• Mònica Millán, Sebastià Remollo, Helena Quesada, Arturo Renú, Alejandro Tomasello, Priyanka Minhas, Natalia Pérez de la Ossa, Marta Rubiera, Laura Llull, Pedro Cardona, Fahad Al-Ajlan, María Hernández, Zarina Assis, Andrew M Demchuk, Tudor Jovin, Antoni Dávalos, and REVASCAT Trial Investigators.
• From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.). mmillan.germanstrias@gencat.cat.
• Stroke. 2017 Apr 1; 48 (4): 983-989.

Background And PurposeHigher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset).MethodsIndependent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression.ResultsComplete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P<0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all P<0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9-10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm.ConclusionsComplete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.© 2017 American Heart Association, Inc.

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