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Published on: January 18, 2018
Outcomes and CT Perfusion Thresholds of Mechanical Thrombectomy for Patients With Large Ischemic Core Lesions
Hongchao Yang1, Dinglai Lin2, Xiaohui Lin2
1Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Insights
Mechanical thrombectomy (MT) is effective for large cerebral infarctions. However, patients over 76 with large core volumes (>90 ml) may not benefit. Age and infarct size predict poor outcomes.
Area of Science:
- Neurology
- Radiology
- Interventional Neurology
Background:
- Large cerebral infarctions pose significant clinical challenges.
- Mechanical thrombectomy (MT) is a key treatment, but patient selection is crucial.
- Computed tomographic perfusion (CTP) aids in assessing infarct core and penumbra.
Purpose of the Study:
- To evaluate clinical outcomes and predictive factors following MT for large cerebral infarctions.
- To determine the optimal cerebral blood flow (CBF) threshold for estimating ischemic core volume.
- To identify patient subgroups who may not benefit from MT.
Main Methods:
- Retrospective analysis of 137 patients with large anterior circulation infarcts treated with MT.
- MIStar software used for infarct core volume assessment.
- Multivariate logistic regression and ROC analysis to identify outcome predictors and optimal thresholds.
Main Results:
- 23% achieved independent outcomes; 36.5% died at 90 days; 14.7% experienced symptomatic intracranial hemorrhage (sICH).
- Older age (>76 years) and larger core volume (>90 ml) were independent predictors of poor outcomes.
- Hypertension and rt-PA treatment predicted sICH; older age and larger infarct volume predicted mortality.
Conclusions:
- MT can be beneficial for large ischemic cores, but age and core volume are critical selection factors.
- Patients >76 years with core volumes >90 ml may have limited benefit from MT.
- Further research is needed to establish optimal CBF thresholds for patient selection.
Objective:
To explore the clinical prognosis and factors after mechanical thrombectomy (MT) in patients with large cerebral infarction assessed by computed tomographic perfusion (CTP)and the optimal threshold of cerebral blood flow (CBF) for estimating ischemic core.
Methods:
We analyzed data from the anterior circulation database of our hospital (August 2018-June 2021). Multivariate logistic regression analyses identified the predictors of clinical outcomes for patients with large baseline infarcts (>50 ml) assessed by the MIStar software. The receiver operating characteristic (ROC) analysis was used to explore the cutoff value of factors.
Results:
The present study included one hundred thirty-seven patients with large baseline infarcts. Moreover, 23 (16.8%) patients achieved functionally independent outcomes, and 50 (36.5%) patients died at 90 days. A total of 20 (14.7%) patients had symptomatic intracranial hemorrhage (sICH). The multivariable analysis showed that higher age and larger core volume were independent of poor outcomes. The cutoff value of core volume was 90 ml, and the age was 76 years. Hypertension and rt-PA treatment were independent factors of sICH. Higher age and larger ischemic volume were independent risk factors of mortality.
Conclusions:
Mechanical thrombectomy can be applied in patients with large ischemic core volumes. Patients older than 76 years with large cores (>90 ml) are unlikely to benefit from MT. These findings may be helpful in selecting patients with large baseline infarcts to be treated by MT. The threshold of CBF < 30% is the independent factor, and this is worth evaluating in future studies to find the optimal threshold of CBF.
