Long-Term Effect of Mechanical Thrombectomy in Stroke Patients According to Advanced Imaging Characteristics.

Author:

Beyeler MorinORCID,Pohle Fabienne,Weber Loris,Mueller Madlaine,Kurmann Christoph C.,Mujanovic Adnan,Clénin Leander,Piechowiak Eike Immo,Meinel Thomas Raphael,Bücke Philipp,Jung Simon,Seiffge David,Pilgram-Pastor Sara M.,Dobrocky Tomas,Arnold Marcel,Gralla Jan,Fischer Urs,Mordasini Pasquale,Kaesmacher Johannes

Abstract

Abstract Purpose Data on long-term effect of mechanical thrombectomy (MT) in patients with large ischemic cores (≥ 70 ml) are scarce. Our study aimed to assess the long-term outcomes in MT-patients according to baseline advanced imaging parameters. Methods We performed a single-centre retrospective cohort study of stroke patients receiving MT between January 1, 2010 and December 31, 2018. We assessed baseline imaging to determine core and mismatch volumes and hypoperfusion intensity ratio (with low ratio reflecting good collateral status) using RAPID automated post-processing software. Main outcomes were cross-sectional long-term mortality, functional outcome and quality of life by May 2020. Analysis were stratified by the final reperfusion status. Results In total 519 patients were included of whom 288 (55.5%) have deceased at follow-up (median follow-up time 28 months, interquartile range 1–55). Successful reperfusion was associated with lower long-term mortality in patients with ischemic core volumes ≥ 70 ml (adjusted hazard ratio (aHR) 0.20; 95% confidence interval (95% CI) 0.10–0.44) and ≥ 100 ml (aHR 0.26; 95% CI 0.08–0.87). The effect of successful reperfusion on long-term mortality was significant only in the presence of relevant mismatch (aHR 0.17; 95% CI 0.01–0.44). Increasing reperfusion grade was associated with a higher rate of favorable outcomes (mRS 0–3) also in patients with ischemic core volume ≥ 70 ml (aOR 3.58, 95% CI 1.64–7.83). Conclusion Our study demonstrated a sustainable benefit of better reperfusion status in patients with large ischemic core volumes. Our results suggest that patient deselection based on large ischemic cores alone is not advisable.

Funder

University of Bern

Publisher

Springer Science and Business Media LLC

Subject

Neurology (clinical),Radiology, Nuclear Medicine and imaging

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