Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy
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Published on: August 11, 2023
Vivek Yedavalli1, Hamza Adel Salim1,2,3, Basel Musmar4
1Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Background:
Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT.
Methods:
This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT.
Results:
Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes.
Conclusions:
FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.
Insights
Follow-up infarct volume (FIV) after mechanical thrombectomy (MT) effectively predicts 90-day outcomes in medium vessel occlusion (MeVO) strokes. Establishing FIV thresholds can guide treatment decisions for M2 segment stroke patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Medium vessel occlusion (MeVO) strokes, particularly M2 segment middle cerebral artery occlusions, are a significant cause of ischemic stroke.
- Predicting functional outcomes in MeVO stroke patients undergoing mechanical thrombectomy (MT) is crucial for effective management.
- Reliable predictors are needed to assess the efficacy of MT in MeVO stroke.
Purpose of the Study:
- To investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients treated with MT.
- To establish potential FIV thresholds for outcome prediction in this patient cohort.
Main Methods:
- A multicenter, retrospective cohort study using data from the MAD-MT registry.
- Inclusion of patients with acute ischemic stroke due to M2 segment occlusion treated with MT.
- Assessment of 90-day functional outcomes (modified Rankin Scale) and FIV (CT/MRI within 12-36 hours post-MT).
Main Results:
- Specific FIV thresholds demonstrated high sensitivity and specificity for predicting outcomes.
- FIV ≤ 5 ml was highly specific for favorable/excellent outcomes; FIV ≤ 15 ml was the optimal cut-off by Youden Index.
- FIV was a superior predictor of functional outcomes compared to recanalization scores (e.g., mTICI), with multivariable analysis confirming its inverse relationship with positive outcomes.
Conclusions:
- Follow-up infarct volume (FIV) within 36 hours post-MT is a potent predictor of 90-day functional outcomes in M2 segment MeVO stroke.
- Established FIV thresholds can aid in stroke prognostication and guide post-intervention treatment decisions.
- Further validation in diverse populations and integration with other markers are recommended to enhance prediction accuracy.
