World neurosurgery

1878-87691252019MayWorld neurosurgeryWorld NeurosurgComplete Recanalization May Exert the Most Important Effect on Outcomes of Endovascular Treatment in Acute Ischemic Stroke with Small Infarct Core Beyond 6 Hours.e544e551e544-e55110.1016/j.wneu.2019.01.131S1878-8750(19)30231-1To explore the differences among grades of recanalization on outcomes of endovascular treatment for acute anterior large vessel occlusion with small infarct core beyond the 6-hour time window.Patients beyond the 6-hour time window with Alberta Stroke Program Early Computed Tomography Score >7 were retrospectively enrolled from the endovascular treatment for acute anterior circulation ischemic stroke (ACTUAL) registry. They were divided into 3 groups according to the degree of recanalization: modified treatment in cerebral infarction (mTICI) 0-2a, 2b, and 3. We compared the differences of outcomes among groups on modified Rankin Scale score at 90 days, symptomatic intracerebral hemorrhage within 72 hours, and mortality.A total of 101 patients were enrolled. Median time from onset to groin puncture was 415 minutes (interquartile range: 387-497 minutes). Favorable functional outcomes were significantly better in patients with successful recanalization than in patients with failed recanalization (mTICI 0-2a, 22.7% [5/22]; mTICI 2b, 48.0% [12/25]; and mTICI 3, 61.1% [33/54]; trend P = 0.01). Complete recanalization (mTICI 3) (odds ratio, 5.34; 95% confidence interval, 1.71-16.66; P = 0.004) was associated with good functional outcome. Mortality was different among groups at 90 days (mTICI 0-2a, 36.4% [8/22]; mTICI 2b, 0, [0/25]; P = 0.001; mTICI 0-2a, 36.4% [8/22]; mTICI 3, 9.3% [5/54]; P = 0.008; and mTICI 2b, 0, [0/25]; mTICI 3, 9.3% [5/54]; P = 0.173). There were no significant differences of symptomatic intracranial hemorrhage among groups (mTICI 0-2a, 22.7% [5/22]; mTICI 2b, 12.0% [3/25]; and mTICI 3, 9.3% [5/54]; P = 0.28).For acute anterior circulation stroke patients, who were beyond the 6-hour time window, yet with small ischemic core, complete recanalization following endovascular treatment may play the most important role on clinical outcome.Copyright © 2019 Elsevier Inc. All rights reserved.YangDongDDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.GengYuYDepartment of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.ZhangMengMDepartment of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China.LinMinMDepartment of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian Province, China.ShiZhonghuaZDepartment of Neurosurgery, The 101st Hospital of The People's Liberation Army, Wuxi, Jiangsu, China.ZiWenjieWDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.HaoYonggangYDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China; Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.WangHuaimingHDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China; Department of Neurology, The 89th Hospital of The People's Liberation Army, Weifang, Shandong Province, China.LiuWenhuaWDepartment of Neurology, Wuhan No. 1 Hospital, Wuhan, Hubei, China.WangWeiWDepartment of Radiology, The First People's Hospital of Yangzhou, Yangzhou University, Yangzhou, Jiangsu, China.XuGelinGDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.XiongYunyunYDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.LiuXinfengXDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China. Electronic address: xfliu2@vip.163.com.ACTUAL InvestigatorsengJournal Article20190201