Successful reperfusion with mTICI 3 following mechanical thrombectomy was associated with higher 3-month functional independence compared to mTICI 2b (55% vs 44%; OR 2.08, 95% CI 1.22-3.53).
Cohort (n=416)
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Does achieving mTICI 3 reperfusion improve functional outcomes and safety compared to mTICI 2b reperfusion in acute ischemic stroke patients treated with mechanical thrombectomy?
Achieving complete reperfusion (mTICI 3) during mechanical thrombectomy for acute ischemic stroke yields significantly better neurological and functional outcomes with fewer hemorrhagic complications than near-complete reperfusion (mTICI 2b).
Odds Ratio: 2.08 (95% CI 1.22–3.53)
Tasa de eventos absoluta: 55% vs 44%
valor p: p=<.05
BACKGROUND: Mechanical thrombectomy (MT) is the current standard of care for acute ischemic stroke (AIS) patients with emergent large-vessel occlusions (ELVO). Successful reperfusion of ELVO is traditionally defined by modified Thrombolysis in Cerebral Infarction (mTICI) grades of 2b or 3. OBJECTIVE: To evaluate the comparative safety and efficacy of mTICI 2b and mTICI 3 reperfusion in AIS patients treated with MT. METHODS: Consecutive ELVO patients who underwent MT at 6 high-volume centers were included in this analysis. Standard safety (3-mo mortality, symptomatic intracranial hemorrhage sICH) and efficacy (absolute and relative reduction in NIHSS-scores during hospitalization, functional-improvement shift analysis in mRS-scores, and functional-independence mRS-scores of 0-2 at 3-mo) were compared between patients who had mTICI 2b and mTICI 3 reperfusion post MT. RESULTS: A total of 416 ELVO patients achieved successful reperfusion with mTICI 2b (n = 216) and mTICI 3 (n = 200) following MT. The mTICI 3 group had significantly (P < .05) greater absolute (11 vs 9 points) and relative (77% vs 63%) reduction in NIHSS-scores during hospitalization, lower sICH (6% vs 12%), and higher 3-mo functional-independence (55% vs 44%) rates. Successful reperfusion with mTICI 3 was independently (P < .05) associated with greater absolute and relative reduction in NIHSS-scores during hospitalization as well as higher odds of 3-mo functional improvement (common odds ratios: 1.67; 95% confidence interval: 1.10-2.56) and functional independence (odds ratio: 2.08; 95% confidence interval: 1.22-3.53) in multivariable regression models adjusting for confounders. CONCLUSION: Successful reperfusion with mTICI 3 was associated with greater neurological improvement during hospitalization and better 3-mo functional outcomes in comparison to mTICI 2b reperfusion.
Goyal et al. (Wed,) conducted a cohort in Acute ischemic stroke with emergent large-vessel occlusions (n=416). mTICI 3 reperfusion vs. mTICI 2b reperfusion was evaluated on 3-month functional independence (mRS scores of 0-2) (OR 2.08, 95% CI 1.22-3.53, p=<.05). Successful reperfusion with mTICI 3 following mechanical thrombectomy was associated with higher 3-month functional independence compared to mTICI 2b (55% vs 44%; OR 2.08, 95% CI 1.22-3.53).