Yu Gao, Minghao Song, Xuan Zhu, Xiaoxi Zhang, Lijun Wang, Hongye Xu, Hongyu Ma, Tianxiang Gao, Hanchen Liu, Rundong Chen, Hongjian Shen, Zifu Li, Pengfei Yang
Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China; Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.
World Neurosurg. 2025 Jun;198:124014. doi: 10.1016/j.wneu.2025.124014. Epub 2025 Apr 30.
To compare functional outcomes between patients achieving good reperfusion (eTICI 2B) after a single pass and those requiring multiple passes to achieve excellent or complete reperfusion (eTICI 2C/3) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).
This single-center retrospective cohort study included 301 AIS patients with large vessel occlusion who underwent MT between January 2018 and December 2022. Patients were categorized into single-pass eTICI 2B (n = 65) and multiple-pass eTICI 2C/3 (2-5 passes, n = 214; >5 passes, n = 22). Functional outcomes were assessed at 90 days using the modified Rankin Scale. Early neurological deterioration, adverse events, and safety outcomes were also analyzed.
No significant difference was observed in a 90-day functional independence between single-pass eTICI 2B and multiple-pass eTICI 2C/3 (47.7% vs. 41.5%, P = 0.39 for 2-5 passes; 27.3% vs. 41.5%, P = 0.24 for >5 passes). However, patients requiring more than 5 passes to achieve eTICI 2C/3 had significantly higher rates of early neurological deterioration (40.9% vs. 18.5%, P = 0.04) and adverse events (63.6% vs. 38.5%, P = 0.04). Mortality rates were similar between groups.
Our study suggests that achieving eTICI 2C/3 through multiple passes does not result in improved functional outcomes compared to single-pass eTICI 2B. Moreover, extended thrombectomy procedures may increase the risk of early neurological deterioration and adverse events, highlighting the need for careful procedural strategy in MT for AIS patients.
比较急性缺血性卒中（AIS）患者接受机械取栓术（MT）时，单次通过实现良好再灌注（eTICI 2B）的患者与需要多次通过以实现优异或完全再灌注（eTICI 2C/3）的患者之间的功能结局。
这项单中心回顾性队列研究纳入了2018年1月至2022年12月期间接受MT的301例大血管闭塞的AIS患者。患者被分为单次通过eTICI 2B组（n = 65）和多次通过eTICI 2C/3组（2 - 5次通过，n = 214；>5次通过，n = 22）。使用改良Rankin量表在90天时评估功能结局。还分析了早期神经功能恶化、不良事件和安全性结局。
单次通过eTICI 2B组和多次通过eTICI 2C/3组在90天时的功能独立性无显著差异（2 - 5次通过时，47.7%对41.5%，P = 0.39；>5次通过时，27.3%对41.5%，P = 0.24）。然而，需要超过5次通过才能实现eTICI 2C/3的患者早期神经功能恶化率（40.9%对18.5%，P = 0.04）和不良事件发生率（63.6%对38.5%，P = 0.04）显著更高。各组之间的死亡率相似。
我们的研究表明，与单次通过eTICI 2B相比，多次通过实现eTICI 2C/3并不会改善功能结局。此外，延长的取栓手术可能会增加早期神经功能恶化和不良事件的风险，凸显了AIS患者MT中谨慎制定手术策略的必要性。
