AI Article Synopsis
- - The study aimed to identify patient-specific predictors of successful recanalization during mechanical thrombectomy for M2 occlusions in acute ischemic stroke, as previous research had primarily focused on larger vessel occlusions.
- - Using data from the German Stroke Registry, 1,294 patients with isolated M2 occlusions were analyzed, finding that general anesthesia was positively associated with successful recanalization, while factors like older age, higher pre-stroke disability, and diabetes increased the likelihood of futile recanalization.
- - Key findings indicated that success rates varied, with 49.7% achieving complete recanalization, and it was noted that certain procedural and patient demographics could significantly influence outcomes, particularly in terms of functional recovery measured by the modified
Article Abstract
Background: Patient-specific factors associated with successful recanalization in mechanical thrombectomy (MT) have been evaluated for acute ischemic stroke with large vessel occlusion. However, MT for M2 occlusions is still a matter of debate, and predictors of successful and futile recanalization have not been assessed in detail. We sought to identify predictors of recanalization success in patients with M2 occlusions undergoing MT based on large-scale clinical data.
Methods: All patients prospectively enrolled in the German Stroke Registry (May, 2015 to December, 2021) were screened (N=13 082). Inclusion criteria for the complete case analysis were isolated M2 occlusions. Standard descriptive statistics and multivariable logistic regression analysis were used to identify factors associated with successful recanalization (Thrombolysis in Cerebral Infarction [TICI]≥2b), complete recanalization (TICI=3) and futile recanalization (TICI≥2b with 90-day modified Rankin Scale [mRS] score >2).
Results: One thousand two hundred ninety-four patients were included, thereof 439 (33.9%) with TICI=2b and 643 (49.7%) with TICI=3. Five hundred sixty-nine (44%) patients had good functional outcome (90-day mRS score ≤2). In multivariable logistic regression, general anesthesia (adjusted odds ratio [aOR], 1.47 [95% CI, 1.05-2.09]; <0.05) was associated with higher probability of TICI≥2b while intraprocedural change from local to general anesthesia (aOR, 0.49 [0.26-0.95]; <0.05) and higher pre-mRS (aOR, 0.75 [0.67-0.85]; <0.001) lowered probability of successful recanalization. Futile recanalization was associated with higher age (aOR, 1.05 [1.04-1.07]; <0.001), higher prestroke mRS (aOR, 3.12 [2.49-3.91]; <0.001), higher NIHSS at admission (aOR, 1.11 [1.08-1.14]; <0.001), diabetes (aOR, 1.96 [1.38-2.8]; <0.001), higher number of passes (aOR, 1.29 [1.14-1.46]; <0.001), and adverse events (aOR, 1.82 [1.2-2.74]; <0.01). Higher Alberta Stroke Program Early CT Score (aOR, 0.85 [0.76-0.94]; <0.01) and IV thrombolysis (aOR, 0.71 [0.52-0.97]; <0.05) reduced risk of futile recanalization.
Conclusions: In patients with M2 occlusions, successful recanalization was significantly associated with general anesthesia and low prestroke mRS, while intraprocedural change from conscious sedation to general anesthesia increased risk of unsuccessful recanalization, presumably caused by difficult anatomy and movement of patients in these cases. Futile recanalization was associated with severe prestroke mRS, comorbidity diabetes, number of passes and adverse events during treatment. IV thrombolysis reduced the risk of futile recanalization.
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| http://dx.doi.org/10.1161/STROKEAHA.123.043285 | DOI Listing |
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Article Synopsis
- Researchers aimed to create and validate a prediction score for futile recanalization (FR) in patients with low Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) who underwent endovascular thrombectomy (EVT) for large vessel occlusions (LVO).
- The study analyzed data from 219 patients with anterior circulation LVO and identified key predictors of FR, resulting in the development of the SNAP score, which considers factors like the site of occlusion and patient age.
- The SNAP score successfully predicted FR with an area under the curve of 0.79 in both training and validation cohorts, indicating its potential usefulness for guiding expectations in patients undergoing EVT for severe strokes.
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