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Acute Stroke With Large Ischemic Core Treated by Thrombectomy.

Pietro Panni1, Benjamin Gory2, Yu Xie3

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Successful recanalization is key for good outcomes in acute stroke patients with large ischemic cores treated with mechanical thrombectomy (MT). Larger baseline lesion volumes and older age predict worse outcomes and higher mortality after MT.

Keywords:
cerebral infarctiondiabetes mellitusdiffusion magnetic resonance imagingstrokethrombectomy

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Stroke Medicine

Background:

  • Acute stroke patients with large ischemic cores may still benefit from mechanical thrombectomy (MT).
  • Predictors of clinical outcomes after MT in this patient group are not well understood.
  • Understanding these predictors is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To investigate clinical and imaging factors associated with good outcome and mortality at 90 days.
  • To identify predictors of successful treatment in acute stroke patients with large ischemic cores undergoing MT.
  • To analyze data from the Endovascular Treatment in Ischemic Stroke (ETIS) registry.

Main Methods:

  • Retrospective analysis of 216 acute ischemic stroke patients from the ETIS registry treated with MT.
  • Definition of large baseline ischemic core using diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (≤5).
  • Assessment of 90-day outcomes using the modified Rankin Scale (mRS) for good outcome (mRS ≤2) and mortality (mRS = 6).

Main Results:

  • Good outcome (mRS ≤2) was achieved in 25.4% of patients; 34.7% died at 90 days.
  • Successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grades ≤2b) predicted good outcome (aOR, 4.56).
  • Older age and increased DWI lesional volume were associated with lower chances of good outcome and higher mortality.

Conclusions:

  • Successful recanalization is a strong predictor of good outcome in stroke patients with large ischemic cores.
  • Baseline DWI lesional volume is a significant predictor of both good outcome and mortality.
  • These findings highlight the importance of recanalization success and baseline infarct size in determining patient prognosis after MT.