Endovascular thrombectomy reduces risk of poor functional outcomes in patients presenting within 0-6 hours with large ischemic core volumes on computed tomography perfusion

•Large ischemic core stroke patients are at high risk for poor outcomes•Large core patients were excluded from some early window thrombectomy trials•Our study demonstrates a benefit for thrombectomy in the 0–6-hour time window•Thrombectomy may also benefit patients with large cores and small penumbr...

Full description

Saved in:
Bibliographic Details
Published in:Journal of stroke and cerebrovascular diseases 2022-08, Vol.31 (8), p.106548-106548, Article 106548
Main Authors: Karamchandani, Rahul R., Yang, Hongmei, Prasad, Tanushree, Strong, Dale, Rhoten, Jeremy B., Defilipp, Gary, Clemente, Jonathan, Stetler, William R., Bernard, Joe, Asimos, Andrew W.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Computed tomography perfusion
Endovascular Procedures - adverse effects
Endovascular Procedures - methods
Humans
Infarction, Middle Cerebral Artery
Ischemia
Large ischemic core
Large vessel occlusion
Mechanical thrombectomy
Middle Aged
Perfusion
Retrospective Studies
Stroke - diagnostic imaging
Stroke - therapy
Thrombectomy - adverse effects
Thrombectomy - methods
Tomography, X-Ray Computed - methods
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:•Large ischemic core stroke patients are at high risk for poor outcomes•Large core patients were excluded from some early window thrombectomy trials•Our study demonstrates a benefit for thrombectomy in the 0–6-hour time window•Thrombectomy may also benefit patients with large cores and small penumbra Patients presenting with large ischemic core volumes (LICVs) on computed tomography perfusion (CTP) are at high risk for poor functional outcomes. We sought to identify predictors of outcome in patients with an internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion and LICV. A large healthcare system's prospectively collected code stroke registry was utilized for this retrospective analysis of patients presenting within 6 hours with at least 50 ml of CTP reduced relative cerebral blood flow (CBF) < 30%. A multivariable logistic regression model was constructed to identify independent predictors (p < 0.05) of poor discharge outcome (modified Rankin scale score 4-6). Over a 38-month period, we identified 104 patients meeting inclusion criteria, with a mean age of 65.4 ± 16.2 years, median presenting National Institutes of Health Stroke Scale score 20 (IQR 16–24), median ischemic core volume (CBF < 30%) 82 ml (IQR 61-118), and median mismatch volume 80 ml (IQR 56-134). Seventy-five patients (72.1%) had a discharge modified Rankin scale score of 4-6. Sixty-six of 104 (63.5%) patients were treated with endovascular thrombectomy (EVT). In the multivariable regression model, EVT (OR 0.303; 95% CI 0.080-0.985; p = 0.049) and lower blood glucose (per 1-point increase, OR 1.014; 95% CI 1.003-1.030; p = 0.030) were independently protective against poor discharge outcome. EVT is independently associated with a reduced risk of poor functional outcome in patients presenting within 6 hours with ICA or MCA occlusions and LICV.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2022.106548