Mechanical thrombectomy failure in anterior circulation strokes: Outcomes and predictors of favorable outcome.
mechanical thrombectomy
prognosis
recanalization
reperfusion failure
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
05
05
2022
accepted:
18
05
2022
pubmed:
2
6
2022
medline:
9
8
2022
entrez:
1
6
2022
Statut:
ppublish
Résumé
Despite continuous improvement and growing knowledge in the endovascular therapy of large vessel occlusion stroke (LVOS), mechanical thrombectomy (MT) still fails to obtain satisfying intracranial recanalization in 10% to 15% of cases. However, little is known regarding clinical and radiological outcomes among this singularly underexplored subpopulation undergoing failed MT. We aimed to investigate the outcome after failed MT and identify predictive factors of favorable outcome despite recanalization failure. We conducted a retrospective analysis of consecutive patients prospectively included in the ongoing observational multicenter Endovascular Treatment in Ischemic Stroke registry from January 2015 to September 2020. Patients presenting with anterior circulation LVOS treated with MT but experiencing failed intracranial recanalization defined as final modified Thrombolysis In Cerebral Infarction (mTICI) score of 0, 1 and 2a were included. Clinical and radiological outcomes were assessed along with the exploration of predictive factors of Day-90 favorable outcome. The study population comprised 533 patients. Mean age was 68.8 ± 16 years, and median admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were 17 (IQR 12-21) and 7 (IQR 5-8), respectively. Favorable outcomes were observed in 85 patients (18.2%) and 186 died (39.0%). The rate of symptomatic intracranial hemorrhage was 14.1%. In multivariable analysis, younger age (odds ratio [OR] 0.96, 95% CI 0.94-0.98, p < 0.001), a lower admission NIHSS (OR 0.87, 95% CI 0.83-0.91, p < 0.001), a lower number of MT passes (OR 0.77, 95% CI 0.77-0.87, p < 0.001), a lower delta ASPECTS between initial and Day-1 imaging (OR 0.83, 95% CI 0.71-0.98, p = 0.026) and stroke etiology [significant difference among etiological subtypes (p = 0.024) with a tendency toward more favorable outcomes for dissection (OR 2.01, 95% CI 0.71-5.67)] were significantly associated with a 90-day favorable outcome. In this large retrospective analysis of a multicenter registry, we quantified the poor outcome after MT failure. We also identified factors associated with favorable outcome despite recanalization failure that might influence therapeutic management.
Sections du résumé
BACKGROUND AND PURPOSE
Despite continuous improvement and growing knowledge in the endovascular therapy of large vessel occlusion stroke (LVOS), mechanical thrombectomy (MT) still fails to obtain satisfying intracranial recanalization in 10% to 15% of cases. However, little is known regarding clinical and radiological outcomes among this singularly underexplored subpopulation undergoing failed MT. We aimed to investigate the outcome after failed MT and identify predictive factors of favorable outcome despite recanalization failure.
METHODS
We conducted a retrospective analysis of consecutive patients prospectively included in the ongoing observational multicenter Endovascular Treatment in Ischemic Stroke registry from January 2015 to September 2020. Patients presenting with anterior circulation LVOS treated with MT but experiencing failed intracranial recanalization defined as final modified Thrombolysis In Cerebral Infarction (mTICI) score of 0, 1 and 2a were included. Clinical and radiological outcomes were assessed along with the exploration of predictive factors of Day-90 favorable outcome.
RESULTS
The study population comprised 533 patients. Mean age was 68.8 ± 16 years, and median admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were 17 (IQR 12-21) and 7 (IQR 5-8), respectively. Favorable outcomes were observed in 85 patients (18.2%) and 186 died (39.0%). The rate of symptomatic intracranial hemorrhage was 14.1%. In multivariable analysis, younger age (odds ratio [OR] 0.96, 95% CI 0.94-0.98, p < 0.001), a lower admission NIHSS (OR 0.87, 95% CI 0.83-0.91, p < 0.001), a lower number of MT passes (OR 0.77, 95% CI 0.77-0.87, p < 0.001), a lower delta ASPECTS between initial and Day-1 imaging (OR 0.83, 95% CI 0.71-0.98, p = 0.026) and stroke etiology [significant difference among etiological subtypes (p = 0.024) with a tendency toward more favorable outcomes for dissection (OR 2.01, 95% CI 0.71-5.67)] were significantly associated with a 90-day favorable outcome.
CONCLUSIONS
In this large retrospective analysis of a multicenter registry, we quantified the poor outcome after MT failure. We also identified factors associated with favorable outcome despite recanalization failure that might influence therapeutic management.
Identifiants
pubmed: 35648445
doi: 10.1111/ene.15429
pmc: PMC9541042
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2701-2707Investigateurs
Adriana Tabarna
(A)
Adrienter Ter Schiphorst
(A)
Adrien Wang
(A)
Agnès Masson
(A)
Alain Meyer
(A)
Alain Viguier
(A)
Anne Claire Lukaszewicz
(AC)
Anne-Christine Januel
(AC)
Anne-Evelyne Vallet
(AE)
Anne-Laure Derelle
(AL)
Anthony Le Bras
(A)
Arnaud Le Guen
(A)
Arturo Consoli
(A)
Augustin Lecler
(A)
Axelle Maurice
(A)
Aymeric Rouchaud
(A)
Barroso Bruno
(B)
Basile Kerleroux
(B)
Benjamin Daumas-Duport
(B)
Benjamin Gory
(B)
Benjamin Maier
(B)
Benoît Guillon
(B)
Bernady Patricia
(B)
Bertrand Lapergue
(B)
Candice Sabben
(C)
Carlos Riquelme
(C)
Caroline Arquizan
(C)
Catherine Lamy
(C)
Cécile Preterre
(C)
Cédric Lenoble
(C)
Charbel Mounayer
(C)
Charlotte Barbier
(C)
Charlotte Rosso
(C)
Christian Denier
(C)
Christine Rodriguez-Régent
(C)
Christophe Cognard
(C)
Chrysanthi Papagiannaki
(C)
Clément Tracol
(C)
Clothilde Isabel
(C)
Cyril Dargazanli
(C)
Dan Mihoc
(D)
David Higué
(D)
David Weisenburger-Lile
(D)
Delvoye François
(D)
Denis Sablot
(D)
Denis Trystram
(D)
Eimad Shotar
(E)
Emmanuel Touze
(E)
Emmanuelle Schmitt
(E)
Eric Manchon
(E)
Evain Sarah
(E)
Evelyne Massardier
(E)
Fabrice Bonneville
(F)
Fatiha Bechiri
(F)
Federico Cagnazzo
(F)
Federico Di Maria
(F)
Fernando Pico
(F)
Flore Baronnet
(F)
Florent Gariel
(F)
Francis Turjman
(F)
Francisco Macian-Montoro
(F)
François Lun
(F)
Francois Mathias Merrien
(FM)
François Rouanet
(F)
François Zhu
(F)
Frédéric Bourdain
(F)
Frédéric Clarençon
(F)
Frédéric Philippeau
(F)
Gaultier Marnat
(G)
Geoffroy Farouil
(G)
Georges Rodesh
(G)
Géraldine Buard
(G)
Gérard Audibert
(G)
Gioia Mione
(G)
Grégoire Boulouis
(G)
Grégory Gascou
(G)
Guillaume Bellanger
(G)
Guillaume Taylor
(G)
Guillaume Turc
(G)
Haja Rakotoharinandrasana
(H)
Hebert Solène
(H)
Hélène Caillez
(H)
Hélène Raoult
(H)
Hocine Redjem
(H)
Hubert Desal
(H)
Ian Seiler
(I)
Igor Sibon
(I)
Imad Derraz
(I)
Iona Podar
(I)
Ionel Alb
(I)
Irene Pierre-Paul
(I)
Isabelle Mourand
(I)
Isabelle Quintana
(I)
Jean Darcourt
(J)
Jean Papaxanthos
(J)
Jean-Christophe Ferre
(JC)
Jean-Christophe Gentric
(JC)
Jean-Christophe Lacour
(JC)
Jean-François Albucher
(JF)
Jean-Marc Olivot
(JM)
Jean-Philippe Desilles
(JP)
Jean-Sebastien Liegey
(JS)
Jean-Yves Gauvrit
(JY)
Jérôme Berge
(J)
Jildaz Caroff
(J)
Julia Birchenall
(J)
Julie Gratieux
(J)
Julien Cogez
(J)
Julien Ognard
(J)
Julien Pottecher
(J)
Karine Blanc-Lasserre
(K)
Kévin Premat
(K)
Laura Mechtouff
(L)
Laura Venditti
(L)
Laure Bottin
(L)
Laurent Derex
(L)
Laurent Lagoarde-Segot
(L)
Laurent Spelle
(L)
Liang Liao
(L)
Lili Detraz
(L)
Lionel Calviere
(L)
Lisa Humbertjean
(L)
Lisa Papillon
(L)
Louis Fontaine
(L)
Louis Veunac
(L)
Lucas Corti
(L)
Lucas Gorza
(L)
Ludovic Lucas
(L)
Madalina Brezeanu
(M)
Malek Ben Maacha
(MB)
Marc Braun
(M)
Marcela Voicu
(M)
Marie Reitter
(M)
Marion Boulanger
(M)
Marion Yger
(M)
Mathilde Poli
(M)
Matthieu Zuber
(M)
Maxime Gauberti
(M)
Maxime Tardieu
(M)
Maya Tchikviladze
(M)
Mélanie Pinault
(M)
Michel Piotin
(M)
Mikael Mazighi
(M)
Mikael Obadia
(M)
Monica Manisor
(M)
Monica Roy
(M)
Morgan Leguen
(M)
Nader Sourour
(N)
Nadia Ajili
(N)
Nicolas Gaillard
(N)
Nicolas Pangon
(N)
Nicolas Raposo
(N)
Norbert Nighoghossian
(N)
Oguzhan Coskun
(O)
Olivier Chassin
(O)
Olivier Heinzlef
(O)
Olivier Naggara
(O)
Omer Eker
(O)
Ovide Corabianu
(O)
Ozlem Ozkul Wermester
(OO)
Pauline Bourst
(P)
Pauline Renou
(P)
Philippe Smadja
(P)
Philippe Tall
(P)
Philippe Tassan
(P)
Pierre Briau
(P)
Pierre-Henri Lefèvre
(PH)
Pierre-Louis Alexandre
(PL)
Raoul Pop
(R)
Raphael Blanc
(R)
Raynouard Igor
(R)
Regis Hubrecht
(R)
Remy Beaujeux
(R)
René Anxionnat
(R)
Roberto Riva
(R)
Romain Bourcier
(R)
Romain Schneckenburger
(R)
Romain Tonnelet
(R)
Roxana Gheoca
(R)
Roxanna Poll
(R)
Sabine Aptel
(S)
Sabrina Cochennec
(S)
Sabrina Debruxelles
(S)
Sarah Guy
(S)
Savatovsky Julien
(S)
Sebastian Richter
(S)
Sébastien Richard
(S)
Seners Pierre
(S)
Serge Bracard
(S)
Serge Evrard
(S)
Serge Timsit
(S)
Sergio Zimatore
(S)
Serkan Cakmak
(S)
Sharmila Sagnier
(S)
Simon Escalard
(S)
Solène de Gaalon
(S)
Sonia Alamowitch
(S)
Sophie Crozier
(S)
Sophie Guettier
(S)
Sophie Planel
(S)
Stanislas Smajda
(S)
Stéphane Olindo
(S)
Stéphane Vannier
(S)
Stéphanie Desmales
(S)
Stéphanie Lenck
(S)
Suzanna Saleme
(S)
Sylvie Marinier
(S)
Tae-Hee Cho
(TH)
Thiên-Nga Chamaraux-Tran
(TN)
Thion Laurie-Anne
(T)
Thomas de Broucker
(T)
Thomas Ronziere
(T)
Thomas Tourdias
(T)
Tristan Kerdraon
(T)
Valérie Domigo
(V)
Valerie Lauer
(V)
Valérie Wolff
(V)
Vanessa Chalumeau
(V)
Veronica Lassale
(V)
Veronique Quenardelle
(V)
Vincent Costalat
(V)
Vincent Degos
(V)
Wagih Ben Hassen
(WB)
Wassim Farhat
(W)
Xavier Barreau
(X)
Yves Samson Anne Léger
(YSA)
Informations de copyright
© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
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