Association of Net Water Uptake With Catastrophic Functional Outcome After Thrombectomy in Patients With Large...

Area of Science:

• Neurology
• Radiology
• Biomedical Engineering

Background:

• Large infarcts pose significant challenges in stroke treatment.
• Endovascular thrombectomy is a key intervention for large vessel occlusions.
• Predicting functional outcomes is crucial for patient management.

Purpose of the Study:

• To investigate the association between net water uptake (NWU) and catastrophic functional outcome (mRS 5-6) at 3 months.
• To develop predictive models for catastrophic functional outcome using preprocedural factors, including NWU.
• To assess NWU as a quantitative imaging biomarker in patients with large anterior circulation infarcts.

Main Methods:

• A multicenter observational cohort study of patients with anterior circulation stroke (ASPECTS ≤5) undergoing endovascular thrombectomy.
• Measurement of ASPECTS10-NWU, a quantitative imaging biomarker derived from noncontrast CT.
• Statistical analysis using mixed-effects logistic regression to assess the association between ASPECTS10-NWU and functional outcome, adjusting for clinical variables.

Main Results:

• Higher ASPECTS10-NWU was independently associated with catastrophic functional outcome (aOR 1.70, P<0.001).
• A predictive model integrating ASPECTS10-NWU and clinical factors showed increased probability of catastrophic outcome with higher ASPECTS10-NWU and NIHSS scores.
• Older patients (≥80 years) and those with higher prestroke mRS (2-4) had a greater predicted probability of poor outcomes.

Conclusions:

• Elevated ASPECTS10-NWU is a strong predictor of catastrophic functional outcome in patients undergoing endovascular thrombectomy for large infarcts.
• Integrating ASPECTS10-NWU with clinical variables offers patient-specific prognostication to aid treatment decisions.
• This imaging biomarker can potentially improve risk stratification and clinical decision-making in acute stroke care.