Complete Revascularization in Stroke Thrombectomy: How and Why to Pursue it

Introduction: Revascularization is one of the main factors associated with good clinical outcome in the endovascular treatment of ischemic stroke due to large vessel occlusion (LVO). A consensus on the best technique, choice of materials for mechanical thrombectomy (MT) and best technical outcome has not yet been established. An important difference in the clinical outcome between the different degrees of revascularization would justify pursuing complete revascularization. There may be technical, clinical and radiological factors that can predict the degree of this revascularization.<br><br>Objective: To assess predictors of complete revascularization and its clinical outcomes.<br><br>Methods: This is a retrospective cohort study including 155 medical records of patients who underwent MT at the Fortaleza General Hospital between January 2017 and July 2021. To assess revascularization, we used the Modified Thrombolysis in Cerebral Infarction (mTICI) scale. To assess clinical outcome, National Institute of Health Stroke Scale (NIHSS) at discharge was used.<br><br>Results: In logistic regression, we found stent diameter as a predictor of complete revascularization (OR 6.06; 95% CI 1.1-33.2; p=0.038). We showed that mTICI 3 is associated with a chance 2.57 times higher to achieve good outcome compared tom TICI 2b (OR 2.57; 95% CI 1.1-5.8; p=0.004).<br><br>Conclusion: There are technical factors in MT that might predict complete revascularization and its clinical benefit justifies the effort to achieve it. The new technical aim of MT should be achievement of complete revascularization. More studies are needed to change international guidelines.<br><br>Funding Information: None to declare. <br><br>Declaration of Interests: None to declare. <br><br>Ethics Approval Statement: This study has been approved by the Research and Ethical Committee of the Hospital Geral de Fortaleza (Statement # 5.101.882)<br><br>