@article {Deb-Chatterjineurintsurg-2019-015641, author = {Milani Deb-Chatterji and Hans Pinnschmidt and Fabian Flottmann and Hannes Leischner and Gabriel Broocks and Anna Alegiani and C Brekenfeld and Jens Fiehler and Christian Gerloff and Goetz Thomalla}, editor = {,}, title = {Predictors of independent outcome of thrombectomy in stroke patients with large baseline infarcts in clinical practice: a multicenter analysis}, elocation-id = {neurintsurg-2019-015641}, year = {2020}, doi = {10.1136/neurintsurg-2019-015641}, publisher = {British Medical Journal Publishing Group}, abstract = {Objective To analyze outcome and its predictors after endovascular treatment (ET) in stroke patients suffering from large vessel occlusion with large pre-treatment infarct cores defined by an Alberta Stroke Program Early CT Score (ASPECTS) \<6.Methods We analyzed data from an industry-independent, multicenter, prospective registry (German Stroke Registry {\textendash} Endovascular Treatment) which enrolled consecutive patients treated by ET (June 2015{\textendash}April 2018) with different devices. Multivariate logistic regression analyses identified predictors of independent outcome (IO) defined as a modified Rankin Scale (mRS) 0{\textendash}2, and mortality at 90 days in patients with ASPECTS \<6.Results Of 1700 patients included in the analysis, 152 (8.9\%) had a baseline ASPECTS \<6. Of these, 33 patients (21.6\%) achieved IO, and 68 (44.7\%) were dead at 90 days. A lower age, lower baseline National Institutes of Health Stroke Scale (NIHSS) score, and successful recanalization (defined as modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) were predictors of IO. Successful recanalization had the strongest association with IO (OR 7.0, 95\% CI 1.8 to 26.8). Pre-treatment parameters predicting IO were age \<70 years (sensitivity 0.79, specificity 0.69) and NIHSS \<12 (0.57 and 0.94). A higher age, a pre-stroke mRS score \>1, and failed recanalization were predictors of death.Conclusions A substantial proportion of stroke patients with an ASPECTS \<6 can achieve independence after thrombectomy, in particular, if they are younger, have only moderate baseline stroke symptoms, and no relevant pre-stroke disability. These results may encourage considering thrombectomy in low ASPECTS patients in clinical practice until randomized trials are available.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/early/2020/02/27/neurintsurg-2019-015641}, eprint = {https://jnis.bmj.com/content/early/2020/02/27/neurintsurg-2019-015641.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }