Incomplete or failed thrombectomy in acute stroke patients with Alberta Stroke Program Early Computed Tomography...

Area of Science:

• Neurology
• Interventional Neuroradiology
• Stroke Medicine

Background:

• The clinical benefit of mechanical thrombectomy (MT) for ischemic stroke patients with low initial Alberta Stroke Program Early Computed Tomography Score (ASPECTS) remains unclear.
• It is unknown if failed or incomplete MT in these patients is harmful.

Purpose of the Study:

• To investigate the clinical outcomes of failed or incomplete MT in acute large vessel occlusion stroke with an initial ASPECTS ≤ 5.
• To compare outcomes of MT (successful, failed, or incomplete) versus best medical treatment only in this patient cohort.

Main Methods:

• Observational cohort study of 170 anterior circulation stroke patients with ASPECTS ≤ 5 (March 2015 - August 2019).
• Failed recanalization defined as Thrombolysis in Cerebral Infarction (TICI) score 0-2a; incomplete as TICI 2b.
• Clinical outcome assessed by modified Rankin Scale (mRS) at 90 days; very poor outcome defined as mRS > 4.

Main Results:

• Ninety-nine patients underwent MT, 71 received best medical treatment only.
• Clinical outcome after failed or incomplete MT (TICI 0-2b) was significantly better than medical treatment only (median mRS 5 vs 5-6, P=0.03).
• Failed or incomplete MT (TICI 0-2b) was associated with a reduced likelihood of very poor outcome (OR 0.39, P=0.01). Failed MT (TICI 0-2a) was not associated with worse outcomes than best medical treatment.

Conclusions:

• Patients with failed or incomplete MT (TICI 0-2b) had a reduced likelihood of very poor outcomes compared to those not receiving MT.
• Randomized trials are necessary to confirm that even failed or incomplete MT is not harmful in patients with low ASPECTS scores.