Association between final eTICI grade 3 reperfusion and improved functional outcomes after endovascular treatment for ischemic stroke: a pooled analysis of three randomized controlled trials

This study aimed to investigate the association between expanded Thrombolysis in Cerebral Infarction (eTICI) grade and clinical outcomes after endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation. This study pooled data from three prospective multicenter randomized controlled trials, including 2,793 patients with AIS due to anterior circulation large vessel occlusion who underwent EVT. The primary outcome was a modified Rankin Scale (mRS) score of 0–2 at 90 days. Secondary outcomes included the distribution of mRS scores, as well as mRS scores of 0–1, 0–3, and 0–4 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 h. Among the 2,793 patients treated with EVT, 266 (9.5%) achieved eTICI grades 0-2a, 602 (21.6%) achieved eTICI 2b, 353 (12.6%) achieved eTICI 2c, and 1,572 (56.3%) achieved eTICI 3. Compared with eTICI 2c, eTICI 3 was significantly associated with higher odds of achieving an mRS score of 0–2 (adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.06–1.78; P = 0.015). No significant associations were observed between eTICI 3 and mortality (aOR, 1.17; 95% CI, 0.83–1.66) or sICH (aOR, 0.80; 95% CI, 0.52–1.23) ( P > 0.05). Among patients with AIS due to anterior circulation LVO undergoing EVT, final eTICI grade 3 was associated with a higher probability of achieving functional independence than eTICI grade 2c. Furthermore, shorter puncture-to-reperfusion time may be associated with better clinical outcomes among patients achieving complete reperfusion.