The Benefit of a Complete over a Successful Reperfusion Decreases with Time

Maïer, Benjamin; Finitsis, Stephanos; Mazighi, Mikaël; Lapergue, Bertrand; Marnat, Gaultier; Sibon, Igor; Richard, Sébastien; Viguier, Alain; Cognard, Christophe; Gory, Benjamin; Olivot, Jean Marc

doi:10.1002/ana.26599

Cited by 8 publications

(6 citation statements)

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“…Data from the ETIS registry were collected and analyzed according to the recommendations of the “Comité consultatif sur le traitement de l'information en matière de recherche dans le domaine de la santé.” Written informed consent was obtained from all patients or their legal representatives. Details regarding data collection and materials have been previously published 20 . As the present study is observational, adherence to the STROBE criteria was enforced 21 …”

Section: Methodsmentioning

confidence: 99%

“…Details regarding data collection and materials have been previously published. 20 As the present study is observational, adherence to the STROBE criteria was enforced. 21 For the present study, inclusion criteria were as follows: (1) adult patients ( ≥ 18 years old) with an anterior LVO (intracranial carotid artery, M1 or M2 segment of the middle cerebral artery) treated by EVT between January 1, 2015 and December 31, 2021; (2) identical anterior LVO between the first angiographic run and the admission noninvasive imaging (ie, failure of proximal recanalization with IVT or physiologic fibrinolysis in the case of IVT contraindication); (3) complete angiographic reperfusion (ie, eTICI 3) with at least one pass of thrombectomy; and (4) time from onset to IVT ≤ 4.5 hours and time from onset to puncture ≤ 6 hours.…”

Section: Study Populationmentioning

confidence: 99%

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Intravenous Thrombolysis before Complete Angiographic Reperfusion: Beyond Angiographic Assessment to Target Microvascular Obstruction?

Gory,

Finitsis,

Olivot

et al. 2024

Annals of Neurology

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BackgroundRecent data suggested that ineffective tissue reperfusion despite successful angiographic reperfusion was partly responsible for unfavorable outcomes after endovascular therapy (EVT) and might be modulated by intravenous thrombolysis (IVT) use before EVT. To specifically decipher the effect played by IVT before EVT, we compared the clinical and safety outcomes of patients who experienced a complete reperfusion at the end of EVT according to IVT use before EVT.MethodsThe Endovascular Treatment in Ischemic Stroke registry is an ongoing, prospective, observational study in 21 centers that perform EVT in France. Patients were included if they had an anterior large vessel occlusion of the intracranial internal carotid artery or middle cerebral artery (M1/M2 segments) and complete reperfusion (eTICI3) with EVT within 6 hours, between January 2015 and December 2021. The cohort was divided into 2 groups according to IVT use before EVT and propensity score matching (PSM) was used to balance the 2 groups. Primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included favorable outcome (mRS 0‐2) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90‐day mortality. Outcomes were estimated with multivariate logistic models adjusted for age, NIHSS, ASPECTS and time from symptom onset to puncture.ResultsAmong 5429 patients included in the ETIS registry, 1093 were included in the study including 651 patients with complete recanalization treated with IVT before EVT. After PSM, 488 patients treated with IVT before EVT were compared to 337 patients without IVT. In the matched cohort analysis, IVT+EVT group had a favorable shift in the overall mRS score distribution (aOR=1.41, 95%CI, 1.04‐1.91, p=0.023) and higher rates of favorable outcome (61.1% versus 48.7%; aOR=1.49, 95%CI, 1.02‐2.20, p=0.041) at 90 days compared with the EVT alone group. Rates of symptomatic intracerebral hemorrhage were comparable between both groups (6.0% versus 4.3%; aOR=1.16; [95% CI, 0.53–2.54]; p=0.709).ConclusionsIn clinical practice, even after complete angiographic reperfusion by EVT, prior IVT use improves clinical outcomes of patients without increasing bleeding risk.This article is protected by copyright. All rights reserved.

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Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Intravenous Thrombolysis before Complete Angiographic Reperfusion: Beyond Angiographic Assessment to Target Microvascular Obstruction?

Gory,

Finitsis,

Olivot

et al. 2024

Annals of Neurology

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“…We considered the images available in ArchiMed for patients explored between January 2015 and January 2022. Details regarding data collection and materials have been previously published (22). Analysis from the images of ETIS patients has not been reported yet.…”

Section: Methodsmentioning

confidence: 99%

Dynamic evolution of infarct volumes at MRI in ischemic stroke due to large vessel occlusion

Munsch,

Planes,

Fukutomi

et al. 2023

Preprint

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Background and ObjectivesThe typical infarct volume trajectories in stroke patients, categorized as slow or fast progressors, remain largely unknown. This study aimed to reveal the characteristic spatiotemporal evolutions of infarct volumes caused by large vessel occlusion (LVO) and show that such growth charts help anticipate clinical outcomes.MethodsWe conducted a secondary analysis from prospectively collected databases (FRAME, 2017– 2019; ETIS, 2015–2022). We selected acute MRI data from anterior LVO stroke patients with witnessed onset which were divided into training- and independent validation-datasets. In the training-dataset, using Gaussian mixture analysis, we classified the patients into three growth groups based on their rate of infarct growth (diffusion volume / time-to-imaging). Subsequently, we extrapolated pseudo-longitudinal models of infarct growth for each group and generated sequential frequency maps to highlight the spatial distribution of infarct growth. We used these charts to attribute a growth group to the independent patients from the validation-dataset. We compared their 3-month modified Rankin scale (mRS) with the predicted values based on a multivariable regression model from the training-dataset that used growth group as independent variable.ResultsWe included 804 patients (median age, 73.0 years [IQR, 61.2-82.0 years]; 409 men). The training-dataset revealed non-supervised clustering into 11% (74/703) slow, 62% (437/703) intermediate, and 27% (192/703) fast progressors. Infarct volume evolutions were best fitted with a linear (r=0.809;P<.001), cubic (r=0.471;P<.001), and power (r=0.63;P<.001) functions for the slow, intermediate and fast progressors, respectively. Notably, the deep nuclei and insular cortex were rapidly affected in the intermediate and fast groups with further cortical involvement in the fast group. The variable “growth group” significantly predicted 3-month mRS (multivariate OR, 0.51; 95% CI: 0.37-0.72,P<.0001) in the training-dataset, yielding a mean AUC of 0.78 (95% CI: 0.66-0.88) in the independent validation-dataset.ConclusionsWe revealed spatiotemporal archetype dynamic evolutions following large vessel occlusion stroke according to three growth phenotypes called slow, intermediate and fast progressors, providing insight into anticipating clinical outcome. We expect this could help in designing neuroprotective trials aiming at modulating infarct growth prior EVT.

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“…2 Furthermore, the degree of recanalization even amongst the successfully recanalized patients plays a role in achieving functional independence. Prior studies have demonstrated that patients who achieve mTICI 2c and 3, also referred to as excellent recanalization, have early neurological improvement 3,4 and better clinical outcomes than those who achieve mTICI 2b. 3,[5][6][7][8][9][10][11] However, few studies have directly investigated which pretreatment and interventional parameters are predictive of mTICI 2c/3 versus 2b in the successfully recanalized AIS-LVO group.…”

Section: Non-standard Abbreviations and Acronymsmentioning

confidence: 99%

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

Yedavalli,

Koneru,

Hoseinyazdi

et al. 2023

Preprint

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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.

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The Benefit of a Complete over a Successful Reperfusion Decreases with Time

Cited by 8 publications

References 30 publications

Intravenous Thrombolysis before Complete Angiographic Reperfusion: Beyond Angiographic Assessment to Target Microvascular Obstruction?

Intravenous Thrombolysis before Complete Angiographic Reperfusion: Beyond Angiographic Assessment to Target Microvascular Obstruction?

Dynamic evolution of infarct volumes at MRI in ischemic stroke due to large vessel occlusion

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

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