Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2024-11-07 DOI:10.1002/ana.27104

Ameer E. Hassan DO, Michael G. Abraham MD, Spiros Blackburn MD, Muhammad S. Hussain MD, Santiago Ortega-Gutierrez MD, Michael Chen MD, Yin C. Hu MD, Deep K. Pujara MBBS, Nabeel A. Herial MD, Jenny P. Tsai MD, Ronald F. Budzik MD, Nathan W. Manning MBBS, Osman Kozak MD, Ricardo A. Hanel MD, Amin N. Aghaebrahim MD, Chirag D. Gandhi MD, Fawaz Al-Mufti MD, Andrew Cheung MBBS, Bernard Yan MBBS, Peter Mitchell MBBS, Jordi Blasco MD, PhD, Luis San Román Manzanera MD, PhD, Nirav Vora MD, Daniel Gibson MD, Adam Wallace MD, Daniel Sahlein MD, Lucas Elijovich MD, Juan F. Arenillas MD, PhD, Teddy Y. Wu PhD, Pere Cardona Portela MD, Natalia Pérez de la Ossa MD, PhD, Joanna D. Schaafsma MD, PhD, William J Hicks MD, Dennis J Cordato PhD, Navdeep Sangha MD, Steven Warach MD, Timothy J Kleinig PhD, Faris Shaker MBChB, Hannah Johns PhD, Wondwossen Tekle MD, Mark J. Dannenbaum MD, Koji Ebersole MD, Gabor Toth MD, Michael Gooch MD, Abdulnasser Alhajeri MD, Krishna Amuluru MD, Abhishek Ray MD, Jan-Karl Burkhardt MD, Mohammad A. Abdulrazzak MD, David P. Rosenbaum-Halevi MD, Haris Kamal MD, Kelsey R. Duncan MD, Clark W. Sitton MD, Leonid Churilov PhD, Vitor Mendes Pereira MD, Jeffrey Sunshine MD, PhD, Thanh N. Nguyen MD, Johanna T. Fifi MD, Edgar A. Samaniego MD, Adam Arthur MD, Stavropoula Tjoumakaris MD, Pascal Jabbour MD, Stephen M. Davis MD, Lawrence Wechsler MD, Nicholas Bambakidis MD, Scott E. Kasner MD, James C. Grotta MD, Michael D. Hill MD, Bruce C. Campbell MD, Marc Ribo MD, Amrou Sarraj MD, the SELECT2 Trial

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引用次数: 0

Abstract

Endovascular thrombectomy (EVT) was shown to be safe and efficacious in patients with large core stroke in multiple randomized controlled trials. However, the impact of reperfusion and other procedural metrics on EVT outcomes in this population has not been well-characterized.

Methods

From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml).

Results

Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01–2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33–2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96–2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87–0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50–1.10) as compared with stent-retriever first.

Interpretation

Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2025;97:175–184

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再灌注和手术特征与大面积核心卒中血管内血栓切除术结果的关系：SELECT2 试验的子分析。

多项随机对照试验显示，血管内血栓切除术（EVT）对大面积核心卒中患者安全有效。然而，再灌注和其他程序指标对这一人群 EVT 结果的影响尚未得到很好的描述：方法：我们从 SELECT2 试验中评估了再灌注状态、首次治疗效果（1 次治疗中接近完全或完全再灌注[脑梗塞扩大溶栓（eTICI）2c-3]）、手术时间和主要技术（抽吸法 vs 支架截流法）与不同 ASPECTS（3 vs 4 vs 5）和核心估计分层接受 EVT 患者的功能预后之间的关系（结果：在接受血栓切除术的 180 名患者中，144 人（80%）成功实现了再灌注（eTICI 2b-3），并获得了更好的临床疗效（调整后的广义几率比 [aGenOR]：1.48，95% 置信区间 [CI]：1.01-2.15）。不同 ASPECTS 和核心估计分层的结果一致。此外，在成功再灌注的患者中，完全或接近完全再灌注（eTICI 2c-3）与更好的功能预后相关（aGenOR：1.99，95% CI：1.33-2.97）。功能预后点估计值更偏向于首次通过效果的患者（167 例中有 42 例（25%），aGenOR：1.46，95% CI：0.96-2.24）。手术时间越长，改良兰金量表（mRS）分布越差（aGenOR：0.92，95% CI：0.87-0.96，10 分钟增量的 p 值 = 0.001）。154例患者中有43例（25%）采用了抽吸先行技术，与支架截流先行技术相比，抽吸先行技术与更高的再灌注率（88% vs 78%，P = 0.18）或更好的功能预后（aGenOR：0.74，95% CI：0.50-1.10）无关：成功的再灌注改善了基线缺血核心分层大核心患者的临床预后。接近完全或完全再灌注与更好的预后进一步相关，而延长手术时间与更差的预后相关。无论使用哪种技术，结果都是一致的。ann neurol 2024。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.