Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy-Reference-Cited by-同舟云学术

Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy

Published:2024-09-13 Issue: Volume: Page:
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Yedavalli Vivek¹,Salim Hamza Adel¹²³^ORCID,Musmar Basel⁴^ORCID,Adeeb Nimer⁴,El Naamani Kareem⁵,Henninger Nils⁶,Sundararajan Sri Hari⁷,Kühn Anna Luisa⁸,Khalife Jane⁹,Ghozy Sherief¹⁰,Scarcia Luca¹¹^ORCID,Tan Benjamin YQ¹²¹³,Regenhardt Robert W²^ORCID,Heit Jeremy J¹⁴,Cancelliere Nicole M¹⁵,Bernstock Joshua D¹⁶,Rouchaud Aymeric¹⁷,Fiehler Jens¹⁰¹⁸^ORCID,Sheth Sunil¹⁹,Puri Ajit S⁸,Dyzmann Christian²⁰,Colasurdo Marco²¹,Barreau Xavier²²,Renieri Leonardo²³,Filipe João Pedro²⁴,Harker Pablo²⁵,Radu Răzvan Alexandru²⁶^ORCID,Abdalkader Mohamad²⁷,Klein Piers²⁷^ORCID,Marotta Thomas R¹⁵,Spears Julian¹⁵,Ota Takahiro²⁸^ORCID,Mowla Ashkan²⁹,Jabbour Pascal⁵^ORCID,Biswas Arundhati³⁰,Clarençon Frédéric³¹³²,Siegler James E⁹,Nguyen Thanh N²⁷^ORCID,Varela Ricardo³³,Baker Amanda³⁴,Essibayi Muhammed Amir³⁴^ORCID,Altschul David³⁴,Gonzalez Nestor R³⁵^ORCID,Möhlenbruch Markus A³⁶^ORCID,Costalat Vincent²⁶,Gory Benjamin³⁷³⁸,Stracke Christian Paul³⁹,Aziz-Sultan Mohammad Ali¹⁶,Hecker Constantin⁴⁰,Shaikh Hamza⁹,Liebeskind David S⁴¹^ORCID,Pedicelli Alessandro⁴²,Alexandre Andrea M⁴²^ORCID,Tancredi Illario⁴³,Faizy Tobias D⁴⁴,Kalsoum Erwah¹¹,Lubicz Boris⁴⁵,Patel Aman B²,Pereira Vitor Mendes¹⁵,Guenego Adrien⁴⁵,Dmytriw Adam A²¹⁵

Affiliation:

1. Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA

2. Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

3. Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA

4. Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA

5. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

6. Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA

7. Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, NJ, USA

8. Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA

9. Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA

10. Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA

11. Department of Neuroradiology, Henri Mondor Hospital, Creteil, France

12. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

13. Division of Neurology, Department of Medicine, National University Hospital, Singapore

14. Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA

15. Divisions of Therapeutic Neuroradiology and Neurosurgery, Neurovascular Centre, St. Michael Hospital, University of Toronto, Toronto, ON, Canada

16. Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

17. Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR, France

18. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

19. Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA

20. Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany

21. Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA

22. Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France

23. Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy

24. Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal

25. Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA

26. Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France

27. Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA

28. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

29. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA

30. Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA

31. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France

32. GRC BioFast., Sorbonne University, Paris VI, France

33. Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal

34. Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

35. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA

36. Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany

37. Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France

38. INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France

39. Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany

40. Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria

41. Department of Neurology, UCLA Stroke Center, UCLA, Los Angeles, CA, USA

42. UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy

43. Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium

44. Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany

45. Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium

Abstract

Background: Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT. Methods: This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12–36 h post-MT. Results: Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes. Conclusions: FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/23969873241275531

Reference57 articles.

1. A review of endovascular treatment for medium vessel occlusion stroke

2. Thrombectomy for Distal, Medium Vessel Occlusions

3. The impact of recanalization on ischemic stroke outcome. Stroke. https://www.ahajournals.org/doi/10.1161/01.str.0000258112.14918.24 (accessed March 2, 2024).

4. Pathophysiology of acute ischemic stroke : continuum: lifelong learning in neurology. https://journals.lww.com/continuum/abstract/2008/12000/pathophysiology_of_acute_ischemic_stroke.4.aspx (accessed March 2, 2024).

5. Preclinical stroke research - advantages and disadvantages of the most common rodent models of focal ischaemia