Eloquence-based reperfusion scoring and its ability to predict post-thrombectomy disability and functional status

Area of Science:

• Neurology
• Interventional Neuroradiology
• Stroke Medicine

Background:

• Current methods for grading reperfusion after endovascular thrombectomy, like the modified thrombolysis in cerebral infarct score, do not account for the location of non-reperfused regions.
• The significance of non-reperfused areas in eloquent brain regions remains understudied.

Purpose of the Study:

• To evaluate the predictive capability of an eloquence-based reperfusion score.
• To determine the impact of non-reperfusion in specific lobar regions on functional outcomes following endovascular thrombectomy.

Main Methods:

• Retrospective analysis of consecutive anterior circulation stroke cases undergoing endovascular thrombectomy (January 2018 - April 2020).
• Digital subtraction angiograms reviewed by blinded neurointerventionalists to assess reperfusion.
• Classification of incomplete reperfusion based on lobar regions affected.
• Functional outcomes assessed using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).

Main Results:

• Frontal and occipital lobe non-reperfusion were associated with worse mental status improvement (MD = -1.60, p=0.002; MD = -1.68, p=0.001, respectively).
• Non-reperfusion in the occipital lobe correlated with poorer visual field improvement (MD = -0.734, p=0.009).
• Frontal lobe non-reperfusion predicted worse NIHSS scores (MD = -5.34, p=0.013) and reduced odds of achieving a favorable mRS at 90 days (OR = 0.279, p=0.028).

Conclusions:

• Eloquence-based reperfusion assessment is a significant predictor of functional outcomes after endovascular thrombectomy.
• The location of non-reperfused brain regions, particularly in eloquent areas, provides critical prognostic information.
• This approach offers a more nuanced understanding of reperfusion efficacy compared to volume-based scores.