Heterogeneity of the Relative Benefits of TICI 2c/3 over TICI 2b50/2b67 : Are there Patients who are less Likely to Benefit?

Kurmann, Christoph C.; Mujanovic, Adnan; Piechowiak, Eike I.; Dobrocky, Tomas; Zibold, Felix; Beyeler, Morin; Vynckier, Jan; Seiffge, David; Meinel, Thomas R.; Mordasini, Pasquale; Arnold, Marcel; Fischer, Urs; Gralla, Jan; Kaesmacher, Johannes (2022). Heterogeneity of the Relative Benefits of TICI 2c/3 over TICI 2b50/2b67 : Are there Patients who are less Likely to Benefit? (In Press). Clinical neuroradiology Springer-Verlag 10.1007/s00062-021-01131-0

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PURPOSE

Incomplete reperfusion after mechanical thrombectomy (MT) is associated with a poor outcome. Rescue therapy would potentially benefit some patients with an expanded treatment in cerebral ischemia score (eTICI) 2b50/2b67 reperfusion but also harbors increased risks. The relative benefits of eTICI 2c/3 over eTICI 2b50/67 in clinically important subpopulations were analyzed.

METHODS

Retrospective analysis of our institutional database for all patients with occlusion of the intracranial internal carotid artery (ICA) or the M1/M2 segment undergoing MT and final reperfusion of ≥eTICI 2b50 (903 patients). The heterogeneity in subgroups of different time metrics, age, National Institutes of Health Stroke Scale (NIHSS), number of retrieval attempts, Alberta Stroke Programme Early CT Score (ASPECTS) and site of occlusion using interaction terms (pi) was analyzed.

RESULTS

The presence of eTICI 2c/3 was associated with better outcomes in most subgroups. Time metrics showed no interaction of eTICI 2c/3 over eTICI 2b50/2b67 and clinical outcomes (onset to reperfusion pi = 0.77, puncture to reperfusion pi = 0.65, onset to puncture pi = 0.63). An eTICI 2c/3 had less consistent association with mRS ≤2 in older patients (>82 years, pi = 0.038) and patients with either lower NIHSS (≤9) or very high NIHSS (>19, pi = 0.01). Regarding occlusion sites, the beneficial effect of eTICI 2c/3 was absent for occlusions in the M2 segments (aOR 0.73, 95% confidence interval [CI] 0.33-1.59, pi = 0.018).

CONCLUSION

Beneficial effect of eTICI 2c/3 over eTICI 2b50/2b67 only decreased in older patients, M2-occlusions and patients with either low or very high NIHSS. Improving eTICI 2b50/2b67 to eTICI 2c/3 in those subgroups may be more often futile.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Kurmann, Christoph Carmelino; Mujanovic, Adnan; Piechowiak, Eike Immo; Dobrocky, Tomas; Zibold, Felix; Beyeler, Morin; Vynckier, Jan Luc; Seiffge, David Julian; Meinel, Thomas Raphael; Mordasini, Pasquale; Arnold, Marcel; Fischer, Urs; Gralla, Jan and Kaesmacher, Johannes

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1869-1447

Publisher:

Springer-Verlag

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

01 Feb 2022 15:48

Last Modified:

01 Feb 2022 15:48

Publisher DOI:

10.1007/s00062-021-01131-0

PubMed ID:

34989817

Uncontrolled Keywords:

Cerebral vessel occlusion Ischemic stroke Mechanical thrombectomy Risk factors Stent retriever

BORIS DOI:

10.48350/164398

URI:

https://boris.unibe.ch/id/eprint/164398

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