Title :

Modified thrombolysis in cerebral infarction 2c/thrombolysis in cerebral infarction 3 reperfusion should be the aim of mechanical thrombectomy: insights from the aster trial (contact aspiration versus stent retriever for successful revascularization)

Author(s) :

Dargazanli, Cyril [Auteur]
CHU Montpellier
Fahed, Robert [Auteur]
Blanc, Raphael [Auteur]
Gory, Benjamin [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Labreuche, Julien [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Duhamel, Alain [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Marnat, Gaultier [Auteur]
Saleme, Suzana [Auteur]
Costalat, Vincent [Auteur]
Bracard, Serge [Auteur]
Desal, Hubert [Auteur]
Mazighi, Mikael [Auteur]
Consoli, Arturo [Auteur]
Piotin, Michel [Auteur]
Lapergue, Bertrand [Auteur]

Journal title :

Stroke

Abbreviated title :

Stroke

Volume number :

49

Pages :

1189–1196

Publisher :

American Heart Association

Publication date :

2018-04-06

ISSN :

1524-4628

English keyword(s) :

aspiration
thrombectomy
reperfusion
stent retriever
stroke
cerebral infarction

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Although successful reperfusion is usually defined as a modified Thrombolysis in Cerebral Infarction (mTICI) 2B or 3 at the end of the procedure, studies have shown that mTICI 2B patients had poorer functional outcomes ...
Show more >Although successful reperfusion is usually defined as a modified Thrombolysis in Cerebral Infarction (mTICI) 2B or 3 at the end of the procedure, studies have shown that mTICI 2B patients had poorer functional outcomes than TICI 3 patients. An mTICI 2C category has been recently introduced for patients with near-complete perfusion except for slow flow in a few distal cortical vessels or presence of small distal cortical emboli after mechanical thrombectomy. The purpose of this study was to evaluate the difference in functional outcome between patients achieving successful reperfusion (ie, mTICI 2B, mTICI 2C, and TICI 3 scores). Ancillary study from the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) prospective multicenter blinded end point trial. Reperfusion results are reported as the mTICI score, including the mTICI 2C grade. Primary outcome was the percentage of patients with favorable outcome defined as a 90-day modified Rankin Scale score of 0 to 2. Two hundred ninety patients with successful reperfusion (mTICI ≥2B), harboring ischemic stroke secondary to occlusion of the anterior circulation within 6 hours of onset of symptoms, undergoing mechanical thrombectomy by contact aspiration or stent retriever were included. Favorable outcome (pre-specified as primary outcome of this ancillary study) did not differ significantly between the 3 reperfusion grades, with a similar positive effect of 2C (odds ratio, 1.71; 95% confidence interval, 0.98-3.00) and 3 (odds ratio, 1.73; 95% confidence interval, 0.88-3.41) grades compared with 2B grade. After combining grades 2C and 3, patients had a significantly higher rate of favorable outcome than patients with 2B (odds ratio, 1.72; 95% confidence interval, 1.01-2.90; P Combining mTICI 2C and TICI 3 grades helps to determine a subgroup of patients achieving better functional outcomes than mTICI 2B patients. Achieving mTICI 2C/3 reperfusion should be the new aim of mechanical thrombectomy for anterior circulation LVO.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T18:18:14Z
2024-03-20T11:41:26Z