TY - JOUR
T1 - Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core
AU - Almallouhi, Eyad
AU - Zandpazandi, Sara
AU - Anadani, Mohammad
AU - Cunningham, Conor
AU - Sowlat, Mohammad Mahdi
AU - Matsukawa, Hidetoshi
AU - Orscelik, Atakan
AU - Elawady, Sameh Samir
AU - Maier, Ilko
AU - Al Kasab, Sami
AU - Jabbour, Pascal
AU - Kim, Joon Tae
AU - Wolfe, Stacey Q.
AU - Rai, Ansaar
AU - Starke, Robert M.
AU - Psychogios, Marios Nikos
AU - Samaniego, Edgar A.
AU - Arthur, Adam S.
AU - Yoshimura, Shinichi
AU - Cuellar, Hugo
AU - Grossberg, Jonathan A.
AU - Alawieh, Ali
AU - Romano, Daniele G.
AU - Tanweer, Omar
AU - Mascitelli, Justin
AU - Fragata, Isabel
AU - Polifka, Adam J.
AU - Osbun, Joshua W.
AU - Crosa, Roberto Javier
AU - Matouk, Charles
AU - Park, Min S.
AU - Levitt, Michael R.
AU - Brinjikji, Waleed
AU - Moss, Mark
AU - Dumont, Travis M.
AU - Williamson, Richard
AU - Navia, Pedro
AU - Kan, Peter
AU - De Leacy, Reade
AU - Chowdhry, Shakeel A.
AU - Ezzeldin, Mohamad
AU - Spiotta, Alejandro M.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024.
PY - 2024/11/22
Y1 - 2024/11/22
N2 - Background Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0-2). Methods Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0-2). A favorable outcome was defined by achieving a modified Rankin scale of 0-3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B. Results We identified 58 patients who presented with ASPECTS 0-2 and underwent MT. Median age was 74.0 (66.3-80.0) years, 30 (51.7%) were females, and 16 (27.6%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 34 (64.2%) patients and stent retriever was used in 8 (15.1%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 41.4%, 31% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes. Conclusions This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0-2.
AB - Background Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0-2). Methods Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0-2). A favorable outcome was defined by achieving a modified Rankin scale of 0-3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B. Results We identified 58 patients who presented with ASPECTS 0-2 and underwent MT. Median age was 74.0 (66.3-80.0) years, 30 (51.7%) were females, and 16 (27.6%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 34 (64.2%) patients and stent retriever was used in 8 (15.1%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 41.4%, 31% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes. Conclusions This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0-2.
KW - Intervention
KW - Intracranial Thrombosis
KW - Stenosis
KW - Stroke
KW - Thrombectomy
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U2 - 10.1136/jnis-2023-021046
DO - 10.1136/jnis-2023-021046
M3 - Article
C2 - 38041671
AN - SCOPUS:85178414240
SN - 1759-8478
VL - 16
SP - 1268
EP - 1274
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 12
ER -