Baseline clinical and neuroradiological predictors of outcome in patients with large ischemic core undergoing mechanical thrombectomy: A retrospective multicenter study.
Andrea M Alexandre, Mauro Monforte, Valerio Brunetti, Luca Scarcia, Luigi Cirillo, Andrea Zini, Irene Scala, Vincenzo Nardelli, Francesco Arbia, Giuseppe Arbia, Giovanni Frisullo, Erwah Kalsoum, Arianna Camilli, Davide De Leoni, Francesca Colò, Serena Abruzzese, Mariangela Piano, Claudia Rollo, Antonio Macera, Maria Ruggiero, Elvis Lafe, Joseph D Gabrieli, Giacomo Cester, Nicola Limbucci, Francesco Arba, Simone Ferretti, Valerio Da Ros, Luigi Bellini, Giancarlo Salsano, Nicola Mavilio, Riccardo Russo, Mauro Bergui, Antonio A Caragliano, Sergio L Vinci, Daniele G Romano, Giulia Frauenfelder, Vittorio Semeraro, Maria P Ganimede, Emilio Lozupone, Andrea Romi, Anna Cavallini, Luca Milonia, Massimo Muto, Paolo Candelaresi, Paolo Calabresi, Alessandro Pedicelli, Aldobrando Broccolini
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Abstract
Background: Recent randomized trials have shown the benefit of mechanical thrombectomy (MT) also in patients with an established large ischemic core.
Aims: The purpose of this study was to define baseline predictors of clinical outcome in patients with large vessel occlusion (LVO) in the anterior circulation and an Alberta Stroke Program Early CT score (ASPECTS) ⩽ 5, undergoing MT.
Material and methods: The databases of 16 comprehensive stroke centers were retrospectively screened for patients with LVO and ASPECTS ⩽5 that received MT. Baseline clinical and neuroradiological features, including the differential contribution of all ASPECTS regions to the composite score, were collected. Primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2. Statistical analysis used a logistic regression model and random forest algorithm.
Results: A total of 408 patients were available for analysis. In multivariate model, among baseline features, lower age (odd ratio (OR) = 0.962, 95% confidence interval (CI) = 0.943-0.982) and lower National Institute of Health Stroke Scale (NIHSS) score (OR = 0.911, 95% CI = 0.862-0.963) were associated with the mRS score 0-2. Involvement of the M2 (OR = 0.398, 95% CI = 0.206-0.770) or M4 (OR = 0.496, 95% CI = 0.260-0.945) ASPECTS regions was associated with an unfavorable outcome. Random forest analysis confirmed that age and baseline NIHSS score are the most important variables influencing clinical outcome, whereas involvement of cortical regions M5, M4, M2, and M1 can have a negative impact.
Conclusion: Our retrospective analysis shows that, along with age and baseline clinical impairment, presence of early ischemic changes involving cortical areas has a role in clinical outcome in patients with large ischemic core undergoing MT.
Data access statement: The data that support the findings of this study are available upon reasonable request.
期刊介绍：
The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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