Background and purpose In acute ischemic stroke (AIS) patients, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is correlated with infarct volume and is an independent factor of functional outcomes. Patients with pretreatment DWI-ASPECTS ≤6 were excluded or underrepresented in the recent randomized endovascular therapy (EVT) trials. Our aim was to assess the impact of recanalization in patients with pretreatment DWI-ASPECTS ≤6 treated with EVT.
Methods We analyzed data collected between January 2012 and August 2015 in 2 prospective clinical registries of AIS patients treated with EVT. 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 outcome was a favorable outcome defined by a modified Rankin Scale of 0 to 2 at 90 days.
Results Two hundred eighteen patients were included. Among them, 145 (66%) had a good recanalization (TICI ≥ 2 b) at the end of EVT. There was no statistically difference in the baseline clinical characteristics between recanalised and non-recanalised patients. Recanalized patients had an increased rate of favorable outcomes (38.7% vs 17.4%, p = 0.002) and a decreased rate of mortality at 3 months (22.5% vs 39.1%, p = 0.013) compared with non-recanalised patients. The symptomatic intracerebral hemorrhage rate was not different in the 2 groups (13% vs 14.1%, p = 0.83).
Conclusion Patients with a pretreatment DWI-ASPECTS ≤6 may still benefit of EVT when a good recanalization is achieved. In particular, EVT-induced recanalization was associated with a reduced rate of mortality without increased risk of symptomatic intracerebral hemorrhage.
Disclosures J. Desilles: None. A. Consoli: None. S. Escalard: None. H. Redjem: None. R. Blanc: None. P. Guedin: None. O. Coskun: None. G. Ciccio: None. S. Smajda: None. C. Ruiz Guerrero: None. P. Sasannejad: None. G. Rodesch: None. M. Piotin: None. B. Lapergue: None.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.