nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-27112025-3-60-69nnp-2631Research ArticleORIGINAL INVESTIGATIONSОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ И МЕТОДИКИPredicting clinical outcomes in patients with ischemic stroke following successful thrombectomy: clinical, neuroradiological, and periprocedural predictorsОпределение прогноза заболевания у пациентов с ишемическим инсультом после успешной тромбоэкстракции: клинические, нейрорадиологические и перипроцедурные предикторыhttps://orcid.org/0000-0002-4532-4434АнисимовК. В.AnisimovK. V.

Кирилл Владимирович Анисимов

109240, Москва, ул. Яузская, 11/6

117513, Москва, ул. Островитянова, 1, стр. 10

Kirill Vladimirovich Anisimov

11/6, Yauzskaya St., Moscow 109240

1, Ostrovityanova St., Build. 10, Moscow 117513

anisimov.org@gmail.comhttps://orcid.org/0000-0001-8922-5764ГорстН. Х.GorstN. Kh.

109240, Москва, ул. Яузская, 11/6

11/6, Yauzskaya St., Moscow 109240

https://orcid.org/0000-0001-5387-4367БердалинА. Б.BerdalinA. B.

117152, Москва, Загородное шоссе, 2

2, Zagorodnoe Sh., Moscow 117152

https://orcid.org/0000-0002-1330-1756КостинА. В.KostinA. V.

127006, Москва, ул. Долгоруковская, 4

4, Dolgorukovskaya St., Moscow 127006

https://orcid.org/0000-0003-1733-267XЖуравлевК. Н.ZhuravlevK. N.

109240, Москва, ул. Яузская, 11/6

 

11/6, Yauzskaya St., Moscow 109240

https://orcid.org/0000-0001-7457-8057СкрыпникД. В.SkrypnikD. V.

109240, Москва, ул. Яузская, 11/6

127006, Москва, ул. Долгоруковская, 4

11/6, Yauzskaya St., Moscow 109240

4, Dolgorukovskaya St., Moscow 127006

https://orcid.org/0000-0001-6250-0762ШамаловН. А.ShamalovN. A.

117513, Москва, ул. Островитянова, 1

1, Ostrovityanova St., Build. 10, Moscow 117513

ГБУЗ г. Москвы «Городская клиническая больница им. И.В. Давыдовского» Департамента здравоохранения г. Москвы; ФГБУ «Федеральный центр мозга и нейротехнологий» ФМБА РоссииРоссияI.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department; Federal Center of Brain and Neurotechnologies, FMBA of RussiaRussian FederationГБУЗ г. Москвы «Городская клиническая больница им. И.В. Давыдовского» Департамента здравоохранения г. МосквыРоссияI.V. Davydovsky City Clinical Hospital, Moscow Healthcare DepartmentRussian Federation3ГБУЗ г. Москвы «Психиатрическая клиническая больница №1 им. Н.А. Алексеева» Департамента здравоохранения г. МосквыРоссияPsychiatric Hospital No. 1 named after N.A. Alexeev of the Department of Health of MoscowRussian FederationФГБОУ ВО «Российский университет медицины» Минздрава РоссииРоссияRussian University of Medicine, Ministry of Health of RussiaRussian FederationГБУЗ г. Москвы «Городская клиническая больница им. И.В. Давыдовского» Департамента здравоохранения г. Москвы; ФГБОУ ВО «Российский университет медицины» Минздрава РоссииРоссияI.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department; Russian University of Medicine, Ministry of Health of RussiaRussian FederationФГБУ «Федеральный центр мозга и нейротехнологий» ФМБА РоссииРоссияFederal Center of Brain and Neurotechnologies, FMBA of RussiaRussian Federation20252406202517360–69Copyright © Anisimov K.V., Gorst N.K., Berdalin A.B., Kostin A.V., Zhuravlev K.N., Skrypnik D.V., Shamalov N.A., 20252025Анисимов К.В., Горст Н.Х., Бердалин А.Б., Костин А.В., Журавлев К.Н., Скрыпник Д.В., Шамалов Н.А.Anisimov K.V., Gorst N.K., Berdalin A.B., Kostin A.V., Zhuravlev K.N., Skrypnik D.V., Shamalov N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/2631

Endovascular thrombectomy (EVT) is a highly effective method of restoring blood flow in patients with large cerebral artery occlusion. However, it is not uncommon for neurological deficits to persist or even worsen despite successful recanalization.

Objective

Objective: to identify factors associated with good and satisfactory functional recovery (mRS 0–3) following successful EVT (defined as achieving TICI 2b/3 reperfusion).

Material and methods

Material and methods. This retrospective analysis included 90 patients with ischemic stroke in the carotid territory who underwent EVT with achieved TICI 2b/3 reperfusion. The prognostic value of clinical, neuroradiological, and periprocedural factors was assessed.

Results

Results. Univariate logistic regression analysis identified several predictors of good or satisfactory outcome after EVT: the degree of neurological disturbances (National Institutes of Health Stroke Scale, NIHSS score) on admission (OR 0.87; 95% CI 0.79–1.02; p=0.005), NIHSS at 24 hours post-EVT (OR 0.70; 95% CI 0.60–0.81; p<0.0005), presence of T-occlusion of the internal carotid artery (OR 0.25; 95% CI 0.06–0.97; p=0.045), hemorrhagic transformation (OR 0.10; 95% CI 0.03–0.34; p<0.0005), the early CT ischemic signs volume (OR 0.97; 95% CI 0.94–0.99; p<0.001), volume with rCBF <30% (OR 0.91; 95% CI 0.87–0.96; p<0.0005), infarct core volume by day 3 (OR 0.95; 95% CI 0.92–0.97; p<0.0005), systemic thrombolysis (OR 5.79; 95% CI 1.24–26.96; p<0.0005), ASPECTS score (OR 2.43; 95% CI 1.67–3.53; p<0.0005), eASPECTS score (OR 1.53; 95% CI 1.18–2.0; p=0.002), Tmax/rCBF mismatch (OR 1.09; 95% CI 1.03–1.16; p=0.002). In multivariate logistic regression, three independent predictors of good or satisfactory functional outcome were identified: ASPECTS score, number of thrombectomy passes, and hemorrhagic transformation (model sensitivity – 95.7%, specificity – 70.0%).

Conclusion

Conclusion: The clinical outcome of ischemic stroke following successful recanalization is determined by a combination of factors reflecting both the initial state of brain tissue and the complexity of the procedure, as well as the occurrence of reperfusion-related postoperative complications.

Эндоваскулярная тромбоэкстракция (ТЭ) – высокоэффективный метод восстановления кровотока у больных с окклюзией крупной церебральной артерии. Однако нередки ситуации, когда, несмотря на достигнутую реканализацию, неврологический дефицит остается на прежнем уровне или даже нарастает.

Цель исследования – определить факторы, связанные с хорошим и удовлетворительным функциональным восстановлением (mRS 0–3) после успешной ТЭ (достижение кровотока TICI 2b/3).

Материал и методы

Материал и методы. В ретроспективный анализ было включено 90 пациентов c ишемическим инсультом в каротидной системе и выполненной ТЭ с достигнутым кровотоком TICI 2b/3. Была изучена прогностическая значимость клинических, нейрорадиологических и перипроцедурных факторов.

Результаты

Результаты. По результатам однофакторного логистического регрессионного анализа выявлены предикторы хорошего или удовлетворительного исхода после ТЭ: степень неврологических нарушений (по шкале NIHSS) при поступлении (ОШ 0,87; 95% ДИ 0,79–1,02; p=0,005), NIHSS через 24 ч после ТЭ (ОШ 0,70; 95% ДИ 0,60–0,81; p<0,0005), наличие Т-окклюзии внутренней сонной артерии (ВСА) (ОШ 0,25; 95% ДИ 0,06–0,97; p=0,045), геморрагическая трансформация (ОШ 0,10; 95% ДИ 0,03–0,34; p<0,0005), объем с ранними КТ-признаками ишемии (ОШ 0,97; 95% ДИ 0,94–0,99; p<0,001), объем с rCBF <30% (ОШ 0,91; 95% ДИ 0,87–0,96; p<0,0005), объем зоны инфаркта к 3-м суткам (ОШ 0,95; 95% ДИ 0,92–0,97; p<0,0005), системная тромболитическая терапия (ОШ 5,79; 95% ДИ 1,24–26,96; p<0,0005), балл по шкале ASPECTS (ОШ 2,43; 95% ДИ 1,67–3,53; p<0,0005), балл по шкале еASPECTS (ОШ 1,53; 95% ДИ 1,18–2,0; p=0,002), Tmax/rCBF несоответствие (ОШ 1,09; 95% ДИ 1,03–1,16; p=0,002). В ходе многофакторного логистического регрессионного анализа было отобрано три предиктора хорошего и удовлетворительного функционального восстановления после ТЭ: ASPECTS, число подходов ТЭ и геморрагическая трансформация (чувствительность модели – 95,7%, специфичность – 70,0%).

Заключение

Заключение. Исход ишемического инсульта в случаях восстановления кровотока (реканализации) связан с совокупностью факторов, отражающих как исходное состояние вещества мозга, так и сложность хода операции, а также возникновение послеоперационных реперфузионных осложнений.

инсультокклюзия крупной церебральной артериитромбоэкстракциянейровизуализацияишемические изменения вещества мозгаASPECTSeASPECTSпредикторы клинического исходаstrokelarge vessel occlusionthrombectomyneuroimagingischemic brain tissue changesASPECTSeASPECTSclinical outcome predictorsИсследование поддержано грантом Правительства Москвы на реализацию научно-практического проекта в медицине №1003-2/23.The study was supported by a grant from the Moscow Government for the implementation of a scientific and practical medical project, No. 1003-2/23.ReferencesLarrue V, von Kummer RR, Müller A, Bluhmki E. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the EuropeanAustralasian Acute Stroke Study (ECASS II). Stroke. 2001 Feb;32(2):438-41. doi: 10.1161/01.str.32.2.438Larrue V, von Kummer RR, Müller A, Bluhmki E. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the EuropeanAustralasian Acute Stroke Study (ECASS II). Stroke. 2001 Feb;32(2):438-41. doi: 10.1161/01.str.32.2.438Hacke W, Kaste M, Bluhmki E, et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656Hacke W, Kaste M, Bluhmki E, et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656Olivot JM, Heit JJ, Mazighi M, et al; FRAME Investigators. What predicts poor outcome after successful thrombectomy in early time window? J Neurointerv Surg. 2022 Nov;14(11):1051-5. doi: 10.1136/neurintsurg2021-017946. Epub 2021 Nov 8.Olivot JM, Heit JJ, Mazighi M, et al; FRAME Investigators. What predicts poor outcome after successful thrombectomy in early time window? J Neurointerv Surg. 2022 Nov;14(11):1051-5. doi: 10.1136/neurintsurg2021-017946. Epub 2021 Nov 8.Peisker T, Vasko P, Mikulenka P, et al. Clinical and radiological factors predicting stroke outcome after successful mechanical intervention in anterior circulation. Eur Heart J Suppl. 2022;24(Suppl B):B48-B52. doi: 10.1093/eurheartjsupp/suac010Peisker T, Vasko P, Mikulenka P, et al. Clinical and radiological factors predicting stroke outcome after successful mechanical intervention in anterior circulation. Eur Heart J Suppl. 2022;24(Suppl B):B48-B52. doi: 10.1093/eurheartjsupp/suac010Wu X, Liu G, Zhou W, et al. Outcome prediction for patients with anterior circulation acute ischemic stroke following endovascular treatment: A single-center study. Exp Ther Med. 2019 Nov;18(5):3869-76. doi: 10.3892/etm.2019.8054. Epub 2019 Sep 25.Wu X, Liu G, Zhou W, et al. Outcome prediction for patients with anterior circulation acute ischemic stroke following endovascular treatment: A single-center study. Exp Ther Med. 2019 Nov;18(5):3869-76. doi: 10.3892/etm.2019.8054. Epub 2019 Sep 25.Jiang S, Fei A, Peng Y, et al. Predictors of Outcome and Hemorrhage in Patients Undergoing Endovascular Therapy with Solitaire Stent for Acute Ischemic Stroke. PLoS One. 2015 Dec 7;10(12):e0144452. doi: 10.1371/journal.pone.0144452Jiang S, Fei A, Peng Y, et al. Predictors of Outcome and Hemorrhage in Patients Undergoing Endovascular Therapy with Solitaire Stent for Acute Ischemic Stroke. PLoS One. 2015 Dec 7;10(12):e0144452. doi: 10.1371/journal.pone.0144452Li J, Duan J, Zhang L, et al. Risk factors for poor outcomes of mechanical thrombectomy after anterior circulation large vessel occlusion-related acute ischemic strokes. 2022. doi: 10.21203/rs.3.rs-2335604/v1. Available at: https://www.researchgate.net/publication/366314268_Risk_factors_for_poor_outcomes_of_mechanical_thrombectomy_after_anterior_circulation_large_vessel_occlusion-related_acute_ischemic_strokesLi J, Duan J, Zhang L, et al. Risk factors for poor outcomes of mechanical thrombectomy after anterior circulation large vessel occlusion-related acute ischemic strokes. 2022. doi: 10.21203/rs.3.rs-2335604/v1. Available at: https://www.researchgate.net/publication/366314268_Risk_factors_for_poor_outcomes_of_mechanical_thrombectomy_after_anterior_circulation_large_vessel_occlusion-related_acute_ischemic_strokesRaoult H, Lassalle MV, Parat B, et al. DWI-Based Algorithm to Predict Disability in Patients Treated with Thrombectomy for Acute Stroke. AJNR Am J Neuroradiol. 2020 Feb;41(2):274-9. doi: 10.3174/ajnr.A6379. Epub 2020 Jan 30.Raoult H, Lassalle MV, Parat B, et al. DWI-Based Algorithm to Predict Disability in Patients Treated with Thrombectomy for Acute Stroke. AJNR Am J Neuroradiol. 2020 Feb;41(2):274-9. doi: 10.3174/ajnr.A6379. Epub 2020 Jan 30.Elwan ME, Mansour OY, Lashin ME, et al. Factors affecting mechanical thrombectomy outcome in acute ischemic stroke patients: an Egyptian sample. Egyptian J Neurol Psychiatry Neurosurg. 2022;58(1). doi: 10.1186/s41983-022-00491-9Elwan ME, Mansour OY, Lashin ME, et al. Factors affecting mechanical thrombectomy outcome in acute ischemic stroke patients: an Egyptian sample. Egyptian J Neurol Psychiatry Neurosurg. 2022;58(1). doi: 10.1186/s41983-022-00491-9Cao W, Ling Y, Yang L, et al. Association of Admission NIHSS Score with Infarct Core Volume and Target Mismatch of Infarct Core/Penumbra Volume on CT Perfusion in Acute Ischaemic Stroke. Cerebrovasc Dis. 2021;50(6):700-6. doi: 10.1159/000515167. Epub 2021 Jul 21.Cao W, Ling Y, Yang L, et al. Association of Admission NIHSS Score with Infarct Core Volume and Target Mismatch of Infarct Core/Penumbra Volume on CT Perfusion in Acute Ischaemic Stroke. Cerebrovasc Dis. 2021;50(6):700-6. doi: 10.1159/000515167. Epub 2021 Jul 21.Furlanis G, Ajcevic M, Stragapede L, et al.Ischemic Volume and Neurological Deficit: Correlation of Computed Tomography Perfusion with the National Institutes of Health Stroke Scale Score in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2018;27(8):2200-7. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.003. Epub 2018 Apr 30.Furlanis G, Ajcevic M, Stragapede L, et al.Ischemic Volume and Neurological Deficit: Correlation of Computed Tomography Perfusion with the National Institutes of Health Stroke Scale Score in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2018;27(8):2200-7. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.003. Epub 2018 Apr 30.Bourcier R, Goyal M, Liebeskind DS, et al. Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials. JAMA Neurol. 2019;76(4):405-11. doi: 10.1001/jamaneurol.2018.4510Bourcier R, Goyal M, Liebeskind DS, et al. Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials. JAMA Neurol. 2019;76(4):405-11. doi: 10.1001/jamaneurol.2018.4510Mazighi M, Chaudhry SA, Ribo M, et al.Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis. Circulation. 2013;127(19):1980-5. doi: 10.1161/CIRCULATIONAHA.112.000311Mazighi M, Chaudhry SA, Ribo M, et al.Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis. Circulation. 2013;127(19):1980-5. doi: 10.1161/CIRCULATIONAHA.112.000311Miteff F, Levi CR, Bateman GA, et al. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain. 2009;132(Pt 8):2231-8. doi: 10.1093/brain/awp155Miteff F, Levi CR, Bateman GA, et al. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain. 2009;132(Pt 8):2231-8. doi: 10.1093/brain/awp155Calleja AI, Cortijo E, Garcia-Bermejo P, et al. Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis. Eur J Neurol. 2013;20(5):795-802. doi: 10.1111/ene.12063Calleja AI, Cortijo E, Garcia-Bermejo P, et al. Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis. Eur J Neurol. 2013;20(5):795-802. doi: 10.1111/ene.12063Rocha M, Jovin TG. Fast Versus Slow Progressors of Infarct Growth in Large Vessel Occlusion Stroke: Clinical and Research Implications. Stroke. 2017;48(9):2621-7. doi: 10.1161/STROKEAHA.117.017673Rocha M, Jovin TG. Fast Versus Slow Progressors of Infarct Growth in Large Vessel Occlusion Stroke: Clinical and Research Implications. Stroke. 2017;48(9):2621-7. doi: 10.1161/STROKEAHA.117.017673Reale G. These times they are a-changing –goodbye time window for reperfusion? 2018. ESO. Available at: https://esostroke.org/these-times-they-are-a-changinggoodbye-time-window-for-reperfusion/Reale G. These times they are a-changing –goodbye time window for reperfusion? 2018. ESO. Available at: https://esostroke.org/these-times-they-are-a-changinggoodbye-time-window-for-reperfusion/Wang D and Wang Y. Tissue window, not the time window, will guide acute stroke treatment. Stroke Vasc Neurol. 2019;4(1):1-2. doi: 10.1136/svn-2018-000211Wang D and Wang Y. Tissue window, not the time window, will guide acute stroke treatment. Stroke Vasc Neurol. 2019;4(1):1-2. doi: 10.1136/svn-2018-000211Hill MD, Goyal M, Demchuk AM, et al.Ischemic Stroke Tissue-Window in the New Era of Endovascular Treatment. Stroke. 2015;46(8):2332-4. doi: 10.1161/STROKEA-HA.115.009688Hill MD, Goyal M, Demchuk AM, et al.Ischemic Stroke Tissue-Window in the New Era of Endovascular Treatment. Stroke. 2015;46(8):2332-4. doi: 10.1161/STROKEA-HA.115.009688Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-35. doi: 10.1161/STR.0000000000000074Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-35. doi: 10.1161/STR.0000000000000074Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Mar;49(3):e46e110. doi: 10.1161/STR.0000000000000158. Epub 2018 Jan 24.Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Mar;49(3):e46e110. doi: 10.1161/STR.0000000000000158. Epub 2018 Jan 24.Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344e418. doi: 10.1161/STR.0000000000000211Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344e418. doi: 10.1161/STR.0000000000000211Bhatia R, Hill MD, Shobha N, et al. Lowrates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254-8. doi: 10.1161/STROKEAHA.110.592535Bhatia R, Hill MD, Shobha N, et al. Lowrates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254-8. doi: 10.1161/STROKEAHA.110.592535Hassan AE, Kotta H, Garza L, et al. Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone. J Neurointerv Surg. 2019;11(12):1187-90. doi: 10.1136/neurintsurg-2019-014837Hassan AE, Kotta H, Garza L, et al. Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone. J Neurointerv Surg. 2019;11(12):1187-90. doi: 10.1136/neurintsurg-2019-014837Hassan AE, Ringheanu VM, Preston L, et al. IV tPA is associated with increase in rates of intracerebral hemorrhage and length of stay in patients with acute stroke treated with endovascular treatment within 4.5 hours: should we bypass IV tPA in large vessel occlusion? J Neurointerv Surg. 2021;13(2):114-8. doi: 10.1136/neurintsurg-2020-016045Hassan AE, Ringheanu VM, Preston L, et al. IV tPA is associated with increase in rates of intracerebral hemorrhage and length of stay in patients with acute stroke treated with endovascular treatment within 4.5 hours: should we bypass IV tPA in large vessel occlusion? J Neurointerv Surg. 2021;13(2):114-8. doi: 10.1136/neurintsurg-2020-016045Yang P, Zhang Y, Zhang L, et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med. 2020. doi: 10.1056/NEJMoa2001123Yang P, Zhang Y, Zhang L, et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med. 2020. doi: 10.1056/NEJMoa2001123LeCouffe NE, Kappelhof M, Treurniet KM,et al. A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke. N Engl J Med. 2021;385(20):1833-44. doi: 10.1056/NEJMoa2107727LeCouffe NE, Kappelhof M, Treurniet KM,et al. A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke. N Engl J Med. 2021;385(20):1833-44. doi: 10.1056/NEJMoa2107727Suzuki K, Matsumaru Y, Takeuchi M, et al.Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial. JAMA. 2021;325(3):244-53. doi: 10.1001/jama.2020.23522Suzuki K, Matsumaru Y, Takeuchi M, et al.Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial. JAMA. 2021;325(3):244-53. doi: 10.1001/jama.2020.23522Fischer U, Kaesmacher J, Strbian D, et al.Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet. 2022;400(10346):104-15. doi: 10.1016/S0140-6736(22)00537-2Fischer U, Kaesmacher J, Strbian D, et al.Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet. 2022;400(10346):104-15. doi: 10.1016/S0140-6736(22)00537-2Mitchell PJ, Yan B, Churilov L, et al. DIRECT-SAFE: A Randomized Controlled Trial of DIRECT Endovascular Clot Retrieval versus Standard Bridging Therapy. J Stroke. 2022;24(1):57-64. doi: 10.5853/jos.2021.03475Mitchell PJ, Yan B, Churilov L, et al. DIRECT-SAFE: A Randomized Controlled Trial of DIRECT Endovascular Clot Retrieval versus Standard Bridging Therapy. J Stroke. 2022;24(1):57-64. doi: 10.5853/jos.2021.03475Ruan Z, Luo X, Liu Y, et al. Effect of directendovascular treatment versus standard bridging therapy in large artery anterior circulation stroke (DEVT): 18-month follow-up of a randomized controlled trial. BMC Neurol. 2023;23(1):84. doi: 10.1186/s12883-023-03111-yRuan Z, Luo X, Liu Y, et al. Effect of directendovascular treatment versus standard bridging therapy in large artery anterior circulation stroke (DEVT): 18-month follow-up of a randomized controlled trial. BMC Neurol. 2023;23(1):84. doi: 10.1186/s12883-023-03111-yMasoud HE, de Havenon A, Castonguay AC,et al. 2022 Brief Practice Update on Intravenous Thrombolysis Before Thrombectomy in Patients With Large Vessel Occlusion Acute Ischemic Stroke: A Statement from Society of Vascular and Interventional Neurology Guidelines and Practice Standards (GAPS) Committee. Stroke Vascul Intervention Neurol. 2022;2(4). doi: 10.1161/svin.121.000276Masoud HE, de Havenon A, Castonguay AC,et al. 2022 Brief Practice Update on Intravenous Thrombolysis Before Thrombectomy in Patients With Large Vessel Occlusion Acute Ischemic Stroke: A Statement from Society of Vascular and Interventional Neurology Guidelines and Practice Standards (GAPS) Committee. Stroke Vascul Intervention Neurol. 2022;2(4). doi: 10.1161/svin.121.000276Gamba M, Gilberti N, Premi E, et al.Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results. BMC Neurol. 2019;19(1):103. doi: 10.1186/s12883-019-1341-3Gamba M, Gilberti N, Premi E, et al.Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results. BMC Neurol. 2019;19(1):103. doi: 10.1186/s12883-019-1341-3Anadani M, Alaweih A, Turner R, et al.P-034 First pass recanalization: incidence, predictors, and outcome. J NeuroIntervent Surg. 2018;10(Suppl 2):A43-A43. doi: 10.1136/neurintsurg-2018-SNIS.70Anadani M, Alaweih A, Turner R, et al.P-034 First pass recanalization: incidence, predictors, and outcome. J NeuroIntervent Surg. 2018;10(Suppl 2):A43-A43. doi: 10.1136/neurintsurg-2018-SNIS.70Liebeskind DS, Flint AC, Budzik RF, et al.Carotid I's, L's and T's: collaterals shape the outcome of intracranial carotid occlusion i n acute ischemic stroke. J Neurointerv Surg. 2015;7(6):402-7. doi: 10.1136/neurintsurg2014-011231Liebeskind DS, Flint AC, Budzik RF, et al.Carotid I's, L's and T's: collaterals shape the outcome of intracranial carotid occlusion i n acute ischemic stroke. J Neurointerv Surg. 2015;7(6):402-7. doi: 10.1136/neurintsurg2014-011231Lee SU, Hong JM, Kim SY, et al.Differentiating Carotid Terminus Occlusions into Two Distinct Populations Based on Willisian Collateral Status. J Stroke. 2016;18(2):179-86. doi: 10.5853/jos.2015.01529Lee SU, Hong JM, Kim SY, et al.Differentiating Carotid Terminus Occlusions into Two Distinct Populations Based on Willisian Collateral Status. J Stroke. 2016;18(2):179-86. doi: 10.5853/jos.2015.01529Vavrova J, Koznar B, Peisker T, et al. Long-term outcomes of thrombectomy for acute ischaemic stroke by occluded artery and stroke aetiology: a PRAGUE-16 substudy. EuroIntervention. 2021;17(2):e169-e177. doi: 10.4244/EIJ-D-19-00997Vavrova J, Koznar B, Peisker T, et al. Long-term outcomes of thrombectomy for acute ischaemic stroke by occluded artery and stroke aetiology: a PRAGUE-16 substudy. EuroIntervention. 2021;17(2):e169-e177. doi: 10.4244/EIJ-D-19-00997Fischer U, Mono ML, Schroth G, et al.Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. Eur J Neurol. 2013 Jul;20(7):1017-24, e87. doi: 10.1111/ene.12094. Epub 2013 Feb 9.Fischer U, Mono ML, Schroth G, et al.Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. Eur J Neurol. 2013 Jul;20(7):1017-24, e87. doi: 10.1111/ene.12094. Epub 2013 Feb 9.Frahm D, Wunderlich S, Schubert MI, et al.Mechanical Thrombectomy in Acute Occlusion of the Carotid-T: A Retrospective Single Centre Study in 51 Patients. Clin Neuroradiol. 2016 Mar;26(1):23-9. doi: 10.1007/s00062-014-0322-6. Epub 2014 Jul 25.Frahm D, Wunderlich S, Schubert MI, et al.Mechanical Thrombectomy in Acute Occlusion of the Carotid-T: A Retrospective Single Centre Study in 51 Patients. Clin Neuroradiol. 2016 Mar;26(1):23-9. doi: 10.1007/s00062-014-0322-6. Epub 2014 Jul 25.Nikoubashman O, Dekeyzer S, Riabikin A,et al. True First-Pass Effect: First-Pass Complete Reperfusion Improves Clinical Outcome in Thrombectomy Stroke Patients. Stroke. 2019 Aug;50(8):2140-6. doi: 10.1161/STROKEAHA.119.025148. Epub 2019 Jun 20.Nikoubashman O, Dekeyzer S, Riabikin A,et al. True First-Pass Effect: First-Pass Complete Reperfusion Improves Clinical Outcome in Thrombectomy Stroke Patients. Stroke. 2019 Aug;50(8):2140-6. doi: 10.1161/STROKEAHA.119.025148. Epub 2019 Jun 20.Di Maria F, Kyheng M, Consoli A, et al.Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: Results from a multicentric prospective registry. Int J Stroke. 2021;16(1):20-8. doi: 10.1177/1747493020923051Di Maria F, Kyheng M, Consoli A, et al.Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: Results from a multicentric prospective registry. Int J Stroke. 2021;16(1):20-8. doi: 10.1177/1747493020923051Memon MZ, Daniel D, Chaudhry MRA, et al. Clinical impact of the first pass effect on clinical outcomes in patients with near or complete recanalization during mechanical thrombectomy for large vessel ischemic stroke. J Neuroimaging. 2021;31(4):743-50. doi: 10.1111/jon.12864Memon MZ, Daniel D, Chaudhry MRA, et al. Clinical impact of the first pass effect on clinical outcomes in patients with near or complete recanalization during mechanical thrombectomy for large vessel ischemic stroke. J Neuroimaging. 2021;31(4):743-50. doi: 10.1111/jon.12864Shi Z, Guo S, Zheng S, et al. Number of Stent Retriever Passes Associated with Clinical Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2020;29(11):105199. doi: 10.1016/j.jstrokecerebrovasdis.2020.105199Shi Z, Guo S, Zheng S, et al. Number of Stent Retriever Passes Associated with Clinical Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2020;29(11):105199. doi: 10.1016/j.jstrokecerebrovasdis.2020.105199Gory B, Bresson D, Kessler I, et al.Histopathologic evaluation of arterial wall response to 5 neurovascular mechanical thrombectomy devices in a swine model. AJNR Am J Neuroradiol. 2013 Nov-Dec;34(11):2192-8. doi: 10.3174/ajnr.A3531. Epub 2013 Mar 28.Gory B, Bresson D, Kessler I, et al.Histopathologic evaluation of arterial wall response to 5 neurovascular mechanical thrombectomy devices in a swine model. AJNR Am J Neuroradiol. 2013 Nov-Dec;34(11):2192-8. doi: 10.3174/ajnr.A3531. Epub 2013 Mar 28.Nogueira RG, Levy EI, Gounis M, Siddiqui AH. The Trevo device: preclinical data of a novel stroke thrombectomy device in two different animal models of arterial thromboocclusive disease. J Neurointerv Surg. 2012 Jul;4(4):295-300. doi: 10.1136/neurintsurg2011-010053. Epub 2011 Aug 20.Nogueira RG, Levy EI, Gounis M, Siddiqui AH. The Trevo device: preclinical data of a novel stroke thrombectomy device in two different animal models of arterial thromboocclusive disease. J Neurointerv Surg. 2012 Jul;4(4):295-300. doi: 10.1136/neurintsurg2011-010053. Epub 2011 Aug 20.Rabinstein AA, Albers GW, Brinjikji W,Koch S. Factors that may contribute to poor outcome despite good reperfusion after acute endovascular stroke therapy. Int J Stroke. 2019 Jan;14(1):23-31. doi: 10.1177/1747493018799979. Epub 2018 Sep 6.Rabinstein AA, Albers GW, Brinjikji W,Koch S. Factors that may contribute to poor outcome despite good reperfusion after acute endovascular stroke therapy. Int J Stroke. 2019 Jan;14(1):23-31. doi: 10.1177/1747493018799979. Epub 2018 Sep 6.Molina CA, Alvarez-Sabin J, Montaner J,et al. Thrombolysis-related hemorrhagic infarction: a marker of early reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke. 2002 Jun;33(6):1551-6. doi: 10.1161/01.str.0000016323.13456.e5Molina CA, Alvarez-Sabin J, Montaner J,et al. Thrombolysis-related hemorrhagic infarction: a marker of early reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke. 2002 Jun;33(6):1551-6. doi: 10.1161/01.str.0000016323.13456.e5Dzialowski I, Pexman JH, Barber PA, et al;CASES Investigators. Asymptomatic hemorrhage after thrombolysis may not be benign: prognosis by hemorrhage type in the Canadian alteplase for stroke effectiveness study registry. Stroke. 2007 Jan;38(1):75-9. doi: 10.1161/01.STR.0000251644.76546.62. Epub 2006 Nov 22.Dzialowski I, Pexman JH, Barber PA, et al;CASES Investigators. Asymptomatic hemorrhage after thrombolysis may not be benign: prognosis by hemorrhage type in the Canadian alteplase for stroke effectiveness study registry. Stroke. 2007 Jan;38(1):75-9. doi: 10.1161/01.STR.0000251644.76546.62. Epub 2006 Nov 22.Kent DM, Hinchey J, Price LL, et al. In acute ischemic stroke, are asymptomatic intracranial hemorrhages clinically innocuous? Stroke. 2004 May;35(5):1141-6. doi: 10.1161/01.STR.0000125712.02090.6e. Epub 2004 Apr 15.Kent DM, Hinchey J, Price LL, et al. In acute ischemic stroke, are asymptomatic intracranial hemorrhages clinically innocuous? Stroke. 2004 May;35(5):1141-6. doi: 10.1161/01.STR.0000125712.02090.6e. Epub 2004 Apr 15.

The authors declare that there are no conflicts of interest present.