Background

Studies have shown that the modified thrombolysis in cerebral ischemia (mTICI) 2B score is associated with better functional outcome; however, 50–99% reperfusion is a large range and there may be factors which can differentiate this further. The effects of very late leptomeningeal collaterals (VLLC) on mTICI-2B patients were studied.

Method

A prospectively collected registry of anterior circulation AIS patients treated with the EmboTrap revascularization device from 2013 to 2016 was evaluated. Imaging parameters and timings, including the mTICI score were verified by an external core laboratory blinded to the clinical data. The final angiogram was examined for the appearance of VLLC in predicting 3‑month outcomes including excellent functional outcomes, defined as modified Rankin scale (mRS) 0–1, bleeding risk and mortality.

Results

A total of 177 consecutive anterior circulation stroke patients were included in the analysis. Of these 94 (53.1%) achieved only mTICI-2B reperfusion, 16/94 (17.0%) patients achieved excellent functional outcomes at 3 months and 26 (27.7%) had hyperdensity on follow-up computed tomography (CT). On univariate analysis, the presence of VLLC was inversely associated with excellent functional outcomes at 3 months and positively associated with mortality in patients with mTICI-2B reperfusion. On multivariate analysis VLLC was inversely associated with excellent outcomes (odds ratio 0.075, 95% confidence interval 0.007–0.765, P = 0.029) but not associated with mortality.

Conclusion

The mTICI-2B grade may be further refined by secondary radiological markers. The VLLC sign is associated with the loss of excellent functional outcomes at 3 months. It is a simple sign to discriminate mTICI-2B into different grades but should be verified in larger populations from other centers.

中文翻译：

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非常晚的软脑膜侧支-可能在脑缺血（mTICI）2B中细分改良溶栓的新方法。

背景

研究表明，改良的脑缺血溶栓（mTICI）2B评分与更好的功能预后相关；然而，50-99％的再灌注范围很广，并且可能有一些因素可以进一步区分这一点。研究了非常晚期的软脑膜侧支（VLLC）对mTICI-2B患者的影响。

方法

评估了从2013年至2016年使用EmboTrap血运重建设备治疗的前循环AIS患者的前瞻性登记资料。成像参数和时间，包括mTICI分数，已由不了解临床数据的外部核心实验室进行了验证。最终血管造影检查了VLLC的出现，以预测3个月的预后，包括出色的功能预后，定义为改良的兰金评分（mRS）0-1，出血风险和死亡率。

结果

该分析总共包括177位连续的前循环中风患者。在这94例（53.1％）仅实现mTICI-2B再灌注的患者中，有16/94例（17.0％）的患者在3个月时获得了良好的功能预后，而26例（27.7％）的患者在随访计算机体层摄影（CT）时出现了高密度。在单因素分析中，VLLC的存在与3个月时良好的功能预后成反比，与mTICI-2B再灌注患者的死亡率成正比。在多变量分析中，VLLC与优异的结果呈负相关（赔率为0.075，95％置信区间为0.007-0.765，P  = 0.029），但与死亡率无关。

结论

mTICI-2B级可以通过二次放射学标记进一步完善。VLLC征兆与3个月时优良的功能预后丧失有关。这是将mTICI-2B区分为不同等级的简单信号，但应在其他中心的大量人群中进行验证。