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Importance of delayed reperfusions in patients with incomplete thrombectomy

Background: - - There is paucity of data regarding the effects of delayed reperfusion (DR) on clinical outcomes in patients with incomplete reperfusion following mechanical thrombectomy. We hypothesized that DR has a strong association with clinical outcome in patients with incomplete reperfusion a...

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Main Authors: Mujanović, Adnan (Author) , Jungi, Noel (Author) , Kurmann, Christoph C. (Author) , Dobrocky, Tomas (Author) , Meinel, Thomas R. (Author) , Almiri, William (Author) , Grunder, Lorenz (Author) , Beyeler, Morin (Author) , Lang, Matthias F. (Author) , Jung, Simon (Author) , Klail, Tomas (Author) , Hoffmann, Angelika (Author) , Seiffge, David J. (Author) , Heldner, Mirjam R. (Author) , Pilgram-Pastor, Sara (Author) , Mordasini, Pasquale (Author) , Arnold, Marcel (Author) , Piechowiak, Eike I. (Author) , Gralla, Jan (Author) , Fischer, Urs (Author) , Kaesmacher, Johannes (Author)
Format: Article (Journal)
Language:English
Published: 7 Oct 2022
In: Stroke
Year: 2022, Volume: 53, Issue: 11, Pages: 3350-3358
ISSN:1524-4628
DOI:10.1161/STROKEAHA.122.040063
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1161/STROKEAHA.122.040063
Verlag, lizenzpflichtig, Volltext: https://www.ahajournals.org/doi/10.1161/STROKEAHA.122.040063
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Author Notes:Adnan Mujanovic, Noel Jungi, Christoph C. Kurmann, Tomas Dobrocky, Thomas R. Meinel, William Almiri, Lorenz Grunder, Morin Beyeler, Matthias F. Lang, Simon Jung, Tomas Klail, Angelika Hoffmann, David J. Seiffge, Mirjam R. Heldner, Sara Pilgram-Pastor, Pasquale Mordasini, Marcel Arnold, Eike I. Piechowiak, Jan Gralla, Urs Fischer, Johannes Kaesmacher
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Summary:Background: - - There is paucity of data regarding the effects of delayed reperfusion (DR) on clinical outcomes in patients with incomplete reperfusion following mechanical thrombectomy. We hypothesized that DR has a strong association with clinical outcome in patients with incomplete reperfusion after mechanical thrombectomy (expanded Thrombolysis in Cerebral Infarction, 2a-2c). - - Methods: - - Single-institution’s stroke registry retrospective analysis of patients admitted from February 2015 to December 2020. DR was defined as the absence of any perfusion delay on ≈24-hour contrast-enhanced follow-up perfusion imaging, whereas persistent perfusion deficit denotes a perfusion delay corresponding to the catheter angiographic deficit directly after the intervention. The association of perfusion outcome (DR versus persistent perfusion deficit) with the occurrence of new infarcts and 90-day functional independence (modified Rankin Scale score 0-2) was evaluated using logistic regression analyses. Comparison of predictive accuracy was evaluated by calculating area under the curve for models with and without perfusion outcome. - - Results: - - In 566 patients (mean age 74, 49.6% female), new infarcts in the incomplete reperfusion areas were less common in DR versus persistent perfusion deficit patients (small punctiform: 17.1% versus 25%, large confluent: 7.9% versus 63.2%; P=0.001). After adjustment for confounders, DR was a strong predictor of functional independence (adjusted odds ratio, 2.37 [95% CI 1.34-4.23]). There was a significant improvement in predictive accuracy of functional independence when perfusion outcome was added to expanded Thrombolysis in Cerebral Infarction alone (area under the curve 0.57 versus 0.62, P=0.01). - - Conclusions: - - Occurrence of DR is closely associated with tissue outcome and functional independence. DR may be an independent prognostic parameter, suggesting it as a potential outcome surrogate for medical rescue therapies.
Item Description:Gesehen am 17.01.2023
Physical Description:Online Resource
ISSN:1524-4628
DOI:10.1161/STROKEAHA.122.040063

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