Association of reperfusion success and emboli in new territories with long term mortality after mechanical thrombectomy.

Beyeler, Morin; Weber, Loris; Kurmann, Christoph C; Piechowiak, Eike Immo I; Mosimann, Pascal J; Zibold, Felix; Meinel, Thomas Raphael; Branca, Mattia; Göldlin, Martina; Pilgram-Pastor, Sara M; Grunder, Lorenz; Arnold, Marcel; Seiffge, David; Meier, Raphael; Heldner, Mirjam R; Dobrocky, Tomas; Mordasini, Pasquale; Gralla, Jan; Fischer, Urs and Kaesmacher, Johannes (2021). Association of reperfusion success and emboli in new territories with long term mortality after mechanical thrombectomy. (In Press). Journal of neurointerventional surgery BMJ Publishing Group 10.1136/neurintsurg-2021-017422

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BACKGROUND

The degree of reperfusion is the most important modifiable predictor of 3 month functional outcome and mortality in ischemic stroke patients treated with mechanical thrombectomy. Whether the beneficial effect of reperfusion also leads to a reduction in long term mortality is unknown.

METHODS

Patients undergoing mechanical thrombectomy between January 2010 and December 2018 were included. The post-thrombectomy degree of reperfusion and emboli in new territories were core laboratory adjudicated. Reperfusion was evaluated according to the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Vital status was obtained from the Swiss population register. Adjusted hazard ratios (aHRs) using time split Cox regression models were calculated. Subgroup analyses were performed in patients with borderline indications.

RESULTS

Our study included 1264 patients (median follow-up per patient 2.5 years). Patients with successful reperfusion had longer survival times, attributable to a lower hazard of death within 0-90 days and for >90 days to 2 years (aHR 0.34, 95% CI 0.26 to 0.46; aHR 0.37, 95% CI 0.22 to 0.62). This association was homogeneous across all predefined subgroups (p for interaction >0.05). Among patients with successful reperfusion, a significant difference in the hazard of death was observed between eTICI2b50 and eTICI3 (aHR 0.51, 95% CI 0.33 to 0.79). Emboli in new territories were present in 5% of patients, and were associated with increased mortality (aHR 2.3, 95% CI 1.11 to 4.86).

CONCLUSION

Successful, and ideally complete, reperfusion without emboli in new territories is associated with a reduction in long term mortality in patients treated with mechanical thrombectomy, and this was evident across several subgroups.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Beyeler, Morin; Kurmann, Christoph Carmelino; Piechowiak, Eike Immo; Mosimann, Pascal John; Zibold, Felix; Meinel, Thomas Raphael; Branca, Mattia; Göldlin, Martina Béatrice; Pilgram-Pastor, Sara Magdalena; Grunder, Lorenz Nicolas; Arnold, Marcel; Seiffge, David Julian; Meier, Raphael; Heldner, Mirjam Rachel; Dobrocky, Tomas; Mordasini, Pasquale; Gralla, Jan; Fischer, Urs and Kaesmacher, Johannes

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

07 May 2021 12:22

Last Modified:

10 May 2021 21:38

Publisher DOI:

10.1136/neurintsurg-2021-017422

PubMed ID:

33911015

Uncontrolled Keywords:

stroke thrombectomy

BORIS DOI:

10.48350/156140

URI:

https://boris.unibe.ch/id/eprint/156140

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