Endovascular therapy in patients with a large ischemic volume at presentation: An aggregate patient-level analysis.
Clin Neurol Neurosurg
; 244: 108452, 2024 Sep.
Article
en En
| MEDLINE
| ID: mdl-39059286
ABSTRACT
INTRODUCTION:
Recently, four randomized controlled trials (RCTs) have demonstrated the benefits of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) and a large ischemic core at baseline (LIC). The purpose of this study was to investigate the features influencing the clinical outcome and the benefits of mechanical thrombectomy in this subgroup.METHODS:
We conducted a multicenter retrospective aggregate cohort study of patients with AIS-LVO and a LIC, assessed with quantitative core volume measures, treated with MT between 2012 and 2019. The data were queried through four registries, including patients with core volumes ≥50cc. Multivariable logistic regression models were employed to determine factors independently associated with clinical outcomes in patients with successful recanalization (modified-Thrombolysis-in-Cerebral-Infarction-score, mTICI=2b-3) and unsuccessful recanalization group (mTICI=0-2a). The primary endpoint was a favorable functional outcome at day-90, defined as a modified Rankin scale (mRS) of 0-3, accounting for the inherent severity of AIS with baseline LIC. Secondary outcomes included functional independence (mRS 0-2) at day-90, mortality, and symptomatic Intracranial Hemorrhage (sICH).RESULTS:
A total of 460 patients were included (mean age 66±14.2 years; 39.6â¯% females). The mean baseline NIHSS was 20±5.2, and the core volume was 103.2±54.6â¯ml. Overall, 39.8â¯% (183/460) of patients achieved a favorable outcome at day-90 (mRS 0-3). Successful recanalization was significantly associated with a more frequent favorable outcome (aOR, 4.79; 95â¯%CI, 2.73-8.38; P<0.01) and functional independence (P<0.01). This benefit remained significant in older patients and in patients with cores above 100cc. At 90 days, 147/460 patients (32â¯%) were deceased, with successful recanalization significantly associated with less frequent mortality (OR, 0.34; 95â¯%CI, 0.22-0.53; P<0.01). The rate of sICH was 17.4â¯% and did not differ significantly between groups.CONCLUSIONS:
In this large, pooled-cohort study of AIS-LVO patients with infarct cores over 50cc at baseline, we demonstrated that successful recanalization was associated with a better functional outcome, lower mortality, and similar rates of symptomatic intracranial hemorrhage for a wide spectrum of patients.Palabras clave
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Base de datos:
MEDLINE
Asunto principal:
Procedimientos Endovasculares
/
Accidente Cerebrovascular Isquémico
Idioma:
En
Revista:
Clin Neurol Neurosurg
Año:
2024
Tipo del documento:
Article