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  • Effect of workflow metrics on clinical outcomes of low diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) patients subjected to mechanical thrombectomy

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Ischemic Stroke
Original research
Effect of workflow metrics on clinical outcomes of low diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) patients subjected to mechanical thrombectomy
  1. Pietro Panni1,
  2. Caterina Michelozzi2,
  3. Sébastien Richard3,
  4. Gaultier Marnat4,
  5. Raphaël Blanc5,
  6. Arturo Consoli6,
  7. Mikael Mazighi7,
  8. Michel Piotin7,
  9. Cyril Dargazanli8,
  10. Caroline Arquizane9,
  11. Igor Sibon10,
  12. René Anxionnat11,
  13. Gabriela Hossu12,
  14. Romain Bourcier13,
  15. Mohammad Anadani14,15,
  16. Bertrand Lapergue16,
  17. Benjamin Gory11
  1. 1 Department of Neurology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
  2. 2 Interventional Neuroradiology and Neurosurgery, Vita-Salute San Raffaele university Hospital; Vita-Salute San Raffaele University, Milano, Italy
  3. 3 Interventional Neuroradiology, Vita-Salute San Raffaele university Hospital; Vita-Salute San Raffaele University, Milano, Italy
  4. 4 Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
  5. 5 Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
  6. 6 Departement of interventional neuroradiology, Fondation Rothschild Hospital, Paris, Paris, France
  7. 7 Interventional Neuroradiologie, Hopital Foch, Suresnes, Ile-de-France, France
  8. 8 Departement of interventional neuroradiology, Fondation Rothschild Hospital, paris, France
  9. 9 Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
  10. 10 Bordeaux 1 University, Talence, Aquitaine, France
  11. 11 Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
  12. 12 Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, Lorraine, France
  13. 13 Department of Neuroradiology, Interventional Neuroradiology, University Hospital Nantes, Nantes, France
  14. 14 Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  15. 15 Neurology, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
  16. 16 Department of Neurology, Foch Hospital, Paris, France
  1. Correspondence to Dr Pietro Panni, Interventional Neuroradiology and Neurosurgery, Vita-Salute San Raffaele university Hospital; Vita-Salute San Raffaele University, Milano 20132, Italy; panni.pietro{at}hsr.it

Abstract

Background Although accumulating evidence has demonstrated the benefit of mechanical thrombectomy (MT) in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), it is still unclear how workflow metrics impact the clinical outcomes of this subgroup of patients.

Methods Patients with acute stroke and diffusion-weighted imaging (DWI) ASPECTS ≤5 at baseline, who underwent MT within 6 hours of symptoms onset, were included from a prospectively maintained national multicentric registry between January 1, 2012 to August 31, 2017. The degree of disability was assessed by the modified Rankin Scale (mRS) at 90 days. The primary outcome was functional independence defined as mRS 0 to 2 at 90 days.

Results The study included 291 patients with baseline DWI-ASPECTS ≤5. Good outcome was achieved in 82 (28.2%) patients, and 104 (35.7%) patients died within 90 days. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) rate was 75.3%, and median onset to recanalization (OTR) time was 2 268min. Among time-related variables, OTR emerged as the strongest predictor of primary outcome (adjusted OR for every 60 min 0.59, 95% CI 0.44 to 0.77; p<0.001). mTICI 2c-3 independently predicted a good outcome (adjusted OR 1.91, 95% CI 1.004 to 3.6; p=0.049) along with age and baseline DWI-ASPECTS. Recanalization status failed to significantly impact outcome in the DWI-ASPECTS 0–3 subpopulation.

Conclusions Near complete reperfusion (mTICI 2c-3) and OTR are the strongest modifiable outcome predictors in patients with DWI-ASPECTS ≤5 treated with MT.

  • stroke
  • MRI
  • intervention
  • brain

https://doi.org/10.1136/neurintsurg-2019-015519

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    Footnotes

    • Correction notice Since this article was first published online the author surname

      Arquizane has been updated to Arquizan.

    • Collaborators A list of ETIS Investigators is given in the Appendix.

    • Contributors All authors: conception and design, analysis of data, writing and drafting the paper, final approval, agreement to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

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

    • Data availability statement Data are available upon reasonable request.