Effect of first pass reperfusion on outcome in patients with posterior circulation ischemic stroke

被引:18
作者
den Hartog, Sanne J. [1 ,2 ,3 ]
Roozenbeek, Bob [1 ,2 ]
Boodt, Nikki [1 ,2 ,3 ]
Bruggeman, Agnetha A. E. [4 ]
van Es, Adriaan C. G. M. [5 ]
Emmer, Bart J. [4 ]
Majoie, Charles B. L. M. [4 ]
van den Wijngaard, Ido R. [6 ,7 ]
van Doormaal, Pieter Jan [2 ]
van Zwam, Wim H. [8 ]
Lingsma, Hester F. [3 ]
Dippel, Diederik W. J. [1 ]
机构
[1] Univ Med Ctr, Neurol, Erasmus MC, Rotterdam, Netherlands
[2] Univ Med Ctr, Radiol & Nucl Med, Erasmus MC, Rotterdam, Netherlands
[3] Univ Med Ctr, Publ Hlth, Erasmus MC, Rotterdam, Netherlands
[4] Amsterdam UMC Locat AMC, Radiol & Nucl Med, Amsterdam, Netherlands
[5] Leiden Univ Med Ctr, Radiol & Nucl Med, Leiden, Netherlands
[6] Haaglanden Med Ctr, Neurol, The Hague, Netherlands
[7] Leiden Univ Med Ctr, Neurol, Leiden, Netherlands
[8] Maastricht Univ Med Ctr, Radiol & Nucl Med, Maastricht, Netherlands
关键词
stroke; thrombectomy; brain; intervention; STENT RETRIEVER THROMBECTOMY; BASILAR ARTERY-OCCLUSION; ENDOVASCULAR TREATMENT; PREDICTORS;
D O I
10.1136/neurintsurg-2021-017507
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
Background First pass reperfusion (FPR), that is, excellent reperfusion (expanded treatment in cerebral ischemia (eTICI) 2C-3) in one pass, after endovascular treatment (EVT) of an occluded artery in the anterior circulation, is associated with favorable clinical outcome, even when compared with multiple pass excellent reperfusion (MPR). In patients with posterior circulation ischemic stroke (PCS), the same association is expected, but currently unknown. We aimed to assess characteristics associated with FPR and the influence of FPR versus MPR on outcomes in patients with PCS. Methods We used data from the MR CLEAN Registry, a prospective observational study. The effect of FPR on 24-hour National Institutes of Health Stroke Scale (NIHSS) score, as percentage reduction, and on modified Rankin Scale (mRS) scores at 3 months, was tested with linear and ordinal logistic regression models. Results Of 224 patients with PCS, 45 patients had FPR, 47 had MPR, and 90 had no excellent reperfusion (eTICI <2C). We did not find an association between any of the patient, imaging, or treatment characteristics and FPR. FPR was associated with better NIHSS (-45% (95% CI: -65% to -12%)) and better mRS scores (adjusted common odds ratio (acOR): 2.16 (95% CI: 1.23 to 3.79)) compared with no FPR. Outcomes after FPR were also more favorable compared with MPR, but the effect was smaller and not statistically significant (NIHSS: -14% (95% CI: -51% to 49%), mRS acOR: 1.50 (95% CI: 0.75 to 3.00)). Conclusions FPR in patients with PCS is associated with favorable clinical outcome in comparison with no FPR. In comparison with MPR, the effect of FPR was no longer statistically significant. Nevertheless, our data support the notion that FPR should be the treatment target to pursue in every patient treated with EVT.
引用
收藏
页码:333 / 340
页数:8
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