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Updated: Sep 23, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Thrombectomy Reduces Risk of Poor Functional Outcomes in Patients Presenting within 0-6 Hours with Large
Rahul R Karamchandani1, Hongmei Yang2, Tanushree Prasad3
1Department of Neurology, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States, 734.883.7844.
Insights
Endovascular thrombectomy (EVT) reduces the risk of poor outcomes in stroke patients with large ischemic cores and artery occlusions. Lower blood glucose levels also correlate with better functional outcomes after stroke.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Large ischemic core volumes (LICVs) in stroke patients predict poor functional outcomes.
- Identifying predictors of outcome is crucial for patients with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion and LICV.
Purpose of the Study:
- To identify predictors of functional outcome in patients with ICA or MCA occlusion and LICV.
Main Methods:
- Retrospective analysis of a prospectively collected stroke registry.
- Inclusion criteria: presentation within 6 hours, LICV (≥50 ml, reduced relative cerebral blood flow < 30%).
- Multivariable logistic regression used to identify predictors of poor discharge outcome (modified Rankin scale score 4-6).
Main Results:
- 104 patients met inclusion criteria; 72.1% had poor discharge outcomes.
- Endovascular thrombectomy (EVT) was associated with reduced risk of poor outcome (OR 0.303; p=0.049).
- Lower blood glucose was independently protective against poor discharge outcome (OR 1.014; p=0.030).
Conclusions:
- EVT is independently associated with better functional outcomes in acute ischemic stroke patients with large core volumes and ICA/MCA occlusions.
- Lower blood glucose levels are also a protective factor for functional outcomes in this patient population.
Introduction:
Patients presenting with large ischemic core volumes (LICVs) on computed tomography perfusion (CTP) are at high risk for poor functional outcomes. We sought to identify predictors of outcome in patients with an internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion and LICV.
Methods:
A large healthcare system's prospectively collected code stroke registry was utilized for this retrospective analysis of patients presenting within 6 hours with at least 50 ml of CTP reduced relative cerebral blood flow (CBF) < 30%. A multivariable logistic regression model was constructed to identify independent predictors (p < 0.05) of poor discharge outcome (modified Rankin scale score 4-6).
Results:
Over a 38-month period, we identified 104 patients meeting inclusion criteria, with a mean age of 65.4 ± 16.2 years, median presenting National Institutes of Health Stroke Scale score 20 (IQR 16-24), median ischemic core volume (CBF < 30%) 82 ml (IQR 61-118), and median mismatch volume 80 ml (IQR 56-134). Seventy-five patients (72.1%) had a discharge modified Rankin scale score of 4-6. Sixty-six of 104 (63.5%) patients were treated with endovascular thrombectomy (EVT). In the multivariable regression model, EVT (OR 0.303; 95% CI 0.080-0.985; p = 0.049) and lower blood glucose (per 1-point increase, OR 1.014; 95% CI 1.003-1.030; p = 0.030) were independently protective against poor discharge outcome.
Conclusions:
EVT is independently associated with a reduced risk of poor functional outcome in patients presenting within 6 hours with ICA or MCA occlusions and LICV.
