Introduction CT-perfusion (CTP) is regularly used to guide mechanical thrombectomy (MT) in patients with ischemic stroke due to large vessel occlusion. CTP-derived baseline ischemic core volume (ICV) often overestimates the true volume of infarction, which even may result in exclusion of patients from MT.
Aim To determine whether ischemic core overestimation (i.e., ghost core phenomenon, GCP) is associated with larger ICV and degree of recanalization.
Methods Multicenter retrospective cohort study of ischemic stroke patients triaged by multimodal-CT undergoing MT. GCP was assumed when CTP-derived ICV was larger than final infarct volume assessed on follow-up imaging. Multivariable logistic regression analysis was used to determine the association of baseline and treatment variables with core overestimation. Secondary outcome was functional independence defined as modified Rankin Scale scores of 0–2 at day-90.
Results 733 patients were included, of which 518 (71%) underwent successful vessel recanalization. GCP was observed in 162 patients (22%), and occurred more often in patients with large ICV >50 ml (47.7% versus 16.2%, p<0.001). A higher degree of vessel reperfusion during MT (aOR/eTICI:1.35,95%CI:1.60–4.18,p<0.001) and larger ICV (aOR:1.02,95%CI:1.01–1.02,p<0.001) were independently associated with GCP, while time from onset showed no association. GCP was an independent predictor of functional independence (aOR:1.87,95%CI:1.22–2.83,p=0.004).
Conclusion Overestimation of the ischemic core occurred more often in patients presenting with large ICV and was associated with better functional outcomes. Although higher core volumes were associated with worse outcomes, timely vessel recanalization may result in significant treatment effects in this subgroup of patients. Large ICVs should not implicitly exclude patients from MT.
Disclosure of Interest NA.
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