Baseline clinical and neuroradiological predictors of outcome in patients with large ischemic core undergoing mechanical thrombectomy: A retrospective multicenter study-Reference-Cited by-同舟云学术

Baseline clinical and neuroradiological predictors of outcome in patients with large ischemic core undergoing mechanical thrombectomy: A retrospective multicenter study

Published:2024-04-16 Issue:7 Volume:19 Page:779-788
ISSN:1747-4930
Container-title:International Journal of Stroke
language:en
Short-container-title:International Journal of Stroke

Author:

Alexandre Andrea M¹^ORCID,Monforte Mauro²^ORCID,Brunetti Valerio²,Scarcia Luca³,Cirillo Luigi⁴,Zini Andrea⁴,Scala Irene⁵^ORCID,Nardelli Vincenzo⁶,Arbia Francesco⁷,Arbia Giuseppe⁶,Frisullo Giovanni²^ORCID,Kalsoum Erwah³,Camilli Arianna⁵,De Leoni Davide⁵,Colò Francesca⁵^ORCID,Abruzzese Serena⁵^ORCID,Piano Mariangela⁸,Rollo Claudia⁸,Macera Antonio⁸,Ruggiero Maria⁹,Lafe Elvis⁹,Gabrieli Joseph D¹⁰,Cester Giacomo¹⁰,Limbucci Nicola¹¹,Arba Francesco¹²^ORCID,Ferretti Simone¹³,Da Ros Valerio¹⁴,Bellini Luigi¹⁴,Salsano Giancarlo¹⁵^ORCID,Mavilio Nicola¹⁵,Russo Riccardo¹⁶,Bergui Mauro¹⁶,Caragliano Antonio A¹⁷,Vinci Sergio L¹⁷,Romano Daniele G¹⁸,Frauenfelder Giulia¹⁸,Semeraro Vittorio¹⁹,Ganimede Maria P²⁰,Lozupone Emilio²¹,Romi Andrea²²,Cavallini Anna²³,Milonia Luca²⁴,Muto Massimo²⁵,Candelaresi Paolo²⁶,Calabresi Paolo²⁵,Pedicelli Alessandro¹^ORCID,Broccolini Aldobrando²⁵^ORCID

Affiliation:

1. Interventional Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

2. Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

3. Neuroradiology Unit, Henri Mondor Hospital, Creteil, France

4. Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy

5. Catholic University School of Medicine, Rome, Italy

6. Department of Statistical Sciences, Catholic University, Rome, Italy

7. Department of Neuroradiology, S. Andrea Hospital, Rome, Italy

8. Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

9. Neuroradiology Unit, M. Bufalini Hospital, Cesena, Italy

10. Neuroradiology Unit, Padua University Hospital, Padua, Italy

11. Interventional Neurovascular Unit, A.O.U. Careggi, Florence, Italy

12. Stroke Unit, A.O.U. Careggi, Florence, Italy

13. NEUROFARBA Department, University of Florence, Florence, Italy

14. Department of Biomedicine and Prevention, “Tor Vergata” University Hospital, Rome, Italy

15. Neuroradiology Unit, “San Martino” Hospital, Genoa, Italy

16. Neuroradiology Unit, A.O. “Città della Salute e della Scienza,” Turin, Italy

17. Neuroradiology Unit, “G. Martino” Hospital, Messina, Italy

18. Neuroradiology Unit, AOU “S Giovanni di Dio e Ruggi di Aragona,” Salerno, Italy

19. Interventional Radiology Unit, “SS Annunziata” Hospital, Taranto, Italy

20. Neuroradiology Unit, “SS Annunziata” Hospital, Taranto, Italy

21. Neuroradiology Unit, “Vito Fazzi” Hospital, Lecce, Italy

22. Neuroradiology Unit, IRCCS “San Matteo” Hospital, Pavia, Italy

23. Cerebrovascular Diseases Unit, IRCCS Fondazione Mondino, Pavia, Italy

24. Interventional Neuroradiology Unit, “Umberto I” University Hospital, Rome, Italy

25. Neuroradiology Unit, A.O.R.N. “Antonio Cardarelli,” Naples, Italy

26. Neurology Unit, A.O.R.N. “Antonio Cardarelli,” Naples, Italy

Abstract

Background: Recent randomized trials have shown the benefit of mechanical thrombectomy (MT) also in patients with an established large ischemic core. Aims: The purpose of this study was to define baseline predictors of clinical outcome in patients with large vessel occlusion (LVO) in the anterior circulation and an Alberta Stroke Program Early CT score (ASPECTS) ⩽ 5, undergoing MT. Material and methods: The databases of 16 comprehensive stroke centers were retrospectively screened for patients with LVO and ASPECTS ⩽5 that received MT. Baseline clinical and neuroradiological features, including the differential contribution of all ASPECTS regions to the composite score, were collected. Primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0–2. Statistical analysis used a logistic regression model and random forest algorithm. Results: A total of 408 patients were available for analysis. In multivariate model, among baseline features, lower age (odd ratio (OR) = 0.962, 95% confidence interval (CI) = 0.943–0.982) and lower National Institute of Health Stroke Scale (NIHSS) score (OR = 0.911, 95% CI = 0.862–0.963) were associated with the mRS score 0–2. Involvement of the M2 (OR = 0.398, 95% CI = 0.206–0.770) or M4 (OR = 0.496, 95% CI = 0.260–0.945) ASPECTS regions was associated with an unfavorable outcome. Random forest analysis confirmed that age and baseline NIHSS score are the most important variables influencing clinical outcome, whereas involvement of cortical regions M5, M4, M2, and M1 can have a negative impact. Conclusion: Our retrospective analysis shows that, along with age and baseline clinical impairment, presence of early ischemic changes involving cortical areas has a role in clinical outcome in patients with large ischemic core undergoing MT. Data access statement: The data that support the findings of this study are available upon reasonable request.

Funder

Ricerca Corrente Reti IRCCS 2022, Rete IRCCS delle Neuroscienze e della Neuroriabilitazione – RIN, Istituto Virtuale Nazionale Malattie Cerebrovascolari

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/17474930241245828

Reference30 articles.

1. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials

2. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy

3. Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging

4. Alberta Stroke Program Early Computed Tomographic Scoring Performance in a Series of Patients Undergoing Computed Tomography and MRI