Just maybe you've rediscovered Capillaries that don't open due to pericytes September 2011. What the fuck is your solution to that problem? Describing a problem with NO solution is grounds for firing! My God, the amount of absolute stupidity in stroke is appalling!
Hypoperfusion is a term that describes "a reduced amount of blood flow".
Persistent Tissue-Level Hypoperfusion (No-Reflow) Negates the Clinical Benefit of Successful Thrombectomy
Abstract
BACKGROUND:
Tissue-level
hypoperfusion (no-reflow) persists in 30% of patients with seemingly
successful upstream angiographic recanalization at thrombectomy. We
investigated the clinical impact of the no-reflow phenomenon by
comparing patients with no-reflow versus patients with varying degrees
of angiographic recanalization.
METHODS:
In
a post hoc pooled analysis of the EXTEND-IA (Endovascular Therapy for
Ischemic Stroke With Perfusion-Imaging Selection) and EXTEND-IA TNK
(Tenecteplase Versus Alteplase Before Thrombectomy for Ischemic Stroke)
part 1 and 2 trials, clinical and radiological outcomes were compared
between patients with (1) full angiographic recanalization with
no-reflow (expanded Treatment in Cerebral Ischemia [eTICI]
2c3–NoReflow), defined as >15% reduction in relative cerebral blood
flow or Volume within the infarct relative to a contralateral homolog on
24-hour-follow-up perfusion computed tomography or magnetic resonance
imaging despite eTICI grade 2c-3 angiographic recanalization, (2) full
angiographic recanalization and tissue reperfusion (eTICI
2c3–CompleteFlow), (3) partial angiographic recanalization (eTICI 2b),
and (4) unsuccessful thrombectomy (eTICI 0-2a). The primary outcome,
functional independence at 90 days, was investigated using a mixed
effect logistic regression model, both unadjusted and adjusted for a
priori-selected covariates, namely age, premorbid modified Rankin Scale,
baseline National Institutes of Health Stroke Scale, and baseline core
volume.
RESULTS:
Among
537 patients from the overall pooled cohort, 456 patients were included
in the analysis. The mean age of the included patients was 71 years
old, and 54% were male. A favorable outcome (90-day modified Rankin
Scale score of 0–2 or return to baseline modified Rankin Scale) was
observed in 43.33% (n=13/30) of patients with eTICI 2c3–NoReflow, 67.50%
(n=81/120) of eTICI 2c3–CompleteFlow, 63.03% (n=150/238) of eTICI 2b,
and 50.00% (n=34/68) of unsuccessful thrombectomy. In multivariable
analysis, patients with eTICI 2c3–NoReflow had lower odds of favorable
outcome compared with those with eTICI 2c3–CompleteFlow (adjusted odds
ratio, 0.31 [95% CI, 0.12–0.77]; P=0.01) and eTICI 2b (adjusted odds ratio, 0.40 [95% CI, 0.17–0.96]; P=0.04) but not unsuccessful thrombectomy (adjusted odds ratio, 1.02 [95% CI, 0.38–2.73]; P=0.97). Patients with eTICI 2c3–NoReflow had similar follow-up infarct volume to unsuccessful thrombectomy (β=−8.26 [95% CI, −27.38 to 10.86]; P=0.40) and eTICI 2b (β=9.38 [95% CI, −7.33 to 26.09]; P=0.27) but had larger infarcts compared with eTICI 2c3–CompleteFlow (β=18.85 [95% CI, 1.16–36.54]; P=0.04).
CONCLUSIONS:
When
no-reflow occurred, clinical and radiological outcomes in patients with
full angiographic recanalization were similar to patients with
unsuccessful thrombectomy. Preventing or reversing no-reflow has the
potential to augment the clinical benefit of reperfusion treatment in
ischemic stroke.
Graphical Abstract
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