Abstract WP5: Effect of Complete Reperfusion on Outcome in Patients Undergoing Endovascular Therapy For Large Vessel Occlusion Stroke

Abstract

Introduction: We investigated how the degree of reperfusion affects functional outcomes according to the puncture-to-reperfusion time and preoperative condition in patients with acute large vessel occlusion. Methods: A post-hoc analysis of the RESCUE-Japan Registry 2, a prospective multicenter registry enrolling patients with acute cerebral large vessel occlusion from 46 centers in Japan between October 1, 2014 and September 30, 2016, was conducted. Among the 2,420 patients in the RESCUE-Japan 2 registry, 1,073 patients who achieved successful reperfusion with endovascular therapy were analyzed. We compared the functional and safety outcomes between patients with modified thrombolysis in cerebral infarction grades 3 (mTICI-3) and 2b (mTICI-2b). Results: The proportion of patients with favorable outcomes (modified Rankin Scale scores of 0 to 2 at 90 days after onset) was higher among patients with mTICI-3 than among those with mTICI-2b (52% versus 38 %; adjusted OR, 1.96; 95% CI, 1.49-2.56). Compared to those in the patients with mTICI-2b within 30 minutes after puncture, favorable outcomes tended to be more common in patients who achieved mTICI-3 within 90 minutes after puncture (0-29 minutes: adjusted OR, 2.60; 95% CI, 1.24-5.46, 30-59 minutes adjusted OR, 1.65; 95% CI, 0.85-3.21, 60-89 minutes: adjusted OR, 1.61; 95% CI, 0.77-3.37; Figure). mTICI-3 reperfusion was associated with favorable outcomes in both anterior (adjusted OR, 1.81; 95% CI, 1.34-2.44) and posterior vessel occlusion (adjusted OR, 2.40; 95% CI, 1.06-5.44). There was no heterogeneity in the effect of mTICI-3 reperfusion on the outcomes with respect to age, NIHSS score, use of alteplase, late-presenting, distal vessel occlusion, or ASPECTS. Conclusions: mTICI-3 reperfusion, possibly even when reperfusion delays slightly, was superior to mTICI-2b. Achieving complete reperfusion, not only early reperfusion, is important to improve the outcomes regardless of preoperative condition.