BACKGROUND Reperfusion status after intra-arterial thrombectomy (IAT) is a critical predictor of functional outcome after acute ischemic stroke. However, most prognostic models have not included a detailed assessment of reperfusion status after IAT. OBJECTIVE The aim of this work was to assess the association between successful reperfusion and clinical outcome. METHODS Clinical, radiological, and procedural variables of patients treated with IAT were extracted from our prospective stroke registry. The association with functional outcome using the modified Rankin Scale (mRS) after 3 months was assessed using multivariable logistic regression. An extension of the modified TICI score, eTICI, was used to classify reperfusion status. The prognostic value of reperfusion status after IAT in addition to age, stroke severity, imaging characteristics, treatment with intravenous thrombolysis, and time from symptom onset to the end of IAT was assessed with logistic regression and summarized with receiver operating characteristic curves. RESULTS In total, 119 patients were included (mean age 66 years). In multivariable analysis, age >80 years (OR 6.8, 95% CI 1.2-39.8), NIHSS at presentation >15 (OR 7.3, 95% CI 2.3-23.5), and incomplete reperfusion status (eTICI score <2C; OR 10.3, 95% CI 3.5-30.6) were the strongest predictors of a poor outcome (mRS 3-6). Adding reperfusion status to the model improved the prognostic accuracy (AUC 0.88, 95% CI 0.91-0.94). Our results indicate a large difference between using an eTICI cutoff of ≥2C versus ≥2B: a cutoff ≥2C improved the predictive value for a good clinical outcome (2C: positive predictive value, PPV, 0.78; 2B: PPV 0.32). CONCLUSION Our results promote using reperfusion status for assessing prognosis in ischemic stroke patients treated with IAT. A model using eTICI ≥2C had greater PPV than eTICI ≥2B and could improve prognostic accuracy.

中文翻译：

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动脉内血栓切除术后再灌注状态对于预测前循环大血管卒中结果的重要性。


背景动脉内血栓切除术（IAT）后的再灌注状态是急性缺血性中风后功能结果的关键预测因子。然而，大多数预后模型并未包括 IAT 后再灌注状态的详细评估。目的 这项工作的目的是评估成功再灌注与临床结果之间的关联。方法 从我们的前瞻性卒中登记中提取接受 IAT 治疗的患者的临床、放射学和手术变量。使用多变量逻辑回归评估 3 个月后使用改良 Rankin 量表 (mRS) 与功能结果的关联。改进的 TICI 评分的扩展 eTICI 用于对再灌注状态进行分类。除了年龄、卒中严重程度、影像学特征、静脉溶栓治疗以及从症状出现到 IAT 结束的时间之外，还通过逻辑回归评估 IAT 后再灌注状态的预后价值，并用受试者工作特征曲线进行总结。结果 总共纳入 119 名患者（平均年龄 66 岁）。在多变量分析中，年龄 >80 岁（OR 6.8，95% CI 1.2-39.8），就诊时 NIHSS >15（OR 7.3，95% CI 2.3-23.5），以及不完全再灌注状态（eTICI 评分 <2C；OR 10.3， 95% CI 3.5-30.6）是不良结果的最强预测因子（mRS 3-6）。在模型中添加再灌注状态可提高预后准确性（AUC 0.88，95% CI 0.91-0.94）。我们的结果表明，使用 ≥2C 与 ≥2B 的 eTICI 截止值之间存在很大差异：≥2C 的截止值提高了良好临床结果的预测值（2C：阳性预测值，PPV，0.78；2B：PPV 0.32）。 结论 我们的结果促进使用再灌注状态来评估接受 IAT 治疗的缺血性卒中患者的预后。使用 eTICI ≥2C 的模型具有比 eTICI ≥2B 更高的 PPV，并且可以提高预后准确性。