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Muszynski P, Anadani M, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Arquizan C, Maïer B, Blanc R, Lapergue B, Consoli A, Eugene F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Clarençon F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Viguier A, Cognard C, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Gory B, Finitsis SN. Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results. J Neurointerv Surg 2021; 14:neurintsurg-2021-017380. [PMID: 34045317 DOI: 10.1136/neurintsurg-2021-017380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The predictors of successful reperfusion and the effect of reperfusion after endovascular treatment (EVT) for M2 occlusions have not been well studied. We aimed to identify predictors of successful reperfusion and the effect of reperfusion on outcomes of EVT for M2 occlusions in current practice. METHODS Patients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0-2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram. RESULTS A total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p<0.01). Admission NIHSS score was the only predictor of successful reperfusion. First-line strategy was not a predictor of successful reperfusion or favorable outcome, but the use of a stent retriever, alone or with an aspiration catheter, was associated with higher rates of procedural complications and 90-day mortality. CONCLUSIONS Successful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.
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Affiliation(s)
- Patricio Muszynski
- Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Mohammad Anadani
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA.,Neurology, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | - Sébastien Richard
- Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Igor Sibon
- Neurology, Stroke Unit, CHU Bordeaux, Bordeaux, France
| | | | | | - Benjamin Maïer
- Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Raphaël Blanc
- Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | | | - Arturo Consoli
- Diagnostic and Therapeutic Neuroradiology, Foch Hospital, Suresnes, France
| | | | | | - Laurent Spelle
- Interventional Neuroradiolology, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | - Frédéric Clarençon
- Sorbonne Université, Paris, France.,Neuroradiology, CHU Pitié-Salpêtrière, Paris, France
| | - Charlotte Rosso
- Neurology, Stroke Unit, CHU Pitié-Salpêtrière, Paris, France
| | | | - Guillaume Turc
- Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
| | | | | | - Alain Viguier
- Neurology, Stroke Unit, CHU Toulouse, Toulouse, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
| | | | - Sarah Evain
- Neurology, Stroke Unit, CH Bretagne Atlantique, Vannes, France
| | | | - Raoul Pop
- Interventional Neuroradiolology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Neurology, Stroke Unit, CHU Brest, Brest, France
| | | | | | | | - Benjamin Gory
- Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France .,IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Stephanos Nikolaos Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece.,Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
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Dutra BG, Tolhuisen ML, Alves HC, Treurniet KM, Kappelhof M, Yoo AJ, Jansen IG, Dippel DW, van Zwam WH, van Oostenbrugge RJ, da Rocha AJ, Lingsma HF, van der Lugt A, Roos YB, Marquering HA, Majoie CB. Thrombus Imaging Characteristics and Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment. Stroke 2019; 50:2057-2064. [DOI: 10.1161/strokeaha.118.024247] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background and Purpose—
Thrombus imaging characteristics have been reported to be useful to predict functional outcome and reperfusion in acute ischemic stroke. However, conflicting data about this subject exist in patients undergoing endovascular treatment. Therefore, we aimed to evaluate whether thrombus imaging characteristics assessed on computed tomography are associated with outcomes in patients with acute ischemic stroke treated by endovascular treatment.
Methods—
The MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry is an ongoing, prospective, and observational study in all centers performing endovascular treatment in the Netherlands. We evaluated associations of thrombus imaging characteristics with the functional outcome (modified Rankin Scale at 90 days), mortality, reperfusion, duration of endovascular treatment, and symptomatic intracranial hemorrhage using univariable and multivariable regression models. Thrombus characteristics included location, clot burden score (CBS), length, relative and absolute attenuation, perviousness, and distance from the internal carotid artery terminus to the thrombus. All characteristics were assessed on thin-slice (≤2.5 mm) noncontrast computed tomography and computed tomography angiography, acquired within 30 minutes from each other.
Results—
In total, 408 patients were analyzed. Thrombus with distal location, higher CBS, and shorter length were associated with better functional outcome (adjusted common odds ratio, 3.3; 95% CI, 2.0–5.3 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted common odds ratio, 1.15; 95% CI, 1.07–1.24 per CBS point; and adjusted common odds ratio, 0.96; 95% CI, 0.94–0.99 per mm, respectively) and reduced duration of endovascular procedure (adjusted coefficient B, −14.7; 95% CI, −24.2 to −5.1 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted coefficient B, −8.5; 95% CI, −14.5 to −2.4 per CBS point; and adjusted coefficient B, 7.3; 95% CI, 2.9–11.8 per mm, respectively). Thrombus perviousness was associated with better functional outcome (adjusted common odds ratio, 1.01; 95% CI, 1.00–1.02 per Hounsfield units increase). Distal thrombi were associated with successful reperfusion (adjusted odds ratio, 2.6; 95% CI, 1.4–4.9 for proximal M1 occlusion compared with internal carotid artery occlusion).
Conclusions—
Distal location, higher CBS, and shorter length are associated with better functional outcome and faster endovascular procedure. Distal thrombus is strongly associated with successful reperfusion, and a pervious thrombus is associated with better functional outcome.
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Affiliation(s)
- Bruna G. Dutra
- From the Departments of Radiology and Nuclear Medicine (B.G.D., H.C.B.R.A., K.M.T., M.K., I.G.H.J., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands
- Biomedical Engineering and Physics (B.G.D., M.L.T., H.C.B.R.A., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
- Department of Radiology, Irmandade Santa Casa de Misericórdia de São Paulo, Brazil (B.G.D., H.C.B.R.A., A.J.d.R.)
| | - Manon L. Tolhuisen
- Biomedical Engineering and Physics (B.G.D., M.L.T., H.C.B.R.A., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - Heitor C.B.R. Alves
- From the Departments of Radiology and Nuclear Medicine (B.G.D., H.C.B.R.A., K.M.T., M.K., I.G.H.J., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands
- Biomedical Engineering and Physics (B.G.D., M.L.T., H.C.B.R.A., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
- Department of Radiology, Irmandade Santa Casa de Misericórdia de São Paulo, Brazil (B.G.D., H.C.B.R.A., A.J.d.R.)
| | - Kilian M. Treurniet
- From the Departments of Radiology and Nuclear Medicine (B.G.D., H.C.B.R.A., K.M.T., M.K., I.G.H.J., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - Manon Kappelhof
- From the Departments of Radiology and Nuclear Medicine (B.G.D., H.C.B.R.A., K.M.T., M.K., I.G.H.J., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - Albert J. Yoo
- Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.)
| | - Ivo G.H. Jansen
- From the Departments of Radiology and Nuclear Medicine (B.G.D., H.C.B.R.A., K.M.T., M.K., I.G.H.J., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - Diederik W.J. Dippel
- Neurology (D.W.J.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wim H. van Zwam
- Departments of Radiology (W.H.v.Z), Maastricht University Medical Center, the Netherlands
- Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University Medical Center, the Netherlands
| | - Robert J. van Oostenbrugge
- Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands
- Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University Medical Center, the Netherlands
| | - Antônio J. da Rocha
- Department of Radiology, Irmandade Santa Casa de Misericórdia de São Paulo, Brazil (B.G.D., H.C.B.R.A., A.J.d.R.)
| | - Hester F. Lingsma
- Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Aad van der Lugt
- Departments of Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Yvo B.W.E.M. Roos
- Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands
| | - Henk A. Marquering
- Biomedical Engineering and Physics (B.G.D., M.L.T., H.C.B.R.A., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - Charles B.L.M. Majoie
- From the Departments of Radiology and Nuclear Medicine (B.G.D., H.C.B.R.A., K.M.T., M.K., I.G.H.J., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands
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