Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial.
Ameer E Hassan, Michael G Abraham, Spiros Blackburn, Muhammad S Hussain, Santiago Ortega-Gutierrez, Michael Chen, Yin C Hu, Deep K Pujara, Nabeel A Herial, Jenny P Tsai, Ronald F Budzik, Nathan W Manning, Osman Kozak, Ricardo A Hanel, Amin N Aghaebrahim, Chirag D Gandhi, Fawaz Al-Mufti, Andrew Cheung, Bernard Yan, Peter Mitchell, Jordi Blasco, Luis San Román Manzanera, Nirav Vora, Daniel Gibson, Adam Wallace, Daniel Sahlein, Lucas Elijovich, Juan F Arenillas, Teddy Y Wu, Pere Cardona Portela, Natalia Pérez de la Ossa, Joanna D Schaafsma, William J Hicks, Dennis J Cordato, Navdeep Sangha, Steven Warach, Timothy J Kleinig, Faris Shaker, Hannah Johns, Wondwossen Tekle, Mark J Dannenbaum, Koji Ebersole, Gabor Toth, Michael Gooch, Abdulnasser Alhajeri, Krishna Amuluru, Abhishek Ray, Jan-Karl Burkhardt, Mohammad A Abdulrazzak, David P Rosenbaum-Halevi, Haris Kamal, Kelsey R Duncan, Clark W Sitton, Leonid Churilov, Vitor Mendes Pereira, Jeffrey Sunshine, Thanh N Nguyen, Johanna T Fifi, Edgar A Samaniego, Adam Arthur, Stavropoula Tjoumakaris, Pascal Jabbour, Stephen M Davis, Lawrence Wechsler, Nicholas Bambakidis, Scott E Kasner, James C Grotta, Michael D Hill, Bruce C Campbell, Marc Ribo, Amrou Sarraj
{"title":"Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial.","authors":"Ameer E Hassan, Michael G Abraham, Spiros Blackburn, Muhammad S Hussain, Santiago Ortega-Gutierrez, Michael Chen, Yin C Hu, Deep K Pujara, Nabeel A Herial, Jenny P Tsai, Ronald F Budzik, Nathan W Manning, Osman Kozak, Ricardo A Hanel, Amin N Aghaebrahim, Chirag D Gandhi, Fawaz Al-Mufti, Andrew Cheung, Bernard Yan, Peter Mitchell, Jordi Blasco, Luis San Román Manzanera, Nirav Vora, Daniel Gibson, Adam Wallace, Daniel Sahlein, Lucas Elijovich, Juan F Arenillas, Teddy Y Wu, Pere Cardona Portela, Natalia Pérez de la Ossa, Joanna D Schaafsma, William J Hicks, Dennis J Cordato, Navdeep Sangha, Steven Warach, Timothy J Kleinig, Faris Shaker, Hannah Johns, Wondwossen Tekle, Mark J Dannenbaum, Koji Ebersole, Gabor Toth, Michael Gooch, Abdulnasser Alhajeri, Krishna Amuluru, Abhishek Ray, Jan-Karl Burkhardt, Mohammad A Abdulrazzak, David P Rosenbaum-Halevi, Haris Kamal, Kelsey R Duncan, Clark W Sitton, Leonid Churilov, Vitor Mendes Pereira, Jeffrey Sunshine, Thanh N Nguyen, Johanna T Fifi, Edgar A Samaniego, Adam Arthur, Stavropoula Tjoumakaris, Pascal Jabbour, Stephen M Davis, Lawrence Wechsler, Nicholas Bambakidis, Scott E Kasner, James C Grotta, Michael D Hill, Bruce C Campbell, Marc Ribo, Amrou Sarraj","doi":"10.1002/ana.27104","DOIUrl":null,"url":null,"abstract":"<p><p>Endovascular thrombectomy (EVT) was shown to be safe and efficacious in patients with large core stroke in multiple randomized controlled trials. However, the impact of reperfusion and other procedural metrics on EVT outcomes in this population has not been well-characterized.</p><p><strong>Methods: </strong>From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml).</p><p><strong>Results: </strong>Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01-2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33-2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96-2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87-0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50-1.10) as compared with stent-retriever first.</p><p><strong>Interpretation: </strong>Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2024.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ana.27104","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Endovascular thrombectomy (EVT) was shown to be safe and efficacious in patients with large core stroke in multiple randomized controlled trials. However, the impact of reperfusion and other procedural metrics on EVT outcomes in this population has not been well-characterized.
Methods: From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml).
Results: Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01-2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33-2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96-2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87-0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50-1.10) as compared with stent-retriever first.
Interpretation: Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2024.
期刊介绍：
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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