Thrombectomy in ischemic stroke patients with large core but minor ischemic changes on non-enhanced computed tomography

医学 轻微中风 计算机断层摄影术 缺血性中风 冲程(发动机) 芯(光纤) 心脏病学 放射科 内科学 缺血 狭窄 机械工程 材料科学 工程类 复合材料
作者
Gabriel Broocks,Helge Kniep,Rosalie McDonough,Matthias Bechstein,Christian Heitkamp,Laurens Winkelmeier,Susan Klapproth,Tobias D. Faizy,Maximilian Schell,Gerhard Schön,Uta Hanning,Susanne Gellißen,André Kemmling,Panagiotis Papanagiotou,Jens Fiehler,Lukas Meyer
出处
期刊:International Journal of Stroke [SAGE Publishing]
卷期号:19 (7): 764-771
标识
DOI:10.1177/17474930241249588
摘要

Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) is regularly used to guide patient selection for mechanical thrombectomy (MT). Similarly, penumbral imaging based on computed tomography perfusion (CTP) may serve as neuroimaging tool to guide treatment. Yet, patients with a large ischemic core on CTP may show only minor ischemic changes resulting in a high ASPECTS. Aim: We hypothesized twofold: (1) the treatment effect of vessel recanalization in patients with core volume > 50 mL but ASPECTS ⩾ 6 is not different compared to high ASPECTS patients with core volume < 50 mL, and (2) recanalization is associated with core overestimation. Methods: We conducted an observational study analyzing ischemic stroke patients consecutively treated with MT after triage by multimodal CT. Functional endpoint was the rate of functional independence at Day 90 defined as modified Rankin Scale (mRS) 0–2. Imaging endpoint was core overestimation, which was considered when CTP-derived core was larger than the final infarct volume assessed on follow-up imaging. Recanalization was evaluated with the extended Thrombolysis in Cerebral Infarction (eTICI) scale. Multivariable logistic regression analysis and propensity score matching (PSM) were used to assess the association of recanalization (eTICI ⩾ 2b) with functional outcome and core overestimation. Results: Of 630 patients with ASPECTS ⩾ 6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS ⩾ 6 (+ 25.8%, 95% CI: 16.3–35.4, p < 0.001) compared to patients with ASPECTS ⩾ 6 and core volume < 50 mL (+ 14.9%, 95% CI: 5.7–24.1, p = 0.002). Recanalization (aOR: 3.46, 95% CI: 1.85–6.47, p < 0.001) and higher core volume (aOR: 1.03, 95% CI: 1.02–1.04, p < 0.001) were significantly associated with core overestimation. Conclusion: In patients with ASPECTS ⩾ 6, core volumes did not significantly modify outcomes following recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with a large ischemic core but minor ischemic changes on non-enhanced CT. Data access statement: The data analyzed in this study will be available and shared on reasonable request from any qualified researcher for the purpose of replicating the results after clearance by the local ethics committee.
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