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. 2024 Nov 7.
doi: 10.1002/ana.27104. Online ahead of print.

Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial

Ameer E Hassan #  1 , Michael G Abraham #  2 , Spiros Blackburn  3 , Muhammad S Hussain  4 , Santiago Ortega-Gutierrez  5 , Michael Chen  6 , Yin C Hu  7 , Deep K Pujara  7 , Nabeel A Herial  8 , Jenny P Tsai  9 , Ronald F Budzik  10 , Nathan W Manning  11 , Osman Kozak  12 , Ricardo A Hanel  13 , Amin N Aghaebrahim  13 , Chirag D Gandhi  14 , Fawaz Al-Mufti  14 , Andrew Cheung  11 , Bernard Yan  15 , Peter Mitchell  15 , Jordi Blasco  16 , Luis San Román Manzanera  16 , Nirav Vora  10 , Daniel Gibson  17 , Adam Wallace  18 , Daniel Sahlein  19 , Lucas Elijovich  20 , Juan F Arenillas  21 , Teddy Y Wu  22 , Pere Cardona Portela  23 , Natalia Pérez de la Ossa  24 , Joanna D Schaafsma  25 , William J Hicks  10 , Dennis J Cordato  11 , Navdeep Sangha  26 , Steven Warach  27 , Timothy J Kleinig  28 , Faris Shaker  3 , Hannah Johns  15 , Wondwossen Tekle  1 , Mark J Dannenbaum  3 , Koji Ebersole  2 , Gabor Toth  4 , Michael Gooch  8 , Abdulnasser Alhajeri  10 , Krishna Amuluru  19 , Abhishek Ray  7 , Jan-Karl Burkhardt  29 , Mohammad A Abdulrazzak  4 , David P Rosenbaum-Halevi  30 , Haris Kamal  31 , Kelsey R Duncan  7 , Clark W Sitton  3 , Leonid Churilov  15 , Vitor Mendes Pereira  32 , Jeffrey Sunshine  7 , Thanh N Nguyen  33 , Johanna T Fifi  34 , Edgar A Samaniego  5 , Adam Arthur  20 , Stavropoula Tjoumakaris  8 , Pascal Jabbour  8 , Stephen M Davis  15 , Lawrence Wechsler  35 , Nicholas Bambakidis  7 , Scott E Kasner  29 , James C Grotta  36 , Michael D Hill  37 , Bruce C Campbell  15   38 , Marc Ribo  39 , Amrou Sarraj  7 ; SELECT2 Trial
Affiliations

Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial

Ameer E Hassan et al. Ann Neurol. .

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.

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References

    1. Yoshimura S, Sakai N, Yamagami H, et al. Endovascular therapy for acute stroke with a large ischemic region. N Engl J Med 2022;386:1303–1313. https://doi.org/10.1056/NEJMoa2118191.
    1. Huo X, Ma G, Tong X, et al. Trial of endovascular therapy for acute ischemic stroke with large infarct. N Engl J Med 2023;10:1272–1283. https://doi.org/10.1056/NEJMoa2213379.
    1. Sarraj A, Hassan AE, Abraham MG, et al. Trial of endovascular thrombectomy for large ischemic strokes. N Engl J Med 2023;10:1259–1271. https://doi.org/10.1056/NEJMoa2214403.
    1. Bendszus M, Fiehler J, Subtil F, et al. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open‐label, randomised trial. Lancet 2023;402:1753–1763. https://doi.org/10.1016/S0140-6736(23)02032-9.
    1. Sarraj A, Abraham MG, Hassan AE, et al. Endovascular thrombectomy plus medical care versus medical care alone for large ischaemic stroke: 1‐year outcomes of the SELECT2 trial. Lancet 2024;403:731–740. https://doi.org/10.1016/S0140-6736(24)00050-3.

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