학술논문
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?
Document Type
article
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
Source
Journal of Stroke, Vol 26, Iss 1, Pp 95-103 (2024)
Subject
Language
English
ISSN
2287-6391
2287-6405
2287-6405
Abstract
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.