Abstract
AimIn acute large vessel occlusions, endovascular therapy (EVT) achieves flow restoration in the majority of cases; however, EVT fails to achieve sufficient reperfusion in a substantial minority of patients. This study aimed to identify predictors of failed reperfusion.MethodsIn this study 2211 patients from the German Stroke Registry who received EVT for anterior circulation stroke were retrospectively analyzed. Failure of reperfusion was defined as thrombolysis in cerebral infarction (TICI) grades 0/1/2a, and sufficient reperfusion as TICI 2b/3. In 1629 patients with complete datasets, associations between failure of reperfusion and baseline clinical data, comorbidities, location of occlusion, and procedural data were assessed with multiple logistic regression.ResultsFailure of reperfusion occurred in 371 patients (16.8%) and was associated with the following locations of occlusion: cervical internal carotid artery (ICA, adjusted odds ratio, OR 2.01, 95% confidence interval, CI 1.08–3.69), intracranial ICA without carotid T occlusion (adjusted OR 1.79, 95% CI 1.05–2.98), and M2 segment (adjusted OR 1.86, 95% CI 1.21–2.84). Failed reperfusion was also associated with cervical ICA stenosis (>70% stenosis, adjusted OR 2.90, 95% CI 1.69–4.97), stroke of other determined etiology by TOAST (Trial of ORG 10172 in acute stroke treatment) criteria (e.g. nonatherosclerotic vasculopathies, adjusted OR 2.73, 95% CI 1.36–5.39), and treatment given outside the usual working hours (adjusted OR 1.41, 95% CI 1.07–1.86). Successful reperfusion was associated with higher Alberta stroke program early CT score (ASPECTS) on initial imaging (adjusted OR 0.85, 95% CI 0.79–0.92), treatment with the patient under general anesthesia (adjusted OR 0.72, 95% CI 0.54–0.96), and concomitant ICA stenting in patients with ICA stenosis (adjusted OR 0.20, 95% CI 0.11–0.38).ConclusionSeveral factors are associated with failure of reperfusion, most notably occlusions of the proximal ICA and low ASPECTS on admission. Conversely, stent placement in the proximal ICA was associated with reperfusion success.
Highlights
Data AcquisitionEndovascular therapy (EVT) has become established as the standard of care in acute stroke due to large vessel occlusions and leads to sufficient reperfusion in the majority of cases [1]; endovascular therapy (EVT) fails to achieve sufficient reperfusion in a substantial minority of anywhere between 12–41% of patients [1, 2].Reasons for reperfusion failure have been investigated in single center studies on a procedural level and have been classified into technical obstacles in reaching the occlusion site vs. failure to remove the clot [3, 4]
Several factors are associated with failure of reperfusion, most notably occlusions of the proximal ICA and low Alberta stroke program early computed tomography (CT) score (ASPECTS) on admission
A negative association with reperfusion failure was found for initial higher ASPECTS, treatment with the patient under general anesthesia, con
Summary
Data AcquisitionEndovascular therapy (EVT) has become established as the standard of care in acute stroke due to large vessel occlusions and leads to sufficient reperfusion in the majority of cases [1]; EVT fails to achieve sufficient reperfusion in a substantial minority of anywhere between 12–41% of patients [1, 2].Reasons for reperfusion failure have been investigated in single center studies on a procedural level (e.g. analyzing anatomical and technical difficulties) and have been classified into technical obstacles in reaching the occlusion site vs. failure to remove the clot [3, 4]. Endovascular therapy (EVT) has become established as the standard of care in acute stroke due to large vessel occlusions and leads to sufficient reperfusion in the majority of cases [1]; EVT fails to achieve sufficient reperfusion in a substantial minority of anywhere between 12–41% of patients [1, 2]. EVT failure has been found to be associated with advanced patient age and distal occlusions [4]. It is unknown which other factors could be associated with reperfusion failure in EVT. It was hypothesized that predictors of failed reperfusion could be identified using a large multicenter cohort of EVT patients, which includes baseline clinical data, admission imaging, location of occlusion, time of treatment, and thrombectomy technique
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