{
  "abstract": "Background Successful recanalization after endovascular thrombectomy (EVT) is commonly defined as achieving a modified Thrombolysis in Cerebral Ischemia (mTICI) score ≥2B, indicating reperfusion of at least 50% of the target territory. While higher mTICI grades are linked to better outcomes, it is unclear whether pursuing additional passes to reach mTICI 2C/3 justifies extra procedural time and risk. We aimed to evaluate the risk-benefit of continued EVT beyond mTICI 2B, focusing on the impact of additional procedure time.Methods We conducted a multicenter cohort study using data from STAR registry (2016-2024), including adult patients who achieved mTICI ≥2B during EVT. Patients were categorized into three groups: (1) Recanalize & STOP, (2) Recanalize & GO, and TICI 2B & STOP. The primary outcome was functional independence at 90 days (modified Rankin Scale [mRS] 0-2). Secondary outcomes included mortality, symptomatic intracranial hemorrhage (sICH) and final angiographic improvement to mTICI 2C/3. Propensity score matching (PSM) and generalized estimating equation (GEE) models with multiple imputation were used to adjust for confounders, center-level clustering, and missing data.Results Among 4,053 patients, 2,303 (56.8%) were in the Recanalize & STOP group, 1,750 (43.2%) in Recanalize & GO, and 1,024 (25.2%) in the TICI 2B & STOP subgroup. Each additional 15 minutes after achieving mTICI 2B was associated with a decreased likelihood of functional independence (adjusted odds ratio [aOR] 0.94; p = 0.02), corresponding to approximately 6% reduction per 15 minutes, and an increased risk of sICH (aOR 1.05 per minute; p = 0.03), equivalent to a 5% increase per 15 minutes. No significant association was observed with mortality (p = 0.6) or improvement to mTICI 2C/3 (p = 0.2). In cases where additional attempts did not result in improved reperfusion, each additional 15 minutes after mTICI 2B was associated with a 17% reduction in the odds of functional independence (P<0.01). In sensitivity analyses using regression-based L-contrast modeling, additional thrombectomy attempts were associated with improved outcomes only when the additional time after mTICI 2B was <15 minutes (P<0.01, AUC 0.56) and total procedure time was <60 minutes (P<0.001, AUC=0.59).Conclusion Among patients achieving mTICI ≥2B, prolonged procedural time after initial reperfusion is associated with worse functional outcomes and increased risk of sICH, without improvement in mortality or angiographic outcomes. Additional thrombectomy attempts beyond mTICI 2B may provide clinical benefit only when achieved within a short time window (<15 minutes, and total procedure time under 60 min).Disclosures A. Chacon: None. L. Zhao: None. B. El Baba: None. Z. Yang: None. M. Cawley: None. A. Rai: None. S. Wolfe: None. F. Siddiqui: None. C. Ogilvy: None. J. Dye: None. D. Hoit: None. M. Moss: None. N. Chalouhi: None. I. Fragata: None. T. Ma: None. A. Alawieh: 1; C; NIH, Department of Defense, Abbott Point of Care, Inc.Abstract O-010 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Emory University School of Medicine, Atlanta, GA"
      ],
      "name": "A Chacon"
    },
    {
      "affiliations": [
        "Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA"
      ],
      "name": "L Zhao"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory University School of Medicine, Atlanta, GA"
      ],
      "name": "B El Baba"
    },
    {
      "affiliations": [
        "Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA"
      ],
      "name": "Z Yang"
    },
    {
      "affiliations": [
        "Emory University, Atlanta, GA"
      ],
      "name": "B Howard"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory University School of Medicine, Atlanta, GA"
      ],
      "name": "M Cawley"
    },
    {
      "affiliations": [
        "Neurosurgery, Wake Forest Baptist Health, Winston-Salem, NC"
      ],
      "name": "A Rai"
    },
    {
      "affiliations": [
        "Neurosurgery, Wake Forest Baptist Health, Winston-Salem, NC, USA, NC"
      ],
      "name": "S Wolfe"
    },
    {
      "affiliations": [
        "Neurology, University of Michigan Health West, Wyoming, MI"
      ],
      "name": "F Siddiqui"
    },
    {
      "affiliations": [
        "Göttingen, Germany"
      ],
      "name": "I Maier"
    },
    {
      "affiliations": [
        "Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"
      ],
      "name": "C Ogilvy"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Illinois at Chicago, Chicago, IL"
      ],
      "name": "A Alaraj"
    },
    {
      "affiliations": [
        "Neurosurgery, Loma Linda University, Loma Linda, CA"
      ],
      "name": "J Dye"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan"
      ],
      "name": "S Yoshimura"
    },
    {
      "affiliations": [
        "Kingwood, TX"
      ],
      "name": "M Ezzeldin"
    },
    {
      "affiliations": [
        "Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "D Romano"
    },
    {
      "affiliations": [
        "Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "P Jabbour"
    },
    {
      "affiliations": [
        "Neurology, University of Tennessee health science center, Memphis, TN"
      ],
      "name": "N Goyal"
    },
    {
      "affiliations": [
        "Neurosurgery, Semmes-Murphey Clinic, Memphis, TN"
      ],
      "name": "C Nickele"
    },
    {
      "affiliations": [
        "Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN"
      ],
      "name": "D Hoit"
    },
    {
      "affiliations": [
        "Neuroradiology, University Medical Center Goettingen, Goettingen, Germany"
      ],
      "name": "M Psychogios"
    },
    {
      "affiliations": [
        "Neurorradiología Intervencionista, Hospital Universitario Donostia, San Sebastian, Spain"
      ],
      "name": "P Navia"
    },
    {
      "affiliations": [
        "Neurosurgery, Washington Regional Medical Center, Fayetteville, AR"
      ],
      "name": "M Moss"
    },
    {
      "affiliations": [
        "Neurosurgery, New York University, New York, NY"
      ],
      "name": "O Tanweer"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Florida, Gainesville, FL, USA, FL"
      ],
      "name": "N Chalouhi"
    },
    {
      "affiliations": [
        "Medical University of South Carolina, Charleston, SC"
      ],
      "name": "E Almallouhi"
    },
    {
      "affiliations": [
        "Mount Sinai Hospital, New York, NY"
      ],
      "name": "J Mascitelli"
    },
    {
      "affiliations": [
        "SUNY SB, Stony Brook, NY"
      ],
      "name": "D Fiorella"
    },
    {
      "affiliations": [
        "Yale University, New Haven, CT"
      ],
      "name": "C Matouk"
    },
    {
      "affiliations": [
        "Neurosurgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal, Portugal"
      ],
      "name": "I Fragata"
    },
    {
      "affiliations": [
        "University at Buffalo, Buffalo, NY"
      ],
      "name": "M Mokin"
    },
    {
      "affiliations": [
        "Medical University of South Carolina, Charleston, SC"
      ],
      "name": "A Spiotta"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory University, Atlanta, GA"
      ],
      "name": "J Grossberg"
    },
    {
      "affiliations": [
        "Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA"
      ],
      "name": "T Ma"
    },
    {
      "affiliations": [
        "Neurosurgery, Semmes Murphey Clinic, Memphis, TN"
      ],
      "name": "A Alawieh"
    }
  ],
  "title": "O-010 Evaluating the risk-benefit of continued thrombectomy after mTICI 2B using time-based modeling",
  "uid": "6148f3d1-99e0-529a-9f58-d7b0bb0d2472"
}