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?
- Author:
Sameh Samir ELAWADY
1
;
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 JR.
;
Pedro NAVIA
;
Peter KAN
;
Reade De LEACY
;
Shakeel CHOWDHRY
;
Mohamad EZZELDIN
;
Alejandro M. SPIOTTA
;
Sami Al KASAB
;
Author Information
- Publication Type:Original Article
- From:Journal of Stroke 2024;26(1):95-103
- CountryRepublic of Korea
- Language:English
-
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.
