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Endovascular Treatment in the DEFUSE 3 Study.

Michael P Marks1, Jeremy J Heit1, Maarten G Lansberg1

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Successful reperfusion via endovascular therapy in extended time windows for ischemic stroke (DEFUSE 3) correlated with better patient outcomes. Higher Thrombolysis in Cerebral Infarction (TICI) scores were linked to reduced infarct growth and improved functional independence.

Keywords:
angiographyangioplastycerebral infarctionreperfusionthrombectomy

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Stroke Medicine

Background:

  • Endovascular therapy (EVT) is effective for acute ischemic stroke, particularly in selected patients within extended time windows.
  • The DEFUSE 3 trial evaluated EVT in patients with large vessel occlusion (LVO) presenting beyond 6 hours from symptom onset.

Purpose of the Study:

  • To correlate angiographic outcomes (Thrombolysis in Cerebral Infarction [TICI] scores) with clinical and imaging outcomes in the DEFUSE 3 study.
  • To assess the impact of reperfusion success on infarct growth and functional independence.

Main Methods:

  • Angiograms were analyzed for primary occlusive lesions and final modified TICI scores.
  • Clinical outcomes were assessed using modified Rankin Scale (mRS) at 90 days.
  • Correlation analysis was performed between TICI scores, reperfusion success, device type, occlusion site, and 24-hour infarct growth.

Main Results:

  • Thrombolysis in Cerebral Infarction (TICI) 2B-3 reperfusion was achieved in 76% of patients.
  • Higher TICI scores (2B-3) were associated with significantly better 90-day functional outcomes (mRS 0-2) and a more favorable mRS distribution.
  • TICI 3 reperfusion correlated with significantly less infarct growth at 24 hours compared to TICI 0-2A and TICI 2B.
  • Successful reperfusion was independent of thrombectomy device, occlusion site, or adjunctive carotid stenting.

Conclusions:

  • Endovascular therapy in extended time windows achieves reperfusion rates comparable to earlier time windows.
  • Successful reperfusion, irrespective of device or technique, is crucial for favorable outcomes.
  • Achieving TICI 3 reperfusion is associated with reduced infarct progression and improved functional outcomes in stroke patients treated with EVT.