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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Baseline clinical and neuroradiological predictors of outcome in patients with large ischemic core undergoing

Andrea M Alexandre1, Mauro Monforte2, Valerio Brunetti2

  • 1Interventional Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

International Journal of Stroke : Official Journal of the International Stroke Society
|March 28, 2024
PubMed

Insights

Younger age and lower NIHSS scores predict better outcomes after mechanical thrombectomy for large ischemic cores. Early ischemic changes in cortical areas, however, are associated with unfavorable results in stroke patients.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Stroke Medicine

Background:

  • Mechanical thrombectomy (MT) is increasingly used for large vessel occlusion (LVO) stroke.
  • Recent trials demonstrate MT benefits even with established large ischemic cores.
  • Predicting outcomes in this specific patient group remains crucial.

Purpose of the Study:

  • To identify baseline predictors of clinical outcomes in patients with anterior circulation LVO and a large ischemic core (Alberta Stroke Program Early CT score [ASPECTS] ≤ 5) undergoing MT.
  • To analyze the impact of specific ASPECTS regions on functional recovery.

Main Methods:

  • Retrospective analysis of 408 patients from 16 stroke centers undergoing MT for LVO with ASPECTS ≤ 5.
  • Collection of baseline clinical and neuroradiological data, including ASPECTS region involvement.
  • Logistic regression and random forest analysis to determine predictors of 90-day modified Rankin Scale (mRS) score 0-2.

Main Results:

  • Lower age and lower National Institute of Health Stroke Scale (NIHSS) scores were associated with favorable 90-day mRS scores (0-2).
  • Involvement of M2 or M4 ASPECTS regions independently predicted unfavorable outcomes.
  • Random forest analysis confirmed age and NIHSS as key predictors, with cortical region involvement (M1, M2, M4, M5) negatively impacting outcomes.

Conclusions:

  • Age and baseline NIHSS score are significant predictors of functional outcome after MT in patients with large ischemic cores.
  • Early ischemic changes in cortical areas (M1, M2, M4, M5) negatively influence outcomes.
  • These findings aid in patient selection and outcome prognostication for MT in selected stroke patients.
Abstract

Keywords:
ASPECTSLarge ischemic coreclinical outcomelarge vessel occlusionmechanical thrombectomy

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