. 2022 Feb;14(2):111-116.

doi: 10.1136/neurintsurg-2020-017193. Epub 2021 Feb 16.

Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

Ching-Jen Chen¹, Reda Chalhoub², Dale Ding³, Jeyan S Kumar⁴, Natasha Ironside⁴, Ryan T Kellogg⁴, Bradford B Worrall⁵, Andrew M Southerland⁵, Pascal Jabbour⁶, Stacey Q Wolfe⁷, Adam S Arthur⁸, Nitin Goyal^{8

9}, Isabel Fragata¹⁰, Ilko Maier¹¹, Charles Matouk¹², Jonathan A Grossberg¹³, Peter Kan¹⁴, Clemens M Schirmer¹⁵, R Webster Crowley¹⁶, William J Ares¹⁷, Christopher S Ogilvy¹⁸, Ansaar T Rai¹⁹, Michael R Levitt²⁰, Maxim Mokin²¹, Waldo R Guerrero²¹, Justin R Mascitelli²², Albert J Yoo²³, Richard Williamson²⁴, Andrew Walker Grande²⁵, Roberto Javier Crosa²⁶, Sharon Webb²⁷, Marios N Psychogios²⁸, Robert M Starke²⁹, Alejandro M Spiotta², Min S Park⁴; STAR collaborators

Collaborators, Affiliations

Collaborators

Affiliations

¹ Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA chenjared@gmail.com.
² Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
⁴ Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
⁵ Neurology, University of Virginia Health System, Charlottesville, Virginia, USA.
⁶ Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁷ Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
⁸ Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁹ Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁰ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
¹¹ Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
¹² Neurosurgery, Yale University, New Haven, Connecticut, USA.
¹³ Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁴ Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
¹⁵ Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
¹⁶ Neurosurgery, Rush University, Chicago, Illinois, USA.
¹⁷ Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA.
¹⁸ Neurosurgery, BIDMC, Boston, Massachusetts, USA.
¹⁹ Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA.
²⁰ Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
²¹ Neurosurgery, University of South Florida, Tampa, Florida, USA.
²² Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²³ Neurointerventional Radiology, Texas Stroke Institute, Plano, Texas, USA.
²⁴ Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA.
²⁵ Neurosurgery, Radiology and Neurology, University of Minnesota, Mendota Heights, Minnesota, USA.
²⁶ Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
²⁷ Neurosurgery, Bon Secours, Greenville, South Carolina, USA.
²⁸ Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
²⁹ Neurological Surgery, University of Miami, Miami, Florida, USA.

PMID: 33593800
PMCID: PMC10947782
DOI: 10.1136/neurintsurg-2020-017193

Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

Ching-Jen Chen et al. J Neurointerv Surg. 2022 Feb.

. 2022 Feb;14(2):111-116.

doi: 10.1136/neurintsurg-2020-017193. Epub 2021 Feb 16.

Authors

Collaborators

Affiliations

¹ Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA chenjared@gmail.com.
² Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
⁴ Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
⁵ Neurology, University of Virginia Health System, Charlottesville, Virginia, USA.
⁶ Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁷ Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
⁸ Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁹ Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁰ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
¹¹ Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
¹² Neurosurgery, Yale University, New Haven, Connecticut, USA.
¹³ Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁴ Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
¹⁵ Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
¹⁶ Neurosurgery, Rush University, Chicago, Illinois, USA.
¹⁷ Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA.
¹⁸ Neurosurgery, BIDMC, Boston, Massachusetts, USA.
¹⁹ Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA.
²⁰ Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
²¹ Neurosurgery, University of South Florida, Tampa, Florida, USA.
²² Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²³ Neurointerventional Radiology, Texas Stroke Institute, Plano, Texas, USA.
²⁴ Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA.
²⁵ Neurosurgery, Radiology and Neurology, University of Minnesota, Mendota Heights, Minnesota, USA.
²⁶ Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
²⁷ Neurosurgery, Bon Secours, Greenville, South Carolina, USA.
²⁸ Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
²⁹ Neurological Surgery, University of Miami, Miami, Florida, USA.

PMID: 33593800
PMCID: PMC10947782
DOI: 10.1136/neurintsurg-2020-017193

Abstract

Background: The benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3.

Methods: This is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage.

Results: The unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; p_interaction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; p_interaction=0.041).

Conclusions: Complete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.

Keywords: stroke; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Competing interests: MRL: Grants from the NIH (R01NS105692, R01NS088072, U24NS100654, UL1TR002319, R25NS079200) and the American Heart Association (18CDA34110295). Unrestricted educational grants from Medtronic, Stryker and Philips Volcano. Consultant for Medtronic. Minor equity/ownership interest in Proprio, Cerebrotech, Synchron. Adviser to Metis Innovative. JAG: Grants from the Georgia Research Alliance. Consultant for Cognition Medical. AJY: Grants from Medtronic, Cerenovus, Penumbra, and Stryker. Consultant for Penumbra and Cerenovus. Equity interest in Insera Therapeutics. RWC: Proctor for Medtronic and Cerenovus. AMS: Research support from Penumbra, Stryker, Medtronic, and Siemens. Consultant for Penumbra, Stryker, Terumo, and Arsenal. MM: Consultant for Medtronic and Cerenovus. Stock ownership in Serenity Medical, Synchron, and Endostream. RMS: Grants from the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, the NIH (R01NS111119-01A1, UL1TR002736, KL2TR002737), the National Center for Advancing Translational Sciences, the National Institute on Minority Health and Health Disparities, and Medtronic. Consultant for Penumbra, Abbott, Medtronic, InNeuroCo and Cerenovus. Others: None.

Figures

**Figure 1**
(A) 90-day mRS distributions of unmatched mTICI 2c versus 3 cohorts. (B) 90-day mRS distributions of matched mTICI 2c versus 3 cohorts. mTICI, modified Thrombolysis in Cerebral Ischemia; mRS, modified Rankin Scale.

**Figure 2**
Subgroup analyses of primary outcome according to reperfusion status of the matched mTICI 2c vs 3 cohorts. IV-tPA, intravenous tissue plasminogen activator; mRS, modified Rankin Scale; ASPECT, Alberta Stroke Program Early CT; ICA, internal carotid artery; mTICI, modified Thrombolysis in Cerebral Ischemia; NIHSS, National Institute of Health Stroke Scale; SR, stent retriever. *Adjusted for age, sex, atrial fibrillation, ASPECT score, NIHSS score, primary vessel occlusion location, symptom onset to puncture time, number of attempts, IV tissue plasminogen activator administration, pre-stroke mRS, and primary mechanical thrombectomy technique.

See this image and copyright information in PMC

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Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

Collaborators

Affiliations

Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical