Cimflova Petra, Ospel Johanna M, Singh Nishita, Marko Martha, Kashani Nima, Mayank Arnuv, Demchuk Andrew, Menon Bijoy, Poppe Alexandre Y, Nogueira Raul, McTaggart Ryan, Rempel Jeremy L, Tymianski Michael, Hill Michael D, Almekhlafi Mohammed A, Goyal Mayank
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
Interv Neuroradiol. 2024 Dec;30(6):804-811. doi: 10.1177/15910199241288874. Epub 2024 Oct 14.
We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial.
Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0-2], excellent outcome (90-day mRS0-1), isolated subarachnoid hemorrhage, symptomatic hemorrhage (sICH) on follow-up imaging, and death were compared across different levels of reperfusion defined by expanded Treatment in Cerebral Infarction (eTICI) Scale. Comparisons were also made between patients with (a) first-pass eTICI 2c3 reperfusion vs multiple-pass eTICI 2c3; (b) final eTICI 2b reperfusion vs eTICI 2b converted-to-eTICI 2c3; (c) sudden reperfusion vs gradual reperfusion if >1 pass was required. Multivariable logistic regression was used to test associations of reperfusion grade and clinical outcomes.
Of 1037 included patients, final eTICI 0-1 was achieved in 46 (4.4%), eTICI 2a in 76 (7.3%), eTICI 2b in 424 (40.9%), eTICI 2c in 284 (27.4%), and eTICI 3 in 207 (20%) patients. The odds for good and excellent clinical outcome gradually increased with improved reperfusion grades (adjOR ranging from 5.7-29.3 and 4.3-17.6) and decreased for sICH and death. No differences in outcomes between first-pass versus multiple-pass eTICI 2c3, eTICI 2b converted-to-eTICI 2c3 versus unchanged eTICI 2b and between sudden versus gradual eTICI 2c3 reperfusion were observed.
Better reperfusion degrees significantly improved clinical outcomes and reduced mortality, independent of the number of passes and whether eTICI 2c3 was achieved suddenly or gradually.
在ESCAPE NA1试验中，我们评估了再灌注质量和不同再灌注模式与临床及影像学结局之间的关联。
数据来自ESCAPE-NA1试验。比较了根据扩展脑梗死治疗（eTICI）量表定义的不同再灌注水平下的良好临床结局[90天改良Rankin量表（mRS）0 - 2]、优异结局（90天mRS 0 - 1）、孤立性蛛网膜下腔出血、随访影像学上的症状性出血（sICH）和死亡情况。还对以下患者进行了比较：（a）首次通过eTICI 2c3再灌注与多次通过eTICI 2c3；（b）最终eTICI 2b再灌注与eTICI 2b转变为eTICI 2c3；（c）如果需要超过1次通过，则比较突然再灌注与逐渐再灌注。采用多变量逻辑回归来检验再灌注等级与临床结局之间的关联。
在纳入的1037例患者中，46例（4.4%）实现了最终eTICI 0 - 1，76例（7.3%）实现了eTICI 2a，424例（40.9%）实现了eTICI 2b，284例（27.4%）实现了eTICI 2c，207例（20%）实现了eTICI 3。良好和优异临床结局的几率随着再灌注等级的改善而逐渐增加（调整后的比值比范围为5.7 - 29.3和 cuatro - 17.6），而sICH和死亡的几率则降低eTICI 2c3、eTICI 2b转变为eTICI 2c3与未改变的eTICI 2b之间以及突然与逐渐eTICI 2c3再灌注之间，未观察到结局差异。
更好的再灌注程度显著改善了临床结局并降低了死亡率，与通过次数以及是否突然或逐渐实现eTICI 2c3无关。
