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Original research
What predicts poor outcome after successful thrombectomy in early time window?
  1. Jean-Marc Olivot1,2,
  2. Jeremy J Heit3,
  3. Mikael Mazighi4,
  4. Nicolas Raposo1,2,
  5. Jean François Albucher1,2,
  6. Vanessa Rousseau5,
  7. Adrien Guenego6,
  8. Claire Thalamas5,
  9. Michael Mlynash7,
  10. Amel Drif5,
  11. Soren Christensen7,
  12. Agnes Sommet5,
  13. Alain Viguier1,2,
  14. Jean Darcourt6,
  15. Anne-Christine Januel6,
  16. Lionel Calviere1,2,
  17. Patrice Menegon6,
  18. François Caparros8,
  19. Fabrice Bonneville6,
  20. Thomas Tourdias6,
  21. Igor Sibon9,
  22. Gregory W Albers7,
  23. Christophe Cognard6
  24. on behalf of the FRAME Investigators
    1. 1Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
    2. 2Toulouse Neuro Imaging Center, Toulouse, France
    3. 3Radiology, Neuroadiology and Neurointervention Division, Stanford University, Stanford, California, USA
    4. 4Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
    5. 5Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
    6. 6Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
    7. 7Stanford Stroke Center, Stanford University, Stanford, California, USA
    8. 8Neurology, Stroke Unit, Centre Hospitalier Universitaire de Lille, Lille, France
    9. 9Neurology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
    1. Correspondence to Professor Jean-Marc Olivot, Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; jmolivot{at}gmail.com

    Abstract

    Background Half of the patients with large vessel occlusion (LVO)-related acute ischemic stroke (AIS) who undergo endovascular reperfusion are dead or dependent at 3 months. We hypothesize that in addition to established prognostic factors, baseline imaging profile predicts outcome among reperfusers.

    Methods Consecutive patients receiving endovascular treatment (EVT) within 6 hours after onset with Thrombolysis In Cerebral Infarction (TICI) 2b, 2c and 3 revascularization were included. Poor outcome was defined by a modified Rankin scale (mRS) 3–6 at 90 days. No mismatch (NoMM) profile was defined as a mismatch (MM) ratio ≤1.2 and/or a volume <10 mL on pretreatment imaging.

    Results 187 patients were included, and 81 (43%) had a poor outcome. Median delay from stroke onset to the end of EVT was 259 min (IQR 209–340). After multivariable logistic regression analysis, older age (OR 1.26, 95% CI 1.06 to 1.5; p=0.01), higher National Institutes of Health Stroke Scale (NIHSS) (OR 1.15, 95% CI 1.06 to 1.25; p<0.0001), internal carotid artery (ICA) occlusion (OR 3.02, 95% CI 1.2 to 8.0; p=0.021), and NoMM (OR 4.87, 95% CI 1.09 to 22.8; p=0.004) were associated with poor outcome. In addition, post-EVT hemorrhage (OR 3.64, 95% CI 1.5 to 9.1; p=0.04) was also associated with poor outcome.

    Conclusions The absence of a penumbra defined by a NoMM profile on baseline imaging appears to be an independent predictor of poor outcome after reperfusion. Strategies aiming to preserve the penumbra may be encouraged to improve these patients’ outcomes.

    • thrombectomy
    • MRI
    • CT perfusion

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @JeremyHeitMDPHD, @GuenegoAdrien

    • Collaborators FRAME Investigators: Louis Fontaine; Neurology, CHU Toulouse, France; François Chollet MD; Neurology, CHU Toulouse, France; Marianne Barbieux MD; Neurology, CHU Toulouse, France; Caterina Michelozzi MD; Neuroradiology, CHU Toulouse, France; Philippe Tall MD; Neuroradiology, CHU Toulouse, France; Brigitte Pouzet PhD; Clinical Investigation Center, CHU Toulouse, France; Fabienne Calvas MD; Clinical Investigation Center, CHU Toulouse, France; Monique Galitzki MD; Clinical Investigation Center, CHU Toulouse, France; Pauline Renou MD; Neurology, CHU Bordeaux, France; François Rouanet MD; Neurology, CHU Bordeaux, France; Jerome Berge MD; Neuroradiology, CHU Bordeaux, France; Gauthier Marnat MD; Neuroradiology, CHU Bordeaux, France; Ludovic Lucas MD; Neurology, CHU Bordeaux, France; Cyrielle Coignon MD; Neurology, CHU Bordeaux, France; Sharmila Sagnier MD; Neurology, CHU Bordeaux, France; Sabrina Debruxelle MD; Neurology, CHU Bordeaux, France; Sylvain Ledure BA; Neurology, CHU Bordeaux, France.

    • Contributors JMO: responsible for the overall content as the guarantor, revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data. JJH: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data. MM: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data. NR: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data. J-FA: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. VR: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Analysis or interpretation of data. AG: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Analysis or interpretation of data. CT: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. MM: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data. AD: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Analysis or interpretation of data. SC: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. AS: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data. AV: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. JD: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Analysis or interpretation of data. ACJ: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. LC: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. PM: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Analysis or interpretation of data. FC: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Analysis or interpretation of data. FB: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. TT: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. IS: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design. GWA: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data. CC: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data.

    • Funding FRAME was supported by a research grant from the French Ministry of Health, Clinical Research Hospital Program 2015. (PHRCI-15–076).

    • Disclaimer The study sponsor, CHU Toulouse, has no role in study design, collection, analysis and interpretation of data, writing of this manuscript, or the decision to submit for publication.

    • Competing interests JMO Medtronic, Aptoll, Abbvie, BMS-Pfizer, Medtronic French Ministry of Health. JJH Ischema View, Medtronic, Microvention. LC Boehringer Ingelheim, BMS-Pfizer, Boehringer. NR Fullbright Foundation, Harvard University and Philippe Foundation. MMa Boerhinger Ingelheim, Medtronic, Air Liquide, Amgen, Acticor Biotech. AG Member of Editorial Board JNIS Fellows. IS AstraZeneca, BMS-Pfizer, Bayer, Boehringer Ingelheim, Medtronic, NovoNordisc. TT Canon Medical, grant from French research secretary. GWA IschemaView, Genentech, grant from NIHCC Medtronic Cerenovus Stryker MIVI Neuroscience, Microvention. SC IschemaView.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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