Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3

Agnetha A E Bruggeman¹, Manon Kappelhof^{1

2}, Sanne J den Hartog^{3

4

5}, James F Burke⁶, Olvert A Berkhemer^{1

4

5}, Adriaan C G M van Es⁷, Wim H van Zwam⁸, Diederik W J Dippel³, Jonathan M Coutinho⁹, Henk A Marquering^{1

2}, Charles B L M Majoie¹, Bart J Emmer¹⁰; MR CLEAN Registry investigators

Collaborators, Affiliations

Collaborators

MR CLEAN Registry investigators:
Diederik Wj Dippel, Aad van der Lugt, Charles Blm Majoie, Yvo Bwem Roos, Robert J van Oostenbrugge, Wim H van Zwam, Jelis Boiten, Jan Albert Vos, Ivo Gh Jansen, Maxim Jhl Mulder, Robert-Jan B Goldhoorn, Kars Cj Compagne, Manon Kappelhof, Josje Brouwer, Sanne J den Hartog, Wouter H Hinsenveld, Bob Roozenbeek, Adriaan Cgm van Es, Bart J Emmer, Jonathan M Coutinho, Wouter J Schonewille, Marieke Jh Wermer, Marianne Aa van Walderveen, Julie Staals, Jeannette Hofmeijer, Jasper M Martens, Geert Lycklama Nijeholt, Sebastiaan F de Bruijn, Lukas C van Dijk, H Bart van der Worp, Rob H Lo, Ewoud J van Dijk, Hieronymus D Boogaarts, J de Vries, Paul Lm de Kort, Julia van Tuijl, Jo P Peluso, Puck Fransen, Jan Sp van den Berg, Boudewijn Aam van Hasselt, Leo Am Aerden, René J Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud Ph Bokkers, Tobien Hcml Schreuder, Roel Jj Heijboer, Koos Keizer, Lonneke Sf Yo, Heleen M den Hertog, Tomas Bulut, Paul Jam Brouwers, Marianne Aa van Walderveen, Marieke Es Sprengers, Sjoerd Fm Jenniskens, René van den Berg, Albert J Yoo, Ludo Fm Beenen, Alida A Postma, Stefan D Roosendaal, Bas Fw van der Kallen, Ido R van den Wijngaard, Lonneke Sf Yo, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Reinoud Ph Bokkers, Marc P van Proosdij, G Menno Krietemeijer, Jo P Peluso, Hieronymus D Boogaarts, Rob Lo, Wouter Dinkelaar, Auke Pa Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, H Zwenneke Flach, Hester F Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Esmee Venema, Vicky Chalos, Ralph R Geuskens, Tim van Straaten, Saliha Ergezen, Roger Rm Harmsma, Daan Muijres, Anouk de Jong, Olvert A Berkhemer, Anna Mm Boers, J Huguet, Pfc Groot, Marieke A Mens, Katinka R van Kranendonk, Kilian M Treurniet, Manon L Tolhuisen, Heitor Alves, Annick J Weterings, Eleonora Lf Kirkels, Eva Jhf Voogd, Lieve M Schupp, Sabine L Collette, Adrien Ed Groot, Natalie E LeCouffe, Praneeta R Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A Ramos

Affiliations

¹ Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
² Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁴ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵ Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶ Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
⁹ Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
¹⁰ Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands b.j.emmer@amsterdamumc.nl.

PMID: 35086964
DOI: 10.1136/neurintsurg-2021-018465

Comparative Study

Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3

Agnetha A E Bruggeman et al. J Neurointerv Surg. 2023 Feb.

. 2023 Feb;15(2):120-126.

doi: 10.1136/neurintsurg-2021-018465. Epub 2022 Jan 27.

Authors

Collaborators

MR CLEAN Registry investigators:
Diederik Wj Dippel, Aad van der Lugt, Charles Blm Majoie, Yvo Bwem Roos, Robert J van Oostenbrugge, Wim H van Zwam, Jelis Boiten, Jan Albert Vos, Ivo Gh Jansen, Maxim Jhl Mulder, Robert-Jan B Goldhoorn, Kars Cj Compagne, Manon Kappelhof, Josje Brouwer, Sanne J den Hartog, Wouter H Hinsenveld, Bob Roozenbeek, Adriaan Cgm van Es, Bart J Emmer, Jonathan M Coutinho, Wouter J Schonewille, Marieke Jh Wermer, Marianne Aa van Walderveen, Julie Staals, Jeannette Hofmeijer, Jasper M Martens, Geert Lycklama Nijeholt, Sebastiaan F de Bruijn, Lukas C van Dijk, H Bart van der Worp, Rob H Lo, Ewoud J van Dijk, Hieronymus D Boogaarts, J de Vries, Paul Lm de Kort, Julia van Tuijl, Jo P Peluso, Puck Fransen, Jan Sp van den Berg, Boudewijn Aam van Hasselt, Leo Am Aerden, René J Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud Ph Bokkers, Tobien Hcml Schreuder, Roel Jj Heijboer, Koos Keizer, Lonneke Sf Yo, Heleen M den Hertog, Tomas Bulut, Paul Jam Brouwers, Marianne Aa van Walderveen, Marieke Es Sprengers, Sjoerd Fm Jenniskens, René van den Berg, Albert J Yoo, Ludo Fm Beenen, Alida A Postma, Stefan D Roosendaal, Bas Fw van der Kallen, Ido R van den Wijngaard, Lonneke Sf Yo, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Reinoud Ph Bokkers, Marc P van Proosdij, G Menno Krietemeijer, Jo P Peluso, Hieronymus D Boogaarts, Rob Lo, Wouter Dinkelaar, Auke Pa Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, H Zwenneke Flach, Hester F Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Esmee Venema, Vicky Chalos, Ralph R Geuskens, Tim van Straaten, Saliha Ergezen, Roger Rm Harmsma, Daan Muijres, Anouk de Jong, Olvert A Berkhemer, Anna Mm Boers, J Huguet, Pfc Groot, Marieke A Mens, Katinka R van Kranendonk, Kilian M Treurniet, Manon L Tolhuisen, Heitor Alves, Annick J Weterings, Eleonora Lf Kirkels, Eva Jhf Voogd, Lieve M Schupp, Sabine L Collette, Adrien Ed Groot, Natalie E LeCouffe, Praneeta R Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A Ramos

Affiliations

¹ Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
² Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁴ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵ Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶ Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
⁹ Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
¹⁰ Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands b.j.emmer@amsterdamumc.nl.

PMID: 35086964
DOI: 10.1136/neurintsurg-2021-018465

Abstract

Background: Higher expanded Treatment In Cerebral Ischemia (eTICI) reperfusion scores after endovascular treatment (EVT) are associated with better outcomes. However, the influence of the number of passes on this association is unclear. We aimed to compare outcomes of single-pass good reperfusion (eTICI 2B) with multiple-pass excellent/complete reperfusion (eTICI 2C/3) in daily clinical practice.

Methods: We compared outcomes of patients in the MR CLEAN Registry with good reperfusion (eTICI 2B) in a single pass to those with excellent/complete reperfusion (eTICI 2C/3) in multiple passes. Regression models were used to investigate the association of single-pass eTICI 2B versus multiple-pass eTICI 2C/3 reperfusion with 90-day functional outcome (modified Rankin Scale (mRS)), functional independence (mRS 0-2), per-procedural complications and safety outcomes.

Results: We included 699 patients: 178 patients with single-pass eTICI 2B, and 242 and 279 patients with eTICI 2C/3 after 2 and ≥3 passes, respectively. Patients with eTICI 2C/3 after 2 or ≥3 passes did not achieve significantly better functional outcomes compared with patients with single-pass eTICI 2B (adjusted common OR (acOR) 1.06, 95% CI 0.75 to 1.50 and acOR 0.88, 95% CI 0.74 to 1.05 for 90-day mRS, and adjusted OR (aOR) 1.24, 95% CI 0.78 to 1.97 and aOR 0.79, 95% CI 0.52 to 1.22 for functional independence).

Conclusions: Our results did not show better outcomes for patients who achieved eTICI 2C/3 in multiple, that is, two or more, passes when compared with patients with single-pass eTICI 2B. However, this concerns observational data. Further research is necessary to investigate the per-pass effect in relation to reperfusion and functional outcome.

Keywords: intervention; stroke; thrombectomy.

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Conflict of interest statement

Competing interests: Amsterdam UMC received funds from Stryker for consultation by CBLM. Unrelated to this study, Amsterdam UMC received grants from the Netherlands Organization for Health Research and Development, Health Holland Top Sector LSH and Nicolab B.V. Erasmus University Medical Center received funds from Stryker, Siemens Healthineers, GE Healthcare and Bracco Imaging for consultation by DWJD. Maastricht University Medical Center received funds from Stryker, Cerenovus, Nicolab B.V. and Philips for consultation by WvZ. JMC reports a grant from Medtronic, all fees paid to institution. HAM is co-founder and shareholder of Nicolab B.V. Dr Charles BLM Majoie reports grants from the TWIN Foundation, CVON/Dutch Heart Foundation, European Commission, Health Evaluation Netherlands, and Stryker, all paid to the institution. CBLM is minor shareholder of Nicolab B.V. Dr Bart J Emmer reports a TKI-Private PPP Grant from the Dutch Ministry of Economics. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3

Collaborators

Affiliations

Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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Full Text Sources

Medical