Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?
Background and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Stroke Society
2024-01-01
|
| Series: | Journal of Stroke |
| Subjects: | |
| Online Access: | http://www.j-stroke.org/upload/pdf/jos-2023-02292.pdf |
| _version_ | 1797321042040979456 |
|---|---|
| author | Sameh Samir Elawady Brian Fabian Saway Hidetoshi Matsukawa Kazutaka Uchida Steven Lin Ilko Maier Pascal Jabbour Joon-Tae Kim Stacey Quintero Wolfe Ansaar Rai Robert M. Starke Marios-Nikos Psychogios Edgar A Samaniego Adam Arthur Shinichi Yoshimura Hugo Cuellar Jonathan A. Grossberg Ali Alawieh Daniele G. Romano Omar Tanweer Justin Mascitelli Isabel Fragata Adam Polifka Joshua Osbun Roberto Crosa Charles Matouk Min S. Park Michael R. Levitt Waleed Brinjikji Mark Moss Travis Dumont Richard Williamson Pedro Navia Peter Kan Reade De Leacy Shakeel Chowdhry Mohamad Ezzeldin Alejandro M. Spiotta Sami Al Kasab |
| author_facet | Sameh Samir Elawady Brian Fabian Saway Hidetoshi Matsukawa Kazutaka Uchida Steven Lin Ilko Maier Pascal Jabbour Joon-Tae Kim Stacey Quintero Wolfe Ansaar Rai Robert M. Starke Marios-Nikos Psychogios Edgar A Samaniego Adam Arthur Shinichi Yoshimura Hugo Cuellar Jonathan A. Grossberg Ali Alawieh Daniele G. Romano Omar Tanweer Justin Mascitelli Isabel Fragata Adam Polifka Joshua Osbun Roberto Crosa Charles Matouk Min S. Park Michael R. Levitt Waleed Brinjikji Mark Moss Travis Dumont Richard Williamson Pedro Navia Peter Kan Reade De Leacy Shakeel Chowdhry Mohamad Ezzeldin Alejandro M. Spiotta Sami Al Kasab |
| author_sort | Sameh Samir Elawady |
| collection | DOAJ |
| description | Background and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS. |
| first_indexed | 2024-03-08T04:51:48Z |
| format | Article |
| id | doaj.art-9204be5877c84de592aff0823e95433a |
| institution | Directory Open Access Journal |
| issn | 2287-6391 2287-6405 |
| language | English |
| last_indexed | 2024-03-08T04:51:48Z |
| publishDate | 2024-01-01 |
| publisher | Korean Stroke Society |
| record_format | Article |
| series | Journal of Stroke |
| spelling | doaj.art-9204be5877c84de592aff0823e95433a2024-02-08T04:10:26ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052024-01-012619510310.5853/jos.2023.02292518Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?Sameh Samir Elawady0Brian Fabian Saway1Hidetoshi Matsukawa2Kazutaka Uchida3Steven Lin4Ilko Maier5Pascal Jabbour6Joon-Tae Kim7Stacey Quintero Wolfe8Ansaar Rai9Robert M. Starke10Marios-Nikos Psychogios11Edgar A Samaniego12Adam Arthur13Shinichi Yoshimura14Hugo Cuellar15Jonathan A. Grossberg16Ali Alawieh17Daniele G. Romano18Omar Tanweer19Justin Mascitelli20Isabel Fragata21Adam Polifka22Joshua Osbun23Roberto Crosa24Charles Matouk25Min S. Park26Michael R. Levitt27Waleed Brinjikji28Mark Moss29Travis Dumont30Richard Williamson31Pedro Navia32Peter Kan33Reade De Leacy34Shakeel Chowdhry35Mohamad Ezzeldin36Alejandro M. Spiotta37Sami Al Kasab38 Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA Department of Neurology, University Medical Center Göttingen, Göttingen, Germany Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA Department of Radiology, West Virginia School of Medicine, Morgantown, WV, USA Department of Neurosurgery, University of Miami Health System, Miami, FL, USA Department of Interventional and Diagnostical Neuroradiology, University of Basel, Basel, Switzerland Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, LA, USA Department of Neurosurgery, Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA Department of Neurosurgery, Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Department of Neuroradiology, Hospital São José Centro Hospitalar, Lisboa, Portugal Department of Neurosurgery, University of Florida, Gainesville, FL, USA Department of Neurological Surgery, Washington University, St. Louis, MO, USA Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA Department of Neurosurgery, University of Washington, Seattle, WA, USA Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, AZ, USA Department of Neurosurgery, University of Arizona, Tucson, AZ, USA Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain Department of Neurological Surgery, University of Texas Medical Branch - Galveston, TX, USA Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA Department of Neurosurgery, NorthShore University Health System, Evanston, IL, USA University of Houston, Department of Clinical Neuroscience, HCA Houston Healthcare Kingwood, Houston, TX, USA Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USABackground and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.http://www.j-stroke.org/upload/pdf/jos-2023-02292.pdfalberta stroke program early computed tomography scoremodified thrombolysis in cerebral infarctionrecanalizationstrokethrombectomy |
| spellingShingle | Sameh Samir Elawady Brian Fabian Saway Hidetoshi Matsukawa Kazutaka Uchida Steven Lin Ilko Maier Pascal Jabbour Joon-Tae Kim Stacey Quintero Wolfe Ansaar Rai Robert M. Starke Marios-Nikos Psychogios Edgar A Samaniego Adam Arthur Shinichi Yoshimura Hugo Cuellar Jonathan A. Grossberg Ali Alawieh Daniele G. Romano Omar Tanweer Justin Mascitelli Isabel Fragata Adam Polifka Joshua Osbun Roberto Crosa Charles Matouk Min S. Park Michael R. Levitt Waleed Brinjikji Mark Moss Travis Dumont Richard Williamson Pedro Navia Peter Kan Reade De Leacy Shakeel Chowdhry Mohamad Ezzeldin Alejandro M. Spiotta Sami Al Kasab Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b? Journal of Stroke alberta stroke program early computed tomography score modified thrombolysis in cerebral infarction recanalization stroke thrombectomy |
| title | Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b? |
| title_full | Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b? |
| title_fullStr | Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b? |
| title_full_unstemmed | Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b? |
| title_short | Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b? |
| title_sort | thrombectomy in stroke patients with low alberta stroke program early computed tomography score is modified thrombolysis in cerebral infarction mtici 2c 3 superior to mtici 2b |
| topic | alberta stroke program early computed tomography score modified thrombolysis in cerebral infarction recanalization stroke thrombectomy |
| url | http://www.j-stroke.org/upload/pdf/jos-2023-02292.pdf |
| work_keys_str_mv | AT samehsamirelawady thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT brianfabiansaway thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT hidetoshimatsukawa thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT kazutakauchida thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT stevenlin thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT ilkomaier thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT pascaljabbour thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT joontaekim thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT staceyquinterowolfe thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT ansaarrai thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT robertmstarke thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT mariosnikospsychogios thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT edgarasamaniego thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT adamarthur thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT shinichiyoshimura thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT hugocuellar thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT jonathanagrossberg thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT alialawieh thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT danielegromano thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT omartanweer thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT justinmascitelli thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT isabelfragata thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT adampolifka thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT joshuaosbun thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT robertocrosa thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT charlesmatouk thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT minspark thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT michaelrlevitt thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT waleedbrinjikji thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT markmoss thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT travisdumont thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT richardwilliamson thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT pedronavia thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT peterkan thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT readedeleacy thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT shakeelchowdhry thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT mohamadezzeldin thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT alejandromspiotta thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b AT samialkasab thrombectomyinstrokepatientswithlowalbertastrokeprogramearlycomputedtomographyscoreismodifiedthrombolysisincerebralinfarctionmtici2c3superiortomtici2b |