The SAVE Technique Tập 29 Số 4 - Trang 669-676 - 2019
Volker Maus, Silja Henkel, Alexander Riabikin, Christian Riedel, Daniel Behme, Ioannis Tsogkas, Amélie Carolina Hesse, Nuran Abdullayev, Olav Jansen, Martin Wiesmann, Anastasios Mpotsaris, Marios‐Nikos Psychogios
Mechanical Thrombectomy in Basilar Artery Occlusion - 2019
Volker Maus, Alev Kalkan, Christoph Kabbasch, Nuran Abdullayev, Henning Stetefeld, Utako Birgit Barnikol, Thomas Liebig, Christian Dohmen, Gereon R. Fink, Jan Borggrefe, Anastasios Mpotsaris
Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke - 2021
Fabian Flottmann, Gabriel Broocks, Tobias D. Faizy, Rosalie McDonough, Lucas Watermann, Milani Deb‐Chatterji, Götz Thomalla, Moriz Herzberg, Christian H. Nolte, Jens Fiehler, Hannes Leischner, Caspar Brekenfeld, Gsr investigators
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.