Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results.

Brain Ischemia / diagnostic imaging Endovascular Procedures / methods Humans Ischemic Stroke Prospective Studies Registries Reperfusion / methods Stroke / diagnostic imaging Thrombectomy / methods Treatment Outcome

stroke thrombectomy

Journal

Journal of neurointerventional surgery

ISSN: 1759-8486

Titre abrégé: J Neurointerv Surg

Pays: England

ID NLM: 101517079

Informations de publication

Date de publication:
May 2022

Historique:

received: 06 02 2021

accepted: 13 05 2021

pubmed: 29 5 2021

medline: 15 4 2022

entrez: 28 5 2021

Statut: ppublish

Résumé

The predictors of successful reperfusion and the effect of reperfusion after endovascular treatment (EVT) for M2 occlusions have not been well studied. We aimed to identify predictors of successful reperfusion and the effect of reperfusion on outcomes of EVT for M2 occlusions in current practice. Patients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0-2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram. A total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p<0.01). Admission NIHSS score was the only predictor of successful reperfusion. First-line strategy was not a predictor of successful reperfusion or favorable outcome, but the use of a stent retriever, alone or with an aspiration catheter, was associated with higher rates of procedural complications and 90-day mortality. Successful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Patients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0-2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram.

RESULTS RESULTS

A total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p<0.01). Admission NIHSS score was the only predictor of successful reperfusion. First-line strategy was not a predictor of successful reperfusion or favorable outcome, but the use of a stent retriever, alone or with an aspiration catheter, was associated with higher rates of procedural complications and 90-day mortality.

CONCLUSIONS CONCLUSIONS

Successful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.

Identifiants

DOI: 10.1136/neurintsurg-2021-017380 PMID: 34045317

pubmed: 34045317

pii: neurintsurg-2021-017380

doi: 10.1136/neurintsurg-2021-017380

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Investigateurs

Michel Piotin (M)

Raphael Blanc (R)

Hocine Redjem (H)

Simon Escalard (S)

Jean-Philippe Dessilles (JP)

François Delvoye (F)

Stanislas Smajda (S)

Benjamin Maier (B)

Hebert Solène (H)

Mikael Mazighi (M)

Mikael Obadia (M)

Candice Sabben (C)

Pierre Seners (P)

Igor Raynouard (I)

Ovide Corabianu (O)

Thomas de Broucker (T)

Eric Manchon (E)

Guillaume Taylor (G)

Malek Ben Maacha (MB)

Laurie-Anne Thion (LA)

Augustin Lecler (A)

Julien Savatovsjy (J)

Adrien Wang (A)

Serge Evrard (S)

Maya Tchikviladze (M)

Nadia Ajili (N)

Bertrand Lapergue (B)

David WeisenburgerLile (D)

Lucas Gorza (L)

Géraldine Buard (G)

Oguzhan Coskun (O)

Arturo Consoli (A)

Federico Di Maria (FD)

Georges Rodesh (G)

Sergio Zimatore (S)

Morgan Leguen (M)

Julie Gratieux (J)

Fernando Pico (F)

Haja Rakotoharinandrasana (H)

Philippe Tassan (P)

Roxanna Poll (R)

Sylvie Marinier (S)

Gaultier Marnat (G)

Florent Gariel (F)

Xavier Barreau (X)

Jérôme Berge (J)

Patrice Menegon (P)

Igor Sibon (I)

Ludovic Lucas (L)

Stéphane Olindo (S)

Pauline Renou (P)

Sharmila Sagnier (S)

Mathilde Poli (M)

Sabrina Debruxelles (S)

François Rouanet (F)

Thomas Tourdias (T)

Jean-Sebastien Liegey (JS)

Pierre Briau (P)

Nicolas Pangon (N)

Romain Bourcier (R)

Lili Detraz (L)

Benjamin Daumas-Duport (B)

Pierre-Louis Alexandre (PL)

Monica Roy (M)

Cédric Lenoble (C)

Hubert Desal (H)

Benoît Guillon (B)

Solènede Gaalon (S)

Cécile Preterre (C)

Benjamin Gory (B)

Serge Bracard (S)

René Anxionnat (R)

Marc Braun (M)

Anne-Laure Derelle (AL)

Romain Tonnelet (R)

Liang Liao (L)

François Zhu (F)

Emmanuelle Schmitt (E)

Sophie Planel (S)

Sébastien Richard (S)

Lisa Humbertjean (L)

Gioia Mione (G)

Jean-Christophe Lacour (JC)

Nolwenn Riou-Comte (N)

Gérard Audibert (G)

Marcela Voicu (M)

Lionel Alb (L)

Marie Reitter (M)

Madalina Brezeanu (M)

Agnès Masson (A)

Adriana Tabarna (A)

Iona Podar (I)

Sarah Guy (S)

Fatiha Bechiri (F)

Francisco Macian-Montoro (F)

Suzanna Saleme (S)

Charbel Mounayer (C)

Aymeric Rouchaud (A)

Laetitia Gimenez (L)

Alexandre Cosnard (A)

Vincent Costalat (V)

Caroline Arquizan (C)

Cyril Dargazanli (C)

Grégory Gascou (G)

Pierre-Henri Lefèvre (PH)

Imad Derraz (I)

Carlos Riquelme (C)

Nicolas Gaillard (N)

Isabelle Mourand (I)

Lucas Corti (L)

Federico Cagnazzo (F)

Adrienter Schiphorst (A)

Francois Eugene (F)

Stéphane Vannier (S)

Jean-Christophe Ferre (JC)

Hélène Raoult (H)

Thomas Ronziere (T)

Maria Lassale (M)

Christophe Paya (C)

Jean-Yves Gauvrit (JY)

Clément Tracol (C)

Sophie Langnier-Lemercier (S)

Axelle Maurice (A)

Sabrina Cochennec (S)

Mélanie Pinault (M)

Eimad Shotar (E)

Nader Sourour (N)

Stéphanie Lenck (S)

Kévin Premat (K)

Yves Samson Anne Léger (YSA)

Sophie Crozier (S)

Flore Baronnet (F)

Sonia Alamowitch (S)

Laure Bottin (L)

Mathon Yger (M)

Vincent Degos (V)

Laurent Spelle (L)

Christian Denier (C)

Olivier Chassin (O)

Vanessa Chalumeau (V)

Jildaz Caroff (J)

Olivier Chassin (O)

Laura Venditti (L)

Mariana Sarov (M)

Nicolas Legris (N)

Olivier Naggara (O)

Wagih Ben Hassen (WB)

Grégoire Boulouis (G)

Christine Rodriguez-Régent (C)

Denis Trystram (D)

Basile Kerleroux (B)

Guillaume Turc (G)

Pierre Seners (P)

Valérie Domigo (V)

Catherine Lamy (C)

Julia Birchenall (J)

Clothilde Isabel (C)

François Lun (F)

Alain Viguier (A)

Christophe Cognard (C)

Anne Christine Januel (AC)

Jean-Marc Olivot (JM)

Louis Fontaine (L)

Nicolas Raposo (N)

Fabrice Bonneville (F)

Jean François Albucher (JF)

Lionel Calviere (L)

Jean Darcourt (J)

Guillaume Bellanger (G)

Philippe Tall (P)

Emmanuel Touze (E)

Charlotte Barbier (C)

Romain Schneckenburger (R)

Marion Boulanger (M)

Julien Cogez (J)

Sophie Guettier (S)

Maxime Gauberti (M)

Serge Timsit (S)

Jean-Christophe Gentric (JC)

Julien Ognard (J)

Francois Mathias Merrien (FM)

OzlemOzku Wermester (O)

Evelyne Massardier (E)

Chrysanthi Papagiannaki (C)

Aude Triquenot (A)

Margeaux Lefebvre (M)

Frédéric Bourdain (F)

Patricia Bernady (P)

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Hélène Cailliez (H)

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Valerie Lauer (V)

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Irene Pierre-Paul (I)

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Remy Beaujeux (R)

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Julien Pottecher (J)

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Thiên-Nga Chamaraux-Tran (TN)

Anthony Le Bras (AL)

Sarah Evain (S)

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Informations de copyright

Déclaration de conflit d'intérêts

Competing interests: BL reports grants from Stryker, Penumbra, and Microvention.