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. 2022 Aug 26:13:928773.
doi: 10.3389/fneur.2022.928773. eCollection 2022.

Unequal Efficacy of Different Infarct Location in Predicting Futile Recanalization of Patients With Acute Ischemic Stroke

Zhao-Shuo Li  1 , Hai-Long Zhong  1 , Teng-Fei Zhou  1 , Ying-Kun He  1 , Qiang Li  1 , Zi-Liang Wang  1 , Liang-Fu Zhu  1 , Chang-Ming Wen  2 , Jian-Feng Han  3 , Tian-Xiao Li  1
Affiliations

Unequal Efficacy of Different Infarct Location in Predicting Futile Recanalization of Patients With Acute Ischemic Stroke

Zhao-Shuo Li et al. Front Neurol. .

Abstract

Objectives: Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion, while futile recanalization is the main factor influencing the prognosis. The present study aimed to investigate the efficacy of different infarct sites in predicting futile recanalization of patients with AIS.

Methods: Data were obtained from two multicenter, prospective, randomized, and controlled trials, which were concurrently conducted in China. Cases achieving a successful recanalization and with complete data of preoperative Alberta Stroke Program Early CT score (ASPECTS) and 90-day follow-up were included. The ASPECTS subregions were used to mark different infarct locations in the two cerebral hemispheres. First, the distribution of each ASPECTS subregion in the left and right hemispheres and the whole brain was analyzed, respectively. Then, the regions associated with futile recanalization were initially assessed by a univariate model. Afterward, a multivariate logistic regression model was used to identify the efficacy of different infarct sites in predicting futile recanalization.

Results: A total of 336 patients were included in this study with a median age of 65 years (IQR: 51-74), of whom 210 (62.50%) patients were male, and 189 (56.25%) met the definition of futile recanalization. The correlation between each ASPECTS subregion and poor outcome was different when it was restricted to a specific cerebral hemisphere. Moreover, in the left hemisphere, the internal capsule region (OR: 1.42, 95%CI: 1.13-1.95, P = 0.03) and the M3 region (OR: 2.26, 95%CI: 1.36-3.52, P = 0.001), and in the right hemisphere, M6 region (OR: 2.24, 95%CI: 1.32-3.36, P = 0.001) showed significantly higher efficacy in predicting futile recanalization.

Conclusion: The efficacy of different infarct locations in predicting futile recanalization is different. Different preoperative patterns of the high-efficiency regions in the infarction core or penumbra can guide the thrombectomy decision-making.

Keywords: Alberta Stroke Program Early Computed Tomography score; endovascular treatment; futile recanalization; predictive factor; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of inclusion and exclusion at each step in the study. ASPECTS, Alberta Stroke Program Early CT score; FR, futile recanalization; ER, effective recanalization.
Figure 2
Figure 2
Distribution of ASPECTS subregions in the cortical (C) and deep-perforator (P) territories according to the left and right cerebral hemispheres.
See this image and copyright information in PMC

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