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Original research
Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy
  1. Alessandro Davoli1,
  2. Caterina Motta1,2,
  3. Giacomo Koch1,2,
  4. Marina Diomedi1,
  5. Simone Napolitano1,
  6. Angela Giordano1,
  7. Marta Panella1,
  8. Daniele Morosetti3,
  9. Sebastiano Fabiano3,
  10. Roberto Floris3,
  11. Roberto Gandini3,
  12. Fabrizio Sallustio1,2
  1. 1 Department of Neuroscience, Comprehensive Stroke Center, University of Tor Vergata, Rome, Italy
  2. 2 Santa Lucia Foundation, Rome, Italy
  3. 3 Department of Diagnostic Imaging, Interventional Radiology and Neuroradiology, University of Tor Vergata, Rome, Italy
  1. Correspondence to Dr Alessandro Davoli, Department of Neuroscience, Comprehensive Stroke Center, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy; aledavoli83{at}yahoo.com

Abstract

Background Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET.

Methods Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.

Results 98 patients were included in the analysis, 35 of whom developed MMI (35.7%). No differences in the rate of successful reperfusion and time from stroke onset to reperfusion were found between the MMI and non-MMI groups. The following parameters were identified as independent predictors of MMI: systolic blood pressure (SBP) on admission (p=0.008), blood glucose (BG) on admission (p=0.024), and the CTangiography (CTA) Alberta Stroke Program Early CT Score (ASPECTS) (p=0.001). A scoreof ≤5 in CTA ASPECTS was the best cut-off to predict MMI evolution (sensitivity 46%; specificity 97%; positive predictive value 78%; negative predictive value 65%).

Conclusions in our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.

  • stroke
  • thrombectomy
  • ct angiography
  • blood pressure
  • malignant

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Footnotes

  • Contributors AD: study concept/design; analysis/interpretation of data; acquisition of data; study supervision/coordination; obtaining funding; drafting/revising the manuscript for content. CM: analysis/interpretation of data; drafting/revising the manuscript for content; statistical analysis. GK: study concept/design; analysis/interpretation of data; obtaining funding; study supervision/coordination. MD: analysis/interpretation of data; drafting/revising the manuscript for content. SN: analysis/interpretation of data; acquisition of data. AG: analysis/interpretation of data; acquisition of data. MP: analysis/interpretation of data; acquisition of data. DM: analysis/interpretation of data; acquisition of data. SF: analysis/interpretation of data; acquisition of data. RF: analysis/interpretation of data; drafting/revising the manuscript for content; study supervision/coordination. RG: analysis/interpretation of data; drafting/revising the manuscript for content, acquisition of data. FS: study concept/design; analysis/interpretation of data; drafting/revising the manuscript for content; obtaining funding; study supervision/coordination; acquisition of data.

  • Funding This work was supported by Italian Ministry of Health grant number RF-2013-02358679.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Local ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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