Mujanovic Adnan, Windecker Daniel, Cimflova Petra, Meinel Thomas R, Seiffge David J, Auer Elias, Boulouis Grégoire, Arnold Marcel, Serrallach Bettina L, Rohner Roman, Janot Kevin, Dobrocky Tomas, Hill Michael D, Goyal Mayank, Piechowiak Eike I, Gralla Jan, Fischer Urs, Kaesmacher Johannes
Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital (A.M., D.W., P.C., B.L.S., R.R., T.D., E.I.P., J.G., J.K.).
Department of Neuroradiology, University Hospital Freiburg, Germany (P.C.).
Stroke. 2025 Feb;56(2):447-455. doi: 10.1161/STROKEAHA.124.049641. Epub 2024 Nov 20.
A third of endovascularly treated patients with stroke experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction [eTICI] <3), and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed the literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy.
A systematic review of MEDLINE, Embase, and PubMed up until March 1, 2024, using a predefined strategy. Only full-text English-written articles reporting rates of either favorable (ie, delayed reperfusion (DR) or no new infarct) or unfavorable progression (ie, persistent perfusion deficit or new infarct) of incompletely reperfused tissue were included. The primary outcome was the rate of DR and its association with functional independence (modified Rankin Scale score, 0-2) at 90 days postintervention. Pooled odds ratios with 95% CIs were calculated using a random-effects model.
Six studies involving 950 patients (50.7% female; median age, 71 years; interquartile range, 60-79) were included. Four studies assessed the evolution of incomplete reperfusion on magnetic resonance imaging perfusion imaging, while 2 studies used diffusion-weighted imaging and noncontrast computed tomography imaging, where new infarct was used to denote unfavorable progression. Five studies defined incomplete reperfusion as eTICI 2b50 or 2c. DR occurred in 41% (interquartile range, 33%-51%) of cases 24 hours postintervention. Achieving DR was associated with a higher likelihood of functional independence at 90 days (odds ratio, 2.5 [95% CI, 1.9-3.4]).
Nearly half of eTICI <3 patients achieve DR, leading to favorable clinical outcomes. This subgroup may derive limited or potentially harmful effects from pursuing additional reperfusion strategies (eg, intra-arterial lytics or secondary thrombectomy). Accurately predicting the evolution of incomplete reperfusion could optimize patient selection for adjunctive reperfusion strategies at the end of an intervention.
URL: https://www.clinicaltrials.gov; Unique identifiers: NCT05499832.
三分之一接受血管内治疗的中风患者经历不完全再灌注（扩展脑梗死溶栓 [eTICI]<3），这种不完全再灌注的自然演变仍不清楚。我们系统回顾了文献，并对血管内治疗后不完全再灌注的自然演变进行了荟萃分析。
使用预定义策略，对截至2024年3月1日的MEDLINE、Embase和PubMed进行系统回顾。仅纳入报告不完全再灌注组织的良好（即延迟再灌注 [DR] 或无新梗死）或不良进展（即持续灌注缺损或新梗死）发生率的英文全文文章。主要结局是DR的发生率及其与干预后90天功能独立性（改良Rankin量表评分，0-2）的关联。使用随机效应模型计算合并优势比及95%置信区间。
纳入6项研究，共950例患者（女性占50.7%；中位年龄71岁；四分位间距，60-79岁）。4项研究通过磁共振成像灌注成像评估不完全再灌注的演变，2项研究使用扩散加权成像和非增强计算机断层扫描成像，其中新梗死用于表示不良进展。5项研究将不完全再灌注定义为eTICI 2b50或2c。干预后24小时，41%（四分位间距，33%-51%）的病例发生DR。实现DR与90天时功能独立的可能性更高相关（优势比，2.5 [95%置信区间，1.9-3.4]）。
近一半eTICI<3的患者实现DR，带来良好的临床结局。该亚组患者采用额外的再灌注策略（如动脉内溶栓或二次血栓切除术）可能产生有限或潜在有害的影响。准确预测不完全再灌注的演变可优化干预结束时辅助再灌注策略的患者选择。
