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Multicenter Study
. 2022 Dec;32(4):939-950.
doi: 10.1007/s00062-022-01156-z. Epub 2022 Apr 12.

Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke

Pietro Panni  1 , Bertrand Lapergue  2 , Benjamin Maïer  3 , Stephanos Finitsis  4 , Frédéric Clarençon  5 , Sébastien Richard  6   7 , Gaultier Marnat  8 , Romain Bourcier  3 , Igor Sibon  9 , Cyril Dargazanli  10 , Raphaël Blanc  11 , Arturo Consoli  12 , François Eugène  13 , Stéphane Vannier  14 , Laurent Spelle  15 , Christian Denier  16 , Marion Boulanger  17 , Maxime Gauberti  18 , Suzana Saleme  19 , Francisco Macian  20 , Charlotte Rosso  21 , Olivier Naggara  22 , Guillaume Turc  23 , Ozlem Ozkul-Wermester  24 , Chrisanthi Papagiannaki  25 , Jean-François Albucher  26 , Jean Darcourt  27 , Anthony Le Bras  28 , Sarah Evain  29 , Valérie Wolff  30 , Raoul Pop  31 , Serge Timsit  32 , Jean-Christophe Gentric  33 , Frédéric Bourdain  34 , Louis Veunac  35 , Caroline Arquizan  36 , Benjamin Gory  37   38 ; ETIS (Endovascular Treatment in Ischemic Stroke) investigators
Collaborators, Affiliations
Multicenter Study

Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke

Pietro Panni et al. Clin Neuroradiol. 2022 Dec.

Abstract

Purpose: To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determine its predictors in current practice.

Methods: We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr.

Results: Early neurological improvement was detected in 82/211 (41.7%) of patients while 3‑month functional independence was achieved by 75 (35.5%) patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of both ENI (aOR 3.6, 95% CI 1.2-7.7; p 0.018) and 3‑month clinical outcome (aOR for mRS shift: 2.2, 95% CI 1-4.6; p 0.030). Only successful recanalization (mTICI 2c-3) independently predicted DWIr in the studied population (aOR 3.3, 95% CI 1.3-7.9; p 0.009).

Conclusion: The DWI reversal occurs in a non-negligible proportion of DWI-ASPECTS 0-5 patients subjected to thrombectomy and significantly influences clinical outcome. The mTICI 2c-3 recanalization emerged as an independent DWIr predictor.

Keywords: DWI reversal; Endovascular procedures; Magnetic resonance imaging; Mechanical thrombectomy; Stroke.

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References

    1. Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M; HERMES collaborators. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol. 2018;17:895–904. Erratum in: Lancet Neurol. 2018;17:e2–3. - DOI
    1. Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Mendes Pereira V, Gralla J, Fischer U. Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke. 2019;50:880–8. - DOI
    1. Panni P, Gory B, Xie Y, Consoli A, Desilles JP, Mazighi M, Labreuche J, Piotin M, Turjman F, Eker OF, Bracard S, Anxionnat R, Richard S, Hossu G, Blanc R, Lapergue B; ETIS (Endovascular Treatment in Ischemic Stroke) Investigators. Acute Stroke With Large Ischemic Core Treated by Thrombectomy. Stroke. 2019;50:1164–71.
    1. Cagnazzo F, Derraz I, Dargazanli C, Lefevre PH, Gascou G, Riquelme C, Bonafe A, Costalat V. Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis. J Neurointerv Surg. 2020;12:350–5. - DOI
    1. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18. - DOI

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