Related Experiment Video
Updated: Mar 7, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients
Jean-Philippe Desilles1, Arthuro Consoli2, Hocine Redjem2
1From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.). jpdesilles@for.paris.
Background And Purpose:
In acute ischemic stroke patients, diffusion-weighted imaging (DWI)-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is correlated with infarct volume and is an independent factor of functional outcome. Patients with pretreatment DWI-ASPECTS ≤6 were excluded or under-represented in the recent randomized mechanical thrombectomy trials. Our aim was to assess the impact of reperfusion in pretreatment DWI-ASPECTS ≤6 patients treated with mechanical thrombectomy.
Methods:
We analyzed data collected between January 2012 and August 2015 in a bicentric prospective clinical registry of consecutive acute ischemic stroke patients treated with mechanical thrombectomy. Every patient with a documented internal carotid artery or middle cerebral artery occlusion with pretreatment DWI-ASPECTS ≤6 was eligible for this study. The primary end point was a favorable outcome defined by a modified Rankin Scale score ≤2 at 90 days.
Results:
Two hundred and eighteen patients with a DWI-ASPECTS ≤6 were included. Among them, 145 (66%) patients had successful reperfusion at the end of mechanical thrombectomy. Reperfused patients had an increased rate of favorable outcome (38.7% versus 17.4%; P=0.002) and a decreased rate of mortality at 3 months (22.5% versus 39.1%; P=0.013) compared with nonreperfused patients. The symptomatic intracranial hemorrhage rate was not different between the 2 groups (13.0% versus 14.1%; P=0.83). However, in patients with DWI-ASPECTS <5, favorable outcome was low (13.0% versus 9.5%; P=0.68) with a high mortality rate (45.7% versus 57.1%; P=0.38) with or without successful reperfusion.
Conclusions:
Successful reperfusion is associated with reduced mortality and disability in patients with a pretreatment DWI-ASPECTS ≤6. Further data from randomized studies are needed, particularly in patients with DWI-ASPECTS <5.
