Neurovascular-Nuggets_ Re-evaluating Reperfusion Targets in Large Ischemic Strokes

🎁the key points from the article - The study retrospectively compared outcomes of endovascular therapy (EVT) achieving modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b (incomplete reperfusion) versus grade 3 (complete reperfusion) in patients with large ischemic strokes. - In 226 patients with large anterior circulation strokes and baseline Alberta Stroke Program Early CT Score (ASPECTS) of 3-5, there was no significant difference in 90-day functional outcomes based on the modified Rankin Scale (mRS) between those with final mTICI 2b versus mTICI 3 reperfusion. - Rates of 90-day mortality and independent ambulation were also similar between mTICI 2b and mTICI 3 groups. - However, symptomatic intracranial hemorrhage (sICH) rates were lower with mTICI 3 compared to mTICI 2b reperfusion (4.5% vs 12.6%). - In subgroup analyses, mTICI 3 reperfusion did not provide added benefit over mTICI 2b reperfusion regardless of patient age, sex, baseline stroke severity, etc. - This suggests mTICI 2b may be an acceptable angiographic endpoint for EVT in large strokes, questioning the need for additional maneuvers to achieve full mTICI 3 reperfusion. 💡Clinical Implications: - The findings suggest interventionalists should carefully weigh risks/benefits of pursuing mTICI 3 if mTICI 2b reperfusion is achieved early in EVT for large ischemic strokes. - mTICI 2b may provide comparable outcomes to mTICI 3 in these patients, while reducing procedural risks such as sICH. - Intraprocedurally evaluating extent of persisting hypoperfusion versus established infarct on imaging could help determine whether to continue manipulating beyond mTICI 2b. - The results may help guide individualized decision making on optimal angiographic targets during EVT for large strokes. More data is needed to develop definitive recommendations. In summary, this study questions the clinical benefit of mandating mTICI 3 reperfusion in EVT for large anterior circulation strokes. It may support stopping at mTICI 2b in some patients to limit procedural risks based on individual characteristics. Read more at hashtag#neurovascularnuggets https://lnkd.in/diJUE4qy