scholarly journals Outcomes of Mechanical Thrombectomy in Patients with Large Diffusion-Weighted Imaging Lesions

Author(s):  
Yong-Hwan Cho ◽  
Jae Hyung Choi
2019 ◽  
Vol 12 (8) ◽  
pp. 742-746
Author(s):  
Pietro Panni ◽  
Caterina Michelozzi ◽  
Sébastien Richard ◽  
Gaultier Marnat ◽  
Raphaël Blanc ◽  
...  

BackgroundAlthough accumulating evidence has demonstrated the benefit of mechanical thrombectomy (MT) in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), it is still unclear how workflow metrics impact the clinical outcomes of this subgroup of patients.MethodsPatients with acute stroke and diffusion-weighted imaging (DWI) ASPECTS ≤5 at baseline, who underwent MT within 6 hours of symptoms onset, were included from a prospectively maintained national multicentric registry between January 1, 2012 to August 31, 2017. The degree of disability was assessed by the modified Rankin Scale (mRS) at 90 days. The primary outcome was functional independence defined as mRS 0 to 2 at 90 days.ResultsThe study included 291 patients with baseline DWI-ASPECTS ≤5. Good outcome was achieved in 82 (28.2%) patients, and 104 (35.7%) patients died within 90 days. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) rate was 75.3%, and median onset to recanalization (OTR) time was 2 268min. Among time-related variables, OTR emerged as the strongest predictor of primary outcome (adjusted OR for every 60 min 0.59, 95% CI 0.44 to 0.77; p<0.001). mTICI 2c-3 independently predicted a good outcome (adjusted OR 1.91, 95% CI 1.004 to 3.6; p=0.049) along with age and baseline DWI-ASPECTS. Recanalization status failed to significantly impact outcome in the DWI-ASPECTS 0–3 subpopulation.ConclusionsNear complete reperfusion (mTICI 2c-3) and OTR are the strongest modifiable outcome predictors in patients with DWI-ASPECTS ≤5 treated with MT.


2016 ◽  
Vol 28 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Tanja Schneider ◽  
Tobias Mahraun ◽  
Julian Schroeder ◽  
Andreas Frölich ◽  
Philip Hoelter ◽  
...  

2020 ◽  
Vol 49 (3) ◽  
pp. 292-300
Author(s):  
Fumihiro Sakakibara ◽  
Shinichi Yoshimura ◽  
Soichiro Numa ◽  
Kazutaka Uchida ◽  
Norito Kinjo ◽  
...  

Background and Purpose: Diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch is an early sign of acute ischemic stroke. DWI-FLAIR mismatch was reported to be valuable to select patients with unknown onset stroke who are eligible to receive intravenous thrombolysis (IVT), but its utility is less studied in patients undergoing mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). We thus investigated the functional outcomes at 90 days between patients with DWI-FLAIR mismatch and those with match who underwent MT for LVO. Methods: We conducted a historical cohort study in consecutive patients who were evaluated by magnetic resonance imaging for suspected stroke at a single center. We enrolled patients with occlusion of internal carotid artery or horizontal or vertical segment of middle cerebral artery who underwent MT within 24 h after they were last known to be well. DWI-FLAIR mismatch was defined when a visible acute ischemic lesion was present on DWI without traceable parenchymal hyperintensity on FLAIR. Image analysis was done by 2 stroke neurologists independently. We estimated the adjusted odds ratio (OR) of DWI-FLAIR mismatch relative to DWI-FLAIR match for moderate outcome defined as modified Rankin Scale (mRS) 0–3, favorable outcome defined as mRS 0–2 and mortality at 90 days after the onset, and symptomatic intracranial hemorrhage (sICH) within 72 h after the onset. Results: Of the 380 patients who received MT, 202 were included. Patients with DWI-FLAIR mismatch (146 [72%]) had significantly higher baseline National Institutes of Health Stroke Scale (median 16 vs. 13, p = 0.01), more transferred-in (78 vs. 63%, p = 0.02), more IVT (45 vs. 18%, p = 0.0003), more cardioembolism (69 vs. 54%, p = 0.03), and shorter onset-to-hospital door times (median 175 vs. 371 min, p < 0.0001) than patients with DWI-FLAIR match. Patients with DWI-FLAIR mismatch had more moderate outcome than those with DWI-FLAIR match (61 vs. 52%, p = 0.24), and the adjusted OR was 3.12 (95% confidence interval [CI]: 1.35–7.19, p = 0.008). sICH within 72 h was less frequent in the DWI-FLAIR mismatch group (10 vs. 20%, p = 0.06), with an adjusted OR of 0.36 (95% CI: 0.13–0.97, p = 0.044). The adjusted ORs for favorable outcome and mortality were 0.87 (95% CI: 0.39–1.94, p = 0.73) and 0.63 (95% CI: 0.20–2.05, p = 0.44), respectively. Conclusions: DWI-FLAIR mismatch was associated with more moderate outcome and less sICH in the adjusted analysis in patients receiving MT for acute LVO. DWI-FLAIR mismatch could be useful to select patients with unknown onset stroke who are eligible to receive MT for acute LVO.


Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Francois Rusch ◽  
Serge Bracard

Objectives: Asymmetrically prominent veins on magnetic susceptibility sequences are thought to reflect the ischemic penumbra, by detecting high levels of desoxyheglobin. We investigated the relation between star-weighted angiography (SWAN)-diffusion weighted imaging (DWI) mismatch and clinical outcome after mechanical thrombectomy. Methods: We performed a retrospective study on patients who experienced anterior circulation stroke and for whom 1.5-Tesla MRI DWI and SWAN were performed upstream of mechanical thrombectomy. Mismatch was determined by using the Alberta Stroke Program Early CT Score (ASPECTS) on the diffusion-weighted and SWAN sequences. Three subgroups were defined in terms of mismatch level: high mismatch (HM), moderate mismatch (MM) and low mismatch (LM). Favorable outcome was defined as a modified Rankin score of 0-2 at three months. Multivariate logistic regression was used to examine associations between mismatch profiles and favorable outcomes. Results: The study included 108 patients who underwent mechanical thrombectomy. High mismatch was significantly associated with favorable clinical outcome (67% in the HM subgroup vs. 51% and 28% in the MM and LM subgroups respectively; odds ratio 1.25; 95 CI 1.02-1.56; p=0.037). No significant associations between SWAN-DWI mismatch and severe hemorrhagic complications or recanalization quality were brought to light by the present study. Conclusion: SWAN-DWI mismatch is a competent predictor of clinical outcome following mechanical thrombectomy.


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