Characteristics of Unsuccessful Recanalization Following Endovascular Thrombectomy: Cohort Study (EVATRISP Collaboration).
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Schwartzmann Yoel, Heldner Mirjam R, Jubran Hamza, Arnold Marcel, Grunder Lorenz, Shalabi Fatma, Jubeh Tamer, Metanis Issa, Nordanstig Annika, Jood Katarina, Rentzos Alexandros, Nederkoorn Paul J, Wali Nabila, van der Meij Anne, Wegener Susanne, Otto Lukas Bastian, Handelsmann Hannah Lea, Michel Patrik, Strambo Davide, Salerno Alexander, De Marchis Gian Marco, Dittrich Tolga D, Curtze Sami, Martinez-Majander Nicolas, Gensicke Henrik, Engelter Stefan T, Altersberger Valerian Laurin, Trüssel Simon, Nolte Christian H, Riegler Christoph, Zini Andrea, Naldi Federica, Bigliardi Guido, Picchetto Livio, Marto João Pedro, Costa José Pedro, Molad Jeremy, Hallevi Hen, Cereda Carlo W, Pezzini Alessandro, Magoni Mauro, Padjen Visnja, Leker Ronen R
Аннотация
METHODS: Prospectively enrolled EVT-treated patients from the EVATRISP registry, which included patients from 18 academic medical centers across Europe between the years 2015 and 2024, were retrospectively studied. Patients had to have data on prestroke and 3-month functional status and recanalization status at the end of EVT. UR was defined as a modified Thrombolysis in Cerebral Infarction score <2b and compared with successful recanalization (modified Thrombolysis in Cerebral Infarction ≥2b). Regression analyses were performed to identify predictors of UR, and a predictive tool was subsequently constructed.
RESULTS: Of the 15 549 patients enrolled in EVATRIPS, 10 942 fulfilled entry criteria and were included in the current analysis. Overall, 8000 (73%) achieved successful recanalization, while 2942 (27%) had UR. In multivariate analysis, factors independently associated with higher odds of UR included older age, higher prestroke mRS, wake-up stroke, interhospital transfer for EVT, higher National Institutes of Health Stroke Scale score at presentation, tPA (tissue-type plasminogen activator) administration, and occlusion of the M2 segment of the middle cerebral artery or proximal anterior or posterior cerebral arteries. Dyslipidemia and occlusion of the M1 middle cerebral artery or basilar artery were associated with successful recanalization. UR was associated with poor clinical outcomes, and higher mortality rates. A predictive tool derived from these variables demonstrated limited discriminatory ability (area under the curve, 0.579 [95% CI, 0.567-0.591]; P<0.001).
CONCLUSIONS: UR is frequent among patients undergoing EVT and is associated with poor clinical outcomes. Although several pre-EVT factors were independently associated with UR, accurately predicting which patients will experience UR remains highly challenging. Our findings suggest that all eligible patients should undergo EVT.