Journal of Stroke (Jan 2024)
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?
- 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,
Affiliations
- Sameh Samir Elawady
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
- Brian Fabian Saway
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
- Hidetoshi Matsukawa
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
- Kazutaka Uchida
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
- Steven Lin
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
- Ilko Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
- Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
- Stacey Quintero Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Ansaar Rai
- Department of Radiology, West Virginia School of Medicine, Morgantown, WV, USA
- Robert M. Starke
- Department of Neurosurgery, University of Miami Health System, Miami, FL, USA
- Marios-Nikos Psychogios
- Department of Interventional and Diagnostical Neuroradiology, University of Basel, Basel, Switzerland
- Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Adam Arthur
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Hugo Cuellar
- Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, LA, USA
- Jonathan A. Grossberg
- Department of Neurosurgery, Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Ali Alawieh
- Department of Neurosurgery, Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Daniele G. Romano
- Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
- Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Isabel Fragata
- Department of Neuroradiology, Hospital São José Centro Hospitalar, Lisboa, Portugal
- Adam Polifka
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
- Joshua Osbun
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
- Roberto Crosa
- Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay
- Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Min S. Park
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
- Michael R. Levitt
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
- Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Mark Moss
- Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, AZ, USA
- Travis Dumont
- Department of Neurosurgery, University of Arizona, Tucson, AZ, USA
- Richard Williamson
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA
- Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
- Peter Kan
- Department of Neurological Surgery, University of Texas Medical Branch - Galveston, TX, USA
- Reade De Leacy
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA
- Shakeel Chowdhry
- Department of Neurosurgery, NorthShore University Health System, Evanston, IL, USA
- Mohamad Ezzeldin
- University of Houston, Department of Clinical Neuroscience, HCA Houston Healthcare Kingwood, Houston, TX, USA
- Alejandro M. Spiotta
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
- Sami Al Kasab
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA
- DOI
- https://doi.org/10.5853/jos.2023.02292
- Journal volume & issue
-
Vol. 26,
no. 1
pp. 95 – 103
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.
Keywords
- alberta stroke program early computed tomography score
- modified thrombolysis in cerebral infarction
- recanalization
- stroke
- thrombectomy
