TY - JOUR
T1 - Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke
T2 - Sub-Analysis from the SELECT2 Trial
AU - the SELECT2 Trial
AU - Hassan, Ameer E.
AU - Abraham, Michael G.
AU - Blackburn, Spiros
AU - Hussain, Muhammad S.
AU - Ortega-Gutierrez, Santiago
AU - Chen, Michael
AU - Hu, Yin C.
AU - Pujara, Deep K.
AU - Herial, Nabeel A.
AU - Tsai, Jenny P.
AU - Budzik, Ronald F.
AU - Manning, Nathan W.
AU - Kozak, Osman
AU - Hanel, Ricardo A.
AU - Aghaebrahim, Amin N.
AU - Gandhi, Chirag D.
AU - Al-Mufti, Fawaz
AU - Cheung, Andrew
AU - Yan, Bernard
AU - Mitchell, Peter
AU - Blasco, Jordi
AU - Manzanera, Luis San Román
AU - Vora, Nirav
AU - Gibson, Daniel
AU - Wallace, Adam
AU - Sahlein, Daniel
AU - Elijovich, Lucas
AU - Arenillas, Juan F.
AU - Wu, Teddy Y.
AU - Portela, Pere Cardona
AU - de la Ossa, Natalia Pérez
AU - Schaafsma, Joanna D.
AU - Hicks, William J.
AU - Cordato, Dennis J.
AU - Sangha, Navdeep
AU - Warach, Steven
AU - Kleinig, Timothy J.
AU - Shaker, Faris
AU - Johns, Hannah
AU - Tekle, Wondwossen
AU - Dannenbaum, Mark J.
AU - Ebersole, Koji
AU - Toth, Gabor
AU - Gooch, Michael
AU - Alhajeri, Abdulnasser
AU - Amuluru, Krishna
AU - Ray, Abhishek
AU - Burkhardt, Jan Karl
AU - Abdulrazzak, Mohammad A.
AU - Hill, Michael D.
N1 - Publisher Copyright:
© 2024 American Neurological Association.
PY - 2025/1
Y1 - 2025/1
N2 - Endovascular thrombectomy (EVT) was shown to be safe and efficacious in patients with large core stroke in multiple randomized controlled trials. However, the impact of reperfusion and other procedural metrics on EVT outcomes in this population has not been well-characterized. Methods: From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml). Results: Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01–2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33–2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96–2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87–0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50–1.10) as compared with stent-retriever first. Interpretation: Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2025;97:175–184.
AB - Endovascular thrombectomy (EVT) was shown to be safe and efficacious in patients with large core stroke in multiple randomized controlled trials. However, the impact of reperfusion and other procedural metrics on EVT outcomes in this population has not been well-characterized. Methods: From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml). Results: Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01–2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33–2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96–2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87–0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50–1.10) as compared with stent-retriever first. Interpretation: Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2025;97:175–184.
UR - https://www.scopus.com/pages/publications/85208626300
U2 - 10.1002/ana.27104
DO - 10.1002/ana.27104
M3 - Artículo
C2 - 39508412
AN - SCOPUS:85208626300
SN - 0364-5134
VL - 97
SP - 175
EP - 184
JO - Annals of Neurology
JF - Annals of Neurology
IS - 1
ER -