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Multicenter Study
. 2017 Apr;48(4):963-969.
doi: 10.1161/STROKEAHA.116.015202. Epub 2017 Feb 24.

Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients With Pretreatment Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤6

Jean-Philippe Desilles  1 , Arthuro Consoli  2 , Hocine Redjem  2 , Oguzhan Coskun  2 , Gabriele Ciccio  2 , Stanislas Smajda  2 , Julien Labreuche  2 , Cristian Preda  2 , Clara Ruiz Guerrero  2 , Jean-Pierre Decroix  2 , Georges Rodesch  2 , Mikael Mazighi  2 , Raphaël Blanc  2 , Michel Piotin  2 , Bertrand Lapergue  2 ; ETIS (Endovascular Treatment in Ischemic Stroke) Research Investigators
Collaborators, Affiliations
Multicenter Study

Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients With Pretreatment Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤6

Jean-Philippe Desilles et al. Stroke. 2017 Apr.

Erratum in

Abstract

Background and purpose: In acute ischemic stroke patients, diffusion-weighted imaging (DWI)-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is correlated with infarct volume and is an independent factor of functional outcome. Patients with pretreatment DWI-ASPECTS ≤6 were excluded or under-represented in the recent randomized mechanical thrombectomy trials. Our aim was to assess the impact of reperfusion in pretreatment DWI-ASPECTS ≤6 patients treated with mechanical thrombectomy.

Methods: We analyzed data collected between January 2012 and August 2015 in a bicentric prospective clinical registry of consecutive acute ischemic stroke patients treated with mechanical thrombectomy. Every patient with a documented internal carotid artery or middle cerebral artery occlusion with pretreatment DWI-ASPECTS ≤6 was eligible for this study. The primary end point was a favorable outcome defined by a modified Rankin Scale score ≤2 at 90 days.

Results: Two hundred and eighteen patients with a DWI-ASPECTS ≤6 were included. Among them, 145 (66%) patients had successful reperfusion at the end of mechanical thrombectomy. Reperfused patients had an increased rate of favorable outcome (38.7% versus 17.4%; P=0.002) and a decreased rate of mortality at 3 months (22.5% versus 39.1%; P=0.013) compared with nonreperfused patients. The symptomatic intracranial hemorrhage rate was not different between the 2 groups (13.0% versus 14.1%; P=0.83). However, in patients with DWI-ASPECTS <5, favorable outcome was low (13.0% versus 9.5%; P=0.68) with a high mortality rate (45.7% versus 57.1%; P=0.38) with or without successful reperfusion.

Conclusions: Successful reperfusion is associated with reduced mortality and disability in patients with a pretreatment DWI-ASPECTS ≤6. Further data from randomized studies are needed, particularly in patients with DWI-ASPECTS <5.

Keywords: ischemic stroke; large ischemic lesion; outcome; reperfusion; thrombectomy.

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Comment in

  • JNA Journal Club.
    [No authors listed] [No authors listed] J Neurosurg Anesthesiol. 2017 Jul;29(3):352-353. doi: 10.1097/ANA.0000000000000435. J Neurosurg Anesthesiol. 2017. PMID: 28538331 No abstract available.

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