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. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Desilles, Jean-Philippe; Consoli, Arturo; Redjem, Hocine; Coskun, Oguzhan; Ciccio, Gabriele; Smajda, Stanislas; Labreuche, Julien; Preda, Cristian; Ruiz Guerrero, Clara; Decroix, Jean-Pierre; Rodesch, Georges; Mazighi, Mikael; Blanc, Raphaël; Piotin, Michel; Lapergue, Bertrand; Wang, Adrien; Evrard, Serge; Tchikviladzé, Maya; Bourdain, Frederic; Gonzalez-Valcarcel, Jaime; Di Maria, Federico; Pico, Fernando; Rakotoharinandrasana, Haja; Tassan, Philippe; Poll, Roxanna; Corabianu, Ovide; de Broucker, Thomas; Smadja, Didier; Alamowitch, Sonia; Obadia, Michael; Ille, Olivier; Manchon, Eric; Garcia, Pierre-Yves;
• Is Part Of: Stroke. Volume 48:Issue 4(2017)
• Publication Date: 2017-04
• Subjects: ischemic stroke -- large ischemic lesion -- outcome -- reperfusion -- thrombectomy; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.116.015202
• Languages: English
• ISSNs: 0039-2499

Abstract

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. Abstract : Supplemental Digital Content is available in the text.