. A large proportion of peripheral emboli is only detected by high-resolution DWI.

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“…TICI-3 patients fared dramatically better than TICI-2B across all outcome measures, including modified Rankin scores and mortality rates 1. This analysis raises two important issues.…”

mentioning

confidence: 97%

“…The meta-analysis by Rizvi et al comparing patients with TICI-3 versus TICI-2B revascularization redefines the meaning of ‘successful’ recanalization 1. TICI-3 patients fared dramatically better than TICI-2B across all outcome measures, including modified Rankin scores and mortality rates 1.…”

mentioning

confidence: 99%

Happy New Year

Albuquerque

2018

J NeuroIntervent Surg

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Redefining ‘success’: a systematic review and meta-analysis comparing outcomes between incomplete and complete revascularization

Cited by 58 publications

References 36 publications

Futile complete recanalization: patients characteristics and its time course

Futile complete recanalization: patients characteristics and its time course

Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization

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