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ADC Threshold Indicating the Ischemic Region for Predicting Efficacy in Thrombectomy.
Hideyuki Ishihara1, Fumiaki Oka2, Takuma Nishimoto2
1Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan. hishi@yamaguchi-u.ac.jp.
Acta Neurochirurgica. Supplement
|July 9, 2025
Summary
Smaller ischemic regions, measured by apparent diffusion coefficient (ADC) values, and faster reperfusion times are linked to better outcomes after endovascular thrombectomy for large strokes.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Endovascular thrombectomy (EVT) is effective for large cerebral infarctions.
- Ischemic region size significantly impacts EVT outcomes.
- Optimal pre-treatment evaluation methods for ischemic regions are unclear.
Purpose of the Study:
- To evaluate apparent diffusion coefficient (ADC) values for assessing pre-treatment ischemic regions.
- To determine the relationship between ADC-defined ischemic volume and patient outcomes after EVT.
Main Methods:
- Retrospective study of 48 patients undergoing EVT for acute large vessel occlusion (LVO) with ASPECTS ≤5.
- Analysis of clinical characteristics and ADC-derived ischemic volumes.
- Assessment of favorable outcome defined as modified Rankin Scale (mRS) 0-3 at 90 days.
Main Results:
- Median age 78 years, median NIHSS 23; 38% achieved favorable outcomes (mRS 0-3).
- An ischemic region with ADC < 540 (ADC540) showed the highest AUC (0.85) in ROC analysis.
- Earlier reperfusion and smaller ADC540 volumes were independently associated with favorable outcomes (p<0.05).
Conclusions:
- Earlier reperfusion is crucial for favorable outcomes in acute LVO patients.
- A smaller ischemic region, defined by ADC540, predicts better outcomes after EVT.
- ADC values provide a valuable metric for assessing ischemic extent and predicting EVT success.
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