Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
Second Department of Neurology, "Attikon University Hospital," School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Neurosurgery. 2019 Mar 1;84(3):680-686. doi: 10.1093/neuros/nyy097.
Mechanical thrombectomy (MT) is the current standard of care for acute ischemic stroke (AIS) patients with emergent large-vessel occlusions (ELVO). Successful reperfusion of ELVO is traditionally defined by modified Thrombolysis in Cerebral Infarction (mTICI) grades of 2b or 3.
To evaluate the comparative safety and efficacy of mTICI 2b and mTICI 3 reperfusion in AIS patients treated with MT.
Consecutive ELVO patients who underwent MT at 6 high-volume centers were included in this analysis. Standard safety (3-mo mortality, symptomatic intracranial hemorrhage [sICH]) and efficacy (absolute and relative reduction in NIHSS-scores during hospitalization, functional-improvement [shift analysis in mRS-scores], and functional-independence [mRS-scores of 0-2] at 3-mo) were compared between patients who had mTICI 2b and mTICI 3 reperfusion post MT.
A total of 416 ELVO patients achieved successful reperfusion with mTICI 2b (n = 216) and mTICI 3 (n = 200) following MT. The mTICI 3 group had significantly (P < .05) greater absolute (11 vs 9 points) and relative (77% vs 63%) reduction in NIHSS-scores during hospitalization, lower sICH (6% vs 12%), and higher 3-mo functional-independence (55% vs 44%) rates. Successful reperfusion with mTICI 3 was independently (P < .05) associated with greater absolute and relative reduction in NIHSS-scores during hospitalization as well as higher odds of 3-mo functional improvement (common odds ratios: 1.67; 95% confidence interval: 1.10-2.56) and functional independence (odds ratio: 2.08; 95% confidence interval: 1.22-3.53) in multivariable regression models adjusting for confounders.
Successful reperfusion with mTICI 3 was associated with greater neurological improvement during hospitalization and better 3-mo functional outcomes in comparison to mTICI 2b reperfusion.
机械血栓切除术（MT）是目前治疗急性缺血性脑卒中（AIS）伴有紧急大血管闭塞（ELVO）患者的标准治疗方法。传统上，ELVO 的再通成功定义为改良脑梗死溶栓（mTICI）分级 2b 或 3。
评估 MT 治疗 AIS 患者时 mTICI 2b 和 mTICI 3 再通的安全性和疗效。
本分析纳入了在 6 家高容量中心接受 MT 的连续 ELVO 患者。比较 MT 后 mTICI 2b 和 mTICI 3 再通患者的标准安全性（3 个月死亡率、症状性颅内出血[sICH]）和疗效（住院期间 NIHSS 评分的绝对和相对降低、功能改善[在 mRS 评分中的变化分析]和 3 个月时的功能独立[mRS 评分 0-2]）。
416 例 ELVO 患者接受 MT 后成功再通 mTICI 2b（n = 216）和 mTICI 3（n = 200）。mTICI 3 组患者在住院期间 NIHSS 评分的绝对（11 分比 9 分）和相对（77%比 63%）降低幅度更大，sICH（6%比 12%）发生率更低，3 个月时功能独立性（55%比 44%）更高。mTICI 3 再通成功与住院期间 NIHSS 评分的绝对和相对降低幅度更大以及 3 个月时功能改善（共同优势比：1.67；95%置信区间：1.10-2.56）和功能独立（优势比：2.08；95%置信区间：1.22-3.53）的可能性更高独立相关（多变量回归模型校正混杂因素后）。
与 mTICI 2b 再通相比，mTICI 3 再通与住院期间神经功能改善更大以及 3 个月时功能结局更好相关。
