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  • O09 Early lesion water uptake modifies the treatment effect of mechanical thrombectomy in patients with low ASPECTS – A secondary analysis of the efficacy and safety of thrombectomy in stroke with extended lesion and extended time window (TENSION) trial

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Abstracts
Ischemic
2.3. Treatment
O09 Early lesion water uptake modifies the treatment effect of mechanical thrombectomy in patients with low ASPECTS – A secondary analysis of the efficacy and safety of thrombectomy in stroke with extended lesion and extended time window (TENSION) trial
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  1. Gabriel Broocks1,2,
  2. Lukas Meyer3,
  3. Martin Bendszus4,
  4. Claus Simonsen5,
  5. Götz Thomalla6,
  6. Elke Gizewski7,
  7. Anne Hege Aamodt8,
  8. Antonin Krajina9,
  9. Laurent Pierot10,
  10. Kamil Zeleňák11,
  11. Blanca Fuentes12,
  12. Michael Hill13,
  13. Helge Kniep3,
  14. Jens Fiehler3
  1. 1University Medical Center Hamburg-Eppendorf
  2. 2Department of Neuroradiology, HELIOS Medical Center Schwerin, Campus of MSH Medical School Hamburg
  3. 3Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf
  4. 4Universitätsklinikum Heidelberg; National Coordinating Center Germany
  5. 5Aarhus Universitetshospital; National Coordinating Center Denmark
  6. 6Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg
  7. 7Medizinische Universität Innsbruck; National Coordinating Center Austria
  8. 8Oslo University Hospital; National Coordinating Center Norway
  9. 9Charles University, Hradec Kralove; National Coordinating Center Czech Republic
  10. 10Centre Hospitalier Universitaire de Reims; National Coordinating Center France
  11. 11Comenius University’s Jessenius, Faculty of Medicine and University Hospital; National Coordinating Center
  12. 12La Paz University Hospital; National Coordinating Center Spain
  13. 13University of Calgary; National Coordinating Center Canada

Abstract

Introduction The beneficial effect of endovascular treatment (EVT) on functional outcome in patients with ischemic stroke and low ASPECTS has recently been demonstrated. ASPECTS rating is based on the presence of ischemic lesion hypodensity, however the degree of hypoattenuation, directly indicating net water uptake (NWU), has not been considered for treatment selection..

Aim of Study We hypothesized that the effect of EVT on functional outcome in low ASPECTS patients depends on early lesion NWU.

Methods The TENSION trial was a randomized multicenter clinical trial including patients with anterior circulation stroke and ASPECTS 3-5. Net water uptake (NWU) was assessed as quantitative imaging biomarker on admission-CT. Primary endpoint was the rate of functional independence defined as modified Rankin Scale (mRS) 0-2 at day-90. The effect of EVT on functional outcome was analyzed according to the degree of NWU within the early infarct lesion.

Results For this pilot study, 120 patients were included (51 EVT patients, 42%; 69 BMT patients). In patients with functional independence, the median NWU was 7.7% (IQR:4.7-9.0), which was lower compared to patients with mRS≥3 (median 12.1, IQR:9.3-16.6,p<0.001). In inverse-probability weighting analysis, the average treatment effect of EVT on functional independence was 27.4% (95%CI:13.5-41.3%) for patients with low NWU (<7.7%), while the effect of EVT in patients with high NWU (>7.7%) was 6.5% (95%CI:-0.1-14.3%)

Conclusion The degree of relative lesion hypodensity on admission-CT (ie. NWU) modified the effect of EVT on functional outcome and should be considered as image criterion besides ASPECTS to select patients for EVT, particularly in borderline cases.

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Disclosure of Interest no.

https://doi.org/10.1136/jnis-2024-ESMINT.9

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