Effect of incomplete reperfusion patterns on clinical outcome:
insights from the ESCAPE-NA1 trial

J 2024

Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial

CIMFLOVÁ, Petra, Nishita SINGH, Manon KAPPELHOF, Johanna M OSPEL, Arshia SEHGAL et. al.

Basic information

Original name

Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial

Authors

Edition

Journal of NeuroInterventional Surgery, London, BMJ PUBLISHING GROUP, 2024, 1759-8478

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.800 in 2022

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1136/jnis-2023-020553

UT WoS

001035982000001

Keywords in English

Thrombectomy; Stroke; Angiography

Abstract

V originále

BackgroundIncomplete reperfusion (IR) after mechanical thrombectomy (MT) can be a consequence of residual occlusion, no-reflow phenomenon, or collateral counterpressure. Data on the impact of these phenomena on clinical outcome are limited. MethodsPatients from the ESCAPE-NA1 trial with IR (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b) were compared with those with complete or near-complete reperfusion (eTICI 2c-3) on the final angiography run. Final runs were assessed for (a) an MT-accessible occlusion, or (b) a non-MT-accessible occlusion pattern. The primary clinical outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Our imaging outcome was infarction in IR territory on follow-up imaging. Unadjusted and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (95% CI) were obtained. ResultsOf 1105 patients, 443 (40.1%) with IR and 506 (46.1%) with complete or near-complete reperfusion were included. An MT-accessible occlusion was identified in 147/443 patients (33.2%) and a non-MT-accessible occlusion in 296/443 (66.8%). As compared with patients with near-complete/complete reperfusion, patients with IR had significantly lower chances of achieving mRS 0-2 at 90 days (aIRR 0.82, 95% CI 0.74 to 0.91). Rates of mRS 0-2 were lower in the MT-accessible occlusion group as compared with the non-MT-accessible occlusion pattern group (aIRR 0.71, 95% CI 0.60 to 0.83, and aIRR 0.89, 95% CI 0.81 to 0.98, respectively). More patients with MT-accessible occlusion patterns developed infarcts in the non-reperfused territory as compared with patients with non-MT occlusion patterns (68.7% vs 46.3%). ConclusionIR was associated with worse clinical outcomes than near-complete/complete reperfusion. Two-thirds of our patients with IR had non-MT-accessible occlusion patterns which were associated with better clinical and imaging outcomes compared with those with MT-accessible occlusion patterns.

Citovat

CIMFLOVÁ, Petra, Nishita SINGH, Manon KAPPELHOF, Johanna M OSPEL, Arshia SEHGAL, Nima KASHANI, Mohammed A ALMEKHLAFI, Andrew M DEMCHUK, Joerg BERROUSCHOT, Franziska DORN, Michael E KELLY, Brian H BUCK, Thalia S FIELD, Dariush DOWLATSHAHI, Michael TYMIANSKI, Michael D HILL and Mayank GOYAL. Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial. Journal of NeuroInterventional Surgery. London: BMJ PUBLISHING GROUP, 2024, 7 pp. ISSN 1759-8478. Available from: https://dx.doi.org/10.1136/jnis-2023-020553.

@article{2371917,
   author = {Cimflová, Petra and Singh, Nishita and Kappelhof, Manon and Ospel, Johanna M and Sehgal, Arshia and Kashani, Nima and Almekhlafi, Mohammed A and Demchuk, Andrew M and Berrouschot, Joerg and Dorn, Franziska and Kelly, Michael E and Buck, Brian H and Field, Thalia S and Dowlatshahi, Dariush and Tymianski, Michael and Hill, Michael D and Goyal, Mayank},
   article_location = {London},
   doi = {http://dx.doi.org/10.1136/jnis-2023-020553},
   keywords = {Thrombectomy; Stroke; Angiography},
   language = {eng},
   issn = {1759-8478},
   journal = {Journal of NeuroInterventional Surgery},
   title = {Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial},
   url = {https://jnis.bmj.com/content/early/2023/07/25/jnis-2023-020553},
   year = {2024}
}

TY  - JOUR
ID  - 2371917
AU  - Cimflová, Petra - Singh, Nishita - Kappelhof, Manon - Ospel, Johanna M - Sehgal, Arshia - Kashani, Nima - Almekhlafi, Mohammed A - Demchuk, Andrew M - Berrouschot, Joerg - Dorn, Franziska - Kelly, Michael E - Buck, Brian H - Field, Thalia S - Dowlatshahi, Dariush - Tymianski, Michael - Hill, Michael D - Goyal, Mayank
PY  - 2024
TI  - Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial
JF  - Journal of NeuroInterventional Surgery
PB  - BMJ PUBLISHING GROUP
SN  - 17598478
KW  - Thrombectomy
KW  - Stroke
KW  - Angiography
UR  - https://jnis.bmj.com/content/early/2023/07/25/jnis-2023-020553
N2  - BackgroundIncomplete reperfusion (IR) after mechanical thrombectomy (MT) can be a consequence of residual occlusion, no-reflow phenomenon, or collateral counterpressure. Data on the impact of these phenomena on clinical outcome are limited. MethodsPatients from the ESCAPE-NA1 trial with IR (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b) were compared with those with complete or near-complete reperfusion (eTICI 2c-3) on the final angiography run. Final runs were assessed for (a) an MT-accessible occlusion, or (b) a non-MT-accessible occlusion pattern. The primary clinical outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Our imaging outcome was infarction in IR territory on follow-up imaging. Unadjusted and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (95% CI) were obtained. ResultsOf 1105 patients, 443 (40.1%) with IR and 506 (46.1%) with complete or near-complete reperfusion were included. An MT-accessible occlusion was identified in 147/443 patients (33.2%) and a non-MT-accessible occlusion in 296/443 (66.8%). As compared with patients with near-complete/complete reperfusion, patients with IR had significantly lower chances of achieving mRS 0-2 at 90 days (aIRR 0.82, 95% CI 0.74 to 0.91). Rates of mRS 0-2 were lower in the MT-accessible occlusion group as compared with the non-MT-accessible occlusion pattern group (aIRR 0.71, 95% CI 0.60 to 0.83, and aIRR 0.89, 95% CI 0.81 to 0.98, respectively). More patients with MT-accessible occlusion patterns developed infarcts in the non-reperfused territory as compared with patients with non-MT occlusion patterns (68.7% vs 46.3%). ConclusionIR was associated with worse clinical outcomes than near-complete/complete reperfusion. Two-thirds of our patients with IR had non-MT-accessible occlusion patterns which were associated with better clinical and imaging outcomes compared with those with MT-accessible occlusion patterns.
ER  -

CIMFLOVÁ, Petra, Nishita SINGH, Manon KAPPELHOF, Johanna M OSPEL, Arshia SEHGAL, Nima KASHANI, Mohammed A ALMEKHLAFI, Andrew M DEMCHUK, Joerg BERROUSCHOT, Franziska DORN, Michael E KELLY, Brian H BUCK, Thalia S FIELD, Dariush DOWLATSHAHI, Michael TYMIANSKI, Michael D HILL and Mayank GOYAL. Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial. \textit{Journal of NeuroInterventional Surgery}. London: BMJ PUBLISHING GROUP, 2024, 7 pp. ISSN~1759-8478. Available from: https://dx.doi.org/10.1136/jnis-2023-020553.

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