Publication details

Effects of reperfusion grade and reperfusion strategy on the clinical outcome: Insights from ESCAPE-NA1 trial

Authors	CIMFLOVÁ Petra OSPEL Johanna M SINGH Nishita MARKO Martha KASHANI Nima MAYANK Arnuv DEMCHUK Andrew MENON Bijoy POPPE Alexandre Y NOGUEIRA Raul MCTAGGART Ryan REMPEL Jeremy L TYMIANSKI Michael HILL Michael D ALMEKHLAFI Mohammed A GOYAL Mayank
Year of publication	2024
Type	Article in Periodical
Magazine / Source	INTERVENTIONAL NEURORADIOLOGY
MU Faculty or unit	Faculty of Medicine
Citation
web	https://journals.sagepub.com/doi/10.1177/15910199241288874
Doi	http://dx.doi.org/10.1177/15910199241288874
Keywords	Ischemic stroke; endovascular treatment; mechanical thrombectomy; first-pass effect; reperfusion grade
Description	Background: We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial. Methods: Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0-2], excellent outcome (90-day mRS0-1), isolated subarachnoid hemorrhage, symptomatic hemorrhage (sICH) on follow-up imaging, and death were compared across different levels of reperfusion defined by expanded Treatment in Cerebral Infarction (eTICI) Scale. Comparisons were also made between patients with (a) first-pass eTICI 2c3 reperfusion vs multiple-pass eTICI 2c3; (b) final eTICI 2b reperfusion vs eTICI 2b converted-to-eTICI 2c3; (c) sudden reperfusion vs gradual reperfusion if >1 pass was required. Multivariable logistic regression was used to test associations of reperfusion grade and clinical outcomes. Results: Of 1037 included patients, final eTICI 0-1 was achieved in 46 (4.4%), eTICI 2a in 76 (7.3%), eTICI 2b in 424 (40.9%), eTICI 2c in 284 (27.4%), and eTICI 3 in 207 (20%) patients. The odds for good and excellent clinical outcome gradually increased with improved reperfusion grades (adjOR ranging from 5.7-29.3 and 4.3-17.6) and decreased for sICH and death. No differences in outcomes between first-pass versus multiple-pass eTICI 2c3, eTICI 2b converted-to-eTICI 2c3 versus unchanged eTICI 2b and between sudden versus gradual eTICI 2c3 reperfusion were observed. Conclusion: Better reperfusion degrees significantly improved clinical outcomes and reduced mortality, independent of the number of passes and whether eTICI 2c3 was achieved suddenly or gradually.