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DWI-Based Algorithm to Predict Disability in Patients Treated with Thrombectomy for Acute Stroke.

H Raoult1, M V Lassalle2, B Parat3

  • 1From the Departments of Neuroradiology (H.R., B.P., F.E., J.C.F., J.Y.G.) helene.raoult@chu-rennes.fr.

AJNR. American Journal of Neuroradiology
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Summary

A new DWI-based algorithm accurately predicts disability after acute stroke thrombectomy. This tool helps identify high-risk patients for better clinical outcomes.

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Area of Science:

  • Neurology
  • Radiology
  • Medical Informatics

Background:

  • Poor clinical outcomes affect nearly half of patients undergoing thrombectomy for acute stroke.
  • Current methods for identifying high-risk patients are insufficient.
  • Diffusion-weighted imaging (DWI) shows potential for risk stratification.

Purpose of the Study:

  • To develop and validate a hierarchic algorithm using DWI to predict disability after acute stroke thrombectomy.
  • To identify key clinical and imaging predictors of poor prognosis.

Main Methods:

  • Retrospective analysis of 149 patients with acute ischemic stroke undergoing thrombectomy for large anterior artery occlusion.
  • Pretreatment DWI was used to assess lesion volume and other imaging parameters.
  • Multivariable regression identified predictors of poor prognosis (modified Rankin Scale > 2) at 3 months.
  • A hierarchic algorithm was developed based on identified predictors.

Main Results:

  • Independent predictors of poor prognosis included DWI lesion volume >80 mL, NIHSS score >14, age >75 years, and time from onset to puncture >4 hours.
  • The developed DWI-based hierarchic algorithm achieved an area under the receiver operating characteristic curve of 0.87.
  • The algorithm accurately predicted the risk of disability at 3 months for all analyzed patients.

Conclusions:

  • A DWI-based hierarchic algorithm is a highly predictive and user-friendly tool for assessing 3-month disability risk post-thrombectomy.
  • This algorithm can aid clinicians in routine practice to better manage patients undergoing acute stroke thrombectomy.