Impact of eloquent motor cortex-tissue reperfusion beyond the traditional thrombolysis in cerebral infarction (TICI) scoring after thrombectomy

• Type of Material: Article
• Authors: Radoslav Raychev, University of California Los Angeles; Hamidreza Saber, University of California Los Angeles; Jeffrey L Saver, University of California Los Angeles; Jason D Hinman, University of California Los Angeles; Scott Brown, BRIGHT Res Partners; Fernando Vinuela, University of California Los Angeles; Gary Duckwiler, University of California Los Angeles; Reza Jahan, University of California Los Angeles; Satoshi Tateshima, University of California Los Angeles; Viktor Szeder, University of California Los Angeles; May Nour, University of California Los Angeles; Geoffrey P Colby, University of California Los Angeles; Lucas Restrepo, University of California Los Angeles; Doojin Kim, University of California Los Angeles; Mersedeh Bahr-Hosseini, University of California Los Angeles; Latisha Ali, University of California Los Angeles; Sidney Starkman, University of California Los Angeles; Neal Rao, University of California Los Angeles; Raul Nogueira, Emory University; David Liebeskind, University of California Los Angeles
• Language: English
• Date: 2021-11-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/neurintsurg-2020-016834
• Title of Journal or Parent Work: JOURNAL OF NEUROINTERVENTIONAL SURGERY
• Volume: 13
• Issue: 11
• Start Page: 990
• End Page: +
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: Surgery; angiography; Life Sciences & Biomedicine; thrombectomy; Science & Technology; ENDOVASCULAR THERAPY; Neuroimaging; MYOCARDIAL-INFARCTION; RECOMMENDATIONS; END-POINTS; ISCHEMIC-STROKE; stroke; RECANALIZATION; STENT-RETRIEVER; LOCATION; INTRAARTERIAL; blood flow; brain; TRIAL; Neurosciences & Neurology
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Targeted eloquence-based tissue reperfusion within the primary motor cortex may have a differential effect on disability as compared with traditional volume-based (thrombolysis in cerebral infarction, TICI) reperfusion after endovascular thrombectomy (EVT) in the setting of acute ischemic stroke (AIS). Methods: We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (modified Rankin Scale, mRS) in AIS patients undergoing EVT. ER-PMC was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (middle cerebral artery (MCA)-precentral, central, postcentral; anterior cerebral artery (ACA)-medial frontal branch arising from callosomarginal or pericallosal arteries) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariate analysis was conducted to assess the impact of ER-PMC on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2a and 2b). Results: Among the 125 patients who met the study criteria, ER-PMC distribution was: Absent (0) in 19/125 (15.2%); partial (1) in 52/125 (41.6%), and complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER-PMC was substantially higher in those patients (P<0.001). In multivariate analysis, in addition to age and symptomatic intracranial hemorrhage, ER-PMC had a profound independent impact on 90-day disability (OR 6.10, P=0.001 for ER-PMC 1 vs 0 and OR 9.87, P<0.001 for ER-PMC 2 vs 0), while the extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day mRS. Conclusions: Eloquent PMC-Tissue reperfusion is a key determinant of functional outcome, with a greater impact than volume-based (TICI) degree of partial reperfusion alone. PMC-Targeted revascularization among patients with partial reperfusion may further diminish post-stroke disability after EVT.