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Clinical impact of EVT with failed reperfusion in patients with acute ischemic stroke: results from the ESCAPE and ESCAPE-NA1 trials

  • Interventional Neuroradiology
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Abstract

Background and purpose

Endovascular treatment (EVT) is a powerful treatment for large vessel occlusion (LVO) stroke if reperfusion can be achieved, while in cases with failed reperfusion, EVT may cause harm, as procedure-related complications may occur. We hypothesized that EVT with failed recanalization does not result in worse outcomes compared to best medical management and compared clinical outcomes of LVO stroke patients who underwent EVT with failed reperfusion to those who were treated with best medical management.

Methods

We included patients with failed reperfusion from the control (EVT-only) arm of the ESCAPE-NA1 trial and the EVT arm of the ESCAPE trial and patients of the ESCAPE control arm who were treated with best medical management. Failed reperfusion following EVT was defined as modified thrombolysis in cerebral infarction score 0–2a. Proportions of good outcome (modified Rankin scale 0–2) were compared between patients who did and did not undergo EVT, and adjusted effect size estimates for EVT on outcomes were obtained.

Results

We included 260 patients (110 failed EVT and 150 non-EVT patients). Proportions of good outcome were 38/110 (34.6%) with failed EVT vs.43/147 (29.3%) without EVT (adjusted odds ratio[aOR]: 1.48 [95%CI: 0.81–2.68]). Mortality and proportions of sICH in the failed EVT group vs. patients treated with best medical management were 26/110 (23.6%) vs. 28/147 (19.1%), aOR: 1.12 (95%CI: 0.56–2.24), and 7/110 (6.4%) vs. 4/150 (2.7%), aOR: 2.34 (95%CI: 0.00–22.97).

Conclusion

Clinical outcomes of EVT patients with failed reperfusion did not differ significantly from patients treated with best medical management

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Acknowledgements

The authors want to thank the ESCAPE and ESCAPE-NA1 investigators.

Funding

ESCAPE: Grants to the University of Calgary from Covidien, Alberta Innovates–Health Solutions, the Heart and Stroke Foundation of Canada, and Alberta Health Services. ESCAPE-NA1: NoNO Inc., Alberta Innovates–Health Solutions, Canadian Institutes of Health Research.

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Authors and Affiliations

  1. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada

    Johanna M. Ospel, Michael D. Hill, Andrew Demchuk, Bijoy K. Menon, Mohammed A. Almekhlafi, Aravind Ganesh, Manon Kappelhof, Nishita Singh, Petra Cimflova, Nima Kashani, Fouzi Bala, Beom Joon Kim & Mayank Goyal

  2. Department of Radiology, University Hospital of Basel, Basel, Switzerland

    Johanna M. Ospel

  3. Department of Radiology, University of Calgary, Calgary, Canada

    Michael D. Hill, Andrew Demchuk, Bijoy K. Menon, Mohammed A. Almekhlafi & Mayank Goyal

  4. Beaumont Hospital, Dublin, Ireland

    John Thornton

  5. University of Alberta Hospital, Edmonton, Canada

    Jeremy Rempel

  6. University Medical Center Amsterdam, Amsterdam, The Netherlands

    Manon Kappelhof

  7. Warren Alpert School of Medicine, Brown University, Providence, USA

    Ryan McTaggart

  8. Centre Hospitalier de L’Université de Montréal, Montreal, Canada

    Alexandre Poppe

  9. Emory University School of Medicine, Grady Memorial Hospital, Atlanta, USA

    Raul G. Nogueira

  10. NoNO Inc, Toronto, Canada

    Michael Tymianski

Authors
  1. Johanna M. Ospel
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  2. Michael D. Hill
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  3. Andrew Demchuk
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  6. Jeremy Rempel
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  7. Mohammed A. Almekhlafi
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  14. Beom Joon Kim
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  15. Ryan McTaggart
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  16. Alexandre Poppe
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  17. Raul G. Nogueira
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  18. Michael Tymianski
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  19. Mayank Goyal
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Corresponding author

Correspondence to Mayank Goyal.

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Conflict of interest

BM: patent (stroke triage systems), stock ownership(Circle Neurovascular). MG: consultant (Medtronic, Stryker, Microvention, GE Healthcare, Mentice). MDH: grants (CIHR, Medtronic, NoNo Inc.) outside the submitted work, patent(US Patent office Number: 62/086,077), Boards: Circle Neurovascular, Canadian Neuroscience Federation, Canadian Stroke Consortium. The remaining authors declare no competing interests.

Ethical approval

This study was approved by the local ethics board of all participating sites.

Informed consent

Informed consent was obtained from all participants prior to enrolment.

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Ospel, J.M., Hill, M.D., Demchuk, A. et al. Clinical impact of EVT with failed reperfusion in patients with acute ischemic stroke: results from the ESCAPE and ESCAPE-NA1 trials. Neuroradiology 63, 1883–1889 (2021). https://doi.org/10.1007/s00234-021-02723-w

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  • DOI: https://doi.org/10.1007/s00234-021-02723-w

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