Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Springer Science and Business Media LLC - 2021
Fabian Flottmann1, Gabriel Broocks, Tobias D. Faizy1, Rosalie McDonough1, Lucas Watermann1, Milani Deb‐Chatterji1, Götz Thomalla2, Moriz Herzberg2, Christian H. Nolte3, Jens Fiehler4, Hannes Leischner1, Caspar Brekenfeld1, Gsr investigators1
1Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Haus Ost 22 (O 22), Martinistr. 52, 20246, Hamburg, Germany
2Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
3Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
4Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany

Tóm tắt

Abstract Aim In acute large vessel occlusions, endovascular therapy (EVT) achieves flow restoration in the majority of cases; however, EVT fails to achieve sufficient reperfusion in a substantial minority of patients. This study aimed to identify predictors of failed reperfusion. Methods In this study 2211 patients from the German Stroke Registry who received EVT for anterior circulation stroke were retrospectively analyzed. Failure of reperfusion was defined as thrombolysis in cerebral infarction (TICI) grades 0/1/2a, and sufficient reperfusion as TICI 2b/3. In 1629 patients with complete datasets, associations between failure of reperfusion and baseline clinical data, comorbidities, location of occlusion, and procedural data were assessed with multiple logistic regression. Results Failure of reperfusion occurred in 371 patients (16.8%) and was associated with the following locations of occlusion: cervical internal carotid artery (ICA, adjusted odds ratio, OR 2.01, 95% confidence interval, CI 1.08–3.69), intracranial ICA without carotid T occlusion (adjusted OR 1.79, 95% CI 1.05–2.98), and M2 segment (adjusted OR 1.86, 95% CI 1.21–2.84). Failed reperfusion was also associated with cervical ICA stenosis (>70% stenosis, adjusted OR 2.90, 95% CI 1.69–4.97), stroke of other determined etiology by TOAST (Trial of ORG 10172 in acute stroke treatment) criteria (e.g. nonatherosclerotic vasculopathies, adjusted OR 2.73, 95% CI 1.36–5.39), and treatment given outside the usual working hours (adjusted OR 1.41, 95% CI 1.07–1.86). Successful reperfusion was associated with higher Alberta stroke program early CT score (ASPECTS) on initial imaging (adjusted OR 0.85, 95% CI 0.79–0.92), treatment with the patient under general anesthesia (adjusted OR 0.72, 95% CI 0.54–0.96), and concomitant ICA stenting in patients with ICA stenosis (adjusted OR 0.20, 95% CI 0.11–0.38). Conclusion Several factors are associated with failure of reperfusion, most notably occlusions of the proximal ICA and low ASPECTS on admission. Conversely, stent placement in the proximal ICA was associated with reperfusion success.

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Tài liệu tham khảo

Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–31.

Kim BM. Causes and solutions of endovascular treatment failure. J Stroke. 2017;19:131–42.

Leischner H, Flottmann F, Hanning U, Broocks G, Faizy TD, Deb-Chatterji M, et al. Reasons for failed endovascular recanalization attempts in stroke patients. J Neurointerv Surg. 2019;11:439–42.

Kaesmacher J, Gralla J, Mosimann PJ, Zibold F, Heldner MR, Piechowiak E, et al. Reasons for reperfusion failures in stent-retriever-based thrombectomy: registry analysis and proposal of a classification system. AJNR Am J Neuroradiol. 2018;39:1848–53.

Alegiani AC, Dorn F, Herzberg M, Wollenweber FA, Kellert L, Siebert E, et al. Systematic evaluation of stroke thrombectomy in clinical practice: the German stroke registry endovascular treatment. Int J Stroke. 2019;14:372–80.

Wollenweber FA, Tiedt S, Alegiani A, Alber B, Bangard C, Berrouschot J, et al. Functional outcome following stroke thrombectomy in clinical practice. Stroke. 2019;50:2500–6.

Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med. 1998;339:1415–25.

R Core Team. R: a language and environment for statistical computing. 2018.

Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993;24:35–41.

Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of Intraarterial treatment for acute Ischemic stroke. N Engl J Med. 2015;372:11–20.

Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t‑PA vs. t‑PA alone in stroke. N Engl J Med. 2015;372:2285–95.

Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.

Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in Ischemic stroke. N Engl J Med. 2015;372:2296–306.

Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.

Froehler MT, Saver JL, Zaidat OO, Jahan R, Aziz-Sultan MA, Klucznik RP, et al. Interhospital transfer before thrombectomy is associated with delayed treatment and worse outcome in the STRATIS registry (systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke). Circulation. 2017;136:2311–21.

Zaidat OO, Castonguay AC, Nogueira RG, Haussen DC, English JD, Satti SR, et al. TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. J Neurointerv Surg. 2018;10:516–24.

Anadani M, Spiotta A, Alawieh A, Turjman F, Piotin M, Steglich-Arnholm H, et al. Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry. J Neurointerv Surg. 2019;11:970-4.

Eker OF, Bühlmann M, Dargazanli C, Kaesmacher J, Mourand I, Gralla J, et al. Endovascular treatment of atherosclerotic tandem occlusions in anterior circulation stroke: technical aspects and complications compared to isolated intracranial occlusions. Front Neurol. 2018;9:1046.

Wallocha M, Chapot R, Nordmeyer H, Fiehler J, Weber R, Stracke CP. Treatment methods and early neurologic improvement after endovascular treatment of tandem occlusions in acute Ischemic stroke. Front Neurol. 2019;10:127.

Zhu F, Bracard S, Anxionnat R, Derelle AL, Tonnelet R, Liao L, et al. Impact of emergent cervical carotid stenting in tandem occlusion strokes treated by thrombectomy: a review of the TITAN collaboration. Front Neurol. 2019;10:206.

Papanagiotou P, Haussen DC, Turjman F, Labreuche J, Piotin M, Kastrup A, et al. Carotid stenting with antithrombotic agents and intracranial thrombectomy leads to the highest recanalization rate in patients with acute stroke with tandem lesions. JACC Cardiovasc Interv. 2018;11:1290–9.

Jadhav AP, Zaidat OO, Liebeskind DS, Yavagal DR, Haussen DC, Hellinger FR Jr, et al. Emergent management of tandem lesions in acute Ischemic stroke. Stroke. 2019;50:428–33.

Tsang COA, Cheung IHW, Lau KK, Brinjikji W, Kallmes DF, Krings T. Outcomes of stent retriever versus aspiration-first thrombectomy in ischemic stroke: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2018;39:2070–6.

Mustanoja S, Meretoja A, Putaala J, Viitanen V, Curtze S, Atula S, et al. Outcome by stroke etiology in patients receiving thrombolytic treatment. Stroke. 2011;42:102–6.

Liebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL. Impact of collaterals on successful revascularization in solitaire FR with the intention for thrombectomy. Stroke. 2014;45:2036–40.

Turk AS 3rd, Siddiqui A, Fifi JT, De Leacy RA, Fiorella DJ, Gu E, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet. 2019;393:998–1008.

Simonsen CZ, Yoo AJ, Sørensen LH, Juul N, Johnsen SP, Andersen G, et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke. JAMA Neurol. 2018;75:470–7.

Wan TF, Xu R, Zhao ZA, Lv Y, Chen HS, Liu L. Outcomes of general anesthesia versus conscious sedation for stroke undergoing endovascular treatment: a meta-analysis. BMC Anesthesiol. 2019;19:69.

Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M, et al. European stroke organisation (ESO)—European society for minimally invasive neurological therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2019;11:535–8.

Regenhardt RW, Mecca AP, Flavin SA, Boulouis G, Lauer A, Zachrison KS, et al. Delays in the air or ground transfer of patients for endovascular thrombectomy. Stroke. 2018;49:1419–25.

Turner M, Barber M, Dodds H, Dennis M, Langhorne P, Macleod MJ, et al. Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes. J Neurol Neurosurg Psychiatry. 2015;87:138–43.

Almallouhi E, Al Kasab S, Harvey JB, Reardon C, Alawieh A, Girotra T, et al. Impact of treatment time on the long-term outcome of stroke patients treated with mechanical thrombectomy. J Stroke Cerebrovasc Dis. 2019;28:185–90.

Mpotsaris A, Kowoll A, Weber W, Kabbasch C, Weber A, Behme D. Endovascular stroke therapy at nighttime and on weekends-as fast and effective as during normal business hours? J Vasc Interv Neurol. 2015;8:39–45.

Nikoubashman O, Probst T, Schürmann K, Othman AE, Matz O, Brockmann MA, et al. Weekend effect in endovascular stroke treatment: do treatment decisions, procedural times, and outcome depend on time of admission? J Neurointerv Surg. 2017;9:336–9.

Hinsenveld WH, de Ridder IR, van Oostenbrugge RJ, Vos JA, Groot AE, Coutinho JM, et al. Workflow intervals of endovascular acute stroke therapy during on- versus off-hours. Stroke. 2019;50:2842–50.

Brehm A, Maus V, Tsogkas I, Colla R, Hesse AC, Gera RG, et al. Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world. BMC Neurol. 2019;19:65.

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