Impact of Stenting with Angioplasty and MTICI 2c-3 Recanalization On Outcome in Acute MCA Occlusion with Underlying Stenosis.
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Alexandre Andrea Maria, Consoli Arturo, Scarcia Luca, Di Stasio Enrico, Brunetti Valerio, Sun Wen, Xu Yingjie, Huang Xianjun, Chung Charlotte, Sgreccia Alessandro, Abdalkader Mohamad, Limbucci Nicola, Pedicelli Alessandro, Capasso Francesco, Arba Francesco, Migliaccio Ludovica, Piano Mariangela, Ganimede Maria Porzia, Lozupone Emilio, Gaudino Chiara, Ricchetti Francesca, Russo Riccardo, Burel Julien, D'Argento Francesco, Abruzzese Serena, Allard Julien, Chausson Nicolas, Partesano Roberta, Cavasin Nicola, Mandruzzato Nicolò, Gabrieli Joseph Domenico, Trombatore Pietro, Caragliano Antonio Armando, Mazzacane Federico, Salsano Giancarlo, Sanna Antioco, Panni Pietro, Zini Andrea, Clarençon Frédéric, Raz Eytan, Nguyen Thanh, Broccolini Aldobrando
Аннотация
METHODS: We conducted a retrospective multicenter study including 115 patients with ICAS-related occlusion of the middle cerebral artery (MCA) treated with MT and RS across 27 international stroke centers. Baseline, procedural, and post-procedural variables were analyzed. The outcome measure was the ordinal shift of the 90-day modified Rankin Scale (mRS) score. Stepwise multivariate regression and structural equation modeling (SEM) were used to identify outcome predictors and explore mediation pathways.
RESULTS: Successful recanalization (modified Treatment in Cerebral Infarction (mTICI) score ≥ 2b) was achieved in 94.8% of patients, with 73.0% reaching mTICI 2c‑3. SEM showed that baseline Alberta Stroke Program Early CT Score (ASPECTS), stenting with angioplasty and achieving mTICI 2c‑3 were associated with improved functional outcome, mediated by higher post-procedural ASPECTS. Post-procedural ASPECTS influenced functional outcome both directly (estimate = -0.45, p < 0.001) and indirectly by reducing the occurrence of symptomatic intracranial hemorrhage (sICH) (estimate = -0.09, p = 0.004). This model explained 36.5% of the variance in 90-day mRS scores.
CONCLUSION: In patients with acute ICAS-related MCA occlusion, stenting with angioplasty and achieving mTICI 2c-3 recanalization are associated with improved clinical outcome. These benefits are mediated by better post-procedural ASPECTS and reduced sICH. Prospective studies are warranted to confirm these findings.