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Olivot JM, Heit JJ, Mazighi M, Raposo N, Albucher JF, Rousseau V, Guenego A, Thalamas C, Mlynash M, Drif A, Christensen S, Sommet A, Viguier A, Darcourt J, Januel AC, Calviere L, Menegon P, Caparros F, Bonneville F, Tourdias T, Sibon I, Albers GW, Cognard C. What predicts poor outcome after successful thrombectomy in early time window? J Neurointerv Surg 2021; 14:1051-1055. [PMID: 34750109 DOI: 10.1136/neurintsurg-2021-017946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Half of the patients with large vessel occlusion (LVO)-related acute ischemic stroke (AIS) who undergo endovascular reperfusion are dead or dependent at 3 months. We hypothesize that in addition to established prognostic factors, baseline imaging profile predicts outcome among reperfusers. METHODS Consecutive patients receiving endovascular treatment (EVT) within 6 hours after onset with Thrombolysis In Cerebral Infarction (TICI) 2b, 2c and 3 revascularization were included. Poor outcome was defined by a modified Rankin scale (mRS) 3-6 at 90 days. No mismatch (NoMM) profile was defined as a mismatch (MM) ratio ≤1.2 and/or a volume <10 mL on pretreatment imaging. RESULTS 187 patients were included, and 81 (43%) had a poor outcome. Median delay from stroke onset to the end of EVT was 259 min (IQR 209-340). After multivariable logistic regression analysis, older age (OR 1.26, 95% CI 1.06 to 1.5; p=0.01), higher National Institutes of Health Stroke Scale (NIHSS) (OR 1.15, 95% CI 1.06 to 1.25; p<0.0001), internal carotid artery (ICA) occlusion (OR 3.02, 95% CI 1.2 to 8.0; p=0.021), and NoMM (OR 4.87, 95% CI 1.09 to 22.8; p=0.004) were associated with poor outcome. In addition, post-EVT hemorrhage (OR 3.64, 95% CI 1.5 to 9.1; p=0.04) was also associated with poor outcome. CONCLUSIONS The absence of a penumbra defined by a NoMM profile on baseline imaging appears to be an independent predictor of poor outcome after reperfusion. Strategies aiming to preserve the penumbra may be encouraged to improve these patients' outcomes.
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Affiliation(s)
- Jean-Marc Olivot
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France .,Toulouse Neuro Imaging Center, Toulouse, France
| | - Jeremy J Heit
- Radiology, Neuroadiology and Neurointervention Division, Stanford University, Stanford, California, USA
| | - Mikael Mazighi
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Nicolas Raposo
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Jean François Albucher
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Vanessa Rousseau
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Adrien Guenego
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Claire Thalamas
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Michael Mlynash
- Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Amel Drif
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Soren Christensen
- Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Agnes Sommet
- Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Alain Viguier
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Jean Darcourt
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Lionel Calviere
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro Imaging Center, Toulouse, France
| | - Patrice Menegon
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Caparros
- Neurology, Stroke Unit, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Fabrice Bonneville
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Thomas Tourdias
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Igor Sibon
- Neurology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Christophe Cognard
- Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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