Complete vs Near-Complete Reperfusion After Endovascular Therapy for Anterior-Circulation Large-Core Stroke:...

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• The benefit of complete reperfusion (mTICI 3) versus near-complete reperfusion (mTICI 2b) in endovascular therapy (EVT) for anterior circulation large-core stroke remains unclear.
• Collateral circulation's role in modifying time-related tissue injury and recovery in stroke is significant.

Purpose of the Study:

• To compare the effectiveness and safety of mTICI 3 versus mTICI 2b reperfusion.
• To investigate the impact of collateral physiology on outcomes in EVT for large-core stroke.

Main Methods:

• Retrospective cohort study of 106 adults with anterior circulation large-vessel occlusion and ASPECTS 3-5.
• Propensity score matching compared mTICI 2b (n=42) and mTICI 3 (n=42) groups.
• Analysis included DWI core volumetry, 90-day outcomes, and collateral grade as an effect modifier of time.

Main Results:

• Functional independence (mRS 0-2) was similar between mTICI 2b (23.8%) and mTICI 3 (26.2%) groups (p=0.66).
• Symptomatic intracranial hemorrhage (sICH) was higher in the mTICI 2b group (14.3% vs 4.8%; p=0.04).
• Longer onset-to-reperfusion time increased core volume and decreased independence odds; higher collateral grade reduced core volume and increased independence odds. Time and collateral interactions were significant.

Conclusions:

• mTICI 3 did not improve 90-day functional outcomes compared to mTICI 2b in EVT for large-core stroke with successful reperfusion.
• mTICI 3 was associated with fewer symptomatic hemorrhages, supporting individualized treatment urgency based on collateral physiology.
• Procedural escalation beyond mTICI 2b should be carefully considered for large-core strokes.