Department of Neurology, The First Hospital of Jilin University, Xinmin Street 1#, Changchun 130021, China.
Department of Neurology, The First Hospital of Jilin University, Xinmin Street 1#, Changchun 130021, China.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105335. doi: 10.1016/j.jstrokecerebrovasdis.2020.105335. Epub 2020 Sep 29.
Modified Thrombolysis in Cerebral Infarction (mTICI)2b/3 has been considered the criterion for successful reperfusion in endovascular treatment. This study aimed to compare the therapeutic safety and efficacy of mTICI2b and mTICI3 recanalization, and to analyze the factors related to outcomes in everyday clinical practice.
This is a single-center retrospective analysis of 224 patients who underwent successful thrombectomy (achieving a mTICI score ≥2b). The primary outcomes included a modified Rankin score (mRS) of 0-2 at 90-day, mortality, and symptomatic intracranial hemorrhage.
A total of 111 patients achieved mTICI2b status (49.6%), and 113 achieved mTICI3 status (50.4%). The comparison between mTICI2b and 3 reperfusions showed no differences in short-term outcomes, 90-day mRS, complications, and mortality. There was a trend toward more passes in mTICI2b patients, although the difference was not significant. The univariate analysis showed that poor outcomes after endovascular treatment were associated with older age, previous history of coronary heart disease, atrial fibrillation, diabetes, tandem occlusions, high National Institutes of Health Stroke Scale (NIHSS) score on admission, and general anesthesia. A previous history of coronary heart disease, a high NIHSS score on admission, and the use of general anesthesia were independent factors that affected the therapeutic effects.
The superiority (efficacy and safety) of mTICI3 reperfusion was not significant compared with that of mTICI2b reperfusion. Prolonged efforts to achieve mTICI3 after achieving mTICI2b should be considered prudently for those with difficulty achieving 100% reperfusion.
改良脑梗死溶栓（mTICI）2b/3 已被认为是血管内治疗中再通成功的标准。本研究旨在比较 mTICI2b 和 mTICI3 再通的治疗安全性和疗效，并分析日常临床实践中与结局相关的因素。
这是一项单中心回顾性分析，纳入了 224 例成功接受血栓切除术（达到 mTICI 评分≥2b）的患者。主要结局包括 90 天改良 Rankin 评分（mRS）为 0-2、死亡率和症状性颅内出血。
共有 111 例患者达到 mTICI2b 状态（49.6%），113 例患者达到 mTICI3 状态（50.4%）。mTICI2b 和 3 再通之间的短期结局、90 天 mRS、并发症和死亡率无差异。尽管差异无统计学意义，但 mTICI2b 患者的再通次数更多。单因素分析显示，血管内治疗后预后不良与年龄较大、既往冠心病史、心房颤动、糖尿病、串联闭塞、入院时国立卫生研究院卒中量表（NIHSS）评分较高和全身麻醉有关。既往冠心病史、入院时 NIHSS 评分较高和全身麻醉的使用是影响治疗效果的独立因素。
与 mTICI2b 再通相比，mTICI3 再通的优势（疗效和安全性）并不显著。对于那些难以达到 100%再通的患者，应谨慎考虑在达到 mTICI2b 后进一步努力实现 mTICI3。
