Relevance of Brain Regions' Eloquence Assessment in Patients With a Large Ischemic Core Treated With Mechanical Thrombectomy. (16th November 2021)

• Record Type: Journal Article
• Authors: Kerleroux, Basile; Benzakoun, Joseph; Janot, Kévin; Dargazanli, Cyril; Eraya, Dimitri Daly; Ben Hassen, Wagih; Zhu, François; Gory, Benjamin; Hak, Jean-Francois; Perot, Charline; Detraz, Lili; Bourcier, Romain; Aymeric, Rouchaud; Forestier, Géraud; Marnat, Gaultier; Gariel, Florent; Mordasini, Pasquale; Seners, Pierre; Turc, Guillaume; Kaesmacher, Johannes; Oppenheim, Catherine; Naggara, Olivier; Boulouis, Gregoire
• Other Names: author non-byline.; Fischer Urs author non-byline.; Gralla Jan author non-byline.; Mosimann Pascal J author non-byline.; Arnold Marcel author non-byline.; Meinel Thomas R author non-byline.; Costalat Vincent author non-byline.; Benali Amel author non-byline.; Derraz Imad author non-byline.; Lefevre Pierre-Henri author non-byline.; Gascou Grégory author non-byline.; Riquelme Carlos author non-byline.; Bonafe Alain author non-byline.; Le Bars Emmanuelle author non-byline.; Moynier Marinette author non-byline.; Barreau Xavier author non-byline.; Berge Jérôme author non-byline.; Menegon Patrice author non-byline.; Tourdias Thomas author non-byline.; Lucas Ludovic author non-byline.; Sibon Igor author non-byline.; Saleme Suzanna author non-byline.; Mounayer Charbel author non-byline.; Girard Nadine author non-byline.; Bartoli Jean-Michel author non-byline.; Brunel Hervé author non-byline.; Testud Benoit author non-byline.; Puech Basile author non-byline.; Laksiri Nadia author non-byline.; Robinet Emmanuelle author non-byline.; Pelletier Jean author non-byline.; Herbreteau Denis author non-byline.; Bibi Richard author non-byline.; Narata Ana-Paula author non-byline.; Boustia Fakhreddine author non-byline.; Maldonado Igor author non-byline.; Cottier Jean- Philippe author non-byline.; Gaudron Marie author non-byline.; Annan Mariam author non-byline.; Meder Jean-François author non-byline.; Trystram Denis author non-byline.; Rodriguez Christine author non-byline.; Edjlali Myriam author non-byline.; Desal Hubert author non-byline.; Daumasduport Benjamin author non-byline.; Lallinec Vincent author non-byline.; Lenoble Cédric author non-byline.; Alexandre Pierre-Louis author non-byline.; Bracard Serge author non-byline.; Anxionnat René author non-byline.; Degrelle Anne-Laure author non-byline.; Tonnelet Romain author non-byline.; Lao Liang author non-byline.; Richard Sébastien author non-byline.; Humbertjean Lisa author non-byline.; Mione Gioia author non-byline.; Labour Jean Christophe author non-byline.;
• Is Part Of: Neurology. Volume 97:Number 20(2021)
• Page Start: e1975
• Page End: e1985
• Publication Date: 2021-11-16
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000012863
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: Individualized patient selection for mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) and large ischemic core (LIC) at baseline is an unmet need. We tested the hypothesis that assessing the functional relevance of both infarcted and hypoperfused brain tissue would improve the selection framework of patients with LIC for MT. Methods: We performed a multicenter, retrospective study of adults with LIC (ischemic core volume >70 mL on MRI diffusion-weighted imaging) with MRI perfusion treated with MT or best medical management (BMM). Primary outcome was 3-month modified Rankin Scale (mRS), favorable if 0–3. Global and regional eloquence-based core perfusion mismatch ratios were derived. The predictive accuracy for clinical outcome of eloquent regions involvement was compared in multivariable and bootstrap random forest models. Results: A total of 138 patients with baseline LIC were included (MT n = 96 or BMM n = 42; mean age ± SD, 72.4 ± 14.4 years; 34.1% female; mRS 0–3: 45.1%). Mean core and critically hypoperfused volume were 100.4 mL ± 36.3 mL and 157.6 ± 56.2 mL, respectively, and did not differ between groups. Models considering the functional relevance of the infarct location showed a better accuracy for the prediction of mRS 0–3 with a c statistic of 0.76 and 0.83 for logistic regression model and bootstrap random forest testing sets, respectively. In these models, the interaction between treatment effect of MT and the mismatch was significant ( p = 0.04). In comparison, in the logistic regression model disregarding functional eloquence, the c statistic was 0.67 and the interaction between MT and the mismatch was insignificant. Conclusions: Considering functional eloquence of hypoperfused tissue in patients with a large infarct core at baseline allows for a more precise estimation of treatment expected benefit. Classification of Evidence: This study provides Class II evidence that, in patients with AIS and LIC, considering the functional eloquence of the infarct location improves prediction of disability status at 3 months.