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KMID : 1142120240260010095
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Journal of Stroke
2024 Volume.26 No. 1 p.95 ~ p.103
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Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?
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Sameh Samir Elawady
Brian Fabian Saway
Hidetoshi Matsukawa
Kazutaka Uchida
Steven Lin
Ilko Maier
Pascal Jabbour
Kim Joon-Tae
Stacey Quintero Wolfe
Ansaar Rai
Robert M. Starke
Marios-Nikos Psychogios
Edgar A Samaniego
Adam Arthur
Shinichi Yoshimura
Hugo Cuellar
Jonathan A. Grossberg
Daniele G. Romano
Omar Tanweer
Justin Mascitelli
Isabel Fragata
Adam Polifka
Joshua Osbun
Roberto Crosa
Charles Matouk
Min S. Park
Michael R. Levitt
Waleed Brinjikji
Mark Moss
Travis Dumont
Richard Williamson Jr.
Pedro Navia
Peter Kan
Reade De Leacy
Shakeel Chowdhry
Mohamad Ezzeldin
Alejandro M. Spiotta
Sami Al Kasab
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Abstract
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Background and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2?5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT.
Methods This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke.
Results Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0?3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18?4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07?4.41; P=0.04).
Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.
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KEYWORD
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Alberta Stroke Program Early Computed Tomography Score, Modified Thrombolysis in Cerebral Infarction, Recanalization, Stroke, Thrombectomy
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