Large Infarct Volume Post Thrombectomy: Characteristics, Outcomes, and Predictors

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• Endovascular therapy (EVT) is increasingly used for large-core strokes.
• Predictors of good outcomes in this specific patient group remain unclear.
• This study investigates factors influencing outcomes after EVT for large-core strokes.

Purpose of the Study:

• To analyze outcomes in patients with large-core strokes treated with EVT.
• To identify independent predictors of favorable functional outcomes at 90 days.
• To define factors associated with mortality in this cohort.

Main Methods:

• Retrospective analysis of prospectively collected data (Jan 2015-Feb 2018).
• Included patients with anterior circulation artery occlusion, successful recanalization (TICI ≥2b), and large follow-up infarct volume (FIV ≥70 cm³).
• Primary outcome: 90-day modified Rankin Scale (mRS) score (favorable: 0-3; unfavorable: 4-6).

Main Results:

• 85 out of 355 eligible patients (24%) had large FIV post-EVT.
• 32% of patients achieved a favorable 90-day mRS score (0-3).
• Independent predictors of favorable outcome: lower FIV, male sex, and intravenous tissue plasminogen activator (IV t-PA) use.
• Independent predictors of mortality: higher FIV and female sex.

Conclusions:

• About one-third of patients with large-core strokes (≥70 cm³) treated with EVT experience favorable 90-day outcomes.
• Male sex, IV t-PA administration, and smaller follow-up infarct volumes are associated with better functional outcomes.
• Higher infarct volumes and female sex predict increased mortality.